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