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Global Health Informatics: Novel Approaches & Applications: Tim Cunningham


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Ngudo Nga Zwinepe (Learning through Photos): A modified photovoice methodology assessing community water and health perceptions in
Limpopo Province, South Africa

Tim Cunningham, University of Virginia

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Global Health Informatics: Novel Approaches & Applications: Tim Cunningham

  1. 1. Tim Cunningham, BA, MSN Candidate Rebeccca Dillingham, MD, MPH Nisha Botchwey, PhD
  2. 2. Water Scarcity in Limpopo Province <ul><li>According to the National Water Resource Agency in South Africa, the water management area that includes the province is 36 million m 3 of water in deficit as of 2000. </li></ul>
  3. 3. Water Collection and Quality in Limpopo Province <ul><li>Quantitative testing for fecal coliforms and diarrheagenic pathogens reveals unacceptable levels in surface water, stored water, and in prepared weaning foods . Similar pathogens found in patients with diarrhea both in the community and in the hospital. </li></ul><ul><ul><ul><ul><ul><li>Obi et al. Water Sci Tech 2003 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Potgieter et al. J Health Pop Nut 2005 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Samie et al. JASTMH.2006 </li></ul></ul></ul></ul></ul>
  4. 4. The Challenge <ul><li>To engage students, faculty, and other partners at UVa and UNIVEN to create innovative solutions to ensure access to water and sanitation & to improve water-related health outcomes in Limpopo Province. </li></ul>
  5. 5. UVA Center for Global Health Microbiology Nursing Hydrology Planning UVa student projects Univen J-term participants Univen research fellows UVa faculty mentors and researchers Univen Institute for Global Health Community clinics and hospitals Engineering Nursing Medicine Environmental Science Sustainable Infrastructure Systems Environmental Planning UVa summer study abroad BI-DIRECTIONAL EXCHANGE Local non-governmental organizations Engineering Students without Borders SAVANA
  6. 6. “ Learning through Photos” A Photovoice Assessment of Water Perceptions Limpopo, South Africa
  7. 7. Community Statistics <ul><li>Population: 1855 </li></ul><ul><li>Households: 265 </li></ul><ul><li>Households w/o sanitation: 189 </li></ul><ul><li>Governance: Chiefdom/Consensus </li></ul><ul><li>Oral traditions: Few written records </li></ul><ul><li>High Unemployment: Reliance on Municipality support </li></ul>
  8. 8. Targeted Populations <ul><li>Members of Selected Community </li></ul><ul><li>Members of the Vhembe Region of Limpopo South Africa </li></ul><ul><li>Model for a Qualitative Approach in Other International Settings </li></ul>
  9. 9. Methods: Photovoice
  10. 10. Background <ul><li>“ Photovoice blends a grassroots approach to photography and social action. It provides cameras not to health specialists, policy makers, or professionals, but to people with least access to those who make decisions affecting their lives.” </li></ul><ul><li>Caroline Wang (2005). Retrieved June 15, 2008. </li></ul><ul><li>Developed in 1992 by Caroline Wang, working with Dr. Mary Ann Burris at UC Berkeley. </li></ul><ul><li>Implemented throughout the USA and in China with various populations. </li></ul><ul><li>Focused on a topic, but open for individual interpretation of the topic at hand  Empowerment. </li></ul>
  11. 11. Methods: Grounded Theory <ul><li>Developed by Glasser and Straus, 1967. Awareness of Dying. </li></ul><ul><li>Deductive Qualitative Method </li></ul><ul><li>Codify, Conceptualize, Categorize, Theorize </li></ul><ul><li>Borgatti, 2008. </li></ul><ul><li>Use of Grounded Theory in data assessment </li></ul><ul><ul><li>Individual and Group Interviews to Codify </li></ul></ul><ul><ul><li>Incorporation of Photos to Conceptualize and Categorize </li></ul></ul><ul><ul><li>Final Report will Suggest Theory of Water Perceptions in Community </li></ul></ul>
  12. 12. Process: <ul><li>Project Length: </li></ul><ul><ul><li>21 Days on-site </li></ul></ul>
  13. 13. Process: Buy - In <ul><li>IRB Approval </li></ul><ul><li>Community Meetings </li></ul><ul><li>“ No Promises” </li></ul><ul><li>Privacy, Confidentiality </li></ul>
  14. 14. Process: Photo Training
  15. 15. Process: Shooting Photos
  16. 16. Process: Individual Interviews <ul><li>Individual Interviews </li></ul><ul><li>Voice Recordings </li></ul><ul><li>Transcription </li></ul><ul><li>Validation </li></ul><ul><li>Grounded Theory Analysis </li></ul>
  17. 17. Process: Group Interviews/Debrief
  18. 18. Process: Group Presentation <ul><li>Empowerment </li></ul><ul><li>Voice </li></ul><ul><li>Photo Gallery </li></ul>
  19. 19. Results
  20. 20. Results: Quantitative <ul><li>Participants: 13 </li></ul><ul><li>Photos Taken: 317 </li></ul><ul><li>Avg. amount of photos taken per person: 24 </li></ul><ul><li>Selected photos: 22 </li></ul><ul><li>Enlarged photos: 13 </li></ul><ul><li>Number of initial interviews: 13 </li></ul><ul><li>Avg. length of initial interviews: 18 minutes 4 second </li></ul><ul><li>Number present at group presentation/debrief: 10 </li></ul><ul><li>Avg. length of group photo/storytelling: 3 minutes 21 seconds </li></ul><ul><li>Length of project in country: 19 days </li></ul><ul><li>Length of project in village: 14 days </li></ul><ul><li>Age Range: 51 years (26-77) </li></ul><ul><li>Median Age: 38 </li></ul><ul><li>Average Age: 43.5 </li></ul><ul><li>Gender: 7 M, 6 F </li></ul>
  21. 21. Results: Qualitative (Coded Groups) <ul><li>Infrastructure/Storage 80% </li></ul><ul><li>Community 61% </li></ul><ul><li>Money 53% </li></ul><ul><li>Food 40% </li></ul><ul><li>Health/Hygiene 38% </li></ul><ul><li>Pain 23% </li></ul>
  22. 22. Infrastructure/Storage
  23. 24. Community
  24. 25. Money and Nourishment
  25. 26. Health/Hygiene
  26. 27. Pain <ul><li>Other themes: </li></ul><ul><ul><li>Naming </li></ul></ul><ul><ul><li>Gender differences </li></ul></ul><ul><ul><li>Deferral to Elders </li></ul></ul><ul><ul><li>Pride </li></ul></ul><ul><ul><li>Public Speaking </li></ul></ul>
  27. 28. Barriers/Biases <ul><li>Interpretation </li></ul><ul><li>Time </li></ul><ul><li>Cameras without Flashes </li></ul><ul><li>Volunteer Selection </li></ul><ul><li>Age </li></ul>
  28. 29. Discussion <ul><li>Certificates given to Particpants </li></ul><ul><li>WHIL project Next Steps </li></ul><ul><li>Value of Photovoice in a Quantitative Context </li></ul><ul><li>Value of Qualitative before Quantitative </li></ul>
  29. 30. Sustainability
  30. 31. <ul><li>“ Such approaches to managing the water supply must be evidence-based, sustainable, affordable, equitable, and acceptable to the local community.” </li></ul><ul><li>Barry, M & Hughes, J.M. (2008). Talking dirty – the politics of clean water and </li></ul><ul><li>sanitation. New England Journal of Medicine. 359:8, 784. </li></ul>
  31. 32. <ul><li>“ Cross-disciplinary efforts…are promising ways to recast the conventional disciplinary lines so that the expertise of the university can be harnessed on complex interdisciplinary challenges.” </li></ul><ul><li>-Jeffrey Sachs, Common Wealth </li></ul><ul><li>“… we need to encourage a certain attitude among our young scientists: that while some of them stay with their own specialty or discipline, some others among them should work in an integrated way across disciplines. Their voice would be the one most likely to be heard, with the least confusion, to the policy makers in government.” </li></ul><ul><li>-Nobel laureate, Norman Borlaug </li></ul>
  32. 33. Ro Livhuwa, Thank You Special Thanks to: Rebecca Dillingham, MD, MPH Nisha Botchwey, PhD Vhonani Netshandama, RN, PhD Doris Greiner, PhD, RN The UVA Center For Global Health The UVA Schools of Nursing, Medicine, Architecture and Engineering