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Tilahun M, Gebresilase TT, Aseffa A, Haile K, Wogayehu T, Murale MT, Yntiso H, Munung NS, Bobosha K, Kaba M. Public perceptions of genomic studies and hereditary diseases in Aari community, South Omo Zone, Ethiopia. Trans R Soc Trop Med Hyg 2024; 118:51-60. [PMID: 38165197 DOI: 10.1093/trstmh/trad051] [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: 04/18/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Genetic and genomic research is revolutionizing precision medicine; however, addressing ethical and cultural aspects is crucial to ensure ethical conduct and respect for community values and beliefs. This study explored the beliefs, perceptions and concerns of the Aari community in South Ethiopia regarding genetic concepts, hereditary diseases and ethical research practices related to sample collection, storage and sharing. METHODS In-depth interviews and focus group discussions were conducted with community elders, health officials, tuberculosis patients and apparently healthy individuals. Data were thematically analysed using MAXQDA software. RESULTS Participants identified diseases such as podoconiosis, leprosy, goitre and epilepsy as hereditary and perceived some as 'curses' due to generational impact and social stigma. Disease susceptibility was attributed to divine intervention or factors such as malnutrition and sanitation. Although hereditary diseases were considered unavoidable, in some cases environmental factors were acknowledged. Participants shared personal examples to demonstrate inheritance concepts. Blood held cultural significance, and concerns about its potential misuse resulted in scepticism towards giving samples. CONCLUSIONS This study emphasizes the significance of comprehending local beliefs and perceptions and stresses the need to establish effective communication, build trust and address underlying causes of hesitancy to improve recruitment and ensure ethical conduct.
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Affiliation(s)
- Melaku Tilahun
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tewodros Tariku Gebresilase
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Kassa Haile
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Teklu Wogayehu
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Moi Top Murale
- Department of Psychology, Jinka University, Jinka, Ethiopia
| | - Hailu Yntiso
- South Aari Woreda Administration, Gazer, South Omo, Ethiopia
| | - Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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2
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Herington J, Connelly K, Illes J. Ethical Imperatives for Working With Diverse Populations in Digital Research. J Med Internet Res 2023; 25:e47884. [PMID: 37721792 PMCID: PMC10546274 DOI: 10.2196/47884] [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: 04/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023] Open
Abstract
Digital research methodologies are driving a revolution in health technology but do not yet fully engage diverse and historically underrepresented populations. In this paper, we explore the ethical imperative for such engagement alongside accompanying challenges related to recruitment, appreciation of risk, and confidentiality, among others. We critically analyze existing research ethics frameworks and find that their reliance on individualistic and autonomy-focused models of research ethics does not offer adequate protection in the context of the diversity imperative. To meet the requirements of justice and inclusivity in digital research, methods will benefit from a reorientation toward more participatory practices.
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Affiliation(s)
- Jonathan Herington
- Department of Health Humanities and Bioethics, University of Rochester, Rochester, NY, United States
| | - Kay Connelly
- Department of Informatics, Indiana University, Bloomington, IN, United States
- College of Engineering, Michigan State University, Lansing, MI, United States
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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3
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Busisiwe N, Seeley J, Strode A, Parker M. Beyond translations, perspectives for researchers to consider to enhance comprehension during consent processes for health research in sub-saharan Africa: a scoping review. BMC Med Ethics 2023; 24:43. [PMID: 37344810 DOI: 10.1186/s12910-023-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Literature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries. METHODS From November 2021 to January 2022, we conducted a literature search using a PRISMA tool. We searched electronic databases (PubMed, EMBASE, EBSCOHOST) to identify relevant peer reviewed studies. We then reviewed the references of these articles to find additional literature that might have been missed through the initial search. We were particularly interested in full text articles in English that focused on the IC process in SSA published between 2006 and 2020. We included systematic reviews, and studies from Western and Asian countries that included data about SSA. We excluded articles that focused on medical interventions and studies that did not require IC. RESULTS Out of the 50 studies included most were multi-country (n = 13) followed by single country studies in South Africa (n = 12); Kenya, Tanzania, Uganda (n = 5) each; Gambia, Ghana and Nigeria (n = 2)each ; and one each for Botswana, Malawi, Mali, Mozambique. We identified three areas of focus: (1) socio-cultural factors affecting IC; (2) gaps in the ethical and legal frameworks guiding the IC process; and (3) strategies used to improve participants' understanding of IC. CONCLUSION Our review showed wide recognition that the process of achieving IC in SSA is inherently challenging, and there are limitations in the strategies aimed at improving comprehension in IC. We suggest that there is a need for greater flexibility and negotiation with communities to ensure that the approach to IC is suited to the diverse socio-cultural contexts. We propose moving beyond the literal translations and technical language to understanding IC comprehension from the participants' perspectives and the researchers' views, while examining contextual factors that impact the IC process.
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Affiliation(s)
- Nkosi Busisiwe
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
- Institute for Global Health, University College London, London, UK.
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ann Strode
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- South African Research Ethics Training Initiative, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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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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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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Norman G, Mason T, Dumville JC, Bower P, Wilson P, Cullum N. Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries. BMJ Open 2022; 12:e064345. [PMID: 36600433 PMCID: PMC10580278 DOI: 10.1136/bmjopen-2022-064345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries. DATA EXTRACTION AND SYNTHESIS Two reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation. RESULTS We identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation. CONCLUSIONS We found a lack of clarity about what 'rapid evaluation' means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Thomas Mason
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Paul Wilson
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
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Gondwe MJ, Toto NM, Gunda C, Gmeiner M, MacCormick IJC, Lalloo D, Parker M, Desmond N. Guardians and research staff experiences and views about the consent process in hospital-based paediatric research studies in urban Malawi: A qualitative study. BMC Med Ethics 2022; 23:125. [PMID: 36471294 PMCID: PMC9720930 DOI: 10.1186/s12910-022-00865-x] [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] [Received: 10/19/2020] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obtaining consent has become a standard way of respecting the patient's rights and autonomy in clinical research. Ethical guidelines recommend that the child's parent/s or authorised legal guardian provides informed consent for their child's participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child's illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will assist in developing appropriate consent guidelines. METHODS We conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants' views about informed consent processes. Data analysis was facilitated by NVIVO 11 software. RESULTS All participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting. CONCLUSION The health care context, culture and research process influenced participants' understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent. Trial registration Not applicable.
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Affiliation(s)
- Mtisunge Joshua Gondwe
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neema Mtunthama Toto
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Charity Gunda
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Markus Gmeiner
- grid.10417.330000 0004 0444 9382Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ian J. C. MacCormick
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David Lalloo
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Parker
- grid.4991.50000 0004 1936 8948The Ethox Centre, University of Oxford, Oxford, UK
| | - Nicola Desmond
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
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Caliebe A, Tekola‐Ayele F, Darst BF, Wang X, Song YE, Gui J, Sebro RA, Balding DJ, Saad M, Dubé M. Including diverse and admixed populations in genetic epidemiology research. Genet Epidemiol 2022; 46:347-371. [PMID: 35842778 PMCID: PMC9452464 DOI: 10.1002/gepi.22492] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
The inclusion of ancestrally diverse participants in genetic studies can lead to new discoveries and is important to ensure equitable health care benefit from research advances. Here, members of the Ethical, Legal, Social, Implications (ELSI) committee of the International Genetic Epidemiology Society (IGES) offer perspectives on methods and analysis tools for the conduct of inclusive genetic epidemiology research, with a focus on admixed and ancestrally diverse populations in support of reproducible research practices. We emphasize the importance of distinguishing socially defined population categorizations from genetic ancestry in the design, analysis, reporting, and interpretation of genetic epidemiology research findings. Finally, we discuss the current state of genomic resources used in genetic association studies, functional interpretation, and clinical and public health translation of genomic findings with respect to diverse populations.
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Affiliation(s)
- Amke Caliebe
- Institute of Medical Informatics and StatisticsKiel University and University Hospital Schleswig‐HolsteinKielGermany
| | - Fasil Tekola‐Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of HealthBethesdaMarylandUSA
| | - Burcu F. Darst
- Center for Genetic EpidemiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Xuexia Wang
- Department of MathematicsUniversity of North TexasDentonTexasUSA
| | - Yeunjoo E. Song
- Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandOhioUSA
| | - Jiang Gui
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth CollegeOne Medical Center Dr.LebanonNew HampshireUSA
| | | | - David J. Balding
- Melbourne Integrative Genomics, Schools of BioSciences and of Mathematics & StatisticsUniversity of MelbourneMelbourneAustralia
| | - Mohamad Saad
- Qatar Computing Research InstituteHamad Bin Khalifa UniversityDohaQatar
- Neuroscience Research Center, Faculty of Medical SciencesLebanese UniversityBeirutLebanon
| | - Marie‐Pierre Dubé
- Department of Medicine, and Social and Preventive MedicineUniversité de MontréalMontréalQuébecCanada
- Beaulieu‐Saucier Pharmacogenomcis CentreMontreal Heart InstituteMontrealCanada
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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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Negash M, Chanyalew M, T Gebresilase T, Sintayehu B, Anteye T, Aseffa A, Newport MJ. Rapid ethical appraisal of stakeholder views on research prior to undertaking immunopathogenesis studies on podoconiosis in northeast Ethiopia during a period of social instability. Trans R Soc Trop Med Hyg 2021; 115:1026-1038. [PMID: 33570141 PMCID: PMC8417087 DOI: 10.1093/trstmh/trab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background Undertaking research and attaining informed consent can be challenging when there is political unrest and community mistrust. Rapid ethical appraisal (REA) is a tool that uses qualitative methods to explore sociocultural issues that may affect the ethical conduct of research. Methods We used REA in northeast Ethiopia shortly following a period of unrest, during which violence against researchers occurred, to assess stakeholder perceptions of research, researchers and the informed consent process. We held 32 in-depth interviews and 2 focus group discussions. Results Most community members had little awareness about podoconiosis or healthcare research. Convincing the community to donate blood for research is challenging due to association with HIV testing. The attack on researchers was mainly motivated by the community's mistrust of their intentions against the background of a volatile political situation. Social media contributed to the spread of misinformation. Lack of community engagement was also a key contributing factor. Conclusions Using REA, we identified potential barriers to the informed consent process, participant recruitment for data and specimen collection and the smooth conduct of research. Researchers should assess existing conditions in the study area and engage with the community to increase awareness prior to commencing their research activities.
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Affiliation(s)
- Mikias Negash
- Brighton and Sussex Centre for Global Health Research , Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Addis Ababa University, College of Health Sciences, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | | | - Tewodros T Gebresilase
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Unit of Health Biotechnology, Institute of Biotechnology, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia
| | | | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research , Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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11
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Affiliation(s)
- Janet Seeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
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12
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Bukini D, Mbekenga C, Nkya S, Purvis L, McCurdy S, Parker M, Makani J. A qualitative study on aspects of consent for genomic research in communities with low literacy. BMC Med Ethics 2020; 21:48. [PMID: 32532327 PMCID: PMC7291634 DOI: 10.1186/s12910-020-00488-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants' comprehension for genomic studies. The purpose of this study was to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension. METHODS Using qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes. RESULTS Findings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension. CONCLUSION The quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants' comprehension need to be developed when consenting participants with low literacy level in genomic studies.
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Affiliation(s)
- Daima Bukini
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Siana Nkya
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
| | - Lisa Purvis
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Centre, Hanover, NH, USA
| | - Sheryl McCurdy
- University of Texas Health Science Centre at Houston, School of Public Health, Houston, TX, USA
| | - Michael Parker
- Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julie Makani
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
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13
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Barugahare J. Bioethical reflexivity and requirements of valid consent: conceptual tools. BMC Med Ethics 2019; 20:44. [PMID: 31272449 PMCID: PMC6610898 DOI: 10.1186/s12910-019-0385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Despite existing international, regional and national guidance on how to obtain valid consent to health-related research, valid consent remains both a practical and normative challenge. This challenge persists despite additional evidence-based guidance obtained through conceptual and empirical research in specific localities on the same subject. The purpose of this paper is to provide an account for why, despite this guidance, this challenge still persist and suggest conceptual resources that can help make sense of this problem and eventually mitigate it’. Main body This paper argues that despite the existence of detailed official guidance and prior conceptual and empirical research on how to obtain valid consent, the question of ‘how to obtain and ascertain valid consent to participation in health-related research’ cannot always be fully answered by exclusive reference to pre-determined criteria/guidance provided by the guidelines and prior research’. To make intelligible why this is so and how this challenge could be allayed, the paper proposes six concepts. The first five of these are intended to account for the persistent seeming inadequacies of existing guidelines. These are fact-skepticism; guideline insufficiency; generality; context-neutrality and presumptiveness. As an outcome of these five, the paper analyzes and recommends a sixth, called bioethical reflexivity. Bioethical reflexivity is reckoned as a handy tool, skill, and attitude by which, in addition to guidance from context-specific research, the persisting challenges can be further eased. Conclusions Existing ethical guidelines on how to obtain valid consent to health-related research are what they ought to be – general, presumptive and context-neutral. This explains their seeming inadequacies whenever they are being applied in concrete situations. Hence, the challenges being encountered while obtaining valid consent can be significantly eased if we appreciate the guidelines’ nature and what this means for their implementation. There is also a need to cultivate reflexive mindsets plus the relevant skills needed to judiciously close the unavoidable gaps between guidelines and their application in concrete cases. This equally applies to the gaps which cannot be filled by reference to additional guidance from prior conceptual and empirical research in specific contexts.
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Affiliation(s)
- John Barugahare
- Department of Philosophy, Makerere University, P. O. Box 7062, Kampala, Uganda.
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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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15
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Gebremariam A, Yalew AW, Hirpa S, Wondimagegnehu A, Kaba M, Assefa M, Mitiku I, Kantelhardt EJ, Jemal A, Addissie A. Application of the rapid ethical assessment approach to enhance the ethical conduct of longitudinal population based female cancer research in an urban setting in Ethiopia. BMC Med Ethics 2018; 19:87. [PMID: 30428895 PMCID: PMC6237025 DOI: 10.1186/s12910-018-0328-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Rapid Ethical Assessment (REA) is an approach used to design context tailored consent process for voluntary participation of participants in research including human subjects. There is, however, limited evidence on the design of ethical assessment in studies targeting cancer patients in Ethiopia. REA was conducted to explore factors that influence the informed consent process among female cancer patients recruited for longitudinal research from Addis Ababa Population-based Cancer Registry. Methods Qualitative study employing rapid ethnographic approach was conducted from May–July, 2017, at the Tikur Anbessa Specialized Referral Hospital. In-depth and key informants’ interviews were conducted among purposively selected 16 participants. Regular de-briefings among the study team helped to identify emerging themes and ensure saturation. Interviews and debriefings were tape recorded in Amharic, and transcribed and translated to English. Coding of the transcripts was facilitated by use of NVivo software. Thematic analysis was employed to respond to the initial questions and interpret findings. Results Perceived barriers to voluntary study participation included lack of reporting back study results of previous studies, the decision making status of women, hopelessness or fatigue in the patients, shyness of the women, data collectors approach to the patient, and patient’s time constraints. Most of the patients preferred oral over written consent and face-to-face interview over telephone interview. Provision of detail information about the study, using short and understandable tool, competent, compassionate and respectful enumerators of the same gender were suggested to assure participation. Due to the perceived severity, the use of the term “cancer” was associated with fear and anxiety. Alternatively, uses of phrases like “breast or cervical illness/disease” were suggested during patient interviews. Conclusions Voluntary participation is not straight forward but affected by different factors. Using competent, compassionate and respectful enumerators, short and precise questioning tools to limit the time of the interview could improve voluntary participation. Moreover, careful consideration of the patients and families concept of the disease such as wording and information has to be taken into account. This assessment helped in improving the consent process of the ongoing project on breast and cervical cancer patients.
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Affiliation(s)
- Alem Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia. .,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selamawit Hirpa
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Cheah PY, Jatupornpimol N, Hanboonkunupakarn B, Khirikoekkong N, Jittamala P, Pukrittayakamee S, Day NPJ, Parker M, Bull S. Challenges arising when seeking broad consent for health research data sharing: a qualitative study of perspectives in Thailand. BMC Med Ethics 2018; 19:86. [PMID: 30404642 PMCID: PMC6223036 DOI: 10.1186/s12910-018-0326-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/25/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Research funders, regulatory agencies, and journals are increasingly expecting that individual-level data from health research will be shared. Broad consent to such sharing is considered appropriate, feasible and acceptable in low- and middle-income settings, but to date limited empirical research has been conducted to inform the design of such processes. We examined stakeholder perspectives about how best to seek broad consent to sharing data from the Mahidol Oxford Tropical Medicine Research Unit, which implemented a data sharing policy and broad consent to data sharing in January 2016. METHODS Between February and August 2017 qualitative data were collected at two sites, Bangkok and the Thai-Myanmar border town of Mae Sot. We conducted eighteen semi-structured interviews. We also conducted four focus group discussions with a total of nineteen people. Descriptive and thematic coding informed analysis of aspects of data sharing that are considered most important to inform participants about, and the best ways to explain complex and abstract topics relating to data sharing. RESULTS The findings demonstrated that clinical trial participants prioritise information about the potential benefits and harms of data sharing. Stakeholders made multiple suggestions for clarifying information provided about data sharing on such topics. There was significant variation amongst stakeholders' perspectives about how much information should be provided about data sharing, and it was clear that effective information provision should be responsive to the study, the study population, the individual research participant and the research context. CONCLUSIONS Effectively communicating about data sharing with research participants is challenging in practice, highlighting the importance of robust and effective data sharing governance in this context. Broad consent should incorporate effective and efficient explanations of data sharing to promote informed decision-making, without impeding research participants' understandings of key aspects of the research from which data will be shared. Further work is required to refine both the development of core information about data sharing to be provided to all research participants, and appropriate solutions for context specific-challenges arising when explaining data sharing.
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Affiliation(s)
- Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK. .,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Nattapat Jatupornpimol
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Napat Khirikoekkong
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittamala
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan Bull
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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17
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Gebresilase TT, Deresse Z, Tsegay G, Tessema TS, Aseffa A, Davey G, Newport M, Tekola-Ayele F, Addissie A. Rapid Ethical Appraisal: A tool to design a contextualized consent process for a genetic study of podoconiosis in Ethiopia. Wellcome Open Res 2017. [DOI: 10.12688/wellcomeopenres.12613.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Obtaining genuine informed consent from research participants in developing countries can be difficult, partly due to poor knowledge about research process and research ethics. The situation is complicated when conducting genomic research on a disease considered familial and a reason for stigmatisation. Methods: We used a Rapid Ethical Appraisal tool to assess local factors that were barriers to getting genuine informed consent prior to conducting a genetic study of podoconiosis (non-filarial elephantiasis) in two Zones of Ethiopia. The tool included in-depth interviews and focus group discussions with patients, healthy community members, field workers, researchers/Institutional Review Board (IRB) members, elders, religious leaders, and podoconiosis administrators who work closely with patients. Results: Most patients and healthy community members did not differentiate research from routine clinical diagnosis. Participants felt comfortable when approached in the presence of trusted community members. Field workers and podoconiosis administrators preferred verbal consent, whereas the majority of patients and healthy community members prefer both verbal and written consent. Participants better understood genetic susceptibility concepts when analogies drawn from their day-to-day experience were used. The type of biological sample sought and gender were the two most important factors affecting the recruitment process. Most researchers and IRB members indicated that reporting incidental findings to participants is not a priority in an Ethiopian context. Conclusions: Understanding the concerns of local people in areas where research is to be conducted facilitates the design of contextualized consent processes appropriate for all parties and will ultimately result in getting genuine consent.
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Ssali A, Nunn A, Mbonye M, Anywaine Z, Seeley J. Reasons for participating in a randomised clinical trial: The volunteers' voices in the COSTOP trial in Uganda. Contemp Clin Trials Commun 2017; 7:44-47. [PMID: 29696167 PMCID: PMC5898547 DOI: 10.1016/j.conctc.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction The reasons why research participants join clinical trials remains an area of inquiry especially in low and middle income countries. Methods We conducted exit interviews with participants who took part in a trial which aimed to evaluate whether long term prophylaxis with cotrimoxazole can be safely discontinued among adults who have been stabilised on antiretroviral therapy (ART). Participants were all reported to be stable on ART and had been participating in the trial for between 12 and 36 months; at the end of the trial participants were interviewed using a semi-structured questionnaire. One of the objectives of the exit interview was to find out what motivated the participants to join the research. Results Participants gave personal reasons for joining the trial, frequently linked to their health and well-being as well as reduction of pill burden. Conclusion We conclude that underlying reasons for joining clinical trials may extend beyond or can be different from the rationale given to the participants before enrolment by the research team. The reasons that motivate enrolment to clinical trials and research in general require further investigation in different settings. Trial registration number ISRCTN44723643.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Uganda
- Corresponding author.
| | - Andrew Nunn
- Medical Research Council Clinical Trials Unit at University College, London, UK
| | - Martin Mbonye
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Uganda
| | | | - Janet Seeley
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Uganda
- London School of Hygiene and Tropical Medicine, UK
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Addissie A, Abay S, Feleke Y, Newport M, Farsides B, Davey G. Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting. BMC Med Ethics 2016; 17:40. [PMID: 27406063 PMCID: PMC4943010 DOI: 10.1186/s12910-016-0127-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 06/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. METHODS A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. RESULT Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p < 0.005) for the intervention and control groups respectively. Overall, the mean informed consent comprehension scores for the intervention and control groups were 73.1 % and 45.2 %, respectively, with a mean difference in comprehension score of 27.9 % (95 % CI 24.0 % - 33.4 %; p < 0.001,). Mean scores for quality of informed consent for the intervention and control groups were 89.1 % and 78.5 %, respectively, with a mean difference of 10.5 % (95 % CI 6.8 -14.2 %; p < 0.001). CONCLUSION Levels of informed consent comprehension, quality of the consent process, study recruitment and retention rates were significantly improved in the intervention group. We recommend REA as a potential modality to improve informed consent comprehension and quality of informed consent process in low resource settings.
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Affiliation(s)
- Adamu Addissie
- Brighton and Sussex Medical School, Brighton, UK. .,Addis Ababa University, Addis Ababa, Ethiopia.
| | - Serebe Abay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Gail Davey
- Brighton and Sussex Medical School, Brighton, UK
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20
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Abay S, Addissie A, Davey G, Farsides B, Addissie T. Rapid Ethical Assessment on Informed Consent Content and Procedure in Hintalo-Wajirat, Northern Ethiopia: A Qualitative Study. PLoS One 2016; 11:e0157056. [PMID: 27258537 PMCID: PMC4892576 DOI: 10.1371/journal.pone.0157056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/24/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Informed consent is a key component of bio-medical research involving human participants. However, obtaining informed consent is challenging in low literacy and resource limited settings. Rapid Ethical Assessment (REA) can be used to contextualize and simplify consent information within a given study community. The current study aimed to explore the effects of social, cultural, and religious factors during informed consent process on a proposed HPV-serotype prevalence study. METHODOLOGY A qualitative community-based REA was conducted in Adigudom and Mynebri Kebeles, Northern Ethiopia, from July to August 2013. Data were collected by a multi-disciplinary team using open ended questions concerning informed consent components in relation to the parent study. The team conducted one-to-one In-Depth Interviews (IDI) and Focus Group Discussions (FGDs) with key informants and community members to collect data based on the themes of the study. Tape recorded data were transcribed in Tigrigna and then translated into English. Data were categorized and thematically analyzed using open coding and content analysis based on pre-defined themes. RESULTS The REA study revealed a number of socio-cultural issues relevant to the proposed study. Low community awareness about health research, participant rights and cervical cancer were documented. Giving a vaginal sample for testing was considered to be highly embarrassing, whereas giving a blood sample made participants worry that they might be given a result without the possibility of treatment. Verbal consent was preferred to written consent for the proposed study. CONCLUSION This rapid ethical assessment disclosed important socio-cultural issues which might act as barriers to informed decision making. The findings were important for contextual modification of the Information Sheet, and to guide the best consent process for the proposed study. Both are likely to have enabled participants to understand the informed consent better and consequently to comply with the study.
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Affiliation(s)
- Serebe Abay
- Ethiopian Public Health Institution, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Bobbie Farsides
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Negussie H, Addissie T, Addissie A, Davey G. Preparing for and Executing a Randomised Controlled Trial of Podoconiosis Treatment in Northern Ethiopia: The Utility of Rapid Ethical Assessment. PLoS Negl Trop Dis 2016; 10:e0004531. [PMID: 26967654 PMCID: PMC4788215 DOI: 10.1371/journal.pntd.0004531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/19/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Community-based randomized controlled trials are often complex pieces of research with significant challenges around the approach to the community, information provision, and decision-making, all of which are fundamental to the informed consent process. We conducted a rapid ethical assessment to guide the preparation for and conduct of a randomized controlled trial of podoconiosis treatment in northern Ethiopia. METHODS A qualitative study was carried out in Aneded woreda, East Gojjam Zone, Amhara Regional State from August to September, 2013. A total of 14 In-depth Interviews (IDIs) with researchers, experts, and leaders, and 8 Focus Group Discussions (FGDs) involving 80 participants (people of both gender, with and without podoconiosis), were conducted. Interviews were carried out in Amharic. Data analysis was started alongside collection. Final data analysis used a thematic approach based on themes identified a priori and those that emerged during the analysis. RESULTS Respondents made a range of specific suggestions, including that sensitisation meetings were called by woreda or kebele leaders or the police; that Health Extension Workers were asked to accompany the research team to patients' houses; that detailed trial information was explained by someone with deep local knowledge; that analogies from agriculture and local social organisations be used to explain randomisation; that participants in the 'delayed' intervention arm be given small incentives to continue in the trial; and that key community members be asked to quell rumours arising in the course of the trial. CONCLUSION Many of these recommendations were incorporated into the preparatory phases of the trial, or were used during the course of the trial itself. This demonstrates the utility of rapid ethical assessment preceding a complex piece of research in a relatively research-naive setting.
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Affiliation(s)
- Henok Negussie
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, United Kingdom
| | - Thomas Addissie
- School of Social Anthropology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, United Kingdom
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Ssali A, Poland F, Seeley J. Volunteer experiences and perceptions of the informed consent process: Lessons from two HIV clinical trials in Uganda. BMC Med Ethics 2015; 16:86. [PMID: 26630924 PMCID: PMC4668674 DOI: 10.1186/s12910-015-0073-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent as stipulated in regulatory human research guidelines requires that a volunteer is well-informed about what will happen to them in a trial. However researchers are faced with a challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. We conducted a qualitative study among volunteers taking part in two HIV clinical trials in Uganda to find out how they defined informed consent and their perceptions of the trial procedures, study information and interactions with the research team. METHODS Between January and December 2012, 23 volunteers who had been in the two trials for over 6 months, consented to be interviewed about their experience in the trial three times over a period of nine months. They also took part in focus group discussions. Themes informed by study research questions and emerging findings were used for content analysis. RESULTS Volunteers defined the informed consent process in terms of their individual welfare. Only two of the volunteers reported having referred during the trial to the participant information sheets given at the start of the trial. Volunteers remembered the information they had been given at the start of the trial on procedures that involved drawing blood and urine samples but not information about study design and randomisation. Volunteers said that they had understood the purpose of the trial. They said that signing a consent form showed that they had consented to take part in the trial but they also described it as being done to protect the researcher in case a volunteer later experienced side effects. CONCLUSION Volunteers pay more attention during the consent process to procedures requiring biological tests than to study design issues. Trust built between volunteers and the research team could enhance the successful conduct of clinical trials by allowing for informal discussions to identify and review volunteers' perceptions. These results point to the need for researchers to view informed consent as a process rather than an event.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
| | | | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
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Traore K, Bull S, Niare A, Konate S, Thera MA, Kwiatkowski D, Parker M, Doumbo OK. Understandings of genomic research in developing countries: a qualitative study of the views of MalariaGEN participants in Mali. BMC Med Ethics 2015; 16:42. [PMID: 26077875 PMCID: PMC4469103 DOI: 10.1186/s12910-015-0035-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/29/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obtaining informed consent for participation in genomic research in low-income settings presents specific ethical issues requiring attention. These include the challenges that arise when providing information about unfamiliar and technical research methods, the implications of complicated infrastructure and data sharing requirements, and the potential consequences of future research with samples and data. This study investigated researchers' and participants' parents' experiences of a consent process and understandings of a genome-wide association study of malaria involving children aged five and under in Mali. It aimed to inform best practices in recruiting participants into genomic research. METHODS A qualitative rapid ethical assessment was undertaken. Fifty-five semi-structured interviews were conducted with the parents of research participants. An additional nine semi-structured interviews were conducted with senior research scientists, research assistants and with a member of an ethics committee. A focus group with five parents of research participants and direct observations of four consent processes were also conducted. French and translated English transcripts were descriptively and thematically coded using OpenCode software. RESULTS Participants' parents in the MalariaGEN study had differing understandings of the causes of malaria, the rationale for collecting blood samples, the purposes of the study and the kinds of information the study would generate. Genomic aspects of the research, including the gene/environment interaction underlying susceptibility or resistance to severe malaria, proved particularly challenging to explain and understand. CONCLUSIONS This study identifies a number of areas to be addressed in the design of consent processes for genomic research, some of which require careful ethical analysis. These include determining how much information should be provided about differing aspects of the research and how best to promote understandings of genomic research. We conclude that it is important to build capacity in the design and conduct of effective and appropriate consent processes for genomic research in low and middle-income settings. Additionally, consideration should be given to the role of review committees and community consultation activities in protecting the interests of participants in genomic research.
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Affiliation(s)
- Karim Traore
- Malaria Research and Training Center, DEAP/FMPOS, UMI3189, Université des Sciences, des Techniques et des Technologies de Bamako, BP 1805, Bamako, Mali.
| | - Susan Bull
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Alassane Niare
- Malaria Research and Training Center, DEAP/FMPOS, UMI3189, Université des Sciences, des Techniques et des Technologies de Bamako, BP 1805, Bamako, Mali.
| | - Salimata Konate
- Malaria Research and Training Center, DEAP/FMPOS, UMI3189, Université des Sciences, des Techniques et des Technologies de Bamako, BP 1805, Bamako, Mali.
| | - Mahamadou A Thera
- Malaria Research and Training Center, DEAP/FMPOS, UMI3189, Université des Sciences, des Techniques et des Technologies de Bamako, BP 1805, Bamako, Mali.
| | | | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Ogobara K Doumbo
- Malaria Research and Training Center, DEAP/FMPOS, UMI3189, Université des Sciences, des Techniques et des Technologies de Bamako, BP 1805, Bamako, Mali.
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Kengne-Ouafo JA, Millard JD, Nji TM, Tantoh WF, Nyoh DN, Tendongfor N, Enyong PA, Newport MJ, Davey G, Wanji S. Understanding of research, genetics and genetic research in a rapid ethical assessment in north west Cameroon. Int Health 2015; 8:197-203. [PMID: 25969503 PMCID: PMC4866326 DOI: 10.1093/inthealth/ihv034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 04/13/2015] [Indexed: 02/02/2023] Open
Abstract
Background There is limited assessment of whether research participants in low-income settings are afforded a full understanding of the meaning of medical research. There may also be particular issues with the understanding of genetic research. We used a rapid ethical assessment methodology to explore perceptions surrounding the meaning of research, genetics and genetic research in north west Cameroon. Methods Eleven focus group discussions (including 107 adults) and 72 in-depth interviews were conducted with various stakeholders in two health districts in north west Cameroon between February and April 2012. Results Most participants appreciated the role of research in generating knowledge and identified a difference between research and healthcare but gave varied explanations as to this difference. Most participants' understanding of genetics was limited to concepts of hereditary, with potential benefits limited to the level of the individual or family. Explanations based on supernatural beliefs were identified as a special issue but participants tended not to identify any other special risks with genetic research. Conclusion We demonstrated a variable level of understanding of research, genetics and genetic research, with implications for those carrying out genetic research in this and other low resource settings. Our study highlights the utility of rapid ethical assessment prior to complex or sensitive research.
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Affiliation(s)
- Jonas A Kengne-Ouafo
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - James D Millard
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Theobald M Nji
- Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - William F Tantoh
- Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - Doris N Nyoh
- Department of Sociology, University of Douala, Cameroon
| | - Nicholas Tendongfor
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Peter A Enyong
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
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Kass NE, Taylor HA, Ali J, Hallez K, Chaisson L. A pilot study of simple interventions to improve informed consent in clinical research: feasibility, approach, and results. Clin Trials 2014; 12:54-66. [PMID: 25475879 DOI: 10.1177/1740774514560831] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research suggests that participants do not always adequately understand studies. While some consent interventions increase understanding, methodologic challenges have been raised in studying consent outside of actual trial settings. This study examined the feasibility of testing two consent interventions in actual studies and measured effectiveness of interventions in improving understanding. METHODS Participants enrolling in any of eight ongoing clinical trials were sequentially assigned to one of three different informed consent strategies for enrollment in their clinical trial. Control participants received standard consent procedures for their trial. Participants in the first intervention arm received a bulleted fact sheet summarizing key study information. Participants in the second intervention arm received the bulleted fact sheet and also engaged in a feedback Q&A session. Later, patients answered closed- and open-ended questions to assess patient understanding and literacy. Descriptive statistics, Wilcoxon -Mann -Whitney and Kruskal-Wallis tests were generated to assess correlations; regression analysis determined predictors of understanding. RESULTS 144 participants enrolled. Using regression analysis, participants receiving the second intervention scored 7.6 percentage points higher (p = .02) on open-ended questions about understanding than participants in the control, although unadjusted comparisons did not reach statistical significance. CONCLUSIONS Our study supports the hypothesis that patients receiving both bulleted fact sheets and a Q&A session had higher understanding compared to standard consent. Fact sheets and short structured dialog are quick to administer and easy to replicate across studies and should be tested in larger samples.
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Affiliation(s)
- Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly A Taylor
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Kristina Hallez
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Lelia Chaisson
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
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Ravinetto RM, Afolabi MO, Okebe J, Van Nuil JI, Lutumba P, Mavoko HM, Nahum A, Tinto H, Addissie A, D'Alessandro U, Grietens KP. Participation in medical research as a resource-seeking strategy in socio-economically vulnerable communities: call for research and action. Trop Med Int Health 2014; 20:63-6. [PMID: 25302444 DOI: 10.1111/tmi.12396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The freedom to consent to participate in medical research is a complex subject, particularly in socio-economically vulnerable communities, where numerous factors may limit the efficacy of the informed consent process. Informal consultation among members of the Switching the Poles Clinical Research Network coming from various sub-Saharan African countries, that is Burkina Faso, The Gambia, Rwanda, Ethiopia, the Democratic Republic of Congo (DRC) and Benin, seems to support the hypothesis that in socio-economical vulnerable communities with inadequate access to health care, the decision to participate in research is often taken irrespectively of the contents of the informed consent interview, and it is largely driven by the opportunity to access free or better quality care and other indirect benefits. Populations' vulnerability due to poverty and/or social exclusion should obviously not lead to exclusion from medical research, which is most often crucially needed to address their health problems. Nonetheless, to reduce the possibility of exploitation, there is the need to further investigate the complex links between socio-economical vulnerability, access to health care and individual freedom to decide on participation in medical research. This needs bringing together clinical researchers, social scientists and bioethicists in transdisciplinary collaborative research efforts that require the collective input from researchers, research sponsors and funders.
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Affiliation(s)
- Raffaella M Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Kengne-Ouafo JA, Nji TM, Tantoh WF, Nyoh DN, Tendongfor N, Enyong PA, Newport MJ, Davey G, Wanji S. Perceptions of consent, permission structures and approaches to the community: a rapid ethical assessment performed in North West Cameroon. BMC Public Health 2014; 14:1026. [PMID: 25277694 PMCID: PMC4195877 DOI: 10.1186/1471-2458-14-1026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding local contextual factors is important when conducting international collaborative studies in low-income country settings. Rapid ethical assessment (a brief qualitative intervention designed to map the ethical terrain of a research setting prior to recruitment of participants), has been used in a range of research-naïve settings. We used rapid ethical assessment to explore ethical issues and challenges associated with approaching communities and gaining informed consent in North West Cameroon. METHODS This qualitative study was carried out in two health districts in the North West Region of Cameroon between February and April 2012. Eleven focus group discussions (with a total of 107 participants) were carried out among adult community members, while 72 in-depth interviews included health workers, non-government organisation staff and local community leaders. Data were collected in English and pidgin, translated where necessary into English, transcribed and coded following themes. RESULTS Many community members had some understanding of informed consent, probably through exposure to agricultural research in the past. Participants described a centralised permission-giving structure in their communities, though there was evidence of some subversion of these structures by the educated young and by women. Several acceptable routes for approaching the communities were outlined, all including the health centre and the Fon (traditional leader). The importance of time spent in sensitizing the community and explaining information was stressed. CONCLUSIONS Respondents held relatively sophisticated understanding of consent and were able to outline the structures of permission-giving in the community. Although the structures are unique to these communities, the role of certain trusted groups is common to several other communities in Kenya and Ethiopia explored using similar techniques. The information gained through Rapid Ethical Assessment will form an important guide for future studies in North West Cameroon.
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Affiliation(s)
- Jonas A Kengne-Ouafo
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Theobald M Nji
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
- />Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - William F Tantoh
- />Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - Doris N Nyoh
- />Department of Sociology, University of Douala, Douala, Cameroon
| | - Nicholas Tendongfor
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Peter A Enyong
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Melanie J Newport
- />Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Falmer Campus, Brighton, BN1 9PX UK
| | - Gail Davey
- />Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Falmer Campus, Brighton, BN1 9PX UK
| | - Samuel Wanji
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
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Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand. PLoS One 2014; 9:e100058. [PMID: 24949864 PMCID: PMC4064984 DOI: 10.1371/journal.pone.0100058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. Methods In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work. Results Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. Discussion Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where biomedical HIV prevention trials occur, and where clinical trials in marginalized populations continue.
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Marshall PA, Adebamowo CA, Adeyemo AA, Ogundiran TO, Strenski T, Zhou J, Rotimi CN. Voluntary participation and comprehension of informed consent in a genetic epidemiological study of breast cancer in Nigeria. BMC Med Ethics 2014; 15:38. [PMID: 24885380 PMCID: PMC4032563 DOI: 10.1186/1472-6939-15-38] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 05/01/2014] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Studies on informed consent to medical research conducted in low or middle-income settings have increased, including empirical investigations of consent to genetic research. We investigated voluntary participation and comprehension of informed consent among women involved in a genetic epidemiological study on breast cancer in an urban setting of Nigeria comparing women in the case and control groups. METHODS Surveys were administered in face-to-face interviews with 215 participants following their enrollment in the genetic study (106 patients, 109 controls). Audio-taped in-depth interviews were conducted with a sub-sample of 17 (8%) women who completed the survey. RESULTS The majority of all participants reported being told that participation in the genetic study was voluntary (97%), that they did not feel pressured to participate in the study (99%), and that they could withdraw from the study (81%). The majority of the breast cancer patients (83%) compared to 58% of women in the control group reported that the study purpose was to learn about the genetic inheritance of breast cancer (OR 3.44; 95% CI =1.66, 7.14, p value = 0.001). Most participants reported being told about study procedures (95%) and study benefits (98%). Sixty-eight percent of the patients, compared to 47% of the control group reported being told about study risks (p-value <0.001). Of the 165 married women, 19% reported asking permission from their husbands to enroll in the breast cancer study; no one sought permission from local elders. In-depth interviews highlight the use of persuasion and negotiation between a wife and her husband regarding study participation. CONCLUSIONS The global expansion of genetic and genomic research highlights our need to understand informed consent practices for studies in ethnically diverse cultural environments such as Africa. Quantitative and qualitative empirical investigations of the informed consent process for genetic and genomic research will further our knowledge of complex issues associated with communication of information, comprehension, decisional authority and voluntary participation. In the future, the development and testing of innovative strategies to promote voluntary participation and comprehension of the goals of genomic research will contribute to our understanding of strategies that enhance the consent process.
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Affiliation(s)
- Patricia A Marshall
- Department of Bioethics, School of Medicine, Room TA 227Case Western Reserve University10900 Euclid Avenue Cleveland, Ohio 44106-4976 Cleveland, USA
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center of the University of Maryland School of Medicine, Baltimore Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD 21201, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
| | - Temidayo O Ogundiran
- Division of Oncology, Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - Teri Strenski
- Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL 60611, USA
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Building 12A, Room 4047, 12 South Dr, MSC 5635, Bethesda, MD, 20892-5635, USA
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Addissie A, Davey G, Newport MJ, Addissie T, MacGregor H, Feleke Y, Farsides B. A mixed-methods study on perceptions towards use of Rapid Ethical Assessment to improve informed consent processes for health research in a low-income setting. BMC Med Ethics 2014; 15:35. [PMID: 24885049 PMCID: PMC4055294 DOI: 10.1186/1472-6939-15-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 04/24/2014] [Indexed: 11/16/2022] Open
Abstract
Background Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia. Methods Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews among health researchers and regulators including ethics committee members in Ethiopian health research institutions and universities. Results In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity (48.1%), inadequate information (34%), language barriers (28.2%), cultural differences (27.4%), undue expectations (26.6%) and power imbalances (20.7%). About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test (pilot) phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed. Conclusion The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended.
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Abstract
Consent and community engagement (CE) in health research are two aspects of a single concern-that research is carried out in a respectful manner where social value is maximized. There are important overlaps and interdependencies between consent and CE; for example, CE can provide insights into how best to tailor consent to context and can be an important component of consent processes. Engaging communities can also have intrinsic and instrumental value beyond consent; for example, as a means of showing respect and identifying appropriate ways of working respectfully. In this paper we critically examine how CE and consent processes are characterized, conducted, and evaluated in diverse health research contexts, and propose a preliminary research agenda to support future learning in these critical areas.
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Abstract
Genomic science and associated technologies are providing scientists and clinicians with novel insights that are transforming the delivery of healthcare and the overall well-being of society. However, these insights inform us that historical population sampling approaches for investigating rare and common genetic variations are not representative of the complex ancestral backgrounds of today's patients. In order for personalized medicine to be meaningful and applicable to the global populations, we will need to know how common and rare genetic variants found in different parts of the world influence health and drug response. This article demonstrates the importance of increasing ethnic and racial diversity among participants in genomic research, highlights areas of opportunity for improving our understanding of genomic diversity among populations, and provides examples of successful models that help to resolve these concerns.
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Affiliation(s)
- Edward Ramos
- Center for Research on Genomics & Global Health, National Human Genome Research Institute, NIH, Bethesda, MD, 20892-5635, USA
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Tindana P, Bull S, Amenga-Etego L, de Vries J, Aborigo R, Koram K, Kwiatkowski D, Parker M. Seeking consent to genetic and genomic research in a rural Ghanaian setting: a qualitative study of the MalariaGEN experience. BMC Med Ethics 2012; 13:15. [PMID: 22747883 PMCID: PMC3441464 DOI: 10.1186/1472-6939-13-15] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 05/08/2012] [Indexed: 11/11/2022] Open
Abstract
Background Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study. Methods The study used a rapid assessment incorporating multiple qualitative methods including in depth interviews, focus group discussions and observations of consent processes. Differences between verbal information provided during community engagement processes, and consent processes during the enrolment of cases and controls were identified, as well as the factors influencing the tailoring of such information. Results MalariaGEN participants and field staff seeking consent were generally satisfied with their understanding of the project and were familiar with aspects of the study relating to malaria. Some genetic aspects of the study were also well understood. Participants and staff seeking consent were less aware of the methodologies employed during genomic research and their implications, such as the breadth of data generated and the potential for future secondary research. Moreover, trust in and previous experience with the Navrongo Health Research Centre which was conducting the research influenced beliefs about the benefits of participating in the MalariaGEN study and subsequent decision-making about research participation. Conclusions It is important to recognise that some aspects of complex genomic research may be of less interest to and less well understood by research participants and that such gaps in understanding may not be entirely addressed by best practice in the design and conduct of consent processes. In such circumstances consideration needs to be given to additional protections for participants that may need to be implemented in such research, and how best to provide such protections. Capacity building for research ethics committees with limited familiarity with genetic and genomic research, and appropriate engagement with communities to elicit opinions of the ethical issues arising and acceptability of downstream uses of genome wide association data are likely to be important.
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Affiliation(s)
- Paulina Tindana
- The Ethox Centre, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom
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