Byrne-Davis, L., Bull, E., Burton, A., Dharni, N., Gillison, F., Maltinsky, W., Mason, C., Sharma, N. and Hart, J., (2017). Global Health Psychology: Research, Volunteering & Consultancy. The European Health Psychologist, 19 (2), pp. 321-325

Bull, E

BURTON, Amy

Byrne-Davis, L M T

Dharni, N

Gillison, F

Hart, J

Maltinsky, W

Mason, C

Sharma, N

STORE - Staffordshire Online Repository

Since we started workingin global health, we havelost count of the numberof Health Psychologistswho have told us of theirattempts to volunteerinternationally and thedifficulties in finding aproject in which they canuse their specific skillsand knowledge. Imaginethen, our surprise, whenwe read the editorial inthe launch of the journal‘Global Health Scienceand Practice’ in 2013entitled ‘The 6 domains ofbehavior change: themissing health systembuilding block’. Thiseditorial described theglobal health priorities that would be addressed byan application of knowledge and skills in behaviourchange. Not written by a psychologist, but by apublic health specialist from the United StatesAgency for International Development, the editorialsets out a broad range of possible contributionsthat psychologists, with expertise in behaviourchange, could make to improving andunderstanding health and healthcare (Shelton,2013)1.Our own involvement began with a chanceconversation with a colleague who worked in a‘health partnership’. These are collaborativepartnerships between UK organisations andorganisations in low and middle income countries(LMIC) with an aim of strengthening healthsystems mainly through supporting education andtraining of healthcare professionals. Typically, UKhealthcare professionals will engage in education,training or mentoring of their counterparts in theLMIC, whilst learning skills themselves aboutteaching, tropical disease management, andmanaging with low resources to name but a few.The partnership in this case was between GuluRegional Referral Hospital, a large governmentfunded hospital in the north of Uganda, andUniversity Hospital of South Manchester (UHSM).The partnership had been active for about 7 yearsat the time and there was good evidence thateducation was being conducted and was having animpact on the knowledge and skills of theworkforce. With the partnership team, we reviewedtheir assessments of knowledge gain in twocourses, maternal and adult acute illnessmanagement, which were 25 item multiple choicequestions before and after training, based on theknowledge taught in the training and we foundthat learners were improving in their knowledgefrom pre to post course (Byrne-Davis et al, 2014;McCarthy et al, 2015). It was not clear, however,what impact the knowledge gain or the gain inskills, which was not robustly assessed, was havingin practice. Nor was it clear what the UK workforcewere learning. With grants from UHSM and theGlobal Health Exchange (the international arm ofHealth Education England:http://www.globalhealthexchange.co.uk), webegan to explore ways of understanding the impactof learning on healthcare professional behaviour inUganda (Byrne-Davis et al, 2016) and, withcolleagues at the University of Salford, ways ofLucie Byrne-DavisUniversity of ManchesterEleanor BullUniversity of ManchesterAmy BurtonStaffordshire UniversityNimarta DharniBradford Institute forHealth ResearchFiona GillisonUniversity of BathWendy MaltinskyUniversity of StirlingCorina MasonNHS GrampianNisha SharmaSolent NHS TrustJo HartUniversity of ManchesterGlobal Health Psychology: Research,Volunteering & Consultancyglobal health psychologyByrne-Davis et al.measuring the impact of volunteering on the UKworkforce.1 We created a collaboration of experts inbehaviour change, Professors Marie Johnston andChris Armitage and an expert in workforce andhealth professional education, Professor Ged Byrne.Working together, we found the health partnershipsand volunteers to be willing and able collaboratorsand we learnt a great deal about working acrosscountries and with a large multidisciplinary team.Thinking about the personal growth thisopportunity had afforded us, alongside the benefitsto the health partnership and the contribution tothe psychological literature, we decided toinvestigate possibilities to scale up our work. Ourkey priorities were to increase capacity for globalhealth work for psychologists, make a difference tothe health partnership projects and contribute tothe science. Byrne-Davis and Hart, with co-applicants Johnston and Armitage, approached anorganisation that, with funding from theDepartment for International Development, offeredgrants to health partnerships: The Tropical Healthand Education Trust (THET: www.thet.org). Afterwe had shared our vision and a proposed projectplan, they offered to fund a pilot project for 12months, beginning in January 2016. Our plan wassimple (and complicated! ) : to recruit volunteerswith expertise in behaviour change and to placethem in existing health partnerships with a remitto: 1) support the partnership in reaching its aimsand 2) conduct small scale action research based oncertain basic frameworks, that could be pooledacross the projects to ask and potentially answercrucial questions about the science of behaviourchange in these applied settings. We had over 40applicants and placed 11 psychologists in 5partnerships. We worked on projects including:1) Emergency obstetric training in Ugandawith the UK Royal College of Obstetrics andGynaecology to investigate practice changefollowing training. We coded the training forbehaviour change techniques (BCTs) (Michie et al,2013), recommended enhancements to the courseand trained Ugandan and UK Health professionalsin behaviour change.2) Twinning midwives in Uganda with theUK Royal College of Midwives; We interviewedmidwives about barriers and enablers to mentoringand we trained UK and Ugandan colleagues inbehaviour and research methods.3) Medication safety in Beira, Mozambiquewith Ipswich Hospital, UK. We coded training forBCTs, audited a cardex system and multidisciplinaryteam working and we trained UK and Beira staff inbehavioural theories and approaches.Challenges and the futureWorking as volunteers in projects geographicallydispersed across continents is undoubtedlychallenging. We found that some of the methodsused in health psychology might not be possible touse with healthcare professionals in thesecountries. For example, there is no tradition ofusing Likert scales and we have multiple anecdotesthat these did not make sense to our healthcareprofessional colleagues. So far, we have eitherreverted to qualitative methods to explorepsychological determinants of practice or we havereduced the Likert responses to simple agree /disagree / don’t know, with the resulting reductionin richness of information. The difficulty in usingLikert scales is an issue that we are exploring in anongoing study in the UK, Rwanda and Malawi. Thebalance between consultancy and research is aglobal health psychologyByrne-Davis et al.1The MOVE project is a University of Salford andUniversity of Manchester project to explore andassess the personal and professional developmentbenefits of international placements for the UKNHS workforce.difficult one. We are creating evidence quickly sothat it can be used to improve each project andultimately make crucial changes to help patientsand the public. These data are necessarily,therefore, less robust than data collected forresearch purposes only: there are morecompromises and there is less time to pilot andrefine questions and methods. We are beginning tohave ideas about methods that might be moreappropriate and are investigating these. There arealways ethical questions about researching andlearning in low-resource settings: are we doingmore harm than good? Are we prioritising our owndevelopment over the development of researchersfrom those countries? There is a lot of interest nowin the mutual benefits of health partnerships (seeTHET, In Our Mutual Interest:http://www.thet.org/resource-library/in-our-mutual-interest) . Volunteers gain personally andprofessionally from volunteering and it is crucial toset out the mutual benefits and costs in anymemorandum of understanding between partners.The use of LMIC settings as a resource for researchdata is also a concern. We made a commitment totry to create a community of people working inLMIC in health and social care workforce research.We recently applied for funding and held a meetingin Rwanda of around 40 colleagues working in thisfield from nine countries and are hoping that thiswill be a start to the sharing of resource andexpertise amongst HIC and LMIC researchers for ourmutual benefit. We continue to apply our ethicalstandards, to adhere to principals of sustainabledevelopment and to work in partnership, ensuringthat the relationship between ourselves and thehealth partnership is one of mutual benefit andultimately benefitting our current and futureclients, patients and the public.As for the health partnerships, they wereunanimously, enormously enthusiastic about thecontribution of the psychologists to their projects.Their feedback (http://www.mcrimpsci.org/case-studies/emergency-obstetric-training-in-uganda/)to us included"I think from our perspective it was like a pieceof the puzzle that had been missing that we hadn’trealised and…I think every project is trying to makechanges to behaviour and without understandingwhat that is and what that looks like then they arenot really going to get anywhere so I think it is areally fundamental part to the work that we aretrying to do"Without you we wouldn’t have thought as muchabout importance of the barriers, behaviours andcultures, and how people behave in their clinicalpractice. People seemed to get the importance of thiswhen we went on the wards because youcommunicated this in your presentations andactivities. With you we were able to hear about 'theunspoken things' in the partnership, as you areneutral and don’t mind asking about difficulties andwhy things don’t happen. With you guys we wereable to focus more on the key areas we wanted tochange… Really, you guys made us see things thatare right in front of us but we didn’t see them untilyou were hereIt is clear from the comments that, as Sheltonsays in his editorial, that having expertise inbehaviour change is a game changer when it comesto addressing issues in global health.The future is, as always, uncertain. Theexperiences have given us all a clearer vision aboutthe impact of our research, a greater desire toengage in activities in which we can advise as wellas study and access to a global health movementthat we did not know existed. In terms of research,there are grants to apply for, studies to conduct,students to supervise and collaborations to bedeveloped across international borders. In terms ofadvice and consultancy, we remain at the disposalof the global health community and have beendeveloping open access e-learning on behaviourchange (see www.mcrimpsci.org), writing openaccess publications about our work and leaving anglobal health psychologyByrne-Davis et al.open door for educators and health systemmanagers who wish to discuss the psychologicaldeterminants of healthcare professional practice.Final ReflectionsReflecting on the potential impact of ourcollaboration, we had the following thoughts. Inour work we are trying to help educators to movefrom knowledge to practice change rather thanourselves change anyone’s practice. The way theprojects were set up (without us – they werealready established when we started working withthem) meant that the data on practice change werenot being collected before we started work withthem, so we can’t tell if our working with them didhelp them achieve increased practice change. Whatwe have given partners is a) the desire to ‘thinkbehaviourally’ about education and training b) aframework to think about what their interventionsare trying to change – C, O, M (Michie et al, 2011)–and a theory-based way of thinking about howchange might happen. For some of them, we helpedthem tweak their education and training (e.g.,adding implementation intentions), which previousevidence would suggest would make practicechange more likely but we don’t have those data –that would require further research.ReferencesByrne-Davis, L., Slattery, H., Whiteside, S., Moro,E., Jackson, M., Onyachi, N., Stevens, A., Hart,J. , Surgenor, M. & Byrne, G. (2014). Efficacy andacceptability of an acute illness managementcourse delivered to staff and students in Ugandaby staff from UK. International Health. doi:10.1093/inthealth/ihu078Byrne-Davis, LMT., Byrne, GJ., Jackson, MJ., Abio,A., McCarthy, R., Slattery, H., Yuill, G., Stevens,A., Townsend, J., Armitage, CJ., Johnston, M. &Hart, J. (2016). Understanding implementationof maternal acute illness management educationby measuring capability, opportunity andmotivation: A mixed methods study in a low-income country. Journal of Nursing Educationand Practice. doi:https://doi.org/10.5430/jnep.v6n3p59McCarthy, R., Byrne-Davis, L. ,Hart., J. , Yuill, G.,Slattery, H., Jackson, M. & Byrne, G. (2015). Afeasible, acceptable and effective way to teachhealthcare workers in low and middle incomecountries a method to manage acutely illobstetric women. Midwifery. doi:10.1016/j.midw.2014.04.009Michie, S., van Stralen, M. M., & West, R. (2011).The behaviour change wheel: a new method forcharacterising and designing behaviour changeinterventions. Implementation science, 6(1), 42.doi: 10.1186/1748-5908-6-42.Michie, S., Richardson, M., Johnston, M., Abraham,C., Francis, J. , Hardeman, W., . . . & Wood, C. E.(2013). The behavior change techniquetaxonomy (v1) of 93 hierarchically clusteredtechniques: building an international consensusfor the reporting of behavior changeinterventions. Annals of behavioral medicine,46(1), 81-95.doi: 10.1007/s12160-013-9486-6global health psychologyByrne-Davis et al.Lucie Byrne-DavisHCPC Registered HealthPsychologist and Senior Lecturerin Assessment and Psychometricsin the Division of MedicalEducation at the University ofManchester, UKlucie.byrne-davis@manchester.ac.ukByrne-Davis et al. global health psychologyEleanor BullHCPC Registered HealthPsychologist and ResearchAssociate at the University ofManchester, UKeleanor.bull@manchester.ac.ukAmy BurtonHCPC Registered HealthPsychologist and a Senior Lecturerin Health Psychology atStaffordshire University, UKamy.burton@staffs.ac.ukNimarta DharniChartered Psychologist & ResearchFellow at Bradford Institute forHealth Researchnimarta.dharni@bthft.nhs.ukFiona GillisonHCPC Registered HealthPsychologist and Senior Lecturerin Health and Exercise Psychologyin the Department for Health,University of Bath, UKf.b.gillison@bath.ac.ukWendy MaltinskyHCPC Registered HealthPsychologist and Research Fellow,University of Stirling andPsychology Programme LeaderUniversity of the Highlands andIslands, Scotlandwendy.maltinsky.ic@uhi.ac.ukCorina MasonHealth Psychologist in Training atNHS Grampiancorina.mason@nhs.netNisha SharmaHealth Psychologist in Training atthe University of the West ofEngland and Behaviour ChangePractitioner at Solent NHS Trust,UKnisha.sharma@nhs.netJo HartHCPC Registered HealthPsychologist and Reader in HealthProfessional Education in theDivision of Medical Education atthe University of Manchester, UK.Chair Elect of the UK Division ofHealth Psychologyjo.hart@manchester.ac.uk

Global Health Psychology: Research, Volunteering & Consultancy.

Global Health Psychology: Research, Volunteering & Consultancy.

Abstract

Similar works

Full text

Available Versions

STORE - Staffordshire Online Repository