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Bosire EN, Khakali L, Shah J, Wambui L, Aballa A, Njoroge W, Ngugi A, Merali Z. Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya. QUALITATIVE HEALTH RESEARCH 2025; 35:275-290. [PMID: 39159921 DOI: 10.1177/10497323241255084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.
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Affiliation(s)
- Edna N Bosire
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Linda Khakali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Lucy Wambui
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Andrew Aballa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Willie Njoroge
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Anthony Ngugi
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Clapp JT, Zucker N, Hernandez OK, Bass EJ, Lane-Fall MB. Ethical Issues in Implementation Science: A Qualitative Interview Study of Participating Clinicians. AJOB Empir Bioeth 2025; 16:22-31. [PMID: 39136531 PMCID: PMC11785497 DOI: 10.1080/23294515.2024.2388537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2025]
Abstract
BACKGROUND Implementation science presents ethical issues not well addressed by traditional research ethics frameworks. There is little empirical work examining how clinicians whose work is affected by implementation studies view these issues. Accordingly, we interviewed clinicians working at sites participating in an implementation study seeking to improve patient handoffs to the intensive care unit (ICU). METHODS We performed semi-structured interviews with 32 clinicians working at sites participating in an implementation study aiming to improve patient handoffs from the operating room to the ICU. We analyzed the interviews using an iterative coding process following a conventional content analysis approach. RESULTS Clinicians' greatest concern about involvement was possible damage to interpersonal relations with more senior clinicians. They were divided about whether informed consent from clinicians was necessary but were satisfied with the study's approach of sending out mass communications about the study. They did not think opting out of the implementation portion of the study was feasible but saw this inability to opt out as unproblematic because they equated the study with routine quality improvement. Those clinicians who helped launch the study at their sites recounted several different ways of doing so beyond simply facilitating access. CONCLUSIONS The risks that clinicians identified stemmed more from their general status as employees than their specific work as clinicians. Implementation researchers should be attuned to the ethical ramifications of involving employees of varying ranks. Implementation researchers using hybrid designs should also be sensitive to the possibility that practitioners affected by a study will equate it with quality improvement and overlook its research component. Finally, the interactions that go into facilitating an implementation study are more various than the "gatekeeping" typically discussed by research ethicists. More research is needed on the ethics of the myriad interactions that are involved in making implementation studies happen.
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Gugel T, Adams K, Baranoski M, Yanez ND, Kampp M, Johnson T, Aydin A, Fajardo EC, Sharp E, Potnis A, Johnson C, Treggiari MM. Design and implementation of community consultation for research conducted under exception from informed consent regulations for the PreVent and the PreVent 2 trials: Changes over time and during the COVID-19 pandemic. Clin Trials 2024; 21:671-680. [PMID: 38676438 PMCID: PMC11512686 DOI: 10.1177/17407745241243045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Emergency clinical research has played an important role in improving outcomes for acutely ill patients. This is due in part to regulatory measures that allow Exception From Informed Consent (EFIC) trials. The Food and Drug Administration (FDA) requires sponsor-investigators to engage in community consultation and public disclosure activities prior to initiating an Exception From Informed Consent trial. Various approaches to community consultation and public disclosure have been described and adapted to local contexts and Institutional Review Board (IRB) interpretations. The COVID-19 pandemic has precluded the ability to engage local communities through direct, in-person public venues, requiring research teams to find alternative ways to inform communities about emergency research. METHODS The PreVent and PreVent 2 studies were two Exception From Informed Consent trials of emergency endotracheal intubation, conducted in one geographic location for the PreVent Study and in two geographic locations for the PreVent 2 Study. During the period of the two studies, there was a substantial shift in the methodological approach spanning across the periods before and after the pandemic from telephone, to in-person, to virtual settings. RESULTS During the 10 years of implementation of Exception From Informed Consent activities for the two PreVent trials, there was overall favorable public support for the concept of Exception From Informed Consent trials and for the importance of emergency clinical research. Community concerns were few and also did not differ much by method of contact. Attendance was higher with the implementation of virtual technology to reach members of the community, and overall feedback was more positive compared with telephone contacts or in-person events. However, the proportion of survey responses received after completion of the remote, live event was substantially lower, with a greater proportion of respondents having higher education levels. This suggests less active engagement after completion of the synchronous activity and potentially higher selection bias among respondents. Importantly, we found that engagement with local community leaders was a key component to develop appropriate plans to connect with the public. CONCLUSION The PreVent experience illustrated operational advantages and disadvantages to community consultation conducted primarily by telephone, in-person events, or online activities. Approaches to enhance community acceptance included partnering with community leaders to optimize the communication strategies and trust building with the involvement of Institutional Review Board representatives during community meetings. Researchers might need to pivot from in-person planning to virtual techniques while maintaining the ability to engage with the public with two-way communication approaches. Due to less active engagement, and potential for selection bias in the responders, further research is needed to address the costs and benefits of virtual community consultation and public disclosure activities compared to in-person events.
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Affiliation(s)
| | | | | | - N David Yanez
- Yale University, New Haven, CT, USA
- Duke University, Durham, NC, USA
| | | | | | | | | | | | | | | | - Miriam M Treggiari
- Yale University, New Haven, CT, USA
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
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Stephens SW, Carroll-Ledbetter C, Duckert S, Coffman T, Nelson M, Brown KN, Rodgers J, Griffin RL, Suen A, Casey J, Sloan SR, Goldstein B, McClintock AJ, Goldkind SF, Gelinas L, Higley AE, Joseph BA, Holcomb JB, Jansen JO. Interactive Media-Based Approach for an Exception From Informed Consent Trial Involving Patients With Trauma. JAMA Surg 2024; 159:1051-1058. [PMID: 38959020 PMCID: PMC11223059 DOI: 10.1001/jamasurg.2024.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024]
Abstract
Importance Exception From Informed Consent (EFIC) research requires community consultation (CC) and public disclosure (PD). Traditional methods of conducting CC and PD are slow, expensive, and labor intensive. Objective To describe the feasibility and reach of a novel interactive, media-based approach to CC and PD and to identify the similarities and differences between trial sites in website views, survey responses, online community forum attendance, and opt-out requests. Design, Setting, and Participants This survey study analyzed the CC and PD campaigns conducted for the TAP trial (Evaluation of BE1116 in Patients With Traumatic Injury and Acute Major Bleeding to Improve Survival), an EFIC trial of the early administration of prothrombin complex concentrate in patients with trauma. The CC and PD campaigns consisted of social media advertisements, linked websites, community surveys, and online community forums. These activities were coordinated from a central site and approved by a central institutional review board. This study focused on the first 52 of 91 TAP trial sites (level I trauma centers) in the US to have completed their CC and PD campaigns. Community members in the catchment areas of the participating trauma centers were targeted. Data analysis was conducted between October 2023 and February 2024. Exposure Social media advertisements, surveys, and online community meetings conducted as part of the CC and PD campaign for the TAP trial. Main Outcomes and Measures Social media campaign reach and engagement, web page views, survey results, online community forum attendance, and opt-out requests. Results Fifty-two trial sites were approved for participant enrollment. Social media advertisements were displayed 92 million times, reaching 11.8 million individuals. The median (IQR) number of people reached in each location was 210 317 (172 068-276 968). Site-specific websites were viewed 144 197 times (median [IQR] viewings per site, 2984 [1267-4038]). A total of 17 206 fully or partly completed surveys were received, and survey respondents had a median (IQR) age of 40.1 (15-65) years and included 10 444 females (60.7%). Overall, 60.6% survey respondents said they would want to be entered into the trial even if they could not give consent, 87.7% agreed that emergency care research was necessary, and 88.0% agreed that the TAP trial should be conducted in their community. Online community forums were attended by a median (IQR) number of 38 (20-63) people. Four opt-out requests were received. Conclusions and Relevance The interactive media-based approach to CC and PD for the ongoing TAP trial showed the feasibility and benefits of executing an efficient, coordinated, centrally run series of locally branded and geographically targeted CC and PD campaigns for a large EFIC study.
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Affiliation(s)
| | | | - Sarah Duckert
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Tanner Coffman
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Margaret Nelson
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Karen N. Brown
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Joel Rodgers
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Russell L. Griffin
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Amy Suen
- Hematology Therapeutic Research Area, CSL Behring, King of Prussia, Pennsylvania
| | - Jeremy Casey
- Hematology Therapeutic Research Area, CSL Behring, King of Prussia, Pennsylvania
| | - Steven R. Sloan
- Hematology Therapeutic Research Area, CSL Behring, King of Prussia, Pennsylvania
| | - Brahm Goldstein
- Hematology Therapeutic Research Area, CSL Behring, King of Prussia, Pennsylvania
| | | | | | | | | | | | - John B. Holcomb
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
| | - Jan O. Jansen
- Center for Injury Science, University of Alabama at Birmingham, Birmingham
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Cunningham‐Erves J, Mayo‐Gamble T, Campbell L, Barlow BC, Barajas C, Jones JL, Winkfield K. The Bidirectional Engagement and Equity (BEE) Research Framework to Guide Community-Academic Partnerships: Developed From a Narrative Review and Diverse Stakeholder Perspectives. Health Expect 2024; 27:e14161. [PMID: 39087753 PMCID: PMC11292665 DOI: 10.1111/hex.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/15/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The engagement of community partners in equitable partnerships with academic teams is necessary to achieve health equity. However, there is no standardized approach to support bidirectional engagement among research stakeholders in the context of partnership equity at each phase of the research process. OBJECTIVE We describe the development of a systematic framework along with competencies and tools promoting bidirectional engagement and equity within community-academic partnerships at each phase of the research process. DESIGN We conducted a four-step research process between November 2020 and December 2023 for framework development: (1) a narrative literature review; (2) expansion of existing bidirectional, equitable framework; (3) a scientific review with two groups of cognitive interviews (five community engagement researchers and five community leaders and members); and (4) three community-based organization leader focus groups. Thematic analysis was used to analyse focus group data. RESULTS Using results of each step, the framework was iteratively developed, yielding four phases of the bidirectional engagement and equity (BEE) research framework: Relationship building and assessment of goals and resources (Phase I); form a community-academic partnership based on shared research interests (may include multilevel stakeholders) (Phase II); develop a research team comprising members from each partnering organization (Phase III); and implement the six-step equitable research process (Phase IV). Bidirectional learning and partnership principles are at the core of the partnership, particularly in Phases II-IV. Competencies and tools for conducting an equitable, engaged research process were provided. DISCUSSION This conceptual framework offers a novel, stepwise approach and competencies for community-academic partners to successfully partner and conduct the research process equitably. CONCLUSION The BEE research framework can be implemented to standardize the conduct of an equitable, engaged research process within a community-academic partnership, while improving knowledge and trust across partners and, ultimately, an increased return on investment and sustainability to benefit both partners in the area of health outcomes and ultimately health equity. PATIENT OR PUBLIC CONTRIBUTION The development of this framework was co-led with a community organization in which two leaders in the organization were equitably involved in each phase of the research process, including grant development, study design, participant recruitment, protocol development for focus groups and community and researcher review, framework design and content and dissemination of this manuscript as a co-author. For grant development, the community leader completed the give-get grid components for them as a partner. They also wrote up their lived experience in the research process for the progress report. For the focus groups, one community leader co-led the focus group with the academic partner. For the narrative review, the community leaders did not actively conduct the narrative review but observed the process through the academic partners. One community leader wrote the section 'relationship building' and 'bidirectional learning' sections with the assistance of the academic partner, while they both equally provided input on other sections of the manuscript alongside academic partners. The community leaders have extensive experience in leading programmes, along with partnering with researchers to address health equity issues and improve health outcomes.
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Affiliation(s)
- Jennifer Cunningham‐Erves
- Division of Public Health PracticeMeharry Medical CollegeNashvilleTennesseeUSA
- Department of Health PolicyVanderbilt University Medical CenterNashvilleUSA
| | - Tilicia Mayo‐Gamble
- Department Community Health Behavior and EducationGeorgia Southern UniversityStatesboroGeorgiaUSA
| | - LaNese Campbell
- Second Missionary Baptist Cooperative MinistriesNashvilleTennesseeUSA
| | | | - Claudia Barajas
- Vanderbilt Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Karen Winkfield
- Vanderbilt Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
- Meharry Vanderbilt AllianceNashvilleTennesseeUSA
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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Ean M, Tripura R, Sothea P, Savoeun U, Peto TJ, Bunthynn S, Callery JJ, Soviet U, Dysoley L, Yeong Cheah P, Adhikari B. A youth advisory group on health and health research in rural Cambodia. Glob Bioeth 2024; 35:2361968. [PMID: 38859929 PMCID: PMC11164040 DOI: 10.1080/11287462.2024.2361968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU's laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE's health promotional interventions may have contributed in enhancing community's health.
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Affiliation(s)
- Mom Ean
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Phann Sothea
- Techo Siem Pang High School, Provincial Department of Education, Youth and Sport, Siem Pang, Stung Treng, Cambodia
| | - Uch Savoeun
- Siem Pang Health Centre, Provincial Health Department, Siem Pang, Stung Treng, Cambodia
| | - Thomas J. Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sam Bunthynn
- District Governor Office, Siem Pang District Administration, Siem Pang, Stung Treng, Cambodia
| | - James J. Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ung Soviet
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Lek Dysoley
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Oladayo AM, Odukoya O, Sule V, Molobe I, Busch T, Akodu B, Adeyemo WL, Gowans LJJ, Eshete M, Alade A, Awotoye W, Adeyemo AA, Mossey PA, Prince AER, Murray JC, Butali A. Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research. BMC Public Health 2024; 24:507. [PMID: 38365612 PMCID: PMC10873930 DOI: 10.1186/s12889-024-17987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.
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Affiliation(s)
- Abimbola M Oladayo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Veronica Sule
- Department of Operative Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Ikenna Molobe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tamara Busch
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Babatunde Akodu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Wasiu L Adeyemo
- Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - Lord J J Gowans
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mekonen Eshete
- School of Medicine, Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azeez Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Waheed Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | | | - Peter A Mossey
- Department of Orthodontics, University of Dundee, Dundee, UK
| | | | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
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Theisen JG, Draheim AA, Darosh A, Layman LC, Stepleman LM. Transgender identity genetic research: Attitudes, opinions & beliefs among members of the transgender and gender diverse communities. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:971-984. [PMID: 39465081 PMCID: PMC11500507 DOI: 10.1080/26895269.2023.2294825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Background: There is growing interest in investigating genetic explanations for transgender identity. In the spirit of a Community-Engaged Research Framework, which highlights the importance of involving community members who would be impacted by research throughout the entire research process, it is important for researchers to understand transgender and gender expansive individuals' views and concerns regarding the potential harms and benefits of transgender identity genetic research (TIGR). Aim: To evaluate the thoughts, opinions, and beliefs in the transgender and gender diverse communities toward TIGR Methods: We conducted an online survey study, asking 409 transgender and gender diverse individuals about their views regarding potential benefits and risks of TIGR. Results: Participants demonstrated a mixture of positive and negative opinions on the search for a genetic contribution to gender identity. Overall, there was a slight trend toward more positive views, with 71% agreeing or strongly agreeing that TIGR made them feel hopeful. Discussion: Given the varied and nuanced views held within the transgender and gender diverse communities toward transgender genetic research, we hope that this study can be one of many evaluating this topic, and that our findings, and those of future studies, can serve as a foundation for conducting transgender genetic research in a way that is in alignment with the ethos and priorities of the transgender and gender diverse communities.
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Affiliation(s)
- J. Graham Theisen
- Department of Obstetrics and Gynecology: Section of Reproductive Endocrinology, Infertility, and Genetics, Augusta University, Augusta, GA, USA
| | | | - Angela Darosh
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Lawrence C. Layman
- Department of Obstetrics and Gynecology: Section of Reproductive Endocrinology, Infertility, and Genetics, Augusta University, Augusta, GA, USA
| | - Lara M. Stepleman
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
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James AS, Nodora J, Maki J, Harlow BL, Low LK, Coyne-Beasley T, Cunningham SD, El-Fahmawi A, Klusaritz H, Lipman TH, Simon M, Hebert-Beirne J. Building Community Engagement Capacity in a Transdisciplinary Population Health Research Consortium. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2024; 16:10. [PMID: 39055611 PMCID: PMC11271685 DOI: 10.54656/jces.v16i2.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Community engagement has been named a research priority by the National Institutes of Health, and scholars are calling for community engagement as an approach to address racism and equity in science. Robust community-engaged research can improve research quality, increase inclusion of traditionally marginalized populations, broaden the impact of findings on real-life situations, and is particularly valuable for underexplored research topics. The goal of this paper is to describe lessons learned and best practices that emerged from community engagement in a multi-institution population health research consortium. We describe how a foundation was laid to enable community-engaged research activities in the consortium, using a staged and stepped process to build and embed multi-level community-engaged research approaches.. We staged our development to facilitate (a) awareness of community engagement among consortium members, (b) the building of solidarity and alliances, and (c) the initiation of long-term engagement to allow for meaningful research translation. Our stepped process involved strategic planning; building momentum; institutionalizing engagement into the consortium infrastructure; and developing, implementing, and evaluating a plan. We moved from informal, one-time community interactions to systematic, formalized, capacity-building reciprocal engagement. We share our speed bumps and troubleshooting that inform our recommendations for other large research consortia-including investing the time it takes to build up community engagement capacity, acknowledging and drawing on strengths of the communities of interest, assuring a strong infrastructure of accountability for community engagement, and grounding the work in anti-racist principles.
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Affiliation(s)
- Aimee S James
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jesse Nodora
- University of California-San Diego, Department of Family Medicine and Public Health, La Jolla, CA
| | - Julia Maki
- Division of Public Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lisa Kane Low
- School of Nursing, Women's Studies, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Ayah El-Fahmawi
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Heather Klusaritz
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Terri H Lipman
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Melissa Simon
- 17Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, University of Illinois at Chicago, School of Public Health, Chicago, IL
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10
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Williams G, Greenhalgh C, Spencer A, Farragher T, Gittins M, Verma A. Identifying indicators for the evaluation of community interventions and initiatives in a multi-site public health programme. J Public Health (Oxf) 2023; 45:i10-i18. [PMID: 38127563 DOI: 10.1093/pubmed/fdad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Measuring success of community-level programmes and interventions is important, and indicators can provide valuable information to achieve this. However, identifying appropriate indicators can be challenging. Indicators can be identified by official local stakeholders such as local authorities, but involving communities can add value and trust to the project, with community involvement likely to improve programme sustainability. METHODS As part of the evaluation of multi-site community initiatives, we used local health profiles to identify core indicators that overlapped sites. In addition, we engaged with members of the community during a pilot data collection training day to identify issues they identified as important for measuring health and well-being locally. RESULTS A total of 313 indicators were identified from local profiles, with 31 indicators meeting inclusion criteria. The community identified 26 issues, collated into eight categories, only three of which were identified in core indicators. Tools were sourced or created for the other community-identified categories. DISCUSSION The methodology identified validated indicators comparable across all sites, based on local health profiles. It also identified tools for measuring issues identified by members of the community. The exercise demonstrated disconnect between priorities of official bodies, researchers and communities, indicating multiple approaches should be considered when evaluating community initiatives.
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Affiliation(s)
- Greg Williams
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
| | - Christine Greenhalgh
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
| | - Angela Spencer
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
| | - Tracey Farragher
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
| | - Arpana Verma
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
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11
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Mohtashemi N, Dubé K, Thio C, Song S, Patel S, Sugarman J, Bhattacharya D. Patient acceptability of, and attitudes towards, hepatitis B cure research - A scoping review and identification of knowledge gaps. J Virus Erad 2023; 9:100354. [PMID: 38161322 PMCID: PMC10755539 DOI: 10.1016/j.jve.2023.100354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Functional cure, defined as durable loss of hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA suppression off therapy, is an increasingly important goal in the treatment of chronic hepatitis B. Although novel treatments aimed at achieving functional cure are being developed and tested in clinical trials, it is important to assess the perspectives of people living with HBV towards these potential treatments and their participation in HBV functional cure research. We have performed a scoping review that revealed that there is limited knowledge regarding patient perspectives of HBV functional cure research and then identified gaps in knowledge for further investigation. Our work highlights the need for further studies in patient perspectives in HBV functional cure research.
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Affiliation(s)
| | - Karine Dubé
- University of California, San Diego, San Diego, CA, USA
| | - Chloe Thio
- Johns Hopkins University, Baltimore, MD, USA
| | - Sihyeong Song
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Shail Patel
- University of California, Los Angeles, Los Angeles, CA, USA
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12
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Chang LW, Muessig KE. Digital Crowdsourcing and Infectious Diseases: Opportunities and Obstacles. J Infect Dis 2023; 228:1479-1481. [PMID: 37811795 PMCID: PMC10681854 DOI: 10.1093/infdis/jiad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Larry W Chang
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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13
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Weston S, Adhkari B, Thriemer K. Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002062. [PMID: 37669255 PMCID: PMC10479888 DOI: 10.1371/journal.pgph.0002062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023]
Abstract
Results-sharing with participants or their communities after the completion of research is an essential element of ethical research. The main objective of this study was to identify and document current practice of trial result dissemination, to explore attitudes among trialists towards result dissemination and to better understand previous experiences and barriers to returning results to participants. This mixed-methods study used a sequential exploratory design with two phases: i) an initial qualitative phase to explore the topic and to inform the quantitative data collection, ii) a quantitative survey. Findings from the survey and interviews were triangulated and presented to a network of clinical malaria researchers for validation. A total of 11 semi-structured interviews (SSIs) were conducted using an interview guide. The quantitative survey had a response rate of 19.9% (42/211). Disseminating results to participants after clinical trials was deemed critical for ethical malaria related research, with 38.1% indicating it as extremely important and 45.2% rating it as mostly important. Most respondents referred to the dissemination of results to policymakers and wider stakeholders as important aspects of research translation. The practice of patient or community engagement was prioritized in the pre-trial period and during the trial for obvious instrumental goals of improving retention, coverage and adherence, but much less priority was given to the post-trial period. The main reason for poor dissemination practice was the notion that the time lag between study participation and the availability of results was too long (42.4%). Other reasons included the assumption that the community was not interested (36.4%), and financial restraints (9.1%). The rich qualitative data revealed detailed accounts of operational, cultural, educational and economic aspects that pose further barriers to results-sharing, including limited knowledge about best practice. Better planning which includes adequate financial resourcing is required for meaningful dissemination of results to study participants. Improved institutional guidance and more stringent requirements by funders could support researchers who are generally interested and willing to complete the process. Best practice methods to conduct such dissemination remains to be explored.
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Affiliation(s)
- Sophie Weston
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Bipin Adhkari
- Mahidol‐Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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14
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Chattopadhyay S, de Kok B. Making research ethics work for global health: towards a more agile and collaborative approach. BMJ Glob Health 2023; 8:e011415. [PMID: 37451687 PMCID: PMC10351231 DOI: 10.1136/bmjgh-2022-011415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/06/2023] [Indexed: 07/18/2023] Open
Abstract
In this reflective essay, we seek to engage in a constructive dialogue with scholars across medicine, public health and anthropology on research ethics practices. Drawing on anthropological research and ethical dilemmas that our colleagues and we encountered as medical anthropologists, we reflect on presumed and institutionalised 'best' practices such as mandatory written informed consent, and problematise how they are implemented in interdisciplinary global health research projects. We demonstrate that mandatory, individualised, written, informed consent may be unsuitable in many contexts and also identify reasons why tensions between professionals in interdisciplinary teams may arise when decisions about ethics procedures are taken. We propose alternatives to written informed consent that acknowledge research governance requirements and contextual realities and leave more room for ethnographic approaches. Beyond informed consent, we also explore the situatedness of ethical practices when working in contexts where decision-making around health is clearly a shared concern. We use vignettes based on our own and colleagues' experiences to illustrate our arguments, using the collective 'we' instead of 'I' in our vignettes to protect our research participants, partners and interlocutors. We propose a decolonial, plural and vernacular approach to informed consent specifically, and research ethics more broadly. We contend that ethics procedures and frameworks need to become more agile, decolonial, pluralised and vernacularised to enable achieving congruence between communities' ideas of social justice and institutional ethics. We argue that global health research can benefit from anthropology's engagement with situated ethics and consent that is relational, negotiated and processual; and accountability that is not only bureaucratic but also constructive. In doing so, we hope to broaden ethical praxis so that the best outcomes that are also just, fair and equitable can be achieved for all stakeholders.
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Affiliation(s)
| | - Bregje de Kok
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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15
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Dubé K, Peterson B, Jones NL, Onorato A, Carter WB, Dannaway C, Johnson S, Hayes R, Hill M, Maddox R, Riley JL, Shull J, Metzger D, Montaner LJ. Community engagement group model in basic and biomedical research: lessons learned from the BEAT-HIV Delaney Collaboratory towards an HIV-1 cure. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:39. [PMID: 37291622 PMCID: PMC10248979 DOI: 10.1186/s40900-023-00449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Achieving effective community engagement has been an objective of U.S. National Institutes of Health-funded HIV research efforts, including participation of persons with HIV. Community Advisory Boards (CABs) have remained the predominant model for community engagement since their creation in 1989. As HIV cure-directed research efforts have grown into larger academic-industry partnerships directing resources toward both basic and clinical research under the Martin Delaney Collaboratories (MDC), community input models have also evolved. The BEAT-HIV MDC Collaboratory, based at The Wistar Institute in Philadelphia, United States, implemented a three-part model for community engagement that has shown success in providing greater impact for community engagement across basic, biomedical, and social sciences research efforts. DISCUSSION In this paper, we review the case study of the formation of the BEAT-HIV Community Engagement Group (CEG) model, starting with the historical partnership between The Wistar Institute as a basic research center and Philadelphia FIGHT as a not-for-profit community-based organization (CBO), and culminating with the growth of community engagement under the BEAT-HIV MDC. Second, we present the impact of a cooperative structure including a Community Advisory Board (CAB), CBO, and researchers through the BEAT-HIV CEG model, and highlight collaborative projects that demonstrate the potential strengths, challenges, and opportunities of this model. We also describe challenges and future opportunities for the use of the CEG model. CONCLUSIONS Our CEG model integrating a CBO, CAB and scientists could help move us towards the goal of effective, equitable and ethical engagement in HIV cure-directed research. In sharing our lessons learned, challenges and growing pains, we contribute to the science of community engagement into biomedical research efforts with an emphasis on HIV cure-directed research. Our documented experience with implementing the CEG supports greater discussion and independent implementation efforts for this model to engage communities into working teams in a way we find a meaningful, ethical, and sustainable model in support of basic, clinical/biomedical, social sciences and ethics research.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Beth Peterson
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Nora L Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Amy Onorato
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - William B Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Christine Dannaway
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Steven Johnson
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Roy Hayes
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Marcus Hill
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Rease Maddox
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - James L Riley
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jane Shull
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Luis J Montaner
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA.
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16
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Mumtaz H, Nadeem A, Bilal W, Ansar F, Saleem S, Khan QA, Tango T, Farkouh C, Belay NF, Verma R, Farkouh M, Saqib M. Acceptance, availability, and feasibility of RTS, S/AS01 malaria vaccine: A review. Immun Inflamm Dis 2023; 11:e899. [PMID: 37382251 PMCID: PMC10266133 DOI: 10.1002/iid3.899] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION In malaria-stricken regions, malaria continues to be one of the primary causes of mortality for children. The number of malaria-related fatalities has drastically decreased because of artemisinin-based pharmacological regimens. METHODS Two independent researchers did a comprehensive literature search using PubMed/MEDLINE and Google Scholar from its inception to September 2022. RESULTS After evaluating RTS, S/AS01 for its safety, effectiveness, and feasibility, the European Medicines Agency (EMA) issued a favorable conclusion. It was suggested that the RTS, S malaria vaccine be used extensively by the World Health Organization on October 6, 2021. The successful pilot program testing the malaria vaccine in Ghana, Kenya, and Malawi served as the basis for this proposal. CONCLUSION Several challenges need to be addressed to ensure the success of vaccination programs. From the acceptability perspective, issues such as inadequate community engagement, concerns about side effects, and issues with the delivery and quality of healthcare services can affect the acceptance of the vaccine. From the feasibility standpoint, factors such as lack of transportation or long distances to healthcare facilities and the perception of completion of the vaccination calendar can affect the feasibility of the vaccine. Lastly, the availability of the vaccine is also a major concern as it may not be readily available to meet the demands.
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17
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Gooden A, Thaldar D. Toward an open access genomics database of South Africans: ethical considerations. Front Genet 2023; 14:1166029. [PMID: 37260770 PMCID: PMC10228717 DOI: 10.3389/fgene.2023.1166029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Genomics research holds the potential to improve healthcare. Yet, a very low percentage of the genomic data used in genomics research internationally relates to persons of African origin. Establishing a large-scale, open access genomics database of South Africans may contribute to solving this problem. However, this raises various ethics concerns, including privacy expectations and informed consent. The concept of open consent offers a potential solution to these concerns by (a) being explicit about the research participant's data being in the public domain and the associated privacy risks, and (b) setting a higher-than-usual benchmark for informed consent by making use of the objective assessment of prospective research participants' understanding. Furthermore, in the South African context-where local culture is infused with Ubuntu and its relational view of personhood-community engagement is vital for establishing and maintaining an open access genomics database of South Africans. The South African National Health Research Ethics Council is called upon to provide guidelines for genomics researchers-based on open consent and community engagement-on how to plan and implement open access genomics projects.
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Affiliation(s)
- Amy Gooden
- School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Donrich Thaldar
- School of Law, University of KwaZulu-Natal, Durban, South Africa
- Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard Law School, Cambridge, MA, United States
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18
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Brown KE, Fohner AE, Woodahl EL. Beyond the Individual: Community-Centric Approaches to Increase Diversity in Biomedical Research. Clin Pharmacol Ther 2023; 113:509-517. [PMID: 36448873 DOI: 10.1002/cpt.2808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
Community-centric approaches to engage underrepresented populations-including community engagement, community-level consent practices, and capacity development for research-are means to enhance diversity in biomedical research populations in a more ethical way. Low diversity is a known problem in biomedical research that presents challenges in translating the benefits of research to the global population. Through long-term partnerships built on trust and collaboration, communities who would otherwise avoid research may be more willing to participate. When communities are engaged in research as partners and research questions are motivated by community health priorities, research is more meaningful and research methods are more respectful. Conversely, a lack of consultation throughout the research process can further alienate the very communities that these efforts are designed to engage. A number of underserved populations-for example American Indian and Alaska Native peoples-may value the benefits of research to a community equally or more than individual benefits. A community's autonomy must be considered, particularly when that community is not adequately protected by traditional informed consent processes. Opportunities for capacity development to support collaborative partnerships between communities and researchers are required to support engagement and understanding of the research process. Changes to research processes and infrastructure that encourage a higher level of research oversight within the community should be supported. In this paper, we present approaches that may improve diversity and equitable access to research and the delivery of health innovations for people that have historically been left out of biomedical research.
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Affiliation(s)
- Karen E Brown
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, Montana, USA
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, USA
| | - Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute of Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Erica L Woodahl
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, Montana, USA
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, USA
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19
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Borthwick J, Evertsz N, Pratt B. How should communities be meaningfully engaged (if at all) when setting priorities for biomedical research? Perspectives from the biomedical research community. BMC Med Ethics 2023; 24:6. [PMID: 36747191 PMCID: PMC9900561 DOI: 10.1186/s12910-022-00879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is now rising consensus that community engagement is ethically and scientifically essential for all types of health research. Yet debate continues about the moral aims, methods and appropriate timing in the research cycle for community engagement to occur, and whether the answer should vary between different types of health research. Co-design and collaborative partnership approaches that involve engagement during priority-setting, for example, are common in many forms of applied health research but are not regular practice in biomedical research. In this study, we empirically examine the normative question: should communities be engaged when setting priorities for biomedical research projects, and, if so, how and for what purpose? METHODS We conducted in-depth interviews with 31 members of the biomedical research community from the UK, Australia, and African countries who had engaged communities in their work. Interview data were thematically analysed. RESULTS Our study shows that biomedical researchers and community engagement experts strongly support engagement in biomedical research priority-setting, except under certain circumstances where it may be harmful to communities. However, they gave two distinct responses on what ethical purpose it should serve-either empowerment or instrumental goals-and their perspectives on how it should achieve those goals also varied. Three engagement approaches were suggested: community-initiated, synergistic, and consultative. Pre-engagement essentials and barriers to meaningful engagement in biomedical research priority-setting are also reported. CONCLUSIONS This study offers initial evidence that meaningful engagement in priority-setting should potentially be defined slightly differently for biomedical research relative to certain types of applied health research and that engagement practice in biomedical research should not be dominated by instrumental goals and approaches, as is presently the case.
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Affiliation(s)
- Josephine Borthwick
- Royal Australian College of General Practitioners, Melbourne, Australia
- Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia
| | | | - Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia.
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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20
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Johnson AR, Nadkarni NM, Weber CQ. Providing Public Engagement Training to Build Connections Between the Community and Research Ethics Professionals: A Pilot Project. J Empir Res Hum Res Ethics 2022; 17:545-553. [PMID: 36113022 DOI: 10.1177/15562646221126282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is growing interest for research ethics professionals to engage with members of the public, yet they often lack the training needed to engage effectively. The STEM Ambassador Program provides a promising framework for training research ethics professionals to form authentic community connections and carry out effective engagement activities based on shared interests and values. The experiences of ten research administrators who participated in a pilot of the STEM Ambassador training for research ethics professionals are presented. Post-training surveys of the research administrators indicate that they valued the training and the skills obtained, and intend to continue with public engagement activities with support of their leadership.
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21
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Dada S, De Brún A, Banda EN, Bhattacharya S, Mutunga Z, Gilmore B. A realist review protocol on communications for community engagement in maternal and newborn health programmes in low- and middle-income countries. Syst Rev 2022; 11:201. [PMID: 36096841 PMCID: PMC9465973 DOI: 10.1186/s13643-022-02061-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement (CE) has been increasingly implemented across health interventions, including for maternal and newborn health (MNH). This may take various forms, from participatory women's groups and community health committees to public advocacy days. While research suggests a positive influence of CE on MNH outcomes, such as mortality or care-seeking behaviour, there is a need for further evidence on the processes of CE in different settings in order to inform the future development and implementation of CE across programmes. Communication is an integral component of CE serving as a link between the programme and community. The aim of the realist review described in this protocol is to understand how, why, to what extent, and for whom CE contributes to intended and unintended outcomes in MNH programming, focusing on the communication components of CE. METHODS Realist review methodology will be used to provide a causal understanding of what communication for CE interventions in MNH programming work, for whom, to what extent, why, and how. This will be done by developing and refining programme theories on communications for CE in MNH through a systematic review of the literature and engaging key experts for input and feedback. By extrapolating context-mechanism-outcome configurations, this review seeks to understand how certain contexts trigger or inhibit specific mechanisms and what outcomes this interaction generates when communication in CE interventions is used in MNH programming. DISCUSSION A realist philosophy is well-suited to address the aims of this study because of the complex nature of CE. The review findings will be used to inform a realist evaluation case study of CE for an MNH programme in order to ascertain transferable findings that can inform and guide engagement activities in various settings. Findings will also be shared with stakeholders and experts involved in the consultative processes of the review (through workshops or policy briefs) in order to ensure the relevance of these findings to policy and practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022293564.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Esther Namwaba Banda
- Zambia Ministry of Health, Lusaka, Zambia
- Midwives Association of Zambia, Lusaka, Zambia
| | | | | | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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22
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Long R, Cleveland Manchanda EC, Dekker AM, Kraynov L, Willson S, Flores P, Samuels EA, Rhodes K. "Community engagement via restorative justice to build equity-oriented crisis standards of care". J Natl Med Assoc 2022; 114:377-389. [PMID: 35365355 PMCID: PMC8963696 DOI: 10.1016/j.jnma.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/12/2022] [Accepted: 02/28/2022] [Indexed: 10/25/2022]
Abstract
The COVID-19 (SARS-CoV-2) Pandemic has revealed multiple structural inequities within the United States (US), with high social vulnerability index communities shouldering the brunt of death and disability of this pandemic. BIPOC/Latinx people have undergone hospitalizations and death at magnitudes greater than White people in the US. The untold second casualties are health care workers that are suffering from increased risk of infection, death, and mental health crisis. Many health care workers are abandoning the profession all together. Although Crisis Standards of Care (CSC) mean to guide the ethical allocation of scare resources, they frequently use scoring systems that are inherently biased. This raises concern for the application of equity in CSC. Data examining the impact of these protocols on health equity is scarce. Structural maltreatment in healthcare and inequities have led to cumulative harms, physiologic weathering and structural adversities for residents of the US. We propose the use of Restorative Justice (RJ) practices to develop CSC rooted in inclusion and equity. The RJ framework utilizes capacity building, circle process, and conferences to convene groups in a respectful environment for dialogue, healing, accountability, and action plan creation. A phased, non-faith-based facilitated RJ approach for CSC development (or revision) that fosters ethically equitable resource distribution, authentic community engagement, and accountability is shared. This opportunity for local, inclusive decision making and problem solving will both reflect the needs and give agency to community members while supporting the dismantling of structural racism and oppressive, exclusive policies. The authors are asking legislative and health system policy makers to adopt Restorative Justice practices for Crisis Standards of Care development. The US cannot afford to have additional reductions in inhabitant lifespan or the talent pool within healthcare.
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Affiliation(s)
- Ruby Long
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
| | | | - Annette M Dekker
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Liliya Kraynov
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Susan Willson
- Together Works Restorative Consulting, Philadelphia, PA, United States
| | - Pedro Flores
- University San Diego School of Leadership and Educational Sciences, San Diego, CA, United States
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, United States
| | - Karin Rhodes
- Department of Emergency Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Egesa M, Ssali A, Tumwesige E, Kizza M, Driciru E, Luboga F, Roestenberg M, Seeley J, Elliott AM. Ethical and practical considerations arising from community consultation on implementing controlled human infection studies using Schistosoma mansoni in Uganda. Glob Bioeth 2022; 33:78-102. [PMID: 35814190 PMCID: PMC9258062 DOI: 10.1080/11287462.2022.2091503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022] Open
Abstract
Issues related to controlled human infection studies using Schistosoma mansoni (CHI-S) were explored to ensure the ethical and voluntary participation of potential CHI-S volunteers in an endemic setting in Uganda. We invited volunteers from a fishing community and a tertiary education community to guide the development of informed consent procedures. Consultative group discussions were held to modify educational materials on schistosomiasis, vaccines and the CHI-S model and similar discussions were held with a test group. With both groups, a mock consent process was conducted. Fourteen in-depth key informant interviews and three group discussions were held to explore perceptions towards participating in a CHI-S. Most of the participants had not heard of the CHI-S. Willingness to take part depended on understanding the study procedures and the consenting process. Close social networks were key in deciding to take part. The worry of adverse effects was cited as a possible hindrance to taking part. Volunteer time compensation was unclear for a CHI-S. Potential volunteers in these communities are willing to take part in a CHI-S. Community engagement is needed to build trust and time must be taken to share study procedures and ensure understanding of key messages.
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Affiliation(s)
- Moses Egesa
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Agnes Ssali
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Edward Tumwesige
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Moses Kizza
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Emmanuella Driciru
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Fiona Luboga
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Meta Roestenberg
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janet Seeley
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Barugahare J, Kass NE. Managing community engagement in research in Uganda: insights from practices in HIV/AIDS research. BMC Med Ethics 2022; 23:59. [PMID: 35701777 PMCID: PMC9199168 DOI: 10.1186/s12910-022-00797-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Community engagement (CE) in research is valuable for instrumental and intrinsic reasons. Despite existing guidance on how to ensure meaningful CE, much of what it takes to achieve this goal differs across settings. Considering the emerging trend towards mandating CE in many research studies, this study aimed at documenting how CE is conceptualized and implemented, and then providing context-specific guidance on how researchers and research regulators in Uganda could think about and manage CE in research. Methods We conducted qualitative interviews and focus group discussions involving forty-one respondents who were experienced in HIV/AIDS biomedical research involving CE. Thirty-eight of these were directly or indirectly associated with Uganda’s leading research institution in the field of HIV/AIDS. They included Principal Investigators, Community Liaisons Officers, Research Ethics Committee members and Community Advisory Board Members. Three respondents were from Uganda National Council for Science and Technology. Data were collected between August 2019 and August 2020, using audio-taped focus group discussions and key informant interviews, transcribed and analyzed manually to generate themes and subthemes. Results Three major themes emerged: goals or value of CE; the means of CE, and, the evaluation of CE. Goals or value of CE generated four subthemes representing the overarching goals of CE: (1) Promote communities’ agency; (2) Generate and sustain trust; (3) Protect and promote communities’ rights and interests; and, (4) Help studies optimize participation in the form of enrolment and retention of participants. What usually comes under the nomenclatures of methods, strategies, and approaches of CE, such as town-hall meetings, sports events, drama, and the like, should simply be understood as the means of CE, and it is not desirable to hold pre-conceived and fixed ideas about the best means to conduct CE in research since a lot depend on the context. Finally, the study found that despite CE’s critical importance, which suggests the need to track and evaluate it, CE is currently intermittently evaluated, and for inadequate motivations. Conclusions Existing guidance on how to conduct robust CE in research is no substitute for creativity, flexibility, and reflexivity on the part of both researchers and research regulators. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00797-6.
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Affiliation(s)
- John Barugahare
- Department of Philosophy, Makerere University, Kampala, P. O. Box 7062, Kampala, Uganda.
| | - Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics and Johns Hopkins Bloomberg School of Public Health, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
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Bloomfield LSP, Tracey C, Mbabazi E, Schultz RL, Henderson R, Bardosh K, Randolph S, Paige S. Research Participation Influences Willingness to Reduce Zoonotic Exposure in Uganda. ECOHEALTH 2022; 19:299-314. [PMID: 35674864 DOI: 10.1007/s10393-022-01589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
The majority of emerging and re-emerging infectious diseases in people are zoonotic. Despite substantial research in communities adjacent to protected areas with high levels of biodiversity, limited data exist on people's knowledge, attitudes, and practices to avoid exposure to infections from domestic and wild animals. We used a modified grounded-theory framework in QS NVivo to develop a Knowledge, Attitude, and Practices (KAP) survey administered at two time points, KAPT1 (April-July 2016) and KAPT2 (February-May 2018) to participants living at the edge of Kibale National Park, Uganda. We measured the difference in willingness to engage in protective behaviors around zoonotic exposure between an Intervention group (n = 61) and a Comparison group (n = 125). Prior to KAPT1, the Intervention group engaged in a human-centered design (HCD) activity identifying behaviors that reduce zoonotic exposure (March-May 2016). Using a difference-in-difference approach, we compared the Intervention and Comparison groups to assess sustained willingness and use of protective behaviors against domestic and wild animal exposures. At KAPT1, Comparison group participants had a significantly lower (p < 0.05) level of willingness to engage in behaviors that increase exposure to zoonoses from domestic animals; Intervention group participants had a significantly higher (p < 0.01) level of willingness to engage in behaviors that increase exposure to zoonoses from wild animals. At KAPT2, the treatment effect was significant (p < 0.01) for sustained willingness to engage in protective behaviors for domestic animal exposure in the Intervention group. There were no significant differences in practices to avoid domestic and wild animal zoonotic exposure between the Intervention and Comparison groups.
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Affiliation(s)
- Laura S P Bloomfield
- Stanford University School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, 94305, USA.
| | - Christopher Tracey
- Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Edith Mbabazi
- Makerere University Biological Field Station, Kibale National Park, Kibale, Uganda
| | - Rhiannon L Schultz
- Department of Anthropology, University of Georgia, Athens, GA, 30602, USA
| | - Rebecca Henderson
- Department of Anthropology, University of Florida, Gainesville, FL, 32607, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Shannon Randolph
- School of Humanities and Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Sarah Paige
- Global Health Institute, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Akondeng C, Njamnshi WY, Mandi HE, Agbor VN, Bain LE, Njamnshi AK. Community engagement in research in sub-Saharan Africa: approaches, barriers, facilitators, ethical considerations and the role of gender - a systematic review protocol. BMJ Open 2022; 12:e057922. [PMID: 35545398 PMCID: PMC9096545 DOI: 10.1136/bmjopen-2021-057922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Meaningful community engagement (CE) is increasingly being considered the major determinant of successful research, innovation and intervention uptake. Community leaders, policy makers and funders have expressed the need to engage communities in research. CE in research empowers the host community to participate in addressing its own health needs and health disparities while ensuring that researchers understand community priorities. Thus, appropriate CE opens a unique way to promote coproduction, coimplementation and coevaluation, which may strengthen both the sense of inclusion, ownership and the effectiveness of the research life-cycle. The aim of this review is to synthesise available evidence on how to engage communities in research in a gender-sensitive, ethical, culture-appropriate and sustainable way in sub-Saharan Africa (SSA). This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and follows the guidance provided by the Cochrane Handbook for Systematic Reviews. METHODS AND ANALYSIS A combination of key text words and medical subject headings such as 'Community Engagement' or 'Community Involvement' will be used to search 009 databases for all literature published between 1 January 2000 and 31 July 2021. Citations retrieved from database searches will be exported into EndNote X9 to remove duplicate citations and imported into Rayyan QCRI for screening. Two independent reviewers will conduct the screening and data extraction process. Disagreements between review authors will be resolved through discussions, consensus a third reviewer serving as a tiebreaker. The risk of bias will be assessed using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The three-staged process described by Thomas and Harden will be used for the thematic and narrative synthesis of findings. ETHICS AND DISSEMINATION This is a systematic review which uses already collected data thus ethical approval not required. Findings will be published in an open access peer-reviewed journal and presented in relevant conferences and workshops. PROSPERO REGISTRATION NUMBER This protocol has been submitted for registration in PROSPERO and has been published under registration number CRD42021282503 .
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Affiliation(s)
- Claudine Akondeng
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Department of programs, Cameroon National Association for Family Welfare (CAMNAFAW), Yaounde, Cameroon
| | - Wepnyu Y Njamnshi
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Education and Training department, Education and Learning for All (ELFA), Yaounde, Cameroon
| | - Henshaw Eyambe Mandi
- Triangle Research Foundation (TRIFT), Limbe, Cameroon
- Department of Vaccine Research Developement, Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Valirie Ndip Agbor
- Clinical Trials and Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Luchuo Engelbert Bain
- Triangle Research Foundation (TRIFT), Limbe, Cameroon
- Lincoln International Institute for Rural Health, LIIRH, College of Social Science, Lincoln University, Lincoin, UK
| | - Alfred K Njamnshi
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Education and Training department, Education and Learning for All (ELFA), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaounde, Yaounde, Cameroon
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Bategereza L, Olotu A, Kamuya D. Community-structures that facilitate engagement in health research: Ifakara Health Research Institute-Bagamoyo case study. AAS Open Res 2022; 4:13. [PMID: 40078895 PMCID: PMC11303950 DOI: 10.12688/aasopenres.13187.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Involvement of communities in health research has been at the forefront of ethical conduct of research worldwide. Despite the fact that many scholars have put forward different ways of engaging communities in health research, debates on the forms and goals of engagement, levels of engagement, who should be engaged in the community and how, still persist. At the Ifakara Health Research Institute (IHI) in Bagamoyo, Tanzania, different approaches to engaging with the community in health research have been used over the last decade. Of the approaches that have been used, are the use of community structures including traditional and administrative leaders, which have been periodically engaged, but with little sharing beyond study-level. Therefore, the present research was aimed to describe the nature of community structures that could be engaged in health research at the Ifakara Research Centre, the strength and weakness of working with such community structures, and the impact of the structures on research conducted in the center, including promoting research participation. METHODS A qualitative study based on social science methodological design and a thematic approach for data analysis was employed. Data collection was undertaken in between February 2019 and December 2019. In this study, a total of 25 interviews with 55 respondents in which 19 were In-Depth Interviews (IDIs), and 6 were Focus Group Discussions (FGDs) were carried out. The In-Depth Interviews (IDIs) involved Village Executive Officers (VEOs), Hamlet Leaders (HLs), Community Health Workers (CHWs), Principal Investigators (PIs), study coordinators (SCs), research project managers (PMs), and field workers (FWs), while 6 Focus Group Discussions (FGDs) involved community respondents who previously participated in IHI research. The FGDs were conducted in 3 villages; two FGDs in each village, one each for men and women. The interviews were audiotaped, transcribed, and analyzed using framework analysis. Comparative thematic analysis was undertaken as more data was added, creating new themes, until there was no new emerging themes, a point of data saturation. The themes were charted across respondent groups to map patterns of the themes across respondents groups. RESULTS Data shows different community structures including the village executive officers, community health workers, hamlet leaders, and community advisory board were involved in engagement activities. Approaches used for engagement as per the findings under this study include community-level public meetings, information giving at household level and at the health facilities, the use of outpatient attendance at hospital/dispensary, the use of Health District Coordinators, the use of some members of village leaders/representatives families through their both informed assent and consent as project or research participants, and the use of routine health care campaigns in the community to create awareness of the particular diseases such as Tuberculosis day (TB day), Malaria day and HIV day. The weaknesses that were reported include inconsistence research feedback, insufficient engagement with participants about specific research projects they are recruited into and false promises by researchers to community stakeholders. Community stakeholders suggested additional ways to engage with the community, these include radio, advertisement, posters, brochures and regular meetings.
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Affiliation(s)
- Leah Bategereza
- Ifakara Health Institute, Bagamoyo, Tanzania
- School of Life Science and Bio-engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Ally Olotu
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
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Davies A, High C, Mwangome N, Hanlin R, Jones C. Evaluating and Engaging: Using Participatory Video With Kenyan Secondary School Students to Explore Engagement With Health Research. Front Public Health 2022; 10:797290. [PMID: 35372206 PMCID: PMC8968085 DOI: 10.3389/fpubh.2022.797290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe growing ethical requirement to engage communities with health research has yielded diversification in approaches and targeted audiences. Conventional approaches like community “town-hall meetings,” laboratory open-days and focus group discussions, have evolved into new methods and audiences such as community drama and school engagement with health research (SEHR) involving learning interactions between researchers and school students. While engagement practices are diversifying, evaluations of these initiatives are rare in Low- and Middle-Income Countries (LMIC). This article focuses on the use of Participatory Video (PV) to explore the influence of the KEMRI-Wellcome Trust Research Programme's (KWTRP) School Engagement Programme (SEP) on the views and understandings of science and research among Kenyan state secondary school students.MethodsTwelve male and twelve female students from four coeducational schools were provided with film-making kits (1 per school), and a one-day PV training workshop. They prepared 22 short films over 8 weeks depicting their experiences and views of research and engagement and conveying their career aspirations. Schools were selected based on prior SEP participation; two schools having experienced different engagement approaches, and the others with no prior school engagement. Study data comprised footage and participant observation notes.ResultsPV provided an opportunity to simultaneously engage and evaluate to inform practice. Through student-led filmmaking, PV stimulated conversations with students about research and engagement, enabling them to share their views in a way they felt was appropriate. These interactions offered an understanding of student gains from engagement, the depth of interaction required to address perceptions held about research and the potential unintended consequences of engagement. PV also provided insights into the context and complexity of life in which engagement is situated. Understanding this context is important because of its potential influence on participation in engagement activities. We draw on these insights to make two recommendations for school engagement practice. First is that PV can provide an enjoyable and insightful means of combining engagement with evaluation. Second, given that time for SEHR is competed for against other important curricular and extracurricular activities, SEHR practitioners must ensure that activities are as beneficial and enjoyable as possible to students.
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Affiliation(s)
- Alun Davies
- The KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Oxford Centre for Global Health Research, Oxford University, Oxford, United Kingdom
- *Correspondence: Alun Davies
| | - Chris High
- Peace and Development Studies, Linnaeus University, Växjö, Sweden
| | - Nancy Mwangome
- The KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rebecca Hanlin
- Trilateral Chair on Transformative Innovation, 4IR and Sustainable Development, University of Johannesburg, Johannesburg, South Africa
| | - Caroline Jones
- The KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Oxford Centre for Global Health Research, Oxford University, Oxford, United Kingdom
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Jansen JO, Stephens SW, Crowley B, Inaba K, Goldkind SF, Holcomb JB. Interactive media-based community consultation for exception from informed consent trials: How representative should (and can) it be? J Trauma Acute Care Surg 2022; 92:e41-e46. [PMID: 34840269 DOI: 10.1097/ta.0000000000003484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jan O Jansen
- From the Center for Injury Science (J.O.J., S.W.S., J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; School of Medicine, University of Alabama at Birmingham; and Center for Injury Science (B.C.), University of Alabama at Birmingham, Birmingham, Alabama; LAC+USC Medical Center, Keck School of Medicine (K.I.), University of Southern California, Los Angeles, California; and Goldkind Consulting, LLC (S.F.G.), Chevy Chase, Maryland
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Young MJ, Bodien YG, Edlow BL. Ethical Considerations in Clinical Trials for Disorders of Consciousness. Brain Sci 2022; 12:211. [PMID: 35203974 PMCID: PMC8870384 DOI: 10.3390/brainsci12020211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
As the clinical trial landscape for patients with disorders of consciousness (DoC) expands, consideration of associated ethical challenges and opportunities is of ever-increasing importance. Responsible conduct of research in the vulnerable population of persons with DoC, including those with coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), minimally conscious state (MCS), covert cortical processing (CCP), and cognitive motor dissociation (CMD), demands proactive deliberation of unique ethical issues that may arise and the adoption of robust protections to safeguard patients, surrogates, and other key stakeholders. Here we identify and critically evaluate four central categories of ethical considerations in clinical trials involving participants with DoC: (1) autonomy, respect for persons and informed consent of individuals with liminal consciousness; (2) balancing unknown benefits and risks, especially considering the epistemological gap between behavior and consciousness that complicates ordinary ascription of subjective states; (3) disclosure to surrogates and clinical teams of investigational results pertaining to consciousness; and (4) justice considerations, including equitable access to clinical trial enrollment across communities and geographies. We outline guiding principles and research opportunities for clinicians, neuroethicists, and researchers engaged in DoC clinical trials to advance ethical study design and deployment in this complex yet crucial area of investigation.
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Affiliation(s)
- Michael J. Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02114, USA
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02114, USA
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Hsu CH, Fowler J, Cranford JA, Thomas MP, Neumar RW. Integration of social media with targeted emails and in-person outreach for exception from informed consent community consultation. Acad Emerg Med 2022; 29:217-227. [PMID: 34416069 DOI: 10.1111/acem.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exception from informed consent (EFIC) enables the enrollment of research subjects with emergent conditions to clinical trials without prior consent. EFIC study approval requires community consultation and public disclosure. We hypothesized that the integration of social media with targeted emails and in-person outreach is an effective community consultation strategy. METHODS We utilized social media with targeted emails and in-person outreach for the community consultation of the ACCESS cardiac arrest trial. Study advertisements were disseminated using Facebook and Instagram, and targeted emails were sent to emergency medicine, prehospital, and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Participants were asked to complete a survey about their opinions about the study. RESULTS We collected 559 surveys over an 8-week period, and 70.5% of the surveys were obtained using social media. The median (IQR) age of survey respondents was 44 (33-57) years; 89.9% were White and 60.1% were women. A total of 91.3% believed ACCESS was an important study. Compared to the in-person group, more from social media (81.8% vs. 63.3%, p < 0.05) and targeted email (77.4% vs. 63.3%, p < 0.05) groups said they would include their loved ones in the study. More from the in-person group believed that their opinion would be considered seriously compared to the social media (75.9% vs. 62.6%, p < 0.05) and targeted email (75.9% vs. 54.5%, p < 0.05) groups. The incorporation of social media and targeted emails for community consultation reduced the cost per survey by fourfold compared to an in-person-only strategy. CONCLUSIONS The integration of social media with targeted emails and in-person outreach was a feasible and cost-saving approach for EFIC community consultation. Future work is necessary to determine the perception and best utilization of social media for community consultation.
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Affiliation(s)
- Cindy H. Hsu
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
- Michigan Center for Integrative Research in Critical Care University of Michigan Ann Arbor Michigan USA
| | - Jennifer Fowler
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
| | - James A. Cranford
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
| | - Michael P. Thomas
- Division of Cardiovascular Medicine Interventional Cardiology University of Michigan Ann Arbor Michigan USA
| | - Robert W. Neumar
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
- Michigan Center for Integrative Research in Critical Care University of Michigan Ann Arbor Michigan USA
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Hickey G, Porter K, Tembo D, Rennard U, Tholanah M, Beresford P, Chandler D, Chimbari M, Coldham T, Dikomitis L, Dziro B, Ekiikina PO, Khattak MI, Montenegro CR, Mumba N, Musesengwa R, Nelson E, Nhunzvi C, Ramirez CM, Staniszewska S. What Does “Good” Community and Public Engagement Look Like? Developing Relationships With Community Members in Global Health Research. Front Public Health 2022; 9:776940. [PMID: 35155342 PMCID: PMC8830293 DOI: 10.3389/fpubh.2021.776940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/31/2021] [Indexed: 12/02/2022] Open
Abstract
Community and public engagement (CPE) is increasingly becoming a key component in global health research. The National Institute for Health Research (NIHR) is one of the leading funders in the UK of global health research and requires a robust CPE element in the research it funds, along with CPE monitoring and evaluation. But what does “good” CPE look like? And what factors facilitate or inhibit good CPE? Addressing these questions would help ensure clarity of expectations of award holders, and inform effective monitoring frameworks and the development of guidance. The work reported upon here builds on existing guidance and is a first step in trying to identify the key components of what “good” CPE looks like, which can be used for all approaches to global health research and in a range of different settings and contexts. This article draws on data collected as part of an evaluation of CPE by 53 NIHR-funded award holders to provide insights on CPE practice in global health research. This data was then debated, developed and refined by a group of researchers, CPE specialists and public contributors to explore what “good” CPE looks like, and the barriers and facilitators to good CPE. A key finding was the importance, for some research, of investing in and developing long term relationships with communities, perhaps beyond the life cycle of a project; this was regarded as crucial to the development of trust, addressing power differentials and ensuring the legacy of the research was of benefit to the community.
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Affiliation(s)
- Gary Hickey
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Katie Porter
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- *Correspondence: Katie Porter
| | - Doreen Tembo
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Una Rennard
- Public Contributor, Oxfordshire, United Kingdom
| | - Martha Tholanah
- AIDS Clinical Trial Group Clinical Research Site Community Advisory Board, Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
- Making Waves Network, Harare, Zimbabwe
| | - Peter Beresford
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - David Chandler
- The Psoriasis and Psoriatic Arthritis Alliance, St Albans, United Kingdom
| | - Moses Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health, Great Zimbabwe University, Masvingo, Zimbabwe
| | - Tina Coldham
- National Institute for Health Research Centre for Engagement and Dissemination, London, United Kingdom
- School for Social Care Research, National Institute for Health Research, London, United Kingdom
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom
| | - Biggy Dziro
- African Mental Health Research Initiative (AMARI), Harare, Zimbabwe
| | | | - Maria I. Khattak
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Cristian R. Montenegro
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, United Kingdom
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noni Mumba
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rosemary Musesengwa
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Erica Nelson
- Health and Nutrition Cluster, The Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Clement Nhunzvi
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Caroline M. Ramirez
- School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
- Harvard Medical School, Boston, MA, United States
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Farley P, Stephens SW, Crowley B, Collins SP, Wong MD, Panas AB, Dennis BM, Richmond N, Inaba K, Brown KN, Holcomb JB, Jansen JO. Exception from informed consent trials: social-media-based community consultation campaigns are representative of target communities. Trauma Surg Acute Care Open 2021; 6:e000830. [PMID: 34901469 PMCID: PMC8634012 DOI: 10.1136/tsaco-2021-000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND 'Community consultation' (CC) is a key step when conducting Exception From Informed Consent research. Social-media-based CC has been shown to reach more people than traditional methods, but it is unclear whether those reached are representative of the community as a whole. METHODS This is a retrospective analysis of the CC performed in preparation for the PHOXSTAT trial. Social media advertisement campaigns were conducted in the catchment areas of the three participating trauma centers and evaluated by examining Facebook user statistics. We compared these data to georeferenced population data obtained from the U.S. Census Bureau. We examined variations in the proportion of each age group reached, by gender. RESULTS Our social media advertisements reached a total of 332 081 individuals in Los Angeles, Birmingham, and Nashville. Although there were differences in the proportion of individuals reached within each age group and gender groups, compared with the population in each area, these were small (within 5%). In Birmingham, participants 55 to 64 years old, 25 to 34 years old, and females 18 to 24 years old were slightly over-represented (a larger proportion of individuals in this age group were reached by the social media campaign, compared with the population resident in this area). In contrast, in Nashville, female participants 45 to 64 years old, and males 25 to 64 years old were over-represented. In Los Angeles, females 45 to 64 years old, and males 25 to 64 years and over were over-represented. DISCUSSION In conclusion, this study demonstrates that social media CC campaigns can be used to reach a sample of the community broadly representative of the population as a whole, in terms of age and gender. This finding is helpful to IRBs and investigators, as it lends further support to the use of social media to conduct CC. Further work is needed to analyze how representative community samples are in terms of other characteristics, such as race, ethnicity, and socioeconomic status. LEVEL III EVIDENCE Economic & Value-based Evaluations.
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Affiliation(s)
- Paige Farley
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
- College of Medicine, University of South Alabama, Mobile, Alabama, USA
| | - Shannon W Stephens
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandon Crowley
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica D Wong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Ashley B Panas
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bradley M Dennis
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neal Richmond
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenji Inaba
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Karen N Brown
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John B Holcomb
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jan O Jansen
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Dickert NW, Metz K, Fetters MD, Haggins AN, Harney DK, Speight CD, Silbergleit R. Meeting unique requirements: Community consultation and public disclosure for research in emergency setting using exception from informed consent. Acad Emerg Med 2021; 28:1183-1194. [PMID: 33872426 DOI: 10.1111/acem.14264] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exception from informed consent (EFIC) regulations for research in emergency settings contain unique requirements for community consultation and public disclosure. These requirements address ethical challenges intrinsic to this research context. Multiple approaches have evolved to accomplish these activities that may reflect and advance different aims. This scoping review was designed to identify areas of consensus and lingering uncertainty in the literature. METHODS Scoping review methodology was used. Conceptual and empirical literature related to community consultation and public disclosure for EFIC research was included and identified through a structured search using Embase, HEIN Online, PubMed, and Web of Science. Data were extracted using a standardized tool with domains for major literature categories. RESULTS Among 84 manuscripts, major domains included conceptual or policy issues, reports of community consultation processes and results, and reports of public disclosure processes and results. Areas of consensus related to community consultation included the need for a two-way exchange of information and use of multiple methods. Public acceptance of personal EFIC enrollment is commonly 64% to 85%. There is less consensus regarding how to assess attitudes, what "communities" to prioritize, and how to determine adequacy for individual projects. Core goals of public disclosure are less well developed; no metrics exist for assessing adequacy. CONCLUSIONS Multiple methods are used to meet community consultation and public disclosure requirements. There remain no settled norms for assessing adequacy of public disclosure, and there is lingering debate about needed breadth and depth of community consultation.
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Affiliation(s)
- Neal W. Dickert
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta Georgia USA
| | - Kathleen Metz
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Michael D. Fetters
- Mixed Methods Program and Department of Family Medicine University of Michigan Medical School Ann Arbor Michigan USA
| | - Adrianne N. Haggins
- Department of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USA
| | - Deneil K. Harney
- Department of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USA
| | - Candace D. Speight
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Robert Silbergleit
- Department of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USA
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Nichol AA, Bendavid E, Mutenherwa F, Patel C, Cho MK. Diverse experts' perspectives on ethical issues of using machine learning to predict HIV/AIDS risk in sub-Saharan Africa: a modified Delphi study. BMJ Open 2021; 11:e052287. [PMID: 34321310 PMCID: PMC8320245 DOI: 10.1136/bmjopen-2021-052287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To better understand diverse experts' views about the ethical implications of ongoing research funded by the National Institutes of Health that uses machine learning to predict HIV/AIDS risk in sub-Saharan Africa (SSA) based on publicly available Demographic and Health Surveys data. DESIGN Three rounds of semi-structured surveys in an online expert panel using a modified Delphi approach. PARTICIPANTS Experts in informatics, African public health and HIV/AIDS and bioethics were invited to participate. MEASURES Perceived importance of or agreement about relevance of ethical issues on 5-point unipolar Likert scales. Qualitative data analysis identified emergent themes related to ethical issues and development of an ethical framework and recommendations for open-ended questions. RESULTS Of the 35 invited experts, 22 participated in the online expert panel (63%). Emergent themes were the inclusion of African researchers in all aspects of study design, analysis and dissemination to identify and address local contextual issues, as well as engagement of communities. Experts focused on engagement with health and science professionals to address risks, benefits and communication of findings. Respondents prioritised the mitigation of stigma to research participants but recognised trade-offs between privacy and the need to disseminate findings to realise public health benefits. Strategies for responsible communication of results were suggested, including careful word choice in presentation of results and limited dissemination to need-to-know stakeholders such as public health planners. CONCLUSION Experts identified ethical issues specific to the African context and to research on sensitive, publicly available data and strategies for addressing these issues. These findings can be used to inform an ethical implementation framework with research stage-specific recommendations on how to use publicly available data for machine learning-based predictive analytics to predict HIV/AIDS risk in SSA.
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Affiliation(s)
- Ariadne A Nichol
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Eran Bendavid
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Farirai Mutenherwa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Chirag Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mildred K Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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Klingberg S, Adhikari B, Draper CE, Bosire EN, Tiigah P, Nyirenda D, Mukumbang FC. Engaging communities in non-communicable disease research and interventions in low- and middle-income countries: a realist review protocol. BMJ Open 2021; 11:e050632. [PMID: 34290072 PMCID: PMC8296813 DOI: 10.1136/bmjopen-2021-050632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Engaging communities and intended beneficiaries at various stages of health research is a recommended practice. The contribution of community engagement to non-communicable disease research in low- and middle-income countries has not yet been extensively studied or synthesised. This protocol describes the steps towards generating an understanding of community engagement in the context of non-communicable disease research, prevention and health promotion using a realist review approach. A realist lens enables a rich explanatory approach to causation while capturing complexity, and an openness to multiple outcomes, including unintended consequences. The review will thus develop an understanding of community engagement without assuming that such practices result in more ethical research or effective interventions. METHODS AND ANALYSIS We propose a realist approach aiming to examine how, why, under what circumstances and for whom community engagement works or does not work. The iterative review steps include clarifying the review scope; searching for evidence; appraising studies and extracting data; synthesising evidence and drawing conclusions; and disseminating, implementing and evaluating the findings. Principles of meta-narrative review (pragmatism, pluralism, historicity, contestation, reflexivity and peer review) are employed to ensure practicable and contextualised review outputs. The proposed review will draw on theoretical and empirical literature beyond specific diseases or settings, but with a focus on informing non-communicable disease research and interventions in low- and middle-income countries. The synthesis of existing literature will be complemented by qualitative realist interviews and stakeholder consultation. Through drawing on multiple types of evidence and input from both experts and intended beneficiaries, the review will provide critical and pragmatic insights for research and community engagement in low- and middle-income countries. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of the Witwatersrand. Dissemination will include traditional academic channels, institutional communications, social media and discussions with a wide range of stakeholders.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Priscilla Tiigah
- Health Equity and Strategy Unit, Public Health England, London, UK
| | - Deborah Nyirenda
- Community Engagement and Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, Malawi
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Vanderslott S, Van Ryneveld M, Marchant M, Lees S, Nolna SK, Marsh V. How can community engagement in health research be strengthened for infectious disease outbreaks in Sub-Saharan Africa? A scoping review of the literature. BMC Public Health 2021; 21:633. [PMID: 33794820 PMCID: PMC8012744 DOI: 10.1186/s12889-021-10348-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community engagement (CE) is a well-established practical and scholarly field, recognised as core to the science and ethics of health research, for which researchers and practitioners have increasingly asked questions about desired standards and evaluation. In infectious disease outbreak contexts, questions may be more complex. However, it is unclear what body of knowledge has been developed for CE specifically as it applies to emerging infectious diseases. This scoping review seeks to describe (1) How CE has been conceptualised and understood; and (2) What conclusions have research teams reached on the effectiveness of CE in these settings, including challenges and facilitators. METHODS We used a scoping review framework by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) to structure our review. We conducted a brainstorming session and initial trial search to inform the protocol, search terms, and strategy. Three researchers discussed, developed and applied agreed screening tools and selection criteria to the final search results. Five researchers used the screening tools to screen abstracts and full text for inclusion by consensus. Additional publications were sought from references of retrieved publications and an expert call for literature. We analysed and reported emerging themes qualitatively. RESULTS We included 59 papers from a total of 722 articles derived from our trial and final literature searches, as well as a process of "citation chasing" and an expert call for grey literature. The core material related exclusively to health research trials during the 2014-2016 West Africa Ebola outbreak. We synthesized reports on components of effectiveness of CE to identify and propose three themes as essential elements of effective CE. CONCLUSIONS While there is a large volume of literature documenting CE activities in infectious disease research settings generally, there are few accounts of effectiveness dimensions of CE. Our review proposes three themes to facilitate the effectiveness of CE initiatives as essential elements of CE activities in infectious diseases studies: (1) Communication towards building collaborative relationships; (2) Producing contextual knowledge; and (3) Learning lessons over time. As there were relatively few in-depth accounts of CE from our literature review, documentation and accounts of CE used in health research should be prioritised.
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Affiliation(s)
- Samantha Vanderslott
- Oxford Vaccine Group & Oxford Martin School, University of Oxford, 34 Broad St, Oxford, OX1 2BD, UK.
| | - Manya Van Ryneveld
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Mark Marchant
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sylvie Kwedi Nolna
- Department of Public Health, University of Yaounde I, Rue Melen, Yaounde, Cameroon
| | - Vicki Marsh
- KEMRI Wellcome Trust Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NDM, Oxford University, Oxford, UK
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
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Nguyen LC, Bakerlee CW, McKelvey TG, Rose SM, Norman AJ, Joseph N, Manheim D, McLaren MR, Jiang S, Barnes CF, Kinniment M, Foster D, Darton TC, Morrison J. Evaluating Use Cases for Human Challenge Trials in Accelerating SARS-CoV-2 Vaccine Development. Clin Infect Dis 2021; 72:710-715. [PMID: 32628748 PMCID: PMC7454474 DOI: 10.1093/cid/ciaa935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/02/2020] [Indexed: 01/07/2023] Open
Abstract
Human challenge trials (HCTs) have been proposed as a means to accelerate SARS-CoV-2 vaccine development. We identify and discuss three potential use cases of HCTs in the current pandemic: evaluating efficacy, converging on correlates of protection, and improving understanding of pathogenesis and the human immune response. We outline the limitations of HCTs and find that HCTs are likely to be most useful for vaccine candidates currently in preclinical stages of development. We conclude that, while currently limited in their application, there are scenarios in which HCTs would be extremely beneficial. Therefore, the option of conducting HCTs to accelerate SARS-CoV-2 vaccine development should be preserved. As HCTs require many months of preparation, we recommend an immediate effort to (1) establish guidelines for HCTs for COVID-19; (2) take the first steps toward HCTs, including preparing challenge virus and making preliminary logistical arrangements; and (3) commit to periodically re-evaluating the utility of HCTs.
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Affiliation(s)
- Linh Chi Nguyen
- Department of Politics and International Relations, University of Oxford, Oxford, United Kingdom
| | - Christopher W Bakerlee
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Sophie M Rose
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David Manheim
- Health and Risk Communication Research Center, School of Public Health, University of Haifa, Haifa, Israel
| | - Michael R McLaren
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
| | - Steven Jiang
- Harvard Law School, Cambridge, Massachusetts, USA
| | | | - Megan Kinniment
- Department of Physics, University of Oxford, Oxford, United Kingdom
| | - Derek Foster
- Rethink Priorities, Redwood City, California, USA
| | - Thomas C Darton
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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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: 1.5] [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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Theisen JG, Amarillo IE. Creating Affirmative and Inclusive Practices When Providing Genetic and Genomic Diagnostic and Research Services to Gender-Expansive and Transgender Patients. J Appl Lab Med 2021; 6:142-154. [PMID: 33236080 DOI: 10.1093/jalm/jfaa165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Gender expansive and transgender (GET) healthcare extends beyond gender-affirming therapies, reaching every medical specialty and subspecialty. As the number of GET patients seeking health services has increased, so has the need for standards of care regarding GET-affirmative practices throughout the healthcare system. As such, the number of publications surrounding GET-affirmative practices has steadily risen. However, even as such research has gained ground in other areas, one realm in which there has been a relative lag is genetics and genomics (GG). CONTENT In this article, we track the GET patient and their laboratory sample from the clinic to the GG laboratory and back. Throughout the preanalytical, analytical, and postanalytical phases, we identify publications, recommendations, and guidelines relevant to the care of the GET community. We also identity knowledge gaps in each area and provide recommendations for affirmative and inclusive processes for addressing those gaps. SUMMARY We have identified the practices involved in GG services that would benefit from GET-affirmative process improvement, reviewing relevant affirmative guidelines. Where guidelines could not be found, we identified those knowledge gaps and suggested potential solutions and future directions for implementing GET-affirmative practices.
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Affiliation(s)
- J Graham Theisen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology, Infertility, and Genetics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Ina E Amarillo
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine in Saint Louis, MO
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Nyirenda D, Sariola S, Kingori P, Squire B, Bandawe C, Parker M, Desmond N. Structural coercion in the context of community engagement in global health research conducted in a low resource setting in Africa. BMC Med Ethics 2020; 21:90. [PMID: 32957967 PMCID: PMC7504839 DOI: 10.1186/s12910-020-00530-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. METHODS A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. RESULTS The results showed that structural coercion arose due to an interplay of factors pertaining to social-economic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. CONCLUSION The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given.
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Affiliation(s)
- Deborah Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Salla Sariola
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Patricia Kingori
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Bertie Squire
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Chiwoza Bandawe
- University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Michael Parker
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Wang Y, Wang Y, Li F, Zhang X, Li H, Yang G, Xu C, Wei C. Spermine Protects Cardiomyocytes from High Glucose-Induced Energy Disturbance by Targeting the CaSR-gp78-Ubiquitin Proteasome System. Cardiovasc Drugs Ther 2020; 35:73-85. [PMID: 32918657 DOI: 10.1007/s10557-020-07064-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the mediation of spermine on energy metabolism disorder and diabetic cardiomyopathy (DCM) development as well as the underlying mechanisms. METHODS An in vitro model of DCM was established by incubating primary cultured neonatal rat cardiomyocytes with high glucose (HG). Spermine content was assessed by RP-HPLC. The protein levels were detected by western blot. Mitochondrial functions were analyzed using the respiratory chain complex assay kit and immunofluorescence staining. RESULTS The endogenous content of spermine was decreased in the HG group, and the protein levels of ornithine decarboxylase, respiratory chain complex (I-V), mitochondrial fusion-related protein (Mfn1, Mfn2), Cx43, N-cadherin, CaSR, and β-catenin (in cytomembrane) were also down-regulated by HG. In contrast, the protein levels of spermine-N1-acetyltransferase, gp78, Fis1, Drp1, and β-catenin were up-regulated by HG. Meanwhile, we observed that HG increased ubiquitination levels of Mfn1, Mfn2, and Cx43, decreased membrane potential (ΔΨm), and the opening of mitochondrial permeability transport pore (mPTP) followed by intracellular ATP leakage. The supplement of spermine or siRNA-mediated knockdown of gp78 significantly alleviated the detrimental effects of HG, while downregulation of CaSR aggravated the development of DCM. We further confirmed that the lower level of spermine by HG activates the gp78-ubiquitin-proteasome pathway via downregulation of CaSR protein level, which in turn damages mitochondrial gap junction intercellular communication and leads to reduced ATP level. CONCLUSION The protective role of spermine on energy metabolism disorder is based on higher CaSR protein level and lower gp78 activation, pointing to the possibility that spermine can be a target for the prevention and treatment of DCM.
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Affiliation(s)
- Yuehong Wang
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China
| | - Yuwen Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Fadong Li
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China
| | - Xinying Zhang
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China
| | - Hongzhu Li
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China
| | - Guangdong Yang
- Departemnt of Chemistry and Biochemistry, Laurentian University, Sudbury, P3E 2C6, Canada
| | - Changqing Xu
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China
| | - Can Wei
- Department of Pathophysiology, Harbin Medical University, Baojian Road, Harbin, 150081, China.
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Mirzazadeh A, Hosseini-Hooshyar S, Shahesmaeili A, Bahramnejad A, Barshan A, Mousavian G, Najafi E, Sharifi H, Haghdoost AA, Briceno A, McFarland W, Page K. Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran. Subst Abuse Treat Prev Policy 2020; 15:56. [PMID: 32758246 PMCID: PMC7405425 DOI: 10.1186/s13011-020-00298-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators. METHODS Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach. RESULTS In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID. CONCLUSIONS Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
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Affiliation(s)
- Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmail Najafi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Alya Briceno
- University of California San Francisco, San Francisco, CA, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Page
- Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Dakić T. No research for the decisionally-impaired mentally ill: a view from Montenegro. BMC Med Ethics 2020; 21:47. [PMID: 32517748 PMCID: PMC7285582 DOI: 10.1186/s12910-020-00489-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many of the important elements of a valid informed consent - comprehension, voluntariness, and capacity - can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent. MAIN BODY Mental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet. To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed. CONCLUSIONS Scientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.
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Affiliation(s)
- Tea Dakić
- Clinical Center of Montenegro, Clinic for Psychiatry, Ljubljanska bb, Podgorica, 81000, Montenegro.
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45
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Ndaba T, Taylor M, Mabaso M. Establishing a community advisory group (CAG) for partnership defined quality (PDQ) towards improving primary health care in a peri-urban setting in KwaZulu-Natal, South Africa. BMC Health Serv Res 2020; 20:392. [PMID: 32384886 PMCID: PMC7206786 DOI: 10.1186/s12913-020-05275-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community advisory groups (CAGs) have been shown to be catalysts who bridge the gap between communities and primary health care facilities by sustaining good working relationships through community engagement to improve the quality of the health care services. This study aimed to explore the establishment, operation, and accomplishments of a CAG towards building a strong partnership between the health facilities and local communities in support of the Partner Defined Quality (PDQ) process, to improve the delivery of quality maternal and neonatal care in a peri-urban setting in the province of KwaZulu-Natal, South Africa. METHODS The study used a qualitative exploratory research design. Recruitment followed a purposive sampling approach. The study targeted leadership representatives from the community, potential beneficiaries, and health care providers in the selected catchment areas. Participants were identified during community mobilization events that took place during the preparatory stage to ensure key stakeholder support. A participatory research approach was used to discuss membership, composition, the selection criteria, including formulation, and agreement on terms of reference of the CAG membership, roles and responsibilities. A rapid assessment method was used for data collection and analysis of establishment of the CAG, its activities and accomplishments. RESULTS The community nominated 24 CAG members during the consultative meetings and the organogram provides clear terms of reference, roles and responsibilities. Immediately after inception, the CAG used four indicators (weaknesses, threats and risks, strengths, and opportunities) to review the community and primary health care challenges that affect their communities. These CAG activities were linked with the phases of the PDQ process. The CAG committed itself going forward to continue to create an enabling environment for all stakeholders working to improve the well-being of the community, especially the PDQ teams working on improving the care of pregnant mothers and their babies pre- and post-delivery. CONCLUSION This work shows that developing community relationships and infrastructure are critical initial stages before embarking on PDQ planning and implementation. Empowerment, local ownership, funding, technical resources and ongoing support are critical elements for sustainability of CAG activities.
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Affiliation(s)
- Thoko Ndaba
- Discipline of Public Health, School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Myra Taylor
- Discipline of Public Health, School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Musawenkosi Mabaso
- Human and Social Capabilities (HSC) Research Division, Human Sciences Research Council, Durban, South Africa
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Wang Y, Chen J, Li S, Zhang X, Guo Z, Hu J, Shao X, Song N, Zhao Y, Li H, Yang G, Xu C, Wei C. Exogenous spermine attenuates rat diabetic cardiomyopathy via suppressing ROS-p53 mediated downregulation of calcium-sensitive receptor. Redox Biol 2020; 32:101514. [PMID: 32234613 PMCID: PMC7113441 DOI: 10.1016/j.redox.2020.101514] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/23/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is a severe complication of type 1 diabetic (T1D) patients, manifested as combined diastolic and systolic dysfunction. DCM is associated with impaired calcium homeostasis secondary to decreased calcium-sensitive receptor (CaSR) expression. Spermine, a direct agonist of CaSR, was found deficient in cardiomyocytes of T1D rats. However, the role of spermine in DCM was unclear. Here, we examined the cardioprotective effect of exogenous spermine on DCM in streptozotocin (STZ) induced-T1D rats and high-glucose (HG)-incubated neonatal rat cardiomyocytes. Exogenous spermine significantly attenuated cardiac dysfunction in T1D rats, characterized by improved echocardiography, less fibrosis, reduced myocardial endoplasmic reticulum (ER) stress and oxidative stress, and increased expression of myocardial membrane CaSR. In cultured neonatal rat cardiomyocytes, exogenous spermine attenuated myocardial injury induced by HG treatment, demonstrated by restored cellular glucose uptake capacity, reduced expression of apoptotic markers, lowered level of oxidative stress, ER stress and unfolded protein response, and upregulated cell membrane CaSR. Mechanistically, the cardioprotective effect of spermine appeared dependent upon effective elimination of reactive oxygen species (ROS) and up-regulation of CaSR expression by suppressing the Nrf2-ROS-p53-MuRF1 axis. Taken together, these results suggest that exogenous spermine protects against DCM in vivo and in vitro, partially via suppressing ROS and p53-mediated downregulation of cell membrane CaSR.
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Affiliation(s)
- Yuehong Wang
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Junting Chen
- Department of Anesthesiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Siwei Li
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Xinying Zhang
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Zuoming Guo
- Department of Hepatobiliary and Pancreatic Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Jing Hu
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Xiaoting Shao
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Ningyang Song
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Yajun Zhao
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Hongzhu Li
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Guangdong Yang
- Department of Chemistry and Biochemistry, Laurentian University, Sudbury, P3E 2C6, Canada
| | - Changqing Xu
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China
| | - Can Wei
- Department of Pathophysiology, Harbin Medical University, Harbin, 150081, China.
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Boulanger RF, Komparic A, Dawson A, Upshur REG, Silva DS. Developing and Implementing new TB Technologies: Key Informants' Perspectives on the Ethical Challenges. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:65-73. [PMID: 31858386 DOI: 10.1007/s11673-019-09954-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify the ethical challenges associated with the development and implementation of new tuberculosis (TB) drugs and diagnostics. METHODS Twenty-three semi-structured qualitative interviews conducted between December 2015 and September 2016 with programme administrators, healthcare workers, advocates, policymakers, and funders based in the Americas, Europe, and Africa. Interviews were analysed using thematic analysis. RESULTS Divergent interests and responsibilities, coupled with power imbalances, are a primary source of ethical challenges; the uncertain risk profiles of new drugs present an additional one. Although this challenge can be partially mitigated through stringent pharmacovigilance, respondents highlighted that high-burden countries tend to lack the resources to facilitate safe implementation. Increased advocacy and community engagement are considered an ethical imperative for future TB development and implementation. CONCLUSIONS This project helps identify some of the ethical challenges of new TB technologies. It demonstrates that investigating ethical challenges through qualitative research is one way to apprehend the difficulty of implementing new TB technologies. Addressing this difficulty will require that those in positions of power reconsider their interests in relation to disempowered communities. POLICY IMPLICATIONS Efforts to build consensus regarding what values should underpin the global governance of TB research, prevention, and care are essential to facilitate the ethical implementation of new TB technologies.
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Affiliation(s)
- Renaud F Boulanger
- Centre for Applied Ethics, McGill University Health Centre, 2155 Guy Street, 2nd floor, Montreal, Quebec, H3H 2R9, Canada
| | - Ana Komparic
- Leslie Dan Faculty of Pharmacy & Joint Centre for Bioethics, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| | - Angus Dawson
- Sydney Health Ethics & Marie Bashir Institute for Infectious Diseases and Biosecurity, Level 1, Medical Foundation Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Ross E G Upshur
- Dalla Lana School of Public Health & Joint Centre for Bioethics, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Diego S Silva
- Sydney Health Ethics & Marie Bashir Institute for Infectious Diseases and Biosecurity, Level 1, Medical Foundation Building, The University of Sydney, Sydney, NSW, 2006, Australia.
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Adhikari B, Pell C, Cheah PY. Community engagement and ethical global health research. Glob Bioeth 2019; 31:1-12. [PMID: 32002019 PMCID: PMC6968663 DOI: 10.1080/11287462.2019.1703504] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022] Open
Abstract
Community engagement is increasingly recognized as a critical element of medical research, recommended by ethicists, required by research funders and advocated in ethics guidelines. The benefits of community engagement are often stressed in instrumental terms, particularly with regard to promoting recruitment and retention in studies. Less emphasis has been placed on the value of community engagement with regard to ethical good practice, with goals often implied rather than clearly articulated. This article outlines explicitly how community engagement can contribute to ethical global health research by complementing existing established requirements such as informed consent and independent ethics review. The overarching and interlinked areas are (1) respecting individuals, communities and stakeholders; (2) building trust and social relationships; (3) determining appropriate benefits; minimizing risks, burdens and exploitation; (4) supporting the consent process; (5) understanding vulnerabilities and researcher obligations; (6) gaining permissions, approvals and building legitimacy and (7) achieving recruitment and retention targets.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Kellogg College, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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49
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Dada S, McKay G, Mateus A, Lees S. Lessons learned from engaging communities for Ebola vaccine trials in Sierra Leone: reciprocity, relatability, relationships and respect (the four R's). BMC Public Health 2019; 19:1665. [PMID: 31829223 PMCID: PMC6907283 DOI: 10.1186/s12889-019-7978-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Building trust and engaging the community are important for biomedical trials. This was core to the set up and delivery of the EBOVAC-Salone and PREVAC Ebola vaccine trials in Sierra Leone during and following the 2014-2016 West African Ebola epidemic. Local community liaison teams (CLT) engaged with the community through public meetings, radio chat shows, and other activities, while a social science team (SST) assessed community members' and participants' perceptions and regularly updated the clinical team to adapt procedures to improve the acceptability and compliance of the trial. The objective of this study was to examine the community engagement (CE) program in these trials and to identify potential barriers and facilitators. METHODS Fifteen CLT and SST members participated in in-depth interviews and 23 community members attended three focus groups to discuss the Ebola vaccine trials and their experiences and perspectives of the CE activities. RESULTS A key aim of the CE program was to build trust between the community and the trial. Four main principles (the "four R's") evolved from the discussions with team members and the community that influenced this trust: reciprocity, relatability, relationships and respect. The CLT and SST ensured reciprocal communication between the trial team and the community. The CLT delivered key messages from the trial, whilst the SST completed ethnographic research in the field to uncover rumors and perceptions of the trial in the community. These ethnographic findings were shared with the CLT and addressed in targeted messaging to the community. Both the CLT and SST approached the communities in an egalitarian manner, by dressing modestly, speaking local dialects, and using relatable examples. Appreciation and understanding of the importance of interpersonal relationships and respect for the people, their customs, and traditions also played a large role in the CE program. CONCLUSION These findings provide an in-depth understanding of how interdisciplinary community liaison and social science teams can work with a clinical team to strengthen trust. The four R's suggest the ways in which trust relations are central to CE and confidence in vaccine trials, and could offer an approach to CE in vaccine trials.
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Affiliation(s)
- Sara Dada
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- The Royal Veterinary College, Royal College Street, London, NW1 0TU UK
| | - Gillian McKay
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ana Mateus
- The Royal Veterinary College, Royal College Street, London, NW1 0TU UK
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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50
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Jull JE, Davidson L, Dungan R, Nguyen T, Woodward KP, Graham ID. A review and synthesis of frameworks for engagement in health research to identify concepts of knowledge user engagement. BMC Med Res Methodol 2019; 19:211. [PMID: 31752691 PMCID: PMC6869315 DOI: 10.1186/s12874-019-0838-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Engaging those who influence, administer and/or who are active users ("knowledge users") of health care systems, as co-producers of health research, can help to ensure that research products will better address real world needs. Our aim was to identify and review frameworks of knowledge user engagement in health research in a systematic manner, and to describe the concepts comprising these frameworks. METHODS An international team sharing a common interest in knowledge user engagement in health research used a consensus-building process to: 1) agree upon criteria to identify articles, 2) screen articles to identify existing frameworks, 3) extract, analyze data, and 4) synthesize and report the concepts of knowledge user engagement described in health research frameworks. We utilized the Patient Centered Outcomes Research Institute Engagement in Health Research Literature Explorer (PCORI Explorer) as a source of articles related to engagement in health research. The search includes articles from May 1995 to December 2017. RESULTS We identified 54 articles about frameworks for knowledge user engagement in health research and report on 15 concepts. The average number of concepts reported in the 54 articles is n = 7, and ranges from n = 1 to n = 13 concepts. The most commonly reported concepts are: knowledge user - prepare, support (n = 44), relational process (n = 39), research agenda (n = 38). The least commonly reported concepts are: methodology (n = 8), methods (n = 10) and analysis (n = 18). In a comparison of articles that report how research was done (n = 26) versus how research should be done (n = 28), articles about how research was done report concepts more often and have a higher average number of concepts (n = 8 of 15) in comparison to articles about how research should be done (n = 6 of 15). The exception is the concept "evaluate" and that is more often reported in articles that describe how research should be done. CONCLUSIONS We propose that research teams 1) consider engagement with the 15 concepts as fluid, and 2) consider a form of partnered negotiation that takes place through all phases of research to identify and use concepts appropriate to their team needs. There is a need for further work to understand concepts for knowledge user engagement.
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Affiliation(s)
- Janet E Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street, Louise D. Acton Building, Kingston, Ontario, Canada. .,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.
| | - Laurie Davidson
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Rachel Dungan
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Tram Nguyen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Krista P Woodward
- Public and Patient Engagement Department, Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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