For policymakers and healthcare providers, achieving successful healthcare interventions can often be reliant on a robust understanding of the communities involved. That’s where the work of Professor Lisa Dikomitis and her collaborators comes in. As a Belgian-Cypriot anthropologist and Director of the Centre for Health Services Studies (CHSS) at Kent, she brings a unique perspective to global health research.
What led you to where you are now?
I am trained as an educator, art historian and anthropologist. As a refugee daughter, I was especially interested in working with Cypriot refugees when I began my career, so spent many years conducting long-term fieldwork in Cyprus. Inevitably, I came across notions of suffering and mental health amongst the Cypriot refugee community which piqued my interest and led to a focus on mental health research. My mother has always worked in mental health services, and my family joked that having spent so many years working on my Cypriot father’s ‘refugee story,’ why not spend time on my mother’s story? And that’s how I started my journey in medical and health research. Following positions in other UK medical schools, I joined the Kent and Medway Medical School (KMMS) in January 2022, where I co-direct research, and became Director of CHSS in 2023.
What does your anthropological perspective bring to medical research?
My focus has always been on the cultural and social dimensions of healthcare. Who provides healthcare, who can access healthcare, who does not access healthcare? Why not? For example, one project I work on examines schizophrenia treatment in Pakistan. The clinicians can only see patients briefly and often do not have time, understandably, to get the whole picture of the patient, or the patient is diagnosed but does not attend appointments because they cannot leave their children alone or cannot afford the transport to the far-away treatment centres. This has similarities to what I have seen in several societies, for instance in the Philippines (through the Stories of Public Health through Local Art-based Community Engagement (SOLACE) project); namely that healthcare in remote, rural areas is often inaccessible, for various context-specific reasons. Our research is helping to show how we can change that and address local issues. Over the past 10 years, I have developed collaborations across the globe and I now lead interdisciplinary global health teams which explore these issues, mainly using anthropological and creative methods, alongside more conventional approaches in medical research.
Why is the creative aspect important?
Often healthcare interventions are effective in one context, but not culturally-appropriate and often perceived as ‘dry’ in another context, and therefore do not capture the community’s attention – that’s where creative methods can be really effective. Through the Empowering people with Cutaneous Leishmaniasis: Intervention Programme to improve patient journey and reduce Stigma via Community Education (ECLIPSE) programme, which I co-lead with Professor Price from Keele University, we have been working in communities affected by cutaneous leishmaniasis to develop interventions to raise awareness and enhance treatment access and uptake of this neglected skin disease. What’s cool is that we’re working with a team of 85 researchers across four countries – Brazil, Ethiopia, Sri Lanka and the UK – and taking a bespoke approach in each. With community members, we have co-created films, street drama, books and folk theatre, which was broadcast on national TV channels in the different countries. In Brazil, one of the films won several awards and our work in Ethiopia led to the opening of new services specifically for cutaneous leishmaniasis.
Involving the public and patients in research is something you champion in CHSS and KMMS. Why is it so important?
Many community members may not know about health and social care research, or many had negative experiences of research. For instance, over the years I learned from community members who told me about participation in trials or other health research, where researchers may have taken their data in the form of blood samples, through an interview or a survey, without really knowing what the research is for or without communicating the research outcomes to them. In CHSS and KMMS, we don’t like that. We go to the communities with a skeleton idea, but the whole body of the research needs to be designed with the community. This can be complex and time-consuming, but by involving community members from the very start of the research idea, we can gain a much better understanding of the community’s needs and identify the most effective ways to involve them with the issues we’re researching and the interventions we create.
What do community members get out of being involved in research?
I really believe that public and patient involvement (PPI) is the most effective way to have true impact in research because we only want to do research that addresses the needs of the community. My biggest joy is when community members are so enthused by our research, they decide to become researchers themselves. They come and study with us for a Master’s or a PhD, as do many of those health and social care professionals we work with. This is important as it brings different perspectives at the University of Kent and helps us produce research which reflects that, leading to more effective healthcare for individuals whose needs might otherwise have been overlooked.
How do you go about getting communities involved?
Nobody is just waiting for an anthropologist to knock on their door, so it’s important that we reach out to communities who are not involved in research. This means going to places of worship, voluntary and community organisations. I can’t stress enough how vital these groups are in helping us connect with community members. That’s why it’s great when an institution offers seed-corn funding which can enable smaller projects focussed on developing such connections.
We must also overcome people’s preconceived perceptions of what research is. They become enthusiastic when they see they will have agency in where the research takes place, when and how the research will take place, who is invited to participate and how we use the funding available to us. This was especially the case for our work in Kent’s Sikh community, a programme of research I co-lead with Professor Sukhi Shergill at KMMS. We are working with Punjabi Sikhs living in Kent to assess factors influencing mental health in their community. We travelled to India, with Kent Sikhs, to visit the villages they migrated from and to collaborate with colleagues in mental health settings. We documented the complexities of the Sikh community’s relationship with mental health in an audio documentary, Sikh Silences across Generations.
Does not having a clearly defined project make it difficult to apply for funding?
I think it’s important to recognise that writing successful grant applications is as much of a craft as writing publications. You need to be able to tell the reviewers, ‘This is what we’re going to look at, we propose these methods and we have already discussed this with all those stakeholders. But what we’re actually going to produce, what the result will be, we do not know yet.’
It helps to involve the funders throughout the research process. For instance, we invited our funders to events at Kent, and across the globe, so that they get more insight into just how complex and time-consuming this type of research can be. For instance, how much effort goes into recruiting participants or the additional measures we need to consider removing barriers to them getting involved. It shows our funders we have expertise in this approach and that we are going to regularly communicate with all stakeholders, including the funder. And that’s really why research is such a team effort.
CHSS’s work is clearly having an impact all over the world, but how is your approach improving healthcare locally?
I am currently leading INTERACT, a project through which we’re working with young people, new mothers, older adults, and members of ethnic minority communities in Kent to capture the lived experiences, perceptions and understandings of mental health and document their hopes and expectations for the future to improve local mental health outcomes. This is just one of a series of projects we’re running locally in partnership with KMMS and with the Kent and Medway NHS and Social Care Partnership Trust (KMPT), the outcomes of which we recently shared with the community at an event at the Turner Contemporary in Margate.
Professor Lisa Dikomitis is Director of the Centre for Health Services Studies and Co-Director of Research at the Kent and Medway Medical School, and Professor of Medical Anthropology and Social Sciences. She has received external funding exceeding £17 million and has published over 90 peer-reviewed research publications and shows a strong commitment to communicating science publicly. Professor Dikomitis is open to being featured in print, on TV and the radio.