Much of behavior change programming is targeted to the individual level. Rational actor theories are heavy on constructs related to an individual’s beliefs and attitudes, basing behavioral choices on whether a person evaluates their abilities or the benefits of the behavior as sufficient to motivate that individual to perform the behavior. These ideas have been assailed on many fronts, as behavioral economists have shown over and over again that we act in “predictably irrational” ways (see Dan Ariely’s accessible introduction). Programs have slowly come to understand that social processes influence behavior, most often characterized by the inclusion of the perception of a social norm supporting or opposing a given behavior in the initial assessment questionnaire. For example, in a study I worked on related to FGM, one of our questions led to an understanding that “social norms” were a powerful motivator for behavior, but this finding left us with little idea of how to change things, and this was part of the reason I turned to social network analysis as an area of investigation.
The bad news is that things are far more complicated than I imagined. I thought that understanding the social determinants of health would essentially boil down to using something like Christina Bicchieri’s operational definitions of social norms to shed light on a norm and then following a set of proscribed procedures to change that norm through private education and/or public commitment. This does seem a reasonable way to proceed in some cases, but what I’ve stumbled upon is that sociology has much more to say about the structure of society than this.
Harrison White’s Identity and Control serves as a great explanation of a multi-level network understanding of society, starting with the basic unit, not of the “person,” but of the identity. This means that his basic unit for understanding society isn’t simply a human being, but an aspect of that personality that interacts with other identities. For example, though I am a person, the identity I have as the author of this blog is quite different from my identity on a parenting website or a non-work-related social media profile. White uses this example of our different internet accounts to explain how we switch between identities based on our contexts and that these bundles of identities and the networks we’re a part of ultimately form who we are as a person, whether online, with work colleagues, within our families, or as we sit on a bus with strangers. So a simplistic understanding of the singular “network” of which we, as “persons” are a part, seems doomed to fail at a basic theoretical level.
But beyond this, the simplistic understanding of a network characterizing structural relationships as opposed to strictly individual attributes is also misleading. Think, for example, of your alumni network. If you meet a fellow alumnus at a networking event and he asks for your help, you don’t agree because of shared individual attributes (level of wealth, race, gender, etc.) or (necessarily) because of your direct network relationship (you know him through you friend who knows John who knows Suzie who knows Steve who knows him, though you may not know this series of connections at all!), but instead because of a shared identity that comes through an indirect sense of connection. But surely this kind of connection is incredibly important, whether it’s an alumni network, supporters of a football team, religious affiliation, or being from the same neighborhood (in the form of a community with a shared identity, as opposed to simply a relationship defined by some geographic proximity).
All of the complexities of White’s theories are far beyond the scope of a blog post, but as I begin to unpack in my own mind how sociological theory can inform SNA for health, these ideas have tangible consequences for how we implement programs. One of the most basic results that I’ve come across is a paper by Shakya et. al. (2014) that examines individual and village-level drivers of latrine uptake compared to the impact of the “network community,” defined in the paper by a strictly analytical method applied to whole network data to determine groups within which social influence is particularly strong. The main result is that these communities have a stronger effect that individual- or village-level influences, which should bring to mind immediate implications for how we target programs to change behaviors that are socially influenced.
As we look beyond the individual to larger “social” determinants of health, let’s be sure to really dig into the rich understanding of social systems and processes that sociological theory can contribute and not just think about “culture” or peer-influences in their reductionist forms.