My PhD journey started when I joined the University of
Salford in 2015. Before this I had completed a BSc in Sport & Exercise
Science and an MSc in Clinical Exercise Physiology, followed by several years
working as a researcher in the health technology industry. Along the way I had
also completed qualifications in gym instruction and exercise referral
instruction. Therefore, the planets aligned well when an opportunity arose to
complete a PhD about exercise referral schemes, combining research experience
with personal interests.
Exercise referral schemes are one of the most common
approaches to increasing physical activity levels in people with long term
conditions, providing access to individualised exercise programmes and support
from qualified exercise professionals. There are hundreds of these schemes
operating across the UK, illustrating their popularity as a method of physical
activity promotion. However, the evidence base underpinning the effectiveness
of these schemes to-date has been poor. The aim of my PhD was to contribute to
this evidence base, by evaluating Tameside’s “Live Active” exercise referral
scheme.
Fortunately, the scope of my PhD was quite broad, meaning
that I could develop and practice a wide range of research skills. The majority
of my data was quantitative, some of which was secondary data collected by the
scheme, and some of which I collected using accelerometers. With so many different types of data, I found myself
conducting several types of statistical analyses, from simple to complex
statistical tests, several of which I was trying for the first time!
Fortunately, I was able to take a break from all of this quantitative data, by
conducting a qualitative study. This was the most enjoyable chapter for me, and
in the end, turned out to be a very important chapter, revealing findings that
were central to my final conclusions.
Dr Faye Prior with supervisor Dr Margaret Coffey at graduation
In March 2019 my PhD journey came to an end, when I successfully defended my thesis at the viva. Following this, I was fortunate enough to be offered a position as a senior research associate at the Equality and Human Rights Commission. Health inequalities were an important consideration in my thesis, and have always been an area of interest and motivation, so this is a fantastic opportunity to explore equality and human rights more broadly. I have no doubt that I would not be in this position, if it were not for the research and transferable skills that I developed throughout my PhD, with the help of my fantastic supervisors, Dr Margaret Coffey, Dr Anna Robins, and Prof Penny Cook. By the end of your PhD, you will have developed more skills than you may realise, some of which will be quite broad and highly valuable, and you must not forget this when planning your next steps after the PhD!
Of course, for myself, and many other students, the PhD
journey provided an opportunity to experience and practice more than just the
intricate details of research study. Throughout the three years I attended
several conferences, both home and abroad, sharing the findings of my research
through posters and oral presentations. I also met several other researchers at
these conferences, with the same research interests as myself. It has been
great to stay in touch with these people, to discuss our research, provide each
other with feedback, and some have been kind enough to invite me to collaborate
on their work in the future. It was also great to complete this PhD with a
partner organisation, Live Active, where I got to develop my stakeholder
engagement skills, and attempt to influence practice with my research findings!
Teams4U is a charity that brings volunteers from the UK to make a difference in children’s lives in countries including Bosnia, Belarus, Romania, Sierra Leone and Uganda. This was my third visit with Teams4U to the Mukongoro district of Kumi Region, Uganda, to participate in their work with schools to improve public health. In recent months Teams4U’s attention has focused on reducing the days missed from school due to sickness and diarrhoea. An intervention to improve hygiene and sanitation has been developed.
Teams4U volunteer with school children
Basic sanitation
There is no water supply or electricity supply to the public schools, although there is typically a hand pump installed at the perimeter of the school grounds, which is shared resource for the school and the local public. There are usually three or four pit latrines for the children to use. The latrines often have no doors for privacy and used by around 1000 children, making the smell and flies unbearable. There is no source of water nearby for hand washing.
Open pit latrine
When children are at home, there are also often no hand washing facilities. Each day water is carried from the nearest hand pump and stored in water containers for cooking and washing, but many homesteads lack a drum with a tap for easy hand washing. Some families are not aware of the importance of hand washing to prevent disease.
A typical homestead
Sanitation solutions
A ‘Tippy tap’ is a contraption that is simple to make with a small water container, rope and wooden supports. A child can easily tip the drum to let the water out by using the foot operated lever. They are suitable for use at a homestead. Some schools have been using them, although a single tippy tap is inadequate for the typical school which has over 1000 children.
Demonstrating the tippy tap
With support from the Welsh Government, Teams4U have begun to install simple hand washing facilities, comprising a large tank with two taps and bars of soap on string. These tanks can store sufficient hand washing water for a whole school. They still require filling by hand, but schools arrange teams of children to carry water from the pump to the tank as part of their daily chores. The tanks can be drained during holidays to allow them to be cleaned. Some schools fill their tanks with soapy water to get over the problem of soap bars going missing.
Hand washing using a new tank supplied and installed by Teams4U
The Teams4U installation also includes ‘toilet flappers’ fitted to each of the long drop latrines and signage about hand washing on the walls. The toilet flappers are simple devices that remain closed to seal off the odours and stop flies from entering the long drop. They function similarly to the flaps in the portable toilets that are used in festivals in the UK.
Toilet flapper to fit to a pit latrine
Volunteers get involved
The whole school also watched as Teams4U volunteers acted out a hand washing story about a Ugandan boy who does not wash his hands and becomes ill. In the story he then learns about hand washing and when to wash hands. The story features the family’s naughty goat, who causes great hilarity amongst the children when he runs amok. The use of the tippy tap is demonstrated, and the boy learns how and when to wash his hands properly. He learns to wash his hands after handling animals, after using the toilet and before meals. He finds in the future he is no longer ill.
Volunteers performing the play for the whole school
As in previous trips, the Teams4U volunteers visit a school each day for seven days. The morning activity is a physical activity intervention where all 1000 or so children take part in simple team games. In the afternoon, there are sessions for the older children that focus on puberty, development and respect for women. These have been the subjects of my previous blogs. There is also an opportunity for volunteers to play with the children. The challenge is to think of activities that overcome the language barrier and can be done with hundreds of children at a time! Successful activities include simple face painting, balloons and bubbles.
Teams4U volunteer face painting to entertain the school children
Click here to see a film of a volunteer entertaining the children with bubbles
The interventions with the children are supported by an education programme for the key church leaders, health care workers and senior women teachers. This is supported by funding from the Department for International Development (DFID). The training aims to provide a legacy for the ongoing education of the children in hygiene and disease prevention, dignity and respect, puberty, menstruation and sexual health.
Volunteers supporting the training of the teachers
How do we know it works?
The onus is on the charity sector to deliver an intervention that has a lasting impact. At schools we visited, there is evidence of previous well-meaning interventions that have had no impact. I asked why the schools needed Teams4U’s water drums when some had evidence of large water storage drums. I was told that the drums had been designed to collect rain water, but no one had ever installed the guttering to harvest the water. Boxes containing computers sit unopened in schools that have never had an electricity supply.
Volunteer in the classroom
In addition to the work to educate local leaders on how to sustain the benefits of the interventions, Teams4U will be collating data on school attendance in the coming weeks in order to determine whether the hygiene interventions have had an impact on absence due to diarrhoea. The aim will be to provide the intervention to all 150 primary/junior schools in the Mukongoro district. The charity has already demonstrated that its puberty and development sessions (‘Develop with Dignity’) are effective: knowledge of menstruation increased after the education sessions, and fewer girls miss school because of their periods.
Girls receiving washable sanitary ware as part of the Teams4U intervention
Get involved
You can join in and help run the sports, ‘Develop with Dignity’ and sanitation programmes. Read more about volunteering opportunities on the Teams4U website. If you come as part of the University of Salford’s BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme during a heavily subsidised 10 day trip (the students pay £200 towards the cost of the trip).
A powerful experience for the volunteers
It is difficult to describe the pure pleasure that these children get from a little attention from the visitors. The impact on the volunteers is also profound as we experience the simple joy that children get from a hand shake or a stream of bubbles. It is also humbling to think how we take our children’s education for granted. In Kumi, there are no staff to clean the school. The sweeping of the classrooms, the fetching of the water and the cleaning of the toilets is all done by the children. Some of the forward thinking schools grow their own vegetables, and the children also tend to these. In several of the schools we are greeted with songs of welcome. The children also sing songs that describe how seriously they take their learning in order to better their lives. We found this truly humbling.
Children playing team ball games as part of the Teams4U intervention
With its numerous and diverse cultures, Winston Churchill wrote “Uganda is truly the Pearl of Africa” and went on to say “The Kingdom of Uganda is a fairy tale. The scenery is different, the climate is different and most of all, the people are different from anything elsewhere to be seen in the whole range of Africa….what message I bring back…concentrate on Uganda”. Over one hundred years later this is still true, and Uganda, relatively untouched by tourism, retains a taste of Authentic Africa.
Children at a primary school in Kumi
The University of Salford has been working with charity Teams4U for over eight years. Recently, the University’s partnership with Teams4U has been developed to allow students to gain hands-on experience of delivering a public health intervention programme in rural Uganda, learning how to break down cultural barriers and to communicate with the people they serve in order to make the programme a success. Students on our BSc Public Health and Health Promotion course have the opportunity to take a subsidised ten day trip to Uganda (the student pays £200 towards the cost).
The Teams4U Uganda programme is the brainchild of honorary Salford graduate Dr Dave Cooke, who wondered if physical activity could help primary school children to achieve better results at school. Since it began, the programme has evolved and changed to tackle some of the underlying issues that lock communities in a cycle of poverty.
Small changes make a big difference
The experience of handing a football to a child that has never touched a ball is something that is difficult to describe. Before the programme began, children in rural primary schools in the Kumi district of Uganda didn’t have PE lessons; with class sizes at over 100 children per teacher, finding an activity that they could all take part in was difficult. To make matters worse, the budget for most schools is just £1.50 per child for the whole year, meaning they can’t afford basic sports equipment like footballs. Often the schools aren’t funded at all – the money just ‘disappears’.
Playing the team games with Teams4U
The concept of the programme is simple, but the impact on the children is profound – headteachers have even said they felt inspired to change the way they teach as a result. However, this is where students can get involved in vital research, as many questions still need answering: does the experience of the teachers of the programme change their attitudes to physical activity? Does the donation of balls for football, netball and other activities have an impact on physical activity and sports in the schools?
Breaking the cycle of poverty
The programme also revealed other barriers to education that children in the community face. While both girls and boys are often kept off school to help out at home or work in the fields, girls in particular are not always encouraged to attend school. To add to this, we found that a big problem keeping girls from school was the lack of feminine hygiene products and limited access to water, meaning that they were missing up to a quarter of their schooling.
Keen to break the cycle of poverty where children drop out of school, girls have babies very young and have large families that they can’t support, the team set up two separate programmes to tackle these issues. The first, ‘Develop with Dignity’, provides washable pads for girls to use, meaning they now feel comfortable going to school on their period. Secondly, we organised educational sessions with parents, children and community leaders to discuss the importance of staying in school.
Girls receiving washable menstrual pads and underwear
Again, research is needed to understand exactly how these interventions work: does the intervention increase school attendance, for girls in particular? Are parents and the community more aware of the importance of education?
Join a trip to Uganda
You can join in and help run the sports and Develop with Dignity programmes. If you come as part of the BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme.
Our volunteers often find that while they go to Uganda with the intention of serving, they end up gaining more than they give: the experience of sharing time with children who get so much joy from the simple gift of your time and attention.
Find out more
Watch this video about the University of Salford’s public health and health promotion opportunities in Uganda
To find out more about the other public health and health promotion work that the University of Salford and Teams4U have carried out in Uganda, go to our related blog posts
I have been given the amazing opportunity to take part in some practical public health interventions in rural Uganda, with Teams4U, an organisation with many years’ experience of work with poverty. My aim is to get some insight so that I can plan trips in the future for University of Salford’s public health students.
Day one
Our journey here from Kampala had taken us 5 hours, during which we had glimpsed some of the poverty that is a reality of everyday life in rural Uganda: the roads were dirt tracks; people were pumping and carrying their water; children were dressed in rags; homes were shacks with little in the way of a decent roof.
Basic living conditions
Day one of the field-work happens to be Sunday. On Saturday night, the leader of our team of volunteers discovered that we were expected to be at a local Church for the 7am service. Thus, at 5.45am we were up, ready to set off at 6.30am. We learned that no practical intervention in the community can happen around here without the involvement of the church–it is the hub of the community, and it serves as a means to spread practical messages to the local people. The priest will be working with us all week in the various schools that we will be visiting. The church service lasted 2 hours, during which we had to get up at the front and introduce ourselves to a few hundred people. It was through the church that the community had been told about our visit, and invited to one of the local schools for a day of fun and activities.
Going to church
Games
By 10am we were at the school. Being a Sunday, we were uncertain of how many people would turn up. In a very well organised operation we started to play team games with the children. There were hundreds. We did the games with batches of 8 children (for each of the 14 team members). We did this 3 times–first with some smaller boys (aged 5 to 12), then with girls (9-14) and then with some older boys (10-16). The games all involved running up and down, sometimes with a ball. They varied in each set, depending on age and gender; for example, games were more complicated for the older ones, and we had been warned that girls often did not own underwear, so we did not do any games involving somersaults. We were on the field without a break for nearly two hours, in the heat: absolutely exhausting but really good fun.
The games served as a draw to the local community, and while the fun was going on, adults were being tested for HIV, and if needed, able to obtain antiviral drugs straight away. We now also had the opportunity to do some basic health interventions with the children, after the games were over.
‘Develop with dignity’ intervention
Sanitation is very poor at this school. There is no water and open pit latrines. Once the girls have started their monthly menstrual periods, the lack of facilities, and lack of any means to manage their periods causes them to leave school for a few days each month. Girls typically manage their period using rags to absorb the blood. Fear of soiling clothing and embarrassment keep them away from school, causing them to miss up to quarter of their education. The aim of our intervention was to explain some basic facts about puberty, sex and management of menstruation. The highlight of the intervention is when we supply the girls with their own pack of re-usable, washable ‘Afripads’, and knickers to hold the pads in place. We also had a sack of donated bras, which the girls were absolutely delighted with!
The girls were very pleased with their washable pads and new knickers
As we left the school, children squabbled over our empty water bottles, which appeared to be a much sought after prize, reminding us how much we have and how much we take for granted. When we saw small groups of children we were able hand out little toys and gifts.
