Behind the Paper: Decolonizing infectious disease programs

In this post, we speak to the authors of a recent PLOS Global Public Health article, Decolonizing infectious disease programs: A mixed methods analysis of a novel multi-country virtual training for Female Genital Schistosomiasis, about the story behind the research. The paper was written by Kari Eller, Kelechi Amy Nwoku, Reda Sadki, Nicole Vecchio, Caroline Pensotti, Charlotte Njua Mbuh, and Julie Jacobson.

What led you to decide on this research question?

TGLF’s peer learning-to-action model has been used with learners from around the world on topics ranging from immunization to emergency response. Along the way, it has brought together participants across countries and across health system levels, from national capitals down to sub-district settings. In many of these contexts, learners stayed engaged with one another and showed a clear interest in turning what they learned into action.

Participants often shared that they would not normally have access to this kind of training or the chance to learn alongside peers facing similar challenges. In that sense, the model helped open up access to knowledge and moved away from more traditional, top-down training approaches. It also created space for participants to bring their own experience into the learning process, working together on solutions that made sense in their local and cultural contexts. To better understand how this played out in practice, we conducted an in-depth mixed-methods analysis to look at who was being reached, what impact the training had, and who might have been left behind.

Fig 1. (from left to right) Co-authors Charlotte Mbuh, Reda Sadki, and Julie Jacobson during a 15-minute introduction to FGS. Photo used with permission from the authors.

Could you talk us through how you designed your study? What was important for your team as you created the study team?

To capture the full impact of the program, we used a mixed-methods design that combined standardized measures with participants’ own accounts of their experiences. The study drew on online survey responses collected before and after each of the two training phases, allowing us to examine change over time while keeping participants’ voices central. Bringing these data together strengthened confidence in the self-reported changes and provided a more complete picture of impact.

Quantitative analyses were selected based on dataset size, with Bayesian approaches used for smaller samples and logistic regression applied to larger ones. Qualitative analyses added depth, generating thematic insights and composite accounts that helped explain how and why changes occurred. From the outset, our aim was to analyze the data rigorously and present the findings in a way that would be meaningful to a broad, international, interdisciplinary, and interprofessional audience.

We also approached the research process itself in the same collaborative spirit as TGLF’s peer learning model. The team met regularly on Zoom throughout the study, working through the data together, questioning assumptions, and jointly shaping the analysis and writing. This shared process helped keep us accountable to our objectives and stakeholders, and resulted in a paper, available in both English and French, where the integration of quantitative and qualitative findings offers more than either could alone.

Fig 2. Co-author Kari Eller began a joint presentation on the research findings to health professions educators. Photo used with permission from the authors.

What challenges did you encounter during your study?

For those of us on the research team who were not as familiar with FGS, more comfortable with one type of analysis than another, or who were perplexed by other aspects of the study, our first challenge was figuring out where to start. The dataset was large, there were many possibilities to explore, seemingly more potential methods of analysis, and we also didn’t know each other very well. Each of us had a preferred path forward, a specialized vocabulary, and yet none of us could go or make sense of it alone. We needed and wanted each other’s expertise. To address these challenges, we set aside a few minutes during our meetings for some social time and made sure to explain our thought processes and understandings. From one meeting to the next, we kept exploring different facets of the data, considering theoretical frameworks, deciding which data and findings would be most relevant to increase impact and improve the model, and brainstorming how best to analyze it. We would do a small part, share it with each other, and maybe keep one essential thing from what we shared. We laughed, we got frustrated, we took a break, and then we’d try again. Slowly, the connections began to build, and we realized the importance of that word, turning to connectivism to help us explain our findings.

Fig 3. Co-author Caroline Pensotti provided a brief overview of FGS during the joint presentation. Photo used with permission from the authors.

What did you find most striking about your results? How will this research be used?

Initially, there were concerns that a virtual peer learning format, especially with such a diverse group, might not work for everyone, and that digital access would pose additional challenges. What stood out in our results was how well the digital format, peer learning, and content worked across the board, regardless of role, country, or position within the health system. Quantitative results showed clear improvements across multiple capacities, and qualitative data explained how these changes occurred. For instance, doctors spoke about the practical value they gained, while community health workers were openly excited about how much they learned.

The first revelation was the approach’s universal applicability; however, a second, equally significant finding emerged: the model catalyzed a transformation in professional identity that extended well beyond disease-specific learning. Participants not only learned more than anticipated, but also described becoming more confident, more proactive in their roles, and more effective in their day-to-day work. They spoke about how peer review and reflection sharpened their thinking, while expanded networks quickly filled critical information gaps and provided support when challenges arose. Just as importantly, participants described giving that same support to others, reinforcing a sense of shared responsibility and collective capacity.

For some, peer learning reshaped their understanding of FGS, reframing it as a pressing public health issue rather than a marginal or neglected condition. Through these interactions, participants strengthened their advocacy toward health authorities and, together, addressed gaps in equitable access to information and resources. Even when formal action plans were not fully completed, collective learning often led to local actions that exceeded the original scope of the plans.

Within our own organizations, we plan to use these findings to refine future programming and to further extend awareness of FGS. More broadly, we aim to further use this peer approach to address additional health and development challenges. We hope the research encourages others, both within and outside global health, to lean more intentionally into peer learning models and to overcome biases that assume centrally driven, top-down learning is the best model. Across contexts and challenges, this kind of collaboration can meaningfully transform local practice and, in some cases, save lives.

Fig 4. Co-author Nicole Vecchio shared results related to the first peer-to-peer virtual training and support program in 2021 during the joint presentation. Photo used with permission from the authors.

What further research questions need to be addressed in this area?

One striking issue was gender. Despite enrolling similar numbers of men and women, women were less likely to complete either or both phases of the program. This raises questions about what is getting in the way and highlights the need to understand what specific supports or design changes could help them stay engaged and complete virtual peer learning programs.

Another question is how the approach can best achieve a longer-term impact through action planning and continued peer networking. We were able to show immediate reach through self-reported numbers of colleagues trained, patients managed, and communities reached from the end-of-course surveys, but we were unable to verify how long they will last, especially once formal program support ends. Related to this is the question of which action plan approaches lead to greater improvements. Based on our observation that integration into existing systems is key, it would also be useful to explore which integration strategies are most effective for advancing FGS efforts and what local factors help those changes stick.

From an FGS-specific perspective, many healthcare workers, despite living and working in endemic areas, were unaware of FGS or unsure how to manage it, pointing to a need for more research, training, and attention. Neglected tropical diseases are among the many global health and development challenges demanding our attention. Our findings highlight how peer learning programs can build community capacity to collectively address common challenges, accelerating and scaling positive change. Learners are highly motivated when presented with actionable knowledge to improve health outcomes and given the opportunity to iterate in real time with their peers. Collecting and analyzing additional types of data could better visualize their ripple effects and help us understand how this learning approach can be adapted to address diverse societal challenges.

Fig 5. Co-author Charlotte Mbuh explained the 2023 FGS peer-to-peer virtual training events during the joint presentation. Photo used with permission from the authors.

Why did you choose PLOS Global Public Health as a venue for your article?

Having invested significant time and resources in rigorously conducting our research and wanting to ensure its accessibility to all, we valued PLOS Global Public Health’s high standards, robust inclusion of articles addressing deeply entrenched inequities, and broad audience base, from epidemiologists and educators to policymakers and funders. Given that our research explored continuing professional development for global health professionals, the journal’s reputation for publishing innovative research both within and beyond formal medical education was also a significant factor in our decision. By publishing in PLOS Global Public Health, we knew our work would be presented well, shared, and reused, reaching a wide range of respected leaders worldwide.

Fig 6. (from left to right) Co-authors Kari Eller, Caroline Pensotti, Amy Nwoku, Nicole Vecchio, Julie Jacobson, and Charlotte Mbuh during a meeting to discuss results.

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