Anne Sales, Faculty of Nursing, University of Alberta

Discuss social networks and their applicability to implementation Describe how to measure social networks Discuss how social networks might affect uptake of implementation interventions Small group exercise Describe issues in measuring and analyzing social networks Ways to manage the influence of social networks

Both sociology and anthropology have histories– somewhat different Date back to early part of 20 th century Hawthorne wiring room studies in the Western Electric Company in Chicago– 1920s Very difficult to do anything other than quite small scale social network studies until computing power became widely available

Moreno’s sociomatrix …

Analyze this… What structure is evident in the arrangement of squares and circles?

Org-chart shows how authority ties should look… SOURCE: Brandes, Raab and Wagner (2001)

… but the digraph* of actual advice-seeking … *Directional graph

… can be restructured to reveal the “real” hierarchy!* *Source: David Knoke

History here also Coleman and Katz (Chicago)– study of diffusion of medical innovation from the early 1950s  Explored the networks of physicians using a new antibiotic  Early, mid- and late adopters had different positions in social networks  Data have been reanalyzed and reinterpreted (more than once)

Opinion leader interventions Typically identify opinion leader through surveys of participants in a given group Surveys (usually) ask questions based on the Hiss instrument, derived from the Coleman and Katz study Please name up to three individuals whom you would go to for information about…/whose opinion you would value about…/whom you would regard as an expert in… Boundaries of the group are rarely clearly defined Once identified, the interventions vary Most often education as the primary vehicle Outcomes have been mixed Cochrane review 2006

Grimshaw et al. paper in Implementation Science 2006 Attempted to identify common opinion leaders across health /disease conditions and across professional groups Unable to do so Effectiveness of opinion leader approaches depends on accurate identification of opinion leaders– or does it?  May depend on other factors such as what type of group and their reliance on expertise  May depend on factors related to disease or health problem and the evidence  Vast majority of opinion leader studies have been among physicians who may be quite different from other health care providers

Theory of planned behavior Individual level theory designed to explain and/or predict individual behavior change (or lack of change)  Largely mediated through intention to change Important set of variables in TPB relates to social and/or professional norms (Godin et al. Implementation Science 2008) TPB and other individual level theories are silent on where and how norms are formed or how they c an be changed There is also an issue of “perceived behavioral control”

Perceived behavioral control Attitudes towards behavior Subjective or social norms Social networks Intervention Intention to change behavior Behavior Perception of intervention Professional norms

Issues of measurement Fundamentally different level from the individual or organization Unit of measurement is the relationship, not the individual Relationships require a minimum of two people Issues of analysis

Relationships have qualities Existence Strength Direction Directness Hierarchy Embeddedness Structural properties Holes Density

Friendship Volitional Mutual but may not be reciprocal beyond a dyad Varying content Professional May or may not be fully volitional May or may not be mutual Professional content Advice-seeking Often not wholly volitional Usually not reciprocal Work or professional related content Mutual aid Similar to advice seeking but may be more mutual and reciprocal

Establishing boundaries is important Work units have appeal Typically finite, have clear demarcation Can use lists of names from work unit May or may not be simple depending on the organization Different approaches to obtaining network data Give people enumerated lists of names with some space to add Ask people to enumerate/name based on specific prompts Ask for limited number (usually 3 or 4) nominations (typically used in opinion leader surveys)

Pick an intervention from this list (one you’re at least somewhat familiar with): Education Academic detailing Opinion leader Audit with feedback Reminders Discuss these questions: How would you incorporate social network measurement and analysis (SNMA) into this intervention? What would you gain by adding SNMA? How could you design or plan an intervention to learn from SNMA?

Reporting back from small group discussions

30 seconds on the intervention Setting (s) Relevance of SNMA Effect on intervention of adding SNMA Design or planning issues

Response bias Recall bias What aspects or types of network do you measure? What attributes of relationships do you want to know about?

SNA does not use traditional individual attribute analysis techniques Fundamentally different kind of data– measures relationships, not aspects or attributes of individuals Learning curve for software and analytic techniques Different level as well as type of analysis Not entirely clear how best to move between these levels Many social network analysts believe that analyzing at an individual level is inappropriate Multi-level techniques may be useful although it’s not entirely clear how to assign the level of the network Different networks may be different levels

New information that may be quite important in understanding uptake of interventions May offer opportunities to adapt interventions based on social network findings

Much social network analysis and research has come from organizational consulting Relatively long history of using SNA to respond to organizational problems and issues Varying effectiveness depending on what is done with network information Independent of other interventions, networks themselves can be manipulated in an organizational context This is not new Measuring, analyzing, and understanding is relatively new

Org-chart shows how authority ties should look… SOURCE: Brandes, Raab and Wagner (2001)

… but the digraph* of actual advice-seeking … *Directional graph

… can be restructured to reveal the “real” hierarchy!* *Source: David Knoke

Structural holes Places where there should be connections but there aren’t Weak lattices Connections exist but are weaker or more negative than they could/should be Hierarchies Specific design that may or may not be intentional Health care is highly hierarchical Cliques Groups that have patterns of not communicating Withholding information for purposes of power

Be mindful of unintended consequences The way you ask questions conditions the responses you get There are different kinds of networks Some may not be relevant to what you want/need to achieve  The group of people I have coffee with may not be highly related to the group of people I would go to for help with a work related problem There is a very large literature on networks