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Laiti M, Pakarinen A, Parisod H, Hayter M, Sariola S, Salanterä S. Supporting LGBTQ+ Students: A Focus Group Study with Junior High School Nurses. J Sch Nurs 2024; 40:295-304. [PMID: 35300547 PMCID: PMC11095055 DOI: 10.1177/10598405221086035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
LBGTQ+ students often miss the support and information they need in the school nursing, but little is known about junior high school (JHS) nurses' work with LGBTQ+ students. 15 JHS nurses were interviewed in focus groups about their perceptions of supporting LGBTQ+ students. Four interconnected themes were identified with inductive thematic analysis: (1) JHS nurses' professional identity and practice; (2) Recognition of sexual and gender diversity in school; (3) Family acceptance process; and (4) LGBTQ+ students as school nursing clients. JHS nurses self-identified as accepting professionals, but having limited skills, knowledge, and education needed in supporting LGBTQ+ students. Supporting LGBTQ+ students is a complex phenomenon, and to enhance JHS nurses' competence in providing care for these students, sexual and gender diversity needs to be included in evidence-based nursing information sources, covered in nursing education, and the school needs to be secured as LGBTQ+ safe place.
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Affiliation(s)
- Minna Laiti
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Anni Pakarinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Heidi Parisod
- Department of Nursing Science, University of Turku, Turku, Finland
- The Nursing Research Foundation, Helsinki, Finland
| | - Mark Hayter
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Salla Sariola
- Faculty of Political Sciences, Discipline of Sociology, University of Helsinki, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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2
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Sariola S. Mistrust: Community engagement in global health research in coastal Kenya. Soc Stud Sci 2023; 53:449-471. [PMID: 37002697 PMCID: PMC10240637 DOI: 10.1177/03063127231162082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article explores a case of mistrust in global health research and community engagement. It uses ethnographic material collected in 2014 and 2016 in Kenya, concerning community engagement by a HIV vaccine research group working with men who have sex with men and transgender women. In 2010, the research group was attacked by members of the wider community. Following the attack, the research group set up an engagement program to reduce mistrust and re-build relationships. Analysis focusing on mistrust shows the dynamics underlying the conflict: Norms around gender and sexuality, political support for LGBTIQ+ rights, and resources disparities were all at stake for those embroiled in the conflict, including researchers, study participants, religious leaders, and LGBTIQ+ activists in the region. Rather than a normative good with liberatory potential, community engagement in this paper is discussed as a relational tool with which mistrust was managed, highlighting the fragility of participation.
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3
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Cañada JA, Sariola S, Butcher A. In critique of anthropocentrism: a more-than-human ethical framework for antimicrobial resistance. Med Humanit 2022; 48:e16. [PMID: 35321873 PMCID: PMC9691817 DOI: 10.1136/medhum-2021-012309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 05/08/2023]
Abstract
Antimicrobial resistance (AMR) is often framed as a One Health issue, premised on the interdependence between human, animal and environmental health. Despite this framing, the focus across policymaking, implementation and the ethics of AMR remains anthropocentric in practice, with human health taking priority over the health of non-human animals and the environment, both of which mostly appear as secondary elements to be adjusted to minimise impact on human populations. This perpetuates cross-sectoral asymmetries whereby human health institutions have access to bigger budgets and technical support, limiting the ability of agricultural, animal health or environmental institutions to effectively implement policy initiatives. In this article, we review these asymmetries from an ethical perspective. Through a review and analysis of contemporary literature on the ethics of AMR, we demonstrate how the ethical challenges and tensions raised still emerge from an anthropocentric framing, and argue that such literature fails to address the problematic health hierarchies that underlie policies and ethics of AMR. As a consequence, they fail to provide the necessary tools to ethically evaluate the more-than-human challenges that the long list of actors involved in managing AMR face in their everyday practices. In response to such shortcomings, and to make sense of these challenges and tensions, this article develops an ethical framework based on relationality, care ethics and ambivalence that attends to the more-than-human character of AMR. We formulate this approach without overlooking everyday challenges of implementation by putting the framework in conversation with concrete situations from precarious settings in West Africa. This article concludes by arguing that a useful AMR ethics framework needs to consider and take seriously non-human others as an integral part of both health and disease in any given ecology.
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Affiliation(s)
- Jose A Cañada
- Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Salla Sariola
- Sociology, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Andrea Butcher
- Sociology, University of Helsinki, Helsinki, Uusimaa, Finland
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4
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Widger T, Tousignant N, Eddleston M, Dawson A, Senanayake N, Sariola S, Simpson B. Research As Development: Book Forum. MAT 2022. [DOI: 10.17157/mat.9.2.6499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Book forum on 'Research as Development'
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5
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Nyirenda D, Sariola S, Desmond N. A critical examination of research narratives 'rumours' and passive community resistance in medical research. BMJ Glob Health 2022; 7:e007563. [PMID: 35459689 PMCID: PMC9036351 DOI: 10.1136/bmjgh-2021-007563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/05/2022] [Indexed: 11/04/2022] Open
Abstract
Several studies in Africa have reported effects of 'rumours, misconceptions or misinformation' on medical research participation and uptake of health interventions. As such, community engagement has sometimes been used for instrumental purposes to enhance acceptability of research or interventions and prevent 'rumours'. This paper seeks to highlight the value of ongoing engagement with communities to understand research narratives 'rumours' reproduced in medical research. We demonstrate that 'rumours' are a form of divergent communication or local interpretation of medical research that needs critical attention, and we question the ethics of dismissing such divergent communication.This paper draws on experiences from ethnographical research, which aimed to understand community engagement in medical research projects conducted in Malawi. We observed that even though community meetings were held to improve participation, 'rumours' about research influenced decision making. 'Rumours' presented local critiques of medical research, legitimate concerns informed by historical experiences and local conceptualisation of health. Structural inequalities, negative outcomes or absence of visible benefits following research participation informed unmet expectations, discontent with research and consequently passive resistance. The sociocultural context where participating research communities often rely on social networks for information nurtured propagation of these divergent perspectives to inform lay discourse around medical research.We conclude that ongoing engagement, critical self-reflection and attempts to decode deeper meaning of 'rumours' throughout research implementation is necessary, to show respect and address community concerns expressed through 'rumours', enhance informed participation and adoption of future health interventions.
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Affiliation(s)
- Deborah Nyirenda
- Social Science, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Salla Sariola
- Faculty of Social Sciences, Sociology, University of Helsinki, Helsinki, Finland
| | - Nicola Desmond
- Social Science, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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7
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Lees S, Sariola S, Schmidt-Sane M, Enria L, Tan KA, Aedo A, Peeters Grietens K, Kaawa-Mafigiri D. Key social science priorities for long-term COVID-19 response. BMJ Glob Health 2021; 6:e006741. [PMID: 34312181 PMCID: PMC8316692 DOI: 10.1136/bmjgh-2021-006741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shelley Lees
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Salla Sariola
- Sociology, University of Helsinki, Helsinki, Finland
| | | | - Luisa Enria
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kit-Aun Tan
- Psychiatry, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Angel Aedo
- Anthropology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Koen Peeters Grietens
- Socio-ecological Health Research Unit, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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8
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Affiliation(s)
- Salla Sariola
- Department of Social Sciences, Sociology, University of Helsinki, Helsinki, Finland
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9
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Nyirenda D, Sariola S, Kingori P, Squire B, Bandawe C, Parker M, Desmond N. Structural coercion in the context of community engagement in global health research conducted in a low resource setting in Africa. BMC Med Ethics 2020; 21:90. [PMID: 32957967 PMCID: PMC7504839 DOI: 10.1186/s12910-020-00530-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. METHODS A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. RESULTS The results showed that structural coercion arose due to an interplay of factors pertaining to social-economic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. CONCLUSION The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given.
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Affiliation(s)
- Deborah Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Salla Sariola
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Patricia Kingori
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Bertie Squire
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Chiwoza Bandawe
- University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Michael Parker
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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10
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Sariola S, Gilbert SF. Toward a Symbiotic Perspective on Public Health: Recognizing the Ambivalence of Microbes in the Anthropocene. Microorganisms 2020; 8:E746. [PMID: 32429344 PMCID: PMC7285259 DOI: 10.3390/microorganisms8050746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
Microbes evolve in complex environments that are often fashioned, in part, by human desires. In a global perspective, public health has played major roles in structuring how microbes are perceived, cultivated, and destroyed. The germ theory of disease cast microbes as enemies of the body and the body politic. Antibiotics have altered microbial development by providing stringent natural selection on bacterial species, and this has led to the formation of antibiotic-resistant bacterial strains. Public health perspectives such as "Precision Public Health" and "One Health" have recently been proposed to further manage microbial populations. However, neither of these take into account the symbiotic relationships that exist between bacterial species and between bacteria, viruses, and their eukaryotic hosts. We propose a perspective on public health that recognizes microbial evolution through symbiotic associations (the hologenome theory) and through lateral gene transfer. This perspective has the advantage of including both the pathogenic and beneficial interactions of humans with bacteria, as well as combining the outlook of the "One Health" model with the genomic methodologies utilized in the "Precision Public Health" model. In the Anthropocene, the conditions for microbial evolution have been altered by human interventions, and public health initiatives must recognize both the beneficial (indeed, necessary) interactions of microbes with their hosts as well as their pathogenic interactions.
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Affiliation(s)
- Salla Sariola
- Faculty of Social Sciences, Sociology, University of Helsinki, 00014 Helsinki, Finland;
| | - Scott F. Gilbert
- Department of Biology, Swarthmore College, Swarthmore, PA 19081, USA
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11
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12
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Laiti M, Parisod H, Pakarinen A, Sariola S, Hayter M, Salanterä S. LGBTQ+ Students' Experiences of Junior High School Nursing in Finland: A Qualitative Study. J Sch Nurs 2020; 37:491-502. [PMID: 32180496 DOI: 10.1177/1059840520910796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Previous research shows that lesbian, gay, bisexual, transgender, queer/questioning, and other (LGBTQ+) students can experience substantial emotional- and health-related issues at school, but research into LGBTQ+ students' experiences of school nursing is limited. This qualitative study describes the experiences of Finnish LGBTQ+ students engaging with junior high school nurses. Data were collected from 35 LGBTQ+ students using an online survey tool comprising of a set of open-ended questions. Two interconnecting themes were identified following thematic analysis: (1) junior high school nurse engagement: a mixed or unsatisfactory experience and (2) LGBTQ+ students' needs for diversity-affirming junior high school nursing. Findings show that LGBQT+ students felt junior high school nurse engagement was often unsupportive with issues around their sexuality and gender identity. LGBTQ+ students expressed the need for diversity-affirming information and support in school settings. Further research from school nurses' perspective is needed to increase understanding of this topic.
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Affiliation(s)
- Minna Laiti
- Department of Nursing Science, University of Turku, Finland
| | - Heidi Parisod
- Department of Nursing Science, University of Turku, Finland.,The Nursing Research Foundation (NRF), Helsinki, Finland
| | - Anni Pakarinen
- Department of Nursing Science, University of Turku, Finland
| | - Salla Sariola
- Faculty of Social sciences, University of Helsinki, Finland
| | - Mark Hayter
- Faculty of Health Sciences, School of Health and Social Work, University of Hull, UK
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Finland.,Turku University Hospital, Finland
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13
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Abstract
In 2005 India changed its pharmaceutical and innovation policy that facilitated a dramatic increase in international clinical trials involving study sites in India. This policy shift was surrounded by controversies; civil society organisations (CSOs) criticised the Indian government for promoting the commercialisation of pharmaceutical research and development. Health social movements in India fought for social justice through collective action, and engaged in normative reasoning of the benefits, burdens and equality of research. They lobbied to protect trial participants from structural violence that occurred especially in the first 5-6 years of the new policy. CSOs played a major role in the introduction of new regulations in 2013, which accelerated a decline in the number of global trials carried out in India. This activism applied interpretations of global social justice as key ideas in mobilisation, eventually helping to institutionalise stricter ethical regulation on a national level. Like government and industry, activists believed in randomised controlled trials and comparison as key methods for scientific knowledge production. However, they had significant concerns about the global hierarchies of commercial pharmaceutical research, and their impact on the rights of participants and on benefits for India overall. Pointing to ethical malpractices and lobbying for stricter ethical regulations, they aimed to ensure justice for research participants, and developed effective strategies to increase controls over the business side of clinical research.
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Affiliation(s)
- Salla Sariola
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Sociology, University of Turku, Turku, Finland
| | - Roger Jeffery
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Amar Jesani
- Independent Researcher and Teacher (Bioethics, Public Health)
| | - Gerard Porter
- School of Law, University of Edinburgh, Edinburgh, UK
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14
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Gichuru E, Kombo B, Mumba N, Sariola S, Sanders EJ, van der Elst EM. Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya. Crit Public Health 2018; 28:294-305. [PMID: 29770367 PMCID: PMC5935049 DOI: 10.1080/09581596.2018.1447647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/28/2018] [Indexed: 01/18/2023]
Abstract
In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM.
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Affiliation(s)
- Evans Gichuru
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bernadette Kombo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Noni Mumba
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salla Sariola
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,University of Turku, Turku, Finland
| | - Eduard J Sanders
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elise M van der Elst
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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15
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Affiliation(s)
- Lindsey Reynolds
- Population Studies and Training Centre, Brown University, USA
- Department of Sociology and Social Anthropology, Stellenbosch University, South Africa
| | - Salla Sariola
- Department of Sociology, University of Turku, Finland
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16
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Nyirenda D, Sariola S, Gooding K, Phiri M, Sambakunsi R, Moyo E, Bandawe C, Squire B, Desmond N. 'We are the eyes and ears of researchers and community': Understanding the role of community advisory groups in representing researchers and communities in Malawi. Dev World Bioeth 2017; 18:420-428. [PMID: 28872746 PMCID: PMC6491972 DOI: 10.1111/dewb.12163] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community engagement to protect and empower participating individuals and communities is an ethical requirement in research. There is however limited evidence on effectiveness or relevance of some of the approaches used to improve ethical practice. We conducted a study to understand the rationale, relevance and benefits of community engagement in health research. This paper draws from this wider study and focuses on factors that shaped Community Advisory Group (CAG) members’ selection processes and functions in Malawi. A qualitative research design was used; two participatory workshops were conducted with CAG members to understand their roles in research. Workshop findings were triangulated with insights from ethnographic field notes, key informant interviews with stakeholders, focus group discussions with community members and document reviews. Data were coded manually and thematic content analysis was used to identify main issues. Results have shown that democratic selection of CAG members presented challenges in both urban and rural settings. We also noted that CAG members perceived their role as a form of employment which potentially led to ineffective representation of community interests. We conclude that democratic voting is not enough to ensure effective representation of community's interests of ethical relevance. CAG members’ abilities to understand research ethics, identify potential harms to community and communicate feedback to researchers is critical to optimise engagement of lay community and avoid tokenistic engagement.
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17
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Kombo B, Sariola S, Gichuru E, Molyneux S, Sanders EJ, van der Elst E. " Facing Our Fears": Using facilitated film viewings to engage communities in HIV research involving MSM in Kenya. Cogent Med 2017; 4:1330728. [PMID: 28670602 PMCID: PMC5470105 DOI: 10.1080/2331205x.2017.1330728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/11/2017] [Indexed: 10/29/2022] Open
Abstract
Kenya is a generally homophobic country where homosexuality is criminalised and people who engage in same sex sexuality face stigma and discrimination. In 2013, we developed a 16 min documentary entitled "Facing Our Fears" that aimed at sharing information on how and why men who have sex with men (MSM) are involved in on-going KEMRI HIV prevention research, and associated community engagement. To consider the film's usefulness as a communication tool, and its perceived security risks in case the film was publicly released, we conducted nine facilitated viewings with 122 individuals representing seven different stakeholder groups. The documentary was seen as a strong visual communication tool with potential to reduce stigma related to homosexuality, and facilitated film viewings were identified as platforms with potential to support open dialogue about HIV research involving MSM. Despite the potential, there were concerns over possible risks to LGBT communities and those working with them following public release. We opted-giving emphasis to the "do no harm" principle-to use the film only in facilitated settings where audience knowledge and attitudes can be carefully considered and discussed. The results highlight the importance of carefully assessing the range of possible impacts when using visuals in community engagement.
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Affiliation(s)
- Bernadette Kombo
- HIV Key Populations Studies, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salla Sariola
- Department of Public Health, The Ethox Centre, University of Oxford, Oxford, UK.,Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Evanson Gichuru
- HIV Key Populations Studies, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sassy Molyneux
- Department of Public Health, The Ethox Centre, University of Oxford, Oxford, UK.,Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Nuffield Department of Medicine, The Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Eduard J Sanders
- HIV Key Populations Studies, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, The Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise van der Elst
- HIV Key Populations Studies, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
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18
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Paul M, Essén B, Sariola S, Iyengar S, Soni S, Klingberg Allvin M. Negotiating Collective and Individual Agency: A Qualitative Study of Young Women's Reproductive Health in Rural India. Qual Health Res 2017; 27:311-324. [PMID: 26531879 PMCID: PMC5302084 DOI: 10.1177/1049732315613038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.
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Affiliation(s)
- Mandira Paul
- Uppsala University, Uppsala, Sweden
- Mandira Paul, Department of Women’s and Children’s health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden.
| | | | | | - Sharad Iyengar
- Action Research & Training for Health, Udaipur, Rajasthan, India
| | - Sunita Soni
- Action Research & Training for Health, Udaipur, Rajasthan, India
| | - Marie Klingberg Allvin
- Karolinska Institutet/Karolinska University Hospital, WHO collaborating Centre, Stockholm, Sweden
- Dalarna University, Falun, Sweden
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Molyneux S, Sariola S, Allman D, Dijkstra M, Gichuru E, Graham S, Kamuya D, Gakii G, Kayemba B, Kombo B, Maleche A, Mbwambo J, Marsh V, Micheni M, Mumba N, Parker M, Shio J, Yah C, van der Elst E, Sanders E. Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities. Health Res Policy Syst 2016; 14:40. [PMID: 27234212 PMCID: PMC4884401 DOI: 10.1186/s12961-016-0106-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background Community engagement, incorporating elements of the broader concepts of public and stakeholder engagement, is increasingly promoted globally, including for health research conducted in developing countries. In sub-Saharan Africa, community engagement needs and challenges are arguably intensified for studies involving gay, bisexual and other men who have sex with men, where male same-sex sexual interactions are often highly stigmatised and even illegal. This paper contextualises, describes and interprets the discussions and outcomes of an international meeting held at the Kenya Medical Research Institute-Wellcome Trust in Kilifi, Kenya, in November 2013, to critically examine the experiences with community engagement for studies involving men who have sex with men. Discussion We discuss the ethically charged nature of the language used for men who have sex with men, and of working with ‘representatives’ of these communities, as well as the complementarity and tensions between a broadly public health approach to community engagement, and a more rights based approach. We highlight the importance of researchers carefully considering which communities to engage with, and the goals, activities, and indicators of success and potential challenges for each. We suggest that, given the unintended harms that can emerge from community engagement (including through labelling, breaches in confidentiality, increased visibility and stigma, and threats to safety), representatives of same-sex populations should be consulted from the earliest possible stage, and that engagement activities should be continuously revised in response to unfolding realities. Engagement should also include less vocal and visible men who have sex with men, and members of other communities with influence on the research, and on research participants and their families and friends. Broader ethics support, advice and research into studies involving men who have sex with men is needed to ensure that ethical challenges – including but not limited to those related to community engagement – are identified and addressed. Summary Underlying challenges and dilemmas linked to stigma and discrimination of men who have sex with men in Africa raise special responsibilities for researchers. Community engagement is an important way of identifying responses to these challenges and responsibilities but itself presents important ethical challenges.
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Affiliation(s)
- Sassy Molyneux
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. .,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK. .,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Salla Sariola
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,Faculty of Social Sciences, University of Torku, Torku, Finland
| | - Dan Allman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Maartje Dijkstra
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evans Gichuru
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Susan Graham
- Kenya Research Group, University of Washington, Seattle, USA
| | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Gloria Gakii
- University of Nairobi, Nairobi, Kenya.,University of Manitoba, Manitoba, USA
| | | | - Bernadette Kombo
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Allan Maleche
- KELIN - Reclaiming rights, Rebuilding Live, Nairobi, Kenya
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vicki Marsh
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Murugi Micheni
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Noni Mumba
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Michael Parker
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Jasmine Shio
- Department of Project Management, Deloitte Consulting Ltd, Dar es Salaam, Tanzania
| | - Clarence Yah
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise van der Elst
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduard Sanders
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Patricia Kingori
- a The Ethox Centre, Nuffield Centre for Population Health , University of Oxford
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Abstract
The World Trade Organisation's Trade Related Intellectual Property Rights [TRIPS] agreement aimed to harmonise intellectual property rights and patent protection globally. In India, the signing of this agreement resulted in a sharp increase in clinical trials since 2005. The Indian government, along with larger Indian pharmaceutical companies, believed that they could change existing commercial research cultures through the promotion of basic research as well as attracting international clinical trials, and thus create an international level, innovation-based drug industry. The effects of the growth of these outsourced and off-shored clinical trials on local commercial knowledge production in India are still unclear. What has been the impact of the increasing scale and commercialisation of clinical research on corporate science in India? In this paper we describe Big-pharmaceuticalisation in India, whereby the local pharmaceutical industry is moving from generic manufacturing to innovative research. Using conceptual frameworks of pharmaceuticalisation and innovation, this paper analyses data from research conducted in 2010-2012 and describes how Contract Research Organisations (CROs) enable outsourcing of randomised control trials to India. Focussing on twenty-five semi-structured interviews CRO staff, we chart the changes in Indian pharmaceutical industry, and implications for local research cultures. We use Big-pharmaceuticalisation to extend the notion of pharmaceuticalisation to describe the spread of pharmaceutical research globally and illustrate how TRIPS has encouraged a concentration of capital in India, with large companies gaining increasing market share and using their market power to rewrite regulations and introduce new regulatory practices in their own interest. Contract Research Organisations, with relevant, new, epistemic skills and capacities, are both manifestations of the changes in commercial research cultures, as well as the vehicles to achieve them. These changes have reinvigorated public concerns that stress not only access to new medicines but also the 'price' of innovation on research participants.
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Affiliation(s)
- Salla Sariola
- Department of Anthropology, University of Durham, UK.
| | | | - Anand Kumar
- Centre for Studies in Ethics and Rights, Mumbai, India
| | - Roger Jeffery
- Sociology/Edinburgh India Institute, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh EH8 9LD, UK
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Gichuru E, Sariola S, Van der Elst EM, Mugo P, Micheni M, Graham SM, Molyneux C, Sanders EJ. ‘Facing our Fears’: Facilitated Film Viewings as a Community Engagement Tool in Research Involving MSM in Kenya. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5263.abstract] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evans Gichuru
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Peter Mugo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Susan M. Graham
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Washington, Seattle, WA, United States
| | - Catherine Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, United Kingdom
| | - Eduard J. Sanders
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, United Kingdom
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Sariola S, Simpson B. Theorising the ‘human subject’ in biomedical research: International clinical trials and bioethics discourses in contemporary Sri Lanka. Soc Sci Med 2011; 73:515-521. [DOI: 10.1016/j.socscimed.2010.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 11/15/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
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Simpson B, Dissanayake VHW, Douglas-Jones R, Sariola S. Ethical review, remit and responsibility in biomedical research in South Asia. Indian J Med Ethics 2010; 7:113-4. [PMID: 20432887 DOI: 10.20529/ijme.2010.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bob Simpson
- Department of Anthropology, Durham University, Durham, United Kingdom.
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Sariola S. Book Review: Sophie Day, On the Game: Women and Sex Work. London: Pluto Press, 2006. Critique of Anthropology 2009. [DOI: 10.1177/0308275x090290010803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sariola S, Roberts S, Douglas-Jones R. Book Reviews. Anthropology in Action 2009. [DOI: 10.3167/aia.2009.160108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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