Odeny Thomas A, Petersen Maya, Muga Charles T, Lewis-Kulzer Jayne, Bukusi Elizabeth A, Geng Elvin H
Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Implement Sci. 2017 Jun 26;12(1):80. doi: 10.1186/s13012-017-0611-y.
Using opinion leaders to accelerate the dissemination of evidence-based public health practices is a promising strategy for closing the gap between evidence and practice. Network interventions (using social network data to accelerate behavior change or improve organizational performance) are a promising but under-explored strategy. We aimed to use mobile phone technology to rapidly and inexpensively map a social network and identify opinion leaders among community health workers in a large HIV program in western Kenya.
We administered a five-item socio-metric survey to community health workers using a mobile phone short message service (SMS)-based questionnaire. We used the survey results to construct and characterize a social network of opinion leaders among respondents. We calculated the extent to which a particular respondent was a popular point of reference ("degree centrality") and the influence of a respondent within the network ("eigenvector centrality").
Surveys were returned by 38/39 (97%) of peer health workers contacted; 52% were female. The median survey response time was 13.75 min (inter-quartile range, 8.8-38.7). The total cost of relaying survey questions through a secure cloud-based SMS aggregator was $8.46. The most connected individuals (high degree centrality) were also the most influential (high eigenvector centrality). The distribution of influence (eigenvector centrality) was highly skewed in favor of a single influential individual at each site.
Leveraging increasing access to SMS technology, we mapped the network of influence among community health workers associated with a HIV treatment program in Kenya. Survey uptake was high, response rates were rapid, and the survey identified clear opinion leaders. In sum, we offer proof of concept that a "mobile health" (mHealth) approach can be used in resource-limited settings to efficiently map opinion leadership among health care workers and thus open the door to reproducible, feasible, and efficient empirically based network interventions that seek to spread novel practices and behaviors among health care workers.
利用意见领袖来加速循证公共卫生实践的传播是缩小证据与实践之间差距的一项有前景的策略。网络干预（利用社交网络数据加速行为改变或改善组织绩效）是一项有前景但尚未充分探索的策略。我们旨在利用手机技术快速且低成本地绘制社交网络，并在肯尼亚西部一个大型艾滋病项目的社区卫生工作者中识别意见领袖。
我们通过基于手机短信服务（SMS）的问卷，对社区卫生工作者进行了一项包含五个项目的社会计量调查。我们利用调查结果构建并描述了受访者中意见领袖的社交网络。我们计算了特定受访者作为受欢迎的参考点的程度（“度中心性”）以及受访者在网络中的影响力（“特征向量中心性”）。
39名被联系的同行卫生工作者中有38名（97%）回复了调查问卷；52%为女性。调查的中位回复时间为13.75分钟（四分位间距为8.8 - 38.7分钟）。通过安全的基于云的短信聚合器转发调查问题的总成本为8.46美元。联系最广泛的个体（高度中心性）也是最具影响力的（高特征向量中心性）。影响力的分布（特征向量中心性）高度偏向于每个地点的单个有影响力的个体。
利用越来越容易获得的短信技术，我们绘制了肯尼亚一个艾滋病治疗项目相关的社区卫生工作者之间的影响力网络。调查参与度高，回复速度快，且调查识别出了明确的意见领袖。总之，我们提供了概念验证，即“移动健康”（mHealth）方法可用于资源有限的环境中，以有效地绘制医护人员中的意见领袖情况，从而为寻求在医护人员中传播新实践和行为的可重复、可行且高效的基于实证的网络干预打开大门。
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