Professional advice for primary healthcare workers in Ethiopia: a social network analysis

Abstract

Background: In an era of increasingly competitive funding, governments and donors will be looking for creative ways to extend and maximise resources. One such means can include building upon professional advice networks to more efficiently introduce, scale up, or change programmes and healthcare provider practices. This crosssectional, mixed-methods, observational study compared professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia. Primary healthcare units include a health centre and typically five satellite health posts. Methods: One hundred sixty staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care. Network and actor-level metrics were calculated including density (ratio of ties between actors to all possible ties), centrality (number of ties incident to an actor), distance (average number of steps between actors) and size (number of actors within the network). Following quantitative network analyses, 20 qualitative interviews were conducted with network study participants from four primary healthcare units. Qualitative interviews aimed to interpret and explain network properties observed. Data were entered, analysed or visualised using Excel 6.0, UCINET 6.0, Netdraw, Adobe InDesign and MaxQDA10 software packages. Results: The following average network level metrics were observed: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), number of ties 95.63 (SD 35.46), size of network 20.25 (SD 3.65). Advice networks for antenatal or maternity care were more utilised than advice networks for post-natal or newborn care. Advice networks were typically limited to primary healthcare unit staff, but not necessarily to supervisors. In seeking advice, a colleague's level of training and knowledge were valued over experience. Advice exchange primarily took place in person or over the phone rather than over email or online fora. There were few barriers to seeking advice.

Community Detection Algorithms in Healthcare Applications: A Systematic Review

“…To detect communities of services, a model based on PCA algorithm and SNA is developed and then a graphical representation for demonstrating and recognizing patterns of care is proposed. In [190], essential details about the professional advice networks in Ethiopia's primary healthcare units are examined and assessed using a set of SNA-based methodology and qualitative interviews. De Brún et al [191] described used community structure-based techniques for describing, diagnosing, and evaluating healthcare systems and networks in a case study of senior managers in a newly established hospital group.…”

“…In Table II, a summary of previously mentioned community detection-based studies employed in healthcare applications, a subfield of their application, utilized techniques, purpose, advantages, and disadvantages, are outlined. The research was narrowed to a single network of medical care services Sabot et al [190],…”

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed‐methods approach

“…If the team's mission extensively constrains a team member, the team member's commitment to the team can diminish 25‐28 . Actively sharing information and knowledge allows team members to effectively reduce the ambiguity of their tasks and adjust their roles and activities to achieve better team performance 10,21,29‐31 . Moreover, when team members are trustworthy and have good interpersonal relationships, the communication process becomes more effective as communication costs are reduced, and team members can fully understand each other's behaviours 24,25,30,32,33 .…”

“…[25][26][27][28] Actively sharing information and knowledge allows team members to effectively reduce the ambiguity of their tasks and adjust their roles and activities to achieve better team performance. 10,21,29,31 Moreover, when team members are trustworthy and have good interpersonal relationships, the communication process becomes more effective as communication costs are reduced, and team members can fully understand each other's behaviours. 24,25,30,32,33 Highly cohesive relationships among team members motivate them to be more supportive, making working conditions more productive.…”

“…24,25,30,32,33 Highly cohesive relationships among team members motivate them to be more supportive, making working conditions more productive. 31,34 Finally, another group of studies has explored how the environmental context, such as the working conditions in a hospital 8,11,12,21,29,35,36 or the organisation's culture for teamwork, can stimulate or hinder effective teamwork. 37 An organisational culture that values and encourages teamwork and participation in a team can facilitate effective teamwork.…”