Research Accolades

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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Hajimu Masuda

Assistant Professor Masuda Hajimu (Department of History) was recently granted the FASS Award for Promising Researcher (APR). This award is presented to researchers who have produced research that shows potential impact and promise. 

Dr Masuda’s research focuses on the modern history of Japan and East Asia, the history of U.S. foreign relations, and the social and global history of the Cold War. A former journalist for Mainichi Shinbun and the author of articles in Foreign Policy, the Journal of Cold War Studies, the Journal of Contemporary History, and Diplomatic History, he has analyzed the evolving power of the people in the modern world, with particular attention to intersections between war and society and politics and culture in the mid-20th century. His first book, Cold War Crucible: The Korean Conflict and the Postwar World, published by Harvard University Press in 2015 and widely praised, has been reviewed in 20 publications.

We congratulated Dr Masuda and spoke to him about his research work.

Your nomination for this award was largely due to your book, Cold War Crucible: The Korean Conflict and the Postwar World. How long did it take you to complete the book and what were some of the most challenging and memorable parts of the process?

book cover

The project began in 2005 as a term paper in a first-year graduate course at Cornell. At that time, I didn’t expect the paper to end up as my first book at all. Looking back, the most challenging part was to go beyond conventional academic boundaries that have long divided the discipline of History, both thematically and geographically. In the case of this project, these include diplomatic history, social history, and cultural history, as well as Asian history, American history, and European history. I was thinking that, in order to fully re-conceptualize Cold War experiences, we need to look at both policymakers’ and ordinary people’s experiences, and do so through synthesizing local, comparative, and global perspectives.

Because of this ambition, eventually I visited fifty-eight archives and libraries in Asia, Europe, and North America over the past decade. This part was, of course, challenging, but mostly memorable because I found that these research trips almost always gave me lots of enjoyment, satisfying my taste for traveling and backpacking. Now, I’m very happy to become a scholar of what I would call a “global and comparative social history” through the process of completing this book.

A group of women in New York City protesting against the Soviet regime (1951)

A group of women in New York City protesting against the Soviet regime (1951)

 

What drew you to research the Cold War, and how does the book conceptualize the Cold War?

Initially, I was thinking of writing an international history of the Korean War, but my project quickly developed into a broader inquiry into the very nature and meanings of the Cold War. This was because I was increasingly frustrated with the ways in which the history of the Cold War had been written and remembered, without much fundamental inquiry into what it really was. Also, I was interested in the metamorphosis of the Cold War during the Korean War period from policymakers’ discourse to ordinary people’s “reality,” and from a diplomatic stand-off in Europe to a gigantic social mechanism that operated on the ground in many parts of the world. 

In short, my book re-conceptualizes the Cold War in three ways: as imagined reality, ordinary people’s war, and social mechanism. I argue that the Cold War was more than an international and geopolitical confrontation between the Western and Eastern blocs. It was also a social mechanism for purity and order, which functioned in many parts of the world to tranquilize chaotic postwar and postcolonial situations through containing a multitude of social conflicts and culture wars at home. In short, what my book aims at is to strip away Cold War imaginings, shedding light on locally specific realities and, in doing so, destabilize our understanding of the Cold War as a single, international confrontation between the two superpowers.

Why did you decide to look at the formation of the Cold War in terms of social and diplomatic history and the role of the Korean War in particular?

The problem with existing literature is a general tendency toward a particular division of labor among scholars. Diplomatic historians have tended to focus on policymakers’ calculations and personalities, while social and cultural historians have tended to look at the effects of the Cold War on society, culture, and the daily lives of ordinary people. Likewise, Asian specialists have tended to look for elements of the Cold War in Asia, exploring how the global conflict impacted that continent. Of course, these studies have their own merits, but, because of the accumulation of them, we tend to have this impression: policymakers’ conduct shaped the Cold War, which, in turn, had enormous aftereffects on ordinary people’s daily lives, and Asia was an end recipient of the global confrontation.

I consider such a narrative problematic. First, as long as we continue accepting this narrative, we will continue to view society, culture, and ordinary people’s daily lives as passive entities under the global and political conflict, and, thus, we will not think about how they might have conditioned and shaped the ways in which the Cold War was made. Second, as long as we continue to view Asia as a passive, end-recipient of the global confrontation, we will continue to accept this Euro-American centric perspective, and, thus, will not imagine how Asia might have also participated in the making of the Cold War world. That’s why I attempted to synthesize social and diplomatic history, as well as Asian and U.S. history, to rewrite Cold War history, to restart our examination of the Cold War, and, in so doing, ultimately, to reconsider the postwar and postcolonial history of the mid-20th century world.

As for the role of the Korean War, I have recently discussed it elsewhere (“H-Diplo Roundtable Review”), but, in a nutshell, the Korean War was significant because it reminded many people of World War II and sparked fear of World War III, which, in turn, helped to codify the imagined reality of the global Cold War.  That’s why I have argued that the “reality” of the Cold War was a product of social and historical construction based on the fear of World War III, built in the shadow of World War II and consolidated by the outbreak of the Korean War.

A mass accusation meeting of land reform at the Yangsi district in Pudong, PRC (1951)

A mass accusation meeting of land reform at the Yangsi district in Pudong, PRC (1951)

 

What were your research methods for investigating the role of ordinary people and small scale local events in contributing to the “reality” of the Cold War? Can you discuss some of your most intriguing findings?

What was significant in the Cold War’s metamorphosis during the Korean War period was that, underneath a global Cold War logic, it actually took on an aspect of “social warfare” at home, with active participation of ordinary people: Suppression of Counter-revolutionaries in China, the White Terror in Taiwan, the Red Purge in Japan, the crackdown on “un-Filipino” activities in the Philippines, and anti-communist and anti-leftist movements in Western societies, such as anti-labor agitation in the United Kingdom and McCarthyism in the United States. Conventionally, these events have been considered the global Cold War’s aftereffects, and have been examined separately.

However, in looking at these events, I was taken aback in seeing how ordinary people actively and quite enthusiastically took part in and used Cold War logic to contain diverse social disagreements and culture wars at home, thus, effectively transforming policymakers’ diplomatic stand-off into an ordinary people’s war at home. That’s why my book re-defines these events as parts of a global phenomenon of nativist backlashes—a sort of social conservative suppression—that operated to silence various disagreements that surfaced in the aftermath of World War II.

Thus, one of the most intriguing findings was that the actual divides of the Cold War existed not necessarily between the Eastern and Western blocs but within each society, with each, in turn, requiring the perpetuation of such an imagined reality to restore and maintain social order and harmony at home. So, perhaps, the Cold War was more than a rivalry among superpowers at the international level. My book suggests that it could be better understood as an imagined reality that took on the role of social tranquilizer, pacifying various disagreements in the aftermath of World War II.

How do you foresee your re-interpretation of the materialization of the Cold War world being incorporated in other areas of research, historical and otherwise?

In terms of scholarly implications, I think my approach could open up new lines of inquiries and discussions as to the reconsideration of postwar and postcolonial histories, in general. What I have tried to do in my book is, in a sense, to relativize the importance of the Cold War narrative in mid-20th century history, and look at locally specific realities underneath the mantle of the Cold War. While only a handful of cases can be discussed in one book, such “unlearning” of Cold War narratives might help us to shed new light on other regions’ and countries’ histories that have been similarly viewed through the Cold War lens, including, for instance, France and Italy, Greece and Iran, Kenya and South Africa, Thailand and Vietnam, and Guatemala and Mexico, as well as the Soviet Union.

In a much broader sense, what I have been problematizing is the imagined and constructed nature of “reality” and “history,” and their functions in society in erecting sorts of “walls” among people and within communities, which operated to clarify lines between “us” and “them.” Once we take off the Cold War lens and re-examine what the Cold War really was, we should be better equipped to see the imagined and constructed nature of our walls, reality, and history, today. I hope that such a recognition would help us to raise questions concerning stereotypical narratives about our world that tend to simplify complex stories and prevent us from thinking further. 

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

Currently I am at work on with a number of projects, including three books. First, I am working on a monograph, tentatively titled “After the Occupation: The Rise of Grassroots Conservatism in Postwar Japan.” It examines Japan’s social experience of war and occupation, with a particular focus on the recurrent rise of grassroots conservative backlashes involving ethnicity, gender, education, and other issues. Viewing these as social conflicts over purity and stability—a phenomenon that was quite common across the world at that time—my study will situate postwar Japan's social experience within the context of a global history of the mid-20th century. A second monograph, provisionally titled “Players of Memory: The Politics of Remembering and Forgetting in Postwar Japan,” explores how diverse memories of the Asia Pacific War emerged and were contested, how specific versions became dominant, and who shaped them and why. Particular attention will be given to roles played by ordinary people, rather than the state, media, or power holders, in choosing, shaping, and maintaining specific versions of war memories.

Third, I am working on an anthology titled “Unlearning Cold War Narratives: Toward Alternative Understandings of the Cold War World.” Through examining regions and countries that my book doesn't discuss, this anthology aims at deconstructing Cold War imaginings and shedding light on locally specific realities and everyday conflicts underneath Cold War narratives, destabilizing common understandings of the Cold War as a single, international confrontation. In addition, I have been working on three articles: “The Social Experience of War and Occupation” for The Cambridge History of Japan; “Reconsidering U.S.-Japanese Relations History” for The Oxford Handbook of American Foreign Relations; and “The Early Cold War” for The Wiley-Blackwell Companion to U.S. Foreign Policy.

Thank you, Dr Masuda. We wish you well in your future projects.

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Jean Yeung

Prof Jean Yeung’s seminal paper, ‘Children's Time with Fathers in Intact Families’, has been recognised as the fifth-most highly cited article of the decade (2001-2010) in theJournal of Marriage and Family (JMF). For nearly 75 years, the JMF has been the leading research journal in the field of family studies (ranked 12/114 in Sociology) and in recognition, the top twenty cited journals have been reprinted in a special virtual issue.

We caught up with Prof Yeung (Sociology) to hear more about this particularly influential paper and to discuss her current research which covers important family/life issues.

 

Prof Yeung, congratulations on your paper’s recent accolade. Were you surprised to hear how widely it has been cited?

Thank you. Well, I knew that I had three particular papers which have a high citation count, all of which stem from my work on the Panel Study of Income Dynamics (PSID) in the US, but it was still a pleasant surprise to hear the paper has had such an impact over the last decade.

 

Tell us more about the paper which came out in 2001 and its significance ten years later.

The paper used the PSID data to look at American family time use and particularly fathers’ time spent with the children. We looked at intact families who used a time-diary to measure time spent together. What was  unique about the paper was down to a number of factors: the data were nationally representative and had a large sample; the time diary method nicely quantifies the time and types of activities fathers do with children (which the literature sorely needs); the sample included children aged 0 to 12, which allowed us to compare across children's developmental stages; the sample provided us the chance to compare fathers of different socioeconomic and ethnic background, and the more recent data allowed us to compare paternal involvement patterns to those in the 1960s and 1980s and to observe changes over the last several decades. 

Our findings suggested that although mothers still shouldered most of the parenting duties, fathers' involvement relative to that of mothers was on the increase. A “new father” role was emerging especially on weekends in intact families. This phenomenon mirrored what had been emerging in Europe and helped to define a new norm in terms of expectations of fathers. We found that fathers who earn more and work longer hours in the week, may spend less time with their children in the week but not so at the weekend. Interestingly mothers' work hours had no effect on children's time with fathers. The paper got the heart of patterns of household division of labour and the changing nature of parent-child relationships.

 

How did you become interested in the fields of family sociology and social demography?

I have always been interested in how gender roles, poverty and social stratification affect the family. I was interested in learning how these factors had broader implications for children’s social psychological well-being and their educational attainment. My PhD dissertation looked at how women’s decision to work affected their timing of childbearing. For many years I studied the time mothers devoted to their employment and the consequent effects on their children. Later, I became interested in looking more at the effects of fatherhood. In many countries, particularly in Asia, some men are ill-prepared to become more involved fathers since they lack role models from previous generations.

 

What have you been working on here at NUS?

My current research and teaching continues to focus on intergenerational studies, family and children’s well-being and policies, social inequality and China’s economic and demographic transition. I teach courses on ‘Social Transformation on Modern China’, ‘Family Sociology’, and on ‘Graduate Research Methods’. I am supervising a couple of masters and PhD students at NUS.  Last year, I organized two conferences in collaboration with the MCYS. One is on the impact of economic stress on families in Asia, the other on Fatherhood in 21st Century Asia. Both conferences garnered much academic and media attention. The fatherhood conference was the first academic conference in Asia on this issue. I have been invited to be a member of the Fathers Action Network in Singapore which aims at promoting fathers’ involvement with children.

I am bringing out two publications, a book titled ‘Economic Stress, Human Capital and Families in Asia’ and a special journal issue of the Journal of Family titled ‘Asian Fatherhood’.

I’m on the Steering committee for the Family, Children and Youth (FCY) Research Cluster in FASS. The FCY Cluster offers a great forum for a meeting of minds from various disciplines. We can all learn about different approaches to complex socio-cultural/economic problems affecting families which in reality do require multiple perspectives.

Over at the Asia Research Institute (ARI) I have a forthcoming conference titled ‘Transitioning to Adulthood in Asia: Courtship, Marriage and Work’. I am working on a paper with a student to look at how Chinese young adults’ decisions and timing of marriage, children and family values have changed in the past five decades.

Recently, I have been preparing to launch a national study on the impact of migration on Chinese children. This survey will cover households in both city and rural areas. I have most recently visited migrant schools in Beijing and Tongcheng in Hubei province (my PhD student Hu Shu’s home town) where half the children in the town are left behind by their migrant parents. Almost all the young workforce have gone to the city leaving the grandparents to bring up the children or putting the children into state-run boarding schools. This phenomenon is likely to have widespread long-term impact on children’s and families' well-being. With good quality data on these patterns and consequences of migration there will be more scope for informed policy-making and better outcomes for affected families.

 

Yeung, W. J., Sandberg, J. F., Davis-Kean, P. E. and Hofferth, S. L. (2001), Children's Time With Fathers in Intact Families. Journal of Marriage and Family, 63: 136–154. doi: 10.1111/j.1741-3737.2001.00136.x

Interviewed by Victoria Giaever-Enger, June 2011.

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