Network-based Health Interventions in Rural Honduras

描述(由申请人提供)：理论模型表明，通过根据目标人群的网络结构调整分配战略，可以提高公共卫生干预措施的效力。这种方法可以在资源匮乏的情况下产生巨大的好处，在那里，有限的卫生基础设施使标准方法无效，但这些概念缺乏经验支持。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的随机对照试验：氯气用于净水，多种维生素用于微量营养素缺乏。在三分之一的村庄中，首先对担任高学历职位的5%的人进行了干预。在另一个三分之一中，对5%的被提名的朋友进行了干预，而其余的村庄则是随机选择的。这项拟议的项目现在旨在评估这项实地试验的结果，以检查干预措施的传播情况、知识、态度和行为的变化，以及最终的健康结果，以检验根据当地网络结构定制公共卫生干预措施可以促进这些干预措施的传播和采用，从而改善人口健康的假设。我的长期职业目标是成为一名独立的医生兼调查员，将临床医学、卫生政策和公共卫生结合在一起，了解和解决与健康相关的知识、态度和行为相关的健康的社会决定因素和潜在的社会结构。作为一名卫生政策医学博士研究生，我专注于医学社会学，我需要更多的分析方法方面的指导和培训，以帮助我制定一种跨学科的研究方法。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发表演讲。我将利用这次培训和我的项目发起人在进行社会网络和健康研究方面的专业知识来实现我的科学目标：更有力地了解公共卫生干预措施的基于网络的目标方法如何影响干预措施的传播。为了实现这一目标，我将努力实现两个具体目标：(1)以随机对照设计评价洪都拉斯农村地区使用网络治疗的实地试验的成果；(2)建立一个模型，说明个人水平的属性和网络特征如何影响卫生干预传播的速度和范围。这项拟议的研究具有创新性，因为它是第一批为基于社会计量分割的公共卫生干预措施提供经验证据的研究之一。它之所以意义重大，是因为它有可能为理论模型提供信息，更重要的是，通过提供对社会关系和健康之间联系的更全面的理解，为未来的干预和卫生政策提供信息。

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.