- Strategic Research Questions and Specific Objectives
1. What factors impact on decision-making and action for treatment and prevention seeking?
a. How does gender influence preventive and treatment engagement?
b. How do perceptions of risk influence prioritisation of particular responses to preventive or treatment-based engagement with health?
c. What is the role of social capital and social networks in decisions towards health and health engagement?
d. How are decisions regarding health seeking influenced by the health system?
2. How to improve response to severe illness through social interventions at primary and community level?
a. Develop and measure the impact of community and primary health service based interventions to improve recognition of and response to severe illness
b. Explore key social determinants of engagement in health interventions.
3. What are the impacts, intended and unintended consequences of emergent health technologies?
a. Understand social harms & benefits of introducing HIV self-testing in key, general populations and couples
b. Explore the social acceptability of emergent technologies to inform contextually relevant and acceptable health interventions.
c. Explore concepts of ‘patient-hood’, risk and responsibility through emergent technologies
d. Explore the impact of gender on engagement with emergent technologies
4. How to support ethical engagement through a behaviour change approach for research?
a. How can we support and improve ethical engagement in medical research and health more broadly through behaviour change approaches?
b. How can we evaluate the impacts of current engagement and science communication approaches to inform evidence-based practice in the future?
Approaches to these themes are framed through conceptual questions: 1)How is the concept of ‘acceptability’ relevant to understanding health and research engagement; what are the requisites to ensure empirical ‘acceptability’ across different interventions: 2)What is the impact of masculinity and femininity discourses on treatment seeking and engagement with health: 3)How do individual & community perceptions of risk translate to inform preventive and treatment seeking behaviours, engagement in emergent health technologies and avertive risk management strategies?
- The Behaviour and Health group was established in 2010, introducing a social science programme into MLW. Since then the group has expanded from two to over 30 staff members from post docs to field staff working across disciplines and across themes. Our research is approached using a range of mixed methods, across a number of different projects. Questions are driven by recognition of the need to understand health behaviour in context. 1) Vertically delivered health interventions targeting individuals in hospitals and communities, recognition and response to illness and adoption of preventive behaviours all rely on decisions within households, communities and amongst families and are rarely experienced in isolation from a complex social world. 2)Late presentation at tertiary impacts on disease outcome for adults and children.
Whilst health interventions tend to target specific diseases, improving the patient pathway to care following illness onset involves a linked approach across both community, primary health, secondary and tertiary settings. Focusing on the improvement of recognition of disease, improvement of service delivery and support for progression between these sectors requires the development of effective and measurable interventions. 3)Emergent technologies include home-based testing options to identify illness or monitor disease progression, new preventive technologies such as the range of HIV biomedical prevention options, hospital-based improvements in managing or monitoring health, contemporary solutions for increasing access to and management of healthcare for users and providers and increasingly opportunities to measure exposure to risk factors for infectious and non-communicable disease.
These new and diverse ‘technological solutions’ to improved health outcomes are largely developed in western settings. Their adoption in non-western settings is likely to highlight unique demand and supply side issues amongst communities, individuals and health systems, with both intended and unintended impacts that may be either beneficial or detrimental to health and health engagement. 4)Understanding impact of community engagement approaches is important in guiding future Science communication activities and process. The Behaviour and Health group supports the Science Communication Department and through a Global Health Bioethics Network grant funded through a Wellcome Trust strategic award supports the improvement of ethical research practice across MLW, in collaboration with other AAPs.
- Recent Grants
1) 2018 STAR Phase 2: Stimulating and shaping the market for HIV self-testing in Africa: two-tier demonstration and evaluation of accuracy and linkage in 5 countries
2) 2018 National Institutes of Health Research, Global Health Research Group on Improving the Management of Acute Brain Infections at University of Liverpool
3) 2018 GCRF Academy of Medical Sciences, Developing Culturally-Appropriate and Sustainable Interventions to Prevent Visual Loss from Diabetes in Low and Middle Income Countries
4) 2018 PATH, Dynamics of Health Care Utilization Strategies in the Context of RTS,S/AS01 Vaccine Introduction in Malawi
5) 2018, MITS in CHAIN: Minimally Invasive Tissue Sampling in children dying of an acute illness with varying forms of undernutrition, determining causes of death within the Malawian ‘CHAIN’ cohort: Social acceptability & ethics
6) 2018, Irish AID, Establishing a feedback system for district monitoring of ETAT at primary health clinics in Blantyre, Malawi
7) 2018 Global Health Bioethics Network, SHARE
8) 2018 Global Health Bioethics Network, BIO2USER
9) 2017 Wellcome Trust, Global Health Bioethics Network Strategic Award Renewal
10) 2017 Wellspring Foundation, Violence Against Women & Girls
11) 2017 Global Health Bioethics Network, ECEF
12) 2017 International AIDS Society, Youth champions for HIV prevention among young key populations
13) 2015 Meningitis Research Foundation & Scottish Government, Triage and treatment, training and engagement. A package for sustainable healthcare improvement in Malawi’s primary health clinics
1) Successful funding applications: Mtisunge Gondwe (Commonwealth PhD), Doreen Sakala (Chevening MPH), Deborah Nyirenda (GHBN Postdoctoral fellowship)
2) Successful completions: Dr Moses Kumenda (PhD CoM), Chimwemwe Phiri (MA in Visual Anthropology Oxford), Dr Deborah Nyirenda (PhD Liverpool School of Tropical Medicine/CoM)
3) Wezzie Lora (PhD student) - scholarship to attend Health Systems Global conference, Ellie MacPherson (Senior Post doctoral researcher) - scholarship to attend AMR grant meeting
Recent Publications (Dec 2017 to Dec 2018)
1. Global Bioethics 2018 "Not just dogs, but rabid dogs": Tensions and conflicts amongst research volunteers in Malawi Mackwellings Phiri, Kate Gooding, Deborah Nyirenda, Rodrick Sambakunsi, Moses Kumwenda, Nicola Desmond 10.1080/11287462.2018.150992
2. BMC Public Health 2018 The effectiveness and cost-effectiveness of community-based lay distribution of HIV self-tests in increasing uptake of HIV testing among adults in rural Malawi and rural and peri-urban Zambia: protocol for STAR (Self-Testing for AfRica) cluster randomized evaluations Melissa Neuman, ScD; Pitchaya Indravudh; Richard Chilongosi; Marc d'Elbée; Nicola Desmond; Katherine Fielding; Bernadette Hensen; Cheryl Johnson; Phillip Mkandawire; Alwyn Mwinga; Mutinta Nalubamba; Getrude Ncube; Lot Nyirenda; Rose Nyirenda; Eveline Otte im Kampe; Miriam Taegtmeyer; Fern Terris-Prestholt; Helen Weiss; Karin Hatzold; Helen Ayles; Elizabeth L Corbett https://doi.org/10.1186/s12889-018-6120-3
3. Social Science & Medicine 2018 Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why? Kate Gooding, Mackwellings Phiri, Ingrid Petersen, Michael Parker, Nicola Desmond https://doi.org/10.1016/j.socscimed.2018.07.040
Postdoctoral research associate
Kate Gooding work focuses on community engagement with research, research ethics, acceptability of health interventions, and health seeking behaviour. She also works with Science Communication on monitoring and evaluation. Kate’s background includes work on health and international development policy, research and evaluation, in universities, donors, NGOs and as a consultant. Kate has a PhD from Leeds University on research by NGOs in Malawi, an MPhil in Development Studies from the Institute of Development Studies, Sussex University, and a BA in Geography from Oxford University. Kate is deputy head of the Behaviour and Health group.
Junior Research Assistant/Youth Champion for HIV prevention among young key populations
Mwiza Sambo is a Social Science Junior Research Assistant at MLW, under the Self -Testing Africa study (STAR). He is one of eight young Africans awarded a grant as a youth champion for HIV prevention among young key populations by the International Aids Society, from February 2017. He has been involved in conducting qualitative research about HIV self-testing in both general and key populations at high risk of HIV infection.His long term goal is to develop as an academic and be an expert in behaviour and health research.
Vincent Kingstone Mkwinda
Field Worker / Junior Research Assistant
Vincent is an upcoming health researcher and holds a Diploma in Journalism obtained at The Polytechnic, University of Malawi. Has two years’ working experience, and joined MLW in 2015. He assisted in the evaluation of the Theatre for Development community intervention with the Behaviour and Health group. Vincent is now working with the ASPIRE project to assist implementation of an intervention study at primary health facilities to improve patient pathways to care.
Wakumanya SibandeJunior Research AssistantWakumanya is an upcoming health researcher with two years of experience working in community mobilisation and engagement in Malawian rural and urban communities. Currently he carries out the role of junior researcher in the Behaviour and Health group, under an HIV self-testing study where he is responsible for community and public engagement and liaison. He is a trained Social Scientist with an undergraduate degree obtained from the Catholic University of Malawi in 2015. Wakumanya aspires to contribute in carrying out evidence based research in areas of human health behaviour, illness and treatment seeking on high burden diseases in Sub-Saharan Africa.Helen MangochiGlobal Health Bioethics Network FellowHelen is a senior research nurse at the Malawi Liverpool Wellcome Trust. She is experienced in both clinical and observation trials. Helen holds a Bachelors degree in Public Health and her major interest is improving research skills, especially for understanding ethical issues in research. Recently Helen was awarded a grant from the Global Health Bioethics Network (GHBN) to conduct an empirical study on assent in paediatric research. Helen likes working with people from different cultural and social background while respecting their beliefs and norms.
Junior Research Assistant
Global Health Bioethics Network (GHBN) Fellow
Mackwellings Phiri work has focused on understanding and improving community engagement through qualitative research. In 2015, he conducted a Wellcome Trust funded project on trust and the role of community volunteers in health research. He is now working on another Wellcome Trust (Global Health Bioethics Network) funded study about data sharing, which explores research stakeholders’ perspectives about research studies sharing participants’ non-anonymised data. Mackwellings is studying for a Bachelors in Public Health. His long-term career goal is capacity to independently and competently conduct health research, backed by theoretical and practical knowledge.