First Advisor

Lynne C. Messer

Term of Graduation

Spring 2023

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Community Health


Health Studies




Community health, Cysticercosis, Qualitative, Social capital, Social networks, Taenia solium



Physical Description

1 online resource (xi, 112 pages)


Background: In Northern Peru and other low- and middle-income countries (LMICs) worldwide, the Taenia solium parasite causes an estimated 30% of acquired epilepsy -- an entirely preventable disease burden. Sanitation development and pork production regulation would reduce infection risk in endemic communities, but large-scale systemic improvements are not likely to occur in the near future. In the meantime, communities can reduce infection risk by adopting protective behaviors. Social networks can provide role modeling and support for health-promoting behaviors, and deliver social capital in the form of trusting relationships, norms of reciprocity, and information exchange in support of T. solium control.

Methods: I estimated the contribution of head-of-households' informational and social support exchanges, within their social networks, to household T. solium prevention behaviors, using binomial logistic regression. Next, I estimated the contribution of household social capital to community efficacy for cysticercosis prevention. Finally, I conducted a thematic analysis of focus group interviews conducted with community leaders and identified contextual, community-level, and individual-level factors that may support or hinder T. Solium control.

Results: Participant heads-of-households who exchanged informational and emotional support with higher proportions of their close social networks had higher odds of self-reported household action to prevent infections than those who rarely talk about the disease with their alters. Being the provider of information and encouragement was more strongly associated with self-reported household T. solium control action than being the recipient of information and encouragement. I then studied elements of cognitive social capital, including interpersonal trust and reciprocity within participating communities, and its relationship to collective efficacy (aim 2), but obtained mixed results on the association between these constructs. Finally, I studied the words of community leaders, and summarized the contextual, community-level, and individual-level barriers and facilitators they described in relation to T. solium control.

Impact: Taken together, these studies illuminate who people are talking to about T. solium control, what types of topics are discussed, how people talk about T. solium in group settings, and community members' perspectives on their collective abilities to control the parasite's transmission and reduce infections. Future studies can employ the methods used in this dissertation, particularly analyses that include human and animal networks, to inform our understanding of how T. solium and other zoonoses move through social system, and where to focus interventions for the largest potential impacts.


©2023 Angela Gayle Spencer

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The parent studies under which this dissertation was conducted were funded by the US National Institute of Neurologic Disorders and Stroke and the Fogarty International Center (NIH/NINDS grant no. R01NS080645). In addition, I received dissertation support from the Northwest Portland Area Indian Health Board’s Native American Research Centers for Health (NARCH grant no. 1S06GM127164-01). I am also grateful for the excellent training I received from the Duke Social Networks and Health Fellowship (NIH/NICHD grant no. 1R25HD079352).

Persistent Identifier

Available for download on Thursday, June 13, 2024

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