RESEARCH UTILIZATION IN NURSING CLASS 6 Judith Anne Shaw, Ph.D., R.N. October 21, 2009.
Anne Sales, Faculty of Nursing, University of Alberta.
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Transcript of Anne Sales, Faculty of Nursing, University of Alberta.
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Anne Sales, Faculty of Nursing, University of Alberta
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Discuss social networks and their applicability to implementation
Describe how to measure social networks
Discuss how social networks might affect uptake of implementation interventionsSmall group exercise
Describe issues in measuring and analyzing social networksWays to manage the influence of social
networks
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Both sociology and anthropology have histories– somewhat different
Date back to early part of 20th century Hawthorne wiring room studies in the
Western Electric Company in Chicago– 1920s
Very difficult to do anything other than quite small scale social network studies until computing power became widely available
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What structure is evident in the arrangement of squares and circles?
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SOURCE: Brandes, Raab and Wagner (2001)
<http://www.inf.uni-konstanz.de/~brandes/publications/brw-envsd-01.pdf>
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*Directional graph
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*Source: David Knoke
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History here alsoColeman and Katz (Chicago)– study of
diffusion of medical innovation from the early 1950s Explored the networks of physicians using
a new antibiotic Early, mid- and late adopters had different
positions in social networks Data have been reanalyzed and
reinterpreted (more than once)
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Opinion leader interventions Typically identify opinion leader through
surveys of participants in a given group Surveys (usually) ask questions based on the
Hiss instrument, derived from the Coleman and Katz study Please name up to three individuals whom you
would go to for information about…/whose opinion you would value about…/whom you would regard as an expert in…
Boundaries of the group are rarely clearly defined
Once identified, the interventions vary Most often education as the primary vehicle
Outcomes have been mixed Cochrane review 2006
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Grimshaw et al. paper in Implementation Science 2006 Attempted to identify common opinion leaders
across health /disease conditions and across professional groups
Unable to do so Effectiveness of opinion leader approaches depends
on accurate identification of opinion leaders– or does it? May depend on other factors such as what type of
group and their reliance on expertise May depend on factors related to disease or health
problem and the evidence Vast majority of opinion leader studies have been
among physicians who may be quite different from other health care providers
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Theory of planned behavior Individual level theory designed to explain
and/or predict individual behavior change (or lack of change) Largely mediated through intention to change
Important set of variables in TPB relates to social and/or professional norms (Godin et al. Implementation Science 2008)
TPB and other individual level theories are silent on where and how norms are formed or how they c an be changed
There is also an issue of “perceived behavioral control”
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Perceived behavioral control
Attitudes towards behavior
Subjective or social norms
Social networks
Intervention
Intention to change behavior
Behavior
Perception of intervention
Professional norms
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Issues of measurementFundamentally different level from the
individual or organizationUnit of measurement is the relationship,
not the individualRelationships require a minimum of two
people Issues of analysis
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Relationships have qualities Existence Strength Direction Directness Hierarchy Embeddedness Structural properties
Holes Density
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Friendship Volitional Mutual but may not be reciprocal beyond a dyad Varying content
Professional May or may not be fully volitional May or may not be mutual Professional content
Advice-seeking Often not wholly volitional Usually not reciprocal Work or professional related content
Mutual aid Similar to advice seeking but may be more mutual
and reciprocal
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Establishing boundaries is importantWork units have appealTypically finite, have clear demarcationCan use lists of names from work unitMay or may not be simple depending on the
organization Different approaches to obtaining network
dataGive people enumerated lists of names with
some space to addAsk people to enumerate/name based on
specific promptsAsk for limited number (usually 3 or 4)
nominations (typically used in opinion leader surveys)
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Pick an intervention from this list (one you’re at least somewhat familiar with):
Education Academic detailing Opinion leader Audit with feedback Reminders
Discuss these questions:
How would you incorporate social network measurement and analysis (SNMA) into this intervention?
What would you gain by adding SNMA?
How could you design or plan an intervention to learn from SNMA?
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Reporting back from small group discussions
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30 seconds on the intervention Setting (s) Relevance of SNMA Effect on intervention of adding
SNMA Design or planning issues
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Response bias Recall bias What aspects or types of network do
you measure?What attributes of relationships do you
want to know about?
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SNA does not use traditional individual attribute analysis techniquesFundamentally different kind of data– measures
relationships, not aspects or attributes of individuals
Learning curve for software and analytic techniques
Different level as well as type of analysis Not entirely clear how best to move between
these levelsMany social network analysts believe that
analyzing at an individual level is inappropriateMulti-level techniques may be useful although it’s
not entirely clear how to assign the level of the network
Different networks may be different levels
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New information that may be quite important in understanding uptake of interventions
May offer opportunities to adapt interventions based on social network findings
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Much social network analysis and research has come from organizational consulting
Relatively long history of using SNA to respond to organizational problems and issuesVarying effectiveness depending on what is
done with network information Independent of other interventions,
networks themselves can be manipulated in an organizational contextThis is not newMeasuring, analyzing, and understanding is
relatively new
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SOURCE: Brandes, Raab and Wagner (2001)
<http://www.inf.uni-konstanz.de/~brandes/publications/brw-envsd-01.pdf>
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*Directional graph
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*Source: David Knoke
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Structural holesPlaces where there should be connections but
there aren’t Weak lattices
Connections exist but are weaker or more negative than they could/should be
HierarchiesSpecific design that may or may not be
intentionalHealth care is highly hierarchical
CliquesGroups that have patterns of not
communicatingWithholding information for purposes of power
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Be mindful of unintended consequences The way you ask questions conditions
the responses you getThere are different kinds of networksSome may not be relevant to what you
want/need to achieve The group of people I have coffee with may not
be highly related to the group of people I would go to for help with a work related problem
There is a very large literature on networkshttp://www.insna.org/