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Baticulon RE, Dewan MC, Karekezi C, Shlobin NA, Garcia RM, Ghotme KA, Thango N, Rosseau G, Hutchinson PJ. Achieving Equity Through Global Neurosurgery Research. Neurosurgery 2024:00006123-990000000-01319. [PMID: 39185879 DOI: 10.1227/neu.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 08/27/2024] Open
Abstract
Since the release of the Lancet Commission on Global Surgery report in 2015, there has been an increase in the number of published papers on global neurosurgery, gaining widespread support from major neurosurgery journals. However, there remains no consensus on what may be considered part of global neurosurgery literature. Here, we propose that global neurosurgery research encompasses all scholarly work that measure, explore, or address inequity in the care of neurosurgical disease. We describe the growth of global neurosurgery research, cite landmark papers, and discuss barriers to participation, particularly among neurosurgeons in low- and middle-income countries. We introduce the 3Rs framework, advocating for global neurosurgery research that is rigorous, responsive, and responsible. This narrative review aims to guide young neurosurgeons and other researchers interested in the field, and to provide a framework through which global neurosurgery practitioners and advocates can evaluate previously accomplished work, paving the way toward neurosurgery that is timely, safe, and affordable to all.
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Affiliation(s)
- Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, University of Rwanda, Kigali, Rwanda
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, Colombia
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Lencucha R. Transforming global health: decoloniality and the human condition. BMJ Glob Health 2024; 9:e015420. [PMID: 39153753 PMCID: PMC11331859 DOI: 10.1136/bmjgh-2024-015420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
The field of global health is at a pivotal moment of transformation. Decoloniality has emerged as a critical framework to assess and transform the pathologies that mark the field. These pathologies include the inequitable sharing of resources, the power hierarchies that entrench decision-making in institutions largely based in North America and Europe and the general predisposition towards paternalistic and exploitative interactions and exchange between North and South. The energy being generated around this transformative moment is widening circles of participation in the discourse on what transformation should look like in the field. The importance of decoloniality cannot be overstated in driving the transformative agenda. At the same time, the popularity of decoloniality as a critical framework may risk omissions in our understanding of the origins of injustice and the pathways to a new global health. To complement the work being done to decolonise global health, I illustrate how the 'human condition' intersects with the transformative agenda. By human condition, I mean the universal features of humanity that lead to oppression and those that lead to cooperation, unity and a shared humanity.
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Ameen K, Airhihenbuwa C. Expanding Bystander Behavioral Approaches to Address Racial Violence in Health Research, Pedagogy, and Practice. Health Promot Pract 2024:15248399241269996. [PMID: 39138834 DOI: 10.1177/15248399241269996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
A bystander to racial violence is conventionally thought of as someone who witnesses an overt act of racial oppression at the interpersonal level, such as police brutality. However, racial violence in health research, pedagogy, and practice often shows up more covertly, like through epistemic injustice, deficits-based framing, and racial essentialism. We aim to expand how we think about bystanders and perpetrators of racial violence within health institutions, and how antiracism bystander behavioral approaches can be deployed to intervene against such violence. Existing public health antiracism frameworks, such as the Public Health Critical Race Praxis and the PEN-3 Cultural Model, offer valuable constructs and processes through which health practitioners, researchers, and academics can disrupt racial violence. Such antiracism frameworks are well suited to provide individuals within public health and health care with the knowledge, skills, and efficacy to intervene as engaged bystanders against racism within their contexts. To illustrate how constructs within antiracism frameworks can be applied by bystanders in various health settings, we outline case examples of antiracism bystander interventions across three scenarios. The more bystanders there are within health institutions that are equipped with antiracism tools, the more likely normative behaviors uplifting White supremacy within these institutions can be disrupted and health equity can be actualized.
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Vo AV, Majnoonian A, Shabalala F, Masuku S, Fielding-Miller R. "Hope is being stirred up": Critical consciousness in gender-based violence interventions. Soc Sci Med 2024; 357:117175. [PMID: 39116699 DOI: 10.1016/j.socscimed.2024.117175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/20/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
Gender-based violence (GBV) research in public health has historically paid close attention to gender as a system of oppression, with less attention paid to the intersections between gender and other oppressive systems such as colonialism, white supremacy, and capitalism. In 2019, we adapted and pilot-tested an individual-level evidence-based sexual violence resistance intervention for university-attending women in Eswatini. We conducted a qualitative assessment of our adapted intervention's acceptability and feasibility using a critical pedagogy lens to explore how power operated in delivering an empowerment intervention, using in-depth interviews with intervention participants and facilitators. We analyzed interview transcripts thematically guided by a critical pedagogy framework and organized emergent themes into a concept map with two primary axes: participant-researcher-driven power and proximal-distal determinants. We located participant experiences with the intervention within three quadrants defined by these axes: 1) "Prescriptive," in which the researcher or facilitator primarily controls the content and delivery, with a principal focus on proximal risk reduction strategies; 2) "Solidarity," which emphasizes fostering critical consciousness among facilitators and intervention participants through dialogue, building collective power through participant-driven discussions of individual experiences; and 3) "Liberation," in which participants critically examined the power structures that underpinned their lived experiences, and expressed a desire to transform these in ways the intervention was not designed to address. These three quadrants suggest the existence of a fourth quadrant, "paternalistic," - in which the interventionist seeks to didactically educate participants about structural drivers of their own experience. Our analysis highlights a fundamental tension in the epistemology of GBV research: While there is a clear consensus that 'empowerment' is a necessary component of successful GBV interventions, "liberatory" approaches that cede power to participants are inherently antithetical to the scripted approach typically required for consistent replication in randomized control trials or other 'gold-standard' approaches for post-positivist evidence generation.
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Affiliation(s)
- Anh Van Vo
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA.
| | - Araz Majnoonian
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA; Joint Doctoral Program in Public Health-Global Health, San Diego State University, San Diego, CA, USA
| | | | - Sakhile Masuku
- Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Rebecca Fielding-Miller
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA
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Valle R, Singh SP, Loch AA, Iyer SN. How "global" is research in early intervention for psychosis? A bibliometric analysis. Asian J Psychiatr 2024; 98:104128. [PMID: 38964005 DOI: 10.1016/j.ajp.2024.104128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Unlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. METHODS We conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors' affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. RESULTS Globally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. CONCLUSIONS LAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world's youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.
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Affiliation(s)
- Ruben Valle
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Research and Innovation, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
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Borowsky HM, Schofield CL, Du T, Margo J, Williams KKA, Sloan D, Bullock K, Sanders JJ. Race Dialogues and Potential Application in Clinical Environments: A Scoping Review. J Gen Intern Med 2024:10.1007/s11606-024-08915-3. [PMID: 39042181 DOI: 10.1007/s11606-024-08915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Race dialogues, conversations about race and racism among individuals holding different racial identities, have been proposed as one component of addressing racism in medicine and improving the experience of racially minoritized patients. Drawing on work from several fields, we aimed to assess the scope of the literature on race dialogues and to describe potential benefits, best practices, and challenges of conducting such dialogues. Ultimately, our goal was to explore the potential role of race dialogues in medical education and clinical practice. METHODS Our scoping review included articles published prior to June 2, 2022, in the biomedicine, psychology, nursing and allied health, and education literatures. Ultimately, 54 articles were included in analysis, all of which pertained to conversations about race occurring between adults possessing different racial identities. We engaged in an interactive group process to identify key takeaways from each article and synthesize cross-cutting themes. RESULTS Emergent themes reflected the processes of preparing, leading, and following up race dialogues. Preparing required significant personal introspection, logistical organization, and intentional framing of the conversation. Leading safe and successful race dialogues necessitated trauma-informed practices, addressing microaggressions as they arose, welcoming participation and emotions, and centering the experience of individuals with minoritized identities. Longitudinal experiences and efforts to evaluate the quality of race dialogues were crucial to ensuring meaningful impact. DISCUSSION Supporting race dialogues within medicine has the potential to promote a more inclusive and justice-oriented workforce, strengthen relationships amongst colleagues, and improve care for patients with racially minoritized identities. Potential levers for supporting race dialogues include high-quality racial justice curricula at every level of medical education and valuation of racial consciousness in admissions and hiring processes. All efforts to support race dialogues must center and uplift those with racially minoritized identities.
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Affiliation(s)
- Hannah M Borowsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Catherine L Schofield
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
| | - Ting Du
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Judy Margo
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
| | | | - Danetta Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bullock
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Justin J Sanders
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Schneider H, Amde W, Carolissen C, Van Wyk B, Lehmann U. Responsive public health doctoral education: experiences and reflections from a School of Public Health in South Africa. BMJ Glob Health 2024; 9:e015095. [PMID: 38964880 PMCID: PMC11227753 DOI: 10.1136/bmjgh-2024-015095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
Institutional capacity for doctoral training is key to addressing the complex challenges facing the global south. In the context of the need for skilled knowledge workers in health systems and growing demand for doctoral places, we reflect on the evolution of a public health doctoral programme in a South African School of Public Health. Through this case, we aim to contribute to wider debates on the form and content of emerging public health doctoral programmes in South Africa and the African continent. Drawing on a multi-level framework of 'curriculum responsiveness' we consider responsive public health doctoral education as simultaneously engaging macro-social, institutional/cultural, disciplinary and individual learning imperatives. We assess the responsiveness of the doctoral programme against these elements, describing the growth, institutional context and systems and pedagogical strategies introduced over the last decade, and areas for further development. We conclude by proposing the multi-level capacities required for responsive public health doctoral education. We highlight the need for diversified curricula (including professional doctorates) that support a wider set of graduate attributes and career trajectories beyond academia, greater investment in doctoral infrastructures within higher education institutions, and disciplinary practices and pedagogies that centre epistemic access and justice.
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Affiliation(s)
- Helen Schneider
- School of Public Health, University of the Western Cape, Bellville, South Africa
- South African Medical Research Council, Tygerberg, South Africa
| | - Woldekidan Amde
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Corinne Carolissen
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Brian Van Wyk
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Airhihenbuwa CO, Ford C, Iwelunmor J, Griffith DM, Ameen K, Murray T, Nwaozuru U. Decolonization and antiracism: intersecting pathways to global health equity. ETHNICITY & HEALTH 2024:1-15. [PMID: 38959185 DOI: 10.1080/13557858.2024.2371429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.
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Affiliation(s)
| | - Chandra Ford
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Juliet Iwelunmor
- Washington University School of Medicine, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Khadijah Ameen
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Teri Murray
- Trudy Busch Valentine School of Nursing, Saint Louis University, Saint Louis, MO, USA
| | - Ucheoma Nwaozuru
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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Rennie N, Degraeuwe E, Deltour C, Serry Senhaji M, Brusselmans J, Vandenheede M, Berrevoet F, Van Daele E, Willaert W. Global surgery education in Belgium: Student's knowledge, attitudes and exposure. MEDICAL TEACHER 2024; 46:971-977. [PMID: 38071668 DOI: 10.1080/0142159x.2023.2289849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/28/2023] [Indexed: 06/27/2024]
Abstract
PURPOSE Understanding how medical students perceive global surgery will be essential in strengthening the global surgery workforce by 2030. This study investigated the knowledge, attitudes and exposure of Belgian medical students towards global surgery and identified avenues for medical institutions to include meaningful educational opportunities. METHODS An online survey was distributed to first to final year medical students across Belgian universities using social media. Data were collected on demographics, exposure, knowledge and attitudes towards global surgery. Odds ratios with 95% confidence intervals were calculated. RESULTS A total of 304 medical students participated from four Belgian universities. A minority reported having exposure to global surgery (24.7%), and most wanted more exposure (75.3%). Almost all respondents agreed (94.4%) that it is a relevant topic for medical students, and most agreed (71%) more compulsory education on the topic is needed. Only 13 to 44% of students could correctly answer questions testing global surgery knowledge. Personal/family responsibilities were the most important barrier to pursuing global surgery careers. CONCLUSIONS Global surgery knowledge and exposure is limited among Belgian medical students despite interest in the field. These results advocate for the inclusion of decolonised global surgery education alongside equitable international clinical internships in medical education worldwide.
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Affiliation(s)
- Nicholas Rennie
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eva Degraeuwe
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Deltour
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | | - Judith Brusselmans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Margo Vandenheede
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Elke Van Daele
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Teixeira da Silva JA, Daly T. Inclusive Editorial Policies Can Reduce Epistemic Injustice in Academic Authorship. Chest 2024; 166:e22-e23. [PMID: 38986649 DOI: 10.1016/j.chest.2024.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
| | - Timothy Daly
- Bioethics Program, FLACSO Argentina, Buenos Aires, Argentina; Science Norms Democracy UMR 8011, Sorbonne Université, Paris, France
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Abimbola S, van de Kamp J, Lariat J, Rathod L, Klipstein-Grobusch K, van der Graaf R, Bhakuni H. Unfair knowledge practices in global health: a realist synthesis. Health Policy Plan 2024; 39:636-650. [PMID: 38642401 PMCID: PMC11145905 DOI: 10.1093/heapol/czae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
Unfair knowledge practices easily beset our efforts to achieve health equity within and between countries. Enacted by people from a distance and from a position of power ('the centre') on behalf of and alongside people with less power ('the periphery'), these unfair practices have generated a complex literature of complaints across various axes of inequity. We identified a sample of this literature from 12 journals and systematized it using the realist approach to explanation. We framed the outcome to be explained as 'manifestations of unfair knowledge practices'; their generative mechanisms as 'the reasoning of individuals or rationale of institutions'; and context that enable them as 'conditions that give knowledge practices their structure'. We identified four categories of unfair knowledge practices, each triggered by three mechanisms: (1) credibility deficit related to pose (mechanisms: 'the periphery's cultural knowledge, technical knowledge and "articulation" of knowledge do not matter'), (2) credibility deficit related to gaze (mechanisms: 'the centre's learning needs, knowledge platforms and scholarly standards must drive collective knowledge-making'), (3) interpretive marginalization related to pose (mechanisms: 'the periphery's sensemaking of partnerships, problems and social reality do not matter') and (4) interpretive marginalization related to gaze (mechanisms: 'the centre's learning needs, social sensitivities and status preservation must drive collective sensemaking'). Together, six mutually overlapping, reinforcing and dependent categories of context influence all 12 mechanisms: 'mislabelling' (the periphery as inferior), 'miseducation' (on structural origins of disadvantage), 'under-representation' (of the periphery on knowledge platforms), 'compounded spoils' (enjoyed by the centre), 'under-governance' (in making, changing, monitoring, enforcing and applying rules for fair engagement) and 'colonial mentality' (of/at the periphery). These context-mechanism-outcome linkages can inform efforts to redress unfair knowledge practices, investigations of unfair knowledge practices across disciplines and axes of inequity and ethics guidelines for health system research and practice when working at a social or physical distance.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Judith van de Kamp
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Joni Lariat
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Lekha Rathod
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Luxembourg Operational Research and Epidemiology Support Unit, Médecins Sans Frontières, Luxembourg City L-1617, Luxembourg
| | - Kerstin Klipstein-Grobusch
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Rieke van der Graaf
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Himani Bhakuni
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- York Law School, University of York, York YO10 5GD, United Kingdom
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MacFarlane A, Huschke S, Marques MJ, Gama A, Kinaan W, Hassan A, Papyan A, Phelan H, Severoni S, Kumar B, Dias S. Normalising participatory health research approaches in the WHO European region for refugee and migrant health: a paradigm shift. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100837. [PMID: 39119099 PMCID: PMC11306213 DOI: 10.1016/j.lanepe.2024.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 08/10/2024]
Abstract
While people's involvement in health research is increasingly the encouraged norm in many countries, the involvement of refugees and migrants in research about their health is rare. Here, we call for a paradigm shift in the field of refugee and migrant health to make participatory health research routine, i.e. normalised. To disrupt 'business as usual', we synthesise evidence about meaningful research partnerships and features of inclusive participatory spaces. We present examples of decolonial, culturally attuned methods that can be used to reimagine and reinvigorate research practice because they encourage critical reflexivity and power-sharing: arts-based research using music and singing, participatory learning and action research, Photovoice and co-design (ideas generation) workshops. We consider the consequences of not making this paradigm shift. We conclude with recommendations for specific structural and policy changes and empirical research questions that are needed to inform the normalisation of participatory health research in this field.
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Affiliation(s)
- Anne MacFarlane
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susann Huschke
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria J. Marques
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Walaa Kinaan
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | | | - Anna Papyan
- Shannon Family Resource Centre, Shannon, Co. Clare, Ireland
| | - Helen Phelan
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Bernadette Kumar
- Division of Health Services Research, Norwegian Institute of Public Health, Norway
- Co- Chair of The Regional Hub Europe Lancet Migration
| | - Sonia Dias
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
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Rid A, Aguilera B, Banda C, Divi R, Harris M, Kim A, Ossandon M, Zervos J, Rowthorn V. Global health reciprocal innovation: ethical, legal and regulatory considerations. BMJ Glob Health 2024; 8:e014693. [PMID: 38821558 PMCID: PMC11144796 DOI: 10.1136/bmjgh-2023-014693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/05/2024] [Indexed: 06/02/2024] Open
Abstract
Global health reciprocal innovation (GHRI) is a recent and more formalised approach to conducting research that recognises and develops innovations (eg, medicines, devices, methodologies) from low- and middle-income countries (LMICs). At present, studies using GHRI most commonly adapt innovations from LMICs for use in high-income countries (HICs), although some develop innovations in LMICs and HICs. In this paper, we propose that GHRI implicitly makes two ethical commitments: (1) to promote health innovations from LMICs, especially in HICs, and (2) to conduct studies on health innovations from LMICs in equitable partnerships between investigators in LMICs and HICs. We argue that these commitments take a significant step towards a more equal global health research enterprise while helping to ensure that populations and investigators in LMICs receive equitable benefits from studies using GHRI. However, studies using GHRI can raise potential ethical concerns and face legal and regulatory barriers. We propose ethical, legal and regulatory considerations to help address these concerns and barriers. We hope our recommendations will allow GHRI to move the global health research enterprise forward into an era where all people are treated equally as knowers and learners, while populations in both LMICs and HICs benefit equitably from studies using GHRI.
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Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center & Department of International Science Policy, Planning and Evaluation, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Bernardo Aguilera
- Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
| | | | - Rao Divi
- Methods and Technologies Branch, Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Matthew Harris
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Amanda Kim
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Miguel Ossandon
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
| | - John Zervos
- The Global Health Initiative, Henry Ford Health, Detroit, Michigan, USA
| | - Virginia Rowthorn
- Graduate School, Umiversity of Maryland Baltimore, Baltimore, Maryland, USA
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Kalinowski J, Hintz EA, Izeogu C. The Untapped Power of "We Don't Know": Epistemological Humility in the Era of COVID-19. J Patient Exp 2024; 11:23743735241252475. [PMID: 38765222 PMCID: PMC11102663 DOI: 10.1177/23743735241252475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic introduced many challenges and nuances that have transformed medical practice and research. The uncertainty caused by COVID-19 led to inevitable challenges to patient-provider relationships. The ever-changing landscape of COVID-19 research and policy proved to be challenging for the medical community and patients. These challenges also exacerbated long-standing issues regarding patient-provider communication and trust. On the other hand, these challenges gave voice to a burgeoning patient advocacy community. Through social media, advocacy and patient organizing, patients harnessed their power and organized over challenges relating to COVID-19 fears and concerns, ramifications of "Long COVID," and much more. During this unprecedented pandemic, there was a realization that the science and research surrounding COVID-19 is evolving and that there may be a benefit to embracing the dynamic nature of research and the scientific process. We propose that providers and the medical community should consider epistemological humility, which acknowledges insufficiencies related to the state of medical knowledge with a sense of understanding and respect for not having all of the answers. We argue that there is untapped potential in saying, "We don't know" and explaining why. There is an implicit culture that providers should be responsible for knowing everything and solving every problem. Epistemological humility challenges this culture, and inherently gives credence and voice to patient perspectives. We assert that epistemological humility is necessity when addressing contemporary health challenges such as COVID-19.
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Affiliation(s)
- Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Chigozirim Izeogu
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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15
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Beardmore-Gray A, Simwinga M, Vwalika B, Chinkoyo S, Chappell L, Sandall J, Shennan A. Understanding the language barriers to translating informed consent documents for maternal health trials in Zambia: a qualitative study. BMJ Open 2024; 14:e076744. [PMID: 38580359 PMCID: PMC11002372 DOI: 10.1136/bmjopen-2023-076744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Providing comprehensible information is essential to the process of valid informed consent. Recruitment materials designed by sponsoring institutions in English-speaking, high-income countries are commonly translated for use in global health studies in other countries; however, key concepts are often missed, misunderstood or 'lost in translation'. The aim of this study was to explore the language barriers to informed consent, focusing on the challenges of translating recruitment materials for maternal health studies into Zambian languages. DESIGN We used a qualitative approach, which incorporated a multistakeholder workshop (11 participants), in-depth interviews with researchers and translators (8 participants) and two community-based focus groups with volunteers from community advisory boards (20 participants). Content analysis was used to identify terms commonly occurring in recruitment materials prior to the workshop. The framework analysis approach was used to analyse interview data, and a simple inductive thematic analysis approach was used to analyse focus group data. SETTING The study was based in Lusaka, Zambia. RESULTS The workshop highlighted difficulties in translating research terms and pregnancy-specific terms, as well as widespread concern that current templates are too long, use overly formal language and are designed with little input from local teams. Framework analysis of in-depth interviews identified barriers to participant understanding relating to design and development of recruitment materials, language, local context and communication styles. Focus group participants confirmed these findings and suggested potential solutions to ensure the language and content of recruitment materials can be better understood. CONCLUSION Our findings demonstrate that the way in which recruitment materials are currently designed, translated and disseminated may not enable potential trial participants to fully understand the information provided. Instead of using overly complex institutional templates, recruitment materials should be created through an iterative and interactive process that provides truly comprehensible information in a format appropriate for its intended participants.
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Affiliation(s)
- Alice Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - Sebastian Chinkoyo
- Department of Obstetrics and Gynaecology, Ndola Teaching Hospital, Ndola, Zambia
| | - Lucy Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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16
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Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M, Nasir N, Causer B, Heightman M, Allsopp G, Wootton D, Khan MA, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Clarke R, Mcfarland S, Gabbay M, Banerjee A, Alwan NA. Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case-finding study. Health Expect 2024; 27:e14037. [PMID: 38634418 PMCID: PMC11024953 DOI: 10.1111/hex.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIM Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.
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Affiliation(s)
- Donna Clutterbuck
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
| | - Mel Ramasawmy
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexFalmerUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Jasmine Hayer
- PPIE Co‐applicant for STIMULATE‐ICPLondonUK
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Fauzia Begum
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyshireUK
| | - Mark Faghy
- Clinical Exercise and Rehabilitation Research CentreUniversity of DerbyDerbyUK
| | - Nayab Nasir
- Department of Health and Social CareOffice for Health Improvement and DisparitiesUK
| | | | | | | | - Dan Wootton
- Clinical Infection Microbiology and ImmunologyUniversity of LiverpoolLiverpoolUK
- Liverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - M. Asad Khan
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Claire Hastie
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Support CharityLondonUK
| | - Monique Jackson
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Clare Rayner
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Darren Brown
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Chelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - Emily Parrett
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Geraint Jones
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Rowan Clarke
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Sammie Mcfarland
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Kids CharitySalisburyUK
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Nisreen A. Alwan
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
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17
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Viaña JNM. Interrogating Sites of Knowledge Production: The Role of Journals, Institutions, and Professional Societies in Advancing Epistemic Justice in Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:63-66. [PMID: 38529993 DOI: 10.1080/15265161.2024.2308144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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18
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Jecker NS, Ravitsky V, Ghaly M, Bélisle-Pipon JC, Atuire C. Proposed Principles for International Bioethics Conferencing: Anti-Discriminatory, Global, and Inclusive. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:13-28. [PMID: 37549186 DOI: 10.1080/15265161.2023.2232748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics' (IAB's) selection of Qatar to host the 2024 World Congress of Bioethics. IAB's choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles. One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing?
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Affiliation(s)
- Nancy S Jecker
- University of Washington School of Medicine, Seattle, WA, USA
- University of Johannesburg, Auckland Park, South Africa
- Chinese University of Hong Kong, Hong Kong, China
| | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | | | - Caesar Atuire
- University of Oxford, Oxford, England
- University of Ghana, Legon, Ghana
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19
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Khan MS, Naidu T, Torres I, Noor MN, Bump JB, Abimbola S. The Lancet and colonialism: past, present, and future. Lancet 2024; 403:1304-1308. [PMID: 38555135 DOI: 10.1016/s0140-6736(24)00102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 04/02/2024]
Abstract
The historical and contemporary alignment of medical and health journals with colonial practices needs elucidation. Colonialism, which sought to exploit colonised people and places, was justified by the prejudice that colonised people's ways of knowing and being are inferior to those of the colonisers. Institutions for knowledge production and dissemination, including academic journals, were therefore central to sustaining colonialism and its legacies today. This invited Viewpoint focuses on The Lancet, following its 200th anniversary, and is especially important given the extent of The Lancet's global influence. We illuminate links between The Lancet and colonialism, with examples from the past and present, showing how the journal legitimised and continues to promote specific types of knowers, knowledge, perspectives, and interpretations in health and medicine. The Lancet's role in colonialism is not unique; other institutions and publications across the British empire cooperated with empire-building through colonisation. We therefore propose investigations and raise questions to encourage broader contestation on the practices, audience, positionality, and ownership of journals claiming leadership in global knowledge production.
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Affiliation(s)
- Mishal S Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Thirusha Naidu
- Department of Behavioural Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan; Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jesse B Bump
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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20
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Lewis NV, Kalichman B, Azeredo YN, Bacchus LJ, d'Oliveira AF. Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives. BMC Med Ethics 2024; 25:32. [PMID: 38504254 PMCID: PMC10949724 DOI: 10.1186/s12910-024-01034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW. METHODS We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. RESULTS We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs' rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. CONCLUSIONS The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics.
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Affiliation(s)
- Natalia V Lewis
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Beatriz Kalichman
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
| | - Yuri Nishijima Azeredo
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Flavia d'Oliveira
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
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21
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Franklin BD, Bartel R, Howitt P. Avoiding harm through hearing our patients. BMJ 2024; 384:q532. [PMID: 38448087 DOI: 10.1136/bmj.q532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Bryony Dean Franklin
- NIHR North West London Patient Safety Research Collaboration, Imperial College Healthcare NHS Trust, London, UK
| | | | - Peter Howitt
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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22
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Viaña JNM. "All from us" or "All with us": Addressing Precision Medicine Inequities Requires Inclusion of Intersectionally Minoritized Populations as Partners and Project Leaders. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:111-114. [PMID: 38394026 DOI: 10.1080/15265161.2024.2303153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
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23
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Jephcott FL, Wood JLN, Cunningham AA, Bonney JHK, Nyarko-Ameyaw S, Maier U, Geissler PW. Ineffective responses to unlikely outbreaks: Hypothesis building in newly-emerging infectious disease outbreaks. Med Anthropol Q 2024; 38:67-83. [PMID: 37948592 DOI: 10.1111/maq.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/20/2023] [Indexed: 11/12/2023]
Abstract
Over the last 30 years, there has been significant investment in research and infrastructure aimed at mitigating the threat of newly emerging infectious diseases (NEID). Core epidemiological processes, such as outbreak investigations, however, have received little attention and have proceeded largely unchecked and unimproved. Using ethnographic material from an investigation into a cryptic encephalitis outbreak in the Brong-Ahafo Region of Ghana in 2010-2013, in this paper we trace processes of hypothesis building and their relationship to the organizational structures of the response. We demonstrate how commonly recurring features of NEID investigations produce selective pressures in hypothesis building that favor iterations of pre-existing "exciting" hypotheses and inhibit the pursuit of alternative hypotheses, regardless of relative likelihood. These findings contribute to the growing anthropological and science and technology studies (STS) literature on the epistemic communities that coalesce around suspected NEID outbreaks and highlight an urgent need for greater scrutiny of core epidemiological processes.
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Affiliation(s)
- Freya L Jephcott
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
- Institute of Zoology, Zoological Society of London, London, UK
| | - James L N Wood
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
| | | | - J H Kofi Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephen Nyarko-Ameyaw
- Disease Control Unit, Techiman Municipal Health Directorate, Ghana Health Service, Techiman, Ghana
| | - Ursula Maier
- Paediatrics Department, Holy Family Hospital, Techiman, Ghana
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24
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Frankfurter R, Malik M, Kpakiwa SD, McGinnis T, Malik MM, Chitre S, Barrie MB, Dibba Y, Mulalu L, Baldwinson R, Fallah M, Rashid I, Kelly JD, Richardson ET. Representations of an Ebola 'outbreak' through Story Technologies. BMJ Glob Health 2024; 9:e013210. [PMID: 38341190 PMCID: PMC10862337 DOI: 10.1136/bmjgh-2023-013210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Attempts to understand biosocial phenomena using scientific methods are often presented as value-neutral and objective; however, when used to reduce the complexity of open systems such as epidemics, these forms of inquiry necessarily entail normative considerations and are therefore fashioned by political worldviews (ideologies). From the standpoint of poststructural theory, the character of these representations is at most limited and partial. In addition, these modes of representation (as stories) do work (as technologies) in the service of, or in resistance to, power. METHODS We focus on a single Ebola case cluster from the 2013-2016 outbreak in West Africa and examine how different disciplinary forms of knowledge production (including outbreak forecasting, active epidemiological surveillance, post-outbreak serosurveys, political economic analyses, and ethnography) function as Story Technologies. We then explore how these technologies are used to curate 'data,' analysing the erasures, values, and imperatives evoked by each. RESULTS We call attention to the instrumental-in addition to the descriptive-role Story Technologies play in ordering contingencies and establishing relationships in the wake of health crises. DISCUSSION By connecting each type of knowledge production with the systems of power it reinforces or disrupts, we illustrate how Story Technologies do ideological work. These findings encourage research from pluriversal perspectives and advocacy for measures that promote more inclusive modes of knowledge production.
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Affiliation(s)
| | - Maya Malik
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Timothy McGinnis
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Momin M Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Smit Chitre
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Lulwama Mulalu
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Raquel Baldwinson
- Department of English Language and Literatures, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, African Union, Addis Ababa, Ethiopia
| | - Ismail Rashid
- Department of History, Vassar College, Poughkeepsie, New York, USA
| | - J Daniel Kelly
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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25
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Perkins J, Nelson S, Birley E, Mcswiggan E, Dozier M, McCarthy A, Atkins N, Agyei-Manu E, Rostron J, Kameda K, Kelly A, Chandler C, Street A. Is qualitative social research in global health fulfilling its potential?: a systematic evidence mapping of research on point-of-care testing in low- and middle-income contexts. BMC Health Serv Res 2024; 24:172. [PMID: 38326871 PMCID: PMC10848363 DOI: 10.1186/s12913-024-10645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Qualitative social research has made valuable contributions to understanding technology-based interventions in global health. However, we have little evidence of who is carrying out this research, where, how, for what purpose, or the overall scope of this body of work. To address these questions, we undertook a systematic evidence mapping of one area of technology-focused research in global health, related to the development, deployment and use of point-of-care tests (POCTs) for low-and middle-income countries (LMICs). METHODS We conducted an exhaustive search to identify papers reporting on primary qualitative studies that explore the development, deployment, and use of POCTs in LMICs and screened results to identify studies meeting the inclusion criteria. Data were extracted from included studies and descriptive analyses were conducted. RESULTS One hundred thirty-eight studies met our inclusion criteria, with numbers increasing year by year. Funding of studies was primarily credited to high income country (HIC)-based institutions (95%) and 64% of first authors were affiliated with HIC-based institutions. Study sites, in contrast, were concentrated in a small number of LMICs. Relatively few studies examined social phenomena related to POCTs that take place in HICs. Seventy-one percent of papers reported on studies conducted within the context of a trial or intervention. Eighty percent reported on studies considering POCTs for HIV and/or malaria. Studies overwhelmingly reported on POCT use (91%) within primary-level health facilities (60%) or in hospitals (30%) and explored the perspectives of the health workforce (70%). CONCLUSIONS A reflexive approach to the role, status, and contribution of qualitative and social science research is crucial to identifying the contributions it can make to the production of global health knowledge and understanding the roles technology can play in achieving global health goals. The body of qualitative social research on POCTs for LMICs is highly concentrated in scope, overwhelmingly focuses on testing in the context of a narrow number of donor-supported initiatives and is driven by HIC resources and expertise. To optimise the full potential of qualitative social research requires the promotion of open and just research ecosystems that broaden the scope of inquiry beyond established public health paradigms and build social science capacity in LMICs.
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Affiliation(s)
- Janet Perkins
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK.
| | - Sarah Nelson
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Emma Birley
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Emilie Mcswiggan
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Marshall Dozier
- Library Academic Support Team, Library & University Collections, and Information Services University of Edinburgh, Argyle House, 3 Lady Lawson Street, Edinburgh, EH3 9DR, Scotland, UK
| | - Anna McCarthy
- Department of Social Work, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK
| | - Nadege Atkins
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Eldad Agyei-Manu
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Jasmin Rostron
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Koichi Kameda
- Centre Population et Développement (CEPED), 45 Rue Des Saints-Pères, 75006, Paris, France
| | - Ann Kelly
- Department of Global Health and Social Medicine, King's College London, Bush House North East Wing, 30 Aldwych, London, WC2B 4BG, England, UK
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, UK
| | - Alice Street
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK
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Gomez AM, Bennett AH, Arcara J, Stern L, Bardwell J, Cadena D, Chaudhri A, Davis L, Dehlendorf C, Frederiksen B, Labiran C, McDonald-Mosley R, Rice WS, Stein TB, Valladares ES, Kavanaugh ML, Marshall C. Estimates of use of preferred contraceptive method in the United States: a population-based study. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100662. [PMID: 38304390 PMCID: PMC10831268 DOI: 10.1016/j.lana.2023.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
Background In the U.S. and globally, dominant metrics of contraceptive access focus on the use of certain contraceptive methods and do not address self-defined need for contraception; therefore, these metrics fail to attend to person-centeredness, a key component of healthcare quality. This study addresses this gap by presenting new data from the U.S. on preferred contraceptive method use, a person-centered contraceptive access indicator. Additionally, we examine the association between key aspects of person-centered healthcare access and preferred contraceptive method use. Methods We fielded a nationally representative survey in the U.S. in English and Spanish in 2022, surveying non-sterile 15-44-year-olds assigned female sex at birth. Among current and prospective contraceptive users (unweighted n = 2119), we describe preferred method use, reasons for non-use, and differences in preferred method use by sociodemographic characteristics. We conduct logistic regression analyses examining the association between four aspects of person-centered healthcare access and preferred contraceptive method use. Findings A quarter (25.2%) of current and prospective users reported there was another method they would like to use, with oral contraception and vasectomy most selected. Reasons for non-use of preferred contraception included side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%), and cost (17.6%). In adjusted logistic regression analyses, respondents who felt they had enough information to choose appropriate contraception (Adjusted Odds Ratio [AOR] 3.31; 95% CI 2.10, 5.21), were very (AOR 9.24; 95% CI 4.29, 19.91) or somewhat confident (AOR 3.78; 95% CI 1.76, 8.12) they could obtain desired contraception, had received person-centered contraceptive counseling (AOR 1.72; 95% CI 1.33, 2.23), and had not experienced discrimination in family planning settings (AOR 1.58; 95% CI 1.13, 2.20) had increased odds of preferred contraceptive method use. Interpretation An estimated 8.1 million individuals in the U.S. are not using a preferred contraceptive method. Interventions should focus on holistic, person-centered contraceptive access, given the implications of information, self-efficacy, and discriminatory care for preferred method use. Funding Arnold Ventures.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Ariana H. Bennett
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Lisa Stern
- Coalition to Expand Contraceptive Access, Washington, DC, USA
| | | | | | | | | | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Whitney S. Rice
- Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tara B. Stein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | - Cassondra Marshall
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Naigaga DA, Kavanagh J, Spillane A, Hickey L, Scott K, Morrissey J, Elmer S, Goss H, Murrin C. Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland. Health Promot Int 2024; 39:daae009. [PMID: 38365191 PMCID: PMC10873780 DOI: 10.1093/heapro/daae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.
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Affiliation(s)
- Desire Alice Naigaga
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, 4 Stillorgan Road, Dublin 4, Ireland
| | | | | | - Laura Hickey
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Katherine Scott
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Janis Morrissey
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Shandell Elmer
- School of Nursing, College of Health and Medicine, University of Tasmania, 71 Brooker Avenue, Glebe, TAS 7000, Australia
| | - Hannah Goss
- School of Health and Human Performance, Dublin City University, Whitehall, Dublin 9, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, 4 Stillorgan Road, Dublin 4, Ireland
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Msoka EF, Bunn C, Msoka P, Yongolo NM, Laurie E, Wyke S, McIntosh E, Mmbaga BT. Rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania. BMJ Glob Health 2024; 9:e013245. [PMID: 38296532 PMCID: PMC10831465 DOI: 10.1136/bmjgh-2023-013245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition. METHODS Rapid ethnographic appraisal was conducted in a periurban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with community leaders, traditional healers, community members and pharmacists.Photographs were taken and included in fieldnotes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software. RESULTS Across the sample, dominant concepts of joint pain were named ugonjwa wa baridi, cold disease; ugonjwa wa uzee, old age disease; rimatizim, disease of the joints; and gauti, gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious rituals. CONCLUSIONS Conceptualisations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong 'lay epidemiology' in these communities. Anthropological methods can support the decolonisation of global health by decentring the imposition of English language biomedicine and pursuing synthetic, dignified languages of care.
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Affiliation(s)
- Elizabeth F Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Emma Laurie
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- School of Health & Wellbeing Social Sciences, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- School of Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Lebu S, Musoka L, Graham JP. Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation. Int J Equity Health 2024; 23:3. [PMID: 38183120 PMCID: PMC10770991 DOI: 10.1186/s12939-023-02083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.
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Affiliation(s)
- Sarah Lebu
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA.
- University of North Carolina, Gillings School of Public Health, Chapel Hill, NC, USA.
| | - Lena Musoka
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
- Georgetown University, McDonough School of Business, Washington, DC, USA
| | - Jay P Graham
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
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Lewin S, Langlois EV, Tunçalp Ö, Portela A. Assessing unConventional Evidence (ACE) tool: development and content of a tool to assess the strengths and limitations of 'unconventional' source materials. Health Res Policy Syst 2024; 22:2. [PMID: 38167048 PMCID: PMC10759469 DOI: 10.1186/s12961-023-01080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND When deciding whether to implement an intervention, decision-makers typically have questions on feasibility and acceptability and on factors affecting implementation. Descriptions of programme implementation and of policies and systems are rich sources of information for these questions. However, this information is often not based on empirical data collected using explicit methods. To use the information in unconventional source materials in syntheses or other decision support products, we need methods of assessing their strengths and limitations. This paper describes the development and content of the Assessing unConventional Evidence (ACE) tool, a new tool to assess the strengths and limitations of these sources. METHODS We developed the ACE tool in four stages: first, we examined existing tools to identify potentially relevant assessment criteria. Second, we drew on these criteria and team discussions to create a first draft of the tool. Third, we obtained feedback on the draft from potential users and methodologists, and through piloting the tool in evidence syntheses. Finally, we used this feedback to iteratively refine the assessment criteria and to improve our guidance for undertaking the assessment. RESULTS The tool is made up of 11 criteria including the purpose and context of the source; the completeness of the information presented; and the extent to which evidence is provided to support the findings made. Users are asked to indicate whether each of the criteria have been addressed. On the basis of their judgements for each criterion, users then make an overall assessment of the limitations of the source, ranging from no or very minor concerns to serious concerns. These assessments can then facilitate appropriate use of the evidence in decision support products. CONCLUSIONS Through focussing on unconventional source materials, the ACE tool fills an important gap in the range of tools for assessing the strengths and limitations of policy-relevant evidence and supporting evidence-informed decision-making.
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Affiliation(s)
- Simon Lewin
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology, Ålesund, Norway.
- Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health, Oslo, Norway.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Hagenaars LL, Maani N, Schmidt LA. Is the commercial determinants conversation confined to the health sciences? Potentially, and that's a problem. Global Health 2024; 20:3. [PMID: 38167207 PMCID: PMC10759639 DOI: 10.1186/s12992-023-00989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
The commercial determinants of health (CDoH) are attracting increased interest and are of great importance when discussing how trade affects health. Through a citation analysis of recent foundational CDoH documents (a Lancet paper series and an Oxford University textbook), we find that fully 71% of all citations reference the health sciences. The health sciences may be well suited to documenting the specific pathways of how commercial (by)products and practices harm human health. However, to operationalize upstream solutions for mitigating these harms, our citation analysis suggests that the field can engage political scientists, economists, sociologists, the trade law and business, as well as advocates in civil society and journalism, more so than it currently does. With CDoH explicitly referring to the interaction between commerce and health, CDoH researchers might be uniquely positioned to get health on the agenda of others, which requires that CDoH methods, datasets, evidence reviews, and proposed interventions are drawn from the widest possible range of sources.
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Affiliation(s)
- Luc Louis Hagenaars
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA.
- Department of Public Health, Amsterdam UMC Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, UK
| | - Laura Anne Schmidt
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
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Divan G, Chiang CH, Villalobos M, Bakare M, Hoekstra RA. Shifting the centre of gravity: Towards a truly global representation in autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:3-5. [PMID: 37982377 PMCID: PMC10771017 DOI: 10.1177/13623613231214644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
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Scheidecker G, Tekola B, Rasheed M, Oppong S, Mezzenzana F, Keller H, Chaudhary N. Ending epistemic exclusion: toward a truly global science and practice of early childhood development. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:3-5. [PMID: 37992724 DOI: 10.1016/s2352-4642(23)00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Affiliation(s)
| | | | | | - Seth Oppong
- University of Botswana, Gaborone, Botswana; University of the Witwatersrand, Johannesburg, South Africa
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Fletcher C, Riva M, Lyonnais MC, Baron A, Saunders I, Lynch M, Baron M. Epistemic inclusion in the Qanuilirpitaa? Nunavik Inuit health survey: developing an Inuit model and determinants of health and well-being. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:20-30. [PMID: 36547790 PMCID: PMC10830955 DOI: 10.17269/s41997-022-00719-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE At the request of Nunavik Inuit health authorities and organizations, the Qanuilirpitaa? 2017 Nunavik regional health survey included an innovative "community component" alongside youth and adult epidemiological cohort studies. The community component objective was to identify and describe community and culturally relevant concepts and processes that lead to health and well-being. METHODS A qualitative, community-based research process involving workshops and semi-structured interviews was used to generate a corpus of data on health concepts and processes specific to Inuit communities in Nunavik. Thematic analysis and repeated community validation allowed for the identification of three key dimensions of health salient to Inuit experience and eight community-level health determinants. RESULTS The health model consists of three linked concepts: ilusirsusiarniq, qanuinngisiarniq, and inuuqatigiitsianiq, which reflect distinct dimensions of Inuit health phenomenology. The determinants community, family, identity, food, land, knowledge, economy, and services were generated through analysis and reflect community-level sources of health and well-being. CONCLUSION The development of the culturally grounded health models and determinants is an exercise of epistemic inclusivity through which researchers and Indigenous communities may form new and equitable paths of knowledge creation.
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Affiliation(s)
- Christopher Fletcher
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada.
- Centre de recherche du CHU de Québec - Université Laval, Quebec City, QC, Canada.
| | - Mylène Riva
- Canada Research Chair in Housing, Community and Health, Institute for Health and Social Policy, Montreal, QC, Canada
- Department of Geography, McGill University, Montreal, QC, Canada
| | | | - Annie Baron
- Nunavik Regional Board of Health and Social Services, Kuujjuaq, QC, Canada
| | | | - Melody Lynch
- Department of Geography, McGill University, Montreal, QC, Canada
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Mitra S, Sarkar S, Ganguli-Mitra A. On the need for an anticolonial perspective in engineering education and practice. Nat Commun 2023; 14:8453. [PMID: 38114470 PMCID: PMC10730537 DOI: 10.1038/s41467-023-43952-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Srinjoy Mitra
- School of Engineering, University of Edinburgh, Edinburgh, UK.
| | - Suvobrata Sarkar
- Department of History, Rabindra Bharati University, Kolkata, India
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Meudec M, Affun-Adegbulu C, Cosaert T. Review of health research and data on/with racially minoritised groups: Implications for addressing racism and racial disparities in public health practice and policies in Europe: a study protocol. F1000Res 2023; 12:57. [PMID: 38434645 PMCID: PMC10904934 DOI: 10.12688/f1000research.128331.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
Historically, across Europe, data and research on/with racially minoritised groups have not been collected or carried out in a sufficient, adequate, or appropriate manner. Yet, to understand emerging and existing health disparities among such groups, researchers and policymakers must obtain and use data to build evidence that informs decision-making and action on key structural and social determinants of health. This systematic search and review aims to contribute to closing this gap and promote a race-conscious approach to health research, strengthening the utilisation and deployment of data and research on/with racially minoritised groups in Europe. Its ultimate goal is to improve equality and equity in health*. Concretely, the study will do so by reviewing and critically analysing the usage of the concepts of race, ethnicity, and their related euphemisms and proxies in health-related research. It will examine the collection, use, and deployment of data and research on/with racially minoritised groups in this area. The study will focus on Belgium, France, and the Netherlands, three countries with graphical proximity and several similarities, one of which is the limited attention that is given to racism and racial inequalities in health in research and policy. This choice is also justified by practical knowledge of the context and languages. The results of the review will be used to develop guidance on how to use and deploy data and research on/with racially minoritised groups. The review is part of a larger project which aims to promote race-conscious research and data. The project does this by a three-pronged approach which: 1) highlights the need for a race-conscious approach when collecting and using data, carrying out research on/with racially minoritised groups; 2) builds expertise for their effective use and deployment, and; 3) creates a knowledge network and community of practice for public health researchers working in Europe.
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Affiliation(s)
- Marie Meudec
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Clara Affun-Adegbulu
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Theo Cosaert
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023; 8:120. [PMID: 38089903 PMCID: PMC10714106 DOI: 10.12688/wellcomeopenres.18915.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods Based on informal literature reviews and a meeting with leaders of one of the multinational COVID-19 adaptive platform trials, we describe some important considerations about research partnership equity in this context. Results We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation and dissemination, and 8) research capacity strengthening and maintenance. Within each category we review normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion In aggregate, these observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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Affiliation(s)
- Chelsea Modlin
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
| | - Jeremy Sugarman
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Gershom Chongwe
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nancy Kass
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Winfred Nazziwa
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - Jemee Tegli
- Family Health International Clinical/Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Joseph Ali
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
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Johnson B. Five award-winning researchers share their tips for inclusive health research. Nat Med 2023; 29:2704-2706. [PMID: 37968373 DOI: 10.1038/s41591-023-02683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Mocumbi AO, Agyepong IA, Kyobutungi C. Building on current progress to shape the future of biomedical science. Lancet 2023; 402:1204-1206. [PMID: 37805195 DOI: 10.1016/s0140-6736(23)01670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Ana Olga Mocumbi
- Universidade Eduardo Mondlane, Campus Universitário, 1102 Maputo, Moçambique.
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Mughal NA, Hussain MH, Ahmed KS, Waheed MT, Munir MM, Diehl TM, Zafar SN. Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review. J Surg Res 2023; 290:188-196. [PMID: 37269802 DOI: 10.1016/j.jss.2023.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. METHODS We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors. RESULTS Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time. CONCLUSIONS There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.
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Affiliation(s)
- Nabiha Akhlaq Mughal
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Muzamil Hamid Hussain
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | | | - Muhammad Talha Waheed
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan; Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Muhammad Musaab Munir
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Keshri VR, Peden M, Singh P, Norton R, Abimbola S, Jagnoor J. Health systems research in burn care: an evidence gap map. Inj Prev 2023; 29:446-453. [PMID: 37532304 DOI: 10.1136/ip-2023-044963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care. METHODS An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM. RESULTS A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies. CONCLUSIONS Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Margaret Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Pratishtha Singh
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
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Elliott LM, Waqa GD, Dalglish SL, Topp SM. A sweet deal for domestic industry: the political economy and framing of Vanuatu's sugar-sweetened beverage tax. BMJ Glob Health 2023; 8:e012025. [PMID: 37813448 PMCID: PMC10565185 DOI: 10.1136/bmjgh-2023-012025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/02/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION The Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO's Best Buys recommendations for addressing non-communicable diseases (NCDs), little is known about the tax's adoption process or whose interests it serves. METHODS Using case study methodology, this study examined how and why Vanuatu's SSB tax was introduced. Policy documents, key informant interviews (n=33) and direct observations were analysed using theories of policy analysis, power analysis and postcolonial theory to map the policy's adoption, surrounding political economy and the ideas, interests and institutions that shaped the tax and its framing. RESULTS The SSB tax emerged during a politically and economically unstable time in Vanuatu's history. The tax's links to the national health agenda were tenuous despite its ostensible framing as a way to combat NCDs. Rather, the tax was designed to respond to tightening economic and trade conditions. Spearheaded by several finance-focused bureaucrats, and with limited input from health personnel, the tax targeted less frequently consumed carbonated SSBs (which are mostly imported) without any revenue reinvestments into health. Driven by the desire to generate much-needed government revenue and instal domestic protections via selective implementation and carve-outs for local producers, the Vanuatu SSB tax did meet national objectives, just not the dual health and economic 'win-win' projected by the NCD Best Buys. CONCLUSION Vanuatu's SSB tax adoption process reveals the limitations of decontextualised policy recommendations, such as the NCD Best Buys, whose framing may be overcome by local political realities. This research highlights the need for further political economy considerations in global health recommendations, since contextual forces and power dynamics are key to shaping both how and why policies are enacted and also whose interest they serve.
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Affiliation(s)
- Lana M Elliott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gade D Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji Institute of Pacific Health Research, Fiji National University, Suva, Fiji
| | - Sarah L Dalglish
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Institute for Global Health, University College London, London, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Kaufman R, Fair E, Reid M, Mirzazadeh A. Authorship equity in global health research: who gets the credit at University of California, San Francisco? BMJ Glob Health 2023; 8:e013713. [PMID: 37848271 PMCID: PMC10583030 DOI: 10.1136/bmjgh-2023-013713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Authorship inequity exists in global health research and can be representative of unequal partnerships. Previous studies showed that low-income and middle-income country (LMIC) authors are under-represented in publications from global collaborative research between LMIC and high-income countries (HIC). However, there are little data on trends for how specific HIC institutions are performing concerning equitable authorship. We used Web of Science to find published articles affiliated with the University of California, San Francisco (UCSF), where an LMIC was referred to in the title, abstract or keywords from 2008 to 2021. The country affiliation of each author for all included articles was grouped based on World Bank data. A total of 5805 articles were included. On average, 53.6% (n=3109) of UCSF affiliated articles had at least one low-income country (LIC) or LMIC author; however, this number increased from 43.2% (n=63) in 2008 to 63.3% (n=421) in 2021. Overall, 16.3% (n=948) of UCSF affiliated articles had an LIC or LMIC researcher as the first author, 18.8% (n=1,059) had an LIC or LMIC researcher as second author, and 14.2% (n=820) had an LIC or LMIC researcher as last author. As long as manuscripts produced by UCSF have no LIC or LMIC authors included the university's commitment to authentic equity is undermined. Global health partnerships cannot be equitable without changing authorship trends between HIC and LMIC institutions.
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Affiliation(s)
- Rebekah Kaufman
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Fair
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael Reid
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Ali Mirzazadeh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran (the Islamic Republic of)
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Wemrell M, Gunnarsson L. Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD. PLoS One 2023; 18:e0291966. [PMID: 37768919 PMCID: PMC10538671 DOI: 10.1371/journal.pone.0291966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Lay online communication about health-related issues has in recent years largely been associated with the spread of misinformation and decreased trust in healthcare. Such communication has included claims about systemic side effects of the copper IUD. In Sweden, a social media group centered on this issue now gathers around 8,700 members. This study aimed to use the case of reported yet unestablished side effects of the copper IUD to investigate experiences of and reasoning about healthcare encounters between caregivers and patients contesting established medical knowledge. METHODS We conducted qualitative, semi-structured, digital group interviews with members of the social media group (seven groups, n = 23) and with midwives and gynecologists (six groups, n = 15). We also gathered essays written by social media group members (n = 23). The material was analyzed thematically. RESULTS The participant accounts pointed towards tensions related to principles of evidence-based medicine, i.e., perceived insufficiency of research on the safety of the copper IUD and lack of clarity in routines for reporting and following up suspected side effects, and of patient-centered care, i.e., listening respectfully to patients. Tension between caregivers' obligation to adhere to evidence-based medicine while also providing patient-centered care was noted. CONCLUSION Healthcare providers' efforts to assess and address patient claims contesting established medical knowledge should include ensuring and communicating sufficient research, clarifying procedures for reporting suspected side effects, and improving person-centered care. This can increase the quality of care while contributing to the mitigation of distrust in healthcare and the spreading of health-related misinformation.
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Affiliation(s)
- Maria Wemrell
- Department of Social Work, Linnaeus University, Växjö, Sweden
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Lena Gunnarsson
- School of Humanities, Education and Social Sciences, Örebro University, Örebro, Sweden
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Pittalis C, Drury G, Mwapasa G, Borgstein E, Cheelo M, Kachimba J, Juma A, Chilonga K, Cahill N, Brugha R, Lavy C, Gajewski J. Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania. Front Public Health 2023; 11:1186307. [PMID: 37780427 PMCID: PMC10536269 DOI: 10.3389/fpubh.2023.1186307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background In 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach. Methods Participatory Action Research workshops were held in the 3 countries in July-October 2017 and in October 2018-July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants' perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres. Results All groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site. Conclusion The inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams.
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Affiliation(s)
- Chiara Pittalis
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Grace Drury
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Gerald Mwapasa
- Deparment of Surgery, College of Medicine, Kamuzu University of Health Sciences (former University of Malawi), Blantyre, Malawi
| | - Eric Borgstein
- Deparment of Surgery, College of Medicine, Kamuzu University of Health Sciences (former University of Malawi), Blantyre, Malawi
| | | | | | - Adinan Juma
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Kondo Chilonga
- Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Niamh Cahill
- School of Medicine, University of South Carolina, Greenville, SC, United States
| | - Ruairi Brugha
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chris Lavy
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jakub Gajewski
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Affiliation(s)
- Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation California, Berkeley, California, USA
| | - Raglan Maddox
- Bagumani (Modewa) Clan, Milne Bay, Papua New Guinea
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Kennedy
- Wiradjuri, Condobolin, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shadi Nahvi
- Departments of Medicine, and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine - Montefiore Medical Center, Bronx, New York, USA
| | - Mignonne C Guy
- African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Ramani S, Whyle EB, Kagwanja N. What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals. Lancet Glob Health 2023; 11:e1464-e1468. [PMID: 37591593 DOI: 10.1016/s2214-109x(23)00299-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 08/19/2023]
Abstract
Much of the current global health publishing landscape is restricted in its epistemological diversity, relying heavily on a biomedical lens to examine and report on global health issues. In this Viewpoint, we argue that the space within global health journals needs to be expanded to include diverse forms of research scholarship, thereby shifting the kinds of stories that get told in these spaces. We particularly call for the inclusion of deeper research that values the tacit, experiential knowledge possessed by actors (eg, communities, health-care workers, policy makers, activisits, and researchers) in low-income and middle-income countries, and legitimises the perspectives of local doers and thinkers; research that pays careful attention to context, and does not treat local realities as mere background occurrences; and research that draws on alternative, counter-dominant epistemologies, that allow for the crucial examination of power imbalances, and that challenge hegemonic discourses in global health. To decolonise academic work in the global health field, we should look beyond diversity in research authorship. We need to tackle other unconscious biases such as presumptions about the superiority of particular forms of evidence over others, and thereby expand the plurality of perspectives in global health.
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Affiliation(s)
| | - Eleanor Beth Whyle
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nancy Kagwanja
- Health Systems Research and Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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Wispelwey B, Osuagwu C, Mills D, Goronga T, Morse M. Towards a bidirectional decoloniality in academic global health: insights from settler colonialism and racial capitalism. Lancet Glob Health 2023; 11:e1469-e1474. [PMID: 37591594 DOI: 10.1016/s2214-109x(23)00307-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023]
Abstract
This Viewpoint considers the implications of incorporating two interdisciplinary and burgeoning fields of study, settler colonialism and racial capitalism, as prominent frameworks within academic global health. We describe these two modes of domination and their historical and ongoing roles in creating accumulated advantage for some groups and disadvantage for others, highlighting their relevance for decolonial health approaches. We argue that widespread epistemic and material injustice, long noted by marginalised communities, is more apparent and challengeable with the consistent application of these two frameworks. With examples from the USA, Brazil, and Zimbabwe, we describe the health effects of settler colonial erasure and racial capitalist exploitation, also revealing the rich legacies of resistance that highlight potential paths towards health equity. Because much of the global health knowledge production is constructed from unregenerate contexts of settler colonialism and racial capitalism and yet focused transnationally, we offer instead an approach of bidirectional decoloniality. Recognising the broader colonial world system at work, bidirectional decoloniality entails a truly global health community that confronts Global North settler colonialism and racial injustice as forcefully as the various colonialisms perpetrated in the Global South.
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Affiliation(s)
- Bram Wispelwey
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Chidinma Osuagwu
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Mills
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA; Global Health Program, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Tinashe Goronga
- Centre for Health Equity Zimbabwe, Equal Health Global Campaign Against Racism, Harare, Harare, Zimbabwe
| | - Michelle Morse
- Department of Medicine, Harvard Medical School, Boston, MA, USA; New York City Department of Public Health and Mental Hygiene, New York, NY, USA
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Bonney E, Elison JT. Confronting Epistemic Injustice and Inequity in IDD Research: The Value of Theorizing Beyond Dominant Culture's Perspective. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:375-378. [PMID: 37644860 DOI: 10.1352/1944-7558-128.5.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This commentary highlights pervasive challenges related to the science of intellectual and developmental disabilities (IDD), which we often take for granted. We argue that social power asymmetry and entrenched patterns of epistemic injustices undermine our science and call attention to the need to maximize our efforts to undo these unfair practices to enhance future care and research in IDD.
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Affiliation(s)
- Emmanuel Bonney
- Emmanuel Bonney and Jed T. Elison, Institute of Child Development, University of Minnesota & Masonic Institute for the Developing Brain, University of Minnesota
| | - Jed T Elison
- Emmanuel Bonney and Jed T. Elison, Institute of Child Development, University of Minnesota & Masonic Institute for the Developing Brain, University of Minnesota
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