Ending with evidence-based decision making

Posted on by nayavill

One of the biggest takeaways from my first year as an MPH student was the importance of using evidence to inform the design and implementation of public health interventions – but what happens when there just isn’t enough evidence to make a concrete decision? This was a major practicum challenge that I didn’t anticipate. After sorting and screening and rereading titles and abstracts for hours upon hours, our article search process that started with nearly 700 publications narrowed down to only 11 – and among these, the majority only included child feces disposal practices nested as one small part of larger sanitation interventions. My research focused on the Asia-Pacific region, which has among the highest rates of open defecation globally, so I was surprised to find so few interventions targeting this behavior. Though perhaps this is due to the widespread perception that child feces aren’t as harmful as adults’.

Even large-scale sanitation interventions, like India’s Total Sanitation Campaign, have been notoriously unsuccessful at improving child health outcomes. Programs like these have focused mainly on providing hardware or subsidies for individual households to construct their own sanitation hardware (think toilets, pour-flush latrines, bathrooms) without actually working toward behavior change. Behavior-Centered Design is a new approach to solving environmental health problems and has been a major area of World Vision’s research, which is super exciting to be a part of! So maybe I didn’t find all the statistically significant effect sizes, confidence intervals or p-values that I was initially looking for to prove that yes, giving people toilets = safe child feces disposal = improved public health. But I did come across some rich qualitative data on what real communities perceive as their barriers to improved sanitation, why they engage in certain behaviors, and what they would prefer from a public health intervention. Using these determinants is the next step in designing an intervention that communities actually want.

It seems like I just blinked and the summer is gone and my practicum experience is wrapping up. Looking back to May, I now feel so much more prepared to work on real-world public health problems instead of just practicing in a classroom (but I am looking forward to being back in the classroom this fall semester to see everyone in person!). Even though I felt like my work wasn’t going as I originally planned, I learned even more than I thought I would.

–Lauren

Communication, communication, communication

Posted on by nayavill

My practicum with NARAL Pro-Choice North Carolina was to take place over 10 weeks, the last of which began on August 2nd. I expected to enjoy my time with NARAL NC, but my practicum has surpassed my anticipations dramatically.

I believe my good experience centers around the way the staff treats me. They speak to me as an equal, not just as a student who needs supervision. While my preceptor helped me identify a few deliverables that I could work on at the beginning of my practicum, she was flexible and supportive when our goals shifted throughout the summer, allowing me to amend my deliverables as needed.

My last deliverable has been my favorite by far. In short, I have been working on a report on a specific public health problem that is meant to be consumed by the public. I started this project by receiving an abundance of raw data that needed to be analyzed, which allowed me to practice my STATA skills. I was able to take some of that raw data and turn it into an ArcGIS map, which I believe will be a valuable addition to the report. Lastly, I’ve been able to practice my graphic design skills by designing the layout and format of the report as I go.

However, my favorite part of this project has been the writing aspect. The MPH program typically requires us to write papers and such in scientific or academic voices, which certainly aligns with the audience they’re meant for. The NARAL NC report, on the other hand, is being created for a non-scientific audience, which has been an amazing challenge for me and my writing skills. I have enjoyed this type of writing more than I expected to. The unique combination of abilities it requires has exercised so many different tools from my toolbox, from data translation and choosing relevant statistics to creative writing and narrative formatting.

This report has really driven home the idea that our job as public health professionals is not just to partake in research and the scientific process, but to make sure our findings are accessible to the world. COVID has been a great example of this, especially now with the concerning Delta variant. The research is somewhat unclear, and while that is to be expected this early in the process, I do not feel that it has been communicated to the world in an organized manner. This, plus government mandates and the loss of progress on “opening back up” adds to confusion and alarm. I’m sure we would agree that the United States could have done many things differently throughout this pandemic, but communication would be towards the top of the list in my opinion.

While my practicum is wrapping up and COVID is picking back up, I will always remember the lessons learned at NARAL Pro-Choice NC.

Stay safe,

Abby

Long days, short (summer) weeks…. Wrapping up a remote global health practicum

Posted on by nayavill

It’s hard to believe that my practicum experience is almost over and that the summer’s almost gone! I keep asking myself where all the time went. For my practicum experience, I have been working with UNC Gillings Zambia on the ARCH study. The goal of the ARCH study is to optimize birth outcomes in low-resources settings, by using household surveillance to gain a better understanding of the social and clinical factors that may affect pregnancy outcomes in women of reproductive age. I think that one of the best parts of the study is that it allows the study team to follow women of reproductive age, from preconception to at least one year after the end of their pregnancy, in the event that they become pregnant during the course of the study. In addition, the study also follows children under the age of 2, to gain a better understanding about factors that impact the health of young children. Thus far, I have learned quite a bit from the study, mostly related to the implementation of such a large-scale study.

One of the most important lessons that I have learned so far has been the importance of flexibility and being willing to adapt to a new situation. At the beginning of my practicum, my preceptor and I thought that it would be most helpful if I worked on developing standard operating procedures (SOPs) for various aspects of the study. As time progressed, it became clear that there were other aspects of study implementation that would be a better fit. As such, we have pivoted from working on SOPs to developing recruitment and training materials. It has been an interesting learning experience, thinking about how best to simplify the language from protocols, written for technical experts, to informationals that can be understood by study participants. I’ve also learned a lot about the seemingly small aspects of study implementation that I had only briefly thought about. As I’ve been charged with drafting some of the training materials and schedules, I find myself thinking about the most pertinent parts of the study protocols and how to engage study staff when they might have days’ worth of training in their future. All in all, it’s been a truly educational experience.

It might not come as a surprise that one of the most challenging aspects of the practicum experience has been my inability to meet most of the people that I’m working with in person. I have tried to keep in touch via email. My preceptor has also been wonderful, as we decided to meet on a weekly basis, just to touch bases. I think that the weekly meetings have been helpful and have provided more opportunity for direct feedback. At this point, we have talked about extending my practicum, but I still don’t think that I will be able to see the actual start of the ARCH study. That said, I plan to follow the study closely and look forward to learning more about the results of the survey.

Lastly, I’m looking forward to enjoying the last weeks of summer, prior to the beginning of the semester. I’m very excited about starting the second year and can’t wait to meet in person!

– ‘Desola