Social Networks in Health

Research

(In order of appearance)David ReevesAnne RogersIvo VassilevBecci Morris

Health Sciences Research Group - Primary Care

Why be interested in networks in primary care?

Traditional variables – eg practice size; staffing; practice culture; patient characteristics - explain very little of the variation in care from one GP practice to another or from one patient to another

Perhaps the missing ingredient has to do with the way in which care is co-ordination across the different people/organisations providing care – ie the networks

Professional networking in Primary Care

Professional networking in primary care can be studied in multiple ways. I am going to describe just three:

- between staff within practices

- between care organisations

- for individual patients

Professional networking in Primary Care

Within-practice Networking

Clinic A: a well-integrated clinic Clinic B: a poorly integrated clinic

MD: doctor; N: nurse; ST: other staff

- Advice-seeking at medical clinics in Minnesota

Within-practice networking

Receiving information networks at one practice

GP ▲ Practice nurse ■ Practice assistant

Chronic heart failure Diabetes

- Information exchange between staff at Netherlands practices

- Plymouth Infant Mental Health Network

Confirmed ties re organising care Confirmed ties re giving care

Between-organisation networking

Care network: The network of professionals providing care to patients with a particular condition (e.g. CHD)

General practice

PCT cardiac nurse

PCT occupational therapist

Primary care

Voluntary worker

Voluntary sector

Housing officer

Social worker

Local authority

Hospital consultant

Dietician

Secondary care

CHD patient

Individual patient networks

- Proposed feasibility study

To determine the feasibility and costs of a study to use SNA to develop a new measure of care coordination.

Individual patient networks

• Can all key people in a patient’s care network be identified from medical records?

• Can an adequate response rate (70%+) to a network questionnaire be achieved?

• Is the network data reliable?

• Can a measure of care co-ordination be derived that reflect the experiences of patients and practitioners?

The NHS Improvement Plan regards self-management as an appropriate level of care for 70-80% of patients with a chronic condition.

Takes a highly individualistic view of self-management:

“…encourage and enable patients to take an active role in their own care…. to use their own skills and knowledge to take effective control over life with a chronic illness” (L.Donaldson 2001)

Largely ignores the social context in which people live. Yet social networks are known to be very relevant to health behaviour.

The role of social networksThe role of social networks

COLLABORATIONS FOR LEADERSHIP IN APPLIEDCOLLABORATIONS FOR LEADERSHIP IN APPLIEDHEALTH RESEARCH AND CARE: HEALTH RESEARCH AND CARE: (CLARHC)(CLARHC)

- - Self-care Support for People with Long Term ConditionsSelf-care Support for People with Long Term Conditions

Objectives :

• The experience and self-care support needs of disadvantaged people living with kidney disease, diabetes and heart disease.

• Peoples’ systems of self-care support and resources (social networks and social capital)

• The role(s) of social networks in chronic illness management - a help or a hindrance?

• Develop new theory and new interventions that focus on social networks

Broad aims of the programmeBroad aims of the programme

• From self-management to illness management

• From self-efficacy to types of work (distribution, coordination)

• Focus on personal networks and inter-organisational networks

Realist reviewRealist reviewQuestions:

• What types of social networks are implicated in long-term condition management?

• Is it possible to say something about their properties?

• For whom do different networks work?

• In what circumstances?

FindingsFindings

Social networks play an important role:• shaping illness knowledge and narratives• defining normalcy and deviance• define the locus of individual and group

responsibilities • shaping the practices and ways in which

illness is managed in everyday life• shaping relations with health services

Comments on findingsComments on findings

1) The available evidence is:• very generic• demonstrating that relationships outside the

professional field do matter 2) The notion of social networks is:• predominantly used in a narrow sense when

applied to illness management • and tend to replicate individually and

professionally centred assumptions in understanding illness management

How we address these questions…How we address these questions…

• Focus on ‘types of work’ • Define networks as ‘networks of networks' (or

personal communities)• Develop a typology of networks of illness

management• Develop a richer conceptual framework around

illness management and everyday life

Empirical workEmpirical work• Administered questionnaire: 330 patients who will be

recruited through GP registers and additional 30 people with the condition who will be recruited through community and voluntary organisations

• We will be aiming to conduct 12 month follow up interviews with these interviewees

• focus groups with people with the conditions• Interviews and focus groups with carers/friends/relatives

of people with the conditions• Audio diaries of carers and people with the conditions• Interviews with local and voluntary organisations and

commissioners of services [health-relevant organisational networks]

Method: concentric circle Method: concentric circle mapping techniquemapping technique

YOU

Network DimensionsNetwork Dimensions

Network structure• What is roughly the distance from where you live

and each one of the people in the diagram? • How often do you see (or talk on the phone, text,

or via internet) with each of them and for how long?

• How much time do you spend with each one of them when you meet (or talk on the phone, text, or via internet)?

• Who among these people know each other?

Network DimensionsNetwork Dimensions

Illness trajectory and network change• How were these relationships different at the

time when you were first diagnosed with this condition

Types of work involved in illness management

PhD social network studyPhD social network study

• Patient level study looking at:– What constitutes a network for individuals with

long term conditions– The relationship between lay and professional

networks in shaping self-management– How individual networks change over time

and does it influence health

MethodsMethods

• 30 participants (16 female, 14 male)

• 1 year Longitudinal study– Initial face-to-face interview– Telephone follow-up during the year– Network mapping technique using concentric

circles -adapted Antonucci (1986)- and interview discussion in final face-to-face interview

3 examples of different networks: 3 examples of different networks:

1. Invisibility of support

2. Who different network members are

3. Importance of different network members

YOU

Wife

1a 2a

Nurse

1b 2eGeneral Practitioner

1b 2e

ID 150a (Diabetes, high cholesterol, male, age: 52)

1. Invisibility of support1. Invisibility of support

ID 150a (Diabetes, high cholesterol, male, age: 52)

Key:

Size of node=distance (larger closer living to 150a)

Shape= significance ( square=most significant, circle=150a,)

Colour=how often in contact with 6150a(red=daily, blue=less often than every couple of months, black=150a)

1. Invisibility of support1. Invisibility of support

Daughter

1B, 2A

Dog

1B, 2A

Friend

1c, 2D

Granddaughter 1B, 2A

YOU

Son

1D, 2B

Brother

1C, 2B

Neighbour A

1B, 2C

Neighbour B

1B, 2CID 600s (Diabetes, high blood

pressure, high cholesterol, male, age: 65)

Grandson 1B, 2A

2. Who different network members are2. Who different network members are

Key:

Size of node=distance (larger closer living to 600s)

Shape= significance ( square=most, circle=mid, triangle=least, diamond=participant)

Colour=how often in contact with 600s (red=daily, green= at lest once a week, yellow = at least once a month, purple=once every couple of months black=600s)

ID 600s (Diabetes, high blood pressure, high cholesterol, male, age: 65)

2. Who different network members are2. Who different network members are

Q: Is there anyone here that is sort of, most important?A: Well, the dog.Q: How come?A: Well she's always here. I don't know how I'd have gone on without her

to be quite honest.Q: Yeah. What does she do? Just sort of…?A: Oh, she’s companyQ: Yeah.A: Company for me really and especially when I lost my wife, like, you

know, and she’s always here like, you know. So I think without the dog I'd get…

Q: Excellent. Does, and do you, would you take [dog] obviously for walks and things?

A: Oh, yeah, every day, yeah. She makes sure. She stares me out when she is ready to go.

Q: She makes you get up?A: Oh, aye, yeah.

ID 600s (Diabetes, high blood pressure, high cholesterol, male, age: 65)

2. Who different network members are2. Who different network members are

YOU

Husband

1A, 2ASon-in-law

1B, 2C

Daughter A

1B, 2B

Son A

1B, 2B

Son B

1C, 2B

Sister A

1D, 2C

Sister B

1C, 2B

Daughter-in-law

1B, 2BBrother

1C, 2D

Practice nurse

1C 2D

General Practitioner

1C 2D

Neighbour A

1B 2B

Neighbour B

1B 2B

Friend

1D 2C

ID 100a (Diabetes, Multiple Sclerosis, underactive thyroid & high cholesterol, female, age 66)

3. Importance of different network 3. Importance of different network membersmembers

ID 100a (Diabetes, Multiple Sclerosis, underactive thyroid & high cholesterol, female, age 66)

Key:

Size of node=distance (larger closer living to 100a)

Shape= significance ( square=most, circle=mid, triangle=least, diamond=participant)

Colour=how often in contact with 600s (red=daily, green= at lest once a week, yellow = at least once a month, purple=at least once every couple of months, black=100a)

3. Importance of different network 3. Importance of different network membersmembers

A: Yeah, she [friend] tells me all her troubles and I tell her mine.

Q: But you say you wouldn't talk to your husband as much?

A: Not as much as um, not as much as me sisters and me friends about different things really, because he's only gets, he gets worried and stressed he gets really stressed so.

ID 100a (Diabetes, Multiple Sclerosis, underactive thyroid & high cholesterol, female, age 66)

3. Importance of different network 3. Importance of different network membersmembers

SummarySummary

Social networks in health research:

1. Personal networks– Invisibility of support– Who different network members are– Importance of different network members

2. Networks between staff within practices

3. Networks between health-relevant organisations