Research Edwin Wouters

Abstract

CITY-MOVE adapts and implements the WHO Global Action Plan on Physical Activity (GAPPA) in six cities across three continents and develops a cross-contextual evaluation framework for transferability and scalability. Physical activity is a key behavior to reduce the NCD burden, including protecting against cancers and type 2 diabetes. There are many evidence-based interventions for cities to promote physical activity, yet they remain under-implemented, with a whole-of-system approach particularly lacking, and often fail to target the least active or vulnerable groups. Knowledge gaps are: a) how to adapt, b) successfully implement, and c) evaluate interventions, and d) how to transfer lessons to other interventions, target groups and contexts. In partnership with the cities, we identified interventions targeting individuals across the life course, particularly vulnerable and least active groups, aligned with the GAPPA domains of active people, societies, environments and systems. CITY-MOVE will: 1) Develop a city-GAPPA Theory of Change and operationalise assessment measures; 2) Adapt city-GAPPA to six cities, engaging stakeholders in each context; 3) Support cities in successful implementation through action research in living labs; 4) Assess reach, adoption, feasibility, fidelity, and sustainability of selected interventions in each city; 5) Improve the development and utilisation of routinely collected data to support successful implementation; 6) Generate cross-contextual evidence on implementation, evaluation and scalability through multi-criteria decision assessment for 12 interventions in six cities; and 7) Generate global capacity through regional Communities of Practice. CITY-MOVE results lead to increased physical activity by target populations, contributing to reduced premature NCD mortality, and to adaptable solutions ready for take-up by implementers.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: Bastiaens Hilde
• Co-promoter: Thornton Lukar
• Co-promoter: Wouters Edwin

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project website

Project type(s)

• Research Project

Abstract

The Joint Action on CARdiovascular diseases and DIabetes (JACARDI) aims to reduce the burden of cardiovascular disease (CVD) and diabetes (DM) in EU countries, both at individual and societal level. JACARDI is designed to integrate validated best practices and/or (cost-)effective interventions across countries and regions through transnational pilot initiatives, complementing and reinforcing existing policies and programs. The initiative covers the entire "patient journey", from improving health literacy and awareness of CVD/DM, travelling through screening and primary prevention among high-risk populations, reaching people living with CVD/DM and their care providers, improving service pathways, self-management, and labour participation. JACARDI also addresses transversal and intersectional aspects, e.g., promoting equity in health, social, cultural, and ethnic diversity and the improvement of data availability. The activities are distributed into 11 Work Packages (WPs): 5 transversal WPs, with one innovative WP on the development of a common methodological framework and integrative approach, and 6 technical WPs. The wide coverage of JACARDI is secured by the involvement of 21 EU countries and 77 partners. The widespread implementation of 142 pilots will ensure broad coverage and geographic extension, while the adoption of a common implementation and assessment methodology will minimise the risks of failure and facilitate the analysis of success and context factors. The resulting roadmap will serve as proof-ofconcept case studies with the potential to extend and scale-up experiences at the national/regional level. JACARDI will enhance cross-national collaboration, maximising the exploitation of lessons learned through a clear strategy, engaging groups of interest, promoting integration and sustainability of approaches to achieve high-level impact, including the implementation of effective interaction, cooperation and co creation between science and policy.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Type 2 diabetes (T2D) and depression are highly prevalent conditions and have significant impact on health outcomes worldwide. Both conditions maintain a bidirectional relationship causing T2D and depression to occur together twice as frequently as would be predicted by chance alone. Current studies on this comorbidity however employ an individualistic perspective and ignore its social drivers– necessitating sociological research on the topic. A merger between Fundamental Cause Theory and Syndemic theory will be applied to(1) assess the clustering of T2D and depression and the role of socio-economic (SE) vulnerability within this clustering; (2) look how the adverse interactions between T2D, depression and SE vulnerability amplify disease burden and complications, and (3) study the contextual forces that cause and/or exacerbate this clustering. I will use HISlink data (Health Interview Survey + Health Insurance data) to assess (1) and (2) in Belgium. Next, I will address (3) by assessing the contextual variation in the syndemic across (a) Belgian communities (using Local Health Interview Survey data) and (b) European countries (using European Health Interview Survey data), and whether this variation can be explained by spatial and health system characteristics, respectively. The resulting fundamental knowledge has the potential to help policymakers in their endeavours to improve population health by offering insight into the drivers of the co-morbidity of T2D and depression.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien
• Fellow: Bos Philippe

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

A major challenge of the newborn child is to learn to regulate internal states (physiological, emotional, and cognitive) and behavior. The child's self-regulation stems from successful co-regulation between the baby and its caregiver(s) and constitutes the basis of mental health. Regulation problems (RP) in early childhood are the seeds for emergent developmental psychopathology and for persistent mental health problems later in life. Given the increasing pressure on our mental health care system, targeting RP at an early age is a cost-effective prevention strategy. Based on growing empirical and clinical evidence, we hypothesize that child RP largely result from/persist through co-regulation difficulties within the child-parent dyad, which itself is largely impacted by stress and regulation difficulties in the parent. Hence, reducing stress and enhancing parents' regulation abilities may be the most optimal gateway for improving self-regulation in the child, thereby preventing future mental health problems. To date, however, there is a dearth of scientific research on this topic, both with respect to the (1) characterization, detection and understanding of regulation (problems) (WP1&2), and (2) the organization of preventive care around early regulation in young children (WP3&4). The current proposal will address these gaps in 4 work packages aimed at: (1) quantifying micro self- and co-regulation dynamics within a 'biobehavioral synchrony framework'; (2) understanding the prevalence and contextual risk and protective factors of RP; (3) pinpointing the missed opportunities in the preventive care for young children with RP and translating 3rd line clinical expertise to fill these gaps and (4) developing and testing a 0th/1st line health care program empowering parents in the co-regulation process with their child. Together with our committed stakeholders, this multidisciplinary project aims to be a game changer in the early prevention of mental health care.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Dhar Monica
• Co-promoter: Van Hal Guido

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

HIV remains a severe public health problem in South Africa. Important gender inequities also persist in the epidemic: the adult prevalence is twice as high in women than in men, while men are significantly less likely to test and be (successfully) treated and thus more likely to die of HIV-related causes. The two are also linked: the heterosexual nature of HIV transmission transfers these male risks into (young) female vulnerabilities (and the high female HIV prevalence). A crucial way to break this destructive cycle is (early) linkage of men to HIV services, creating a need to find feasible strategies to render HIV services male-friendly and accessible. The project aims to build a research partnership –the Men & Health Consortium– which will strengthen local research capacity as well as the relationships with policy makers and societal stakeholders (building a multi-stakeholder network and improving science-society communication). These activities will enable the consortium to use crowdsourcing (as an innovative methodology) to solicit locally appropriate and specific solutions to increase men's use of HIV services – which can form the basis for future interventions and policies.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

South Africa has a high burden of severe mental illness – such as schizophrenia, bipolar disorder and major depressive disorder. In step with global movements and budgetary limitations, the country promotes deinstitutionalisation – from hospitals to local communities – to care for these people living with severe mental illness (PSMI). This push towards deinstitutionalisation, however, has not been fit with an according health care model in these communities. PSMI are discharged into a household context without any support – often resulting in treatment non-adherence and a cyclical pattern of short readmissions to the hospitals that they have been discharged from, following relapses in treatment gains. In the context of limited resources for deinstitutionalized mental health care, research into the potential of the household in the care for discharged PSMI is a clear priority. We hypothesize that improving the mental health knowledge and communication skills of households will enable ownership of the problem and increase social support to the PSMI. This will eventually positively impact treatment adherence and lower re-admission rates of PSMI. Aim of this project is to develop and test an intervention stimulating this mental-health competence of households – in a cluster randomized-controlled trial using a longitudinal process evaluation. As such, this project responds to the urgent need in many low- and middle income settings to optimize the deinstitutionalisation of PSMI.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Most traditional youth mental health interventions fail to achieve sustainable impact at scale because they overly rely on individualized, medical illness-focused models and treat youth as passive beneficiaries. citiesRISE, a multi-stakeholder initiative founded in 2017 to address these gaps, has worked with youth, communities, and professionals across five cities, as well as social innovators in over twenty countries, to develop a set of evidence-based, scalable youth mental health interventions and implementation models. The YiPEE project aims to provide robust evidence on the feasibility, adaptability, effectiveness, and cost-effectiveness of a multi-component intervention targeting the inner, social, and environmental dimensions that underpin mental health and broader NCD risk reduction outcomes, when implemented using a youth-informed and -activated approach. This will be achieved through a a mixed-methods approach, conducting a realist evaluation across the four sites (Chennai, India; Nairobi, Kenya; Cape Town, South Africa; Stockholm, Sweden) to study key implementation outcomes following the Practical Robust Implementation and Sustainability Model (PRISM) as well as the mechanisms underlying why the intervention works, for whom, and under what real-world conditions. In Chennai, YiPEE will conduct a randomized controlled trial for more robust evaluation of effectiveness and cost-effectiveness in achieving key mental health and other NCD related lifestyle behavioral outcomes. YiPEE focuses on the combination of a school-based multicomponent intervention targeting positive disruption in the inner, social, and environmental dimensions of adolescents' mental health and a youth-informed and -activated implementation model that puts young people at the centre of transformation, working collaboratively with a range of other stakeholders.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: De Man Jeroen
• Co-promoter: Willem Lander
• Co-promoter: Wouters Edwin

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

The combination of the growing mental health care burden and the limited human and monetary resources for health stresses the clear need for effective prevention strategies. It is increasingly demonstrated that regulatory problems in infancy – resulting from co-regulation difficulties within the caregiver(s)-child relationship – hold extreme importance for mental health, constituting the seeds for emergent developmental psychopathology and persistent mental health problems later in life. However, to date, there has been limited fundamental research which aims to intervene in this vicious cycle of mental health problems, especially with respect to (1) understanding the vicious cycle of regulatory problems within a larger social context and (2) exploring how to structurally prevent and treat infant regulatory problems. In the current FWO-proposal, I will address these gaps using a mixed-method multi-stakeholder design focusing on 3 research objectives: (1) disentangling the micro vicious cycle of dysregulation within the parent(s)-child interaction and understanding how this vicious cycle is impacted by and impacts environmental stressors, taking into account gender and SES differences, (2) investigating the experiences of professional childcare workers in addressing regulatory problems, and (3) exploring effective strategies to structurally optimize infant mental health care around self- and co-regulation.

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: De Bruyn Sara

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Sustainable Development Goal 3 underlines the right of everyone to have timely access to primary healthcare (PHC). Despite the fact that Belgium has put various reforms in place to make PHC more affordable and accessible, inequalities in access to care are even getting bigger – creating the need for innovative measures. A new health care model should thus be designed and tested to link people who have difficulties accessing PHC (PDAP) to the existing PHC system. Such a new model requires new fundamental knowledge, as former solutions have repeatedly failed. Since the country is also confronted with increasing health demands and limited budgets, there is impetus to tap into the potential of reverse innovations from low and middleincome countries (LMICs). A review of health innovations in LMICs and a theoretical analysis on the required characteristics of such a new model resulted in a community health worker (CHW) intervention – inspired by the Family Health System in Brazil and Re-engineering PHC in South Africa. We hypothesise that an outreaching PHC model with a CHW intervention will address the access-to-care challenges in Flanders, Belgium. We will first study the interplay over time between the different barriers PDAP experience throughout the access-to-care continuum in Flanders (WP 1). Secondly, we will investigate the innovative PHC models in South Africa and Brazil to develop the CHW intervention (WP2). In WP3, we will design a new outreaching PHC model which uses CHWs to improve access to care for PDAP in Flanders. In WPs 4 and 5, we will implement and evaluate the CHW intervention in a cluster randomised controlled trial. Finally, we will also assess the cost-effectiveness of the intervention (WP6). Throughout this work, academic experts from sociology, family medicine, and economics closely collaborate with committed societal stakeholders to join scientific insights and implementation knowhow, to optimise fit to practice and societal impact.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The increasing prevalence of Type 2 Diabetes (T2D) and the frequent concurrence of comorbidity puts a heavy strain on societies (both the patients and health system), in terms of healthcare cost, patients' quality of life and loss of productivity. Interventions such as Integrated Chronic Care (ICC) and disease specific care trajectories are introduced to better address these complex needs but there is limited evaluation of these interventions. Most existing evaluations are limited in three ways: a) They show effects on diabetes-specific clinical outcomes, but do not take into account the comorbidity dimension; b) They do not take into account the variation in implementation of ICC; and c) have limited information on health-related quality of life (HRQoL) and cost-effectiveness. This proposal will triangulate different data sources (available health insurance data, laboratory and primary health care data combined with primary HR QoL data) in Belgium to addresses those gaps by examining the cost and cost-effectiveness of ICC for people with T2D and potential comorbidities for different levels of ICC implementation in Flanders. More specifically, we aim to (1) estimate the cost of care for T2D patients with and without comorbidities for different levels of ICC implementation in Flanders; (2) assess the impact of different levels of ICC implementation on HRQoL among T2D patients with and without comorbidities; and (3) evaluate the cost-effectiveness of different levels of ICC implementation in the provision of care among T2D patients with and without comorbidities. This project responds to a strongly felt need among 22 interviewed stakeholders that the increasing prevalence of chronic patients necessitates a move towards more ICC but that financing is a major barrier. This project pushed the boundaries of knowledge by quantifying costs and benefits. The knowledge generated in this study can contribute to a more effective and efficient implementation of ICC for the management of diabetes patients (with comorbidities) in Flanders. This is extremely relevant in a society with increasing health inequity and financial barriers to healthcare utilization and self-management.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien
• Fellow: Nugraha Ryan Rachmad

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

South Africa has a high burden of severe mental disorders. The country promotes deinstitutionalisation for people living with a severe mental disorder (PSMD) – shifting the locus of care from hospitals to local communities. This push, however, has not been fit with an according care model in these communities. PSMD are discharged into households without any support – often resulting in a cyclical pattern of short-term readmissions to the hospitals that they have been discharged from, sometimes with devastating consequences. The project aims to build a research partnership between the Univ. of KwaZulu-Natal, the Univ. of Cape Town and the Univ. of Antwerp which will (1) exchange knowledge on the potential of households in health care, (2) strengthen the relationships with policy makers and (3) improve the curriculum of social work auxiliaries providing household support. The combination of these activities is aimed at enabling a research program to durably improve the well-being of PSMD using a household intervention – thereby stopping the revolving door syndrome and the devastating social/economic/health consequences it creates.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Emergence of antibiotic resistance (AMR) is a serious concern for Low and Middle Income Countries (LMIC). Unregulated use of antibiotics, a major AMR driver, is highly prevalent in LMIC, with medicine stores as key providers. Close physical interactions between One Health compartments increase cross-domain transmission risks, although the relative importance of different reservoirs is uncertain, with community-level dynamics of AMR in LMICs largely unquantified. We will develop and evaluate a behavioural intervention bundle, targeting medicine stores and their communities, to optimise antibiotic use and improve hygiene, and hence reduce AMR prevalence and transmission. After a 6-month local co-development phase, the intervention will be implemented over 12 months in established health demographic surveillance sites in Burkina Faso and DR Congo with clinical microbiology facilities, and evaluated in a cluster RCT, comparing intervention and control villages. Primary outcome measure is a change in Watch antibiotic provision from medicine stores (where a formal prescription is not required), assessed via patient exit interviews and simulated client visits. Changes in hygiene practices and AMR pathogen and gene carriage will be assessed in repeated population surveys. Rodents, living in close proximity to humans in much of sub-Sahara Africa, provide a proxy estimate of environmental AMR pathogen and gene exposure. Using modelling and sequencing of selected human and rodent isolates, we will quantify how changes in antibiotic use and hygiene practices impact AMR transmission.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Previous studies have clearly identified the population groups who experience difficulties in the access to primary health care (PHC) in Belgium, namely financially vulnerable individuals as well as individuals with low- educational attainment. The barriers to PHC are not only related to individual characteristics, but also to the organizational characteristics of primary healthcare. In order to overcome these barriers related to access to PHC, the Federal Government (FOD Volksgezondheid) has instigated a community health worker (CHW) project in Belgium in response to the COVID-19 pandemic. Aim of the CHW project is to improve access to primary healthcare for vulnerable groups in socially disadvantaged communities. This research project will assess this implementation of this CHW project by conducting in-depth qualitative research with the CHWs themselves, the recipients of the CHW support and the CHW supervisors.

Researcher(s)

• Promoter: Masquillier Caroline
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The HIV/AIDS epidemic is still severely impacting South Africa: in 2021, approximately 1 out of 5 adult South Africans was HIV positive. As a response, the South African government has rolled out life-saving antiretroviral treatment (ART) in the public health sector, with approximately 5.5 million people currently receiving ART. ART has been proven to be highly effective: when achieving 95% adherence, HIV is transitioned from a terminal illness to a controllable chronic condition. The required high life-long adherence for effectiveness is however a clear bottleneck. ART adherence is reported as inadequate: the proportion of South Africans not achieving the ideal 95% adherence rate ranges from 23% to 60% and optimal viral load suppression rates have been achieved for only an estimated 47% of PLHIV on ART. Evidence-based knowledge on potential routes to stimulate ART adherence in South Africa are thus a clear research priority. Given the over-burdened health system with severe human resource shortages in the health sector, it is evident that potential solutions need to capitalize on the available social fabric, namely the patient and its household. Despite extensive literature on impediments and enablers of antiretroviral treatment (ART) adherence, not much is documented about (1) the patient's experience of living with HIV as a chronic illness, (2) how the patient's family context may influence the experience and (3) how the experience ultimately affects the patients' outcomes, specifically, adherence to ART. This is particularly noteworthy for high HIV-burdened and resource-constrained settings such as South Africa. Rooted within the larger SINAKO trial on the mediating role of the household, Phyllis Sematlane aims to respond to these research needs. She more specifically investigates the relationship between (1) illness identity in HIV and (2) clinical outcomes (ART adherence, viral load suppression, disclosure and overall self-management ) while also (3) assessing the potential mediating role of household HIV competence in an HIV positive, treatment-naive adult population enrolled in care at clinics in the Western Cape Province of South Africa. Drs. Sematlane uses the pre- and post-intervention data of the SINAKO trial (cluster RCT (180 vs. 180 patients) with a household HIV competence intervention) to achieve her objectives. In the past years, she has already successfully executed a review study on HIV Illness Identity and validated a generic Illness Identity scale for application in HIV research. Currently, she is exploring the impact of the household HIV competence intervention on the successful construction of an HIV Illness Identity. During the proposed one-year DOCPRO-1 scholarship, she would investigate the impact of household HIV competence, via HIV Illness Identity, on ART adherence (and subsequent viral suppression). The resulting knowledge could potentially be a game changer for HIV treatment interventions in resource-limited settings as stimulating the HIV Illness Identity (combined with enhanced household HIV competence) could be a feasible and sustainable strategy to optimize the outcomes of HIV treatment strategies in a vulnerable context where this knowledge in needed most.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The quality of formal childcare has been cited as an important determinant of young children's mental health, as it has been demonstrated that children's self-regulation abilities – resulting from repeated cycles of co-regulation in caregiving – hold extreme importance for their mental health, now and later in life. Given the high uptake of formal childcare in Flanders and the high enrollment rates of the youngest children, childcare teachers thus play an very important role in these co- and self-regulation processes. High job strains within the sector, however, put these services at risk of inducing stress and mental well-being problems among childcare teachers, possibly impacting the co-regulation processes. Fundamental research is scarce in measuring, disentangling and optimizing these relationships. In the current proposal, we will address these gaps using a mixed-method design focusing on 3 research objectives (ROs): (RO1) map the job characteristics that explain job strain in childcare teachers (structural quality), and investigate its association with childcare teachers' ensuing mental well-being, (RO2) examine the impact of childcare teachers' strain and ensuing mental well-being on their co-regulation attitudes and practices (process quality), and (RO3) explore effective strategies to structurally optimize both the structural and process quality of formal childcare.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Van de Velde Sarah
• Co-promoter: Van Hal Guido

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Imagine getting post-doc time from us. Post-doc time with the sole obligation to prepare a post-doc proposal to apply for – and ideally obtain - your own research grant. The Centre for Population, Family and Health of the University of Antwerp is launching a competition to attract talented PhDs in the Social Sciences who want to pursue their careers in our research centre. For this challenge, you will write a scientific essay describing a problem that urgently needs to be researched. The problem also needs academic attention from a European comparative perspective and touches on issues from social demography, family sociology and/or the sociology of disease and health. You document the problem with an empirical analysis, preferably in a comparative perspective. When elaborating the essay, you pay particular attention to issues of gender and/or social inequality. The winner's essay will be submitted to Population Europe for publication in their Pop Digest series.

Researcher(s)

• Promoter: Mortelmans Dimitri
• Co-promoter: Neels Karel
• Co-promoter: Van de Velde Sarah
• Co-promoter: Wouters Edwin
• Fellow: Maes Julie

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The proposed sabbatical leave aims to build a new, innovative and timely line of research which looks at illness from a syndemic perspective. The empirical establishment of these interrelationships between diseases and the social context in which they thrive (research objective 1) will be matched by the development and testing of appropriate healthcare interventions (research objective 2).

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The proposed sabbatical leave aims to build a new, innovative and timely line of research which looks at illness from a syndemic perspective. The empirical establishment of these interrelationships between diseases and the social context in which they thrive (research objective 1) will be matched by the development and testing of appropriate healthcare interventions (research objective 2).

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Type 2 Diabetes (T2D) is one of the leading causes of death in the world (3.7 million deaths/year). In Belgium, 6.1% of the population is diagnosed with diabetes. Effective treatment exits and is relatively straightforward from a technical point of view, but T2D care is socially and organizationally complex. It requires lifelong follow-up and self-management along a continuum of care: patients need to be diagnosed, treated, followed-up, and supported to achieve glycaemic control. Unfortunately, people (especially vulnerable groups) are lost at each of these steps, leading to complications and avoidable hospitalizations. Knowledge is urgently needed on the determinants of these leakages in the care continuum. In accordance with the socioecological model, we aim to disentangle the determinants of drop-out at 3 levels (patient, health system & community level) through an innovative multilevel Cascade-of-Care approach. The Cascade-of-Care visualizes the drops between the steps of the care continuum while our multilevel analyses will attempt to explain each drop using determinants at the 3 levels. We will build a unique dataset combining (1) individual health insurance and medical lab data, (2) organizational data of primary care practices and (3) administrative and self-gathered data of neighborhoods. Spatial multilevel analysis will allow us to assess (1) the relative impact of and (2) interaction between the determinants at these 3 levels on each step of the continuum of care.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

This project aims to investigate the impact of the COVID-19 pandemic on well-being in higher-education students. Our research consists of three parts. In a first part we use the C19 ISWS dataset, which collected information on student well-being during the first wave of the COVID-19 pandemic, and this in more than 100 educational institutions from 26 countries. With this data we want to investigate (1) to what extent differences exist between the different countries and educational institutions, (2) how these differences can be related to the protective measures implemented by the governments, and (3) by the educational institutions. In a second part, we zoom in on the Belgian context, combining the Belgian sample of the C19 ISWS with information collected through focus groups with student representatives and members of the cells for innovation and quality of education. Not only do we want to identify at-risk groups, we also want to explain how the implemented measures had an impact on the student population and on these atrisk groups, as well as which coping mechanisms students used during the pandemic. The information from these two strands will be brought together to identify best practices that promote the well-being of the student population during future outbreaks.

Researcher(s)

• Promoter: Van de Velde Sarah
• Co-promoter: Van Hal Guido
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Cambodia is confronted with a growing diabetes epidemic, translated in an increase of the prevalence of deaths attributable to this chronic disease by 42.9% between 2005 and 2016. The diabetes epidemic is projected to severely hamper the country's much needed developmental progress. The country's public health system has been primarily designed to tackle acute diseases and is therefore not capable of comprehensively addressing this public health problem. The proposed project intends to address this problem by joining forces with two local actors – NIPH and MoPoTsyo – to generate context-sensitive strategies to co-create comprehensive but context-specific diabetes care. More specifically, it aims to (1) investigate where current policies and strategies differ from the optimal WHO ICCC framework, and (2) see how these differences translate in suboptimal outcomes in diabetes management, and finally (3) develop roadmaps (together with the stakeholders) to overcome the shortcomings in the current approaches.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: Diabetes and hypertension are increasingly dominant in the global burden of disease. Effective interventions for prevention, detection, treatment and control of both conditions are available, but do not reach all people in need. Countries are struggling how to scale-up interventions sustainably and effectively. There is an urgent need to develop and document strategies on how to do so. Method: This project examines the scale-up of existing evidence-based packages for control of diabetes and/or hypertension with five components: (a) identification of people with hypertension and/or type 2 diabetes and (b) treatment in primary care services, (c) health education and (d) self-management support to patients and caregivers, and (e) collaboration among caregivers. The project develops, implements and evaluates roadmaps for the national scale-up of this package, in three different types of countries: a low-middle income country with a developing health system (Cambodia), a former socialist country with a centralised health system (Slovenia), and a Western European country with a decentralised system (Belgium). The research objectives are: 1) to analyse the organisational capacity to scale-up the integrated care package and to assess contextual barriers and facilitators; 2) to develop and implement roadmaps for a national scale-up strategy in each country; 3) to evaluate the impact of scale-up on health outcomes and costs; and 4) to generate lessons for other countries. Outcomes: The project will result in comprehensive scale-up strategies and increased diabetes and hypertension control in each country. The involvement of policy-makers, professionals and patients will ensure the local relevance and impact. The project is innovative in applying the conceptual insights from scale-up science to the field of noncommunicable diseases. The lessons on scale-up will benefit policy-makers in other countries with similar contexts.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Remmen Roy
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The impact of an HIV infection on an individual's life, family and society is enormous. Worldwide major progress has been made in reducing AIDS related morbidity and mortality by treating HIV infected people with antiretroviral treatment (ART). ART reduces infectiousness, and hence transmission of HIV. However, prevention remains the most important challenge. HIV incidence has been stable or even increased among specific subpopulations such as men having sex with men (MSM) in Western Europe, despite access to ART. An innovative response to further reduce HIV infections is urgently needed, including the development and evaluation of new tools, as well as better tailoring of approaches to key populations. Pre-exposure prophylaxis (PrEP) is such a novel prevention tool, involving ART given to uninfected persons to block HIv HIV transmission. Oral PrEP, mostly used as Truvada (containing Emtricitabine and Tenofovir), has been shown to be efficacious in 11 clinical trials, in different populations and geographical areas. The overall aim of this project is to learn how PrEP roll out can be optimized to result in maximum impact on HIV and sexual health. This question will be addressed looking at 4 interrelated themes each including research objectives (ROs): Among community of MSM (WP 1): RO 1.1 Assess the number of MSM eligible for PrEP in Flanders RO 1.2 Examine whether PrEP is reaching the right MSM – those most at risk – in Flanders RO 1.3 Explore the impact of PrEP on the sexual culture and health of MSM in Flanders Among community of Sub-Saharan African Migrants (WP 2): RO 2.1 To identify and estimate the proportion of eligible PrEP users within the SAM communities RO 2.2 To explore perceived community barriers and facilitators for PrEP acceptability and feasibility RO 2.3 To explore perceived individual barriers and facilitators for potential and actual PrEP use Among users (WP 3): RO 3.1 To differentiate patterns of PrEP use and sexual risk behaviour among PrEP users in Flanders RO 3.2 To describe differences in PrEP care needs among users RO 3.3 To document the frequency and associated factors of syndemics among PrEP Among providers (WP 4): RO 4.1 Describe (barriers to) PrEP care in Belgium RO 4.2 Inventory interventions that could address the most prevalent syndemics among PrEP users RO 4.3 Explore GPs' attitudes towards PrEP and their self-perceived roles in PrEP care. RO 4.4 Inform the development of a model for self-managed PrEP care.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

This project evaluates activities for the promotion of sexual health of sub-Saharan African migrants (SAM) in Flanders. Based on the results of the document-analysis and the qualitative research (key informant interview and focus group discussions), the research team will formulate recommendations for future activities for SAM.

Researcher(s)

• Promoter: Masquillier Caroline
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The burden of chronic diseases including type two diabetes mellitus (T2D) is increasing rapidly, especially in low- and middle-income countries. In high-income countries, evidence shows that T2D disproportionally affects socio-economically disadvantaged and vulnerable populations, which makes it an important contributor to inequality. Self-management is an essential and effective strategy for people with T2D, but is poorly adopted in vulnerable groups and low-resource settings. Research on self-management support interventions has been focused on the general population of high-income countries, ignoring the populations that need it the most. The objective of this study is to identify the motivational mechanisms that determine self-management outcomes in vulnerable and socio-economic disadvantaged populations living in suburbs in Sweden, an urban slum in South-Africa, and a rural area in Uganda. The study is based on self-determination theory and hypothesizes that higher intrinsic motivation leads to better self-management which will improve physical and psychological outcomes. Moreover, increase of intrinsic motivation happens through fulfillment of the basic psychological needs which are perceived autonomy, competence and relatedness. In the same framework, we hypothesize that higher psychological adjustment – which refers to the absence of mental distress and the ability to cope with change – leads to better self-management and related outcomes. The study builds on an ongoing cluster-randomized experimental trial evaluating the effectiveness of a context-appropriate community intervention to enhance self-management for people with T2D called SMART2D. The aim of this new proposal is to identify the motivational mechanisms that explain the effect of the intervention in the SMART2D trial. More specifically, this new proposal will assess the mediating role of perceived autonomy, perceived relatedness, perceived competence, intrinsic motivation, and psychological adjustment. Quantitative data on these psychological factors will be collected through the SMART2D project. To determine the mediating effect of these latent variables, a structural equation model will be developed and tested. We will use multi-group structural equation modelling to test the model across the three different sites. This new project will also collect additional qualitative data through semi-structural interviews with the people at risk for or with T2D to further explain the differences across the three study settings. This study will inform us on how self-management support interventions need to be developed when targeting populations in disadvantaged or under-resourced areas, in order to make care more equal and inclusive.

Researcher(s)

• Promoter: Remmen Roy
• Co-promoter: Wouters Edwin
• Fellow: De Man Jeroen

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project website

Project type(s)

• Research Project

Abstract

The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Ponnet Koen
• Co-promoter: Van Hal Guido
• Fellow: De Bruyn Sara

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The response to the HIV epidemic in South Africa is complicated by human resource shortages in healthcare. Building health-enabling households with the capacity to actively stimulate a lifestyle that fosters health offers a potential strategy to tackle South Africa's current prevention and treatment challenges. Research is thus urgently needed on how to create 'HIV competent households', which adopt preventive strategies and help HIV positive members to adhere to treatment and remain in care. Aim of this post-doctoral research is to investigate to what extent and how a household intervention can: (1) increase HIV competence in people living with HIV (PLWH) and their households, and subsequently (2) improve prevention (PLWH + household) and treatment (PLWH) outcomes. Methodologically, this study adopts a longitudinal mixed methods design. To respond to our quantitative research aims, data from the cluster randomized controlled trial, the "HIV competent Household" (HCH) study, will be analysed, using latent cross-lagged modelling. To construct a comprehensive picture of the mechanisms underlying the impact of the intervention on the household and the PLWH, various qualitative data sources will be used (i.e., participatory observations and repeated in-depth interviews with PLWH; and their household members).

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The HIV epidemic is putting a massive burden on South Africa's health system. Given the shortage of human resources for health, community health worker (CHW) support is cited as an integral part of a sustainable antiretroviral treatment (ART) strategy. Evidence supports the potential of CHW involvement but demonstrates large variability in its effective-ness. Work by this research team demonstrated that this variability can be largely explained by the household context – CHW support stimulates ART success in HIV competent households but does not work in less competent households. This proposal aims to build on this knowledge by developing and testing – in a cluster randomized controlled trial – a household intervention to (1) stimulate HIV competence levels and create HIV competent households, and thus (2) opti-mize the impact of CHW support on individual ART outcomes. With the activities outlined, the TEAM project will (1) build new knowledge and skills at the South partner in order to (2) develop an evidence-based, feasible and sustainable strat-egy to optimize the outcomes in vulnerable contexts where this knowledge is needed most.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

With 7 million South Africans currently infected with HIV and 3.5 million currently receiving lifesaving antiretroviral treatment (ART), the epidemic is putting a massive burden on the country's health system. Given the severe shortage of human resources in the healthcare sector, community health worker (CHW) support is being increasingly cited as an integral part of a sustainable ART strategy. Recent review studies support the potential of CHW involvement but also signal the large variability in the effectiveness of such support. Previous work by the current research team demonstrated that this variability can be largely explained by the household context in which the CHWs are active – demonstrating that CHW support stimulates ART adherence in HIV competent households but does not work in less competent households. The current FWO projct aims to build on this knowledge by developing and testing – in a cluster randomized controlled trial – an evidence-based household intervention to (1) stimulate HIV competence levels and create HIV competent households, and thus (2) optimize the impact of CHW support on individual ART outcomes. The resulting knowledge could potentially be a game changer for HIV treatment interventions in resource-limited settings as stimulating HIV competence at the household level could be a feasible and sustainable strategy to optimize the outcomes of these CHW interventions in a vulnerable context where this knowledge in needed most.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: In contemporary Belgium, the university or college experience has become an important transitional period in the life course. Culturally, these years are viewed as a time of transition, experimentation and risk-taking. This transitional period in life is not without risk: increasing attention – especially in the United States – is given to the elevated stress levels that university and college students experience, which can be linked to increased substance use and mental health problems. However, little is known about the interrelationships between study stress, substance use and mental health among the Flemish student population – stressing the need for research on this relevant student health problem. In addition, students do not live and study in a social vacuum: they are surrounded by peers and embedded in study programs. This context can potentially alter the interrelationships between study stress, substance use and mental health problems: (1) social support as a potential buffer and (2) the characteristics of the study program as a driver for inter-study-program variance. Little is however known on the impact of these social and organizational factors on the described interrelationships. Objectives: The present BOF DOCPRO Bonus-project aims to address these shortcomings by examining the impact of student stress on both mental health problems and substance misuse, mediated by the on- and off-line social support available to the student and across different study programs. Methods: More specifically, we will (1) study the interrelationships between study stress, the use of three substances (stimulants, prescription sleeping pills and cannabis) and mental health problems using the 2017 Head in the Clouds dataset (expected n = approx. 20.000). (2) We will use Structural Equation Modelling to test which theoretical model best mimics the role of on- and off-line support in these interrelationships: a direct effect, an indirect effect (via study stress) or a buffer effect (impacting on the path between stress and substance use/mental health). (3) We will employ multiple group SEM to assess how these relationships differ across the different study programs: do differing levels of knowledge and competition impact on these interrelationships? The two latter research questions will be addressed using a newly gathered dataset among the students of the Association University and Colleges of Antwerp. Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying substance use and mental health problems among a large student population – with special attention for the role of social and organizational determinants. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to help students channel study stress and avoid detrimental health choices and mental health problems.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Van Hal Guido
• Fellow: Tholen Robert

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Ponnet Koen
• Co-promoter: Van Hal Guido
• Fellow: De Bruyn Sara

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed DOCPRO BOF-project aims to (1) scientifically assess the extent and sources of HIV- and TB-related stigma among the healthcare workforce as well as (2) develop and (3) test evidence-based stigma-reduction interventions in randomly selected public hospitals in the Free State Province of South Africa. A cluster randomized controlled trial (RCT) in 8 hospitals (a minimum of 584 respondents in 4 intervention and 4 control sites) in the Free State province of South Africa will be employed to address these research questions and optimally assess the net impact of the developed interventions. Several factors favor the successful completion of the proposed research activities, namely (1) the innovative character of the project and its solid research design, (2) the availability of sufficient VLIR-UOS funding to roll-out the proposed RCT in South Africa, (3) the stable, long-term research collaboration between the Southern and Northern partner, and (4) the unique opportunity for a Belgian PhD-student to optimally capitalize on the rich dataset gathered in such a large, international research project.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The generations approaching retirement age have witnessed a double shift in family behaviours: a breakdown of traditional patterns of family formation, and an even larger diversity of families among their adult children. This project measures the impact of these increasingly complex lifecourses on intergenerational solidarity within families and look at upward (personal care) and downward (childcare) solidarity and the intervening role of health.

Researcher(s)

• Promoter: Mortelmans Dimitri
• Co-promoter: Neels Karel
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Setting: While substantial progress is made in tuberculosis (TB) control, the success of public health efforts is hampered by pervasive stigma. Objective: We performed a systematic literature review to assess the effectiveness of interventions aimed at reducing TB stigma in patients, healthcare workers, caregivers and the general community. Design: Studies were eligible for inclusion if they evaluated interventions aimed at reducing TB stigma and were published between 1950-2015. We searched eight databases (Pubmed, Cochrane Library, Ovid, Embase, PsycInfo, Sociological Abstracts, CNHA and LILACS WHO) and complemented the searches by using the snowball strategy and review of relevant gray literature (WHO, STOP TB partnership, STOP TB USA, TB CDC, KNCV and the UNION conference on Tuberculosis and Lung Disease).

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed DOCPRO BOF-project aims to (1) scientifically assess the extent and sources of HIV and TB-related stigma among the healthcare workforce as well as (2) develop and (3) test evidence-based stigma-reduction interventions in randomly selected public hospitals in the Free State Province of South Africa. A cluster randomized controlled trial (RCT) in 8 hospitals (a minimum of 584 respondents in 4 intervention (347 respondents) and 4 control (237 respondents) sites) in the Free State province of South Africa will be employed to address these research questions and optimally assess the net impact of the developed interventions. Several factors favour the successful completion of the proposed research activities and the envisioned PhD, namely (1) the innovative character of the project and its solid research design (a cluster RCT), (2) the availability of sufficient VLIR-UOS funding to roll-out the proposed RCT in South Africa, (3) the stable, long-term research collaboration between the Southern and Northern partner – Prof. Edwin Wouters is officially appointed as a senior research associate of the Centre for Health Systems Research & Development in South Africa – and (4) the unique opportunity for a Belgian student to optimally capitalize on the rich dataset gathered in such a large-scale, international research project.

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: Sommerland Nina

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed TEAM project aims to (1) scientifically assess the extent and sources of HIV & TB stigma among the healthcare workforce and (2) refine and test innovative stigma-reduction interventions in randomly selected public health sites in the Free State Province of South Africa.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: From a large-scale survey among Flemish university and college students, it is known that a substantial part of these students (almost 7%) use stimulant drugs – mainly methylphenidates, such as Ritalin®, prescribed to treat ADHD – as a means for performance enhancement. Apart from the question of unfair competition during the exams, the misuse of prescription stimulants can also have detrimental psychological and physical health effects, rendering it a research priority. Although we have a view on the prevalence of the prescription stimulant misuse by students, almost nothing is known about the characteristics of these users, its impact on students' physical and mental well-being, and the sociological and psycho-social motives to misuse stimulants. In addition, there is a dearth of knowledge on the supply side of this public health problem. Research Objectives: The proposed study aims to fill the above-cited research gaps and generate scientific knowledge on the misuse of methylphenidates in Flanders using an innovative, comprehensive research design. In particular, the proposed research program aims to study (1) which students groups misuse these stimulants as well as the subsequent impact of this use on their well-being, (2) why these students perform this behavior and (3) how these students access the prescription drugs. Methods: The study uses an exploratory mixed methods research design comprising three phases, each addressing an above-cited research objective. Firstly, the available dataset from the quantitative survey among Flemish university and college students (n = 18,000) will be employed to identify the user population and measure their well-being (1). Secondly, a more focused quantitative and qualitative data gathering will be executed to identify the mechanisms underlying the misuse by testing two alternative conceptual models described in the literature (2). Finally, a web-survey among medical doctors and pharmacists will be employed to create scientific knowledge on the supply system of the research issue (3). Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying stimulant drug use among a large student population. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to steer students away from these detrimental health choices.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Van Hal Guido
• Fellow: De Bruyn Sara

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: Although the initial outcomes of the South African public antiretroviral treatment (ART) programme are promising, there are still important challenges to be met to successfully fight the HIV/AIDS epidemic in the long term, namely (1) HIV/AIDS care as chronic disease care requires psychosocial care on top of biomedical care to ensure long-term adherence and patient retention and (2) HIV incidence levels need to drop by positively altering the knowledge, attitudes and practices towards HIV/AIDS. Mobilizing and enabling local families and communities – to develop supportive and healthy behavior – is increasingly cited as a potential strategy to address the above-cited challenges. Ample recent studies have pointed to the need for scientific research on the factors positively impacting on the knowledge, attitudes and practices of local families towards HIV/AIDS – i.e. the AIDS competence – in order to develop interventions combating the remaining challenges in the fight against HIV/AIDS Research objectives: The overall objective of the proposed project is to develop an intervention to build health-enabling families which can fight the HIV/AIDS-epidemic in a sustainable manner. The current study aims to optimally employ the knowledge and experience of HIV/AIDS patients who initiated ART as catalysts of the spread of AIDS competence in local families and communities. Our hypothesis is that public-sector ART, with its associated treatment knowledge and experiences can over time be translated into the positive attitudinal and behavior changes – henceforth called AIDS competence – necessary to successfully and sustainably combat HIV/AIDS at the family level. Methods: The proposed study uses an explanatory mixed methods research design, within which the quantitative data from the existing Effective Aids Treatment and Support in the Free State (FEATS) cohort study (n = 2168) will be used to inform more in-depth longitudinal qualitative work. First, structural equation modeling techniques will be used to explore the relationships between various personal and family characteristics and AIDS competence over time. Special attention will be given to the mediating role of family functioning in facilitating the diffusion of AIDS competence to family members. Secondly, 50 positive deviant cases (i.e. households where positive changes in key knowledge, attitudes and behaviors were observed over time) and 50 negative deviant cases (i.e. households where no or negative changes in key knowledge, attitudes and behaviors were observed over time) will be identified with the aid of statistical analyses of the quantitative FEATS data. These cases will form the basis for further qualitative investigation into the nature and determinants of AIDS competence in positive and negative deviant cases. Four rounds of three-monthly in-depth interviews will be conducted with 100 families to fully disentangle the complex interrelationships between HIV/AIDS and ART on the one hand, and the associated AIDS competent knowledge, attitudes and behaviors at the family level. Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, this is the first study to longitudinally study the complex interrelationships between public-sector ART, family dynamics and AIDS competence. The mixed-methods design will produce potentially valuable insights into the pathways through with AIDS competence is spread. Practically, the research project aims to optimally capitalize on the benefits of the public-sector ART programme by identifying good practices and developing interventions through which the positive ART experiences and associated AIDS knowledge can be translated into higher levels of AIDS competence at the family level.

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

This PhD project aims to address both aforementioned limitations by developing an extended multidimensional conceptualisation of child vulnerability. Subsequently, the concept will be measured empirically using confirmatory factor analysis. Recent data from 33 Sub-Saharan African countries will be used to accomplish this measurement model. Factors that affect vulnerability outcomes for children will be determined by developing a structural model. Both models allow to investigate child vulnerability while accounting for its multidimensionality and latent nature. Lastly, the construct will be tested on its stability over time.

Researcher(s)

• Promoter: Mortelmans Dimitri
• Co-promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

To gain a more profound understanding of the intrinsic dynamics (why) and processes (how) by which social factors positively or negatively affect the creation of the new identity as a chronic HIV/AIDS patient on ART, additional qualitative data is needed. The general aim is therefore to undertake a qualitative sociological study ¿ interviewing 120 HIV/AIDS patients on ART in the Free State Province of South Africa ¿ of this transition to life as a chronic HIV/AIDS patient.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Antiretroviral treatment has transformed AIDS from an acute, degenerative disease into a chronic - albeit incurable - illness. Hence, the illness is not an external assault on the body, but an internal one, becoming part of the patient's identity as a 'chronic HIV/AIDS patient'. This research project aims to assess the mechanisms through which the illness and the associated treatment influence the lives and the identity of the patients.

Researcher(s)

• Promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The general research aim is to undertake a sociological study of the impact of HIV/AIDS and the associated ART on the lives of those affected and more specifically on the identity reconstruction of HIV/AIDS patients receiving ART in sub-Saharan Africa. This research views ART not only as the turning point in the treatment of an 'ill body', detached from the social reality, but also as a turning point in the experience of AIDS as a chronic illness, embedded in this social reality. The study will attempt to draw an overall picture of the HIV/AIDS patient receiving ART as a 'social entity' with a chronic illness, and his/her consequent place and role in society. In practice, we will study the factors that positively affect the possibility of a successful treatment and the associated identity reconstruction.

Researcher(s)

• Promoter: Meulemans Herman
• Co-promoter: Van Loon Francis
• Fellow: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The research aims to discern the different dimensions of the quality of life (QoL) in AIDS patients. The notion of QoL should be understood in the broadest sense possible. In accordance with standardized scales, physical functioning as well as mental, social and role functioning and the capacities to mobilize social capital and social support networks are included in the measurement of QoL. The different dimensions of QoL in AIDS patients and the factors influencing them will be analyzed on the base of data from approximately 400 South-African AIDS patients. Special attention will be given to the influence of their antiretroviral treatment. In the research the conceptualization of the dimensions and dynamics of the quality of life in AIDS patients in South Africa is the core interest. Executed in co-operation with the Centre for Health Systems Research and Development (CHSR&D), University of the Free State (UFS), Bloemfontein, South Africa.

Researcher(s)

• Promoter: Meulemans Herman
• Fellow: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The research aims to discern the different dimensions of the quality of life (QoL) in AIDS patients. The notion of QoL should be understood in the broadest sense possible. In accordance with standardized scales, physical functioning as well as mental, social and role functioning and the capacities to mobilize social capital and social support networks are included in the measurement of QoL. The different dimensions of QoL in AIDS patients and the factors influencing them will be analyzed on the base of data from approximately 400 South-African AIDS patients. Special attention will be given to the influence of their antiretroviral treatment. In the research the conceptualization of the dimensions and dynamics of the quality of life in AIDS patients in South Africa is the core interest. Executed in co-operation with the Centre for Health Systems Research and Development (CHSR&D), University of the Free State (UFS), Bloemfontein, South Africa.

Researcher(s)

• Promoter: Meulemans Herman
• Fellow: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project