As the summer holiday approaches, Changzhi students experience their busiest time of the year as they prepare diligently for their exams and wait for the results of the year-end parent-teacher conference. At the same time, researchers from the Changzhi School Edu-Salt “salt reduction in school children” project rush to collect the project’s baseline data that including samples and data from the students and their families, before the summer holiday.

Research fellow Jing ZHANG and intern Yuan MA have been in Changzhi for nearly a month collecting data. Their colleagues in Beijing barely hear anything from them except for a few texts messages.

“It’s exhausting! Everyone is under a huge strain.” Jing adds a frowning emoticon at the end of his sentence. “It feels like 70% of the time is spent on communicating with different people.”

His experience may break the stereotype held by most people about medical research. Generally speaking, clinical research is thought to be about the data analyzed and achievements published in professional medical journals. The reality of implanting a project in the field is very different from that impression.

Non-communicable diseases (NCDs) studies aim at searching for approaches to improve health cost-effectively and in a short time. By communicating with different populations and winning their trust, The George Institute for Global Health at Peking University Health Science Center (TGI @ PUHSC) is able to translate our research findings into policy guidelines and practice, influencing policy-makers to bring the best available evidence into their decision making, which will then affect crucial change and benefit more people.

Since our focus is on behavioral change rather than biological samples, good communication skills are particularly important. Especially in the field of NCD research, communication is an essential and indispensable tool.

The 40 days of a large-scale baseline assessment reveals the art and power of communication.

Tenaciously follow-up with the participants

A prefecture-level city of Shanxi province, Changzhi city has a population of over three million, half of which are reside in urban environments. A total of 28 primary schools with 280 children aged ≈11 years were recruited into the study. Additionally, 560 adult family members of the participating children were invited as well. Implementing this study in an urban area, as opposed to rural area, may result in low compliance and high participant attrition.

“During the baseline assessment, we need to measure blood pressure, height and weight circumference, and collect two 24-hour urines, the latter being of the greatest importance. However, people in urban area all live a fast-paced life with enormous pressure from work, so it is hard to make appointments with them at home to collect the data. Collecting two 24-hour urines is a considerable inconvenience. In addition, factors such as the long distance between work and home also impacts on the time and quality of urine collection,” said intern Yuan MA.

She added “It’s quite common that people miss appointments. Therefore we need to proactively communicate with the students and their parents, confirm everything, and be flexible to respond to any emergencies that may turn up.”

Eliminate concerns

It’s natural for some participants to miss appointments, but the main challenge is to remember this fact when in the field. Jing said, “Some participants were very cooperative, some refused to participate immediately due to personal reasons, and there were others who had agreed to participate at first but when we tried to collect urine thought we might be trying to sell drugs or promote particular hospitals and withdrew. We understand their behavior in view of today’s social environment in China.”

He continued, “Therefore our key work is to be upfront and explain that that our study has with no commercial purpose. We provide detailed information about every procedure of the study, and reiterate the difficulties of urine collection. At the same time, results of the laboratory tests, the accuracy of which we explain to them is determined by the correctness and timeliness of the urine collection, will be returned to them. As long as they are aware that the study is for their health, their concerns can be alleviated. In fact, most of the participants are quite supportive of our work after being introduced thoroughly to the whole project.”

Jing recalled, “There was a father, a truck driver, whose work required him to drive at night. Unfortunately he failed to meet us at the agreed upon time for the urine collection. When the clock said 20:00, we figured this collection was a failure when suddenly we got a call from him. He assured us that he had finished the collection as requested and would deliver it directly after finishing his work at 23:00. We were deeply touched by his dedication, especially since at first he was reluctant to participate, but then obviously had a change of heart”

Mobilize personnel

It’s not possible for Jing and Yuan to coordinate 280 students and their family members on their own. Approximately 20 professors and 40 students from the Changzhi Medical School, led by provincial PI Dr. Xiangxian FENG, served as local research coordinators and assistants. To coordinate a team of this size, personnel management and time management became crucial to work efficiently while maintaining data quality.

“Challenges and disagreements are inevitable; motivation may wane. Yet we need to be aware of our role. In addition to research work, we were also responsible for coordinating the promotion of the study and all the local staff,” Jing said. “We respect and appreciate everyone that has participated in the study. Timely and proactive communication is critical to problem-solving. Seeking help from the management team is also important when the problem we can not solve problems on our own.”

Communication skills are acquired and accumulated through experience, and key to the successful implementation of projects. The School Edu-Salt project in Changzhi is halfway through its course, providing our researchers an important opportunity to enrich their communication experience. TGI @ PUHSC can capitalize on this field experience for future NCD studies when working with unique study populations that require a localized approach.

On the 3^_rd July 2013 The George Institute for Global health in China had the honor of hosting Professor Norbert Berend, Professor Emeritus at the University of Sydney and Head of Respiratory Research at the George Institute for Global Health. Professor Berend presented on chronic obstructive pulmonary disease (COPD) and comorbidities.

The presentation was relevant to the current environment in Beijing, since air pollution is a significant causative factor in the development of COPD. In his presentation, Professor Berend commented on the relationship between air pollution, particularly particulate matter (PM2.5), and COPD.

In the introduction by Professor Yangfeng Wu, Professor Berend’s many academic accomplishments were highlighted. Professor Berend has a distinguished background in respiratory research, and he has also held several administrative positions in the field of public health. Currently, Professor Berend holds the position of Head of Respiratory Research at George Clinical in Sydney, Australia.

Professor Berend highlighted the facts that COPD is associated with increased hypertension, cardiovascular disease, diabetes, osteoporosis, and muscle weakness as well as a number of other debilitating conditions. These comorbidities have traditionally been regarded as coexistent medical conditions. However they are increasingly being regarded as causally related to COPD. These comorbidities have an important effect of the quality of life, morbidity and mortality associated with COPD as well as affecting disease management and treatment outcomes. New research reveals that the link between these comorbidities and COPD may be through systemic inflammation, which subsequently opens up pathways for new treatment options.

Professor Berend’s presentation sparked debate amongst the researchers in attendance, including Professor Hebei and Huangwei of Peking University Health Science Center. There were many areas of common research interest and it is hoped that this will lead to future academic collaborations.

In his closing remarks, Philip Gregory, the General Manager of George Clinical China thanked Professor Berend for his informative presentation and for the lively discussion from the audience. Today’s Beijing Health Research lecture Series marks the first time that the George Institute and George Clinical have co-hosted such a presentation and it is hoped that this will form the basis for collaborations in the future.

On Wednesday 22 May, over 40 professional from a variety of backgrounds including academics, healthcare professionals, government and industry met at The George Institute for Global Health at Peking University Health Science Center for the eHealth and Healthcare Innovation Workshop, which engaged participants in detailed discussions on integrated eHealth systems and future potential applications in healthcare innovation in China.

eHealth is a term for healthcare practice supported by electronic technology and communication technology. It can be applied on disease diagnosis, prevention, control, and treatment. Examples of eHealth include electronic health record, mobile Health, and healthcare information systems.

Speakers included Dr Li Qun Xu, Chief Scientist at China Mobile Research Institute (CMRI), Dr Gari Clifford, Director for Affordable Health Technology at George Center for Healthcare Innovation, University of Oxford, Dr David Clifton, Lecturer from Institute of Biomedical Engineering at University of Oxford, Professor Jian Cai, Executive Dean of Innovation Research Institute at Peking University, and Associate Professor David Peiris, Head for Primary Health Care of The George Institute for Global Health Australia at University of Sydney. They each gave a keynote speech on cutting edge technology and information.

These speeches introduced a great number of flagship projects and international collaborations operated by the institute and organization they were affiliate d with. Topics ranged from mobile health (mHealth), affordable and sustainable health care technology, “big data” machine learning methods in healthcare sector, relevant policies and regulations, to barriers emerged from practice.

Dr Xu introduced the end to end mHealth services delivery architecture by listing ‘I Shang’, a carefully designed wearable gadget, and Remote monitoring system and service for cardiovascular conditions developed by CMRI.

Dr Clifford described how his research group is combining the latest research in artificial intelligence, with low cost sensor design and open source information infrastructures to deliver rapid and accurate healthcare support in remote regions. The current beneficiary and achievements of eHeath, said Professor Cai, is great, “It can decrease the trust cost between doctors and patients, provide an opportunity to develop social capital, and let the patients make use of their fragmented time more efficiently, thus improve their lifestyle and increase their time value.”

Yet there still lies a long and difficult way in front of all health care workers and experts from a global perspective. It is facing huge challenges today. As Professor Peiris, whose work focusing on disadvantaged populations, said, “Access to affordable, high quality health care is limited.”

One prior task is to figure out a way to increase the products of eHealth research, and enlarge the scale of resent studies. The current health system in China is even worse, as the existing social and financial barriers hold back the process of reform; the distrust between patients and doctors raise fierce disputes; and inadequate integration of the system reduces efficiency.

Solutions have been raised and put into practice, for instance,reengineering workforce, developing technology supported and evidence based care, patient centred approaches, and innovating systems strategies, to release the global burden. But more need to be done as soon as possible.

However, as the path unfolds in front of us, we can look forward to the bright future led by the eHealth and new health care system.