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Mdala V, Nyirenda D, Mpinganjira S, Mwapasa V, Nyondo-Mipando AL. "When selling anything to an audience, visible publicity is key:" experiences, barriers, and enablers to participate in a COVID-19 study in Malawi. BMC Med Res Methodol 2024; 24:207. [PMID: 39285321 PMCID: PMC11403996 DOI: 10.1186/s12874-024-02329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Many studies in infectious diseases struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study reported a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored the reasons for participating in the SCATHIM study. METHODS A descriptive qualitative study informed by the theory of reasoned action was conducted in Blantyre between January 2022 and March 2022 to assess factors that influence participation in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. The data were collected via in-depth interview guides, audio recorded, transcribed, managed via NVIVO and analysed via a thematic approach. RESULTS The factors that motivated participation in the study included one's knowledge of COVID-19; potential access to medical services, including free COVID-19 tests for members of the household; financial reimbursements; and the ability to contribute scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures, and suboptimal financial reimbursements. CONCLUSION Effective publicity and outreach strategies have the potential to decrease refusal rates in study participation, especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.
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Affiliation(s)
- Vanessa Mdala
- Department of Epidemiology and Statistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Samuel Mpinganjira
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Mwapasa
- Department of Epidemiology and Statistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
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Appiah R, Raviola G, Weobong B. Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research. J Empir Res Hum Res Ethics 2024; 19:143-172. [PMID: 38497301 PMCID: PMC11298123 DOI: 10.1177/15562646241237669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024]
Abstract
Objective: This review explores the ethico-cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to manage them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 to 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges, that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethics dumping, safeguard the integrity of the research process, and promote respectful engagement.
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Affiliation(s)
- Richard Appiah
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Center for African Studies, Harvard University, Cambridge, MA, USA
- College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Benedict Weobong
- College of Health Sciences, University of Ghana, Accra, Ghana
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
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Appiah R. Facilitating change processes in group-based behaviour change interventions in rural African contexts: practical lessons from Ghana. Int J Ment Health Syst 2023; 17:3. [PMID: 36747199 PMCID: PMC9900900 DOI: 10.1186/s13033-023-00571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behaviour change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population.
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Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana. .,Center for African Studies, Harvard University, Cambridge, MA, USA. .,Department of Psychology, University of Johannesburg, Johannesburg, South Africa.
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Teixeira da Silva JA. Handling Ethics Dumping and Neo-Colonial Research: From the Laboratory to the Academic Literature. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:433-443. [PMID: 35731331 PMCID: PMC9215145 DOI: 10.1007/s11673-022-10191-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/11/2022] [Indexed: 05/07/2023]
Abstract
This paper explores that the topic of ethics dumping (ED), its causes and potential remedies. In ED, the weaknesses or gaps in ethics policies and systems of lower income countries are intentionally exploited for intellectual or financial gains through research and publishing by higher income countries with a more stringent or complex ethical infrastructure in which such research and publishing practices would not be permitted. Several examples are provided. Possible ED needs to be evaluated before research takes place, and detected prior to publication as an academic paper, because it might lead to a collaborative effort between a wealthier country with restrictive ethical policies and a less wealthy country with more permissive policies. Consequently, if that collaboration ultimately results in an academic paper, there are ethical ramifications of ED to scholarly communication. Institutional review board approval is central to avoid ED-based collaborations. Blind trust and goodwill alone cannot eliminate the exploitation of indigenous or "vulnerable" populations' intellect and resources. Combining community-based participatory research using clear codes of research conduct and a simple but robust verification system in academic publishing may reduce the risks of ED-based research from being published.
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Appiah R. Context matters: Sociocultural considerations in the design and implementation of community-based positive psychology interventions in sub-Saharan Africa. CULTURE & PSYCHOLOGY 2022. [DOI: 10.1177/1354067x221118916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scholars conducting cross-cultural research in mental health often import intervention programs found to be efficacious in one social context (e.g., Western) and directly implement them in other contexts (e.g., African and Asian) without recourse to the sociocultural disparities between the target populations and the theoretical foundations of the constructs and principles underpinning the intervention programs. Such efforts mistakenly assume that positive psychology interventions (PPIs), most of which were developed from Western perspectives and assumed individualistic cultural orientation and value systems, operate equally across all contexts. Drawing on the extant literature and on insights from designing, implementing, and evaluating group-based (mental) health behavior change intervention programs across several communities in Ghana, we discuss some sociocultural, theoretical, and methodological issues that can significantly constrain the design, uptake, and effectiveness of PPIs in the rural, low literate, socioeconomically disadvantaged, highly collectivistic context of Ghana, and sub-Saharan Africa more generally. In all illustrations, we offer suggestions to guide the design and implementation processes to ensure culturally appropriate, highly acceptable, and potentially effective intervention programs. We argue that PPIs can be potentially fructuous in the sub-region when adapted to, or embedded in, the cultural values of the target population and tailored to the needs, capacities, and circumstances of participants.
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Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Ghana; and Center for African Studies, Harvard University, Cambridge, MA, USA
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Khumalo IP, Appiah R, Wilson Fadiji A. Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model. Front Psychol 2022; 13:885278. [PMID: 35795445 PMCID: PMC9252463 DOI: 10.3389/fpsyg.2022.885278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalising mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis such as confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF, and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual-continua model of mental health, with implications for the assessment of mental health, to inform policy, practise, and future research in community and clinical settings in Africa.
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Affiliation(s)
- Itumeleng P. Khumalo
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- *Correspondence: Itumeleng P. Khumalo,
| | - Richard Appiah
- Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra, Ghana
- Center for African Studies, Harvard University, Cambridge, MA, United States
| | - Angelina Wilson Fadiji
- University of Pretoria, Pretoria, South Africa
- North-West University, Potchefstroom, South Africa
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Appiah R. A look back, a path forward: Revisiting the mental health and well-being research and practice models and priorities in sub-Saharan Africa. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cychosz M, Cristia A. Using big data from long-form recordings to study development and optimize societal impact. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2022; 62:1-36. [PMID: 35249679 DOI: 10.1016/bs.acdb.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Big data are everywhere. In this chapter, we focus on one source: long-form, child-centered recordings collected using wearable technologies. Because these recordings are simultaneously unobtrusive and encompassing, they may be a breakthrough technology for clinicians and researchers from several diverse fields. We demonstrate this possibility by outlining three applications for the recordings-clinical treatment, large-scale interventions, and language documentation-where we see the greatest potential. We argue that incorporating these recordings into basic and applied research will result in more equitable treatment of patients, more reliable measurements of the effects of interventions on real-world behavior, and deeper scientific insights with less observational bias. We conclude by outlining a proposal for a semistructured online platform where vast numbers of long-form recordings could be hosted and more representative, less biased algorithms could be trained.
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Affiliation(s)
- Margaret Cychosz
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, United States; Center for Comparative and Evolutionary Biology of Hearing, University of Maryland, College Park, MD, United States
| | - Alejandrina Cristia
- Laboratoire de Sciences Cognitives et de Psycholinguistique, Département d'études cognitives, ENS, EHESS, CNRS, PSL University, Paris, France.
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Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:302-328. [PMID: 33821476 DOI: 10.1002/jcop.22566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.
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Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marié P Wissing
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
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Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. Participants' experiences and impressions of a group-based positive psychology intervention programme for rural adults in Ghana. Int J Qual Stud Health Well-being 2021; 16:1891760. [PMID: 33641624 PMCID: PMC7919891 DOI: 10.1080/17482631.2021.1891760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: There is growing evidence that group-based mental health intervention programmes can encourage the development of peer support, psychosocial skills, and collaborative therapeutic relationships with longer lasting effects. This study explored participants' experiences of, perceived benefits of, and recommendations to improve a 10-session group-based multicomponent positive psychology intervention (mPPI)-the Inspired Life Programme (ILP)-designed to promote positive mental health and reduce symptoms of depression and negative affect in a sample of rural Ghanaian adults.Method: Face-to-face semi-structured individual interviews were conducted with 18 randomly selected programme participants three months after their participation in the ILP. Data were analysed thematically with an inductive approach.Results: Participants described their experience of the ILP as a forum for growth that granted them the opportunity to introspect, practicalise and situate everyday life challenges, connect with others, and to develop a sense of mutual accountability. Results indicate that the ILP led participants to develop a stronger sense of positivity and well-being, fructify their ideas, and to cultivate stronger social networks and relationships that led to increased vocational productiveness. Participants recommended that researchers include facets of physical health promotion in the programme and invite close relations of participants to participate in the programme.Conclusion: This study provides the first insight into participants' experiences of a group-based mPPI in Ghana. These findings may provide useful information to inform the design of context-appropriate community-based mental health interventions to fit participants' specific needs, capacities, and circumstances.
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Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marie P. Wissing
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Appiah R. Gurus and Griots: Revisiting the research informed consent process in rural African contexts. BMC Med Ethics 2021; 22:98. [PMID: 34301252 PMCID: PMC8299170 DOI: 10.1186/s12910-021-00659-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may conflict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document. MAIN TEXT Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing field situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki's statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards. CONCLUSION We recommend that, rather than adopt a universal one-size-fits-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.
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Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Korle-Bu, P. O. Box KB 143, Accra, Ghana.
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