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Mthembu Z, Chimbari M. Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community. Front Public Health 2023; 11:1050589. [PMID: 37333558 PMCID: PMC10272796 DOI: 10.3389/fpubh.2023.1050589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The goal of community involvement in health research is to improve a community's ability to address its own health needs while ensuring that researchers understand and consider the community's priorities. Recent data show that socio-economic and environmental challenges continue to be a barrier to informing, consulting, involving and empowering communities in community-based health research beneficial to them. The aim of this study was to assess the extent to which the Ingwavuma community in KwaZulu-Natal Province, in rural South Africa, was informed, consulted, involved and empowered about two research projects conducted between 2014 and 2021. Methods The study used the modified random-route procedure to administer a standardized questionnaire to 339 household heads selected randomly. The questionnaires were administered face-to-face. The sample size was estimated using the Yamane sample size generating formula. Chi-square tests were performed to assess associations between demographic variables (age, gender, education, village) and respondents' knowledge and information of the projects, Malaria and Bilharzia in Southern Africa and Tackling Infections to Benefit Africa as well as their participation. Results The communities were generally well-informed about the health projects that were being carried out. Fewer than half of those who had heard about the projects had directly participated in them. The majority had been tested for one or more diseases and conditions, mostly high blood pressure, diabetes, and schistosomiasis, and had participated in a community feedback group; many had given their children's permission to be tested for schistosomiasis or to participate in project research activities. Others participated in public awareness campaigns and surveys. There was some evidence of a consultation process in the form of public consultation discussed in the projects, and not much discussion on empowerment. Discussion The findings demonstrate that researchers' CE approach was adaptable as communities were largely educated, involved, and subsequently empowered though without much consultation and that researchers had provided a space for sharing responsibilities in all engagement process decision-making. For the empowerment of the community, projects should take into account the intrapersonal and personal aspects affecting the community's capacity to effectively benefit from the information, consultation, involvement, and empowerment procedures.
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Affiliation(s)
- Zinhle Mthembu
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Anthropology and Development Studies, Faculty of Humanities and Social Sciences, University of Zululand, KwaDlangezwa, South Africa
| | - Moses Chimbari
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Anthropology and Development Studies, Faculty of Humanities and Social Sciences, University of Zululand, KwaDlangezwa, South Africa
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Heynemann S, Lipworth W, McLachlan SA, Philip J, John T, Kerridge I. When research becomes practice: the concept of the therapeutic misconception and challenges to consent in clinical trials. Intern Med J 2023; 53:271-274. [PMID: 36822606 DOI: 10.1111/imj.16015] [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: 09/30/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
Many factors influence patients' decisions to participate in clinical trials. For many, the primary motivation is the possibility that they might derive some benefit from participation. This is particularly true for patients with limited treatment options, such as patients with advanced cancer. While this is not surprising, it is potentially problematic if patients fail to recognise the distinction between research and clinical care (a phenomenon known as the 'therapeutic misconception'). This is becoming increasingly problematic as clinical trial designs become more complex, as clinical trials become more embedded in routine clinical care, and as trials are increasingly used by patients and clinicians to access new diagnostic platforms and therapies. We outline some of these recent trends, focusing on the cancer clinical trials landscape as this provides a good case study of the phenomenon. We conclude by making preliminary suggestions that changes to the consent process, perhaps using 'dynamic consent' platforms, might help to mitigate the therapeutic misconception and note the need for further research to guide strategies for improving communication and decision-making.
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Affiliation(s)
- Sarah Heynemann
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, New South Wales, Sydney, Australia
| | - Sue-Anne McLachlan
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tom John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian Kerridge
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Philosophy, Macquarie University, New South Wales, Sydney, Australia.,Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Ochieng J, Kwagala B, Barugahare J, Möller M, Moodley K. Feedback of individual genetic and genomics research results: A qualitative study involving grassroots communities in Uganda. PLoS One 2022; 17:e0267375. [PMID: 36399445 PMCID: PMC9674126 DOI: 10.1371/journal.pone.0267375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetics and genomics research (GGR) is associated with several challenges including, but not limited to, methods and implications of sharing research findings with participants and their family members, issues of confidentiality, and ownership of data obtained from samples. Additionally, GGR holds significant potential risk for social and psychological harms. Considerable research has been conducted globally, and has advanced the debate on return of genetic and genomics testing results. However, such investigations are limited in the African setting, including Uganda where research ethics guidance on return of results is deficient or suboptimal at best. The objective of this study was to assess perceptions of grassroots communities on if and how feedback of individual genetics and genomics testing results should occur in Uganda with a view to improving ethics guidance. METHODS This was a cross-sectional study that employed a qualitative exploratory approach. Five deliberative focus group discussions (FGDs) were conducted with 42 participants from grassroots communities representing three major ethnic groupings. These were rural settings and the majority of participants were subsistence farmers with limited or no exposure to GGR. Data were analysed through thematic analysis, with both deductive and inductive approaches applied to interrogate predetermined themes and to identify any emerging themes. NVivo software (QSR international 2020) was used to support data analysis and illustrative quotes were extracted. RESULTS All the respondents were willing to participate in GGR and receive feedback of results conditional upon a health benefit. The main motivation was diagnostic and therapeutic benefits as well as facilitating future health planning. Thematic analysis identified four themes and several sub-themes including 1) the need-to-know health status 2) paternity information as a benefit and risk; 3) ethical considerations for feedback of findings and 4) extending feedback of genetics findings to family and community. CONCLUSION Participation in hypothetical GGR as well as feedback of results is acceptable to individuals in grassroots communities. However, the strong therapeutic and/or diagnostic misconception linked to GGR is concerning given that hopes for therapeutic and/or diagnostic benefit are unfounded. Viewing GGR as an opportunity to confirm or dispute paternity was another interesting perception. These findings carry profound implications for consent processes, genetic counselling and research ethics guidance. Privacy and confidentiality, benefits, risks as well as implications for sharing need to be considered for such feedback of results to be conducted appropriately.
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Affiliation(s)
- Joseph Ochieng
- Makerere University School of Biomedical Sciences, Kampala, Uganda
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Betty Kwagala
- Makerere University School of Statistics and Planning, Kampala, Uganda
| | | | - Marlo Möller
- Division of Molecular Biology and Human Genetics, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Roberts LR, Rivers BM, Yates CC, Newman LA, Sarkodie BD, Davis MB, Asare-Aboagye Y, Adjei AA, Harris AE, Awuah B. Unmet Needs in Oncology Clinical Research and Treatment in Africa: Focus on Ghana. Oncologist 2022; 27:760-767. [PMID: 35726905 PMCID: PMC9438909 DOI: 10.1093/oncolo/oyac109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
Cancer incidence is increasing worldwide and is a major cause of mortality. The relative magnitude of the increase is remarkably high in low human development index (HDI; 95%) and medium HDI (64%) countries. On the African continent, a corresponding increase in cancer burden is predicted, particularly for sub-Saharan Africa. Current epidemiologic data indicate that mortality rates of certain cancers, such as breast and cervical cancers, in sub-Saharan Africa are the highest in the world, and the cancer risks are broadly comparable to the risks in high-income countries, such as the United States and Europe. Although emerging data alludes to the unique genetic profile of cancer in African populations, most cancer therapies are introduced to Africa without confirmatory clinical trials. Therefore, there is an increasing need for clinical trials directed toward prevention, screening, diagnosis, and identification of innovative treatments in the African context. This review will discuss the increasing cancer burden in Africa, with a particular focus on Ghana, unmet clinical needs in cancer, current medical systems, clinical trial regulatory systems, and challenges to clinical trial recruitment.
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Affiliation(s)
| | | | | | | | | | - Melissa B Davis
- Weill Cornell Medical College and Englander Institute of Precision Medicine, New York, NY, USA
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Odedina FT, Shamley D, Okoye I, Ezeani A, Ndlovu N, Dei-Adomakoh Y, Meza K, Agaba R, Fathi P, Askins N. Landscape of Oncology Clinical Trials in Africa. JCO Glob Oncol 2021; 6:932-941. [PMID: 32614728 PMCID: PMC7392757 DOI: 10.1200/jgo.19.00189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The burden of cancer in Africa is of significant concern for several reasons, including that incidence of cancer in Africa continues to rise while Africa is also dealing with communicable diseases. To combat cancer in Africa, oncology clinical trials are needed to develop innovative interventions for cancer prevention, screening, diagnosis, treatment, and survivorship. Unfortunately, there is a paucity of clinical trials in Africa and it is difficult for African clinicians to get information on open oncology clinical trials and impossible for African patients with cancer to access this information. The primary objective of this study was to identify open oncology clinical trials in Africa. METHODS This project was part of a large-scale study to develop an African Virtual Platform for Oncology Clinical Trials Registry. The study was a quantitative, web-based, retrospective review of clinical trials registries. RESULTS A total of 109 open oncology clinical trials were identified. Most of the trials were in Egypt, South Africa, Algeria, and Kenya. The top cancer types for oncology clinical trials in Africa were breast, cervical, and lung cancers. The top sponsor of oncology clinical trials in Africa was academic institutions, especially institutions in the United States. CONCLUSION The paucity of clinical trials in Africa will continue to magnify the global disparities of cancer in the African population. Clinical trials are needed to ensure therapeutic interventions are safe and effective in the African population. In the era of personalized and precision health, it no longer suffices to assume that drugs developed in North America, Europe, or Asia will be effective in the African population.
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Affiliation(s)
- Folakemi T Odedina
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | | | - Ifeoma Okoye
- Prostate Cancer Transatlantic Consortium, Orlando, FL.,University of Nigeria, Nsukka, Nigeria
| | - Adaora Ezeani
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Ntokozo Ndlovu
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Kimberly Meza
- Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Ruth Agaba
- Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Parisa Fathi
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Nissa Askins
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
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Jaffe K, Korthuis T, Richardson L. 'This could be my last chance': Therapeutic optimism in a randomised controlled trial for substance use disorders. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1286-1300. [PMID: 34117637 DOI: 10.1111/1467-9566.13297] [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: 12/02/2020] [Revised: 03/21/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
In randomised controlled trials (RCTs), 'therapeutic optimism' describes a participant's belief they will benefit from the study treatment, despite the express goal of RCTs to test unknown aspects of interventions. Harbouring such expectations may interfere with RCT participation experiences, particularly among marginalised populations, such as people with substance use disorders (PSUD) who may experience social and structural barriers to participation that also increase their vulnerability to therapeutic optimism. However, little research explores therapeutic optimism within substance use trials. Thus, we conducted a nested qualitative study within an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Using interviews with 22 participants in Vancouver, Canada, analysis revealed themes relevant to therapeutic optimism, that were specifically linked to intrinsic (e.g. health-related) or extrinsic motivations (e.g. stipend). First, compared to extrinsically motivated participants, intrinsically motivated participants held high expectations for the trial and attributed greater agency to the study medication. Second, intrinsically motivated participants expressing therapeutic optimism anticipated marked changes in their lives from the study/medication. Finally, some participants predicted the treatment would solve substance-related issues in their communities. These findings highlight the interplay between therapeutic optimism and complex interpretations of RCT objectives among PSUD.
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Affiliation(s)
- Kaitlyn Jaffe
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
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Alenichev A, Peeters Grietens K, Gerrets R. Conceptions within misconceptions: Pluralisms in an Ebola vaccine trial in West Africa. Glob Public Health 2019; 15:13-21. [PMID: 31237180 DOI: 10.1080/17441692.2019.1632368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants' understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects' motives for participation, and to creating space for studies of empirical ethics.
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Affiliation(s)
- Arsenii Alenichev
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.,The Barcelona Institute for Global Health, Barcelona, Spain
| | | | - René Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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Villafranca A, Kereliuk S, Hamlin C, Johnson A, Jacobsohn E. The Appropriateness of Language Found in Research Consent Form Templates: A Computational Linguistic Analysis. PLoS One 2017; 12:e0169143. [PMID: 28146568 PMCID: PMC5287453 DOI: 10.1371/journal.pone.0169143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/11/2016] [Indexed: 11/18/2022] Open
Abstract
Background To facilitate informed consent, consent forms should use language below the grade eight level. Research Ethics Boards (REBs) provide consent form templates to facilitate this goal. Templates with inappropriate language could promote consent forms that participants find difficult to understand. However, a linguistic analysis of templates is lacking. Methods We reviewed the websites of 124 REBs for their templates. These included English language medical school REBs in Australia/New Zealand (n = 23), Canada (n = 14), South Africa (n = 8), the United Kingdom (n = 34), and a geographically-stratified sample from the United States (n = 45). Template language was analyzed using Coh-Metrix linguistic software (v.3.0, Memphis, USA). We evaluated the proportion of REBs with five key linguistic outcomes at or below grade eight. Additionally, we compared quantitative readability to the REBs’ own readability standards. To determine if the template’s country of origin or the presence of a local REB readability standard influenced the linguistic variables, we used a MANOVA model. Results Of the REBs who provided templates, 0/94 (0%, 95% CI = 0–3.9%) provided templates with all linguistic variables at or below the grade eight level. Relaxing the standard to a grade 12 level did not increase this proportion. Further, only 2/22 (9.1%, 95% CI = 2.5–27.8) REBs met their own readability standard. The country of origin (DF = 20, 177.5, F = 1.97, p = 0.01), but not the presence of an REB-specific standard (DF = 5, 84, F = 0.73, p = 0.60), influenced the linguistic variables. Conclusions Inappropriate language in templates is an international problem. Templates use words that are long, abstract, and unfamiliar. This could undermine the validity of participant informed consent. REBs should set a policy of screening templates with linguistic software.
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Affiliation(s)
- Alexander Villafranca
- University of Manitoba, Department of Anesthesiology and Perioperative Medicine, CR31-42 369 Tache Ave, Winnipeg, MB, Canada
- * E-mail:
| | - Stephanie Kereliuk
- University of Manitoba, Department of Anesthesiology and Perioperative Medicine, CR31-42 369 Tache Ave, Winnipeg, MB, Canada
| | - Colin Hamlin
- University of Manitoba, Department of Anesthesiology and Perioperative Medicine, CR31-42 369 Tache Ave, Winnipeg, MB, Canada
| | - Andrea Johnson
- University of Manitoba, Department of Anesthesiology and Perioperative Medicine, CR31-42 369 Tache Ave, Winnipeg, MB, Canada
| | - Eric Jacobsohn
- University of Manitoba, Department of Anesthesiology and Perioperative Medicine, CR31-42 369 Tache Ave, Winnipeg, MB, Canada
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Staunton C. Informed consent for HIV cure research in South Africa: issues to consider. BMC Med Ethics 2015; 16:3. [PMID: 25591806 PMCID: PMC4324028 DOI: 10.1186/1472-6939-16-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/02/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND South Africa has made great progress in the development of HIV/AIDS testing, treatment and prevention campaigns. Yet, it is clear that prevention and treatment campaigns alone are not enough to bring this epidemic under control. DISCUSSION News that the "Berlin patient" and the "Mississippi baby" have both been "cured" of HIV brought hope to people living with HIV/AIDS in South Africa that a cure for HIV/AIDS is within reach. Despite the recent setbacks announced in the "Mississippi Baby" case, protocols aimed at curing HIV/AIDS are being developed in South Africa. However with evidence to suggest that participants in clinical trials do not understand the basic concepts in the informed consent process, there is concern that future participants in HIV/AIDS cure research will lack comprehension of the basic elements of future clinical trials that aims to cure HIV/AIDS and confuse research with clinical care. SUMMARY Research ethics committees have an important role to play in ensuring that participants understand the basic concepts discussed in the informed consent process, that they understand that research is not clinical care and they are unlikely to benefit from any early phase trials seeking to cure HIV/AIDS.
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Affiliation(s)
- Ciara Staunton
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Francie van Zijl Drive, 7505 Tygerberg, South Africa.
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