title: Agency, access, and Anopheles: neighborhood health perceptions and the implications for community health interventions in Accra, Ghana.
abstract: BACKGROUND
  Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions.
  
  
  OBJECTIVE
  We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions.
  
  
  METHODS
  Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes.
  
  
  RESULTS
  Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health.
  
  
  CONCLUSIONS
  Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions.
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA; majankowska@ucsd.edu.
authors.forename: Marta M
authors.initials: MM
authors.lastname: Jankowska
authors.affiliation: Department of Geography and Regional Studies, University of Miami, Coral Gables, FL, USA.|Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Stoler
authors.affiliation: Department of Geography, The George Washington University, Washington, DC, USA.
authors.forename: Caetlin
authors.initials: C
authors.lastname: Ofiesh
authors.affiliation: Department of Geography, The George Washington University, Washington, DC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rain
authors.affiliation: Department of Geography, San Diego State University, San Diego, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Weeks
mesh_terms: D004777:Environment; D005260:Female; D017144:Focus Groups; D005869:Ghana; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D010465:Perception; D012111:Residence Characteristics; D066270:Social Capital; D012959:Socioeconomic Factors; D014505:Urban Population
keywords: Africa; Ghana; community intervention; health perceptions; health-care access; malaria; neighborhood effects