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Astbury CC, Lee KM, McGill E, Clarke J, Egan M, Halloran A, Malykh R, Rippin H, Wickramasinghe K, Penney TL. Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review. Int J Health Policy Manag 2023; 12:6772. [PMID: 37579437 PMCID: PMC10125079 DOI: 10.34172/ijhpm.2023.6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2023] [Indexed: 08/16/2023] Open
Abstract
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.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Kirsten M. Lee
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Janielle Clarke
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Afton Halloran
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
- Department of Nutrition, ExercDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.ise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Regina Malykh
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Tarra L. Penney
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
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Wolbring L, Schmidt SCE, Niessner C, Woll A, Wäsche H. Community networks of sport and physical activity promotion: an analysis of structural properties and conditions of cooperation. BMC Public Health 2022; 22:1966. [PMID: 36289498 PMCID: PMC9608923 DOI: 10.1186/s12889-022-14383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background: The importance of intersectoral cooperation networks among community organizations located in people’s immediate environments in addressing population health problems such as physical inactivity has come into focus in recent years. To date, there is limited evidence on how and why such networks emerge. Therefore, the aims of this study were (a) to analyze the structural properties and (b) to identify the conditions of cooperation in interorganizational community networks of sport and physical activity promotion. Methods: Survey data on cooperative relationships and organizational attributes of sports and physical activity providers as well as sports administrating organizations in two community networks located in urban districts in southern Germany were collected (Network I: n = 133 organizations; Network II: n = 50 organizations). Two quantitative descriptive procedures – network analysis and stochastic analyses of network modeling (exponential random graphs) – were applied. Results: Similar structures and conditions of cooperation were found in the networks (e.g. low density, centralization). The community sports administrations had the most central positions in both networks. Exponential random graph modeling showed that cooperation took place more frequently in triangular structures (closure effect) and revolved around a few central actors (preferential attachment effect). Organizations from different sectors cooperated more often than organizations from the same sector (heterophily effect). Conclusion: The study provided valid and robust findings on significant mechanisms and conditions of interorganizational cooperation in community networks focused on sport and physical activity promotion. Based on the results, implications for the development and most efficient governance of these networks can be derived. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14383-3.
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Affiliation(s)
- Laura Wolbring
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Steffen Christian Ekkehard Schmidt
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Claudia Niessner
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Hagen Wäsche
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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Exploring Intra and Interorganizational Integration Efforts Involving the Primary Care Sector – A Case Study from Ontario. Int J Integr Care 2022; 22:15. [PMID: 36131888 PMCID: PMC9461681 DOI: 10.5334/ijic.5541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
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Power DD, Lambe BM, Murphy NM. Using systems science methods to enhance the work of national and local walking partnerships: practical insights from Ireland. Eur J Public Health 2022; 32:i8-i13. [PMID: 36031825 PMCID: PMC9421407 DOI: 10.1093/eurpub/ckac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity (PA) literature is dominated by individual-level descriptive studies, which are known to have limited impact on population PA levels. Leveraging systems science methods offers opportunities to approach PA in a manner which embraces its inherent complexity. This study describes how participatory systems mapping and social network analysis (SNA) were used to understand the work of local and national level walking systems in Ireland. Methods Two adapted participatory action research workshops with multisectoral stakeholders were used to develop a systems map for walking in Cork, Ireland. The Global Action Plan for Physical Activity 2018–2030 (GAPPA) map was used as a framework to categorize workshop outcomes. Secondly, SNA methods were used to analyse the communication network between partners of Get Ireland Walking, a national walking promotion initiative, as defined within their strategic plan and the actual communication network as experienced by the partners. Results The systems mapping process allowed stakeholders to identify 19 suggested actions for the Cork walking system. The SNA found that there were considerably fewer communication ties between partners in the actual communication network than in the strategy defined network. Conclusion The systems mapping process was a useful catalyst for engaging stakeholders in cross-sectoral communication and the GAPPA was a practical way to organize workshop outcomes. Social network analysis methods highlighted that the communication network of a national level walking promotion partnership is not working as planned. Overall, the use of systems science methods can provide practical insights for local and national level walking systems.
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Affiliation(s)
- Dylan D Power
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Ireland
| | - Barry M Lambe
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Ireland
| | - Niamh M Murphy
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Ireland
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Farrugia DM, Vilches SL, Gerber A. Effective inter-organisational networks for Responsible Research and Innovation and global sustainability: a scoping review. OPEN RESEARCH EUROPE 2022; 1:144. [PMID: 37645166 PMCID: PMC10446013 DOI: 10.12688/openreseurope.13796.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 08/31/2023]
Abstract
Background: Achieving the United Nations Sustainable Development Goals (SDGs) is beyond the capacity of any single organisation. The model for Responsible Research and Innovation (RRI) includes principles of engaging stakeholders and suggests that an engaged, multi-sectoral approach hold promise to mobilise humanity to solve complex and urgent global issues. Methods: This scoping review explores the characteristics of effective and sustainable inter-organisational networks for fostering RRI in service of the SDGs. An inductive-deductive search of prior studies (1990-2020), with the exception of Benson's (1975) seminal work was conducted, which focused on strategies to initiate and maintain inter-organisational networks relevant to the implementation of RRI and/or SDGs. The search began with themes derived from prior network theory, focusing on: (a) the type and function of networks; (b) the aims and vision; and (c) the relationships between networks and network members. In total, 55 articles on inter-organisational network theory were included for the final analysis. Results: Results are reported under themes of: (1) Effectiveness, Sustainability, and Success; (2) Governance and Management; and (3) Network Relationship. Network structures, forms of management and funding are linked to sustainable networks. Potential threats include power imbalances within networks, and internal and external factors that may affect relationships at network and community levels. Few studies examine diversity or cultural viewpoints. Studies highlight the benefits of networks such as enhancing knowledge sharing among researchers, practitioners, and other stakeholders. Conclusions: The effectiveness of the managerial structure may be observed as outputs of the intention and values of an inter-organisational network. Our review demonstrates that a global inter-organisational network approach is achievable. Such a network would have many benefits, including allowing organisations to be responsive and flexible towards change and innovation. Keywords RRI, SDGs, network theory, inter-organisational networks, governance, trust.
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Affiliation(s)
- Danielle Martine Farrugia
- University of Malta, Msida, MSD 2080, Malta
- International Consortium of Research Staff Associations (ICoRSA), Cork City, Ireland
| | - Silvia Leonor Vilches
- Department of Human Development and Family Studies, Auburn University, Auburn, United States, Auburn, USA
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Wäsche H, Wolbring L, Woll A. Physical activity promotion in an urban district: Analyzing the mechanisms of interorganizational cooperation. PLoS One 2021; 16:e0260053. [PMID: 34780572 PMCID: PMC8592486 DOI: 10.1371/journal.pone.0260053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Past research has identified the importance of cooperation among community-based organizations from different sectors to address public health problems such as insufficient physical activity. However, little is known about how and why interorganizational cooperation occurs. The present study sought to analyze the structure and emergent patterns of interorganizational cooperation within a network promoting physical activity based in an urban district neighborhood of a city in Southwestern Germany. Survey data on cooperative relations among 61 network organizations and organizational attributes (e.g., possession of sport facilities) were collected. Social network analysis was applied to examine network properties and exponential random graph models were estimated to test hypotheses concerning mechanisms and conditions of cooperative tie formation. The results show that the network of cooperation is sparse but characterized by a tendency for cooperation to occur in triangular structures. Other significant mechanisms of cooperative tie formation are preferential attachment, with the community department for education and sports being the most central network actor, and heterophily regarding the cooperation of organizations from different sectors. This study provides valid and reliable findings on conditions of network formation and significant mechanisms of interorganizational cooperation in the field of physical activity promotion. Knowledge about these mechanisms can help to manage networks effectively and efficiently and reveal potentials for improvement and intensification of interorganizational cooperation in both the present and other research areas of health promotion.
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Affiliation(s)
- Hagen Wäsche
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Laura Wolbring
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Timm I, Rapp S, Jeuter C, Bachert P, Reichert M, Woll A, Wäsche H. Interorganizational Networks in Physical Activity Promotion: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7306. [PMID: 34299760 PMCID: PMC8306254 DOI: 10.3390/ijerph18147306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Public health challenges such as physical inactivity are multiplex and cannot be effectively addressed by single organizations or sectors. For this reason, public health policies have to involve various sectors and foster partnerships among organizations. Social network analysis (SNA) provides a methodological toolkit that enables the investigation of relationships between organizations to reveal information about the structure and cooperation within networks. This systematic review provides an overview of studies utilizing SNA to analyze the structure of networks that promote physical activity, including the structural set-up, types, and conditions of cooperation, the existence or absence of key actors, the characteristics of organizations working together, and potential barriers limiting collaboration. In total, eight eligible studies were identified. To evaluate the quality of these studies, a quality assessment tool for SNA was created. Relevant aspects from each study were systematically outlined using a data extraction template developed for network studies. The studies reported low to moderate density scores with many ties not being realized. Organizations tend to work side by side than as real partners, whereas organizations of the same type are more strongly connected. Most of the studies identified governmental health organizations as key players in their networks. Network maturity influences network outcomes. Shared goals and geographic proximity are potential facilitators for network development. For future research, more sophisticated methods and longitudinal studies are required to describe how networks, with the aim of promoting physical activity, develop and change to identify predicting factors for an effective network structure.
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Affiliation(s)
- Irina Timm
- Mental mHealth Lab, Chair of Applied Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany;
| | - Simone Rapp
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany; (S.R.); (C.J.); (P.B.); (A.W.); (H.W.)
| | - Christian Jeuter
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany; (S.R.); (C.J.); (P.B.); (A.W.); (H.W.)
| | - Philip Bachert
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany; (S.R.); (C.J.); (P.B.); (A.W.); (H.W.)
| | - Markus Reichert
- Mental mHealth Lab, Chair of Applied Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany;
- Central Institute of Mental Health (CIMH), Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany
- Department of eHealth and Sports Analytics, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany; (S.R.); (C.J.); (P.B.); (A.W.); (H.W.)
| | - Hagen Wäsche
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany; (S.R.); (C.J.); (P.B.); (A.W.); (H.W.)
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Ebuenyi ID, Smith EM, Kafumba J, Jamali MZ, Munthali A, MacLachlan M. Implementation of the Assistive Product List (APL) in Malawi through development of appropriate policy and systems: an action research protocol. BMJ Open 2020; 10:e040281. [PMID: 33158833 PMCID: PMC7651723 DOI: 10.1136/bmjopen-2020-040281] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Assistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi. METHOD AND ANALYSIS We propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice-and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations. ETHICS AND DISSEMINATION The study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Monica Z Jamali
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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Campbell EJ, Lee Olstad D, Spence JC, Storey KE, Nykiforuk CIJ. Policy-influencer perspectives on the development, adoption, and implementation of provincial school-based daily physical activity policies across Canada: A national case study. SSM Popul Health 2020; 11:100612. [PMID: 32637553 PMCID: PMC7327280 DOI: 10.1016/j.ssmph.2020.100612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives School-based daily physical activity (DPA) policies represent a promising intervention for increasing physical activity levels among children. Between 2005 and 2010, five Canadian provinces adopted and implemented DPA policies. This national case study explored facilitators and challenges to developing, adopting and implementing DPA policies from the perspective of key stakeholders (‘policy-influencers’) in these five provinces. Methods Development, adoption and implementation of DPA policies at the provincial level was the phenomenon of interest, with each province constituting a distinct case. Semi-structured interviews were conducted with 15 purposively selected policy-influencers across the five case provinces. Cases were first analyzed separately, and then concurrently in a cross-case comparison. Qualitative content analysis was used to code interviews and develop themes. Results Four themes related to the development, adoption, and implementation of DPA policies emerged: existing resources and capacity for policy change; top-down policy development/adoption and bottom-up implementation; political will and windows of opportunity; and, ideology and policy change. Each of these themes encompassed facilitators and challenges related to policy processes surrounding development, adoption and implementation of DPA policies. Conclusion These findings can inform development of future health-related polices in schools. Stakeholders can, for instance, remain attuned to the opening of political windows and capitalize on them as an opportunity to advocate for policy change or create communities of practice to enhance coordination among policy stakeholders. Future studies that explore why other jurisdictions have failed to adopt DPA policies might yield novel insights regarding leverage points to support widespread diffusion of DPA policies. Between 2005 and 2010, five Canadian provinces adopted and implemented DPA policies. A national case study explored facilitators and challenges to adopting and implementing provincial DPA policies. Four key themes related to policy change: capacity, adoption and implementation, political will, and ideology. Recommendations can inform development and implementation of school-based physical activity and health promotion policy.
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Affiliation(s)
| | - Dana Lee Olstad
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Jamshidi E, Eftekhar Ardebili H, Yousefi-Nooraie R, Raeisi A, Malekafzali Ardakani H, Sadeghi R, Hanafi-Bojd AA, Majdzadeh R. A social network analysis on immigrants and refugees access to services in the malaria elimination context. Malar J 2019; 18:1. [PMID: 30602373 PMCID: PMC6317246 DOI: 10.1186/s12936-018-2635-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background There has been significant progress in eliminating malaria in Iran. The aim of this study is to investigate the structure of inter-organizational collaboration networks in the field of unauthorized immigrants and refugees access to services in order to eliminate malaria. Methods This study employed social network analysis, in which nodes represented stakeholders associated with providing access of immigrants and refugees to services in the field of malaria elimination, and ties indicated the level of collaboration. This study adopted socio-centric analysis and the whole network was studied. In this regard, 12 districts of the malaria-endemic area in Iran were selected. Participants included 360 individuals (30 representatives of the organization/group in each district). The data were gathered by interview, using the levels of collaboration scale. UCINET 6 was used for data analysis. The indices of density, centralization, reciprocity, and clustering were investigated for each twelve network and at each level of collaboration. Results The average density of the networks was 0.22 (SD: 0.04). In districts with a high incidence of imported malaria, the values of network density and centralization were high and the networks comprised of a larger connected component (less isolated clusters). There were significant correlations between density of network (r = 0.66, P = 0.02), degree centralization (r = 0.65, P = 0.02), betweenness centralization (r = 0.76, P = 0.004), and imported malaria cases. In general, the degree centrality and betweenness centrality of the organizations of health, district governor, and foreign immigrants’ affairs were higher. In all networks, 60% of the relationships were bilateral. At a higher level of collaboration, the centralization declined and reciprocity increased. The average of betweenness centralization index was 22.76 (SD = 3.88). Conclusions Higher values of network indices in border districts and districts with more cases of imported malaria, in terms of density and centralization measures, can propose the hypothesis that higher preparedness against the issue and centralization of power can enable a better top-down outbreak management, which needs further investigations. Higher centrality of governmental organizations indicates the need for involving private, non-governmental organizations and representatives of immigrant and refugee groups. Recognition of the existing network structure can help the authorities increase access to malaria prevention, diagnosis, and treatment services among immigrants and refugees. Electronic supplementary material The online version of this article (10.1186/s12936-018-2635-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ensiyeh Jamshidi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran, Iran
| | - Hassan Eftekhar Ardebili
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Raeisi
- Department of Medical Entomology and Vector Control, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Malekafzali Ardakani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Hanafi-Bojd
- Department of Medical Entomology and Vector Control, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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