Network-based Health Interventions in Rural Honduras

洪都拉斯农村地区基于网络的健康干预措施

• 批准号: 8742564
• 负责人: ALISON R HWONG
• 金额: $ 4.77万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2016-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8742564
• 关键词: Address; Adoption; Affect; Attitude; Award; Behavior; Behavioral; Characteristics; Chlorine; Clinical Medicine; Complement; Counseling; Data; Data Analyses; Diffuse; Diffusion; Disease; Doctor of Philosophy; Economics; Effectiveness; Elderly; Evaluation; Friends; Funding; Future; Goals; Health; Health Benefit; Health Knowledge, Attitudes, Practice; Health Policy; Healthcare; Honduran; Honduras; Individual; Injection of therapeutic agent; Institution; Interdisciplinary Study; Intervention; Investigation; Joints; Knowledge; Low income; Manuscripts; Medical Sociology; Mentors; Mentorship; Methods; Modeling; Multivitamin; Network-based; Outcome; Pathway Analysis; Physicians; Play; Positioning Attribute; Public Health; Public Health Practice; Public Policy; Randomized; Randomized Controlled Trials; Research; Research Infrastructure; Research Methodology; Research Personnel; Resources; Role; Rural; Sampling; Shapes; Social Network; Sociology; Structure; Target Populations; Testing; Theoretical model; Training; Vaccination; Vulnerable Populations; Water Purification; Work; Writing; base; career; community living; design; global health; improved; innovation; mathematical model; meetings; micronutrient deficiency; model design; population health; public health relevance; research study; social; social health determinants

DESCRIPTION (provided by applicant): Theoretical models suggest that the efficacy of public health interventions could be enhanced by tailoring distribution strategies to the network structure of target populations. Such approaches could yield large benefits in low-resource settings, where limited health infrastructure renders standard approaches ineffective, but the concepts lack empirical support. In 32 villages of rural Honduras, a research team and I conducted a randomized controlled trial of network-based public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. In one-third of villages, interventions were first introduced to a 5% sample of individuals occupying high in-degree positions. In another third, interventions were introduced to a 5% sample of nominated friends, while the remaining villages were targeted randomly. This proposed project now aims to evaluate the results of this field experiment to examine the dissemination of the interventions, changes in knowledge, attitudes, and behavior, and ultimately health outcomes, in order to test the hypothesis that tailoring public health interventions to local network structure can enhance the spread and adoption of those interventions and thereby improve population health. My long-term career goal is to become an independent physician-investigator who brings together clinical medicine, health policy, and public health to understand and address the social determinants of health and underlying social structures that are associated with health-related knowledge, attitudes, and behaviors. As an MD-PhD candidate in health policy, with a medical sociology focus, I need additional mentorship and training in analytic methods to help me craft an interdisciplinary research approach. My three-year Training Plan will include coursework, supervised data analysis, manuscript writing, and attendance and presentations at professional meetings. I will utilize this training and my Project Sponsors' expertise on conducting research on social networks and health to accomplish my scientific objective: to acquire a more robust understanding of how network-based targeting methods for public health interventions can affect the spread of the interventions. In pursuit of this objective, I will seek to achieve two specific aims: (1) evaluate outcomes of a field experiment implemented in rural Honduras using network-based treatments in a randomized controlled design; and (2) develop a model for how individual-level attributes and network characteristics shape the rate and scope of diffusion of health interventions. The proposed research is innovative because it is among the first to provide empirical evidence for targeting public health interventions based on sociometric segmentation. It is significant because it has the potential to inform theoretical models, and more importantly, future interventions and health policies by providing a more comprehensive understanding of the articulations between social ties and health.

描述（由申请人提供）：理论模型表明，可以通过针对目标人群的网络结构量身定制分配策略来增强公共卫生干预措施的功效。这种方法在低资源环境中可能会产生巨大的好处，在这种情况下，健康基础设施有限使标准方法无效，但这些概念缺乏经验支持。在32个农村洪都拉斯村庄中，我和一个研究团队进行了一项基于网络的公共卫生干预措施的随机对照试验：用于水净化的氯和微量营养素缺陷的多种维生素。在三分之一的村庄中，首先将干预措施引入了5％占据高度职位的个人样本。在另一个三分之一中，将干预措施引入了5％的提名朋友样本，而其余村庄则是随机的。现在，该提出的项目旨在评估该领域实验的结果，以检查对干预措施，知识，态度和行为的变化的传播，以及最终的健康成果，以检验以下假设：将公共卫生干预量化对本地网络结构的裁缝可以增强这些干预措施的传播和采用。我的长期职业目标是成为一名独立的医师评估者，他们汇集了临床医学，健康政策和公共卫生，以理解和解决与健康相关知识，态度和行为相关的健康社会决定因素以及基本的社会结构。作为卫生政策的MD-PHD候选人，以医学社会学的重点，我需要进行其他指导和分析方法培训，以帮助我制作一种跨学科研究方法。我的三年培训计划将包括课程工作，监督数据分析，手稿写作以及在专业会议上的出席和演讲。我将利用这项培训以及我的项目赞助商在进行社交网络和健康研究方面的专业知识来实现​​我的科学目标：对基于网络的针对公共卫生干预措施如何影响干预措施的分布有更深入的了解。为了实现这一目标，我将寻求实现两个具体的目标：（1）评估在洪都拉斯农村实施的现场实验的结果，并在随机控制的设计中使用基于网络的治疗方法； （2）为个人级别的属性和网络特征如何影响健康干预措施扩散的速率和范围开发一个模型。拟议的研究具有创新性，因为它是第一个提供基于社会计量分割的公共卫生干预措施的经验证据之一。这很重要，因为它有可能通过对社会关系与健康之间的表达方式提供更全面的理解来告知理论模型，更重要的是，未来的干预措施和健康政策。