University of New Mexico UNM Digital Repository Nursing ETDs Electronic Theses and Dissertations 2-1-2016 Influence of Social Capital on Community-Based Health Care Programs in Rural Papua New Guinea: An Ethnographic Study Carol J. Bett Follow this and additional works at: https://digitalrepository.unm.edu/nurs_etds Recommended Citation Bett, Carol J.. "Influence of Social Capital on Community-Based Health Care Programs in Rural Papua New Guinea: An Ethnographic Study." (2016). https://digitalrepository.unm.edu/nurs_etds/23 This Dissertation is brought to you for free and open access by the Electronic Theses and Dissertations at UNM Digital Repository. It has been accepted for inclusion in Nursing ETDs by an authorized administrator of UNM Digital Repository. For more information, please contact [email protected]. Carol J. Bett Candidate College of Nursing Department This dissertation is approved, and it is acceptable in quality and form for publication: Approved by the Dissertation Committee: Dr. Jennifer Averill, Chairperson Dr. Geoff Schuster Dr. Dorinda Welle Dr. Richard Crespo i INFLUENCE OF SOCIAL CAPITAL ON COMMUNITY-BASED HEALTH CARE PROGRAMS IN RURAL PAPUA NEW GUINEA: AN ETHNOGRAPHIC STUDY by CAROL J. BETT B.S., Nursing, Point Loma Nazarene University, 1979 M.A., Missiology, Nazarene Theological Seminary, 1984 M.N., Education, University of Phoenix, 1996 DISSERTATION Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing The University of New Mexico Albuquerque, New Mexico December, 2015 ii DEDICATION This dissertation is dedicated to the Koban people of middle-Ramu and the people of Angalimp South Wahgi district in Jiwaka Province who participated in this study and their willingness to teach me about the true meaning of kinship and health. iii ACKNOWLEDGEMENTS I would like to acknowledge the support and guidance of my advisor and committee chair, Dr. Jennifer Averill, who graciously encouraged me during my doctoral journey. I also appreciate the valuable insights from my committee members: Dr. Geoff Schuster, Dr. Dorinda Welle, Dr. Rebekah Salt, and Dr. Richard Kimball. Special thanks to Dr. Ricard Crespo whose expertise in community health played an essential role in my understanding of health promotion in developing countries. I especially want to thank my husband Brian for his encouragement and assistance during my coursework and lengthy international trips. His understanding and willingness to support me during my doctoral education has been such a blessing. I would like to express my gratitude to Dr. Rebecca Morsch and Mr. Matthew Galman, who played an essential role in coordinating my field work in the villages. I also wish to thank the staff at Nazarene College of Nursing and Nazarene Health Ministries who helped me frame interview questions and identify cultural and linguistic nuances. My special appreciation goes to Dr. Jim and Kathy Radcliff for their hospitality during my time at Kudjip and their sympathetic support when my mother passed away during my first research trip to Papua New Guinea. This study was partially funded by grants from the University of New Mexico Office of Graduate Studies, the Wichita State University Human Capital Development Fund, and General Nursing Foundation Fund. iv INFLUENCE OF SOCIAL CAPITAL ON COMMUNITY-BASED HEALTH CARE PROGRAMS IN RURAL PAPUA NEW GUINEA: AN ETHNOGRAPHIC STUDY by Carol J. Bett B.S., Nursing, Point Loma Nazarene University, 1979 M.A., Missiology, Nazarene Theological Seminary, 1984 M.N., Education, University of Phoenix, 1996 Ph.D., Nursing, University of New Mexico, 2015 ABSTRACT This descriptive, ethnographic study explored the influence of cultural health beliefs and social capital on the adoption of community-based health care interventions by rural villages in Papua New Guinea. The development of local level resources that lead to improved health indices requires an awareness of both the cultural context and the relational components of social capital that link people within the community. Social capital has been defined as resources that are an inherent part of a social group and the elements of social organization such as trust, networks, and norms of reciprocity that facilitate mutual cooperation (Billings, 2000; Carpiano, 2006). The configuration of social capital in a group can potentially be operationalized to support the capacity of the community to create health-promoting change. Findings revealed that relational harmony was seen as essential for the maintenance of health. Strong kinship ties and consensual decision-making is the norm in rural villages, however women continue to have a limited voice. A synthesis of traditional health beliefs and innovative practices influenced how health promotion activities are perceived and implemented; and religious practices are viewed as integral to societal stability and psychosocial health. Developing a comprehensive understanding of sociocultural and contextual influences on the adoption of health promotion practices can help nurses facilitate community empowerment and sustainability of community-based health care programs in rural areas. KEYWORDS: Rural, community-based health, social capital, health promotion, ethnography, Papua New Guinea v Table of Contents LIST OF FIGURES ........................................................................................................... xi LIST OF TABLES ............................................................................................................ xii Chapter 1: Introduction ................................................................................................... 1 Problem Statement .............................................................................................................. 3 Statement of Purpose and Research Questions ................................................................... 3 Background and Context..................................................................................................... 4 Health disparities in Papua New Guinea ..................................................................... 9 Papua New Guinean health care system. ................................................................... 14 Cultural and Socio-political Context ................................................................................ 18 A Community-Based Frame of Reference ........................................................................ 21 Community Based Health Care Program in Papua New Guinea ...................................... 24 Theoretical Concepts of Social Capital............................................................................. 27 Assumptions ...................................................................................................................... 28 Rationale and Significance of the Study ........................................................................... 29 Definitions......................................................................................................................... 29 Conclusion ........................................................................................................................ 30 Chapter 2: Review of Literature ................................................................................... 32 Conceptualization of Social Capital.................................................................................. 33 Health and social capital ............................................................................................ 39 Measures of social capital.......................................................................................... 41 Facilitation of Collective Social Action ............................................................................ 43 Cognitive social capital ............................................................................................. 46 vi Structural social capital. ............................................................................................ 47 Social Capital and Non-Western Societies ....................................................................... 50 Social Capital in Papua New Guinea ................................................................................ 52 Health Care Issues in Developing Countries .................................................................... 54 Papua New Guinean Cultural Beliefs and Social Structure .............................................. 56 Community Based Health Care ........................................................................................ 58 Conclusion ........................................................................................................................ 62 Chapter 3: Methods ........................................................................................................ 66 Rationale for Research Approach ..................................................................................... 67 Ethnography ...................................................................................................................... 68 Ethnography in nursing ............................................................................................. 70 The Researcher in Ethnography ........................................................................................ 71 Overview of Information Needed ..................................................................................... 72 Research Design...............................................................................................................