Using network analysis to understand community-based programs: a case study from highland Madagascar.
BACKGROUND
Programs using community-based distribution (CBD) of family planning services have had mixed success in Sub-Saharan Africa. Knowledge about why these programs succeed or fail is limited.


METHODS
In 1999, a total of 159 women and men of reproductive age were interviewed in a village in highland Madagascar with an active community-based family planning program. Network analysis informed by chi-square tests and multiple regression analysis was used to test whether respondents' communication with CBD agents and the location of their discussion partners were associated with their knowledge and use of family planning.


RESULTS
The CBD agents were highly central in the village's family planning network; 35% of women and 19% of men directly communicated with a CBD agent about family planning or were indirectly linked to an agent. Knowledge of family planning was associated with having either a direct or an indirect link to a CBD agent; use of a modern method was associated with discussing family planning only with someone outside the village (odds ratio, 12.6) or with discussing it in the village and communicating directly with a CBD agent (10.8).


CONCLUSIONS
Network analysis can improve the understanding of community-based program functioning by providing a way to examine who receives information from and is influenced by CBD agents.
Stoebenau
Kirsten
K
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Valente
Thomas W
TW
D000293:Adolescent; D000328:Adult; D019058:Community Networks / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008270:Madagascar; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D015397:Program Evaluation