[Same words, different meanings: How epidemiological terminology struggles with population health intervention research]

[French version of The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, in a French law context]

INTRODUCTION

There is growing evidence on the ethical challenges raised by cluster randomized trials. This specificity is not reflected in the legal texts regulating research, which creates difficulties for researchers implementing these experimental designs. The Ottawa Statement (Weijer et al. 2012) aims to provide detailed guidance on the ethical design, conduct and assessment of cluster trials. More broadly aims to help research stakeholders and decision-makers to make informed ethical decisions regarding the particularity of these experimental designs. It seems that this international statement, written in English, is not sufficiently accessible to all of the French professionals involved in health research. The aim of this article is to provide these professionals with a contextualized and illustrated French translation of the "Ottawa statement".

METHOD

. The "complex design" working group of the RECaP network (Research in Clinical Epidemiology and Public Health), carried out this work. A first version was discussed by the authors in several meetings. It was completed by contextual explanations and examples of French studies currently conducted by the authors. The final version was obtained by consensus and validated by the group.

RESULTS

. This work reports 15 recommendations grouped into 7 key questions: How to justify cluster design? How to submit an article to an ethics committee? How to identify research participants? How and when to obtain informed consent? Who are the gatekeepers? How to assess benefits and harm? How to protect vulnerable participants? Each of these recommendations is specific to cluster trials. The recommendations are explained and detailed through concrete examples.

CONCLUSION

Without interfering with current French laws, this work provides a framework for the organization, conduct and ethical assessment of cluster randomized trials in France. In the present-day context, it is essential that all concerned groups can base their decisions on recommendations in line with the elementary principles of health research ethics.

Relocating to a new or pre-existing social housing unit: significant health improvements for Inuit adults in Nunavik and Nunavut

OBJECTIVES

In 2014-2015, over 400 social housing units were constructed in selected communities in Nunavik and Nunavut, two Inuit regions in northern Canada where housing shortages and poor quality housing are endemic and undermine population health. This paper presents results from a before-and-after study examining the effects of rehousing, i.e., relocating to a newly constructed or pre-existing social housing unit, on psychosocial health and asthma-related symptoms for Inuit adults.

METHODS

Baseline data were collected 1-6 months before, and follow-up data 15-18 months after rehousing. Of the 289 participants at baseline, 186 were rehoused. Of the 169 participants eligible at follow-up, 102 completed the study. Self-reported health measures included psychological distress, perceived stress in daily life, perceived control over one's life, and asthma-related symptoms. Data are analyzed using multilevel models for longitudinal data.

RESULTS

After adjusting for age, sex, and region of residence, participants reported significantly lower levels of psychological distress and perceived stress in daily life, and improved sense of control over their lives 15 to 18 months after rehousing. Participants were also significantly less likely to report asthma-related symptoms at follow-up.

CONCLUSION

Significant positive health impacts are observed for adults who relocated to newly constructed or pre-existing social housing units. Increasing investments to redress the housing situation across Inuit Nunangat is required, not only to improve living conditions but also to improve the health and well-being of the population.

Critical reflections on methodological challenge in arts and dementia evaluation and research

Methodological rigour, or its absence, is often a focus of concern for the emerging field of evaluation and research around arts and dementia. However, this paper suggests that critical attention should also be paid to the way in which individual perceptions, hidden assumptions and underlying social and political structures influence methodological work in the field. Such attention will be particularly important for addressing methodological challenges relating to contextual variability, ethics, value judgement and signification identified through a literature review on this topic. Understanding how, where and when evaluators and researchers experience such challenges may help to identify fruitful approaches for future evaluation.