The role of social capital for awareness and utilization of health care services: Personal network size and perceptions on community belongingness as correlates of health services outcomes among younger men who have sex with men

Edward Tsai, Patricia Mullen, Maria Fernandez-Esquer, John Schneider, Kayo Fujimoto


Background: Preventive health service venues play an important role in reducing transmission of Sexually Transmitted Infections (STIs) through providing access to HIV/STI testing and preventive care such as pre-exposure prophylaxis (PrEP), a daily-use antiviral drug. Emerging evidence suggests social capital (e.g., benefits and resources accrued through community or individually through personal networks) increases awareness and utilization of health care services, but this relation has not often been explored in most-at-risk populations, such as younger MSM who are members of racial/ethnic minority groups. Additionally, most social capital research studies conceptualize social capital at only one level (either through personal networks or through community resources), including research focused on health services outcomes, is unable to consider the role that both levels of social capital play, either independently or through interaction, on enhancing awareness and utilization of health care services. Guided by the resource-based theory of social capital for health, we assessed whether associations between individuals’ perceptions on community belongingness (community level social capital) and the levels of awareness and utilization of health care services are conditioned on personal network sizes (individual level social capital). Methods: Our sample came from 755 young MSM recruited during 2014-2016 through respondent-driven sampling methods in two urban contexts in Houston (n=378) and Chicago (n=377). In structured interviews, we asked respondents’ sociodemographic characteristics, sexual and substance use related health behaviors, social and sexual partners, community capital, health services venue awareness (number of venues being heard of) and use (levels of visit frequency in the past 12 months). Individual level social capital was measured by the numbers of social and sexual partners in one’s personal networks (network size), and community level capital was measured by self-report on the level of belongingness to neighborhoods and the local MSM community. Multivariable Poisson regression models were estimated to assess whether the association between community level social capital and the levels of venue awareness/utilization depend on the level of individual social capital (personal network size). Results: For Chicago MSM, higher levels of perceptions on community level social capital were associated with more awareness of health care services, as personal network sizes increased (p=.004, 95% CI (1.02, 1.11)). For Houston, on the other hand, the similar tendency was observed with smaller personal networks (p=.052, 95% CI (.876, 1.00)). Health care venue utilization was not associated with levels of community belongingness (community social capital). Discussion: Our results suggest that depending on size of personal networks, some young MSM of color may tend to receive health information through the local community at large, whereas others may tend to receive information more through close personal networks. This reflects other research where individuals in social contexts with more highly developed tightly knit communities tend to derive more benefit from groups, compared to social environments with lower levels of community belongingness where individuals draw more on immediate personal networks. In the former, interventions seeking to build ties to strong core communities may be more effective than in the latter, where approaches leveraging personal networks may be more suitable.

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