Lava grey and antique cream: the diaspora of health research.

It may appear to the outsider that the world of health research consists of a homogenous collective of nerdy academics crunching numbers in an attempt to answer scientifically important questions. But for those of us living in that world there sometimes arises occasions that throw into stark relief the contrasting dynamics at play amongst our own peers.

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Source: thebillproject.org

This realisation came to the fore this week during the formalities of the annual Royal Australasian College of Physicians Victoria Trainee Research Awards. I was lucky enough to have my abstract, which recounts my research on child health in same-sex families, selected to present in the Paediatric division. I had made the somewhat bold decision to present the entirety of my PhD in the very strict 12 minute time restriction, but having twice competed in the 3 Minute Thesis competition 12 minutes seemed like a luxury!

On arrival I flicked through the program for the evening and straight away knew it would be an interesting night. My sole-author paper immediately contrasted with all the other abstracts which contained lists of authors as long as your arm. They were jam packed with p values and confidence intervals and had long complex words like sarco-osteoporosis or bamboozling molecular markers such as FLT-3. I was entering a room full of clinicians and lab-based researchers who knew that black is black and white is white. My mixed methods approach, drawing heavily on the social sciences, allowed black to be lava grey and white to be antique cream. It was going to blow some minds.

The presentation itself went well. I kept to time and handled the slightly predictable questions comfortably: “aren’t the parents better educated and earn more money”; “but don’t all children have to deal with bullying of some sort”. As the marks for each presentation were collated a panel discussion on ‘advanced training and research’ re-emphasised the focus on clinical work. One participant even suggested that being a clinician made you a better researcher and that good researchers do better clinical work. It’s over 5 years since I’ve seen a real patient!

In this clinical world it was a little surprising therefore that I discovered I had won the Paediatric prize. It may have been somewhat of a euphemistic win (if such a thing is possible) as the comments included: “weren’t your slides pretty” and “good on you for having the guts to use a different methodology.” Perhaps throwing words like post-positivism, social constructivism, queer theory and heteronormativity out at the audience did the job of impressing and confusing in equal measure. Putting all modesty aside it is more likely that the judges recognised the originality of my research and the efforts required to pull together the tricky mixed methods that I had had the ‘guts’ to use.

Mixed methods

While I am proud of the award, and proud that the college was able to recognise my work, I was reminded that there is a huge gulf between the more social perspectives of health, and public health in general, and the way in which many clinicians often think. As I continue my research, drawing on the social determinants of health, this illuminating night acts as an important reminder that we need to continually engage with our clinical partners to ensure that all the multidimensional aspects of health and wellbeing are brought to bear in our efforts to improve the health of the whole population.

I would like to thank Elizabeth Waters and Ruth McNair who have supervised my research, the Advisory Committee who allowed the development of a robust mixed methods framework and the whole of the Jack Brockhoff Child Health and Wellbeing Program for their advice and support.

Dr Simon Crouch, Honorary Research Fellow and Lead Investigator, The Australian Study of Child Health in Same-Sex Families

Promoting inclusive research with families: A visit to the Peninsula Cerebra Research Unit in Exeter, UK

I had the opportunity to recently visit the Peninsula Cerebra Research Unit (PenCRU), which is based within the Peninsula Medical School, at the University of Exeter in the UK. PenCRU is funded by the charity Cerebra and focuses on Childhood Disability Research. Over the last five years PenCru has evolved the practice of involving families in all stages of their research. This ensures that research is relevant to improving the health and wellbeing of disabled children and their families. It is also worth noting that in the UK it is mandatory to involve patients and members of the public in research when applying for government sponsored funding streams. The aim of my visit to PenCRU was to learn about the practice of involvement and how partnerships were formed between researchers and the local families.

As an early career research fellow working in the area of childhood disability, and having a passion for engaging with families, the concept of involvement was not necessarily something new. Our Program always ensures parents and carers have the opportunity to sit on advisory groups, and that their perspectives are captured within the research design if the research we do concerns them. However, after spending time at PenCRU and talking with the parents that they worked with, the concept of involvement demonstrated a more profound meaning to me.

PenCru have established a Family Faculty, where families (most often, mothers) who have an interest in being involved in research will participate in various activities with researchers. A lot of work was done in the early stages to encourage families to get involved, such as holding forums, websites, newsletters and launch events. To date there is over 200 families in the Family Faculty database. There is no formal structure to this involvement; parents can join in at any stage of the research process whether this is identifying important issues that research needs to address, actually formulating research questions or prioritising those questions for funding applications. Families can assist in the design of research, writing of summaries and grants and also finding sources of funding through support services and charities they know of. Members of the Family Faculty are consulted on all research ideas or queries that come to PenCru to see if there is sufficient interest to explore the topic and shape into a research question that is meaningful to families.

I managed to spend a good amount of time with four of the parents on the Family Faculty who felt empowered in their roles with researchers and that this opportunity enabled them to have a voice and share their life experiences in an informed way. They enjoyed having the choice to be involved in projects that interested them the most and attending meetings when it was convenient for them in their caring role. This really felt like a partnership that worked respectfully and fruitfully for both the parents and the researchers.

My own take away message from PenCRU was to think of involvement as a core research activity and one that is flexible, it is not something that can be allotted a particular research stage. To simply start by communicating widely to families about the work that we do, and to encourage families to share their views will be good starting point.

The Peninsula Cerebra Research Unit is part of the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC). PenCLAHRC is a collaboration of Universities and NHS organisations in the South West of England which aims to deliver high-quality health research that influences medical practice, ensuring that research addresses issues that are relevant to patients and carers and results in beneficial new treatments and services. 

Read more at http://www.pencru.org/aboutus/#GCial3kPGMX4JIEc.99

Written by: Kim-Michelle Gilson

An update from the Cochrane Public Health Group

Our work within Public Health Insight aims to generate evidence-informed solutions for decision makers. Public Health Insight incorporates the Cochrane Public Health Group (CPHG) and we thought it was time to provide an update on the work of CPHG and highlight the scope of our Cochrane reviews.

By way of background, in 2005 the World Health Organisation (WHO) convened the Commission on Social Determinants of Health to determine the available evidence globally on health inequities. The ultimate goal of the commission was to identify strategies to curb the increase in inequities.

The results suggested that inequities were not naturally occurring and could be avoidable by improving policy choices, i.e. acting on the social and structural determinants of population health.

In 2008, the Cochrane Public Health Group (CPHG) was registered as an editorial group with the international Cochrane Collaboration to address these challenges. Our mandate is to produce systematic reviews of interventions that seek to support decision-making involving the upstream determinants of health. Our group filled a crucial gap in the existing coverage of Cochrane review topics relevant to global population-level health evidence.

CPHG authors, guided by our editorial team, have utilised contemporary systematic review methods to identify not only whether interventions work, but the ability of these interventions to reduce inequities. Our reviews also seek to identify pointers to potential ineffectiveness or harm (including inequities) due to implementation or resource issues. We understand the need for decision-makers to have access to information about how to implement effective interventions in their own contexts. Review authors are also asked to highlight issues for low and middle income countries, often in the absence of good quality evidence in these countries.

The CPHG works with the Campbell and Cochrane Equity Methods Group to encourage authors to utilise the PROGRESS (Places of residence, race/ethnicity, occupation, gender, religion, socioeconomic status and social capital) tool for extracting data and reporting outcomes.

We currently have a wide range of reviews published or underway (see below). If you are interested in learning more visit our website and please join us on Twitter (@CochranePH), where you will be notified of exciting new reviews published and other news items of relevance to evidence-informed public health. If you are interested in being involved in any of the topics (for example, by commenting as a content expert) contact our Managing Editor (Jodie Doyle: jodied@unimelb.edu.au).

Education

  • Later school start times for supporting the education, health and well-being of high school students
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity
  • prevention in child care settings
  • Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition

Employment & the Work Environment

  • Flexible working conditions and their effects on employee health and wellbeing
  • Workplace-based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity

Food Supply/Access and Public Health Nutrition

  • Staple crops biofortified with increased micronutrient content for improving vitamin and mineral status in populations
  • Interventions for preventing undernutrition in children (0-5 years) living in slum environments Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Policy level and environmental interventions for reducing the consumption of non-alcoholic sweet drinks among children
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews
  • Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders
  • Nutritional labelling to promote healthier food purchasing and consumption
  • Fortification of condiments and seasonings with iron for preventing anaemia and improving health
  • Community-level interventions to improve food security in developed countries
  • Community-level interventions for improving access to food in low- and middle-income countries
  • Fortification of rice with vitamins and minerals for addressing micronutrient malnutritition
  • Fortification of staple foods with vitamin A for preventing vitamin A deficiency
  • Wheat flour fortification with iron for reducing anaemia and improving iron status in whole and at-risk populations
  • Fortification of maize flour with iron for preventing anaemia and iron deficiency in populations
  • Fortification of wheat and maize flour with folic acid for population health outcomes
  • Population-level interventions in government jurisdictions for dietary sodium reduction
  • Food fortification with calcium and vitamin D: impact on health outcomes
  • Fortification of staple foods with zinc for improving health outcomes in the general population
  • Food fortification with multiple micronutrients: impact on health outcomes

Housing and the Built Environment

  • Housing improvements for health and associated socio-economic outcomes
  • Built environment interventions for physical activity in adults and children
  • Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children
  • Slum upgrading strategies and their effects on health and social outcomes
  • Interventions to reduce ambient particulate matter air pollution and their effect on health

Income Distribution and Financial Interventions

  • Welfare to work interventions and their effects on the health and wellbeing of lone parents and their children
  • In-work tax credits for families and their impact on health status in adults
  • Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low and middle income countries
  • Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low and middle income countries
  • Livestock development programs: effects on indicators of livelihood and health status for families in low and middle income countries

Natural Environment

  • Interventions for reducing adverse health effects of high temperature and heatwaves
  • Participation in environmental enhancement and conservation activities for health and well-being in adults
  • Participation in outdoor education programs in natural environments and children’s health

Public Safety

  • Interventions for preventing abuse in the elderly

Social Networks/Support

  • Social cohesion and community building interventions in local communities for improving health and quality of life
  • Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people
  • Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations
  • Individual-, family-, and school-level interventions for preventing multiple risk behaviours in individuals aged 8 to 25 years
  • Population-level intervention for preventing multiple risk behaviours in 8 to 25 year olds

Systems for Health

  • Interventions implemented through sporting organisations for increasing participation in sport
  • Policy interventions implemented through sporting organisations for promoting healthy behaviour change
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in childcare services
  • Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Collaboration between local health and local government agencies for health improvement
  • Service brokerage for improving health outcomes in ex-prisoners (previously entitled, Population level interventions for improving health outcomes in ex-prisoners)
  • Community-based, population level interventions for promoting child oral health
  • Knowledge translation strategies for facilitating evidence-informed public health decision making among managers and policymakers
  • Interventions for improving the use of the oral healthcare services by adults

Transport, Active Transport and Physical Activity

  • Legislative and engineering interventions for preventing road traffic injuries and fatalities among vulnerable road users (nonmotorised road users and motorised two-wheel road users) in low and middle income countries
  • Community wide interventions for increasing physical activity
  • Environmental and behavioural interventions for reducing sedentary behaviour in community dwelling older adults
  • Public health interventions for increasing physical activity in adults, adolescents and children: an overview of systematic reviews
  • Workplace based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in child care settings
  • Built environment interventions for physical activity in adults and children
  • Incentive-based interventions to increase physical activity
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews