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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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Huq T, Alexander EC, Manikam L, Jokinen T, Patil P, Benjumea D, Das I, Davidson LL. A Systematic Review of Household and Family Alcohol Use and Childhood Neurodevelopmental Outcomes in Low- and Middle-Income Countries. Child Psychiatry Hum Dev 2021; 52:1194-1217. [PMID: 33369706 PMCID: PMC8528783 DOI: 10.1007/s10578-020-01112-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
Childhood exposure to alcohol misuse by household adults has been related to childhood developmental delay, cognitive impacts, mental illness, and problem behaviours. Most evidence comes from high income countries. This systematic review only included studies from low- and middle-income countries (LMICs). Five databases were searched from 1990-2020. Twenty-eight studies of children 0-12 years were included, with 42,599 participants from 11 LMICs. The most common outcome was behavioural problems/disorders (19 studies). Despite varying study designs, this review found that alcohol misuse by household members in LMICs is associated with adverse child neurodevelopmental outcomes, although casual inferences cannot be drawn in the absence of well conducted prospective studies. Statistically significant correlations were described between parental alcohol misuse and child emotional and behavioural difficulties, cognitive delay, and risky behaviours. In future, prospective cohort studies are recommended, with adjustment for confounders.
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Affiliation(s)
- Tausif Huq
- GKT School of Medical Education, King's College London, London, UK
| | - Emma C Alexander
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, UK
- Aceso Global Health Consultants Limited, London, UK
| | - Logan Manikam
- Aceso Global Health Consultants Limited, London, UK.
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK.
| | - Tahir Jokinen
- GKT School of Medical Education, King's College London, London, UK
| | - Priyanka Patil
- Aceso Global Health Consultants Limited, London, UK
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Darrin Benjumea
- Mailman School of Public Health, Columbia University, New York, USA
| | - Ishani Das
- Mailman School of Public Health, Columbia University, New York, USA
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Jokinen T, Alexander EC, Manikam L, Huq T, Patil P, Benjumea D, Das I, Davidson LL. A Systematic Review of Household and Family Alcohol Use and Adolescent Behavioural Outcomes in Low- and Middle-Income Countries. Child Psychiatry Hum Dev 2021; 52:554-570. [PMID: 32785812 PMCID: PMC8238760 DOI: 10.1007/s10578-020-01038-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Exposure to alcohol misuse is considered an adverse childhood experience impacting on neurodevelopmental and behavioural outcomes in adolescents including substance use, mental illness, problem behaviours, suicidality, and teenage pregnancy. Most research on this issue has focussed on higher income countries, whereas patterns of alcohol use and related factors may be different in low- and middle-income countries (LMICs). This systematic review therefore seeks to collate all published studies from 1990-2020 on the topic set in LMICs. 43 studies were included, totalling 70,609 participants from 18 LMICs. Outcomes assessed included: substance use; depression/anxiety; suicidal ideation; problem behaviour; emotional dysfunction; teenage pregnancy; and self-harm. Despite heterogeneity in the studies identified, this review documented some association between exposure to household alcohol misuse and adverse adolescent outcomes in LMICs, including mental health problems, problem behaviours, and suicidality. The mechanisms leading to these outcomes are likely varied, and further research in different socio-economic and cultural contexts, particularly in the form of longitudinal studies, is called for.
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Affiliation(s)
- Tahir Jokinen
- GKT School of Medical Education, King's College London, London, UK
| | - Emma C Alexander
- London North West University Healthcare NHS Trust, London, UK
- Aceso Global Health Consultants Limited, London, UK
| | - Logan Manikam
- Aceso Global Health Consultants Limited, London, UK.
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK.
| | - Tausif Huq
- GKT School of Medical Education, King's College London, London, UK
| | - Priyanka Patil
- Aceso Global Health Consultants Limited, London, UK
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Darrin Benjumea
- Mailman School of Public Health, Columbia University, New York, USA
| | - Ishani Das
- Mailman School of Public Health, Columbia University, New York, USA
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Pavarini G, Smith LM, Shaughnessy N, Mankee-Williams A, Thirumalai JK, Russell N, Bhui K. Ethical issues in participatory arts methods for young people with adverse childhood experiences. Health Expect 2021; 24:1557-1569. [PMID: 34318573 PMCID: PMC8483199 DOI: 10.1111/hex.13314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/02/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
Context Participatory arts‐based methods such as photovoice, drama and music have increasingly been used to engage young people who are exposed to psychosocial risks. These methods have the potential to empower youth and provide them with an accessible and welcoming environment to express and manage difficult feelings and experiences. These effects are, however, dependent on the way these methods are implemented and how potential ethical concerns are handled. Objective Using the current literature on arts‐based health research as a foundation, this paper examines ethical issues emerging from participatory arts methods with young people with traumatic experiences. Results We present a typology covering relevant issues such as power, accessibility, communication, trust and ownership, across the domains of partnership working, project entry, participation and dissemination. Drawing on our extensive clinical and research experiences, existing research and novel in‐practice examples, we offer guidance for ethical dilemmas that might arise at different phases of research. Conclusion Adequate anticipation and consideration of ethical issues, together with the involvement of young people, will help ensure that arts methods are implemented in research and practice with young people in a fair, meaningful and empowering way. Patient or Public Contribution The issues reviewed are largely based on the authors' experience conducting participatory research. Each of the projects referenced has its own systems for PPI including, variously, consultations with advisory groups, coproduction, youth ambassadors and mentor schemes. One of the coauthors, Josita Kavitha Thirumalai, is a young person trained in peer support and has provided extensive input across all stages.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Lindsay M Smith
- Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | | | | | | | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,World Psychiatric Association UK Collaborating Centre, Oxford, UK.,Centre for Understanding Personality (CUSP), East London NHS Foundation, London, UK
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Bruno W, Haar RJ. A systematic literature review of the ethics of conducting research in the humanitarian setting. Confl Health 2020; 14:27. [PMID: 32489418 PMCID: PMC7245798 DOI: 10.1186/s13031-020-00282-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Research around humanitarian crises, aid delivery, and the impact of these crises on health and well-being has expanded dramatically. Ethical issues around these topics have recently received more attention. We conducted a systematic literature review to synthesize the lessons learned regarding the ethics of research in humanitarian crises. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to identify articles regarding the ethics of research in humanitarian contexts between January 1, 1997 and September 1, 2019. We analyzed the articles to extract key themes and develop an agenda for future research. Results We identified 52 articles that matched our inclusion criteria. We categorized the article data into five categories of analysis: 32 were expert statements, 18 were case studies, 11 contained original research, eight were literature reviews and three were book chapters. All included articles were published in English. Using a step-wise qualitative analysis, we identified 10 major themes that encompassed these concepts and points. These major themes were: ethics review process (21 articles, [40.38%]); community engagement (15 articles [28.85%]); the dual imperative, or necessity that research be both academically sound and policy driven, clinical trials in the humanitarian setting (13 articles for each, [25.0%)]; informed consent (10 articles [19.23%]); cultural considerations (6 articles, [11.54%]); risks to researchers (5 articles, [9.62%]); child participation (4 articles [7.69%]); and finally mental health, and data ownership (2 articles for each [3.85%]). Conclusions Interest in the ethics of studying humanitarian crises has been dramatically increasing in recent years. While key concepts within all research settings such as beneficence, justice and respect for persons are crucially relevant, there are considerations unique to the humanitarian context. The particular vulnerabilities of conflict-affected populations, the contextual challenges of working in humanitarian settings, and the need for ensuring strong community engagement at all levels make this area of research particularly challenging. Humanitarian crises are prevalent throughout the globe, and studying them with the utmost ethical forethought is critical to maintaining sound research principles and ethical standards.
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Affiliation(s)
- William Bruno
- Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, USA
| | - Rohini J Haar
- Division of Epidemiology and Biostatistics, School of Public Health, Research Fellow, Human Rights Center, School of Law, University of California at Berkeley, Berkeley, USA
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Hejoaka F, Varloteaux M, Desclaux-Sall C, Ndiaye SM, Diop K, Diack A, Niasse F, Cames C. Improving the informed consent process among HIV-infected undisclosed minors participating in a biomedical research: insights from the multicentre nutritional SNACS study in Senegal. Trop Med Int Health 2019; 24:294-303. [PMID: 30624827 DOI: 10.1111/tmi.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Providing research information in a manner accessible to minors participating in biomedical research is a major challenge. Guidance is dramatically lacking regarding best practices for seeking informed consent among undisclosed minors enrolled in HIV-related research. We implemented an improved informed consent process (IICP) and identified factors associated with understanding of the information presented to HIV-infected minors prior to their enrolment in a study. METHODS We enrolled study participants attending 12 paediatric HIV clinics in Senegal. Children ≥7 years were provided with standardised research information using the IICP, which involves viewing a video and taking part in extended group discussions. Understanding was assessed by seven basic questions scored 1 or 2 points, with a maximum score of 11 points. A score of 9 or more points was defined as satisfactory understanding. Factors associated with understanding were identified using a stepwise logistic regression model. RESULTS Overall, 112 children, with a median age of 12.9 years (IQR: 10.2-15.0), participated in the IICP, of whom 37% were HIV disclosed. 71% achieved a satisfactory understanding score and all gave consent to participate in the research. HIV-disclosed children were more likely to demonstrate satisfactory understanding than undisclosed children (aOR = 3.2, 95% CI: 1.1-9.6). Age, study setting and education level were not associated with satisfactory understanding. CONCLUSION These findings provide practical guidance for the development of improved and friendly informed consent processes in research involving minors. The implementation of the paediatric HIV research agenda will require a standardised and operational definition of informed consent, integrating the issue of HIV disclosure.
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Affiliation(s)
- Fabienne Hejoaka
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Marie Varloteaux
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Caroline Desclaux-Sall
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Sidy Mokhtar Ndiaye
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal
| | - Karim Diop
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal.,Division de lutte contre le sida et les IST/Ministère de la santé et de l'action sociale, Dakar, Sénégal
| | - Aminata Diack
- Centre hospitalier national d'enfants Albert Royer, Dakar, Sénégal
| | - Fatou Niasse
- Conseil national de lutte contre le sida, Dakar, Sénégal
| | - Cécile Cames
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
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Betancourt TS, Fazel M. Commentary: Advancing an implementation science agenda on mental health and psychosocial responses in war-affected settings: comment on trials of a psychosocial intervention for youth affected by the Syrian crisis - by Panter-Brick et al. (2018). J Child Psychol Psychiatry 2018; 59:542-544. [PMID: 29667736 DOI: 10.1111/jcpp.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
Syria's civil conflict has created the largest humanitarian disaster of our time, causing massive population displacement, tremendous exposure to trauma, and loss. Advancing the mental health and psychosocial responses of war-affected populations both during acute humanitarian emergencies and in post-conflict transition is imperative in forging a constructive implementation agenda. This study makes an important contribution in building evidence toward effective interventions to advance the mental health and well-being of those affected by the Syrian crisis. Using an innovative approach, this work demonstrates that a thoughtful, ethical, and scientifically valid trial can be carried out in the midst of mass displacement. Further research is urgently needed on the effectiveness of interventions for vulnerable populations, with a growing need to embed studies of evidence-based mental health interventions within humanitarian responses.
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Correction: Ethics in Community-Based Research with Vulnerable Children: Perspectives from Rwanda. PLoS One 2016; 11:e0163384. [PMID: 27631364 PMCID: PMC5025136 DOI: 10.1371/journal.pone.0163384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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