Catherine Montgomery

Understanding the international student experience

Presents a contemporary approach to the experience of international students in Higher Education. Using empirical and qualitative data, the book explores their social and cultural context and its impact on their learning experience.

Social Networks and the International Student Experience: An International Community of Practice?

An implicit perception of international students is that they have difficulty in becoming involved in social exchange with other students who do not share their “culture” and language. This picture of a group of students isolated and disadvantaged by their lack of contact with “UK culture” is questioned in this article. Data from a recent research project suggests that international students form a strong international community that supports their learning and provides them with a supportive learning environment. Thus, contrary to perceptions, the strength of this international community challenges the view that international students need to develop social and academic exchange with UK students to get the most from their university experience. The international community of practice described here presents a picture of a more positive and active international student experience, with international students as the providers of support and knowledge within a supportive and purposeful student community.

The role of partnership dynamics in determining the acceptability of condoms and microbicides

Abstract Microbicides are a class of substances under development that could reduce the sexual transmission of HIV and other sexually transmitted diseases when applied locally to genital mucosal surfaces. Microbicide acceptability research has largely focused on product characteristics, rather than processes of negotiation within relationships about use. Gender relations, decision-making power and communication within sexual relationships are recognised as important determinants of condom and contraceptive use, and are likely to determine microbicide use also. As part of social science research linked to the Microbicides Development Programme (MDP) we combine relationship-based theories with anthropological work conducted with women and men using a placebo gel. We explore communication and decision-making in gel and condom use, including constructions of risk and trust. During the MDP301 Phase III pilot study, in-depth interviews were conducted at sites in South Africa, Tanzania, Uganda and Zambia. Following four weeks of placebo gel use, women and their partners were asked about gel use and acceptability, partner involvement, sexual practices and condom use. Data from 45 couples at five sites were analysed using a grounded theory approach in NVivo. Participation in the study did not require women to inform their partners, yet our data shows women seeking permission from their partners, negotiating disclosure, exchanging information and persuading or motivating for gel use. Although gel was supposedly ‘woman-controlled’, men exercised considerable influence in determining whether and how it was used. Despite this, negotiations around use were largely successful, since the gel increased sexual pleasure and provided opportunities for intimate communication and the building of trust. Decisions about condom and microbicide use are made in a dyadic context and involve a complex negotiation of risk and trust. Whilst preferences relating to product characteristics are largely individual, use itself is dependent on partnership dynamics and the broader social context in which sexual risk management occurs.

A mixed methods and triangulation model for increasing the accuracy of adherence and sexual behaviour data: the Microbicides Development Programme

Background The collection of accurate data on adherence and sexual behaviour is crucial in microbicide (and other HIV-related) research. In the absence of a “gold standard” the collection of such data relies largely on participant self-reporting. After reviewing available methods, this paper describes a mixed method/triangulation model for generating more accurate data on adherence and sexual behaviour in a multi-centre vaginal microbicide clinical trial. In a companion paper some of the results from this model are presented [1]. Methodology/Principal Findings Data were collected from a random subsample of 725 women (7.7% of the trial population) using structured interviews, coital diaries, in-depth interviews, counting returned gel applicators, focus group discussions, and ethnography. The core of the model was a customised, semi-structured in-depth interview. There were two levels of triangulation: first, discrepancies between data from the questionnaires, diaries, in-depth interviews and applicator returns were identified, discussed with participants and, to a large extent, resolved; second, results from individual participants were related to more general data emerging from the focus group discussions and ethnography. A democratic and equitable collaboration between clinical trialists and qualitative social scientists facilitated the success of the model, as did the preparatory studies preceding the trial. The process revealed some of the underlying assumptions and routinised practices in “clinical trial culture” that are potentially detrimental to the collection of accurate data, as well as some of the shortcomings of large qualitative studies, and pointed to some potential solutions. Conclusions/Significance The integration of qualitative social science and the use of mixed methods and triangulation in clinical trials are feasible, and can reveal (and resolve) inaccuracies in data on adherence and sensitive behaviours, as well as illuminating aspects of “trial culture” that may also affect data accuracy.

Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review

Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration.

Re-framing microbicide acceptability: findings from the MDP301 trial

Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic (‘insider’) perspective or attempt to understand how microbicides fit into the broader context of womens and mens everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Womens experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on womens practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of womens and mens sexuality and sexual health.

Assessing the Accuracy of Adherence and Sexual Behaviour Data in the MDP301 Vaginal Microbicides Trial Using a Mixed Methods and Triangulation Model

Background Accurate data on adherence and sexual behaviour are crucial in microbicide (and other HIV-related) research. In the absence of a “gold standard” the collection of such data relies largely on participant self-reporting. The Microbicides Development Programme has developed a mixed method/triangulation model for generating more accurate data on adherence and sexual behaviour. Methodology/Principal Findings Data were collected from a random subsample of 725 women using structured case record form (CRF) interviews, coital diaries (CD) and in-depth interviews (IDI). Returned used and unused gel applicators were counted and additional data collected through focus group discussions and ethnography. The model is described in detail in a companion paper [1]. When CRF, CD and IDI are compared there is some inconsistency with regard to reporting of sexual behaviour, gel or condom use in more than half. Inaccuracies are least prevalent in the IDI and most prevalent in the CRF, where participants tend to under-report frequency of sex and gel and condom use. Women reported more sex, gel and condom use than their partners. IDI data on adherence match the applicator-return data more closely than the CRF. The main reasons for inaccuracies are participants forgetting, interviewer error, desirability bias, problems with the definition and delineation of key concepts (e.g. “sex act”). Most inaccuracies were unintentional and could be rectified during data collection. Conclusions/Significance The CRF – the main source of self-report data on behaviour and adherence in many studies – was the least accurate with regard to measuring sexual behaviour, gel and condom use. This has important implications for the use of structured questionnaires for the collection of data on sexual behaviour and adherence. Integrating in-depth interviews and triangulation into clinical trials could increase the richness and accuracy of behavioural and adherence data.

'To help them is to educate them': power and pedagogy in the prevention and treatment of malaria in Tanzania.

Objectives  Acknowledging that mothers are often the primary caregivers at the household level, malaria control efforts have emphasized educating women in its early recognition. This fails to consider the context in which knowledge will be transformed into action, as women lack decision‐making responsibility and financial resources. We examine the knowledge and power dynamics of provider–patient interactions and the implications for malaria treatment of educating mothers during consultations.

Does assessment for learning make a difference? The development of a questionnaire to explore the student response

Assessment for learning is a widely used term and the concept forms the basis of many teaching innovations in higher education. However, the definitions and scope of assessment for learning vary considerably. We describe a conceptualisation of assessment for learning that encompasses current thinking in a holistic way and which has been trialled and extensively refined in practice. A student questionnaire is presented which has enabled us to explore the student experience. Results indicate that the overall student experience is more positive in modules where assessment for learning approaches are used and students are more likely to take a deep approach to learning. It also demonstrates that the student experience is centred on staff support and module design, feedback, active engagement and peer learning. The full questionnaire is made available and its wider use in evaluation, enhancement and research is encouraged.

Making prevention public: The co-production of gender and technology in HIV prevention research

This paper brings together the study of transnational flows in global health and the gendering of technological artefacts. It does so through a case study of vaginal microbicides for HIV prevention, which have commonly been advocated for as a tool for women’s empowerment in parts of the world where HIV is most prevalent, namely sub-Saharan Africa. Drawing on fieldwork in the UK and Zambia, I argue that there is nothing inherently gendered about this ‘woman-controlled’ technology. Combining the notions of scripting and ‘making things public’, I demonstrate the political nature of transnational technology design and testing in the field of sexual health. Rather than framing this in terms of ethical debates, as is frequently the case in studies about the ‘global South’, I ground the analysis in the scripting and de-scripting of technologies and users. By focusing on how things are made public in HIV prevention, I draw attention to the normative, transformative and political potentials of new technologies, such as microbicides, and discuss the implications for their therapeutic success.