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Pillay N, Ncube N, Moopelo K, Mothoagae G, Welte O, Shogole M, Gwiji N, Scott L, Moshani N, Tiffin N, Boulle A, Griffiths F, Fairlie L, Mehta U, LeFevre A, Scott K. Translating the consent form is the tip of the iceberg: using cognitive interviews to assess the barriers to informed consent in South African health facilities. Sex Reprod Health Matters 2023; 31:2302553. [PMID: 38277196 PMCID: PMC10823893 DOI: 10.1080/26410397.2024.2302553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
The increasing digitisation of personal health data has led to an increase in the demand for onward health data. This study sought to develop local language scripts for use in public sector maternity clinics to capture informed consent for onward health data use. The script considered five possible health data uses: 1. Sending of general health information content via mobile phones; 2. Delivery of personalised health information via mobile phones; 3. Use of women's anonymised health data; 4. Use of child's anonymised health data; and 5. Use of data for recontact. Qualitative interviews (n = 54) were conducted among women attending maternity services in three public health facilities in Gauteng and Western Cape, South Africa. Using cognitive interviewing techniques, interviews sought to:(1) explore understanding of the consent script in five South African languages, (2) assess women's understanding of what they were consenting to, and (3) improve the consent script. Multiple rounds of interviews were conducted, each followed by revisions to the consent script, until saturation was reached, and no additional cognitive failures identified. Cognitive failures were a result of: (1) words and phrases that did not translate easily in some languages, (2) cognitive mismatches that arose as a result of different world views and contexts, (3) linguistic gaps, and (4) asymmetrical power relations that influence how consent is understood and interpreted. Study activities resulted in the development of an informed consent script for onward health data use in five South African languages for use in maternity clinics.
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Affiliation(s)
- Nirvana Pillay
- Senior Lecturer, Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa; Director, Sarraounia Public Health Trust, 20 4th Avenue, Parktown North, Johannesburg, 2193, South Africa. Correspondence:
| | - Nobukhosi Ncube
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Kearabetswe Moopelo
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Gaolatlhe Mothoagae
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Olivia Welte
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Manape Shogole
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nasiphi Gwiji
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Scott
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Noma Moshani
- Social Scientist, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Professor, Life Sciences Building, South African Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Andrew Boulle
- Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Frances Griffiths
- Professor, Warwick Medical School, UK; Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Director of Maternal and Child Health, Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ushma Mehta
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amnesty LeFevre
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Independent research consultant, Toronto, Canada; Associate Faculty, Johns Hopkins School of Public Health, Baltimore, MD, USA
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McKenzie HA, Varcoe C, Nason D, McKenna B, Lawford K, Kelm ME, Wajuntah CO, Gervais L, Hoskins J, Anaquod J, Murdock J, Murdock R, Smith K, Arkles J, Acoose S, Arisman K. Indigenous Women's Resistance of Colonial Policies, Practices, and Reproductive Coercion. QUALITATIVE HEALTH RESEARCH 2022; 32:1031-1054. [PMID: 35385333 PMCID: PMC9251744 DOI: 10.1177/10497323221087526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This analysis of urban Indigenous women's experiences on the Homeland of the Métis and Treaty One (Winnipeg, Manitoba, Canada), Treaty Four (Regina, Saskatchewan, Canada), and Treaty Six (Saskatoon, Saskatchewan, Canada) territories illustrates that Indigenous women have recently experienced coercion when interacting with healthcare and social service providers in various settings. Drawing on analysis of media, study conversations, and policies, this collaborative, action-oriented project with 32 women and Two-Spirit collaborators demonstrated a pattern of healthcare and other service providers subjecting Indigenous women to coercive practices related to tubal ligations, long-term contraceptives, and abortions. We foreground techniques Indigenous women use to assert their rights within contexts of reproductive coercion, including acts of refusal, negotiation, and sharing community knowledge. By recognizing how colonial relations shape Indigenous women's experiences, decision-makers and service providers can take action to transform institutional cultures so Indigenous women can navigate their reproductive decision-making with safety and dignity.
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Affiliation(s)
| | | | - Dory Nason
- First Nations University of Canada, Regina, SK, Canada
| | | | | | | | | | | | | | | | | | | | | | - Jillian Arkles
- First Nations University of Canada, Saskatoon, SK, Canada
| | - Sharon Acoose
- First Nations University of Canada, Saskatoon, SK, Canada
| | - Kayla Arisman
- University of British Columbia, Vancouver, BC,
Canada
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