1
|
Ardrey J, Jehan K, Desmond N, Kumbuyo C, Nyirenda D, Gordon SB, Mortimer K, Tolhurst R. 'Why would they spend all this money and give us these items for free?': Exploring precarity and power in a cleaner cookstove intervention in rural Malawi. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001537. [PMID: 36963027 PMCID: PMC10022019 DOI: 10.1371/journal.pgph.0001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023]
Abstract
We carried out a qualitative study to gain a deeper understanding of the social context of the Cooking and Pneumonia Study (CAPS) and implications for implementation of clean cooking and similar interventions. Such initiatives are recognised as complex, power-laden processes, which has consequences for outcomes and uptake. However, understanding of how precarious livelihoods and unequal power differentials impact on trials of technology is limited and potentially hampers the achievement of the SDGs including SDG 7, Affordable and Clean Energy. An in-depth exploration of experiences and perceptions of cooking and cookstove use within CAPS was completed using qualitative methods and the participatory methodology Photovoice. Ten CAPS participants from each of five villages participated in Photovoice activities and five village representatives were interviewed. Twelve fieldworkers participated in gender specific focus groups and four were interviewed. A thematic content approach was used for data analysis. The analysis showed that economic and power inequity underpinned the complex social relationships within CAPS impacting on trial participation, perceptions of the cookstoves, and on the potential of the intervention to affect health and other benefits. Power can be understood as relational and productive within the research environment. This is illustrated by an analysis of the role of fieldworkers and community representatives who needed to negotiate resistance to trial compliance decisions, including 'satanic' rumours about cookstoves and blood-taking. Transformative approaches that challenge existing power inequities are needed to maximise the success and beneficence of cookstove and other health promoting interventions, and achievement of the SDGs.
Collapse
Affiliation(s)
- Jane Ardrey
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kate Jehan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Nicola Desmond
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Stephen B. Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
2
|
Yator O, Khasakhala L, Stewart GJ, Kumar M. Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis. BMC Womens Health 2022; 22:240. [PMID: 35717156 PMCID: PMC9206094 DOI: 10.1186/s12905-022-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV). Method The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services. Results The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities. Conclusion Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01807-w.
Collapse
Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 799-00517, Nairobi, Kenya.
| | - Lincoln Khasakhala
- Department of Psychiatry, University of Nairobi, P. O. Box 30197-00100, Nairobi, Kenya
| | - Grace-John Stewart
- University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 47074-00100, Nairobi, Kenya.,Department of Psychology, University College London, London, UK
| |
Collapse
|
3
|
Blackwell D, Morrell E. Community Perspectives During a Lead Contaminated Drinking Water Crisis: Lessons for Lactation and Other Health Providers. J Hum Lact 2021; 37:331-342. [PMID: 33975514 DOI: 10.1177/0890334420933134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Millions of people today live in contaminated environments. Often, these environments disproportionately affect nonwhite, racialized families who are low-income, pregnant, and/or feeding young children. Despite the overwhelming recognition among scholars and practitioners of these realities, however, few lactation or other health professionals center socially disadvantaged families' perspectives in their work. Community expertise is therefore often absent from the credentialed lactation and associated support that tends to be advanced in contaminated environments. RESEARCH AIMS The aims of this study were to: (1) Describe how vulnerable community members experience toxic environments, and (2) Explore the strategies vulnerable community members themselves employ and seek out from professionals to achieve resilience in these environments. METHODS The research design for this study was prospective and cross-sectional. We surveyed 62 Milwaukeean African American women of childbearing age and their close networks of support from predominantly low-income census tracts, and we engaged 14 women in a community conversation on their experiences, strategies, and desires generated from living in Milwaukee during a lead contaminated drinking water crisis. RESULTS Participants were aware and concerned about toxic poisoning in their environment, especially as it affects their children. Nonetheless, societal factors constrained their levels of preparedness and action in response, including around chestfeeding, breastfeeding, expressed milk feeding, and artificial feeding methods. CONCLUSION Lactation providers and other health professionals can better support at-risk families by integrating their perspectives into dominant frameworks for information-sharing, preventative resource distribution, and supporting community self-determination.
Collapse
Affiliation(s)
| | - Erica Morrell
- 2250 Assistant Professor of Sociology, St. Lawrence University, Canton, NY, USA
| |
Collapse
|
4
|
Kombe FK, Marsh V, Molyneux S, Kamuya DM, Ikamba D, Kinyanjui SM. Enhancing fieldworkers' performance management support in health research: an exploratory study on the views of field managers and fieldworkers from major research centres in Africa. BMJ Open 2019; 9:e028453. [PMID: 31857297 PMCID: PMC6937094 DOI: 10.1136/bmjopen-2018-028453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Fieldworkers are part of the system that promotes scientific and ethical standards in research, through data collection, consenting and supporting research, due to their insider cultural knowledge and fluency in local languages. The credibility and integrity of health research, therefore, rely on how fieldworkers adhere to institutional and research procedures and guidelines. OBJECTIVES This study mapped out existing practices in training, support and performance management of fieldworkers in Africa, described fieldworkers' and their managers' experiences, and lessons learnt. A consultative process, involving field managers from 15 international health research institutions, was used to identify appropriate ways of addressing the challenges fieldworkers face. METHODS In phase 1, we conducted 32 telephone interviews with 20 field managers and 12 senior fieldworkers from 18 major research centres in Africa, Medical Research Council-UK and the INDEPTH Network Secretariat. In phase 2, we held a 2.5-day workshop involving 25 delegates, including 18 field managers from the institutions that were involved in phase 1 and 7 additional stakeholders from the KEMRI Wellcome Trust Research Programme (KWTRP). An earlier report from phase 1 was published in BMC MedicalEthics in 2015. Data transcribed from the interviews and workshop proceedings were analysed thematically using NVivo V.10 software. RESULTS Most institutions employed fieldworkers, usually with 12 years of formal education and residing within the geographical areas of research, to support studies. Although their roles were common, there were marked differences in the type of training, professional development schemes and fieldworkers support. Fieldworkers faced various challenges, with the potential to affect their ethical and scientific practices. DISCUSSION Fieldworkers undertake vital tasks that promote data quality and ethical practice in research. There is a need for research institutions to develop a structured support system, provide fieldworkers with interpersonal skills training, and provide space for discussion, reflection and experience sharing to help fieldworkers tackle the practical and ethical challenges they face.
Collapse
Affiliation(s)
- Francis Kazungu Kombe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- African Research Integrity Network, Kilifi, Kenya
| | - Vicki Marsh
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Dorcas Mwikali Kamuya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | | | - Samson Muchina Kinyanjui
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| |
Collapse
|
5
|
Davies A, Mwangome N, Yeri B, Mwango G, Mumba N, Marsh V, Kamuya D, Molyneux S, Kinyanjui S, Jones C. Evolution of a programme to engage school students with health research and science in Kenya. Wellcome Open Res 2019; 4:39. [PMID: 30906884 PMCID: PMC6419976 DOI: 10.12688/wellcomeopenres.15106.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/28/2023] Open
Abstract
Facilitating mutually-beneficial educational activities between researchers and school students is an increasingly popular way for research institutes to engage with communities who host health research, but these activities have rarely been formally examined as a community or public engagement approach in health research. The KEMRI-Wellcome Trust Research Programme (KWTRP) in Kilifi, Kenya, through a Participatory Action Research (PAR) approach involving students, teachers, researchers and education stakeholders, has incorporated 'school engagement' as a key component into their community engagement (CE) strategy. School engagement activities at KWTRP aim at strengthening the ethical practice of the institution in two ways: through promoting an interest in science and research among school students as a form of benefit-sharing; and through creating forums for dialogue aimed at promoting mutual understanding between researchers and school students. In this article, we provide a background of CE in Kilifi and describe the diverse ways in which health researchers have engaged with communities and schools in different parts of the world. We then describe the way in which the KWTRP school engagement programme (SEP) was developed and scaled-up. We conclude with a discussion about the challenges, benefits and lessons learnt from the SEP implementation and scale-up in Kilifi, which can inform the establishment of SEPs in other settings.
Collapse
Affiliation(s)
- Alun Davies
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nancy Mwangome
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Betty Yeri
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Grace Mwango
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Noni Mumba
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Vicki Marsh
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dorcas Kamuya
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Samson Kinyanjui
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,IDEAL, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Biochemistry, Pwani University, Kilifi, Kenya
| | - Caroline Jones
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
6
|
Complexities and dilemmas in community consultation on the design of a research project logo in Malawi. PLoS One 2018; 13:e0205737. [PMID: 30335816 PMCID: PMC6193680 DOI: 10.1371/journal.pone.0205737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community engagement on research design is widely highlighted as an important approach for ethical research. This article reports the experience of consulting with communities on the logo used for an influenza study in Malawi. The logo was designed for use on badges worn by study researchers, participant information sheets and other project documents, and could affect perceptions of the study and consequent engagement in the research. METHODS Four focus group discussions were conducted with populations targeted by the influenza study: pregnant women, people with HIV, mothers and community members. The focus groups incorporated a participatory matrix exercise focusing on key themes emerging from the discussions such as: attractiveness, comprehension, acceptability and suggestions for improvement. Findings from the focus groups were analyzed according to these key themes. RESULTS The consultation highlighted important benefits of discussion with communities on research design, including providing new perspectives and helping to avoid harm. For example, people living with HIV felt that one of the possible logos could increase stigma within communities. The experience also indicated potential challenges of consultation. In particular, there were contrasting perspectives among the groups, such that the consultation did not provide a clear answer about which logo should be selected. CONCLUSIONS Our experience adds to current evidence on community engagement by reporting on an area where there is less discussion of community consultation for design of a study logo. The consultation exercise reaffirmed the value of community engagement, but also the difficulty of relying on a brief consultation for decision-making in research design. Further ethical guidance is required on how to negotiate contradictory views during consultations.
Collapse
|
7
|
Mundeva H, Snyder J, Ngilangwa DP, Kaida A. Ethics of task shifting in the health workforce: exploring the role of community health workers in HIV service delivery in low- and middle-income countries. BMC Med Ethics 2018; 19:71. [PMID: 29973217 PMCID: PMC6032788 DOI: 10.1186/s12910-018-0312-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers (CHWs), task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. Methods We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. Results CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. Conclusions CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted.
Collapse
Affiliation(s)
- Hayley Mundeva
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Jeremy Snyder
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David Paul Ngilangwa
- Amref Health Africa Tanzania, Ali Hassan Mwinyi Road, Plot 1019, P.O. Box 2773, Dar es Salaam, Tanzania
| | - Angela Kaida
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| |
Collapse
|
8
|
Musesengwa R, Chimbari MJ. Experiences of community members and researchers on community engagement in an Ecohealth project in South Africa and Zimbabwe. BMC Med Ethics 2017; 18:76. [PMID: 29237440 PMCID: PMC5729516 DOI: 10.1186/s12910-017-0236-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Community engagement (CE) models have provided much needed guidance for researchers to conceptualise and design engagement strategies for research projects. Most of the published strategies, however, still show very limited contribution of the community to the engagement process. One way of achieving this is to document experiences of community members in the CE processes during project implementation. The aim of our study was to explore the experiences of two research naïve communities, regarding a CE strategy collaboratively developed by researchers and study communities in a multicountry study. Methods The study was carried out in two research naïve communities; Gwanda, Zimbabwe and uMkhanyakude, South Africa. The multicentre study was a community based participatory ecohealth multicentre study. A qualitative case study approach was used to explore the CE strategy. Data was collected through Focus Group Discussions, Key Informant Interviews and Direct Observations. Data presented in this paper was collected at three stages of the community engagement process; soon after community entry, soon after sensitisation and during study implementation. Data was analysed through thematic analysis. Results The communities generally had positive experiences of the CE process. They felt that the continuous solicitation of their advice and preferences enabled them to significantly contribute to shaping the engagement process. Communities also perceived the CE process as having been flexible, and that the researchers had presented an open forum for sharing responsibilities in all decision making processes of the engagement process. Conclusions This study has demonstrated that research naïve communities can significantly contribute to research processes if they are adequately engaged. The study also showed that if researchers put in maximum effort to demystify the research process, communities become empowered and participate as partners in research.
Collapse
Affiliation(s)
- Rosemary Musesengwa
- College of Health Sciences, University of KwaZulu Natal, 1st Floor George Campbell Building, King George V Ave, Durban, 4041, South Africa.
| | - Moses J Chimbari
- College of Health Sciences, University of KwaZulu Natal, 1st Floor George Campbell Building, King George V Ave, Durban, 4041, South Africa
| |
Collapse
|
9
|
Musesengwa R, Chimbari MJ. Community engagement practices in Southern Africa: Review and thematic synthesis of studies done in Botswana, Zimbabwe and South Africa. Acta Trop 2017; 175:20-30. [PMID: 27005396 DOI: 10.1016/j.actatropica.2016.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/26/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
Community Engagement (CE) is intended to enhance the participation of community stakeholders in research. CE is usually mentioned in publications as researchers discuss how they carried out community entry, consent and retained study participants but the actual CE activities are not always well documented. This paper reviews CE strategies employed in health research in Botswana, South Africa and Zimbabwe with reference to the development of a CE strategy for a multi-centre study to be conducted in these countries. The search was conducted using JANE (Journal/Author Name Estimator), Google Scholar and PubMed with known institutions and researchers providing context-specific material. The final synthesis includes 35 publications, 2 reports and 2 abstracts. There is evidence of CE being practiced in health research and eight closely related CE strategies were revealed. We conclude that since communities are heterogeneous and unique, CE activities will not have similar results in different settings. Even though there was insufficient evidence to determine which CE strategy is most effective, the review provides sufficient information to develop a CE strategy for a multi-centre study using the various strategies and activities described.
Collapse
Affiliation(s)
- Rosemary Musesengwa
- College of Health Sciences, 1st Floor Desmond Clarence Building Howard College, University of KZN, Durban 4041, South Africa.
| | - Moses J Chimbari
- College of Health Sciences, 1st Floor Desmond Clarence Building Howard College, University of KZN, Durban 4041, South Africa
| |
Collapse
|
10
|
Sambakunsi R, Kumwenda M, Choko A, Corbett EL, Desmond NA. 'Whose failure counts?' A critical reflection on definitions of failure for community health volunteers providing HIV self-testing in a community-based HIV/TB intervention study in urban Malawi. Anthropol Med 2016; 22:234-49. [PMID: 26762610 PMCID: PMC4720041 DOI: 10.1080/13648470.2015.1077202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The category of community health worker applied within the context of health intervention trials has been promoted as a cost-effective approach to meeting study objectives across large populations, relying on the promotion of the concept of ‘com-munity belonging’ to encourage altruistic volunteerism from community members to promote health. This community-based category of individuals is recruited to facilitate externally driven priorities defined by large research teams, outside of the target research environment. An externally defined intervention is then ‘brought to’ the community through locally recruited community volunteers who form a bridge between the researchers and participants. The specific role of these workers is context-driven and responsive to the needs of the intervention. This paper is based on the findings from an annual evaluation of community health worker performance employed as community counsellors to deliver semi-supervised HIV self-testing (HIVST) at community level of a large HIV/TB intervention trial conducted in urban Blantyre, Malawi. A performance evaluation was conducted to appraise individual service delivery and assess achievements in meeting pre-defined targets for uptake of HIVST with the aim of improving overall uptake of HIVST. Through an empirical ‘evaluation of the evaluation’ this paper critically reflects on the position of the community volunteer through the analytical lens of ‘failure’, exploring the tensions in communication and interpretation of intervention delivery between researchers and community volunteers and the differing perspectives on defining failure. It is concluded that community interventions should be developed in collaboration with the population and that information guiding success should be clearly defined.
Collapse
Affiliation(s)
- Rodrick Sambakunsi
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Science Communication , PO Box 30096 , Chichiri , Blantyre , Malawi
| | - Moses Kumwenda
- b College of Medicine , University of Malawi , Blantyre , Malawi.,c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi
| | - Augustine Choko
- c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.,d London School of Hygiene & Tropical Medicine , London , UK
| | - Elizabeth L Corbett
- c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.,d London School of Hygiene & Tropical Medicine , London , UK
| | - Nicola Ann Desmond
- c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.,e Liverpool School of Tropical Medicine , Liverpool , UK
| |
Collapse
|
11
|
Molyneux S, Sariola S, Allman D, Dijkstra M, Gichuru E, Graham S, Kamuya D, Gakii G, Kayemba B, Kombo B, Maleche A, Mbwambo J, Marsh V, Micheni M, Mumba N, Parker M, Shio J, Yah C, van der Elst E, Sanders E. Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities. Health Res Policy Syst 2016; 14:40. [PMID: 27234212 PMCID: PMC4884401 DOI: 10.1186/s12961-016-0106-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background Community engagement, incorporating elements of the broader concepts of public and stakeholder engagement, is increasingly promoted globally, including for health research conducted in developing countries. In sub-Saharan Africa, community engagement needs and challenges are arguably intensified for studies involving gay, bisexual and other men who have sex with men, where male same-sex sexual interactions are often highly stigmatised and even illegal. This paper contextualises, describes and interprets the discussions and outcomes of an international meeting held at the Kenya Medical Research Institute-Wellcome Trust in Kilifi, Kenya, in November 2013, to critically examine the experiences with community engagement for studies involving men who have sex with men. Discussion We discuss the ethically charged nature of the language used for men who have sex with men, and of working with ‘representatives’ of these communities, as well as the complementarity and tensions between a broadly public health approach to community engagement, and a more rights based approach. We highlight the importance of researchers carefully considering which communities to engage with, and the goals, activities, and indicators of success and potential challenges for each. We suggest that, given the unintended harms that can emerge from community engagement (including through labelling, breaches in confidentiality, increased visibility and stigma, and threats to safety), representatives of same-sex populations should be consulted from the earliest possible stage, and that engagement activities should be continuously revised in response to unfolding realities. Engagement should also include less vocal and visible men who have sex with men, and members of other communities with influence on the research, and on research participants and their families and friends. Broader ethics support, advice and research into studies involving men who have sex with men is needed to ensure that ethical challenges – including but not limited to those related to community engagement – are identified and addressed. Summary Underlying challenges and dilemmas linked to stigma and discrimination of men who have sex with men in Africa raise special responsibilities for researchers. Community engagement is an important way of identifying responses to these challenges and responsibilities but itself presents important ethical challenges.
Collapse
Affiliation(s)
- Sassy Molyneux
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. .,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK. .,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Salla Sariola
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,Faculty of Social Sciences, University of Torku, Torku, Finland
| | - Dan Allman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Maartje Dijkstra
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evans Gichuru
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Susan Graham
- Kenya Research Group, University of Washington, Seattle, USA
| | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Gloria Gakii
- University of Nairobi, Nairobi, Kenya.,University of Manitoba, Manitoba, USA
| | | | - Bernadette Kombo
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Allan Maleche
- KELIN - Reclaiming rights, Rebuilding Live, Nairobi, Kenya
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vicki Marsh
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Murugi Micheni
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Noni Mumba
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Michael Parker
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Jasmine Shio
- Department of Project Management, Deloitte Consulting Ltd, Dar es Salaam, Tanzania
| | - Clarence Yah
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise van der Elst
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduard Sanders
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Joseph PD, Caldwell PHY, Tong A, Hanson CS, Craig JC. Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review. Pediatrics 2016; 137:e20152800. [PMID: 26812926 DOI: 10.1542/peds.2015-2800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. OBJECTIVE To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. DATA SOURCES Electronic databases were searched to August 2014. STUDY SELECTION Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs. DATA EXTRACTION Findingswere analyzed by using thematic synthesis. RESULTS Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives' pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits). LIMITATIONS Studies not published in English were excluded. CONCLUSIONS Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.
Collapse
Affiliation(s)
- Pathma D Joseph
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and The Pharmacy Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Patrina H Y Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Camilla S Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| |
Collapse
|
13
|
Kombe F. Enhancing quality and integrity in biomedical research in Africa: an international call for greater focus, investment and standardisation in capacity strengthening for frontline staff. BMC Med Ethics 2015; 16:77. [PMID: 26567112 PMCID: PMC4643532 DOI: 10.1186/s12910-015-0071-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/09/2015] [Indexed: 12/05/2022] Open
Abstract
The integrity of biomedical research depends heavily on the quality of research data collected. In turn, data quality depends on processes of data collection, a task undertaken by frontline research staff in many research programmes in Africa and elsewhere. These frontline research staff often have additional responsibilities including translating and communicating research in local languages, seeking informed consent for study participation and maintaining supportive relationships between research institutions and study participants and wider communities. The level of skills that fieldworkers need to undertake these responsibilities clearly affects the quality of data collected, the ethics of research ‘on the ground’ and the short and long term acceptability of research. We organised an international workshop in Kenya in July 2014 to discuss the role of frontline staff in scientific research. A total of 25 field managers from 9 African countries and the UK met for 2.5 days to discuss the relationship between data quality and institutional performance management systems and how they affect career progression and supportive supervision policies of research frontline staff. From this workshop, and supporting an expanding literature on the role of fieldworkers in international health research, participants agreed that fieldworkers’ roles present them with practical and ethical challenges that their routine training does not adequately prepare them for. We argue that the common and complex challenges facing fieldworkers should in part be addressed through increased investment and collaborative agreements across types of research institutions in Africa. We call for standardization of core elements of training for this critically important cadre of research staff who perform similar roles and encounter similar challenges in many African settings. Although many valuable training elements are offered in institutions, there is a need to develop broader, more grounded and innovative strategies to address complex realities for fieldworkers, and support the integrity and ethics of health research in these settings.
Collapse
Affiliation(s)
| | - Francis Kombe
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
| |
Collapse
|
14
|
McPake B, Edoka I, Witter S, Kielmann K, Taegtmeyer M, Dieleman M, Vaughan K, Gama E, Kok M, Datiko D, Otiso L, Ahmed R, Squires N, Suraratdecha C, Cometto G. Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Bull World Health Organ 2015; 93:631-639A. [PMID: 26478627 PMCID: PMC4581637 DOI: 10.2471/blt.14.144899] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 03/05/2015] [Accepted: 06/19/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. METHODS Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value. FINDINGS The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective. CONCLUSION Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.
Collapse
Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Ijeoma Edoka
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Sophie Witter
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Karina Kielmann
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | | | | | - Elvis Gama
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Maryse Kok
- Royal Tropical Institute, Amsterdam, Netherlands
| | - Daniel Datiko
- REACHOUT, Hidase Hulentenawi Agelglot Yebego Adragot Mahber, Awassa, Ethiopia
| | | | - Rukhsana Ahmed
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Neil Squires
- Public Health England, North of England Region, England
| | - Chutima Suraratdecha
- United States Agency for International Development, Washington, DC, United States of America
| | - Giorgio Cometto
- Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland
| |
Collapse
|
15
|
Barogui YT, Sopoh GE, Johnson RC, de Zeeuw J, Dossou AD, Houezo JG, Chauty A, Aguiar J, Agossadou D, Edorh PA, Asiedu K, van der Werf TS, Stienstra Y. Contribution of the community health volunteers in the control of Buruli ulcer in Bénin. PLoS Negl Trop Dis 2014; 8:e3200. [PMID: 25275562 PMCID: PMC4183479 DOI: 10.1371/journal.pntd.0003200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. Methodology/Principal Findings In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. Conclusions/Significance This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU. Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually, the number of patients presenting with ulcers in an advanced stage is high. This complicates treatment and increases the risk of disabilities. The disease is endemic mainly in West Africa. The primary strategy for control is early detection using community village volunteers. In Bénin, data was collected to understand the role of the different referral systems on the stage of disease at presentation in the hospital and the diagnostic precision. About a quarter of the patients were referred to the hospital by the community health volunteers. Community health volunteers referred patients more frequently in an earlier stage of disease. The PCR confirmation rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. We found that community health volunteers played an important role in the referral system of BU patients in Bénin. This information is relevant for health care programs attempting to control BU but may also be relevant for health care programs working on other diseases in areas with restricted resources.
Collapse
Affiliation(s)
- Yves Thierry Barogui
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Lalo, Ministère de la Santé, Cotonou, Bénin
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ghislain Emmanuel Sopoh
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Roch Christian Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Janine de Zeeuw
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ange Dodji Dossou
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Jean Gabin Houezo
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Annick Chauty
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Pobè, Ministère de la Santé, Cotonou, Bénin
| | - Julia Aguiar
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Zangnanado, Ministère de la Santé, Cotonou, Bénin
| | - Didier Agossadou
- Programme National de Lutte Contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | - Patrick A. Edorh
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
16
|
Marshall PA, Adebamowo CA, Adeyemo AA, Ogundiran TO, Strenski T, Zhou J, Rotimi CN. Voluntary participation and comprehension of informed consent in a genetic epidemiological study of breast cancer in Nigeria. BMC Med Ethics 2014; 15:38. [PMID: 24885380 PMCID: PMC4032563 DOI: 10.1186/1472-6939-15-38] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 05/01/2014] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Studies on informed consent to medical research conducted in low or middle-income settings have increased, including empirical investigations of consent to genetic research. We investigated voluntary participation and comprehension of informed consent among women involved in a genetic epidemiological study on breast cancer in an urban setting of Nigeria comparing women in the case and control groups. METHODS Surveys were administered in face-to-face interviews with 215 participants following their enrollment in the genetic study (106 patients, 109 controls). Audio-taped in-depth interviews were conducted with a sub-sample of 17 (8%) women who completed the survey. RESULTS The majority of all participants reported being told that participation in the genetic study was voluntary (97%), that they did not feel pressured to participate in the study (99%), and that they could withdraw from the study (81%). The majority of the breast cancer patients (83%) compared to 58% of women in the control group reported that the study purpose was to learn about the genetic inheritance of breast cancer (OR 3.44; 95% CI =1.66, 7.14, p value = 0.001). Most participants reported being told about study procedures (95%) and study benefits (98%). Sixty-eight percent of the patients, compared to 47% of the control group reported being told about study risks (p-value <0.001). Of the 165 married women, 19% reported asking permission from their husbands to enroll in the breast cancer study; no one sought permission from local elders. In-depth interviews highlight the use of persuasion and negotiation between a wife and her husband regarding study participation. CONCLUSIONS The global expansion of genetic and genomic research highlights our need to understand informed consent practices for studies in ethnically diverse cultural environments such as Africa. Quantitative and qualitative empirical investigations of the informed consent process for genetic and genomic research will further our knowledge of complex issues associated with communication of information, comprehension, decisional authority and voluntary participation. In the future, the development and testing of innovative strategies to promote voluntary participation and comprehension of the goals of genomic research will contribute to our understanding of strategies that enhance the consent process.
Collapse
Affiliation(s)
- Patricia A Marshall
- Department of Bioethics, School of Medicine, Room TA 227Case Western Reserve University10900 Euclid Avenue Cleveland, Ohio 44106-4976 Cleveland, USA
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center of the University of Maryland School of Medicine, Baltimore Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD 21201, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
| | - Temidayo O Ogundiran
- Division of Oncology, Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - Teri Strenski
- Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL 60611, USA
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
| |
Collapse
|
17
|
Massawe IS, Lusingu JP, Manongi RN. Community perception on biomedical research: A case study of malariometric survey in Korogwe District, Tanga Region, Tanzania. BMC Public Health 2014; 14:385. [PMID: 24755404 PMCID: PMC4000435 DOI: 10.1186/1471-2458-14-385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/15/2014] [Indexed: 12/02/2022] Open
Abstract
Background Community perception in biomedical research remains critical in Africa with many participants being driven by different motives. The objective of this study was to explore the perceived motives for women or females guardians to volunteer for their children to participate in biomedical research and to explore experiences and challenges faced by Community Owned Resource Persons (CORPs) when mobilizing community members to participate in biomedical research. Methods This cross sectional study was conducted in Korogwe district, in north-eastern Tanzania. Qualitative methods combining random and purposive sampling techniques were used for data collection. A randomly selected sample using random table method from the existing list of households in the ward office was used to select participants for Focus Group Discussions (FGDs). A purposive sampling technique was used for In-Depth Interviews (IDIs) with CORPs. Thematic framework analysis was used to analyze the data. Results Need for better health services, availability of qualified clinicians, and better access to services provided at the research points were reported as main motives for community members to participate in biomedical research. With regard to experience and challenges faced by CORPs, the main reasons for mothers and guardians not participating in biomedical research were linked to misconception of the malariometric surveys, negative perception of the validity and sensitivity of rapid diagnostic tests, fear of knowing Human Immunodeficiency Virus Infection (HIV)/Acquired Immune Deficiency Syndrome (HIV/AIDS) sero status, and lack of trust for the medical information provided by the CORPs. Challenges reported by CORPs included lack ofawareness of malariometric surveys among participants, time consumption in mobilization of the community, difficulties in identifying individual results, and family responsibilities. Conclusion This study has shown that majority of community members had positive perceptions of the about malariometric surveys services provided. The availability of free health services was the major determining factor for community members’ participation in malariometric surveys. CORPs are instrumental in mobilizing community members participation during malariometric surveys, despite their experiences and the challenges they face.
Collapse
Affiliation(s)
- Isolide S Massawe
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania.
| | | | | |
Collapse
|
18
|
Angwenyi V, Kamuya D, Mwachiro D, Kalama B, Marsh V, Njuguna P, Molyneux S. Complex realities: community engagement for a paediatric randomized controlled malaria vaccine trial in Kilifi, Kenya. Trials 2014; 15:65. [PMID: 24565019 PMCID: PMC3974049 DOI: 10.1186/1745-6215-15-65] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 02/07/2014] [Indexed: 01/22/2023] Open
Abstract
Background Community engagement (CE) is increasingly promoted for biomedical research conducted in resource poor settings for both intrinsic and instrumental purposes. Given the potential importance of CE, but also complexities and possibility of unexpected negative outcomes, there is need for more documentation of CE processes in practice. We share experiences of formal CE for a paediatric randomized controlled malaria vaccine trial conducted in three sites within Kilifi County, Kenya. Methods Social scientists independent of the trial held in-depth individual interviews with trial researchers (n = 5), community leaders (n = 8) and parents (15 with enrolled children and 4 without); and group discussions with fieldworkers (n = 6) and facility staff (n = 2). We conducted a survey of participating households (n = 200) and observed over 150 CE activities. Results The overall CE plan was similar across the three study sites, although less community-based information in site C. Majority perceived CE activities to clear pre-existing concerns and misconceptions; increase visibility, awareness of and trust in trial staff. Challenges included: some community leaders attempting to exert pressure on people to enrol; local wording in information sheets and consent forms feeding into serious anxieties about the trial; and concerns about reduced CE over time. Negative effects of these challenges were mitigated through changes to on-going CE activities, and final information sharing and consent being conducted individually by trained clinical staff. One year after enrolment, 31% (n = 62) of participants’ parents reported malaria prevention as the main aim of the activities their children were involved in, and 93% wanted their children to remain involved. Conclusion The trial teams’ goals for CE were relatively clear from the outset. Other actors’ hopes and expectations (like higher allowances and future employment) were not openly discussed, but emerged over the course of engagements. Encouraging open discussion of all actors’ intentions and goals from the outset takes time, risks raising expectations that cannot be met, and is complex. However, doing so in future similar trials may allow successes here to be built upon, and some challenges minimized or avoided. Trial registration ClinicalTrials.gov NCT00866619 (registration 19-Mar-2009).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sassy Molyneux
- The Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, P,O, Box, 230-80108, Kilifi, Kenya.
| |
Collapse
|