Socialising Health Burden Through Different Network Topologies: A - PDF document

Socialising Health Burden Through Different Network Topologies: A Simulation Study Adrian PEACOCK a , Anthony CHEUNG b , Peter KIM b and Simon K. POON a,1 a The University of Sydney, School of Information Technologies, Australia b The University of Sydney, School of Mathematics and Statistics, Australia Abstract. An aging population and the expectation of premium quality health services combined with the increasing economic burden of the healthcare system requires a paradigm shift toward patient oriented healthcare. The guardian angel theory described by Szolovits [1] explores the notion of enlisting patients as primary providers of information and motivation to patients with similar clinical history through social connections. In this study, an agent based model was developed to simulate to explore how individuals are affected through their levels of intrinsic positivity. Ring, point-to-point (paired buddy), and random networks were modelled, with individuals able to send messages to each other given their levels of variables positivity and motivation. Of the 3 modelled networks it is apparent that the ring network provides the most equal, collective improvement in positivity and motivation for all users. Further study into other network topologies should be undertaken in the future. Keywords. Guardian Angel, social network, agent-based model, emotional contagion, NetLogo Introduction Despite an increase in the number of medical practitioners in Australia over recent years [1], growth in the aging demographic and associated chronic disease, combined with a demand for quality health services from the entire population has driven the need for a change in approach to chronic disease treatment and management. The associated economic strain mounting on the healthcare system is of concern [2], and it is unreasonable to think that physicians can accommodate this pertinent issue without a change in focus to healthcare delivery. Using an agent-based simulation, this study aims to gain insight into the effect that social network topology has on distribution of benefit to individuals, when deploying a Guardian Angel type healthcare system. The concept of a Guardian Angel system was first described as a patient centered system that provides the individual with support via access to education, monitoring progress, transmitting alerts and reminders, and offering support through contact with other patients and medical professionals [3]. The aim was to empower the user to take an active role in their health, and make better personal decisions in promoting their own 1 Corresponding Author: Associate Professor Simon Poon, Faculty of Engineering and IT, The University of Sydney, NSW 2006, Australia; E-mail: simon.poon@sydney.edu.au.

health status. Since its conception, the focus has been magnified further toward a social, patient centered structure to alleviate strain on health practitioners and the health system. The use of a telephone based network platform to facilitate support and improve health behaviors and outcomes between individuals has been investigated with promising results [4], [5]. With significant potential shown by these systems and others, it validates the potential for further application of the guardian angel concept in providing personal support and care for patients with a range of chronic diseases. While these structures in health allow for relations among individuals who share similar diseases, economic, geographic, or cultural backgrounds, and perceptions of health [6], there is minimal research into if these systems equally distribute the user derived health stimulus. Patient driven social networks hold significant potential and value in healthcare due to their unquestionable ability to promote ideas and information to other individuals, provide support to achieve goals, high scalability, and their economic value [7]. Currently however, group dynamics and health outcomes relating to the affect that different network structures have on the ability for all users to receive equally shared improved health is poorly understood and further study is required. 1. Methods A simulation model developed based on the c oncept of “emotional contagion” introduced by Christakis and Fowler [8], eGuardian Angel is an agent based model of a social innovation for individuals with chronic disease, modelled on assisting them in keeping motivated to reach their individual health goals. The simulation consists of two primary agents: guardians and children. Guardians provide support to their child through motivational messages, support, advice, and personal experience through aspects including achieving goals, diet, exercise, and psychological health [9]. The role of the child is to provide feedback to their guardian if they were positively affected by the message sent to them. Each user can be both a guardian and a child, or either, depending on the network topology being employed. NetLogo is a multi-agent programming language and modelling environment, particularly useful in simulating social phenomena [10]. All agents can interact with each other and perform tasks concurrently, and the model is rendered in a graphical user interface. The simulation can be run in 3 different network topologies: Ring, point- to-point (paired buddies), or random. Random Paired Ring Figure 1 . Factors effecting user motivation & Positivity.

1.1. Agent Attributes It is critical in complex systems modelling to include the necessary variables or rules relevant to each agent. This bottom-up approach emphasises the need for individual agent simplicity, while producing complex social phenomena when they interact. Motivation plays a key role in setting and achieving goals, particularly in changing health behaviors [11]. All actions undertaken are driven by some form of motivation, which can be influenced by multiple factors such as the environment and relationships. This is particularly evident in theories of social influence, where one ’ s motivation to achieve their set goals comes from another individual [12]. Motivation for the individual to achieve health related tasks is influenced directly by messages received from their guardian. Positivity is influenced by one’s motiva tion, and closely reflects one’s mood, attitude, and emotions toward a stimulus. The theory of mood contagion elaborates on the ability of one’s mood in affecting another person’s cognitive expressions in a way that influences their motivation [13], as well suggesting that a leader with high positivity saw better performance from those they were prompting [14]. In the model, positivity represents the theoretical measure of how much influence the guardian has on their child. Figure 2 . Factors effecting user motivation & positivity. 1.2. Simulation Schedule User environment can affect motivation, simulating events occurring outside the system. If they have sufficient positivity, a message is composed by the guardian and the degree to which it affects the child depends on their level of positivity. Feedback is then sent from child to guardian. In addition, the increase in motivation seen when the user receives a message is transferred to positivity, where they now have an increased chance of sending their child a message. If the individual does not receive a message from their guardian, the individual’s lack of support causes their motivation to decrease. This is depicted in Figure 2. The basis of the simulation schedule and its functions lay in the foundational principles of emotion and mood contagion [14-16].