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Current Alzheimer Research, XXXX, XX, 1-19 1
RESEARCH ARTICLE
1567-2050/XX $65.00+.00 © XXXX Bentham Science Publishers
Social Network Analysis of Alzheimer’s Teams: A Clinical Review and
Applications in Psychiatry to Explore Interprofessional Care
Carlo Lazzari1,*, Yasuhiro Kotera2, Pauline Green2 and Marco Rabottini1
1International Centre for Healthcare and Medical Education, Bristol, United Kingdom; 2Department of Health and
Social Care, University of Derby, United Kingdom!
!
A R T I C L E H I S T O R Y!
Received: July 13, 2020
Revised: May 21, 2021
Accepted: June 15, 2021
DOI:
10.2174/1567205018666210701161449!
Abstract: Introduction: Understanding the social networks of professionals in psychiatric hospitals
and communities working with persons with Alzheimer’s (PWA) disease helps tackle the knowledge
management in patient care and the centrality of team members in providing information and advice to
colleagues.
Objectives: To use Social Network Analysis (SNA) to confirm or reject the hypothesis that psychiatric
professionals have equal status in sharing information and advice on the care of PWA and have recip-
rocal ties in a social n etwork.
Methods: The sample consisting of 50 psychiatric professionals working in geriatric psychiatry in the
UK completed an anonymous online survey asking them to select the professional categories of the
colleagues in the interprofessional team who are most frequently approached when providing or receiv-
ing advice about patient care and gathering patient information. SNA is both a descriptive qualitative
analysis and a quantitative method that investigates the degree of the prestige of professionals in their
working network, the reciprocity of their ties with other team members, and knowledge management.
Results: The social network graphs and numerical outcomes showed that interprofessional teams in
geriatric psychiatry have health carers who play central roles in providing the whole team with the
knowledge necessary for patient care; these are primarily senior professionals in nursing and medical
roles. However, the study reported that only 13% of professionals had reciprocal ties with knowledge
sharing within teams.
Conclusion: The current research findings show that knowledge management in interprofessional
teams caring for PWA is not evenly distributed. Those with apparently higher seniority and experience
are more frequently consulted; however, other more peripheral figures can be equally valuable in inte-
grated care.!
Keywords: Alzheimer’s disease, social network analysis, interprofessional, psychiatry, knowledge management, care.
1. INTRODUCTION
1.1. Interprofessional Care in Alzheimer’s Disease
Interprofessional practice includes collaborative learning
among healthcare professionals who aim to advance their
teamwork and their patients’ care by utilizing proper com-
munication skills and by understanding their own roles as
well as the roles of their teammates [1]. Data suggest that
there are 850,000 people in the United Kingdom (UK) with
dementia, this number representing 1% of the population
[2]. Persons with dementia engage 25% of hospital beds and
remain under secondary care longer than people with other
illnesses [3]. A Nationwide survey resulted in more than one
million carers trained to support people with dementia
*Address correspondence to this author at the Department of Psychiatry,
South-West Yorkshire, NHS Foundation Trust, United Kingdom; E-mail:
carlolazzari2015@gmail.com
consisting in 400,000 National Health Service professionals
and 100,000 social workers [3, 4]. This substantial number
of professionals working with persons with Alzheimer's
disease (PWA) in the hospital and community will be able
to integrate their care as long as they focus on interprofes-
sional practice.
Working collaboratively with other employees in inter-
professional teams is reported as the primary target in pa-
tient-centered care in the healthcare system [5-7]. At times,
shared participation and knowledge management are less
than optimal. One study found that healthcare workers who
were not nurses or doctors reported the desire to participate
more in interprofessional practice, as corporate communica-
tion appeared inadequate [8]. Other times a prejudicial atti-
tude towards other professions can hamper interprofessional
practice. The presence of biases and simplifications about
other professional roles might reduce collaborative practice
and information sharing between team members [9]. Being
2 Current Alzheimer Research, XXXX , Vol. XX, No. XX Lazzari et al.
able to embrace the perspectives of other professionals
rather than focusing exclusively on one’s own is the inter-
professional skill most valued by team members [10]. In a
cooperative activity, each psychiatric professional is en-
couraged to analyze a problem using the frame of under-
standing and inquiry of other professionals in the team [11].
The complexity of cases and patient management in psy-
chiatric wards can pose extra challenges to the collaboration
within the staff. A study of psychiatric teams in Sweden has
shown that staff members might already know the standards
of patient care and interprofessional teamwork; however, the
hurdles they deal with in routine work, such as inadequate
settings, inequalities in authority, and deficiencies in work
organization, increase their isolation from colleagues and
reduce opportunities for teamwork [12].
According to a series of publications by the Royal Col-
lege of Physicians, professional negligence cases are fre-
quently due to ineffective cooperation and information shar-
ing in interprofessional teams [5]. A recent systematic re-
view of 30 studies evaluating challenges to quality care in
different countries found that the causes of poor patient care
in 70% of cases are from poor interprofessional practice and
rigid hierarchical leadership in 57% of cases [13]. Further-
more, hierarchies within healthcare teams are considered
obstacles to open communication within a team [6].
Instead, the primary route to interprofessional coopera-
tion within healthcare teams is to promote a give-and-take
culture of feedback [7]. Improved teamwork, communica-
tion, and collaboration and the reduction of silo manage-
ment have been associated with reduced readmissions of
patients after discharge from the hospital [14]. During a
systematic review of databases, including 47 studies from
1980 to 2015, 55% of reports found that interprofessional
consultation was the area needing significant improvements
for increasing workplace cultures and effectiveness in surgi-
cal wards [15].
1.2. Background to the Topic
Significant challenges to healthcare partnerships can
derive from a lack of collaboration, coordination, and mu-
tual trust in an interprofessional team [16]. Collaborative
care means acting supportively, adopting welcoming and
empathic communication, and acknowledging diversity in
reflective practice [17]. Stereotypes about other profession-
als and little understanding of members’ roles in interpro-
fessional teams are other obstacles to collaboration [18].
Cooperating teams reduce risks to patients and enhance the
quality of care, but they also make the hospital’s climate or
ward more optimistic, involved, and robust [19].
1.3. Social Network Analysis in Healthcare
Social Network Analysis (SNA) can assess organiza-
tional relationships, opinion leadership in networks, how
knowledge is shared in teams, and recommendations on
quality of care and patient safety [20]. There is growing
research in this direction, although only Pomare et al.
(2018) have used SNA to study interprofessional teams in
psychiatry [21]. A social network is a relationship between a
group of persons or units [22]. Table 1 shows a list of key
topics in SNA.
SNA is the study of the relationships or links in a net-
work that a person or entity has with other persons and enti-
ties to share values, capital, and knowledge [23] SNA can
also help recognize areas of improvement in interprofes-
sional care [24]. SNA has some additional advantages com-
pared to quantitative methods, as it can graphically illustrate
hidden relations within the actors of a network [24, 38].
Hence, SNA is a set of qualitative research methods show-
ing social events comprising exchanges, links, and negotia-
tions that relate one actor or node to other actors or nodes
while looking for the statistical significance of the configu-
ration of these relations [39]. The components of a social
network are ‘nodes’ or ‘actors’ that represent individuals or
organizations and ‘ties’ or ‘edges or arrows’ that symbolize
the interactions between the nodes [28, 25]. Double-headed
arrows symbolize the sharing of data or resources and repre-
sent the interactions between nodes or actors or some form
of collaboration between the units of a social network [25].
Multiple mathematical parameters are used to characterize
social networks. The one used in the current study and that
frequently characterizes the relations in the healthcare sys-
tem is ‘degree of centrality’ [28]. SNA is based on the the-
ory that all ties between units are interdependent [40]. Be-
sides, ‘centrality’ is when an actor has many inward and
outward ties with others, while ‘prestige’ is where inward
ties prevail [27].
Various software packages can do the mathematics relat-
ing to social networks. The current study uses open-source
SocNetv 2.4 [29]. A social network researcher tends to fo-
cus on single individuals interacting as a group within net-
works of interpersonal relationships; however, these net-
works of direct interactions can become collective events
and develop as autonomous activities [41]. A sociogram can
thus provide a pictorial representation of the configuration
of a team and highlight who occupies the more central and
influential positions in it [42]. Each unit or node of the net-
work interacts with other units or nodes to exchange exper-
tise, skills, knowledge, and ideas [23]. When a social net-
work is constructed to investigate interpersonal selections or
relations, the researcher asks the participants to indicate
another member of their network according to a significant
object of investigation [30]. Arrows directed from one actor
to another actor represent the relationship between nodes in
the network [24]. An outbound arrow begins from one
node/actor, which initiates an action or a relationship, to
another actor accepting the act, as in the one-mode matrix,
or to another class of categories as in the two-mode matrix
[24]. In this last case, the arrowhead will point to the second
actor/node accepting the undertakings from the first actor; in
a case where the actions are mutual, the arrowheads point to
both nodes/actors [24]. Hence, actors or nodes in the net-
work are connected to share information, resources, and
goals [23]. An advantage of the graphic illustration of SNA
is that it shows concealed connections within the actors of
the network (Fig. 1) [24, 38].
Understanding social networks, inclusive of the dynam-
ics of the interchange of information and advice between
different professional figures on interprofessional teams, is
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 3
Table 1. Key topics in SNA.
Social Network
Feature
Key Structural Finding
Study or Source
Social networks
Relationships between a group of persons or entities
Wasserman and Faust, 1994 [22]
Social Network
Analysis
Study of the relationships in a network
Crossley et al., 2015 [23]
Node or actor
Each unit of the network
Crossley et al., 2015 [23]
One-mode matrix
A network where the units share the same characteristics and are
of the same group
Lockhart, 2017 [24] ; Yang, Keller and Zheng, 2017 [25]
Centrality
Central is the person who is more well-liked in his or her net-
work
Scott, 2000 [26]
Prestige
The degree to which an actor collects or performs the aim of the
interactions directed by other actors in the network
Knoke and Yang, 2008 [27]
Reciprocity
Is the relation of two nodes or actors where each one is a con-
tributor and recipient of the action
Prell, 2012 [28]
Degree of
reciprocity r
Measures of how intense are dyadic interactions within actors in
a team
Social Network Visualizer, 2019 [29]
SNA enquire
Method where the researcher asks the persons participating in
the research to select another member of their network according
to a significant object of investigation
De Brún and McAuliffe, 2018 [30]
Adjacency matrix
A table with nodes described both in rows and columns and
defining their relationships
Yang, Keller and Zheng, 2017 [25]
Homophily
Social networks where individuals tend to select others based on
some similarities
McPherson, Smith-Lowin and Cook, 2001 [31]
Heterophily
Social networks where actors are linked to other actors in the
network who have characteristics dissimilar from their own
Xie et al., 2016 [32]
Hubs
Areas of social networks with a high density of ties between
nodes
Franks et al., 2008 [33]
Opinion leaders
Actors of the network who are more central and contacted more
frequently when other actors require information
Yousefi Nooraie et al., 2017 [34]
Core-periphery
A network where there is a center with nodes more closely re-
lated and a periphery of less tied nodes
Gamble et al., 2016. [35]
Gap
Lack of partnership within actors or social distance between
nodes
Bright et al. 2019; [36] Qiao et al., 2014 [37]
Edges
Are the lines or ties that connect the nodes
Crossley et al., 2015 [23]
Core-periphery
Core-periphery configuration has a central part with actors in-
tensely tied between them and a periphery with dispersed nodes
mostly tied to core actors than between themselves
Crossley et al., 2015 [23]
considered vital for patient safety and the quality of care
[42]. SNA analysis captures the areas of interprofessional
practice that need remedial actions to reduce gaps in patient
care [43]. The application of SNA in healthcare research has
found correlations between social networks and outcomes in
patient care [44]. These interactions usually occur between
actors or nodes, while the intensity of these connections is
captured by mathematical models and figuratively by the
thickness of the ties or arrows in SNA [28].
1.4. Key Topics in Social Network Analysis
Different terms and categories are linked to the study of
social networks (Fig. 1). Networks, where there is a flow of
knowledge and information, tend to conform to a layout
called core-periphery, with the core represented by indi-
viduals closely tied and often independent from individuals
in the peripheral area of the network, frequently consisting
4 Current Alzheimer Research, XXXX , Vol. XX, No. XX Lazzari et al.
of actors creating small cliques or independent clusters [35].
Core-periphery configuration displays a central region with
actors intensely tied between them and a periphery with
dispersed nodes more frequently bound to core actors than
themselves [23]. The concept of homophily was first created
by McPherson, Smith-Lowin, and Cook (2001) to indicate
that in social networks, individuals tend to select others
based on similarities that can be economic, demographic,
ethical, or attitudinal; occupying the same roles and posi-
tions within social networks can create the conditions for
homophylic relationships [31]. Crossley et al. (2015, p. 15)
further distinguish between ‘Status Homophily’ and ‘Value
Homophily’ [23]. ‘Status Homophily’ is a trend within a
network for actors to be highly linked to other actors who
have one or more similar prominent characteristics [23].
‘Value Homophily’ is a trend within a network for actors to
be highly linked to other actors because they share some
standards and or choices [23]. In sociology, the search for
others who are different from the self in some characteris-
tics, heterophily, infers a risky venture, while homophily is
more helpful in large social groups [45].
In social networks, a high level of reciprocal ties is indi-
cated by the dominance of double-headed harrows between
nodes [46]. Individuals in homophilic groups tend to interact
and communicate within themselves more intensely or fre-
quently than with other actors as in heterophilic groups [47].
Homophilic ties tend to be reinforced by the process of
natural selection of other members with strong similarities
[48].
Zones with high homophily tend to form ‘hubs,’, that is,
areas of social networks with a high density of ties within
individual nodes and a greater likelihood of getting new
contacts within actors of the hub [33, 49]. Hubs are often
occupied by more experienced people in the team, or ‘opin-
ion leaders,’ that occupy the more central region of the so-
Fig. (1). The figure represents a social network with a core-periphery configuration. The more interconnected nodes usually occupy the core;
they can also create a hub. Nodes with higher centrality also have a larger size. In the figure, the social gaps between core actors are small.
There are more dispersed nodes of heterophilic individuals at the periphery with little connections with other actors in the network and be-
tween themselves. In the social network reported, the gap between individuals in the periphery and individuals in the core is significant.
When present, single-headed arrows go from one node to another in a single direction. When reciprocity is instead present, the arrows be-
come double-headed, connecting two nodes in a mutual relationship. (A higher resolution / colour version of this figure is available in the elec-
tronic copy of the article).
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 5
cial network and, in healthcare, are the most frequently con-
tacted by their team when information, knowledge, and ex-
perience are needed in patient care [34]. Hence, actors with
strong affiliations also tend to have more frequent reciprocal
ties and form cliques or clusters of different sizes [25, 50].
However, extreme homophily might reduce the diffusion
of information and knowledge within the social network and
amongst other professionals [51, 52]. More extensively, the
likelihood of medical practitioners adopting evidence-based
medicine was positively associated with participation in
heterophilic or multidisciplinary teams and negatively asso-
ciated with homophilic groups [53]. Areas of a social net-
work with few ties between members and a lower degree of
partnership between them are called ‘gaps’; they lead to the
reduced effectiveness of the whole organization [36]. A gap
can be interpreted as the social distance between individuals
in the social network, both when closely associated (small
gaps) (in this case sharing the same social characteristics
such as job, working in the same environment, having the
same goals), and when loosely associated (significant gaps)
(not sharing the same collective characteristics) [37]. Hence,
SNA provides both a graphic and sociometric account of
how healthcare workers interact within interprofessional
teams, while the presence of gaps helps provide the instru-
ments for backing collaborative care and social development
[54]. Network analysis might refer to this occurrence as
‘structural holes,’ indicating breaks between several areas of
a social network [55]. These conglomerations or bonds be-
tween the actors of a social network are driven by different
factors (e.g., professional backgrounds), giving rise to large
or small sub-groups [56].
1.5. Applications of Social Network Analysis
Understanding social networks, inclusive of the dynam-
ics of the interchange of information, knowledge manage-
ment, and advice between different professional figures on
interprofessional teams, is considered vital for patient safety
and the quality of care [42]. SNA analysis captures the areas
of interprofessional practice that need remedial actions to
reduce gaps in patient care [43]. The application of SNA in
healthcare research has found correlations between social
networks and outcomes in patient care [44].
SNA is also an instrument for evaluating whether coop-
eration or divisions are apparent in providing care to shared
patients and capturing areas of reinforcement [57]. Network
cohesion has been linked to the continuity of care of patients
with psychiatric pathologies [58]. The primary goal of SNA
is to represent social events by measuring the organizational
relationships of small groups of persons, organizations, or
larger sets and by capturing their patterns of interactions
[27]. SNA helps estimate the degree of centrality and pres-
tige of the healthcare actors of a network by portraying their
influence on the social network of reference; moreover, it
can determine closeness and reciprocity and estimate the
degree to which members of a social network form recipro-
cal ties [59]. Therefore, the primary objective of SNA is to
capture the interactions between the actors of a social sys-
tem [60]. The following paragraphs describe the research
methodology for tackling the study hypothesis.
2. AIMS AND OBJECTIVES
2.1. Aim
The current study critically evaluates interprofessional
collaboration in patient-centered practice in hospital and
community psychiatry for PWA.
2.2. Justification of Aims
Currently, few studies are addressing interprofessional
practice in dementia care [61]. Most research has focussed
on the interprofessional practice between doctors and nurses
[62]. Previous research from the authors suggests that inte-
grated care of PWA more than other geriatric specialties can
be implemented only when healthcare workers cooperate to
address synchronously − all at the same time on a specific
task as in inpatient settings − or asynchronously − different
carers at different moments as in community settings − dif-
ferent aspects of PWA personhood [63]. Studies of interpro-
fessional geriatric care suggest that collaboration is vital for
chronic dementia and its requirements are integrated and
holistic care provided and advanced only by working col-
laboratively and not in silos management [64]. Besides, col-
laborative care does not develop intuitively [65], while there
is limited research on the practical configuration of interpro-
fessional care in inpatient and outpatient geriatric settings
for PWA [63]. More than any other medical setting, inter-
professional care of PWAs is a pivotal action to promote
their biological (e.g., reduction of risk choking), individual
(e.g., communicating empathically), and sociologic (e.g.,
involving community meetings) personhood [66]. Without
this coordinated action in geriatric care, there is a risk of
reinforcing interprofessional barriers and endorse a ‘Type
A’ setting with rigid divisions between professionals and
missing information between more senior positions and
other professionals also involved in the PWA care [67].
2.3. Objectives and Research Hypotheses
Objective 1 aims to use SNA to evaluate how different
geriatric psychiatric professionals in PWA care collaborate
and identify opinion leaders in their teams. SNA will assess
their Degrees of Prestige (DP) when they are engaged in
exchanging information and receiving and providing advice
to colleagues. Study 1 will tackle Objective 1.
Objective 2 aims to identify the Degree of Reciprocity r
in interprofessional teamwork in the geriatric psychiatric
care of PWA. Study 2 will tackle Objective 2.
Research or Null Hypothesis Ho1 is that SNA shows
no differences in DP in the teams assessed.
Research or Null Hypothesis Ho2 is that SNA shows
no differences in r in the teams assessed.
3. POPULATION AND METHODS
3.1. Methodology
The current study is based on hypothesis testing and is a
cross-sectional study with a mixed-method research approach.
In SNA, the nodes represent psychiatric professionals who
collaborate in patient care. The figurative illustration of their
6 Current Alzheimer Research, XXXX , Vol. XX, No. XX Lazzari et al.
interactions, the social network, describes the qualitative part
of the research, showing in one preview how professionals
collaborate. The network model of such collaboration illus-
trates ‘how’ people/nodes interact, cluster, isolate or collabo-
rate within the social network via their ‘edges’ or ties (Fig. 1),
representing the information and advice received or provided
by each node [23]. All these data are not numerical but repre-
sent the qualitative/descriptive aspect of the network analysis
of interactions between nodes. The data necessary to con-
struct the network are extracted from the adjacency matrix
(Table 3) that provides a nominal output where the column is
the professional who is choosing, and the row is the profes-
sional that is chosen in the survey. In other words, the qualita-
tive inquiry answers the question ‘which professional is cho-
sen by whom?’ The numerical or quantitative analysis cap-
tures ‘how frequently’ people are central in the network;
hence, it shows how many edges or ties (representing ex-
changed information and advice) each node/person has with
other nodes [23]. The quantitative outcome is the degree of
prestige and reciprocity of each professional figure within the
own team [29].
3.2. Setting and Data Collection
The setting was represented by dementia psychiatric
wards and community psychiatric teams treating PWA. The
current study was initially piloted in several general psychi-
atric inpatient and outpatient services to improve the re-
search instruments. The second stage involved the piloting
of the action research into dementia psychiatric inpatient
and outpatient services. In these teams, interprofessional
collaboration is central for enhancing the quality of care and
reducing PWA’s risk to self and others. Each member
should coordinate with other colleagues with different roles
to address complex needs and deliver integrated care. The
population comprised people from age 60 above with a di-
agnosis of dementia and Alzheimer’s disease. The sample
teams worked on a 24-hour shift and were active through
constant exchanges of advice and information and knowl-
edge in PWA care.
3.3. Selection Criteria: Inclusion and Exclusion Criteria
The data were collected online. The sample participated
voluntarily and comprised anonymous responses to an on-
line survey. The target population was psychiatric profes-
sionals working with PWA in the UK. The SNA survey was
completed online by accessing a web platform. The criterion
for inclusion was that the professional worked in the
healthcare system in geriatric psychiatry in a public or pri-
vate setting. The criterion for exclusion was healthcare pro-
fessionals not involved in psychiatric teams. Those on leave
could also access the survey.
3.4. Statistical Methods
3.4.1. Quantitative and Frequency Analysis
An online survey collected the data. The outcome of the
quantitative research was the frequency or percentage of
times an individual professional was consulted for advice
and information in patient care and percentages in DP,
hence providing a numerical value for the social network.
Confirmatory meta-analysis computing the coefficient of
heterogeneity I2 was used to accept or reject the null hy-
potheses. Open-Meta-analyst [68, 69] was the software of
choice for such computation. A statistically significant I2
indicated an unequal distribution in the outcome percent-
ages; consequently, the null hypothesis Ho, implying that
percentages of the outcomes were equally distributed, could
be rejected. The alpha or type one error was set at p=.05,
accepting as statistically significant only values equal or less
than alpha. The differences in percentages were also set by
stating that the outcomes (percentages in the survey items
answers) showed significant heterogeneity. The measure I2
conveyed this degree of heterogeneity; it can span from 0%
(zero) to 25% (small), 50% (modest) or 100% (significant),
demonstrating that the percentages of the responses exhib-
ited a non-random division [70]. Similarly, the probability p
at meta-analysis for I2 also established this non-random dis-
tribution in the numerical outcomes [71].
3.4.2. Qualitative and Quantitative Analysis
3.4.2.1. Study 1: Calculating the Degree of Prestige
The Software Social Network Visualizer 2.4 [29] gener-
ated the SNA graphs and computed the DP and r of each pro-
fessional figure in the psychogeriatric teams. The qualitative
research resulted in pictorial representations of how the pro-
fessional figures in the social network collaborated; these
graphs reported the centrality and isolation of specific profes-
sional roles. SNA utilized the percentage of degrees of pres-
tige (%DP), where 0% represents no ties, and 100% corre-
sponds to an actor having ties with every interprofessional
team member. Ties can also be ‘interprofessional’ for team
members sharing the same profession (e.g., two consultants)
or ‘interprofessional’ for team members who do not share the
same profession (e.g., the senior nurse and the consultant)
[72]. The ties or edges within nodes or team members also
have different weights or thickness measures in the graph
according to the number of ties that link the team members
[72]. In the network graphs, the size of a node is related to the
centrality of the actor. SNA also has the advantage of captur-
ing the number of ties that link the network’s members [30].
A related concept that emerged from the figurative analysis of
the social networks of the current study, generating circular
configurations, was that of the ‘core,’ where the links be-
tween the nodes are more intense than those at the ‘periph-
ery,’ where individual nodes have fewer links with the other
members of the network or none at all [73].
3.4.2.2. Study 2: Calculating the Degree of Reciprocity
SNA captured dyads of reciprocity r that determine the
probability that the nodes of a network are mutually related,
with values ranging from ‘0’ when there is no reciprocity in
the network to ‘1’ when all actors have reciprocal connec-
tions [29]. The r can also be expressed as a percentage with
a minimum value of 0%; a maximum of 100% expresses
total reciprocated connections within a network (Fig. 2).
3.5. Sample
The sample population was represented by 50 psycho-
geriatric professionals working in dementia psychiatric
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 7
wards and community dementia teams accessed by PWA.
The minimal number of people required to generate a so-
cial network was one professional for each category.
Hence, the model needed at least 18 different professions.
In other words, the SNA network had at least 18 nodes
(professionals) with 153 ties ([18×17]/2) [23]. The sam-
pling was opportunistic, as respondents were invited by
email or in-person to anonymously complete an online
survey. Those who did not meet the cited categories were
automatically excluded from the research. The number of
choices/ties that generated the summative network graph
was 415.
3.5.1. Demographic Characteristics
• Professional figures of the target population in psycho-
geriatric teams consisted of consultant, middle-grade
doctor, specialist registrar or associate specialist, junior
doctor or trainee doctor, ward manager, registered
nurse, senior nurse or sister, ward manager, clinical
leader, healthcare assistant, clinical psychologist, occu-
pational therapist, art therapist, physiotherapist, ward
clerk, medical secretary, care coordinator, social
worker, hospital or ward pharmacist.
• Types of contracts with the hospital were permanent
contract, fixed-term contract, part-time contract, locum
agency contract, other forms of contracts.
• Length of experience in the profession was less than 1
year; from 1 to 5 years; from 5 to 10 years; more than
10 years.
3.5.2. Survey Questions
• “Which professional members of your team do you
most frequently approach for advice on the care of
PWA?” It is a multiple-choice question asking the re-
spondents to select up to three professional figures they
usually approach for receiving guidance during the care
of a PWA.
• “Which professional member of your team do you most
frequently approach to advise on the care of PWA?” It
is a multiple-answer question asking the respondents to
select up to three professional figures they usually ap-
proach to guide the care of a PWA.
• “Which professional member of your team do you most
frequently approach to get information on PWA?” It is
a multiple-answer question asking the respondents to
select up to three professional figures they usually ap-
proach for information during the care of a PWA.
4. RESULTS
4.1. Population
Table 2 shows that the most represented professional
role was the staff or senior nurse (16%), with a permanent
contract (76%) and with 5 to 10 years of experience (26%).
4.2. Summative Data
The data were condensed into Table 3 and Figs. (3 to 9).
Table 3 is the adjacent matrix for the whole study, while
Table 4 summarizes the whole study.
4.3. Study 1
The objective of study 1 was to use SNA to illustrate
how different psychogeriatric professionals collaborate in
their teams in terms of sharing information and receiving
and providing advice in PWA care. Results are summarised
in Table 4 and Figs. (3-5).
4.3.1. The Professional in the Team that is Approached
Most Frequently to Receive Advice About Patient Care
The summative findings are provided in Table 4 and Fig.
(3). The figurative, qualitative and quantitative analysis of
the social network confirmed that some professionals occu-
pied central positions with a high degree prestige (%DP),
such as the consultant (DP = 21.37%), ward manager (DP =
16.55%), senior nurse (DP = 16.55%), speciality doctor (DP
= 11%) (also called middle-grade doctor) and registered
nurse (DP = 8.96%). The findings are not equally dispersed
as data show high heterogeneity in the distribution of DP (I2
= 99.85%: p<0.001).
Fig. (2). Non-reciprocal and reciprocal ties. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
8 Current Alzheimer Research, XXXX , Vol. XX, No. XX Lazzari et al.
Table 2. Biographical characteristics of the sample.
Role
Count (N) (total n=50)
Percentage (%)
Professional role:
Consultant
4
8
Specialty doctor
2
4
Junior doctor
4
8
Medical student
1
2
Student nurse
2
4
Registered nurse
4
8
Staff or senior nurse
8
16
Ward manager or sister
2
4
Care coordinator
3
6
Healthcare assistant
5
10
Clinical psychologist
1
2
Occupational therapist
2
4
Hospital or ward pharmacist
4
8
Social worker
2
4
Ward clerk
1
2
Medical secretary
2
4
Other
3
6
Form of contract:
Permanent
38
76
Fixed-term
1
2
Part-time
1
2
Locum agency
1
2
Other forms
2
4
Years of experience in the service p rovision:
Less than one year
11
22
From one to five years
4
8
From five to ten years
13
26
More than ten years
18
36
No answer
4
8
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 9
Table 3. Adjacency matrix for the summative findings.
PROFESSIONAL SELECTED
Consultant
Middle-grade or senior doctor
Junior doctor
Medical stude nt
Student nurse
Registered nurse
Staff or senior nurse
Ward manager or sister
Care coordinator
Clinical manager
Healthcare assistant
Clinical psychologist
Occupational therapist
Physiotherapist
Hospital or ward pharmacist
Social worker
Medical secretary
Ward clerk
Patient
Other
Consultant
5
2
2
0
0
3
1
1
4
2
1
1
0
0
0
1
0
0
0
1
Middle-grade or
senior doctor
4
1
0
0
0
0
2
1
1
0
0
0
0
0
0
0
0
0
0
0
Junior doctor
7
5
2
1
0
2
9
1
0
0
3
0
0
0
0
0
0
0
0
1
Medical student
3
2
2
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Student nurse
1
2
0
0
1
2
5
1
0
0
1
0
0
0
0
1
0
0
0
0
Registered nurse
7
3
0
0
1
7
10
4
1
0
3
0
0
0
0
3
0
0
1
0
Staff or senior nurse
18
4
3
1
1
3
13
14
5
0
0
0
0
0
2
0
0
0
2
1
Ward manager or
sister
2
0
0
0
0
1
3
2
5
0
1
0
0
0
4
0
0
0
1
0
Care coordinator
8
2
2
1
1
4
6
7
3
0
1
0
0
0
0
3
0
0
1
0
Clinical manager
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Healthcare assistant
0
0
0
0
0
8
12
10
0
0
3
0
0
0
0
0
0
0
1
0
Clinical
psychologist
0
0
0
0
0
0
0
1
3
0
0
2
0
0
0
0
0
0
0
0
Occupational
therapist
4
3
0
0
2
7
6
4
0
0
0
1
6
4
0
0
0
0
0
0
Physiotherapist
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Hospital or ward
pharmacist
8
9
2
0
0
2
8
6
0
0
0
0
0
0
0
0
0
0
1
0
Social worker
5
0
1
0
0
6
0
0
2
0
3
0
0
0
0
2
0
0
0
0
Medical secretary
6
6
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PROFESSIONAL SELECTING
Ward clerk
2
0
0
0
0
0
0
2
0
1
1
0
0
0
0
0
0
1
0
0
10 Current Alzheimer Research, XXXX, Vol. XX, No. XX Lazzari et al.
Table 4. Summary of study 1 and 2.
-
Provided Advice About
PWA Care
Received Advice on PWA
Care
Provided Information
About PWA
Summative
Data
Degree of
Reciprocity
Professional
(Sample N=50)
%Answers
%DP
%Answers
%DP
%Answers
%DP
%DP
r
Consultant
68%
21.37%
46%
16.40%
52%
14.44%
19.27%
0.07
Speciality doctor
32%
11.03%
24%
9.37%
22%
7.09%
9.39%
0.12
Junior doctor
12%
4.13%
16%
6.25%
10%
3.54%
4.57%
0.11
Medical student
2%
0.69%
4%
0.78%
0%
0.00%
0.72%
0.00
Student nurse
2%
0.69%
6%
2.34%
2%
0.00%
1.68%
0.14
Registered nurse
26%
8.96%
30%
11.71%
42%
14.89%
12.28%
0.09
Senior nurse
48%
16.55%
48%
18.75%
54%
18.44%
19.27%
0.08
Ward manager
44%
16.55%
32%
12.50%
40%
15.60%
13.01%
0.09
Care coordinator
16%
5.51%
12%
4.68%
20%
7.09%
5.78%
0.10
Clinical manager
4%
0.69%
2%
0.78%
4%
1.41%
0.72%
0.00
Healthcare assis-
tant
10%
3.44%
12%
4.68%
12%
3.54%
3.61%
0.14
Clinical psycholo-
gist
6%
2.06%
2%
0.78%
0%
0.00%
0.96%
0.33
Occupational
therapist
6%
2.06%
4%
1.56%
4%
1.41%
1.44%
0.20
Physiotherapist
2%
0.69%
4%
1.56%
2%
0.00%
0.96%
0.00
Ward pharmacist
6%
4.13%
6%
2.34%
0%
1.41%
1.44%
0.00
Social worker
4%
1.37%
8%
3.12%
8%
1.41%
2.65%
0.18
Medical secretary
0%
0.00%
0
0.00%
2%
0.00%
0.00%
0.00
Ward clerk
0%
0.00%
0
0.00%
0%
0.70%
0.00%
0.00
Patient
-
-
14%
4.96%
1.44%
0.00
Others
-
-
2%a
-
0.72%
0.00
I2
96.36%
99.85%
94.01%
99.85%
95.83%
99.84%
99.83%
89.23%
P-value
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
Tau2
0.008
0.000
0.005
0.00
0.04
0.00
0.00
0.001
Q
467.42
114.57
314.93
109.72
432.166
109.23
112.53
178.02
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 11
Fig. (3). Social network graph of psychiatric professionals most frequently approached for asking advice on the care of PWA. (A higher
resolution / colour version of this figure is available in the electronic copy of the article).
4.3.2. The Professional who is Approached Most Fre-
quently to Provide Advice on Patient Care
The summative findings are provided in Table 4 and Fig.
(4). The figurative, qualitative and quantitative analysis of
the social network confirmed that some professionals oc-
cupy central positions with a high degree of prestige %DP,
including the senior nurse (DP = 18.75%), consultant (DP =
16.40%), ward manager (DP = 12.50%), registered nurse
(DP = 11.71%) and speciality doctor (DP = 9.37%). All
other professional figures have more peripheral positions
with lower %DP. The findings are not equally dispersed as
data show high heterogeneity in the distribution of DP (I2 =
99.85%: p<0.001).
4.3.3 The Professional that is Approached Most Fre-
quently for Receiving Information About a Patient
The summative findings are provided in Table 4 and Fig.
(5). The figurative, qualitative and quantitative analysis of
the social network confirmed that some professionals oc-
cupy central positions with a high degree of prestige %DP,
including the senior nurse (DP = 18.44%), ward manager
(DP = 15.60%), consultant (DP = 14.44%), registered nurse
(DP = 14.89%) and speciality doctor (DP = 7.09%). All
other professional figures (who are also involved in patient
care) have, instead, more peripheral positions with lower
%DP. The findings are not equally dispersed as data show
high heterogeneity in the distribution of DP (I2 = 99.84%:
p<0.001).
4.3.4. Summative Findings and the Global SNA Model
The cumulative results showed that the number of total
ties was 415. The roles with the maximum degree of pres-
tige were consultant (DP = 19.27%), senior nurse (DP =
19.27%), ward manager (DP = 13.01%), registered nurse
(DP = 12.28%) and speciality doctor (DP = 9.39%) (Table 4
and Fig. 6). The findings reject the Null Hypothesis Ho1 as
data are not equally dispersed while showing high heteroge-
neity in the distribution of DP for all professionals (I2 =
99.83%; p<0.001) (Table 4 and Fig. 7).
4.3.5. Visual Analysis of Social Networks
Social networks (Figs. 6 and 7) show a characteristic
core-periphery layout. The core forms a hub with psycho-
geriatric professionals with highly intense ties. These pro-
fessionals show status homophily (being in the nursing and
medical professions, years of professional seniority, per-
forming clinical tasks) and value homophily (having highly
intense contacts with PWA). The periphery is occupied by
psychogeriatric professionals showing status heterophily
(having different professional roles) and value heterophily
(having less frequent contacts with PWA). The profession-
als at the core of the network have homophilic ties and tend
to interact with other core professionals with the same roles
(i.e., a senior nurse with a ward manager or a consultant
with a middle-grade doctor). The professionals at the pe-
riphery of the network are more dispersed and have hetero-
philic ties with professionals in the core, e.g., the care
12 Current Alzheimer Research, XXXX, Vol. XX, No. XX Lazzari et al.
Fig. (4). Social network graph of psychiatric professionals most frequently approached for providing advice on the care of PWA. (A higher
resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (5). Social network graph of professionals most frequently approached to receive information about PWA care. (A higher resolution /
colour version of this figure is available in the electronic copy of the article).
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 13
Fig. (6). Summative SNA for the degree of prestige. (A higher resolution / colour version of this figure is available in the electronic copy of
the article).
Fig. (7). Forest-plot for summative SNA of the degree of prestige. (A higher resolution / colour version of this figure is available in the elec-
tronic copy of the article).
14 Current Alzheimer Research, XXXX, Vol. XX, No. XX Lazzari et al.
coordinator with the consultant. The professionals at the
periphery tend not to have ties between them. There are
network gaps between core and peripheral professionals.
Consultants, senior nurses, ward managers, registered nurses,
and middle-grade doctors frequently occupy the core.
Medical students, junior doctors, student nurses, social
workers, ward clerks, ward pharmacists, medical secretaries,
physiotherapists, occupational therapists, healthcare
assistants, clinical psychologists, and clinical managers fre-
quently occupy the periphery. The care coordinator appears to
form a hub with central psychiatric professionals.
4.4. Study 2
The objective of Study 2 was to assess the degree of
reciprocity r of all professionals in psychogeriatric teams by
using SNA. The computation of the reciprocity factor r in-
dicates how the actors in the network form dyads and have
reciprocal ties [41]. This last parameter provides more evi-
dence of interprofessional teamwork than unilateral ties or
outbound arrows from one actor to another. In this case, the
results showed that of all the pairs of actors examined in the
network, only 13% had reciprocal connections and relation-
ships. The findings show that the clinical psychologist had
slightly more symmetric ties with other professionals (r =
0.33), followed by the occupational therapist (r = 0.20), the
social worker (r = 0.18), the student nurse (r = 0.14), the
healthcare assistant (r = 0.14), the middle-grade doctor (r =
0.12) and the junior doctor (r = 0.11) (Table 4). The find-
ings reject the null hypothesis Ho2 that reciprocity is uni-
formly distributed as data show high heterogeneity in the
reciprocity factor r (I2 = 89.23%; p<0.001) (Table 4; Fig. 9).
The figurative analysis of the social network (Fig. 8) con-
firms that the professional figures with more reciprocal ties
are different from those with more prestige than previous
networks; in the figures of the social network, professionals
with higher r occupy the centre.
5. DISCUSSION
5.1. SNA and the Configuration of Social Networks
Objective 1 of the current study evaluated how different
professionals collaborate and identify opinion leaders in
psychiatric teams by SNA. The data and configuration of
the social networks emerging in the current research provide
theoretical support of a core-periphery layout with homo-
philic professions occupying the core of the network and
heterophilic professions more dispersed at the periphery.
The findings are in keeping with the theory that suggests
that the presence of homophily leads to the creation of a
core-periphery social network [74]. The current research
data also support other theories suggesting that where there
is a flow of knowledge and information, social networks
conform to a core-periphery layout [35]. The current study’s
findings also indicate that the core is occupied by those pro-
fessionals that more frequently provide the whole interpro-
fessional team with information and advice in patient care,
such as consultants and senior nurses, followed by the ward
managers, middle-grade doctors, and registered nurses.
They also have higher degrees of prestige compared to other
professionals. All other psychiatric professionals, such as
clinical leaders, healthcare assistants, clinical psychologists,
occupational therapists, art therapists, physiotherapists,
ward clerks, medical secretaries, care coordinators, social
workers, and ward pharmacists, occupy more peripheral
regions. As suggested by other authors, elite actors tend to
occupy the network’s core and have more dense connections
within themselves [75].
5.2. SNA and Interprofessional Teamwork
Objective 2 of the study was to identify the degree of
reciprocity in interprofessional teamwork in psychogeriatric
care by using SNA. The findings of the current study indi-
cate that although there are intense ties between the network
professionals, only a low percentage of these connections
satisfy the condition of reciprocity. Hence, very few nodes
are linked to adjacent ones by a bilateral connection where
each actor is both a source and recipient of the knowledge in
patient care [23, 28]. Consequently, knowledge management
is not equally distributed.
As previously mentioned, the presence of central hubs
occupied by those who have more seniority might decrease
the flow of knowledge to the periphery, hence reducing the
likelihood that the whole network can quickly react to po-
tential crises [76] in patient care. As other authors advise,
for effective interprofessional practice, relationships be-
tween different professional roles are more important than
relationships with professionals sharing the same areas of
expertise [77]. However, this hypothetical configuration
appears to be under-represented in the networks captured in
the current study.
5.3. How Interprofessionalism Improves Care?
In a recent survey, core trainees in psychiatry expressed
gaps in their training and areas of reinforcement in learning
collaborative work (also including patients), shared decision
making, and joint care planning [78]. A systematic review
of 141 studies indicated that collaborative team-based care
practice had been found to have a positive impact on pa-
tients’ care, although limited evidence exists for positive
outcomes when involving opinion leaders and specialists
[79]. The findings of the current study indicate a centraliza-
tion of prestige (decision-making and advice-giving) in the
most senior geriatric figures, suggesting policies to reinforce
collaborative care, information sharing, and interprofession-
alism while avoiding silos management in the care of PWA.
Besides, the current study also captured a small number of
reciprocal ties/edges between all healthcare professionals in
geriatric care and the creation of centralized cliques (senior
psychogeriatric professionals) to the detriment of decen-
tralization and peer-support and knowledge sharing. In the
United States, a report commissioned by The National
Academy found that the bulk of healthcare errors are not the
result of human irresponsibility but rather are the result of
flawed programs, procedures, and circumstances that cause
individuals to make errors or neglect to avoid them [80].
Despite evidence-based policies that support interprofes-
sional cooperation and treatment, human factors often im-
pede successful implementation; policy aspects of interpro-
fessional collaboration include providing a voice to all team
participants and promoting discussion based on diverse
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 15
Fig. (8). SNA for the degree of reciprocity. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (9). Forest plot for SNA of the degree of reciprocity. (A higher resolution / colour version of this figure is available in the electronic copy
of the article).
16 Current Alzheimer Research, XXXX, Vol. XX, No. XX Lazzari et al.
experiences and opinions [80]. Reduced interprofessional
practice jeopardizes evidence-based medicine where each
professional’s action is instead guided by reciprocal sharing
of knowledge with colleagues; this process will accrue the
personal and collective bank of information about patients
and deliver holistic and coordinated care [81]. Besides, inte-
grated interprofessional team practice reduces medical and
pharmacological errors by improving shared information,
reducing gaps in actions and collateral support, and increas-
ing responsivity and accountability in multidisciplinary
teams [82].
5.4. How Does SNA Inform Clinical Outcomes?
The promotion of PWA personhood and cognitive
stimulation and activation requires the participation of di-
verse experts (e.g., nurses, doctors, psychologists, physio-
therapists, healthcare assistants, and other healthcare profes-
sionals), each one with the know-how necessary to attend to
the multifaceted aspects of Alzheimer’s disease [20, 83].
Social networks configuration emerging in the current study
provide some hint that centralized geriatric care, although
based on pivotal senior and expert figures, might not pro-
vide rapid response in clinical conditions of novelty, emer-
gence, and rapid deterioration of PWA [66] where in these
last conditions (centralized knowledge management), and
immediate consultation and information might not be avail-
able, for instance, in decentralized geriatric units, night
shifts, community work and for ‘peripheral workers’, PWA
are at risk for safety and health [66]. Instead, these findings
should match the National Institute for Health and Care Ex-
cellence plan to implement interprofessional trust and
shared help provision to support patient-centred care [84].
SNA can help reconfigure teamwork in PWA’s psychogeri-
atric care while capturing when silos leadership inclines to a
centralized vs. collaborative care to PWA. For instance, a
systematic review found that one strategy to promote col-
laborative care is to increase multidisciplinary meetings
which promote increasing internal audits and improve pa-
tient care [85]. Nonetheless, owing to the variety of activi-
ties required for the activation of cognitive and social skills
in PWA, dementia health carers can reorganize their re-
sources when shaping diverse acts for patient promotion in
an environment of reciprocal recognition, self-reflection,
change, and the quest for innovative alternatives in patient
care [17]. This reconfiguration of the sociograms capturable
by SNA was also found to increase each member of staff’s
job satisfaction by encouraging feelings of coalition and
support from peers during complex tasks on patients [86].
5.6. How do Social Networks and Diffusion of Knowl-
edge in PWA Differ from other Geropsychiatric Units at
other Institutes?
Interprofessional practice in psychogeriatric inpatient
sees the same professional as promoting different aspects of
PWA personhood, or on the contrary, different professionals
advancing the same aspect of PWA personhood independ-
ently from their professional specification [63]. If collabora-
tive care is vital for addressing PWA with multiple needs,
the model proposed cannot always be replicated in other
specialties and healthcare sectors where more specific divi-
sions of the tasks and skills are required to complete a task.
Other times, the capitalization of knowledge moves its steps
also according to scientific development where technologi-
cally advanced students use know-how and collaboration
within several individuals from various fields (e.g., architec-
ture, industry, and health care) to collaborate as an interdis-
ciplinary team to apply creative ideas to a task also as crea-
tive hubs [87]. Research conducted in a teaching hospital in
the Netherlands confirms that team members differ in the
interpretation of care planning. At the same time, physicians
reported a central and pivotal role in medical decisions [88].
Due to the complexity of PWA needs, SNA findings
showed the high DP of senior figures, although more pe-
ripheral figures could equally provide valuable inputs to the
whole team when consulted. From our experience, inde-
pendently from seniority in the team, many professionals,
also those who occupy more peripheral areas of the social
network, undergo specialized training in specific areas of
PWA care. If their capital of knowledge is not shared with
colleagues in interprofessional teams, there is a risk of loss
of vital information for the care of PWA. The current study
confirms that centralized cliques are still active in PWA
psychogeriatric care, and it can be hypothesized the risk of
loss of capital knowledge with small reciprocity of ties. In-
stead, diffuse interprofessional care would suggest more
reciprocal ties/edges in information and consultation sharing
where each professional is guided by and can guide others
in a coordinated PWA care.
5.3. Limitations of the Current Study
The findings of the current study can only be applied to
psychogeriatric teams working with the adult population
with dementia and Alzheimer’s disease. Besides, the appli-
cation of the findings is restricted due to the limited number
of professionals who completed the survey. The groups of
participants were not randomly selected, hence reducing the
generalisability of the study. Furthermore, no control group
from non-psychiatric wards was used for a comparison of
collaborative care. Therefore, it is predictable that distinc-
tive social networks exist in other teams, although the cur-
rent analysis did not capture these dynamics. The findings
are linked to the teams explored here and can only be hypo-
thetically generalised to similar teams. Therefore, the cur-
rent research has some degree of contextual limitation. An-
other limitation derives from the nature of consultation and
information sharing within the healthcare system, where
much can occur on a digital platform independently from
face-to-face approaches. Hence, the SNA can be both a
natural and virtual network of exchanges inclusive of face-
to-face encounters or distance communication. The current
study did not explore such differences. Besides, the configu-
rations of the social networks did not provide any informa-
tion about their effectiveness in PWA care; this last has only
been assumed based on similar studies.
CONCLUSION
SNA offered a snapshot of psychogeriatric teams in
terms of professional figures who are more central in dis-
seminating knowledge to the whole team and the degree of
reciprocity in interprofessional relations. The current re-
Social Network Analysis of Alz heimer’s Teams Current Alzheimer Research, XXXX, Vol. XX, No. XX 17
search findings have practical applications in the implemen-
tation of collaborative practice as recommended by national
and international guidelines in interprofessional care. Hence,
the current study results can help policymakers understand
team dynamics within psychogeriatric teams and advocate
targeted interprofessional training and knowledge manage-
ment for such teams. The initial findings appear encourag-
ing in identifying SNA as a reliable and valid instrument to
study interprofessional practice in healthcare settings and
old-age psychiatry. The current study could be continued by
involving other psychiatric teams that were hard to reach
during the current stage of assessment. This opportunity
would explore other dynamics in interprofessional care in
psychiatry and other areas of reinforcement.
LIST OF ABBR EVIATIONS
DP = Degree of Prestige
SNA = Social Network Analysis
PWA = Persons with Alzheimer’s Disease
ETHICS APPROVAL AND CONSENT TO
PARTICIPATE
Participation to the current research was anonymous,
voluntary and online. According to the Medical Research
Council and NHS Health Research Authority requirements,
the current research did not need national clearance in the
UK. The research project was approved by the University of
Derby ethical committee.
HUMAN AND ANIMAL RIGHTS
No Animals/Humans were used for studies that the base
of this research.
CONSENT FOR PUBLICATION
Local managers and participants gave their verbal con-
sensus to publication at the condition that no identifiable
data was disclosed.
AVAILABILITY OF DATA AND MATERIALS
The data supporting the findings of the article are avail-
able in the current study only. Therefore, researchers, hospi-
tals, and users interested in the data will be provided with
the link to access the present article or access it via search
engines.
FUNDING
None.
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or
otherwise.
ACKNOWLEDGEMENTS
Declared none.
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