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Dixit A, Johns NE, Ghule M, Battala M, Begum S, Saggurti N, Silverman J, Reed E, Kiene SM, Benmarhnia T, Averbach S, Raj A. Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India. CULTURE, HEALTH & SEXUALITY 2023; 25:521-536. [PMID: 35465833 PMCID: PMC9588848 DOI: 10.1080/13691058.2022.2062052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry and purdah, compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours, including women's control over contraceptive decision-making, couples' communication about contraception, and ever use of contraceptives, among married women aged 18-29 years (N = 1,200) and their husbands in rural Maharashtra, India. Multivariable logistic regression was used to examine the association between these marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (AOR 1.76, 95% CI 1.16-2.68), and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, CA, USA
| | - Nicole E. Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Division of Health Promotion and Behavior, San Diego State University, San Diego, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
- Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA. USA
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Gondwe MJ, Toto NM, Gunda C, Gmeiner M, MacCormick IJC, Lalloo D, Parker M, Desmond N. Guardians and research staff experiences and views about the consent process in hospital-based paediatric research studies in urban Malawi: A qualitative study. BMC Med Ethics 2022; 23:125. [PMID: 36471294 PMCID: PMC9720930 DOI: 10.1186/s12910-022-00865-x] [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] [Received: 10/19/2020] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obtaining consent has become a standard way of respecting the patient's rights and autonomy in clinical research. Ethical guidelines recommend that the child's parent/s or authorised legal guardian provides informed consent for their child's participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child's illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will assist in developing appropriate consent guidelines. METHODS We conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants' views about informed consent processes. Data analysis was facilitated by NVIVO 11 software. RESULTS All participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting. CONCLUSION The health care context, culture and research process influenced participants' understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent. Trial registration Not applicable.
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Affiliation(s)
- Mtisunge Joshua Gondwe
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neema Mtunthama Toto
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Charity Gunda
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Markus Gmeiner
- grid.10417.330000 0004 0444 9382Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ian J. C. MacCormick
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David Lalloo
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Parker
- grid.4991.50000 0004 1936 8948The Ethox Centre, University of Oxford, Oxford, UK
| | - Nicola Desmond
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
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Hoverd EJ, Hawker-Bond G, Staniszewska S, Dale J. Factors influencing decisions about whether to participate in health research by people of diverse ethnic and cultural backgrounds: a realist review. BMJ Open 2022; 12:e058380. [PMID: 35589353 PMCID: PMC9121482 DOI: 10.1136/bmjopen-2021-058380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To develop and refine a programme theory that explains factors that influence decisions to take part in health research by people of diverse ethnic and cultural backgrounds. DESIGN Realist review following a sequence of five steps: (a) scoping search and identification of programme theory; (b) evidence searching; (c) critical appraisal and data extraction; (d) organisation of evidence and (e) refinement of programme theory. ELIGIBILITY CRITERIA Documents (including peer-reviewed articles, grey literature, websites, reports and conference papers) either full text, or a section of relevance to the overarching research question were included. DATA SOURCES EMBASE, Medline, Web of Science, Psych Info, Google and Google Scholar were searched iteratively between May and August 2020. Search strategy was refined for each database providing a broad enough review for building of programme theory. ANALYSIS Data from eligible documents was extracted to build understanding of the factors that influence decision-making. Data were mapped to create a data matrix according to context (C), mechanism (M), outcome (O), configurations (C) (CMOCs) for the process of informed consent, to aid interpretation and produce final programme theory. RESULTS 566 documents were screened and 71 included. Final programme theory was underpinned by CMOCs on processes influencing decisions to take part in research. Key findings indicate the type of infrastructure required, for example, resources, services and policies, to support inclusion in health research, with a greater need to increase the social presence of researchers within communities, improve cultural competency of individuals and organisations, reduce the complexity of participant information, and provide additional resources to support adaptive processes and shared decision making. CONCLUSION The review indicates the need for a more inclusive research infrastructure that facilitates diverse participation in health research through incorporating adaptive processes that support shared decision making within the informed consent process and in the conduct of research projects.
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Affiliation(s)
| | - George Hawker-Bond
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | | | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Amayoa FA, Nakwagala FN, Barugahare J, Munabi IG, Mwaka ES. Understanding of Critical Elements of Informed Consent in Genomic Research: A Case of a Paediatric HIV-TB Research Project in Uganda. J Empir Res Hum Res Ethics 2022; 17:483-493. [PMID: 35548950 DOI: 10.1177/15562646221100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several studies have reported inadequate comprehension of informed consent for genomic research. This study aimed to assess research participants' understanding of critical elements of informed consent for genomic research. A cross-sectional survey involving 123 parents/caregivers of children participating in a paediatric genomic TB/HIV study was conducted. Only 47.2% of the participants had adequate understanding of consent information. The mean objective (actual) and subjective (perceived) understanding scores were 78.7% and 91.7% respectively. Participants adequately understood most elements of consent however, some elements were poorly understood including foreseeable risks, protection of confidentiality and compensation for research related injury. Overall there was inadequate comprehension of critical elements of informed consent and there was dissonance between actual and perceived comprehension of informed consent.
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Affiliation(s)
| | | | - John Barugahare
- College of Humanities and Social Sciences, Makerere University, Uganda
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Mitra K, Mondal S, Bhattacharya S, Jana P. A comparative study on comprehension of informed consent before emergency and elective surgical operative procedures. ACTA MEDICA INTERNATIONAL 2022. [DOI: 10.4103/amit.amit_90_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Rojo P, Carpenter D, Venter F, Turkova A, Penazzato M. The HIV drug optimization agenda: promoting standards for earlier investigation and approvals of antiretroviral drugs for use in adolescents living with HIV. J Int AIDS Soc 2020; 23 Suppl 5:e25576. [PMID: 32869500 PMCID: PMC7459170 DOI: 10.1002/jia2.25576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Most clinical trials for new antiretroviral (ARV) agents are conducted among narrowly defined adult populations. Only after safety and efficacy have been clearly demonstrated among adults living with HIV are trials including adolescents, children and infants conducted. This approach contributes to significant delays in the availability of optimal new ARV regimens for infants, children and adolescents. This commentary discusses issues related to the inclusion of adolescents aged 12 to 18 years in initial HIV clinical phase 3 trials of novel antiretrovirals (ARVs) or conducting parallel phase 3 clinical trials among adolescents. DISCUSSION The absorption, metabolic and excretion or elimination pathways for drugs do not significantly differ between adolescents and adults. In fact, dosing recommendations for ARVs are the same for adults and adolescents who meet the age and weight criteria. Although conducting clinical trials among adolescents present special challenges (e.g. consenting minors and concerns about trial completion and contraception), these challenges can be addressed to obtain high-quality trial results. Importantly, new agents and optimized combinations have more favourable dosing schedules and side-effect profiles and are more effective ARV agents with higher HIV drug resistance thresholds, which would be extremely beneficial to improve outcomes among HIV-positive adolescents. CONCLUSIONS Adolescents may not present with significantly different pharmacokinetic characteristics from those in adults. Including HIV-positive adolescents in phase 3 ARV clinical trials, either with adults or in specific adolescent studies conducted in parallel, would allow adolescents to access promising, more effective treatment for HIV years earlier than with the current stepwise approach.
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Affiliation(s)
- Pablo Rojo
- Pediatric Infectious Diseases UnitDepartment of PediatricsHospital 12 de OctubreUniversidad ComplutenseMadridSpain
| | - Deborah Carpenter
- Maternal and Child Health BranchDivision of Global HIV and TuberculosisCenter for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - François Venter
- Wits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Anna Turkova
- MRC Clinical Trials Unit at UCLInstitute of Clinical Trials & MethodologyLondonUnited Kingdom
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De Pretto-Lazarova A, Brancati-Badarau DO, Burri C. Informed consent approaches for clinical trial participation of infants with minor parents in sub-Saharan Africa: A systematic review. PLoS One 2020; 15:e0237088. [PMID: 32750084 PMCID: PMC7402474 DOI: 10.1371/journal.pone.0237088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regulations are vague regarding the appropriate decision-maker and authority to consent for children of minor parents participating in clinical trials. In countries with high rates of underage mothers, such as in sub-Saharan Africa, this lack of guidance may affect the rights of potential paediatric participants already bearing increased vulnerability. It can also influence the recruitment and generalizability of the research. We provide evidence and discuss informed consent management in such cases to inform best practice. MATERIALS AND METHODS We searched PubMed/MEDLINE, Embase, CINAHL, and Google Scholar for articles published up to March 2019. In total, 4382 articles were screened, of which 16 met our inclusion criteria. Studies addressing informed consent in clinical trials involving children with minor parents in sub-Saharan Africa were included. We performed descriptive and qualitative framework analyses. The review was registered in PROSPERO: CRD42018074220. RESULTS Various informed consent approaches were reported. Articles supporting individual consent by minor parents based on emancipation or "mature minor" status lacked evidence in the context of research. National laws on medical care guided consent instead. When no laws or guidance existed an interpretation of the local decision-making culture, including community engagement and collaboration with local ethics committees, defined the informed consent approach. CONCLUSIONS The review emphasises that the implementation of informed consent for children with minor parents may be variable and hampered by absent or ambiguous clinical trial regulations, as well as divergent local realities. It may further be influenced by the research area and study-specific risks. Clear guidance is required to help address these challenges proactively in clinical trial planning. We provided a set of questions to be considered in the development of an ethically acceptable informed consent approach and proposed information that should be integrated into international clinical trial guidelines.
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Affiliation(s)
- Angela De Pretto-Lazarova
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Domnita Oana Brancati-Badarau
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Life and Health Sciences and Aston Brain Centre, Aston University, Birmingham, United Kingdom
| | - Christian Burri
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Barugahare J. Bioethical reflexivity and requirements of valid consent: conceptual tools. BMC Med Ethics 2019; 20:44. [PMID: 31272449 PMCID: PMC6610898 DOI: 10.1186/s12910-019-0385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Despite existing international, regional and national guidance on how to obtain valid consent to health-related research, valid consent remains both a practical and normative challenge. This challenge persists despite additional evidence-based guidance obtained through conceptual and empirical research in specific localities on the same subject. The purpose of this paper is to provide an account for why, despite this guidance, this challenge still persist and suggest conceptual resources that can help make sense of this problem and eventually mitigate it’. Main body This paper argues that despite the existence of detailed official guidance and prior conceptual and empirical research on how to obtain valid consent, the question of ‘how to obtain and ascertain valid consent to participation in health-related research’ cannot always be fully answered by exclusive reference to pre-determined criteria/guidance provided by the guidelines and prior research’. To make intelligible why this is so and how this challenge could be allayed, the paper proposes six concepts. The first five of these are intended to account for the persistent seeming inadequacies of existing guidelines. These are fact-skepticism; guideline insufficiency; generality; context-neutrality and presumptiveness. As an outcome of these five, the paper analyzes and recommends a sixth, called bioethical reflexivity. Bioethical reflexivity is reckoned as a handy tool, skill, and attitude by which, in addition to guidance from context-specific research, the persisting challenges can be further eased. Conclusions Existing ethical guidelines on how to obtain valid consent to health-related research are what they ought to be – general, presumptive and context-neutral. This explains their seeming inadequacies whenever they are being applied in concrete situations. Hence, the challenges being encountered while obtaining valid consent can be significantly eased if we appreciate the guidelines’ nature and what this means for their implementation. There is also a need to cultivate reflexive mindsets plus the relevant skills needed to judiciously close the unavoidable gaps between guidelines and their application in concrete cases. This equally applies to the gaps which cannot be filled by reference to additional guidance from prior conceptual and empirical research in specific contexts.
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Affiliation(s)
- John Barugahare
- Department of Philosophy, Makerere University, P. O. Box 7062, Kampala, Uganda.
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Kostovski E, Miloshevska Jakimovska V, Lidal IB, Biering-Sørensen F. Cross-sectional and prospective data-collection in North Macedonia-methodological considerations. Spinal Cord Ser Cases 2019; 5:58. [PMID: 31632716 PMCID: PMC6786405 DOI: 10.1038/s41394-019-0204-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/01/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Cross-sectional and prospective cohort-study. Objectives To describe methodological issues, experienced challenges related to data collection in North Macedonia and to discuss possible improvements of epidemiological data collection in future studies. Setting Clinic for Traumatology, Orthopedics, Anesthesia, Reanimation, Intensive Care Unit and Emergency Center, Mother Teresa Skopje University Hospital, Skopje and community settings, North Macedonia. Method A description of methodological challenges experienced in collecting data from 78 persons with acute and chronic traumatic spinal cord injury (SCI) examined and interviewed in 2015-2017 using a semiquantitative questionnaire and standard assessments tools. Results This study identified three major challenges with data collection in this setting: (1) research logistics and procedures, such as recruitment, infrastructure, and compensation, (2) ethical issues and the initial lack of mutual trust and understanding between researchers and participants, and (3) scientific quality and interpretation, including representativeness. Conclusions Methodological issues influenced by settings, are important to consider when interpreting study results. Healthcare systems vary between (and sometimes in) countries, language and culture may introduce barriers to understanding, and epidemiological research also rely on infrastructure and surroundings. For this study, making time for and listening to the participants without being intruding was of special importance in building trust and a good relationship with the participants during recruiting participants and collecting data. We here provide suggestions regarding how to facilitate future epidemiological data collections in North Macedonia.
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Affiliation(s)
| | | | | | - Fin Biering-Sørensen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zeeshan MF, Yousufi Z, Khan D, Malik FR, Ashfaq F, Batool F, Atta L, Tariq H, Huma Z, Ghafoor R, Jamil A, Qazi U. Informed consent practice for obstetric and gynaecologic procedures: A patients' perspective from a developing country. J Eval Clin Pract 2019; 25:491-497. [PMID: 30815974 DOI: 10.1111/jep.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan. METHODS Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients. RESULTS About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P < 0.001). Patients had increased odds to recall consent if they felt empowered, odds ratio (OR) = 4.5; had an opportunity to ask questions, OR = 7.2; wanted more explanation, OR = 2.8; and had consent administered in their mother tongue, OR = 6.9. DISCUSSION Patients' recall of key elements of consent was low. The time spent with the patient for consenting was much shorter than recommended. The printed consent forms were mostly not available in patients' mother tongue. CONCLUSIONS Consent practice for OB-GYN procedures was suboptimal in studied hospitals. Patients' attitude toward informed consent practices largely reflected providers' focus on obtaining a legally valid signed consent as opposed to administering a consent that empowers patients to make an informed decision in the absence of any external pressure.
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Affiliation(s)
- Muhammad F Zeeshan
- Prime Institute of Public Health, Riphah International University, Islamabad, Pakistan.,Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Zainab Yousufi
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Durdana Khan
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Farhat R Malik
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Fizza Ashfaq
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Fatima Batool
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Lyaba Atta
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Hira Tariq
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Zille Huma
- Department of Health, Khyber Pakhtunkhwa, Pakistan
| | - Rahat Ghafoor
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayisha Jamil
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Umair Qazi
- Prime Institute of Public Health, Riphah International University, Islamabad, Pakistan
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Sullivan KA, Little MO, Rosenberg NE, Zimba C, Jaffe E, Gilbert S, Coleman JS, Hoffman I, Mtande T, Anderson J, Gross MS, Rahangdale L, Faden R, Lyerly AD. Women's views about contraception requirements for biomedical research participation. PLoS One 2019; 14:e0216332. [PMID: 31067273 PMCID: PMC6505940 DOI: 10.1371/journal.pone.0216332] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/18/2019] [Indexed: 11/18/2022] Open
Abstract
The scientific and ethical importance of including women of reproductive age in biomedical research is widely acknowledged. Concerns about preventing fetal exposure to research interventions have motivated requirements for contraception among reproductive aged women in biomedical studies-often irrespective of risks and benefits or a woman's actual potential for pregnancy, raising important questions about when such requirements are appropriate. The perspectives of women themselves on these issues are largely unexplored. We conducted 140 interviews, 70 in the U.S. and 70 in Malawi, with women either living with or at-risk for HIV, exploring their views about the practice of requiring contraception in clinical trials. A majority of women interviewed from both countries indicated overall support for the practice, with seven themes characterizing advantages and disadvantages raised: reproductive control, health effects, prevention of fetal harm, burden on women, deferral to authority, autonomy regarding enrollment and birth control method, and relationship concerns. While women in the US frequently raised prevention of fetal harm as a key advantage, many other positives noted by women in both countries were related to contraception use in general, not specific to a trial context. With regard to disadvantages, U.S. women tended to focus on biomedical risks such as side effects and impact on fertility, whereas Malawian women focused on the social risks of contraception requirements, including violations of trust in marital relations and suspicions of potential infidelity. Given the potential benefits and burdens highlighted, contraception in research should be sensitive to actual fetal risk assessments; directed where justified at optimizing effective pregnancy prevention; responsive to women's reproductive preferences; and made available as an ancillary benefit even where risk thresholds do not justify requirement-in order to facilitate trials that are both ethical and robustly oriented around the interests and lives of women who will participate in them.
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Affiliation(s)
- Kristen A. Sullivan
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Margaret Olivia Little
- Kennedy Institute for Ethics, Georgetown University, Washington, D.C., United States of America
| | - Nora E. Rosenberg
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Elana Jaffe
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sappho Gilbert
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jenell S. Coleman
- Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Jean Anderson
- Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Marielle S. Gross
- Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ruth Faden
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Anne Drapkin Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Al-Sheyab NA, Alomari MA, Khabour OF, Shattnawi KK, Alzoubi KH. Assent and consent in pediatric and adolescent research: school children's perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2019; 10:7-14. [PMID: 30804694 PMCID: PMC6375532 DOI: 10.2147/ahmt.s185553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background School students’ views and perceptions of informed parental consent and child assent about child participation in research in the Middle East are not known. Methods Focus group interviews were conducted to understand high school students’ perspectives toward child and adolescent assents and consents in research including the importance of, and depth of information needed in consent and assent, and perception toward written vs verbal consent and assent. Results The majority of students agreed that it is necessary to take parental approval and that they would not participate in research if their parents refused. Furthermore, the majority of male students agreed that if the research requires only questionnaires to be completed, then child’s approval is sufficient whereas measures, such as blood sugar screening required approval from both the parent and child. Females believed it is enough to provide parental consent to participate in research unless information provided is adequate, then child approval is enough. All students stressed the importance of including detailed information; however, parental consent needs to have more detailed information than child assent. Conclusion Parts of the students’ perceptions were congruent, whereas other views were not congruent with proper conduct of pediatric research. Such a situation warrants further research and actions.
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Affiliation(s)
- Nihaya A Al-Sheyab
- Faculty of Nursing, Maternal and Child Health Department, Jordan University of Science and Technology, Irbid, 22110, Jordan,
| | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan.,Department of Physical Education, Qatar University, Doha 2713, Qatar
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khulood K Shattnawi
- Faculty of Nursing, Maternal and Child Health Department, Jordan University of Science and Technology, Irbid, 22110, Jordan,
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology. Irbid, 22110, Jordan
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Colom M, Rohloff P. Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review. BMJ Paediatr Open 2018; 2:e000298. [PMID: 30613801 PMCID: PMC6307601 DOI: 10.1136/bmjpo-2018-000298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Conducting research with children in low/middle-income countries (LMIC) requires consideration of socioeconomic inequalities and cultural and linguistic differences. Our objective was to survey the literature on informed consent in paediatric LMIC research, assessing for practical guidance for culturally and linguistically appropriate procedures. METHODS We conducted a scoping review on informed consent in paediatric LMIC research searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were published in English, from any date range, of any study design or format. RESULTS The search identified 2027 references, of which 50 were included in the analysis following full-text review. Reviewed guidelines emphasised individual, informed and voluntary consent from parents and caregivers. Reviewed articles provided detailed practical guidance on adapting these guiding principles to LMIC settings, including considerations for community engagement, verbal or other alternative consent procedures for low-literacy settings or less commonly spoken languages and guarding against therapeutic misconception by caregivers. There was uncertainty, however, on how to best protect individual autonomy, especially when influenced by gender dynamics, leadership hierarchies or the social status of researchers themselves. There was, furthermore, limited research discussing the special case of research involving adolescents or of procedures for documenting assent by participating children. CONCLUSIONS A scoping review of paediatric research in LMICs revealed substantial guidance on several features of culturally appropriate informed consent. However, additional research and guidance is needed, especially in the areas of gender imbalances, research with adolescents and children's own assent to participate in research.
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Affiliation(s)
- Marcela Colom
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Amorim KPC, Garrafa V, Melo ADD, Costa AVB, Oliveira GCL, Lopes HG, Pereira EJDS, Fernandes Júnior FA. PARTICIPANTES DE ENSAIOS CLÍNICOS EM ONCOLOGIA: PERFIL E ASPECTOS ENVOLVIDOS NAS SUAS DECISÕES. TRABALHO, EDUCAÇÃO E SAÚDE 2018. [DOI: 10.1590/1981-7746-sol00139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Estudo sobre os participantes de ensaios clínicos na área de oncologia, discutindo o paradoxo entre progresso científico e iniquidade social. Buscou-se conhecer quem são essas pessoas e analisar aspectos envolvidos nas suas decisões, com base em entrevistas e documentos. Houve maior participação feminina. Os participantes tendem a ter poucos anos de estudo formal e baixa renda. A maioria é aposentada e do lar e não tem assistência à saúde privada. Suas decisões giraram em torno da busca pela cura ou melhora, e pela garantia de acesso regular a cuidados integrais de saúde e medicamentos. A assinatura do termo de consentimento livre e esclarecido não garantiu a expressão da autonomia, pois informações essenciais como os objetivos, riscos e cuidados pós-estudo são praticamente desconhecidas. Os participantes da pesquisa tendem a não compreender os objetivos da investigação, ou superestimam os benefícios médicos diretos de sua participação, sem consciência dos riscos envolvidos e do que significa uma pesquisa. Os resultados deveriam incitar ao exercício e ao diálogo mais críticos entre os diferentes atores e instituições envolvidos na área da pesquisa com seres humanos, objetivando promover uma ciência consciente e responsável, que impeça que pessoas sejam colocadas em situação de desigualdade, vulnerabilidade e sofrimento moral.
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15
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Mutenherwa F, Wassenaar DR, de Oliveira T. Experts' Perspectives on Key Ethical Issues Associated With HIV Phylogenetics as Applied in HIV Transmission Dynamics Research. J Empir Res Hum Res Ethics 2018; 14:61-77. [PMID: 30486713 DOI: 10.1177/1556264618809608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of phylogenetics in HIV molecular epidemiology has considerably increased our ability to understand the origin, spread, and characteristics of HIV epidemics. Despite its potential to advance knowledge on HIV transmission dynamics, the ethical issues associated with HIV molecular epidemiology have received minimal attention. In-depth interviews were conducted with scientists from diverse backgrounds to explore their perspectives on ethical issues associated with phylogenetic analysis of HIV genetic data as applied to HIV transmission dynamics studies. The Emanuel framework was used as the analytical framework. Favorable risk-benefit ratio and informed consent were the most invoked ethical principles and fair participant selection the least. Fear of loss of privacy and disclosure of HIV transmission were invariably cited as key ethical concerns. As HIV sequence data become increasingly available, comprehensive guidelines should be developed to guide its access, sharing and use, cognizant of the potential harms that may result.
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Affiliation(s)
- Farirai Mutenherwa
- 1 University of KwaZulu-Natal, South Africa.,2 KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tulio de Oliveira
- 1 University of KwaZulu-Natal, South Africa.,2 KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,3 Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
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16
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Harapan H, Mudatsir M, Yufika A, Nawawi Y, Wahyuniati N, Anwar S, Yusri F, Haryanti N, Wijayanti NP, Rizal R, Fitriani D, Maulida NF, Syahriza M, Ikram I, Fandoko TP, Syahadah M, Asrizal FW, Jamil KF, Rajamoorthy Y, Wagner AL, Groneberg DA, Kuch U, Müller R, Sasmono RT, Imrie A. Willingness to Participate and Associated Factors in a Zika Vaccine Trial in Indonesia: A Cross-Sectional Study. Viruses 2018; 10:E648. [PMID: 30453663 PMCID: PMC6266114 DOI: 10.3390/v10110648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
One of the crucial steps during trials for Zika and other vaccines is to recruit participants and to understand how participants' attitudes and sociodemographic characteristics affect willingness to participate (WTP). This study was conducted to assess WTP, its explanatory variables, and the impact of financial compensation on WTP in Indonesia. A health facility-based cross-sectional study was conducted in eleven regencies in the Aceh and West Sumatra provinces of Indonesia. Participants were recruited via a convenience sampling method and were interviewed. The associations between explanatory variables and WTP were assessed using a two-step logistic regression analysis. A total of 1,102 parents were approached, and of these 956 (86.8%) completed the interview and were included in analysis. Of those, 144 (15.1%) were willing to participate in a Zika vaccine trial without a financial compensation. In the multivariate analysis, WTP was tied to an age of more than 50 years old, compared to 20⁻29 years (odds ratio (OR): 5.0; 95% confidence interval (CI): 2.37⁻10.53), to being female (OR: 2.20; 95% CI: 1.11⁻4.37), and to having heard about Zika (OR: 2.41; 95% CI: 1.59⁻3.65). Participants' WTP increased gradually with higher financial compensation. The rate of WTP increased to 62.3% at the highest offer (US$ 350.4), and those who were still unwilling to participate (37.7%) had a poorer attitude towards childhood vaccination. This study highlights that pre-existing knowledge about Zika and attitudes towards childhood vaccination are important in determining community members being willing to participate in a vaccine trial. Financial incentives are still an important factor to enhance participant recruitment during a vaccine trial.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia.
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Yusuf Nawawi
- Department of Family Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Nur Wahyuniati
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Fitria Yusri
- School of Medicine, Malikussaleh University, Lhokseumawe, Aceh 24352, Indonesia.
| | - Novi Haryanti
- Community Health Centre of Meurah Mulia, North Aceh, Aceh 24372, Indonesia.
| | | | - Rizal Rizal
- Bunda Hospital, Lhokseumawe, Aceh 24351, Indonesia.
| | - Devi Fitriani
- Community Health Centre of Teunom, Aceh Jaya, Aceh 23653, Indonesia.
| | | | - Muhammad Syahriza
- Department of Public Health and Community Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Ikram Ikram
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Try Purwo Fandoko
- Community Health Centre of Gunung, Padang Panjang, West Sumatera 27122, Indonesia.
| | - Muniati Syahadah
- Community Health Centre of Lima Kaum, Tanah Datar, West Sumatera 27211, Indonesia.
| | | | - Kurnia F Jamil
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Internal Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor 43000, Malaysia.
| | - Abram Luther Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
- Unit of Medical Entomology, Institute of Tropical Medicine, Antwerp 2000, Belgium.
| | - R Tedjo Sasmono
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia.
| | - Allison Imrie
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia.
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Sullivan KA, Little M, Rosenberg NE, Mtande T, Zimba C, Jaffe E, Anderson J, Coleman JS, Gilbert S, Gross Wolf MS, Hoffman I, Rahangdale L, Faden R, Lyerly AD. Women's Views About a Paternal Consent Requirement for Biomedical Research in Pregnancy. J Empir Res Hum Res Ethics 2018; 13:349-362. [PMID: 29998787 PMCID: PMC6360530 DOI: 10.1177/1556264618783834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical research to inform the evidence base to guide nonobstetrical care during pregnancy is critically important for the well-being of women and their future offspring. Conversations about regulations for such research, including whether paternal consent should ever be required, should be informed by the perspectives of those most affected, namely, pregnant women. We conducted in-depth interviews with 140 pregnant women living with or at risk of HIV-70 in Malawi, 70 in the United States-exploring their views on requiring paternal consent for pregnant women's participation in trials offering the prospect of direct benefit solely to the fetus. The majority of women supported such a requirement; others raised concerns. A trio of themes-the father's or pregnant woman's rights, fetal protection, and gender/relationship dynamics-characterized views both supporting and against a paternal consent requirement, expanding the range of considerations that should inform approaches to paternal involvement in research with pregnant women.
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Affiliation(s)
- Kristen A. Sullivan
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine
| | | | - Nora E. Rosenberg
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health
| | | | | | - Elana Jaffe
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine
| | - Jean Anderson
- Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
| | - Jenell S. Coleman
- Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
| | | | | | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine
| | - Ruth Faden
- Berman Institute of Bioethics, Johns Hopkins University
| | - Anne Drapkin Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina School of Medicine
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18
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Afolabi MO, Rennie S, Hallfors DD, Kline T, Zeitz S, Odongo FS, Amek NO, Luseno WK. An adapted instrument to assess informed consent comprehension among youth and parents in rural western Kenya: a validation study. BMJ Open 2018; 8:e021613. [PMID: 30002013 PMCID: PMC6082480 DOI: 10.1136/bmjopen-2018-021613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To adapt and validate a questionnaire originally developed in a research setting for assessment of comprehension of consent information in a different cultural and linguistic research setting. DESIGN The adaptation process involved development and customisation of a questionnaire for each of the three study groups, modelled closely on the previously validated questionnaire. The three adapted draft questionnaires were further reviewed by two bioethicists and the developer of the original questionnaire for face and content validity. The revised questionnaire was subsequently programmed into an audio computerised format, with translations and back translations in three widely spoken languages by the study participants: Luo, Swahili and English. SETTING The questionnaire was validated among adolescents, their parents and young adults living in Siaya County, a rural region of western Kenya. PARTICIPANTS Twenty-five-item adapted questionnaires consisting of close-ended, multiple-choice and open-ended questions were administered to 235 participants consisting of 107 adolescents, 92 parents and 36 young adults. Test-retest was conducted 2-4 weeks after first questionnaire administration among 74 adolescents, young adults and parents. OUTCOME MEASURE Primary outcome measures included ceiling/floor analysis to identify questions with extremes in responses and item-level correlation to determine the test-retest relationships. Given the data format, tetrachoric correlations were conducted for dichotomous items and polychoric correlations for ordinal items. The qualitative validation assessment included face and content validity evaluation of the adapted instrument by technical experts. RESULTS Ceiling/floor analysis showed eight question items for which >80% of one or more groups responded correctly, while for nine questions, including all seven open-ended questions,<20% responded correctly. Majority of the question items had moderate to strong test-retest correlation estimates indicating temporal stability. CONCLUSIONS Our study demonstrates that cross-cultural adaptation and validation of an informed consent comprehension questionnaire is feasible. However, further research is needed to develop a tool which can estimate a quantifiable threshold of comprehension thereby serving as an objective indicator of the need for interventions to improve comprehension.
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Affiliation(s)
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Center for Bioethics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Denise Dion Hallfors
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina, USA
| | - Tracy Kline
- Department of Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA
| | - Susannah Zeitz
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Frederick S Odongo
- Department of HIV Implementation Science and Services, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nyaguara O Amek
- Department of HIV Implementation Science and Services, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Winnie K Luseno
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina, USA
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Ossemane EB, Moon TD, Sacarlal J, Sevene E, Kenga D, Gong W, Heitman E. Assessment of Parents'/Guardians' Initial Comprehension and 1-Day Recall of Elements of Informed Consent Within a Mozambican Study of Pediatric Bacteremia. J Empir Res Hum Res Ethics 2018; 13:247-257. [PMID: 29667543 PMCID: PMC5993589 DOI: 10.1177/1556264618767780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Participants' understanding of key elements of a research protocol is essential to their ethical enrollment in the study. Ongoing participation should be based on continued comprehension and consent, which presumes a high degree of recall. Many obstacles can prevent full understanding of information about the research protocol. This study's aim was to evaluate the comprehension and 1-day recall of the elements of informed consent by the parents/guardians of children enrolled in a clinical study in Mozambique. We developed a 10-question test based on the study's informed consent document. We asked participants to answer questions shortly after being read the informed consent document and again the following day. Participants who did not demonstrate good or reasonable understanding at enrollment were provided the information again as a refresher. Overall high rates of initial comprehension demonstrate that attention to the informed consent process can result in Mozambicans' informed, voluntary participation in clinical trials.
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Affiliation(s)
- Ezequiel B. Ossemane
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Vanderbilt University Medical Center Department of Pediatrics, Division of Infectious Diseases, Nashville, Tennessee, USA
| | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Darlene Kenga
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Wu Gong
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, Tennessee, USA
| | - Elizabeth Heitman
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- University of Texas South Western, Dallas, Texas, USA
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20
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Shoemaker SJ, Brach C, Edwards A, Chitavi SO, Thomas R, Wasserman M. Opportunities to Improve Informed Consent with AHRQ Training Modules. Jt Comm J Qual Patient Saf 2018; 44:343-352. [PMID: 29793885 DOI: 10.1016/j.jcjq.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Informed consent is a process of communication between clinician and patient that results in the patient's decision about whether to undergo a specific intervention. However, patients often do not understand the risks, benefits, and alternatives, even after signing a consent form. METHODS Mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules implemented in four hospitals. Methods included staff and patient surveys, interviews, site visits, and pre- and posttests of the modules. RESULTS A low proportion of clinicians reported using teach-back (40.0%) or high-quality decision aids (55.0%). Patients reported limited use of best practices, including being asked to teach-back (58.4%), having other options described (54.9%), viewing decision aids (37.4%), and finding the form very easy to understand (66.8%). Content of the training modules aligned well with identified deficiencies. Barriers to completing the modules included staff turnover, competing demands, and lack of accountability. Facilitators included committed champions with available time, motivation, and release time for staff to take modules. Knowledge increased for leaders (p <0.05) and staff (p <0.001) who completed the training modules. Hospitals reported the effects of piloting the modules included fostering dialogue and identifying opportunities for improvements, identifying and rectifying policy ambiguity and noncompliance, reinforcing the use of interpreter services, and using modules' strategies and tools to improve informed consent. CONCLUSION Many opportunities exist for hospitals to improve their informed consent practices. AHRQ's two training modules, have face validity, addressed demonstrated deficiencies in hospitals' informed consent policies and processes, and stimulated improvement activity in motivated hospitals.
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Nagai K, Saito AM, Saito TI, Kaneko N. Reporting quality of randomized controlled trials in patients with HIV on antiretroviral therapy: a systematic review. Trials 2017; 18:625. [PMID: 29282092 PMCID: PMC5745624 DOI: 10.1186/s13063-017-2360-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To allow for correct evaluation of clinical trial results, readers require comprehensive, clear, and highly transparent information on the methodology used and the results obtained. This study aimed to evaluate the quality of reporting in articles on randomized controlled trials (RCTs) of antiretroviral therapy (ART) in the field of HIV/AIDS. METHODS We searched for original articles on RCTs of ART developed in the field of HIV/AIDS in PubMed database by 5 April 2016. Searched articles were divided into three groups based on the revision year in which the Consolidated Standards of Reporting Trials (CONSORT) guidelines were published: Period 1 (1996-2001); Period 2 (2002-2010); and Period 3 (2011-2016). We evaluated the articles using the reporting rates of the 37 items in the CONSORT 2010 checklist, five items in the protocol deviation, and the three items in the ethics. RESULTS Fifty-two articles were extracted and included in this study. Many of the reporting rates calculated using the CONSORT 2010 checklist showed a significantly increasing trend over the successive periods (65% in Period 1, 67% in Period 2, 79% in Period 3; p < 0.0001). The items with reporting rates < 50% were "the presence or absence of a protocol change and the reason for such a change," "randomization and blinding," and "where the full trial protocol can be accessed." Reporting rates of deviations were as low as < 30%, while the reporting rates for patient compliance were the highest (>80% in Period 3) among the five items. The reporting rates for obtaining informed consent and approval by the ethics committee or institutional review board were high (>88%), regardless of the time period assessed. CONCLUSION In terms of representative RCT articles in the field of HIV/AIDS, the reporting rate of the items defined by CONSORT was approximately 70%, improving over the successive CONSORT statement revision periods.
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Affiliation(s)
- Kaori Nagai
- Department of Global and Community Health, Graduate School of Nursing, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
- Department of Clinical Research Management, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001 Japan
| | - Akiko M. Saito
- Department of Clinical Research Management, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001 Japan
| | - Toshiki I. Saito
- Department of Clinical Research Management, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001 Japan
| | - Noriyo Kaneko
- Department of Global and Community Health, Graduate School of Nursing, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
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22
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Ssali A, Poland F, Seeley J. Volunteer experiences and perceptions of the informed consent process: Lessons from two HIV clinical trials in Uganda. BMC Med Ethics 2015; 16:86. [PMID: 26630924 PMCID: PMC4668674 DOI: 10.1186/s12910-015-0073-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent as stipulated in regulatory human research guidelines requires that a volunteer is well-informed about what will happen to them in a trial. However researchers are faced with a challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. We conducted a qualitative study among volunteers taking part in two HIV clinical trials in Uganda to find out how they defined informed consent and their perceptions of the trial procedures, study information and interactions with the research team. METHODS Between January and December 2012, 23 volunteers who had been in the two trials for over 6 months, consented to be interviewed about their experience in the trial three times over a period of nine months. They also took part in focus group discussions. Themes informed by study research questions and emerging findings were used for content analysis. RESULTS Volunteers defined the informed consent process in terms of their individual welfare. Only two of the volunteers reported having referred during the trial to the participant information sheets given at the start of the trial. Volunteers remembered the information they had been given at the start of the trial on procedures that involved drawing blood and urine samples but not information about study design and randomisation. Volunteers said that they had understood the purpose of the trial. They said that signing a consent form showed that they had consented to take part in the trial but they also described it as being done to protect the researcher in case a volunteer later experienced side effects. CONCLUSION Volunteers pay more attention during the consent process to procedures requiring biological tests than to study design issues. Trust built between volunteers and the research team could enhance the successful conduct of clinical trials by allowing for informal discussions to identify and review volunteers' perceptions. These results point to the need for researchers to view informed consent as a process rather than an event.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
| | | | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
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Karan A, Somasundaram P, Michael H, Shayegani A, Mayer H. The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India. Indian J Ophthalmol 2015; 62:171-5. [PMID: 24008787 PMCID: PMC4005233 DOI: 10.4103/0301-4738.116488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Context: The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. Aims: We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. Settings and Design: We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. Materials and Methods: The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item “True/False/I don’t know” quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. Statistical Analysis Used: Scores on the quiz were compared across groups and time-points using paired t-tests. Results: Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10-6) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10-16). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. Conclusion: Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.
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Affiliation(s)
- Abraar Karan
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Kengne-Ouafo JA, Millard JD, Nji TM, Tantoh WF, Nyoh DN, Tendongfor N, Enyong PA, Newport MJ, Davey G, Wanji S. Understanding of research, genetics and genetic research in a rapid ethical assessment in north west Cameroon. Int Health 2015; 8:197-203. [PMID: 25969503 PMCID: PMC4866326 DOI: 10.1093/inthealth/ihv034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 04/13/2015] [Indexed: 02/02/2023] Open
Abstract
Background There is limited assessment of whether research participants in low-income settings are afforded a full understanding of the meaning of medical research. There may also be particular issues with the understanding of genetic research. We used a rapid ethical assessment methodology to explore perceptions surrounding the meaning of research, genetics and genetic research in north west Cameroon. Methods Eleven focus group discussions (including 107 adults) and 72 in-depth interviews were conducted with various stakeholders in two health districts in north west Cameroon between February and April 2012. Results Most participants appreciated the role of research in generating knowledge and identified a difference between research and healthcare but gave varied explanations as to this difference. Most participants' understanding of genetics was limited to concepts of hereditary, with potential benefits limited to the level of the individual or family. Explanations based on supernatural beliefs were identified as a special issue but participants tended not to identify any other special risks with genetic research. Conclusion We demonstrated a variable level of understanding of research, genetics and genetic research, with implications for those carrying out genetic research in this and other low resource settings. Our study highlights the utility of rapid ethical assessment prior to complex or sensitive research.
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Affiliation(s)
- Jonas A Kengne-Ouafo
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - James D Millard
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Theobald M Nji
- Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - William F Tantoh
- Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - Doris N Nyoh
- Department of Sociology, University of Douala, Cameroon
| | - Nicholas Tendongfor
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Peter A Enyong
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
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Ruiz-Casares M. Research ethics in global mental health: advancing culturally responsive mental health research. Transcult Psychiatry 2014; 51:790-805. [PMID: 24668025 DOI: 10.1177/1363461514527491] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Global mental health research is needed to inform effective and efficient services and policy interventions within and between countries. Ethical reflection should accompany all GMHR and human resource capacity endeavors to ensure high standards of respect for participants and communities and to raise public debate leading to changes in policies and regulations. The views and circumstances of ethno-cultural and disadvantaged communities in the Majority and Minority world need to be considered to enhance scientific merit, public awareness, and social justice. The same applies to people with vulnerabilities yet who are simultaneously capable, such as children and youth. The ethical principles of respect for persons or autonomy, beneficence/non-maleficence, justice, and relationality require careful contextualization for research involving human beings. Building on the work of Fisher and colleagues (2002), this article highlights some strategies to stimulate the ethical conduct of global mental health research and to guide decision-making for culturally responsible research, such as developing culturally sensitive informed consent and disclosure policies and procedures; paying special attention to socioeconomic, cultural, and environmental risks and benefits; and ensuring meaningful community and individual participation. Research and capacity-building partnerships, political will, and access to resources are needed to stimulate global mental health research and consolidate ethical practice.
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Gazzinelli MF, Souza VDS, Campos ELW, Fernandes MM, Lobato L. Autonomous decision and behavior required in clinical trials: study with a socioeconomically vulnerable population. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014002410013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Quasi-experimental study conducted to assess the effects of an educational intervention based on the Health Action Process Approach Model, in which autonomous decision-making and behaviors required for the participation in a clinical study were favored. This is an intervention study involving participants in a clinical trial conducted in the State of Minas Gerais, Brazil. The intervention was based on the social and cognitive variables of the Health Action Process Approach model and assessed by applying questionnaires before and after intervention. The results were compared using the McNemar test. The educational intervention favored knowledge on both the expectations about the results of the clinical trial and risk of infection by intestinal helminths, development of the ability to plan the behaviors required by the clinical trial and the necessary confidence to lead, keep, and retrieve them. Analysis of the results showed that the educational intervention favored both autonomous decision-making and the behavior required by clinical trials.
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Lobato L, Bethony JM, Pereira FB, Grahek SL, Diemert D, Gazzinelli MF. Impact of gender on the decision to participate in a clinical trial: a cross-sectional study. BMC Public Health 2014; 14:1156. [PMID: 25377601 PMCID: PMC4232621 DOI: 10.1186/1471-2458-14-1156] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/28/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In order for Informed Consent to be ethical and valid each clinical trial participant must be able to make a voluntary decision to participate, free from pressure or coercion. Nonetheless, many factors may influence the decision reached, and such influences may be different for male and female volunteers. Being aware of these differences may help researches develop better processes for obtaining consent that safeguard the right of autonomy for all participants. The goal of this study was to evaluate potential gender-based differences in the factors influencing clinical trial participation. METHODS This cross-sectional study was conducted in the Northeast region of Minas Gerais, Brazil, in October 2011. A structured questionnaire was administered to 143 volunteers (48 male, 95 female) screened for participation in a clinical study of an investigational functional food with potential anthelminthic properties. Answers regarding their decision to participate in the study were compared, by gender, using chi-square and Mann Whitney tests. Odds ratios (OR) was used to measure association. RESULTS A majority of subjects (58% of males, 59% of females) listed the desire to collaborate with the development of a product against parasitic worms as their main reason for participation. Females were significantly more likely to report a decision influenced by friends, family, or researchers (OR 3.14, 3.45, and 3.46 respectively, p < 0.005). Females were also significantly more likely to report a decision influenced by general altruistic considerations (OR 8.45, p < 0.005). There was no difference, by gender, in the report of decisions influenced by informational meetings, understanding of the disease, or the availability of medical treatments or exams. There was also no difference in knowledge of the rights of research participants. CONCLUSION Study results indicate that there is a strong difference between male and female participants regarding social influences on the decision to participate in clinical research. Further research into the impact this may have on autonomy is warranted.
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Affiliation(s)
- Lucas Lobato
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
| | - Jeffrey Michael Bethony
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - Fernanda Bicalho Pereira
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
| | - Shannon Lee Grahek
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - David Diemert
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - Maria Flávia Gazzinelli
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
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Mbuagbaw L, Slogrove A, Sas J, Kunda J, Morfaw F, Mukonzo J, Thabane L. CIHR canadian HIV trials network HIV workshop: ethical research through community participation and strengthening scientific validity. Pan Afr Med J 2014; 19:44. [PMID: 25667706 PMCID: PMC4315477 DOI: 10.11604/pamj.2014.19.44.4766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/11/2014] [Indexed: 12/04/2022] Open
Abstract
The CIHR canadian HIV trials network mandate includes strengthening capacity to conduct and apply clinical research through training and mentoring initiatives of HIV researchers by building strong networks and partnerships on the African continent. At the17th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), the CTN facilitated a two-day workshop to address ethical issues in the conduct of HIV research, and career enhancing strategies for young African HIV researchers. Conference attendees were allowed to attend whichever session was of interest to them. We report on the topics covered, readings shared and participants’ evaluation of the workshop. The scientific aspects of ethical research in HIV and career enhancement strategies are relevant issues to conference attendees.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, ON, Canada ; Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Amy Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa ; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jacqueline Sas
- CIHR Canadian HIV Trials Network, University of British Columbia, Canada
| | - John Kunda
- Community Information and Epidemiological Technologies, Lusaka, Zambia
| | - Frederick Morfaw
- Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jackson Mukonzo
- School of Biomedical Sciences, College of Health Sciences, University of Makerere, Kampala, Uganda
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, ON, Canada ; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, ON, Canada ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
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MacQueen KM, Chen M, Ramirez C, Nnko SEA, Earp KM. Comparison of closed-ended, open-ended, and perceived informed consent comprehension measures for a mock HIV prevention trial among women in Tanzania. PLoS One 2014; 9:e105720. [PMID: 25157899 PMCID: PMC4144899 DOI: 10.1371/journal.pone.0105720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
Verifying participant comprehension continues to be a difficult ethical and regulatory challenge for clinical research. An increasing number of articles assessing methods to improve comprehension have been published, but they use a wide range of outcome measures including open-ended, closed-ended, and self-perceived measures of comprehension. Systematic comparisons of different measures have rarely been reported. This study evaluated the likely direction of bias observed when using open-ended, closed-ended, and perceived ease of comprehension measures among women administered a mock informed consent process in Mwanza, Tanzania. Participants were randomized to either a closed-ended or an open-ended assessment of comprehension, administered the consent process for a hypothetical HIV prevention trial in Kiswahili, and then administered a comprehension assessment, per their randomization. They were then asked how easy or hard it was to understand each of the informed consent components measured in the comprehension assessment. Women in the closed-ended arm had significantly higher overall comprehension scores than in the open-ended arm. Perceived scores were significantly higher when compared to both open-ended and close-ended scores within arms but were similar between arms. Findings highlight the importance of comprehension assessments in complex clinical trials that go beyond asking participants if they understand or have any questions. They also indicate the need for continued exploration of objective measures of comprehension in international clinical research settings, so that points in need of clarification can be efficiently and effectively identified and addressed. Such measures would reduce burdens on both staff and participants that result from well-intentioned but potentially unnecessary time spent explaining in unwarranted detail things already understood.
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Affiliation(s)
- Kathleen M. MacQueen
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
- * E-mail:
| | - Mario Chen
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Catalina Ramirez
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Soori E. A. Nnko
- Sexual and Reproductive Health, National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Kelly M. Earp
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
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Lobato L, Gazzinelli MF, Gazzinelli A, Soares AN. [Knowledge and willingness to participate in research: a descriptive study of volunteers in a clinical trial]. CAD SAUDE PUBLICA 2014; 30:1305-14. [PMID: 25099053 DOI: 10.1590/0102-311x00127813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/06/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate volunteers' knowledge of the information on the free informed consent form and their willingness to participate in a clinical trial. This was a quantitative, descriptive, cross-sectional study conducted in November 2011 with subjects from a clinical trial in Americaninhas, northeast Minas Gerais State, Brazil. A convenience sample included 143 adults of both sexes, 18 to 45 years of age. A structured questionnaire was applied one week after signing the free informed consent form. Most participants signed the free informed consent without sufficient knowledge of the research information and were influenced in their decision to participate in the trial. The authors conclude that signing the free informed consent form fails to express all participants' autonomy in clinical trials.
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Affiliation(s)
- Lucas Lobato
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Andréa Gazzinelli
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Health Care Voluntourism: Addressing Ethical Concerns of Undergraduate Student Participation in Global Health Volunteer Work. HEC Forum 2014; 26:285-97. [DOI: 10.1007/s10730-014-9243-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Afolabi MO, Bojang K, D'Alessandro U, Ota MOC, Imoukhuede EB, Ravinetto R, Larson HJ, McGrath N, Chandramohan D. Digitised audio questionnaire for assessment of informed consent comprehension in a low-literacy African research population: development and psychometric evaluation. BMJ Open 2014; 4:e004817. [PMID: 24961716 PMCID: PMC4078776 DOI: 10.1136/bmjopen-2014-004817] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/17/2014] [Accepted: 06/02/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and psychometrically evaluate an audio digitised tool for assessment of comprehension of informed consent among low-literacy Gambian research participants. SETTING We conducted this study in the Gambia where a high illiteracy rate and absence of standardised writing formats of local languages pose major challenges for research participants to comprehend consent information. We developed a 34-item questionnaire to assess participants' comprehension of key elements of informed consent. The questionnaire was face validated and content validated by experienced researchers. To bypass the challenge of a lack of standardised writing formats, we audiorecorded the questionnaire in three major Gambian languages: Mandinka, Wolof and Fula. The questionnaire was further developed into an audio computer-assisted interview format. PARTICIPANTS The digitised questionnaire was administered to 250 participants enrolled in two clinical trials in the urban and rural areas of the Gambia. One week after first administration, the questionnaire was readministered to half of the participants who were randomly selected. Participants were eligible if enrolled in the parent trials and could speak any of the three major Gambian languages. OUTCOME MEASURE The primary outcome measure was reliability and validity of the questionnaire. RESULTS Item reduction by factor analysis showed that 21 of the question items have strong factor loadings. These were retained along with five other items which were fundamental components of informed consent. The 26-item questionnaire has high internal consistency with a Cronbach's α of 0.73-0.79 and an intraclass correlation coefficient of 0.94 (95% CI 0.923 to 0.954). Hypotheses testing also showed that the questionnaire has a positive correlation with a similar questionnaire and discriminates between participants with and without education. CONCLUSIONS We have developed a reliable and valid measure of comprehension of informed consent information for the Gambian context, which might be easily adapted to similar settings. This is a major step towards engendering comprehension of informed consent information among low-literacy participants.
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Affiliation(s)
- Muhammed O Afolabi
- Medical Research Council Unit, Fajara, The Gambia
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, The Gambia
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin O C Ota
- Research, Publications & Library Services, World Health Organization—Regional Office for Africa, Brazzaville, Congo
| | | | - Raffaella Ravinetto
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nuala McGrath
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Combs Thorsen V, Sundby J, Meguid T, Malata A. Easier said than done!: methodological challenges with conducting maternal death review research in Malawi. BMC Med Res Methodol 2014; 14:29. [PMID: 24559148 PMCID: PMC3946085 DOI: 10.1186/1471-2288-14-29] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/10/2014] [Indexed: 11/20/2022] Open
Abstract
Background Maternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi. Methods Critical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation. Results Challenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses. Conclusion Conducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized.
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Affiliation(s)
- Viva Combs Thorsen
- Department of Community Medicine, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway.
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Kaewkungwal J, Pitisuttithum P, Rerks-ngarm S, Nitayaphan S, Khamboonruang C, Kunasol P, Suntharasamai P, Pungpak S, Vanijanonta S, Bussaratid V, Maek-a-nantawat W, Dhitavat J, Thongcharoen P, Pawarana R, Sabmee Y, Benenson MW, Morgan P, O’Connell RJ, Kim J. Issues in women's participation in a phase III community HIV vaccine trial in Thailand. AIDS Res Hum Retroviruses 2013; 29:1524-34. [PMID: 23343395 PMCID: PMC3809940 DOI: 10.1089/aid.2012.0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To assess qualities and outcomes of women participating in a large, community-based HIV vaccine trial, the present study was conducted among female participants of the RV 144 prime-boost trial in Thailand from 2003 to 2009. Qualities of participation refer to complete vaccination, retention, and status change. Outcomes of participation refer to incident rate, adverse event, and participation impact event. A total of 6,334 (38.6%) women participated in the trial, of whom about 50% were classified as low risk and 11% as high risk. About 85% of participants completed four vaccinations and 76% were included in the per-protocol analysis of the on-time vaccination schedule. More women (88%) completed 42 months follow-up compared with men (85%). Women aged 21 and above had more adverse events compared to younger age groups. More women (5%) compared with men (3%) reported participation impact events (PIEs). High-risk women had more PIEs and a higher infection rate compared to the low-risk group. Complete vaccination and retention on last follow-up were more common in married women aged above 21, and being a housewife. Female volunteers showed the same qualities and outcomes of participation as males in the HIV vaccine trial. There was no statistically significant difference in vaccine efficacy between men and women, especially among the high-risk and married women. The study highlighted the important behavioral, social, and cultural issues that could be considered for future HIV vaccine trial designs.
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Affiliation(s)
- Jaranit Kaewkungwal
- Center of Excellence for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | | | - Prayura Kunasol
- Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | - Pravan Suntharasamai
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Swangjai Pungpak
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sirivan Vanijanonta
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Valai Bussaratid
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirach Maek-a-nantawat
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jittima Dhitavat
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Rungrawee Pawarana
- Center of Excellence for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yupa Sabmee
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mike W. Benenson
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Patricia Morgan
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Jerome Kim
- U.S. Military HIV Research Program, Rockville, Maryland
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Bassett IV, Giddy J, Chaisson CE, Ross D, Bogart LM, Coleman SM, Govender T, Robine M, Erlwanger A, Freedberg KA, Katz JN, Walensky RP, Losina E. A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial. BMC Infect Dis 2013; 13:390. [PMID: 23972276 PMCID: PMC3765953 DOI: 10.1186/1471-2334-13-390] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/20/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite increases in HIV testing, only a fraction of people newly diagnosed with HIV infection enter the care system and initiate antiretroviral therapy (ART) in South Africa. We report on the design and initial enrollment of a randomized trial of a health system navigator intervention to improve linkage to HIV care and TB treatment completion in Durban, South Africa. METHODS/DESIGN We employed a multi-site randomized controlled trial design. Patients at 4 outpatient sites were enrolled prior to HIV testing. For all HIV-infected participants, routine TB screening with sputum for mycobacterial smear and culture were collected. HIV-infected participants were randomized to receive the health system navigator intervention or usual care. Participants in the navigator arm underwent a baseline interview using a strengths-based case management approach to assist in identifying barriers to entering care and devising solutions to best cope with perceived barriers. Over 4 months, participants in the navigator arm received scheduled phone and text messages. The primary outcome of the study is linkage and retention in care, assessed 9 months after enrollment. For ART-eligible participants without TB, the primary outcome is 3 months on ART as documented in the medical record; participants co-infected with TB are also eligible to meet the primary outcome of completion of 6 months of TB treatment, as documented by the TB clinic. Secondary outcomes include mortality, receipt of CD4 count and TB test results, and repeat CD4 counts for those not ART-eligible at baseline. We hypothesize that a health system navigator can help identify and positively affect modifiable patient factors, including self-efficacy and social support, that in turn can improve linkage to and retention in HIV and TB care. DISCUSSION We are currently evaluating the clinical impact of a novel health system navigator intervention to promote entry to and retention in HIV and TB care for people newly diagnosed with HIV. The details of this study protocol will inform clinicians, investigators, and policy makers of strategies to best support HIV-infected patients in resource-limited settings. TRIAL REGISTRATION Clinicaltrials.gov. unique identifier: NCT01188941.
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Affiliation(s)
- Ingrid V Bassett
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
| | | | - Christine E Chaisson
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Douglas Ross
- St. Mary’s Hospital, Mariannhill, Durban, South Africa
| | - Laura M Bogart
- Harvard Medical School, Boston, MA, USA
- Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
- Division of General Pediatrics, Department of Medicine, Boston, Children’s Hospital, Boston, MA, USA
| | - Sharon M Coleman
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | | | - Marion Robine
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Alison Erlwanger
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rochelle P Walensky
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elena Losina
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston MA, USA
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Rodrigues RJ, Antony J, Krishnamurthy S, Shet A, De Costa A. 'What do I know? Should I participate?' Considerations on participation in HIV related research among HIV infected adults in Bangalore, South India. PLoS One 2013; 8:e53054. [PMID: 23460780 PMCID: PMC3584073 DOI: 10.1371/journal.pone.0053054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/27/2012] [Indexed: 11/18/2022] Open
Abstract
Background India has the highest number of HIV infected persons in the world after South Africa. Much HIV related behavioral, clinical and laboratory based research is ongoing in India. Yet little is known on Indian HIV patients' knowledge of research, their processes of decision making and motives for participation. We aimed to explore these areas among HIV infected individuals to understand their reasons for participating in research. Methodology/Principal Findings This is a cross sectional survey among 173 HIV infected adults at a tertiary level hospital in Bangalore, India, done between October 2010 and January 2011. A pre-tested questionnaire was administered to the participants by trained research assistants to assess their knowledge regarding research, willingness to participate, decision making and determinants of participation. Participants were presented with five hypothetical HIV research studies. Each study had a different level of intervention and time commitment. Of respondents, 103(60%), said that research meant ‘to discover something new’ and 138(80%) were willing to participate in research. A third of the respondents were unaware of their right to refuse participation. Willingness to participate in research varied with level of intervention. It was the lowest for the hypothetical study involving sensitive questions followed by the hypothetical drug trial; and was the highest for the hypothetical cross sectional questionnaire based study (p<0.0015). Individual health benefits and altruism were the primary motives for participation in research and indicate the presence of therapeutic misconception. Women were less likely to make autonomous decisions for participation in interventional studies. Conclusions/Significance Despite a majority willing to participate, over a third of respondents did not have any knowledge of research or the voluntary nature of participation. This has ethical implications. Researchers need to focus on enabling potential research participants understand the concepts of research, promote autonomous decisions, especially by women and restrict therapeutic misconception.
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Vreeman R, Kamaara E, Kamanda A, Ayuku D, Nyandiko W, Atwoli L, Ayaya S, Gisore P, Scanlon M, Braitstein P. Community perspectives on research consent involving vulnerable children in Western Kenya. J Empir Res Hum Res Ethics 2013; 7:44-55. [PMID: 23086047 DOI: 10.1525/jer.2012.7.4.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.
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Affiliation(s)
- Rachel Vreeman
- Indiana University, 107 S. Indiana Ave., Bloomington, IN 47405-7000, USA.
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Abdool Karim Q, Kharsany ABM, Frohlich JA, Werner L, Mlotshwa M, Madlala BT, Abdool Karim SS. HIV incidence in young girls in KwaZulu-Natal, South Africa--public health imperative for their inclusion in HIV biomedical intervention trials. AIDS Behav 2012; 16:1870-6. [PMID: 22618892 DOI: 10.1007/s10461-012-0209-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Young women are particularly vulnerable for acquiring HIV yet they are often excluded from clinical trials testing new biomedical intervention. We assessed the HIV incidence and feasibility of enrolling a cohort of young women for potential participation in future clinical trials. Between March 2004 and May 2007, 594 HIV uninfected 14-30 year old women were enrolled into a longitudinal HIV risk reduction study in KwaZulu-Natal, South Africa. The overall HIV prevalence at screening in young girls below the age of 18 years was 27.6 % compared to 52.0 % in the women above 18 years, p < 0.001. HIV incidence was 4.7 [95 % Confidence interval (CI) 1.5-10.9) and 6.9 (95 % CI 4.8-9.6)/100 women years (wy), p = 0.42 and pregnancy rates were 23.7 (95 % CI 14.9-35.9) and 16.4 (95 % CI 12.9-20.6)/100 wy, p = 0.29, in the women below and above 18 years respectively. Retention was similar in both groups (71.0 vs. 71.5 %, p = 0.90). This study demonstrates that the inclusion of young girls between the ages of 14 and 17 years in longitudinal studies is feasible and their inclusion in clinical trials would maintain scientific integrity and power of the study.
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Affiliation(s)
- Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, Durban 4013, South Africa
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Bwakura-Dangarembizi M, Musesengwa R, Nathoo KJ, Takaidza P, Mhute T, Vhembo T. Ethical and legal constraints to children's participation in research in Zimbabwe: experiences from the multicenter pediatric HIV ARROW trial. BMC Med Ethics 2012; 13:17. [PMID: 22818109 PMCID: PMC3521203 DOI: 10.1186/1472-6939-13-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/05/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Clinical trials involving children previously considered unethical are now considered essential because of the inherent physiological differences between children and adults. An integral part of research ethics is the informed consent, which for children is obtained by proxy from a consenting parent or guardian. The informed consent process is governed by international ethical codes that are interpreted in accordance with local laws and procedures raising the importance of contextualizing their implementation. FINDINGS In Zimbabwe the parental informed consent document for children participating in clinical research is modeled after Western laws of ethics and requires that the parent or legally authorized representative provide consent on behalf of a minor. This article highlights the experiences and lessons learnt by Zimbabwean researchers in obtaining informed consent from guardians of orphaned children participating in a collaborative HIV clinical trial involving the Medical Research Council, United Kingdom and four centers, three of which are in Uganda. Researchers were faced with a situation where caregivers of orphaned children were not permitted to provide informed consent for trial participation. The situation contrasted with general clinical practice where consent for procedures on orphans is obtained from their caregivers who are not legal guardians. CONCLUSION The challenges faced in obtaining informed consent for orphans in this clinical trial underscores the need for the Zimbabwe ethics committee to develop an ethical and legal framework for pediatric research that is based on international guidelines while taking into account the cultural context. The Medical Research Council of Zimbabwe has since started the process that is expected to involve critical stakeholders namely the community including children, ethicists, the legal fraternity and researchers.
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Affiliation(s)
- Mutsa Bwakura-Dangarembizi
- Department of Pediatrics and Child Health, University of Zimbabwe College of Health Sciences, Box A178, Avondale, Harare, Zimbabwe
| | - Rosemary Musesengwa
- Medical Research Council of Zimbabwe, P.O. Box CY489, Causeway, Harare, Zimbabwe
| | - Kusum J Nathoo
- Department of Pediatrics and Child Health, University of Zimbabwe College of Health Sciences, Box A178, Avondale, Harare, Zimbabwe
| | - Patrick Takaidza
- Medical Research Council of Zimbabwe, P.O. Box CY489, Causeway, Harare, Zimbabwe
| | - Tawanda Mhute
- University of Zimbabwe Clinical Research Centre, P.O. Box A1578, Avondale, Harare, Zimbabwe
| | - Tichaona Vhembo
- University of Zimbabwe Clinical Research Centre, P.O. Box A1578, Avondale, Harare, Zimbabwe
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Faber M, Kruger HS. Nutrition research in rural communities: application of ethical principles. MATERNAL AND CHILD NUTRITION 2012; 9:435-51. [PMID: 22591024 DOI: 10.1111/j.1740-8709.2012.00414.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This narrative review focuses on ethics related to nutrition-specific community-based research, within the framework of science for society, and focusing on the rights and well-being of fieldworkers and research participants. In addition to generally accepted conditions of scientific validity, such as adequate sample size, unbiased measurement outcome and suitable study population, research needs to be appropriate and feasible within the local context. Communities' suspicions about research can be overcome through community participation and clear dialogue. Recruitment of fieldworkers and research participants should be transparent and guided by project-specific selection criteria. Fieldworkers need to be adequately trained, their daily schedules and remuneration must be realistic, and their inputs to the study must be recognized. Fieldworkers may be negatively affected emotionally, financially and physically. Benefits to research participants may include physical and psychological benefits, minimal economic benefit, and health education; while risks may be of a physical, psychological, social, or economic nature. Targeting individuals in high-risk groups may result in social stigmatization. The time burden to the research participant can be minimized by careful attention to study procedures and questionnaire design. Potential benefits to the community, fieldworkers and research participants and anticipated knowledge to be gained should outweigh and justify the potential risks. Researchers should have an exit strategy for study participants. For effective dissemination of results to individual research participants, the host community and nutrition community, the language, format and level of presentation need to be appropriate for the target audience.
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Affiliation(s)
- Mieke Faber
- Nutritional Intervention Research Unit, Medical Research Council, Tygerberg, South Africa Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Abstract
UNLABELLED Increasingly, US-sponsored research is carried out in developing countries, but how US Institutional Review Boards (IRBs) approach the challenges they then face is unclear. METHODS I conducted in-depth interviews of about 2 hours each, with 46 IRB chairs, directors, administrators and members. I contacted the leadership of 60 IRBs in the United States (US) (every fourth one in the list of the top 240 institutions by National Institutes of Health (NIH) funding), and interviewed IRB leaders from 34 (55%). RESULTS US IRBs face ethical and logistical challenges in interpreting and applying principles and regulations in developing countries, given economic and health disparities, and limited contextual knowledge. These IRBs perceive wide variations in developing world IRBs/RECs' quality, resources and training; and health systems in some countries may have long-standing practices of corruption. These US IRBs often know little of local contexts, regulations and standards of care, and struggle with understandings of other cultures' differing views of autonomy, and risks and benefits of daily life. US IRBs thus face difficult decisions, including how to interpret principles, how much to pay subjects and how much sustainability to require from researchers. IRB responses and solutions include trying to maintain higher standards for developing world research, obtain cultural expertise, build IRB infrastructure abroad, communicate with foreign IRBs, and 'negotiate' for maximum benefits for participants and fearing 'worst-case scenarios'. CONCLUSIONS US and foreign IRBs confront a series of tensions and dilemmas in reviewing developing world research. These data have important implications for increased education of IRBs/RECs and researchers in the US and abroad, and for research and practice.
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Affiliation(s)
- Robert L Klitzman
- Columbia University College of Physicians and Surgeons - Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA.
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Corneli AL, Sorenson JR, Bentley ME, Henderson GE, Bowling JM, Nkhoma J, Moses A, Zulu C, Chilima J, Ahmed Y, Heilig CM, Jamieson DJ, van der Horst C. Improving participant understanding of informed consent in an HIV-prevention clinical trial: a comparison of methods. AIDS Behav 2012; 16:412-21. [PMID: 21656146 PMCID: PMC3923514 DOI: 10.1007/s10461-011-9977-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Empirical research on informed consent has shown that study participants often do not fully understand consent information. This study assessed participant understanding of three mock consent approaches describing an HIV-prevention clinical trial in Lilongwe, Malawi prior to trial implementation. Pregnant women (n = 297) were systematically selected from antenatal-care waiting lines and sequentially allocated to receive an enhanced standard consent form (group 1), a context-specific consent form (group 2), or context-specific counseling cards (group 3). Understanding of research concepts and study procedures was assessed immediately postintervention and at 1-week follow-up. At postintervention, participants in groups 2 and 3 understood more about research concepts and study procedures compared with group 1. Group 3 participants also understood more about study procedures compared with group 2. At follow-up, participants in groups 2 and 3 continued to understand more about research concepts and study procedures. Context-specific approaches improved understanding of consent information in this study.
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Affiliation(s)
- Amy L Corneli
- Department of Health Behavior and Health Education, The University of North Carolina at Chapel Hill, USA.
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Randomized controlled trials of HIV/AIDS prevention and treatment in Africa: results from the Cochrane HIV/AIDS Specialized Register. PLoS One 2011; 6:e28759. [PMID: 22194905 PMCID: PMC3240627 DOI: 10.1371/journal.pone.0028759] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 11/14/2011] [Indexed: 11/26/2022] Open
Abstract
Introduction To effectively address HIV/AIDS in Africa, evidence on preventing new infections and providing effective treatment is needed. Ideally, decisions on which interventions are effective should be based on evidence from randomized controlled trials (RCTs). Our previous research described African RCTs of HIV/AIDS reported between 1987 and 2003. This study updates that analysis with RCTs published between 2004 and 2008. Objectives To describe RCTs of HIV/AIDS conducted in Africa and reported between 2004 and 2008. Methods We searched the Cochrane HIV/AIDS Specialized Register in September 2009. Two researchers independently evaluated studies for inclusion and extracted data using standardized forms. Details included location of trials, interventions, methodological quality, location of principal investigators and funders. Results Our search identified 834 RCTs, with 68 conducted in Africa. Forty-three assessed prevention-interventions and 25 treatment-interventions. Fifteen of the 43 prevention RCTs focused on preventing mother-to-child HIV transmission. Thirteen of the 25 treatment trials focused on opportunistic infections. Trials were conducted in 16 countries with most in South Africa (20), Zambia (12) and Zimbabwe (9). The median sample size was 628 (range 33-9645). Methods used for the generation of the allocation sequence and allocation concealment were adequate in 38 and 32 trials, respectively, and 58 reports included a CONSORT recommended flow diagram. Twenty-nine principal investigators resided in the United States of America (USA) and 18 were from African countries. Trials were co-funded by different agencies with most of the funding obtained from USA governmental and non-governmental agencies. Nineteen pharmaceutical companies provided partial funding to 15 RCTs and African agencies co-funded 17 RCTs. Ethical approval was reported in 65 trials and informed consent in 61 trials. Conclusion Prevention trials dominate the trial landscape in Africa. Of note, few principal investigators and funders are from Africa. These findings mirror our previous work and continue to indicate a need for strengthening trial research capacity in Africa.
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Andanda P, Awah P, Ndebele P, Onigbogi O, Udatinya D, Mwondela M. The ethical and legal regulation of HIV-vaccine research in Africa: lessons from Cameroon, Malawi, Nigeria, Rwanda and Zambia. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2011; 10:451-63. [DOI: 10.2989/16085906.2011.646660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
This article highlights a number of ethical challenges I face in obtaining informed consent from very sick subjects with suspected pulmonary tuberculosis (TB). Some of the subjects with TB have an associated human immunodeficiency virus (HIV) infection. From my experience in administering informed consent and health surveys, I found the subjects to be generally mentally stable but physically exhausted. Many of the very sick subjects cough excessively and cannot tolerate a 45-minute conversation with the study staff in order for them to administer consent and conduct a survey after the routine clinical evaluation. In this situation, the administration of a qualitative consent that preserves the subject's right and autonomy becomes a challenge.
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Affiliation(s)
- Gambo G Aliyu
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Malik AY. Physician-Researchers' Experiences of the Consent Process in the Sociocultural Context of a Developing Country. AJOB PRIMARY RESEARCH 2011; 2:38-46. [PMID: 22816063 PMCID: PMC3396358 DOI: 10.1080/21507716.2011.616183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: International guidelines for medical research involving human subjects maintain the primacy of informed consent while recognizing cultural diversity. Methods: This article draws on empirical data obtained from interviews with physician-researchers in teaching hospitals of Lahore, Pakistan, to identify social and cultural factors that affect the consent process for participants in research. Results: This article presents variable findings with regards to communication, comprehension, and decision making. While some physicians consider that social factors such as lack of education, a patriarchal family system, and skepticism about research can make patients dependent on either the physician-researcher or the family, others believe that patients do make independent decisions. Conclusions: In light of the findings, the article ends with a recommendation for communication and decision making that is sensitive to the local sociocultural environment while at the same time meeting the ethical imperative of respect for persons.
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Stenson AL, Kapungu CT, Geller SE, Miller S. Navigating the challenges of global reproductive health research. J Womens Health (Larchmt) 2010; 19:2101-7. [PMID: 20849297 PMCID: PMC3004132 DOI: 10.1089/jwh.2010.2065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reproductive health research in low-resource settings poses unique and complex challenges that must be addressed to ensure that global research is conducted with strict adherence to ethical principles, offers direct benefit to the research subjects, and has the potential for adoption of positive findings to the target population. This article addresses challenges to conducting reproductive health research in low-resource settings in the following areas: (1) establishment and maintenance of global collaboration, (2) community partnerships, (3) ethical issues, including informed consent and the role of incentives, (4) staff training and development, (5) data collection and management, and (6) infrastructure and logistics. Particular attention to these challenges is important to ensure that research is culturally appropriate and methodologically sound and enhances the adoption of health-promoting behaviors. Rigorous evaluation of interventions in low-resource settings may be a cost-effective and time-efficient way to identify interventions for large-scale program replication to improve women's health.
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Affiliation(s)
- Amy L Stenson
- David Geffen School of Medicine at the University of California, Los Angeles, California 90095, USA.
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Isaacson G, Drum ET, Cohen MS. Surgical missions to developing countries: Ethical conflicts. Otolaryngol Head Neck Surg 2010; 143:476-9. [PMID: 20869554 DOI: 10.1016/j.otohns.2010.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 05/12/2010] [Indexed: 11/19/2022]
Abstract
Each year scores of American physicians and nurses travel overseas, usually at their own expense, aiming to improve the lot of desperate patients in developing countries. Our journals are filled with images of smiling children who have benefited from these gifts of care. Still, practicing medicine, and especially surgery, in a sporadic fashion in distant lands can lead to poor outcomes. It does little to improve public health or advance medical education. We address some of the ethical dilemmas intrinsic to international surgical missions and discuss how we might redirect our resources to provide better care to more people.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
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Jones C. Practical problems of doing research across different cultures: experiences from the RACHEL study. Intensive Crit Care Nurs 2010; 26:125-7. [PMID: 20197236 DOI: 10.1016/j.iccn.2010.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 01/28/2010] [Indexed: 11/30/2022]
Abstract
For many nurses the thought of conducting a research study, even one based in one centre, is daunting but coordinating a multi-centred study across different countries with different cultures can seem overwhelming. Some of the practical problems of doing research across different cultures are predictable and can be planned for, while others may surface as the study is started and need to be reacted to as they happen. Clear lines of communication are therefore essential. This article discusses some of the issues and problems that can occur using examples from a large multi-national nursing study by the RACHEL group.
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Affiliation(s)
- Christina Jones
- ICU, Whiston Hospital, Prescot and School of Clinical Science, University of Liverpool, UK
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