The Balashika Conference

1. The Balashika Conference “Crossing Cultural and Disciplinary Borders: Enhancing Outcomes and Sustainability” Rollins School of Public HealthEmory UniversityMarch 24th and 25th, 2006 Margaret H. Mills, Ph.D, MPH The University of Iowa

2. Emory Russian and Eastern European Studies Center (REES) proposals: • To address social and economic contexts which shape decisions by women and their families • To identify cultural referents to aid in promotion of public health education

3. Expanding potential Stakeholders:Local team-building and “ownership” • Identify Russian academicsin gender, health, and the emerging field of social work to bring in complementary expertise. • Further enhance local and regional political leaders NGO directors, and various media to “buy in” to the MRPC initiative. • Develop ties to nearby Russian Business Institutes (MBA, Marketing) to explore possible shared goals in designing and evaluating a MRPC public health campaign

4. Comparative states of the field of Program Evaluation in US and Russia • Sub-specialty within US Colleges of Public Health • Very recent development in Russia: primarily in NGOs • 2000 Eurasia Foundation “Train the Trainers” seminars in Moscow

5. Current Example of Collaborative US and Russian Program Evaluation • 2003 – 2006 DOS grant with ISU and Kiev to advance gender studies education and training programs • Process evaluation took place on-site at ISU by US evaluator (in Russian and English) • Final evaluation scheduled for July 2006 by Russian evaluator on-site in Kiev.

6. Enhanced data collection in Phase II: strategies for success • Ensuring each partner has its own translator and translation services • Expansion of data collection: • Comprehensive medical data • Local needs assessments and client satisfaction surveys to implement new educational programs and measure progress • Important to follow “gold standard” of social science research in international surveys

7. Preparing to pilot an MRPC“client satisfaction survey” • Survey design team: specialists from medicine, public health, one native Russian translator, one native English-speaking translator • Four-step process • Finalize English language survey • Translate survey into Russian • “Back translation” into English • COMPARE the two English versions to adjust and edit the Russian survey to be used in Russia

8. Value of a culturalspecialist in the interdisciplinary research team • Early experiences in US health initiatives in Russia and my role as “the fixer” • When to bring in the “cultural expert?” • Constant cultural “filter” for planning, negotiations, and implementations • Balashika Project highly successful Phase I • Incorporation of Russian area specialists at Emory University to build on that success.

9. Vital communication patterns: physicians and cultural specialists • Obvious differential in “knowledge sets” • Shared basic overview of agenda items prior to planning and/or negotiation meetings (e.g., US physician’s “100+” health proposal for Moscow) • Incorporation of cultural specialist into planning process prior to piloting studies in Russian facilities (e.g., “functional assessments of 55+ population in Moscow”)

10. Emerging cultural “disconnects” in Russian women’s and maternal health • Basic medical history taking “Do you drink alcohol?” • Correct translation – incorrect responses. • Beer - fastest growing industry in Russia today. “Beer by number” – Baltikabrewed from .5 to .12. Illegal to purchase <18; a note from parent suffices. • In recent surveys, over 50% of Russians polled did not consider beer to be an “alcoholic beverage.”

11. Additional (unanticipated) benefits of a truly “multidisciplinary” research team • Personal experience of sitting in planning meetings with physicians, nurses, political scientists, and biostatisticians as a relative “silent” partner. • Determining sample sizes? Chi-squared tests?The mysterious Confidence Intervals! • Elected to return to school for MPH • In addition to advancing my research agenda, currently teaching a course on “Health Care and Reforms in Russia.” • Training the next generation of interdisciplinary scholars: Majors in Russian and Global Health.

12. Casting a “wider net” of Russian and US collaborators for further research • Including specialists in public policy, gender and health, business, and the humanities bodes well for building on MRPC success as a primary research base for future projects. • Funding sources such as the US Department of State require “impact on public policy” as a key component to any successful proposal. The “Balashika Project” exemplifies the spirit and letter of that goal. • Seek additional research/training grants to augment the original FOR project. SOURCES? • Open Society Institute, Soros Foundation, Ford Foundation, Eurasia Foundation, IREX, and ACTR-ACCELS. Many specifically require Joint Principle Investigators – one Russian and one American.

13. Quantitative and Qualitative Research:Enhanced Outcomes • Successful Program Evaluation projects build key design models by employing quantitative and qualitative methods in both data collection and analysis. • Through adapting a similar design model, multidisciplinary research teams have potential for much broader dissemination of findings to multiple audiences.