Sex differences in social connectedness, health, and quality of life: evidence from a cross-sectional survey in urban Accra, Ghana

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BACKGROUND: Social relationships are recognised as a determinant of health and well-being. However, cultural norms, including those related to sex roles, shape how individuals form and experience social connections, and may influence how they affect health and quality of life (QoL). Yet, most existing evidence on the links between social connectedness and well-being comes from high-income countries and focuses primarily on subjective outcomes. Less is known about these associations in low- and middle-income settings, particularly when considering both objective and subjective health and QoL measures. This study explored how indicators of social connectedness were associated with health and QoL outcomes among women and men in a low-income urban neighbourhood in Accra, Ghana. METHODS: We used data from the Contextual Awareness Response and Evaluation: Diabetes in Ghana project (CARE) community-based survey conducted in Ga Mashie, Ghana. We employed logistic and linear regression models to study associations between four indicators of social connectedness and a range of well-being and health outcomes, including QoL, self-rated health, diabetes risk, and overweight and obesity. RESULTS: Women reported, on average, lower levels of social connectedness compared to men. Moreover, most statistically significant associations were found for subjective rather than objective outcomes, and these associations varied by sex. Among men, participation in associations was positively linked to psychological and environmental dimensions of QoL. For women, group participation was associated with better self-rated health. A small association also suggested that friendships could be linked to a potential negative impact on some dimensions of women's QoL. CONCLUSION: Our study underscores the importance of examining sex-specific patterns in the relationships between social connectedness, QoL and health outcomes. Social connections appear to have both beneficial and non-beneficial effects, especially among women, although the magnitude of these effects was often small. This may reflect complex social dynamics shaped by cultural and traditional roles that differ by sex. Further research is needed to better understand these findings. This includes identifying potential mediating variables that explain the associations between social connectedness and individual health and QoL, and exploring why some of these associations differ by sex.

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