an a-z of research disasters lucie cluver
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Puff adders, taxi lords and budgets from hell. . An A-Z of research disasters Lucie Cluver. Collaborative research: science to assist policy. Longitudinal panel survey of AIDS-orphanhood: 1025 children, 2005-2009. 4-year longitudinal survey 2005: N=1021 (aged 10-18) - PowerPoint PPT PresentationTRANSCRIPT
An A-Z of research disasters
Lucie Cluver
Puff adders, taxi lords and budgets from hell.
CollaborativeOVCY research
Universities: Oxford, UCT, Wits, Curtin,
UKZN
Collaborative research: science to assist policy
Longitudinal panel survey of AIDS-orphanhood: 1025 children, 2005-2009
4-year longitudinal survey• 2005: N=1021 (aged 10-18)• 2009: 71.5% follow-up• 3 provinces South Africa• Comparing AIDS-orphaned/other-
orphaned/non-orphaned children
Measures and analysis:• Standardised scales, national surveys
(census, DHS etc.)• Verbal autopsy method (sensitivity 83%,
specificity 75%)• multivariate logistic, log-linear and
mediation modelling• All controlling for socio-demographics
Qualitative link studies• Pilot and follow-up: n=290 children
National longitudinal study: 6850 children, 2500 adult caregivers, 2008-2012
Longitudinal national survey• Main study: N=6000 (age: 10-18) • 3 provinces South Africa; 6 sites >30% prevalence• Stratified random sampling of census EAs• Every household with a child aged 10-17• Urban/rural, 1 year follow-up in 2 provinces (n=3401, 97% follow-up)
Measures• Standardised scales, national surveys • Transactional sex, age-disparate sex, sex using substances, unprotected sex, multiple partners
Ethics• Approved by University of Cape Town, Oxford, KwaZulu-Natal, Province Health & Education Depts• Social & health service referralsControlling for prior HIV risk
• Adapt the best evidence-based programs for child abuse prevention to sub-Saharan Africa
• Work collaboratively with government, UNICEF, WHO, NGOs and communities
• To pre-test, improve, pre-test, improve and test in RCTs
• If they work, to provide freely within the developing world
Sinovuyo Teen – Parenting for Lifelong Health
Recruitment
Baseline data collection
Control wait-listIntervention group
Treatment as usual
1-year follow-up data collection
Immediate post-test data collection
Random allocation
Group intervention, ongoing peer
support
Control group: group intervention, ongoing peer
support
Timetables go to hellCan be almost any cause:• Riots, strikes, floods• Under-estimating how long things
take• Staff crises/exhaustion• Contracts/funding/running out of cash
Some helpful responses:• Accept that it will never be perfect• Always make Plan B (and have a secret Plan C)• Try to have some back-up cash (I need to follow own advice here)• Encourage/force team to tell you as soon as things start going wrong• Don’t blame them – problem-solve together• Apologise to them if you messed up.
Serious safety concernsCommon causes:• Urban: political violence, violent crime• Rural: snakes, escaped animals• All: road accidents
Things that might help:• Safety protocols: plan with team• Community and community leader liaison• Community crime leader liaison• Travelling in pairs• Staff safety has to be the priority in all decisions• Insurance and car licenses. Training for all drivers. • This is a complete nightmare and never gets better.
Can’t cope with what we are seeing (for staff and you)
Common causes:• Over-exposure to child abuse• Working too hard – exhaustion• Child disclosure of really horrific abuse• Inability to help sufficiently• Often leads to staff arguments and tension
Some ways of approaching this• Regular supervision• Treats, Enforced holidays• Staff need to know you’ve got their back• Action – referrals and helping kids (also part of
ethics)
Methodology goes haywire Common causes• Political interference• Local gatekeepers• Riots/floods/fires/war etc.
Some things that help• Make staff safety the priority,• Be realistic. • Not everything has to go into the publication…• Do the best you can in each circumstance• Call/write and ask for advice• Tell your funders (if there’s a good reason)
Some key issues• Kids completely uninterested in detailed IRB consent forms,
verbal description crucial• Field staff – perverse incentives against informed consent• No guardian/abusive guardian• When you have to break confidentiality
Ethics get really tricky
Some responses:• Engage with ethics committees• Have a social worker/psychologist to
supervise field staff• Don’t make payment/success
dependent just on recruitment numbers
• Can get alternative consent• Be strong for your team.
A: when existing systems can’t help with severe child Abuse cases
Common causes• Overburdened health/social services• Staff burnout• Remote, rural areas far from services
Some things that help• Mapping services before you start• Find good professionals• Have a social worker to supervise staff• Emergency protocols i.e. rape cases• Just do stuff if it’s needed – sort out the details later• Providing disclosure-handling skills to field staff
Longitudinal follow-upCan be really tricky• Children move homes• Areas get destroyed• Cellphones die• No administrative data
Some things that help• Get three names addresses and cell numbers
of people who would be able to find them• Send back the same interviewers• Certificates help people remember and find
kids again• This is like detective work – set money aside,
and be tenacious!
W: Getting the findings to the WorldNobody will know your findings if:• You don’t actively disseminate• You don’t market findings at the right level• People/organisations feel they are being attacked
Some helpful ideas:• Make a list of ‘who needs to know this’ at community,
provincial, national, international level• Engage with them early, ideally in planning stages of
the research – make them involved and make your research more useful
• Ask how they would like results: presentations/policy briefs/video
• Use the media: local radio, newspapers, your org’s press office
Z having that Zing impactGet your research out there:• Have a very simple, clear
message (in 1 sentence!)• Simplify results, don’t try to
look clever• Use graphs/pictures not
words• Publishing in peer-reviewed
journals can really help. Worth the hassle (eventually).
• Give credit to the NGOs/governments involved. 12-14 years 15-17 years
0
1
2
3
4
5
6
7
8 % Incidence of transactional sex (OR .49
CI .26-.93*)
No cash transfer
Child cash transfer
Healthy carer AIDS-orphaned AIDS-sick carer0
5
10
15
20
25
% children reporting abuse
Physical abuseEmotional abuseDomestic violenceSexual abuse
Cluver, L (2011). Nature, 474 27-29.
Parental AIDS predicts child abuse (OR1.8 CI 1.6-2.0)
Compound effects of abuse & parental AIDS on child risk of transactional sexual exploitation
Cluver, L, Orkin, M, Boyes et al, (2011). JAIDS
Healthy family AIDS-sick parent Abused & hungry AIDS-sick parent, abused, hungry
1%
7%
13%
57%
Moderated mediation model 59: (Hayes 2012), controlling for age, baseline HIV risk behavior
p<.001B-.82Severe
poverty
Physical/emotional
abuse
HIV-risk behavior incidence
Care & support
Economic support
p<.047B.151
p<.001B.15
p<.001B-.11
Mechanism 4: Care and support reduces HIV-risk behavior through abuse
The Nuffield Foundation
Funders: thank you.www.youngcarers.org.za
National Department of Social Development
The National Research Foundation
HEARD, University of KwaZulu-Natal
The John Fell Fund
The Claude Leon Foundation
The Economic & Social Research Council
Regional Interagency Task Team for Children Affected by AIDS – Eastern & Southern Africa
I’m not the only one going through this. There are many other kids in the same situation. I would like to say to them that they mustn’t give up. They must just accept it and at the end of the day believe that they
will succeed at something. They mustn’t give up.
TAG team member, 14 yrs. www.youngcarers.org.za