The role of social network analysis in scaling-up and sustaining community-based health programmes in low- and middle-income countries

Abstract

Background: Non-communicable diseases [NCDs] are an ever-increasing burden globally with low- and middle-income countries [LMICs] disproportionately affected. Community-based programmes [CBPs], which aim to improve the wellbeing of specified populations in a contextually relevant way, have been identified by the World Health Organization as a cost-effective prevention and management strategy of NCDs. However, evidence for scaling-up and sustaining CBPs remains limited. A potential tool to scale-up CBPs could be social network analysis [SNA] which considers real-world complexity by quantifying and visualising relationships between stakeholders. Objective: To explore the role of SNA in scaling-up and sustaining CBPs in LMICs. Methods: Mixed-methods, five sequential studies: 1) scoping review of SNA in scaling-up and sustaining CBPs in LMICs; 2) feasibility study of SNA within the case study programme, WoW!, 3) full SNA of WoW!, 4) interviews with WoW! stakeholders exploring context and mechanism factors that might be present in the scale-up and sustainability of WoW!; 5) interviews exploring the perceptions of WoW! stakeholders of the process and value of SNA. Results: Study 1 identified only three studies that conducted SNA, supporting this research. Study 2 identified practical challenges of collecting SNA data within complex settings, informing approaches for Study 3 which revealed a centralised network, unclear role differentiation, and low rural representation. Study 4 interviewees provided contextual understanding of the SNA findings, with Study 5 participants indicating that while some aspects of SNA were useful, i.e., visual outputs, most analyses did not provide actionable information. They proposed the use of a “live mapping” tool providing the visual benefits of SNA while taking into account the data collection capabilities and information needed to measure and act in complex community networks. Conclusion: This research contributes to the development of a pragmatic and feasible SNA tool in improving the scale-up and sustainability of complex CBPs, particularly in LMICs.

Date of Award	10 Jan 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Nick P Townsend (Supervisor) & Zoi Toumpakari (Supervisor)