Graduation Year

2017

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Anthropology

Major Professor

Nancy Romero Daza, Ph.D.

Co-Major Professor

David Himmelgreen, Ph.D.

Committee Member

Heide Castañeda, Ph.D., MPH

Committee Member

Kathleen MacQueen, Ph.D., MPH

Committee Member

David Turkon, Ph.D.

Keywords

Capacity, Dissemination, Participation, Qualitative, Development, Ethics

Abstract

In the field of HIV, more than 30 years into the epidemic, the need to ensure that what researchers learn makes its way into tangible actions in the real world is especially poignant. This dissertation addresses the critical divide between research production and its translation into practice. It advances ways to measure the investments of citizens and stakeholders in qualitative studies and offers new perspectives on the losses inadvertently caused by particular investments in health research and services. Unfortunately, many of the problems in how we practice and disseminate research are rampant throughout the health and development research sector. Therefore, while this anthropological dissertation focuses on HIV and Lesotho, several of the findings are applicable in other geographical and topical settings.

This dissertation explores how the practice of conducting qualitative research becomes a type of disease prevention intervention itself cutting across systems. Using a large qualitative HIV sexual, social, and behavioral health research project, as a case study, I illuminate how health research knowledge makes its way (or not) to the populations for whom it is intended. Following up four years later, using in-depth semi-structured and structured interviews, I probe practical and theoretical issues involving the original research assistants, a comparison group, and representatives from organizations targeted to be most likely to use the research findings. I pilot a communication diffusion measurement tool that visualizes the researchers’ ability to apply what they learned from the research experience in talking to their families, partners, acquaintances, work colleagues, and students/trainees. The results indicate significant differences between the original team and the comparison group’s communication diagrams, demonstrating the tool’s usefulness in visualizing who is talking to whom, with what magnitude, and the types of life moments that trigger opportunities to have quality conversations about HIV, sex, and Multiple Concurrent Partnerships (MCP).

As evidenced in this study, team members are part of the larger social system. They have the potential to influence the formal dissemination of HIV prevention information into policy and programming as well as the informal diffusion into their own life and in the lives of those they encounter in their social network. Nowhere in translation and dissemination research descriptions are the research team members discussed. Based on this research, I argue that, in addition to greater involvement of the public and stakeholders in translational research, there is a need to include the “implementers” of research beyond that of the principal investigators: the research staff. There is a need to further conceptualize the role of the “research team” in the translation of research to practice paradigm.

Data have been collected from grey documents, project reports, scientific papers, newspapers, and websites establishing current points of focus for well-funded global entities in context with our understanding of transmission and prevention dynamics and debates. Analysis of these sources reveal strong rhetoric for combined biomedical, social, behavioral and structural approaches but programming and funding reports reflect much more weight and financing to biomedical solutions. The findings from organizational representatives interviewed in this study reveal that the creation of research and diffusion of information will follow the funding. Similar to Lesotho, many researchers and health professionals in developing countries are hired into biomedical or clinical projects for employment. This project explores the HIV response as part of economic, social and health development in Lesotho supported by the aid industry, and presents data on how the investments of money influence the ways in which local leaders and everyday citizens define, communicate, and conceive solutions to the problem of HIV.

In the mid-term, translating biomedical findings into real world realities requires qualitative research. Ethically sound and well-trained qualitative researchers are fundamental in the creation and diffusion of knowledge. As the findings in this study indicate, the qualitative experience provides an opportunity to understand the epidemic that leads people to change their own behaviors, influence those around them, and have the desire to facilitate conversations to provoke social action and change. However, this study also demonstrates how people can go years talking, studying, and working in HIV without ever having an “awakening” or deeper understanding of HIV in their local reality. Study results delve into the long-term effects on the local researchers, furthering our understanding of the different ways in which “capacity” is built in the local involvement. The dissertation also explores critical questions about qualitative research methods and ethics within a context of investigating a disease where everyone—researchers and the researched—are either infected or affected.

Based on this research, I argue that true education about HIV is a dialogical perpetual process of interrogating what we know, imagining what should be done and trying: Praxis. This heightened awareness of how our daily research practices link to larger systems will help us not to allow our do-gooder attempts to blind us to the harm we may inadvertently do, or to the lost opportunities we squander. Instead, we must capture and maximize our investments in research and people as agents of change and not only as patients, participants, or employees.

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