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Liwanag HJ, James O, Frahsa A. A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice. BMJ Glob Health 2023; 8:e012906. [PMID: 38084477 PMCID: PMC10711908 DOI: 10.1136/bmjgh-2023-012906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Accountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better understanding of the concept and practice of accountability in global health. We sought to analyse accountability processes in practice in global health funding, research collaborations and training. METHODS This study is a literature review that systematically searched PubMed and Scopus for articles on formal accountability processes in global health. We charted information on processes based on accountability lines ('who is accountable to whom') and the outcomes the processes were intended for ('accountability for what'). We visualised the representation of accountability in the articles by mapping the processes according to their intended outcomes and the levels where processes were implemented. RESULTS We included 53 articles representing a wide range of contexts and identified 19 specific accountability processes for various outcomes in global health funding, research collaborations and training. Target setting and monitoring were the most common accountability processes. Other processes included interinstitutional networks for peer checking, litigation strategies to enforce health-related rights, special bodies that bring actors to account for commitments, self-accountability through internal organisational processes and multipolar accountability involving different types of institutional actors. Our mapping identified gaps at the institutional, interinstitutional and broader system levels where accountability processes could be enhanced. CONCLUSION To rebalance power in global health, our review has shown that analysing information on existing accountability processes regarding 'who is accountable to whom' and 'accountability for what' would be useful to characterise existing lines of accountability and create lines where there are gaps. However, we also suggest that institutional and systems processes for accountability must be accompanied by political engagement to mobilise collective action and create conditions where a culture of accountability thrives in global health.
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Affiliation(s)
- Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Oria James
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Harper A, Pratt B. Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other? J Empir Res Hum Res Ethics 2022; 17:431-454. [PMID: 34931853 DOI: 10.1177/15562646211058253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.
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Affiliation(s)
- Adrian Harper
- School of Population and Global Health, University of Melbourne, Australia
| | - Bridget Pratt
- School of Population and Global Health, University of Melbourne, Australia
- Queensland Bioethics Centre, 1513Australian Catholic University, Australia
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Chu C, Griffin G, Williams JL. Taking Pause: A COVID-19 Student Reflection on Global Health Research Opportunities, Training, and Institutional Reform. FRONTIERS IN SOCIOLOGY 2022; 7:768821. [PMID: 35127891 PMCID: PMC8811217 DOI: 10.3389/fsoc.2022.768821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/04/2022] [Indexed: 05/17/2023]
Abstract
Restrictions to research due to COVID-19 have required global health researchers to factor public health measures into their work and discuss the most ethical means to pursue research under safety concerns and resource constraints. In parallel, global health research opportunities for students have also adapted to safety concerns and resource constraints. Some projects have been canceled or made remote, but inventively, domestic research opportunities have been created as alternatives for students to continue gaining global health learning competencies. Knowing the ethical challenges inherent in short-term student global health research and research in strained health systems, it is intriguing why these safer alternatives were not previously pervasive in global health education. This paper provides perspectives from students training at academic institutions in the US on how COVID-19 disrupted student research and what can be learned from the associated shifts in global health research. Additionally, the authors take this opportunity to advocate for academic institutions from high-income countries to reflect on long-standing global health research conventions that have been perpetuated and bolster training for students conducting global health research. The authors draw on their experiences, existing literature, and qualitative interviews with students who pursued global health research during COVID-19.
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Affiliation(s)
- Casey Chu
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Gianna Griffin
- Yale College, Yale University, New Haven, CT, United States
| | - Joseph L. Williams
- Yale School of Public Health, Yale University, New Haven, CT, United States
- Yale Institute for Global Health, Yale University, New Haven, CT, United States
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Stallwood L, Adu PA, Tairyan K, Astle B, Yassi A. Applying equity-centered principles in an interprofessional global health course: a mixed methods study. BMC MEDICAL EDUCATION 2020; 20:224. [PMID: 32664903 PMCID: PMC7362565 DOI: 10.1186/s12909-020-02141-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Medical students, practitioners and other health professionals are commonly unprepared to address the many complex issues that emerge while conducting research in the Global South. As a response to identified deficiencies in global health education, a hybrid online/face-to-face multi-institutional credit course was developed based on the equity-centered principles advanced by the Canadian Coalition for Global Health Research (CCGHR), namely Authentic partnering, Inclusion, Shared benefits, Commitment to the future, Responsiveness to causes of inequities, and Humility. This study aimed to analyze the extent to which the course was effective in fortifying attitudes consistent with the CCGHR principles; identify successes and challenges; and assess how a course such as this can fill an identified gap. METHODS This interprofessional course was offered to 25 graduate and postgraduate students in various health professions and public health. Faculty were drawn from medicine, public health, nursing and social sciences from four universities in Western Canada. A pre-post retrospective survey, key informant interviews and participant observation were used to gather data for this study. RESULTS Findings showed that student attitudes regarding global health research and practice significantly evolved towards views consistent with the principles articulated. The multiple instructors and hybrid course format created both opportunities and challenges; the interprofessional nature of the cohort was considered a strong asset, as was the fact that many students came from the Global South. Some students suggested that the course could be further strengthened by concretely partnering with institutions in the Global South rather than offered solely to learners registered in universities in the Global North. CONCLUSIONS While weaknesses were identified, results support the conclusion that a course focused on the CCGHR principles could be useful in preparing the next generation of global health researchers and practitioners to mitigate historical limitations in this field. Longitudinal follow-up is warranted to provide more definitive conclusions.
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Affiliation(s)
- Lisa Stallwood
- Faculty of Health Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Prince A Adu
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Kate Tairyan
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Barbara Astle
- School of Nursing, Trinity Western University, 7600 Glover Rd, Langley, BC, V2Y 1Y1, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
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Plamondon KM, Bisung E. The CCGHR Principles for Global Health Research: Centering equity in research, knowledge translation, and practice. Soc Sci Med 2019; 239:112530. [PMID: 31539786 DOI: 10.1016/j.socscimed.2019.112530] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
Abstract
Medical geography and global health share a fundamental concern for health equity. Both fields operate within similar multiple intersecting funding, academic, health systems, and development landscapes to produce scholarship. Both reflect complex interactions and partnerships between people, communities and institutions of unequal power. The Canadian Coalition of Global Health Research Principles for Global Health Research evolved from deep concern about the absence of standards for how Canadians engage in this field. They can serve as a broadly relevant framework to guide how to integrate equity considerations into everyday research, knowledge translation, and practice activities. Comprised of six principles (authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility), they are an aspirational and reflective frame that can elevate equity as a central procedural goal and outcome. In this commentary, we describe each of the six principles and offer examples of how they are being applied to guide research practices, inform knowledge translation science and build capacity. We invite collective reflection about moving our field toward more meaningful health equity research and action, using the CCGHR Principles for Global Health Research to spark dialogue about how to align our practices with desire for a more equitable world.
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Affiliation(s)
- Katrina M Plamondon
- Faculty of Health & Social Development, School of Nursing, University of British Columbia; and Regional Practice Leader, Research & Knowledge Translation, Interior Health, Canada.
| | - Elijah Bisung
- School of Kinesiology & Health Studies, Queens University, Canada
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Aluri J, Moran D, Kironji AG, Carroll B, Cox J, Chen CCG, DeCamp M. The ethical experiences of trainees on short-term international trips: a systematic qualitative synthesis. BMC MEDICAL EDUCATION 2018; 18:324. [PMID: 30594168 PMCID: PMC6310968 DOI: 10.1186/s12909-018-1424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/05/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical student and resident participation in short-term international trips for trainees (STINTTs) has increased in the past few decades. However, there has been no systematic review of trainees' actual ethical experiences. The authors sought to identify what ethical issues medical trainees encounter during STINTTs, as elicited by and reported in peer-reviewed, quantitative and qualitative research papers. METHODS The authors systematically searched five academic databases finding 659 unique titles and abstracts. The authors applied inclusion and exclusion criteria to these titles and abstracts resulting in fourteen papers, which were analyzed using qualitative thematic synthesis. RESULTS The qualitative analysis of the papers generated four themes: (1) Trainees' Concerns Over Perpetuating Medical Tourism; (2) Struggling to Identify and Balance the Benefits and Harms of STINTTs; (3) The Complicated Trainee Mens (mind); and (4) Ethical Situations Encountered by Trainees. The fourth theme, which was the largest, was further divided into (a) Navigating social and cultural dynamics, (b) Trainees' experiences related to the learner role, and (c) Ethical situations not qualifying for other catagories. Some of these issues reported in the empirical research papers are well represented in the broader literature on STINTTs, while others were less so-such as mistreatment of trainees. All included papers were published after 2010, and comprised a total of less than 170 medical trainees. CONCLUSIONS Medical trainees report experiencing a wide range of ethical challenges during short-term international trips in which they engage in clinical or research activities. The authors call educators' attention to specific challenges that trainees face. The relevant literature covering US and Canadian STINTTs is relatively young and largely qualitative. The authors briefly sketch a program for expanding the research on this increasingly common educational experience.
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Affiliation(s)
- James Aluri
- Department of Psychiatry, Johns Hopkins Hospital, Meyer 4-181, 600 N. Wolfe Street, Baltimore, MD 21287-7381 USA
| | - Dane Moran
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas USA
| | - Antony G. Kironji
- Department of Emergency Medicine, Boston University Medical Campus, Boston, Massachusetts USA
| | - Bryn Carroll
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Jacob Cox
- Department of Medicine, Newton-Wellesley Hospital, Boston, MA USA
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA USA
| | | | - Matthew DeCamp
- Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Satterfield CA, Dacso MM, Patel P. Development of an effective mentorship program for preclinical medical student global health research training: An evaluation of a pilot mentorship program. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1240847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Caley A. Satterfield
- Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0434, USA
| | - Matthew M. Dacso
- Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0434, USA
| | - Premal Patel
- Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0434, USA
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Opoku EC, Olsen A, Browne E, Hodgson A, Awoonor-Williams JK, Yelifari L, Williams J, Magnussen P. Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren. Glob Health Action 2016; 9:32197. [PMID: 27633035 PMCID: PMC5025525 DOI: 10.3402/gha.v9.32197] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren. OBJECTIVE To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren. DESIGN This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue(®) photometer was used to measure haemoglobin (Hb), while the code transmission test (CTT), adapted from the Test of Everyday Attention for Children (TEA-Ch), was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012. RESULTS We observed significant malaria parasite prevalence reductions of 62.8 and 59.2% in Study Arm 1 from 24.2 to 9.0%, p<0.01, and 59.2% in Study Arm 2 from 26.7 to 10.9%, p<0.01), respectively, compared to 8.93% in Control Arm 3 (from 34.7 to 31.6%, p>0.05). Meanwhile, anaemia prevalence reduced significantly (p<0.01) in all three study arms after interventions by 38.4% (from 19.8 to 12.2%), 20.7% (from 26.6 to 21.1%), and 36.0% (from 28.3 to 18.1%) in Study Arms 1, 2, and 3, respectively. Although the interventions had no significant effects on Hb levels, anaemia prevalence reduced insignificantly by 38.4 and 20.7% in Study Arms 1 and 2, respectively, compared to 36.0% in Control Arm 3. Among schoolchildren in Study Arms 1 and 2, mean CTT score improved significantly after interventions by 10.4% (from 3.18 to 3.55, p=0.01) and 20.5% (from 2.83 to 3.56, p=0.01) respectively, compared to 5.75% in Control Arm 3 (from 2.95 to 3.13, p=0.09). Likewise, mean recall test score improvements after interventions were 16.9% (from 2.07 to 2.49, p=0.01) and 27.9% (from 1.91 to 2.65, p=0.01) in Study Arms 1 and 2, respectively, compared to 18.3% (from 1.92 to 2.35, p=0.01) in Control Arm 3. CONCLUSION Combined intermittent preventive treatment of malaria and deworming reduced prevalence of anaemia and improved sustained attention and recall in schoolchildren. Best results for sustained attention and recall were seen in Study Arm 2.
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Affiliation(s)
- Ernest Cudjoe Opoku
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Copenhagen School of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Annette Olsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Edmund Browne
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | | | - Lawrence Yelifari
- Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana
| | - John Williams
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Pascal Magnussen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yassi A, Adu PA, Nophale L, Zungu M. Learning from a cluster randomized controlled trial to improve healthcare workers' access to prevention and care for tuberculosis and HIV in Free State, South Africa: the pivotal role of information systems. Glob Health Action 2016; 9:30528. [PMID: 27341793 PMCID: PMC4920939 DOI: 10.3402/gha.v9.30528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
Abstract
Background Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce. Objective This mid-term evaluation aimed to analyze how well the intervention was being implemented, seek evidence of impact or harm, and draw lessons. Methods Both intervention and comparison sites had been instructed to conduct bi-annual and issue-based infection control assessments (when healthcare workers [HCW] are diagnosed with TB) and offer HCWs confidential TB and HIV counseling and testing, TB treatment and prophylaxis for HIV-positive HCWs. Intervention sites were additionally instructed to conduct quarterly workplace assessments, and also offer HCWs HIV treatment at their occupational health units (OHUs). Trends in HCW mortality, sick-time, and turnover rates (2005–2014) were analyzed from the personnel salary database (‘PERSAL’). Data submitted by the OHUs were also analyzed. Open-ended questionnaires were then distributed to OHU HCWs and in-depth interviews conducted at 17 of the sites to investigate challenges encountered. Results OHUs reported identifying and treating 23 new HCW cases of TB amongst the 1,372 workers who used the OHU for HIV and/or TB services; 39 new cases of HIV were also identified and 108 known-HIV-positive HCWs serviced. Although intervention-site workforces used these services significantly more than comparison-site healthcare staff (p<0.001), the data recorded were incomplete for both the intervention and comparison OHUs. An overall significant decline in mortality and turnover rates was documented over this period, but no significant differences between intervention and comparison sites; sick-time data proved unreliable. Severe OHU workload as well as residual confidentiality concerns prevented the proper implementation of protocols, especially workplace assessments and data recording. Particularly, the failure to implement computerized data collection required OHU staff to duplicate their operational data collection duties by also entering research paper forms. The study was therefore halted pending the implementation of a computerized system. Conclusions The significant differences in OHU use documented cannot be attributable to the intervention due to incomplete data reporting; unreliable sick-time data further precluded ascertaining the benefit potentially attributable to the intervention. Computerized data collection is essential to facilitate operational monitoring while conducting real-world intervention research. The digital divide still requires the attention of researchers along with overall infrastructural constraints.
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Affiliation(s)
- Annalee Yassi
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada;
| | - Prince A Adu
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Letshego Nophale
- Provincial Occupational Health Unit, Free State Department of Health, University of the Free State, Bloemfontein, South Africa
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, A Division of the National Health Laboratory Service, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Haintz GL, Graham M, McKenzie H. Navigating the ethics of cross-cultural health promotion research. Health Promot J Austr 2016; 26:235-240. [PMID: 26569504 DOI: 10.1071/he15050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/18/2015] [Indexed: 11/23/2022] Open
Abstract
Health promotion researchers must consider the ethics of their research, and are usually required to abide by a set of ethical requirements stipulated by governing bodies (such as the Australian National Health and Medical Research Council) and human research ethics committees (HRECs). These requirements address both deontological (rule-based) and consequence-based issues. However, at times there can be a disconnect between the requirements of deontological issues and the cultural sensitivity required when research is set in cultural contexts and settings etic to the HREC. This poses a challenge for health promotion researchers who must negotiate between meeting both the requirements of the HREC and the needs of the community with whom the research is being conducted. Drawing on two case studies, this paper discusses examples from cross-cultural health promotion research in Australian and international settings where disconnect arose and negotiation was required to appropriately meet the needs of all parties. The examples relate to issues of participant recruitment and informed consent, participants under the Australian legal age of consent, participant withdrawal when this seemingly occurs in an ad hoc rather than a formal manner and reciprocity. Although these approaches are context specific, they highlight issues for consideration to advance more culturally appropriate practice in research ethics and suggest ways a stronger anthropological lens can be applied to research ethics to overcome these challenges.
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Affiliation(s)
- Greer Lamaro Haintz
- Centre for Health through Action on Social Exclusion, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Melissa Graham
- Centre for Health through Action on Social Exclusion, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Hayley McKenzie
- Centre for Health through Action on Social Exclusion, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
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Shields M, Quilty J, Dharamsi S, Drynan D. International fieldwork placements in low-income countries: Exploring community perspectives. Aust Occup Ther J 2016; 63:321-328. [PMID: 27111028 DOI: 10.1111/1440-1630.12291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND There has been a significant increase in the number of occupational and physical therapy students going on international fieldwork placements in low-income countries. Yet, there has been a lack of research describing this experience from the agencies that host students. The research question was 'how do members of an agency within a low-income country perceive, interpret and give meaning to international fieldwork placements where students from a Canadian university provide occupational and physical therapy services?' METHODS Purposive sampling was used to recruit participants from five affiliated international fieldwork sites. Six semi-structured interviews exploring the perspectives of individuals from agency sites in low-income countries facilitated the data collection. Interviews were audiotaped and transcribed verbatim for thematic analysis. RESULTS Four themes provided insight into the participants' experience of hosting student therapists. Participants emphasised: (i) there was a reciprocity of learning between agency members and students; (ii) they felt responsible for the health and safety of the students, as well as providing an enriching experience; (iii) participants questioned the preparation phase; and (iv) recommendations were made by participants to strengthen partnerships while contemplating sustainable practices. CONCLUSIONS This study highlighted that effective preparation, enhanced communication, reflection and reciprocity is necessary to achieve what hosting agencies view as sustainable international placements. These results provide a platform for stakeholders to question their current processes for fieldwork placement engagement and potential suggestions for improving current international fieldwork partnerships.
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Affiliation(s)
- Megan Shields
- Department of Occupational Therapy and Occupational Science, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jenny Quilty
- Department of Occupational Therapy and Occupational Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shafik Dharamsi
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Drynan
- Department of Occupational Therapy and Occupational Science, University of British Columbia, Vancouver, British Columbia, Canada
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Yassi A, Spiegel JB, Lockhart K, Fels L, Boydell K, Marcuse J. Ethics in Community-University-Artist Partnered Research: Tensions, Contradictions and Gaps Identified in an 'Arts for Social Change' Project. JOURNAL OF ACADEMIC ETHICS 2016; 14:199-220. [PMID: 27563284 PMCID: PMC4981172 DOI: 10.1007/s10805-016-9257-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Academics from diverse disciplines are recognizing not only the procedural ethical issues involved in research, but also the complexity of everyday “micro” ethical issues that arise. While ethical guidelines are being developed for research in aboriginal populations and low-and-middle-income countries, multi-partnered research initiatives examining arts-based interventions to promote social change pose a unique set of ethical dilemmas not yet fully explored. Our research team, comprising health, education, and social scientists, critical theorists, artists and community-activists launched a five-year research partnership on arts-for-social change. Funded by the Social Science and Humanities Research Council in Canada and based in six universities, including over 40 community-based collaborators, and informed by five main field projects (circus with street youth, theatre by people with disabilities, dance for people with Parkinson’s disease, participatory theatre with refugees and artsinfused dialogue), we set out to synthesize existing knowledge and lessons we learned. We summarized these learnings into 12 key points for reflection, grouped into three categories: community-university partnership concerns (n = 3), dilemmas related to the arts (n = 5), and team issues (n = 4). In addition to addressing previous concerns outlined in the literature (e.g., related to consent, anonymity, dangerous emotional terrain, etc.), we identified power dynamics (visible and hidden) hindering meaningful participation of community partners and university-based teams that need to be addressed within a reflective critical framework of ethical practice. We present how our team has been addressing these issues, as examples of how such concerns could be approached in community-university partnerships in arts for social change.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia, 430-2206 East Mall, UBC, Vancouver, BC V6T 1Z3 Canada
| | - Jennifer Beth Spiegel
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada ; English Department, Concordia University, Montreal, QC Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, 430-2206 East Mall, UBC, Vancouver, BC V6T 1Z3 Canada
| | - Lynn Fels
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, Australia ; Departments of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Judith Marcuse
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada
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Plamondon KM, Bottorff JL, Cole DC. Analyzing Data Generated Through Deliberative Dialogue: Bringing Knowledge Translation Into Qualitative Analysis. QUALITATIVE HEALTH RESEARCH 2015; 25:1529-1539. [PMID: 25896793 DOI: 10.1177/1049732315581603] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Deliberative dialogue (DD) is a knowledge translation strategy that can serve to generate rich data and bridge health research with action. An intriguing alternative to other modes of generating data, the purposeful and evidence-informed conversations characteristic of DD generate data inclusive of collective interpretations. These data are thus dialogic, presenting complex challenges for qualitative analysis. In this article, we discuss the nature of data generated through DD, orienting ourselves toward a theoretically grounded approach to analysis. We offer an integrated framework for analysis, balancing analytical strategies of categorizing and connecting with the use of empathetic and suspicious interpretive lenses. In this framework, data generation and analysis occur in concert, alongside engaging participants and synthesizing evidence. An example of application is provided, demonstrating nuances of the framework. We conclude with reflections on the strengths and limitations of the framework, suggesting how it may be relevant in other qualitative health approaches.
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Affiliation(s)
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada Faculty of Health Sciences, Australian Catholic University, Melbourne, Austalia
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Stewart KA. Teaching corner: the prospective case study : a pedagogical innovation for teaching global health ethics. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:57-61. [PMID: 25630595 DOI: 10.1007/s11673-014-9605-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/09/2014] [Indexed: 06/04/2023]
Abstract
Over the past decade, global health has emerged as one of the fastest growing academic programs in the United States. Ethics training is cited widely as an essential feature of U.S. global health programs, but generally it is not deeply integrated into the global health teaching and training curricula. A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the value of case study pedagogy for a full-semester graduate course in global health ethics at an American university. I address some of the pedagogical challenges of teaching global health ethics through my innovative use of case study methodology-the "prospective case study" (PSC).
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Affiliation(s)
- Kearsley A Stewart
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina, 27708, USA,
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Spiegel JM, Breilh J, Yassi A. Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Global Health 2015; 11:9. [PMID: 25880442 PMCID: PMC4353467 DOI: 10.1186/s12992-015-0091-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/27/2015] [Indexed: 01/21/2023] Open
Abstract
Background Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis. Discussion In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth). Conclusions We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.
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Affiliation(s)
- Jerry M Spiegel
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
| | - Jaime Breilh
- Health Sciences Area, University Andina Simon Bolivar, Quito, Ecuador.
| | - Annalee Yassi
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
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Tsuei SHT, Yassi A, Spiegel JM. Critical reflection on a summer global health research internship: the need for education on global development paradigms in medical schools. MEDICAL TEACHER 2015; 37:196-198. [PMID: 25180880 DOI: 10.3109/0142159x.2014.955843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Yassi A, O'Hara LM, Engelbrecht MC, Uebel K, Nophale LE, Bryce EA, Buxton JA, Siegel J, Spiegel JM. Considerations for preparing a randomized population health intervention trial: lessons from a South African-Canadian partnership to improve the health of health workers. Glob Health Action 2014; 7:23594. [PMID: 24802561 PMCID: PMC4009485 DOI: 10.3402/gha.v7.23594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/31/2014] [Indexed: 11/24/2022] Open
Abstract
Background Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. Objective We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships. Design We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. Results The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. Conclusion Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada;
| | | | - Michelle C Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Kerry Uebel
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Letshego Elizabeth Nophale
- Provincial Occupational Health Unit, Free State Department of Health, University of the Free State, Bloemfontein, South Africa
| | | | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jacob Siegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jerry Malcolm Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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