Social network analysis in healthcare settings: a systematic scoping review

Exploring the use of social network analysis methods in process improvement within healthcare organizations: a scoping review

BACKGROUND

Communication breakdowns among healthcare providers have been identified as a significant cause of preventable adverse events, including harm to patients. A large proportion of studies investigating communication in healthcare organizations lack the necessary understanding of social networks to make meaningful improvements. Process Improvement in healthcare (systematic approach of identifying, analyzing, and enhancing workflows) is needed to improve quality and patient safety. This review aimed to characterize the use of SNA methods in Process Improvement within healthcare organizations.

METHODS

Relevant studies were identified through a systematic search of seven databases from inception - October 2022. No limits were placed on study design or language. The reviewers independently charted data from eligible full-text studies using a standardized data abstraction form and resolved discrepancies by consensus. The abstracted information was synthesized quantitatively and narratively.

RESULTS

Upon full-text review, 38 unique articles were included. Most studies were published between 2015 and 2021 (26, 68%). Studies focused primarily on physicians and nursing staff. The majority of identified studies were descriptive and cross-sectional, with 5 studies using longitudinal experimental study designs. SNA studies in healthcare focusing on process improvement spanned three themes: Organizational structure (e.g., hierarchical structures, professional boundaries, geographical dispersion, technology limitations that impact communication and collaboration), team performance (e.g., communication patterns and information flow among providers., and influential actors (e.g., key individuals or roles within healthcare teams who serve as central connectors or influencers in communication and decision-making processes).

CONCLUSIONS

SNA methods can characterize Process Improvement through mapping, quantifying, and visualizing social relations, revealing inefficiencies, which can then be targeted to develop interventions to enhance communication, foster collaboration, and improve patient safety.

Variation in patient-sharing network characteristics of health care professionals treating different mental and substance use disorder patient sub-groups in primary care

BACKGROUND

Providing efficient and targeted services for patients with mental health problems requires efficient collaboration and coordination within healthcare providers, but measuring collaboration using traditional methods is challenging.

AIMS

To explore the patient-sharing networks of professionals taking care of different groups of patients with mental or substance use disorders.

METHOD

We used data that covered adult patients' visits to the primary care service providers of seven municipalities in Finland during year 2021. Data included 8,217 patients (147,430 visits) with mental or substance use disorders who were treated by 1,566 health care professionals. We calculated descriptive network metrics to examine the connectivity of professionals in three different patient groups (patients with substance use disorders, psychotic disorders, and depressive disorders) and compared these characteristics to a network based on all patients. We also analyzed whether patient sharing was associated with the health care professionals' attributes (occupational group, municipality) using Exponential Random Graph Models (ERGM).

RESULTS

Diagnosis-specific networks were denser and more connected compared to the all-patients network. Nurses were the most central occupation in all the diagnosis-specific networks and especially in the substance use disorder patients network. When examining all patients, two professionals were more likely to share patients when they belonged to the same occupational group. However, in the network with depressive disorder patients we found the opposite: professionals were more likely to share patients if they were of different occupational groups.

CONCLUSIONS

Patient-sharing networks within patients with a specific mental or substance use disorders are denser and more connected than networks based on all patients with mental or substance use disorders. In the substance use disorder patients network particularly, nurses were the most central occupation. Multi-professional connections were more likely in depressive disorder networks than in the all-patients network.

Network development in workplace health promotion - empirically based insights from a cross-company network promoting physical activity in Germany

BACKGROUND

In the field of health promotion, interorganisational networks are of growing relevance. However, systematic and target-oriented network management is of utmost importance for network development. The aim of this article is to report on the development of a cross-company network promoting physical activity, and to identify necessary activities and competencies for a systematic network management.

METHODS

The network was systematically planned and implemented in a German technology park comprising different companies. To assess and describe the development of the network, quantitative social network analysis was conducted. To answer the question on the activities and competencies for systematic network development semi-structured interviews with participating stakeholders, and a focus group discussion with health promotion experts were conducted. The interviews were analysed deductively and inductively with the structuring content analysis method and the focus group discussion was analysed deductively by summarising key aspects of the discussion.

RESULTS

Network metrics showed that the network became larger and denser during the planning phase, and stagnated during the implementation phase. As key facilitators for network development, participation of all stakeholders, a kick-off event, and the driving role of a network manager were identified. Necessary activities of the network manager were related to structural organisation, workplace health promotion offers, and cross-sectional tasks. The results suggested that not only professional and methodological competencies, but also social and self-competencies were required by the manager.

CONCLUSIONS

Our study provides initial guidance regarding the activities and required competencies of an interorganisational network manager. The results are of particular relevance for the context of workplace health promotion, since a network manager can be considered as a driving role for planning and implementing a cross-company network.

TRIAL REGISTRATION

The study is registered in the German Clinical Trials Register (DRKS00020956, 18/06/2020).

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

Considerations for conducting a scoping review in pharmacy education

Interrogating the literature is among the first steps a researcher undertakes when actuating a research project or also when any scholar might seek to know what has been done in an area, best practices for conducting a certain activity, or simply to seek answers for a question ranging from one's own personal curiosity to those that might affect departmental or institutional guidance. Decisions on the type of review process to undertake is one that is not taken lightly. This methods commentary outlines the reasons for conducting a scoping review versus a systematic review for topics related to pharmacy education. Considerations for conducting the scoping review are outlined including considerations for writing a protocol prior to conducting a scoping review, to potential platforms to use for transparency of sharing data, processes related to guidelines for data extraction and types of search strategies utilized.

Quality in care homes: How wearable devices and social network analysis might help

Social network analysis can support quality improvement in care homes but traditional approaches to social network analysis are not always feasible in care homes. Recalling contacts and movements in a home is difficult for residents and staff and documentary and other sources of individual contacts can be unreliable. Bluetooth enabled wearable devices are a potential means of generating reliable, trustworthy, social network data in care home communities. In this paper, we explore the empirical, theoretical and real-world potential and difficulties in using Bluetooth enabled wearables with residents and staff in care homes for quality improvement. We demonstrate, for the first time, that a relatively simple system built around the Internet of Things, Bluetooth enabled wearables for residents and staff and passive location devices (the CONTACT intervention) can capture social networks and data in homes, enabling social network analysis, measures, statistics and visualisations. Unexpected variations in social network measures and patterns are surfaced, alongside "uncomfortable" information concerning staff time spent with residents. We show how technology might also help identify those most in need of social contact in a home. The possibilities of technology-enabled social network analysis must be balanced against the implementation-related challenges associated with introducing innovations in complex social systems such as care homes. Behavioural challenges notwithstanding, we argue that armed with social network information, care home staff could better tailor, plan and evaluate the effects of quality improvement with the sub-communities that make up a care home community.

Social Network Analysis in Undergraduate and Postgraduate Medical Education: A Scoping Review

PURPOSE

Social network analysis (SNA) is a theoretical framework and analytical approach used to study relationships among individuals and groups. While SNA has been employed by many disciplines to understand social structures and dynamics of interpersonal relationships, little is known about its use in medical education. Mapping and synthesizing the scope of SNA in undergraduate and postgraduate medical education can inform educational practice and research.

METHOD

This scoping review was based on searches conducted in Medline, Embase, Scopus, and ERIC in December 2020 and updated in March 2022. After removal of duplicates, the search strategy yielded 5,284 records, of which 153 met initial inclusion criteria. Team members conducted full-text reviews, extracted relevant data, and conducted descriptive and thematic analyses to determine how SNA has been used as a theoretical and analytical approach in undergraduate and postgraduate medical education.

RESULTS

Thirty studies, from 11 countries, were retained. Most studies focused on undergraduate medical students, primarily in online environments, and explored students' friendships, information sharing, and advice seeking through SNA. Few studies included residents and attending staff. Findings suggested that SNA can be a helpful tool for monitoring students' interactions in online courses and clinical clerkships. SNA can also be used to examine the impact of social networks on achievement, the influence of social support and informal learning outside the classroom, and the role of homophily in learning. In clinical settings, SNA can help explore team dynamics and knowledge exchange among medical trainees.

CONCLUSIONS

While SNA has been underutilized in undergraduate and postgraduate medical education, findings indicate that SNA can help uncover the structure and impact of social networks in the classroom and the clinical setting. SNA can also be used to help design educational experiences, monitor learning, and evaluate pedagogical interventions. Future directions for SNA research in medical education are described.

The Daily Fact Pile: Exploring Mutual Microlearning in Neurology Resident Education

Problem: A significant proportion of learning during residency takes place through informal channels. Spontaneous collaboration among medical learners significantly contributes to this informal learning and is increasingly recognized as a component of the hidden curriculum in medical education. Yet historically, a disproportionate emphasis in medical education has been placed on didactic, structured, and faculty-initiated methods, leaving an important force in medical education understudied and underutilized. We hypothesize that there is significant educational potential in studying and deploying targeted tools to facilitate collaboration among medical learners. Intervention: At our institution, neurology residents implemented the "Daily Fact Pile" (DFP), a resident-led, email-based collaboration that served as a platform to share clinical pearls in an informal, digital way. Participation was voluntary and participants were encouraged to share facts that were new to them and thought to be clinically relevant. Motivated by the positive collective experience, we conducted a retrospective examination of this phenomenon. In this context, we developed the concept of "mutual microlearning" to characterize this efficient, multidirectional exchange of information. Context: Thirty-six residents in a single neurology residency program utilized the DFP at a large university hospital in the USA between 2018 and 2019. After 21 months of spontaneous and voluntary participation, we assessed the feasibility of the DFP, its impact on the education and morale of neurology residents, and compared its mutual microlearning approach to traditional lectures. This was done through a survey of the DFP participants with a response rate of 80.7%, and analysis of the statistics of participation and interaction with the DFP. Impact: Most participants felt that the DFP was beneficial to their education and thought they often or always learned something new from reading the DFP. The impact of the DFP extended beyond education by improving interest in neurology, morale, and sense of teamwork. The DFP was feasible during neurology residency and participation was high, though participants were more likely to read facts than share them. Lessons learned: Mutual microlearning represents an opportunity to augment residents' education, and well-designed mutual microlearning tools hold promise for complementing traditional teaching methods. We learned that efficiency, ease of use, and a supportive, non-judgmental environment are all essential to the success of such tools. Future research should delve deeper into the underlying mechanisms of mutual microlearning to establish its position within the theoretical frameworks of medical education.

Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review

BACKGROUND

Primary health care (PHC) improvement is often undermined by implementation gaps in low- and middle-income countries (LMICs). The influence that actor networks might have on the implementation has received little attention up to this point.

OBJECTIVE

This study sought to offer insights about actor networks and how they support PHC implementation in LMICs.

METHODS

We reviewed primary studies that utilised social network analysis (SNA) to determine actor networks and their influence on aspects of PHC in LMICs following the five-stage scoping review methodological framework by Arksey and O'Malley. Narrative synthesis was applied to describe the included studies and the results.

RESULTS

Thirteen primary studies were found eligible for this review. Ten network types were identified from the included papers across different contexts and actors: professional advice networks, peer networks, support/supervisory networks, friendship networks, referral networks, community health committee (CHC) networks, inter-sectoral collaboration networks, partnership networks, communications networks, and inter-organisational network. The networks were found to support PHC implementation at patient/household or community-level, health facility-level and multi-partner networks that work across levels. The study demonstrates that: (1) patient/household or community-level networks promote early health-seeking, continuity of care and inclusiveness by enabling network members (actors) the support that ensures access to PHC services, (2) health facility-level networks enable collaboration among PHC staff and also ensure the building of social capital that enhances accountability and access to community health services, and (3) multi-partner networks that work across levels promote implementation by facilitating information and resource sharing, high professional trust and effective communication among actors.

CONCLUSION

This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in PHC implementation. Social Network Analysis may be a useful approach to health policy analysis (HPA) on implementation.

Care networks of home-dwelling older adults in the Netherlands: proof of concept of a network typology

BACKGROUND

Studies on care networks of home-dwelling older adults often focus on network composition. However, looking at network mechanisms (negotiation, navigation and contagion) can be helpful to improve the support generated by the care network. A European study on diabetes patients identified network types based on interaction, which can be beneficial (generative, proxy) or detrimental (struggling, avoidant) to support. This study explored whether these network types are present in care networks of home-dwelling older adults in the Netherlands, and how these types manifest in composition or mechanisms.

METHODS

The present study is a cross-sectional qualitative study of care networks supporting 19 home-dwelling older adults. Face-to-face interviews were conducted with the older adult and their informal and formal caregivers between March and September 2016. Network composition and mechanisms were abstracted from content analysis of interview transcripts, then network type was determined for each network.

RESULTS

Three of the 19 networks had only one respondent and were excluded, yielding 16 for analysis: eight proxy networks, three generative networks, two avoidant networks, one struggling network, and two possibly hybrid networks. In the proxy networks, all negotiation and navigation were centralised by the proxy. In generative networks, negotiation was possible if the older adult could reciprocate, and the network supported this. In avoidant networks, informal and formal caregivers had to deal with an older adult who refused support. In the struggling network, the underlying problem could not be addressed. Furthermore, two networks could either be hybrid network types or networks in a transition process from generative to proxy network.

CONCLUSION

Our results suggest that the network typology developed in the context of diabetes patients is relevant and mostly replicable in networks of multi-morbid older adults. We found that a care network typology based on mechanisms offered additional information beyond network composition. It also appears that the network type can change over time, but more research is needed to confirm this. This study suggests that interventions in avoidant or struggling networks are difficult. Also, actions of network participants seemed aimed at developing proxy networks. Interventions designed to develop or maintain generative networks seem underused.

Describing the state of a research network: A mixed methods approach to network evaluation

Diabetes Action Canada Strategy for Patient-Oriented Research (SPOR) Network in Chronic Disease was formed in 2016 and is funded primarily through the Canadian Institutes of Health Research (CIHR). We propose a novel mixed-methods approach to a network evaluation integrating the State of Network Evaluation framework and the Canadian Academy of Health Sciences (CAHS) preferred framework and indicators. We measure key network themes of connectivity, health and results, and impact and return on investment associated with health research networks. Our methods consist of a longitudinal cross-sectional network survey of members and social network analysis to examine Network Connectivity and assess the frequency of interactions, the topics discussed during them, and how networking effectively facilitates interactions and collaboration among members. Network Health will be evaluated through semistructured interviews, a membership survey inquiring about satisfaction and experience with the Network, and a review of documentary sources related to funding and infrastructure to evaluate Network Sustainability. Finally, we will examine Network Results and Impact using the CAHS preferred framework and indicators to measure returns on investment in health research across the five domains of the CAHS framework, which include: advancing knowledge, capacity building, informing decision making, health impact, and economic and social impact. Indicators will be assessed with various methods, including bibliometric analyses, review of relevant documentary sources (annual reports), member activities informing health and research policy, and Patient Partner involvement. The Network Evaluation will provide members and stakeholders with information for planning, improvements, and funding future Network endeavors.

Network approaches and interventions in healthcare settings: A systematic scoping review

INTRODUCTION

The growing interest in networks of interactions is sustained by the conviction that they can be leveraged to improve the quality and efficiency of healthcare delivery systems. Evidence in support of this conviction, however, is mostly based on descriptive studies. Systematic evaluation of the outcomes of network interventions in healthcare settings is still wanting. Despite the proliferation of studies based on Social Network Analysis (SNA) tools and techniques, we still know little about how intervention programs aimed at altering existing patterns of social interaction among healthcare providers affect the quality of service delivery. We update and extend prior reviews by providing a comprehensive assessment of available evidence.

METHODS AND FINDINGS

We searched eight databases to identify papers using SNA in healthcare settings published between 1st January 2010 and 1st May 2022. We followed Chambers et al.'s (2012) approach, using a Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We distinguished between studies relying on SNA as part of an intervention program, and studies using SNA for descriptive purposes only. We further distinguished studies recommending a possible SNA-based intervention. We restricted our focus on SNA performed on networks among healthcare professionals (e.g., doctors, nurses, etc.) in any healthcare setting (e.g., hospitals, primary care, etc.). Our final review included 102 papers. The majority of the papers used SNA for descriptive purposes only. Only four studies adopted SNA as an intervention tool, and measured outcome variables.

CONCLUSIONS

We found little evidence for SNA-based intervention programs in healthcare settings. We discuss the reasons and challenges, and identify the main component elements of a network intervention plan. Future research should seek to evaluate the long-term role of SNA in changing practices, policies and behaviors, and provide evidence of how these changes affect patients and the quality of service delivery.

Social network analysis of nationwide interhospital emergency department transfers in Taiwan

Transferring patients between emergency departments (EDs) is a complex but important issue in emergency care regionalization. Social network analysis (SNA) is well-suited to characterize the ED transfer pattern. We aimed to unravel the underlying transfer network structure and to identify key network metrics for monitoring network functions. This was a retrospective cohort study using the National Electronic Referral System (NERS) database in Taiwan. All interhospital ED transfers from 2014 to 2016 were included and transfer characteristics were retrieved. Descriptive statistics and social network analysis were used to analyze the data. There were a total of 218,760 ED transfers during the 3-year study period. In the network analysis, there were a total of 199 EDs with 9516 transfer ties between EDs. The network demonstrated a multiple hub-and-spoke, regionalized pattern, with low global density (0.24), moderate centralization (0.57), and moderately high clustering of EDs (0.63). At the ED level, most transfers were one-way, with low reciprocity (0.21). Sending hospitals had a median of 5 transfer-out partners [interquartile range (IQR) 3-7), while receiving hospitals a median of 2 (IQR 1-6) transfer-in partners. A total of 16 receiving hospitals, all of which were designated base or co-base hospitals, had 15 or more transfer-in partners. Social network analysis of transfer patterns between hospitals confirmed that the network structure largely aligned with the planned regionalized transfer network in Taiwan. Understanding the network metrics helps track the structure and process aspects of regionalized care.

Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction

BACKGROUND

Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challenging to represent the function and dysfunction of such systems in a scientific manner. We describe a Network Science approach to that dilemma. General hospitals with large emergency caseloads are the resource intensive components of health systems. We propose that the care-delivery services in such entities are modular, and that their structure and function can be usefully analysed by contemporary Network Science. We explore that possibility in a study of Australian hospitals during 2019 and 2020.

METHODS

We accessed monthly snapshots of whole of hospital administrative patient level data in two general hospitals during 2019 and 2020. We represented the organisations inpatient services as network graphs and explored their graph structural characteristics using the Louvain algorithm and other methods. We related graph topological features to aspects of observable function and dysfunction in the delivery of care.

RESULTS

We constructed a series of whole of institution bipartite hospital graphs with clinical unit and labelled wards as nodes, and patients treated by units in particular wards as edges. Examples of the graphs are provided. Algorithmic identification of community structures confirmed the modular structure of the graphs. Their functional implications were readily identified by domain experts. Topological graph features could be related to functional and dysfunctional issues such as COVID-19 related service changes and levels of hospital congestion.

DISCUSSION AND CONCLUSIONS

Contemporary Network Science is one of the fastest growing areas of current scientific and technical advance. Network Science confirms the modular nature of healthcare service structures. It holds considerable promise for understanding function and dysfunction in healthcare systems, and for reconceptualising issues such as hospital capacity in new and interesting ways.

A social media network analysis of trypophobia communication

Trypophobia has attracted scientific attention in recent years. Few related studies have recruited participants using online methods, and even less is known about health communication in an environment where trypophobia was first widely discussed (i.e., the Internet). This study describes communication patterns in a Facebook group for trypophobia by detecting frequent topics, top contributors, and their discourses. We identified key commenters and performed word frequency analysis, word co-occurrence analysis, topic modeling, and content analysis. Impactful users posted and replied more often when discussing peer-reviewed science. Triggering content was actively removed by the group administrators. A wide variety of triggers not discussed in trypophobia-related literature were frequently mentioned. However, there was a lack of discussion on peer-reviewed treatments. The combination of a few expert and many supportive amateur gatekeepers willing to understand trypophobia, along with active monitoring by administrators, might contribute to in-group trust and the sharing of peer-reviewed science by top users of the trypophobia Facebook group.

Social Network Analysis as a Tool to Inform a Children's Hospital's Efforts to Improve Population Health

OBJECTIVES

A children's hospital explored the feasibility and utility of social network analysis as a tool for system building in community child health, to identify gaps and opportunities in community partnerships, and to assess its role as a contributor to collective impact.

METHODS

We employed social network analysis with the PARTNER survey to assess relationships among community-based organizations and a children's hospital's community-oriented programs. We utilized a two-stage, snowball sampling strategy to identify community partners. We analyzed social capital, network density, degree centralization, perceived trust, and perceived value. Network mapping depicted the hospital programs' relationships with community partners.

RESULTS

Of the 153 contacted potential respondents, 76 responded for a response rate of 50%. Respondents reported a total of 1116 ties, ranging in strength from awareness and cooperation to coordination and integration. Approximately 60% of network members could reach 100 or more members in 2 steps or less. The overall network trust score was 74%. Network mapping indicated that hospital programs enhance bonding relationships within sectors, bridge gaps between partners from different sectors, and provide linkages to resources such as funders. Deficits in bonding, bridging, and access to funding are evident when the hospital's programs are omitted from network maps.

CONCLUSIONS

Findings support the feasibility and utility of social network analysis as a tool for system building in community child health. The study demonstrates the potential of a children's hospital's programs to provide social capital in the form of bonding, bridging, and linking relationships.

Local Dynamics of Collaboration for Maternal, Newborn and Child Health: A Social Network Analysis of Healthcare Providers and Their Managers in Gert Sibande District, South Africa

BACKGROUND

Accountability for maternal, newborn and child health (MNCH) is a collaborative endeavour and documenting collaboration dynamics may be key to understanding variations in the performance of MNCH services. This study explored the dynamics of collaboration among frontline health professionals participating in two MNCH coordination structures in a rural South African district. It examined the role and position of actors, the nature of their relationships, and the overall structure of the collaborative network in two sub-districts.

METHODS

Cross-sectional survey using a social network analysis (SNA) methodology of 42 district and sub district actors involved in MNCH coordination structures. Different domains of collaboration (eg, communication, professional support, innovation) were surveyed at key interfaces (district-sub-district, across service delivery levels, and within teams).

RESULTS

The overall network structure reflected a predominantly hierarchical mode of clustering of organisational relationships around hospitals and their referring primary healthcare (PHC) facilities. Clusters were linked through (and dependent on) a combination of district MNCH programme and line managers, identified as central connectors or boundary spanners. Overall network density remained low suggesting potential for strengthening collaborative relationships. Within cluster collaborative patterns (inter-professional and across levels) varied, highlighting the significance of small units in district functioning.

CONCLUSION

SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics which could point to system strengths and weaknesses. It offers insights on the level of fragmentation within and across small units, and the need to strengthen cohesion and improve collaborative relationships, and ultimately, the delivery of health services.

Analyzing annual changes in network structures of a social media application-based information-sharing system in a Japanese community

Background

Understanding the evolution of social network services (SNSs) can provide insights into the functions of interprofessional information-sharing systems. Using social network analysis, we aimed to analyze annual changes in the network structure of SNS-based information sharing among healthcare professionals over a 3-year period in Japan.

Methods

We analyzed data on SNS-based information sharing networks with online message boards for healthcare professionals for 2018, 2019, and 2020 in a Japanese community.

These networks were created for each patient so that healthcare professionals could post and view messages on the web platform. In the social network analysis (SNA), healthcare professionals registered with a patient group were represented as nodes, and message posting and viewing relationships were represented as links. We investigated the structural characteristics of the networks using several measures for SNA, including reciprocity, assortativity and betweenness centrality, which reflect interrelational links, the prevalence of similar nodes with neighbors, and the mediating roles of other nodes, respectively. Next, to compare year-to-year trends in networks of patients overall, and between receiving nursing care levels 1–3 (lighter care requirement) and levels 4–5 (heavier care requirement), we described the annual structural differences and analyzed each measure for SNA using the Steel–Dwass test.

Results

Among 844, 940, and 1063 groups in each year, groups for analysis in care levels 1–3/4–5 were identified as 106/135, 79/89, and 57/57, respectively. The overall annual assessment showed a trend toward increased diameter and decreased density, but the differences were not significant. For those requiring care levels 1–3, assortativity decreased significantly, while for those requiring care levels 4–5, reciprocity decreased and betweenness centrality increased significantly. No significant differences were found in the other items.

Discussion

This study revealed that the network of patients with a lighter care requirement had more connections consisting of nodes with different links, whereas the network of patients with a heavier care requirement had more fixed intermediary roles and weaker interrelationships among healthcare professionals. Clarifying interprofessional collaborative mechanisms underlying development patterns among healthcare professionals can contribute to future clinical quality improvement.

Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: a mixed-method study

Background

Interdisciplinary collaborations (i.e., where various disciplines work coordinated and interdependently toward shared goals) are stated to yield higher team effectiveness than multidisciplinary approaches (i.e., where various disciplines work in parallel within their professional boundaries) in somatic health care settings. Nevertheless, research is lacking on interdisciplinary approaches for alcohol use disorder (AUD) treatment of hospitalized patients as these types of approaches are still uncommon. This study aims to evaluate an innovative interdisciplinary AUD treatment initiative at a general hospital department by 1) identifying which and to what extent network partners are involved and 2) to explore how network partners experienced the interdisciplinary collaboration.

Methods

A mixed-method study was conducted, using 1) measures of contact frequency and closeness in a social network analysis and 2) semi-structured interviews, which were analyzed thematically. Respondents were network partners of an interdisciplinary collaboration in a general hospital department, initially recruited by the collaborations’ project leader.

Results

The social network analysis identified 16 network partners, including a ‘core’ network with five central network partners from both inside and outside the hospital. The project leader played an important central role in the network and the resident gastroenterologist seemed to have a vulnerable connection within the network. Closeness between network partners was experienced regardless of frequency of contact, although this was especially true for the ‘core’ group that (almost) always consisted of the same network partners that were present at biweekly meetings. Interview data showed that presence of the ‘core’ network partners was reported crucial for an efficient collaboration. Respondents desired knowledge about the collaborations’ effectiveness, and one structured protocol with working procedures, division of responsibilities and agreements on information sharing and feedback.

Conclusions

The design of this interdisciplinary collaboration has potential in improving the treatment of hospital patients with AUD and was evaluated positively by the involved network partners. Interdisciplinary collaborations may offer a critical solution to increase treatment rates of patients with AUD and should be adopted in hospitals on a larger scale. Research towards the effectiveness of interdisciplinary collaborations in the treatment of hospitalized patients with AUD is needed.

Network Analysis for a Community-Based School- and Family-Based Obesity Prevention Program

Rising childhood obesity with its detrimental health consequences poses a challenge to the health care system. Community-based, multi-setting interventions with the participatory involvement of relevant stakeholders are emerging as promising. To gain insights into the structural and processual characteristics of stakeholder networks, conducting a network analysis (NA) is advisable. Within the program “Family+—Healthy Living Together in Families and Schools”, a network analysis was conducted in two rural model regions and one urban model region. Relevant stakeholders were identified in 2020–2021 through expert interviews and interviewed by telephone to elicit key variables such as frequency of contact and intensity of collaboration. Throughout the NA, characteristics such as density, centrality, and connectedness were analyzed and are presented graphically. Due to the differences in the number of inhabitants and the rural or urban structure of the model regions, the three networks (network#1, network#2, and network#3) included 20, 14, and 12 stakeholders, respectively. All networks had similar densities (network#1, 48%; network#2, 52%; network#3, 42%), whereas the degree centrality of network#1 (0.57) and network#3 (0.58) was one-third higher compared with network#2 (0.39). All three networks differed in the distribution of stakeholders in terms of field of expertise and structural orientation. On average, stakeholders exchanged information quarterly and were connected on an informal level. Based on the results of the NA, it appears to be useful to initialize a community health facilitator to involve relevant stakeholders from the education, sports, and health systems in projects and to strive for the goal of sustainable health promotion, regardless of the rural or urban structure of the region. Participatory involvement of relevant stakeholders can have a positive influence on the effective dissemination of information and networking with other stakeholders.

Inter-individual relationships within a Canadian SPOR research network: a social network study

Background

Efforts have been made by health research granting agencies to bring research closer to patients’ concerns. In Canada, such efforts were formalized in 2011 with the funding of the Strategy for Patient-Oriented Research (SPOR)’s research networks to address research priorities identified by patients and accelerate the translation of research findings into patient care and health care policy. Among these networks, SPOR Diabetes Action Canada (DAC) has created patient-partner circles to facilitate their integration within the network. The nature of the relationships within this atypical patient-oriented research network is systematically explored in this paper.

Methods

A cross-sectional social network study was conducted among the SPOR DAC’s network members to examine inter-individual interactions, and the topics discussed the most between members. Descriptive data analyses were conducted to explore which discussion topics were discussed most among members whose primary roles were research, administration, governance, and patient representation.

Results

The response rate was 51.9%, providing data on 76.5% of the maximum number of connections in the network. The survey captured 2763 inter-individual relationships. Responses to a sub-question inserted in the survey show that 482 of these relationships (17,4%) existed before joining the network in collaboration on a research project. Most ties captured in the survey were yearly or quarterly, while few relationships were monthly, weekly, or daily. In measured relationships, members discussed several topics, the most frequent being scientific research, patient engagement, network coordination and governance, and operations and management. The topics associated with the most significant proportion of relationships captured in the survey were scientific research (45.4%) and patient engagement (40.7%). Management & operations and governance & coordination follow, corresponding to 24.3 and 23.9% of the captured relationships. All discussion topic subnetworks were either somewhat or highly centralized, meaning that relationships were not equally distributed among members involved in these discussions. Of the 1256 relationships involving exchanges about scientific research, 647 (51.5%) involved a researcher, 419 (33.3%) an administrator, 182 (14.5%) a patient partner, and 82 (6.5%) a member whose primary role is network governance.

Conclusions

Scientific research and patient engagement were the most common topics discussed, consistent with the patient-centered research at the heart of the SPOR Diabetes Action Canada network. The study identified several relationships where a patient partner has discussed scientific research with a researcher. However, relationships involving research discussions were three times more common between a researcher and an administrator than between a researcher and a patient partner, although twice as many patient partners as administrators participated in the survey. The institutionalization of patient-partner involvement in large research networks is an evolving practice for which optimal engagement methods are still being explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08343-1.

A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations

BACKGROUND

Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited.

PURPOSE

We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers' job satisfaction.

METHODOLOGY

We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual's job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual's network). We examined this relationship for both instrumental and expressive ties.

RESULTS

Individuals who were more central in the expressive network were less satisfied in their job, b = -0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05.

CONCLUSION

Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers' risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers' access to full information, supporting competence and confidence.

PRACTICE IMPLICATIONS

Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers' sense of well-being.

Geographic accessibility to cancer treatment in Brazil: A network analysis

Background

Geographic accessibility to healthcare services is a fundamental component in achieving universal health coverage, the central commitment of the Brazilian Unified Health System (SUS). For cancer patients, poor accessibility has been associated with inadequate treatment, worse prognosis, and poorer quality of life.

Methods

We explored nationwide healthcare data from the SUS health information systems, and mapped the geographic accessibility to cancer treatment in two time-frames: 2009-2010 and 2017-2018. We applied social network analysis (SNA) to estimate the commuting route, flow, and distances travelled by cancer patients to undergo surgical, radiotherapy, and chemotherapy treatment.

Findings

A total of 12,751,728 treatment procedures were analyzed. Overall, more than half of the patients (49·2 to 60·7%) needed to travel beyond their municipality of residence for treatment, a fact that did not change over time. Marked regional differences were observed, as patients living in the northern and midwestern regions of the country had to travel longer distances (weighted average of 296 to 870 km). Cancer care hubs and attraction poles were mostly identified in the southeast and northeast regions, with Barretos being the main hub for all types of treatment throughout time.

Interpretation

Important regional disparities in the accessibility to cancer treatment in Brazil were revealed, suggesting the need to review the distribution of specialized care in the country. The data presented here contribute to ongoing research on improving access to cancer care and can provide reference to other countries, offering relevant data for oncological and healthcare service evaluation, monitoring, and strategic planning.

Funding

This work was funded by the Oswaldo Cruz Foundation - Fiocruz (Inova - no. 8451635123 to BPF) and the National Council for Scientific and Technological Development - CNPq (no. 407060/2018-9 to BPF); Coordination for the Improvement of Higher Education Personnel - CAPES (scholarship to PCA, Finance Code 001); and Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças de Populações Negligenciadas (INCT-IDPN).

Resumo

A acessibilidade geográfica aos serviços de saúde é um componente fundamental para o alcance da cobertura universal de saúde, compromisso central do Sistema Único de Saúde (SUS). Para pacientes com câncer, a baixa acessibilidade aos serviços especializados tem sido associada ao tratamento inadequado, piora no prognóstico e na qualidade de vida.Neste estudo, dados de saúde dos sistemas de informação em saúde do SUS foram utilizados para mapear a acessibilidade geográfica ao tratamento do câncer em dois períodos: 2009-2010 e 2017-2018. Aplicamos a análise de redes sociais (ARS) para estimar os fluxos de deslocamento e as distâncias percorridas por pacientes com câncer para receberem tratamento cirúrgico, radioterápico e quimioterápico.Um total de 12.751.728 procedimentos de tratamento foram analisados. Em geral, mais da metade dos pacientes (49,2 a 60,7%) precisaram se deslocar de seus municípios de residência para receber tratamento, fato que não mudou comparando os dois períodos de tempo analisados. Foram observadas importantes diferenças regionais no acesso. Pacientes residentes das regiões norte e centro-oeste do país tiveram que percorrer maiores distâncias para alcançar os serviços (média ponderada = 296 a 870 km). A maioria dos hubs e polos de atração para atendimento oncológico foram identificados nas regiões Sudeste e Nordeste, sendo o município de Barretos o principal hub para todos os tipos de tratamento ao longo do tempo.As disparidades de acessibilidade para o tratamento de câncer, alertam para a necessidade de revisar a distribuição dos serviços de atenção especializada no país. A metodologia e os resultados apresentados neste estudo contribuem para as pesquisas sobre a melhoria do acesso ao tratamento do câncer e podem servir como referência para outros países, oferecendo dados relevantes para avaliação, monitoramento e planejamento estratégico de serviços oncológicos e de saúde em geral.

The use of social network analysis in social support and care: a systematic scoping review protocol

BACKGROUND

In recent decades, the literature on Social Network Analysis and health has experienced a significant increase. Disease transmission, health behavior, organizational networks, social capital, and social support are among the different health areas where Social Network Analysis has been applied. The current epidemiological trend is characterized by a progressive increase in the population's ageing and the incidence of long-term conditions. Thus, it seems relevant to highlight the importance of social support and care systems to guarantee the coverage of health and social needs within the context of acute illness, chronic disease, and disability for patients and their carers. Thus, the main aim is to identify, categorize, summarize, synthesize, and map existing knowledge, literature, and evidence about the use of Social Network Analysis to study social support and care in the context of illness and disability.

METHODS

This scoping review will be conducted following Arksey and O'Malley's framework with adaptations from Levac et al. and Joanna Briggs Institute's methodological guidance for conducting scoping reviews. We will search the following databases (from January 2000 onwards): PubMed, MEDLINE, Web of Science Core Collection, SCOPUS, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, PROSPERO, and DARE. Complementary searches will be conducted in selected relevant journals. Only articles related to social support or care in patients or caregivers in the context of acute illnesses, disabilities or long-term conditions will be considered eligible for inclusion. Two reviewers will screen all the citations, full-text articles, and abstract the data independently. A narrative synthesis will be provided with information presented in the main text and tables.

DISCUSSION

The knowledge about the scientific evidence available in the literature, the methodological characteristics of the studies identified based on Social Network Analysis, and its main contributions will highlight the importance of health-related research's social and relational dimensions. These results will shed light on the importance of the structure and composition of social networks to provide social support and care and their impact on other health outcomes. It is anticipated that results may guide future research on network-based interventions that might be considered drivers to provide further knowledge in social support and care from a relational approach at the individual and community levels.

TRIAL REGISTRATION

Open Science Framework https://osf.io/dqkb5 .

Analysis of Information About Medicines Available on Facebook

There are many anxieties have been shown and perceived by the experts for SMP of medicines. This procedure of DTCA can be reciprocated, and one of the reason is the platform is uncontrolled; the advantages of the medicines could be exaggerated compared to the disadvantages. Also, patients can share their own experience of using medicine on social networking sites. There is a high probability for the patients to be exposed to ambiguous, contradicting, and confusing information about medicines on social media. Our focal point is to inspect how drug pages in social media influencing the overall population or web-based media clients. We tried to investigate the data available on Facebook pages of popular drugs. Many social media users often go through the content posted on social networking sites. Patients and their family members are likely to be exposed to drug product claims while looking for information about medicines of a specific disease on social media.

Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal

There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.

What Types of Networks Do Professionals Build, and How Are They Affected by the Results of Network Evaluation?

Background: We aimed to explore what kind of social networks characterizable as "consult/be consulted" are built among healthcare professionals in a community and the impact of providing the professionals with these findings. Methods: We adopted mixed methods exploratory study using social network analysis (SNA) and content analysis. SNA can visualize social network structures such as relationships between individuals. The healthcare professionals were asked about the key persons they consulted and were consulted by concerning these healthcare issues: (1) daily work; (2) a person with acute back pain; (3) a garbage-filled house reported by a neighbor; (4) a person with dementia; and (5) a study meeting. We identified the key roles depending on the issues using SNA. After analysis, the analytical findings were shared with the participants. To explore their cognitive responses, an open-ended questionnaire was delivered and a content analysis was implemented. Results: Of 54 healthcare professional participants, the data of 52 were available for analysis. The findings (in the respective order of the five topics above) were as follows: the number of nodes was 165, 95, 85, 82, and 68; clustering coefficient was 0.19, 0.03, 0.02, 0.11, and 0.23; assortativity was -0.043, -0.11, -0.23, -0.17, and -0.23; reciprocity was 0.35, 0.31, 0.39, 0.29, and 0.48. The top three centralities included nurses. Eighty-seven free comments were received, of which 39 were categorized as descriptive, 10 as analytical, and 38 as critical. Discussion: The structure of "consult/be consulted" networks differed by topic. SNA is available to detect the healthcare resources network and it may have helped them to reflect on their own networks.

Review of social networks of professionals in healthcare settings-where are we and what else is needed?

Background

Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries.

Methods

We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively.

Results

Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable.

Conclusions

Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks.

PROSPERO registration number

The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00772-7.

The influence of social network on COVID-19 vaccine hesitancy among healthcare workers: a cross-sectional survey in Chongqing, China

The factors that lead to coronavirus disease 2019 (COVID-19) vaccine hesitancy among health-care workers (HCWs) are unclear. We aimed to identify the factors that influence HCWs' hesitancy, especially the influence of their social network. Using an online platform, we surveyed HCWs in Chongqing, China, in January 2021 to understand the factors that influence the COVID-19 vaccine hesitancy among HCWs. Proportional allocation stratified sampling method was used to recruit respondents. Multivariable logistic regression and social network analysis (SNA) were used to analyze the influence factors. A total of 5247 HCWs were included and 23.3% of them were vaccine-hesitant. Participants were more hesitant if they had chronic diseases (OR = 1.411, 95% CI: 1.146-1.738), worked in tertiary hospitals (OR = 1.546, 95% CI: 1.231-1.942), and reported a history of vaccine hesitancy (OR = 1.637, 95% CI: 1.395-1.920) and refusal toward other vaccines (OR = 2.433, 95% CI: 2.067-2.863). The participants with a social network to communicate COVID-19 immunization were less hesitant (OR = 0.850, 95% CI: 0.728-0.993). Several influential members with social networks were found in SNA. Most of these influential members in the networks were department leaders who were willing to get COVID-19 vaccines (P < .05). Hesitant subgroups among Chinese HCWs were linked to the lack of a social network to communicate COVID-19 immunization. Our findings may lead to tailored interventions to enhance COVID-19 vaccine uptake among HCWs by targeting key members in social network.

A systems approach to the exploration of research activity and relationships within a local authority

Background

Organizations with responsibilities for public health are increasingly required to use evidence-based practice to inform programme delivery, requiring research to generate relevant evidence, and dissemination and use of evidence to inform decisions and practices. Understanding how relationships between organizational structures, systems and processes influence evidence-based practices is critical to improving practice at both an institutional and system level, yet how these relationships should best operate is not well understood. Understanding how to better support research within local authorities, the elected administrative bodies responsible for services including public health at a regional level in the United Kingdom, is a priority for the National Institute for Health Research (NIHR) Public Health Research. This study is based on Norfolk County Council, a local authority in the east of England. We aimed to apply a systems perspective to develop a better understanding of the structures, systems and processes that support a local authority in becoming research-active, identifying gaps in understanding and recommendations for action to address them.

Methods

Taking a participatory action research approach, we applied qualitative methods to explore research activity and relationships in Norfolk County Council. We surveyed employees and used network analysis to map individuals, departments and external partners involved in research activities and the connections between them. We then applied participatory approaches to conduct a series of focus groups and semi-structured interviews to explore stakeholders’ experiences and perceptions of being involved in research at, or with, the authority, and their ideas for recommendations for future actions.

Results

A range of research activity is undertaken at the local authority, with an emphasis on applied work to improve service delivery. We identified several examples of effective practice and models of research collaboration in some departments. Challenges such as limitations in resources, capacity and knowledge exchange were evident, yet there was a readiness amongst key stakeholders to develop and implement actions that may better support the authority in becoming more research-active.

Conclusion

In large complex organizations, a key challenge is how to share learning across teams and implement good practice at an organizational and system level. Our findings highlight the potential for developing improved collaborative partnership models and systems to support sustainable processes and practices for research and knowledge exchange at an institutional and interorganizational level. The insights gained and shared will support other local authorities and similar large, multilevel organizations with responsibilities for evidence-based public health to explore their own setting and implement change where needed, and provide stimulus for further research into system-level change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00792-0.

Making sense of the French public hospital system: a network-based approach to hospital clustering using unsupervised learning methods

BACKGROUND

Hospitals in the public and private sectors tend to join larger organizations to form hospital groups. This increasingly frequent mode of functioning raises the question of how countries should organize their health system, according to the interactions already present between their hospitals. The objective of this study was to identify distinctive profiles of French hospitals according to their characteristics and their role in the French hospital network.

METHODS

Data were extracted from the national hospital database for year 2016. The database was restricted to public hospitals that practiced medicine, surgery or obstetrics. Hospitals profiles were determined using the k-means method. The variables entered in the clustering algorithm were: the number of stays, the effective diversity of hospital activity, and a network-based mobility indicator (proportion of stays followed by another stay in a different hospital of the same Regional Hospital Group within 90 days).

RESULTS

Three hospital groups were identified by the clustering algorithm. The first group was constituted of 34 large hospitals (median 82,100 annual stays, interquartile range 69,004 - 117,774) with a very diverse activity. The second group contained medium-sized hospitals (with a median of 258 beds, interquartile range 164 - 377). The third group featured less diversity regarding the type of stay (with a mean of 8 effective activity domains, standard deviation 2.73), a smaller size and a higher proportion of patients that subsequently visited other hospitals (11%). The most frequent type of patient mobility occurred from the hospitals in group 2 to the hospitals in group 1 (29%). The reverse direction was less frequent (19%).

CONCLUSIONS

The French hospital network is organized around three categories of public hospitals, with an unbalanced and disassortative patient flow. This type of organization has implications for hospital planning and infectious diseases control.

Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review

OBJECTIVES

Medical students' experiences of harassment and its influence on quality of life were examined.

DESIGN

A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified.

RESULTS

The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life.

CONCLUSIONS

Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review

OBJECTIVES

Medical students' experiences of harassment and its influence on quality of life were examined.

DESIGN

A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified.

RESULTS

The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life.

CONCLUSIONS

Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Interorganizational Networks in Physical Activity Promotion: A Systematic Review

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.

Supporting Cross-Company Networks in Workplace Health Promotion through Social Network Analysis-Description of the Methodological Approach and First Results from a Model Project on Physical Activity Promotion in Germany

Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.

Exploring the value of social network 'care maps' in the provision of long-term conditions care

OBJECTIVES

There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of 'care maps' - a patient-identified social network map of their care community - for health professionals in providing person-centred care.

METHODS

We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes.

RESULTS

Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients' support networks, synthesising what is known and unknown. Health professionals understood patients' perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice.

DISCUSSION

Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had 'social function' for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients' lifeworlds.

Patterns of integrating palliative care into standard oncology in an early ESMO designated center: a 10-year experience

BACKGROUND

Integration of specialist palliative care (PC) into standard oncology care is recommended. This study investigated how integration at the Cantonal Hospital St. Gallen (KSSG) was manifested 10 years after initial accreditation as a European Society for Medical Oncology (ESMO) Designated Center (ESMO-DC) of Integrated Oncology and Palliative Care.

METHODS

A chart review covering the years 2006-2009 and 2016 was carried out in patients with an incurable malignancy receiving PC. Visual graphic analysis was utilized to identify patterns of integration of PC into oncology based on the number and nature of medical consultations recorded for both specialties. A follow-up cohort collected 10 years later was analyzed and changes in patterns of integrating specialist PC into oncology were compared.

RESULTS

Three hundred and forty-five patients from 2006 to 2009 and 64 patients from 2016 were included into analyses. Four distinct patterns were identified using visual graphic analysis. The 'specialist PC-led pattern' (44.9%) and the 'oncology-led pattern' (20.3%) represent disciplines that took primary responsibility for managing patients, with occasional and limited involvement from other disciplines. Patients in the 'concurrent integrated care pattern' (18.3%) had medical consultations that frequently bounced between specialist PC and oncology. In the 'segmented integrated care pattern' (16.5%), patients had sequences of continuous consultations provided by one discipline before alternating to a stretch of consultations provided by the other specialty. In the 2016 follow-up, while the 'oncology-led pattern' occurred significantly less frequently relative to the 'specialist PC-led pattern' and the 'segmented integrated care pattern', the 'concurrent integrated care pattern' emerged more frequently when compared with the 2006-2009 follow-up.

CONCLUSION

The 'specialist PC-led pattern' was the most prominent pattern in this data. The 2016 follow-up showed that a growing number of patients received a collaborative pattern of care, indicating that integration of specialist PC into standard oncology can manifest as either segmented or concurrent care pathways. Our data suggest a closer, more dynamic and flexible collaboration between oncology and specialist PC early in the disease course of patients with advanced cancer and concurrent with active treatment.

Social Network Analysis of the Effects of a Social Media-Based Weight Loss Intervention Targeting Adults of Low Socioeconomic Status: Single-Arm Intervention Trial

Background

Obesity is a known risk factor for cardiovascular disease risk factors, including hypertension and type II diabetes. Although numerous weight loss interventions have demonstrated efficacy, there is considerably less evidence about the theoretical mechanisms through which they work. Delivering lifestyle behavior change interventions via social media provides unique opportunities for understanding mechanisms of intervention effects. Server data collected directly from web-based platforms can provide detailed, real-time behavioral information over the course of intervention programs that can be used to understand how interventions work.

Objective

The objective of this study was to demonstrate how social network analysis can facilitate our understanding of the mechanisms underlying a social media–based weight loss intervention.

Methods

We performed secondary analysis by using data from a pilot study that delivered a dietary and physical activity intervention to a group of participants via Facebook. We mapped out participants’ interaction networks over the 12-week intervention period and linked participants’ network characteristics (eg, in-degree, out-degree, network constraint) to participants’ changes in theoretical mediators (ie, dietary knowledge, perceived social support, self-efficacy) and weight loss by using regression analysis. We also performed mediation analyses to explore how the effects of social network measures on weight loss could be mediated by the aforementioned theoretical mediators.

Results

In this analysis, 47 participants from 2 waves completed the study and were included. We found that increases in the number of posts, comments, and reactions significantly predicted weight loss (β=–.94, P=.04); receiving comments positively predicted changes in self-efficacy (β=7.81, P=.009), and the degree to which one’s network neighbors are tightly connected with each other weakly predicted changes in perceived social support (β=7.70, P=.08). In addition, change in self-efficacy mediated the relationship between receiving comments and weight loss (β=–.89, P=.02).

Conclusions

Our analyses using data from this pilot study linked participants’ network characteristics with changes in several important study outcomes of interest such as self-efficacy, social support, and weight. Our results point to the potential of using social network analysis to understand the social processes and mechanisms through which web-based behavioral interventions affect participants’ psychological and behavioral outcomes. Future studies are warranted to validate our results and to further explore the relationship between network dynamics and study outcomes in similar and larger trials.

A network analysis of patient referrals in two district health systems in Tanzania

Patient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households.

Identifying ICU admission decision patterns in a '20-questions game' approach using network analysis

Background

The complex intensive care unit (ICU) admission decision process has numerous non-linear relationships involving multiple factors. To better describe and analyse this process, exploration of novel techniques to clearly delineate the importance and interrelationships of factors is warranted. Network analysis (NA), based on graph theory, attempts to identify patterns of connections within a network and may be useful in this regard.

Objectives

To identify patterns of ICU decision-making pertaining to patients referred for admission to ICU and to identify key factors, their distribution, connection and relative importance. The secondary aim was to compare subgroups as per decision outcomes and case labels.

Methods

NA was performed using Gephi software package as a secondary analysis on a dataset generated from a previous study on ICU admission decision-making process using a 20-questions game approach. The data were standardised and coded up to a quaternary level for this analysis.

Results

The coding process generated 31 nodes and 964 edges. Regardless of the measure used (centrality, prestige, authority and hubs), properties of the acute illness, progress of the acute illness and properties of comorbidities emerged consistently as among the most important factors and their relative rankings differed. Using different measures allowed important factors to emerge differentially. The six subgroups that emerged from the modularity measure bore little resemblance to traditional factor subgroups. Differences were noted in the subgroup comparisons of decision outcomes and case prognoses.

Conclusion

The use of NA with its various measures has facilitated a more comprehensive exploration of the ICU admission decision, allowing us to reflect on the process. Further studies with larger datasets are needed to elucidate the exact role of NA in decision-making processes.

Contributions of the study

We performed a novel analysis of a complex decision-making process that allowed for comparison with traditional analytic methods. It allowed for identification of key factors, their distribution, connection and relative importance. This may subsequently allow for reflection on difficult decision-making processes, thereby leading to more appropriate outcomes. Moreover, this may lead to new considerations in developing decision support systems such as the formulation of pro-forma data-capture tools (e.g. referral forms). Further, the way factors have been traditionally subgrouped may need to be reconsidered, with different subgroups being partitioned to better reflect their connection. This study offers a good basis for more advanced future studies in this area to use a new variety of analytical tools.

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

OBJECTIVE

Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.

DESIGN

Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.

SETTING

This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.

PARTICIPANTS

Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.

RESULTS

Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.

CONCLUSION

This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.

Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study

Background

Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals.

Objective

We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected.

Methods

We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors.

Results

We detail the spatiotemporal distributions of staff members’ inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery.

Conclusions

Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network.

A systematic scoping review and thematic analysis of interprofessional mentoring in medicine from 2000 to 2019

Interprofessional mentoring in palliative care sees different members of the interprofessional team providing holistic, personalised andlongitudinal mentoring support, skills training and knowledge transfer as they mentor trainees at different points along their mentoring journeys. However, gaps in practice and their risk of potential mentoring malpractice even as interprofessional mentoring use continues to grow in palliative medicine underlines the need for careful scrutiny of its characteristics and constituents in order to enhance the design, evaluation and oversight of interprofessional mentoring programmes. Hence, a systematic scoping review on prevailing accounts of interprofessional mentoring in medicine is conducted to address this gap. Using Arksey and O'Malley's (2005) methodological framework for conducting scoping reviews and identical search strategies, 6 reviewers performed independent literature reviews of accounts of interprofessional mentoring published in 10 databases. Braun and Clarke's (2006) thematic analysis approach was adopted to evaluate across different mentoring settings. A total of 11111 abstracts were identified from 10 databases, 103 full-text articles reviewed and 14 full-text articles were thematically analysed to reveal 4 themes: characterizing, implementing, evaluating and obstacles to interprofessional mentoring. Interprofessional mentoring is founded upon a respectful and collaborative mentoring relationship that thrives despite inevitable differences in individual values, ethical perspectives at different career stages within diverse working environments. This warrants effective mentor-mentee trainings, alignment of expectations, roles and responsibilities, goals and timelines, and effective oversight of the programmes. Drawing upon the data provided, an interprofessional mentoring framework is forwarded to guide the design, evaluation and oversight of the programmes.

A personal network approach to the study of nurse champions of innovation and their innovation projects' spread

AIMS

To develop and test the relationship between nurse champions' personal social networks and innovation success in terms of spread.

DESIGN

A cross sectional.

METHOD(S)

Data were collected on 94 nurse champions at three medium-large tertiary medical centres from 2015-2016. Data from champions on their personal network were assessed via a standardized and acceptable three-step network survey. Success in terms of innovation spread was assessed via perceived extent of spread. Network structural and relational characteristics were depicted by level of spread. Multivariate linear regression was used to assess the relationship between network characteristics and innovation spread.

FINDINGS

Above and beyond various project and network control variables, network density was significantly and positively related to project spread, tie-strength diversity was significantly and negatively related to project spread and difference in ethnic origin between champions and alters was significantly and positively related to project spread. Maximum age of network members was marginally significantly related to project spread.

CONCLUSION(S)

Our findings show that high-density personal social networks; networks where tie strength among network members is similar, thus, creating liking and trust among members; having at least one older network member who might have close access to professional and organizational resources acquired throughout their career; and having ties with network members from different ethnic groups to prevent knowledge stickiness, all promote innovation spread. Champions should be carefully nominated based on their ability to engage network members and to build ties with various network members inside and outside the nursing unit; once selected, champions should be aware of their social networks.

IMPACT

The current study explored champions' personal-network structure, composition and variance measures and their implications for innovation project spread. The findings demonstrated that nursing champions' personal social networks matter for innovation spread. This finding has implications for the nominating and the coaching of champions.

Identifying integration and differentiation in a Hospital's logistical system: a social network analysis of a case study

Background

Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration.

Methods

The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network.

Results

This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents.

Conclusions

This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.

Super-factors associated with transmission of occupational COVID-19 infection among healthcare staff in Wuhan, China

BACKGROUND

Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood.

AIM

To identify the super-factors causing COVID-19 infection in medical staff in China.

METHODS

A cross-sectional study was conducted between January 1st and February 30th, 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors.

FINDINGS

A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes.

CONCLUSION

High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working.

Exploring the structure of social media application-based information-sharing clinical networks in a community in Japan using a social network analysis approach

OBJECTIVE

Currently, use of social networking services (SNSs) for interprofessional collaboration is increasing. However, few studies have reported on virtual interprofessional interactions in community healthcare services. Revealing such structural characteristics of the networks can provide insight into the functions of the interprofessional information-sharing network and lead to smoother collaboration. Thus, we aimed to explore the structure of SNS-based information-sharing clinical networks.

DESIGN

Social network analysis (SNA).

SETTING

We selected a community in City X in Japan.

DATA COLLECTION

We analysed SNS-based information-sharing clinical network data linked to patients receiving home medical care or care services between January and December 2018. A network was created for each patient to allow healthcare professionals to post and view messages on the web platform. In the SNA, healthcare professions registered in a patient group were represented as nodes, and message posting/viewing relationships were represented as links in the patient network. We investigated the structural characteristics of the target networks using several measures for SNA, including indegree centrality and outdegree centrality, which reflect the number of incoming and outgoing links to/from a node, respectively. Additionally, the professions forming the most central nodes were investigated based on their ranking to identify those with a central role in the networks. Finally, to compare the networks of nursing care levels 1-3 (lighter care requirement) and those with nursing care levels 4-5 (heavier care requirement), we analysed the structural differences in the networks and investigated the roles of healthcare professionals using centrality measures of nodes.

RESULTS

Among 844 groups, 247 groups with any nursing care level data were available for analysis. Increasing nursing care level showed higher density, reciprocity and lower centralisation. Healthcare professions with high indegree centrality (physicians, care workers and physical therapists) differed from those with high outdegree centrality (home care workers, physical therapists, and registered dieticians). Visiting nurses and nurses in the clinic played a central role, but visiting nurses tended to have higher indegree and outdegree centrality, while nurses in the clinic had higher closeness and betweenness centrality in networks with heavier care requirement.

CONCLUSION

The SNS-based information-sharing clinical network structure showed that different professions played some form of a central role. Associations between network structures and patient outcomes, cost effectiveness and other factors warrant further investigation.

Examining the effect of the individual characteristics of implementers and the interaction of multiple relationships on the structure of psychosocial intervention teams

BACKGROUND

Teams' structure may undergo modifications due to the individual attributes of actors and collective-level variables. This research aims to understand the effect of extensive experience working in the program and the simultaneous interaction among different relationships in the network structure of a team of implementers. The Psychosocial Care Program for Victims of Conflict is implemented by psychologists, social workers, and community advocates.

METHODS

A cross-sectional study was carried out. Multivariate analysis, quadratic assignment procedures, and graphic visualization are used to (a) determine how seniority affects the professionals' level of centrality in the program and (b) clarify how the interaction among professionals favors new relationships.

RESULTS

Longer-lasting professionals in the program report stronger network bonding, predisposition to work, and information exchange. The nonparametric permutation test indicates an intense association between the information requests submitted and received and between the predisposition to work network and the network of received information requests. The results are discussed to optimize the teams implementing the intervention programs.

CONCLUSIONS

Network analysis is a powerfull tool to evaluate program implementation processes. Analyzing the interactions among multiples relationships that emerge between members of multidisciplinary teams allows knowing how certain relationships (e.g., information exchange) triggering other kind of relationships (e.g., users referral). The implementers who have been collaborating in the program for a long time are key informants who can facilitate the process of adaptation of newly incorporated professionals.