Network-based Health Interventions in Rural Honduras

描述（由申请人提供）：理论模型表明，公共卫生干预措施的有效性可以通过针对目标人群的网络结构制定分配策略来提高。在资源匮乏的环境中，由于卫生基础设施有限，标准方法无法发挥作用，但这些概念缺乏经验支持，因此这些方法可产生巨大效益。在洪都拉斯农村的32个村庄，一个研究小组和我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：用于水净化的氯和用于微量营养素缺乏症的多种维生素。在三分之一的村庄，干预措施首先介绍了5%的样本个人占据高学位的职位。在另外三分之一的国家，干预措施被引入到5%的被提名的朋友样本中，而其余的村庄则是随机选择的。该项目旨在评估这一实地实验的结果，以检查干预措施的传播，知识，态度和行为的变化，并最终健康结果，以检验这一假设，即根据当地网络结构定制公共卫生干预措施可以提高这些干预措施的传播和采用，从而改善人口健康。我的长期职业目标是成为一名独立的医生调查员，将临床医学，卫生政策和公共卫生结合在一起，以了解和解决健康的社会决定因素以及与健康相关的知识，态度和行为相关的潜在社会结构。作为卫生政策的MD-PhD候选人，以医学社会学为重点，我需要额外的指导和分析方法的培训，以帮助我制定跨学科的研究方法。我的三年培训计划将包括课程作业，监督数据分析，手稿写作，以及出席专业会议和演讲。我将利用这次培训和我的项目赞助商在开展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：更深入地了解公共卫生干预措施中基于网络的定向方法如何影响干预措施的传播。为了实现这一目标，我将寻求实现两个具体目标：（1）评估在洪都拉斯农村实施的一项现场实验的结果，该实验采用随机对照设计，采用基于网络的治疗方法;（2）开发一个模型，说明个人层面的属性和网络特征如何塑造健康干预措施的传播速度和范围。拟议的研究是创新的，因为它是第一个提供经验证据，有针对性的公共卫生干预措施的基础上社会计量细分。这是重要的，因为它有可能告知理论模型，更重要的是，未来的干预措施和卫生政策，通过提供一个更全面的了解社会关系和健康之间的联系。

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.