 Yes, welcome everybody to this new seminar series called Tackling Global Health Challenges. My name's Sassi Mollinu, I'm a social scientist and I'm based in the Health Systems Collaborative Group here in Oxford and I'm going to be chairing this series and I'm co-chairing it together with Professor Mike English who's a clinical researcher and an implementation health systems researcher also based in the same group. So we're really delighted over the next four sessions, different seminars and to be bringing together speakers from different major research programs. So we're bringing together speakers from the Oxid Centre for Global Health Research and speakers from three different Africa and Asia programs. So these are all large programs being run out of Thailand in the case of Moru, Vietnam in the case of Ocru and Kenya in the case of the Can We Welcome Trust program. So really delighted to have speakers from these different contexts and working in these different programs that are linked. So just a bit more background and introduction to the series. So I'm sure everybody here is aware that global health problems are very complex problems and it's important to have effective research collaborations both across different sectors but also different disciplines in order to tackle these complex problems. And effective and creative collaborations as a starting point really needs different disciplines to be aware of what each other can bring to tackling the problems. So exposure to different fields and disciplines and what we hope to do over this series is to hear about different methods and approaches that fall under the umbrella of health policy and systems research and to see how they're being brought into thinking about and researching different global health challenges. So a little bit more about what health policy and systems research is. There's a commonly used definition on the left hand side of the screen there but there are quite a few different definitions and the important thing to take away about the field is that it's characterized largely by the types of methods not by the types of methods that it employs but rather by the types of questions that it seeks to answer. And so in health policy and systems research as the name suggests is trying to understand about health systems different elements of health health systems how they interact with each other how they function and importantly how health systems might be strengthened. So it's an applied field very pragmatic in its orientation and this means and it takes seriously at the heart of the field the importance of understanding problems and issues in context. So a big strength of the field is that it brings together different disciplines different types of knowledge paradigms and research designs and methods. Situating health policy and systems research in other health research traditions what we can see in this visual is that it operates across the individual level and the societal level and that it draws heavily on and incorporates social sciences into the field. And incorporated within the overall umbrella of health policy and systems research are all these different more specific types of research listed on the left of the slide and in there is implementation science implementation research that I'll come back to. So what we are planning to do over this seminar series is to have an opportunity to talk about a series of different challenges tackling AMR is today so I'll give an overview first of interdisciplinary research and introduction to that and then I'll hand over to Ben Cooper who's going to chair our today's session on tackling AMR and then over the next couple of months we're going to have at the same time on a Thursday a series of different topics. So one on introducing new technologies one on ensuring medicine quality and another on strengthening patient experience and outcomes. So these topics obviously overlap with each other and we hope that the issues the experience sharing and so on will be very much cross cutting across these different sessions. So before I hand over to Ben to run the AMR session today we thought it would be useful perhaps to give an introduction to interdisciplinary research what is it and what are the kinds of opportunities and challenges that we face in conducting interdisciplinary research. And in the next couple of slides I'm going to draw quite heavily on this paper by Yan Ding and colleagues which was published last year in BMJ Global Health. So drawing on other people's papers and thinking Yan Ding and colleagues talk about the overarching term or set of approaches called cross-disciplinary research and this brings together three different typologies of working across different disciplines and moving across the slide from the left to the right what we're seeing there is disciplines being integrated more completely so increasing integration across different disciplines. So in the multi-disciplinary research on the left hand side different disciplines or fruits are brought together to add breadth knowledge and different types of methods to a particular problem. But there is not in this typology a cognitive effort or a deliberate attempt to integrate the different forms of knowledge and expertise so the different fruits into more of a fruit salad. So in this middle into disciplinary research there is much more of a cognitive effort to bring the learning across disciplines together but the integrity of each discipline and its bases is maintained in interdisciplinary research. With transdisciplinary research there's a deliberate effort to transcend the different disciplines to create something new a new blend with the fruits and the hope with this is that it brings extra creativity new fields of inquiry new questions that wouldn't emerge from only having emerging of the disciplines in the way it does in the other typologies. So this is a rather simplified way of distinguishing these different types of cross-disciplinary research and in practice there's lots of blurring between them and there's movement even in one project from one type of cross-disciplinary research to another. But it might be helpful for us in this seminar series to be looking for what kind of methods are we seeing what's their disciplinary base and what are the opportunities for and what are we already seeing in terms of the way those disciplines are being integrated. So cross-disciplinary research is an umbrella term covering the three type typologies where there's different two at least disciplines brought together and combined sometimes integrated and different concepts methods and theories are brought together and this can be done in teams across collaborations and networks or by an individual. So the value of cross-disciplinary research is that in tackling complex challenges like global health challenges bringing different disciplines can lead to a more comprehensive understanding, greater innovation and also there can be in cross-disciplinary research a good and strengthened ability to be able to translate that knowledge into practice so to have an influence on policy and practice in ways that address societal challenges including health. So an opportunity but also a challenge in working in a cross-disciplinary team is that often we're working across quite different overarching paradigms or ways of understanding the world of understanding what counts as knowledge and I'm in this screen here I've brought together the two dominant different types of paradigms that are that feature in many disciplines and I've put them on a spectrum to show the extremes to make the point but on the left hand side we have one of the dominant paradigms which is a positivist paradigm and here the understanding of the world is that in an extreme putting it in an extreme way is that there's a single reality that exists out there that's independent of human experience and in this paradigm there's an assumption that there can that reality can be understood with the right methods and that the right methods tend to be experimental quantitative and deductive in the way that they work and with a researcher in this paradigm they should largely be absent from that reality so they should be able to examine it in an unbiased way or at least be controlled for. That's very different from an interpretivist paradigm or way of understanding the world in this paradigm the reality itself is understood to be very complex very multi-layered there are multiple realities and that these are constructed and shift over time and place through people's different experiences and interactions so a single phenomenon might be interpreted very differently by different people or even the same person might interpret a phenomenon differently when they move between new contexts so here the knowledge is about trying to understand this complexity and these multiple realities and qualitative inductive approaches are seen to be much more appropriate for that and the researcher is not trying to be controlled for or unbiased but the researcher is really key in constructing the knowledge and their different values perspectives and influences that they bring to that knowledge it's really important in qualitative interpretivist paradigms to be open about that and recognize it so just to give an illustration of how that works for instance in TB a more positivist paradigm and approach would be to say that TB is caused by TB Bacillus and people either know or they don't know the cause of TB and that's a understandable and a perspective to have on the other end of this perspective is that TB is interpreted and experienced very differently by different people in different places depending on their social locations and also the context in which they're operating so there are different questions that might be tackled that have different underlying epistemological assumptions across this spectrum so even just looking at that example what we can see is that there's a big opportunity of working between and across different disciplines but it can also be challenging and come back to some of those challenges so in terms of thinking about the scope of cross-disciplinary research one way is to think about what are the different disciplines the different paradigms that are being brought together but also another set of dimensions to think about are also illustrated in this slide so organizational scope and they might be working more within an organization or across sectors it could be in geographical scale and it could also be in analytical scope so the foci of the project or piece of research so I find this visual together we're thinking about the different disciplines helpful in terms of thinking about with our different cross-disciplinary research where do we sit along these dimensions and it also helps to show how complex and cross disciplinary research can be so moving more specifically to implementation research I mentioned that this is one form of research in the field of health policy and systems research and it's often multi-disciplinary cross-disciplinary in fact implementation research actually builds on different research traditions across that spectrum of paradigms that I introduced and so for that reason there can be really considerable debate over its scope the different theories involved methods and areas of emphases but a really broad definition is highlighted on this slide and was in the paper by Theobald et al in the Lancet so this is the scientific inquiry into questions concerning implementation so carrying an attention into effect and in health research it could be policies programs or individual practices a more specific definition is again emphasizing the scientific study of methods to promote the systematic uptake of a whole range of different types of interventions that have already been proven but to systematically uptake them into routine practice in order to improve health and in this context it could include a range of different types of influences on patient healthcare professionals and looking at organizational behavior it could be in a range of different healthcare facilities healthcare provision settings or in communities what's really important is that the outcome of interest is the measure of delivery as opposed to the health status of the subjects so both of those definitions and all definitions emphasize scientific methods and rigor and one way to do that is to use different theories and frameworks either to test apply or to build them depending on which spectrum across the different paradigms one might be working from so this is just one example of a well-known framework for implementation research and it requests or it includes thinking about five different dimensions that should be considered in looking at an intervention and how it fits and shifts in context and so the intervention characteristics of which there are many different elements on the right hand side of the drawing at the bottom the characteristics of individuals involved in the intervention and its implementation in context those who are affected by it as well as the inner settings so closer context in which interventions are operating and the broader more wider context the sociopolitical context the influences that more inner setting or inner context as well as the processes of the intervention and how it functions and shifts over time and all of these different dimensions are constantly shifting and interacting with each other so for example individuals have agency and they will act in ways that are not necessarily as intended by interventions in ways that are very much shaped by the inner and outer contexts so in terms of defining characteristics for implementation research in that paper that I mentioned earlier in the Lancet there are a whole series of defining characteristics that are down the left hand side of the slide there just to highlight a few that I haven't mentioned yet. Implementation research should be demand driven and involve multiple stakeholders as well as multi be multidisciplinary and so in being demand driven it should be being tailored to those who are going to be using and needing the information that's being developed through the research or that's being constructed through the research and so then stakeholders who might be involved might well be policymakers, health managers, potential beneficiaries within health systems or within communities. Implementation research should also be real world and real time so it shouldn't be dealing with imagined ideal world situations but more like the often messy realities and very complex realities of the real world and findings are often needed in real time in order to make a difference because of the pragmatic orientation of the field. So those are some of the defining characteristics and some of the challenges and trade-offs that the field has are in terms of rigor and adherence to the methodological requirements of different disciplines that are being brought together often quite time consuming so balancing this need for rigor against the need to be timely in producing findings and making sure that they're usable and often the people who want the findings from implementation research want it much faster than researchers can produce it. A second trade-off or challenge is about whether the implementation research should be embedded within the system or the organization that's being studied and adapted and learning while the implementation is going on or whether it should be more external and objective and able to view and learn from outside. Another trade-off is between being very context specific so that the research is really useful in the particular context really understanding it in depth and detail and against wider learning and being able to have more generalizable transferable findings and this is where the theories and the frameworks can be so important and useful in terms of that wider learning. Another trade-off is between and it's similar to the others whether the interest is to study and maintain fidelity of a particular intervention over time so fidelity being the intervention remaining as it was initially designed and intended versus the adaptation and learning over the course of implementation and some of these trade-offs and where people sit within these trade-offs might depend on where they fit on that spectrum that I introduced earlier of the different paradigms and the combinations of those different paradigms and how they're brought together. So the really key message about implementation research is that really to do implementation research one does have to embrace complexity and it's far more than being able to do it with a few interviews. There's a need for rigor, there's a need to incorporate theory and frameworks and to build these and strengthen them and there's also need for engagement with multiple different players with researchers, with health managers, policymakers, participants and across different disciplines. For implementation research and for cross-disciplinary research more generally there can be a lot of challenges working across those different paradigms can bring quite big differences and the challenge of coming together and having shared understandings and outputs can be quite big. There can be competition across a research project or program between the different disciplines in terms of where are the resources split, how are they split, how fair is it, what are the workloads, who gets credit for the outputs and the different paradigms can mean that there are quite different understandings of what counts as knowledge, what is a measurement, one of the sort of standards around measurements, quantitative, qualitative, some of the framing of concepts for instance validity, often in a more interpretive framework might be thought of more as transferability and trustworthiness where theory and practice fits in the disciplinary backgrounds can also be quite different and lead to some debates and challenges of bringing these different perspectives together. So the overall message is that cross-disciplinary research across all of these different sort of resources and so on is it can be extremely valuable in knowledge and in translation but it's also hard and this paper that I introduced by Yanding and colleagues is valuable in bringing together different practical actions ideas for this from the literature for fostering cross-disciplinary research and they give a whole load of different ideas for academic institutes, research team leaders, research funders and individuals so if anybody's interested in this I think that's a really good paper to read and the team have also published a whole series of shorter learning briefs or materials that are available online so we can we can share how to access those resources if anybody's keen to see those. There are also many resources online for implementation research more specifically so there are practical guides available, research toolkits, there's online training courses so lots of opportunities to learn about and get more engaged in this more implementation and cross-disciplinary work. So that's an introduction to interdisciplinary research and what we're really hoping for this seminar series is that we'll have an opportunity to be exposed to different methods and approaches from health policy and systems research which I've mentioned is itself multidisciplinary and to be able to see how these different methods and approaches are drawn into examining different global health challenges. Those challenges and the approaches are very much overlapping but we also just hope it's an opportunity for us all to make new connections and learn about what's happening in different parts of the world and we really value hearing from all of you on this call about your own examples, resources, insights that we should we should be accessing and learning about.