Are you interested in applied social science and medical anthropology research, in the field of maternal and perinatal health and care? Do you recognize the value of interdisciplinary research and team work? Is it your ambition to become a top-tier researcher?

Project description

Improving care for pregnant women with hypertensive disorders: An ethnographic study of the use of shared-decision making tools in health facilities in Ghana

Maternal and perinatal mortality rates remain high in low and middle-income settings, where quality of maternity care has emerged as a bottleneck that hampers further gains. (Human) resource shortages are a key barrier to achieve quality maternity care. Risk-based medicine might address the resource problem and improve outcomes, by facilitating patient triage and clinical decisions leading to provision of the right care, to the right person, at the right moment. Whilst we can use epidemiology and other clinical sciences to develop risk prediction models, we do not yet know how exactly to implement these models. According to current WHO maternal care standards, quality care is not only based on the provision of evidence-based care, but also on the experience of care, which ought to respect women’s needs and principles of shared decision making. For practitioners, how to use risk prediction models and adhere to principles of respectful maternity care and shared-decision making requires further guidance. This can be challenging, especially in low and middle income settings where resources (e.g. time) are scant and practitioners and clients alike may subscribe less to the shared-decision making ideology. Moreover, shared-decision making in the context of hypertensive disorders is complicated by potential tensions between the health interest of the woman and baby. Survival of a woman may require termination of a pregnancy and delivery of a premature infant. Risk of death of the foetus or baby is real, and may have major social and economic implications. This raises questions about whether and how husbands or relatives need to be involved in the decision-making regarding clinical management of hypertensive disorders.

In this four year interdisciplinary, mixed-method project involving medical and social science we will (1) develop a clinical decision-making tool to improve clinical and respectful care, and facilitate shared decision making (2) implement the SPOT tool in hospitals in the Greater Accra Region and Eastern Region in Ghana (3) evaluate the impact of the SPOT tool. The PhD candidate will conduct ethnographic research in all three phases of the project.

1. Formative research

We explore how practitioners currently care for women with hypertensive disorders, and examine interactions between providers and clients in which risks and treatment options are discussed. In addition to ethnographic observations, interviews and focus groups, we use conversation analysis for detailed analysis of clinical encounters. Qualitative and quantitative findings are combined to develop a decision-making tool.

2. Implementation phase

We implement the decision-making tool, and conduct a qualitative process evaluation to examine whether and how practitioners use this tool, using hospital ethnography and conversation analysis.

3. Impact evaluation

Using qualitative and ethnographic methods we assess how use of the tool changes provider-client interactions, quality of care, and providers’ and women’s care experiences.

What will you be doing?

• You will be affiliated with the AISSR’s organized PhD training. The academic work is to result in a doctoral thesis that will be defended at the Faculty of Social Sciences with a view to obtaining the degree of PhD;
• you will conduct up to one-year ethnographic fieldwork in Ghana;
• for the remainder of the employment period, you are expected to live in Amsterdam and take active part in the research environment at the AISSR;
• teaching (up to 10% of your time) and organizational support for the project leader will be part of your job responsibilities.

You have the following credentials.

Essential:

• a Master’s degree or equivalent with a relevant specialization within the social sciences or humanities e.g. medical anthropology. The degree must have been obtained by the time of application;
• excellent oral and written communication skills in English;
• prior training in ethnographic methods;
• ethnographic fieldwork experience;
• independent thinking and critical analytical skills;
• the ability to work relatively independently;
• the ability to collaborate in interdisciplinary teams.

Desirable:

• expertise or familiarity with anthropology of reproduction and maternal health;
• prior training in and experience of conversation analysis or related discursive method;
• ability to collect data in Twi or other relevant Ghanaian language;
• previous living or work experience in Ghana or other low or middle income setting.

Fixed-term contract: Four years.

The position concerns a temporary appointment of 38 hours per week for a maximum term of four years. The initial appointment is for one year, preferably starting on 1 November 2019. Following a positive assessment and barring altered circumstances, this term will be extended by a maximum of 36 months, which should result in the conferral of a doctorate. We will put together a curriculum which will also include the opportunity to attend training courses and both national and international events.

Your salary will be €2,325 gross per month in the first year and will increase to €2,972 in the final year, based on full-time employment and in keeping with the Collective Labour Agreement of Dutch Universities. We additionally offer an extensive package of secondary benefits, including 8% holiday allowance and a year-end bonus of 8.3%.

What else can we offer you?

An intellectually exciting work environment with a variety of duties and ample scope for individual initiative and development within an inspiring organisation. The social and behavioural sciences play a leading role in addressing the major societal challenges faced by the world, the Netherlands and Amsterdam, now and in the future.

To work at the University of Amsterdam is to work in a discerning, independent, creative, innovative and international climate characterised by an open atmosphere and a genuine engagement with the city of Amsterdam and society.

University of Amsterdam

With over 5,000 employees, 30,000 students and a budget of more than 600 million euros, the University of Amsterdam (UvA) is an intellectual hub within the Netherlands. Teaching and research at the UvA are conducted within seven faculties: Humanities, Social and Behavioural Sciences, Economics and Business, Law, Science, Medicine and Dentistry. Housed on four city campuses in or near the heart of Amsterdam, where disciplines come together and interact, the faculties have close links with thousands of researchers and hundreds of institutions at home and abroad.  

The UvA’s students and employees are independent thinkers, competent rebels who dare to question dogmas and aren’t satisfied with easy answers and standard solutions. To work at the UvA is to work in an independent, creative, innovative and international climate characterised by an open atmosphere and a genuine engagement with the city of Amsterdam and society.

Faculty of Social and Behavioural Sciences – Department of Anthropology

The Department of Anthropology is one of the departments in the Faculty of Social and Behavioural Sciences. We are seeking a PhD candidate for the SPOT-IMPACT project, a four year interdisciplinary, mixed-methods study funded by the Dutch NWO. The project, to be carried out in Ghana, seeks to develop, implement and evaluate a decision-making tool meant to improve care for women with hypertensive disorders in pregnancy. We are looking for a PhD candidate to work on the qualitative, ethnographic arm of the project, led by Dr Bregje de Kok (Anthropology, University of Amsterdam) and Dr Trudie Gerrits. The PhD project will involve collaboration with other disciplines such as epidemiology, medicine, health economics and ethics. The PhD track is part of the Amsterdam Institute for Social Science Research (AISSR) programme group Health Care and the Body.