Care Groups: Using the Power of Social Networks

By March 13, 2010 5 Comments

I’ve been reading a host of exciting books on social networks and social network theory lately:  Linked, Connected, etc.   We are not talking about Facebook here, but the networks that we find in all communities and countries, regardless of their internet connectivity.  Findings presented in Connected show that we have a measurable influence out to three degrees — our friends’ friends’ friends — in our social network.  There are more and more studies showing how behaviors and outcomes spread through networks including cigarette smoking/cessation, obesity, and even happiness.   New findings in social network theory are driving changes in many domains including genetics, behaviorism, health promotion.

As I’ve read these books, I’ve become increasingly convinced that one reason we are seeing such amazing results in behavior change using Care Groups is that we are utilizing the power of scale-free social networks.  By having beneficiary mothers choose “their” Leader Mother (who does health promotion with them), they are more likely to be choosing one of the “hubs” in their social network — someone who is in a much better position to convince them to make healthy changes.  Also, with the structure put in place by Care Groups, there are fewer links to traverse between any two given mothers, so communication and persuasion is enhanced.   The mothers who serve as connectors between mothers are also more likely to be practicing healthy behaviors, and so healthy behaviors are more likely to be spread.  If  a Leader Mother — who is more often than not a hub — hears about a positive story of a mother using ORS, for example, she is more likely to transmit that information to other mothers with which she is connected (since it is in tune with her beliefs and experience) than she is to transmit a story about ORS “not working.”  Certain types of information (e.g., pro-exclusive breastfeeeding info) is preferentially transmitted through the social network, and that’s important when you are going against the prevailing cultural practice.

I am convinced, however, that we could be doing a lot more to harness the power of social networks for child survival and community health if more of us understood the latest findings and developed the tools needed to better understand the networks that we are dealing with and our effect on those networks.  Findings from modeling on immunization strategies, for example, show that we could dramatically decrease the number of people who we need to immunize to stop an epidemic if we focused on people’s acquaintances (who are more likely to be hubs) in a given community.  Given that behaviors also flow through these social networks, it would make sense that focusing more on those hubs (and using them to influence others) should make behavior change happen more quickly and at lower cost.  Doing some social network analysis can also help us to know who in the broader community to target and who has the most influence on mothers and their child survival behaviors.  (See this article on breastfeeding and social networks in Bolivia, for example.)

If you are new to social networks, I recommend these videos on social network theory and acquaintance immunization.
[youtube=http://www.youtube.com/watch?v=tLiZRwF9cVc&w=480&h=385] [youtube=http://www.youtube.com/watch?v=5BdQxvHtMIQ&w=480&h=385]

Efficient Immunization Approaches to Avoid Epidemic Spreading

Tom Davis, MPH

Chairman, CORE Group Board of Directors

Director of Health Programs, Food for the Hungry


Author fhadmin

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Join the discussion 5 Comments

  • Outstanding insights as always, Tom. You should be aware that HKI and IFPRI have a small grant from 3ie to examine how social networks influence the diffusion of innovations in nutrition practices and homestead food production in a project we are implementing in Burkina with the support of USAID’s Office of Foreign Disaster Assistance. We are looking at two models of behavior change promoted by influential community members: grandmothers and village health committees.
    Specifically, our analysis will investigate whether there are differences in treatment effects (the adoption of behaviours that improve children’s nutritional status) according to the households’ level of assets, ethnic status or education. If information flows most easily across links with similar characteristics, households with higher levels of education or wealth may be more able to receive the projects’ nutrition information and adopt improved nutritional practices, while households with lower levels may not as easily receive the information and thus evidence less behaviour change. In this structure, we would expect the targeting approach of mothers + grandmothers to be more effective among better resourced families, as information is reaching these households through two members. If information passes more easily through influential people in the village who have large networks and establish new social norms easily, such as those in the village health committee, both men and women might be influenced by the mothers + health committee diffusion strategy.
    So stay tuned!

  • tdavismph says:

    That’s great! You might want to look at this article on spread of BF messages in Bolivia through social networks: http://www.jhuccp.org/research/publications/Fonseca-Becker_breastfeedingpromotion.pdf

  • These effects need to be extended into Development.
    Social Networking is a misleading nomen. I say Web 2.0. Most people do not get it. There is a Third Divide.

    There is a deeper effect going on. Collective Intelligence. Dan Tapscott, in the classic , said “The person who knows the answer to your problem does not work for you.” (or you wouldn’t have that particular problem).
    Think of how that applies to all of Development.
    Development has been using a centralized planning model, but now..

  • tdavismph says:

    Greetings from Haiti. “Social Networks” go much further than the internet (hence not just web 2.0), but exist in every little village in Sudan, Paris, etc. I do believe there are times when we function as a group, as if we had collective intelligence, as if we are acting as one Superorganism. And that part of development is laying those “neural networks” between people who know (e.g., positive deviants, people who are coping) and those who do not, but also between those who have hope and those who do not, those who have the skills and those who do not. We connect parts of the same global body, and through that, healing occurs.

    Indeed, “those parts of the body that seem to be weaker are indispensable, and the parts that we think are less honorable we treat with special honor … there should be no division in the body, but that its parts should have equal concern for each other.
    If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.”


  • Jay Edison says:

    Thank you Tom for elucidating this valuable concept. The strength of child health programs, as implemented by CORE Group member NGOs, is in their concentration of effort at the family and community level. That is where truly effective social networking is most likely to occur. I immediately recognized the source of your “body part” quotation.