Adolescents as doubly-vulnerable research subjects

Federal Interpretation and Enforcement of Protections for Vulnerable Participants in Human Research

Regulations and policies governing research, codes of ethics, and the research ethics literature reflect the need to provide special protections to vulnerable research participants. Nevertheless, there is disagreement about who is vulnerable and why, what protections are appropriate, and when to disallow research involving vulnerable persons. The Common Rule (CR) governs much of the human research conducted in the United States and the Office for Human Research Protections (OHRP) oversees much of this research. The CR requires special protections for pregnant women, fetuses, neonates, prisoners, and children. Although it also requires that researchers employ “additional safeguards” to protect other vulnerable persons, it does not define vulnerability or identify appropriate “safeguards.” Very little is known about how OHRP interprets the “additional safeguards” requirement. We examined all letters of determination posted on the OHRP website between July 1, 2000 and December 31, 2006 (n = 636) to study the extent to which OHRP addressed, in its audits and investigations, the requirement to protect vulnerable persons. The letters did not reveal guidance on understanding vulnerability, determining whether a study includes vulnerable persons or protecting vulnerable participants. If institutions and investigators are to fulfill the ethical obligation to provide appropriate safeguards when conducting research on vulnerable persons, they must develop and implement mechanisms to identify and address vulnerability.

Determining Content Validity of a Self-Report Instrument for Adolescents Using a Heterogeneous Expert Panel

BACKGROUND

The use of experiential experts, especially children and adolescents, in content validity evaluations of new instruments has not been described well.

OBJECTIVE

To describe the use of experiential experts in a content validity evaluation of a new instrument.

METHODS

Experiential (adolescents and parents, n = 11) and professional (diabetes clinicians and researchers, n = 17) expert judges evaluated the content validity of a new instrument that measures self-management of Type 1 diabetes in adolescents. The content validity index for each of 99 items (I-CVIs) for the total group of experts (n = 28; I-CVI-ALL) and for the experiential experts only (I-CVI-EXPERIENTIAL) were calculated, respectively, and both were used to inform decisions about whether to retain, eliminate, or revise each item.

RESULTS

There were 20 items where the I-CVI-ALL was >/=.80 and the I-CVI-EXPERIENTIAL was <.80. Each of these 20 items was evaluated critically. Some were retained (n = 3), some were eliminated (n = 7), and some were revised as suggested by the experts (n = 10).

DISCUSSION

Using experiential content validity experts (adolescents and parents) and critically evaluating their recommendations regarding items can result in further elimination and revision of items beyond what is suggested by content validity assessment done by professional experts. The result may be a more thorough content validity assessment of the instrument, leading to an instrument with greater relevance for the target population.