Abstract
BackgroundUsing opinion leaders to accelerate the dissemination of evidence-based public health practices is a promising strategy for closing the gap between evidence and practice. Network interventions (using social network data to accelerate behavior change or improve organizational performance) are a promising but under-explored strategy. We aimed to use mobile phone technology to rapidly and inexpensively map a social network and identify opinion leaders among community health workers in a large HIV program in western Kenya.MethodsWe administered a five-item socio-metric survey to community health workers using a mobile phone short message service (SMS)-based questionnaire. We used the survey results to construct and characterize a social network of opinion leaders among respondents. We calculated the extent to which a particular respondent was a popular point of reference (“degree centrality”) and the influence of a respondent within the network (“eigenvector centrality”).ResultsSurveys were returned by 38/39 (97%) of peer health workers contacted; 52% were female. The median survey response time was 13.75 min (inter-quartile range, 8.8–38.7). The total cost of relaying survey questions through a secure cloud-based SMS aggregator was $8.46. The most connected individuals (high degree centrality) were also the most influential (high eigenvector centrality). The distribution of influence (eigenvector centrality) was highly skewed in favor of a single influential individual at each site.ConclusionsLeveraging increasing access to SMS technology, we mapped the network of influence among community health workers associated with a HIV treatment program in Kenya. Survey uptake was high, response rates were rapid, and the survey identified clear opinion leaders. In sum, we offer proof of concept that a “mobile health” (mHealth) approach can be used in resource-limited settings to efficiently map opinion leadership among health care workers and thus open the door to reproducible, feasible, and efficient empirically based network interventions that seek to spread novel practices and behaviors among health care workers.
Highlights
Using opinion leaders to accelerate the dissemination of novel, innovative, or evidence-based practices in health care is a promising strategy for closing the gap between evidence and practice
We describe a case study of application of mobile phone technology to map the network of social influence and identify opinion leaders with regard to professional behavior among a cadre of community health workers in Kenya where mobile phone networks are robust and cell phone ownership is common
We aimed to identify opinion leaders who would serve as referral contacts for clinical and community health assistants (CCHA) peer navigator work
Summary
Using opinion leaders to accelerate the dissemination of novel, innovative, or evidence-based practices in health care is a promising strategy for closing the gap between evidence and practice. Network interventions, defined by Valente as “the process of using social network data to accelerate behavior change or improve organizational performance” (e.g., the use of opinion leaders to catalyze dissemination) are promising [8]. Socio-metric surveys can be difficult to carry out repeatedly in all settings where an intervention is desired Despite their promise, the feasibility of network-based interventions in resource poor settings is unclear. Using opinion leaders to accelerate the dissemination of evidence-based public health practices is a promising strategy for closing the gap between evidence and practice. Network interventions (using social network data to accelerate behavior change or improve organizational performance) are a promising but under-explored strategy.
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