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Social networks as influencers of health behavior change

By Artur Direito, on 28 February 2018

By Dr. Madalina Sucala, Manager of Behavioral Science at Johnson and Johnson

When discussing social networks’ relevance for healthcare, we must keep in mind that non-virtual social networks have been studied in biology, epidemiology, and public health for a long time, with a wealth of knowledge acquired. The type of social network, along with its density, hierarchies, strength of ties, or influential nodes are among the variables shown to impact the way a network influences health. Communicable diseases would be an easy example of how a network can impact health (think of a crowded office during flu season), but noncommunicable disease can also have unintended health effects in other people to whom we are connected. For example, depression may impact someone’s ability to care for their chronically ill child, thus affecting the health of the entire family.

Social networks can also positively impact our health through influencing our health behaviors, and there are studies suggesting that such networks have a role in reducing certain risk behaviors, such as smoking or alcohol consumption. For example, there is evidence suggesting that smoking trends can spread through close and distant social connections, and that groups of connected people stop smoking in concert, with remaining smokers becoming increasingly more marginalized. Recognizing that behavior can spread and cascade across social networks, researchers are now focusing on how to leverage the effect of such networks to promote healthy behaviors. In 2015, a study showed that introducing a nutritional health intervention within a social network and targeting the influential individuals of that network (the nominated friends of random individuals – because what you always feared and suspected is true and “your friends have more friends than you do”) enhanced that intervention’s adoption.

With technology becoming increasingly embedded into the fabric of our lives, social networks can also take a virtual shape, and social media is becoming increasingly used as a platform for networks focused on health. For example, users can benefit from joining health specific groups, such as Smokefree Women Facebook page, or Breast Cancer Social Media Twitter #BCSM, where they can find informational and support resources to help them better manage their health. In addition to social media options, there are various other health information platforms. For example, Cancer.com, is designed specifically to help provide information from reliable sources. Another platform, PatientsLikeMe, helps patients connect with other patients with the same disease with whom they can share information about treatment, symptoms, and outcome data.

While showing promise, research is still needed to hone the optimal strategies for initiating and maintaining health behavior change by leveraging virtual social networks. Social network analysis, a method that quantifies participant engagement and offers a visual and descriptive analysis of the network, may uncover the variables or mechanisms that may drive innovation and strategy in such interventions. For example, a recent study investigating how the social network of a smoking cessation community behaves within the confines of a Facebook group highlighted the key role that moderators play for network engagement. By acknowledging the role of social networks and studying their impact on our health behaviors, we can have a better understanding of the system of factors that we can leverage for improving health outcomes.

Beyond the fact that technology enables the existence of such virtual social networks, it also enables a faster and more precise data collection and analysis of their role and impact as influencers of health behavior change. Technology can be leveraged to influence health not only because it supports wider access to information, or because recent advancements bring more engaging social media features, but more importantly, because people’s health behaviors, along with their influencers, can be better understood.  On the basis of such findings, researchers and practitioners can improve design, implementation, and program evaluation of social network sites focused on health behavior. They can also have a better understanding of what works, for whom, and for what health outcomes, allowing the personalization and optimization of interventions that will outperform the “one size fits all” model. This is valuable because it may allow greater patient engagement and sustain health outcomes over time.

Food for thought:

  • Think about a health behavior that you might want to target and consider the role that the participants’ social networks might have in influencing their behavior change process
  • What are the mechanisms through which social networks would influence that specific behavior and how would you leverage them in a digital health intervention?


Dr. Madalina Sucala

Madalina Sucala, PhD, is a Manager of Behavioral Science at Johnson and Johnson, where she focuses on the development, evaluation and implementation of digital behavior change interventions.



2 Responses to “Social networks as influencers of health behavior change”

  • 1
    Colin Bullen wrote on 12 March 2018:

    Great blog Madalina, thank you. We’ve been fans of Christakis and Fowler’s work for some time. In response to your questions:
    – we think the employer has an important role to play in connecting employees in a ‘social contagion’ loop designed to enhance healthy and performance behaviours
    – behaviour change by social influence only will have limited impact. To create widespread change we think you need to consider the other contexts, including the virtual/systems context (which includes legislation, culture, policies, procedures etc) and the physical/built (spaces) environment.
    – The social network should be an environment for storytelling, not for pumping out facts. People respond to stories from ‘people like me’, and these heuristic learning mechanisms have greater longevity, allowing people to stay the course until new (healthier) habits are created.
    – In summary, technology might provide the vehicle (and this might take many forms), but content will generate the change.

  • 2
    MS Variance: Empowered patients and the role of self-directed care : MS Academy wrote on 3 December 2018:

    […] in Shift-ms, he is well placed to understand the positive effect of belonging to a network, and cited studies suggesting that these social networks can positively reduce risk behaviours and ought to be used to […]

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