Responsible inclusion: A systematic review of consent to social-behavioral research with adults with intellectual disability in the US

BACKGROUND

In recognition of their status as a health disparities population, there is growing emphasis on conducting research inclusive of adults with intellectual disability to generate new knowledge and opportunities to improve health and equity. Yet they are often excluded from research, and human research participant protection experts and researchers lack agreement on effective consent protocols for their inclusion.

OBJECTIVE

We sought to identify approaches to consent in US-based social-behavioral research with adults with intellectual disability.

METHODS

We conducted a systematic review on approaches to self-consent with adults with intellectual disability published between 2009 and 2023, identified via searching eight databases and reference list hand searches. We identified 13 manuscripts and conducted a thematic analysis.

RESULTS

Our analysis identified themes related to guiding principles, strategies to enhance informed and voluntary consent, approaches to consent capacity, involving individuals subject to guardianship, and strategies for expressing decisions and enhancing ongoing decisions.

CONCLUSIONS

Manuscripts largely reflected an emphasis on identifying approaches to consent that reflect disability rights principles to promote the right to be included and make one's own decisions based on assessment of relevant information, risks and benefits, and to employ reasonable modifications to achieve inclusion. To avoid the risks of exclusion and advance the responsible inclusion of adults with intellectual disability, we make recommendations to align consent approaches anchored in contemporary thinking about human research participant protections, including through integration with disability rights.

Advancing inclusive research with people with profound and multiple learning disabilities through a sensory-dialogical approach

People with profound and multiple learning disabilities are often excluded from the processes of knowledge production and face barriers to inclusion in research due to cognitive and communicative challenges. Inclusive research-even when intending to be inclusive-tends to operate within criteria that exclude people with profound and multiple learning disabilities. The aim of this article is to provide a state-of-the-art review of the topic of inclusive research involving people with profound disabilities and thereby challenge traditional assumptions of inclusive research. The review presents themes that will inform a discussion on how to challenge the criteria in ways that make it possible to understand inclusive research for people who communicate in unconventional ways. We argue that a fruitful way of rethinking inclusive research is by applying a sensory-dialogical approach that privileges the dialogical and sensory foundations of the research. We suggest this might be a way to understand inclusive research that regards the person's communicative and cognitive distinctiveness.

Has the Pandemic Altered Public Perception of How Local Green Spaces Affect Quality of Life in the United Kingdom?

Green spaces unquestionably improve both physical and mental health, but there is little information on how they affect quality of life. This study investigates whether the public perception of how local green spaces and their impact on quality of life have altered as a result of restrictions imposed by the U.K.’s SARS-CoV-2 pandemic containment strategy. Qualitative data were collected using an online questionnaire distributed via social media platforms and postal flyers. The results clearly demonstrate that 90% of participants believe that green spaces improved their quality of life during the pandemic, with over 85% thinking that green spaces will continue to have a positive impact on their quality of life once the pandemic is over. Whether this is a permanent change in public thinking or a short-term adaptation to the stresses of the pandemic can be assessed in future research studies. More detailed research is required to understand more clearly the aspects and types of green spaces that are the most valuable for improving quality of life so that future ones can be designed to provide maximum benefits.

Informed Consent or Assent Strategies for Research With Individuals With Deafblindness or Dual Sensory Impairment: A Scoping Review

OBJECTIVE

To synthesize evidence on existing informed consent/assent strategies and processes that enable the participation of individuazls with deafblindness or dual sensory impairment in research.

DATA SOURCES

Five scientific databases (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and PsycINFO) and other sources such as Google Scholar, Journal of Visual Impairment and Blindness, and British Journal of Visual Impairment were hand-searched from January 2015 until July 2020.

STUDY SELECTION

Studies were selected using a priori inclusion criteria of sensory and cognitive disabilities and focused on consent/assent strategies and processes in research within this population. Articles related to the medical or sexual consent processes were excluded.

DATA EXTRACTION

An Excel spreadsheet was used to extract data from the eligible sources. Discrepancies were resolved in discussion with team members.

DATA SYNTHESIS

A total of 2163 sources were screened, and 16 articles were included in the review. Seven sources only examined consent strategies, whereas the remaining 8 included a combination of consent/assent and dissent strategies. Using thematic analysis, 3 key themes emerged: consent/assent strategies, researcher capacity, and capacity to consent tools. Key identified strategies included the accessibility of the consent/assent process, building relationships with participants and caregivers, identifying behavioral cues, and communication training for researchers.

CONCLUSIONS

Despite the absence of literature on consent/assent strategies within the population with deafblindness, the review found promising strategies applied to individuals with other cognitive or sensory disabilities that researchers can adopt. Researchers are encouraged to use best practices in creating an inclusive research environment to include individuals with deafblindness.