How quitters navigate their social networks: the importance of subjectivity and dynamic interaction in smoking cessation

Abstract

There is widespread recognition of the need for preventive healthcare to support people in adopting healthy lifestyles that will reduce their risk of long term conditions such as diabetes, cardiovascular disease and cancer. In recent years, a number of observational studies have shown that social networks may play an important role in health behaviour change. Thus far, however, there has been limited success in translating these findings into effective interventions, suggesting a failure to tap into real-world social processes. The aim of my thesis is to develop our understanding of the role that social networks play in one key area of health behaviour change, namely smoking cessation, with a view to gaining insights into how networks can be better utilised to improve quit outcomes. Whilst most research into health behaviour change is rooted in psychological theory, this study draws on a somewhat different perspective, that of social network studies in health. More specifically, it uses a longitudinal qualitative approach to investigate the role of social networks in giving up smoking. Thirteen participants from diverse sociodemographic backgrounds were recruited through three stop smoking services in central Scotland, and interviewed four weeks after quitting; nine participants took part in a follow-up interview two months later. In-depth interviews combined an interactive network mapping exercise with a detailed exploration of the complex inter-relationships between participants’ social networks and their experiences of quitting. A thematic data analysis was undertaken. Quitting was found to be enmeshed in an intricate web of social relationships and interactions. Quitters were not, though, powerless in the face of these social forces, but rather actively sought to navigate their social networks. Existing theorisations tend to view the social network as acting on a passive individual and, as such, overlook the importance of subjective meaning and dynamic interaction in shaping the quit attempt. My thesis demonstrates, however, that the mechanisms of subjectivity and interaction operate in complex ways, encompassing a myriad of overlapping sources of meaning which include the immediate context of interactions, the wider nature of individual relationships, and the overall construction of the social network. These processes jointly unfold, moreover, as the quit attempt proceeds. Efforts to develop network-based cessation interventions must, therefore, move away from attempts to “fix” the network, and must instead seek to find ways of helping quitters to more effectively navigate their social networks.