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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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2
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Perrone C, Schilling W, Callery JJ, Ashley EA, Chambers M, Chase H, Dahal P, Kanthawang N, Nedsuwan S, Hanboonkunupakarn B, Intralawan D, Karkey A, Mayxay M, Souvong V, Tran Minh H, Udas Shakya S, Sharma SK, Uranw S, Vannachione S, Woodrow C, White NJ, Cheah PY. Good participatory practice for coronavirus disease 2019 (COVID-19) research: the case of a COVID-19 prevention study. Wellcome Open Res 2022; 6:216. [PMID: 36866279 PMCID: PMC9971639 DOI: 10.12688/wellcomeopenres.16880.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The COPCOV study (chloroquine/ hydroxychloroquine prevention of coronavirus disease), which started recruitment in April 2020, is a multi-country double-blind, randomised, placebo-controlled trial which is being conducted in healthcare facilities involved in COVID-19 case management. Participants are staff employed in facilities managing people with proven or suspected COVID-19. As part of the study, we conducted a series of engagement sessions. The aims were to assess the feasibility of the study, to identify context-specific ethical issues, to understand possible concerns, to fine tune research procedures and to refine the COPCOV information materials. Methods: The COPCOV study was approved by relevant institutional review boards. The sessions described in this paper were part of the study. We conducted a series of engagement sessions, each involving a short presentation of the study, a section where attendees were asked to express their willingness to participate in such a study, which information they would need to change their view and an open Q&A section. Answers were transcribed and coded into themes by two independent investigators. Themes were derived from the data. They complemented other site-specific engagement, communication, and public relation activities such as press releases and websites. Results and conclusions: From 16 th March 2020 to 20 th January 2021, 12 engagement sessions were conducted in Thailand, Laos, Vietnam, Nepal and the UK involving 213 attendees in total. Issues raised revolved around the social value and study rationale; safety of trial medications and risk-benefit balance; study design and commitments. These sessions helped us identify concerns people had, which helped us refine information materials as well as complement site feasibility assessments. Our experience strongly supports the use of participatory practices prior to conducting clinical trials.
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Affiliation(s)
- Carlo Perrone
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,
| | - William Schilling
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James J. Callery
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Mary Chambers
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh city, Vietnam
| | - Hannah Chase
- Medical Sciences Divisional Office, University of Oxford, Oxford, UK
| | - Piyush Dahal
- KHDC Program, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Daranee Intralawan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit (OUCRU-Nepal), Patan Hospital,, Kathmandu, Nepal
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic,University of Health Sciences in Lao P.D.R., Vientiane, Lao People's Democratic Republic
| | - Vimalay Souvong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Hien Tran Minh
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh city, Vietnam
| | - Summita Udas Shakya
- Oxford University Clinical Research Unit (OUCRU-Nepal), Patan Hospital,, Kathmandu, Nepal
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surendra Uranw
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Souphaphone Vannachione
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Charles Woodrow
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,John Radcliffe Hospital, Oxford, UK
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,The Ethox Centre, University of Exford, Oxford, UK
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3
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Perrone C, Schilling W, Callery JJ, Ashley EA, Chambers M, Chase H, Dahal P, Kanthawang N, Nedsuwan S, Hanboonkunupakarn B, Intralawan D, Karkey A, Mayxay M, Souvong V, Tran Minh H, Udas Shakya S, Sharma SK, Uranw S, Vannachione S, Woodrow C, White NJ, Cheah PY. Good participatory practice for coronavirus disease 2019 (COVID-19) research: the case of a COVID-19 prevention study. Wellcome Open Res 2022; 6:216. [PMID: 36866279 PMCID: PMC9971639 DOI: 10.12688/wellcomeopenres.16880.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The COPCOV study (chloroquine/ hydroxychloroquine prevention of coronavirus disease), which started recruitment in April 2020, is a multi-country double-blind, randomised, placebo-controlled trial which is being conducted in healthcare facilities involved in COVID-19 case management. COPCOV aims to recruit healthcare workers and other staff employed in facilities managing people with proven or suspected COVID-19. Methods: We conducted a series of engagement sessions, each involving a short presentation of the study, a section where attendees were asked to express if they would be interested in participating in such a study and which information they would need to change their view and an open Q&A section. Answers were transcribed and coded into themes by two independent investigators. Themes were derived from the data. The aims were to assess the feasibility of the study at the respective sites, to identify context-specific ethical issues, to understand concerns potential participants might have, to fine tune research procedures and to refine COPCOV information materials. They complemented other site-specific engagement, communication and public relation activities such as press releases and websites. Results: From 16 th March 2020 to 20 th January 2021, 12 engagement sessions were conducted in Thailand, Laos, Vietnam, Nepal and the UK involving 213 attendees in total. The sessions were designed to encourage potential participants and research professionals not directly involved in the project to interact with those who planned the study and those conducting it. Many attendees were keen to join the study while others had concerns. Questions raised revolved around the social value and study rationale; safety of trial medications and risk-benefit balance; study design and commitments. Conclusions: These sessions helped us refine information materials, identify misunderstandings about the study as well as complement site feasibility assessments. Our experience strongly supports the use of participatory practices prior to conducting clinical trials.
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Affiliation(s)
- Carlo Perrone
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,
| | - William Schilling
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James J. Callery
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Mary Chambers
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh city, Vietnam
| | - Hannah Chase
- Medical Sciences Divisional Office, University of Oxford, Oxford, UK
| | - Piyush Dahal
- KHDC Program, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Daranee Intralawan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit (OUCRU-Nepal), Patan Hospital,, Kathmandu, Nepal
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic,University of Health Sciences in Lao P.D.R., Vientiane, Lao People's Democratic Republic
| | - Vimalay Souvong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Hien Tran Minh
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh city, Vietnam
| | - Summita Udas Shakya
- Oxford University Clinical Research Unit (OUCRU-Nepal), Patan Hospital,, Kathmandu, Nepal
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surendra Uranw
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Souphaphone Vannachione
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Charles Woodrow
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,John Radcliffe Hospital, Oxford, UK
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,The Ethox Centre, University of Exford, Oxford, UK
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4
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Volkov BB, Hoyo V, Hunt J. Engaging community in the translational process: Environmental scan of adaptive capacity and preparedness of Clinical and Translational Science Award Program hubs. J Clin Transl Sci 2022; 7:e1. [PMID: 36755545 PMCID: PMC9879920 DOI: 10.1017/cts.2022.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022] Open
Abstract
This paper is part of the Environmental Scan of Adaptive Capacity and Preparedness of Clinical and Translational Science Award (CTSA) hubs, illuminating challenges, practices, and lessons learned related to CTSA hubs' efforts of engaging community partners to reduce the spread of the virus, address barriers to COVID-19 testing, identify treatments to improve health outcomes, and advance community participation in research. CTSA researchers, staff, and community partners collaborated to develop evidence-based, inclusive, accessible, and culturally appropriate strategies and resources helping community members stay healthy, informed, and connected during the pandemic. CTSA institutions have used various mechanisms to advance co-learning and co-sharing of knowledge, resources, tools, and experiences between academic professionals, patients, community partners, and other stakeholders. Forward-looking and adaptive decision-making structures are those that prioritize sustained relationships, mutual trust and commitment, ongoing communication, proactive identification of community concerns and needs, shared goals and decision making, as well as ample appreciation of community members and their contributions to translational research. There is a strong need for further community-engaged research and workforce training on how to build our collective and individual adaptive capacity to sustain and improve processes and outcomes of engagement with and by communities-in all aspects of translational science.
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Affiliation(s)
- Boris B. Volkov
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
- Institute for Health Informatics and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Verónica Hoyo
- Northwestern University Clinical and Translational Science (NUCATS) Institute, Chicago, IL, USA
- Clinical and Translational Research Institute, UC San Diego, La Jolla, CA, USA
| | - Joe Hunt
- Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA
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5
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Factors that impact on recruitment to vaccine trials during a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2022; 2022:MR000065. [PMCID: PMC8751669 DOI: 10.1002/14651858.mr000065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This is a protocol for a Cochrane Review (qualitative). The review aims to explore the factors associated with a person’s decision to take part in a pandemic or epidemic vaccine trial.
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McNay LA, Arnoczy G, Martell M, Mock P, Wright ME, Simpson S, Smolskis M, Higgs ES. Community-based hospitals: New partners for government-sponsored clinical research during public health emergencies. Vaccine 2021; 39:6183-6185. [PMID: 34535316 PMCID: PMC8438589 DOI: 10.1016/j.vaccine.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
In the United States, clinical trials of COVID-19 vaccines and therapeutics quickly exhausted available clinical research capacity at large medical centers. The NIAID Division of Clinical Research tapped community hospitals to help fill the gap.
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Affiliation(s)
- Laura A McNay
- National Institute for Allergy and Infectious Diseases, Bethesda, MD, United States.
| | | | - Mary Martell
- Cotton O'Neil Clinical Research Center, Topeka, KS, United States
| | - Polly Mock
- CHRISTUS Spohn Hospital, Corpus Christi, TX, United States
| | - Mary E Wright
- National Institute for Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Shelly Simpson
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory, MD, United States
| | - Mary Smolskis
- National Institute for Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Elizabeth S Higgs
- National Institute for Allergy and Infectious Diseases, Bethesda, MD, United States
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