Hanson, Dale William (2007) Community safety promotion networks: from metaphor to methodology. PhD thesis, James Cook University.

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Abstract

Injuries are preventable. However, discrepancy between academic, practitioner, community and political perceptions regarding injury causation remain an important barrier to mounting an effective response.

The biomechanical model of injury prevention dominated the late 20th century. Injury was defined as “any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen”. This reductionist perspective overlooks the importance of the psychological and sociological determinants of injury. Safety has physical, psychological and sociological dimensions. Interventions aiming to achieve long term improvements in community safety must seek to develop sustainable safety promoting characteristics within the target community.

The thesis proposes the “injury iceberg”, a unifying cognitive framework designed to facilitate productive dialogue between the academic, professional and community groups required to design and implement effective community based safety promotion interventions. The individual is, metaphorically speaking, the “tip of the iceberg,” just one part of a complex ecological system. While they may be the most visible part of this system, important determinants of behaviour and environmental risk are “hidden below the waterline.”

While this comprehensive, wholistic model of safety promotion offers many opportunities to address a community’s injury problem, it also poses special challenges. The dynamic, multi-causal, multi-level nature of community safety means it is resistant to interventions designed by a single profession or agency. Promoting safety requires a multifaceted, comprehensive response.

Networks have been advocated as an effective response to the complex problems that plague modern society. Health practitioners, researchers, administrators and politicians have all embraced the network metaphor. By networking, sharing knowledge, expertise and resources, it is argued that communities can be empowered to generate the critical mass of expertise, resources and activity required to promote their own health and safety.

The Mackay Injury Surveillance Network was established in 1997 as part of the Queensland Injury Surveillance Network. It reported 35,211 injury presentations to regional Emergency Departments over the three year period from the 1st of January 1998 to the 31st of December 2000. This represented an age standardised rate of 12,584 per 100,000 for males, 2.0 times that observed in South Brisbane, and 6,319 per 100,000 for females, 1.7 times that observed in South Brisbane, suggesting that Mackay, like other Australian regional cities, had comparatively high injury rates in relation to major urban centres.

Mackay Whitsunday Safe Communities was launched in February 2000 in response to excess injury morbidity observed in the region. In keeping with contemporary wisdom it formed a collaborative network. Given that Mackay Whitsunday Safe Communities used a social process, a collaborative network, to achieve its public health objectives, it was important to evaluate the network using a research tool able to analyse the structure and function of this social system. The standard approach used by epidemiologists and health promotion researchers is to define a population and study a representative sample of individuals with this population. A key assumption is that the attributes and behaviour of individuals are independent. However, in human systems, the interdependence of actors and their social and physical environment is an essential characteristic of human social interaction. To meaningfully understand how social systems work, research tools must be able to describe and model the inter-dependence of human social systems.

This thesis used social network analysis to evaluate Mackay Whitsunday Safe Communities. Social network analysis is a quantitative sociological methodology that maps and analyses the relationships observed in a social network. By collating this set of relationships, it is possible using graph theory to mathematically describe and analyse a social system. Social network analysis therefore has the capacity to model the interdependent interaction between individuals, their immediate interpersonal environment and the overall social system. It therefore had the potential to provide unique insights into how safety promotion networks such as Mackay Whitsunday Safe Communities function.

The network was delineated using a snowballing technique that followed a chain of relationships emanating from the Mackay Whitsunday Safe Communities Network Support Group over three survey waves. Respondents were asked to actively recall relationships with people they considered facilitated their contribution to community safety, including people who were not members of Mackay Whitsunday Safe Communities. This allowed the identification of an external support network that may also contribute to the capacity of the network.

Social network analysis proved a powerful tool, providing diagrammatic representation of the social structure and quantifying important changes in the structure and function of community safety promotion network and its external support network. Since the network was established the number of relationships doubled from 500 to 1002, the relational distance separating network members decreased (average distance reduced from 3.9 to 2.7) and cohesiveness of the network increased (density increased from 0.022 to 0.036). There was increased tendency for group formation (clustering coefficient increased from 0.30 to 0.50) and a more centralised structure (centralisation index increased from 18% to 43%). Mackay Whitsunday Safe Communities had clearly succeeded in developing cohesive social capital – the ability to collaborate for mutual benefit.

However, social network analysis also provided compelling evidence that a small number of well-connected social entrepreneurs played an important facilitative role in network activities. Whether measured in terms of direct social influence, efficiency of communication, or brokering potential, six actors were disproportionately influential, maintaining 44% of all relationships and brokering 52% of in-kind, 54% of human and 66% of financial investments made in the network. They provided an important social conduit for the transfer of information, expertise and resources within the system.

In 2004 the network accessed an estimated 6.5 FTE of staff time and $0.9 million dollars. However, Mackay Whitsunday Safe Communities is an open network. It can only be properly understood in the context of its external support network. While rich in social resources, the discretionary in-kind, human and financial resources mobilised within this community network were limited. These resources were largely accessed from, and controlled by, an external support network. Open systems never achieve equilibrium, a theoretic state of in which the resources produced by the system are sufficient to sustain system function. Rather, open systems can only be sustained in steady state, a dynamic state in which the flux of resources into and out of the system are sufficient to maintain network function. The entrepreneurial bridging relationships that unite network members around a cause and facilitate access to the in-kind, human, financial and social resources necessary to maintain network productivity are therefore critical to ensure the sustainability of community safety promotion networks.

Maintaining a functional safety promotion network has a cost. In this study the number of relationships maintained by network members was strongly correlated with the amount of time they invested in network activities. However, the relational pressure this placed on the network facilitators was evident. As a group they process 258 incoming relationships (43 relationships per facilitator), compared with 1.8 incoming relationships for other network members.

This network analysis identified that two types of social capital were necessary to develop and sustain a productive community safety promotion network: cohesive social capital and entrepreneurial social capital. The development of stronger, dense relationships (cohesive social capital) meant that Mackay Whitsunday Safe Communities was better positioned to co-operate for mutual benefit and thereby promote safe standards of community conduct and a safe physical environment. However, to develop this state and facilitate a sustainable resource base to maintain it, the entrepreneurial social capital of key network facilitators appeared to be critical component of network function.

Item ID:	1751
Item Type:	Thesis (PhD)
Keywords:	Mackay, Whitsunday, safety, intervention, accidents, emergency, support, prevention, promotion, community, social capital, social network analysis, injury iceberg, cognitive framework, ecological health promotion, sustainable, safe communities, health education, Mackay Injury Surveillance Network, Mackay Whitsunday Safe Communities, hospital separations, admissions, discharges, triad census, actor centrality
Copyright Information:	Copyright © 2007 Dale William Hanson
Date Deposited:	13 Nov 2007
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111708 Health and Community Services @ 0% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111711 Health Information Systems (incl Surveillance) @ 0% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111712 Health Promotion @ 0%
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