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Beardmore-Gray A, Simwinga M, Vwalika B, Chinkoyo S, Chappell L, Sandall J, Shennan A. Understanding the language barriers to translating informed consent documents for maternal health trials in Zambia: a qualitative study. BMJ Open 2024; 14:e076744. [PMID: 38580359 PMCID: PMC11002372 DOI: 10.1136/bmjopen-2023-076744] [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: 06/15/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Providing comprehensible information is essential to the process of valid informed consent. Recruitment materials designed by sponsoring institutions in English-speaking, high-income countries are commonly translated for use in global health studies in other countries; however, key concepts are often missed, misunderstood or 'lost in translation'. The aim of this study was to explore the language barriers to informed consent, focusing on the challenges of translating recruitment materials for maternal health studies into Zambian languages. DESIGN We used a qualitative approach, which incorporated a multistakeholder workshop (11 participants), in-depth interviews with researchers and translators (8 participants) and two community-based focus groups with volunteers from community advisory boards (20 participants). Content analysis was used to identify terms commonly occurring in recruitment materials prior to the workshop. The framework analysis approach was used to analyse interview data, and a simple inductive thematic analysis approach was used to analyse focus group data. SETTING The study was based in Lusaka, Zambia. RESULTS The workshop highlighted difficulties in translating research terms and pregnancy-specific terms, as well as widespread concern that current templates are too long, use overly formal language and are designed with little input from local teams. Framework analysis of in-depth interviews identified barriers to participant understanding relating to design and development of recruitment materials, language, local context and communication styles. Focus group participants confirmed these findings and suggested potential solutions to ensure the language and content of recruitment materials can be better understood. CONCLUSION Our findings demonstrate that the way in which recruitment materials are currently designed, translated and disseminated may not enable potential trial participants to fully understand the information provided. Instead of using overly complex institutional templates, recruitment materials should be created through an iterative and interactive process that provides truly comprehensible information in a format appropriate for its intended participants.
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Affiliation(s)
- Alice Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - Sebastian Chinkoyo
- Department of Obstetrics and Gynaecology, Ndola Teaching Hospital, Ndola, Zambia
| | - Lucy Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Tiruneh G, Yilma M, Wakuma B, Abdisa E, Bayisa L, Nichols M, Bedeker A, Tiffin N. Compliance with research ethics in epidemiological studies targeted to conflict-affected areas in Western Ethiopia: validity of informed consent (VIC) by information comprehension and voluntariness (ICV). BMC Med Ethics 2024; 25:9. [PMID: 38238678 PMCID: PMC10795316 DOI: 10.1186/s12910-024-01003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The conduct of research is critical to advancing human health. However, there are issues of ethical concern specific to the design and conduct of research in conflict settings. Conflict-affected countries often lack strong platform to support technical guidance and monitoring of research ethics, which may lead to the use of divergent ethical standards some of which are poorly elaborated and loosely enforced. Despite the growing concern about ethical issues in research, there is a dearth of information about ethical compliance in conflict areas. Valid and ethically informed decision-making is a premier pact with research participants in settling possible ethical issues before commencing the research, which is ensured by gaining informed consent from prospective participants of the research. AIMS This research aimed to explore compliance with research ethics and consent validity in community-based epidemiological research conducted previously. METHODS Research participants were recruited in the western part of Ethiopia in three districts subjected to conflicts. A community-based cross-sectional study design was utilized, and 338 residents were enrolled as study participants. All participants had previously been enrolled as research participants in epidemiological studies. Data was collected using a questionnaire that was pilot-tested before the commencement of the main data collection. The questionnaire focused on participants' experiences of the informed consent process followed when they were recruited for an epidemiological study and covered themes such as essential information provided, level of comprehension, and voluntarism of consent. RESULTS Over half of the study participants, 176 (52%), were not provided with essential information before consenting. And 135 (40%) of them did not comprehend the information provided to them. One hundred and ninety (56%) participants freely and voluntarily agreed to partake in one of these epidemiological studies, with over a quarter (97; 28.7%) of them reporting they were subjected to undue influence. Written consent was obtained from only 32 (9.4%) of the participants.
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Affiliation(s)
- Gemechu Tiruneh
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Mekdes Yilma
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Michelle Nichols
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Anja Bedeker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Nicki Tiffin
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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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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Chemonges Wanyama E, Dicko B, Pare Toe L, Coulibaly MB, Barry N, Bayala Traore K, Diabate A, Drabo M, Kayondo JK, Kekele S, Kodio S, Ky AD, Linga RR, Magala E, Meda WI, Mukwaya S, Namukwaya A, Robinson B, Samoura H, Sanogo K, Thizy D, Traoré F. Co-developing a common glossary with stakeholders for engagement on new genetic approaches for malaria control in a local African setting. Malar J 2021; 20:53. [PMID: 33478519 PMCID: PMC7818942 DOI: 10.1186/s12936-020-03577-y] [Citation(s) in RCA: 6] [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: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022] Open
Abstract
Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are mainly lacking in local languages, yet when research activities involve international partnership, the question of technical jargon and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language centre) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.
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Affiliation(s)
| | - Bakara Dicko
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lea Pare Toe
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mamadou B Coulibaly
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nourou Barry
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Abdoulaye Diabate
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mouhamed Drabo
- Department of Life Sciences, Imperial College London, London, UK
| | - Jonathan K Kayondo
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Souleymane Kekele
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Souleymane Kodio
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Anselme Dinyiri Ky
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Emmanuel Magala
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Solome Mukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Annet Namukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Hatouma Samoura
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Kadiatou Sanogo
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Delphine Thizy
- Department of Life Sciences, Imperial College London, London, UK.
| | - Fatoumata Traoré
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Ditai J, Kanyago J, Nambozo MR, Odeke NM, Abeso J, Dusabe-Richards J, Olupot-Olupot P, Carrol ED, Medina-Lara A, Gladstone M, Storr J, Faragher B, Weeks AD. Optimising informed consent for participants in a randomised controlled trial in rural Uganda: a comparative prospective cohort mixed-methods study. Trials 2018; 19:699. [PMID: 30577809 PMCID: PMC6304001 DOI: 10.1186/s13063-018-3030-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Poor participant understanding of research information can be a problem in community interventional studies with rural African women, whose levels of illiteracy are high. This study aimed to improve the informed consent process for women living in rural eastern Uganda. We assessed the impact of alternative consent models on participants' understanding of clinical trial information and their contribution to the informed consent process in rural Uganda. METHODS The study applied a parallel mixed-methods design for a prospective comparative cohort, nested within a pilot study on the community distribution of an alcohol-based hand rub to prevent neonatal sepsis (BabyGel pilot trial). Women of at least 34 weeks' pregnancy, suitable for inclusion in the BabyGel pilot trial, were recruited into this study from their homes in 13 villages in Mbale District. As part of the informed consent process, information about the trial was presented using one of three consent methods: standard researcher-read information, a slide show using illustrated text on a flip chart or a video showing the patient information being read as if by a newsreader in either English or the local language. In addition, all women received the patient information sheet in their preferred language. Each information-giving method was used in recruitment for 1 week. Two days after recruitment, women's understanding of the clinical trial was evaluated using the modified Quality of Informed Consent (QuIC) tool. They were also shown the other two methods and their preference assessed using a 5-point Likert scale. Semi-structured interviews were administered to each participant. The interviews were audio-recorded, transcribed and translated verbatim, and thematically analysed. RESULTS A total of 30 pregnant women in their homes participated in this study. Their recall of the trial information within the planned 48 h was assessed for the majority (90%, 27/30). For all three consent models, women demonstrated a high understanding of the study. There was no statistically significant difference between the slide-show message (mean 4.7; standard deviation, SD 0.47; range 4-5), video message (mean 4.9; SD 0.33; range 4-5) and standard method (mean 4.5; SD 0.53; range 4-5; all one-way ANOVA, p = 0.190). The slide-show message resulted in the most objective understanding of question items with the highest average QuIC score of 100 points. For women who had been recruited using any of the three models, the slide show was the most popular method, with a mean score for all items of not less than 4.2 (mean 4.8; SD 0.6; range 4-5). Most women (63%, 19/30) preferred the slide-show message, compared with 17% (5/30) and 20% (6/30) for the standard and video messages, respectively. The reasons given included the benefits of having pictures to aid understanding and the logical progression of the information. CONCLUSION Our results from this small study suggest that slide-show messages may be an effective and popular alternative way of presenting trial information to women in rural Uganda, many of whom have little or no literacy. TRIAL REGISTRATION ISRCTN, ISRCTN67852437 . Registered on 18 March 2018.
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Affiliation(s)
- J Ditai
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda. .,Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's' Hospital, Crown Street, Liverpool, L8 7SS, UK.
| | - J Kanyago
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - M R Nambozo
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - N M Odeke
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - J Abeso
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda.,Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - J Dusabe-Richards
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - P Olupot-Olupot
- Busitema University, Faculty of Health Sciences, PO Box 1460, Mbale, Uganda
| | - E D Carrol
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE, UK
| | - A Medina-Lara
- Health Economics Group, University of Exeter, Exeter, UK
| | - M Gladstone
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's' Hospital, Crown Street, Liverpool, L8 7SS, UK.,International Community Paediatrics, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's' Hospital, Crown Street, Liverpool, L8 7SS, UK
| | | | - B Faragher
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - A D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's' Hospital, Crown Street, Liverpool, L8 7SS, UK
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Colom M, Rohloff P. Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review. BMJ Paediatr Open 2018; 2:e000298. [PMID: 30613801 PMCID: PMC6307601 DOI: 10.1136/bmjpo-2018-000298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Conducting research with children in low/middle-income countries (LMIC) requires consideration of socioeconomic inequalities and cultural and linguistic differences. Our objective was to survey the literature on informed consent in paediatric LMIC research, assessing for practical guidance for culturally and linguistically appropriate procedures. METHODS We conducted a scoping review on informed consent in paediatric LMIC research searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were published in English, from any date range, of any study design or format. RESULTS The search identified 2027 references, of which 50 were included in the analysis following full-text review. Reviewed guidelines emphasised individual, informed and voluntary consent from parents and caregivers. Reviewed articles provided detailed practical guidance on adapting these guiding principles to LMIC settings, including considerations for community engagement, verbal or other alternative consent procedures for low-literacy settings or less commonly spoken languages and guarding against therapeutic misconception by caregivers. There was uncertainty, however, on how to best protect individual autonomy, especially when influenced by gender dynamics, leadership hierarchies or the social status of researchers themselves. There was, furthermore, limited research discussing the special case of research involving adolescents or of procedures for documenting assent by participating children. CONCLUSIONS A scoping review of paediatric research in LMICs revealed substantial guidance on several features of culturally appropriate informed consent. However, additional research and guidance is needed, especially in the areas of gender imbalances, research with adolescents and children's own assent to participate in research.
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Affiliation(s)
- Marcela Colom
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Shaker SH, Hosseini Kasnavieh SM, Amini M, Tahmasebi A, Soltani S. A Survey of Current Practice of Informed Consent in Iranian Hospitals. Hosp Top 2018; 96:69-74. [PMID: 29787344 DOI: 10.1080/00185868.2018.1451261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Informed consent is legal and ethical process which is considered as important issue in quality of patient's treatment. The aim of the current study was to assess current informed consent of patients admitted in Iranian selected Hospitals, 2016. MATERIALS AND METHODS This cross-sectional study was conducted on 2150 patients admitted in 11 public Hospitals. Data was collected using a dichotomous questionnaire with 30 questions. Statistical analysis was done using SPSS software (version 18). RESULTS The results shown that 46% of patients had medium perception about informed consent, 44% believed to get insufficient information and 66% claimed to have active participation in treatment process. The significant associations were found between some dimensions and important parameters: Understanding of information dimension and education level (p = 0.008), Participation (in decision-making) dimension and type of hospitalization (p = 0.01), and level of patients' information dimension with resident address (p = 0.027) and medical specialty (p < 0.001). CONCLUSION In our study the current informed consent of patients wasn't in desirable condition. The Necessary measures are required to achieve a level that the patients' informed consent convert to informed choices. Hospital healthcare team need to take proper actions such as give proper information, patient training, sufficient information and etc.
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Affiliation(s)
- Seyed Hosein Shaker
- a Department of Emergency Medicine , Iran University of Medical Sciences , Tehran , Iran
| | | | - Milad Amini
- b Trauma and Injury Research Center, Iran University of Medical Sciences , Tehran , Iran
| | - Ali Tahmasebi
- b Trauma and Injury Research Center, Iran University of Medical Sciences , Tehran , Iran
| | - Siamak Soltani
- c Department of Forensic Medicine , Iran University of Medical Sciences , Tehran , Iran
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Martínez Pérez G, Tarr-Attia CK, Breeze-Barry B, Sarukhan A, Lansana DP, Meyer García-Sípido A, Rosés A, Maixenchs M, Bassat Q, Mayor A. 'Researchers have love for life': opportunities and barriers to engage pregnant women in malaria research in post-Ebola Liberia. Malar J 2018; 17:132. [PMID: 29606141 PMCID: PMC5880008 DOI: 10.1186/s12936-018-2292-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adoption of prevention and therapeutic innovations to ensure that National Malaria Control Programmes meet their incidence reduction targets is highly dependent on the conduct of rigorous clinical trials. In Liberia, malaria control virtually halted during the recent Ebola epidemic, and could enormously benefit from innovations to protect its most vulnerable populations, including pregnant women, against malaria. Health policy-planners could feel more inclined to adopt novel interventions with demonstrated safety and efficacy when trialled among their women population. However, pregnant women are especially vulnerable when targeted as research participants. Whilst some studies in the region attempted to understand the ethical issues around the conduct of clinical research, there is need of such information from Liberia to inform future malaria research. METHODS This is a grounded theory study that aims to understand the barriers and opportunities for pregnant women to consent to participate in malaria research in Liberia. The study was conducted between November 2016 and May 2017 at the St Joseph's Catholic Hospital, Monrovia. In-depth interviews and focus group discussions were held with hospital staff, traditional community representatives, and pregnant women. RESULTS According to the participants, useful strategies to motivate pregnant women to consent to participate in malaria research could be providing evidence-based education on malaria and research to the general population and encouraging engagement of traditional leaders in research design and community mobilization. Fears and suspicions towards research and researchers, which were amplified during the conduct of Ebola vaccine and drug clinical trials, may influence women's acceptance and willingness to engage in malaria research. Population's mistrust in the public healthcare system might hinder their acceptance of research, undermining the probability of their benefiting from any improved malaria control intervention. CONCLUSION Benchmarking for acceptable practices from previous public health interventions; building community discussion and dissemination platforms; and mapping communication and information errors from how previous research interventions were explained to the Liberian population, are strategies that might help ensure a safe and fully informed participation of pregnant women in malaria research. Inequity issues impeding access and use of biomedical care for women must be tackled urgently.
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Affiliation(s)
- Guillermo Martínez Pérez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia.
| | - Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Bondey Breeze-Barry
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | | | - Anna Rosés
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - María Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Jasińska KK, Guei S. Neuroimaging Field Methods Using Functional Near Infrared Spectroscopy (NIRS) Neuroimaging to Study Global Child Development: Rural Sub-Saharan Africa. J Vis Exp 2018. [PMID: 29443053 DOI: 10.3791/57165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Portable neuroimaging approaches provide new advances to the study of brain function and brain development with previously inaccessible populations and in remote locations. This paper shows the development of field functional Near Infrared Spectroscopy (fNIRS) imaging to the study of child language, reading, and cognitive development in a rural village setting of Côte d'Ivoire. Innovation in methods and the development of culturally appropriate neuroimaging protocols allow a first-time look into the brain's development and children's learning outcomes in understudied environments. This paper demonstrates protocols for transporting and setting up a mobile laboratory, discusses considerations for field versus laboratory neuroimaging, and presents a guide for developing neuroimaging consent procedures and building meaningful long-term collaborations with local government and science partners. Portable neuroimaging methods can be used to study complex child development contexts, including the impact of significant poverty and adversity on brain development. The protocol presented here has been developed for use in Côte d'Ivoire, the world's primary source of cocoa, and where reports of child labor in the cocoa sector are common. Yet, little is known about the impact of child labor on brain development and learning. Field neuroimaging methods have the potential to yield new insights into such urgent issues, and the development of children globally.
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Affiliation(s)
- Kaja K Jasińska
- Linguistics and Cognitive Science Department, University of Delaware; Haskins Laboratories;
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Diemert DJ, Lobato L, Styczynski A, Zumer M, Soares A, Gazzinelli MF. A Comparison of the Quality of Informed Consent for Clinical Trials of an Experimental Hookworm Vaccine Conducted in Developed and Developing Countries. PLoS Negl Trop Dis 2017; 11:e0005327. [PMID: 28114401 PMCID: PMC5289607 DOI: 10.1371/journal.pntd.0005327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/02/2017] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Informed consent is one of the principal ethical requirements of conducting clinical research, regardless of the study setting. Breaches in the quality of the informed consent process are frequently described in reference to clinical trials conducted in developing countries, due to low levels of formal education, a lack of familiarity with biomedical research, and limited access to health services in these countries. However, few studies have directly compared the quality of the informed consent process in developed and developing countries using the same tool and in similar clinical trials. This study was conducted to compare the quality of the informed consent process of a series of clinical trials of an investigational hookworm vaccine that were performed in Brazil and the United States. A standardized questionnaire was used to assess the ethical quality of the informed consent process in a series of Phase 1 clinical trials of the Na-GST-1/Alhydrogel hookworm vaccine that were conducted in healthy adults in Brazil and the United States. In Brazil, the trial was conducted at two sites, one in the hookworm non-endemic urban area of Belo Horizonte, Minas, and one in the rural, resource-limited town of Americaninhas, both in the state of Minas Gerais; the American trial was conducted in Washington, DC. A 32-question survey was administered after the informed consent document was signed at each of the three trial sites; it assessed participants’ understanding of information about the study presented in the document as well as the voluntariness of their decision to participate. 105 participants completed the questionnaire: 63 in Americaninhas, 18 in Belo Horizonte, and 24 in Washington, DC. Overall knowledge about the trial was suboptimal: the mean number of correct answers to questions about study objectives, methods, duration, rights, and potential risks and benefits, was 45.6% in Americaninhas, 65.2% in Belo Horizonte, and 59.1% in Washington, DC. Although there was no difference in the rate of correct answers between participants in Belo Horizonte and Washington, DC, there was a significant gap between participants at these two locations compared to Americaninhas (p = 0.0002 and p = 0.0001, respectively), which had a lower percentage of correct answers. Attitudes towards participating in the clinical trial also differed by site: while approximately 40% had doubts about participating in Washington, DC and Belo Horizonte, only 1.5% had concerns in Americaninhas. Finally, in Belo Horizonte and Washington, high percentages cited a desire to help others as motivation for participating, whereas in Americaninhas, the most common reason for participating was personal interest (p = 0.001). Understanding of information about a Phase 1 clinical trial of an experimental hookworm vaccine following informed consent was suboptimal, regardless of study site. Although overall there were no differences in knowledge between Brazil and the US, a lower level of understanding about the trial was seen in participants at the rural, resource-limited Brazilian site. These findings demonstrate the need for educational interventions directed at potential clinical trial participants, both in developing and developed countries, in order to improve understanding of the informed consent document. Informed consent is an essential element of the ethical conduct of clinical trials of new vaccines, regardless of the study setting. However, the quality of informed consent is often suboptimal. Some research has suggested that the quality of the informed consent process may be reduced in resource-limited areas compared to developed country settings. To test this, we conducted a study of the quality of the informed consent process in two similar Phase 1 clinical trials of the Na-GST-1/Alhydrogel hookworm vaccine that were conducted in healthy adult volunteers in Brazil and in the United States. In Brazil, the trial was conducted at two sites, one a large urban area (Belo Horizonte), and the other a rural, resource-limited region of the state of Minas Gerais; in the United States, the trial was conducted in Washington, DC. A structured questionnaire was administered after the informed consent document was signed at each of the three clinical trial sites, which tested understanding about the information contained in the document and attitudes toward the volunteers’ participation in the clinical trial. The results indicate that there were no substantial differences between the overall quality of the informed consent obtained from participants in the United States and in Brazil. However, a significant association was found between the particular site where the trial was conducted and the quality of the informed consent process, with residents of the site in rural Brazil having the lowest percentage of correct answers on the informed consent questionnaire. The informed consent process should therefore take into account the specific characteristics of the population in which the trial is being conducted.
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Affiliation(s)
- David J. Diemert
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
- * E-mail:
| | - Lucas Lobato
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashley Styczynski
- Department of Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
| | - Maria Zumer
- Department of Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
| | - Amanda Soares
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Flávia Gazzinelli
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Foe G, Larson EL. Reading Level and Comprehension of Research Consent Forms. J Empir Res Hum Res Ethics 2016; 11:31-46. [DOI: 10.1177/1556264616637483] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Consent forms continue to be at a higher reading level than the recommended sixth to eighth grade, making it difficult for participants to comprehend information before enrolling in research. To assess and address the extent of the problem regarding the level of literacy of consent forms and update previously published reports, we conducted an integrative literature review of English language research published between January 1, 2000, and December 31, 2013; 35 descriptive and eight intervention studies met inclusion criteria. Results confirmed that developing forms at eighth-grade level was attainable though not practiced. It was found that risks of participation was the section most poorly understood. There was also a lack of consensus regarding the most effective method to increase comprehension. Further research using standardized tools is needed to determine the best approach for improving consent forms and processes.
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Gallagher B, Berman AH, Bieganski J, Jones AD, Foca L, Raikes B, Schiratzki J, Urban M, Ullman S. National Human Research Ethics: A Preliminary Comparative Case Study of Germany, Great Britain, Romania, and Sweden. ETHICS & BEHAVIOR 2015; 26:586-606. [PMID: 27746664 PMCID: PMC5044765 DOI: 10.1080/10508422.2015.1096207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics” (NHREs), that is, national ethical guidelines (NEGs), Institutional Review Boards (IRBs), and research stakeholder’ ethical attitudes and behaviors (EABs). We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity.
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Affiliation(s)
| | - Anne H Berman
- Department of Clinical Neurosciences, Karolinska Institutet
| | | | - Adele D Jones
- School of Human and Health Sciences, University of Huddersfield
| | - Liliana Foca
- Department of Psychology, Asociația Alternative Sociale
| | - Ben Raikes
- Division of Social Work, University of Huddersfield
| | | | - Mirjam Urban
- Department of Medicine, Technische Universitaet Dresden
| | - Sara Ullman
- Department of Investigation, The Swedish Police
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Baiden F, Akazili J, Chatio S, Achana FS, Oduro AR, Ravinetto R, Hodgson A. Should consent forms used in clinical trials be translated into the local dialects? A survey among past participants in rural Ghana. Clin Trials 2015; 13:234-9. [PMID: 26452387 DOI: 10.1177/1740774515609290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obtaining informed consent is part of the expression of the principle of participant autonomy during clinical trials. It is critical that participants understand the content of informed consent forms and remain in a position to seek independent advice on its content. We conducted a survey among past participants of a clinical trial in the Kassena-Nankana Districts of rural northern Ghana about the usefulness of informed consent forms that are written in the local dialects. The written forms of local dialects are largely undeveloped. METHOD We contacted a randomly selected sample of caregivers whose children were enrolled in a completed clinical trial and interviewed them using a structured questionnaire. Analysis sought to determine participants' preference and whether or not they were likely to find confidants who will be able to read, understand and give advice on the content of the informed consent form to them when they take the informed consent forms home. RESULTS We interviewed 394 caregivers, 88.6% of whom were women. About half (54%) of the respondents wanted the informed consent forms to be in the English language. Caregivers with higher than primary level education were more likely to prefer the informed consent form to be in English than those with no formal education (74% versus 26%, p = 0.04). The majority (85%) indicated that they would be able to find close confidants who would be able to read and explain it to them if it is in English. In contrast, only 8% thought they would be able to do the same if the informed consent form was written in the local language. Respondents were more likely to find close confidants to read and explain the informed consent form if it were written in English than if it were written in the local language (94% versus 19%, p value < 0.01). CONCLUSION The practice of translating informed consent forms into undeveloped local dialects and giving such copies to trial participants to send home needs to be re-evaluated. In populations where the written forms of local dialects are undeveloped and literacy is low, the use of local dialect versions of informed consent forms could ironically enhance the vulnerability of trial participants.
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Affiliation(s)
| | | | | | | | | | - Raffaella Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Abraham Hodgson
- Health Research and Development Division, Ghana Health Service, Accra, Ghana
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Morrow BM, Argent AC, Kling S. Informed consent in paediatric critical care research--a South African perspective. BMC Med Ethics 2015; 16:62. [PMID: 26354389 PMCID: PMC4565047 DOI: 10.1186/s12910-015-0052-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/24/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive. By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa. DISCUSSION Voluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent. Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices. We propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child's participation in clinical research when it is ethically justifiable and in the best interests of both child participant and parent. Where appropriate, alternatives to prospective informed consent should be considered to ensure that important paediatric critical care research can be undertaken in South Africa, whilst being cognisant of research risk. This document could provide a basis for debate on consent options in paediatric critical care research and contribute to efforts to advocate for South African law reform.
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Affiliation(s)
- Brenda M Morrow
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, 5th Floor ICH Building, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Rondebosch, Cape Town, 7700, South Africa.
- Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Rondebosch, Cape Town, 7700, South Africa.
| | - Sharon Kling
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Box 241, Cape Town, 8000, South Africa.
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Kalabuanga M, Ravinetto R, Maketa V, Muhindo Mavoko H, Fungula B, Inocêncio da Luz R, Van Geertruyden JP, Lutumba P. The Challenges of Research Informed Consent in Socio-Economically Vulnerable Populations: A Viewpoint From the Democratic Republic of Congo. Dev World Bioeth 2015; 16:64-9. [PMID: 26346178 DOI: 10.1111/dewb.12090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio-economic vulnerability. To ensure children's protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children's responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of 'culturally acceptable representative' under supervision of the local Ethics Committee may be more suitable. To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don't have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue. In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to 'competition' to access the research-related benefits, with a risk of disturbance at societal or household level. Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees.
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Lobato L, Bethony JM, Pereira FB, Grahek SL, Diemert D, Gazzinelli MF. Impact of gender on the decision to participate in a clinical trial: a cross-sectional study. BMC Public Health 2014; 14:1156. [PMID: 25377601 PMCID: PMC4232621 DOI: 10.1186/1471-2458-14-1156] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/28/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In order for Informed Consent to be ethical and valid each clinical trial participant must be able to make a voluntary decision to participate, free from pressure or coercion. Nonetheless, many factors may influence the decision reached, and such influences may be different for male and female volunteers. Being aware of these differences may help researches develop better processes for obtaining consent that safeguard the right of autonomy for all participants. The goal of this study was to evaluate potential gender-based differences in the factors influencing clinical trial participation. METHODS This cross-sectional study was conducted in the Northeast region of Minas Gerais, Brazil, in October 2011. A structured questionnaire was administered to 143 volunteers (48 male, 95 female) screened for participation in a clinical study of an investigational functional food with potential anthelminthic properties. Answers regarding their decision to participate in the study were compared, by gender, using chi-square and Mann Whitney tests. Odds ratios (OR) was used to measure association. RESULTS A majority of subjects (58% of males, 59% of females) listed the desire to collaborate with the development of a product against parasitic worms as their main reason for participation. Females were significantly more likely to report a decision influenced by friends, family, or researchers (OR 3.14, 3.45, and 3.46 respectively, p < 0.005). Females were also significantly more likely to report a decision influenced by general altruistic considerations (OR 8.45, p < 0.005). There was no difference, by gender, in the report of decisions influenced by informational meetings, understanding of the disease, or the availability of medical treatments or exams. There was also no difference in knowledge of the rights of research participants. CONCLUSION Study results indicate that there is a strong difference between male and female participants regarding social influences on the decision to participate in clinical research. Further research into the impact this may have on autonomy is warranted.
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Affiliation(s)
- Lucas Lobato
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
| | - Jeffrey Michael Bethony
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - Fernanda Bicalho Pereira
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
| | - Shannon Lee Grahek
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - David Diemert
- />Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
| | - Maria Flávia Gazzinelli
- />School of Nursing, Federal University of Minas Gerais, 190 Av. Alfredo Balena, Room 508, Belo Horizonte, MG 30130-100 Brazil
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Lobato L, Gazzinelli MF, Gazzinelli A, Soares AN. [Knowledge and willingness to participate in research: a descriptive study of volunteers in a clinical trial]. CAD SAUDE PUBLICA 2014; 30:1305-14. [PMID: 25099053 DOI: 10.1590/0102-311x00127813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/06/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate volunteers' knowledge of the information on the free informed consent form and their willingness to participate in a clinical trial. This was a quantitative, descriptive, cross-sectional study conducted in November 2011 with subjects from a clinical trial in Americaninhas, northeast Minas Gerais State, Brazil. A convenience sample included 143 adults of both sexes, 18 to 45 years of age. A structured questionnaire was applied one week after signing the free informed consent form. Most participants signed the free informed consent without sufficient knowledge of the research information and were influenced in their decision to participate in the trial. The authors conclude that signing the free informed consent form fails to express all participants' autonomy in clinical trials.
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Affiliation(s)
- Lucas Lobato
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Andréa Gazzinelli
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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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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Afolabi MO, Okebe JU, McGrath N, Larson HJ, Bojang K, Chandramohan D. Informed consent comprehension in African research settings. Trop Med Int Health 2014; 19:625-642. [PMID: 24636078 DOI: 10.1111/tmi.12288] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous reviews on participants' comprehension of informed consent information have focused on developed countries. Experience has shown that ethical standards developed on Western values may not be appropriate for African settings where research concepts are unfamiliar. We undertook this review to describe how informed consent comprehension is defined and measured in African research settings. METHODS We conducted a comprehensive search involving five electronic databases: Medline, Embase, Global Health, EthxWeb and Bioethics Literature Database (BELIT). We also examined African Index Medicus and Google Scholar for relevant publications on informed consent comprehension in clinical studies conducted in sub-Saharan Africa. 29 studies satisfied the inclusion criteria; meta-analysis was possible in 21 studies. We further conducted a direct comparison of participants' comprehension on domains of informed consent in all eligible studies. RESULTS Comprehension of key concepts of informed consent varies considerably from country to country and depends on the nature and complexity of the study. Meta-analysis showed that 47% of a total of 1633 participants across four studies demonstrated comprehension about randomisation (95% CI 13.9-80.9%). Similarly, 48% of 3946 participants in six studies had understanding about placebo (95% CI 19.0-77.5%), while only 30% of 753 participants in five studies understood the concept of therapeutic misconception (95% CI 4.6-66.7%). Measurement tools for informed consent comprehension were developed with little or no validation. Assessment of comprehension was carried out at variable times after disclosure of study information. No uniform definition of informed consent comprehension exists to form the basis for development of an appropriate tool to measure comprehension in African participants. CONCLUSIONS Comprehension of key concepts of informed consent is poor among study participants across Africa. There is a vital need to develop a uniform definition for informed consent comprehension in low literacy research settings in Africa. This will be an essential step towards developing appropriate tools that can adequately measure informed consent comprehension. This may consequently suggest adequate measures to improve the informed consent procedure.
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Affiliation(s)
- Muhammed O Afolabi
- Medical Research Council Unit, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Heidi J Larson
- London School of Hygiene and Tropical Medicine, London, UK
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Vanhelst J, Hardy L, Bert D, Duhem S, Coopman S, Libersa C, Deplanque D, Gottrand F, Béghin L. Effect of child health status on parents' allowing children to participate in pediatric research. BMC Med Ethics 2013; 14:7. [PMID: 23414421 PMCID: PMC3582492 DOI: 10.1186/1472-6939-14-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify motivational factors linked to child health status that affected the likelihood of parents' allowing their child to participate in pediatric research. METHODS Parents were invited to return their completed questionnaires anonymously to assess motivational factors and factors that might improve participation in pediatric research. RESULTS Of 573 eligible parents, 261 returned the completed questionnaires. Of these, 126 were parents of healthy children (group 1), whereas 135 were parents of sick children who were divided into two groups according to the severity of their pathology, i.e., 99 ambulatory children (group 2) and 36 nonambulatory children (group 3). The main factor motivating participation in a pediatric clinical research study was "direct benefits for their child" (87.7%, 100%, and 100% for groups 1, 2, and 3, respectively). The other factors differed significantly between the three groups, depending on the child's health status (all p < 0.05). Factors that might have a positive impact on parental consent to the participation of their child in a pediatric clinical research study differed significantly (χ2 test, all p ≤ 0.04), depending on the child's health status. The main factor was "a better understanding of the study and its regulation" for the healthy children and ambulatory sick children groups (31.2% and 82.1%, respectively), whereas this was the third factor for the nonambulatory sick children group (50%). CONCLUSIONS Innovative strategies should be developed based on a child's health status to improve information provision when seeking a child's participation in pediatric research. Parents would like to spend more time in discussions with investigators.
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Affiliation(s)
- Jérémy Vanhelst
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Unité Inserm U995 & Université Lille Nord de France, Lille, France
| | - Ludovic Hardy
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
| | - Dina Bert
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
| | - Stéphane Duhem
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Comité de Protection des Personnes Nord Ouest IV, Lille, France
| | - Stéphanie Coopman
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
| | - Christian Libersa
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Département de Pharmacologie, Faculté de Médecine, Université Lille Nord de France, Lille, France
| | - Dominique Deplanque
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Département de Pharmacologie, Faculté de Médecine, Université Lille Nord de France, Lille, France
| | - Frédéric Gottrand
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Unité Inserm U995 & Université Lille Nord de France, Lille, France
| | - Laurent Béghin
- Centre d’Investigation Clinique, CIC-PT-9301-Inserm-CH&U, Lille, 59037, France
- Unité Inserm U995 & Université Lille Nord de France, Lille, France
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Mandava A, Pace C, Campbell B, Emanuel E, Grady C. The quality of informed consent: mapping the landscape. A review of empirical data from developing and developed countries. JOURNAL OF MEDICAL ETHICS 2012; 38:356-65. [PMID: 22313664 PMCID: PMC4825806 DOI: 10.1136/medethics-2011-100178] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Some researchers claim that the quality of informed consent of clinical research participants in developing countries is worse than in developed countries. To evaluate this assumption, we reviewed the available data on the quality of consent in both settings. METHODS We conducted a comprehensive PubMed search, examined bibliographies and literature reviews, and consulted with international experts on informed consent in order to identify studies published from 1966 to 2010 that used quantitative methods, surveyed participants or parents of paediatric participants in actual trials, assessed comprehension and/or voluntariness, and did not involve testing particular consent interventions. Forty-seven studies met these criteria. We compared data about participant comprehension and voluntariness. The paucity of data and variation in study methodology limit comparison and preclude statistical aggregation of the data. RESULTS AND DISCUSSION This review shows that the assertion that informed consent is worse in developing countries than in developed countries is a simplification of a complex picture. Despite the limitations of comparison, the data suggest that: (1) comprehension of study information varies among participants in both developed and developing countries, and comprehension of randomisation and placebo controlled designs is poorer than comprehension of other aspects of trials in both settings; and (2) participants in developing countries appear to be less likely than those in developed countries to say they can refuse participation in or withdraw from a trial, and are more likely to worry about the consequences of refusal or withdrawal.
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Affiliation(s)
- Amulya Mandava
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Pace
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Benjamin Campbell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ezekiel Emanuel
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Bull S, Farsides B, Tekola Ayele F. Tailoring information provision and consent processes to research contexts: the value of rapid assessments. J Empir Res Hum Res Ethics 2012; 7:37-52. [PMID: 22378133 PMCID: PMC3427649 DOI: 10.1525/jer.2012.7.1.37] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guidance requires that consent processes for research be appropriately tailored to their cultural context. This paper discusses the use of rapid assessments to identify cultural and ethical issues arising when explaining research in studies in The Gambia and Ethiopia. The assessments provided insights into appropriate ways of providing information to minimize the risk of stigmatizing vulnerable research populations; research participants' views about the most important information to provide about research and their understandings of research; and perceived constraints upon reaching voluntary decisions about participation. These insights demonstrate that rapid assessments are a relatively quick and inexpensive intervention that can provide valuable information to assist in the tailoring of information provision and consent processes to research context while maintaining and enhancing participants' fundamental protections.
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Affiliation(s)
- Susan Bull
- The Ethox Centre, Division of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, United Kingdom.
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Norman ID, Aikins MK, Binka FN. Ethics and electronic health information technology: challenges for evidence-based medicine and the physician-patient relationship. Ghana Med J 2011; 45:115-24. [PMID: 22282579 PMCID: PMC3266146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES The National Health Insurance Scheme (NHIS), and the National Identification Authority (NIA), pose ethical challenges to the physician-patient relationship due to interoperability. This paper explores (1) the national legislation on Electronic Health Information Technology (EHIT), (2) the ethics of information technology and public health and (3) the effect on the Physician-patient relationship. METHOD This study consisted of systematic literature and internet review of the legislation, information technology, the national health insurance program, and the physician-patient relationship. RESULT The result shows that (1) EHIT have eroded a big part of the confidentiality between the physician and patient; (2) The encroachment on privacy is an inevitable outcome of EHIT; (3) Legislation on privacy, the collection, storage and uses of electronic health information is needed and; (4) the nexus between EHIT, NHIS, NHA, Ethics, the physician-patient relationship and privacy. CONCLUSION The study highlights the lack of protection for physician-patient relationship as medical practice transitions from the conventional to the modern, information technology driven domain.
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Affiliation(s)
- I D Norman
- Department of Biological, Environmental & Occupational Health Science, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
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Sarkar R, Sowmyanarayanan TV, Samuel P, Singh AS, Bose A, Muliyil J, Kang G. Comparison of group counseling with individual counseling in the comprehension of informed consent: a randomized controlled trial. BMC Med Ethics 2010; 11:8. [PMID: 20470423 PMCID: PMC2877053 DOI: 10.1186/1472-6939-11-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 05/14/2010] [Indexed: 11/25/2022] Open
Abstract
Background Studies on different methods to supplement the traditional informed consent process have generated conflicting results. This study was designed to evaluate whether participants who received group counseling prior to administration of informed consent understood the key components of the study and the consent better than those who received individual counseling, based on the hypothesis that group counseling would foster discussion among potential participants and enhance their understanding of the informed consent. Methods Parents of children participating in a trial of nutritional supplementation were randomized to receive either group counseling or individual counseling prior to administration of the informed consent. To assess the participant's comprehension, a structured questionnaire was administered approximately 48-72 hours afterwards by interviewers who were blinded to the allocation group of the respondents. Results A total of 128 parents were recruited and follow up was established with 118 (90.2%) for the study. All respondents were aware of their child's participation in a research study and the details of sample collection. However, their understanding of study purpose, randomization and withdrawal was poor. There was no difference in comprehension of key elements of the informed consent between the intervention and control arm. Conclusions The results suggest that the group counseling might not influence the overall comprehension of the informed consent process. Further research is required to devise better ways of improving participants' understanding of randomization in clinical trials. Trial Registration Clinical Trial Registry - India (CTRI): CTRI/2009/091/000612
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Affiliation(s)
- Rajiv Sarkar
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu, India
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