Partnering on a global scale

Something had been nagging Dr Lucie Byrne-Davis and Dr Jo Hart, health psychologists at the University of Manchester. Looking around them and then at the world news each day, there was a disconnect. 'We knew of so many willing volunteers, but how could we go about finding a global project to help make a difference?', they asked. Then came a chance conversation with a colleague who worked in a health partnership; collaborative projects between UK organisations and those in low- and middle-income countries that aim to strengthen health systems through supporting education and the training of healthcare professionals. Byrne-Davis and Hart eventually gained funding for a pilot project between Gulu Regional Referral Hospital in Uganda, and University Hospital of South Manchester. This concluded in January; we spoke to them about their work, and next steps.

Typically in health partnerships, UK professionals will educate, train or mentor counterparts in a given country, whilst learning themselves about teaching, tropical disease management and managing with low resources. This particular partnership had been active for seven years, but Byrne-Davis and Hart began to explore ways of understanding the impact of learning on healthcare professional behaviour in Uganda and ways of measuring the impact of volunteering on the UK workforce. 'We found the health partnerships and volunteers to be willing and able collaborators,' Byrne-Davis said. 'We learnt a great deal about working across countries and with a large multidisciplinary team.'

They scaled up the project with a year-long pilot. 'Our plan was simple, and complicated! We wanted to recruit volunteers with expertise in behaviour change and to place them in existing health partnerships with a remit to support the partnership, and to conduct small-scale research to address crucial questions about the science of behaviour change in these applied settings.' Education and training is a huge problem in global health, Byrne-Davis said, because there is such a widespread lack of healthcare workers. 'We realised that in order to understand when and in what circumstances training would change practice we needed to take an approach based on behavioural science, looking at health workers' practice through a behavioural lens rather than a competency lens,' she added.

The Tropical Health and Education Trust (THET) run a Health Partnership Scheme funded by the UK Department for International Development. Hart and Byrne-Davis, along with colleagues Professor Marie Johnston, Professor Chris Armitage, Dr Richard Elmsley and Professor Ged Byrne, approached THET with a plan to create a collaboration amongst the Health Psychology community in the UK. It would volunteer alongside existing health partnerships, using behavioural science to help them meet their partnership goals.  

Importantly, Hart said, the collaboration would swap and share evaluation, research and knowledge born of hands-on experiences about how to work in these contexts. This would, they hoped, provide fertile ground for research projects and further opportunities for knowledge translation, evaluation and volunteering. They named the collaboration 'The Change Exchange'.  

Hart said: 'The collaboration is an organic group: anyone who wants to be involved can be, and their support can be offered in a variety of ways from critiquing documents, attending meetings, translating between languages to going to work alongside educators in low- and middle-income countries. We have had support from Professor Karen Rodham of the BPS Division of Health Psychology, Dr Diane Dixon, Dr Vera Araujo-Soares and Dr Angela Rodrigues.'

During the year-long pilot project 11 volunteer senior health psychologists, including Hart and Byrne-Davis, collaborated with projects in Uganda, Mozambique and Sierra Leone carrying out a range of projects, including training staff in behaviour change, and research. At the Kitovu Health Care Complex, Uganda, and Royal College of Obstetrics & Gynaecology partnership, volunteers Amy Burton, Fiona Gillison and Nisha Sharma carried out observation and improvement of existing interventions, for example suggesting adopting a WhatsApp group as a social support tool for people putting their new skills into practice. At the Central Hospital, Beira, Mozambique, and Ipswich Hospital partnership, volunteers Eleanor Bull and Corina Mason developed a gamification approach to teaching and developed focus groups with staff around barriers and enablers of practice change. With the Ugandan Private Midwives Association and Royal College of Midwives, volunteers Wendy Maltinksy and Nimarta Dharni trained others about behaviour change and research.

Byrne-Davis said the projects had raised a few challenges, not least trying to organise volunteers working for projects dispersed across Africa. She added: 'We found that some of the methods used in health psychology might not be possible to use with healthcare professionals in these countries. For example, there is no tradition of using Likert scales and we have multiple anecdotes that these did not make sense to our healthcare professional colleagues.'  

Carrying out research and providing consultancy was a tricky balance to strike, she said: sourcing evidence to improve each project quickly could sometimes mean a compromise of using less robust data. Working and learning in lower-resource settings, she added, raises some ethical questions. 'Are we doing more harm than good? Are we prioritising our own development over the development of researchers from those countries? We continue to apply our ethical standards, to adhere to principals of sustainable development and to work in partnership.'  

But what of the future? Byrne-Davis said the project had given her a clearer view of the impact of her and her colleagues' work and a greater desire to engage in activities in which she can advise as well as study. 'We remain at the disposal of the global health community with open access e-learning on behaviour change being developed, open-access publications being written about our work and an open door for educators and health system managers who wish to discuss the psychological determinants of healthcare professional practice. We are always happy to talk to psychologists who are interested in global health and in volunteering – we might not have the answers but we might have some suggestions.'

To get in touch e-mail Dr Lucie Byrne-Davis on [email protected]