| Table of Contents | TRAINEES Collaborative Approaches for Writing and Publishing in Global Mental Health In an increasingly interdependent and interconnected world, collaborative writing is crucial for the effective conduct of global mental health research and the application of research findings. However, despite the benefits of collaborative writing, inequitable representation of collaborators from low- and middle-income countries (LMICs) in academic publications persists. We define collaboration in global mental health writing and publishing to include partnerships that involve researchers, research assistants, translators, consumers, policy makers, and other stakeholders, spanning the entire writing process from conceptualization of the research question(s) to dissemination of its finding(s). In this issue of GlobalTracks, we discuss the steps, challenges, and benefits of collaborative writing and highlight the unique experience of Brandon Kohrt, M.D., Ph.D., in collaborative writing. Dr. Kohrt is an early career investigator and a recipient of the NIMH Administrative Supplements to Enable Continuity of Research Experiences of M.D./Ph.D.s During Clinical Training (NOT-MH-11-014), through which he conducted research with the South Asian Hub for Advocacy, Research and Education on Mental Health (SHARE). He recently completed a psychiatry residency at the Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., and is now Assistant Professor of Global Health and Psychiatry at the Duke Global Health Institute. Dr. Kohrt studies populations affected by war-related trauma and chronic stressors of poverty, discrimination, and lack of access to healthcare and education. He has been conducting global mental health research in Nepal since 1996 and has worked regularly with Transcultural Psychosocial Organization (TPO) Nepal since 2006. TPO Nepal is a non-governmental organization that promotes psychosocial well-being and mental health of children and families in Nepal. Part of Dr. Kohrt’s activities at TPO Nepal involves training and collaborating with Nepali early career investigators to jointly write and publish articles in global mental health. However, as Dr. Kohrt notes, collaborative writing can be fraught with challenges: “Some of the common pitfalls in collaborative research in global mental health include no representation at all and token representation. With no representation, collaborators are either not part of the writing process, or…are part of the writing process, but are not included in the authorship list. In token representation, collaborators are included on paper, but are not actively engaged in the writing process. This represents a form of devaluing others’ contributions by including their names, but not their ideas.” In the course of his collaborative writing exercise, Dr. Kohrt has taken the following steps to address this issue: “The solution to no representation at all is simple—inclusion. Meanwhile, addressing token representation involves engaging with co-authors at the very beginning of the writing process. At TPO-Nepal, where I work, we dedicate a substantial amount of time [to] training staff on research basics: ideas about empiricism, hypotheses, observation, and the scientific method. I openly discuss hypotheses with them so that they play a part in assuring the best study design and implementation to test hypotheses. Because of this openness, I have had community researchers come back from field sites with ideas that diverge greatly from our original hypothesis. These discussions about alternative interpretations and processes are reinforced, and an environment of open questioning is fostered.” Ultimately, a research team can implement an ethically sound and truly collaborative writing process by incorporating core components of collaborative writing in each of the following steps. Team building and pre-writing Team building and pre-writing constitute the foundational components of the collaborative writing process. During this step, important issues such as group functioning and culture are negotiated and agreed upon by the team[1]. However, for an early career investigator with no prior engagement or experience in collaborative writing, pre-writing begins with finding the right team or partner(s) with whom to collaborate. A team or partner can be local or non-local and may include a supervisor, a mentor, a peer, a senior investigator, or possibly a non-researcher (e.g., policy-maker, consumer, and people living with mental disorders). The type and purpose of the research determines group configuration. For example, a multidisciplinary team is likely well-suited for tackling a cross-cutting issue such as policy-making in global mental health. Broadening one’s network through face-to-face (e.g., workshops and conferences) or virtual (e.g., listservs) platforms increases avenues for interaction with potential partners for joint research undertaking. This is especially important for investigators in LMICs or in low-resource settings within high-income countries who are often geographically isolated from research hubs. After finding a team or partner, other remaining questions such as formula for determining first authorship, each member’s role and contribution in the overall project, and the timeline for submitting written drafts of the manuscript can be addressed. Dr. Kohrt notes the following approach has enabled him to address first authorship and distribution of tasks when working with partners with limited research experience in a LMIC setting: “Working with graduate students while conducting research in Haiti, I have found that dividing projects by lead authorship works well. Each graduate student chooses a different manuscript to develop as the first author. In collaborative projects, assigning less complex tasks to co-authors with minimal experience and progressively supporting them [to] take on more complex tasks as they gain experience helps builds their confidence and increase their engagement and enthusiasm in the writing process.” Writing The writing phase marks a transition from planning to implementation. At this stage, members of the writing group tackle the portions of the paper for which they are expected to make the most meaningful contribution. For example, a local collaborator is better placed to correctly describe the local meanings of race and ethnicity, uses of language, socio-cultural factors, and how these relate to the study population and the research question(s). How well these contextual issues are described has ramifications for the relevance and application of the research findings. Based on his experience in reviewing and co-authoring scientific papers, Dr. Kohrt describes important sections of a paper where including a local collaborator can be critically important: “The Methods section is an area where inclusion of a local collaborator is especially vital for producing an accurate and high-quality manuscript. When reviewing global mental health research manuscript submissions for journals, one of the most common revisions I request is for more information related to language and adaptation of instruments for use with participants. For example, every language has many terms ([descriptors]) for mental-health–related issues. When authors do not report specific terms in the write-up, future studies may fail to replicate findings because subsequent researchers select other terminology.” “…the Demographic section of the paper is an important area where including a local investigator is important…Given that social categories have often been misused as proxies for genetic differences, journal editors now ask for justification of why racial, ethnic, tribal, and other social categories are used in study designs and analyses. It is therefore most helpful to have groups categorized by locally salient ethnic, tribal, or other identity groups; writing with LMIC collaborators fosters the use of categories that are locally salient.” “…writing the Discussion with a local partner will help the team determine whether the results have face validity with someone who lives and works in that cultural setting. Input from the local collaborator may also help answer the following questions: are there other interpretations of the results that may be more or less culturally appropriate? How can the recommendations and implications be translated into feasible improvements in interventions at the public health and clinical levels? Including LMICs collaborators in the writing process with local connections facilitates research dissemination and uptake of its findings by policy makers, journalists, and consumers within the region.” Post-writing and publishing Post-writing refers to activities and actions by the team after the manuscript is published. A team that values the career development of its members, and seeks to sustain group cohesion for future joint writing endeavors, will find debriefing a useful post-publishing exercise to evaluate the collaborative writing process, and incorporate key lessons learned into future joint writing projects. Specifically, for an early career investigator, it may be worthwhile to evaluate whether or not engaging in a joint writing project enabled him/her to gain new skills that will contribute to advancing his/her career. The relevance of collaborative writing in advancing global mental health research cannot be overemphasized. As the field continues to expand, there is a growing need for collaborative research partnerships that optimize the unique contributions of partners from around the globe, strengthen their capacity, and further their career development as researchers. FUNDING Global Health Service Partnership The Peace Corps in collaboration with Seed Global Health have launched the Global Health Service Partnership (GHSP) to strengthen the health care workforce capacity in LMICs. Recruits will serve one year assignments as either Physician Trainer and Educator or Nurse Trainer and Educator and will provide medical care and strengthen the capacity of local providers in any one or a combination of the following specialties: mental health, general adult care in internal medicine/critical care, pediatrics, general surgery, family medicine, obstetrics and gynecology, anesthesia, pathology, and infectious diseases, depending on in-country needs. The application period for deployments in July 2014 is open and will close on November 1, 2013.
[1] Salas-Lopez D, Deitrck L, Mahady ET, et al. Getting published in an academic-community hospital: the success of writing groups. J Gen Intern Med. 2011; 27 (1):113-6. INFO Contact Us! For questions, comments, or suggestions, please contact Jude Awuba at jude.awuba@nih.gov or 301-443-9650. GLOBALTRACKS is supported by the Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, U.S.A. |
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