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Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships.

Fuller J, Hermeston W, Passey M, Fallon T, Muyambi K - BMC Health Serv Res (2012)

Bottom Line: Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups.The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively.According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table".

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. jeffrey.fuller@flinders.edu.au

ABSTRACT

Background: While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery.

Methods: Local research groups comprising 13-19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively.

Results: Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table". While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships.

Conclusion: Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that "boundary spanning" staff can facilitate commitment to partnership goals.

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Related in: MedlinePlus

Team care links at site B. Directed arrows indicate those who undertake team care with that worker, with node size adjusted to the number of links. Broken line “surround” indicates those workers with the highest betweenness score
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Figure 1: Team care links at site B. Directed arrows indicate those who undertake team care with that worker, with node size adjusted to the number of links. Broken line “surround” indicates those workers with the highest betweenness score

Mentions: Some of the mapped and tabulated data for site B are provided as an illustration of the type of information fed back to the local research groups. The map of site B team care links (Figure1) shows two aspects of these data. First, the workers with the largest number of direct links (larger degree centrality = larger node size) were the Site B Coordinator, another non-Aboriginal worker in the mainstream health service (MHS) and two non-Aboriginal workers in the Aboriginal Medical Service (AMS). Second, the workers who performed the main bridging functions (large node betweenness centrality shown with dotted surround) were the workers who occupy critical positions that join workers in different parts of the network. These bridging workers would have the greatest impact in breaking up the whole network if they were not present. The workers who occupied the main bridging positions on the team care network at site B were in order, the site B Coordinator, an Aboriginal Health Worker from the AMS and a non-Aboriginal worker from the AMS. Through visualisation of these data on maps we were able to show that the network of workers linked by the exchange of team care was highly centred on the site B Coordinator, both in terms of direct links with others, but also as a bridging person. The network of workers linked by the exchange of management and planning in the partnership was also highly centred both in degree centrality and betweenness centrality on this site B Coordinator (map not shown).


Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships.

Fuller J, Hermeston W, Passey M, Fallon T, Muyambi K - BMC Health Serv Res (2012)

Team care links at site B. Directed arrows indicate those who undertake team care with that worker, with node size adjusted to the number of links. Broken line “surround” indicates those workers with the highest betweenness score
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472193&req=5

Figure 1: Team care links at site B. Directed arrows indicate those who undertake team care with that worker, with node size adjusted to the number of links. Broken line “surround” indicates those workers with the highest betweenness score
Mentions: Some of the mapped and tabulated data for site B are provided as an illustration of the type of information fed back to the local research groups. The map of site B team care links (Figure1) shows two aspects of these data. First, the workers with the largest number of direct links (larger degree centrality = larger node size) were the Site B Coordinator, another non-Aboriginal worker in the mainstream health service (MHS) and two non-Aboriginal workers in the Aboriginal Medical Service (AMS). Second, the workers who performed the main bridging functions (large node betweenness centrality shown with dotted surround) were the workers who occupy critical positions that join workers in different parts of the network. These bridging workers would have the greatest impact in breaking up the whole network if they were not present. The workers who occupied the main bridging positions on the team care network at site B were in order, the site B Coordinator, an Aboriginal Health Worker from the AMS and a non-Aboriginal worker from the AMS. Through visualisation of these data on maps we were able to show that the network of workers linked by the exchange of team care was highly centred on the site B Coordinator, both in terms of direct links with others, but also as a bridging person. The network of workers linked by the exchange of management and planning in the partnership was also highly centred both in degree centrality and betweenness centrality on this site B Coordinator (map not shown).

Bottom Line: Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups.The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively.According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table".

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. jeffrey.fuller@flinders.edu.au

ABSTRACT

Background: While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery.

Methods: Local research groups comprising 13-19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively.

Results: Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table". While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships.

Conclusion: Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that "boundary spanning" staff can facilitate commitment to partnership goals.

Show MeSH
Related in: MedlinePlus