Introduction to Social Network Analysis for Dissemination and Implementation Research Miruna Petrescu-Prahova, PhD mirunapp@uw.edu Health Promotion Research Center Department of Health Services · University of Washington July 1, 2018
Prime time for more social network analysis in HSR ◮ Social network concepts are frequently used, but rarely formally measured ◮ Computing power and data access allow for analysis of large-scale networks, but underlying mechanisms are not well understood Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 2 / 34
Outline 1. Terms and definitions 2. Relevance of social networks in dissemination and implementation research 3. Social network measures and study design 4. Example: Advice-seeking among grantees of CDC’s Colorectal Cancer Control Program (CRCCP) Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 3 / 34
Defining principles of social network theory ◮ Motivated by a relational, structural perspective ◮ Actors and their actions are interdependent ◮ Ties between actors are channels for exchange of resources, information, norms ◮ Network ties enable but may also constrain actions ◮ Structure (i.e., enduring patterns of relations) influences outcomes ◮ Social mechanisms lead to certain structural patterns ◮ Homophily (“birds of a feather flock together”) ◮ Reciprocity and transitivity (“friend of a friend is also a friend”) ◮ Preferential attachment (“the rich [in ties] get richer”) Social network analysis: study of patterns of relations in social systems Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 4 / 34
We need to think formally about networks “Network” is not just a metaphor: it is a precise mathematical construct ◮ Network : a collection of nodes, together with a set of relations (ties) on those nodes ◮ Nodes: individuals, organizations, states ◮ Relations: friendship, advice, collaboration, competition Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 5 / 34
Dissemination and implementation research definitions ◮ Dissemination research: the scientific study of targeted distribution of information about evidence-based interventions to a specific public health or clinical practice audience. ◮ Implementation research: the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings. Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 6 / 34
Social networks are the backbone of diffusion and dissemination HPRC Dissemination Framework (Harris et al., 2012) Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 7 / 34
Social networks are part of implementation context Consolidated Framework for Implementation Research (Damschroeder et al., 2009) Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 8 / 34
Two ways to think about social networks in health services research 1. As conduits for knowledge transfer 2. As part of the context in which implementers are embedded, and which may influence their ability to implement a program successfully Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 9 / 34
Three levels of social network analysis 1. Descriptive: what are the properties of the network we observe? 2. Null hypothesis tests: how does the network compare with random networks of same size and basic structure? Is there evidence of an underlying process? 3. Statistical models: what are the processes that have led the network to its particular configuration (out of the set of all possible configurations?) ◮ Cannot simply use existing statistical methods ◮ Want to explicitly model interdependencies, relations, linkages, structural patterns Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 10 / 34
Steps for network study design 1. Define the boundaries of the group 2. Define the relationship(s) of interest and propose mechanisms operating through the relationship(s) 3. Collect data on the relationship through surveys, archival sources, observation, or sensors 4. Create a network visualization 5. Analyze the network using descriptive or statistical methods 6. (Optional) Design an intervention to improve dissemination, support implementation, or accelerate behavior change Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 11 / 34
Network Interventions (Valente, 2012) 1. Identification of opinion leaders 2. Identification of clusters 3. Peer-driven interventions 4. Rewiring Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 12 / 34
Advice-seeking among Colorectal Cancer Control Program Grantees, 2011-2012 ◮ Colorectal cancer (CRC) is the second leading cause of cancer deaths among men and women in the United States ◮ CRC screening reduces cancer deaths by detecting cancers at an early stage and by detecting and removing precancerous polyps before cancer develops ◮ People without health insurance or a regular health care provider are more likely never to have been screened Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 13 / 34
CDC’s Colorectal Cancer Control Program (CRCCP) ◮ Goal: to increase CRC screening rates among men and women aged 50 years and older from about 64% to 80% ◮ Provided funding to 25 states and 4 tribes across the United States for five years (2009-2014) ◮ Evidence-based strategies to be implemented by CRCCP grantees 1. Client reminders 2. Small media 3. Reducing structural barriers 4. Provider reminders 5. Provider assessment and feedback Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 14 / 34
CRCCP grantees Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 15 / 34
CRCCP evaluation - annual grantee survey ◮ Screening promotion: use of the 5 evidence-based strategies, reasons for using those interventions, and their ease of use ◮ Percentage of grantees implementing evidence-based CRC strategies Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 16 / 34
CRCCP evaluation - annual grantee survey ◮ Evaluation question ◮ Do grantees seek advice from each other about evidence-based strategy implementation? ◮ Rationale ◮ Helps identify opinion leaders, or best practice disseminators ◮ May provide a structure for the dissemination of other evidence-based strategies, perhaps in other domains like cardiovascular disease ◮ Network survey item ◮ What other CRCCP programs do you go to for advice or support to use the five Community Guide-recommended (evidence-based) strategies? (followed by a list of all grantees) Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 17 / 34
2011 and 2012 CRCCP advice networks Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 18 / 34
Descriptive analysis 1. Network-level indices: density, reciprocity (mutuality), centralization, transitivity 2. Node-level indices: centrality, brokerage 3. Group identification: core-periphery, clustering, blockmodels Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 19 / 34
Descriptive measures Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 20 / 34
Results of statistical analysis to identify mechanisms ◮ 2011: observed advice-seeking patterns can be explained by a tendency for grantees seeking advice to both reciprocate requests and form clusters of advice-seeking, as well as homophily by region, and whether they are implementing strategies to reduce structural barriers ◮ 2012: advice-seeking was largely explained by the existence of a previous relationship in 2011, although there is still strong homophily by region ◮ Results suggest that encouraging advice-seeking among grantees may lead to long-lasting, mutual support relationships in this group Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 21 / 34
Questions? Miruna Petrescu-Prahova, PhD (HPRC) Social Network Analysis July 1, 2018 22 / 34
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