Social Network Assessments and Interventions for Health Behavior Change: A Critical Review

"This article documents how social network interventions have been successfully utilized for a range of health behaviors including HIV risk practices, smoking, exercise, dieting, family planning, bullying, and mental health."

This author manuscript of an article published in Behavioral Medicine "examines hypothesized social influence mechanisms including social norms, modeling, and social rewards and the factors of social identity and social rewards that can be employed to sustain social network interventions." The authors sought to 1) examine evidence from social network and social influence approaches to health promotion; 2) present issues in measurement of social networks related to health behaviours; 3) examine interpersonal relationships associated with health behaviours; 4) delineate mechanisms of positive and negative influences on individual and network behaviour change; 5) describe behaviour change approaches in network interventions; and 6) describe methodological issues in network interventions.

The authors describe network intervention usage in health behaviour change programmes, often delivered face-to-face, but, more recently, delivered through social media and mhealth components. They ask the question whether network inventories, used to measure network attributes contributing to social influence, have validity as measures. They show how name and attribution lists can chart such things as drug use and HIV risk behaviours, if adapted for study population, context, and health topic. Stability and frequency of interactions can be monitored through network turnover. Also personal networks can be gathered through establishing boundaries with common linking in subsets, for instance, cliques or classrooms.

As stated here, identifying influential individuals in networks offers candidates for training in behaviour change programmes. Gender and associated partnership can influence behaviours within networks - interpersonal conflict being negatively associated with behaviour change, supportive partners being positively associated. "It is likely that factors to consider in choosing network members may include the health condition, target behavior, social and economic status, gender and other social roles, as well as resources and support functions and frequency of interaction with social network members."

Social network analyses that may help to explain emotional, financial or material, informational, instrumental, and socialisation supports can identify sources of conflict in support networks, such as over-involvement, undermining of autonomy or self-efficacy, mismatching, indebtedness, and gender or familial conflict that can impede or aid health outcomes. Perceived and enacted support and strong versus weak ties may result in different outcomes, such as enhanced well-being versus sustained behaviour change.

Mechanisms employed in social network interventions may include: reward and punishment; behaviour modelling; changes in communication norms for talking about diseases and prevention; training for communication on diseases; and promotion by peers.

Communication training can relate to message frequency, manner of conversation, perceived judgement; communicating personal lessons learned, etc. Motivation to continue encouragement of social networks can be self rewards of identity strengthening, social status, and member feedback. Assigned roles such as health educator may legitimise conversation. Support in testing rebuttal skills, testing in realistic situations, and reframing negative feedback can help in peer situations. Role play in small group trainings can be used in problem solving.

Differential affiliation (e.g., drug users associating with those who use rather than those who have quit) is a factor to examine in evaluating results of social influence. Social media networks in small group formats can be organised as self-help networks that can "bolster norms, model behavior, provide social support and cues for behavior change, and serve as an avenue for feedback to address barrier to behavior change. " However, they are often comprised of weak relationship ties, whereas face-to-face networks often include stronger ties.

Social diffusion in networks can enhance behaviour change - one mechanism might be to train several members to reinforce each others' messages. It also may contribute to the problem of spreading messages from the intervention group to a control group within a designed experiment. The authors conclude with suggestions for ongoing research.