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Abimbola S, van de Kamp J, Lariat J, Rathod L, Klipstein-Grobusch K, van der Graaf R, Bhakuni H. Unfair knowledge practices in global health: a realist synthesis. Health Policy Plan 2024; 39:636-650. [PMID: 38642401 PMCID: PMC11145905 DOI: 10.1093/heapol/czae030] [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] [Received: 08/29/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
Unfair knowledge practices easily beset our efforts to achieve health equity within and between countries. Enacted by people from a distance and from a position of power ('the centre') on behalf of and alongside people with less power ('the periphery'), these unfair practices have generated a complex literature of complaints across various axes of inequity. We identified a sample of this literature from 12 journals and systematized it using the realist approach to explanation. We framed the outcome to be explained as 'manifestations of unfair knowledge practices'; their generative mechanisms as 'the reasoning of individuals or rationale of institutions'; and context that enable them as 'conditions that give knowledge practices their structure'. We identified four categories of unfair knowledge practices, each triggered by three mechanisms: (1) credibility deficit related to pose (mechanisms: 'the periphery's cultural knowledge, technical knowledge and "articulation" of knowledge do not matter'), (2) credibility deficit related to gaze (mechanisms: 'the centre's learning needs, knowledge platforms and scholarly standards must drive collective knowledge-making'), (3) interpretive marginalization related to pose (mechanisms: 'the periphery's sensemaking of partnerships, problems and social reality do not matter') and (4) interpretive marginalization related to gaze (mechanisms: 'the centre's learning needs, social sensitivities and status preservation must drive collective sensemaking'). Together, six mutually overlapping, reinforcing and dependent categories of context influence all 12 mechanisms: 'mislabelling' (the periphery as inferior), 'miseducation' (on structural origins of disadvantage), 'under-representation' (of the periphery on knowledge platforms), 'compounded spoils' (enjoyed by the centre), 'under-governance' (in making, changing, monitoring, enforcing and applying rules for fair engagement) and 'colonial mentality' (of/at the periphery). These context-mechanism-outcome linkages can inform efforts to redress unfair knowledge practices, investigations of unfair knowledge practices across disciplines and axes of inequity and ethics guidelines for health system research and practice when working at a social or physical distance.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Judith van de Kamp
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Joni Lariat
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Lekha Rathod
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Luxembourg Operational Research and Epidemiology Support Unit, Médecins Sans Frontières, Luxembourg City L-1617, Luxembourg
| | - Kerstin Klipstein-Grobusch
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Rieke van der Graaf
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Himani Bhakuni
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- York Law School, University of York, York YO10 5GD, United Kingdom
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Greer RC, Kanthawang N, Roest J, Perrone C, Wangrangsimakul T, Parker M, Kelley M, Cheah PY. The challenges and potential solutions of achieving meaningful consent amongst research participants in northern Thailand: a qualitative study. BMC Med Ethics 2023; 24:111. [PMID: 38115021 PMCID: PMC10729394 DOI: 10.1186/s12910-023-00991-0] [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] [Received: 05/10/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. METHOD We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other key informants. A thematic analysis was conducted. RESULTS Our analysis identified four interrelated themes surrounding participants' ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. CONCLUSIONS Participant's agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors.
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Affiliation(s)
- Rachel C Greer
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Nipaphan Kanthawang
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carlo Perrone
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Foláyan MO, Haire B. What's trust got to do with research: why not accountability? Front Res Metr Anal 2023; 8:1237742. [PMID: 38025960 PMCID: PMC10679329 DOI: 10.3389/frma.2023.1237742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
This paper explores the intricate dynamics of trust, power, and vulnerability in the relationship between researchers and study participants/communities in the field of bioethics. The power and knowledge imbalances between researchers and participants create a structural vulnerability for the latter. While trust-building is important between researchers and study participants/communities, the consenting process can be challenging, often burdening participants with power abrogation. Trust can be breached. The paper highlights the contractual nature of the research relationship and argues that trust alone cannot prevent exploitation as power imbalances and vulnerabilities persist. To protect participants, bioethics guidance documents promote accountability and ethical compliance. These documents uphold fairness in the researcher-participant relationship and safeguard the interests of socially vulnerable participants. The paper also highlights the role of shared decision-making and inclusive deliberation with diverse stakeholders and recommends that efforts should be made by researchers to clarify roles and responsibilities, while research regulatory agents should transform the research-participant relationship into a legal-based contract governed by accountability principles. While trust remains important, alternative mechanisms may be needed to ensure ethical research practices and protect the interests of participants and communities. Striking a balance between trust and accountability is crucial in this regard.
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Affiliation(s)
| | - Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Perez KM, Asim M, Weiss EM, Valentine GC, Kavi A, Somannavar MS, Iwuh I, Chiweza C, Tickell KD, Singa BO, Beima-Sofie K, Batra M, Walson JL, Umoren R, Kelley M, Saleem S. Considering Risks to Researchers and Staff in Low-Resource Settings during Public Health Crises: A Proposed Conceptual Model. CHILDREN 2023; 10:children10030463. [PMID: 36980021 PMCID: PMC10047058 DOI: 10.3390/children10030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.
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Affiliation(s)
- Krystle M. Perez
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Correspondence:
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Elliott M. Weiss
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Gregory C. Valentine
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi 590010, India
| | - Manjunath S. Somannavar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi 590010, India
| | - Ibezimako Iwuh
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Global Women’s Health Centre of Excellence, Lilongwe Private Bag B-397, Malawi
| | - Chikondi Chiweza
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Global Women’s Health Centre of Excellence, Lilongwe Private Bag B-397, Malawi
| | - Kirkby D. Tickell
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Benson O. Singa
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
- Kenya Medical Research Institute (KEMRI), Nairobi P.O. Box 54840-00200, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Maureen Kelley
- Center for Ethics in Health Care, Oregon Health and Science University, Portland, OR 97239, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
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Nguyen YHT, Dang TT, Lam NBH, Le PT, Nguyen PH, Bull S, Kestelyn E, Van Nuil JI. Fragmented understanding: exploring the practice and meaning of informed consent in clinical trials in Ho Chi Minh City, Vietnam. BMC Med Ethics 2023; 24:3. [PMID: 36647039 PMCID: PMC9843952 DOI: 10.1186/s12910-023-00884-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The informed consent process in clinical trials has been extensively studied to inform the development processes which protect research participants and encourage their autonomy. However, ensuring a meaningful informed consent process is still of great concern in many research settings due to its complexity in practice and interwined socio-cultural factors. OBJECTIVES This study explored the practices and meaning of the informed consent process in two clinial trials conducted by Oxford University Clinical Research Unit in collaboration with the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. METHODS We used multiple data collection methods including direct observervations, in-depth interviews with study physicians and trial participants, review of informed consent documents from 2009 to 2018, and participant observation with patients' family members. We recruited seven physicians and twenty-five trial participants into the study, of whom five physicians and thirteen trial participants completed in-depth interviews, and we held twenty-two direct observation sessions. RESULTS We use the concept "fragmented understanding" to describe the nuances of understanding about the consent process and unpack underlying reasons for differing understandings. CONCLUSIONS Our findings show how practices of informed consent and different understanding of the trial information are shaped by trial participants' characteristics and the socio-cultural context in which the trials take place.
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Affiliation(s)
- Yen Hong Thi Nguyen
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Thuan Trong Dang
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Ngoc Bao Hong Lam
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Phuong Thanh Le
- grid.414273.70000 0004 0469 2382Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phu Hoan Nguyen
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.444808.40000 0001 2037 434XSchool of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
| | - Susan Bull
- grid.4991.50000 0004 1936 8948The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK ,grid.9654.e0000 0004 0372 3343Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Evelyne Kestelyn
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Ilo Van Nuil
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Calia C, Chakrabarti A, Sarabwe E, Chiumento A. Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18269.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.
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Suwalowska H, Kingori P, Parker M. Navigating uncertainties of death: Minimally Invasive Autopsy Technology in global health. Glob Public Health 2023; 18:2180065. [PMID: 36853068 PMCID: PMC9988304 DOI: 10.1080/17441692.2023.2180065] [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: 03/01/2023]
Abstract
Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context.
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Affiliation(s)
- Halina Suwalowska
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Halina Suwalowska Ethox Centre and Wellcome Centre for Ethics and Humanities Nuffield Department of Population Health, University of Oxford, Oxford | OX3 7LF, UK
| | - Patricia Kingori
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Parker
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Khirikoekkong N, Asarath SA, Nosten S, Hanboonkunupakarn B, Jatupornpimol N, Roest J, Parker M, Nosten F, McGready R, Cheah PY, Kelley M. Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001875. [PMID: 37141207 PMCID: PMC10159138 DOI: 10.1371/journal.pgph.0001875] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Despite advances, international research ethics guidelines still tend to consist of high-level ethical principles reflecting residual influence from North American and European traditions of ethics. Local ethics committees and community advisory boards can offer more culturally-sensitive approaches to training but most institutions lack substantive practical ethics guidance to engage rich moral understandings in day-to-day research practice in diverse cultural contexts. To address this gap, we conducted an international series of qualitative research ethics case studies, linked prospectively to active research programs in diverse settings. Here, we share findings from two case studies with a research team working on malaria and hepatitis B prevention with pregnant women in clinics serving migrants along the Thai-Myanmar border. In this sociocultural ethical analysis, we consider how core ethical requirements of voluntary participation, provision of fair benefits, and understandings of research risks and burdens are shaped, enriched, and in some instances challenged, by deep-seated and widespread Burmese, Karen and Thai cultural norms known as Arr-nar (in Burmese and Karen) or Kreng-jai (in Thai), encompassing multiple meanings including consideration for others and graciousness. We offer a model illustrating how one might map ethically significant sociocultural influences across the research practice pathway and close with lessons for developing a more culturally responsive research ethics practice in other international settings.
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Affiliation(s)
- Napat Khirikoekkong
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supa-At Asarath
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattapat Jatupornpimol
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Michael Parker
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Francois Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Nkosi B, Van Nuil JI, Nyirenda D, Chi PC, Schneiders ML. 'Labouring' on the frontlines of global health research: mapping challenges experienced by frontline workers in Africa and Asia. Glob Public Health 2022; 17:4195-4205. [PMID: 36183409 DOI: 10.1080/17441692.2022.2124300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Drawing on the reflections and discussions from a special session at the 2021 Global Health Bioethics Network summer school, this paper has summarised the key challenges faced by Frontline Workers (FWs) across research sites in Africa and Asia in performing the everyday 'body work' entailed in operationalising global health research. Using a 'body work' lens, we specifically explore and map key challenges that FWs face in Africa and Asia and the physical, social, ethical, emotional, and political labour involved in operationalising global health in these settings. The research encounter links with wider social and economic structures, and spatial dimensions and impacts on the FWs' performance and well-being. Yet, FWs' 'body-work' and the embedded emotions during the research encounter remain hidden and undervalued.
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Affiliation(s)
- Busisiwe Nkosi
- Africa Health Research Institute, Durban, South Africa.,Institute for Global Health, University College London, London, UK.,School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Mira Leonie Schneiders
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
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10
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Fehr A, Nieto-Sanchez C, Muela J, Manneh E, Baldeh D, Ceesay O, D’Alessandro U, Dabira E, Kingori P, Grietens KP, Bardají A, Bunders-Aelen J, Zuiderent-Jerak T. Doing 'reciprocity work': The role of fieldworkers in a mass drug administration trial in the Gambia. Glob Public Health 2022; 17:4116-4128. [PMID: 36183416 PMCID: PMC7614349 DOI: 10.1080/17441692.2022.2125998] [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] [Received: 03/31/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
In their roles as nurses, data collectors, or other, fieldworkers undertake myriad tasks working intimately with and on the bodies of others - a type of work called 'body work'. This work further includes the micro-political relations shaping these interactions, and studies have shown the importance of these relationships in the success of clinical trials, particularly in the Gambia. This study seeks to expand the concept of body work to understand the roles and interactions of fieldworkers within the trial community, and the effect on a mass drug administration (MDA) clinical trial. We conducted a mixed-methods social science study alongside the MDA in 2018-2019, including in-depth interviews, focus group discussions, and semi-structured observations with the population involved (and not) in the MDA, as well as the MRC fieldworkers. We found that fieldworkers participated in what we call 'reciprocity work'. Through their regular tasks and interactions, they necessarily showed respect and established trust in a way that formed and contributed to reciprocal relationships, the results of which impacted the trial and individuals' autonomy in the decision-making process. Understanding the role of fieldworkers and their reciprocity work is a vital component in comprehending how research ethics are made and conducted in global health research.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Centre, Universitat Rovira I Virgili, Tarragona, Spain
| | - Ebrima Manneh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Dullo Baldeh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Omar Ceesay
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Edgard Dabira
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Azucena Bardají
- IS Global, Barcelona Institute for Global Health, Barcelona, Spain
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Sheikh ZA. Dealing with complicity in fieldwork: Reflections on studying genetic research in Pakistan. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44 Suppl 1:41-56. [PMID: 35322443 PMCID: PMC10078743 DOI: 10.1111/1467-9566.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Health-related ethnography undertaken in a context marked by social inequalities and colonial legacies requires critical attention to power imbalances in the fieldwork. In this paper, I draw on my own experiences from studying genetic research in Pakistan. As a Danish-born female researcher with roots in Pakistan, I have followed genetic researchers and families dealing with genetic conditions in Pakistan. Through examples I unearth how encounters in the field were shaped by complicities of being in-between the Danish and the Pakistani, of studying and doing international research at the same time, and of my inaction towards suffering families. I base my analysis on the notion that complicity manifests in a generative, and unavoidable, engagement with both complex structures of inequality and interlocutors. We can never fully understand the specificities or consequences of complicity-whether moral or epistemic-when entering, engaging with or representing our fields. However, by staying constructively with the tensions, instead of attempting to move beyond the discomfort that they might create, we can learn how to deal with the consequences and in that, build further the value of ethnographic activity.
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Affiliation(s)
- Zainab Afshan Sheikh
- Centre for Advanced Studies in Biomedical Innovation LawFaculty of LawUniversity of CopenhagenCopenhagenDenmark
- Centre for Medical Science and Technology StudiesSection for Health Services ResearchDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
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12
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Calia C, Chakrabarti A, Sarabwe E, Chiumento A. Maximising impactful and locally relevant mental health research: ethical considerations. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18269.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.
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Lawrence DS, Ssali A, Moshashane N, Nabaggala G, Maphane L, Harrison TS, Meya DB, Jarvis JN, Seeley J. Decision making in a clinical trial for a life-threatening illness: Therapeutic expectation, not misconception. Soc Sci Med 2022; 305:115082. [PMID: 35649301 DOI: 10.1016/j.socscimed.2022.115082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/10/2023]
Abstract
Potential participants for clinical trials which aim to define treatments for life-threatening conditions are often extremely unwell. When exploring why individuals participate in clinical trials one common observation is a misplaced expectation of personal benefit - a therapeutic misconception. The care offered in some clinical trials is of a higher standard than is routinely available and this has led to criticism around the freedom of choice to enrol - structural coercion. We embedded an ethnographic study within a randomised controlled trial for HIV-associated cryptococcal meningitis in Gaborone, Botswana and Kampala, Uganda. We aimed to gain an understanding of decision-making around the trial and how this was impacted by the study design and broader social context. We conducted in-depth interviews with trial participants, surrogate decision makers and researchers, combined these with direct observations and analysed data using thematic analysis. Between January 2020 and June 2021 we interviewed 89 individuals. We found previous exposure to and awareness of clinical research was limited, as was understanding of the trial objectives and design. Through observations and engagement with healthcare facilities decision-makers were able to identify the trial as providing the best possible chance of survival. Hesitation and reluctance were mostly due to fear of lumbar punctures which was sometimes based on rumours but often based on tragic personal experience. Despite fear, and sometimes conviction that they would die, individuals agreed to consent, often against the wishes of family members. Reassurance and confidence came from trust in routine care staff and the research team but also from fellow participants and their surrogates. We argue that participants made informed decisions based on a therapeutic expectation from the trial and that rather than being the result of structural coercion this was an informed and voluntary choice.
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Affiliation(s)
- David S Lawrence
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | - Agnes Ssali
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Institute, Entebbe, Uganda; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Neo Moshashane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Georgina Nabaggala
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Institute, Entebbe, Uganda
| | | | - Thomas S Harrison
- Institute of Infection and Immunity, St George's University London, London, UK; Clinical Academic Group in Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph N Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Janet Seeley
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Institute, Entebbe, Uganda; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
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14
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Chi PC, Owino EA, Jao I, Bejon P, Kapulu M, Marsh V, Kamuya D. Ethical considerations around volunteer payments in a malaria human infection study in Kenya: an embedded empirical ethics study. BMC Med Ethics 2022; 23:46. [PMID: 35443642 PMCID: PMC9019790 DOI: 10.1186/s12910-022-00783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Human Infection Studies (HIS) have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid 'undue' levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers' attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning.
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Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Vicki Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
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Diallo BA, Usuf E, Ceesay O, D'Alessandro U, Roca A, Martinez-Alvarez M. Clinical research on COVID-19: perceptions and barriers to participation in The Gambia. BMJ Glob Health 2022; 7:e007533. [PMID: 35190459 PMCID: PMC8861886 DOI: 10.1136/bmjgh-2021-007533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/29/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The need to rapidly identify safe and efficacious drug therapies for COVID-19 has resulted in the implementation of multiple clinical trials investigating potential treatment options. These are being undertaken in an unprecedented research environment and at a higher speed than ever before. It is unclear how West African communities perceive such activities and how such perceptions influence participation in COVID-19 clinical trials. This qualitative study was conducted to assess the level of acceptability of a clinical trial on the prevention and treatment of COVID-19 in The Gambia and identify strategies to better engage communities in participating in such a trial. METHODS Data were collected using digitally recorded semistructured interviews (SSIs) and focus group discussions (FGDs) in Brikama and Kanifing local government areas. These are two of the most densely populated administrative subdivisions in The Gambia, where the clinical trial was to be implemented by the MRC Unit The Gambia. 26 men and 22 women aged between 19 and 70 years, with diverse socioeconomic profiles, participated in 8 FGDs (n=36) and 12 SSIs (n=12). Thematic analysis was used to analyse the data. RESULTS Fear of stigmatisation of patients with COVID-19 was a recurring theme in most FGDs and SSIs, with detrimental effects on willingness to accept COVID-19 testing and home visits to follow up patients with COVID-19 and their household contacts. Preserving the privacy of individuals enrolled in the study was key to potentially increase trial participation. Trust in the implementing institution and its acknowledged expertise were facilitators to accepting the administration of investigational products to sick individuals and their close contacts. CONCLUSION COVID-19 is a stigmatising disease. Developing a research-participant collaboration through an ongoing engagement with community members is crucial to a successful enrolment in COVID-19 clinical trials. Trust and acknowledged expertise of the implementing institution are key facilitators to foster such collaboration.
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Affiliation(s)
- Brahima Amara Diallo
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Effua Usuf
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Omar Ceesay
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Anna Roca
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Melisa Martinez-Alvarez
- Disease Control and Elimination (DCE), Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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Campbell JI, Musiimenta A, Natukunda S, Eyal N, Haberer JE. "The research assistants kept coming to follow me up; I counted myself as a lucky person": Social support arising from a longitudinal HIV cohort study in Uganda. PLoS One 2022; 17:e0262989. [PMID: 35077497 PMCID: PMC8789171 DOI: 10.1371/journal.pone.0262989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/10/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Participation in longitudinal research studies in resource-limited settings often involves frequent interactions with study staff and other participants, as well as receipt of incentives and transportation reimbursements. Social support-receipt of material and emotional resources from one's social network-has been linked to antiretroviral adherence in sub-Saharan Africa. The extent to which social support arises from study participation, its range and depth, and its implications for observational study conduct, have not been extensively described. METHODS We conducted individual open-ended and semi-structured interviews with participants in a longitudinal, observational antiretroviral therapy adherence monitoring study in Mbarara, Uganda. Participants were asked about their experiences in the longitudinal study and their interactions with research staff. We also interviewed study research assistants (RAs). Deductive and inductive coding were used to identify content related to the experience of study participation. Codes were organized into themes, and relationships between themes were used to develop overarching categories. RESULTS Sixty longitudinal study participants and 6 RAs were interviewed. Instrumental and emotional social support emerged as pervasive and valued aspects of longitudinal study participation. Instrumental support that participants received consisted of enhanced linkage to medical care, health education, and direct and indirect material benefits. Emotional support consisted of perceptions of feeling "cared for" and social interactions that permitted escape from HIV-related stigma. Both instrumental and emotional support often arose through the close relationships participants formed with research staff and with each other. Study-derived social support motivated some participants to adhere to antiretroviral therapy-an unanticipated effect potentially influencing the longitudinal study's primary observational outcome. CONCLUSIONS Longitudinal study participation resulted in instrumental and emotional social support for participants. The depth of support participants experienced has implications for observational study design in resource-limited settings, including need to assess potential effects on study outcomes; consideration of social support during risk/benefit assessment in study ethics review and consent; and vigilance for consequences of social support loss when studies end.
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Affiliation(s)
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Nir Eyal
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, United States of America
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Jessica E. Haberer
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Vincent R, Adhikari B, Duddy C, Richardson E, Wong G, Lavery J, Molyneux S. 'Working relationships' across difference - a realist review of community engagement with malaria research. Wellcome Open Res 2022; 7:13. [PMID: 37621950 PMCID: PMC10444998 DOI: 10.12688/wellcomeopenres.17192.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 08/26/2023] Open
Abstract
Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to 'work', and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature , we conducted a realist review of CE with malaria research - a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional 'working relationships' across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing 'dominant health research paradigm context', such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.
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Affiliation(s)
- Robin Vincent
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
| | - The REAL team: Mary Chambers, Phaik Yeong Cheah, Al Davies, Kate Gooding, Dorcas Kamuya, Vicki Marsh, Noni Mumba, Deborah Nyirenda, and Paulina Tindana.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
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18
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Nouvet E, Grandjean Lapierre S, Knoblauch A, Baril L, Andriamiadanarivo A, Raberahona M, Mattern C, Donelle L, Andriantsoa JR. Consent to Research in Madagascar: Challenges, Strategies, and Priorities for Future
Research. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1087201ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kaye DK. Motivation to participate and experiences of the informed consent process for randomized clinical trials in emergency obstetric care in Uganda. BMC Med Ethics 2021; 22:104. [PMID: 34320963 PMCID: PMC8317416 DOI: 10.1186/s12910-021-00672-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Informed consent, whose goal is to assure that participants enter research voluntarily after disclosure of potential risks and benefits, may be impossible or impractical in emergency research. In low resource settings, there is limited information on the experiences of the informed consent process for randomized clinical trials in the emergency care context. The objective of this study was to explore the experiences of the informed consent process and factors that motivated participation in two obstetrics and newborn care randomized clinical trials (RCTs). Methods This was a qualitative study conducted among former participants of RCTs in the emergency obstetric care context, conducted at Kawempe National Referral Hospital, Uganda. It employed 30 in-depth interviews conducted from June 1, 2019 to August 30, 2019. Issues explored included attitudes about research, the purpose of the research in which they participated, motivations to take part in the study, factors that influenced enrolment decisions, and experiences of the informed consent process. Results Respondents felt that research was necessary to investigate the cause, prevention or complications of illness. The decisions to participate were influenced by hope for material or therapeutic benefit, trust in the healthcare system and influence of friends and family members. Many were satisfied with the informed consent process, though they did not understand some aspects of the research. Conclusion Respondents valued participation in RCTs in emergency obstetric and newborn care. Hope for benefit, altruism, desire to further scientific knowledge and trust in the investigators featured prominently in the motivation to participate. Both intrinsic and extrinsic factors were motivators for RCT participation.
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Affiliation(s)
- Dan Kabonge Kaye
- College of Health Sciences, Department of Obstetrics and Gynecology, Makerere University, P.O. Box 7072, Kampala, Uganda. .,Johns Hopkins University, Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
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20
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Molyneux S, Sukhtankar P, Thitiri J, Njeru R, Muraya K, Sanga G, Walson JL, Berkley J, Kelley M, Marsh V. Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya. BMJ Glob Health 2021; 6:e004937. [PMID: 34244204 PMCID: PMC8268889 DOI: 10.1136/bmjgh-2021-004937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
Health research in low-resource settings often involves individuals and populations defined as 'vulnerable'. There is growing attention in the literature to the ethical dilemmas that frontline research staff face while conducting such research. However, there is little documented as to how research staff might support one another in identifying and handling these dilemmas in different contexts. Over the course of conducting empirical ethics research embedded in the Childhood Acute Illness & Nutrition Network, we developed an approach to examine and respond to the ethical issues and dilemmas faced by the study teams, particularly frontline staff. In this paper we describe the specific tools and approach we developed, which centred on regular cross-team ethics reflection sessions, and share lessons learnt. We suggest that all studies involving potentially vulnerable participants should incorporate activities and processes to support frontline staff in identifying, reflecting on and responding to ethical dilemmas, throughout studies. We outline the resources needed to do this and share piloted tools for further adaptation and evaluation. Such initiatives should complement and feed into-and certainly not in any way replace or substitute for-strong institutional ethics review, safeguarding and health and safety policies and processes, as well broader staff training and career support initiatives.
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Affiliation(s)
- Sassy Molyneux
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Priya Sukhtankar
- Department of Child Health, Gloucester Hospitals NHS Foundation Trust, Gloucester, UK
| | - Johnstone Thitiri
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Rita Njeru
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kui Muraya
- Kemri-Wellcome Trust, Centre for Geographic Medicine Research Coast, Nairobi, Kenya
| | - Gladys Sanga
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James Berkley
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maureen Kelley
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vicki Marsh
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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21
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Zakayo SM, Kimani MN, Sanga G, Njeru R, Charo A, Berkley JA, Walson JL, Kelley M, Marsh V, Molyneux S. Vulnerability, Agency, and the Research Encounter: Family Members' Experiences and Perceptions of Participating in an Observational Clinical Study in Kenya. J Empir Res Hum Res Ethics 2021; 16:238-254. [PMID: 33764228 PMCID: PMC7613023 DOI: 10.1177/15562646211005304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric clinical research in low-resourced countries involves individuals defined as "vulnerable" in research ethics guidance. Insights from research participants can strengthen the design and oversight of studies. We share family members' perspectives and experiences of an observational clinical study conducted in one Kenyan hospital as part of an integrated empirical ethics study. Employing qualitative methods, we explored how research encounters featured in family members' care-seeking journeys. Our data reveals that children's vulnerability is intricately interwoven with that of their families, and that research processes and procedures can inadvertently add to hidden burdens for families. In research, the potential for layered and intersecting situational and structural vulnerability should be considered, and participants' agency in constrained research contexts actively recognized and protected.
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Affiliation(s)
- Scholastica M Zakayo
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mary N Kimani
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gladys Sanga
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rita Njeru
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anderson Charo
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
| | - Judd L Walson
- Department of Global Health, 7284University of Washington, Seattle, USA
| | - Maureen Kelley
- The Ethox Centre, Nuffield Department of Population Health, 6396University of Oxford, Oxford, UK
| | - Vicki Marsh
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
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22
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Sansom LJ, Minh TPN, Hill IE, Ha QNT, Trong TD, Vidaillac C, Quynh ND, Turner HC, Van Nuil JI, Phuong DNT, Kestelyn E. Towards a fair and transparent research participant compensation and reimbursement framework in Vietnam. Int Health 2021; 12:533-540. [PMID: 33165550 PMCID: PMC7651161 DOI: 10.1093/inthealth/ihaa066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Providing compensation for participants in clinical research is well established and while international guidelines exist, defining a context-specific and fair compensation for participants in low-resource settings is challenging due to ethical concerns and the lack of practical, national compensation and reimbursement frameworks. Methods We reviewed Oxford University Clinical Research Unit (OUCRU) internal reimbursement documentation over a 10-y period and conducted a scoping literature review to expand our knowledge of compensation and reimbursement practices including ethical concerns. We developed a preliminary reimbursement framework that was presented to community advisory boards (CAB) and clinical investigators to assess its applicability, fairness and transparency. Results The main topics discussed at the workshops centered on fairness and whether the reimbursements could be perceived as financial incentives. Other decisive factors in the decision-making process were altruism and the loss of caregivers’ earnings. Investigators raised the issue of additional burdens, whereas the CAB members were focused on non-monetary elements such as the healthcare quality the patients would receive. All elements discussed were reviewed and, where possible, incorporated into the final framework. Conclusion Our new reimbursement framework provides a consistent, fair and transparent decision-making process and will be implemented across all future OUCRU clinical research in Vietnam.
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Affiliation(s)
- Lucy J Sansom
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Trang Pham Nguyen Minh
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Iona E Hill
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George St, Glasgow G1 1RD, UK
| | - Quyen Nguyen Than Ha
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Thuan Dang Trong
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Celine Vidaillac
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Nhu Dong Quynh
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Hugo C Turner
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, Level 2, Faculty Building South Kensington Campus, London SW7 2AZ, UK
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Dung Nguyen Thi Phuong
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
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McGowan CR, Hellman N, Baxter L, Chakma S, Nahar S, Daula AU, Rowe K, Gilday J, Kingori P, Pounds R, Cummings R. A graphic elicitation technique to represent patient rights. Confl Health 2020; 14:86. [PMID: 33317586 PMCID: PMC7734610 DOI: 10.1186/s13031-020-00331-8] [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: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy. METHODS To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein. RESULTS Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities. CONCLUSIONS Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.
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Affiliation(s)
- Catherine R McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK. .,Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Nora Hellman
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Sonali Chakma
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Samchun Nahar
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Ahasan Ud Daula
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Kelly Rowe
- Save the Children Australia, 33 Lincoln Square South, Carlton, VIC, 3053, Australia
| | - Josie Gilday
- Save the Children International, St Vincent House, 30 Orange Street, London, WC2H 7HH, UK
| | - Patricia Kingori
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Rachel Pounds
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
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Chiumento A, Rahman A, Frith L. Writing to template: Researchers' negotiation of procedural research ethics. Soc Sci Med 2020; 255:112980. [PMID: 32311514 DOI: 10.1016/j.socscimed.2020.112980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
This qualitative study examines researchers' views of research ethics in everyday global mental health research practice. We present data from a multi-site study conducted in 2014-15 involving 35 individual in-depth interviews that explore researchers' perceptions of procedural ethics in research conducted in South Asia. We examine how researchers' negotiate ethical procedures, and consider the impact this has on ethical practice. This study foregrounds researchers' pivotal role in procedural research ethics: they produce ethical documents including research protocols and informed consent forms; engage in ethical review; and apply ethical documents to research practice. We apply the analytical framework of boundary objects to show the active work that ethical documents simultaneously enable and inhibit as researchers and ethical review boards apply these as templates for interaction. This analysis shows how the documents required by procedural ethics processes facilitate representations of research that are generalised, standardised, and abstracted from the situated context in which they are applied. Researchers' engagement with these standardised forms cannot prepare them for potential ethical issues in research practice. These templates therefore act as ideal constructions of what research ethics could be, documenting moral intent that researchers draw upon to translate into practice.
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Affiliation(s)
- Anna Chiumento
- Department of Psychological Sciences, University of Liverpool, United Kingdom.
| | - Atif Rahman
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - Lucy Frith
- Department of Health Services Research, University of Liverpool, United Kingdom
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25
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Engel N. Aligning in the dark: Variable and shifting (user-) settings in developing point-of-care diagnostics for tuberculosis and HIV. SOCIAL STUDIES OF SCIENCE 2020; 50:50-75. [PMID: 31928147 DOI: 10.1177/0306312719900545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To be effective, healthcare technologies should be attuned to particular contexts of use. This article examines how such attuning is articulated in global innovation practices for tuberculosis and HIV diagnostics, and to what effect. It examines the development of point-of-care (POC) diagnostics - promised to be designed for users outside laboratories or in resource constrained settings - to study what developers and implementers do to align diagnostic technologies to the POC. Fieldwork among global health actors involved in diagnostic development, including manufacturers, donors, industry consultants, international organizations, policymakers, regulators and researchers, is combined with fieldwork among users of diagnostics in India, including decision-makers, NGOs, program officers, laboratory technicians and nurses. The article adds to STS's theory of alignment and user interaction, where the setting and user to which developers and implementers of global health diagnostics align are multiple, varied, emerging and keep shifting. The characteristics of a local user setting include multiple engaged and imagined user settings, but also the settings of developers, of global intermediaries, competitors and diseases. As such, alignment is happening across multiple dimensions and scales and has an important temporal dimension. The results reveal how alignment happens to some extent in the dark, characterized by uncertainty about the elements that should align. Standardizing elements, politics and scarce resources cause frictions in the temporalities of aligning and over what constitutes a well-aligned diagnostic.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society and Care and Public Health Research Institute, Maastricht University, The Netherlands
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26
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Van Nuil JI, Nguyen TTT, Le Nguyen TN, Nguyen VVC, Chambers M, Ta TDN, Merson L, Nguyen TPD, Hoang MTV, Parker M, Bull S, Kestelyn E. Researcher and study participants' perspectives of consent in clinical studies in four referral hospitals in Vietnam. BMC Med Ethics 2020; 21:4. [PMID: 31924199 PMCID: PMC6954581 DOI: 10.1186/s12910-020-0445-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/31/2019] [Indexed: 02/01/2023] Open
Abstract
Background Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. In this study, we explored the consent practices and attitudes regarding essential information required for the consent process within hospital-based trial communities from four referral hospitals in Vietnam. Methods We collected surveys from and conducted semi-structured interviews with study physicians, study nurses, ethics committee members, and study participants and family members regarding their experiences of participating in research, their perspectives toward research, and their views about various elements of the consent process. Results In our findings, we describe three interrelated themes related to the consent process: (1) words and regulation; (2) reimbursement, suspicions, and joining; and (3) responsibilities. In general, stakeholders had highly varied perspectives of nghiên cứu (Eng.: research) and researchers used varying levels of detail regarding all aspects of the study in the consent process to build trust with and/or promote potential research participants’ choices about taking part in research. Findings additionally highlight how researchers felt that offering financial reimbursements in a hospital setting, where payment for services was routine, would be unfamiliar to participants and could raise suspicions about the research. Participants, however, focused their discussions on reimbursement or alternative reasons for joining the study, such as health related benefits or altruism. Finally, participants often relied on their physician to help them decide about joining a study or not. Conclusion Further research is needed to understand how researchers and participants make sense of and practice consent, and how that impacts participants’ decision-making about research participation. To promote valid consent within this context, it is important to engage with hospital-based trial communities as a whole. The data from this study will inform future research on consent, guide the revisions of consent related policies within our research sites and point to several larger issues surrounding researcher-participant expectations, communication, and trust.
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Affiliation(s)
- Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Thi Thanh Thuy Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam
| | | | | | - Mary Chambers
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Laura Merson
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory, Oxford, UK
| | - Thi Phuong Dung Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam
| | | | | | - Susan Bull
- Ethox Centre, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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27
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Fisher JA, Monahan T, Walker RL. Picking and Choosing Among Phase I Trials : A Qualitative Examination of How Healthy Volunteers Understand Study Risks. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:535-549. [PMID: 31713712 PMCID: PMC6938537 DOI: 10.1007/s11673-019-09946-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
This article empirically examines how healthy volunteers evaluate and make sense of the risks of phase I clinical drug trials. This is an ethically important topic because healthy volunteers are exposed to risk but can gain no medical benefit from their trial participation. Based on in-depth qualitative interviews with 178 healthy volunteers enrolled in various clinical trials, we found that participants focus on myriad characteristics of clinical trials when assessing risk and making enrolment decisions. These factors include the short-term and long-term effects; required medical procedures; the type of trial, including its design, therapeutic area of investigation, and dosage of the drug; the amount of compensation; and trust in the research clinic. In making determinations about the study risks, participants rely on information provided during the consent process, their own and others' experiences in clinical trials, and comparisons among studies. Our findings indicate that the informed consent process succeeds in communicating well about certain types of risk information while simultaneously creating lacunae that are problematically filled by participants through their collective experiences and assumptions about risk. We discuss the ethical implications of these findings and make recommendations for improving the consent process in healthy volunteer trials.
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Affiliation(s)
- Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, CB 3285, Chapel Hill, NC 27599-3285 USA
| | - Rebecca L. Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
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28
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Folayan MO, Haire B, Noseda V. Re: Pre-Exposure Prophylaxis for Mitigating Risk of HIV Transmission During HIV Cure–Related Clinical Trials With a Treatment Interruption. J Infect Dis 2019; 220:1231-1233. [DOI: 10.1093/infdis/jiz263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
| | - Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, Australia
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29
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van den Berg M, Ogutu B, Sewankambo NK, Merten S, Biller-Andorno N, Tanner M. Clinical trials in low-resource settings: the perspectives of caregivers of paediatric participants from Uganda, Tanzania and Kenya. Trop Med Int Health 2019; 24:1023-1030. [PMID: 31215122 PMCID: PMC6852514 DOI: 10.1111/tmi.13281] [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] [Indexed: 12/02/2022]
Abstract
Objectives Vaccine clinical trials in low‐resource settings have unique challenges due to structural and financial inequities. Specifically, protecting participant and caregiver autonomy to participate in the research study can be a major challenge, so understanding the setting and contextual factors which influence the decision process is necessary. This study investigates the experience of caregivers consenting on behalf of paediatric participants in a malaria vaccine clinical trial where participation enables access to free, high‐quality medical care. Methods We interviewed a total of 78 caregivers of paediatric participants previously enrolled in a phase II or III malaria vaccine clinical trial in Uganda, Tanzania and Kenya. Interviews were qualitative and analysed using a thematic framework analysis focusing on the embodied caregiver in the political, economic and social reality. Results Caregivers of participants in this study made the decision to enrol their child based on economic, social and political factors that extended beyond the trial into the community and the home. The provision of health care was the dominant reason for participation. Respondents reported how social networks, rumours, hierarchal structures, financial constraints and family dynamics affected their experience with research. Conclusions The provision of medical care was a powerful motivator for participation. Caregiver choice was limited by structural constraints and scarce financial resources. The decision to participate in research extended beyond individual consent and was embedded in community and domestic hierarchies. Future research should assess other contexts to determine how the choice to participate in research is affected when free medical care is offered.
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Affiliation(s)
- Machteld van den Berg
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Bernhards Ogutu
- Kenya Medical Research Institute, Nairobi, Kenya.,CREATES, Strathmore University, Nairobi, Kenya
| | | | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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30
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Channeling hope: An ethnographic study of how research encounters become meaningful for families suffering from genetic disease in Pakistan. Soc Sci Med 2019; 228:103-110. [PMID: 30904814 PMCID: PMC6481513 DOI: 10.1016/j.socscimed.2019.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
Abstract
The Pakistani population has become particularly interesting for international genetic research due to its high rates of consanguinity. Based on 5 months fieldwork in Faisalabad among Pakistani genetic researchers from December 2015–January 2016 and February–April 2017 and interviews with 36 families and 14 researchers, this article focuses on research encounters. It demonstrates how genetic research figures in the lives of families affected by genetic medical conditions in light of their everyday struggles with disease, and considers their perspectives on destiny and hope. Through examining the potentials of the research encounter, we ask how research becomes meaningful in the lives of Pakistani families affected by genetic disease: how these families and individuals enable different modes of sharing tragic stories, contemplating hope and contesting logics of consanguinity. International genetic research depends on human raw material. If we wish to understand the precarious lives this research relies on, then the everyday struggles with disease, and the perspectives of families must be methodologically and theoretically engaged. Ethnographic study of genetic research encounters in Pakistan. Illustrates suffering and hopes of families responding to genetic disease. Discusses researcher-participant interaction in genetic research. Calls for a focus on how research participation becomes meaningful for families.
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31
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Alenichev A, Nguyen VK. Precarity, clinical labour and graduation from Ebola clinical research in West Africa. Glob Bioeth 2019; 30:1-18. [PMID: 30692879 PMCID: PMC6338271 DOI: 10.1080/11287462.2019.1566973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/04/2019] [Indexed: 12/03/2022] Open
Abstract
The provision of gifts and payments for healthy volunteer subjects remains an important topic in global health research ethics. This paper provides empirical insights into theoretical debates by documenting participants' perspectives on an Ebola vaccine trial in West Africa. This trial provided hundreds of Africans with regular payments, food packages and certificates for participation. The researchers conducting the trials considered these socioeconomic provisions to be gifts in accordance with contemporary ethical standards and principles. Trial participants viewed them differently, however, approaching trial participation as a means for training and employment in what was from their perspective a new job market: the post-Ebola expansion of research and health care systems. This paper analyses participation in contemporary research by viewing the context-specific histories of trial participants through the lens of prior interventions, specifically participatory reintegration programmes conducted in Anglophone West Africa to overcome civil war crises. In particular, we argue that participation in the Ebola vaccine trial was inadvertently shaped by the design and outcomes of past reintegration programmes. Our results highlight the need to investigate existing socioeconomic landscapes which surround and indeed permeate clinical research as a prerequisite for understanding the participatory motives of vulnerable participants in West Africa and elsewhere.
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Affiliation(s)
- Arsenii Alenichev
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.,ISGlobal, Barcelona, Spain
| | - Vinh-Kim Nguyen
- Graduate Institute of International and Development Studies, Geneva, Switzerland
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32
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Gooding K, Phiri M, Peterson I, Parker M, Desmond N. Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why? Soc Sci Med 2018; 213:190-198. [PMID: 30142500 PMCID: PMC7614255 DOI: 10.1016/j.socscimed.2018.07.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
Ethics guidelines emphasise that research should be acceptable to the people invited to take part. However, acceptability is subjective and dependent on context, complicating its assessment and use as an ethical standard. This paper examines the concept of acceptability in relation to parents' perspectives on a paediatric vaccine trial in Malawi. We examined decisions on participation and experiences of the trial through interviews with parents in 41 households invited to enrol their children and participant observation of trial processes. Fieldwork took place in Chikwawa, Southern Malawi from February-October 2016. Parents were not neatly split between those who saw the trial as acceptable and those who did not; instead there were mixed and changing feelings among parents who enrolled their children, and among those who withdrew or did not take part. Some parents agreed to participate but had concerns about the trial, while others expressed satisfaction with the trial but still did not take part. These experiences indicate substantial variation in the nature of acceptance. We describe these variations in relation to six dimensions of acceptability: how acceptable the trial is, what aspects are acceptable, changes over time, circumstances affecting acceptability, variations between people, and reasons for participation or non-participation. The findings illustrate the difficulty of determining whether a trial is sufficiently acceptable to potential participants. We suggest that clarifying definitions of acceptability and examining how acceptability varies in degree, between trial components, over time, and between people and contexts may help researchers generate more nuanced descriptions of acceptability that support responsive and ethical trial design.
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Affiliation(s)
- Kate Gooding
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Mackwellings Phiri
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Ingrid Peterson
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Michael Parker
- Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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33
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Dixon J, Tameris M. Clean Blood, Religion, and Moral Triage in Tuberculosis Vaccine Trials. Med Anthropol 2018; 37:708-721. [DOI: 10.1080/01459740.2018.1463528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Justin Dixon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Michèle Tameris
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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34
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Pol S, Fox-Lewis S, Neou L, Parker M, Kingori P, Turner C. If you come from a well-known organisation, I will trust you: Exploring and understanding the community's attitudes towards healthcare research in Cambodia. PLoS One 2018; 13:e0195251. [PMID: 29668693 PMCID: PMC5905956 DOI: 10.1371/journal.pone.0195251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore Cambodian community members' understanding of and attitudes towards healthcare research. DESIGN This qualitative study generated data from semi-structured interviews and focus group discussions. This study was conducted at a non-governmental paediatric hospital and in nearby villages in Siem Reap province, Cambodia. A total of ten semi-structured interviews and four focus group discussions were conducted, involving 27 participants. Iterative data collection and analysis were performed concurrently. Data were analysed by thematic content analysis and the coding structure was developed using relevant literature. RESULTS Participants did not have a clear understanding of what activities related to research compared with those for routine healthcare. Key attitudes towards research were responsibility and trust: personal (trust of the researcher directly) and institutional (trust of the institution as a whole). Villagers believe the village headman holds responsibility for community activities, while the village headman believes that this responsibility should be shared across all levels of the government system. CONCLUSIONS It is essential for researchers to understand the structure and relationship within the community they wish to work with in order to develop trust among community participants. This aids effective communication and understanding among all parties, enabling high quality ethical research to be conducted.
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Affiliation(s)
- Sreymom Pol
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Shivani Fox-Lewis
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Patricia Kingori
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Angkor Hospital for Children, Siem Reap, Cambodia
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35
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Mtove G, Kimani J, Kisinza W, Makenga G, Mangesho P, Duparc S, Nakalembe M, Phiri KS, Orrico R, Rojo R, Vandenbroucke P. Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings. Trials 2018; 19:190. [PMID: 29566732 PMCID: PMC5863846 DOI: 10.1186/s13063-018-2563-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2018] [Indexed: 01/07/2023] Open
Abstract
Background Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. Main body During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the “Sponsoring Entities” for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Conclusion Engagement with key stakeholders at international and national levels enabled the Sponsoring Entities to address challenges by aligning the study design with the requirements of health and regulatory agencies and to understand and address healthcare infrastructure needs prior to trial initiation. Local stakeholder engagement, including community members, study participants, and family enabled the investigators to address challenges by ensuring that study design and conduct were adapted to local considerations and ensuring accurate information about the study aims was shared with the public. Trial registration ClinicalTrials.gov, ID: NCT01103063. Registered on 7 April 2010.
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Affiliation(s)
- George Mtove
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania.
| | - Joshua Kimani
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - William Kisinza
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Geofrey Makenga
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Peter Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | | | | | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
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36
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Ward CL, Shaw D, Anane-Sarpong E, Sankoh O, Tanner M, Elger B. The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania. J Empir Res Hum Res Ethics 2017; 13:26-41. [PMID: 29179625 DOI: 10.1177/1556264617742236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk-benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.
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37
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Kerasidou A. Trust me, I'm a researcher!: The role of trust in biomedical research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:43-50. [PMID: 27638832 PMCID: PMC5318478 DOI: 10.1007/s11019-016-9721-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In biomedical research lack of trust is seen as a great threat that can severely jeopardise the whole biomedical research enterprise. Practices, such as informed consent, and also the administrative and regulatory oversight of research in the form of research ethics committees and Institutional Review Boards, are established to ensure the protection of future research subjects and, at the same time, restore public trust in biomedical research. Empirical research also testifies to the role of trust as one of the decisive factors in research participation and lack of trust as a barrier for consenting to research. However, what is often missing is a clear definition of trust. This paper seeks to address this gap. It starts with a conceptual analysis of the term trust. It compares trust with two other related terms, those of reliance and trustworthiness, and offers a defence of Baier's attribute of 'good will' a basic characteristic of trust. It, then, proceeds to consider trust in the context of biomedical research by examining two questions: First, is trust necessary in biomedical research?; and second, do increases in regulatory oversight of biomedical research also increase trust in the field? This paper argues that regulatory oversight is important for increasing reliance in biomedical research, but it does not improve trust, which remains important for biomedical research. It finishes by pointing at professional integrity as a way of promoting trust and trustworthiness in this field.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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38
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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.
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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
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