Research Accolades

Alan Ziegler - Award for Excellent Researcher 2017

Professor Alan D. Ziegler (Department of Geography) recently received the FASS Award for Excellent Researcher (AER) which is presented to researchers based on the overall impact and strength of their research. The successful researcher would have “achieved consistent research excellence, produced a piece of research of great impact and be recognised by the research community as having achieved a significant breakthrough.”

Alan examines the interactions of physical and ecological systems, with water resources serving as a common nexus. The work typically involves developing environmental monitoring programs that facilitate understanding catchment processes, as they vary both naturally and anthropogenically over different spatial and temporal scales. Alan is particularly interested in exploring the risks of rural populations in developing areas to ingestion of contaminated drinking water, exposure to anthropogenic contaminants (heavy metals and pesticides), and exposure to water-borne pathogens.

One of his current research focus areas is determining if intensive agrarian systems on sloping lands in Southeast Asia are environmentally sustainable in terms of water availability, water quality, land degradation processes, biodiversity, and carbon sequestration. Some of his other areas of focus are determining the extent of co-facilitation among of mangroves, seagrass, and coral ecosystems; modelling environmental processes with artificial intelligence models; and examining the linkage between hydrological processes, infectious disease, and human health in developing countries.

Alan has also conducted research on hazard governance, which is aimed at addressing flood disaster governance in the Himalaya Region through improving estimates of high-intensity rainfall and increasing the understanding of vulnerable populations. Prof Ziegler’s interest in the area of hazard governance developed during the interactions of several research events at NUS over the last few years, including special workshops he organized as the Chair of the FASS Environment Cluster.

An impressive aspect of Alan’s recent research is the transdisciplinary approaches he has employed by incorporating scientists with a broad range of expertise in physical and human phenomena to tackle important questions related to public health and disaster preparedness.

We congratulated Alan and spoke to him about his research work.


Congratulations on receiving the Award for Excellent Researcher, Alan! What initially sparked your interest in the connection between water resources and human health?

Growing up I wanted to be a doctor, the medical kind not the academic kind, so it is not too farfetched that I eventually incorporated a public health angle into my research. Actually, I credit others for a large push: a handful of eager students who wanted to investigate worms, bacteria, and other organisms that created a hydrological hazard in rural landscapes; and a colleague at NUS who had been doing interesting work on the relationship between cancer and liver flukes in the fish that people ate. My role in all this was not being scared off by the steep learning curve involved in meshing a water resources background with medical ecology, the latter I largely left to the students who were fearless in the field, in the lab, and in developing partnerships with medical collaborators in Thailand and Malaysia. 


Your recent research on water resources and human health has investigated environmental controls of parasites such as Cryptosporidium, Giardia, and Burkholderia pseudomallei, the bacterium that causes the disease Melioidosis, in water-dominated landscapes in Thailand. The research revealed that the frequency of these organisms doubled during the rainy season in sampled water bodies compared with the dry season, highlighting the importance of water as an agent of disease transport. Your research team recommends holistic, transdisciplinary approaches to mitigate exposure and risk to diseases associated with water resources, rather than relying solely on engineering and/or biological approaches that may have unintended environmental consequences or cannot be maintained by some communities with limited resources. Could you explain what this response would involve and how resource poor communities could be involved in its undertaking?

I see this type of interaction as part of the transdisciplinary approach you asked about. The “trans” means that we try to transcend boundaries of our disciplines, integrating knowledge and methods. This is a bit different than simply including people from many disciplines, such as in a multidisciplinary approach, because one has to be humble to the notion that her/his specialty may be no more important in solving a problem than that of any of other specialists involved. The complicated public health issues that we were investigating (e.g., risk to melioidosis, cryptosporidiosis, and giardiasis) require thinking about the interaction of culture, hydrology, engineering, ecology, evolution, medicine, environmental health, public policy, to name a few areas. 

Any type of cross-disciplinary collaboration can be hindered by territoriality. In fact the melioidosis paper was slow coming out because it was being reviewed by people who didn’t understand why we were focusing on non-medical aspects of a well-known disease. Our contribution was to find where in the landscape the bacteria that caused it existed, how its presence changed seasonally and with local water management practices, and ultimately how risk varied for farmers working in rice fields. Also at risk are school kids on playgrounds, some livestock, and various zoo animals such as camels and pandas. This complexity of risk in time and space strongly hints that disease management needs to consider solutions beyond eradication of the vector in the environment and treatment after it is contacted. We argue this is the case for other diseases, for example the one caused by the liverfluke mentioned before.

Ironically, transdisciplinary approaches are not easy to conduct because of the inefficiency or self-serving nature of academia. We argued in a paper wrote a few years back that Geography had perhaps missed the opportunity to make great contributions in solving difficult human-nature problems because tenure-track academics are forced to produce knowledge in a way that develops a subfield, or establishes a person as an expert on a particular (narrow) subject, or forces one to work independently (as a lone ranger) to demonstrate originality and competence. All of this is needed for promotion and tenure. Can early-career academics afford to risk working on a complex problem using a transdisciplinary approach for which they may not be able to control the timing or outlet for dissemination of the results, or even the nature of the message? Interwoven in the difficulty of using a trans-disciplinary approach is that communication between partners is reduced because our individual fields almost require us to write in discipline-specific languages, rather than in a common voice understandable to all—particularly the layperson. Many of us feel that this communication problem is often the reason that some good research discoveries take so long to be implemented into policy


Your research team’s 2016 article ‘A Clear and Present Danger: Ladakh’s increasing vulnerability to flash floods and debris flows’ in Hydrological Processes investigates the nature of the increasing presence of these hazards in the Indian Himalayas, specifically the Ladakh region, a high mountain desert locale. The team found that although this increase may be related to climate change, the main cause of loss of life has been uncontrolled, reckless development, including improperly managed tourism and immigration. How did your team make this discovery?

In the work in Ladakh on flood hazards we also champion transdisciplinary approaches to flood risk reduction because the cause of the disaster in the Leh area was more than just heavy rainfall. In a forthcoming work we examine the spatial distribution of population growth in the region, traditional building strategies, reconstructed climate regimes, and the history of flood occurrences. When one considers the roles of migration, tourism, development, policy, disaster response, geology, changing social structure, hydrology, climatology, the issue is very complex—more complex than one lone ranger can handle. Needed are the voices and expertise of many, not just academic voices, but local voices too.

We say the flood disaster should not simply be blamed on climate change because we want to draw attention to the fact that the population of Leh has increased more than ten–fold over the last 140 years; and now many of these new people are living in at-risk areas that people didn’t occupy permanently in the past. We find evidence that throughout the last few centuries large floods have been associated with brief wet periods separated by dry periods. We observed that many villages were located historically in strategic areas for defense from invaders/enemies, and perhaps natural hazards such as floods.  The several decades prior to the flood in 2010 were relatively flood free, possibly creating the illusion that formerly unsettled areas were safe from flooding. We know this is not the case; the flood sediments and debris flow boulders deposited in the adjacent flood plains of mountain streams tell a different story. 


The article argues that the increasing vulnerability to water hazards in Ladakh should be addressed with sound disaster governance strategies that are proactive, rather than reactionary. Could you elaborate on what formulating strategies for disaster governance entails?

We stress in the new work that one can’t simply blame the settlers or the government for the current status of increased risk to deadly floods. A nuanced approached is needed that considers exactly how this situation has arisen. We firmly believe the solution is more complex than building huge retaining walls around the multitude of tributaries of the Indus River to battle a changing climate. The idea of working together in a transdisciplinary way seems ideal for such developing areas where expensive and large-scale engineering works could never be economically feasible, and perhaps, the uniqueness of the location has helped create a particularly difficult issue involving human-environmental relationships.


You have carried out research collaborations with the Tropical Marine Science Institute, the NUS Department of Biological Sciences, Singapore’s National Parks Board, and the Public Utilities Board to investigate biodiversity and hydrology in the Nee Soon Swamp forest, the only remaining freshwater swamp forest in Singapore, located in the southeast of Seletar Reservoir in the Central Catchment Nature Reserve. Your team’s current project in the 750 hectare wetland area aims to integrate various geography, vegetation, faunal, and modelling teams to research the area’s suitability for stream management and conservation, and is attempting to find impacts of land-use and natural changes through sediment cores, metal analysis, GIS mapping and stream monitoring. What are some of the related research projects you are planning to work on?

What’s next? I will continue working locally in Nee Soon Catchment where a new project is up and running with a great team and collaborators at NParks. Nee Soon is a special place as it is contains the only remaining freshwater swamp forest in Singapore. The new research will help us understand more about a small, yet crucial part, of the natural capital of Singapore. Collectively, swamp forests, mangroves, and terrestrial forests have important aesthetic, cultural, ecological, and educational value. They also represent historical environmental archives of changes occurring over time (e.g., past climates, changes in pollution sources). Despite the recognized value, they are endangered.  Learning all we can about them, and making his information available to the public and government decision makers, is important for helping to protect and preserve them. 

We are also still trying to figure out the relationship between extreme rainfall and flood hazards in the Himalaya – I have two students still working in India and Nepal. Students and colleagues of mine are investigating paleofloods on the Ping and Mekong Rivers, as well as current flood risks. I am collaborating with my former Princeton group and Thai colleagues to identify the triggers and consequences of recent unexpected forest loss on the forest frontiers, particularly in relationship to the expansion of cultivated crops on sloping lands. We also look to expand the work of another finishing student to further explore nutrient exchange between mangroves and the ocean—that work will compare sites in Thailand, Vietnam, New Caledonia and West Papua. I am brainstorming with a group of Singapore scientists about developing an “Asia Water and Health” research program that investigates various issues related to public health and water resources in the region. We also look to expand the liverfluke work into Cambodia.   

I also want to continue to operate my hydrological monitoring network on the Sa River in northern Thailand, which was installed in 2004 in collaboration with Hawaii and Thai colleagues, as it is both a source of new data for research and a resource for teaching. International field work is important to me because it provides our students with opportunities to do fieldwork that is not possible in Singapore. I also firmly believe NUS should be the leader in the region in helping other nations tackle complicated issues through mutually beneficial collaborations. We originally installed the network to help local officials manage the high sediment concentrations that were associated with farming intensification. Now the problem is chemical loading from pesticides and urbanizing areas that are urbanizing because of tourism.  

I have frequently been asked about the benefit of such international research to the US, and now to NUS. To me the answer is obvious: exposure, educational opportunity, leadership, societal impact, livelihood transformation, and soft diplomatic power. Most of these ideas are written on the NUS splash page. NUS is recognized as one of the top universities worldwide. These rankings are based, in part, on research findings on globally important issues, international reputation, and the training and placement of graduate students among other things. Some of the most important global issues today involve the humid tropics of Asia. Work abroad generates exposure, which is important in branding NUS. Students benefit by working in unfamiliar environments, learn about different cultures, and work in locations where an issue can be investigated conveniently. For example, I performed my PhD work on the impact of mountain roads in Thailand because access/liability issues in the USA would have made research very difficult. The work was funded by the USA National Science Foundation who understood the legitimacy of working abroad on this particular topic. I now feel the funding landscape has changed since I came to NUS in 2009. It is getting harder and harder to support research abroad. I encourage funding agencies not to underestimate the value of foreign-based research to the education and nurturing of Singapore’s university students.  


Finally, what are some of the most memorable experiences you and your team have had doing field research in Southeast Asia?

Many of my most valuable research moments were as a graduate student in the field, rarely in the lab or behind a computer. Nearly all involved serendipity. As a student I lived among Karen and Lisu people in northern Thailand for two years. Simultaneously, I worked on a landscape fragmentation in northern Vietnam, living in a Tay village. I spent a lot of time with farmers in their fields, participating in planting and harvesting, playing with kids—but also unknowingly observing that their practices had been changing over time. Later that knowledge allowed me to join a group of international scientists exploring the implications of the demise in swidden agriculture. Part of that knowledge too came from work set in Bulan, Tai, and Hani villages in Xishuangbanna, China. This is where we first observed that large-scale conversion to rubber plantations had the potential to affect hydrology at various scales on the landscape—this finding was completely unanticipated, and the issue became another major research area for me years later. Today I am most proud of the work on swiddening and I relish lessons learned accidentally in the mountains. We also learned another lesson in the mountains of China: prepare carefully and communicate. Two years into the project, the Army tore down all our equipment. Apparently, our climate stations were too close to the Myanmar border. A lot of finger pointing occurred, but I think the issue was that we just had not communicated well enough with the Army. Alas, that equipment are now part of the hydrological network on the Sa River, 14 years and running.


Thank you, Alan. We wish you well in your future projects.

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Dan Friess - Award for Excellent Researcher 2017

Associate Professor Dan Friess (Department of Geography) recently received the FASS Award for Excellent Researcher (AER) which is presented to researchers based on the overall impact and strength of their research. The successful researcher would have “achieved consistent research excellence, produced a piece of research of great impact and be recognised by the research community as having achieved a significant breakthrough.”

Dan's research focuses on threats to tropical coastal habitats and is based on three interdisciplinary themes: 1) quantifying ecosystem services; 2) habitat loss due to sea level rise; and 3) habitat loss due to deforestation. He concentrates on human-environment interactions in the coastal zone, particularly tropical mangrove forests. Dan is interested in the benefits (ecosystem services) that mangroves provide to human populations, and the threats that mangroves face, such as sea level rise and deforestation due to development and agriculture. His work on sea level rise and deforestation in Southeast Asia has been published in high impact journals such as Nature, Nature Climate Change, Biological Reviews, Proceedings of the National Academy of Sciences, Conservation Biology, Biological Conservation, Global Ecology, Biogeography, Global Environmental Change and Annals of the Association of American Geographers. Find out more about Dan's projects at The Mangrove Lab.

Dan was recently awarded (as lead PI, joint with Singapore-ETH Centre) ~SG$4.8 million by the National Research Foundation to conduct a Singapore Ecosystem Services Assessment, where the benefits provided by Singapore’s environment and how ecosystem services will change with development are quantified. The output of this is a planning document and decision support tool to aid land use planning.

We congratulated Dan and spoke to him about his research work.


Congratulations on receiving the Award for Excellent Researcher, Dan! How did you and your team come to develop the research plan for the Singapore Ecosystem Services Assessment?

Between 2014 and 2017 we were funded by the Ministry of Education to undertake a project that quantified several ecosystem services of mangrove forests, and then projected their fate under future land use scenarios. Through this project we came up with some novel techniques to measure ecosystem services such as carbon, fisheries, and cultural values. This project proved to be a kind of pilot study for our broader Singapore Natural Capital Assessment, which takes a similar approach for all ecosystems in Singapore, projects their distribution under scenarios such as the Master Plan, and provides a decision support tool for decision makers to use to test future land use scenarios.


Could you discuss the term ‘Natural Capital’ that the Ecosystem Services Assessment aims to quantify? Could you also elaborate on the term ‘Ecosystem Services’ and its relationship to ‘Natural Capital’? What is the history behind these terms?

‘Ecosystem Services’ are the direct and indirect benefits that natural habitats provide to people. It is a term that was first coined in the early 1980s, though arguably we’ve been using the concept in management for more than a hundred years. ‘Natural Capital’ refers to abiotic (physical) and biotic (biological) assets that contribute to economic output and social wellbeing. These assets encompass ecosystem services, alongside other parts of the environment that help produce ecosystem services.


What are the challenges of carrying out an Ecosystem Services Assessment in Singapore?

National-scale Assessments are increasingly being conducted in Europe (such as the UK’s National Ecosystem Assessment), but we are one of the first to conduct such an assessment in the urban tropics. This poses two major challenges: firstly, our knowledge of tropical urban ecosystem services is quite low compared to other parts of the world, so we need to increase this baseline. Secondly, conducting an assessment in an urban area is much harder than an equivalent national assessment in a larger country with more rural areas. This is because Singapore’s urban landscape is very heterogeneous, so ecosystems are mixed up in close proximity to each other, and boundaries between ecosystems are fuzzy. This is a huge challenge for mapping and monitoring, but provides us with a unique opportunity to show that ecosystem services assessments can be achieved at a variety of scales.


The project will produce a tool for policy makers that will incorporate ecosystem services into land use planning. How could this tool be modified for use beyond Singapore?

The project will provide a framework for the assessment of tropical urban Natural Capital. This framework should provide a tool kit that is applicable enough that it could be taken and applied to any other comparable tropical urban setting.


The 2016 article ‘Rates and drivers of mangrove deforestation in Southeast Asia, 2000-2012’, co-authored with Dr Dan Richards in Proceedings of the National Academy of Sciences USA, discusses the novel remote sensing analysis you undertook to quantify the key causes of mangrove deforestation in Southeast Asia between 2000 and 2012. How did you develop this new method of conducting remote sensing analysis?

We took advantage of some new global datasets that had recently become available. Firstly, researchers at the United States Geological Survey had produced a global mangrove map, so we knew where mangroves were found. Secondly, researchers at the University of Maryland had created a dataset of global forest loss from 2000 to 2012. We merged these datasets to show where mangroves had been lost, and then we looked at what each patch of lost mangrove (40 000 patches!) had been converted into. From this, we could tell if mangroves had been lost to aquaculture, rice, oil palm or urban development.


You indicate that prior to this research, most researchers, NGOs and policy makers were under the assumption that mangroves were being lost at 1-3% per year, and you showed that in fact deforestation rates had reduced substantially to ~0.18% per year. Why was this assumption taken for granted? In addition, your research revealed that oil palm was a regional deforestation driver – how much did this come as a surprise?

This assumption was present because those were the only statistics available at the time. They had been produced 10-20 years ago, and were best guesses based on a literature review of previous (smaller scale) studies. These numbers kept getting cited and recycled in the literature, without much critical thought. Our study, along with another global study published in 2016, were some of the first to quantitatively map regional and global mangrove change for the 21st century, and showed that the real rates were now almost an order of magnitude lower. This is due to many things such as aquaculture intensification, changing land uses, and the successful implementation of government conservation policies. But we still have more to do!

Oil palm as a driver of mangrove loss came as a surprise, as we never talk about it in academic circles. But when we contacted NGOs on the ground and newspaper articles, we found a lot of evidence that this was a fairly common cause of mangrove deforestation. We are happy that our study has highlighted this and has been able to communicate it to other researchers and to the policy arena.


Could you tell us about your upcoming book, Ecosystem Services of Mangrove Forests, due to be published by Routledge in 2019? What can readers expect?

Our knowledge of mangrove ecosystem services is spread across so many disciplines – geography, ecology, conservation science, chemistry, economics and policy. This book aims to bring all of this knowledge together in one place to provide a comprehensive overview. It also has several chapters on mangrove conservation and policy, and how ecosystem services can contribute to this. So I hope that it will be of interest to practitioners and decision makers, as well as students and mangrove researchers.


Lastly, what are your future research projects and plans?

My future plans are to continue highlighting the importance of ecosystem services in Southeast Asia. We’ll be doing this through the Singapore Natural Capital Project, but also through continuing studies of mangroves in the region. My ultimate aim is to have applied, as well as conceptual impact in this field.


Thank you, Dan. We wish you well in your future projects.

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Konstadina Griva

Associate Professor Konstadina Griva (Department of Psychology) recently received the FASS Award for Excellent Researcher (AER) which is presented to researchers based on the overall impact and strength of their research. The successful researcher would have “achieved consistent research excellence, produced a piece of research of great impact and be recognised by the research community as having achieved a significant breakthrough.”

A/P Griva is an accomplished awardee. She is an internationally recognized leader in the field of psychonephrology, which is an appreciation of the psychological and social issues affecting those living with the physical burden of kidney disease. Her Hemodialysis Self Management Randomized Trial (HEDSMART) landed a research award from the European Renal Association – European Dialysis Transplantation Association (ERA_EDTA). HEDSMART is also the largest Randomized Controlled Trial of psychological intervention for renal patients (sample size of 242), comprehensive assessments of clinical endpoints, behaviours and adjustment indicators, and inclusion of long-term follow up assessments (12 & 24 months) to explore sustainability. HEDSMART has contributed to further competitively funded research: the Combined Diabetes and Renal Control Trial (C-DIRECT), sponsored by Singapore’s National Kidney Foundation, and an Agency for Integrated Care-funded diabetes adaptation of the programme set to run from 2017 to 2020.

We congratulated A/P Griva and spoke to her about her research work.

Your nomination for this award was heavily due to HEDSMART, a Hemodialysis Self Management Randomized Trial that ran from 2009 to 2014 and assessed the short and long term effects of a practical, low intensity self-management intervention for hemodialysis patients from ethnically diverse backgrounds who have low socioeconomic status. How did you and your research team come to develop HEDSMART?

My work in the field of PsychoNephrology has spanned more than 20 years now – while my earlier renal research work was on mapping key patient outcomes across the journey, ultimately the goal was to put research in the service of patients and providers and contribute to improved patient care.  To this end, the priority has always been the development of programmes to help patients with long-term conditions to get the best from treatment by supporting optimal adherence or better allowing existing health services to meet patients’ needs.
Interventions specifically designed for CKD patients are limited (at best) – which contrasts the abundance of support programs for patients of other conditions (such as diabetes). HEDSMART was conceived to address this gap. The intention was to develop a feasible, light touch intervention to support patients on dialysis. Pragmatic, feasible and culture sensitive were key considerations in this work. We opted to develop HEDSMART using a ‘bottom-up approach’ seeking input from various stakeholders rather than ‘transplant’ packages from other settings. The work was guided by psychological principles but foci, content, and delivery/implementation procedures were finalised following extensive formative work with patients in the local context and input from renal health providers so as to ensure relevance and good engagement for users and frontline staff respectively.  While the program was mainly to address and support patients, we placed equal weight on supporting the staff involved (facilitators) who were the  ‘lifeline’ of the project by developing a training course, complete manual and debriefing/mentoring opportunities in the pilot phase of the research. We are grateful for the hard work of many people on both research and implementation who have made this work possible – and truly consider HEDSMART an exemplary partnership of front care staff in NKF and researchers in NUS and UK for improved patient care.

What initially drew you to the field of psychonephrology?

When I embarked on my work in the field I was surprised by dearth of studies on renal population(s). Much of the evidence was either lacking or was somewhat outdated/conducted in the 1970/80s when models of renal care were different. I wanted to revisit key questions with a stronger methodology and to fill in gaps left unaddressed in the limited literature. The questions remain relevant today as numbers of patients with CKD are rising rapidly due to ageing and diabetes.
From the behavioural medicine perspective, there are few parallels for the burden of Chronic Kidney Disease/End Stage Renal Disease for patients and health care systems.  Aside the staggering costs, CKD has a profound effect on all aspects of life and functioning including cognitive capacity, identity, emotions, family, relationships, and employment -
Patients are facing an intense, complex and demanding treatment regimen, dependence on artificial means for survival (dialysis), and multiple difficult treatment decisions and transitions. These may regard the commencement of dialysis, a switch from one treatment type to another (as in the case of patients receiving a kidney transplant), patients withdrawing from dialysis or converting from one modality (home based dialysis, peritoneal dialysis) to in centre hemodialysis, and/or a return to dialysis after graft failure.
The various renal replacement modalities have distinct characteristics, including different delivery methods (eg, in-center vs. at home), schedules (intermittent vs. daily; nocturnal vs. daytime), requirements for self-care (eg, clinician-directed or carer-assisted vs. self-care), and physical invasiveness (eg, need for catheters or surgery). Renal care is a journey for patients and families.

renal dialysis technician

Renal Dialysis Technician by wlstechcolleges (Flickr)

Your 2016 article Quality of life and emotional distress in patients and burden in caregivers: a comparison between assisted peritoneal dialysis and self-care peritoneal dialysis published in Quality of Life Research suggested that caregiver burden and quality of life should not prevent the use of assisted peritoneal dialysis (PD).  What most intrigues you about this finding?

The lack of differences between assisted PD and self care PD is compelling as it challenges the notion that PD is only or best suited for young and ambulatory patients who can self-care and self-administer treatment at home. Outcomes for assisted PD – ie. patient dependence on caregivers for performance of PD were comparable and the burden to their caregiver was NOT higher. The findings would therefore support expanding utilization of assisted PD to cater to the growth of frailer elderly people or patients who are unable to self care and require dialysis by supporting dialysis at home, away from tertiary care centres.

Focal to my research work are patient-reported outcomes (i.e. quality of life; emotional adjustment, behavioral responses) – such measures capture patients’ experience and have prognostic value and utility over and beyond clinical markers/indicators. Good measurement (reliable, valid, sensitive) and pertinent to the population under study are however important.

You developed the Transplant Effects Questionnaire to measure emotional and behavioural responses to transplantation. This questionnaire has been adapted for kidney, liver, heart, and lung transplant populations, translated into German, Dutch, and Turkish, and has hundreds of registered users worldwide. Could you shed light on how you developed it?

The Transplant Effects Questionnaire (TxEQ), a transplantation specific tool to measure emotional and behavioral responses to transplantation was developed as part of my research with renal transplant patients in the UK. Developing a questionnaire is a challenging and arduous ‘task’ – at best to be avoided, as I typically advise my research students. Yet we felt the TXEQ was timely and much needed as evidence indicated a range of areas and concerns of transplantation not captured in existing measures. We have developed the measure based on an extensive review of the transplantation literature, a transplant focus group and in-depth interviews with transplant recipients and two research studies comprising more 330 kidney transplants.
The combined approach of such quantitative and qualitative methodologies was thought to be the best approach to capturing transplant recipients’ perspectives on their post-transplant experience and establishing the psychometric properties of the questionnaire. The instrument has been well received in the transplantation community – it has been translated in other languages. We have recently completed a study at NUH using the TXEQ with renal transplant recipients in Singapore.

How do you foresee your findings being incorporated in related fields of behavioural science and health psychology?

I believe my work has contributed to scientific and empirical literature of my field (Behavioural Science/Health Psychology) by mapping key outcomes across a course of diseases and treatments (neuropsychological, behavioural and emotional) for a population, which not been well researched, and by advancing measurement (e.g. the Transplant Effects Questionnaire). Like most researchers however, I would like to see my research work transcending the realms of my scientific field/discipline (Health Psychology/Behavioural) - contributing to better care and health services.

It does sound rather cliché but ultimately everybody that chooses a career in caring professions (including Psychology) aspires to be helpful to others. I have hence strived to align my research with issues of more direct relevance to patients’ experience and heart so that my work has both scientific and pragmatic value:
(a) by alerting the health care community to key challenges and support needs of their patients – e.g. symptoms of depression, and cognitive impairments related to dialysis that may compromise adjustment or highlighting their misperceptions and misunderstanding that may hinder the decision making process and hence may need to elicited or addressed in consultations/pre-dialysis care.
(b) by informing the development of support programs (adjust to usual care) such as HEDSMART to improve outcomes for patients.


What are some of the research topics you are preparing to work on in the future?

In terms of my future research plans I would like to continue my work in the field of long-term conditions and focus more on scalability and sustainability of interventions to extend care beyond tertiary settings.
Some key themes and directions are as follows:

(a) Develop programs to support culture-sensitive home-based care for people with long term conditions in their communities and with their caregivers/family members through the use of technology. I would like to contribute to the development and evaluation of telehealth-based care for wide pool patients and their caregivers. This line of work can have great value for key clinical issues such as increasing utilisation and penetration of peritoneal dialysis regimes, supporting chronic disease management by patients and caregivers, decongesting tertiary care by obviating routine appointments and allowing more room for 'on demand' appointments.
(b) Initiate a research programme to specifically target the fast growing numbers of patients who have multiple co-morbidities/coexisting conditions. With the ageing of the population and the increased prevalence rates of diabetes, patients with multiple diagnoses have already become the norm of health care users. The presence of multiple chronic conditions increases the burden of disease and negatively influences health status beyond the sum of the effects of each single condition. The importance of managing co-existing chronic conditions is critical to slow progression and prevents associated complications, yet this is particularly challenging for patients and health care providers alike. Nevertheless health care systems worldwide continue to focus on the treatment of single disease at a time, a fragmented approach, which does not match the profile of typical patient nowadays. Likewise, psychological support programs and interventions have failed to address the needs of these patients. Up to date there has been a reliance on very intensive interventions delivered in tertiary care settings by leading experts and multidisciplinary teams with highly selected, motivated, and uncomplicated patients. I therefore aim to expand and build on my experience with chronic disease populations by exploring the multiple needs of patients with multiple co-morbidities and coexisting conditions with the view of developing and evaluating models of support interventions to facilitate adjustment and improve outcomes.

Thank you, A/P Griva. We wish you well in your future projects.

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