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.
Tom Davis, MPH
Chairman, CORE Group Board of Directors
Director of Health Programs, Food for the Hungry