1
|
Mattingly TJ, Baquet CR, Lance F, Medeiros M, Mullins CD. Community-Academic Partnerships for Health Research: An Iterative and Transparent Process of Patient Engagement Before the Research Begins. Ethn Dis 2024; 34:53-59. [PMID: 38973801 PMCID: PMC11223035 DOI: 10.18865/ed.34.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background The root causes of coronavirus disease 2019 (COVID-19) disparities include longstanding systemic racial bias in economic advancement and care delivery, discrimination, lack of access, and social determinants of health. To address these causes, research institutions and health care systems must shift their lens from one that focuses solely on changing behaviors among underserved and vulnerable populations to one that is inward facing. Methods We worked with a community advisory board and an African American church that has partnered on research for more than a decade to identify community norms, needs, and key resources needed for establishing community-academic partnerships for COVID-19 testing. Participants were purposefully sampled with equal representation from 3 groups: (1) church members and leaders, (2) academic or organization researchers with experience in community-engaged research, and (3) community members with experience participating in community-engaged research. Participants engaged in a hands-on exercise in the church basement as part of a town hall-style meeting. Results Active discussion led to the identification of business model components salient to COVID-19 testing in an underserved Baltimore community, predominantly made up of African Americans. Our discussion identified key partners, activities, resources, costs, value propositions, community relationships, community groups, communication channels, and outputs for community buy-in. Conclusion Developing the business case for mutual trustworthiness to be better prepared for future pandemics and public health crises may foster more sustainable community-academic partnerships. Using a Business Model Canvas, we delineate the major components, activities, and value propositions that are needed to achieve authentic community-academic partnerships to advance health equity.
Collapse
Affiliation(s)
- T. Joseph Mattingly
- PATIENTS Program, Baltimore, MD
- University of Maryland School of Pharmacy, Baltimore, MD
- University of Utah College of Pharmacy, Salt Lake City, UT
| | - Claudia Rose Baquet
- PATIENTS Program, Baltimore, MD
- University of Maryland School of Pharmacy, Baltimore, MD
- Hope Institute, LLC, Columbia, MD
| | - Franklin Lance
- Mount Lebanon Baptist Church, Baltimore, MD
- Parks & People, Inc., Baltimore, MD
| | - Michelle Medeiros
- PATIENTS Program, Baltimore, MD
- University of Maryland School of Pharmacy, Baltimore, MD
| | - C. Daniel Mullins
- PATIENTS Program, Baltimore, MD
- University of Maryland School of Pharmacy, Baltimore, MD
| |
Collapse
|
2
|
Roy E, Chino F, King B, Madu C, Mattes M, Morrell R, Pollard-Larkin J, Siker M, Takita C, Ludwig M. Increasing Diversity of Patients in Radiation Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2023; 116:103-114. [PMID: 36526234 PMCID: PMC10414211 DOI: 10.1016/j.ijrobp.2022.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Radiation oncology clinical trials lack full representation of the ethnic and racial diversity present in the general United States and in the cancer patient population. There are low rates of both recruitment and enrollment of individuals from underrepresented ethnic and racial backgrounds, especially Black and Hispanic patients, people with disabilities, and patients from underrepresented sexual and gender groups. Even if approached for enrollment, barriers such as mistrust in medical research stemming from historical abuse and contemporary biased systems, low socioeconomic status, and lack of awareness prohibit historically marginalized populations from participating in clinical trials. In this review, we reflect on these specific barriers and detail approaches to increase diversity of the patient population in radiation oncology clinical trials to better reflect the communities we serve. We hope that implementation of these approaches will increase the diversity of clinical trials patient populations in not only radiation oncology but also other medical specialties.
Collapse
Affiliation(s)
- Emily Roy
- Baylor College of Medicine, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin King
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chika Madu
- Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York
| | - Malcolm Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rosalyn Morrell
- Advanced Radiation Center of Beverly Hills, Beverly Hills, California
| | | | - Malika Siker
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christiane Takita
- Department of Radiation Oncology, Miami University School of Medicine, Miami, Florida
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
3
|
Robertson C, Woods A, Bergstrand K, Findley J, Balser C, Slepian MJ. Diverse patients' attitudes towards Artificial Intelligence (AI) in diagnosis. PLOS DIGITAL HEALTH 2023; 2:e0000237. [PMID: 37205713 DOI: 10.1371/journal.pdig.0000237] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/20/2023] [Indexed: 05/21/2023]
Abstract
Artificial intelligence (AI) has the potential to improve diagnostic accuracy. Yet people are often reluctant to trust automated systems, and some patient populations may be particularly distrusting. We sought to determine how diverse patient populations feel about the use of AI diagnostic tools, and whether framing and informing the choice affects uptake. To construct and pretest our materials, we conducted structured interviews with a diverse set of actual patients. We then conducted a pre-registered (osf.io/9y26x), randomized, blinded survey experiment in factorial design. A survey firm provided n = 2675 responses, oversampling minoritized populations. Clinical vignettes were randomly manipulated in eight variables with two levels each: disease severity (leukemia versus sleep apnea), whether AI is proven more accurate than human specialists, whether the AI clinic is personalized to the patient through listening and/or tailoring, whether the AI clinic avoids racial and/or financial biases, whether the Primary Care Physician (PCP) promises to explain and incorporate the advice, and whether the PCP nudges the patient towards AI as the established, recommended, and easy choice. Our main outcome measure was selection of AI clinic or human physician specialist clinic (binary, "AI uptake"). We found that with weighting representative to the U.S. population, respondents were almost evenly split (52.9% chose human doctor and 47.1% chose AI clinic). In unweighted experimental contrasts of respondents who met pre-registered criteria for engagement, a PCP's explanation that AI has proven superior accuracy increased uptake (OR = 1.48, CI 1.24-1.77, p < .001), as did a PCP's nudge towards AI as the established choice (OR = 1.25, CI: 1.05-1.50, p = .013), as did reassurance that the AI clinic had trained counselors to listen to the patient's unique perspectives (OR = 1.27, CI: 1.07-1.52, p = .008). Disease severity (leukemia versus sleep apnea) and other manipulations did not affect AI uptake significantly. Compared to White respondents, Black respondents selected AI less often (OR = .73, CI: .55-.96, p = .023) and Native Americans selected it more often (OR: 1.37, CI: 1.01-1.87, p = .041). Older respondents were less likely to choose AI (OR: .99, CI: .987-.999, p = .03), as were those who identified as politically conservative (OR: .65, CI: .52-.81, p < .001) or viewed religion as important (OR: .64, CI: .52-.77, p < .001). For each unit increase in education, the odds are 1.10 greater for selecting an AI provider (OR: 1.10, CI: 1.03-1.18, p = .004). While many patients appear resistant to the use of AI, accuracy information, nudges and a listening patient experience may help increase acceptance. To ensure that the benefits of AI are secured in clinical practice, future research on best methods of physician incorporation and patient decision making is required.
Collapse
Affiliation(s)
- Christopher Robertson
- University of Arizona, Tucson, Arizona, United States of America
- Boston University, Boston, Massachusetts, United States of America
| | - Andrew Woods
- University of Arizona, Tucson, Arizona, United States of America
| | - Kelly Bergstrand
- University of Texas at Arlington, Arlington Texas, United States of America
| | - Jess Findley
- University of Arizona, Tucson, Arizona, United States of America
| | - Cayley Balser
- University of Arizona, Tucson, Arizona, United States of America
| | - Marvin J Slepian
- University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
4
|
Makarovs K, Allum N. Social identity and racial disparities in science literacy. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:373-388. [PMID: 36647715 PMCID: PMC10074749 DOI: 10.1177/09636625221141378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research on African-Americans' relationship with science, while relatively sparse, in general suggests higher levels of alienation than among their White counterparts, whether in the form of less positive attitudes to science, or lower scientific literacy. In this article, we leverage social identity theory to examine the role of racial social identity and ingroup evaluation as putative mechanisms that produce these disparities. We use data from the General Social Survey, pooled over three waves, as the basis for our investigation. The results of the analysis indicate that, when controlling for other covariates, there is no statistically significant difference in the effect of racial self-identification on science knowledge among African-Americans and Whites. However, we provide evidence that the effect of favourable ingroup evaluation on science knowledge differs in these two groups, being more positive for African-Americans compared to Whites.
Collapse
Affiliation(s)
- Kirils Makarovs
- Kirils Makarovs, Faculty of Social and Behavioral
Sciences, University of Amsterdam, Nieuwe Achtergracht 166, 1018NW Amsterdam, The
Netherlands.
| | | |
Collapse
|
5
|
Núñez-Núñez M, Andrews JC, Fawzy M, Bueno-Cavanillas A, Khan KS. Research integrity in clinical trials: innocent errors and spin versus scientific misconduct. Curr Opin Obstet Gynecol 2022; 34:332-339. [PMID: 35895940 DOI: 10.1097/gco.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW High-quality research underpins the best healthcare practice. This article focuses on analyzing the current literature to promote research integrity across clinical trials. RECENT FINDINGS Recent admissions of questionable practices by researchers have undermined practitioner and public confidence. There is limited evidence specifically for ethical and professional standards in clinical trials to guide researchers and institutions to embed integrity into research practice. SUMMARY Unintentional errors and spin in research are not uncommon as training in design and conduct of clinical trials is not part of health education for medical and allied health professions. There is unfamiliarity with procedures, such as prospective registration, a priori documentation of statistical analysis plans, openness in data sharing, and so forth. This, combined with the academic culture of secrecy, has led to an environment where scientific suspicion, instead of trust, is the norm. Existing science integrity documents are devoid of specific recommendations about how to translate any guidance into clinical trial practice. There is a need for constructive, supportive and multidisciplinary approaches based on open dialogue and continuous training, targeting the research environment. Research integrity now needs to take centre stage to re-instill confidence in randomized trial evidence to inform clinical practice.
Collapse
Affiliation(s)
- María Núñez-Núñez
- Clínico San Cecilio Clinical University Hospital, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
- Biosanitary Research Institute of Granada (Ibs.Granada), Granada, Spain
| | | | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Egypt
| | - Aurora Bueno-Cavanillas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
- Biosanitary Research Institute of Granada (Ibs.Granada), Granada, Spain
| | - Khalid Saeed Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
| |
Collapse
|
6
|
Lewis MA, Uhrig JD, Adams ET, Brown JA, Sanders A. Engagement marketing for social good: Application to the All of Us Research Program. Front Genet 2022; 13:889195. [PMID: 36993788 PMCID: PMC10041337 DOI: 10.3389/fgene.2022.889195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/06/2022] [Indexed: 03/16/2023] Open
Abstract
Engagement marketing, when applied to increasing the social good, involves making a deliberate effort to engage communities with an organization’s brand that might not have otherwise happened organically. Organizations that typically focus on increasing the social good include non-profits, community organizations, public health departments, and federal, state, and local agencies. Engagement marketing builds relationships, gives a voice to, and fosters collaboration with community members to transform their insights into impactful experiences that motivate and empower them to act to increase the social good. These actions may include making an informed decision, changing a health or prosocial behavior, or joining an effort that promotes or increases social good. In this paper, we translate the commercial engagement marketing approach, typically used, and studied widely to increase profits, to one that uses engagement marketing to increase prosocial outcomes. We propose a new definition of engagement marketing applied to the social good, a multi-level conceptual framework that integrates individual, social, community and macro-level processes and outcomes, and illustrates an example applying this translated model to co-create digital engagement experiences using a human centered design approach for the All of Us Research Program. This model can also guide research and practice related to DNA-based population screening.
Collapse
|
7
|
Dee EC, Pierce LJ, Winkfield KM, Lam MB. In pursuit of equity in cancer care: moving beyond the Affordable Care Act. Cancer 2022; 128:3278-3283. [PMID: 35818772 DOI: 10.1002/cncr.34346] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
Although Medicaid Expansion under the Patient Protection and Affordable Care Act (ACA) has been associated with many improvements for patients with cancer, Snyder et al. provide evidence demonstrating the persistence of racial disparities in cancer. This Editorial describes why insurance coverage alone does not ensure access to health care, highlights various manifestations of structural racism that constitute barriers to access beyond the direct costs of care, and calls for not just equality, but equity, in cancer care.
Collapse
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Nichol AA, Mwaka ES, Luyckx VA. Ethics in Research: Relevance for Nephrology. Semin Nephrol 2021; 41:272-281. [PMID: 34330367 DOI: 10.1016/j.semnephrol.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research is crucial to progress in nephrology. It is important that studies are conducted rigorously from the scientific perspective, as well as in adherence to ethical standards. Traditional clinical research places a high value on individual research subject autonomy. Research questions often include the clinical effectiveness of new interventions studied under highly controlled conditions. Such research has brought the promise of new game-changers in nephrology, such as the sodium-glucose cotransporter 2 inhibitors. Implementation research takes such knowledge further and investigates how to translate it into broader-scale policy and practice, to achieve swift and global uptake, with a focus on justice and equity. Newer challenges arising globally in research ethics include those relating to oversight of innovation, biobanking and big data, human-challenge studies, and research during emergencies. This article details the history of clinical research ethics and the role of research ethics committees, describes the evolving spectrum of biomedical research in human medicine, and presents emerging clinical research ethics issues using illustrative examples and a hypothetical case study. It is imperative that researchers and research ethics committees are well versed in the ethical principles of all forms of human research such that research is conducted to the highest standards and that effective interventions can be implemented at scale as rapidly as possible.
Collapse
Affiliation(s)
- Ariadne A Nichol
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Erisa S Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
9
|
Tomić V, Buljan I, Marušić A. Perspectives of key stakeholders on essential virtues for good scientific practice in research areas. Account Res 2021; 29:77-108. [PMID: 33719790 DOI: 10.1080/08989621.2021.1900739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In contrast to the principle-based approach to ethics and research integrity (ERI) training, which stresses the importance of following moral rules, the virtue-based approach focuses on developing good character traits. This study has aimed to explore what virtues mean in scientific practice and their suitable place in ERI training, using a qualitative approach. Two face-to-face focus group discussions were conducted with 21 participants. Heterogeneous purposive sampling was used to reach participants from different countries, organization types (academia, research, publishing, private sector), scientific disciplines and stages of their scientific careers. Data generated during the focus group discussions were analyzed using a reflexive thematic analysis approach, and three main themes were developed. The first theme addressed the relativity of virtue meanings because the participants differed in their definitions and understandings of the concept of virtue. The second theme referred to the acquisition of virtues through social interactions because participants saw virtues mostly as social constructs acquired through socialization and education. The third theme addressed the differences in the importance of particular virtues in research. Participants felt that particular virtues were more important than others because some of them are necessary for responsible research, and some are not.
Collapse
Affiliation(s)
- Vicko Tomić
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Split, Croatia
| | - Ivan Buljan
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Split, Croatia
| |
Collapse
|
10
|
Wadhwani SI, Brokamp C, Rasnick E, Bucuvalas JC, Lai JC, Beck AF. Neighborhood socioeconomic deprivation, racial segregation, and organ donation across 5 states. Am J Transplant 2021; 21:1206-1214. [PMID: 32654392 PMCID: PMC8191504 DOI: 10.1111/ajt.16186] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Abstract
One in 10 people die awaiting transplantation from donor shortage. Only half of Americans register as organ donors. In this cross-sectional study, we evaluated population-level associations of neighborhood socioeconomic deprivation and racial segregation on organ donor registration rates. We analyzed state identification card demographic and organ donor registration data from 5 states to estimate the association between a neighborhood socioeconomic deprivation index (range [0, 1]; higher values indicate more deprivation) and a racial index of concentration at the extreme (ICE) (range [-1, 1]; lower values indicate predominantly black neighborhoods, higher values indicate predominantly white neighborhoods) on organ donor registration rates within a specified geography (census tract or ZIP code tabulation area [ZCTA]). Among 26 720 738 registrants, 32% of the sample were registered organ donors. At the census tract level, with each 0.1 decrease in the deprivation index, the organ donor registration rate increased by 6.8% (95% confidence interval [CI]: 6.6%, 7.0%). With each 0.1 increase in the racial ICE, the rate increased by 1.5% (95% CI: 1.5%, 1.6%). These associations held true at the ZCTA level. Areas with less socioeconomic deprivation and a higher concentration of white residents have higher organ donor registration rates. Public health initiatives should consider neighborhood context and novel data sources in designing optimal intervention strategies.
Collapse
Affiliation(s)
- Sharad I. Wadhwani
- University of California, San Francisco; San Francisco, CA,Cincinnati Children’s Hospital Medical Center; Cincinnati, OH
| | - Cole Brokamp
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH,University of Cincinnati College of Medicine; Cincinnati, OH
| | - Erika Rasnick
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH
| | - John C. Bucuvalas
- Icahn School of Medicine at Mount Sinai; New York, NY,Kravis Children’s Hospital at Mount Sinai; New York, NY
| | | | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH,University of Cincinnati College of Medicine; Cincinnati, OH
| |
Collapse
|
11
|
Brincks AM, Shiu-Yee K, Metsch LR, del Rio C, Schwartz RP, Jacobs P, Osorio G, Sorensen JL, Feaster DJ. Physician Mistrust, Medical System Mistrust, and Perceived Discrimination: Associations with HIV Care Engagement and Viral Load. AIDS Behav 2019; 23:2859-2869. [PMID: 30879211 DOI: 10.1007/s10461-019-02464-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Medical mistrust is an important risk factor for many health outcomes. For individuals with HIV and substance use co-morbidities, mistrust may influence engagement with health care, and affect overall health and transmission risk. Medical mistrust can be measured by an individual's mistrust of his/her physician, or mistrust of the medical system. This study examined both types of mistrust among 801 substance-using individuals with uncontrolled HIV infection. The aims were to determine how physician mistrust, medical system mistrust, and discrimination experiences were associated with engagement in HIV primary care. Findings indicated higher levels of physician mistrust, but not medical system mistrust, were associated with a longer time since the last visit to an HIV provider. Longer time since seeing an HIV care provider was associated with higher viral load. This study refines our understanding of the relationship between mistrust and HIV care engagement for a large, diverse sample of substance-using individuals.
Collapse
|
12
|
Govender P, Naidoo D, Naidoo U. Participant incentives in rehabilitation research: a pilot study of researchers' perspectives. Afr Health Sci 2019; 19:2778-2783. [PMID: 32127851 PMCID: PMC7040259 DOI: 10.4314/ahs.v19i3.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the use of research incentives in the recruitment and retention of participants for research studies, there remains debate over the acceptable use of participant incentives in research. There appears to be a paucity of guidelines that can assist researchers in demonstrating practically how incentives may be ethically used in research. OBJECTIVE This single site pilot study explored the experiences of key stakeholders involved in rehabilitation research to highlight what may constitute acceptable practices for incentives. METHODS A qualitative inquiry with use of semi-structured interviews with four key informants from a single site was undertaken. Data was audio-recorded and analysed thematically using deductive reasoning. RESULTS The findings reflect a description of what incentives constitute; the issues around undue inducement and use of incentives in practice. Participants' offered their perceptions on perceived acceptable versus unacceptable practices in the use incentives in research. Participants shared their concern over research incentives being used to sway participation in research rather than reimburse participants for their expenses or offering a token of appreciation. CONCLUSION There is a need for education of practitioners and researchers to develop skill to aid researchers to evaluate the ethical dilemmas related to the use of incentives in research.
Collapse
Affiliation(s)
- Pragashnie Govender
- University of KwaZulu Natal (Westville campus)-School of Health Sciences, Private Bag x54001 Durban 4000, Westville, KwaZulu-Natal 4052, South Africa
| | - Deshini Naidoo
- University of KwaZulu Natal (Westville campus)-School of Health Sciences, Private Bag x54001 Durban 4000, Westville, KwaZulu-Natal 4052, South Africa
| | - Urisha Naidoo
- University of KwaZulu Natal (Westville campus)-School of Health Sciences, Private Bag x54001 Durban 4000, Westville, KwaZulu-Natal 4052, South Africa
| |
Collapse
|
13
|
Driving Miss Evers' Boys to the Historical Tuskegee Study of Untreated Syphilis. J Natl Med Assoc 2019; 111:371-382. [PMID: 30853113 DOI: 10.1016/j.jnma.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
The Tuskegee Study of Untreated Syphilis (TSUS) intersects racial and research ethics discourse in medicine and public health. Miss Evers' Boys is a fictionalized play of the 40-year TSUS. In 2016, the Cultural Programs of the National Academy of Sciences and the Shakespeare Theatre Company in Washington, DC co-sponsored a reading of the play at the National Academy of Sciences Auditorium. Ethics instructors and students, who may use the play for research training and professional development, may lack awareness of a pattern of deviations from the TSUS historical record. This may compromise what instructors and students teach and learn, respectively. Historical analysis revealed that the playbill-handed to play patrons-had challenges in the core arguments about the TSUS, particularly the notion of "bad blood." A broad collection of documents from a variety of sources-documents concurrent with the TSUS-illustrated how the term, "bad blood" was used. Bad blood was syphilis and syphilis was bad blood. "Bad blood as syphilis," in post-hoc reviews, was suppressed and nullified. In another area, the focus on the denial of penicillin at the Birmingham Rapid Treatment Center (RTC)-an important scene in the play and the history of the TSUS-exposed conflicts with the historical record. The origin and the devices that developed this image also were disclosed. The article specifically exposed, unraveled, analyzed, and challenged other misinformation and paradigm-defining misconduct. The TSUS narrative requires correction by the responsible historical and ethical communities, changing what is taught about the TSUS and Miss Evers' Boys. This is critically important in academic research training and professional development. If left unchallenged, the faulty TSUS scholarship-coupled with Miss Evers' Boys-fuels and reinforces the incorrect standard narratives of the TSUS and their impact on the history of the TSUS. This is especially true regarding what the TSUS men were told about their diagnosis-bad blood and not syphilis-and the denial of "a hip shot of that penicillin" at the RTC.
Collapse
|
14
|
Abstract
Mistrust of medical advances and the medical professions continues to persist, and is perhaps increasing. The popular press has documented the growing number of parents globally whose concerns around childhood vaccination, albeit based on faulty scientific information, has led to the anti-vax movement which has already resulted in outbreaks of measles in various parts of the U.S. In recent years, the AIDS Healthcare Foundation has increased speculation and mistrust with regard to the denialism of the effectiveness of pre-exposure prophylaxis (PrEP) to avert HIV infections, again based on misinformation. However, in other cases, medical mistrust reflects the very real historical and ongoing injustices experienced by socially and economically marginalized groups. Whether the genesis of the mistrust is based on fact or fallacy, the results may be similar. There are myriad negative consequences associated with medical mistrust, including lower utilization of healthcare and poorer management of health conditions. Mistrust is thought to provide a partial explanation for staggering health disparities, particularly among Black and African American people, and much of the public health and medical literature cites the infamous Tuskegee Study as a main catalyst for this persistent health-related mistrust among people of color and other groups who experience social and economic vulnerability. While mistrust is often referred to as a phenomenon existing within an individual or community, we must rethink this conceptualization and instead locate mistrust as a phenomenon created by and existing within a system that creates, sustains and reinforces racism, classism, homophobia and transphobia, and stigma. The purpose of this article is to briefly address the state of the medical mistrust literature, and to provide a summary of the articles included in this special issue on medical mistrust. Although the scholarship in this issue addresses diverse methodologies, outcomes and populations, they share a message: social inequality drives mistrust.
Collapse
Affiliation(s)
- Jessica Jaiswal
- Department of Health Science, University of Alabama, Russell Hall, Box 870311, Tuscaloosa, AL 35487,Center for Health, Behavior, Identity and Prevention Studies, Rutgers University,Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT 06510
| | - Perry N. Halkitis
- Center for Health, Behavior, Identity and Prevention Studies, Rutgers University,Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West Piscataway, NJ 08854,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854,Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway Township, NJ 08854,School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102
| |
Collapse
|
15
|
Dee J, Garcia Calleja JM, Marsh K, Zaidi I, Murrill C, Swaminathan M. HIV Surveillance Among Pregnant Women Attending Antenatal Clinics: Evolution and Current Direction. JMIR Public Health Surveill 2017; 3:e85. [PMID: 29208587 PMCID: PMC5736873 DOI: 10.2196/publichealth.8000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022] Open
Abstract
Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data.
Collapse
Affiliation(s)
- Jacob Dee
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Kimberly Marsh
- Strategic Information and Monitoring Division, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Irum Zaidi
- Office of the US Global AIDS Coordinator, Washington, DC, United States
| | - Christopher Murrill
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mahesh Swaminathan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
16
|
Goodwin MA, Stange KC, Zyzanski SJ, Crabtree BF, Borawski EA, Flocke SA. The Hawthorne effect in direct observation research with physicians and patients. J Eval Clin Pract 2017; 23:1322-1328. [PMID: 28752911 PMCID: PMC5741487 DOI: 10.1111/jep.12781] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES This study examines the degree to which a "Hawthorne effect" alters outpatient-visit content. METHODS Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. RESULTS Visits on the first versus the second observation day were longer by an average of 1 minute (P < .001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. CONCLUSIONS In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.
Collapse
Affiliation(s)
- Meredith A Goodwin
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kurt C Stange
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, Department of Sociology, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen J Zyzanski
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin F Crabtree
- Department of Family Medicine, Rutgers University, New Brunswick, New Jersey, USA
| | - Elaine A Borawski
- Prevention Research Center for Healthy Neighborhoods and Department of Epidemiology and Biostatistics, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan A Flocke
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, Prevention Research Center for Healthy Neighborhoods and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
17
|
Shaw S, Boynton PM, Greenhalgh T. Research Governance: Where did it Come From, What Does it Mean? J R Soc Med 2017; 98:496-502. [PMID: 16260798 PMCID: PMC1275997 DOI: 10.1177/014107680509801110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For a variety of historical and social reasons, research has become increasingly formalized and regulated. This change has potential benefits (reduction in fraud and misconduct, protection of vulnerable groups, financial probity) but also disadvantages (increased paperwork, time delays, constraints on research freedom). The terms ‘research’ and ‘governance’ mean different things in different contexts. Even with explicit guidance, ambiguities must be resolved by human judgement. Variation in the nature and outcome of approval decisions is therefore a fact of life. The type of approval needed for a research study depends on the official remit of the approval body, the question to be addressed; the methods to be used; the context in which the work will take place; the level of analysis and interpretation; and the plans for how the findings will be presented and used.
Collapse
Affiliation(s)
- Sara Shaw
- Open Learning Unit, Department of Primary Care and Population Sciences, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, UK.
| | | | | |
Collapse
|
18
|
Mathew SS, Barwell J, Khan N, Lynch E, Parker M, Qureshi N. Inclusion of diverse populations in genomic research and health services: Genomix workshop report. J Community Genet 2017; 8:267-273. [PMID: 28755064 DOI: 10.1007/s12687-017-0317-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/29/2017] [Indexed: 01/09/2023] Open
Abstract
Clinical genetic services and genomic research are rapidly developing but, historically, those with the greatest need are the least to benefit from these advances. This encompasses low-income communities, including those from ethnic minority and indigenous backgrounds. The "Genomix" workshop at the European Society of Human Genetics (ESHG) 2016 conference offered the opportunity to consider possible solutions for these disparities from the experiences of researchers and genetic healthcare practitioners working with underserved communities in the USA, UK and Australia. Evident from the workshop and corresponding literature is that a multi-faceted approach to engaging communities is essential. This needs to be complemented by redesigning healthcare systems that improves access and raises awareness of the needs of these communities. At a more strategic level, institutions involved in funding research, commissioning and redesigning genetic health services also need to be adequately represented by underserved populations with intrinsic mechanisms to disseminate good practice and monitor participation. Further, as genomic medicine is mainstreamed, educational programmes developed for clinicians should incorporate approaches to alleviate disparities in accessing genetic services and improving study participation.
Collapse
Affiliation(s)
- Savio S Mathew
- University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Julian Barwell
- Clinical Genetics Department, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Nasaim Khan
- Genomic medicine, St. Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Ella Lynch
- Melbourne Genomics Health Alliance, c/o WEHI, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| |
Collapse
|
19
|
Howell J. Race and U.S. medical experimentation: the case of Tuskegee. CAD SAUDE PUBLICA 2017; 33Suppl 1:e00168016. [PMID: 28492710 DOI: 10.1590/0102-311x00168016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022] Open
|
20
|
Beyond the Precautionary Principle: Protecting Public Health and the Environment in the Face of Uncertainty. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-26167-6_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
21
|
Konkel L. Racial and Ethnic Disparities in Research Studies: The Challenge of Creating More Diverse Cohorts. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:A297-302. [PMID: 26625444 PMCID: PMC4670264 DOI: 10.1289/ehp.123-a297] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
22
|
Paul C, Brookes B. The Rationalization of Unethical Research: Revisionist Accounts of the Tuskegee Syphilis Study and the New Zealand "Unfortunate Experiment". Am J Public Health 2015; 105:e12-9. [PMID: 26270295 PMCID: PMC4568718 DOI: 10.2105/ajph.2015.302720] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/04/2022]
Abstract
Two studies, widely condemned in the 1970s and 1980s-the Tuskegee study of men with untreated syphilis and the New Zealand study of women with untreated carcinoma in situ of the cervix-received new defenses in the 21st century. We noted remarkable similarities in both the studies and their defenses. Here we evaluate the scientific, political, and moral claims of the defenders. The scientific claims are largely based on incomplete or misinterpreted evidence and exaggeration of the uncertainties of science. The defenders' political arguments mistakenly claim that identity politics clouded the original critiques; in fact such politics opened the eyes of the public to exploitation. The moral defenses demonstrate an overreliance on codes of conduct and have implications for research ethics today.
Collapse
Affiliation(s)
- Charlotte Paul
- Charlotte Paul is emeritus professor in the Department of Preventive and Social Medicine and Barbara Brookes is with the Department of History and Art History, University of Otago, Dunedin, New Zealand
| | - Barbara Brookes
- Charlotte Paul is emeritus professor in the Department of Preventive and Social Medicine and Barbara Brookes is with the Department of History and Art History, University of Otago, Dunedin, New Zealand
| |
Collapse
|
23
|
Abstract
African Americans, compared to Whites, are starkly underrepresented in scientific and technological professions, are especially reluctant to participate as research subjects, and they express attitudes that are skeptical of science and scientific institutions. This article seeks to explain the racial gap in confidence in science (race being socially defined), putting to empirical test explanations suggested by research on human capital, inequality in educational opportunity, and culture. The results show that differential returns to schooling account for about a third of the racial divide, with various cultural mechanisms explaining most of the balance.
Collapse
Affiliation(s)
- Eric Plutzer
- The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
24
|
Mays VM. The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton's Apology. ETHICS & BEHAVIOR 2012; 22:411-418. [PMID: 23630410 PMCID: PMC3636721 DOI: 10.1080/10508422.2012.730808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the "cultural paranoia" of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform.
Collapse
Affiliation(s)
- Vickie M Mays
- Professor of Psychology and Health Services, Director, UCLA Center on Bridging Research, Innovation, Training and Education for Minority Health Disparities Solutions
| |
Collapse
|
25
|
Shonkoff JP. Leveraging the biology of adversity to address the roots of disparities in health and development. Proc Natl Acad Sci U S A 2012; 109 Suppl 2:17302-7. [PMID: 23045654 PMCID: PMC3477384 DOI: 10.1073/pnas.1121259109] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Extensive evidence that personal experiences and environmental exposures are embedded biologically (for better or for worse) and the cumulative knowledge of more than four decades of intervention research provide a promising opportunity to mobilize evolving scientific insights to catalyze a new era of more effective early childhood policy and practice. Drawing on emerging hypotheses about causal mechanisms that link early adversity with lifelong impairments in learning, behavior, and health, this paper proposes an enhanced theory of change to promote better outcomes for vulnerable, young children by strengthening caregiver and community capacities to reduce or mitigate the impacts of toxic stress, rather than simply providing developmental enrichment for the children and parenting education for their mothers.
Collapse
Affiliation(s)
- Jack P Shonkoff
- Center on Developing Child at Harvard University, Cambridge, MA 02138, USA.
| |
Collapse
|
26
|
Falusi AG, Olopade OI, Olopade CO. Establishment of a standing ethics/institutional review board in a nigerian university: a blueprint for developing countries. J Empir Res Hum Res Ethics 2012; 2:21-30. [PMID: 19385889 DOI: 10.1525/jer.2007.2.1.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AN ETHICS/INSTITUTIONAL REVIEW BOARD (IRB) was established according to International standards at the University of Ibadan in Nigeria. To achieve this, a private-public partnership was developed to support a review of prevailing practice and the development of necessary infrastructure for an effective IRB. An internationally registered and well-constituted IRB with a federal-wide assurance (FWA) from the National Institute of Health in the United States was established within a year. Over a 3-year period, the number of proposals reviewed increased by 150% while time to approval decreased by 62%. International collaboration and external research funding has increased substantially. These findings support our initial supposition that the development of a properly functioning IRB can be a catalyst for increased research productivity at academic centers in developing countries while ensuring the protection of vulnerable human research subjects. The University of Ibadan is now assisting other academic Institutions in Nigeria and sub-Saharan Africa with the establishment of their own IRBs.
Collapse
Affiliation(s)
- Adeyinka G Falusi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | | | | |
Collapse
|
27
|
|
28
|
Joynt G. Obtaining informed consent for clinical trials – Seldom easy, often difficult, and sometimes impossible. Int J Obstet Anesth 2012; 21:4-6. [DOI: 10.1016/j.ijoa.2011.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/24/2011] [Indexed: 11/27/2022]
|
29
|
Green BL, Li L, Morris JF, Gluzman R, Davis JL, Wang MQ, Katz RV. Detailed knowledge of the Tuskegee syphilis study: who knows what? A framework for health promotion strategies. HEALTH EDUCATION & BEHAVIOR 2011; 38:629-36. [PMID: 21482701 DOI: 10.1177/1090198110391529] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents' level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks' scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research.
Collapse
Affiliation(s)
- B Lee Green
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Jonassaint CR, Santos ER, Glover CM, Payne PW, Fasaye GA, Oji-Njideka N, Hooker S, Hernandez W, Foster MW, Kittles RA, Royal CD. Regional differences in awareness and attitudes regarding genetic testing for disease risk and ancestry. Hum Genet 2010; 128:249-60. [PMID: 20549517 PMCID: PMC2940428 DOI: 10.1007/s00439-010-0845-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 06/01/2010] [Indexed: 01/10/2023]
Abstract
Little is known about the lay public’s awareness and attitudes concerning genetic testing and what factors influence their perspectives. The existing literature focuses mainly on ethnic and socioeconomic differences; however, here we focus on how awareness and attitudes regarding genetic testing differ by geographical regions in the US. We compared awareness and attitudes concerning genetic testing for disease risk and ancestry among 452 adults (41% Black and 67% female) in four major US cities, Norman, OK; Cincinnati, OH; Harlem, NY; and Washington, DC; prior to their participation in genetic ancestry testing. The OK participants reported more detail about their personal ancestries (p = 0.02) and valued ancestry testing over disease testing more than all other sites (p < 0.01). The NY participants were more likely than other sites to seek genetic testing for disease (p = 0.01) and to see benefit in finding out more about one’s ancestry (p = 0.02), while the DC participants reported reading and hearing more about genetic testing for African ancestry than all other sites (p < 0.01). These site differences were not better accounted for by sex, age, education, self-reported ethnicity, religion, or previous experience with genetic testing/counseling. Regional differences in awareness and attitudes transcend traditional demographic predictors, such as ethnicity, age and education. Local sociocultural factors, more than ethnicity and socioeconomic status, may influence the public’s awareness and belief systems, particularly with respect to genetics.
Collapse
|
31
|
Hyatt RR, Gute DM, Pirie A, Page H, Vasquez I, Dalembert F. Transferring knowledge about human subjects protections and the role of institutional review boards in a community-based participatory research project. Am J Public Health 2009; 99 Suppl 3:S526-31. [PMID: 19890152 DOI: 10.2105/ajph.2008.155390] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Among the first tasks in a collaboration between Tufts University and community organizations in Somerville, MA, was designing an interview instrument to assess occupational health needs among immigrant workers. Human subjects protections was a critical issue, but community partners were not well informed about the need for such protections or the role of the institutional review board (IRB). During research meetings, members of the team from Tufts trained community collaborators to work with research participants and organized a presentation by a key university IRB administrator. We present findings from the process evaluation of this project and suggest ways to (1) assess community partners' understanding about working with research volunteers, (2) train collaborators, and (3) involve IRBs.
Collapse
Affiliation(s)
- Raymond R Hyatt
- Public Health and Family Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Katz RV, Jean-Charles G, Green BL, Kressin NR, Claudio C, Wang M, Russell SL, Outlaw J. Identifying the Tuskegee Syphilis Study: implications of results from recall and recognition questions. BMC Public Health 2009; 9:468. [PMID: 20015361 PMCID: PMC2801681 DOI: 10.1186/1471-2458-9-468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 12/16/2009] [Indexed: 12/02/2022] Open
Abstract
Background This analysis assessed whether Blacks, Whites and Puerto-Rican (PR) Hispanics differed in their ability to identify the Tuskegee Syphilis Study (TSS) via open-ended questions following lead-in recognition and recall questions. Methods The Tuskegee Legacy Project (TLP) Questionnaire was administered via a Random-Digit Dial (RDD) telephone survey to a stratified random sample of Black, White and PR Hispanic adults in three U.S. cities. Results The TLP Questionnaire was administered to 1,162 adults (356 African-Americans, 313 PR Hispanics, and 493 non-Hispanic Whites) in San Juan, PR, Baltimore, MD and New York City, NY. Recall question data revealed: 1) that 89% or more of Blacks, Whites, and PR Hispanics were not able to name or definitely identify the Tuskegee Syphilis Study by giving study attributes; and, 2) that Blacks were the most likely to provide an open-ended answer that identified the Tuskegee Syphilis Study as compared to Whites and PR Hispanics (11.5% vs 6.3% vs 2.9%, respectively) (p ≤ 0.002). Even when probed by a recognition question, only a minority of each racial/ethnic group (37.1%, 26.9%, and 8.6%, for Blacks, Whites and PR Hispanics, respectively) was able to clearly identify the TSS (p < 0.001). Conclusions The two major implications of these findings for health disparity researchers are 1) that it is unlikely that detailed knowledge of the Tuskegee Syphilis Study has any current widespread influence on the willingness of minorities to participate in biomedical research, and 2) that caution should be applied before assuming that what community leaders 'know and are aware of' is equally 'well known' within their community constituencies.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology, NYU College of Dentistry, 250 Park Ave South, NY, NY 10012, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Slomka J. Manufacturing mistrust: issues in the controversy regarding foster children in the pediatric HIV/AIDS clinical trials. SCIENCE AND ENGINEERING ETHICS 2009; 15:503-516. [PMID: 19859829 DOI: 10.1007/s11948-009-9179-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/21/2009] [Indexed: 05/28/2023]
Abstract
The use of foster children as subjects in the pediatric HIV/AIDS clinical trials has been the subject of media controversy, raising a range of ethical and social dimensions. Several unsettled issues and debates in research ethics underlie the controversy and the lack of consensus among professional researchers on these issues was neither adequately appreciated nor presented in media reports. These issues include (1) the tension between protecting subjects from research risk while allowing them access to the possible benefits of research; (2) the blurring of the potentially conflicting roles of investigator and physician and the boundaries between research and therapy; (3) the adequacy of Institutional Review Board oversight; and (4) trust and the relationships among physicians, investigators and industry. The media controversy about the pediatric HIV/AIDS clinical trials can be seen as a means of "manufacturing mistrust" in health care, research and social services that have not always met the needs and expectations of the public. In an era of emerging infections, it is critical to the public's health that people understand the role of rigorous and ethical research in the development of safe and effective care. Investigators, journalists and the public need to become knowledgeable about major ethical issues in the conduct of research in order to engage in dialogue about balancing research risks and benefits and to be able to distinguish fact from distortion in an era of multiple and rapid transmission of information.
Collapse
Affiliation(s)
- Jacquelyn Slomka
- Division of Health Promotion and Behavioral Sciences, School of Public Health,UCT 2530, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| |
Collapse
|
34
|
Katz RV, Green BL, Kressin NR, James SA, Wang MQ, Claudio C, Russell SL. Exploring the "legacy" of the Tuskegee Syphilis Study: a follow-up study from the Tuskegee Legacy Project. J Natl Med Assoc 2009; 101:179-83. [PMID: 19378637 DOI: 10.1016/s0027-9684(15)30833-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this follow-up 2003 3-City Tuskegee Legacy Project (TLP) Study was to validate or refute our prior findings from the 1999-2000 4 City TLP Study, which found no evidence to support the widely acknowledged "legacy" of the Tuskegee Syphilis Study (TSS), ie, that blacks are reluctant to participate in biomedical studies due to their knowledge of the TSS. The TLP Questionnaire was administered in this random-digit-dial telephone survey to a stratified random sample of 1162 black, white, and Puerto Rican Hispanic adults in 3 different US cities. The findings from this current 3-City TLP Study fail to support the widely acknowledged "legacy" of the TSS, as awareness of the TSS was not statistically associated with the willingness to participate in biomedical studies. These findings, being in complete agreement with our previous findings from our 1999-2000 4-City TLP, validate those prior findings.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, 250 Park Ave S, New York, NY 10003, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Rennie S, Turner AN, Mupenda B, Behets F. Conducting unlinked anonymous HIV surveillance in developing countries: ethical, epidemiological, and public health concerns. PLoS Med 2009; 6:e4. [PMID: 19166264 PMCID: PMC2628398 DOI: 10.1371/journal.pmed.1000004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stuart Rennie and colleagues argue that while unlinked anonymous HIV testing is valuable and ethical, such surveillance can be conducted in ethically questionable ways in certain circumstances.
Collapse
Affiliation(s)
- Stuart Rennie
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
| | | | | | | |
Collapse
|
36
|
Lazzarini Z, Case P, Thomas CJ. A walk in the park: a case study in research ethics. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2009; 37:93-103. [PMID: 19245606 DOI: 10.1111/j.1748-720x.2009.00354.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Can researchers, interested in novel ways to assess HIV seroprevalence among populations which are otherwise hidden, collect condoms that have been discarded on the ground in a public sex environment and test them for HIV? Researchers, who use other types of abandoned samples, such as discarded syringes, hair or saliva samples, or excess biological samples, confront similar issues. This review evaluates whether such abandoned tissues can be studied based on U.S. Code of Federal Regulations and literature on related issues including: research involving banked tissues, blinded seroprevalence studies, and property claims that individuals might make on the samples. It also addresses broader questions of potential for stigma and risk to individuals and communities. The article concludes that the research should be permitted legally because either it does not involve human subjects, or it satisfies the requirements for waiver of consent; and that the research should also be permitted because the ethical principal of avoiding harm to individuals is fully satisfied based on a careful reading of the lessons of the tissue bank, biological property rights, and blinded seroprevalence study debates, as well as a consideration of other potential harms that might be involved.
Collapse
|
37
|
Oransky M, Fisher CB, Mahadevan M, Singer M. Barriers and opportunities for recruitment for nonintervention studies on HIV risk: perspectives of street drug users. Subst Use Misuse 2009; 44:1642-59. [PMID: 19938935 PMCID: PMC3638737 DOI: 10.1080/10826080802543671] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study used focus-group discussions in response to a video vignette to examine attitudes toward recruitment for nonintervention research involving HIV testing. Participants were 100 ethnically diverse, economically disadvantaged urban drug users, who were recruited from New York City and Hartford, Connecticut in the spring and summer of 2006. Content analyses revealed themes including (1) fears of stigma and legal trouble balanced by trustworthiness of the recruiter; (2) fears of learning one's HIV status balanced by prospects for health benefits, and (3) the right to receive fair monetary compensation balanced by risks of coercion during periods of cravings. Limitations and implications for recruitment practices have been discussed here.
Collapse
Affiliation(s)
- Matthew Oransky
- Center for Ethics Education, Fordham University, Bronx, New York 10458, USA
| | | | | | | |
Collapse
|
38
|
Katz RV, Green BL, Kressin NR, Kegeles SS, Wang MQ, James SA, Russell SL, Claudio C, McCallum JM. The legacy of the Tuskegee Syphilis Study: assessing its impact on willingness to participate in biomedical studies. J Health Care Poor Underserved 2008; 19:1168-80. [PMID: 19029744 DOI: 10.1353/hpu.0.0067] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The phrase, 'legacy of the Tuskegee Syphilis Study', is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932-72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people's willingness to participate in research. Future studies should explore this.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, 250 Park Avenue South, New York, NY 10003, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Katz RV, Wang MQ, Green BL, Kressin NR, Claudio C, Russell SL, Sommervil C. Participation in biomedical research studies and cancer screenings: perceptions of risks to minorities compared with whites. Cancer Control 2008; 15:344-51. [PMID: 18813202 DOI: 10.1177/107327480801500409] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This analysis was conducted to determine whether there is a difference among blacks, Hispanics, and whites in their perception of risks associated with participating in either a biomedical study or a cancer screening. METHODS The Tuskegee Legacy Project Questionnaire, which focused on research subject participation, was administered in two different surveys (1999-2000 and 2003) in seven cities. The Cancer Screening Questionnaire was administered in 2003 in three cities. RESULTS The study sample across the three surveys consisted of 1,064 blacks, 781 Hispanics, and 1,598 non-Hispanic whites. Response rates ranged from 44% to 70% by city. Logistic regression analyses, adjusted for age, sex, education, income, and city, revealed that blacks and Hispanics each self-reported that minorities, compared with whites, are more likely to be "taken advantage of" in biomedical studies and much less likely to get a "thorough and careful examination" in a cancer screening (odds ratios ranged from 3.6 to 14.2). CONCLUSIONS Blacks and Hispanics perceive equally high levels of risk for participating in cancer screening examinations and for volunteering to become research subjects in biomedical studies. This perception provides a strong message about the need to overtly address this critical health disparities issue.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, NY 10012, USA.
| | | | | | | | | | | | | |
Collapse
|
40
|
Epstein S. The rise of 'recruitmentology': clinical research, racial knowledge, and the politics of inclusion and difference. SOCIAL STUDIES OF SCIENCE 2008; 38:801-832. [PMID: 19227822 DOI: 10.1177/0306312708091930] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Recent debates concerning the biomedical meaning and significance of race have paid relatively little attention to the practical implications of new policies in the US mandating the inclusion of racial and ethnic minorities (along with other 'underrepresented groups') as research subjects in clinical studies. I argue that pressures to enroll underrepresented groups have stimulated the development in the US of an auxiliary science I term 'recruitmentology': an empirical body of studies scientifically evaluating the efficacy of various social, cultural, psychological, technological, and economic means of convincing people (especially members of 'hard-to-recruit populations') that they want to become, and remain, human subjects. Via the filtering of social scientific frameworks into the clinical research domain, recruitmentology has promoted hybrid ways of thinking about race--awkward encounters in which depictions of race as a bounded, quasi-biological medical and administrative category sit uneasily alongside an interest in understanding racial identities and communities as sociocultural phenomena. I analyze how recruitmentologists, in addressing the mandate to recruit racially diverse subject populations, conceptualize race while simultaneously grappling with problems of trust, collective memory, and participation. I also examine how the increasingly transnational character of biomedical research is intensifying the exploitative dimensions of recruitment while further transforming the racialized character of human experimentation. This analysis highlights the tensions underlying projects to eliminate health disparities by race.
Collapse
Affiliation(s)
- Steven Epstein
- Department of Sociology, University of California, San Diego, La Jolla 92093-0533, USA.
| |
Collapse
|
41
|
|
42
|
Katz RV, Kegeles SS, Kressin NR, Green BL, James SA, Wang MQ, Russell SL, Claudio C. Awareness of the Tuskegee Syphilis Study and the US presidential apology and their influence on minority participation in biomedical research. Am J Public Health 2007; 98:1137-42. [PMID: 17901437 PMCID: PMC2377291 DOI: 10.2105/ajph.2006.100131] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the influence of awareness of the Tuskegee Syphilis Study and the presidential apology for that study on the willingness of Blacks, non-Hispanic Whites, and Hispanics to participate in biomedical research. METHODS The Tuskegee Legacy Project Questionnaire was administered to 1133 adults in 4 US cities. This 60-item questionnaire addressed issues related to the recruitment of minorities into biomedical studies. RESULTS Adjusted multivariate analysis showed that, compared with Whites, Blacks were nearly 4 times as likely to have heard of the Tuskegee Syphilis Study, more than twice as likely to have correctly named Clinton as the president who made the apology, and 2 to 3 times more likely to have been willing to participate in biomedical studies despite having heard about the Tuskegee Syphilis Study (odds ratio [OR]=2.9; 95% confidence interval [CI]=1.4, 6.2) or the presidential apology (OR=2.3; 95% CI=1.4, 3.9). CONCLUSIONS These marked differences likely reflect the cultural reality in the Black community, which has been accustomed to increased risks in many activities. For Whites, this type of information may have been more shocking and at odds with their expectations and, thus, led to a stronger negative impact.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology & Health Promotion, NYU College of Dentistry, 345 E 24th St, MC-9416, New York, NY 10010, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Katz RV, Kegeles SS, Kressin NR, Green BL, Wang MQ, James SA, Russell SL, Claudio C. The Tuskegee Legacy Project: willingness of minorities to participate in biomedical research. J Health Care Poor Underserved 2007; 17:698-715. [PMID: 17242525 PMCID: PMC1780164 DOI: 10.1353/hpu.2006.0126] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The broad goal of the Tuskegee Legacy Project (TLP) study was to address, and understand, a range of issues related to the recruitment and retention of Blacks and other minorities in biomedical research studies. The specific aim of this analysis was to compare the self-reported willingness of Blacks, Hispanics, and Whites to participate as research subjects in biomedical studies, as measured by the Likelihood of Participation (LOP) Scale and the Guinea Pig Fear Factor (GPFF) Scale. The Tuskegee Legacy Project Questionnaire, a 60 item instrument, was administered to 1,133 adult Blacks, Hispanics, and non-Hispanic Whites in 4 U.S. cities. The findings revealed no difference in self-reported willingness to participate in biomedical research, as measured by the LOP Scale, between Blacks, Hispanics, and Whites, despite Blacks being 1.8 times as likely as Whites to have a higher fear of participation in biomedical research on the GPFF Scale.
Collapse
Affiliation(s)
- Ralph V Katz
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, USA.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
McCallum JM, Arekere DM, Green BL, Katz RV, Rivers BM. Awareness and knowledge of the U.S. Public Health Service syphilis study at Tuskegee: implications for biomedical research. J Health Care Poor Underserved 2007; 17:716-33. [PMID: 17242526 PMCID: PMC1828138 DOI: 10.1353/hpu.2006.0130] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this review was to collect and interpret the findings of all published qualitative or quantitative research that assessed African Americans' 1) general awareness and/or specific knowledge of the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, and 2) attitudes towards and/or willingness to participate in biomedical research. An exhaustive review of the literature produced eight articles that fit the aforementioned selection criteria. All articles that assessed both awareness and knowledge found that familiarity with the USPHS Syphilis Study at Tuskegee did not necessarily ensure accurate knowledge of it. Four studies also found that awareness of the USPHS Syphilis Study at Tuskegee did not relate to willingness to participate in biomedical research. In addition to awareness and knowledge of the USPHS Syphilis Study at Tuskegee, published studies suggest that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies.
Collapse
Affiliation(s)
- Jan M McCallum
- Department of Health and Kinesiology, Office of Health Informatics, Center for the Study of Health Disparities, Texas A&M University, USA.
| | | | | | | | | |
Collapse
|
45
|
Baker SM, Brawley OW, Marks LS. Effects of untreated syphilis in the negro male, 1932 to 1972: a closure comes to the Tuskegee study, 2004. Urology 2005; 65:1259-62. [PMID: 15922414 DOI: 10.1016/j.urology.2004.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Revised: 09/22/2004] [Accepted: 10/11/2004] [Indexed: 11/16/2022]
|
46
|
Shaw S, Boynton PM, Greenhalgh T. Research governance: where did it come from, what does it mean? J R Soc Med 2005. [PMID: 16260798 DOI: 10.1258/jrsm.98.11.496] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
For a variety of historical and social reasons, research has become increasingly formalized and regulated. This change has potential benefits (reduction in fraud and misconduct, protection of vulnerable groups, financial probity) but also disadvantages (increased paperwork, time delays, constraints on research freedom). The terms 'research' and 'governance' mean different things in different contexts. Even with explicit guidance, ambiguities must be resolved by human judgement. Variation in the nature and outcome of approval decisions is therefore a fact of life. The type of approval needed for a research study depends on the official remit of the approval body, the question to be addressed; the methods to be used; the context in which the work will take place; the level of analysis and interpretation; and the plans for how the findings will be presented and used.
Collapse
Affiliation(s)
- Sara Shaw
- Open Learning Unit, Department of Primary Care and Population Sciences, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, UK.
| | | | | |
Collapse
|
47
|
Barsdorf NW, Wassenaar DR. Racial differences in public perceptions of voluntariness of medical research participants in South Africa. Soc Sci Med 2005; 60:1087-98. [PMID: 15589676 DOI: 10.1016/j.socscimed.2004.06.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The reign of apartheid in South Africa was characterized by systematic violation of the human rights of the Black population. Ruling institutions of the country perpetuated and enforced such violations. Consequently, Black South Africans may be apprehensive of scientific research in which the Black population is targeted for participants, regardless of the reason for their being selected. This exploratory study aims to (1) contribute to the relatively limited body of empirical research on the concept of voluntariness and (2) assess racial differences in public perceptions of the voluntariness of medical research participants. We sampled 111 employees from two companies. The sample consisted of 39 Black, 37 Indian, and 38 White participants. A structured questionnaire was used to interview respondents. Results showed that Black respondents scored significantly lower on scores of perceived voluntariness than both Indian and White respondents. These racial differences in perceptions of voluntariness were found to be independent of level of education, knowledge of medical research procedures, and close or personal experience of medical research. Perceptions of voluntariness did not however appear to impact on participants' personal willingness to participate in future research. Implications for recruitment of future health research participants in South Africa are discussed.
Collapse
Affiliation(s)
- Nicola Wendy Barsdorf
- HIV AIDS Vaccines Ethics Group (HAVEG) School of Psychology, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | |
Collapse
|
48
|
Kaufman CE, Ramarao S. Community confidentiality, consent, and the individual research process: Implications for demographic research. POPULATION RESEARCH AND POLICY REVIEW 2005. [DOI: 10.1007/s11113-004-0329-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
List JM. Histories of mistrust and protectionism: disadvantaged minority groups and human-subject research policies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2005; 5:53-6; author reply W15-8. [PMID: 16036664 DOI: 10.1080/15265160590927741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Justin M List
- Institute for Ethics, American Medical Association, USA
| |
Collapse
|
50
|
|