In building 1, out of 100 residents, 42 (42%) people were interviewed (23 for sociometrics, 19 qualitative), 32 women and 10 men with a mean age of 74 and 38 live alone. 20 persons have never participated to CHAP sessions, 9 only one time and 13 two times and more. In building 2, 27 (54%) people out of 50 residents were interviewed (14 for sociometrics, 13 qualitative), 19 women and 8 men with a mean age of 70, 12 living alone, 10 in couple, 2 widowed and 3 living with another member of the family. 16 persons have never participated to CHAP sessions, 7 only one time and 4 two times and more.
Maps of complete network
Using the quantitative data to identify the people in their network and the links between other known neighbors even if they were not close to them (31, 33), we were able to map the connections for 75% of the building 1 and 92% of the building 2.
The maps of the complete networks of the 2 buildings (Figs. 1 & 3) illustrate the centrality of certain tenants in the buildings and the distribution of conflicts. People in the center of the maps are more central in the buildings’ networks, which means that others name them more frequently. The links in grey represent the connections (knowing the neighbor) and the links in red represent conflicts they had with the named neighbor. The node names represent the gender (M for male or F for female) and the number of CHAP sessions attended (0 to 7). According to the type of relationships residents identified with from the coding grid, these persons were consulted when they needed information, services and wanted to attend building activities.
In the next two maps (Figs. 2 & 4), the links representing conflicting relationships (red links) and people who did not attend and were not directly connected to someone who attended (green nodes) had been removed. These maps aimed to illustrate the direct diffusion opportunities between people in each building. In the building 1 network configuration, we could reach 59% residents and 82% in the building 2. By removing conflicting links we could identify the main actors of diffusion in each building.
Social Networks in Building 1, the leader makes the difference
In building 1 (Fig. 1), which has a relatively high attendance rate (34.3%) at CHAP sessions, there were 2 clans (identified with qualitative interviews and network measures). A recent conflict between the leaders of these two clans in the building had an effect on different activities (including CHAP session attendance). Figure 1 shows that a clan leader had many red links (conflicts), one of which is with the other clan leader. This person did not attend any CHAP sessions for this reason, because the other person participated in all sessions. The first clan chief was a leader (F6 in centre) with 23.2% In-degree (‘named by others’ frequency). She attended all sessions, which may explain the fact that this building still had a high attendance rate. This position of leader for F6 was confirmed after having removed the conflicting links (Fig. 2) with a total degree (total of links when ‘someone named others’ and ‘be named by others’) of 28.4% for F6 and 0.17% for F0.
In addition, the In-degree ranking indicates that 4 out of 6 of clan 1 attended at least one session, versus 2 out of 6 for clan 2 (Fig. 1) which illustrates the group influence of clan 1 in CHAP attendance. The map of diffusion potentialities in the network configuration of building 1 (Fig. 2) shows that the total degree remained high for the leader (F6), which means that she remained a main actor of diffusion and a key-agent for the CHAP implementation (before, F6 18.2% and F0 11.6% ; after removing conflict links F6 28.4% and F0 0.17%).
Social Networks in Building 2, the hidden bridge
In building 2 (see Fig. 3), which had a lower attendance rate (23.9%), the leaders (FM0) had 32.7% In-degree and did not attend any sessions (0 out of 7). There is also a presence of 2 main clans in this building. The presence of conflicts indicates that there were more conflicts around the central leader than around the peripheral leader. The In-degree ranking indicates that 5 out of 6 tenants from clan 1 did not attend and 1 out of 6 had attended one time. We can see that in this network configuration (Fig. 4), the total degree (in and out degree) changes between the leaders (FM0) and a CHAP participant (F1) who was not identified as central (only 2% In-degree). Before removing conflicting links, FM0 had 27.6% and F1, 17.3%. After removing conflicting links, F1 goes up to 19.5% and FM0 goes down to 13.4%, which means that F1 is the most important person in this building to promote the program activities in the building. This person is, with M0 (in Fig. 3), a main actor of diffusion and a key-agent for the CHAP implementation, whom we should have involved in the program diffusion strategies. Thus, F1 is a common relation to the two cited main leaders and represents a kind of bridge in this divided network.
Proximity and distance strategies from residents
Qualitative analysis has shown that residents of both buildings adopt proximity and distance strategies in the relationships they have with neighbors, and that there are some variations in degree. The first level of proximity strategies represents general polite behaviors: “There is this woman that I often chat with. She likes to sit on one of the chairs in the indoor lobby downstairs. Whenever I see her there, we wave to one another. You could say that this is a kind of interaction. .. Yeah, we greet each other, and then maybe just say a few words, nothing more.” (R8/F1). Most people appreciated greetings and respect for an acceptable noise level. In addition, some were willing to exchange some services occasionally and this means that they were sharing closer relationships with some neighbors, especially with people who were highly involved in the community and/or members of tenants association and local leaders. A greater level of proximity is also seen when some have few (1–2) people with whom they make regular exchanges of services and visit:“R: Sure, sometimes I’ll just go there or sometimes we just help each other out in small ways. For instance, if I make a big batch of homemade soup, I might bring some of it to neighbors who have done me a favor. These are the kind of encounters I have. Q: How about meeting for activities? R: No, that hasn’t happened.” (R3F/F0) Or confide and share activities: “Well, I know XY: I see her pretty often, especially when there are activities down below, or whenever she walks her dog. .. and then there is X and Y, who I would say are good friends.” (R2F/F0). They also demonstrate their connection by helping more in case of illness or by larger services during the more serious illness, rather than only helping in emergencies. The highest level of proximity is to contribute to the community through volunteering or by being members of the tenants association.
People participated in different activities for a variety of reasons, among other things, to socialize with people and create new friendships. However, some did not need participation in activities to rub shoulders with people. Some people tended to be more involved because of the participation of (a) particular person(s) in the same activity: “Yes, I did go to the CHAP session once. It’s the kind of thing I go to with X and his girlfriend. I had asked them to come with me. […] because I am not really all that comfortable going there alone yet. Once I get a better sense of who is there and how it unfolds, I’ll probably go on my own. But right now, I am still just checking it out.” (R9/F3). Tenants, instead, preferred to focus on the activity rather than the interaction between neighbors: “When I do go to one of those places, it is usually because I like going there and I want to learn something.” (R6/F4).
The majority of tenants also mentioned using distance strategies. First, several only helped in case of emergency, for example, power outage, fall, or they charged for the services they render. Then, a widely used strategy was the avoidance of neighbors in common spaces. Sometimes they wanted to avoid a particular person they have a conflict with: “I try not to bump into her whenever possible. For instance, I avoid opening my front door when I know she is behind.” (R1/F1). Sometimes they adopted this behavior as a habit: “I go when I think no one is there, but if I see someone, I immediately turn around.” (R2/F4). This strategy seemed to be used particularly to avoid conflicts or being judged: “I am just afraid of making a bad impression on others. .. so because I worry about that a lot […] So I have become really withdrawn as a result. I can’t stand conflict.”(R1/F1); or to be included in gossip sessions: “I am just not the kind of person who wants to get close to neighbors. Gossip turns me off.” (R3F/F0); or even to be caught in clans: “Yes, there can be tribalistic behavior here. In fact, that is the main reason why I decided to take a distance from people I had established relationships with.” (R7/M0).
The reasons for conflicts can be the noise, divergent opinions, personal attacks, gossip, etc. In addition, more personal problems such as negative behaviors or strong personalities cause tensions. These conflicts may be current, past and may have caused break-ups and stopped the mutual assistance that was once present, and some can become reluctant to form new relationships with neighbors. These same reasons also justify the isolation of some. Many appreciate or are used to loneliness. There is also the presence of relatives there for them occasionally and living outside the building that influences their withdrawal from neighbors and makes loneliness more appreciable. However, not the totality of people live well with loneliness and some people express some distress regarding the relationships they have with neighbors: “Maybe it is because I am not in a good head space right now…because, you know, I don’t think I am a bad person and I certainly don’t mean anyone harm, but I don’t like how people treat me here […] they remind me that I am worthless, or worse. And so that is how I feel now: worthless.” (R10/F4)
This portrait needs to be nuanced by the fact that it is not possible to strictly classify people in these two separate types of strategies. The interviews show a deeper ambiguity. For example, a person can help a neighbor intensively during a period or be friends with them and start afterward to avoid this person because of a time consuming relationship, problem of trust or health that make the respondent not be able (or not want to) to continue this relationship. On the other hand, a person can sometimes use a distance or proximity strategy and a mix of both in the daily life depending on the mood, the health, the people they meet: “On the one hand, I need to keep to myself and I need to live alone, and on the other hand, I don’t want to be all alone all the time. I do need to see people sometimes and then after I do, I need to be alone again to get back to my peace and quiet.” (R6/F4)
Reasons for attending and for not attending CHAP sessions
Regarding the reasons for attending the program, they were related to the program’s objectives namely, knowing the health status, checking the blood pressure, following up with the doctor, acquiring new knowledge through conferences, motivation to take care of oneself: “I go once in a while. The last time, only went to attend the nutritionist’s talk on healthy eating. I found it really interesting.”(R2/F4). Some participants attended the sessions for the benefits of the program and because even if they don’t appreciate social interaction, they met a person there they were comfortable with:“I go to those sessions to get my blood pressure checked. There is only one or two people that I chat with. Because, as I see it…most women show up in pairs, they are always in pairs of two. .. There is one person that I regularly talk to and it is always chill between us. That has been my experience. Q: Is that really the extent of your interactions? R: I have very, very few. I am telling you…I am not comfortable with social interaction. .. I think I have put a wall around myself.” (R2/F4). Moreover, some attendants came to the CHAP sessions because a neighbor invites them to the activity. For example, respondent R1 who is generally isolated from the neighbors did come once: “When X told me about it and said she was going, I said to her, ‘Alright, I’ll come with you.’”but also said that “The only reason I don’t go is because I don’t want to see any of my neighbors.”
Besides the fact that some respondents didn’t feel the need to attend CHAP sessions because they were already followed by their doctor, the main reasons mentioned for not participating were related to the relationships respondents had with their neighbors: “Since I already have a family doctor, I can consult with her over the phone whenever I need to. I think maybe I just want to avoid being around certain groups in this building.” (R5/F0). They also mentioned the atmosphere that can be heavy between residents during the CHAP sessions as a barrier to attend: “I try to go but I am not sure I will keep going. .. even though going means that I can get my blood pressure taken. Q: Are you disappointed? R: Yes, because I want to listen to the talks; I want to hear the expert’s health tips and what she has to say.” (R2/F4). Also, respondents didn’t want neighbors to be aware of their health status when taking the pressure: “Yeah, well you know some of us may feel self-conscious about attending those sessions. Q: In the sense that your neighbors might see you there? R: Yes, that is what I mean.” (R7/M0)
In general, participation in the CHAP was considered like any other activities in the building. People did not participate in any activities including CHAP because they generally prefer to avoid conflicts and retaliation: “Personally, I often go. And I noticed that it is usually the same ones who tend to participate too. For instance, 90% of people who show up for bingo are regulars. Q: From one of those two gangs? Have you seen there any of the women that you describe as mean-spirited? R: I guess so. To tell you the truth, I am not sure […] I went only once [to bingo] and I kept to myself; I kept my head down.” (R11/F0); and especially gossip: “There is this 53 year-old woman who stopped coming to the sessions. I told her, ‘I miss you. I liked seeing you there.’ She replied, ‘There is too much gossiping and I just can’t deal with it.’ I think she is right to say that there are many people in this building who like to gossip.” (R8/F1). Finally, another reason that has been mentioned is the presence of cliques and clans in the buildings: “There are tribalistic groups that have coalesced in this building. They get together downstairs and they say slanderous things […] It is so draining; I can’t wait to get back up to my place when I hear them get started.” (R5/F0)