Applying Social Network Analysis to Evaluate Implementation of a Multisector Population Health Collaborative That Uses a Bridging Hub Organization

Network development in workplace health promotion - empirically based insights from a cross-company network promoting physical activity in Germany

BACKGROUND

In the field of health promotion, interorganisational networks are of growing relevance. However, systematic and target-oriented network management is of utmost importance for network development. The aim of this article is to report on the development of a cross-company network promoting physical activity, and to identify necessary activities and competencies for a systematic network management.

METHODS

The network was systematically planned and implemented in a German technology park comprising different companies. To assess and describe the development of the network, quantitative social network analysis was conducted. To answer the question on the activities and competencies for systematic network development semi-structured interviews with participating stakeholders, and a focus group discussion with health promotion experts were conducted. The interviews were analysed deductively and inductively with the structuring content analysis method and the focus group discussion was analysed deductively by summarising key aspects of the discussion.

RESULTS

Network metrics showed that the network became larger and denser during the planning phase, and stagnated during the implementation phase. As key facilitators for network development, participation of all stakeholders, a kick-off event, and the driving role of a network manager were identified. Necessary activities of the network manager were related to structural organisation, workplace health promotion offers, and cross-sectional tasks. The results suggested that not only professional and methodological competencies, but also social and self-competencies were required by the manager.

CONCLUSIONS

Our study provides initial guidance regarding the activities and required competencies of an interorganisational network manager. The results are of particular relevance for the context of workplace health promotion, since a network manager can be considered as a driving role for planning and implementing a cross-company network.

TRIAL REGISTRATION

The study is registered in the German Clinical Trials Register (DRKS00020956, 18/06/2020).

Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review

BACKGROUND

Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.

METHODS

Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.

RESULTS

4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.

CONCLUSION

This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

Exploring the Multidimensionality of Trust in Participatory Health Partnerships - A Network Approach

Introduction

Previous studies have identified “trust” as a key mechanism to achieve sustainable partnerships in participatory health research, which themselves can represent social networks. A recent review discussed the potential for social network analysis to investigate the development and maintenance of trust and its effects on partnership functioning in participatory health research partnerships. This review also recommended considering a comprehensive, nuanced and multidimensional approach to conceptualizing, operationalizing and measuring trust in research partnerships. Thus, this study aims to explore empirically the conceptualizing, operationalizing and measuring of trust in a multidimensional manner, approaching each trust dimension as an individual trust network, as well as combined as an overall trust network.

Methods

We sampled the whole network, recruiting from a newly established network of 57 individuals that must collaborate to achieve a common goal. These individuals represented academic, service and community organizations of an existing participatory partnership, the Public and Patient Involvement Ignite Network in Ireland. Of the 57 individuals invited to take part in the study, 75% (n = 43) individuals completed the network survey. A survey about trust was designed based on literature in the area and was administered via Qualtrics. The survey included eight network questions: one on collaboration, and seven on specific dimensions of trust. From this, we constructed a network for each trust dimension. We compared several core network measures of each to identify structural differences between the dimensions of trust. To statistically validate them, we compared them to a random and preferential null model.

Results

All the networks had a high reciprocity but were decentralized. Key differences were identified across trust dimensions, particularly in terms of integrity and shared values, visions and goals. None of the networks compared well to the null models indicating participants did not randomly or preferentially (based on how much trust they receive for a particular trust dimension) trust other partners.

Discussion/Conclusion

This novel empirical social network analysis of trust in a real-world partnership elucidates the nuances and multidimensional nature of trust. This provides support for expanding this research direction to enhance understanding of and interventions for trust in participatory health research.

Mapping the Lay of the Land: Using Interactive Network Analytic Tools for Collaboration in Rural Cancer Prevention and Control

BACKGROUND

Cancer mortality rates in the United States are higher in rural than urban areas, especially for colorectal cancer. Modifiable cancer risks (e.g., tobacco use, obesity) are more prevalent among U.S. rural than urban residents. Social network analyses are common, yet rural informal collaborative networks for cancer prevention and control and practitioner uses of network findings are less well understood.

METHODS

In five service areas in rural Missouri and Illinois, we conducted a network survey of informal multisector networks among agencies that address cancer risk (N = 152 individuals). The survey asked about contact, collaborative activities, and referrals. We calculated descriptive network statistics and disseminated network visualizations with rural agencies through infographics and interactive Network Navigator platforms. We also collected feedback on uses of network findings from agency staff (N = 14).

RESULTS

Service areas had more connections (average degree) for exchanging information than for more time-intensive collaborative activities of co-developing and sustaining ongoing services and programs, and co-developing and sharing resources. On average, collaborative activities were not dependent on just a few agencies to bridge gaps to hold networks together. Users found the network images and information useful for identifying gaps, planning which relationships to establish or enhance to strengthen certain collaborative activities and cross-referrals, and showing network strengths to current and potential funders.

CONCLUSIONS

Rural informal cancer prevention and control networks in this study are highly connected and largely decentralized.

IMPACT

Disseminating network findings help ensure usefulness to rural health and social service practitioners who address cancer risks.

Participatory Systems Modelling for Youth Mental Health: An Evaluation Study Applying a Comprehensive Multi-Scale Framework

The youth mental health sector is persistently challenged by issues such as service fragmentation and inefficient resource allocation. Systems modelling and simulation, particularly utilizing participatory approaches, is offering promise in supporting evidence-informed decision making with limited resources by testing alternative strategies in safe virtual environments before implementing them in the real world. However, improved evaluation efforts are needed to understand the critical elements involved in and to improve methods for implementing participatory modelling for youth mental health system and service delivery. An evaluation protocol is described to evaluate the feasibility, value, impact, and sustainability of participatory systems modelling in delivering advanced decision support capabilities for youth mental health. This study applies a comprehensive multi-scale evaluation framework, drawing on participatory action research principles as well as formative, summative, process, and outcome evaluation techniques. Novel data collection procedures are presented, including online surveys that incorporate gamification to enable social network analysis and patient journey mapping. The evaluation approach also explores the experiences of diverse stakeholders, including young people with lived (or living) experience of mental illness. Social and technical opportunities will be uncovered, as well as challenges implementing these interdisciplinary methods in complex settings to improve youth mental health policy, planning, and outcomes. This study protocol can also be adapted for broader international applications, disciplines, and contexts.

Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal

There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.

Connecting community-delivered evidence-based programs and the healthcare system: Piloting a learning "wellcare" system

INTRODUCTION

Many evidence-based programs (EBPs) have been determined in randomized controlled trials to be effective, but few studies explore the real-world effectiveness of EBPs implemented in the natural community setting. Our study evaluated whether a novel linked infrastructure would enable such insights and continuous improvement as part of a learning healthcare-community bridged "wellcare" ecosystem.

METHODS

We created a secure, web-based data entry and storage platform with a network of Minnesota community-based organizations to record EBP participants' demographics and attendance, and program details. We then linked participant's information to their Rochester Epidemiology Project (REP) medical records. With this infrastructure, we conducted a proof of concept, retrospective cohort study by matching EBP participants to REP controls and comparing medical record-documented outcomes over 1 year follow-up.

RESULTS

We successfully linked EBP participant records with medical records in 77.6% of cases, and the infrastructure proved feasible and scalable. Still, key challenges remain in obtaining participant consent for data sharing. Upfront resource investments and the availability of REP-like warehouses limit generalizability. Optimal learning will be improved by enhancements that better track program fidelity. Our pilot study established a proof-of-concept, but sample sizes (n = 99 for falls prevention and n = 97 chronic disease/pain management EBP completers) were too small to detect significant differences in hospital admittance as compared to matched controls for either EBP group, (OR = 0.66[0.36, 1.19]) and (OR = 0.81[0.43, 1.54]), respectively. Events were too rare to gather meaningful information about effects on fall rates.

CONCLUSIONS

Our pilot demonstrates the feasibility of developing an online infrastructure that connects information from community leaders with medical record documented health outcomes, bridging the knowledge gap between community programs and the health care system. Insights gleaned from our infrastructure can be used to continuously shape community program delivery to reduce the need for formal health care services.

Identification of Network Promoters in a Regional and Intersectoral Health Promotion Network: A Qualitative Social Network Analysis in Southern Germany

Health in all policies is a key approach to promote health and calls for cooperation between diverse levels of government and different sectors. In this paper, we analyze how a network called ‘Healthy Region Plus’ in Southern Germany addresses intersectoral cooperation at city and county levels. We aim to analyze the different roles of actors involved in the network based on the promoter model. We conducted two socio-material network mappings based on the Net-map approach by Schiffer and Hauck. The analysis followed three steps: data visualization, descriptive analysis of network properties, and interpretation of findings. Our findings reveal a complex intersectoral cooperation structure, with county and city level clusters, with network members who act as diverse power, expert, process, or relationship promoters. We also identified certain relevant sectors not to be part of the network. We discuss that the success of the network depends on the members’ active participation in and their outreach beyond the existing network, between city and county levels, and across sectors to promote health and build health-promoting structures in the region.

Integrating dissemination and implementation sciences within Clinical and Translational Science Award programs to advance translational research: Recommendations to national and local leaders

The National Center for Advancing Translational Sciences (NCATS) has defined translation as the process of turning observations into interventions that are adopted, sustained, and improve health. Translation must attend to research and community systems and context at multiple levels, and to key stakeholders. Dissemination and implementation (D&I) sciences are informed by an understanding of the critical role of people and systems in disseminating, adopting, and sustaining innovations within real-world settings. Thus, the D&I sciences provides a set of principles that can guide the translational work of Clinical and Translational Science Award (CTSA) programs from basic research to public health. In this special communication, our cross-domain working group of the CTSA consortium, comprised of experts in methods and processes, workforce development, evaluation, stakeholder engagement, and D&I sciences, share a vision of how CTSAs can enhance translation across the translational spectrum through the integration of D&I sciences into the critical areas of methods and processes, workforce development, and evaluation. We propose a set of recommendations for NCATS national and local leaders that are intended to move D&I sciences out of a position of unfamiliarity and ancillary value and into the core identity of who CTSAs are, how they think, and what they do, to advance translation and health.

Teaching for implementation: A framework for building implementation research and practice capacity within the translational science workforce

Implementation science offers a compelling value proposition to translational science. As such, many translational science stakeholders are seeking to recruit, teach, and train an implementation science workforce. The type of workforce that will make implementation happen consists of both implementation researchers and practitioners, yet little guidance exists on how to train such a workforce. We-members of the Advancing Dissemination and Implementation Sciences in CTSAs Working Group-present the Teaching For Implementation Framework to address this gap. We describe the differences between implementation researchers and practitioners and demonstrate what and how to teach them individually and in co-learning opportunities. We briefly comment on educational infrastructures and resources that will be helpful in furthering this type of approach.

Supporting Cross-Company Networks in Workplace Health Promotion through Social Network Analysis-Description of the Methodological Approach and First Results from a Model Project on Physical Activity Promotion in Germany

Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.

Basic Criteria, Models, and Indicators of Intersectoral Collaboration in Health Promotion: A Scoping Review

Background:

In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration.

Methods:

This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest.

Results:

52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators.

Conclusion:

The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

Addressing Challenges to Coordinating the Implementation of Place-Based Chronic Disease Prevention Interventions in Los Angeles

CONTEXT

Chronic disease prevention initiatives have traditionally been structured to address a single disease, potentially limiting the scope of health impacts. In the past decade, initiatives have increasingly adopted a coordinated approach, in which multiple interventions are intended to work synergistically-often in a bounded geographic area-to address interrelated risk factors and diseases. However, despite increased interest in this coordinated approach, few examples exist of how coordination has been operationalized in local public health practice.

IMPLEMENTATION

In 2014, the Los Angeles County Department of Public Health launched the 4-year Chronic Disease Prevention Strategy (CDPS). Through CDPS, the Los Angeles County Department of Public Health implemented a range of environmental, lifestyle change, and health system interventions intended to collectively reduce chronic disease among adults in Los Angeles, with concentrated implementation occurring in 1 high-need neighborhood.

EVALUATION

This case study examined the activities undertaken to coordinate across CDPS interventions and documented challenges to these efforts. Data were collected via a document review of programmatic materials and structured conversations with staff leading implementation of CDPS interventions.

RESULTS

Document review and structured conversations with staff identified 3 primary coordination activities: (1) collaborating on outreach materials to unify messaging, (2) developing a network of common partners, and (3) investing in shared data collection. Operational challenges identified were disparate short-term objectives across interventions, minimal alignment between clinical practice and CDPS goals, restrictions around bidirectional referrals between organizations, and limited bandwidth among new partners to engage with multiple CDPS interventions. Contextual challenges identified were competing social and political issues, and geographic fluidity regarding where community members sought health resources.

CONCLUSION

Developing an initiative-specific coordination plan prior to implementation may help reduce challenges to coordination. Modifications in how health initiatives are funded and structured may be needed: greater flexibility in how funding is administered, and the inclusion of coordination-specific metrics, may enable more robust coordination.