Abstract
The uptake of health and nutrition interventions depends upon the way they are perceived by the local community, and their resultant social acceptability, which is influenced by local culture and shared values. Cultural understanding is essential to adapt interventions to suit local contexts, improve their coverage and ensure ethical Global Health Research. Despite this, there is a persistent gap between the acknowledged need to include culture in Global Health Research and practice of including cultural elements. This work focusses on three main aspects of intervention research: improving cultural understanding through the articulation of local shared values, navigating specific cultural “barriers” to an intervention, and improving social acceptability.This work concerns child stunting and was carried out at two sites of the UKRI GCRF Action Against Stunting Hub (Kaffrine, Senegal and East Lombok, Indonesia), where multi-national inter-disciplinary researchers are working to understand and reduce child stunting, including developing interventions.
This study demonstrates the use of a shared-values approach, the WeValue InSitu plus PEX (WVIS_plus_PEX). It is used here for identifying relevant broad grounded cultural themes in the target population, by engaging stakeholder groups in a meaning-making process that ‘crystallises’ their shared values. That method is immediately followed with specialised focus group discussions (termed Perspectives EXploration (PEX)) on local life practices relevant to child stunting, which are inherently framed by those tacit shared values. Participants included fathers, mothers, teachers, market traders, administrators, farmers and community health workers (CHWs), totalling 83 participants in 20 groups.
Cultural themes (such as the importance of living life in Islam, and the importance of education for their children) in each locality were translated into grounded recommendations to guide engagement within the communities. The PEX discussion data revealed specific factors such as particular traditional social hierarchies which could be accommodated for with new intervention elements. The potential impact of knowing about such cultural factors for improving social acceptability was demonstrated through a ranking exercise of the acceptability of three different proposed stunting interventions.
By starting from shared values, it was possible to create both general and specific cultural recommendations that could be used to localise interventions to be implemented in East Lombok, Indonesia and Kaffrine, Senegal with an expected improvement to social acceptability. This work contributes to the inclusion of culture in Global Health Research by providing a new approach to effectively elicit important aspects of local culture for easy communication to external researchers, as well as to systematically link cultural themes to health factors; and more generally to formative research literature.
| Date of Award | Aug 2023 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Marie Harder (Supervisor), Nick Marshall (Supervisor) & SubbaRao Gavaravarapu (Supervisor) |