Individual interactions in a multi-country implementation-focused quality of care network for maternal, newborn and child health: A social network analysis.
Individual interactions in a multi-country implementation-focused quality of care network for maternal, newborn and child health: A social network analysis.
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DOI：
10.1371/journal.pgph.0001769
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发表时间：
2023
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建立了提高产妇、新生儿和儿童健康护理质量网络(QCN)，以建立一个关于提高质量实施办法以降低死亡率的联合学习的跨国平台。本文描述和探讨了四个国家和全球的QCN的结构。利用社会网络分析(SNA)，这项横断面研究绘制了全球一级和四个国家(孟加拉国、埃塞俄比亚、马拉维和乌干达)的QCN网络图，并评估了相关行为者之间的互动。经过有目的的滚雪球抽样，303个关键行为者于2022年初完成了预先测试的封闭式结构问卷。将数据输入在线调查工具，并导出到Microsoft Excel进行数据管理和分析。作为更广泛评估的一部分，这项研究得到了伦理上的认可。SNA确定了这四个国家和全球一级的566个行为者。孟加拉国、马拉维和乌干达拥有多枢纽网络，这意味着多个行为者集群反映了设施或地区网络，而埃塞俄比亚和全球一级的网络则具有更集中的网络。各国网络都有一些共同特点，如网络总体密度低、系统各级行为者参与、被确定为行为者主要作用的相关委员会成员以及各种类型的互动(学习、行动和信息共享)。联系最密切的行为者是除埃塞俄比亚以外所有国家的设施一级行为者，埃塞俄比亚大多有国家级行为者。结果显示了评估中评估的每个网络的独特性和复杂性。他们还肯定对这些网络的性质进行更广泛的定性评价，包括其组成和领导力。网络成员之间的沟通存在差距，国家之间和与全球一级的行动者之间的互动有限，表明有机会加强合格国家网络。
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) was established to build a cross-country platform for joint-learning around quality improvement implementation approaches to reduce mortality. This paper describes and explores the structure of the QCN in four countries and at global level. Using Social Network Analysis (SNA), this cross-sectional study maps the QCN networks at global level and in four countries (Bangladesh, Ethiopia, Malawi and Uganda) and assesses the interactions among actors involved. A pre-tested closed-ended structured questionnaire was completed by 303 key actors in early 2022 following purposeful and snowballing sampling. Data were entered into an online survey tool, and exported into Microsoft Excel for data management and analysis. This study received ethical approval as part of a broader evaluation. The SNA identified 566 actors across the four countries and at global level. Bangladesh, Malawi and Uganda had multiple-hub networks signifying multiple clusters of actors reflecting facility or district networks, whereas the network in Ethiopia and at global level had more centralized networks. There were some common features across the country networks, such as low overall density of the network, engagement of actors at all levels of the system, membership of related committees identified as the primary role of actors, and interactions spanning all types (learning, action and information sharing). The most connected actors were facility level actors in all countries except Ethiopia, which had mostly national level actors. The results reveal the uniqueness and complexity of each network assessed in the evaluation. They also affirm the broader qualitative evaluation assessing the nature of these networks, including composition and leadership. Gaps in communication between members of the network and limited interactions of actors between countries and with global level actors signal opportunities to strengthen QCN.