Building Qualitative Research Capacity Among Interdisciplinary Teams to Investigate Girls’ Challenges With Menstruation: Process and Lessons Learned From a 14-Country E-Course

Abstract

Public health–related decisions are influenced by a variety of actors operating on local to global levels, including community leaders, educators, nongovernment organizations, government officials, donors, and researchers, many of whom may lack formal public health training. The provision of public health instruction to interdisciplinary professionals has the potential to strengthen the capacity of all stakeholders to make informed, evidenced-based decisions about health policies and programs. The use of online learning is emerging as a promising means of providing public health training, particularly among those living in geographically disparate areas and from multidisciplinary backgrounds. This article describes an online course created to teach participants in stakeholder teams from 14 low- and middle-income countries how to design and conduct qualitative research to understand girls’ challenges managing menstruation at school. The goal of the course was to strengthen each country team’s ability to conduct research by building the capacity of the members. Thus, completion of the course by all team members was an objective, but less of a focus than assuring that each team as a collective was gaining public health insights and working together to make informed decisions about their research goals. This course led to benefits beyond capacity strengthening, including the formation of a broader community of learning and practice that extended beyond country boundaries. We recommend embedding training opportunities for multidisciplinary stakeholders into research endeavors given the potential for positive effects on individual participants and overall policy decisions to improve community health and provide lessons learned for doing so.

Keywords

distance learning qualitative research online course stakeholder engagement

Introduction

Public health–related decisions, including the development of policy, allocation of funding, and the development and dissemination of support programs and services, are influenced by various actors operating on local to global levels, including community leaders, educators, international and local nongovernment organizations (NGOs), government officials, donors, and researchers. This diversity of perspective is integral to solving complex public health problems (Albrecht, Freeman, & Higginbotham, 1998). While the diversity of perspective, background, education, and experience is critical, public health or related training can specifically enable stakeholders to rigorously assess the contribution of available evidence, how it was obtained, and if further research may be warranted.

Furthermore, the provision of public health instruction to multidisciplinary teams, including those with and without formal public health backgrounds, has the potential to create opportunities for collaboration, enable the exchange of ideas from varied perspectives, catalyze movement on a common agenda from multidisciplinary ends, and build or strengthen the capacity of stakeholders to make informed, evidenced-based decisions about public health policies and programs.

The use of online learning, defined here as per Ally (2008) as the use of the Internet to acquire knowledge, grow, and construct personal meaning by accessing learning materials, interacting with content, instructors, and learners, and gain support while learning, is emerging as promising means of providing public health training (McKinney, 2017; Mincey, 2015). The use of online teaching platforms can connect learners with instructors and subsequently has the potential to increase the size of the public health workforce (Rosenstock et al., 2008). In the United States alone, online course enrolment increased from 5.9% in 2000 to 32.1% in 2012 (Ortagus, 2017), demonstrating a growing acceptance of this form of learning. Moreover, online courses can connect learners with one another, resulting in the creation of networks and communities that can enable action learning and problem solving around common areas of interest (Finch, Burrell, & McAfee, 2012). Those with similar goals who are living in geographically disparate areas and/or lacking opportunities for in-person training or education may benefit the most (Stamatikos & Ratnapradifa, 2011), including professionals who engage in public health work but are not public health professionals in title. A review of e-learning initiatives specifically for medical education in low- and middle-income countries (LMICs) concluded that e-learning can result in increased learning opportunities for students, but cautioned that quality of instruction and Internet connectivity, computer availability, Internet bandwidth, cost-effectiveness, and faculty and student ability to navigate the e-learning platforms can present challenges (Frehywot et al., 2013).

The aim of this article is to describe the development, facilitation, and lessons learned of an online course created to teach participants in teams from 14 LMIC countries how to design and conduct qualitative research to understand girls’ challenges managing menstruation at school. The goal of the course was to strengthen the ability of each country team to carry out research by building the capacity of the members. By the end of the course, we wanted all teams to have (a) a common base understanding of how menstruation poses challenges to adolescent girls in school and why it is important; (b) a foundational understanding of principles and tools of qualitative research methods, including ethics; (c) strengthened multidisciplinary connections within their own country teams, as well as with teams from other countries; and (d) locally generated evidence to inform policy and program decision making. Thus, completion of the course by all team members was a hope, but less of a focus than assuring that each team as a collective was gaining insights and working together to make informed decisions and progress on their collective research goals.

In this article, we provide a justification for developing the course, describe course participants, provide an overview of content and delivery, outline key achievements of country teams, and provide recommendations and lessons learned for future online learning initiatives aimed at strengthening public health capacity, particularly among nonpublic health professionals in LMICs who share common objectives.

Justification for Course Development

Menstrual hygiene management (MHM) has been recognized as a public health issue that is gaining attention in the global sphere (Sommer, Hirsch, Nathanson, & Parker, 2015). Qualitative research from Bolivia, Ghana, India, Kenya, Mali, the Philippines, Sierra Leone, Tanzania, and elsewhere have found that girls lack practical knowledge about menstruation, access to appropriate water and sanitation facilities and materials for managing their periods, and social support for understanding what is happening to their bodies, leading girls to report confusion, shame, fear, stress, teasing, distraction, reduced participation during class, and missing school (Alam et al., 2017; Caruso et al., 2013; Ellis et al., 2016; Girod, Ellis, Andes, Freeman, & Caruso, 2017; Haver et al., 2013; Long et al., 2013; Mason et al., 2013; Phillips-Howard et al., 2015; Sommer, 2009; Trinies, Caruso, Sogore, Toubkiss, & Freeman, 2015; van Eijk et al., 2016). Yet, despite growing research around this emerging topic, it remains so nascent, and taboo (Sommer & Sahin, 2013), that research has not been undertaken in many countries for policymakers and practitioners to understand girls’ experiences in their own local context. Furthermore, NGO practitioners, policymakers, donors, and other actors have limited guidance for how to address girls’ challenges.

There is consensus that action needs to be taken to ensure that girls can manage their menstruation while at school in a comfortable, dignified, safe, and equitable manner, and that local research is needed to inform enabling strategies. A recent call to action article outlined key priorities for addressing girls’ menstrual hygiene needs in schools, including building a strong cross-sectorial evidence base of local research to understand the contextually specific needs of girls to inform policy and practice (Sommer et al., 2016). A subsequent article outlining research priorities highlighted the need for participatory qualitative methods to ensure girls’ voices are integrated into policy decisions that impact their lives (Phillips-Howard et al., 2016).

In 2012, Emory University and UNICEF collaborated to research girls’ menstrual experiences at school in Bolivia, the Philippines, Rwanda, and Sierra Leone to provide local actors with evidence to inform policy and programs, resulting in the development of an overarching research methodology, various reports and manuscripts, an open-source booklet of tools for adaptation to other contexts, and increased interest from other UNICEF offices to conduct similar research (Caruso, 2014; Caruso et al., 2013; Haver et al., 2013; Long et al., 2013). To address this interest, UNICEF led the “WASH [water, sanitation and hygiene] in Schools for Girls: Advocacy and Capacity Building for Menstrual Hygiene Management through WASH in Schools Programmes” (WinS for Girls) project with funding from the Government of Canada (Sinden, Sahin, & Francois, 2015). UNICEF approached Emory University to develop and facilitate the e-course described here to build in-country qualitative research capacity, strengthen local ownership and investment in the issue, and connect teams with various stakeholders from across the globe carrying out similar work. Both UNICEF and Emory University agreed that the e-course approach would have a more lasting impact in terms of capacity, agency, and collaboration, than if Emory University lead the research itself, as had been done previously.

Course Participants

Twenty-six UNICEF country offices applied to headquarters to participate in the WinS for Girls program. Based on demand and geographic representation, the UNICEF headquarters selected 10 country teams from Afghanistan, Bolivia, Burkina Faso, Eritrea, Ghana, Kyrgyzstan, Mongolia, Niger, Nigeria, and Zambia. Four additional country teams received partial funding to participate given they had ongoing funded MHM research activities: India, Indonesia, Nepal, and Pakistan.

All selected country offices were advised to establish working groups composed of UNICEF staff, local government officials, local university and practitioner partners, and hired research consultants. All country team members were eligible and encouraged to enroll in the online course.

One hundred and twenty-seven participants enrolled in the course in November 2014, representing all 14 countries. At a midpoint check-in in March 2015, only 81 indicated they were able to continue participation. Of the 46 participants who discontinued participation, 28 (61%) were from the four countries that had ongoing research activities on MHM and did not receive full funding to participate in the program. As a result, two countries (India and Indonesia) no longer had any participants in the course. Research in both of these countries was well underway when the course started and later modules were not as relevant as a result. Of the 81 that remained in the course until the end, 32 (40%) were UNICEF staff, 22 (27%) were government staff, 8 (10%) were local research partners, 15 (19%) worked for local partner NGOs, and 4 (5%) were hired consultants (see Table 1).

Table 1.

Participants Enrolled in the Course and Receiving Certificates of Completion by Affiliation.

Participant affiliation	Enrolled in course at midline		Represented on country team certificate at end^a		Earned any individual certificate^b		Earned basic individual certificate^c		Earned individual certificate with excellence^d
All	81		80		44		19		25
UNICEF	32	40%	32	40%	17	39%	9	47%	8	32%
Local nongovernment organization partner	15	19%	15	19%	5	11%	1	5%	4	16%
Government	22	27%	21	26%	15	34%	6	32%	9	36%
Research partner	8	10%	8	10%	4	9%	2	11%	2	8%
Consultant	4	5%	4	5%	3	7%	1	5%	2	8%

Team certificates given to country teams who completed all course assignments. ^bAny certificate is either the basic certificate or certificate with honors. ^cBasic certificates given to participants who completed 12 module quizzes (indicating viewing of all course modules). ^dCertificates with excellence given to participants that completed 12 module quizzes and posted at least 12 times on the discussion board.

Course Content and Delivery

Modules

The course included 13 modules taught live online at the same time for all participants approximately every 2 weeks from 20 November, 2014, to 28 May, 2015. It was intentionally spread over several months to provide sufficient time for participants to apply knowledge gained from class sessions between modules. Coauthors BAC, AE, and MS designed the outline of the course anticipating participants had little to no previous research experience or understanding of girls’ experiences of menstruation in school settings.

The course provided topical background and addressed three distinct research phases: preparation, execution, and application (see Table 2). Background modules (1-3) provided a broad overview of research on MHM in schools, water, sanitation, and hygiene (WASH) in schools, and key concepts in gender research. Research preparation modules (4-8) introduced participants to research ethics; described the fundamentals of research planning, with emphasis on working with multiple stakeholders; discussed the strengths and weaknesses of qualitative and quantitative research methods, particularly for taboo subjects like menstruation; and instructed participants on how to adapt and develop research tools. Research execution modules (9-11) covered data collection and management, research assistant training and piloting, and data analysis. Last, the research application modules (12 and 13) covered advocacy and application of findings for program planning. Modules and associated assignments covered several global health competencies expected of master’s-level students as recommended by the Association of Schools of Public Health at the time (see Table 2; Ablah et al., 2014). A syllabus with in-depth descriptions of each course module (Caruso, Ellis, & Sahin, 2015) and associated slides and materials (UNICEF, 2015) are available online for public use.

Table 2.

Course Modules and Associated Learning Objectives, Discussion Board Questions, Assignments, and Competency Domains.

Overall learning objectives of modules and assignments	Discussion thread questions	Assignments	Corresponding ASPH global health competency domains
1. Introduction to WinS for Girls Program
Understand objective of program; Learn local protocols for ethical approval	What are the expectations that you have for the course (i.e., What do you hope to learn)? What are the expectations that you have for Emory University course instructors?	Research local ethical review protocols	3: Ethical reasoning and professional practice
2. MHM and WASH in Schools
Understand existing evidence on MHM in Schools	After Module 2, you may have some additional questions about puberty, adolescence, and menstruation. While these topics might be difficult to discuss sometimes, we encourage you to write your questions or observations here.	Conduct a desk review of local MHM, WASH and gender-related research, policy and practice	4: Health equity and social justice;6: Sociocultural and political awareness
3. Incorporating Gender Into MHM Programming (Guest lecture by Sue Cavill with support from Amritpal K. Sandhu)
Understand how to address gender in research and programming	What are some examples of gender norms in your country or region? How do you plan to integrate gender into your MHM research or future programming?	Conduct a desk review (continued)	4: Health equity and social justice
4. Fundamentals of research ethics
Know principals of research ethics and how to obtain ethical clearance	How can you enforce privacy and confidentiality of your participants? What might be the challenges to participant privacy in your country?	Collectively brainstorm research ideas and priorities	3: Ethical reasoning and professional practice
5. Planning MHM research
Understand how to design and write a research protocol; engage local actors as relevant	What special considerations in your country will you need to take into account when determining your sampling plan? What challenges might you encounter related to your ideal sampling plan?	Map key stakeholders (NGO, research, government)	5: Program management
6. Understanding qualitative and quantitative methods for MHM research
Understand the strengths and weaknesses of qualitative and quantitative research approaches	When in the past have you used qualitative and quantitative research methods to inform or improve programming? How and why did you select your methods?	Outline draft research plan	5: Program management
7. Tools for MHM Research, Part 1
Draft objectives for research tools	Tell your fellow classmates about one of the methods you will be using in your research. Why have you chosen this method and what areas of inquiry do you want your tool to address?	Adapt existing MHM tools; create new tools as needed to align with identified research objectives	5: Program management
8. Tools for MHM research, Part 2
Draft objective-driven research tools	Of the different methods that we discussed in class during Module 8, which methods will you use and why? What objectives will you seek to answer more completely using triangulation?	Continue drafting objective-driven research tools	5: Program management
9. Collecting data: Recording, note taking, and managing data
Be able to create a work plan to conduct research activities and manage data appropriately	What are the resources you possess to protect data management? Is it possible to adhere to strict research protocols while in the field? What are the research activities that you have planned for your research protocol?	Continue drafting objective-driven research tools; Refine draft research plan	5: Program management
10. Training, piloting, and execution of research
Understand how to train research assistants, pilot tools, carry out research	What research challenges are you experiencing? How could you better prepare your team on these challenges through training?	Revise previous assignments based on feedback	5: Program management
11. Analyzing collected MHM data to identify key issues
Understand how to develop strategies for analyzing data and analyze accordingly	What are some preliminary codes or themes that you think you may use to answer your research questions? Will you conduct validation exercises with participants? Why or why not?	Revise previous assignments based on feedback	7: Strategic analysis and evaluation
12. Advocacy and dissemination of research findings (Guest lecture by Elynn Walter)
Know how to write a final report summarizing findings; propose evidence based recommendations	What advocacy activities have you been involved in? Did you use evidence to create your key messages? If yes, provide an example of one of your key messages.	Revise previous assignments based on feedback	2: Collaborating and partnering;5: Program management;6: Sociocultural and political awareness
13. Turning MHM Research Into Practice (Guest lecture by Marni Sommer)
Consider feasibility of creating a puberty book in local context	What topics would need to be included if a puberty book was made for your specific country context? Do you predict any challenges working with the local Ministry of Education to get a puberty book published and distributed? Do you foresee any challenges to creating a puberty book?	Finalize research protocols and tools	4: Health equity and social justice;7: Strategic analysis and evaluation

Note. NGO = nongovernment organization; ASPH = Association of Schools of Public Health; MHM = menstrual hygiene management.

Course Delivery

Coauthors BAC and AE served as the lead instructors and delivered most course modules. A noted benefit of online instruction, we easily and cost-efficiently recruited global experts to develop and deliver three sessions from afar (Finch et al., 2012): Sue Cavill with support from Amritpal K. Sandhu (Incorporating Gender Into MHM Programming), Marni Sommer (Turning MHM Research into Practice), and Elynn Walter (Advocacy and Dissemination of Research Findings).

The course was taught live via Adobe Connect in English from 7 a.m. to 8 a.m. EST in order to best accommodate participants across a range of time zones, though some sessions extended up to 30 minutes longer than the hour depending on the content needed to be covered or questions from participants. When signing into sessions, participants indicated the country from which they were participating and the number of people logging into the same computer as part of their username (i.e., Anna_USA_3). In many circumstances, computer and Internet access was limited and many participants gathered around a single computer to engage. This basic information in the username allowed participants to share about themselves and let instructors and others know the context from which comments were made.

Many participants from two countries, Niger and Burkina Faso, spoke French only or spoke limited English. To accommodate these participants, all slides were made available to participants several days to a week in advance to enabled teams to have the slides translated into French. This allowed participants to review the slides independently and follow-along with a translated deck during the live session. Team members who spoke English well were able to clarify questions for other team members. The Burkina Faso team had a translator available to translate all the sessions, either live or from the session recordings.

Questions were posed to participants several times throughout each module and the “chat” feature enabled active live participation during the modules. Instructors waited for and reacted to participant responses provided in the chat box, intentionally calling on contributors by name to recognize and encourage inputs. Emory University–based teaching assistants (coauthors GS and CG) and program leads from UNICEF headquarters (coauthors MS and SC) participated in all sessions, actively answering questions posed by participants and responding to or posting comments online via the chat window as the instructor delivered the course content. Their online activity motivated participants to be active and pose questions and responses to others. Most important, the chat feature allowed course participants to get to know one another; participants often directly posed questions to specific participants based on what they had come to learn about their context and experience.

Participants received e-mail reminders about the course the day before each scheduled module, with an embedded course link to the online platform. Due to work schedules, time differences, and unreliable Internet connections, it was not uncommon for participants to miss the live modules. All modules were recorded to enable later access as needed.

The course used Blackboard, a virtual learning and course management system, to manage the course schedule, readings, module PowerPoints and recordings, quizzes, a discussion board platform, and resources to reference and adapt (e.g., consent form templates, tools, and data entry forms used in other studies, etc.).

Assignments, Discussion Board, and Quizzes

After each module, participants received a group assignment and two individual tasks: a discussion board response and a “review and feedback” quiz.

All assignments aimed to sequentially guide country teams, step-by-step, through their own MHM research as part of the broader WinS for Girls Program. Example assignments included a literature review (which could later inform tool design or be incorporated into ethical review protocols and final reports), identification of research objectives, and drafting of research plans and tools (see Table 2 for all assignments). Though covered in depth later in the course, the first assignment required teams to investigate local research ethics review processes in their country given the lengthy amount of time typically needed for review and approval. Assignments were not graded. Rather, teams received feedback on all assignments from instructors and teaching assistants to strengthen their research. As each team worked in a different context, our comments focused largely on research methodology, though we also shared our knowledge of MHM-related issues in similar context to suggest readings, a line of inquiry, or probes that the team could consider if of interest. Teams were encouraged to submit revisions of research plans and tools for further feedback as often as they were motivated to do so. Each team had a “focal person” who was responsible for submission of all team assignments, facilitating communication.

Participants accessed a discussion board, where a new discussion thread was posted after each module session (see Table 2 for the discussion prompts), and the “review and feedback” quizzes via Blackboard. These individual assignments served to maintain participant engagement between module sessions and the discussion board facilitated sharing within and across country teams. Participants were encouraged to post on the discussion board after each module and could also initiate their own discussion threads, whether asking about a method, sharing an anecdote from their research, or asking other teams if participants in their study had reported similar experiences or beliefs. The quizzes reviewed key concepts from the modules using multiple choice, matching, and fill-in-the-blank questions, and elicited feedback from participants on the most useful thing they learned from the module session, concepts they were still uncertain about, and any suggestions or general feedback they had for the course. Course instructors and teaching assistants selected common questions or informative comments posted on the discussion board and from the quiz feedback questions to present at the beginning of the next course module, giving credit to contributors and addressing areas that needed greater explanation.

Office Hours

Office hours were held every other week (when course modules were not webcast). Office hours increased knowledge sharing between individuals and country teams and allowed course instructors additional opportunities to engage with participants. Initially, office hours were used to provide opportunities for participants to ask the instructors questions about the research that teams were initiating in their country. Participants could either e-mail questions in advance or ask them during the session. Later, office hours were led by country teams. They provided updates on their research progress. Teams signed up to provide brief 10- to 15-minute presentations describing their research challenges and achievements and their plans for next steps. Teams then received feedback and questions from instructors and other participants.

Individual and Country Team Achievements

At the end of the course, participants were eligible for certificates of participation. Basic individual course participation certificates were given to participants who completed 12 module quizzes (indicating viewing of all course modules); a participation with excellence certificate was given to participants who completed 12 module quizzes and posted at least 12 times on the discussion board. Team certificates were given to country teams who completed all course assignments. All twelve active country teams received team certificates and completed formative research and reports as hoped. Five of those country teams presented research findings at international conferences, and eight reported using formative research findings for advocacy purposes. Notably, both Mongolia and Zambia reported the integration of menstruation issues into national education policies. As the work of policymaking and program creation takes time, it is possible that teams will have achieved more by date of publication. Forty-four participants received individual certificates, including 25 who received certificates with excellence (see Table 1).

Reflections and Lessons Learned

Participant Reflections

Participants reported that the course not only aided with the overall research and provided them with new skill sets, but it also brought stakeholders from various sectors and cultures together, increased buy-in from government stakeholders on the topic, and engendered interest in additional learning opportunities. Still, unreliable Internet and managing the time for the course amid other work commitments remained a challenge (see Supplemental Table S1, available in the online version of this article, for participant reflections).

Instructor Reflections

In Table 3, we present recommendations for others designing e-courses. We emphasize key lessons learned, particularly when working with a range of stakeholders in LMICs, though consider most recommendations to be applicable in non-LMIC contexts as well. Overall, active learning and opportunities for application, engagement, and teamwork are valuable tools for e-courses, just as they are in traditional classroom settings. Logistical issues are important to anticipate a priori, including consideration of time zones, language needs, and familiarity with technology.

Table 3.

Recommendations for Future E-Courses Designed to Increase Capacity of Non–Public Health Trained Stakeholders, Particularly in Low- and Middle-Income Countries.

Structural and delivery-related recommendations	Justification based on e-course experience
Combine course with preexisting research or project	The inclusion of this course as part of a larger research initiative enabled participants to directly apply what was learned to their work. It allowed a range of stakeholders to participate and lend insights based on their roles. If no such initiative exists, a preidentified project that is embedded from the start would enable similar active learning.
Have participants work in teams, if possible	E-course participants in each country worked as a team on assignments that were designed to push the research forward. Each team, composed of various stakeholders (nongovernment organization, academic, government) incorporated a wide range of perspectives into their work, assuring buy-in from relevant stakeholders from the outset. A lead member was responsible for handing in assignments on behalf of others and communicating about overall progress.
Enable active involvement during lectures	Participants appreciated opportunities to be engaged during the live-taught modules. In each session we posed questions and waited while participants composed responses in the “chat” window. We would then read off a selection of comments and note from whom they came. Our teaching assistants responded to questions and comments as they arose mid-lecture, making participants feel their insights were valued.
Create opportunities for students to engage material and instructors outside of lectures	Discussion boards enabled participants to draw on personal experiences and reflect on course material, and interact with participants from different countries. “Office hours” enabled course participants to have more interaction with instructors and peers, present work in progress, discuss challenges, share knowledge based on their own experiences, and pose questions. These forums enabled participants to create relationships with international colleagues with similar interests.
Provide multiple opportunities for course feedback	Instructors benefited from the feedback provided by participants throughout the course via open-ended questions on quizzes, discussion boards, or other avenues. We iteratively made adaptations in response, including the addition of office hours, for example.
Introduce the web platforms used prior to the first class session	We held introductory sessions prior to the official start of the course to introduce participants to the Blackboard and Adobe Connect. UNICEF staff use a different platform for webinars. Adobe was selected for a number of reasons including stability and ease of use with a large number of participants. The slides contained screenshots of the various platforms used and how to log on, access content, post, adjust settings, etc. It is important to anticipate that participants, especially those in low- and middle-income countries, will not know how to use the online course systems.
Recognize that bad internet, power failures, and unexpected conflicts may occur and identify solutions a priori	For most participants, Internet and even electricity connections were unreliable. In addition, many participants, although participating as part of their jobs, had competing work-related interests. Participants in the government sector typically had the greatest challenge attending live sessions and maintaining involvement.
	To accommodate, we live-recorded all lectures and uploaded them so participants could access them at times that were most convenient. We also worked with some teams to revise all assignment due dates based on competing priorities (i.e., the need to turn attention to earthquake response).
Consider solutions for those who are not fluent in English or the primary language of instruction	Not all course participants spoke English fluently. In some cases, select team members did not have English language capacity. In others, entire teams did not speak English. All the same, they were a part of the overall research initiative and needed accommodation.
	We were careful to deliver lectures slowly and to have key information written clearly in accessible language on slides. We made all slides available several days before the live lectures as some teams translated them prior and shared them with regional colleagues (to avoid duplication of effort). Some teams also arranged for translators to translate the sessions live or to translate live recordings (e.g., the Francophone countries).
Consider time zones of all participants to accommodate broad participation	Finding a time that works for all participants can be challenging if they come from geographically dispersed locations. It is important to solicit feedback from participants to determine if there are certain times of the day when electricity or Internet is not functional so potential scheduling accommodations can be made.

Conclusion

Creating and embedding an e-course within a larger research initiative enabled all teams and participants to gain or improve research skills that benefited country-level research and that of the project as a whole. The course, however, had limitations. As reported by Frehywot et al. (2013), Internet connectivity was a challenge. Some participants could only access Internet from certain locations (i.e., not at home) influencing their availability to participate in real-time if they needed to go home or work in an alternate location, and in some places Internet was weaker at certain times of day affecting the quality of what participants received. Some participants did not have access to individual computers requiring them to tune-in as a group, limiting their ability to “chat” or engage in discussions. And, because the course was delivered to countries around the globe, the course could be early in the day, during the workday, or late in the evening, further influencing participation depending on personal schedules and ability to participate at those times. Despite challenges and limitations, however, the course also had several benefits, some also noted by others reporting on the design and delivery of e-courses: It enabled individuals to access information and learning opportunities that would be otherwise inaccessible (Stamatikos & Ratnapradifa, 2011); it provided a platform for participants from geographically disparate areas to share their perspectives and experiences on a common topic, engendering a community of practice and learning (Finch et al., 2012; Kanekar, 2017); it brought together diverse stakeholders in the same community working on the same problem who may not otherwise have had regular occasions to interact; and it created a support structure such that teams struggling with specific challenges could solicit feedback from both instructors and members of other global teams to determine a way forward or simply get assurance that their struggles were not uncommon.

E-courses have the potential to assist in tackling complex, public health issues that require engagement from a variety of stakeholders at local and global levels and their further development and deployment among public health and nonpublic health professionals should be explored further.

Supplemental Material

PHP811983_Supplemental_Material – Supplemental material for Building Qualitative Research Capacity Among Interdisciplinary Teams to Investigate Girls’ Challenges With Menstruation: Process and Lessons Learned From a 14-Country E-Course

Supplemental material, PHP811983_Supplemental_Material for Building Qualitative Research Capacity Among Interdisciplinary Teams to Investigate Girls’ Challenges With Menstruation: Process and Lessons Learned From a 14-Country E-Course by Bethany A. Caruso, Anna Ellis, Gloria Sclar, Candace Girod, Gauthami Penakalapati, Murat Sahin and Sue Cavill in Pedagogy in Health Promotion

Footnotes

Acknowledgements

The authors wish to acknowledge Gabrielle Berman, Lizette Burgers, Maria Carmelita Francois, Matthew Freeman, Nora Fyles, Molly Linabarger, Jeanne Long, Meera Mohan, Yodit Sheido, Marni Sommer, Elynn Walter, Brooke Yamakoshi, and all the participants for their contributions to this article or the course itself.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The e-course was part of the program “WASH [water, sanitation and hygiene] in Schools for Girls: Advocacy and Capacity Building for Menstrual Hygiene Management through WASH in Schools Programmes (WinS for Girls)” undertaken with the financial support of the Government of Canada provided through Global Affairs Canada. BAC was funded in part by the NIH/NIGMS Institutional Research and Academic Career Development Award (IRACDA), 5K12-GM000680-18.

Supplemental Material

Supplemental Table S1 is available in the online version of this article at .

ORCID iD

Bethany A. Caruso

References

Ablah

Biberman

D. A.

Weist

E. M.

Buekens

Bentley

M. E.

Burke

. . . Gotsch

A. R.

(2014). Improving global health education: Development of a global health competency model. American Journal of Tropical Medicine and Hygiene, 90, 560-565.

Alam

M.-U.

Luby

S. P.

Halder

A. K.

Islam

Opel

Shoab

A. K.

. . . Unicomb

(2017). Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: Results from a cross-sectional survey. BMJ Open, 7(7), e015508.

Albrecht

Freeman

Higginbotham

(1998). Complexity and human health: The case for a transdisciplinary paradigm. Culture, Medicine, and Psychiatry, 22(1), 55-92.

Ally

(2008). Foundations of educational theory for online learning. In Anderson

(Ed.), The theory and practice of online learning (2nd ed., pp. 15–44). Edmonton, Canada: Athabasca University Press.

Caruso

B. A.

(2014). WASH in schools empowers girls’ education: Tools for assessing menstrual hygiene management in schools. New York, NY: United Nations Children’s Fund.

Caruso

B. A.

Ellis

Sahin

(2015). WASH in schools for girls e-course: Increasing national capacity to conduct research on menstrual hygiene management in schools. New York, NY: United Nations Children’s Fund.

Caruso

B. A.

Fehr

Inden

Sahin

Ellis

Andes

K. L.

Freeman

M. C.

(2013). WASH in schools empowers girls’ education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools. New York, NY: United Nations Children’s Fund.

Ellis

Haver

Villasenor

Parawan

Venkatesh

Freeman

M. C.

Caruso

B. A.

(2016). WASH challenges to girls’ menstrual hygiene management in Metro Manila, Masbate, and South Central Mindanao, Philippines. Waterlines, 35, 306-323.

Finch

Burrell

D. N.

McAfee

(2012). The benefits of e-learning to higher education in public health and public health research. Review of Higher Education and Self-Learning, 5(17), 55-66.

10.

Frehywot

Vovides

Talib

Mikhail

Ross

Wohltjen

. . . Scott

(2013). E-learning in medical education in resource constrained low-and middle-income countries. Human Resources for Health, 11(1), 4.

11.

Girod

Ellis

Andes

K. L.

Freeman

M. C.

Caruso

B. A.

(2017). Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. Journal of Urban Health, 94, 835-846.

12.

Haver

Caruso

B. A.

Ellis

Sahin

Villasenor

J. M.

Andes

K. L.

Freeman

M. C.

(2013). WASH in schools empowers girls’ education in Masbate Province and Metro Manila, Philippines: An assessment of menstrual hygiene management in schools. New York, NY: United Nations Children’s Fund.

13.

Kanekar

(2017). Designing an e-learning health promotion course: Meeting the national benchmarks. Pedagogy in Health Promotion. Advance online publication. doi:10.1177/2373379917733752

14.

Long

Caruso

B. A.

Lopez

Vancraeynest

Sahin

Andes

K. L.

Freeman

M. C.

(2013). WASH in schools empowers girls’ education in rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools. New York, NY: United Nations Children’s Fund.

15.

Mason

Nyothach

Alexander

Odhiambo

F. O.

Eleveld

Vulule

. . . Phillips-Howard

P. A.

(2013). “We keep it secret so no one should know”: A qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western Kenya. PLoS One, 8(11), e79132.

16.

McKinney

W. P.

(2017). Assessing the evidence for the educational efficacy of webinars and related Internet-based instruction. Pedagogy in Health Promotion, 3(Suppl. 1), S47-S51.

17.

Mincey

K. D.

(2015). Development of an online course in public health for undergraduates. Pedagogy in Health Promotion, 1, 47-52.

18.

Ortagus

J. C.

(2017). From the periphery to prominence: An examination of the changing profile of online students in American higher education. Internet and Higher Education, 32, 47-57.

19.

Phillips-Howard

Caruso

B. A.

Torondel

Zulaika

Sahin

Sommer

(2016). Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: Research priorities. Global Health Action. Advance online publication. doi:10.3402/gha.v9.33032

20.

Phillips-Howard

Otieno

Burmen

Otieno

Odongo

Odour

. . . Odhiambo

(2015). Menstrual needs and associations with sexual and reproductive risks in rural Kenyan females: A cross-sectional behavioral survey linked with HIV prevalence. Journal of Women’s Health, 24, 801-811.

21.

Rosenstock

Silver

G. B.

Helsing

Evashwick

Katz

Klag

. . . Sumaya

(2008). On linkages: Confronting the public health workforce crisis: ASPH statement on the public health workforce. Public Health Reports, 123, 395-398.

22.

Sinden

Sahin

Francois

(2015). WASH in schools for girls: Voices from the field: Advocacy and capacity building for menstrual hygiene management through WASH in schools programmes. New York, NY: United Nations Children’s Fund.

23.

Sommer

(2009). Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania. Journal of Adolescence, 33, 521-529. doi:10.1016/j.adolescence.2009.03.008

24.

Sommer

Caruso

B. A.

Sahin

Calderon

Cavill

Mahon

Phillips-Howard

P. A.

(2016). A time for global action: Addressing girls’ menstrual hygiene management needs in schools. PLoS Med, 13(2), e1001962.

25.

Sommer

Hirsch

J. S.

Nathanson

Parker

R. G.

(2015). Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue. American Journal of Public Health, 105, 1302-1311.

26.

Sommer

Sahin

(2013). Overcoming the taboo: Advancing the global agenda for menstrual hygiene management for schoolgirls. American Journal of Public Health, 103, 1556-1559.

27.

Stamatikos

Ratnapradifa

(2011). Online learning in public health education. Techniques, 86(2), 48-51.

28.

Trinies

Caruso

B. A.

Sogore

Toubkiss

Freeman

M. C.

(2015). Uncovering the challenges to menstrual hygiene management in schools in Mali. Waterlines, 34. doi:10.3362/1756-3488.2015.004

29.

UNICEF. (2015). The WinS4Girls E-course. Retrieved from http://washinschoolsmapping.com/the-wins4girls-e-course/

30.

van Eijk

A. M.

Sivakami

Thakkar

M. B.

Bauman

Laserson

K. F.

Coates

Phillips-Howard

P. A

. (2016). Menstrual hygiene management among adolescent girls in India: A systematic review and meta-analysis. BMJ Open, 6(3), e010290.

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