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Ng SH, Kaur S, Cheah PY, Ong ZL, Lim J, Voo TC. Migration health ethics in Southeast Asia: a scoping review. Wellcome Open Res 2024; 8:391. [PMID: 38595706 PMCID: PMC11002524 DOI: 10.12688/wellcomeopenres.19572.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background Asia hosts the second-largest international migrant population in the world. In Southeast Asia (SEA), key types of migration are labour migration, forced migration, and environmental migration. This scoping review seeks to identify key themes and gaps in current research on the ethics of healthcare for mobile and marginalised populations in SEA, and the ethics of research involving these populations. Methods We performed a scoping review using three broad concepts: population (stateless population, migrants, refugees, asylum seekers, internally displaced people), issues (healthcare and ethics), and context (11 countries in SEA). Three databases (PubMed, CINAHL, and Web of Science) were searched from 2000 until May 2023 over a period of four months (February 2023 to May 2023). Other relevant publications were identified through citation searches, and six bioethics journals were hand searched. All searches were conducted in English, and relevant publications were screened against the inclusion and exclusion criteria. Data were subsequently imported into NVivo 14, and thematic analysis was conducted. Results We identified 18 papers with substantial bioethical analysis. Ethical concepts that guide the analysis were 'capability, agency, dignity', 'vulnerability', 'precarity, complicity, and structural violence' (n=7). Ethical issues were discussed from the perspective of research ethics (n=9), clinical ethics (n=1) and public health ethics (n=1). All publications are from researchers based in Singapore, Thailand, and Malaysia. Research gaps identified include the need for more research involving migrant children, research from migrant-sending countries, studies on quality of migrant healthcare, participatory health research, and research with internal migrants. Conclusions More empirical research is necessary to better understand the ethical issues that exist in the domains of research, clinical care, and public health. Critical examination of the interplay between migration, health and ethics with consideration of the diverse factors and contexts involved is crucial for the advancement of migration health ethics in SEA.
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Affiliation(s)
- Shu Hui Ng
- School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Sharon Kaur
- Faculty of Law, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Oxford, OX3 7LG, UK
| | - Zhen Ling Ong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jane Lim
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
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2
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Khirikoekkong N, Asarath SA, Munruchaitrakun M, Blay N, Waithira N, Cheah PY, Nosten F, Lubell Y, Landier J, Althaus T. Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study. BMC Infect Dis 2023; 23:501. [PMID: 37525093 PMCID: PMC10388507 DOI: 10.1186/s12879-023-08482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has complexified how is perceived, and what actions are taken towards it. We investigated the concept of fever and the determinants influencing health-seeking behaviours among migrants on the Thai-Myanmar border, where rapid economic development collides with precarious political and socio-economic conditions. METHODS We implemented a mixed-methods study between August to December 2019. Phase I used a qualitative approach, with in-depth interviews and focus group discussions. Phase II used a quantitative approach with a close-ended questionnaire based on Phase I findings. A conditional inference tree (CIT) model first identified geographic and socio-demographic determinants, which were then tested using a logistic regression model. RESULTS Fever corresponded to a high diversity of conceptions, symptoms and believed causes. Self-medication was the commonest behaviour at fever onset. If fever persisted, migrants primarily sought care in humanitarian cost-free clinics (45.5%, 92/202), followed by private clinics (43.1%, 87/202), health posts (36.1%, 73/202), public hospitals (33.7%, 68/202) and primary care units (30, 14.9%). The qualitative analysis identified distance and legal status as key barriers for accessing health care. The quantitative analysis further investigated determinants influencing health-seeking behaviour: living near a town where a cost-free clinic operated was inversely associated with seeking care at health posts (adjusted odds ratio [aOR], 0.40, 95% confidence interval [95% CI] [0.19-0.86]), and public hospital attendance (aOR 0.31, 95% CI [0.14-0.67]). Living further away from the nearest town was associated with health posts attendance (aOR 1.05, 95% CI [1.00-1.10] per 1 km). Having legal status was inversely associated with cost-free clinics attendance (aOR 0.27, 95% CI [0.10-0.71]), and positively associated with private clinic and public hospital attendance (aOR 2.56, 95% CI [1.00-6.54] and 5.15, 95% CI [1.80-14.71], respectively). CONCLUSIONS Fever conception and believed causes are context-specific and should be investigated prior to any intervention. Distance to care and legal status were key determinants influencing health-seeking behaviour. Current economic upheavals are accelerating the unregulated flow of undocumented migrants from Myanmar to Thailand, warranting further inclusiveness and investments in the public health system.
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Affiliation(s)
- Napat Khirikoekkong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Supa-At Asarath
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Mayreerat Munruchaitrakun
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Naw Blay
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Naomi Waithira
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - François Nosten
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Yoel Lubell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Jordi Landier
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
- Institut de Recherche pour le Développement (IRD), Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Thomas Althaus
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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3
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Perez KM, Asim M, Weiss EM, Valentine GC, Kavi A, Somannavar MS, Iwuh I, Chiweza C, Tickell KD, Singa BO, Beima-Sofie K, Batra M, Walson JL, Umoren R, Kelley M, Saleem S. Considering Risks to Researchers and Staff in Low-Resource Settings during Public Health Crises: A Proposed Conceptual Model. CHILDREN 2023; 10:children10030463. [PMID: 36980021 PMCID: PMC10047058 DOI: 10.3390/children10030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.
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Affiliation(s)
- Krystle M. Perez
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Correspondence:
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Elliott M. Weiss
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Gregory C. Valentine
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi 590010, India
| | - Manjunath S. Somannavar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi 590010, India
| | - Ibezimako Iwuh
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Global Women’s Health Centre of Excellence, Lilongwe Private Bag B-397, Malawi
| | - Chikondi Chiweza
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Global Women’s Health Centre of Excellence, Lilongwe Private Bag B-397, Malawi
| | - Kirkby D. Tickell
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Benson O. Singa
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
- Kenya Medical Research Institute (KEMRI), Nairobi P.O. Box 54840-00200, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Maureen Kelley
- Center for Ethics in Health Care, Oregon Health and Science University, Portland, OR 97239, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
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4
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Ngwenya N, Ilo Van Nuil J, Nyirenda D, Chambers M, Cheah PY, Seeley J, Chi P, Mafuleka L, Nkosi B, Kamuya D, Davies A, Schneiders ML, Mumba N, Dlamini S, Desmond N, Marsh V, Rippon D, Parker M, Molyneux S. A network of empirical ethics teams embedded in research programmes across multiple sites: opportunities and challenges in contributing to COVID-19 research and responses. Wellcome Open Res 2023; 7:48. [PMID: 37636839 PMCID: PMC10457565 DOI: 10.12688/wellcomeopenres.17548.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 08/29/2023] Open
Abstract
Covid-19 continues to teach the global community important lessons about preparedness for research and effective action to respond to emerging health threats. We share the COVID-19 experiences of a pre-existing cross-site ethics network-the Global Health Bioethics Network-which brings together researchers and practitioners from Africa, Europe, and Southeast Asia. We describe the network and its members and activities, and the work-related opportunities and challenges we faced over a one-year period during the pandemic. We highlight the value of having strong and long-term empirical ethics networks embedded across diverse research institutions to be able to: 1) identify and share relevant ethics challenges and research questions and ways of 'doing research'; 2) work with key stakeholders to identify appropriate ways to contribute to the emerging health issue response - e.g., through ethics oversight, community engagement, and advisory roles at different levels; and 3) learn from each other and from diverse contexts to advocate for positive change at multiple levels. It is our view that being embedded and long term offers opportunities in terms of deep institutional and contextual knowledge, existing relationships and access to a wide range of stakeholders. Being networked offers opportunities to draw upon a wide range of expertise and perspectives, and to bring together internal and external insights (i.e.drawing on different positionalities). Long term funding means that the people and resources are in place and ready to respond in a timely way. However, many tensions and challenges remain, including difficulties in negotiating power and politics in the roles that researchers and research institutions can and should play in an emergency, and the position of empirical ethics within research programmes. We discuss some of these tensions and challenges and consider the implications for our own and similar networks in future.
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Affiliation(s)
- Nothando Ngwenya
- Africa Health Research Institute, Durban, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Janet Seeley
- Africa Health Research Institute, Durban, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Primus Chi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lindiwe Mafuleka
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alun Davies
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mira L Schneiders
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Noni Mumba
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Nicola Desmond
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Vicki Marsh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Michael Parker
- Ethox, University of Oxford, Oxford, UK
- Oxford Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Oxford Pandemic Sciences Institute, University of Oxford, Oxford, UK
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5
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Ngwenya N, Ilo Van Nuil J, Nyirenda D, Chambers M, Cheah PY, Seeley J, Chi P, Mafuleka L, Nkosi B, Kamuya D, Davies A, Schneiders ML, Mumba N, Dlamini S, Desmond N, Marsh V, Rippon D, Parker M, Molyneux S. A network of empirical ethics teams embedded in research programmes across multiple sites: opportunities and challenges in contributing to COVID-19 research and responses. Wellcome Open Res 2023; 7:48. [PMID: 37636839 PMCID: PMC10457565 DOI: 10.12688/wellcomeopenres.17548.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 08/31/2023] Open
Abstract
Covid-19 continues to teach the global community important lessons about preparedness for research and effective action to respond to emerging health threats. We share the COVID-19 experiences of a pre-existing cross-site ethics network-the Global Health Bioethics Network-which brings together researchers and practitioners from Africa, Europe, and Southeast Asia. We describe the network and its members and activities, and the work-related opportunities and challenges we faced over a one-year period during the pandemic. We highlight the value of having strong and long-term empirical ethics networks embedded across diverse research institutions to be able to: 1) identify and share relevant ethics challenges and research questions and ways of 'doing research'; 2) work with key stakeholders to identify appropriate ways to contribute to the emerging health issue response - e.g., through ethics oversight, community engagement, and advisory roles at different levels; and 3) learn from each other and from diverse contexts to advocate for positive change at multiple levels. It is our view that being embedded and long term offers opportunities in terms of deep institutional and contextual knowledge, existing relationships and access to a wide range of stakeholders. Being networked offers opportunities to draw upon a wide range of expertise and perspectives, and to bring together internal and external insights (i.e.drawing on different positionalities). Long term funding means that the people and resources are in place and ready to respond in a timely way. However, many tensions and challenges remain, including difficulties in negotiating power and politics in the roles that researchers and research institutions can and should play in an emergency, and the position of empirical ethics within research programmes. We discuss some of these tensions and challenges and consider the implications for our own and similar networks in future.
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Affiliation(s)
- Nothando Ngwenya
- Africa Health Research Institute, Durban, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Janet Seeley
- Africa Health Research Institute, Durban, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Primus Chi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lindiwe Mafuleka
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alun Davies
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mira L Schneiders
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Noni Mumba
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Nicola Desmond
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Vicki Marsh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Michael Parker
- Ethox, University of Oxford, Oxford, UK
- Oxford Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Oxford Pandemic Sciences Institute, University of Oxford, Oxford, UK
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6
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Greer RC, Kanthawang N, Roest J, Wangrangsimakul T, Parker M, Kelley M, Cheah PY. Vulnerability and agency in research participants' daily lives and the research encounter: A qualitative case study of participants taking part in scrub typhus research in northern Thailand. PLoS One 2023; 18:e0280056. [PMID: 36696400 PMCID: PMC9876277 DOI: 10.1371/journal.pone.0280056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Researchers have a responsibility to protect all participants, especially vulnerable participants, from harm. Vulnerability is increasingly understood to be context specific, yet limited guidance is available regarding the vulnerability and agency of research participants in different cultural settings. This study aims to explore research participants' daily vulnerability and agency, and how these interact with participants' research experiences in their own words. Researchers' views and responses were also explored. METHODS A qualitative study was conducted around two scrub typhus research studies in northern Thailand. A thematic analysis was carried out on 42 semi-structured interviews with research participants, their families, researchers and key informants. RESULTS The majority of the research participants belonged to a hill tribe ethnic minority group. Common challenges were related to Thai language barriers, travel difficulties, uncertain legal status, unstable employment, lack of education and healthcare. We did not identify new vulnerabilities but we found that the extent of these vulnerabilities might be underestimated or even hidden from researchers in some cases. Despite these challenges people demonstrated agency in their daily lives and were often motivated and supported in this by family members. The majority of perceived research benefits were related to healthcare and gaining knowledge, while attending follow-up visits could be a burden for some. CONCLUSIONS Our approach to research in culturally and socioeconomically diverse settings should be more responsive to participants' specific vulnerabilities and abilities evidenced in their daily life, rather than attributing vulnerability on the basis of membership of pre-defined 'vulnerable groups'. Researchers need to be aware and responsive towards the challenges participants face locally in order to minimise the burdens of research participation whilst allowing participants to benefit from research.
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Affiliation(s)
- Rachel C. Greer
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Nipaphan Kanthawang
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Parker
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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7
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Khirikoekkong N, Asarath SA, Nosten S, Hanboonkunupakarn B, Jatupornpimol N, Roest J, Parker M, Nosten F, McGready R, Cheah PY, Kelley M. Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001875. [PMID: 37141207 PMCID: PMC10159138 DOI: 10.1371/journal.pgph.0001875] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Despite advances, international research ethics guidelines still tend to consist of high-level ethical principles reflecting residual influence from North American and European traditions of ethics. Local ethics committees and community advisory boards can offer more culturally-sensitive approaches to training but most institutions lack substantive practical ethics guidance to engage rich moral understandings in day-to-day research practice in diverse cultural contexts. To address this gap, we conducted an international series of qualitative research ethics case studies, linked prospectively to active research programs in diverse settings. Here, we share findings from two case studies with a research team working on malaria and hepatitis B prevention with pregnant women in clinics serving migrants along the Thai-Myanmar border. In this sociocultural ethical analysis, we consider how core ethical requirements of voluntary participation, provision of fair benefits, and understandings of research risks and burdens are shaped, enriched, and in some instances challenged, by deep-seated and widespread Burmese, Karen and Thai cultural norms known as Arr-nar (in Burmese and Karen) or Kreng-jai (in Thai), encompassing multiple meanings including consideration for others and graciousness. We offer a model illustrating how one might map ethically significant sociocultural influences across the research practice pathway and close with lessons for developing a more culturally responsive research ethics practice in other international settings.
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Affiliation(s)
- Napat Khirikoekkong
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supa-At Asarath
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattapat Jatupornpimol
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Michael Parker
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Francois Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Nkosi B, Van Nuil JI, Nyirenda D, Chi PC, Schneiders ML. 'Labouring' on the frontlines of global health research: mapping challenges experienced by frontline workers in Africa and Asia. Glob Public Health 2022; 17:4195-4205. [PMID: 36183409 DOI: 10.1080/17441692.2022.2124300] [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] [Indexed: 02/07/2023]
Abstract
Drawing on the reflections and discussions from a special session at the 2021 Global Health Bioethics Network summer school, this paper has summarised the key challenges faced by Frontline Workers (FWs) across research sites in Africa and Asia in performing the everyday 'body work' entailed in operationalising global health research. Using a 'body work' lens, we specifically explore and map key challenges that FWs face in Africa and Asia and the physical, social, ethical, emotional, and political labour involved in operationalising global health in these settings. The research encounter links with wider social and economic structures, and spatial dimensions and impacts on the FWs' performance and well-being. Yet, FWs' 'body-work' and the embedded emotions during the research encounter remain hidden and undervalued.
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Affiliation(s)
- Busisiwe Nkosi
- Africa Health Research Institute, Durban, South Africa.,Institute for Global Health, University College London, London, UK.,School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Mira Leonie Schneiders
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Delmas MV, Soan M, Khirikoekkong N, Aung KK, Ler Wah S, Htun WPP, Maung B, Mukaka M, Cheah PY. Under the Mask: A Film on Tuberculosis at the Thai-Myanmar Border. Front Public Health 2022; 10:795503. [PMID: 35530731 PMCID: PMC9068961 DOI: 10.3389/fpubh.2022.795503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
In this paper, we describe the development of the film, “Under the Mask,” which follows the lives of three fictional characters who live on the Thai-Myanmar border as they journey from diagnosis of tuberculosis (TB) to completion of treatment. Under the Mask was filmed on location on the Thai-Myanmar border by local filmmakers and former refugee populations. Cast members were chosen from communities living along the border. This paper describes the script development process, filming, and screening in the community. We also report the findings from the pre- and post-screening questionnaires and post-film focus group discussions. A total of 77 screening events took place between March 2019 and March 2020 to 9,510 audience members in community venues such as village squares, temples and monasteries (N = 21), schools/migrant learning centers (N = 49), and clinics (N = 4). The pre-and post-screen questionnaires showed a significant gain in self-perceived TB knowledge on prevention, transmission, signs and symptoms, and related discrimination. Our findings from 18 post-screening focus group discussions conducted with 188 participants showed that there were improvements in knowledge and awareness of the disease and treatment, as well as in the awareness of stigma, and the burdens of tuberculosis on patients and their families.
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Affiliation(s)
- Michele Vincenti Delmas
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mary Soan
- Sermpanya (FilmAid) Foundation, Mae Sot, Thailand
| | - Napat Khirikoekkong
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Saw Ler Wah
- Sermpanya (FilmAid) Foundation, Mae Sot, Thailand
| | - Win Pa Pa Htun
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Banyar Maung
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Population Health, The Ethox Centre, Oxford, United Kingdom
- *Correspondence: Phaik Yeong Cheah
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Lawrence DS, Gyapong M. Spotlight on global health research. Int Health 2020; 12:507-508. [PMID: 33165555 PMCID: PMC7651010 DOI: 10.1093/inthealth/ihaa082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- David S Lawrence
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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