Leaving no one behind in CEI: What do we mean?

This is the first episode of our podcast series, Spotlight on community engagement and involvement (CEI): Leaving no one behind. 

Episode 1 introduces the Leave No One Behind agenda and discusses its importance in the context of CEI. 

Gary Hickey, NIHR Senior Research Manager for Patient and Public Involvement and Engagement hosts this podcast and is joined by Professor Kara Hanson, Director of Global Health Research Programmes at NIHR and Noni Mumba, Head of Community Engagement at KEMRI Wellcome Trust Research Programme. 

The guests discuss the importance of CEI in NIHR-funded research and what is meant by leaving no one behind, challenges and examples from their work, and provide tips for leaving no one behind in CEI. 

Get to know our speakers

Gary Hickey is a Senior Research Manager at the NIHR and also Chair of the International Patient and Public Involvement Network. He is passionate about promoting and sharing knowledge from across the globe about how to involve the public and communities in research. Gary works with researchers and the public providing advice, guidance and training on patient and public involvement in health and social care research. In addition, he writes, presents and is involved in several podcasts on these issues.

Kara Hanson is Professor of Health System Economics and Dean, Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine. She holds degrees in Economics and Political Science (McGill University, Canada); Economics and politics of development (University of Cambridge); and International Health Economics (Harvard University). Her research contributions are in the areas of health financing and the private health sector. She is Director of the UK NIHR Global Health Research Programme.

Noni Mumba is an engagement practitioner with over 10 years expertise in community engagement for global health research. This expertise also includes engaging broadly with specific publics of interest, including local and national policy makers in Kenya. Her role at KEMRI Wellcome Trust Research Programme (KWTRP) includes development of engagement strategies and innovative approaches for the engagement and involvement of host communities, stakeholders, and policy makers in research planning, conduct, and uptake of findings into policy. She also supports monitoring, evaluation and learning of engagement activities.

Noni is involved in building the capacity of KWTRP engagement staff and researchers on engagement. In the last 5 years, this capacity strengthening has extended beyond KWTRP through webinars, teaching engagements, and collaborative research projects.

Transcript

Spotlight on CEI: Leaving no one behind 

Episode 1 - Leaving no one behind in CEI: What do we mean?

Host: Gary Hickey

Guests: Kara Hanson, Noni Mumba

Gary Hickey  00:00

Hello! My name is Gary Hickey, and I work for the National Institute for Health and Care Research, an organisation based in the UK that funds research both in the UK and indeed globally. Welcome to our podcast series ‘Spotlight on community engagement and involvement: Leaving no one behind’. Back in 2022, we released our first podcast series that explored community engagement and involvement in the delivery of global health research. We discussed what good community engagement and involvement looks like, and challenges faced, and we shared lots of learning. In this, our second series, we're going to focus on how we involve and engage in research those people in communities who are most marginalised and vulnerable; how we fulfil our commitment to leave no one behind. We will have conversations with community engagement specialists, members of the public, researchers and indeed experts from across the world about how inclusive community engagement and involvement can impact both communities and research. The intention is that we, researchers and public, will learn from experience and opinions of our podcast guests and so improve how we go about community engagement and involvement and make it truly inclusive.

In this first episode in the new series, we would explore what leaving no one behind may mean in community engagement and involvement, its impact, and why it's important to the National Institute for Health and Care Research and the global health research that we fund, and I'm delighted today to be joined by two people who have far more knowledge about these issues than I do. So, we have Kara Hanson, Director of the Global Health Research Programme at the National Institute for Health and Care Research. Hello, Kara, how are you?

Kara Hanson 01:53

I'm very well, Gary, nice to see you here. 

Gary Hickey  01:56

Thank you. And we also have Noni Mumba, Head of Engagement at the Kenya Medical Research Institute Wellcome Trust Research Programme. Welcome Noni.

Noni Mumba  02:07

Thank you very much, Gary, I'm very happy to be here.

Gary Hickey  02:11

Fantastic. I'm going to start by just asking both of you a little bit about your work and what it is you do. So, Kara, tell us a little bit about yourself and what you do.

Kara Hanson  02:21

Well, I have two roles. The first that we're talking about today is my role as the Programme Director for the NIHR’s Global Health Research Programme. And that means that I have scientific oversight over the programme. That's the seven different funding streams that we administer directly, as well as oversight over the partnerships that we have with other funding organisations, things that some of your listeners might be familiar with, like the European Clinical Trials Partnership and the Global Alliance for Chronic Diseases, both of which are research funding mechanisms through which we also fund Global Health research. My other job, is as a professor of Health Economics at the London School of Hygiene and Tropical Medicine, where for the last 30 years, I’ve contributed to and led programmes of research around health systems and health economics with a focus on how health systems are financed and organised in low and middle income countries.

Gary Hickey  03:18

Fantastic, thank you Kara. And Noni, tell us a bit more about your role at KEMRI.

Noni Mumba  03:23

Thank you, Gary. So, my work revolves around developing innovative engagement approaches that support or bring together scientists and community members, primarily to develop relationships, and then from those relationships, be able to have inputs, have scientists understand the point of view of community members and also have community members understand science to be able to make research better generally. So, I work with a team within the research programme, so I am responsible for supporting them in terms of their capacity building. Of late, I've also been involved in capacity strengthening across the region, so supporting other research institutes around Africa for example, to be able to develop their own community engagement and involvement programmes to support their research work. I've been part of advisory committees advising on ethical issues related especially to community members and their participation in research. 

Gary Hickey  04:38

Fantastic, thank you. So, that gives a flavour of our two guests today. And given this is the first episode in the new series, it's nice to kind of set a little bit of a [a] scene, if you like. So, Kara, can you tell us a bit about the NIHR’s Global Health Programme, and why community involvement and engagement is important in this research.

Kara Hanson  05:00

Thanks, Gary. Well, the NIHR has funded global health research since 2016, and this programme uses money from the official development aid budget of the UK Government to fund research that addresses the health needs of people and communities in low and middle income countries. We work across three broad thematic priorities. One is to address the changing global burden of disease. The second is research that develops health systems to identify and respond to population health needs. And the third is research that builds resilience to tackle future health threats.

What's special about the Global Health Research Programme is that it works through some underlying principles that crosscut the way that NIHR is funded and how that works in practice. So, one is a focus on capacity strengthening of research teams both in the UK and in low and middle income countries. The second, is that research must be undertaken through equitable partnerships between organisations that are working together to deliver research, and that means that those partnerships are constructed in a way that ensures a fair distribution of resources, a fair distribution of authority and power in decision making, and a fair distribution of the benefits of undertaking research; the opportunities to publish and to present the findings. The third principle is that we really want the research that we fund to be impactful and policy relevant. And that's where community involvement and engagement comes in because it's only through doing research that identifies research questions that are meeting the needs of communities and is done in a way that involves communities throughout the process, that it can really be impactful and influence policy and practice.

Gary Hickey  06:47

Fantastic, thank you Kara. I'm hoping this podcast, we're going to have listeners that have been applicants, successful, applicants, unsuccessful, and also potential applicants. So could you say something, Kara, about what is it you'd expect applicants to do in terms of community engagement and involvement in their applications?

Kara Hanson  07:06

When people are applying for NIHR Global Health Research funding, we're looking for them to include community involvement and engagement in all stages of the research to provide evidence that communities have been involved in setting the research questions, that they're aware of and have opportunities to participate in the research itself, and that they're really involved in the dissemination of the research.

The key, when we're looking across different sizes of proposals and different funding streams, is proportionality. So, some of our awards are relatively small and some are really very large. So, we would obviously be looking for a much more developed and sophisticated community engagement plan, consisting of a bigger range of activities and with more expertise in the much larger awards. In some cases researchers and the communities that they're working in are quite new to the idea of involving communities in research, and that would be appropriate for funding at smaller levels or for less experienced teams to be at the beginning of that journey of developing their skills and their experience. And so looking to learn how to do community engagement and to be part of the capacity strengthening elements of that research. So, when people are completing their applications, there are specific sections that they need to fill to demonstrate what activities they'll undertake, but we're also looking for them to allocate enough resources in their budgets to be able to really undertake community engagement well.

Gary Hickey  08:44

Brilliant, thank you, Kara. I'd now just like to tackle this phrase that we use about leave no one behind, and it's something the NIHR uses often and describes in its approach to community engagement and involvement. Could you Kara, explain to listeners where this phrase comes from and what it actually means?

Kara Hanson  09:03

Leaving no one behind emerges from the language that's used in the 2030 Sustainable Development Goals. The idea is that development is only meaningful if everybody can benefit from it. There are no groups that experience exclusion or discrimination in their access to the benefits of development. So obviously, we're interested there in the experiences of those who are more traditionally left behind; women and girls, children, young people, people with disabilities, older people, indigenous people, migrants. And it's also important that who is excluded or marginalised is defined in context, because exclusion and marginalisation will themselves be processes that differ in different parts of the world. 

An important element of this is the measurement agenda. So, it's not enough to improve development outcomes on average, we want to be able to demonstrate that the benefits of development are shared by everybody in a country, by everybody in a community, and to be able to do that, you need to be able to measure it as well. And so this, [this] question of leave no one behind, it's a shared framework, a shared agenda for action to really promote equality in all its forms; equality, non-discrimination, vertical and horizontal equity. In terms of research, this means thinking about research that includes disadvantaged groups. It's research that's done in an equitable way that involves disadvantaged groups in the research process, and that includes community members, but also equity in the partnership between research organisations as well. So, we're looking for work that embodies those equitable partnerships and community involvement and engagement is a vehicle for doing this throughout the research process, for identifying, incorporating marginalised people in the research itself and for doing the research in a way that is inclusive and equitable.

Gary Hickey  11:05

Thank you, Kara. Noni, I'd like to bring you in here. Did you have anything to add to Kara's explanation and in particular, why you think it benefits research?

Noni Mumba  11:14

Yeah, if I can just start maybe a bit behind. I think when you're thinking about leave no one behind, and how eventually that can come to, you know, really support science to be better science, you want to be thinking about the context, just as has already been said; who are these groups of people? Who are these populations that you want to ensure are not being left behind? What kind of situations are they in? Where can they be found? And so, it's really important for the research to be able to have a very good understanding of the context and the populations that live within that context. And you know, once you have had that good understanding, then you can begin to think about, what are their situations, and how then is your research question linked to the situations that these populations are living in, and how then can you bring them on board? When you talk about, how can you bring them on board, it's you know, where do you find them? At what time do you find them? How do you prepare even your materials to share your research with them? How do you take in their views? Because if you're talking about not leaving anyone behind, it's not just about sharing the work that you're doing so that you know they know and you have not left them behind, it includes, how do you take on their views? If they want things changed, for example, in the research, what mechanisms are in place to ensure that these specific populations feel that they actually have been heard and they have been involved in a meaningful way.

Gary Hickey  13:05

Thanks, Noni. Given that what you've said, and I know that you work in research, so have you got examples about research you've undertaken or been involved in that reflects all the things you've said and embraces the leave no one behind agenda?

Noni Mumba  13:21

There are studies that we have undertaken within our research programme. I am an engagement practitioner, while I might do research studies that are related to engagement, a lot of our work revolves around supporting other research studies. So, for example, for quite a long time, we have conducted HIV studies within our setting in the coastal part of Kenya. These HIV studies initially began in the general population and as research findings came out, we quickly began to realise that there were pockets of the population that were more affected and were possibly continuing on the spread of infections, and these were, you know, sex workers and men who have sex with men. So, obviously there was a need to really engage these populations. Now, especially in the coastal area here in Kenya, it's largely a Muslim population, and so it was quite sensitive to be engaging with sex workers, you know, or male sex workers who sell sex to fellow men and that kind of a thing. And it really required for us to do a lot of sensitisation to the broader population, to the general population, and especially having engagement activities with religious leaders, to be able to open for us doorways to have engagement activities with this, what we call a key population, without getting backlash from the community. 

A lot of people who are doing community engagement and they want to involve, you know, populations that could very easily drop off the table or fall through the cracks, you'd really have to develop an elaborate plan that encompasses everyone and is able to see; are there areas that could be sticky points? Areas of conflict? And how then are you going to resolve those to ensure that you are involved? In our general studies, we have involved, you know, people of low literacy, for example, our CAB members. We have ensured that even people who may not have gone to school can be part of a CAB and we can share our science to them in a completely lay language, and be able to gather their own views about the studies that we do.

Gary Hickey  15:55

Noni, you mentioned CAB members there. Could you just explain for our listeners and for me, what a CAB member is?

Noni Mumba  16:03

The acronym CAB stands for community advisory board and some other versions it's also referred to as a community advisory group, or CAG. And these really are individuals that are drawn from a specific population, they are dependent on the type of research that is being conducted or the area where research is being conducted. And these are individuals that are either elected or nominated or selected in some format. They are not employed by a research project or a research organisation, and they are completely independent. And their role, really, is to offer their views as community members about research, and sometimes also offer advice on how to go about certain sticking points of research, like recruitment. They also advise on strategy, research strategy. They offer their own priorities in terms of research priorities. They can also advise on specific research processes.

Gary Hickey  17:07

Thank you, Noni. You started sort of touching on some things that I want to kind of dig deeper into in my next question, and it's, what are the reasons why people are left behind, and what are the challenges when seeking to leave no one behind?

Noni Mumba  17:23

So, I think in our context here in Kilifi, some of the things that you know we have learnt in terms of challenges relate to the people themselves who are attempting to engage. So, one of the really big things in community engagement and involvement is the skills of the people who are engaging; in our own experience, it's not something that anybody can do. So, you need skilled people who are able to do what I have, sort of like touched on, so what we call segmentation of the population. Is there somebody who understands, you know how to segment the population, to be able to point out; so this is the total population; these are the people who we are involving right now; these are people who are completely not participating in our research activities or our engagement activities; how do you reach them? What type of means are you going to use to reach them? So, those are some of the challenges that lead to people being left behind. 

What type of approaches are being used? You could be using a certain approach to reach women, for example, you know, we've heard from Kara that women are some of those groups that are sometimes not involved in community engagement activities either because of, the type of a population, it could be patriarchal, and, you know, women are not allowed in meeting spaces. So, what approaches then do you use? If you're using the wrong approaches, there'll be a barrier in terms of, you know, reaching these groups of people. And so in terms of attempting to ensure that they are actually not being left behind, is looking at, you know, what are the challenges and then, how do you fill in the gaps? 

If it is language, and as a scientist I've been in meetings, for example, Gary, where you know scientists are talking to community members, and you can see from the community members, they have a glazed look on their eye, because everything is just going off and the scientist feels actually, that I'm communicating, I'm talking to these people. I mean, we're having a conversation, but they're using language, which for the community members, you know, they don't understand. So, there has to be an element of breaking down the language. 

During COVID, for example, we attempted to use technology, and we realised as we were using technology, we were leaving people behind, you know, community members who don't have smartphones. If you're saying you're going to have a Skype meeting with community members, you'll only have from our over 200 CAB members, we only managed to have about 90 in our WhatsApp group. So, if you're having a conversation with just 90, what happens to the rest? You're leaving them behind. So, technology also can be a means of leaving people behind, and you have to work your way around it.

Gary Hickey  20:17

Thank you, Noni. I think I recognize the glazed look when I'm talking as well, thank you. Kara, did you want to add anything to that about why people are left behind and the challenges when seeking to leave no one behind?

Kara Hanson  20:32

Well, I have a few more things to add to Noni's comments. One, to pick up on an earlier challenge is to recognise that communities are heterogeneous. There'll be a distribution within a community of power and of influence, and when you're doing community engagement work, you always need to ask, Who has voice here? Who's representing whom? And on what basis is that representation identified? And then, as Noni said, what technologies are being used as well, either for the interventions or for data collection, who really controls access to the opportunities to contribute to the research. And if we're really, really determined to leave no one behind, we need to dig into that heterogeneity, dig into those inequalities at the community level and identify those people who don't traditionally have access to researchers or to research, and who won't have a voice unless they're actively sought out. And then we need to think about what sorts of methods that can be used to seek these people out and make sure that they are included in the research activities.

Another challenge is really listening. If you're committed to engaging communities in research. You have to really listen to their concerns and priorities and be prepared to accommodate those in so far as you can in your research activities. A few weeks ago I was at a dissemination event for a research meeting for a research project. It was a project about a neglected tropical disease and stigma, and what was interesting was that in their work with communities, and engaging with communities around these issues, what they heard was that the really big problem is road access, and that's a more important and more salient problem than the stigma that's attached to leishmaniasis.

So, it's not that there is no stigma attached to this tropical disease, but in addition to traditional health problems, there are development problems as well. And once you hear that, that there are some bigger problems that communities are facing, and they share that with you, you can't unknow it. You have a responsibility not necessarily to fix those in your research project, but to recognise that you bring some authority as a researcher and some power as a researcher, and you can become the voice of those who you are working with to help make sure that their needs are shared and advocated for.

I'd say a third challenge is being really modest, realising that in the hierarchies of expertise and authority that scientists have a lot of power, and those who are researched traditionally have less power. We have to change that mindset and understand that we all have things to learn that mutual learning and mutual exchange is an important part of a research process that leaves no one behind, and that no one group of experts or non-experts has a monopoly.

Gary Hickey  23:27

Thank you, Kara. What I wanted to come in with was something that I think you sort of touched on in the first part of your answer was about the power dynamics and how we address that, and I wonder if either you or Noni have got some advice or tips about how we address those power dynamics within the groupings, if you like, within the room?

Kara Hanson  23:47

So, I have one suggestion, and Noni, I'd love to hear your response to this, because you've got much more experience than I do doing this. But I do remember some years ago, many years ago, when I was doing some research that involved focus group discussions with women of small children - we were looking at some health financing issues. And we found that as soon as we began to gather groups of women together, the older men would circle around, and they wanted to hear what was being asked, they wanted to hear what the women were saying. A benevolent view would be that something exciting was going on that they wanted to be part of. A slightly more skeptical one would be that they wanted to make sure that they were comfortable with the experience that the women were sharing.

So we decided that we could, we could help to give women the space that they needed to share by having our own focus group with the men. Let them have their chance to have their views known. Let them know that we weren't asking questions that were particularly sensitive, and try to make them more comfortable and less suspicious about what the work that we were doing. And by doing that, leave us free to talk to the women of the young children who were the views that we were really interested in eliciting, because obviously these were the people who were responsible for [for] the care of these children.

So, there's something about [about] breaking into groups that can help. Of course, there's many more challenges than that, because even within a group of women with young children there will be some who are more educated and less educated women who have more and less experience and more and less autonomy. So, I think it really takes skilled researchers and working very closely with people who have expertise and engagement to be able to identify the best ways to gain the trust of the different groups of women that you want to study.

Gary Hickey  25:41

Thank you, Kara. Noni, have you got anything to add to that about addressing power dynamics?

Noni Mumba  24:46

Yeah, so when it comes to power or power dynamics, it's a little bit tricky. I think in our experience, what we have seen works is chipping away at power slowly by slowly, you know, sort of like pulling down a house a brick at a time. Because, specifically, I mean, power is such a thing that, you know, when people are feel like their power is being taken away, then you get a block, you can't really [you can't really] work with them very well. 

So. what we have done is, for example, when we are in an engagement meeting, even just the seating arrangement can show power, or can be able to, you know, reduce, sort of like the power dynamics. So, when we go out into a community, we don't sit for example, classroom style, you know, where you know the sort of like experts, you know, are at the front, and then the rest of the community is sort of like sitting waiting to listen. We try and sit it sort of like in a circle, where everybody feels equal, and the facilitators are facilitators that need also to be skilled to be able to understand how to play around. So, if we have men and women sitting together in [in] our local setting, here in the coastal part of Kenya, in Kilifi, you know women tend not to speak when men are in the room, and so you may have a conversation, and when you ask for contribution you might find that it is only men who are talking. And so a facilitator, a skilled facilitator, should be able to, quite politely, you know, tell the males in the room that we now want to hear the (women), so that you're drawing in the voices of these, this group of people who otherwise would not be heard. 

So, there's an element of you know, where are you having meetings? If it is us as KEMRI Wellcome, are we calling community members to come and have a serious discussions within our premises? You know, people might feel disempowered, so you might want to take a meeting outside your premises, either in a hotel or within a school compound, or outside a primary health care facility, you put up a tent and you sit there and you have a conversation in the space of the community. So, a lot of things to be considered when thinking about power and how to minimise/reduce the power dynamics to enable these groups of people who otherwise would not be heard, to make them feel comfortable enough to be able to share their views. 

Gary Hickey  28:28

Thank you, and is there something to be said for embracing if you like creative ways of enabling people to express their views, because you both hinted that sometimes in a formal research environment it isn't always the best approach is it to enable people to express themselves, because Noni you spoke about language differences and people glazing over. And one of the things that I'm always fascinated by in community engagement and involvement, and something that people in the UK I think can learn from, is [is] that idea of embracing the arts and creative processes to enable people to express themselves., and I wonder Noni if you could say something about that?

Noni Mumba  29:06

Um, yeah. I mean, we have used one approach. It's an approach that I borrowed from my days in working within HIV, malaria and water and sanitation programmes that are not research, it was development programmes. And some of the things that we used to do, for example, to create awareness, was using theatre, or what we just call drama, you know, in our setting here in Kenya. So, we [we] borrowed that approach and that methodology and tried it also for, you know, health research, getting a professional theatre company, and then co-developing scripts around research and around research studies, and then performing these out in the community under a tree, for example. And so, the professional theatre group acts out specific things that depict science happening, themes or disease, you know areas that are being researched on, and then the community, or the audience, which is basically an audience of community members, are invited to share their thoughts, their views, they are even invited, you know, to [to] act in some of the scenes. And this really helps to break down technical jargon, break down very heavy science. If you call people into a meeting and tell them, we want to come and talk to you about science, they actually may not turn up. But if you call them to come and watch a play, you know they'll turn up in large numbers, they'll enjoy it, and they will leave having learnt something to share their views and so the research team will also leave having learnt something from the community members or the audience that is watching. So, we have used drama in the past, and it's a really good tool.

Kara Hanson  30:48

I love Noni's example about the use of arts-based methods. And we're seeing a lot of this in our NIHR proposals now; the use of creative activities that could be theatre or photo voice that involves putting inexpensive cameras into the hands of community members to get them to generate the images that can communicate their challenges and problems in a more effective way than sometimes words do. So, gaining skills and bringing expertise in these broader approaches to engagement is a really great opportunity for a researcher.

Gary Hickey  31:22

I agree, it's like a combination of education entertainment, edutainment, if you will. You can reference me and quote me on that one, thank you very much! 

I'm going to finish now with one question for you, it's about advice and top tips. I'll ask you first, Kara, what advice or top tips would you give to those doing community engagement and involvement to ensure that no one is left behind?

Kara Hanson  31:45

Well, I've got a few tips. One would be to start by always asking who you've left out. Keep asking those questions. Who haven't we heard from? Is there anybody in this community who we've not heard from? How can we take a really consistently and constant, constantly reflective approach to inclusion?

The second would be to reflect on the toolbox of methods, arts-based methods, other types of participatory methods and theatre that will [that will] open up the opportunities to have new forms of communication with community members. And I think to do that, we have to go back to this idea of modesty and realise that as researchers we are not experts in community engagement. But we should be able to strengthen our skills so that we have a better understanding of the purpose, the tools and the approaches and skills that are needed. 

And of course my third tip would be to work with experts. I think it's amazing how people at KEMRI Wellcome Trust have access to Noni and her team to work with, and I hope over time through the research that NIHR funds we can help to develop the capacity of community engagement experts who can be there to advise researchers. 

My last bit would be to retain that modesty. Community engagement is an area of expertise, and just because you're a great researcher doesn't make you a great community engagement practitioner. So, in constructing your teams, make sure you've got the right skills there; be clear where you have things to learn, where you have to contribute, and where you can get those new skills from.

Gary Hickey  33:16

Thank you, and Noni, what advice or tips would you give to those doing community engagement and involvement to ensure that no one is left behind?

Noni Mumba  33:24

I think most of them have already been said in terms of advice or tips. Perhaps one of the things that I could add, and that has worked very well for us in our community engagement and involvement in the setting we are in, is involving those groups themselves. Sometimes, you know, when we are approaching what can be maybe marginalised groups, we think, you know, they can't do anything for themselves, so we go in offering everything. I think it's really important for people to understand that they [they] have autonomy, they are able, they are not, you know, completely empty in their head. So, involving them, in fact, even if you can employ some of them, if you have a research project. So, you can have a senior member who is sort of like a research social scientist to run the engagement, but also hire an engagement facilitator from that particular group, that will go a long way in ensuring that you know your engagement really goes very well. So, I think for me, that's one of the, you know, great areas that sometimes we don't really look into, but it's really very helpful when you're engaging, to hire, you know, locals, to be able to support you and work with you in the engagement activities. 

Gary Hickey  34:47

Wise words Noni, thank you. Well, thank you Noni and thank you Kara, I shall bring the podcast to a close now, and a huge thank you from all of us to you the listener. Please do share, post on X and tune into other episodes in this series, which can be found on our website or wherever you listen to your podcasts. And please do let us know what you think by sending an email to social.media@nihr.ac.uk. 

And finally, a reminder that the NIHR and Mesh online course, An Introduction and Practical Guide to Community Engagement and Involvement in Global Health Research, is now available and it's free to everyone. For more details, please visit the Global Health Training Center website, or visit www.nihr.ac.uk and search for community engagement and involvement, and you'll find the course in the resources section. 

So, that's all from us, so thank you very much again for listening, and please do enjoy the rest of your day.