Faculty collaborate with UP Manila as part of larger global health equity initiative

Two faculty members in the Department of Epidemiology and Biostatistics—Carmen Tekwe, Ph.D. and Roger Zoh, Ph.D.—recently obtained a "Memorandum of Intent (MOI) for Collaboration between School of Public Health at Indiana University and College of Public Health, University of the Philippines Manila (UP Manila)" to establish continued research to combat health disparities in obesity and the collection of data about type 2 diabetes.

"We signed the MOI in February, and we are now working to become visiting UP faculty to more easily collaborate with their researchers and students—and that is something we are excited about," says Dr. Tekwe. "We have not gotten to the phase of getting data yet as we need to get this next step done first, but the exciting thing is that anyone from IU who is interested in working with the College of Public Health with UP Manila can do that through this agreement."

This is just a small part of a global initiative that Drs. Tekwe and Zoh developed over the course of the last year in Singapore and Thailand, with intentions of extending to Ghana this year. The initiative is designed to help improve collection and analysis of biobehavioral data obtained from wearable devices such as sleep, physical activity, glucose monitoring, and blood pressure—and to see if there are different patterns in various subgroups of people and how those patterns relate to health outcomes.

"We want to know if these patterns only exist within the U.S. or extend beyond our country. Is there something we can do to come up with just one recommendation of how to do this correction across the board?" shares Dr. Tekwe.

This initiative is an extension of the work currently funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to develop measurement error correction methods in physical activity and dietary intake among different subgroups and to see if the same approaches are equally applicable to all individuals - or, if there are needs for more personalized methods that account for other important factors such as culture, climate, and environment.

"There comes a challenge of how to interpret the data coming out—do you use metrics that have been validated here in the U.S. population but don't necessarily translate in the other population in their own cases?" says Dr. Zoh. "This collaboration [with UP Manila] really helps us think more broadly about how to approach data and developing methods that equally benefits all demographics included in the data."

Dr. Tekwe says they will examine whether the U.S. methods for addressing those data issues can be translated to other parts of the world, as well as different demographics. For example, patterns of activity between a 45-year-old White female and a Black female of the same age might be different for reasons other than racial differences—and might require other methods of data collection and improvement.

"There are so many other issues that create these differences in individuals beyond race and we are trying to explore this a bit further and find out what those things are," says Dr. Tekwe.

Humanizing the numbers

Another benefit to these international outreach efforts is humanizing the process of data collection and understanding that results will vary depending on the individual.

"One of the things driving the work we do is we have historically developed methods to address different data issues in statistics and then just leave it there," says Dr. Tekwe. "What I try to stress to my students is someone is on the other side of that data, behind that number, that we need to understand."

Tekwe says there are ways of coming up with a simple equation to develop more personalized methods of addressing measurement error with wearable technology and devices that will require further testing.

"When we look at a lot of larger U.S. databases, we oversample minority groups so we have enough to represent the number or percentage of minority individuals within the country," says Dr. Tekwe. "But often Asian groups or Native American people get grouped into the 'other' category and we won't see a difference between that group and 'White people,' for example. It is teasing out those 'other' categories a bit to help us understand these different patterns we are observing."

Exploring accurate data collection on a budget

Another challenge is conducting research in lower- or middle-income environments where not everyone may have access to wearable technology such as an Apple Watch.

"How we assess physical activity or inactivity in a constrained budget environment is a conversation we plan to have as part of this collaboration with UP Manila," says Dr. Zoh. "There is so much untapped potential here. We can send our students there as there is always something to be gained in understanding how our statistical research can be done in all environments including lower-income and middle-income resource environments."

Other issues to consider: If a smaller sample size is all that can feasibly be acquired—for example, 20 participants versus 1,000—can meaningful data still be gleaned from such a small group?

"If a smaller sample is the best we can do, we would examine what kind of information we can still gather that would allow us to make some larger recommendations," says Dr. Tekwe.

Currently Drs. Tekwe and Zoh are developing a similar agreement with Mahidol University in Thailand. Keep up with all the exciting updates on this project at go.iu.edu/48bx.