Why and how to make the best from multi-multidisciplinary

research on HIV/AIDS?

To contribute to the global goal of reverse the epidemic by 2015

Group Discussion

Discuss the topic provided among the group and attempt to answer the posed questions. The focus should be on a multidisciplinary approach so try to incorporate the experience of all fields represented round the table.

It should be kept in mind that innovative, cost effective and long term approaches are required to achieve the challenging goal of a reversal of the HIV epidemic. Please choose one of the following topics:

A. Building on previous successes.

The effect of programs which address the HIV epidemic have had differing success. It is important therefore to make a good assessment of the effect of such a program.

1. How do you differentiate the impact of different stakeholders e.g. national health services, NGOs, faith-based organizations who are intervening in the same population?
2. Could these populations develop unexpected negative effects caused by multiple simultaneous interventions? Which would these negative effects be and how would you reduce/prevent them?

B. Making the money work.

Anti-retroviral therapy (ART) implemented when an individual begins to develop AIDS can prolong life expectancy considerably. In developing countries, however, these drugs are prohibitively expensive and cannot be discontinued for the life of the patient. Prevention is a far more cost-effective strategy (education in Abstinence, Be faithful and Condoms, circumcision, treatment of other sexually transmitted infections which are risk factors).

1. How do you weigh up the conflicting financial needs of treatment and prevention strategies?
2. How do you coordinate the actions of the diverse stakeholders in order to improve the capacity of a country to absorb and use funding efficiently?

C. National vs local programs.

The global HIV epidemic can be considered a patchwork of smaller individual epidemics, each characterised by different patterns of ages, sexualities, transmission routes and access to healthcare and education. They affect not only how the virus spreads but also the effectiveness of health interventions.

1. What kind of differences have you encountered which affect the HIV “landscape”?
2. How do you incorporate these crucial local differences into a nationally rolled out HIV prevention and treatment program?

D. Societal factors which affect risk.

Many of the groups most at-risk from HIV infection (injecting drug users, homosexuals, sex workers) are also traditionally discriminated against by “normal” members of society. HIV positive status itself is also stigmatized in many societies, which reduces the likelihood that people will get tested or be open about being HIV positive. The people most heavily affected by the epidemic continue to remain on the periphery of decision making in many countries. However, these are the people with the best knowledge of how to reach those in greatest need and how to create the best response to interventions.

1. How do you address these issues by engaging with the stigmatized groups? By engaging with society as a whole? Through policy measures?
2. How would you manage the collaboration between experts on HIV transmission/prevention and experts on local community needs/social networks? Which other sets of professionals are required in this collaboration?

hne100@york.ac.uk, Department of Health Sciences, University of York

Background: The UK has one of the highest rates of caesarean section (CS) in the world, and this has continued to increase over the past decades, with no associated decrease in numbers of instrumental births, and no improvement in perinatal outcomes. CS and other interventions in childbirth represent a psychological risk to mothers, a physiological risk to both mothers and babies and a substantial cost to the NHS. There is a need to understand this trend of increased intervention and reverse it.

Objective: To identify the demographic, psychosocial and clinical characteristics of women who have high rates of intervention at birth.

Methods: The sample consisted of 18,238 natural mothers of infants from the Millennium Cohort Study. Multivariable regression models, stratified by parity, were used to examine socio-demographic, cultural, socio-economic, psychosocial and pregnancy characteristics in relation to mode of birth.

Results: Among primiparous mothers, all types of intervention (instrumental delivery, planned CS and emergency CS) were more likely with increasing maternal age and for mothers who had clinical problems during pregnancy. Instrumental births were more likely for mothers with lower occupational status, and less likely for mothers who were Black, Hindu, closely involved with the father of the baby. Planned CSs were more likely for Pakistani or Bangladeshi origin and for mothers who never saw their own mother, and less likely for Muslim and low income mothers. Emergency CSs were less likely for Pakistani or Bangladeshi mothers, Black mothers and mothers who were closely involved with the father of the baby. Among multiparous mothers, increasing maternal age and clinical problems during pregnancy were more likely for all types of intervention. Instrumental births were also more likely for Indian, mixed race and low income mothers. Planned CSs were more likely for other non-Christian mothers, and less likely for mothers whose parents ever separated. Emergency CSs were more likely for mothers of “other” ethnic background.

Conclusion: Maternal age, ethnic identity, socio-economic status and family relationships were all significantly related to mode of birth. An understanding of the characteristics of women at high risk of intervention is crucial to developing and providing appropriate and high quality maternity services.

My research is interdisciplinary as it is social epidemiology; an investigation into how health, social and psychosocial factors relate to obstetric interventions. Discovering who the women are who are most at risk of intervention in birth will also have the potential to influence policy.

george.shirreff07@ic.ac.uk. Department of Infectious Disease Epidemiology, Imperial College, London

Addressing the social significance of HIV is essential in understanding and preventing its spread and alleviating its impact on the population.

HIV infections are often most prevalent among hard-to-reach populations such as intravenous drug users and commercial sex workers. This creates challenges for identifying and treating individual infections, and it is also difficult to estimate the prevalence of the infection and the effectiveness of interventions. Many with HIV infection experience considerable stigma and this is a barrier both to human well-being and to control of the epidemic. Social reactions to HIV are also important in assessing the impact of changes to behaviour such as condom use or other sexual risk factors. For example, how does condom use change following a test, either with a positive or negative result.

In most cases, the spread of HIV is highly dependent on sex and therefore sexual networks. Network science is an emerging field and is essential to epidemiology of HIV infection. The spread of HIV through sexual networks is dependent on many aspects of the network such as number of partners, heterogeneity of sexual behaviour and concurrency of multiple partnerships. The spread of other sexually transmitted infections is also important as a risk factor for HIV.

In countries where HIV prevalence is extremely high, as in sub-Saharan Africa, the infection devastates the working age population. Large quantities of orphans and a shortage of teachers are among the more direct effects of the premature deaths caused by AIDS.

tls504@york.ac.uk, Department of Health Sciences, University of York

Purpose: The study’s purpose is to relate how acupuncturists envision treating IBS in routine practice to the treatments they actually deliver as part of a pragmatic trial of acupuncture for IBS.

Methods: In-depth interviews based on a flexible topic guide were used to access acupuncturist views on potential treatments. A purposive sample of acupuncturists, with membership in the British Acupuncture Council and a background in traditional Chinese medicine, was invited to participate. Data were analyzed using a thematic framework approach. The second part of the research question – exploring what acupuncturists actually delivered – was addressed using extracted material from acupuncturists’ log books, which was then (or will be) compared to material from the interviews.

Results: Twelve acupuncturists completed an in-depth interview. Acupuncturists acknowledged that patients rarely mention IBS as their primary complaint, but as many as half of their patients have irregular bowel symptoms. Additionally acupuncturists agreed on several commonly encountered diagnoses based on TCM principles and the importance of diagnosis in influencing treatment principle, point selection, use of additional therapies (i.e. moxa), and dissemination of lifestyle advice. The trial of acupuncture for IBS, which will provide results for the second part of the research question, began in October 2008. Since this is a pragmatic trial, we expect treatments to be highly individualized as indicated by the interviews. The treatments themselves may vary from the ones described due to the fact that trial participants will have a known diagnosis of IBS, which is not commonly encountered in routine practice.

Conclusions: Although there was some repetition of diagnoses and points selected, acupuncturists maintained that understanding each individual case was essential to determining the treatment to be delivered. Thus researchers may make generalizations about the treatment of IBS with regard to acupuncture, however each patient will receive a treatment based on his/her needs. Whether this notion correlates with the treatments delivered in the trial is under evaluation.

Why this study has relevance interdisciplinary: This study is directly relevant to the health sciences because it explores the delivery of a treatment modality for IBS. Additionally this study is relevant to the social sciences because it explores what influences the acupuncturists’ decisions and actions regarding treatment.

gt501@york.ac.uk, Department of Social Policy and Social Work, University of York

Background and Aims: Government response to public concerns has been to develop policies to deal with them. Policy makers are increasingly designing strategies to address public needs and problems. With regard to health policies, governments play significant roles in developing them and executing them. Meanwhile, policy recipients tend to have little or no role in the development and measurement of these policies. The public’s understanding of a policy affect how they respond to it and the outcome. Yet little has been done to involve them. This study explored the views and perceptions of community residents on their understanding and experience of the National Health Insurance Policy (NHIP) in Ghana. It tests how much the public knew about the policy, how that affect the response to healthcare use under the scheme, what additional information they require on NHIP and the significance of that knowledge to them, their decisions and reactions to it.

Data and Methods: A qualitative research was employed to explore participants’ views, using nine focus group discussions based on a purposive sampling of three districts with previous experience of community health financing. These discussions were set to include residents of: Dangme West; Kwahu West; and Nkoranza districts. Participants included both scheme and non-scheme members who are 18 years and above from various socio-demographic backgrounds. Each FGD consisted between 8-16 participants.

Results and Conclusion: Findings from the study showed that the public want to be adequately informed of health policies and decisions made at both the national and local levels. They noted that even though the NHIP require their participation at the community level and affect their decision on healthcare, they have very vague information on it. Policies tend to be imposed on them with little or no reference to their individual circumstances. As a result, membership to the scheme is challenged, despite the policy’s aim to improve healthcare access. And this is because the level of information and education about the scheme is very limited. The general public lack information on the NHIP and their place as members, so they tend to rely on uninformed sources. They, therefore, expressed interest in being informed of health policies undertaken locally and nationally. The study concluded that policy recipients must be included more in policy processes, especially, when it has direct impact on them. Policy makers and implementers must employ various means to communicate policy decisions to the best of their ability and beyond the general provision of advertisements.

tr535@york.ac.uk. Department of Educational Studies, The University of York

Background: The last two decades have witnessed a worldwide proliferation of inter-communication pedagogical practices in the field of education. Several studies have showed that the introduction of Communicative Language Teaching (CLT) curriculum in several developing countries is often not preceded by a systematic research-based needs analysis of both teachers and learners. Although such curricula ideally urges teachers to employ inter-communicative approaches, EFL teachers in Syria continue to teach in the grammar-translation approach dominated by: rote learning, recitation, translation, and the transmission of facts through teacher explanation with overwhelming predominance of teacher-fronted explanations and question-answer exchanges. The co-construction of knowledge is a shared responsibility between teachers and learners (Hardman, 2008).

Aim: The research is meant to begin to develop baseline about EFL Syrian secondary teachers: their background and training, their priorities, the problems they face in the classroom and the influence that the new CLT course guidelines have actually had on teaching practice. Also, it will fill a gap in research to date in the Syrian context to investigate how teachers interact with students in English classrooms over time.

It contributes to the world literature on the professional development of language teachers because achieving quality in English teaching necessitates training teachers to use interactive style of teaching.

Methods: A mixed method approach will be taken up. This would involve an array of methods like systematic computerized observation, digitally audio-visual observation, and post-observation interviews with teachers. The participants will be teachers at two Syrian urban schools, one average and one dedicated for the elite students. I will be working with 2 teachers in each school observing 4 lessons of each teacher over 2 or 3 months with the hope of generating a total of 16 observed lessons.

References:

Hardman, F. (2008) The Guided Co-construction of Knowledge. In M. Martin-Jones, A. M. de Mejia and N. H. Hornberger (eds.), Encyclopaedia of Language and Education (3) Discourse and Education, 253-263.

R.H.Sirriyeh07@leeds.ac.uk. Institute of Psychological Sciences, University of Leeds

Whilst attempting to conduct a systematic review of research relating to the impact of medical error on the health professional, the lack of a suitable tool to assess study quality where study designs are diverse became apparent. A number of existing scales were examined which led to the identification of a set of 17 criteria (Jackson, Cheater & Reid, 2008) that had been developed for diverse studies based on prior attempts (Edwards, Hood, Matthews et al, 2000; Thomas & Harden, 2008; Thomas, Sutcliffe, Harden et al, 2003). However, difficulties arose in their application due to the dichotomous nature of assessments, reliance on reviewer’s judgements and omissions within the criteria. Therefore, the aim of this project was to combine existing strategies with expert opinion to devise a tool to be used in systematic reviews for the assessment of study quality where study designs are diverse.

The original 17 criteria were adapted to form a new set of 16 new criteria. Each item was scored using a scaled response from 0 ‘no mention at all’ – 3 ’complete’, to indicate the extent to which the issue had been covered in each paper. Guidelines for scoring each item were developed to minimise the level of judgement or expertise required from reviewers. The tool was trialled with 3 reviewers and a random sample of the papers from the review (4). Following 2 stages of revisions and refinements to the tool, substantial agreement (Landis & Koch, 1977) was established between 3 reviewers (κ = 62.9%) and the scale was applied to all the 25 papers in the review. Review findings indicated that the quality of evidence was poor in this set of papers, achieving only 47.8% of the total possible maximum score. Despite descriptive components of the papers scoring highly, key weaknesses were identified in aspects of study design such as sample size, and the quality of the measurement tools that were employed.

This project has established a quality assessment tool to establish the quality of evidence where studies are diverse. Such a tool is valuable for much health and social research where variation in study design often raises challenges in determining the strength of evidence in a body of research. Further work to determine the validity and usability of this tool continues.

ell500@york.ac.uk. Educational Studies Department, University of York

Background: Lower-Secondary School is the final stage of compulsory education in Mexico, yet statistics indicate that not all eligible children are enrolled in school. Why, in reality, is it not compulsory? What are the factors affecting students’ academic performance at this level of education?

Aim: This study explores (a) what the factors that influence secondary school girls and boys’ failure in this level of education are and, simultaneously, (b) the factors that enhance their academic success and finally, (c) to what extent these factors vary if coming from a socioeconomically advantaged or disadvantaged background.

Methods: Data was collected using a total of 80 semi-structured interviews with high-achievers, under-achievers, dropouts, parents and staff at schools in advantaged and disadvantaged locations.

Based on models similar to those of authors who have looked into this problem (Rumberger 1983, 2001, Ekstrom et al., 1986, Orfield, 2004), interviews took into consideration factors that included family, school, educational policies and geographical location.

Findings: Findings revealed that various factors intertwine in students’ educational outcomes: contrary to what is generally expected, parental socio-economic status (SES) did not seem to be directly proportional to students’ academic performance. It may, however, add additional value in so far as educational resources become more available at home. In addition, parents with a higher SES are more likely to monitor their children’s educational performance.

Due to the fact that homework is a very important part of the Mexican system for basic education, having assistance for homework seems to be a major key element that impacts on students’ attainment in school.

Stability at home and having good communication within the family seems to motivate students to do well in school. Consequently, instability at home triggers students’ disinterest in school. The “It’s in my head all day” effect appears to be one of the main reasons that lead children to disengage from the family nucleus, by getting jobs, joining gangs or by getting married.

School factors also exert a strong influence, particularly the quality of teaching.

Participants thought that not all teachers are able to deliver appropriate teaching, which limits students’ learning processes and educational outcomes. Old classroom methods (corporal punishment, removing a child for being disruptive, etc.) and punitive school policies (not allowing a child in school because of incorrect uniform, ‘unacceptable’ appearance, or if a girl is found to be pregnant) are practices that, if in conjunction with unfavourable conditions at home, reinforce students’ disengagement from their education.

Discussion and conclusions:

Making compulsory education a reality forms part of the internationally agreed goals that emerged from the World Declaration on Education for All, and Lower-Secondary Education for all is not yet a reality in Mexico.

As Rumberger (2003) stated, it is a complex problem for which there is no simple solution. It is imperative that the social and health sciences work together towards the design of strategies that help students to have better educational opportunities.

Teachers and social workers need to develop their skills to offer adequate welfare assistance by either providing better counseling at school or by establishing formal agreements with health institutions that could assist students in the emotional and physical arenas.

Educational policies also need changing to prevent early marriage, teenage pregnancy and drug abuse, yet making sure students are able to remain in school.

Equally imperative is that parents and teachers become more sensitive to their crucial and indistinguishable roles as guardians and educators.

References:

Ekstrom, R.B., Goertz, M.E., Pollack, J.M., and Rock, D.A. (1986). Who drops out of high school and why? Findings from a national study. Teachers College Record, 87, 356-373.

Orfield, G. (2004) Dropouts in America: Confronting the Graduation Rate Crisis. Cambridge (MA): Harvard Education Press.

Rumberger, R. (1983) Dropping out of High School: The Influence of Race, Sex and Family Background. American Educational Research Journal, 20 (2), 199-220.

Rumberger, R. (2001) Why Students Drop Out of School and What Can be Done. Paper prepared for the Conference “Dropouts in America: How Severe is the Problem? What Do We Know about Intervention and Prevention?, Harvard University, January 13, 2001.

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skh500@york.ac.uk. Department of Social Policy and Social Work, University of York

Background: While individual environmental behaviour is currently high on the agenda, both in academia and in policy circles, our understanding of the topic remains patchy. Key issues, such as the factors that drive behavioural change, remain only partially understood. To understand these issues, an interdisciplinary approach is needed. This study draws on literature from psychology and behavioural studies, sociology, social policy and political studies. While studies in the past have provided descriptions of behaviour across the population, in-depth, individual-scale approaches are also needed, to explain the underlying psychological and emotional processes.

Aim: This study aims to address this need, taking account of the dynamic nature of environmental behaviour throughout the life-course, and recognising that environmental behaviour may be entwined with other aspects of an individual’s life, and needs to be studied within this social and personal context. The central question to be answered by this study is: How and why does participation in action on climate change develop over time?

Methods: The study adopts a Narrative Life-Course approach. This combines elements of Narrative Inquiry (Riessman, 2008) with elements of Life Course or Biographical methods. In-depth interviews are being conducted with environmentally-active individuals in York. By inviting participants to “tell the story” of their environmental behaviour over time, this study takes a holistic approach to an individual’s life, focusing on processes of change, and the factors driving and obstructing them.

Results/Findings, Discussion, Conclusion: This paper presents some preliminary results from the first phase of data-collection, including life graphs drawn by participants. It also offers reflections on the challenges and benefits of this unconventional methodology, with particular reference to its potential applications within other disciplines.

References:

Riessman, C. K. (2008) “Narrative Methods for the Human Sciences”, Sage: London.