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Robinson JA. Editorial: Research priorities concerning formal and informal learning in low- and middle-income countries. Front Psychol 2024; 15:1391089. [PMID: 38566945 PMCID: PMC10986789 DOI: 10.3389/fpsyg.2024.1391089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Tiruneh G, Yilma M, Wakuma B, Abdisa E, Bayisa L, Nichols M, Bedeker A, Tiffin N. Compliance with research ethics in epidemiological studies targeted to conflict-affected areas in Western Ethiopia: validity of informed consent (VIC) by information comprehension and voluntariness (ICV). BMC Med Ethics 2024; 25:9. [PMID: 38238678 PMCID: PMC10795316 DOI: 10.1186/s12910-024-01003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The conduct of research is critical to advancing human health. However, there are issues of ethical concern specific to the design and conduct of research in conflict settings. Conflict-affected countries often lack strong platform to support technical guidance and monitoring of research ethics, which may lead to the use of divergent ethical standards some of which are poorly elaborated and loosely enforced. Despite the growing concern about ethical issues in research, there is a dearth of information about ethical compliance in conflict areas. Valid and ethically informed decision-making is a premier pact with research participants in settling possible ethical issues before commencing the research, which is ensured by gaining informed consent from prospective participants of the research. AIMS This research aimed to explore compliance with research ethics and consent validity in community-based epidemiological research conducted previously. METHODS Research participants were recruited in the western part of Ethiopia in three districts subjected to conflicts. A community-based cross-sectional study design was utilized, and 338 residents were enrolled as study participants. All participants had previously been enrolled as research participants in epidemiological studies. Data was collected using a questionnaire that was pilot-tested before the commencement of the main data collection. The questionnaire focused on participants' experiences of the informed consent process followed when they were recruited for an epidemiological study and covered themes such as essential information provided, level of comprehension, and voluntarism of consent. RESULTS Over half of the study participants, 176 (52%), were not provided with essential information before consenting. And 135 (40%) of them did not comprehend the information provided to them. One hundred and ninety (56%) participants freely and voluntarily agreed to partake in one of these epidemiological studies, with over a quarter (97; 28.7%) of them reporting they were subjected to undue influence. Written consent was obtained from only 32 (9.4%) of the participants.
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Affiliation(s)
- Gemechu Tiruneh
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Mekdes Yilma
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Michelle Nichols
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Anja Bedeker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Nicki Tiffin
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Basukala S, Shrestha O, Thapa N, Karki S, Pandit A, Thapa BB, Thapa A. How informed is informed consent?-Evaluating the quality of informed consent among surgical patients in a tertiary care hospital in Nepal. PLoS One 2023; 18:e0288074. [PMID: 37428760 DOI: 10.1371/journal.pone.0288074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Informed consent-taking is a part of clinical practice that has ethical and legal aspects attached to it. This protects the autonomy of the patients by providing complete information regarding the rationale, modality, potential risks, benefits, and alternatives of the planned procedure to the patients. This enables the patients to make the right decision for themselves and their care. This study aims to find out if the informed consent-taking process has ensured the active participation of the patients or the next of kin in the decision-making. MATERIALS AND METHODS This is a prospective cross-sectional study conducted in a military healthcare institution among patients undergoing major surgical procedures from July 2022 to October 2022. Ethical clearance was obtained before the commencement of this study. A structured questionnaire was prepared, and the collected data was refined in Excel and imported into SPSS for analysis. RESULTS A total of 350 individuals of mean age 47.95 ± 16.057 years were part of this study. The majority of the respondents were married, literate, and family by beneficiary category. All of the respondents received and signed the consent form. About 77% of the respondents read it completely, and 95.4% of them reported that it was understandable. The majority of the patients did not know who was going to perform the surgery, the alternatives to the planned treatment, the benefits of the surgery, or the outcome of non-treatment. On the patient satisfaction scale, 16.28% of the participants agreed that they were satisfied with the informed consent-taking process. CONCLUSION Deficiencies in the informed consent-taking process were the lack of dissemination of adequate information on the nature, duration, pros and cons, post-operative state, and alternative of the planned procedure. A well-structured format of the consent form that is specific to a particular procedure should be adopted, and various alternatives to it must be disseminated to the patient or the next of kin to improve the quality of the informed consent-taking process.
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Affiliation(s)
- Sunil Basukala
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Oshan Shrestha
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Niranjan Thapa
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sagun Karki
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ayushma Pandit
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Bikash Bikram Thapa
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Anup Thapa
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Abstract
An Ethics Committee (EC) is an independent body composed of members with expertise in both scientific and nonscientific arenas which functions to ensure the protection of human rights and the well-being of research subjects based on six basic principles of autonomy, justice, beneficence, nonmaleficence, confidentiality, and honesty. MEDLINE, Scopus, and Directory of Open Access Journals were searched for studies relevant to this topic. This review is focused on the types of research articles that need EC approval, the submission process, and exemptions. It further highlights the constitution of ECs, their duties, the review process, and the assessment of the risk-benefit of the proposed research including privacy issues. It's pertinent for academicians and researchers to abide by the rules and regulations put forth by ECs for upholding of human rights and protecting research subjects primarily, as well as avoiding other issues like retraction of publications. Despite various issues of cost, backlogs, lack of expertise, lesser representation of laypersons, need for multiple approvals for multisite projects, conflicts of interest, and monitoring of ongoing research for the continued safety of participants, the ECs form the central force in regulating research and participant safety. Data safety and monitoring boards complement the ECs for carrying out continuous monitoring for better protection of research subjects. The establishment of ECs has ensured safe study designs, the safety of human subjects along with the protection of researchers from before the initiation until the completion of a study.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India.
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
| | - Birzhan Seiil
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Gondwe MJ, Toto NM, Gunda C, Gmeiner M, MacCormick IJC, Lalloo D, Parker M, Desmond N. Guardians and research staff experiences and views about the consent process in hospital-based paediatric research studies in urban Malawi: A qualitative study. BMC Med Ethics 2022; 23:125. [PMID: 36471294 PMCID: PMC9720930 DOI: 10.1186/s12910-022-00865-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obtaining consent has become a standard way of respecting the patient's rights and autonomy in clinical research. Ethical guidelines recommend that the child's parent/s or authorised legal guardian provides informed consent for their child's participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child's illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will assist in developing appropriate consent guidelines. METHODS We conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants' views about informed consent processes. Data analysis was facilitated by NVIVO 11 software. RESULTS All participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting. CONCLUSION The health care context, culture and research process influenced participants' understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent. Trial registration Not applicable.
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Affiliation(s)
- Mtisunge Joshua Gondwe
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neema Mtunthama Toto
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Charity Gunda
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Markus Gmeiner
- grid.10417.330000 0004 0444 9382Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ian J. C. MacCormick
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David Lalloo
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Parker
- grid.4991.50000 0004 1936 8948The Ethox Centre, University of Oxford, Oxford, UK
| | - Nicola Desmond
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
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Gildner TE, Eick GN, Schneider AL, Madimenos FC, Snodgrass JJ. After Theranos: Using point-of-care testing to advance measures of health biomarkers in human biology research. Am J Hum Biol 2022; 34:e23689. [PMID: 34669210 DOI: 10.1002/ajhb.23689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The rise and fall of the health technology startup Theranos is emblematic of the promise and peril of point-of-care testing (POCT). Instruments that deliver immediate results from minimally invasive samples at the location of collection can provide powerful tools to deliver health data in clinical and public health contexts. Yet, POCT availability is driven largely by market interests, which limits the development of inexpensive tests for diverse health conditions that can be used in resource-limited settings. These constraints, combined with complex regulatory hurdles and substantial ethical challenges, have contributed to the underutilization of POCT in human biology research. METHODS We evaluate current POCT capabilities and limitations, discuss promising applications for POCT devices in resource-limited settings, and discuss the future of POCT. RESULTS As evidenced by publication trends, POCT platforms have rapidly advanced in recent years, gaining traction among clinicians and health researchers. We highlight POCT devices of potential interest to population-based researchers and present specific examples of POCT applications in human biology research. CONCLUSIONS Several barriers can limit POCT applications, including cost, lack of regulatory approval for non-clinical use, requirements for expensive equipment, and the dearth of validation in remote field conditions. Despite these issues, we see immense potential for emerging POCT technology capable of analyzing new sample types and used in conjunction with increasingly common technology (e.g., smart phones). We argue that the fallout from Theranos may ultimately provide an opportunity to advance POCT, leading to more ethical data collection and novel opportunities in human biology research.
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Affiliation(s)
- Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Alaina L Schneider
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA
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Regmi PR, Dhakal Adhikari S, Aryal N, Wasti SP, van Teijlingen E. Fear, Stigma and Othering: The Impact of COVID-19 Rumours on Returnee Migrants and Muslim Populations of Nepal. IJERPH 2022; 19:ijerph19158986. [PMID: 35897356 PMCID: PMC9331294 DOI: 10.3390/ijerph19158986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
The paper explores how COVID-19-related moral panics have led to fear and othering practices among returnee Nepalese migrants from India and Muslims living in Nepal. This qualitative study included in-depth interviews with 15 returnee migrants, 15 Muslims from Kapilvastu and Banke districts of Nepal, and eight interviews with media and health professionals, and representatives from migration organisations. Four themes emerged from our data analysis: (1) rumours and mis/disinformation; (2) impact of rumours on marginalised groups (with three sub-themes: (i) perceived fear; (ii) othering practices; (iii) health and social impact); (3) resistance; and (4) institutional response against rumours. Findings suggest that rumours and misinformation were fuelled by various media platforms, especially social media (e.g., Facebook, YouTube) during the initial months of the lockdown. This created a moral panic which led to returnee migrants and Muslim populations experiencing fear and social isolation. Resistance and effective institutional responses to dispel rumours were limited. A key contribution of the paper is to highlight the lived experiences of COVID-19 related rumours on marginalised groups. The paper argues that there is a need for clear government action using health promotion messages to tackle rumours (health-related or otherwise), mis/disinformation and mitigating the consequences (hatred and tensions) at the community level.
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Affiliation(s)
- Pramod R. Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK; (S.D.A.); (N.A.); (E.v.T.)
- Correspondence:
| | - Shovita Dhakal Adhikari
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK; (S.D.A.); (N.A.); (E.v.T.)
| | - Nirmal Aryal
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK; (S.D.A.); (N.A.); (E.v.T.)
| | - Sharada P. Wasti
- School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK; (S.D.A.); (N.A.); (E.v.T.)
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Regmi PR, Aryal N, van Teijlingen E, Simkhada P, Adhikary P. Nepali Migrant Workers and the Need for Pre-departure Training on Mental Health: A Qualitative Study. J Immigr Minor Health 2021; 22:973-981. [PMID: 31853806 PMCID: PMC7441079 DOI: 10.1007/s10903-019-00960-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Every year around 1000 Nepali migrant workers die abroad. Every one in three females and one in ten males commit suicide, reflecting a high mental health risk among Nepali migrant workers. This study aims to identify triggers of mental ill-health among Nepali migrant workers and their perceptions on the need of mental health components in the pre-departure orientation programme. We conducted five focus group discussions (FGD) and seven in-depth interviews with Nepali migrant workers and eight semi-structured interviews with stakeholders working for migrants. Participants were invited at Kathmandu’s international airport on return from abroad, at hotels or bus stations near the airport, through organisations working for migrants, and participants’ network. All FGD and interviews were conducted in Kathmandu and audio recorded, transcribed and translated into English. Data were analyzed thematically. High expectations from families back home, an unfair treatment at work, poor arrangements of accommodation, loneliness and poor social life abroad were frequently reported factors for poor mental health. Access to mental health services abroad by Nepali migrant was also poor. We found little on mental health in the pre-departure orientation. We need to improve our knowledge of mental health risks to provide better, more focused and more up-to-date pre-departure training to new migrant workers leaving Nepal.
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Affiliation(s)
- Pramod R Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth House (B220), Bournemouth, BH1 3LH, UK.
| | - Nirmal Aryal
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth House (B220), Bournemouth, BH1 3LH, UK
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth House (B220), Bournemouth, BH1 3LH, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
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Patterson JK, Pant S, Jones DF, Taha S, Jones MS, Bauserman MS, Montaldo P, Bose CL, Thayyil S. Informed consent rates for neonatal randomized controlled trials in low- and lower middle-income versus high-income countries: A systematic review. PLoS One 2021; 16:e0248263. [PMID: 33690703 PMCID: PMC7943024 DOI: 10.1371/journal.pone.0248263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Legal, ethical, and regulatory requirements of medical research uniformly call for informed consent. We aimed to characterize and compare consent rates for neonatal randomized controlled trials in low- and lower middle-income countries versus high-income countries, and to evaluate the influence of study characteristics on consent rates. METHODS In this systematic review, we searched MEDLINE, EMBASE and Cochrane for randomized controlled trials of neonatal interventions in low- and lower middle-income countries or high-income countries published 01/01/2013 to 01/04/2018. Our primary outcome was consent rate, the proportion of eligible participants who consented amongst those approached, extracted from the article or email with the author. Using a generalised linear model for fractional dependent variables, we analysed the odds of consenting in low- and lower middle-income countries versus high-income countries across control types and interventions. FINDINGS We screened 3523 articles, yielding 300 eligible randomized controlled trials with consent rates available for 135 low- and lower middle-income country trials and 65 high-income country trials. Median consent rates were higher for low- and lower middle-income countries (95.6%; interquartile range (IQR) 88.2-98.9) than high-income countries (82.7%; IQR 68.6-93.0; p<0.001). In adjusted regression analysis comparing low- and lower middle-income countries to high-income countries, the odds of consent for no placebo-drug/nutrition trials was 3.67 (95% Confidence Interval (CI) 1.87-7.19; p = 0.0002) and 6.40 (95%CI 3.32-12.34; p<0.0001) for placebo-drug/nutrition trials. CONCLUSION Neonatal randomized controlled trials in low- and lower middle-income countries report consistently higher consent rates compared to high-income country trials. Our study is limited by the overrepresentation of India among randomized controlled trials in low- and lower middle-income countries. This study raises serious concerns about the adequacy of protections for highly vulnerable populations recruited to clinical trials in low- and lower middle-income countries.
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Affiliation(s)
- Jacquelyn K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
| | - Denise F. Jones
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Syed Taha
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
| | - Michael S. Jones
- Department of Agricultural and Resource Economics, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Melissa S. Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
| | - Carl L. Bose
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
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Ngwenya N, Luthuli M, Gunda R, Gumede NA, Adeagbo O, Nkosi B, Gareta D, Koole O, Siedner M, Wong EB, Seeley J. Participant understanding of informed consent in a multidisease community-based health screening and biobank platform in rural South Africa. Int Health 2020; 12:560-566. [PMID: 33165556 PMCID: PMC7651191 DOI: 10.1093/inthealth/ihaa072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/31/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In low- and middle-income settings, obtaining informed consent for biobanking may be complicated by socio-economic vulnerability and context-specific power dynamics. We explored participants experiences and perceptions of the research objectives in a community-based multidisease screening and biospecimen collection platform in rural KwaZulu-Natal, South Africa. METHODS We undertook semi-structured in-depth interviews to assess participant understanding of the informed consent, research objectives and motivation for participation. RESULTS Thirty-nine people participated (individuals who participated in screening/biospecimen collection and those who did not and members of the research team). Some participants said they understood the information shared with them. Some said they participated due to the perceived benefits of the reimbursement and convenience of free healthcare. Most who did not participate said it was due to logistical rather than ethical concerns. None of the participants recalled aspects of biobanking and genetics from the consent process. CONCLUSIONS Although most people understood the study objectives, we observed challenges to identifying language appropriate to explain biobanking and genetic testing to our target population. Engagement with communities to adopt contextually relevant terminologies that participants can understand is crucial. Researchers need to be mindful of the impact of communities' socio-economic status and how compensation can be potentially coercive.
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Affiliation(s)
- Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Manono Luthuli
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | - Oluwafemi Adeagbo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
PurposeIt is widely believed that transgender individuals in Nepal inject silicone for face and body manipulation, a phenomenon thought to be common among transgender individuals globally. Therefore, this qualitative study conducted in Nepal explored: (1) awareness of silicone use and sources of information; (2) reasons for using silicone; (3) notion of cost and quality of these procedures; (4) reported negative aspects, including side effects and (5) health seeking behaviors of Nepali transgender women.Design/methodology/approachThe authors carried out eight focus group discussions (FGDs) with transgender women at four different districts of Nepal, five in the capital Kathmandu and three in different rural areas. We also interviewed three transgender women who preferred not to participate in the FGD but were happy to be interviewed separately. Similarly, six interviews with stakeholders working for sexual and gender minority populations were also conducted.FindingsMost FGD participants were young (mean age 23.06 ± 3.9 years) and the majority (55%; n = 34) completed grade six to high school level. Peer networks of transgender people and the Internet were the more popular sources of information about silicone. The decision to use silicone was largely influenced by the desire to look beautiful and more feminine. Often they appear not to follow the recommended procedures for silicone use. Their health seeking behavior regarding side effects or complications of these procedures was very poor.Originality/valueFindings reflect that targeted interventions aimed at transgender individuals should educate them on the use of silicone, as well as explore safe and affordable approaches to meet gender-related appearance needs of Nepali transgender people.
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Aryal N, Regmi PR, van Teijlingen E, Trenoweth S, Adhikary P, Simkhada P. The Impact of Spousal Migration on the Mental Health of Nepali Women: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:E1292. [PMID: 32079358 PMCID: PMC7068335 DOI: 10.3390/ijerph17041292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/04/2022]
Abstract
Spousal separation, lack of companionship, and increased household responsibilities may trigger mental health problems in left-behind female spouses of migrant workers. This study aimed to examine mental ill-health risk in the left-behind female spouses of international migrant workers in Nepal. A cross-sectional survey was carried out in the Nawalparasi district. Study areas were purposively chosen; however, participants were randomly selected. Nepali versions of the 12-item General Health Questionnaire (GHQ), Beck Depression Inventory (BDI), and Connor-Davidson Resilience Scale (CD-RISC) were used. Mental ill-health risk was prevalent in 3.1% of the participants as determined by GHQ. BDI identified mild or moderate depression in 6.5% of the participants with no one having severe depression. In bivariate analysis, a high frequency of communication with the husband was associated with lower mental ill-health risk and depression, as well as increasing resilience. Reduced return intervals of husbands and a high frequency of remittance were also associated with a low GHQ score. In a multiple regression model, adjusting for potential confounding variables, participants who communicated with their husbands at least once a day had a greater mean CD-RISC score (i.e., high resilience against mental ill-health risk) compared to those who did so at least once a week; a mean difference of 3.6 (95% CI 0.4 to 6.9), P = 0.03. To conclude, a low mental ill-health risk was found in the female spouses of migrants.
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Affiliation(s)
- Nirmal Aryal
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
| | - Pramod R. Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
- Chitwan Medical College, Tribhuvan University, Bharatpur P.O. Box No. 42, Nepal
- Datta Meghe Institute of Medical Sciences, Wardha 442001, India
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
- Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kathmandu P.O. Box No. 15201, Nepal;
- Nobel College, Pokhara University, Kathmandu GPO 10420, Nepal
| | - Steven Trenoweth
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
| | - Pratik Adhikary
- School of Public Health, University of California, Berkeley, CA 94720-7360, USA;
- Green Tara Nepal, Kathmandu GPO 9874, Nepal
| | - Padam Simkhada
- Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kathmandu P.O. Box No. 15201, Nepal;
- Nobel College, Pokhara University, Kathmandu GPO 10420, Nepal
- School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
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Abstract
OBJECTIVES There is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue. SETTING The study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski. DESIGN AND PARTICIPANTS This qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017. RESULTS Our participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use. CONCLUSION Hormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors' prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices.
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Affiliation(s)
- Pramod R Regmi
- Nursing and Clinical Sciences, Bournemouth University, Bournemouth, UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK
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Regmi PR, Teijlingen EV, Mahato P, Aryal N, Jadhav N, Simkhada P, Zahiruddin QS, Gaidhane A. The Health of Nepali Migrants in India: A Qualitative Study of Lifestyles and Risks. Int J Environ Res Public Health 2019; 16:E3655. [PMID: 31569445 DOI: 10.3390/ijerph16193655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Background: Most health research on Nepali migrant workers in India is on sexual health, whilst work, lifestyle and health care access issues are under-researched. Methods: The qualitative study was carried out in two cities of Maharashtra State in 2017. Twelve focus group discussions (FGDs) and five in-depth interviews were conducted with Nepali male and female migrant workers. Similarly, eight interviews were conducted with stakeholders, mostly representatives of organisations working for Nepali migrants in India using social capital as a theoretical foundation. Results: Five main themes emerged from the analysis: (i) accommodation; (ii) lifestyle, networking and risk-taking behaviours; (iii) work environment; (iv) support from local organisations; and (v) health service utilisation. Lack of basic amenities in accommodation, work-related hazards such as lack of safety measures at work or safety training, reluctance of employers to organise treatment for work-related accidents, occupational health issues such as long working hours, high workload, no/limited free time, discrimination by co-workers were identified as key problems. Nepali migrants have limited access to health care facilities due to their inability to prove their identity. Health system of India also discriminates as some treatment is restricted to Indian nationals. The strength of this study is the depth it offers, its limitations includes a lack of generalizability, the latter is a generic issue in such qualitative research. Conclusion: This study suggests risks to Nepali migrant workers’ health in India range from accommodation to workplace and from their own precarious lifestyle habit to limited access to health care facilities. We must conduct a quantitative study on a larger population to establish the prevalence of the above mentioned issues and risks. Furthermore, the effectiveness of Nepali migrant support organisations in mitigating these risks needs to be researched.
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Petrova M, Barclay S. Research approvals iceberg: how a 'low-key' study in England needed 89 professionals to approve it and how we can do better. BMC Med Ethics 2019; 20:7. [PMID: 30678668 PMCID: PMC6346542 DOI: 10.1186/s12910-018-0339-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The red tape and delays around research ethics and governance approvals frequently frustrate researchers yet, as the lesser of two evils, are largely accepted as unavoidable. Here we quantify aspects of the research ethics and governance approvals for one interview- and questionnaire-based study conducted in England which used the National Health Service (NHS) procedures and the electronic Integrated Research Application System (IRAS). We demonstrate the enormous impact of existing approvals processes on costs of studies, including opportunity costs to focus on the substantive research, and suggest directions for radical system change. MAIN TEXT We have recorded 491 exchanges with 89 individuals involved in research ethics and governance approvals, generating 193 pages of email text excluding attachments. These are conservative estimates (e.g. only records of the research associate were used). The exchanges were conducted outside IRAS, expected to be the platform where all necessary documents are provided and questions addressed. Importantly, the figures exclude the actual work of preparing the ethics documentation (such as the ethics application, information sheets and consent forms). We propose six areas of work to enable system change: 1. Support the development of a broad range of customised research ethics and governance templates to complement generic, typically clinical trials orientated, ones; 2. Develop more sophisticated and flexible frameworks for study classification; 3. Link with associated processes for assessment, feedback, monitoring and reporting, such as ones involving funders and patient and public involvement groups; 4. Invest in a new generation IT infrastructure; 5. Enhance system capacity through increasing online reviewer participation and training; and 6. Encourage researchers to quantify the approvals processes for their studies. CONCLUSION Ethics and governance approvals are burdensome for historical reasons and not because of the nature of the task. There are many opportunities to improve their efficiency and analytic depth in an age of innovation, increased connectivity and distributed working. If we continue to work under current systems, we are perpetuating, paradoxically, an unethical system of research approvals by virtue of its wastefulness and impoverished ethical debate.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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Colom M, Rohloff P. Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review. BMJ Paediatr Open 2018; 2:e000298. [PMID: 30613801 PMCID: PMC6307601 DOI: 10.1136/bmjpo-2018-000298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Conducting research with children in low/middle-income countries (LMIC) requires consideration of socioeconomic inequalities and cultural and linguistic differences. Our objective was to survey the literature on informed consent in paediatric LMIC research, assessing for practical guidance for culturally and linguistically appropriate procedures. METHODS We conducted a scoping review on informed consent in paediatric LMIC research searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were published in English, from any date range, of any study design or format. RESULTS The search identified 2027 references, of which 50 were included in the analysis following full-text review. Reviewed guidelines emphasised individual, informed and voluntary consent from parents and caregivers. Reviewed articles provided detailed practical guidance on adapting these guiding principles to LMIC settings, including considerations for community engagement, verbal or other alternative consent procedures for low-literacy settings or less commonly spoken languages and guarding against therapeutic misconception by caregivers. There was uncertainty, however, on how to best protect individual autonomy, especially when influenced by gender dynamics, leadership hierarchies or the social status of researchers themselves. There was, furthermore, limited research discussing the special case of research involving adolescents or of procedures for documenting assent by participating children. CONCLUSIONS A scoping review of paediatric research in LMICs revealed substantial guidance on several features of culturally appropriate informed consent. However, additional research and guidance is needed, especially in the areas of gender imbalances, research with adolescents and children's own assent to participate in research.
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Affiliation(s)
- Marcela Colom
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Pineda C, Sandoval H. Consent for publishing case reports in Rheumatology. Reumatol Clin (Engl Ed) 2018; 14:181-182. [PMID: 30075945 DOI: 10.1016/j.reuma.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Carlos Pineda
- División de Enfermedades Musculoesqueléticas y Reumáticas. Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra. Ciudad de México, México.
| | - Hugo Sandoval
- División de Enfermedades Musculoesqueléticas y Reumáticas. Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra. Ciudad de México, México
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Craig SR, Lahey T, Dixit A, Fordham von Reyn C. Altruism, Scepticism, and collective decision-making in foreign-born U.S. residents in a tuberculosis vaccine trial. BMC Public Health 2018; 18:535. [PMID: 29685114 PMCID: PMC5914029 DOI: 10.1186/s12889-018-5460-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15-20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development. METHODS One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States - a poorly studied population - decide to participate, or not, in clinical trials. RESULTS We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how 'informed consent' can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making. CONCLUSIONS This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation. TRIAL REGISTRATION NCT02063555 .
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Affiliation(s)
- Sienna R Craig
- Department of Anthropology, Dartmouth College, 6047 Silsby Hall, Hanover, NH, 03755, USA.
| | - Timothy Lahey
- Geisel School of Medicine, Dartmouth College, Hanover, USA
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