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标题：Association Between Social Network Communities and Health Behavior: An Observational Sociocentric Network Study of Latrine Ownership in Rural India
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作者：Holly B. Shakya ; Nicholas A. Christakis ; James H. Fowler 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：5
页码：930-937
DOI：10.2105/AJPH.2013.301811
语种：English
出版社：American Public Health Association
摘要：Objectives. We identified communities of interconnected people that might serve as normative reference groups for individual-level behavior related to latrine adoption. Methods. We applied an algorithmic social network method to determine the network community from respondent-reported social ties of 16 403 individuals in 75 villages in rural Karnataka, India; data were collected from 2006 to 2008. We used multilevel modeling to test the association between latrine ownership and community-level and village-level latrine ownership. We also investigated the degree to which network cohesion affected individual latrine ownership. Results. Three levels of social contacts (direct friends, social network community, and village) significantly predicted individual latrine ownership, but the strongest effect was found at the level of social network communities. In communities with high levels of network cohesion, the likelihood was decreased that any individual would own a latrine; this effect was significant only at lower levels of latrine ownership, suggesting a role for network cohesion in facilitating the nonownership norm. Conclusions. Although many international health and development interventions target village units, these results raise the possibility that the optimal target for public health interventions may not be determined through geography but through social network interactions. Interconnected groups of individuals can shape the health-related behavior of the constituent individuals, in part by promulgating and enforcing group-specific social norms. An understanding of the process whereby such groups are assembled and such norms are enforced could be used to improve the health of both individuals and groups. Recently developed social network community detection techniques allow us to discern these groups and suggest ways of exploiting social processes to foster desirable behavior change in diverse settings, 1–3 and other work has begun to use network community detection to understand normative constraints in outcomes as diverse as smoking cessation 4 and adolescent delinquency. 5 Descriptive norms are those regular behaviors that can be observed within a community and that can be adopted regardless of the expectations of others. 6 Injunctive norms, on the contrary, reflect community standards and are enforced through social sanctions; sanctions can be negative for transgressions or positive for conformity and can be as blatant as a public shaming or as subtle as unspoken disapproval. 7–10 Simply observing others’ behaviors can unconsciously motivate action, 11 but injunctive norms are more complex, and may even be conflicting, because their primary function is to maintain social relationships. 12 Medicine and public health have a rich tradition of efforts to change norms and hence move individuals and communities toward better health. 5,13,14 However, a key task of interventions seeking to do this is to identify the valid community or “reference group” for each individual in the population of interest. Normative change hinges on the fact that the individuals involved place a value on the expectations of those with whom they share social connections. 9,15,16 However, from which particular groups of people do individuals take their guidance? How is such a group defined? The theory of planned behavior, for instance, includes self-reported measures of reference groups subjectively defined as “people who are important to you.” 17–19 Most research surveys (e.g., with outcomes as diverse as the use of contraception 20,21 or adolescent smoking 22 ) have not collected data specific to social norms, requiring researchers instead to create measures of possible norms through the aggregation of existing measures and to infer reference groups from geographic boundaries, such as villages. However, does a valid reference group include (1) just those to whom one is directly connected (friends), (2) those to whom one is more broadly and indirectly connected (e.g., friends of friends), or (3) a still larger aggregation (e.g., the village or town in which one resides)? And are structural features of the network in which individuals are embedded relevant to the ability of reference groups to enforce norms or stimulate the adoption of new behaviors? Not only may the group one picks as a normative referent be relevant, but also the structure of the ties within that group may be crucial to any normative effect. Network cohesion is an important such structural characteristic. Cohesion can be quantified with transitivity, which is the probability that 2 of someone’s social connections are connected to each other. 5,23–27 Transitivity can either constrain or compel adoption of complex behaviors (see Figure 1 for a theoretical illustration of this concept). 25,28,29 For example, people in more highly interconnected communities may be less likely to embrace behavior change because the strongly clustered nature of their social groups means that they may have little access to new information outside of their networks. 23,30 Furthermore, in highly interconnected communities, the effect of injunctive norms on individuals may be more powerful. 25,31–33 It can be very difficult for an individual to defy a social norm even when the expected outcome may be personally beneficial—because the individual can avoid sanctions only if the entire community is willing to change simultaneously. 34–36 This dynamic also works inversely, such that when a critical mass of a highly interconnected group has adopted a behavior, the probability also increases that any individual in that group will adopt it. 28,29,37,38 Open in a separate window FIGURE 1— Theoretical changes in community latrine proportion as a function of transitivity at 3 different levels of community latrine proportion. Note. When the overall latrine ownership proportion in a community is low, then the effect of transitivity is to act as a normative constraint on overall latrine ownership within the community. When latrine ownership is medium, then the effect of transitivity is null. At high levels of latrine ownership, transitivity then acts as a catalyst toward adoption, and community-level latrine ownership will increase. We used algorithmic social network analytic methods to identify community groups and predict a socially influenced health behavior: latrine ownership in rural India. Poor sanitation, including the lack of clean, functioning toilets, is a major contributor to morbidity and mortality from infectious disease, particularly in India. 39–41 Open defecation has been practiced in many communities for centuries. 42 A large body of qualitative research points to the fact that, above and beyond demographic factors, social dynamics can influence the decision to build a latrine. 40,43 Although the government of India has devoted considerable resources, including subsidies, to latrine-building campaigns over the last decade, results have been mixed, and considerable socioeconomic disparities persist. 44–46 The most successful latrine-building campaigns have been those initiated by Community-Led Total Sanitation; these successfully shift the norms of the community through village-wide agreements to stop open defecation, and these include shaming of those who transgress, and community commitment to invest in building latrines. 47,48 We used so-called community detection methods to mathematically identify relevant social groups of interconnected people. These network communities are subsets of individuals with relatively strong within-group social connections and relatively weak between-group connections. 3,49,50 As such, they include not only direct social contacts (friends) but also friends of friends and friends of friends of friends. 51 Because latrine interventions in the developing world typically are implemented at the village level, we expected that both village-level latrine ownership practices and social network community–level practices would have important implications for individual behaviors. Our research aims were to (1) quantify groups of interconnected individuals with a social network algorithm; (2) assess whether latrine ownership at the level of direct contacts, community network groups, or villages was associated with individual latrine ownership; and (3) test the degree to which the level of connectivity at the community and village levels was associated with latrine ownership. Research that uses a community-detection approach to test the association between social network features and health behavior is rare; hence, this study offers the opportunity to investigate whether network-derived communities are a good unit of analysis for the measurement of injunctive social norms.