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Social network analysis: a research methodology for health and nursing

Deyvyd Manoel Condé Andrade^I; Helena Maria Scherlowski Leal David^II

^I Master in Nursing. Municipal Health Department of Leopoldina. Leopoldina, Minas Gerais, Brazil. E-mail: dvdmcaenf@gmail.com
^II PhD in Public Health. Associate Professor of the Postgraduate Program in Nursing at the Nursing Faculty of the State University of Rio de Janeiro. Brazil. E-mail: helenalealdavid@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.14861

ABSTRACT

Social network analysis is a methodological proposal for analyzing social structures, their interactions and social networks. From sociograms and indicators, it can be determined quantitatively and qualitatively how interactions occur, knowledge is mediated and information flows. This article presenting social network analysis as a methodology for research in health and nursing, highlights concepts and offers some possible examples of its application. By affording public health policaymaking access to the real dimensions of interactions among health professionals, managers and users, the methodology brings health care and nursing planning to consider new actions often omitted from such policies, which fail to contemplate the real situation of the social actors involved.

Keywords: Methodology; nursing; social network analysis; health.

INTRODUCTION

Social networks have been presented, these days, as a ubiquitous concept occupying growing discourse in academia, in the media, in the various types of organizations and common sense¹. These networks are connected by relationships / interactions that can be motivated by friendship and working relationships or sharing information which, through these connections, the social structure has been (re) built².

Importantly, the concept of social capital is present and is central to the construction of social networks. These are constructed from a social capital in constant motion, constituted from relations linked to a group of agents that are not only endowed with common properties, but united by permanent and useful links. These links are not reduced to close relationships in terms of geographical area or in the economic and social space in which they are submitted, for example, they occur from inseparable material and symbolic exchanges. These allow for the establishment and perpetuation of the (re) cognition of this proximity³.

Social capital can be understood as the totality of funds arising from a relation network of mutual recognition demarcated in social fields. These resources are used by agents through a progress strategy within the social hierarchy of the field, which results from the interaction of the individual with the structure and vice versa. Each field can be characterized as a manifestation space of power relations; so these fields start to structure themselves from unequal relations of a social quantum, determining, therefore the position of each agent, according to the power they concentrate ⁴.

In this regard, the concept of social network, even if still in theoretical- methodological systematization phase, is understood as a valuable resource, which may explain the mobilizing potential of civil society and innovative political perspectives, strengthened by solidarity actions horizontally generated between individuals and social groups within the civil society, in the sphere of power of governments, etc. This makes it possible to understand the challenges of building a democratic citizenry, entered in the era of globalization. It is emphasized, then, that the concept of social networking is appropriate not only for centering its focus on analysis in fixed actors from certain positions or status, but mainly in the relationship itself. The basic value of social actions focuses not in the preferences or interests of actors, but in the social relationship itself: in its morphology, density, intensity and direction⁵.

Therefore, these concepts can be employed based on social theories, requiring additional empirical data capable of identifying the links and relations between individuals. For this, a theoretical and methodological approach that addresses demands of research, the social network analysis, can be applied in studies with different situations and social issues ⁶.

From these considerations, the aim of this article was to present the analysis of social networks as a proposal for research methodology in health and in nursing, presenting concepts and bringing some possible examples of application of this methodology.

The methodology of social networks analysis

The network analysis establishes a new proposal for studies involving social structure. In studying behaviors and opinions of individuals, it is necessary to identify the structures in which the links (individuals) are inserted. The analysis does not only rest on individual attributes (class, sex, age, gender), but on the set of interactions that individuals establish with each other. This structure is seen as a network of relationships and constraints, which falls upon the choices, orientations, behaviors and opinions of individuals⁶.

Through network analysis, one can understand its structure, whose form is explanatory for the study of these phenomena. Its goal is to demonstrate that the analysis of a dyad - interaction between two people - makes sense only when in conjunction with many other network dyads, since the structural position of these dyads has effects on the form of the network, its content and its function. The function of a relationship will depend on the structural position of the links (represented by an individual, an organization, for example), the same occurring with the status and the role of the actor. Importantly, the network is not limited in the sum of relationships and, therefore, its form influences every relationship⁶.

Social network analysis is a tool that enables researchers to understand the interactions between any groups of individuals, preferably through qualitative rather than quantitative data. Since this methodology requires qualitative information due to its own characteristics, it must follow some basic techniques that allow sorting the information generated by interactions between individuals, so that such interactions can be represented in a graph or network ⁷.

Networks (or graphs) are an important tool to represent the interactions between individuals or group of individuals. However, it is not always enough to represent them graphically to establish a deeper analysis of each individual within the network. Usual statistics tools alone do not allow a more detailed and thorough analysis of the complexity of social interactions. Thus, some researchers in the exact sciences have developed some specific tools for network analysis, making it possible to create indicators that explain the structure of a network, both in its parts and in its entirety.^7,8

One of the main indicators to measure the potential of certain actors, that could compose one or more social networks, is the centrality index. This indicator defines the position of the actors and their relevance to the group of established relationships. Depending on the position occupied by an individual on the network, their opportunities to connect within this network will be grater and, as a development, they will have greater chances to obtain individual and / or collective prestige. The centrality in a network brings the idea of power^6,9.

Individuals who have more links (contacts) may have more advantageous positions and such links can bring alternative ways to meet their needs and hence to be less dependent than other individuals. Because they have many ties, they have access to certain resources, which makes them more adept at resorting to many other resources available on the network¹⁰.

Other indicators are also used for the analysis of social networks. The centrality of information is an indicator that identifies the one actor who receives information coming from other parts of the network, making him a strategic source. The centrality of intermediation has to do with those actors who serve as a bridge, facilitating the flow of information. An individual may not have as many contacts, establish weak links (different links, contacts), but be important in mediating exchanges. This feature marks the power to control information circulating on the network, and its path. The centrality of flow analyzes the actors' contact paths, which increases the measure of centrality of intermediation, that only identifies the shortest path between the actors; in the centrality of flow, the intermediation is measured by the volume of flow between them, which passes through paths in which the subject is inserted. And finally, the centrality of closeness indicates the distance between the actors, which allows, in a sense, the possibility of communicating with many people involved in a network with a minimum number of intermediaries¹¹.

Another highlight for the social networks analysis are the concepts of strong and weak ties. The strong ties allow that the network has a common identity, and the relations found therein have high level of credibility and influence. Individuals who share strong ties are inserted in the same social circle and individuals that have many weak ties are important as they are connected to as many individuals who hold other networks of relationships. Thus, the fewer the weak ties, the fewer the bridges between individuals and less innovation and lower the flow of information in the network as a whole^12,13.

So, to get to these indicators, it is necessary to develop a data collection instrument (questionnaires, interviews, focus groups...) that enables search of information to build the network and then to calculate the indicators. The data found are thrown into a matrix that is found in Ucinet software. Within this program, the Netdraw is responsible for the structural design of the network, with its links and connections. After the network is built, it is started the calculation of indicators through Ucinet, that enables a quantitative analysis of the findings. Other qualitative methodologies can enrich the treatment of the additional data, such as content analysis, for example.

The social network analysis in research in health and nursing

In studies in health and nursing, the social network analysis methodology can be addressed in its qualitative and quantitative aspects. In the qualitative approach, relationships patterns that are produced in the context in which they develop are investigated, considering individuals as social actors who (re) built reality in the search for new meanings, from social interactions and specificities that mediate information sharing and knowledge building in the network. In the quantitative approach, the focus is on the relationship patterns, emphasizing the objectivity of relations. This enables the mapping of information flow, of patterns of communication and awareness of important individuals in this process¹⁴.

In this regard, the studies using this methodology through the use of indicators and sociograms (structural network) seek to analyze the relationship, for example, between health professionals with entities / health organizations, through the social bonds that the relationship raises, within a broader process that begins, in many cases, out of the health system and will permeate the relationship in the public and private sphere. As a result, these relationships involve actions that are beyond the sanitary demands, going beyond the health field and the local community⁹.

The social network analysis emerges as an important investigative tool for transversal actions for social planning, running through several realities. This methodology, in the health field, provides, through its results, the planning of public actions in the health sector, as it contributes with indicators that take into account social participation and the entities / organizations that have a closer relationship with more vulnerable populations ⁹.

Such actions can be of critical importance in places that have serious diseases proliferation problems and maternal and child mortality, for example, as social research has pointed to some determinants. These can be evidenced by the disarticulation and disorganization of actions between the services and the health needs of individuals and communities (through solidarity networks)⁹.

Another possibility found in the use of the methodology, in relation to work in health, has to do with the plot of interactions between health professionals, managers, users and health care and the everyday life. These interactions favor the democratization of information that encourage social participation in health, both with regard to policies, and in which is provided by the public health system. This methodology allows identifying the exchange of information between the actors involved, and the interaction of people with their circles and social networks, which can be described as different sociability fields that, when matched, can broaden perspectives for health practices¹⁵.

Therefore, studies that use this methodology in health seek to identify the circulating in social interactions in favor of maintaining the bonds, mutual recognition among actors involved and collective transformations that gain expressiveness from the incessant movement of the triad give - receive - return ^16,17.

CONCLUSION

The social network analysis methodology provides a considerable amount of research in health and nursing, especially when combining qualitative and quantitative approaches.

In the health planning, the findings provided by the use of this methodology bring a diversity of possibilities and actions that identify the main actors, who are engaged in knowledge mediation processes and flow of information, and also the links that are built and their development of social networks.

Regarding public health policies, network analysis also enables the identification of problems and opportunities, estimating some parameters and finding solutions to achieving success in the application of a particular action within a given context. In addition, it enables a scan of interactions and informal networks that are built, which allows identifying strategies and alternatives developed between individuals and communities, to outline a problem that in many cases, are not considered and included in public policies health, as an action able to change reality.

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