MSc Global Health 2010-2011

Country: Ireland
Background: Nursing

Research Project: Assessment of the Advocacy Campaign of the Egyptian Government and NGOs to Eradicate FGC Practice in Egypt from 1994 to 2010

Objectives: The objective of this study is to assess the strategy and methodology used by the Egyptian government and NGOs in the period 1994 – 2010 to eradicate FGC through their advocacy campaigns.
Methods: The research approach and orientation depend on study and analysis of advocacy campaign documents and documentation pertaining to FGC in Egypt.  A survey was carried to assess the effect of the campaigns and to estimate any level of attitude or behaviour change in the community as a result of it. 
Results: The study concludes that the sum total of the anti-Female Genital Cutting advocacy campaign operations by the Egyptian Government and NGOs, has not managed to abolish FGC or decrease it significantly. The findings of the Egyptian Demographic Health Surveys, verified by the study’s independently conducted statistical research, confirm this conclusion.

Key Words: Female Genital Cutting, Eradication, Advocacy Campaign, Assessment, Egyptian Government/NGOs.
Dissertation Word Count: 14,983

Country: USA
Background: Biological Sciences

Research Project: Research Protocol for Exploring the Local Women’s Beliefs about the Piave Maternity Ward and Counselling Centre and Traditional Services in Nakuru, Kenya

In the Rift Valley Province in Kenya, it has been reported that over 66% of women give birth at home and over 30% of women use a traditional birth attendant at birth (Kenya DHS 2008). More specifically, in the Nakuru district, the hospitals and public health centres were insufficiently equipped in addition to only about 40% of births being attended by qualified health workers (Reach Out to Humanity 2006). Because of these facts and the high prevalence of HIV and AIDS in the area, in 2006 the Reach Out to Humanity for Health organisation decided that a maternity ward with an HIV and AIDS counselling centre and dispensary was a necessity in the community and needed to be built. An update of the status of the Piave Maternity Ward and Counselling Centre was given in 2010, three years after the opening of the facility but no formal research conducted on its progress and perceived underuse.

Therefore purpose of this investigation will be to evaluate the reasons for the underuse of the Piave Maternity Ward and Counselling Centre. In addition to evaluating the underuse of the facility by the surrounding community, the study will also investigate how the view of traditional medicine, more specifically traditional birth attendants, has been impacted.

This study aims to aid the Piave Maternity Ward and Counselling Centre to align their objectives and services more accurately with the surrounding community’s health priorities. 
The study will also investigate how traditional birth attendants’ “business” has been impacted as well as attempt to assess if combining their traditional medical culture with the Western biomedical culture would be possible to be able to reach out to as many people in the community as possible. If the combining of the two medical cultures is in fact possible and both sets of health workers could respectfully work together, the number of human resources for health in that community would increase substantially.

The study is qualitative in nature and will interview women who use the maternity ward and counselling centre, key informants including Ministry of Health staff, health care facility workers, community leaders and traditional birth attendants. NVivo9 will be used to draw themes from the interviews after translating and back translating the interviews. The results will be disseminated by compiling the data into a report for the health workers to analyse and use to help improve their facility.

Keywords: traditional birth attendants, biomedicine, maternal health

Word count: 10067

Country: Australia
Background: International Development and Food Policy

Research Project: Add Men and Stir: A Case Study Investigating Teenage Pregnancy and Male Inclusion in Teenage Pregnancy Prevention

Sierra Leone has an estimated population of 5.6 million, approximately one third of which live in urban areas and more than 50% are below age 19.  Teenage pregnancy has recently emerged as a societal issue.   Each year global statistics estimate that 16 million girls aged 15 to 19 give birth and an uncounted number of births are to girls even younger (WHO, 2008a). Approximately 95% of these births occur in low and middle income countries, where early marriage is common (WHO, 2008b).  There is sparse literature associated with the topic of male inclusion in teenage pregnancy prevention in Sub-Saharan Africa. This study aimed to explore the socio-cultural factors associated with male inclusion in teenage pregnancy prevention in Freetown, Sierra Leone.  The study was based on primary investigations and draws on a pilot project as a case study.  Qualitative methods included focus group discussions and semi-structured interviews with project participants and key stakeholders including teenage boys and girls, adult community members, health workers and project staff.   Findings highlight the importance of analysing the axes of power and culture in the GAD approach.  Findings indicate that patriarchal structures and gender norms can disempower women, men, boys and girls and inhibit better reproductive health.  Understanding these and the possible changes, provide valuable insights with which to inform programmes.  Therefore including males is important to support adolescent rights and improve adolescent sexual and reproductive health.  However, sexual and reproductive health information alone is insufficient to address the barriers to better reproductive health.  It is recommended that programmes seek to include gender transformative strategies, partnerships and advocacy efforts to improve address root causes and improve adolescent reproductive health.

Key words: Teenage Pregnancy, patriarchy, gender, masculinity, Sierra Leone

Word Count: 14,455

Country: USA
Background:  Bachelor of Science

Research Project: The Politics of Global Health in U.S. Foreign Policy: 2000 - 2010.  Rhetorical Framing of Global Health-Related Multilateral Agreements

Country: USA
Background:  Bachelor of Arts

Research Project: Attitudes, Knowledge, Behaviour and Beliefs regarding Second Hand Smoke and Cigarette Smoke among Cardiovascular Patients in Ireland

Principal Argument and Objectives: The tobacco epidemic and the cardiovascular disease epidemic are global issues annually affecting the lives of millions of people.  Targeting the tobacco epidemic and targeting the associated exposure to second hand smoke has been shown to produce positive results on attempts to eradicate the cardiovascular disease epidemic.  However, the increasing death rates due to both tobacco and second hand smoke indicate the paramount need to improve interventions aimed at reducing smoking rates and second hand smoke exposure.  Utilizing health related knowledge has emerged as an approach to successfully alter behavior.  The aim of this study was to assess knowledge about second hand smoke among a group of cardiovascular patients, and investigate the relationship between smoking-related behaviors and knowledge about second hand smoke.   

Methods:  Quantitative research utilizing hypothesis testing, referral sampling and questionnaire tools was conducted to explore levels of knowledge about and attitudes toward second hand smoke among cardiovascular patients at St. James’s Hospital.  Data on age, sex, and smoking status was collected to evaluate for factors influencing patients’ knowledge, and to identify a possible trend between smoking behavior and knowledge about second hand smoke.  A knowledge index scale was formed from responses to four questions on specific health effects associated with second hand smoke.  Analysis was conducted using the Statistical Package for the Social Sciences (SPSS 18.0).

Results: The research identified an overall low level of knowledge about the health effects associated with second hand smoke among cardiovascular patients.  Analysis of the results revealed the presence of a relationship between smoking status and knowledge about second hand smoke, and a relationship between smoking status and attitudes towards the health effects associated with second hand smoke and cigarette smoking.  Knowledge with respect to second hand smoke was lowest among current smokers who likewise identified less strong attitudes and weaker acceptance for statements on cigarette smoke and second hand smoke.

Conclusions:  Results suggest that current efforts aimed at informing patients of the health risks due to second hand smoke are inadequate.  At-risk patients, such as individuals with cardiovascular, need to be better informed of specific health consequences linked with their disease.  Increasing detailed knowledge regarding the effects of smoking and second hand smoke exposure could lead to stronger risk perceptions and thus, reductions in smoking rates.  Utilizing improved informational interventions to increase levels of knowledge and strengthen concomitant attitudes could aid in both the global tobacco epidemic and the global cardiovascular epidemic.

Key Words: Second Hand Smoke, Cigarette Smoke, Cardiovascular Disease, Knowledge

Word Count: 14,956

Country: USA
Background:  Biology

Research Project: Patient Physician Communication: A comparison of how patient socioeconomic status and physician empathy affect the interaction.

There is a need to address inequalities in healthcare relevant to socioeconomic status.  Understanding physician communication and empathy can play an important role in improving the quality of care and reducing inequalities in deprived areas.
This study used an exploratory quantitative analysis of video consultations in a primary care setting to assess the relationship between communication patterns, physician empathy and deprivation.  This research used a sample of secondary data that included eight GPs working in the West of Scotland that were selected for variance in deprivation scores of their practice and their patient-rated empathy scores, as defined by the Consultation and Relational Empathy (CARE) measure.  The two GPs with the highest CARE scores and the two GPs with the lowest CARE scores were selected from GPs that work with patients in areas of high deprivation.  The same selection process was used for the GPs working in affluent areas. The Roter Interaction Analysis System (RIAS) was utilized to code and identify differences is sociolinguistic patterns and compare verbal utterances with the CARE and Scottish Index of Multiple Deprivation (SIMD) scores.  Approximately ten consultations per GP were coded.  
Results showed that high CARE GPs (i.e. those physicians who indicate a high level of empathy)   demonstrated more utterances in categories associated with positive and socio-emotional talk.  Yet, interestingly enough, negative rapport building utterances were increased in the high CARE group.  Furthermore, the total number of patient utterances were increased in the high CARE group.  When assessing high and low deprivation, the results showed that doctors asked more medical questions and gave more medical advice to those in affluent areas, while they spent more time with procedural comments such as transitions, asking the patient to repeat himself/herself, or giving ‘other’ information in high deprivation areas.  Finally, when CARE scores were assessed as a factor of deprivation, the results showed an interesting correlation between dominance and the affluent/high CARE group.  Also, in high deprivation areas open-ended and closed-ended psychosocial questions asked by the physician were associated with low CARE scores.  On the contrary, in the affluent areas they were associated with high CARE scores. Similarly, GPs in affluent areas gave more information regarding psychosocial questions whereas there was no correlation in high deprivation areas, despite the increased number of patients presenting with psychosocial problems.  As expected, positive and emotional utterances correlated with higher CARE scores.  
It has been previously established by a multitude of studies that there are significant differences in physician communication in relation to patient socio-economic status.  However, the results from this study contribute to this field of research by revealing specific verbal utterances that correlate with patient-rated empathy scores.  It also takes a unique approach to the social exchange theory and perspective on physician dominance by recognizing the need for balance in the ratio of physician to patient utterances and on the choice of verbal utterances used to progress through the clinical encounter.  The results of this study indicate that when the patient and physician share common goals and communication behaviours, a balanced level of physician dominance is not only expected but considered empathic.  Recognizing and identifying specific areas of communication allows for strategic approaches in tackling and improving health inequalities in deprived areas. 

Word Count: 12,423
Key Words: Patient-physician communication, General Practice, RIAS, Empathy, Socioeconomic status

Country: Ireland
Background:  Microbiology

Research Project: Examining the experiences of carers and parents of children with disabilities in Moshi town, Tanzania; a qualitative study.

Objectives: Gain an insight into how having a disabled child has impacted upon participants lives; examine if participants have experienced any negative stigma or discrimination as a result of having a disabled child, investigate if participants experience carer burden and examine their positive experiences of caring for a child with a disability.

Method: The study is qualitative and exploratory in nature and followed a phenomenological method. Convenience sampling methods were used to recruit fourteen carers of children with disabilities in Moshi town, Tanzania. Qualitative interviews were undertaken with all participants. The interviews ranged in length from 25-50 minutes and were conducted through a translator. 
Findings: Data was inductively analysed manually by the researcher. A number of themes emerged which shed light on the experiences of carers; objective challenges in terms of financial and employment issues as well as the demands of care, along with subjective challenges in the form of stigma, isolation and pity. The child’s progress, respect and happiness were all seen as positive experiences by participants. Participants identified both material and financial needs. In order to deal with the challenges participants use a range of coping mechanisms these include their beliefs, support from different sources and various attitudes.
Conclusions: The findings of this research suggest that objective challenges are common and more significant than subjective challenges. Positive experiences are not as easily identified by the participants as the challenges, but having analysed the data it is felt that the carers do not see their job as entirely negative. This study concludes with recommendations for the setting up of peer support networks for parents so that they can deal better with the subjective burden. Emotional support through peer support networks could improve stress levels among carers. An extension of the hours of care provided by the day care centres run by BCC would enable better opportunities for carers to work and earn a living thus reducing their needs, the financial challenges they face and the objective burden.

Key Words: disability, caregiving, Tanzania, burden, coping strategies.

Word Count: 14,921