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Iveniuk J, Wilder J, Monk E. The Threefold Path to Equity: Approaches for Health and Aging Researchers. THE GERONTOLOGIST 2024; 64:gnad068. [PMID: 37326609 PMCID: PMC10943508 DOI: 10.1093/geront/gnad068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 06/17/2023] Open
Abstract
The authors present a model for pursuing equity in research on health and aging, in terms of: (a) community-driven research governance, with reference to examples inside and outside of the United States, (b) a focus on policy change, where policy is defined broadly in terms of all legislative and regulatory change, and (c) equity-focused research practices, at the level of measurement, analysis, and study design. The model is visualized as a "threefold path" that researchers may walk, to achieve changes within our field, and changes in how we interface with other fields, and communities.
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Affiliation(s)
- James Iveniuk
- The Bridge at NORC, National Opinion Research Center, Chicago, Illinois, USA
| | - Jocelyn Wilder
- The Bridge at NORC, National Opinion Research Center, Chicago, Illinois, USA
| | - Ellis Monk
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
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2
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De Shalit A, van der Meulen E, Guta A. Social service responses to human trafficking: the making of a public health problem. CULTURE, HEALTH & SEXUALITY 2021; 23:1717-1732. [PMID: 32896219 DOI: 10.1080/13691058.2020.1802670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
Human trafficking has received considerable attention from policymakers, researchers and service providers globally, with resulting interventions often positioning trafficking as something that simply exists. Drawing on Bacchi's 'What's the Problem Represented to be?' approach, this article proposes that trafficking is continually made through efforts designed to eradicate it. We conducted 22 interviews with representatives from social service organisations funded by the government of Ontario, Canada, for anti-trafficking programming. These interviews provide insight into how trafficking is being represented and with what effects. Our findings suggest that organisational initiatives often rely on individualised health-related interventions, such as trauma-informed counselling and other mental health support, to address trafficking. In the process, various sex work activities are deemed 'symptoms' of trafficking, and perceived pathways to engaging in sex work (such as drug use/dependence, a history of trauma and low self-esteem) are produced as 'causes' or 'risk factors'. We contend that by pathologising sex work and sex workers, organisations are employing a contradictory neoliberal paternalism to advance a public health representation of human trafficking that simultaneously responsibilises and disenfranchises purported victims.
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Affiliation(s)
| | | | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
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3
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Bellingham B, Kemp H, Boydell K, Isobel S, Gill K, River J. Towards epistemic justice doing: Examining the experiences and shifts in knowledge of lived experience researchers over the course of a mental health research training programme. Int J Ment Health Nurs 2021; 30:1588-1598. [PMID: 34263518 DOI: 10.1111/inm.12910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
Participation of people with lived experience (LE) in mental health research is vital for improving the quality and relevance of research priorities, outcomes, and knowledge translation. Inclusion of people with LE is also recognized as central for achieving health service reform including commitments to human rights, social, and epistemic justice. Although a lack of research training is cited as a barrier to LE participation, few studies have examined the value of training for, or the specific requirements of, people with LE. This study seeks to address this gap. It reports on a longitudinal, qualitative study examining shifts in experience and knowledge, and unmet needs, of people with LE over the course of a coproduced research training programme. Findings indicate that the programme enabled participants to understand the role, value, and levels of LE participation in research. Participants also stressed the importance of the 'embodied lived expertise' of LE researchers who co-delivered the training programme. Nonetheless, participants indicated that they felt unprepared for the challenges of working in systems where LE knowledge is subordinated, and experiences of being silenced and powerless could mirror those previously experienced in mental health services and the community. Participants indicated a need for training that provided them with the epistemic resources to render such experiences intelligible. Findings also indicate that training in participatory research is required for conventional mental health researchers, to support them to navigate power asymmetries and value LE knowledge contributions.
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Affiliation(s)
- Brett Bellingham
- NSW Health, Nepean Blue Mountains Mental Health Service, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Holly Kemp
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,NSW Health, Canterbury Community Health Centre, Sydney, New South Wales, Australia
| | - Katherine Boydell
- Black Dog Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie Isobel
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, The University of Sydney, Sydney, New South Wales, Australia
| | - Jo River
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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4
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Roura M, Dias S, LeMaster JW, MacFarlane A. Participatory health research with migrants: Opportunities, challenges, and way forwards. Health Expect 2021; 24:188-197. [PMID: 33528082 PMCID: PMC8077110 DOI: 10.1111/hex.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Migration is one of the most politically pressing issues of the 21st century but migrant health remains an under-researched area. The International Collaboration for Participatory Health Research (ICPHR) working group on migration developed this position statement to address opportunities and challenges in relation to migrant health. It aims to contribute to a shift from a deficit model that sees migrants as passively affected by policies to their reconceptualization as citizens who are engaged in the co-creation of solutions. METHODS This paper examines the opportunities and challenges posed by the use of PHR with migrants. It draws on a broad literature to provide examples of successful PHR with migrants and highlights critical issues for consideration. FINDINGS Successful initiatives illustrate the value of engaging migrants in the definition of the research agenda, the design and implementation of health interventions, the identification of health-protective factors and the operationalization and validation of indicators to monitor progress. Within increasingly super diverse contexts, fragmented community landscapes that are not necessarily constructed along ethnicity traits, inadequate structures of representation, local tensions and operational barriers can hamper meaningful PHR with migrants. CONCLUSION For each research context, it is essential to gauge the 'optimal' level and type of participation that is more likely to leverage migrants' empowerment. The development of Monitoring and Evaluation tools and methodological strategies to manage inter-stakeholder discrepancies and knowledge translation gaps are steps in this direction. PATIENT OR PUBLIC CONTRIBUTION This paper draws from contributions of migrant populations and other stakeholders to policymaking.
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Affiliation(s)
- Maria Roura
- School of Public HealthUniversity College CorkCorkIreland
| | - Sonia Dias
- NOVA National School of Public Health, Public Health Research CenterUniversidade NOVA de Lisboa & Comprehensive Health Research Center (CHRC)LisboaPortugal
| | | | - Anne MacFarlane
- School of Medicine LimerickLimerickIreland
- Health Research InstituteUniversity of LimerickLimerickIreland
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5
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Abstract
As increasing value is placed on community engagement, co-creation, and transdisciplinarity as essential ingredients to improve policies; participatory health research has gained popularity as a promising avenue for stakeholders to collaborate and solve problems in innovative ways. Participatory research has a history of success but important caveats caution against romanticizing the approach. The assumption that participation will empower participants overlooks potential feelings of disappointment or exploitation amid power imbalances, vested interest, and representativeness issues. This article outlines a multilevel conceptual framework that explicitly situates power dynamics within a wider system of bidirectional interconnections operating at the individual, interpersonal, and structural levels. It then provides a practical tool to examine and address these dynamics in a comprehensive and systematic way. This can be helpful for researchers and community practitioners working in contexts where democratic principles are not broadly endorsed and where power dynamics operate in subtle ways.
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Rowland P, MacKinnon KR, McNaughton N. Patient involvement in medical education: To what problem is engagement the solution? MEDICAL EDUCATION 2021; 55:37-44. [PMID: 32350875 DOI: 10.1111/medu.14200] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Patient and public engagement is gaining momentum across many domains of health care, inclusive of education and research. In this framing, engagement is offered as a solution to a myriad of problems. Yet, the way problems and solutions are linked together may be assumed, rather than made explicit. In the absence of clarity, there is a risk that solutions that may have worked in one domain of health care could falter, or even create new problems, in another. METHODS We use a model from organisational studies as a way to make sense of the relationships between the problems, solutions and stakeholders operating in the name of patient and public engagement in health care. The 'garbage can model' is a playfully phrased but meaningful attempt to decipher the complex world of decision making in organisations. We use this model to guide our framing of the solutions of patient engagement practice and the wide range of problem statements that animate all of this activity. RESULTS Following a discussion of the complexity of the field of patient engagement, we identify strategies for educators to conceptually weave problem statements, solutions and stakeholders together in mosaics of engagement activity. We further suggest a movement away from considering problems to be solved to thinking about polarities to be navigated. CONCLUSIONS As patient engagement becomes more embedded in decision-making spaces in health professions education, we need a better understanding of how decisions are actually made in these organisations. We also need to consider that our most treasured solutions may have an uneasy fit, and some unintended consequences, as they enter new domains of health care. Finally, we advocate for critical approaches not just to the solutions of patient engagement, but to understand problem statements as they are defined, upheld and disrupted through all of this work.
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Affiliation(s)
- Paula Rowland
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - Kinnon R MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Liu C, Meyers K. Beyond clinical trials: social outcomes of structured stakeholder engagement in biomedical HIV prevention trials in China. CULTURE, HEALTH & SEXUALITY 2020; 22:1365-1381. [PMID: 31702447 PMCID: PMC7205565 DOI: 10.1080/13691058.2019.1683230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/17/2019] [Indexed: 05/31/2023]
Abstract
Stakeholder engagement is increasingly recognised and institutionalised as an essential component of HIV-related biomedical research. However, we know little about stakeholder engagement's social outcomes, such as its influence on the community it engages with, in authoritarian regimes and beyond high-income countries. This study evaluates a multi-site structured stakeholder engagement programme conducted in parallel with two HIV prevention studies among men who have sex with men in China. We conducted a one-month ethnographic study and 41 semi-structured interviews with participants of a structured stakeholder engagement programme in six Chinese cities. We found that the structured stakeholder engagement programme offered community stakeholders additional and flexible funding, networking opportunities, increased clinical research literacy, and strengthened their connections with the community. However, the structured stakeholder programme generated unintended consequences in some cases. It caused community stakeholders to expend their social capital, introduced moral conflicts and created tension between stakeholders' 'community representative' and 'research assistant' identities. Our findings suggest that despite these unintended consequences, structured stakeholder engagement could effectively mitigate negative outcomes generated by such engagement if such programmes are more sensitive and responsive to the broader socio-political structure in which trials are embedded.
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Affiliation(s)
- Chuncheng Liu
- Department of Sociology, University of California San Diego, La Jolla, CA, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
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"Red is not the only color of a rainbow": The making and resistance of the "MSM" subject among gay men in China. Soc Sci Med 2020; 252:112947. [PMID: 32240911 DOI: 10.1016/j.socscimed.2020.112947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/20/2022]
Abstract
Public health scholars classify gay men as "men who have sex with men (MSM)" in their studies and interventions. Debates have been raised about the MSM classification for decades. However, we know little about how people who are classified as MSM perceive and respond to this classification, particularly in the authoritarian context where the biopower interacts with the repressive state power. Drawing upon Ian Hacking's dynamic nominalism theory, this study tries to fill these gaps with interviews of 40 gay men in three Chinese cities about their interactions with public health education materials. I examined their perceptions of MSM knowledge and discourses associated with the classification, as well as their identifications to the MSM subject. I found that, on the one hand, many gay men had internalized the MSM subjectivity and considered themselves essentially at high risk of HIV infection. This compliance was constructed through various biopower techniques with the support of the state's repressive power, as the Chinese state censored almost all public representations of gay men except the HIV/AIDS subject MSM. On the other hand, some of my interviewees were resistant to be part of the MSM classification. I showed how this failure is an unintended consequence of the hegemonic MSM discourse and the authoritarian regime's institutional exclusion of the gay men's community's engagement in the expertise network that develops intervention materials and strategies. At last, I proposed to move beyond the debate around the name and representational character of the MSM by moving toward a more reflexive public health.
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Switzer S, Flicker S, McClelland A, Chan Carusone S, Ferguson TB, Herelle N, Yee D, Guta A, Strike C. Journeying together: A visual exploration of "engagement" as a journey in HIV programming and service delivery. Health Place 2020; 61:102247. [PMID: 32329724 DOI: 10.1016/j.healthplace.2019.102247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/02/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022]
Abstract
The experiences of people living with, or impacted by HIV, who participate in research and programming are relatively-well documented. However, how stakeholders within the HIV sector understand engagement, or how it functions discursively, is undertheorized. We used a comparative case study design and photovoice to explore engagement in three community-based organizations providing HIV programs or services in Toronto, Canada. We invited stakeholders to photograph their subjective understandings of engagement. We employ a visual and thematic analysis of our findings, by focusing on participants' use of journey metaphors to discuss engagement within and across sites. Visual metaphors of journey were employed by participants to make sense of their experience, and demonstrated that for many, engagement was a dynamic, affective and relational process. Our findings illustrate how journey may be an apt metaphor to explore the relational, contingent and socio-spatial/political specificities of engagement within and across HIV organizations. We conclude with a discussion on implications for practice.
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Affiliation(s)
| | | | | | - Soo Chan Carusone
- Casey House Hospital, Toronto, Ontario, M4Y 1P2, Canada; McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Tatiana B Ferguson
- Empower, Parkdale Queen West Community Health Centre, Gendering Adolescent AIDS Prevention, Toronto, Ontario, M5V 2R4, Canada
| | - Neil Herelle
- Toronto People with AIDS Foundation, Toronto, Ontario, M5A 2E6, Canada
| | - Derek Yee
- Casey House Hospital, Toronto, Ontario, M4Y 1P2, Canada
| | - Adrian Guta
- University of Windsor, Windsor, Ontario, N9B 3P4, Canada
| | - Carol Strike
- University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
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10
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McKie RM, Davies AWJ, Nixon KD, Lachowsky NL. A theoretical examination using governmentality to understand gay men’s risk and sexual behaviours. CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2018-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article explores the link between Foucault’s (1991) governmentality theory, specifically as it relates to gay men’s sexual practices and perceptions of HIV risk. Foucault’s (1991) theory of governmentality elucidates the means through which individual behaviours and norms (at a micro level) are governed through the production of disciplinary norms and structures that are instantiated at a broader structural and institutional level (the macro-level). Foucauldian theoretical conversations pertaining to what is meant by conceptions and definitions of HIV/STI risk are furthered through this paper’s theoretical contributions as they relate to gay men. From a Foucauldian perspective, we assess how gay men may alter or monitor their sexual practices through governmental scripts produced at a state level and manifested through micro- and macro-level behavioural and ideological shifts based on dominant socio-sexual norms. A model of the interrelationship between governmentality, scripting, the micro/macro levels, and the situation-specific is presented for future consideration when examining gay men’s sexual practices. Historical oppression and segregation of gay men are considered when exploring these theories from a critical social scientific lens.
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Affiliation(s)
| | - Adam W. J. Davies
- Department of Curriculum Studies and Teacher Development, University of Toronto, Toronto, ON
| | - Kevin D. Nixon
- Department of Anthropology, University of Toronto, Toronto, ON
| | - Nathan L. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
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11
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Guta A, Murray SJ, Strike C, Flicker S, Upshur R, Myers T. Governing Well in Community-Based Research: Lessons from Canada's HIV Research Sector on Ethics, Publics and the Care of the Self. Public Health Ethics 2018; 10:315-328. [PMID: 29731810 DOI: 10.1093/phe/phw024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, we extend Michel Foucault's final works on the 'care of the self' to an empirical examination of research practice in community-based research (CBR). We use Foucault's 'morality of behaviors' to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves-and others-in ways that often resist the propensity for domination through public health research. '…there are different ways to "conduct oneself" morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.' (Foucault, 1985: 26).
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Affiliation(s)
- Adrian Guta
- Department of Health Sciences, Carleton University; Dalla Lana School of Public Health, University of Toronto
| | - Stuart J Murray
- Department of English Language and Literature, Carleton University; Department of Health Sciences, Carleton University
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto
| | | | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto
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12
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Koen J, Wassenaar D, Mamotte N. The 'over-researched community': An ethics analysis of stakeholder views at two South African HIV prevention research sites. Soc Sci Med 2017; 194:1-9. [PMID: 29035778 DOI: 10.1016/j.socscimed.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
Abstract
Health research in resource-limited, multi-cultural contexts raises complex ethical concerns. The term 'over-researched community' (ORC) has been raised as an ethical concern and potential barrier to community participation in research. However, the term lacks conceptual clarity and is absent from established ethics guidelines and academic literature. In light of the concern being raised in relation to research in low- and middle-income countries (LMICs), a critical and empirical exploration of the meaning of ORC was undertaken. Guided by Emanuel et al.'s (2004) eight principles for ethically sound research in LMICs, this study examines the relevance and meaning of the terms 'over-research' and 'over-researched community' through an analysis of key stakeholder perspectives at two South African research sites. Data were collected between August 2007 and October 2008. 'Over-research' was found to represent a conglomeration of ethical concerns often used as a proxy for standard research ethics concepts. 'Over-research' seemed fundamentally linked to disparate positions and perspectives between different stakeholders in the research interaction, arising from challenges in inter-stakeholder relationships. 'Over-research' might be interpreted to mean exploitation. However, exploitation itself could mean different things. Using the term may lead to obscured understanding of real or perceived ethical concerns, making it difficult to identify and address the underlying concerns. It is recommended that the term be carefully and critically interrogated for clarity when used in research ethics discourse. Because it represents other legitimate concerns, it should not be dismissed without careful exploration.
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Affiliation(s)
- Jennifer Koen
- HIV AIDS Vaccines Ethics Group, Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209, South Africa.
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209 South Africa.
| | - Nicole Mamotte
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209 South Africa.
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13
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Damon W, Callon C, Wiebe L, Small W, Kerr T, McNeil R. Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers. Soc Sci Med 2017; 176:85-92. [PMID: 28135693 DOI: 10.1016/j.socscimed.2017.01.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 12/16/2022]
Abstract
Community-based participatory research (CBPR) has become an increasingly common approach to research involving people who use(d) drugs (PWUD), who are often employed as peer researchers on these projects. This paper seeks to understand the impact of CBPR on PWUD, particularly those living in heavily researched and stigmatized neighbourhoods where CBPR projects are often located. This study draws on 14 in-depth interviews with PWUD who had previous experience as both peer researchers and research participants in CBPR projects conducted between July 2010 and February 2011. The study employed a CBPR approach in its study design, recruitment, interviewing, and analysis. Our analysis indicates that participants were supportive of CBPR in principle and described the ways in which it helped contest stigmatizing assumptions and researcher bias. Participants also reported positive personal gains from participation in CBPR projects. However, many participants had negative experiences with CBPR projects, especially when CBPR principles were implemented in a superficial or incomplete manner. Participants emphasized the importance of inclusiveness and active deconstruction of hierarchy between researchers and community members to successful CBPR among drug using populations. CBPR has been widely adopted as a research approach within marginalized communities but has often been implemented inconsistently. Still, CBPR can empower communities to contest forms of social stigma that are often reproduced through academic research on marginalized communities. Our findings describe how the benefits of CBPR are maximized when CBPR principles are consistently applied and when community-based researchers are supported in ways that reduce power hierarchies. This suggests a need for capacity building within affected communities to develop independent support, training, and grievance processes for peer researchers.
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Affiliation(s)
- Will Damon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Cody Callon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lee Wiebe
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Closson K, McNeil R, McDougall P, Fernando S, Collins AB, Baltzer Turje R, Howard T, Parashar S. Meaningful engagement of people living with HIV who use drugs: methodology for the design of a Peer Research Associate (PRA) hiring model. Harm Reduct J 2016; 13:26. [PMID: 27717364 PMCID: PMC5054577 DOI: 10.1186/s12954-016-0116-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Community-based HIV, harm reduction, and addiction research increasingly involve members of affected communities as Peer Research Associates (PRAs)—individuals with common experiences to the participant population (e.g. people who use drugs, people living with HIV [PLHIV]). However, there is a paucity of literature detailing the operationalization of PRA hiring and thus limited understanding regarding how affected communities can be meaningfully involved through low-barrier engagement in paid positions within community-based participatory research (CBPR) projects. We aim to address this gap by describing a low-threshold PRA hiring process. Results In 2012, the BC Centre for Excellence in HIV/AIDS and the Dr. Peter AIDS Foundation collaborated to develop a mixed-method CBPR project evaluating the effectiveness of the Dr. Peter Centre (DPC)—an integrative HIV care facility in Vancouver, Canada. A primary objective of the study was to assess the impact of DPC services among clients who have a history of illicit drug use. In keeping with CBPR principles, affected populations, community-based organizations, and key stakeholders guided the development and dissemination of a low-barrier PRA hiring process to meaningfully engage affected communities (e.g. PLHIV who have a history of illicit drug use) in all aspects of the research project. The hiring model was implemented in a number of stages, including (1) the establishment of a hiring team; (2) the development and dissemination of the job posting; (3) interviewing applicants; and (4) the selection of participants. The hiring model presented in this paper demonstrates the benefits of hiring vulnerable PLHIV who use drugs as PRAs in community-based research. Conclusions The provision of low-barrier access to meaningful research employment described herein attempts to engage affected communities beyond tokenistic involvement in research. Our hiring model was successful at engaging five PRAs over a 2-year period and fostered opportunities for future paid employment or volunteer opportunities through ongoing collaboration between PRAs and a diverse range of stakeholders working in HIV/AIDS and addictions. Additionally, this model has the potential to be used across a range of studies and community-based settings interested in meaningfully engaging communities in all stages of the research process. Electronic supplementary material The online version of this article (doi:10.1186/s12954-016-0116-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - R McNeil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - P McDougall
- Dr. Peter AIDS Foundation, Vancouver, Canada
| | - S Fernando
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - A B Collins
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - T Howard
- Positive living society and the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - S Parashar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Abstract
Community centrality is a growing requirement of social science. The field's research practices are increasingly expected to conform to prescribed relationships with the people studied. Expectations about community centrality influence scholarly activities. These expectations can pressure social scientists to adhere to models of community involvement that are immediate and that include community-based co-investigators, advisory boards, and liaisons. In this context, disregarding community centrality can be interpreted as failure. This paper considers evolving norms about the centrality of community in social science. It problematises community inclusion and discusses concerns about the impact of community centrality on incremental theory development, academic integrity, freedom of speech, and the value of liberal versus communitarian knowledge. Through the application of a constructivist approach, this paper argues that social science in which community is omitted or on the periphery is not failed science, because not all social science requires a community base to make a genuine and valuable contribution. The utility of community centrality is not necessarily universal across all social science pursuits. The practices of knowing within social science disciplines may be difficult to transfer to a community. These practices of knowing require degrees of specialisation and interest that not all communities may want or have.
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Affiliation(s)
- Dan Allman
- University of Toronto, Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario, M5T 3M7Canada
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Roura M, Bisoffi F, Navaza B, Pool R. "Carrying Ibuprofen in the Bag": Priority Health Concerns of Latin American Migrants in Spain- A Participatory Qualitative Study. PLoS One 2015; 10:e0136315. [PMID: 26317781 PMCID: PMC4552793 DOI: 10.1371/journal.pone.0136315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/02/2015] [Indexed: 11/25/2022] Open
Abstract
Background An estimated 2.7 million Latin Americans reside in Europe, mostly in Spain. Part of a broader project aimed at developing a research agenda on the health status and determinants of this population, this qualitative study engaged Latin American migrants in the identification of research priorities. Methods We conducted 30 group discussions between November 2012—March 2013 with 84 participants purposively selected for maximum diversity in Madrid and Barcelona (Spain). We facilitated sequences of task-oriented visual activities to explore their views on priority health concerns. We tape-recorded and transcribed discussions and developed a coding frame based on socio-ecological frameworks, which we applied to all the data using NVIVO-10. A final round of eight group discussions allowed us to triangulate and enrich interpretations by including participants’ insights. Findings The cumulative toll of daily stresses was the major health concern perceived by a population that conceptualised ill-health as a constellation of symptoms rather than as specific diseases. Work-related factors, legislative frameworks regulating citizenship entitlements and feeling ethnically discriminated were major sources of psycho-social strain. Except for sexually transmitted infections, participants rarely referred to communicable diseases as a concern. The perception that clinicians systematically prescribed painkillers discouraged health seeking and fostered self-medication. Participants felt that the medicalised, chemicalised, sexually liberal and accelerated culture of the host society damaged their own, and the local populations’ health. Conclusion Health systems bear a disproportionate responsibility in addressing health problems rooted in other sectors. Occupational and migration policies should be recognised explicitly as health policies. The mismatch between researchers’ emphasis on communicable infections and the health concerns of Latin American migrants highlights the need for greater interaction between different forms of knowledge. In this process, the biomedical culture of reliance on pharmacological solutions should not remain unquestioned.
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Affiliation(s)
- Maria Roura
- ISGlobal, Barcelona Centre for International Health Research (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Federico Bisoffi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Barbara Navaza
- ISGlobal, Barcelona Centre for International Health Research (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Robert Pool
- Centre for Social Science and Global Health University of Amsterdam, Amsterdam, The Netherlands
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Flicker S, O'Campo P, Monchalin R, Thistle J, Worthington C, Masching R, Guta A, Pooyak S, Whitebird W, Thomas C. Research Done in "A Good Way": The Importance of Indigenous Elder Involvement in HIV Community-Based Research. Am J Public Health 2015; 105:1149-54. [PMID: 25880963 DOI: 10.2105/ajph.2014.302522] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the role that Indigenous Elders can play in ensuring that community-based research (CBR) is conducted ethically. METHODS We present data from a larger qualitative study exploring ethical issues that occur in HIV-related CBR through the experiences of researchers engaged in CBR. Between May 2010 and July 2011, we interviewed 51 academic and community research team leaders of federally funded HIV CBR studies. We used thematic analysis techniques to identify themes. RESULTS Participating researchers engage Elders in research because Elders are keepers of Indigenous knowledge, dynamic ethical consultants, community protectors, and credible sources of information who are able to counsel and support, mediate conflict, provide local context and history, and conduct ceremonial roles. Potential challenges cited by participants to engaging Elders in research include finding the right "fit," approaching Elders in a culturally appropriate way, and bureaucratic environments that do not honor Indigenous processes. CONCLUSIONS Culturally appropriate Elder engagement in HIV CBR with Indigenous communities is vital for promoting positive relationships and culturally safe research that respects ceremony and Indigenous ways of knowing.
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Affiliation(s)
- Sarah Flicker
- Sarah Flicker, Renée Monchalin, and Jesse Thistle are with the Faculty of Environmental Studies, York University, Toronto, Ontario. Patricia O'Campo is with the Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Catherine Worthington is with the School of Public Health and Social Policy, Victoria, British Columbia. Renée Masching is with the Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia. Adrian Guta is with Carleton University, Ottawa, Ontario. Sherri Pooyak is with the Canadian Aboriginal AIDS Network, Victoria, British Columbia. Wanda Whitebird is with the Ontario Aboriginal HIV/AIDS Strategy, Toronto, Ontario. Cliff Thomas is with the Canadian Aboriginal AIDS Network, Ottawa, Ontario
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Switzer S, Guta A, de Prinse K, Chan Carusone S, Strike C. Visualizing harm reduction: Methodological and ethical considerations. Soc Sci Med 2015; 133:77-84. [PMID: 25841098 DOI: 10.1016/j.socscimed.2015.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of visual methods is becoming increasingly common and accepted in health research. This paper explores the opportunities and constraints of using photo-based methods in the context of a community-based participatory research study on how to engage people living with HIV in conversations about a hospital's recently introduced harm reduction policy. Using a blended approach of photovoice and photo-elicited interviews, we provided participants (n = 16) with cameras and asked them to take a series of photos that "show how you feel about or have experienced harm reduction as a Casey House client." We reflect on methodological insights from the study to think through the process of doing photo-based work on a stigmatized topic in a small hospital setting by foregrounding: 1) how the act of taking photos assisted participants in visualizing connections between space, harm reduction, and substance use; 2) expectations of participation and navigating daily health realities; and 3) issues of confidentiality, anonymity and stigma in clinical settings. These reflections provide a case study on the importance of critically examining the process of engaging with photo-based methods. We conclude the paper by re-thinking issues of context and photo-based methods. Rather than viewing context as a neutral backdrop to apply a method, context should be viewed as an active force in shaping what can or cannot be done or produced within the space. Photo-based methods may offer an effective community-engagement strategy but may require modification for use in a clinical setting when working on a stigmatized topic with individuals with complex health care needs. Given the potential of visual methods as a community engagement strategy, research teams are advised to understand the entire process as a data collection opportunity so that these methods can be further explored in a variety of contexts.
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Affiliation(s)
- S Switzer
- Faculty of Environmental Studies, York University, Toronto, Canada.
| | - A Guta
- Faculty of Arts & Social Sciences, Carleton University, Canada; Department of Gender, Sexuality, and Women's Studies, Simon Fraser University, Canada
| | | | - S Chan Carusone
- Casey House Hospital, Toronto, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada
| | - C Strike
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
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