AMR / 2019.07.30

Constructive collaborations between the social and medical sciences: Examples from antimicrobial resistance

Echoing calls from Nesta and The Lancet to “burst the biomedical bubble,” Sonar-Global aims to promote more extensive collaboration between the social and the medical sciences. However desirable, interdisciplinary research projects are challenging. Just some of the problems that I encountered over the past decade include distinct and sometimes obscure disciplinary “languages” and jargon, implicit disciplinary hierarchies, disagreements about the relevance of a research problem, or different and sometimes incompatible approaches to doing research.

Such frictions are symptomatic of deeper-rooted disciplinary divides, like researchers’ attitudes towards ambiguity. Project management and communication tools like having a project mediator with experience in interdisciplinary work or a clear role allocation for every project member can offer short-term relief. But to address deeper-rooted divides rather than just the symptoms of interdisciplinary friction requires institutional solutions and increased socio-medical research capacity, for instance through research internships at the training and early career stage.

Dealing with problems in Socio-Medical research

Overcoming such problems is tricky but rewarding. To give you a glimpse of the opportunities resulting from a successful collaboration between the medical and social sciences, here are three examples from our recent work on antimicrobial resistance in Southeast Asia:

1. Constructive Inputs into Clinical Trials and Global Health Research

We recently integrated a social research study into a clinical trial of point-of-care biomarker tests to guide antibiotic prescriptions on the primary care level in Thailand and Myanmar. Qualitative research surrounding the clinical trial did not only help us to understand what fever and antibiotics meant for trial participants (and therefore how data from the trial’s case report forms should be interpreted). It also enabled a broader assessment of the intended and unintended outcomes of the biomarker test and how perceived infectious disease risks, the health system context, and healthcare demand influenced the operation of these trials across countries.

Collaboration between the social and the medical sciences

Point-of-care biomarker testing in Myanmar

 

 

 

 

 

 

 

 

 

 

 

2. Models and Evaluation Methods for Public Engagement

As part of a large-scale health behaviour survey, we organised public engagement workshops with 25 to 35 participants in five villages in Thailand and Laos. The workshops were designed to share information about drug resistance and to learn from the villagers themselves about their understanding and uses of medicine, rather than to change behaviours or “mobilise communities.” And yet, a comprehensive social research assessment demonstrated how a villager in Thailand gained so much confidence in the subject that she started selling antibiotics, while in Laos information about the workshops appeared to circulate mostly among more privileged segments of the villages. At the same time, insights from the villagers also enabled our team to formulate and test new hypotheses about people’s attitudes and uses of antibiotics.

Collaboration between the social and the medical sciences

Public engagement workshop participant in Thailand.

3. New Research Impulses

Social scientists, too, stand to gain from closer integration into public health research and practice. Although our initial task was to inform medical research activities, our research team uncovered new questions of relevance in global health and beyond. Do social networks reinforce entrenched behaviours? What are substitutes for antibiotic use if we look at the problem from a strategic marketing perspective? What can we learn from antibiotic use for a more general social theory of human behaviour? Through such reflections, our research team has now reached a point where we combine development studies and behavioural sciences approaches to ask whether precarious living conditions in low- and middle-income countries may contribute to drug resistance.

Collaboration between the social and the medical sciences

Antibiotics

 

If we can bridge the gaps successfully, then interdisciplinary collaboration between the medical and social sciences does not only offer constructive and unconventional routes for tackling global health challenges. It can also create new impulses for social theory within and beyond health.

 


Read more about our work:

Social context of point-of-care biomarker tests

  • Haenssgen, MJ, Charoenboon, N, Thuy, NDT, Althaus, T, Khine Zaw, Y et al. (2019). How context can impact clinical trials: a multi-country qualitative case study comparison of diagnostic biomarker test interventions. Trials, 20(111). doi: 10.1186/s13063-019-3215-9
  • Khine Zaw, Y, Charoenboon, N, Haenssgen, MJ & Lubell, Y (2018). A comparison of patients’ local conceptions of illness and medicines in the context of C-reactive protein biomarker testing in Chiang Rai and Yangon. American Journal of Tropical Medicine and Hygiene, 98(6), 1661-1760. doi: 10.4269/ajtmh.17-0906
  • Haenssgen, MJ, Charoenboon, N, Althaus, T, Greer, RC, Intralawan, D et al. (2018). The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in northern Thailand. Social Science & Medicine, 202, 1-12. doi: 10.1016/j.socscimed.2018.02.018

Public engagement

  • Charoenboon, N., Haenssgen, M. J., Warapikuptanun, P., Xayavong, T., & Khine Zaw, Y. (2019). Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages. Palgrave Communications, 5(23). doi: 10.1057/s41599-019-0226-9
  • Haenssgen, M. J., Xayavong, T., Charoenboon, N., Warapikuptanun, P., & Khine Zaw, Y. (2018). The consequences of AMR education and awareness raising: outputs, outcomes, and behavioural impacts of an antibiotic-related educational activity in Lao PDR. Antibiotics, 7(4), 95. doi: 10.3390/antibiotics7040095
  • Haenssgen, MJ, Charoenboon, N, Thavethanutthanawin, P & Wibunjak, K (2019). Tales of treatment: how local voices and public engagement activities can shape global health research and policy. Development Studies Association 2019 annual conference, 19-21 June 2019, Milton Keynes. Available at: https://nomadit.co.uk/conference/dsa2019/view/paper-download/paper/47649

Health behaviour survey protocol

  • Haenssgen, M. J., Charoenboon, N., Zanello, G., Mayxay, M., Reed-Tsochas, F., Jones, C. O. H., et al. (2018). Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation, and knowledge diffusion. BMJ Global Health, 3(e000621). doi: 10.1136/bmjgh-2017-000621
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About the Author



Marco J Haenssgen

Assistant Professor in Global Sustainable Development at the University of Warwick and an Associate Fellow at the Institute of Advanced Study

Marco J Haenssgen is a social scientist with a background in management and international development and experience in aid evaluation, intergovernmental policymaking, and management consulting. His research emphasizes marginalization and health behavior in the context of health policy implementation, technology diffusion, and antimicrobial resistance with a geographical focus on Southeast Asia.

Marco’s work

Follow @HaenssgenJ on Twitter.



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