UC Santa Barbara

Geography is a crucial dimension of the social determinants of health. Higher resolution data on individual movement and daily activity can offer insights into social and structural disease exposures and various health outcomes. In this dissertation, I ask, what are the individual and community-level activity and movement characteristics of rural Malawians? Further, how can these patterns be characterized in ways that could inform targeted HIV care and treatment? To do this, I implement a two-phased geospatial data collection and analysis protocol in rural Malawi. This protocol was designed to examine the geographical component of the social determinants of health framework within a Global South setting by 1) describing the context in which the activity and/or movement happens, and 2) examining patterns of individual activity and movement. With HIV/AIDS being the leading cause of death in Malawi, this research aims to help reduce geographic barriers of HIV treatment and testing provision. The research protocol described in this thesis may provide a structured methodology to help health service providers visualize, analyze, and understand patterns of mobility and activity within rural villages in the Global South. I present the application of my research protocol within two rural villages in central Malawi. In the first phase, I conducted gender-segregated guided focus groups from each village. Next, I implemented 199 individual geospatial surveys with village residents. I use latent profile analysis and dynamic time warping to categorize and cluster activity and movement data collected from individual geospatial surveys. The results from these analyses indicate that gender has a magnified impact on individual activity and movement. This research further emphasizes that situational context and community input are crucial components to consider when deploying community-based geospatial research.