Assessing the effectiveness of a longitudinal knowledge dissemination intervention: Sharing research findings in rural South Africa

Knowledge dissemination interventions (KDIs) are integral to knowledge brokerage activities in research as part of the ethics of practice, but are seldom evaluated. In this case study, we critically reflect on an annual KDI as part of knowledge brokerage activities in the MRC/Wits-Agincourt Unit health and demographic surveillance system (HDSS) in rural South Africa from 2001 to 2015. The HDSS findings on births, deaths and migrations, as well as nested research project results, were shared with villagers, village leaders and service providers. The data used for this case study comprised secondary analysis of 13 reports and 762 evaluation forms of annual village-based meetings; records of requests for data from stakeholders; and qualitative analysis of 15 individual and five focus group interviews with local leaders and service providers involving 60 people. Over time, the KDI evolved from taking place over one week a year to being extended over six months, and to include briefings with service providers and local leaders. Attendance at village-level meetings remained low at an average of 3 per cent of the total adult population. Since 2011, the KDI village-based meetings have developed into an embedded community forum for discussion of topical village issues. There has been a decrease in requests for health-care and other services from the research unit, with a concurrent increase in research-related questions and requests for data from service providers, village leaders and political representatives. We conclude that, in this setting, the dissemination of research findings is not a linear exchange of information from the researchers to village residents and their leadership, but is increasingly multi-directional. KDIs are a key component of knowledge brokerage activities and involve, influence and are influenced by other aspects of knowledge brokerage, such as identifying, engaging and connecting with stakeholders and supporting sustainability

Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa

The authors would also like to acknowledge the field staff at the MRC/Wits Agincourt unit, particularly Ms Rirhandzu Debs and Dr Kerstin Edin from the Umeå Centre for Global Health Research, Umeå University, who facilitated data collection and made important contributions to the fieldwork.Peer reviewedPublisher PD

Moving from medical to health systems classifications of deaths : extending verbal autopsy to collect information on the circumstances of mortality

Acknowledgements The authors would also like to acknowledge the field staff at the MRC, SA/Wits Agincourt Unit, particularly Sizzy Ngobeni. The authors also acknowledge Drs Malin Eriksson and Edward Fottrell at Umeå Centre for Global Health Research *UCGHR) who contributed to the development of the SF-VA indicators, Dr Nawi Ng at UCGHR who advised on the cause of death categories, and Dr Kerstin Edin at UCGHR who provided comments on the manuscript categories, and Dr Kerstin Edin who provided comments on the manuscript. Funding A Health Systems Research Initiative Development Grant from the UK Department for International Development (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC (and the Wellcome Trust (MR/N005597/1) funds the research presented in this paper. Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the University of the Witwatersrand and Medical Research Council, South Africa.Peer reviewedPublisher PD

Initiating a participatory action research process in the Agincourt health and socio–demographic surveillance site

Financial disclosure Funding: The research presented in this paper is funded by a Development Grant as part of the Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1). The fieldwork was completed with the Umeå Centre for Global Health Research, with support from FORTE: Swedish Council for Health, Working Life and Welfare (grant No. 2006–1512). The School of Public Health at the University of the Witwatersrand, the South African Medical Research Council, and the Wellcome Trust, UK support the MRC/Wits Rural Public Health and Health Transitions Research Unit and Agincourt HDSS (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). OW is a recipient of an MSc Chevening Scholarship, the UK government's global scholarship programme, funded by the Foreign and Commonwealth Office (FCO) and partner organizations (Chevening Ref.: NGCV–2015–1194).Peer reviewedPublisher PD

Verbal autopsy with participatory action research (VAPAR) programme in Mpumalanga, South Africa : protocol for evaluation

The research is supported by the Health Systems Research Initiative from Department for International Development (DFID)/ Medical Research Council (MRC)/Economic and Social Research Council (ESRC) (MR/N005597/1, MR/ P014844/1), South African Department of Science and Innovation, the University of the Witwatersrand, and the Medical Research Council, South Africa, and previously the Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z).Peer reviewedPublisher PD

Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

Introduction: Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. Objectives: We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting.Method:We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. Results: CM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. Conclusions: To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific domains is required, they provide an extremely valuable organizational tool to guide CM programming and evaluation of critically needed mobilizing initiatives in Southern Africa

Voice needs teeth to have bite’! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa

Funding: Joint Health Systems Research Initiative Medical Research Council (MRC)/Department for International Development (DFID)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1).Peer reviewedPublisher PD

Adolescents' understanding of obesity: a qualitative study from rural South Africa.

Funder: Department of HealthBACKGROUND: Levels of obesity are rising in South Africa, notably among adolescent females. Excessive energy-dense diets and physical inactivity are among the factors contributing to this increase. Given that these factors are largely behavioural, understanding young people's views of obesity can contribute to more targeted behavioural interventions. Yet little is known of how rural South African adolescents view obesity. OBJECTIVES: The aim of this study was to explore rural South African adolescents' views of obesity, including their understanding of its causes, consequences, and solutions. METHODS: This qualitative study took place within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) study area, in rural northeast South Africa. Three focus group discussions were held with male (n = 16) and female adolescents (n = 15), aged 14-19 years in 2018. Data were analysed using thematic analysis and the Social Cognitive Theory used to frame the findings. RESULTS: Participants presented conflicting views of obesity, with both positive and negative opinions expressed. Causes of obesity were seen to be multifactorial, including genetics, diet, lack of physical activity, and HIV treatment. Adolescents proposed medication and hospitalisation as ways to address obesity. When discussing interventions to address obesity, adolescents expressed the need for more information, suggesting that providing information to both themselves and their family members as part of interventions would be important. CONCLUSIONS: Rural South African adolescents have a complex perspective of obesity, likely driven in part by the current nutrition transition underway and do not inherently see individual behaviour as a driver or mitigator of obesity. Complex interventions including the involvement of other household members are needed to change adolescents' views on the role of the individual, and ultimately, change both individual and household behaviour to prevent obesity

Relationship between children's cognitions and later educational progress in rural South Africa:A longitudinal study

Background: Children in low and middle-income countries (LMIC) who remain in school have better health and employment outcomes. South Africa, like many LMIC, has a secondary school completion rate under 50%, leaving room for improvement if we can identify factors that affect educational attainment. This is the first longitudinal study to examine the effects of childhood mental health and cognitions on educational outcomes in LMIC. Methods: Using the Strengths and Difficulties Questionnaire (SDQ) and Cognitive Triad Inventory for Children (CTI-C), we assessed the psychological functioning and cognition of children aged 10-12 in rural South Africa. We linked that data with measures of educational progress collected five years later and examined associations between educational progress and 1) behavioural and emotional problems and 2) cognitive interpretations, adjusting for possible confounders. Results: Educational data was available for 443 individuals. 92% (n= 408) of individuals had advanced three or fewer grades in seven years. Having more positive cognitions (CTIC-C) was positively associated with progressing at least three grade levels (adjusted OR: 1.43; 95% CI: 1.14-1.79). There was no evidence for an association between emotional and behavioural problems (SDQ) and educational progress (OR: 0.90; 95% CI: 0.72-1.11). Conclusion: If children in LMIC can develop more positive perspectives, they may be able to stay in school longer. Cognitions can be modified, and future studies should test interventions that work to improve cognition in childhood, guided , for example, by principles of cognitive behavioral therapy