Research

General Research Interests

Comparative politics; public policy; polycentric governance and the politics of public services in developing countries, focusing particularly on health systems and natural resources; the social determinants of health outcomes; non-governmental organizations and political behavior in the newly democratic settings; international development; Latin America.

Publications

(2) Zarychta, Alan. Forthcoming (estimated 2015). “Community Trust and Household Health: A Spatially-Based Approach with Evidence from Rural Honduras.” Social Science & Medicine.

What is the relationship between community trust and household health? Scholars working to understand the effects of trust and social capital on human health tend to focus on individual characteristics or social environments, frequently without integrating these two dimensions.   In light of this, the present paper makes contributions in both conceptualization and measurement. First, I develop a spatially-based approach for operationalizing community trust as the product of individual orientation and social environment. This approach highlights the need for a household to trust its neighbors and for those neighbors to reciprocate trust in order to constitute the psychological and material mechanisms critical for linking social context to individual health. Second, I illustrate the utility of this measure by evaluating the relationship between community trust and self-rated health status using an original population census survey from 2009-2010 for two municipalities in western Honduras (approximately 2,800 households with a response rate of 94.9%). I implement spatial regression analysis and show that there is a positive and substantively meaningful relationship between community trust and household health; households that are trusting and surrounded by similarly trusting neighbors report better health status, while those in uncertain or mutually distrusting environments report worse health. The theory and results presented here suggest an important link between trust and social capital at the community level, which is particularly salient for rural regions in developing countries where health resources are scarce and community-based interventions are common.

(1) He, Yuan, Zarychta, Alan, Ranz, Joseph B., Carroll, Mary, Singleton, Lori M., Wilson, Paria M., and Schlaudecker, Elizabeth P. 2012. “Childhood Immunization Rates in Rural Intibuca, Honduras: An Analysis of a Local Database Tool and Community Health Center Records for Assessing and Improving Vaccine Coverage.” BMC Public Health 12: 1056.

Background:  Vaccines are highly effective at preventing infectious diseases in children, and prevention is especially important in resource-limited countries where treatment is difficult to access. In Honduras, the World Health Organization (WHO) reports very high immunization rates in children. To determine whether or not these estimates accurately depict the immunization coverage in non-urban regions of the country, we compared the WHO data to immunization rates obtained from a local database tool and community health center records in rural Intibucá, Honduras.

Methods:  We used data from two sources to comprehensively evaluate immunization rates in the area: 1) census data from a local database and 2) immunization data collected at health centers. We compared these rates using logistic regression, and we compared them to publicly available WHO-reported estimates using confidence interval inclusion.

Results:  We found that mean immunization rates for each vaccine were high (range 84.4 to 98.8 percent), but rates recorded at the health centers were significantly higher than those reported from the census data (p≤0.001). Combining the results from both databases, the mean rates of four out of five vaccines were less than WHO-reported rates (p<0.05). Overall immunization rates were significantly different between townships (p=0.03). The rates by individual vaccine were similar across townships (p>0.05), except for diphtheria/tetanus/pertussis vaccine (p=0.02) and oral polio vaccine (p<0.01).

Conclusions:  Immunization rates in Honduras were high across data sources, though most of the rates recorded in rural Honduras were less than WHO-reported rates. Despite geographical difficulties and barriers to access, the local database and Honduran community health workers have developed a thorough system for ensuring that children receive their immunizations on time. The successful integration of community health workers and a database within the Honduran decentralized health system may serve as a model for other immunization programs in resource-limited countries where health care is less accessible.