shcr review 2015 - appendix 4 real-time insights

1 | S H C R i m p a c t r e v i e w – A p p e n d i x 4

The School for Health and Care Radicals: what impact has it had?

Appendix 4: Real-time insights into the SHCR

Stella Martorana, CIPD


Contents Note......................................................................................................................................................... 2

Introduction ............................................................................................................................................ 3

Facebook group ....................................................................................................................................... 3

Group activity over time .................................................................................................................... 12

Perceived value of the school ................................................................................................................ 15

Realise the value of relationship ....................................................................................................... 17

Resilience .......................................................................................................................................... 17

Energy ............................................................................................................................................... 17

Technical aspects .................................................................................................................................. 18

Conclusion ............................................................................................................................................. 19

References ............................................................................................................................................. 20

Note This appendix forms part of the review of the 2015 School for Health and Care Radicals run by NHS Improving Quality. The review was conducted by the research arm of the CIPD between November 2014 and September 2015. The main report, which presents an overview of the findings, is also available.


Introduction The School for Health and Change Radicals is a free virtual learning programme for change activists in health and social care. The 2015 programme contains five modules over five weeks covering the following themes

Module 1. Being a health and care radical: change starts with me (30th January) Module 2. Building alliances: forming communities for change (6th February) Module 3: Rolling with resistance (13th February) Module 4: Making change happen (20th February) Module 5: Beyond the edge; what now? (27th February)

Modules are presented in webinars taking place on Friday every week and are complemented by learning materials, volunteer coaches/mentors, hub activity and regional school days, Tweetchats and online discussion on a Facebook group open to members only.

Early statistics from the 2015 school show a high level of take up and active engagement.

Nearly 5,000 enrolees in 2014 & 2015 2015: #SHCR: 20,786,339 impressions across 14,288 tweets @School4Radicals: reached 35,044 unique twitter accounts and had 1,686 followers 24,551 views of school materials, including attendees on live webinars. 426 members of the SHCR Facebook group

This report forms part of the second phase of the CIPD hindsight, insight and foresight review of the SHCR. It captures participants’ ‘real-time’ reflections on the school as they took part in it.

This insight was gathered through social interaction on the SHCR Facebook group, which was set up the 13th January to enhance the learning experience, facilitate knowledge sharing and networking.

To date (1st April 2015) it counts 426 members. Further data on this community is provided in the following sections.

Facebook group The Facebook group counts 426 members to date (1st April 2015).

In order to explore its structure and activities, we combined quantitative and qualitative research methods and used different software to support our analysis.

Our methods included data extraction though the app Netvizz, which helped us identify gender and Facebook local of group members but not the interaction because of API issues.

Data related to group activities were extracted and analysed through NodeXL, a free, open source excel template to explore network graphs and extract data related to posts and activity in the group. Further insights on the group such as social network metrics and data visualisation were produced with Gephi, an open-source network analysis and visualisation platform particularly used for big data.

With regards to our qualitative research, this was based on the real-time analysis of posts in the news feed of the group. The software NVivo 10 was used to support content analysis of the data.

The research team posted open questions on the Facebook page and followed up participants’ existing posts with probing questions. Participants were informed and reminded in such posts that their comments would form part of the SHCR evaluation. For example:


“Great to see so much social media activity on day 1 of the school. As part of our ongoing evaluation of # SHCR we'd like to understand how & why each of the modules resonate with your experience. What did you find useful in Module 1

today? Some posts on this already, but tell us more! How has your thinking changed from what you heard and what are you still grappling with? And most importantly, are you planning on doing anything differently? Please share your

thoughts!” Jonny Gifford, CIPD

The report focuses on three areas. Primarily, we explore the structure of the network. We present descriptive statistics, overall network metrics (no. nodes, edges), rankings (betweenness centrality) and other main metrics that will be described in the following section. We also provide a network graph illustrating the structure of the group.

Secondly, we focus on the value perceived by people doing the programme. It is not possible to demonstrate that these perceived benefits are transferred to real-life situations but they do give us insight into the perceived value, uses and benefits of the school and will guide our questions in latter parts of the evaluation. We structure this part of the report according to the themes that emerged from the content analysis.

Finally, we summarise comments on technical aspects of the school such as session times, Webex and Youtube recordings.

The network structure Gender

322 women 98 men 6 gender undisclosed.

Fig. 1 Gender of Facebook members

Facebook Local ‘Facebook local’ is the language chosen by users. This is selected by the user upon registration to Facebook and can be changed at any time in the ‘general setting’ tab. The qualitative analysis of posts allowed us to identify many Australian people active in the group. They are likely to fall into the category ‘en_US’ or ‘en_GB’. In this case the variable ‘Facebook local’ is clearly insufficient to identify the country where members are living or their nationality.

76%

23%

1%

women

men

undisclosed


Fig. 2 Facebook local of members

Table 1. Facebook local of members

n. group members Facebook local 1 da_DK Danish

226 en_gb English, GB 184 en_US English, US

1 es_LA Spanish 2 fr_FR French 3 it_IT Italian 1 lv_LV Latvian 1 nb_NO Norwegian 3 nl_NL Dutch 4 sv_SE Swedish

tot = 426 Active members 62% of Facebook members (263 people out of 426) have been active at least once. This means that they engaged at least once in one of the following activities: writing a post/comment or simply put a like to someone else’s post. The ones who did not write any comment but liked posts are 106. The remaining 38% have been inactive. In the part of the report where we present the network structure and the main network metrics, we will exclude any relationship created by “likes” and will narrow our attention to individuals who wrote comments/posts. These are 156 people which equals to 37% of group members. This result is aligned with the findings of our literature review (please see phase 1 report) according to which not all MOOCs participants engage in activities. The following activities have been detected.

• 240 posts • 918 comments • 1664 likes (this excludes likes to comments which cannot be tracked)

Edges = 31344 Edges represent interaction between users and define the size of the network. Below a list.

• Co-commenter = 8917 • Co-liker = 10694 • Commented post = 918 • Consecutive commenters = 8916

2%

54%

44% Europe, various

English, GB

English, US


• Created post = 232 (68 people wrote posts, which equals to 16% of group members) • Liked post = 1664

Comments to posts The total number of posts is 240 but not all of them generated discussions. 162 posts did and generated 918 replies in total. They were written by 150 people which equals to 35% of group members. The number of comments on a post ranges from 1 to 89. Below we present the most engaging posts sorted by number of replies.


Post Content Time Total Likes

Total Comments

I'm pondering over my #NHSChangeDay action for this year. I'm really passionate about continuing to support change agents / radicals to continue in their amazing work, but I wanted to run an idea past you first. My understanding is that what is really missing for these people (like you) is the emotional, psychological and relational support to (a) start the change and (b) continue, despite resistance. The change tools / methodologies / theory is all out there, but who do we have to turn to, bounce ideas off and listen to us when it gets tough - or we just need some peer support? That's my idea. A network of people who all want to be part of a people platform for catalysing change (name TBC!). We could hold webinars, chats, exchange visits, Skype calls, have a FB page / forum etc. It isn't in competition to the School (that's my day job!), it is to enhance it. Before I go any further in developing this - what do you think?

2015-02-14T13:20:44+0000

16 89

The truth is in there... Let's get the SHCR Playlist started! I like the idea of a "playlist for radicals." When you're feeling upbeat, music can fan the feeling from a spark to a flame, raise you higher to soar like an eagle until nothing can compare 2 U and you feel like you're into something good. You'll rise up to the challenge of your rivals, they ain't seen the best of you yet. And when you come up against another brick in the wall or you feel you're taking one step up and two steps back, don't worry about a thing because songs can help you look for the hero inside yourself. So pick yourself up, dust yourself off and start all over again - oops there goes another rubber tree plant! Now tell me what you want, what you really really want. Join the discussion here or using #SHCRplaylist on Twitter, and they'll be put on the SHCR Spotify list :)

2015-02-05T12:00:12+0000

15 44



Total Comments

I'm still thinking about the troublemaker/ rebel continuum, and wondering if we nearly have to start off towards the 'troublemaker' end...motivated by something that bothers us personally, inspired by negative emotions and unable to see what we can do about it? The 'alone', 'other' and 'disempowered' feelings are particularly relevant when a patient/ family member- outsiders almost by definition. Hmm. More space to ramble here than on twitter- that may not be a good thing ;)

2015-01-31T10:00:09+0000

14 39

Hello everyone - have any of you set up or joined a learning group since last week? We would love to put up a list of new groups in the WebEx tomorrow so if you know of a School group, please could you let us know about it? Many thanks.

2015-02-05T18:51:41+0000

2 36

Greetings and welcome to this week's new members. I hope you will feel free to ask questions, seek support, build alliances, let us know about great stuff you are doing and engage in conversations with other radicals. To get the conversation going, what's the most radical thing you did last week?!

2015-03-09T10:01:04+0000

5 20

Hello, you radical things. Now you've had your final injection of anti-stasis inspiration that was Module 5, you're doubtless thinking ahead to how you can apply the defibrillator to your organisation's change system, or perhaps massage the stiffness out of decision making procedures... As I've mentioned before, we're reviewing the SHCR and want to hear what worked well for you in the school and what you struggled with - either with the theory & content or with technical aspects like accessing materials - and even more importantly, what value the school represented to you, how your thinking's changed, what you're going to do differently. We're conscious that the learning doesn't stop here! Hopefully you'll be doing your final 'homework' reporting on impact for the end of March. This will be of great help to the review. But as you go back to the materials, as you continue to reflect, as you get new insights from contacts you've made, as you learn from experimentation... if you also want to share stories,

2015-02-27T16:57:44+0000

9 19



Total Comments

examples, changes, light-bulb moments with us - either here on FB, or directly, that would be great. I would like to share some PDSA notes with you ref: Module 1 tweet chat today. Would welcome your comments & contributions please! Aims: Make tweetchats user-friendly, engaging & change orientated helping student move swiftly from pre-contemplation to active change stage How will we know we have achieved it? - increased engagement, - more explicit change related tweets e.g. "I will..." - positive feedback from participants (to be asked during tweetchat) This will be achieved by: - less cerebral 'thinky' questions & more action 'doing' questions that help people move from contemplation to decision to active change - less questions: 3 is max! - less jargon - prepare definition tweets to help those who may not associate with the language / concepts - perhaps ways for different kinds of learners to engage? (Ideas?) - embed Twitter tool into website to enable people to engage in Twitter chat that way (may attract more - seem less scary)

2015-02-04T19:20:30+0000

3 18

Welcome to all new members! I hope you enjoyed today's module. Please do post your thoughts, reactions, ideas, suggestions, and connect with one another.

2015-01-30T11:10:33+0000

17 18

Great to see so much social media activity on day 1 of the school. 2015-01- 7 17



Total Comments

As part of our ongoing evaluation of #SHCR we'd like to understand how & why each of the modules resonate with your experience. What did you find useful in Module 1 today? Some posts on this already, but tell us more! How has your thinking changed from what you heard and what are you still grappling with? And most importantly, are you planning on doing anything differently? Please share your thoughts!

30T16:15:07+0000

Can radicals survive in this environment? I would love your views ...

2015-02-08T16:49:37+0000

25 16

Hi everyone I'd really welcome your advice. We're organising a wide dementia event in June to share good practice across the region. I had a bit of a lightbulb moment yesterday when I was watching Module 1 again. At previous events we've focused very much on the 'what to do' - tool kits, approaches from different areas etc. I'm keen to bring in a balance of transformational learning to engage people's emotions and increase capacity in the 'how'. Any thoughts on how to do

2015-02-11T10:08:23+0000

5 16

https://www.facebook.com/photo.php?fbid=10153071215187154&set=gm.1530813667207807&type=1



Total Comments

this? Patient/carer stories is about as far as I can get so any ideas much appreciated! New territory for me! Many thanks


Group activity over time The graph below depicts the group activity, in terms of number of comments and posts, since the group was set up, the 13th January, in coincidence with the webinars (3 Jan; 6 Feb; 13 Feb; 20 Feb; 27Feb) and until the 1st April 2015.

It is clear that the activity had a rise when the course started, in particular the number of comments had a steep increase in coincidence with the first webinar. The activity decreased in the following weeks to increase once again in coincidence with the end of the course.

As we aim to capture real-time reflections concerning the group we considered only data up to the 1st of April but the group is still active and more people are writing posts and comments.

Fig. 3 Number of comments and posts from 13 January to 1 April 2015

Social network analysis: main metrics and graph diagram

To create a visual representation of the network, we extracted data concerning participants and posts (vertices) and connections (edges).

Edges represent interaction between users such as co-commenter, co-liker, commented post, consecutive commenters, created post, liked post. For a complete list of edges detected in the network please see previous paragraph titled ‘edges’.

Before presenting the findings of our analysis please note the following points

Interaction represented by “likes” has been excluded Inactive members of the group have been excluded because the main metrics are designed for connected components. Therefore we considered only 157 members (vertices). This

23

51 55

21 23

67 48

279

179

137

60

215

0

50

100

150

200

250

300

posts comments


number was obtained by subtracting the number of individuals who only liked posts (106) to the total number of ‘active’ people (263).

The metrics calculated are the following

Vertices = 157 Edges = 3227 Betweness centrality. We provide an indication of these values in figure 4. Average degree = 20.5 Modularity = 0.31 Average path length = 2.04 Graph density = 0.14 Network diameter = 5

To produce a clear visualisation of the Facebook group, we laid out the graph using the algorithm “Force Atlas” that pushes the most connected hubs apart from each other and positions nodes connected to them in clusters around the hubs.

The centrality measure we calculated is “betweness”. Centrality measures offer an indication of the social power of a node and betweness in particular reflects “the extent to which a node lies between other nodes in the network” (Wasserman, Faust, 1994:9). Nodes with the highest values appear on the shortest path between any two randomly selected nodes in the network.

In figure 1, the size of the nodes has been adjusted by betweness centrality. Pip Hardy emerges as the individual responsible for connecting different individuals or subgroups together. This reflects her formal role as she is the Facebook group owner and main moderator.

Modularity calculations allowed us to identify clusters of nodes more densely connected together that with the rest of the network. If we look at figure 4 we will see two clusters coloured in blue and red. These two main groups include 71.34% (blue) and 21% of the nodes respectively.

The average path length is the average of the distances between any pair of nodes in the network (Wasserman, Fraus, 2004). This value is 2.04, in other words clusters are well connected.

The average degree is 20.554 which means that on average a member of this group is Facebook friend with other 20 people who are also part of this group and this is a pretty good result.

Clustering is 0.7 (min=0; max=1). This is the degree to which nodes in the graph tend to cluster together (ibidem).

Graph density is 0.132 (min=0; max=1). This value is relative to the maximum number of edges (connections) in the group. In other words, a dense graph is a graph in which the number of edges is close to the maximal number of edges. As highlighted by Wasserman and Fraus (1994:84) the distinction between sparse and dense graph is vague.

In figure 4 we see the general structure of the network of active people.


Fig. 4 Structure of the SHCR social network on Facebook


Perceived value of the school In this section we present the results of our qualitative research, based on code analysis of posts published in the Facebook group from the 13th January to the 13th March. We structure this part of the report according to the themes that emerged from the content analysis.

Aligning with a shared purpose and mission is a central theme in individual posts and conversation threads, frequently intertwined with other outcomes identified in the CIPD impact model (see Appendix 2) such as ‘encourage and support others’ or ‘realise the value of relationships’.

“Fantastic being part of this global movement. I think this is the key one for me, and learning how to support others to believe the same.” SHCR participant

“I'm happy to learn there is such an amazing community building up the positivity of all the things we CAN do to impact health and care beginning at the personal level. Such a strong believer of this concept and the energy built by the collective belief in improvement WILL manage to get it done!” SHCR participant

Self-awareness is another dominant theme, emerging in post spontaneously written by students but also stimulated by prompts such as images and quotes. The post below is a self-reflection of a group member that turned tacit knowledge into explicit understanding of factors playing a role in the success of a ‘rebel’ project.

“Reflecting on troublemaker vs. rebel. At one of my placements I challenged a case, so my mentor just called me a troublemaker in the most positive sense. And I liked this. But now I think somewhat differently. Looking back, I do not think that I was a troublemaker. I think I was a rebel unconsciously, in this case, who was passionate about a young boy's care. I was optimistic as I saw the possibilities of better outcomes for him. My mission-focused approach created a team around the child. The team then generated even more energy and attracted other professionals. In the end, together we provided this young boy and his family with better care. But I had an excellent mentor, quite possibly a rebel himself, who supported me and let this happen. I aim to turn this unconscious process into a conscious framework.” SHCR participant

Online posts and images can stimulate debates around a topic and facilitate reflection and self-awareness. The Facebook group becomes a supportive space where people can experiment with the new things learned and embed knowledge of new methods in their actions. This gives students the opportunity to do some practice with new concepts, in other words it increases the odds of new behaviour display (Rogers, 2003). Figure 1 shows a post that resonated with several students, stimulating self-reflection and facilitating resilience.


Fig. 5 Facebook post

Encouraging and supporting others runs as a thread in many conversations. It can be identified in specific posts if the unit of analysis is the individual but it is better depicted by entire conversation threads where a person shares his thoughts or experiences and other members reply with encouraging comments and support.

“I'm hoping to keep in touch with some other radicals so we can inspire one another, share ideas, help 'troubleshoot', and support the times when being a radical is a bit tough” SHCR participant

“I am a speech & language therapy undergraduate with a year to go before qualifying and it has been so encouraging to know that there are people like the SHCR grads out there making things happen. The news about the NHS is often so discouraging that I sometimes wonder whether there is going to be anything left worth joining this time next year, but you have all shown me that the future is brighter than it might at times appear. Thanks!” SHCR participant

Knowledge of change methods is combined with encourage and support. Facebook members not only discuss the content of the module but frequently want to share their experiences, hear new ideas and seek peer support.


“We are just starting a service development to improve our community learning disability teams, and save money. It had started in a very traditional way but using what I have learnt it has just been agreed that I can set up a supporting group of change agents and engage staff in different ways. Very excited by this but looking for support. Doing a RCT today.” SHCR participant

Realise the value of relationship Understanding the value of relationships is one of the main learning objectives of the school, which run a dedicated module for it (‘Building alliances for change’) even though the importance of others and their appreciation runs as a thread throughout the course

“I understand that effective change doesn't happen from the top-down anymore (if it ever did), but I assumed that personal dynamism and a sense of get-up-and-go was enough to make things happen. Maybe it's enough to get things started, but I now understand that change will always be limited in its scope and impact if one doesn't at the same time seek to build networks and relations with like-minded people. So, yes: a day of revelation for me!” SHCR participant

“I keep thinking about how the power of network and relationships is greater than the power of hierarchy.” SHCR participant

Resilience Many posts contain the theme resilience, describing episodes and stories where individuals struggled with achieving their change objective because of external barriers. One student wrote ‘change is bloody hard…but bloody marvellous when it starts to come together’.

In this context, resilience emerges as the ability not to rely on contextual factors, often negative, but to persist in the change activity despite of them. There is a linkage with the social identity provided by the group, in other words the intermediate outcome ‘support and validation through network of peers’ becomes salient. Individuals define themselves in terms of group membership (Radical Change Agents) and this provides them with motivators independent from the immediate context.

“I will feel more confident advocating for the change I want to see and believe in and not focus on how I may be judged in the system. I'm well enough into my career to not be concerned with career limiting moves and experienced enough now to trust my gut and rock the boat!” SHCR participant

“I guess what I'm saying is that as radical change agents we should not be seeking out external factors for validation or motivation!” SHCR participant

Energy The posts below are exemplifications of the positive and energising effect attributed to social media.

“I think the conversation over the weekend has helped to embed the ideas, with all these great additional viewpoints layered on and offering a breadth of perspectives. I've never experienced a learning experience like it that feels so vital, so immediate, so full of energy!” SHCR participant

“Such a great experience to be building something together in real-time. And then that energy leaked back onto the chat group that ran contemporaneously with the presentation” SHCR participant

The different activities going on and the use of different platforms stimulated energy and excitement but need to be followed by quiet moments and spaces where people can reflect and assimilate all new learnings, as illustrated in the below posts.


“I found the live webinar a bit frenzied but there are so many ways to review and reflect on the course material that this is not a failing. Instead I try to immerse myself in the energy and worry about what I might have learnt when things are a little quieter” SHCR participant

“Can someone please put time on pause for a minute? I’m inspired by all this, but am having trouble reading all I want to in the time between Fridays! After doing the 2nd module live, I have felt really excited.” SHCR participant

Overall, participants who are active on Facebook value positively the integration of learning activities with online networking.

“Judging by the animated and wide-ranging debate that has been taking place pretty much non-stop since Friday, and that has been thriving especially over the weekend, I'd say the networks and social interaction are invaluable. They provide a safe space for us as a group to reflect on, help one another with, and work through the material that we heard presented on Friday. I would, therefore, say that, for me, the effectiveness of the two learning modes are indissociable and complementary.” SHCR participant

Technical aspects According to many students the live webinar should be moved to another day and time because Friday is a busy day, especially for Medical students. The alternative offline sessions (Youtube recordings) are valued positively by most participants.

“I’m a members of the 2015 school but sadly I have not been able to take part in the live sessions, but have thoroughly enjoyed playing catch-up” SHCR participant

“I haven't taken part in live sessions either, but feel the catch up option is almost as good. At least I don’t have to worry about my super slow broadband frustrating me during a live session!” SHCR participant

Some participants suggested to show photo of speakers in the Youtube recordings however also the live sessions show the main speaker only.

“Any chance the presentation for the next module could include photos of each of the presenters? They wouldn't have to stay up for long, but I do find it personalises things a bit more”. SHCR participant

Those less familiar with the concepts discussed during each module would like to access introductory materials before the webinars; this suggestion has already been accepted and implemented by the School.

“I have already made a few comments for those of us who don't have academic or medical backgrounds many of the cohort do, mainly around the value of getting an overview of the next module so that those of us who find focusing on both presentation and the chat window a bit of an overload if we are coming to the subject cold.” SHCR participant

Some felt that downloading and printing materials should be made easier as highlighted by a number of participants who struggled doing this.

“You can download the guides and print them. Took me a while to work out the button for that was off the bottom of the screen, had to scroll down on the main bar on the right of the screen to see it, not the document itself (in Internet Explorer)” SHCR participant


The integration of social media such as Twitter and Facebook in School activities received contradictory feedback. The Facebook group counts only 400 members and the active ones are much fewer.

“I don’t belong to Facebook. I find it a bit annoying that it plays such a central role in the School. I understand the role of social media, but also like to have some privacy for my personal life. I will join Twitter as I am curious and it allows me to maintain my sense of privacy.” SHCR participant

“Found the whole (tweet) chat a waste of my time, left isolated and bemused, lacking any real direction! I see lots of promise and potential here so keep at it, but please work on taking me with you, I just didn't get either the mechanism of Twitter at the technical 'how to' level, nor the value of it to me as a change agent - felt like glamour over substance.. Where does one go to even understand what a Twitter chat is, how to interact with it and etiquette and the like? Then make doubly clear in plain English where one find what is to be the subject of the chat. The provided signposting left me cold and abandoned. […]I just missed the essence of the value proposition of the chat.” SHCR participant

The complaints made around Twitter have been welcomed by the School, which published a Tweetchat top tips in response (what is Twitter; what’s the purpose, practical recommendations). The availability and visibility of this document is highly recommended for future courses as well.

Also Webex chats attracted both criticism and enthusiasm, with some participants saying ‘… there were so many of us. Would you be able to enable the private chat facility this might help’ and others commenting ‘such a great experience to be building something together in real-time. And then that energy leaked back onto the chat group that ran contemporaneously with the presentation’.

Overall, these findings highlight the value of a range of channels for interaction to suit diverse participants.

Conclusion This report focused on themes emerging from the social interaction in Facebook and included comments on technical aspects of the school such as session times, Webex and Youtube recordings. It also explored the structure of the social network and provided a graph diagram of it.

The main themes emerging from our code analysis are listed below.

Align with a shared purpose and mission Encouraging and supporting others Knowledge of change methods Realise the value of relationships Resilience Energy

In conclusion, the SHCR Facebook group is a supportive space where people experiment with new things learned and embed knowledge of new methods in their actions.

Online posts and images stimulate debates around a topic and facilitate reflection and self-awareness. This gives students the opportunity to do some practice with new concepts, in other words it increases the odds of new behaviour display (Rogers, 2003).


In fact, Facebook members not only discuss the content of the module but frequently want to share their experiences, hear new ideas and seek peer support. Content shared online resonates with them, stimulating self-reflection and facilitating resilience.

From a technical point of view, a number of participants, in particular medical students, suggest moving the live webinar to another day of the week due to work and study commitments.

Those less familiar with the concepts discussed during each module would like to access introductory materials before the webinars and the school has already accepted and implemented their suggestions. This shows the responsiveness of the team and the value of live chats and Facebook.

Overall, the integration of learning activities with online networking is valued positively by active members of the group and in order to suit diverse participants we highlight the value of a range of channels for interaction.

References ROGERS, E.M. (2013). Diffusion of Innovations. New York: Simon & Schuster International

WASSERMAN, S., and FAUST, K. (1994). Social Network Analysis: Methods and Applications. Cambridge. ENG and New York: Cambridge University Press

shcr review 2015 - appendix 4 real-time insights

Health & Medicine