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Vincent R, Adhikari B, Duddy C, Richardson E, Wong G, Lavery J, Molyneux S. 'Working relationships' across difference - a realist review of community engagement with malaria research. Wellcome Open Res 2022; 7:13. [PMID: 37621950 PMCID: PMC10444998 DOI: 10.12688/wellcomeopenres.17192.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 08/26/2023] Open
Abstract
Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to 'work', and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature , we conducted a realist review of CE with malaria research - a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional 'working relationships' across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing 'dominant health research paradigm context', such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.
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Affiliation(s)
- Robin Vincent
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
| | - The REAL team: Mary Chambers, Phaik Yeong Cheah, Al Davies, Kate Gooding, Dorcas Kamuya, Vicki Marsh, Noni Mumba, Deborah Nyirenda, and Paulina Tindana.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
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Mwangi N, Bascaran C, Ng'ang'a M, Ramke J, Kipturgo M, Gichuhi S, Kim M, Macleod D, Moorman C, Muraguri D, Gakuo E, Muthami L, Foster A. Feasibility of a cluster randomized controlled trial on the effectiveness of peer-led health education interventions to increase uptake of retinal examination for diabetic retinopathy in Kirinyaga, Kenya: a pilot trial. Pilot Feasibility Stud 2020; 6:102. [PMID: 32695434 PMCID: PMC7364632 DOI: 10.1186/s40814-020-00644-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/06/2020] [Indexed: 01/18/2023] Open
Abstract
Background People living with diabetes can reduce their risk of vision loss from diabetic retinopathy by attending screening, which enables early detection and timely treatment. The aim of this pilot trial was to assess the feasibility of a full-scale cluster randomized controlled trial of an intervention to increase uptake of retinal examination in this population, as delivered within existing community-based diabetes support groups (DSGs). Methods All 16 DSGs in Kirinyaga county were invited to participate in the study. The first two groups recruited took part in the pilot trial. DSG members who met the eligibility criteria were recruited before the groups that were randomized to the two arms. In the intervention group, two peer educators were trained to deliver monthly DSG-based eye health education and individual telephone reminders to attend screening. The control group continued with usual DSG practice which is monthly meetings without eye health education. The recruitment team and outcome assessors were masked to the allocation. We documented the study processes to ascertain the feasibility, acceptability, and potential effectiveness of the intervention. Feasibility was assessed in terms of clarity of study procedures, recruitment and retention rates, level of acceptability, and rates of uptake of eye examination. We set the target feasibility criteria for continuation to the main study to be recruitment of 50 participants in the trial, 80% monthly follow-up rates for individuals, and no attrition of clusters. Results Of the 122 DSG members who were assessed for eligibility, 104 were recruited and followed up: 51 (intervention) and 53 (control) arm. The study procedures were well understood and easy to apply. We learnt the DSG meeting days were the best opportunities for recruitment. The study had a high acceptance rate (100% for clusters, 95% for participants) and high follow-up and retention rate (100% of those recruited). All clusters and participants were analysed. We observed that the rate of incidence of eye exam was about 6 times higher in the intervention arm as compared to the control arm. No adverse unexpected events were reported in either arm. Conclusions The study is feasible and acceptable in the study population. The results support the development of a full-scale cluster RCT, as the success criteria for the pilot were met. Trial registration Pan African Clinical Trials Registry PACTR201707002430195 Registered on 25 July 2017.
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Affiliation(s)
- Nyawira Mwangi
- Kenya Medical Training College, Nairobi, Kenya.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Min Kim
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Esbon Gakuo
- Kerugoya County Referral Hospital, Kerugoya, Kenya
| | | | - Allen Foster
- London School of Hygiene and Tropical Medicine, London, UK
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Degaga TS, Weston S, Tego TT, Abate DT, Aseffa A, Wayessa A, Price RN, Hailu A, Thriemer K. Disseminating clinical study results to trial participants in Ethiopia: insights and lessons learned. Malar J 2020; 19:205. [PMID: 32513176 PMCID: PMC7282093 DOI: 10.1186/s12936-020-03279-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/29/2020] [Indexed: 01/13/2023] Open
Abstract
International regulatory authorities and funders require that research be disseminated promptly and appropriately to all involved stakeholders. However, following completion of clinical trials participants often either do not receive any feedback or materials provided are not appropriate for the context. The investigators of a multicentre anti-malarial clinical trial (the IMPROV study) conducted a dissemination meeting at one of the study sites in Ethiopia; trial participants and medical staff were provided feedback on the study results. This report summarizes the dissemination strategies adopted by the investigators, including a plain language visual aid and simple communication techniques. Lessons learned are reported with a discussion on the operational challenges to dissemination of clinical trials in resource limited settings.
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Affiliation(s)
- Tamiru S Degaga
- College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sophie Weston
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Tedla T Tego
- Arba Minch General Hospital, Arba Minch, Ethiopia
| | - Dagimawie T Abate
- College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Adugna Wayessa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Asrat Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
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Ward CL, Shaw D, Anane-Sarpong E, Sankoh O, Tanner M, Elger B. The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania. J Empir Res Hum Res Ethics 2017; 13:26-41. [PMID: 29179625 DOI: 10.1177/1556264617742236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk-benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.
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