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Innovation diffusion: how homogenous networks influence the uptake of community-based injectable contraceptives

  • Akinyemi, Oluwaseun1, 2
  • Harris, Bronwyn3, 4
  • Kawonga, Mary2
  • 1 |University of Ibadan, Department of Health Policy and Management, College of Medicine, Ibadan, Nigeria , Ibadan (Nigeria)
  • 2 University of the Witwatersrand, Department of Community Health, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa , Johannesburg (South Africa)
  • 3 University of the Witwatersrand, Centre for Health Policy, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa , Johannesburg (South Africa)
  • 4 University of Warwick, Division of Health Sciences, Warwick Medical School, Coventry, UK , Coventry (United Kingdom)
Published Article
BMC Public Health
Springer (Biomed Central Ltd.)
Publication Date
Nov 14, 2019
DOI: 10.1186/s12889-019-7819-5
Springer Nature


BackgroundStudies have shown that social networks influence health behaviors, including the adoption of health innovations. This study explored the potential for early adopters of community health worker-delivered injectable contraceptives (CHWDIC) to influence the uptake of this innovation by women in their social networks.MethodsThis Social Network Analysis (SNA) study was conducted in Gombe, Nigeria. Twenty women who were early adopters of the CHWDIC were recruited. Each participant (ego) listed ten women of reproductive age (alters) with whom they related. An interviewer-administered questionnaire was used to collect from each ego, data about the nature of her relationship with each alter (ego-alter relationship), whether she talked about CHWDIC with each alter, and whether her listed alters talked to each other about CHWDIC (alter-alter relationship). Data were also collected on age, marital status and education level for each ego and alter. Data were analyzed with UCINET social network analysis software. Variables of interest include homophilia (similarity), density (number of ties as a proportion of possible ties), degree (popularity) and betweeness (frequency of connecting actor pairs who otherwise might not communicate).ResultsThere were 20 egos and 200 alters. Between two thirds (alters) and three quarters (egos) of the women were 30 years or older. All of the egos and 196 (98%) of alters were married. Most of the networks had similar (homophilic) actors according to certain sociodemographic characteristics - ethnicity, age, education and type of marriage. More than 90% of the networks had density greater than 50%, suggesting high cohesion in most networks. The majority of actors in these networks used injectable contraceptives. In some of the networks, few actors with the highest prominence (betweeness centrality) were not users of injectable contraceptives.ConclusionThe study illustrates the application and feasibility of ego SNA in identifying champions and opinion leaders among women of reproductive age group. It also shows the influence of social networks on the diffusion of community-based injectable contraceptives, and how homophilic and dense networks may have positive health externality. The interrelatedness of network members’ decision to adopt a health innovation was also demonstrated by the findings of this study.

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