Practical actions for fostering cross-disciplinary global health research: lessons from a narrative literature review

A mixed-methods evaluation of capacity strengthening within an international conservation agriculture research consortium

Background: The Strengthening Capacity in Environmental Physics, Hydrogeology and Statistics for conservation agriculture research (CEPHaS) consortium sought to to strengthen research capacity among a network of African and UK researchers, and their respective institutions, to fill knowledge gaps on the impacts of conservation agriculture practices on the water cycle in cultivated soils. We examined experiences of consortium membership and, drawing on this information, determined key recommendations for future programmes with similar objectives. Methods: A mixed methods study encompassing an online survey (N=40) and semi-structured interviews (N=19) completed between June 2021 and February 2022 with CEPHaS consortium members from Malawi, UK, Zambia and Zimbabwe. Survey and interview data were analysed separately, using univariate statistics and framework synthesis respectively Results: Survey and interview findings were generally aligned, with both revealing a wide range of reported capacity strengthening gains resulting from CEPHaS engagement at both an individual and institutional level. Participants consistently expressed their CEPHaS involvement in positive terms with praise for the applied 'learn by doing' approach underpinning many of the activities as well as the engaging and highly inclusive leadership. There was evidence that the various trainings and resources provided through CEPHaS were valued, frequently utilised, and often transferred beyond the immediate CEPHaS membership for wider benefit. Resource provision and staff training were seen as foundational for long-term institutional benefits. Some challenges and suggested areas for improvement were reported by participants as were potential opportunities to facilitate greater impact. Conclusion: Our findings suggest that the basic 'template' of the CEPHaS consortium provided a strong basis for research capacity strengthening in Conservation Agriculture, especially at the level of individual researchers, and that this template could be further enhanced in any future iteration of the same or similar programme. Recommendations for replicating and enhancing CEPHaS programme strengths are presented.

Addressing institutional and community barriers to development and implementation of community-engaged research through competency-based academic and community training

Introduction

The National Center for Advancing Translational Sciences (NCATS) focuses on reducing barriers to effective translational research that rapidly translates science to clinical and community interventions to improve individual and community health. Community-Engaged Research (CEnR) plays a crucial role in this process by bridging gaps between research and practice. It effectively generates bi-directional knowledge and communication by engaging patients and communities throughout the translation research process. Skills development, however, is critical to enable investigators and communities to establish successful partnerships in research. While there are many independent CEnR education programs nationally, few curricula are mapped to identified domains and competencies.

Assessment of current community engagement educational frameworks and competencies

We located three comprehensive efforts to identify CEnR domains and competencies that we aligned to inform development of our curriculum, which we then mapped to these competencies. The first, undertaken by the NCATS Joint Workgroup on Researcher Training and Education and Community Capacity Building (JWG) was developed to assess training opportunities for academic researchers and community partners to increase their capacity to meaningfully engage collaborators in translational research. The JWG identified curricula, resources, tools, strategies, and models for innovative training programs and community engagement in all stages of research. It also conducted a gap analysis of deficiencies in available resources. Using Competency Mapping, they developed a framework for curriculum mapping that included eight domains, each with two to five competencies of knowledge, attitudes, and skills. The second aligned community-engaged research competencies with online training resources across the CTSA consortium, while the third was focused on Dissemination and Implementation training.

Actionable recommendations

Further informed by a conceptual model to advance health equity, we have adapted and integrated these components into a set of modules designed to educate and empower investigators, trainees, students, and community partners to engage in effective CEnR.

Discussion

This curriculum fills an important gap in our workforce development and helps to meet needs of our community partners. Following program evaluation and validation, we will offer the curriculum for use and further evaluation by other groups interested in using or adapting it for their own programming.

From reflection diaries to practical guidance for transdisciplinary research: learnings from a Kenyan air pollution project

Transdisciplinary research (TDR) approaches have been cited as essential for overcoming the intractable sustainability challenges that the world is currently facing, including air pollution, water management and climate change. However, such approaches can be difficult to undertake in practice and can consequently fail to add value. Therefore, examples of what works in practice (and what does not) are helpful to guide future research. In this study, we used a conceptual TDR framework as the basis to examine and evaluate the strengths and weaknesses of our approach in a project exploring air pollution in an informal settlement in Nairobi, Kenya. Reflection diaries exploring experiences of participation in the project were undertaken by the project team (comprising academic and community partners) at multiple time points throughout the project. These reflection diaries played an important role in evaluation and for providing space for team learning. Diaries were thematically coded according to the TDR framework to explore aspects of the project that worked well, and areas which presented challenges. We draw upon our reflections, and the extant literature, to make practical recommendations for researchers undertaking TDR projects in future. Recommendations focus on three key project stages (pre-funding, funded period, post-funding) and include; building the team in a way that includes all key stakeholders in relevant and appropriate roles, giving everyone sufficient time to work on the project, and ensuring regular and open communication. Building these recommendations into the design and delivery of transdisciplinary sustainability science projects will support progress towards achieving the Sustainable Development Goals (SDGs).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-023-01317-0.

Joint Research Mentoring Through the Community of Young Research Peers: A Case for a Unifying Model for Research Mentorship at Higher Learning Institutions

BACKGROUND

Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa.

METHODS

Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students.

RESULTS

By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won.

CONCLUSION

The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.

Identifying actions to foster cross-disciplinary global health research: a mixed-methods qualitative case study of the IMPALA programme on lung health and tuberculosis in Africa

OBJECTIVES

To identify actions for fostering cross-disciplinary research (CDR) skills and collaborations in global health, and to produce recommendations for improving the design, implementation and management of cross-disciplinary global health research programmes.

DESIGN

Using a North-South global health research programme as a case study-and following an adapted framework-we conducted qualitative research using document reviews, semi-structured interviews (purposive sampling) and participatory observation. We used baseline survey findings to identify potential interviewees and tailor interview guides.

SETTING

Our case study was a 4.5-year (2017-2021) programme, namely, the International Multidisciplinary Programme to Address Lung Health and Tuberculosis in Africa (IMPALA). Led by a UK research institute, IMPALA spanned 22 partner organisations from 13 countries (10 in sub-Saharan Africa), and involved five research discipline groups: clinical science, social science, health systems, health economics and policy/research capacity.

PARTICIPANTS

Thirty-one IMPALA members were interviewed (July 2018-November 2019), with interviewees evenly split by gender (16 female and 15 male) and by Global North/South institution (15 non-African and 16 African). Twenty-five (81%) were researchers, comprising 18 senior researchers (professors, readers, associate professors and senior lecturers) and seven early career researchers (assistant professors, lecturers, research fellows, postdocs, research assistants and PhD students). Twenty-four programme events were observed (September 2018-April 2020) and 49 documents were reviewed (December 2017-April 2020). All 66 IMPALA staff were sent the baseline survey, receiving 51 responses (43/56 researchers and 8/10 non-researchers).

RESULTS

Fourteen themes emerged, which suggested that CDR-while valued by many-is not universally understood, and the time it requires is often underestimated. We found that fostering CDR and managing tensions needs planning and continuous discussions and interactions. A shared vision with explicitly agreed goals and roles and active management of cross-disciplinary activities is essential.

CONCLUSIONS

Active planning, implementation and management of cross-disciplinary activities are essential for the success of cross-disciplinary global health research and should be separate from the primary research activities.

Household food insecurity, maternal nutrition, environmental risks and infants' health outcomes: protocol of the IMPALA birth cohort study in Uganda

INTRODUCTION

In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce.

AIM

To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity.

METHODS AND ANALYSIS

Pregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6-10 weeks of age. Infant weight and length will also be collected.A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers' food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households' environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models.

ETHICS AND DISSEMINATION

Ethical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.

OUP accepted manuscript

In order to design appropriate antimicrobial stewardship (AMS) programmes, it is crucial to understand challenges to tackling antibiotic resistance (AMR) specific to each healthcare setting. Antibiotic prescribing in primary care accounts for most prescriptions with a significant proportion considered clinically inappropriate. Qualitative research has a long history in social sciences, but its value and contribution are still contested in medical journals including in the AMR/AMS field. However, through its focus on understanding, meaning making and explaining, qualitative research can offer insights in how to improve AMS efforts in primary care. This paper provides an overview of unique considerations, contributions and challenges related to using qualitative research in AMS to help the AMS community new to qualitative research to utilize its potential most fully. First, we discuss specific considerations for AMS in relation to the stages of conducting a qualitative study, including identifying a research question and choosing a suitable methodology; sampling appropriate participants; planning a recruitment strategy; choosing a method of data collection; and conducting data analysis. These are illustrated with examples of qualitative AMS studies in primary care. Second, we highlight the importance of patient and public involvement throughout all stages of the project and ensuring quality in qualitative AMS research. Finally, drawing on these considerations, we make a further case for the value and contribution of qualitative methodologies in AMS/AMR research while outlining future directions for both AMS and qualitative research, including the need for studies with diverse actors; interdisciplinary collaborations; and complex decisions on methodologies and timelines.

Systems Approaches to Combating Wildlife Trafficking: Expanding Existing Frameworks to Facilitate Cross-Disciplinary Collaboration

Wildlife trafficking is a complex conservation issue that threatens thousands of species around the world and, in turn, negatively affects biodiversity and human well-being. It occurs in varied social-ecological contexts; includes numerous and diverse actors along the source-transit-destination trade chain, who are involved in illicit and often covert human behaviors driven by interacting social, economic, cultural, and political factors; and involves numerous stakeholders comprising multiple sectors and disciplines. Such wicked problems can be difficult to define and usually lack simple, clear solutions. Systems thinking is a way to understand and address complex issues such as wildlife trafficking and requires multisectoral, cross-disciplinary collaboration to comprehensively understand today's increasingly complex problems and develop holistic and novel solutions. We review methods utilized to date to combat wildlife trafficking and discuss their strengths and limitations. Next, we describe the continuum of cross-disciplinarity and present two frameworks for understanding complex environmental issues, including the illegal trade in wildlife, that can facilitate collaboration across sectors and disciplines. The Open Standards for the Practice of Conservation provides guidance and tools for defining complex social-ecological systems and identifying strategic points of intervention. One Health focuses on the nexus of human, wildlife, and environmental health, and can provide a framework to address concerns around human-wildlife interactions, including those associated with the illegal wildlife trade. Finally, we provide recommendations for expanding these and similar frameworks to better support communication, learning, and collaboration in cross-disciplinary efforts aimed at addressing international wildlife trafficking and its intersections with other complex, global conservation issues.

Bridging research integrity and global health epidemiology (BRIDGE) guidelines: explanation and elaboration

Over the past decade, two movements have profoundly changed the environment in which global health epidemiologists work: research integrity and research fairness. Both ought to be equally nurtured by global health epidemiologists who aim to produce high quality impactful research. Yet bridging between these two aspirations can lead to practical and ethical dilemmas. In the light of these reflections we have proposed the BRIDGE guidelines for the conduct of fair global health epidemiology, targeted at stakeholders involved in the commissioning, conduct, appraisal and publication of global health research. The guidelines follow the conduct of a study chronologically from the early stages of study preparation until the dissemination and communication of findings. They can be used as a checklist by research teams, funders and other stakeholders to ensure that a study is conducted in line with both research integrity and research fairness principles. In this paper we offer a detailed explanation for each item of the BRIDGE guidelines. We have focused on practical implementation issues, making this document most of interest to those who are actually conducting the epidemiological work.