Challenges and Opportunities of US and Arab Collaborations in Health Services Research: A Case Study from Qatar

Abstract

Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly “North-South” collaborations in which the more developed “North” country works together with a developing “South” country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research methodology or techniques and research implementation. This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building a successful research collaboration between a team in the United States and a team in Qatar, a rich Arabic nation in Gulf. We present a case study that provides an overview of our own project focused on the development of a culturally and linguistically adapted health care quality instrument for Qatar, discussing many of the benefits and challenges we encountered during each phase of instrument development. We present recommendations for researchers seeking sustainable and equitable partnerships with the Arab World.

Achieving Integration in Mixed Methods Designs—Principles and Practices

“…Items for inclusion in a survey are built upon previously collected qualitative data that generate hypotheses or identify constructs or language used by research participants. For example, in a project involving the cultural adaptation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for use in the Arabian Gulf (Hammoud et al 2012), baseline qualitative interviews identified new domains of importance such as gender relations, diet, and interpreter use not found in the existing CAHPS instrument. In addition, phrases participants used during the interviews informed the wording of individual items.…”

The 3 Cs of Content, Context, and Concepts: A Practical Approach to Recording Unstructured Field Observations

“…served as co-principal investigator on a multistage, mixed methods parent study in Qatar to develop a health care quality assessment instrument that was adapted for populations whose native languages were Arabic, English, Hindi, and Urdu. 44 A theoretical model, Cultural Construction of Clinical Reality developed by Kleinman et al, 45 guided the research. During the first stage of qualitative data collection, Qatari team members expressed concern about how potential participants would respond to recruitment strategies dictated by US-based institutional review boards.…”

Patient responses to research recruitment and follow-up surveys: findings from a diverse multicultural health care setting in Qatar

“…To date, no published study has compared response rates of surveys conducted in person versus by mail, nor has any study reported participants’ preferred procedure of data collection or preference for reminders in Qatar or the Middle East. Few studies suggest strategic methods to help recruit participants in a multicultural context [ 26 , 35 ]. One generally useful strategy is to hire research assistants (RAs) who reside in-or have built trust with-the community, or who have the same cultural background as the potential participants [ 2 , 3 , 5 , 23 , 25 , 27 , 29 ].…”

“…Community-based research and research networks are not yet well-established in Qatar; moreover, research awareness is relatively new in this highly linguistically and culturally diverse society [ 35 ]. Understanding the pros and cons of different recruitment strategies is particularly important in Qatar, where postal addresses are mainly work addresses or personal post office (PO) boxes.…”

“…Given the mosaic population in Qatar, the researchers sought to develop a robust measure of acculturation, the Multicultural Assessment Instrument (MAI). Development and testing of this novel instrument is part of a bigger multistage investigation funded by the Qatar National Research Fund to develop a health care quality-assessment instrument in the four most commonly spoken languages in Qatar: Arabic, English, Hindi, and Urdu [ 26 , 35 ]. The overarching theoretical framework for the entire multistage mixed methods investigation was the “cultural construction of clinical reality” model originating from the work of medical anthropologist Arthur Kleinman [ 38 , 39 ].…”