Delineating interpersonal communication networks: a study of the diffusion of an intervention among female entertainment workers in Shanghai, China.
Diffusion of innovation (DOI) is widely cited in the HIV behavior change literature; however there is a dearth of research on the application of DOI in interventions for sex workers. Following a randomized-controlled trial of HIV risk reduction among female entertainment workers (FEWs) in Shanghai, China, we used qualitative approaches to delineate potential interpersonal communication networks and contributing factors that promote diffusion of information in entertainment venues. Results showed that top-down communication networks from the venue owners to the FEWs were efficient for diffusion of information. Mammies/madams, who act as intermediaries between FEWs and clients form an essential part of FEWs' social networks but do not function as information disseminators due to a conflict of interest between safer sex and maximizing profits. Diffusion of information in large venues tended to rely more on aspects of the physical environment to create intimacy and on pressure from managers to stimulate communication. In small venues, communication and conversations occurred more spontaneously among FEWs. Information about safer sex appeared to be more easily disseminated when the message and the approach used to convey information could be tailored to people working at different levels in the venues. Results suggest that safer sex messages should be provided consistently following an intervention to further promote intervention diffusion, and health-related employer liability systems in entertainment venues should be established, in which employers are responsible for the health of their employees. Our study suggests that existing personal networks can be used to disseminate information in entertainment venues and one should be mindful about the context-specific interactions between FEWs and others in their social networks to better achieve diffusion of interventions.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. star107c@gmail.com
Yiyun
Y
Chen
Carl
C
Latkin
David D
DD
Celentano
Xiushi
X
Yang
Xiaoming
X
Li
Guomei
G
Xia
Jia
J
Miao
Pamela J
PJ
Surkan
D000293:Adolescent; D000328:Adult; D002681:China; D003142:Communication; D017280:Condoms / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D011477:Sex Work; D060386:Sex Workers; D012747:Sexual Partners; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D047568:Unsafe Sex; D055815:Young Adult