Using Social Network Analysis Methods to Map Ghanaian Community Health Team Interactions in Mobile Phone Closed User Groups
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Abstract
Background
The network structure of an organization influences how well or poorly an organization communicates and manages/utilizes its resources. Within the Millennium Villages Project (MVP), information flow is critical to the success of programs. To enhance intra-site communication among members of a large health team, a mobile phone closed user group (CUG) was set-up at all MVP sites. This CUG allows members of a site’s health team to hold voice conversations, via mobile phone, with one another at no cost.
Objective
To date, no analysis of the CUG’s use and utility has been conducted. Consequently, it was not clear whether the flow of information had improved within the health teams or what kind of impact the CUG-related information flows were having on day-to-day activities of the health workers. The purpose of this study was to assess if and how a mobile phone CUG ‘disrupts’ the traditional social/communication structure of the Bonsaaso MVP Health Team through the innovative use of social network analysis (SNA) methods.
Methods
SNA methods were used to assess if the mobile phone CUG disrupted the traditional, hierarchical communication structure of the organization as well as the efficiency of information flow within that system. We also used SNA to identify central actors within and outside the CUG. The foundation of the social network data was de-identified call data obtained from the Mobile Operator, spanning from March 2011 through September 2011. This data was analysed using UCINET. NetDraw was used to create sociograms of the network data for observational analyses. The call data was complemented by a qualitative component that included interviews with key informants of the Bonsaaso cluster. This data was analysed using NVivo9. The key informants also kept prospective call journals that were then analysed using NVivo9 and Excel.
Results
CUG members conversed with Health Team members within and outside of their catchment area. Midwives had the most intra-site communication. The Health Team Management (HTM) bypassed the traditional chain of command and spoke directly with those at the bottom of the Health Team hierarchy, and vice versa. While community health nurses were identified as the central actors in the traditional network, members of the HTM were the most central actors in the CUG network. These results were consistent over time. High rates of personal call use were also documented and were not limited to the weekend.
Conclusion
As evidenced by the SNA and qualitative data, the CUG (and use of mobile phones) creates constructively disruptive communications channels between members of the Bonsaaso Health Team, subverting traditional hierarchies of authority and information control. This may, in part, explain the central role of the HTM in our SNAs. Implications of this include a heavier burden on the HTM as they deal with increased communication in addition to fulfilling their daily responsibilities. However, the unlikely connections may allow for issues to be resolved quickly, increased capacity (i.e. knowledge base) at all levels and information to be channeled more quickly and directly to relevant persons. This study also shows how social network analysis and de-identified mobile phone data can be used to improve the performance of health teams.
The network structure of an organization influences how well or poorly an organization communicates and manages/utilizes its resources. Within the Millennium Villages Project (MVP), information flow is critical to the success of programs. To enhance intra-site communication among members of a large health team, a mobile phone closed user group (CUG) was set-up at all MVP sites. This CUG allows members of a site’s health team to hold voice conversations, via mobile phone, with one another at no cost.
Objective
To date, no analysis of the CUG’s use and utility has been conducted. Consequently, it was not clear whether the flow of information had improved within the health teams or what kind of impact the CUG-related information flows were having on day-to-day activities of the health workers. The purpose of this study was to assess if and how a mobile phone CUG ‘disrupts’ the traditional social/communication structure of the Bonsaaso MVP Health Team through the innovative use of social network analysis (SNA) methods.
Methods
SNA methods were used to assess if the mobile phone CUG disrupted the traditional, hierarchical communication structure of the organization as well as the efficiency of information flow within that system. We also used SNA to identify central actors within and outside the CUG. The foundation of the social network data was de-identified call data obtained from the Mobile Operator, spanning from March 2011 through September 2011. This data was analysed using UCINET. NetDraw was used to create sociograms of the network data for observational analyses. The call data was complemented by a qualitative component that included interviews with key informants of the Bonsaaso cluster. This data was analysed using NVivo9. The key informants also kept prospective call journals that were then analysed using NVivo9 and Excel.
Results
CUG members conversed with Health Team members within and outside of their catchment area. Midwives had the most intra-site communication. The Health Team Management (HTM) bypassed the traditional chain of command and spoke directly with those at the bottom of the Health Team hierarchy, and vice versa. While community health nurses were identified as the central actors in the traditional network, members of the HTM were the most central actors in the CUG network. These results were consistent over time. High rates of personal call use were also documented and were not limited to the weekend.
Conclusion
As evidenced by the SNA and qualitative data, the CUG (and use of mobile phones) creates constructively disruptive communications channels between members of the Bonsaaso Health Team, subverting traditional hierarchies of authority and information control. This may, in part, explain the central role of the HTM in our SNAs. Implications of this include a heavier burden on the HTM as they deal with increased communication in addition to fulfilling their daily responsibilities. However, the unlikely connections may allow for issues to be resolved quickly, increased capacity (i.e. knowledge base) at all levels and information to be channeled more quickly and directly to relevant persons. This study also shows how social network analysis and de-identified mobile phone data can be used to improve the performance of health teams.
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