Peter Winch, MD MPH
Director, Social and Behavioral Interventions Program
International Health, Bloomberg School of Public Health
- Social and Behavioral Interventions Program
- Environment, Energy, Sustainability and Health Institute
- Johns Hopkins Water Institute
International Health, Behavior change interventions, community participation, qualitative research methods, vector-borne diseases, malaria, neonatal health, treatment-seeking behavior, compliance with antimicrobial treatment, community health workers, operational research, environmental sustainability, adaptation to climate change
- Topic 1: Applied social science and vector-borne disease control
From the beginning of my research career, I have examined the application of social science theory and methods to the control of infectious diseases, especially vector-borne diseases such as malaria, dengue hemorrhagic fever and schistosomiasis. This work has spanned program evaluations (Winch et al. 2002); examination of local terminology and how it shapes perceptions of diseases and their causes (Winch et al. 1996); perceptions of seasonal variation in rainfall, mosquito populations and disease occurrence, and how it affects willingness to practice preventive measures like sleeping under mosquito nets (Winch et al. 1994); and community and social factors that affect preventive behaviors (Winch et al. 1997).Winch PJ, Leontsini E, Rigau-Pérez JG, Ruiz-Pérez M, Clark GG, Gubler DJ. Community-based dengue prevention programs in Puerto Rico: impact on knowledge, behavior, and residential mosquito infestation. Am J Trop Med Hyg. 2002 Oct;67(4):363-70. PubMed PMID: 12452490. Winch PJ, Makemba AM, Kamazima SR, Lurie M, Lwihula GK, Premji Z, Minjas JN, Shiff CJ. Local terminology for febrile illnesses in Bagamoyo District, Tanzania and its impact on the design of a community-based malaria control programme. Soc Sci Med. 1996 Apr;42(7):1057-67. PubMed PMID: 8730911. Winch PJ, Makemba AM, Kamazima SR, Lwihula GK, Lubega P, Minjas JN, Shiff CJ. Seasonal variation in the perceived risk of malaria: implications for the promotion of insecticide-impregnated bed nets. Soc Sci Med. 1994 Jul;39(1):63-75. PubMed PMID: 8066488. Winch PJ, Makemba AM, Makame VR, Mfaume MS, Lynch MC, Premji Z, Minjas JN, Shiff CJ. Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania. Trop Med Int Health. 1997 Aug;2(8):760-70. PubMed PMID: 9294546.
- Topic 2: Community health workers
I have a long-standing interest in community health workers (CHWs) as a strategy for delivering interventions to populations living far from health facilities. I was the lead author on two reviews that defined potential roles of community health workers in more detail (Winch et al. 2002 and 2005), and established a foundation for subsequent systematic reviews on interventions delivered by CHWs, and policy recommendations by global health organizations. I have also examined factors that motivate CHWs to carry out their work on a voluntary or semi-voluntary basis, under difficult conditions across a number of studies including Rahman et al. 2010, Greenspan et al. 2013, which have contributing to policy discussions on appropriate CHW incentive strategies.Winch PJ, Leban K, Casazza L, Walker L, Pearcy K. An implementation framework for household and community integrated management of childhood illness. Health Policy Plan. 2002 Dec;17(4):345-53. PubMed PMID: 12424206. Winch PJ, Gilroy KE, Wolfheim C, Starbuck ES, Young MW, Walker LD, Black RE. Intervention models for the management of children with signs of pneumonia or malaria by community health workers. Health Policy Plan. 2005 Jul;20(4):199-212. Review. PubMed PMID: 15965032. Rahman SM, Ali NA, Jennings L, Seraji MH, Mannan I, Shah R, Al-Mahmud AB, Bari S, Hossain D, Das MK, Baqui AH, El Arifeen S, Winch PJ. Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh. Hum Resour Health. 2010 May 3;8:12. doi: 10.1186/1478-4491-8-12. PubMed PMID: 20438642; PubMed Central PMCID: PMC2875202. Greenspan JA, McMahon SA, Chebet JJ, Mpunga M, Urassa DP, Winch PJ. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Resour Health. 2013 Oct 10;11:52. doi: 10.1186/1478-4491-11-52. Review. PubMed PMID: 24112292; PubMed Central PMCID: PMC3852396.
- Topic 3: Implementation of maternal, newborn and child health interventions
Building on Topic 1, I have examined the application of social science theory and methods to the design and evaluation of maternal and newborn health interventions. This has included conducting formative research to design the behavior change interventions (Winch et al. 2005; Alam et al. 2008) for several large cluster-randomized trials e.g. Baqui et al. 2008. More recently, I have examined how disrespectful maternity care and abuse during childbirth affect antenatal care attendance and facility delivery in rural Tanzania, a situation of great relevance to a range of countries with elevated maternal mortality ratios (McMahon et al. 2014).Winch PJ, Alam MA, Akther A, Afroz D, Ali NA, Ellis AA, Baqui AH, Darmstadt GL, El Arifeen S, Seraji MH; Bangladesh PROJAHNMO Study Group. Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study. Lancet. 2005 Aug 6-12;366(9484):478-85.PubMed PMID: 16084256. Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, Mannan I, Rahman SM, Shah R, Saha SK, Syed U, Winch PJ, Lefevre A, Santosham M, Black RE; Projahnmo Study Group. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet. 2008 Jun 7;371(9628):1936-44. doi:10.1016/S0140-6736(08)60835-1. PubMed PMID: 18539225. Alam MA, Ali NA, Sultana N, Mullany LC, Teela KC, Khan NU, Baqui AH, El Arifeen S, Mannan I, Darmstadt GL, Winch PJ. Newborn umbilical cord and skin care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine. J Perinatol. 2008 Dec;28 Suppl 2:S61-8. doi: 10.1038/jp.2008.164. PubMed PMID: 19057570; PubMed Central PMCID: PMC2929163. McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RN, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth. 2014 Aug 12;14:268. doi: 10.1186/1471-2393-14-268. PubMed PMID: 25112432; PubMed Central PMCID: PMC4261577.
- Topic 4: Behavior change interventions for water, sanitation and hygiene (WASH)
Building again on Topic 1, I have examined the application of social science theory and methods to the design and evaluation of interventions to promote WASH behaviors including handwashing with soap at key times, home water treatment, and latrine use. Similar to Topic 3, I have conducted formative research (Hulland et al. 2013) to inform the intervention content of large cluster-randomized trials including WASH Benefits Bangladesh (Arnold et al. 2013). I also helped design a new framework for the analysis of factors at different levels that affect WASH behaviors (Dreibelbis et al. 2013), and factors that affect sustained adoption of WASH behaviors after active promotion by externally-funded projects comes to an end (Hulland et al. 2015).Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, Ahmed T, Ashraf S, Christensen G, Clasen T, Dentz HN, Fernald LC, Haque R, Hubbard AE, Kariger P, Leontsini E, Lin A, Njenga SM, Pickering AJ, Ram PK, Tofail F, Winch PJ, Colford JM Jr. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open. 2013 Aug 30;3(8):e003476. doi: 10.1136/bmjopen-2013-003476. PubMed PMID: 23996605; PubMed Central PMCID: PMC3758977. Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP. The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013 Oct 26;13:1015. doi: 10.1186/1471-2458-13-1015. Review. PubMed PMID: 24160869; PubMed Central PMCID: PMC4231350. Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, Nizame FA, Luby SP, Ram PK, Winch PJ. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health. 2013 Sep 23;13:877. doi: 10.1186/1471-2458-13-877. PubMed PMID: 24060247; PubMed Central PMCID: PMC3852554. Hulland K, Martin N, Dreibelbis R, DeBruicker Valliant J, Winch P (2015) What factors affect sustained adoption of safe water, hygiene and sanitation technologies? A systematic review of literature. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education. ISBN: 978-1-907345-77-7. URL: https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3475
- Topic 5: Climate change adaptation
I am highly engaged in efforts to respond to climate change as a faculty member at Johns Hopkins University. I serve as Co-Coordinator of the MPH Concentration in Global Environmental Sustainability and Health, an academic track which offers a comprehensive set of courses on climate change, food security, energy policy and the built environment, and work closely with the JHU Energy, Environment, Sustainability and Health Institute (e2shi.jhu.edu). I currently advise 2 doctoral students conducting dissertation research on environmental sustainability. I have examined how increasing fossil fuel prices impact health and health care services in low and middle-income countries (LMIC) (Winch and Stepnitz, 2011), and described localization as a strategic direction to help residents of LMIC to adapt to both increasing prices for fossil fuels, and the effects of climate change on rural livelihoods (Dalglish et al. 2013). I have an active collaboration on program evaluation with the Population-Health-Environment Consortium of Ethiopia (www.phe-ethiopia.org), examining the effectiveness of their programs in helping affected populations adapt to climate change (Gonsalves et al. 2015). I am also investigating the feasibility of necessary lifestyle changes in high-income countries, including steps to increase local food production (Poulsen et al. 2014). In related work, I have a current NSF grant examining strategies to reduce waste accumulation in low-income neighborhoods of Baltimore.Winch P, Stepnitz R. Peak oil and health in low- and middle-income countries: impacts and potential responses. Am J Public Health. 2011 Sep;101(9):1607-14. doi: 10.2105/AJPH.2011.300231. PubMed PMID: 21778508; PubMed Central PMCID: PMC3154234. Poulsen MN, Hulland KRS, Gulas CA, Pham H, Dalglish SL, Wilkinson RK, Winch PJ. Growing an Urban Oasis: A Qualitative Study of the Perceived Benefits of Community Gardening in Baltimore. Culture, Agriculture, Food and Environment. 2014; 36(2) 69-82. doi: 10.1111/cuag.12035 Dalglish SL, Poulsen MN, Winch PJ. Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices. Global Health. 2013 Nov 7;9:56. doi: 10.1186/1744-8603-9-56. PubMed PMID: 24199690; PubMed Central PMCID: PMC3826843. Gonsalves L, Donovan SE, Ryan V, Winch PJ. Integrating population, health, and environment programs with contraceptive distribution in rural Ethiopia: a qualitative case study. Stud Fam Plann. 2015 Mar;46(1):41-54. doi: 10.1111/j.1728-4465.2015.00014.x. PubMed PMID: 25753058.
- Maximizing the Effective Use of Artemisinin Combination Therapy in Sikasso Region, Mali
- Etiology, Prevention and Treatment of Neonatal Infections in the Community
- Introduction of Zinc Treatment for Childhood Diarrhea in Tanzania
- Planning of Training Program on Operational and Health Services Research in Mali
- Virtual Community Health Services - For Equity & Quality in Health Car in Mali
- WSUP Research on Large-Scale Sanitation Promotion to Improve Usage
- Review and evaluation of interventions to promote home water treatment
- Training Program on Operational and Health Services Research on Malaria in Mali
- Health Research Challenge for Impact: Subaward: ICDDR, B III
- Piloting interventions to promote home water treatment, handwashing, and sanitation in rural Bangla