I’ve just submitted my PhD! Cue a giant sigh of relief.
I’ve been with The Cynefin Co, on the Health Programme team, since April 2021. Alongside this, I have been on a four-year journey of a cotutelle PhD in Exercise, Nutrition, and Health Sciences between the University of Bristol and the University of Cape Town, titled:
“The role of social network analysis in scaling-up and sustaining community-based health programmes in low- and middle-income countries.”
In (very) brief, I conducted a five study exploration of how to use social network analysis, the measurement and visualisation of relationships between actors in a network, to strengthen community-based health promotion programmes using a South African case study (abstract at the end). All the relevant reports and publications will follow after my viva but for now I’d like to reflect on how The Cynefin Co influenced where my research started to where it ended up.
For the first two years, the aim of this PhD was to explore “what works”. My plan was to determine exactly what social network structures of health programmes lead to their scale-up and sustainability – I’m sorry, I was young and naïve then! It became very clear that not only would it be difficult to measure the social networks of a complex, widely spread community programme which had no way of objectively and simply being labelled a success, but applying any findings to another context would likely not be very valuable.
It was around this time that I joined The Cynefin Co. It was working here that I really learnt about complex adaptive systems and the value of mapping what is currently happening in order to make small decisions that move to an improved future. The work of The Cynefin Co and Dave Snowden validated my feelings that the PhD trajectory I was on, that of trying to create acontextual end-goals of community programme networks, was not worth the time and energy I would have expended on it. It was too late down the line to include The Cynefin Co tools like SenseMaker®, and Estuarine Mapping didn’t exist in the public domain then, but I knew I could use these ways of thinking about, and valuing, complexity in my PhD work.
The Cynefin Co alone didn’t change my PhD focus (that of now taking a step back and exploring the feasibility of SNA in community programme settings). The participants of my research themselves reflected a need for capturing the complexity of their network, being open to unexpected and expected changes, and using real-time data to make small actions towards strengthened relationships (very Vector Theory of Change). I did not use the tools offered but The Cynefin Co helped to give language to what was already being expressed by those on the ground. In the end, I came out with a PhD that provides more questions than answers to community health programmes – and I’m far happier for it.
I suppose my take-away message would be for those who are interested but you/your company are not ready to engage in SenseMaker, Estuarine Mapping, entangled trios etc. Know that you don’t have to use these tools to engage in complexity thinking. The Cynefin Co. is not a gatekeeper to sense-making, it’s a supporter. Challenge yourself and those around you to think about narratives and vector theory of change. Start opening conversations and thought experiments about how it might apply to the work you are doing. Normalise complexity thinking, because the world is so often complex and powerful ideas can come out of it if we listen to it.
….of course, if you would like to engage in our support and tools, let us know!
Background: Non-communicable diseases [NCDs] are an ever-increasing burden globally with low- and middle-income countries [LMICs] disproportionately affected. Community-based programmes [CBPs], which aim to improve the wellbeing of specified populations in a contextually relevant way, have been identified by the World Health Organization as a cost-effective prevention and management strategy of NCDs. However, evidence for scaling-up and sustaining CBPs remains limited. A potential tool to scale-up CBPs could be social network analysis [SNA] which considers real-world complexity by quantifying and visualising relationships between stakeholders. Objective: To explore the role of SNA in scaling-up and sustaining CBPs in LMICs. Methods: Mixed-methods, five sequential studies: 1) Scoping review of SNA in scaling-up and sustaining CBPs in LMICs; 2) Feasibility study of SNA within the case study programme, WoW!, 3) Full SNA of WoW!, 4) Interviews with WoW! stakeholders exploring context and mechanism factors that might be present in the scale-up and sustainability of WoW!, and 5) Interviews exploring the perceptions of WoW! stakeholders of the process and value of SNA. Results: Study 1 identified only three studies that conducted SNA, supporting this research. Study 2 identified practical challenges of collecting SNA data within complex settings, informing approaches for Study 3 which revealed a centralised network, unclear role differentiation, and low rural representation. Study 4 interviewees provided contextual understanding of the SNA findings, with Study 5 participants indicating that while some aspects of SNA were useful, i.e., visual outputs, most analyses did not provide actionable information. They proposed the use of a “live mapping” tool providing the visual benefits of SNA while taking into account the data collection capabilities and information needed to measure and act in complex community networks. Conclusion: This research contributes to the development of a pragmatic and feasible SNA tool in improving the scale-up and sustainability of complex CBPs, particularly in LMICs.
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