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Institute of Health and Wellbeing Early Career Researchers' Blog

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  • Sep 24 / 2014
  • 0
Methods

Building Bridges in Qualitative Research

By Katie Gallacher:

The late John Donne famously said “No man is an island”. However can we say the same of our research projects? In relation to quantitative research, we probably can. Systematic review has become the “gold standard” method of research used to inform national policies and guidelines. This is widely accepted as a method of synthesis for quantitative research, but finding an equivalent for qualitative studies has been more controversial. As part of my PhD, I have endeavoured to carry out a systematic review of qualitative studies, fully aware there is still widespread debate about whether this is an appropriate or worthwhile task (and I certainly found it no mean feat!).  Renowned qualitative researchers Glaser and Strauss warned in their early work that the continued failure to link local grounded theories into larger formal theories would relegate the findings of individual studies to “little islands of knowledge” which may never be utilised if kept in separation. So should we start to build bridges between these islands in order to encourage policy makers to use qualitative research in their decision making?  Would this help us ‘keep up’ with our quantitative neighbours? Or does the synthesis of qualitative work simply destroy the underlying principles of this type of research? Any thoughts on this by readers would be greatly appreciated!

In a nutshell, quantitative research is generally associated with a realist positivist stance, which assumes that knowledge is objective and true and accessible through what can be observed.  This is the customary stance taken by those carrying out a systematic review, the typical purpose of which is to summarise the findings of available studies to estimate the ‘true’ answer to a particular research question. Qualitative work has strong links with interpretivism rather than positivism. This assumes that there are multiple realities, and that knowledge is a socially produced construct, making truly interpretivist approaches deeply cynical of any one coherent theory as a singular explanation of phenomena. As you can imagine, holding this viewpoint makes the synthesis of studies challenging, as if there is no ‘truth’ to be discovered, only a collection of different stories that all have their own truths, then synthesis would be pointless and would destroy the integrity of individual projects. Sandelowski eloquently states “Just as it goes against the nature of poetry to attempt to summarize even one poem about love, so it seems both epistemologically and ethically inappropriate to attempt to summarize findings from one or more qualitative studies about human experiences of health and illness”.

I hold the opinion, similar to others before me, that by synthesising qualitative studies, it is possible to generate more powerful theory, and that by not doing so we risk isolation from policy makers and clinicians. I am an academic GP carrying out a PhD which examines the experiences of those who have had a stroke, and I believe that the synthesis of qualitative research can add to our knowledge of how individuals experience healthcare, and how we can improve their interactions with healthcare providers. I understand that not all patients have the same experience, and that caution should be exerted when making generalisations. But with enough knowledge about the sample being researched, and with enough transparency in reporting by qualitative researchers, I believe that synthesis is possible, and in fact, important. So, I guess my stance is that of a ‘modified’ or ‘critical’ realist, with sensitivity to the heterogeneous nature of the studies involved, and with the appreciation that what I seek to understand is a variety of representations of the reality of living with stroke. Are there any other modified realists out there? Or indeed any realists or interpretivists who would like to challenge my viewpoint?

Even for those who feel that synthesis is possible, the best method remains under debate, with a plethora of choices available. This could be viewed as inspiring or infuriating, either way it is certainly a demonstration of how popular this type of research is becoming. As is the case with all good research, the correct method is no doubt heavily reliant on the individual research question and underlying assumptions. One thing is for certain: the increasing numbers of qualitative studies and their use in informing health policy has undoubtedly led to a demand for the appraisal and synthesis of this type of research, and this has to be a good thing. So let’s continue to build bridges!

  • Sep 10 / 2014
  • 2
Current Affairs

Suicide Prevention: We Need Everyone

By Olivia Kirtley

 

Today is World Suicide Prevention Day.  Last week the World Health Organization (WHO) released the first ever World Suicide Report, showing that around 800,000 people die by suicide each year.  In fact, around the world, one person will die by suicide every 40 seconds, which means in the time it’s taken me to write these few sentences, around 14 people have taken their own lives.  Every mortality statistic in suicide research represents many personal tragedies.  Sometimes I find the sheer scale of the task in front of us, as suicide researchers, overwhelming.  But all around the world, people are doing something to try and reduce suicide.

The sad death of Robin Williams last month prompted an outpouring of tributes and stories of people’s favourite memories of him.  One of the things I remember Robin Williams for the most, is his role as inspirational teacher Mr Keating in the Dead Poets Society.  In one scene, he stands on his desk and asks his students why he is doing this.  He says: “I stand on my desk to remind myself that we must constantly look at things in a different way.”  I’ve been thinking a lot about this quote recently and how if we’re going to reduce suicides, we need to look at suicide in a different way.

A different way of looking at suicide is something highlighted in several recent journal articles (Glenn & Nock, 2014; Klonsky & May, 2014; O’Connor & Nock, 2014): we need to become better at working out what’s different between people who think about suicide, without acting, and those who actually translate those thoughts into actions.  This is one of the main aims of the Suicidal Behaviour Research Laboratory (SBRL) here at the University of Glasgow.  We do research using experimental and self-report methods to try and work out what some of these differences may be, because once we know, we can develop interventions to try and stop suicidal thoughts from becoming suicide attempts.  But we know that one size does not fit all, so we also need to think about which risk factors are specific to the individual.

Researchers are not the only ones trying to look at suicide in a different way.  New York photographer Dese’Rae L. Stage is working on a remarkable project called Live Through This, which pairs the stories of suicide survivors along with a photographic portrait of the person and for a topic such as suicide, this is completely groundbreaking.  Suicide is too often the stigmatising preserve of hushed voices and side-ways glances and those who have attempted suicide face that stigma also.  Live Through This is a quantum leap in the fight against stigma and shows that people who attempt to end their lives are regular people like you and me.

Why is this important?  Because sometimes for a really big task, like trying to reduce suicides, research is not enough on its own.  We need people to give faces and voices to those who have thought about and attempted suicide, to research potential causes and interventions for suicidal behaviour, to translate that research into policy change, to implement these changes into our healthcare and education services and to share their own stories and experiences of survivorship and bereavement.  The theme for this year’s World Suicide Prevention Day is “Suicide Prevention: One World Connected”, so carpe diem!  Do something today to help prevent suicide.  We need all the help that we can get.  We need everyone.

How do you think we can look at suicide in a different way?  Do you feel like your research area requires a global “group effort”?  IHAWKES would love to hear from you.  Please leave comments below.

  • Aug 27 / 2014
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Academia, Matt Jamieson

Gender imbalance in academia and the Athena SWAN award

By Matt Jamieson

In August 2011 Glasgow University joined the Athena SWAN charter, a scheme which recognises excellence in higher education and which is particularly focused on increasing the representation of women in academia. The beliefs underpinning the charter are: That the advancement of science, technology, engineering, maths and medicine (STEMM) is fundamental to quality of life, and that it is vitally important that women are adequately represented in what has traditionally been and is still, a male-dominated area. It is stated that science cannot reach its full potential unless it can benefit from the talents of the whole population, and until women and men can benefit equally from the opportunities it affords. Continue Reading

  • Aug 13 / 2014
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David Blane, Methods

Putting the tea into theory-driven research

Image by Mark Mags. © 2016. © CC0 Public Domain via Pixabay.

Image by Mark Mags. © 2016. © CC0 Public Domain via Pixabay.

By David Blane

As early career health researchers, we IHAWKES have some familiarity with theory, whether it’s a theory of behaviour change from psychology or a grand theory like Marxism or feminism from sociology. I would suggest, however, that when it comes to applying theory to our research, many novice researchers (myself included) are a little less confident. What theory should we use? How do we apply it? Can we generate our own theory? Continue Reading

  • Jul 30 / 2014
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Current Affairs

Promoting equality: what can we do?

By Adele Warrilow:

As I write, the 2014 Commonwealth Games are well underway in Glasgow – there is a fabulous atmosphere across the city and there has been a good haul of medals for Scotland and the other UK teams! Although the opening ceremony received varying reviews across social media, the collaboration with UNICEF was something that everyone could show their support for. During the ceremony they showed videos of the work that UNICEF is doing to promote the rights of children: the right to an education, to be healthy, to a childhood, to be treated fairly and to be heard.

The UNICEF Children First campaign is a magnificent idea and to date, Glasgow and the Commonwealth have raised a staggering £3.5 million! (You can still donate online or by text: click here to find out more )

There are numerous ways that researchers at all career stages can work to reduce inequality. These include: supporting others with similar goals, being aware of and contributing to university/institute policies, conducting research that seeks to understand or reduce inequality, considering whether your research is inclusive, presenting science careers and your research in accessible ways and being a good role model – taking action when you see practices that promote inequality.

Equal access to educational opportunities is something that I have felt strongly about ever since visiting the David Livingstone centre as a child and being struck at how motivated and committed this young boy was to his studies and ambition to become a doctor – propping his books on the loom to read as he worked at the mill. Without the opportunities, role models and support that I have had there is no way I would be training as a medical academic today. Sadly, there are children around the world with the talent to become leading scientists who will never fulfil their potential without access to education.

We are incredibly privileged to have the opportunities for education in the UK that we do. There are still inequalities however, particularly in the number of women reaching senior positions in science, technology, engineering, mathematics and medicine (STEMM) academia. Raising awareness of the importance of equal opportunities is important throughout our research careers and this is highlighted in the Researcher Development Framework (Section D1:8 for anyone completing their Postgraduate Review Paperwork!). The Institute of Health and Wellbeing, together with the University of Glasgow recognises the importance of equality in academia and their commitment to tackling inequality through the Athena Swan Charter and awards which promote the importance of gender equality in academic careers.

Gender inequalities in the encouragement to pursue certain interests begin early. In the toy department of a local shop, I was shocked to find educational fridge magnets labelled – “girl’s words” and “boy’s words” [sic]. The “girls’ words” included “make-up, sparkle, hairband, cooking, butterfly, love, friends” whereas the “boys’ words” included “money, climbing, aeroplane, skeleton, dinosaur”. Such products promote inequality and in particular may discourage girls from STEMM subjects from a young age. I contacted the shop regarding this and I am pleased to report that the shop in question had similar feedback from other customers and no longer stocks these products.

In choosing a PhD topic I was keen to choose a field of study that could raise awareness of the inequalities faced by children with neurodevelopmental problems throughout their lives. As a child and adolescent psychiatrist, my research interests include the epidemiology of children with neurodevelopmental difficulties who despite having multiple problems, do not meet the criteria for a specific psychiatric diagnosis and, I suspect, subsequently face multiple health and social inequalities. This is challenging as until now, much of the scientific research has focussed on single disorders but it is an important field of study and clinical practice that requires a scientific evidence base. Anna Isaacs’ IHAWKES blog, PhD research with marginalised communities: a few questions about ethics, discussed some of the dilemmas and challenges faced by students working to reduce health inequalities.

IHAWKES would love to hear from you! Tell us about how your research could help to reduce inequalities. Has considering potential inequalities had an impact on your research?  Have you been involved in any projects to promote equal access to STEMM subjects? Any good ideas? What encouraged you to work in academic science?  Please leave your comments below.

 

 

 

  • Jul 16 / 2014
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Matt Jamieson, Methods

Some opinions about cross-departmental collaboration

Photo by Alejandro Escamilla. © 2013. © CC0 License via Unsplash.

Photo by Alejandro Escamilla. © 2013. © CC0 License via Unsplash.

By Matt Jamieson

At last month’s Institute of Health and Wellbeing student led conference (IHAWC), Professor Lawrence Moore talked about multi-disciplinary collaboration.  As a cross-discipline PhD student with supervisors in computing science and psychology, I could relate to the themes of the talk, e.g. the advantages of broadening the scope of your research and adapting to working in different academic cultures.  I’ll try to add to these with a few observations of my own. Continue Reading

  • Jul 02 / 2014
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Anna Isaacs, Methods

PhD research with marginalised communities: a few questions about ethics…

Photo by Alexandra. © 2015. © CC0 Public Domain via Pixabay.

Photo by Alexandra. © 2015. © CC0 Public Domain via Pixabay.

By Anna Isaacs

In my distant pre-PhD life, I spent a considerable amount of time each week volunteering with migrant and refugee organizations. In fact, the improvement of migrant and refugee health, and more broadly the reduction of health inequalities have long been my primary ‘vocational’ goals. To me, doing a PhD is a logical extension of these interests, a way that I can best develop my particular skills to meet these ends, albeit in the setting of academia rather than a non-governmental organisation (NGO). Continue Reading

  • Jun 18 / 2014
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Current Research

A ‘Fifth Wave’ in Public Health: Where Do We Start?

By Camilla Baba:

A debate in the Lancet co-authored by Dame Sally Davies, which addresses the ‘fifth wave’ in public health, recently caught my attention. Hanlon et al first discussed the concept of a ‘fifth wave’ in public health in 2011, suggesting that current challenges in public health require a delivery approach where a culture of healthy choices and behaviours is the norm. In their recent piece, Davies and colleagues (2014) consider practical approaches for the fifth wave. They preface this by charting the history of the various ‘waves’ of public health, suggesting that each links to a major shift in thinking about the nature of society and health. If we think back to the period of the late 19th – early 20th century, social medicine identified the link between unsanitary living conditions and the spread of disease (see Chadwick’s report). In this first wave, structural works such as the provision of clean water to urban areas became a priority. Wave two spanned the late 19th to the mid- 20th century. Modern technology gave rise to hospitals and the concept of an ‘expert’ was born. This led to theories of disease that are still applied today. The end of WWII saw great social change, as the welfare state was first conceived. The role of our everyday life and lifestyles on our health was explored. This was wave three (1940-1980) in action! Mid-20th century onwards has been dominated by efforts to combat disease risk and by the emergence of systems thinking. Health has an agenda item for policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.

Why a fifth wave?

Hanlon et al suggest that a ‘fifth wave’ in public health is necessary as a means to address serious issues such as social inequalities, loss of wellbeing (rise in depression and anxiety) and obesity, which are occurring in a context where society is also facing challenges due to “the broader problems of exponential growth in population, money creation and energy usage” (2011). Simply put, something has to give and necessity requires a new approach to public health.

The authors suggest a health-promoting societal context where healthy behaviours are the norm and a multi-sector (holistic) approach is taken to ensure this is promoted by our physical, social and economic environments. They argue that 3 practical mechanisms could be used:

  • Value of health – reward healthy behaviours and create social and institutional environments to encourage healthy choices;
  • Healthy choices as default – at the point of decision-making, address health consequences of choices;
  • Minimise influences to unhealthy behaviour – eradicate factors that can encourage unhealthy behaviours (e.g. the Public Health Responsibility Deal)

The importance of marketing and financial incentives in the new drive for public health is stressed. Yet, with the current economic climate I am not convinced. Can we truly tackle these challenges by relying on manufacturers/corporate bodies and their commitment to the ‘common good’? Would that be financially feasible for them and a profitable business model? As a budding health economist I hear myself asking how much profit would they trade for these non –monetary gains? With an increasing percentage of the population living below the poverty line, is a more radical approach needed? As demonstrated by the recent television show ‘The Great British Budget Menu’, healthier choices are often a luxury for those facing food poverty. Perhaps we can go further and make public health the sole priority in the UK. Rather than the’ easier’ option, why not the ‘only’ option? After all, looking back, previous waves have all included a radical aspect in their approaches.

What do you think? Are we in need of a new wave in public health? Have Davies et al got it right? Leave your comments below and continue the debate!

References:

BBC. (2013). The Great British Budget Menu http://www.bbc.co.uk/programmes/b036x3pv aired 02/08/2013

Davies, S.C., Winpenny, E., Ball, S., et al. (2014). For debate: a new wave in public health improvement. The Lancet. E-pub: 03/04/2014.

Hanlon P, Carlisle S et al. (2011). Making the case for a ‘fifth wave’ in public health. Public Health 125,1:30-36.

The Victorian Web. (2002). Chadwick’s Report on Sanitary Conditions. http://www.victorianweb.org/history/chadwick2.html

 

 

 

  • Jun 03 / 2014
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Current Research

Sensitivity and Sensationalism: Media Reporting of Suicide and the Science of Why it Matters.

By Olivia Kirtley:

I am currently the IHAWKES roving reporter at Columbia University, New York City.  Just one of the many intriguing pieces of research to come out of Columbia Psychiatry recently, is a Lancet Psychiatry article by Professor Madelyn Gould and other colleagues from Dartmouth College and Tufts University, looking at how the reporting of suicide in newspapers may be involved in teenage suicide clusters.  Point clusters of suicides are when a higher than expected number of suicides occur within a shorter than average time period, e.g. a week or a year; and/or in a similar space, such as within an individual school, or town (Mesoudi, 2009).

Gould et al’s study looked at all suicide clusters that occurred in 13-20 year olds in the US, from 1988-1996, and matched them to other non-clustered suicides.  The researchers then examined newspapers that were published after the index cluster or non-cluster suicide from each area where suicides occurred, and searched for stories relating to suicide, e.g. a headline including “suicide” or another word/phrase suggesting a person had taken their own life.

Findings show that in areas where cluster suicides occurred, there were significantly more news stories published about suicide than in areas where the index suicide was not followed by another death.  These news stories were also more likely to be front-page news, give more details about the individual and the method of suicide and also to use sensationalist headlines containing the word suicide or the method used.  Crucially, subsequent suicide deaths were specifically associated with stories about suicidal individuals rather than with general stories that included suicide related content.  Whilst the findings from this study do not demonstrate that overly explicit and detailed news reporting about individuals who die by suicide causes subsequent suicides, it does show an association.  The authors urge caution, however, as suicide is complex and usually involves many different factors, of which exposure to news stories may only be one.

Indeed, not all suicides are reported in the media.  What is it about one suicide relative to another that makes it newsworthy? Another recent study by Machlin, Pirkis and Spittal (2013) from the University of Melbourne, investigated the characteristics of suicides that were reported in the press and whether or not these suicides had specific features which may have made them more likely to hit the headlines.  They looked at data on suicides collected by the National Coroners Information System and also radio, TV and newspaper reports that included the word suicide which occurred from 2006-2007.  Suicides reported in the media were significantly more likely to be those of younger people (29 years or younger), to involve violent methods (e.g.,firearms) or to occur in an institutional setting (e.g., a hospital).  In addition to potentially leading to copycat suicides, sensationalist reporting of suicides in the media can also affect how the public understands suicide, maybe leading to the idea that particular groups of people are the only ones at risk of suicide.

This research highlights the critical importance of sensitively reporting suicide in the media and the crucial role the media has to play in suicide prevention.  There are both national and international guidelines for media reporting of suicide, including from from the Samaritans in the UK and the International Association for Suicide Prevention and World Health Organization internationally.  The guidelines advise against giving detailed descriptions of the method that a person has used to kill themselves or the location of the death, as this could provide a “how to guide” for someone who is vulnerable and considering ending their life.  The media guidelines for suicide reporting are supported by a wealth of scientific evidence and are intended not as bureaucratic red tape or media censorship, but quite simply, to save lives.

References:

Gould, M. S., Kleinman, M. H., Lake, A. M., Forman, J., & Bassett Midle, J. (2014). Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988—96: a retrospective, population-based, case-control study. Lancet Psychiatry. Advance online publication. doi: 10.1016/S2215-0366(14)70225-1

International Association of Suicide Prevention & World Health Organization.  (2008). Preventing Suicide: A Guide for Media Professionals.  Retrieved from http://www.who.int/mental_health/prevention/suicide/resource_media.pdf

Machlin, A., Pirkis, J., & Spittal, M. J. (2013). Which Suicides Are Reported in the Media – and What Makes Them “Newsworthy”? Crisis, 34(5), 305–313. doi:10.1027/0227-5910/a000177

Mesoudi, A. (2009). The Cultural Dynamics of Copycat Suicide. PLoS ONE, 4(9), e7252. doi:10.1371/journal.pone.0007252

Samaritans. (2014). Media Guidelines for the Reporting of Suicide.  Retrieved from http://www.samaritans.org/media-centre/media-guidelines-reporting-suicide

 

  • May 13 / 2014
  • 0
PhD Experience

Hello from the IHAWKES!

We are are excited to be launching our brand new blog today, to coincide with the University of Glasgow’s Institute of Health and Wellbeing Student-Led Conference!

If you have been inspired hearing about the research being carried out by IHW’s postgraduate students today,  then we hope you will enjoy this blog where are our regular contributors will be writing about topics related to their PhD research as well as offering perspectives on health-related news stories.

We hope to stimulate conversations both within IHW and the wider public health community so please comment on the blog posts, tweet us (@ihawkes1) and share with interested colleagues.

First up, Olivia a PhD student in Mental Health and Wellbeing is blogging about media guidelines on the reporting of suicides.

Happy reading!

Anna and the rest of the IHAWKES team

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