Opinion by Fogarty Director Dr Roger I Glass
Have you ever tried to break a bad habit? It's not easy! Whether you're adopting a healthier diet, taking up an exercise program or quitting smoking, it's difficult to change ingrained behaviors.
There's often a disconnect between what scientific evidence tells us we should do, and what we actually do. This is universally true, which makes behavioral and social sciences a key element of global health research. After all, what good are evidence-based solutions if they're not acceptable to the target populations? A solid understanding of the local cultural and social influences is essential for researchers interested in improving health.
People may understand the need to be tested for HIV so that, if the results are positive, they can begin taking the drugs that will save their lives. But fear of being shunned may prevent them from doing so.
Women likely comprehend that cooking over an open fire is damaging their lungs and harming their children, who are also exposed. But if that's the only way she can prepare the foods her family enjoys, it can be difficult to get her to switch to an unfamiliar, clean-burning cookstove.
Some societies put more faith in injectable medicines rather than those taken orally. Yet, in low-resource settings it's more difficult to provide shots, since they require a higher level of training than pill administration.
These are some of the thorny issues that we at NIH grapple with, under the sage leadership provided by the Office of Behavioral and Social Sciences Research (OBSSR). For the past two decades, OBSSR has focused NIH attention on these cross-cutting topics and catalyzed efforts to advance our understanding of these disciplines. It's critical that scientists consider the various behavioral, social and cultural factors at play in a given population, before planning or undertaking research projects. This information can often mean the difference between success and failure of an intervention.
In partnership with OBSSR, Fogarty has supported numerous groundbreaking behavioral and social science studies. For instance, we jointly funded research that provided a better understanding of the role of stigma in HIV prevention, which is fundamental to advancing our goal of achieving an AIDS-free generation. Other projects studied how social interactions with neighbors advanced the adoption of bed nets to prevent malaria.
Risky behaviors and risk evaluation in decision making are other areas our grantees have investigated. For instance, studying how best to encourage the use of seatbelts or motorcycle helmets among people whose sense of fatalism overrides their appreciation of scientific evidence. Tobacco cessation research is another area of mutual interest and the studies we've funded have helped make the case for national public smoking bans and increased cigarette taxes - both of which have proven effective at reducing smoking.
Scientists are studying how to use novel mHealth applications to monitor adherence to drug therapy and compliance, which is a key problem with patients on any chronic medication. From TB and HIV where failure to take medications can lead to recurrence of disease or drug resistance, to chronic problems like hypertension and diabetes, where poor compliance can lead to major complications of the underlying diseases, text messages are being used to advise women who are pregnant about their health needs, encourage smokers to quit smoking, and help alcoholics to refrain from drinking. There are clear research needs that determine the effectiveness of these and similar interventions - all slated to alter people's behaviors and improve their health.
OBSSR has also been at the forefront of supporting the study of new communication technologies, methods and tools - such as smartphones - that provide a wealth of opportunities for behavioral and social scientists, particularly those working in low-resource settings. They can now collect and analyze real-time data to better understand how and why individuals behave as they do.
In addition, there are more advanced brain scanning tools, computer modeling and genome technologies that all hold great potential to increase our understanding of the impact of behavior and social sciences on health. We look forward to sustaining and strengthening our valuable partnership with OBSSR, to continue to advance this incredibly important research agenda in the decades to come.