Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

There is long tradition of social sciences in medicine, and the communication with the medical sciences is now improving. Social researchers can help, for instance, better design clinical trials to include social factors, contextualise interventions and put the results at a population level perspective.

My name is Marco Haenssgen, I am a social scientist working at the Centre for Tropical Medicine and Global Health in Oxford, but my position is also shared with the Saïd Business School in Oxford.

When it comes to antibiotic use and the behaviour of people in rural Thailand and Laos, I think the biggest challenge is that we don’t understand it well enough. We have a vague notion of what we should do to improve behaviour using communication, education, but there are so many other factors, structural factors like poverty, histories that people have, cultural histories that drives their behaviour in a particular way. What do people do when they are sick? What meaning do they attribute to medicines for instance? What means could care for them? There are many questions that are worth answering because it influences so much what we should do and what we can do and cannot do to improve behaviour.

In rural Thailand and Laos we carried out a survey to understand health behaviours more generally, the broader pathways that people go through when they are sick. What kinds of public health care providers, what kinds of private health care providers and informal health care providers do they access? What kinds of medicine do they use, how do they even think about medicine and antibiotics? Do they have an understanding of what antibiotics are? Have they heard of drug resistance and what does it means to them? But also how does information spread, for instance in communities? We don’t only have representative surveys but we also have social network surveys. We can apply some quite interesting social research methods to understand and inform something that is quite interesting for the medical sciences.

There is a very long tradition of social sciences in medicine, but its communication with the medical sciences is changing now. I think that this is the most important development that we see at the moment, this cross-disciplinary fertilisation that hasn’t been done so well in the past. Before we were separate camps, now we’re talking to each other more and I think that’s were a lot of inspiration comes from and a lot of new impetus for research and also new solutions – solutions beyond health care.

A practical application of the work that I do relate, for instance, to a recent study we did in diagnostic testing. We contributed to a clinical trial on a diagnostic test, a finger prick test, to help health care workers - nurses - in Thailand and Myanmar, prescribe antibiotics better. What we did as social researchers was to contextualise this whole intervention. We could contribute a better understanding of what happens when you introduce this test, how does this change the relationship between nurses and patients, who do you reach, who do you not reach? Nurses often already have some kind of solution, some kind of tactic and strategy to prescribe or not prescribe an antibiotic, so does this new test change the existing behaviours?

We social researchers have the techniques and the theories available to answer these questions and can ultimately make interventions more effective, maybe locally more appropriate, and it can also help us understand what happens during an intervention.

Social research complements clinical research rather well I’d say. Before a clinical trial for instance we can help understand the context from a patient perspective, for instance where to intervene, what are the behaviours that we need to change, if we want to change them. In our specific case in a clinical trial about antibiotic use, you cannot simply ask the patient “did you take an antibiotic or not” because they wouldn’t understand the question, they might not know what an antibiotic is. Rather one would have to ask, for instance in Thailand “did you take an anti-inflammatory drug?”, we can help inform these questions. What is more, by doing population level research starting with the general population rather than patients specifically, we can give a broad understanding of the diversity of health care behaviours that people have. If there is for instance a clinical trial focusing on primary care in the public sector, then our population perspective can help put this clinical trial into perspective and see, on a population level, what is the impact? Who might be left out? What might be the equity implications? Is it fair to do this? And what else might we have to do to in order to reach, for instance, the poorest of the poor who might be excluded from the primary care level?

Marco Haenssgen

Dr Marco J Haenssgen is a social scientist with a background in management and international development and experience in aid evaluation, intergovernmental policy making, and management consulting. His research emphasises marginalization and health behaviour in the context of health policy implementation, technology diffusion, and antimicrobial resistance.

More podcasts related to Global Health

Mike English: Health services that deliver for newborns

Basic hospital care may be key to saving newborn lives. Professor Mike English outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi’s 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Tran Hien: Infectious diseases in the tropics

Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Ronald Geskus: Sophisticated biostatistics for complex clinical research

The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Rogier Van Doorn: Research at OUCRU Hanoi

Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Heiman Wertheim: Clinical research in low and middle-income countries

Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Guy Thwaites: Tuberculosis meningitis

Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Motiur Rahman: OUCRU laboratory management

OUCRU laboratories provide support to the unit’s extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance helps prescribe the right medicine in time, contributing to better patient management.

Raph Hamers: Developing collaborative clinical trials in Indonesia

Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Jeremy Day: Central nervous system and HIV infections in Vietnam

Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Abhilasha Karkey: Connecting research with communities in Nepal

Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.