02/16/2021
By Katharine Webster

Assoc. Prof. Comfort Enah, who holds the new Donna Manning Endowed Chair in the Solomont School of Nursing, knows about disparate health outcomes in low-income countries and communities.

She saw those disparities growing up in Cameroon, and then again as a student at Berea College, located in the heart of Appalachia.

Now, Enah works to reduce health disparities. After earning her Ph.D. in public health nursing at the University of Cincinnati, she embarked on a research and teaching career aimed at improving sexual and reproductive health among underserved populations, especially Black teens in the U.S. and young teens and mothers in Cameroon. Enah’s area of expertise is using mobile applications to address major public health problems.

After 11 years at the University of Alabama at Birmingham as part of a research group that partners with the National Institutes of Health and a health care system in Cameroon, Enah arrived at UMass Lowell in summer 2020. She is teaching courses in epidemiology for health promotion, qualitative research methods and evidence dissemination, primarily to students in the Ph.D. and Doctor of Nursing Practice programs.

Recently, she took the time to talk about her research.

Q: Your best-known project to date involves a video game designed to help prevent HIV infections among Black teenagers in rural Alabama. How did you come up with that idea, and how does it work?

A: My dissertation research involved an intervention to help Cameroonian girls postpone sexual activity, primarily to prevent infection with HIV. When I got to Alabama, I talked to people who could benefit from my research and asked them how I could help them. Young Black men, especially in the poor, rural communities of the Black Belt, are infected with HIV at 10 times the state average, but there’s still a big stigma around HIV and AIDS.

Health interventionists kept telling me, “We talk to them, but they don’t really listen,” and, “They’re always on their phones.” I got permission to interview 140 middle school students about what they knew about sexual health and what would hold their interest on the topic. They all said, “Games are fun,” so I worked with a team that included adolescent psychologists and engineers to design a video game about sexual health and HIV. They could create their own avatars, make choices and then see the outcome of those choices.

Next, we did a small study which found that students who played the game and were already sexually active were more likely to use condoms and have fewer sexual partners.

Now we are hoping to get funding to do a large-scale study. A lot of public health groups would like to use the game, and I’d like to adapt it for use in Africa on cellphones.

Q: You are one of the principal investigators on a $1.2 million, five-year grant from the National Institutes of Health to try to reduce maternal and infant deaths in Cameroon. What are the challenges there, and how do you plan to address them?

A: Cameroon has the ninth-highest rate of maternal deaths in the world. A lot of deaths can be attributed to problems of care and a lack of access to care. There are interventions for many issues that women experience, but in rural areas, expertise and standardized protocols are lacking. Many of the specialists and hospitals that could address these issues are in the large urban areas, so we’re bridging that gap. There’s a big opportunity in the proliferation of mobile devices – cellphones and tablets.

Working with Cameroon Baptist Convention Health Services, we are developing an interactive, mobile app that doctors, nurses and midwives can use at the point of care to treat perinatal issues. Caregivers will be able to enter data including the mother’s age, symptoms and level of distress, and the app will direct them to protocols based on World Health Organization standards of care. We will also establish a telephone hotline that caregivers can call in emergencies. The hotline will be staffed by nurses and general practice physicians, with specialists on call.

Q: What other research have you done?

A: The grants I take the lead on mostly involve HIV prevention, maternal-child outcomes and adolescent health.

I’m interested in looking at diseases that manifest at the maternal-child level – what are their origins? If you want to focus on prevention, you have to focus on the teen years and contextual factors that affect adolescent health and sexual health. If you can help teens with decision-making, with delaying certain behaviors until they are a little bit smarter or can control things that happen to them a little bit more, then you can have a greater impact. If you wait until they’re adults, some things have already been set in motion.

Q: You did multiple studies with the teenagers in Alabama before you even started to develop the video game, and then you went back to them at every stage of game development to get their feedback. Do you take this approach with all of your research?

A: Yes. With my public health background, I’m always exploring ways to make whatever interventions I develop sustainable, and to do that, you have to have buy-in from the community.

In Cameroon, we’re doing qualitative research with pregnant women, maternal health providers, mobile phone companies and people who support the mobile health infrastructure. That will provide the context. Right now, we’re starting virtual trainings for some of the people who will actually implement the work.

Moving forward with the video game, I’m changing the focus to be broader and to include other health conditions besides HIV and sexually transmitted diseases. I’m also looking at working with community health agencies here in the (Merrimack Valley) region. I hope to work with some after-school organizations that focus on teens, and also pediatricians who provide care to teens, to have a local partnership where the game can be tested.