Understanding complex interactions using social network analysis.

AIMS AND OBJECTIVES: The aim of this paper is to raise the awareness of social network analysis as a method to facilitate research in nursing research. BACKGROUND: The application of social network analysis in assessing network properties has allowed greater insight to be gained in many areas including sociology, politics, business organisation and health care. However, the use of social networks in nursing has not received sufficient attention. DESIGN: Review of literature and illustration of the application of the method of social network analysis using research examples. METHODS: First, the value of social networks will be discussed. Then by using illustrative examples, the value of social network analysis to nursing will be demonstrated. RESULTS: The method of social network analysis is found to give greater insights into social situations involving interactions between individuals and has particular application to the study of interactions between nurses and between nurses and patients and other actors. CONCLUSION: Social networks are systems in which people interact. Two quantitative techniques help our understanding of these networks. The first is visualisation of the network. The second is centrality. Individuals with high centrality are key communicators in a network. RELEVANCE TO CLINICAL PRACTICE: Applying social network analysis to nursing provides a simple method that helps gain an understanding of human interaction and how this might influence various health outcomes. It allows influential individuals (actors) to be identified. Their influence on the formation of social norms and communication can determine the extent to which new interventions or ways of thinking are accepted by a group. Thus, working with key individuals in a network could be critical to the success and sustainability of an intervention. Social network analysis can also help to assess the effectiveness of such interventions for the recipient and the service provider.

Cohesive subgroups and drug user networks in Dhaka City, Bangladesh.

The purpose of this paper was to explore group drug taking behaviour in a slum area of Dhaka, Bangladesh. We set out to examine the relationships between those who met, at least weekly, to take illegal drugs together, and how these relationships might shape their drug behaviour. Sociometric and behavioural data were collected using questionnaires via semi-structured interviews. We found that the likelihood of injecting drugs and sharing needles increased with age, duration of group membership and length of drug use. Drug users were classified into two clusters: one was more cohesive and comprised longer-term users, who were more likely to inject drugs and had poorer physical and mental health. The other cluster comprised younger, better educated members who were more transient, less cohesive, less likely to inject drugs and had better health. Qualitative data suggested that members of the first cluster were less accepting of outsiders and confirmed more to group norms. We conclude that emotionally bonded cohesive subgroups acquire norms, which reinforce problematic drug-using behaviour. Thus, health initiatives need to consider group relationships and norms and those initiatives which work with networks may be more effective and more appropriate for low-income countries.

Social networks and contraception practice of women in rural Bangladesh.

This paper analyzed the association of social networks with contraceptive use using both structural and attitudinal properties of social networks. Data were collected from seven villages in rural Bangladesh by face-to-face interviews using a structured questionnaire (N = 694). Sociometric data and the centrality positions of women in their social networks were analyzed as proxies for structural properties, and the perception of network members' approval and encouragement towards family planning as attitudinal properties. The perception of network members' attitude towards family planning and power within networks was found to be positively associated with contraception use. The strong association of the social network members' encouragement of contraception and the significance over both in-degree (number of nominations received by the participant from other village women) and out-degree centrality (number of nominations given by a participant) provides further confirmation that immediate network members' attitude is important to explain current contraceptive use of women in rural Bangladesh.

Social networks, normative influence and health delivery in rural Bangladesh.

This paper examines the association of social networks with the experience of neonatal death and the type of assistance that a woman obtains at childbirth in rural Bangladesh. Data were collected by interviewing 694 women from seven villages using a structured questionnaire. From the use of both social network analysis and statistical methods, we find that the experience of neonatal death and the type of assistance that a woman gets at childbirth are associated with the characteristics of their social networks along with a set of socioeconomic factors that are usually considered to be important. The higher the degree of centrality of a woman in her social network, the less likely it is that she will experience neonatal death, and the experience of neonatal death is significantly associated with the type of assistance she obtained at giving birth. Using a multivariate multinomial logistic regression model to explore the likelihood of using different types of birth assistance, we find that the higher the degree centrality of a woman, the less likely she will be attended by professional assistance. Further investigations reveal that the dominant norm in villages is to use traditional birth attendants and the perception about professional birth assistance is that it is 'not needed'. Moreover, the respondents' network members were also interviewed, and from the sociograms we find that there was an inward connectivity between the same types of assistance users. These findings have implications for norm change interventions among the village women using a network approach and in particular using opinion leaders.

Communication and contraception in rural Bangladesh.

This paper examines the association of communication in explaining the decision of women in rural Bangladesh to use or not to use contraception. Using survey data from villages in Bangladesh, we found that communication is an important influence on the ideational change for a smaller family norm and the practice of contraception. This is evident even when socioeconomic and cultural variables are controlled for. We recommend that to foster the use of contraception, communication factors should be given greater emphasis, especially to target husbands in the family planning program and to improve the image of female children.