1. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2006, The Johns Hopkins University and William Brieger. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. JOHNS HOPKINS BLOOMBERG SCHOOL of PUBLIC HEALTH

2. 1 JOHNS HOPKINS BLOOMBERG SCHOOL of PUBLIC HEALTH Social Networks William R. Brieger, MPH, CHES, DrPH Johns Hopkins University

3. 2 Structure of a Network Density –Connections or linkages within Size –Number of direct contacts Range –Extent, heterogeneity Intensity –Emotional closeness, focal person

4. Continued 3 Network Characteristics Influence Diffusion of Ideas, Behaviors, Even Diseases Density – HIGH density: Many connections easier flow of innovations – LOW density: Few connections slower or more difficult flow

5. 4 High Density Many of the Potential Contacts Are Made within a Period of Time

6. Continued 5 Network Characteristics Influence Diffusion of Ideas, Behaviors, Even Diseases Range – HIGH range: Variety of different members; greater opportunity for new ideas to enter network; greater influence in terms of community change; as those members will themselves have a variety of networks

7. 6 Network Characteristics Influence Diffusion of Ideas, Behaviors, Even Diseases – LOW range: Members more homogeneous; fewer points where new ideas can enter network

8. 7 Wide Range Group Members Come from A Variety of Backgrounds Focal person

9. 8 Youth Who Drink Alcohol Social contacts as sources Self 17% Friends 36% Acquaintance 6% Mothers 6% Fathers 26% Brothers 9%

10. 9 Rural to Urban Migration Rural Dwelle r becomes Urban Social events Visitor Family Business Friend

11. 10 Urban to Rural (And Others) In the community Polygamy Boy/Girl Friends Divorcees Commercial Sex Workers Drivers Farm Laborers Lagos Returnees

12. 11 Intervention Can Build on Group Support Training village health workers

13. 12 Courtesy of the Hesperian Foundation: http://www.hesperian.org. THE NETWORK OF LEARNING FOR COMMUNITY HEALTH Everyone helps the instructors learn Instructors help health workers learn Health workers help instructors learn Everyone helps student health worker: learn Health workers help parents learn Health workers help children learn Health workers help workers learn Health workers help midwives learn Children help parents learn Parents help health workers learn Parents help children learn Children Help children learn Workers help health workers learn Midwives help health workers learn COMMUNITY TRAININ G COURSE

14. 13 Network of Learning Village health workers become a social network during training They reach out to other networks in which they are members to share knowledge and skills

15. 14 Youth Groups Help Community El Progresso, Honduras

16. 15 Self-Help Among Diabetic Patients Members provide emotional support when family members reject someone They teach each other skills and provide encouragement to enhance self-efficacy As a group, they negotiate with medicine shops for lower prices Diabetic club

17. 16 Mothers clubs for child health

18. 17 Peer education builds on social support/networks

19. 18 Peer education programs are based on theory and assumptions that young people can communicate among themselves better

20. Social Network Differences Influence Peer Education Effects In-school networks – Captive audience – Well defined groups like classes – Structured opportunities to interact Continued 19

21. 20 Social Network Differences Influence Peer Education Effects Out-of-school networks – Small networkse.g. 6 apprentices in a workshop – Overall populations larger, more diverse

22. 21 Peer Education May Not Work the Same for Every Group VariableLocation Score InterventionControl P-value Knowledge Contraceptive Willing to buy Used Modern In-school Out-of-school In-school Out-of-school In-school Out-of-school In-school Out-of-school In-school Out-of-school In-school Out-of-school

23. Theoretical Bases For Peer Education Building knowledge –Information flows more freely among peers Perception of risk –Risk perception closely linked with emotional development stages Continued 22

24. Continued 23 Theoretical Bases For Peer Education Perception of norms –Beliefs of whether the behavior is acceptable, approved of by social network

25. 24 Theoretical Bases For Peer Education Self-efficacy – Enhanced through observational learning, especially by observing people in similar situations/similar backgrounds – Greater sense of identity with people of similar background

26. 25 Social support is often needed to support public health efforts like immunization. Do family members (who help watch over other children at home) approve?... etc

27. Continued 26 Networks Are Units of Identity People know to which network they belong People belong to many networks

28. 27 Networks Are Units of Identity Different networks may meet differing needs for social support – Emotional, appraisal, material, and informational – Networks mediate between the individual and the larger community Networks collectively comprise the fabric of the community

29. 28 Network Analysis Memberships Connections Sources of support Define an individuals coping strategy

30. 29 Network Analysis Note – Networks do not include social services and service providers – Networks serve as mediators between these services and individual group members

31. 30 Memberships Co- op/ union Extended family Farmer Religiou s sect Social club

32. Continued 31 Union or co-op –Material support Access to government fertilizers as a group Loans, contributions Different Groups, Different Support

33. Continued 32 Different Groups, Different Support Union or co-op – Information support Sharing ideas about crop production and availability of agricultural inputs – Appraisal support Feedback on production methods, crop choices

34. Continued 33 Different Groups, Different Support Social club – Emotional support Attend each member s social events Come together for mourning

35. 34 Different Groups, Different Support Social club – Material support Contribute financially to ceremonies Loan each other money – Appraisal support Feedback on performance of social roles

36. Copyright 2005, The Johns Hopkins University and Bill Brieger. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. Farmer with Guinea Worm Sources of Social Support Farm work group with Akin and Niyi helps harvest his yams Yam sellers association helps market his yams Farmers Coop helps him buy his supply of fertilisers for next season Extended familiy members provide food, medicines, advice on care Members of social club visit and give emotional support Bamikale has guinea worm