By Salam Zoha, Samara Bengall and Virginia Le (originally published on May 13, 2020)
Days after the WHO declared COVID-19 a pandemic, with coursework for our winter semester wrapping up, we decided to apply our passion for global health by joining a team working on a rapid qualitative study: Triage and COVID-19: global preparedness, socio-cultural considerations, and communication. The goals of this ongoing study, led by Dr. Elysée Nouvet, Assistant Professor in the School of Health Studies at the University of Western Ontario, are to inform discussion and approaches to the care and treatment of seriously ill patients who will not be prioritized for critical care during COVID-19. This work is being conducted under the COVID-19 Research Roadmap (social-science working group) convened by the WHO. Ultimately, the objective is to generate evidence to inform governments and healthcare organizations in their development and implementation of realistic, socially, and culturally sensitive COVID-19 triage and communication strategies.
This blog is written by three of us who are trainees (Virginia, Samara, and Salam) involved in different facets of the study. We would like to share our insights regarding the process of conducting a qualitative rapid research study in global health during a pandemic. This was a fast-moving project. With an objective of gathering and analyzing experiences and perspectives on triage and triage communication from healthcare workers on the front lines of the pandemic, it involved 53 interviews conducted through Zoom and over the phone with participants from each of the 6 WHO regions. It also included an online survey. The team included co-investigators from three academic institutions (Western University, McMaster University, and the University of Turin in Italy), as well as 10 trainees.
There are various reasons why we decided to volunteer for this project. Virginia is interested in investigating different cultural contexts and social inequities. This project has allowed her to explore the cultural considerations of triage in the context of a pandemic. She also remarks that this project has given her the opportunity to partake in qualitative research. Samara has an interest in global health, and experience in clinical settings abroad, Samara wanted to gain experience working on qualitative research about cultural differences in health care. She is interested in exploring the impact of COVID-19 on care that can be provided, as she believes that this is a new area for qualitative research. Salam has related experience by working on an international quantitative psychology study involving 18 countries. She wanted experience from a qualitative approach, as her interests are in mixed-method approaches.
The range of tasks that we took on could be broadly broken down into three positions: Coordinator, Interviewer, and Data Analyst. We each occupied these roles, but also did tasks distinct from our main position.
The Coordinators oversaw aspects of the project ranging from communication to data management. The Communications Coordinator was responsible for contacting news outlets to share the study, scheduling meetings, and taking meeting minutes. Virginia was the Data Management Coordinator who was responsible for organizing and sharing information between co-investigators, analysts, and interviewers. Virginia was accountable for knowledge translation and created various visuals for showcasing the growing participant demographics.
The Interviewers conducted interviews with the participants in either English or French. They also completed a series of summary notes at the end, where they wrote down points and quotes that were crucial. Samara was involved in this role as recruitment coordinator, but she also did data analysis, data collation, and assisted with managing the OneDrive Folder.
Some of the trainees were assigned responsibilities as Data Analysts. In this case, what this involved was listening to interviews and reviewing notes created by the interviewer to then fill out a data extraction table per interview. The table sought specific answers to questions in order for this study to proceed rapidly. The interview summary tables were a tool designed for this project, providing boxes identified with space for responses to interview guide questions. This approach was modelled on approaches to rapid ethnography used by teams from the Centre for Disease Control during the West Africa Ebola outbreak. Ideally, these allow for structured data extraction and organization of information for future data analysis. Some challenges noted by our fellow trainees were that it was difficult to remain in the sentence limitations, maintaining objectivity as personal interpretations often came in, and accents or speaking quickly made it hard to interpret words. Some found it hard to navigate interviews that deviated from the summary table, and others noted findings that did not fall into the table. Salam and Samara were involved in this, but Salam also helped develop summary tables, edit scripts, and recruited participants from her own research network.
Although we have only been involved with the project for two months, we have learned a great deal about COVID-19, cultural considerations in health care, and the rapid-response approach to research. We wanted to share some of our lessons learned as we believe they may be useful to students who are thinking of venturing into doing research in global health!
Lesson #1: Global health research can be winding
- Depending on the nature of the project, things will move quite differently. Research in global health is not a linear process due to external factors sometimes weighing more, such as time zones. Your collaborators or participants might not be available at ideal times, and therefore you must schedule appropriately. Sometimes unexpected setbacks occur and being flexible is necessary.
Lesson #2: The question of payment
- Being paid is not always a given, as there might be limitations due to funding availability. This is an important factor to consider if you are in a situation where money is important. If you would still like to get involved and this is a concern, you can always discuss with the primary investigator ways to contribute that are suitable to your situation. Paid or unpaid, your contribution will be important to the project.
Lesson #3: Working in a group…but apart
- You might be working in a large group, as global health research is often interdisciplinary. If you feel like you work better in smaller groups with one-on-one interactions, then this is something you should think about. However, you will not be alone, and depending on your team’s schedule, frequent meetings will be held where everyone can share their ideas.
Lesson #4: Know your work-style and boundaries
- The pace of the project can either be quick or slow, and this will influence the responsibilities given and deadlines. It is important that you take on what you feel is appropriate based on your comfort level, knowledge, and personal schedule.
Lesson #5: Sharing what you learned
- Even though it is not always possible to contribute to the degree that allows for co-authorship in a publication, there will always be other venues for sharing research! Since science communication is increasingly taking place on a variety of social media platforms (e.g., Twitter, Buzzfeed, and podcasts), it is important to utilize them to reach broader audiences. Also, this is an accessible method regarding sharing research as many educational institutions around the world do not have access to a variety of journal subscriptions. As the field of global health aims to promote equity through well-being, we should also consider that knowledge needs to be available in accessible forms. This project has been a great experience as it allowed us to develop skills as researchers who are interested in pursuing careers related to this field. Working with an interdisciplinary team introduced us to different views, and therefore broadened our knowledge of issues in global health and how to conduct research within this space. We are thankful to Dr. Nouvet and the co-investigators for this opportunity.
About the authors
Salam Zoha is currently pursuing her Master of Science with a thesis in Global Health at McMaster University. She focuses on refugee and immigrant mental health, specifically in the cross-cultural contexts of stress, coping, and resiliency from a mixed-method approach.
Samara Bengall is a Bachelor of Health Sciences student at Western University. She plans to continue studying global health with an interest in social inequalities while pursuing a career in medical sciences.
Virginia Le is currently a fourth-year student at Western University studying Health Sciences. She hopes to work in the field of global health as an international lawyer, with current areas of interest being cultural contexts, social inequities, and healthcare law.