Setting a research agenda to improve community health: An inclusive mixed-methods approach in Northern Uganda.

Abstract

The United Nations Sustainable Development Goals stress the importance of equitable partnerships in research and practice that integrate grass-roots knowledge, leadership, and expertise. However, priorities for health research in low-and-middle income countries are set almost exclusively by external parties and priorities, while end-users remain "researched on" not "researched with". This paper presents the first stage of a Community-Based Participatory Research-inspired project to engage communities and public-health end-users in setting a research agenda to improve health in their community. Photovoice was used in Kuc, Gulu District, Uganda to engage community members in the selection of a research topic for future public health research and intervention. Alcohol-Use Disorders emerged from this process the health issue that most negatively impacts the community. Following identification of this issue, a cross-sectional survey was conducted using the Alcohol Use Disorder Identification Test (n = 327) to triangulate Photovoice findings and to estimate the prevalence of Alcohol-Use Disorders in Kuc. Logistic regression was used to test for associations with demographic characteristics and Alcohol-Use Disorders. Photovoice generated four prominent themes, including alcohol related issues, sanitation and compound cleanliness, water quality and access, and infrastructure. Alcohol-Use Disorders were identified by the community as the most important driver of poor health. Survey results indicated that 23.55% of adults in Kuc had a probable Alcohol Use Disorder, 16.45 percentage points higher than World Health Organization estimates for Uganda. Community members engaged in the participatory, bottom-up approach offered by the research team to develop a research agenda to improve health in the community. Participants honed in on the under-researched and underfunded topic of Alcohol-Use Disorders. The findings from Photovoice were validated by survey results, thereby solidifying the high prevalence of Alcohol-Use Disorders as the health outcome that will be targeted through future long-term research and partnership.