Children's Perception of Research Participation: Examining Trauma Exposure and Distress

Children's participatory needs in injury prevention: reflections on supporting children's right to invite and comfort in discussing sensitive topics

BACKGROUND

Child-centred approaches in injury prevention emphasise the importance of practising bidirectional communications and decentring researcher-child power relations to support children's participation in research. To date, however, a dearth of scholarship offers methodological reflections on how to bolster children's feelings of comfort in discussing sensitive topics such as their injury experiences.

GOAL

Drawing from lessons we learnt working with children in a low-income to mid-income neighbourhood in Vancouver, Canada, we discuss the ways in which our strategies to support their participation succeeded in, and at times fell short of, supporting their participatory needs.

DISCUSSION

Our discussions focus attention on two important areas for consideration in future injury prevention studies: (1) Children's inclusion in research and the demand for them to share experience and (2) supporting children's right to invite and comfort in discussing sensitive topics such as injury experiences. We discuss the benefits of making research fun for children and being sensitive to their needs at preliminary recruitment and data collection stages.

IMPLICATIONS

These discussions can strengthen researchers' work with children by helping them to reflect on strategies that can bolster their desire to participate and feel comfortable sharing perspectives.

Examination of the Transient Changes in Affect Resulting From Participation in Research Addressing Intimate Partner Violence

As a result of the proliferation of data examining intimate partner violence (IPV), there has been an emerging interest in how this research emotionally affects participants, particularly those with a history of personal experience with IPV. While a large body of IPV research suggests that only a small proportion of individuals experience transient emotional distress as the result of participation, this research is limited by examining only the emotional responses at the conclusion of the research, rather than examining changes in affect during the research. Therefore, this research sought to examine negative affect among participants throughout the research to better examine the trajectory of affect during participation in research on IPV. We recruited a sample of 914 college students who completed a measure of negative affect at the beginning, after being exposed to violence questionnaires, and at the conclusion of the research. The findings suggested that among the total sample, negative affect generally declined over the course of the research, although there was a significant interaction for victims of both psychological and physical IPV, such that their negative affect remained stable over participation in the research. Negative affect was significantly correlated with measures of reactions to the research globally, and not significantly related to perceptions of the overall benefits of the research. These data suggest that participation in research on IPV does not increase negative affect, even among those with a history of IPV. Implications of these data for future research on IPV are discussed.

Older Adolescents' Understanding of Participant Rights in the BlackBerry Project, a Longitudinal Ambulatory Assessment Study

For a long-term, longitudinal study that used BlackBerry smartphones for passive ambulatory assessment among older adolescents, this study focused on three areas of ethical concern: (1) adolescents' competence to give assent; (2) understanding of confidentiality, the protection of information, and project goals; and (3) awareness of procedures and benefits, and comfort with the research design. One hundred and seventy-eight participants were 17 and 18 years old (84 girls). Results suggested that participants freely gave consent and understood most, but not all of the informed consent information. Participants reported a high level of satisfaction. Participants showed less understanding of when their confidentiality would be broken and how data would be protected.

Maltreatment history, trauma symptoms and research reactivity among adolescents in child protection services

OBJECTIVE

There is a well-documented link between child maltreatment and poor health across the lifespan. This provides a strong case for ongoing research with youth involved in the child welfare system to reduce negative outcomes and support resilience while being inclusive of youth voices. However, detailed inquiries about maltreatment history and health consequences may cause re-experiencing of events and psychological distress for study participants. Data that accounts for different contexts, such as severity of maltreatment history and current trauma symptomatology, have been limited in considering the question of potential harms to youth who participate in research-especially longitudinal studies.

METHODS

This study compared self-reported impact of research participation against maltreatment history and current post-traumatic stress symptomatology among a randomly selected group of adolescents (< 18 years old) in the child protection service (CPS) system.

RESULTS

Adolescents who report more serious child maltreatment and current trauma symptom severity reported higher scores on distress questions from pre- to post-assessment participation. Critically, participants who were more negatively impacted by study involvement also reported greater benefit from study involvement.

CONCLUSION

The increase in both negative and positive impact does not shift the risk/reward ratio for participation, as risks alone do not increase for this vulnerable group of CPS involved youth. These results are consistent with previous findings from studies involving non-CPS populations and underlies the importance of empirical data to address the question of change in the risk/reward ratio and what factors might play a role in any change. This information can inform inclusion/exclusion criteria for future research with these vulnerable populations, thereby reducing the risk of distress among study participants.

Conducting evaluation research with children exposed to violence: How technological innovations in methodologies and data collection may enhance the process

Research and program evaluation processes that engage children and youth are becoming much more common due to influences from children's rights and the acknowledgement that children have the capacity to contribute to research, both as participants and co-researchers (Roberts, 2017). Recent technological advances in the form of tablet and internet-based applications have provided researchers with additional methodological tools to better capture the voices and experiences of children and their caregivers (Livingstone & Blum-Ross, 2017). However, little has been written on the ways in which these new technological advances can improve research experiences for children who have been exposed to intimate partner and family violence, as well as other forms of traumatic experiences. This paper provides a review of current literature and a case study example of how one children's mental health agency has implemented tablet-based data collection procedures.

Risk Perceptions for Trauma-Related Research: An Exploratory Study of Undergraduate Student Researchers in Psychology

The purpose of this study was to examine student researchers' perceptions of risks associated with trauma-related research. The participants were 92 students enrolled in an introductory Research Methods course. Students evaluated (a) trauma-exposed participants' ability to provide informed consent and (b) the potential consequences of participating in trauma-focused research. Risk perceptions were assessed at the beginning of the course, after completion of the Collaborative Institutional Training Initiative (CITI) ethics education, and at the end of the course. Results show that student researchers' perceptions of risk changed significantly across time. After completing the CITI ethics education, students perceived trauma-exposed individuals as less able to provide informed consent and also perceived greater potential for negative consequences from participation in trauma-focused research, perceptions that were relatively maintained throughout the remainder of the course.

Does the Risk Outweigh the Benefits? Adolescent Responses to Completing Health Surveys

The aim of this study is to describe the self-reported experiences of adolescents in population-based samples when completing health-related surveys on topics with varying potential for evoking distress. Survey data were collected in three school-based studies of bullying behaviors (N = 1,771, 12-14 years), alcohol use (N = 823, 12, 15, and 17 years), and electronic image sharing (N = 274, 13 years). Between 5% and 15% of respondents reported being upset at survey completion, but at most 1.4% were entirely negative in their evaluation. Age was not associated with being upset, but younger adolescents were more likely to see benefit in participation. Although concurrent mental health symptoms increased the risk of being upset, this was mostly mitigated by perceived benefits from participation.

The child's perspective on discomfort during medical research procedures: a descriptive study

OBJECTIVE

The evaluation of discomfort in paediatric research is scarcely evidence-based. In this study, we make a start in describing children's self-reported discomfort during common medical research procedures and compare this with discomfort during dental check-ups which can be considered as a reference level of a 'minimal discomfort' medical procedure. We exploratory study whether there are associations between age, anxiety-proneness, gender, medical condition, previous experiences and discomfort. We also describe children's suggestions for reducing discomfort.

DESIGN

Cross-sectional descriptive study.

SETTING

Paediatric research at three academic hospitals.

PATIENTS

357 children with and without illnesses (8-18 years, mean=10.6 years) were enrolled: 307 from paediatric research studies and 50 from dental care.

MAIN OUTCOME MEASURES

We measured various generic forms of discomfort (nervousness, annoyance, pain, fright, boredom, tiredness) due to six common research procedures: buccal swabs, MRI scans, pulmonary function tests, skin prick tests, ultrasound imaging and venepunctures.

RESULTS

Most children reported limited discomfort during the research procedures (means: 1-2.6 on a scale from 1 to 5). Compared with dental check-ups, buccal swab tests, skin prick tests and ultrasound imaging were less discomforting, while MRI scans, venepunctures and pulmonary function tests caused a similar degree of discomfort. 60.3% of the children suggested providing distraction by showing movies to reduce discomfort. The exploratory analyses suggested a positive association between anxiety-proneness and discomfort.

CONCLUSIONS

The findings of this study support the acceptability of participation of children in the studied research procedures, which stimulates evidence-based research practice. Furthermore, the present study can be considered as a first step in providing benchmarks for discomfort of procedures in paediatric research.

Are positive experiences of children in non-therapeutic research justifiable research benefits?

BACKGROUND

Conducting non-therapeutic research is ethically challenging because participation conveys risks and burden and no health benefit. In this paper, we report the positive experiences of a diverse group of healthy and ill children (6-18 years) who participated in non-therapeutic research studies and discuss whether these positive experiences can justifiably be viewed as benefits.

METHODS

We used semistructured interviews from an earlier study about children's experiences in clinical research and did a secondary analysis on the positive experiences of the children in the non-therapeutic studies (N=30). Interviews were analysed using 'thematic' analysis.

RESULTS

The interviewed children most frequently mentioned as positive experiences of non-therapeutic research participation helping others and the gratification that comes with it, possible health benefits in the future, having fun and new/increased knowledge about the human body, hospitals and doing research. Less frequently mentioned were getting a present, not having to go to school and getting extra attention from healthcare staff.

CONCLUSIONS

Our study shows that children participating in non-therapeutic research have various positive experiences while taking part. We argue that some of these justifiably could be taken into the risk-benefit analysis in certain situations or maybe even as a standard part of this analysis. This may help to increase the number of (crucial) non-therapeutic studies with children.

Understanding Ethical Issues of Research Participation From the Perspective of Participating Children and Adolescents: A Systematic Review

BACKGROUND

The past 20 years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing pediatric research enterprise. Additional information on children's and adolescents' experiences during research participation is needed to better inform researchers on the ethical conduct of research with this vulnerable population.

AIMS

The objective of this analysis was to examine ethical issues in research with children and adolescents from their perspective as participants, including: assent, parental consent, risk perception, impact of research participation, and incentives.

METHODS

This systematic review was conducted per the Long, Godfrey, Randall, Brettle, and Grant framework by means of an iterative searching process. Using the key words "research ethics" and "child or pediatric or adolescent," PubMed, CINAHL, and EBSCOhost databases were searched to identify articles. Limitations placed on the searches were: English language, year of publication between 2003 and 2014, humans, abstract available, and age birth-18 years.

FINDINGS

Twenty-three empiric studies were identified and formed the sample. Included studies represented a diverse range of areas of research, methods, settings, sample demographics, authors, and journals.

LINKING EVIDENCE TO ACTION

Even young children demonstrated the ability to understand essential elements of research, although there is variability in children's level of understanding. Trust was a significant contributing factor to children's and adolescents' participation in research, and also shaped their assessments of risk. Research participation was mainly beneficial for children and adolescents. Incentives were mainly viewed positively, although concerns of possible undue influence were expressed.

Perceptions of trauma research with a sample of at-risk youth

Growing body of research demonstrates that participants generally report favorable perceptions of participating in trauma research. However, questions remain on the long-term impact of asking at-risk youth about trauma in settings where such questions are unexpected. Perceptions of participation were examined in the current longitudinal study comprising a sample of adolescent girls recruited from the child welfare system to participate in a healthy relationship project. Over a year, teens (n = 180) completed four research sessions during which they were interviewed about interpersonal trauma exposure and trauma-related symptoms. Results indicated that adolescents reported stable, favorable benefit-to-cost ratios over time. Perceptions of research participation and symptom severity did not impact retention.

Through the eyes of the wounded: a narrative analysis of children's sexual abuse experiences and recovery process

Numerous children receive counseling for sexual abuse, yet their personal perspectives related to the abuse, the impact of making the disclosure, and the recovery process are noticeably absent from the scholarly literature. This study addressed this gap by analyzing trauma narratives written by children as part of a counseling intervention. Qualitative analysis revealed three themes: memories of the abuse, the disclosure and subsequent events, and the healing journey. Children's descriptions of their thoughts, feelings, and beliefs about their experiences are delineated and recommendations are provided for counseling professionals to increase the efficacy of care provided.

Perceptions of participating in longitudinal trauma research among women exposed to intimate partner abuse

We examine motivations for, and costs/benefits of, participation in three interviews across a one-year period among women recently exposed to intimate partner abuse (IPA). Recruited from publicly accessible police reports, women were not informed that the study focused on IPA in recruiting materials or when they scheduled the first interview. Women's ratings on the Response to Research Participation Questionnaire (RRPQ) indicated a positive benefit-to-cost ratio across all three interviews. Negative responses to participation as well as severity of IPA and PTSD symptoms did not predict retention at the next interview. These data demonstrate that studies asking about IPA experiences, even when survivors do not know in advance that IPA will be the focus of study, can be implemented within a stable benefit-to-cost ratio over time.

Ethical issues in mental health research: the case for community engagement

PURPOSE OF REVIEW

To describe community-engaged research (CEnR) and how it may improve the quality of a research study while addressing ethical concerns that communities may have with mental health and substance abuse research. This article includes a review of the literature as well as recommendations from an expert panel convened with funding from the US National Institute of Mental Health.

RECENT FINDINGS

CEnR represents a broad spectrum of practices, including representation on institutional ethics committees, attitude research with individuals from the study population, engaging community advisory boards, forming research partnerships with community organizations, and including community members as co-investigators.

SUMMARY

CEnR poses some challenges; for example, it requires funding and training for researchers and community members. However, it offers many benefits to researchers and communities, and some form of CEnR is appropriate and feasible in nearly every study involving human participants.

The appraisal of quantitative and qualitative trauma-focused research procedures among pregnant participants

Despite the importance of studying the dynamics and consequences of trauma, there has been concern that trauma-focused questionnaires and interviews could further harm vulnerable participants, such as pregnant women who have suffered prior sexual trauma (e.g., rape, incest, sexual abuse). There has also been concern that employing personal interviews, rather than anonymous written questionnaires in trauma-focused research procedures may compromise participants' confidentiality. This exploratory study examined the methodological differences associated with perceived discomforts and benefits among pregnant women participants in a two-phase, trauma-focused research study. In Phase I, pregnant women (N = 109) completed anonymous, trauma-related questionnaires. In Phase II, a subsample of Phase I participants (N = 10) who reported a previous history of sexual trauma completed in-depth, personal interviews. Participants in both phases of the study rated their reaction to research participation using the Response to Research Participation Questionnaire Revised (RRPQ-R). Results suggest that both written survey and personal interview methods are well tolerated by pregnant women. Specific findings indicated that pregnant women with a sexual trauma history reported significantly higher "personal benefit" from participating in personal interview procedures compared to written questionnaires. Recommendations for conducting trauma-focused research with potentially high-risk or vulnerable populations are provided. In addition, recommendations for future research are outlined in an effort to further extend the ethical understanding of the benefits and costs of trauma-focused research.

Overview of research addressing ethical dimensions of participation in traumatic stress studies: autonomy and beneficence

One element of the design of human research studies is ethically informed decision-making. Key issues include the safety, costs, and benefits of participation. Historically, much of this decision-making was based on opinion rather than formal evidence. Recently, however, investigators in the traumatic stress field have begun to collect data that are relevant to these decisions. In this article, the authors focus on issues emanating from the ethical concepts of autonomy and respect for persons and beneficence and nonmaleficence, and then summarize relevant evidence from studies with trauma-exposed individuals. Discussion addresses implications of this evidence for research practice and policy, and identifies some potentially informative data collections opportunities for future trauma studies.