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5S Framework

The 5S Foundation had three main objectives: situational aims, strategic aims, and capacity-building aims.

Situational Aims

  • To examine the cultural logics and social and economic contexts of the selected NTDs,utilizing cross cutting social science perspectives;
  • To understand the dynamics and dimensions of stigma;
  • To investigate how all three diseases have been conceptualized at the national and international policy levels;
  • To evaluate existing interventions in areas in which they have already been developed

Strategic Aims

  • To refine a framework developed to identify gaps in understanding of the social contexts and consequences of podoconiosis, mycetoma and scabies;
  • To develop a comprehensive intervention strategy for each disease utilising all the evidence gathered from the above;

Capacity Building Aims

  • To support endemic-country training posts (PhD and postdoctoral) in a manner that will leave enduring capacity for social science research across a range of local health priorities, including NTDs;
  • To facilitate South-South and North-South sharing of best practice in research and advocacy applicable to a wide range of stigmatising conditions in low-resource, low-literacy settings.

5S Framework

What does a Framework do?

        • Provides a structure to organise the components of a balanced and focused research question

        • Capture complexity and simplify core principles

5S Foundation Framework

A framework was designed to structure and organize the aims of 5S components. The framework took a three-level approach—macro (the policy environment), meso (community dynamics), and micro (individual experience). The framework was developed through collaborative process involving inputs from various stakeholders. The framework helped in structuring the research questions to capture the complexity of the issues at hand. A diagram was prepared to visualize different components.

Components of the Framework

Macro
  • Content (Policy and Legal)
  • Context (Political and Historical)
  • Process (Policy making and implementation)
  • Actor  (Policy Stakeholder)
Meso
  • Substitutability (Genetic, environmental and behavioural)
  • Cultural Logic
  • Social Difference (Class, gender, disability and ethnicity)
  • Stigmatization (domestic and social)
  • Care and Health Seeking (formal and informal)
Micro
  • Individual understanding and embodied experience

Revisiting the Framework

The PhD and Postdoctoral research projects examined the interlevel and intralevel dynamics of the targeted NTDs (Mycetoma, Podoconiosis, and Scabies) in Rwanda, Ethiopia, and Sudan. The focus varied across the projects, with some emphasizing the micro, meso, or all three levels. During the final project meeting in Addis Ababa, Ethiopia, in May 2024, the framework was revisited and discussed with all project stakeholders.

The 5S Foundation study projects identified several macro-level factors influencing the impact of skin conditions, framing them through theoretical concepts like structural violence and precarity, especially within refugee populations. Most studies also highlighted a lack of policy attention to neglected tropical diseases (NTDs) at the state level and identified a gap in social science research on NTDs in the target countries.

At the meso level, it was found that when explaining NTDs such as mycetoma, podoconiosis, or scabies, people hold both biomedical and indigenous beliefs about the causes of these diseases. As a result, individuals seek help from both biomedical and traditional healthcare sectors. A study on environmental factors for mycetoma revealed new potential environmental causes, while behavioral factors like low shoe use were common in cases of both mycetoma and podoconiosis. Stigma was prevalent across all three skin conditions, varying between perceived and enacted forms, with the disease’s consequences being intersectional, depending on social, economic, and gender positions.

At the micro level, the dominant individual experience of the disease was characterized by suffering, though participants also demonstrated agency and resistance.

Issues to consider:

Did we manage to incorporate the intervention evaluation component in the framework?

Did we successfully analysis the interlevel and intra-level interactions?

Did we successfully integrate knowledge generation and public engagement?

Do we have any original contribution in conceptualizing of stigma dynamics?

Did we successfully facilitate South South collaboration?