Social science Flashcards
How is medical anthropology associated to global mental health?
- It is associated with the emergence of GMH
- It is the subject of the critics of GMH
What does medical anthropology examine?
The social and cultural construction of health and illness
- consider how perceptions of the body and self shape the experience of illness
- used to investigate eastern medical practices
- now investigates western medical practices
Who was Evans-Pritchard?
20th century anthropologist
What is the book of Evans-Pritchard ‘Witchcraft oracles, and Magic among the Azande’ (1937)?
> First modernist work of anthropology - influential
> Empiricist tradition
> In-depth ethnographic exploration of witchcraft in the explanation of illness and misfortune
- Azande witchcraft “is not an objective reality” vs. scientific understandings
How did Evans-Pritchard’s empiricism reflect on clinical encounters around the world?
> Doctors saw empirical evidence as needed for the patients’ complaints to be considered meaningful
> Doctor-patient differences in models and understandings of illness and treatments can be problematic
- inhibiting resolution of health
What did the psychiatrist Roland Littlewood (1999) in the context of anthropology and psychiatry?
He recognised clinical training of psychiatrists was missing information on culture and experience
- vital to understanding the patient’s problems
What did the work of Roland Littlewood (1999) reflect?
A move from pure biological approach to one grounded in history, culture and interpretation
What did the new approach to medical anthropology consist of?
Interactions between philosophy, anthropology and social science
-> more cautious, self-reflective and critical approach
-> anthropology to understand how cultures formulate reality in different distinctive ways
What did the new approach to medical anthropology at the end of the 20th century acknowledge?
- Undermined claims that biomedicine is an arbiter between knowledge and belief
- Ethnographers are no longer seen as impartial
- Culture is no longer understood as mentalistic, voluntary and individualist
- Individualism does not match this new understanding
What is the role of culture in global mental health?
Role of culture in shaping experience must be taken into account in the design and implementation of research and services
Which two approaches polarised cross-cultural psychiatry?
- Emic approach
- Etic approach
What does the Emic approach consist of?
Evaluates phenomena from within the culture to understand its significance in local context
-> more difficult to compare across different cultural settings
What does the Etic approach consist of?
Presumes psychiatric categories, instruments and models designed in the west are universally acceptable
-> experiences outside of narrow categories may be excluded
What does the integrated approach of global mental health consist of?
Places value on both
- local beliefs about illness and its categorisation
- AND the western biomedical model
Who were the pioneers of the integrated approach of global mental health?
What did they develop?
Vikram Patel and Arthur Kleinman
- > Exploratory model approach
- to assess illness experience
What is the common ground most global mental health researchers set themselves in?
Between the Universalist approach and the Relativist approach
- many mental disorders have core symptoms which are shared across cultures (expression varies)
- cultural variation is an important force
- > ethnographic methods are essential to understanding the experience of mental illness
- crucial for meeting global aims
How is universality reflected in depression?
Shared core symptoms
-> depression must be universal
How is cultural specificity reflected in depression?
- Different rates are observed in different cultures
- Personal and social implications of depression vary across cultures
- Recognition by clinicians vary across the world
- > Expressions of distress are culture-bound syndromes
What does the hierarchy of evidence imply?
- Science is cumulative, builds on evidence
- Only considers quantitative evidence
- Important questions (how, why) can only be addressed by qualitative methods
What does epidemiology emerge from?
Positivism:
- objective reality that we can reduce to a set of empirical indicators
- uncover a single truth
- investigator and investigated are separate
What does anthropology emerge from?
Constructivism:
- reality = social construct
- multiple realities that change
- qualitative: relationship research-subject will shape the findings and explicitly explore the phenomenon
- > focus on social processes and meanings
What is the benefit of multi-disciplinary research?
Can help to provide a full picture of health and illness?
Why is it important to select the right research question?
What your inquiring determines the methodology
What is the benefit of mixed research methods and triangulating quantitative and qualitative?
- They allow multiple perspectives
- Can support findings or call them into question
What is the role of qualitative methods in research?
They are essential to understanding the burden and incidence of disease
What are the benefits of qualitative methods in research?
- Useful to provide exploratory information on an unexplored area
- Useful in explaining mechanisms for quantitative findings
- > understand how interventions are experienced and why it worked or didn’t work
What are the four ways mixed methods are implemented?
- Parallel qualitative and quantitative collection of data
- Quantitative data collected at specific times, and continuous qualitative assessment
- Qualitative followed by quantitative
- to address questions identified in the qualitative work - Quantitative survey may suggest qualitative field study
- and lead to quantitative experiment
What type of questions are suitable for qualitative research?
- How
- Why (mechanisms)
What are the two most used qualitative methodologies?
- Focus groups
- In-depth interviews
What are the two currently underused qualitative methodologies?
- Ethnography
- Participant observation
What do in-depth interviews consist of?
> Naturalistic conversation between research and participant
> Topic guide
- prompts to direct the flow towards topics of interest
- interviewer should make notes on key events in person’s life
When are in-depth interviews used?
- Often to examine the perspectives of different parties involved
(e. g. patients, carers, service providers) - To examine procedures and experiences before and after an intervention
What do focus group discussions consist of?
Provide insights into social processes and environments
When are focus group discussions used?
- To examine the validity of new measures
- Often to examine the acceptability of new services, developments or treatments
What characterises the samples in qualitative research?
> They are smaller than samples need for quantitative
> Diversity of experience is needed
- > recruitment from different groups
(e. g. gender balance)
What are the interviewer skills in qualitative research?
- Researcher’s role is to encourage the participant to talk freely
- Researcher characteristics are particularly important
- > co-production between participant and researcher
What are the four criteria to ascertain quality in qualitative research?
- Credibility
- Transferability
- Dependability
- Confirmability
What is the 10/66 study?
An international collaboration between scientists in Latin America, China, UK and Nigeria
What is the aim of the 10/66 study?
To examine the changing health of older people in LMICs
What did the INDEP study consist of?
> Mixed methods study
> 10/66 study
> What are the social and economic effects of care for older people with chronic health problems?
> How is care allocated and delivered?
> Mexico, Peru, China and Nigeria
> Case studies based on naturalistic interviews
How did the INDEP study assess a multidimensional view on the process of allocation and delivery of care?
The older person and everyone in each household who played a role as caregiver to the older person were interviewed
How did the INDEP study carry out interviews in a narrative style?
- Naturalistic interviews
- Encouraging participants to tell a story about the health and care needs of the older person, and how these were experienced over time
What were the investigated relationships in the INDEP study?
> Care dependence of older adults - Economic circumstances of the household
> Care needs - Household impoverishment
What were the questions the INDEP study sought to answer?
- What promotes resilience?
- Does the policy environment contribute to this resilience?
- What influences the organisation and provision of caregiving?
Which quantitative method was used in the INDEP study?
Cross-sectional survey
- Household with older people with care needs
vs. - Households with healthy older people
How is qualitative data analysed?
Transcript -> categorisation of data into patterns
- Draw out multiple perspectives from qualitative data (particularly in cross-sectional studies)
- Process should be iterative (repeated for improvement) and should involve several people
- Accurately capture complexity
- Be aware of your own biases and perspectives
What does a framework analysis consist of?
Qualitative analysis begins with a framework and transcript is coded accordingly
-> allows researcher to look at links with overall aim to reveal the social reality of participants
When is a framework analysis useful?
When you have clear a priori questions and topics to investigate
When is a framework analysis not useful?
When using a pure anthropological approach
e.g. using grounded theory
What was the aim of the qualitative and quantitative research in Butajira (Ethiopia) research (Hanlon et al., 2016)?
Qualitative methods to facilitate the development of a quantitative questionnaire
What is the aim of mixed methods approaches in global mental health research?
Capturing burdens or outcomes in a culturally-appropriate way
How are mixed methods approaches operated in global mental health research?
> Approaches as close as possible to lived reality of participants
> Need to summarise experiences for planning and developing services
> Qualitative methods used to understand local concepts and constructs
> Quantitative methods then used to validate the new measure
What is the importance of measuring satisfaction and develop new culturally-appropriate measures in LMICs (e.g. Ethiopia - Mayston et al., 2017)?
> Satisfaction is an important part of outcome and quality in high income countries
> Underexplored in low income settings
> Measuring satisfaction with new models of primary care delivered services is an important part of successful scale-up
-> need to develop new culturally-appropriate measures
What does the TaSCs trial consist of?
Task-Sharing for the Care of severe mental disorders in a low-income country
- comparing outcomes of people receiving treatment from psychiatric nurses in hospital
vs. people receiving community-based care from non-specialists - non-inferiority trial
What is a non-inferiority trial?
Checking that the outcomes for the intervention group are no worse than those for the treatment-as-usual group
How was the satisfaction of service users researched in the Ethiopia study (Mayston et al., 2017)?
> In-depth interviews
> Focus group discussions
> Topic guide for the discussions
> Participants presented with items from the Verona Service Satisfaction Scale (VSSS)
- asked to comment on the relevance of those items within the scale to their experience
How were qualitative and quantitative methods used to improve an instrument in the study in Ethiopia (Mayston et al., 2017)?
- Qualitative findings + Quantitative instrument
- Hypothesis (satisfaction is associated with adherence and therapeutic alliance)
- Sample of 200 service users
- > measure generally had good psychometric properties - Expert panel for comments and revisions
- Sample of 150 service users
- > Unidimensionality of the measure was improved
What were the four contributors to satisfaction found in the study on mental health service satisfaction in Ethiopia (Mayston et al., 2017)?
- Medication and benefits of treatment
- Quality and content of communication
- Healthcare worker characteristics
- Clinical environment
- findings comparable and consistent with conceptualisations of mental health service satisfaction in European and American settings
What do the mixed-methods studies in global health research tell us?
- Localisation of measures is important
- to rule out cultural differences and conceptualisations - Underlying conceptualisations may be similar, BUT language and idioms used must fit local approaches
- It’s important to involve service users in research and service development
- > Researchers should work to improve that
