Social network targeting to maximise population behaviour change: a cluster randomised controlled trial

• Published in: The Lancet (British edition) 2015-07, Vol.386 (9989), p.145-153
• Main Authors: Kim, David A, BSc, Hwong, Alison R, BSc, Stafford, Derek, BSc, Hughes, D Alex, BSc, O'Malley, A James, Prof, Fowler, James H, Prof, Christakis, Nicholas A, Prof
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Chlorine; Disinfection - utilization; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Health promotion; Health Promotion - organization & administration; Honduras; Humans; Internal Medicine; Intervention; Male; Medication Adherence - statistics & numerical data; Micronutrients - deficiency; Middle Aged; Population; Public health; Public Health - methods; Rural Health - statistics & numerical data; Social Change; Social Class; Social Networking; Social networks; Socioeconomics; Sodium Hypochlorite; Studies; Villages; Vitamins - administration & dosage; Water purification; Water Purification - methods; Young Adult
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(15)60095-2

Summary Background Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change. Methods In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov , number NCT01672580. Findings Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25–541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1–20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p