Capacity building in self harm research in low and middle income countries
I recently talked about the SASHI programme of research at two very different events. What I took away was the keen interest of the national and international practitioners and researchers at those events in how we can make a difference in terms of suicide prevention and address challenges in low and middle-income countries (LMIC).
The first event was a seminar organised by the Manchester-based Global Health and Cultural Psychiatry Group for the World Suicide Prevention day (10thof September 2018). Professor Nusrat Hussain and Professor Athula Sumathipala also spoke at the event, one presenting on-going research in Pakistan (http://pill.org.pk/cmap/) and the other talking about self harm and suicide prevention in Sri Lanka.
Important issues we all highlighted related to the need to adapt research approaches and tools in order to collect meaningful data in an ethically responsible way. Also, the importance of supporting communities in setting their own research priorities and valuing local knowledge and skills when it comes to the research design and implementation.
For example, Professor Hussain highlighted the importance of culturally adapting tools and presented findings from the promising C-MAP project (Culturally adapted manually assisted problem solving training). The tool was initially developed in the UK, but has been translated and adapted by the multidisciplinary mental health research team to reflect Pakistani culture and include appropriate case scenarios and images[i]. The team not only considered the adaptation of the tool but also carefully considered the most appropriate way data should be collected – taking onto consideration the importance of family.
Professor Sumithapala in particular reflected in what makes research LMICs ethical. In this context, he raised general issues such as autonomy, informed consent, and beneficence amongst others, but also specific cultural, religious and social issues that need to be considered when conducting research. In particular, he emphasized that ethical challenges may be harder for LMICs to address due to existing disparities in infrastructure and knowledge. There is a need for more transparent discussion about what governance processes should be used.
The second event was a presentation at the 7thQualitative Research on Mental Health (http://www.qrmh7.com/) conference in Berlin. I reported findings from a small study piloting the use of a narrative interview schedule with health professionals. This moved very quickly into questions and debate about how we can address issues and questions such as:
- power differences between high and low middle income countries
- how to encourage and support participative research (if we can even agree on what this means);
- the suitability of the dominant Western bio-medical model in different cultures and for different groups of people;
- cultural differences
- historical legacies such as colonialism and partition.
This was a great and thought-provoking event providing the opportunity to talk and learn from others.
Ajoy Datta argues that a shift is needed from undertaking research ondevelopment to undertaking research fordevelopment. He suggests that “The latter requires a shift amongst academics from being passive observers to taking on an active role in contexts where networks of actors with varying levels of power and capacity are competing and collaborating with one another to bring about change for specific groups of people.”[ii]
These are all issues that SASHI grapples with and that we aim to address in a variety of ways. Capacity-building is an on-going process and there will be things we don’t get right the first, and maybe not even the second time. What is encouraging is the interest and support from others in the national and international practice and research community and the willingness to share and learn from each other.
Anne Krayer is a Research Fellow in the School of Healthcare Sciences at Bangor University. She is a co-investigator of the Global Challenges Research Fund South Asia Self Harm Initiative (SASHI).
You can follow @a_krayer (group account @SASHI_Research ) on Twitter
[i]The full article is available here: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/3D760EF1084B7536CCAD139DF8BFC3E1/S0007125000276654a.pdf/brief_psychological_intervention_after_selfharm_randomised_controlled_trial_from_pakistan.pdf
Publication date: 23 October 2018