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Richardson EZ, Bandewar SV, Boulanger RF, Mehta R, Lin T, Vincent R, Molyneux S, Goldstone A, Lavery JV. Addressing diversity and complexity in the community engagement literature: The rationale for a realist review. Wellcome Open Res 2021; 5:1. [PMID: 34632082 PMCID: PMC8474101 DOI: 10.12688/wellcomeopenres.15525.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
In this research note we reflect on our failed attempt to synthesize the community engagement literature through a standard systematic review and explain our rationale for now embarking on a realist synthesis of community engagement in global health research. We believe this paper will be helpful for many who grapple with the lack of clarity about community engagement's core elements and mechanisms.
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Affiliation(s)
- Emma Z.L. Richardson
- Centre for Ethical, Social and Cultural Risk, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
| | - Sunita V.S. Bandewar
- Health, Ethics and Law Institute, 422 Veer Savarkar Marg, Prabhadevi, Mumbai, 400 025, India
- Vidhyak Trust, C-5, Mantri Avenue, Pune, MH, 411 008, India
| | - Renaud F. Boulanger
- Centre for Applied Ethics, McGill University, 2155 Guy Street, 223.08, Montréal, H3H 2R9, Canada
| | - Rukshan Mehta
- Nutrition and Health Sciences PhD Program, Rollins School of Public Health and Laney Graduate School, Emory University, 1518 Clifton Road NE, CNR, Atlanta, GA, 30322, USA
| | - Tinya Lin
- Department of Obstetrics and Gynecology, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Robin Vincent
- Independent researcher, Sheffield, UK
- REAL, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OS1 3SY, UK
| | - Sassy Molyneux
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Ethox Centre, Department of Public Health,, Oxford University, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Arisa Goldstone
- Centre for Ethical, Social and Cultural Risk, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health & Center for Ethics, Emory University, 1518 Clifton Road NE, CNR 5007, Atlanta, GA, 30322, USA
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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. J Bioeth Inq 2020; 17:65-73. [PMID: 31858386 DOI: 10.1007/s11673-019-09954-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Boulanger RF, García-García L, Ferreyra-Reyes L, Canizales-Quintero S, Palacios-Martínez M, Ponce-de-Leon A, Lavery JV. Integrating tuberculosis research with public health infrastructure: Lessons on community engagement from Orizaba, Mexico. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13058.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Orizaba Health Region, in Veracruz, Mexico, has hosted the research programme of the Consorcio Mexicano contra la Tuberculosis since 1995. Methods: The objective of this retrospective case study conducted in 2009 was to describe and explain the evolution and outcomes of the stakeholder and community engagement activities of the Consorcio. Recorded interviews and focus groups were coded to identify major themes related to the success of stakeholder and community engagement activities. Results: The Consorcio successfully managed to embed its research program into the local public health infrastructure. This integration was possible because the core research team tailored its engagement strategy to the local context, while focusing on a large spectrum of stakeholders with various positions of authority and responsibility. The overall engagement strategy can be described as a three-pronged endeavor: building a “coalition” with local authorities, nurturing “camaraderie” with community health workers, and striving to be “present” in the lives of community members and participants. Conclusions: The Consorcio’s efforts teach valuable lessons on how to approach stakeholder and community engagement in tuberculosis (TB) research, particularly in developing countries. Furthermore, the health outcomes reveal stakeholder and community engagement as a potentially under-tapped tool to promote disease control.
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Richardson EZ, Bandewar SV, Boulanger RF, Mehta R, Lin T, Vincent R, Molyneux S, Goldstone A, Lavery JV. Addressing diversity and complexity in the community engagement literature: The rationale for a realist review. Wellcome Open Res 2020; 5:1. [PMID: 34632082 PMCID: PMC8474101 DOI: 10.12688/wellcomeopenres.15525.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 09/22/2023] Open
Abstract
In this research note we reflect on our failed attempt to synthesize the community engagement literature through a standard systematic review and explain our rationale for now embarking on a realist synthesis of community engagement in global health research. We believe this paper will be helpful for many who grapple with the lack of clarity about community engagement's core elements and mechanisms.
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Affiliation(s)
- Emma Z.L. Richardson
- Centre for Ethical, Social and Cultural Risk, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
| | - Sunita V.S. Bandewar
- Health, Ethics and Law Institute, 422 Veer Savarkar Marg, Prabhadevi, Mumbai, 400 025, India
- Vidhyak Trust, C-5, Mantri Avenue, Pune, MH, 411 008, India
| | - Renaud F. Boulanger
- Centre for Applied Ethics, McGill University, 2155 Guy Street, 223.08, Montréal, H3H 2R9, Canada
| | - Rukshan Mehta
- Nutrition and Health Sciences PhD Program, Rollins School of Public Health and Laney Graduate School, Emory University, 1518 Clifton Road NE, CNR, Atlanta, GA, 30322, USA
| | - Tinya Lin
- Department of Obstetrics and Gynecology, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Robin Vincent
- Independent researcher, Sheffield, UK
- REAL, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OS1 3SY, UK
| | - Sassy Molyneux
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Ethox Centre, Department of Public Health,, Oxford University, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Arisa Goldstone
- Centre for Ethical, Social and Cultural Risk, Li Ka Shing Knowledge Institute, Unity Health, 250 Yonge Street, Suite 600, Toronto, Ontario, M5B 2L7, Canada
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health & Center for Ethics, Emory University, 1518 Clifton Road NE, CNR 5007, Atlanta, GA, 30322, USA
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Komparic A, Dawson A, Boulanger RF, Upshur REG, Silva DS. A failure in solidarity: Ethical challenges in the development and implementation of new tuberculosis technologies. Bioethics 2019; 33:557-567. [PMID: 30681168 PMCID: PMC6563531 DOI: 10.1111/bioe.12554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/09/2018] [Accepted: 10/30/2018] [Indexed: 06/07/2023]
Abstract
Prominent tuberculosis (TB) actors are invoking solidarity to motivate and justify collective action to address TB, including through intensified development and implementation (D&I) of technologies such as drugs and diagnostics. We characterize the ethical challenges associated with D&I of new TB technologies by drawing on stakeholder perspectives from 23 key informant interviews and we articulate the ethical implications of solidarity for TB technology D&I. The fundamental ethical issue facing TB technological D&I is a failure within and beyond the TB community to stand in solidarity with persons with TB in addressing the complex sociopolitical contexts of technological D&I. The failure in solidarity relates to two further ethical challenges raised by respondents: skewed power dynamics that hinder D&I and uncertainties around weighing risks and benefits associated with new technologies. Respondents identified advocacy and participatory research practices as necessary to address such challenges and to motivate sustained collective action to accelerate toward TB elimination. We present the first empirical examination of bioethical accounts of solidarity in public and global health. Our study suggests that solidarity allows us better to understand and address the ethical challenges that arrest the D&I of new TB technologies. Solidarity lends credence to policies and practices that address the relational nature of illness and health through collective action.
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Affiliation(s)
- Ana Komparic
- Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoOntarioCanada
| | - Angus Dawson
- School of Public HealthUniversity of SydneySydneyNSWAustralia
| | | | - Ross E. G. Upshur
- University of Toronto Dalla Lana School of Public HealthTorontoOntarioCanada
| | - Diego S. Silva
- Faculty of Health SciencesSimon Fraser UniverstiyBurnabyBritish ColumbiaCanada
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Cochrane L, Boulanger RF, Sheikheldin GH, Song G. The Case for Local Ethics Oversight in International Development Research. bioethics 2019. [DOI: 10.7202/1058307ar] [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] [Indexed: 11/17/2022] Open
Abstract
This paper argues that international development research should be submitted to the oversight of research ethics committees from the countries where data will be collected. This includes research conducted by individuals who may fall outside the jurisdictions of most ethics guidelines or policies, such as individuals contracted by non-governmental organizations. The argument is grounded in an understanding of social justice that recognizes that not seeking local ethics approval can be an affront to the decolonization movement, and may lead to significant direct harms to participants. Local ethics oversight can help ensure projects appropriately take into consideration local laws, regulations, priorities and context. For example, a local research ethics committee may be in a better position than a foreign one to assess whether any given proposed project carries context-specific risks. In addition, submitting to a local research ethics committee is to acknowledge the legitimacy of local authorities, thereby taking a stance against the history of colonizing disempowerment. Local oversight is a mechanism to increase the accountability of researchers working abroad: if respect for local authority and tailoring to local context are to be upheld, there must be mechanisms to ensure that research that does not meet these requirements does not proceed. Objections based on the limited oversight capacity in some countries and on concerns related to the politicization of the review process are discussed. Finally, the roles and responsibilities of the various stakeholders in the implementation of greater local ethics oversight are laid out.
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Affiliation(s)
| | | | - Gussai H Sheikheldin
- Research Fellow, Science, Technology and Innovation Policy Research Organization, Tanzania
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Boulanger RF, Hunt MR, Benatar SR. Where Caring Is Sharing: Evolving Ethical Considerations in Tuberculosis Prevention Among Healthcare Workers. Clin Infect Dis 2017; 62 Suppl 3:S268-74. [PMID: 27118857 DOI: 10.1093/cid/ciw013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In many settings, the dedication of healthcare workers (HCWs) to the treatment of tuberculosis exposes them to serious risks. Current ethical considerations related to tuberculosis prevention in HCWs involve the threat posed by comorbidities, issues of power and space, the implications of intersectoral collaborations, (de)professionalization, just remuneration, the duty to care, and involvement in research. Emerging ethical considerations include mandatory vaccination and the use of geolocalization services and information technologies. The following exploration of these various ethical considerations demonstrates that the language of ethics can fruitfully be deployed to shed new light on policies that have repercussions on the lives of HCWs in underresourced settings. The language of ethics can help responsible parties get a clearer sense of what they owe HCWs, particularly when these individuals are poorly compensated, and it shows that it is essential that HCWs' contribution be acknowledged through a shared commitment to alleviate ethically problematic aspects of the environments within which they provide care. For this reason, there is a strong case for the community of bioethicists to continue to take greater interest both in the micro-level (eg, patient-provider interactions) and macro-level (eg, injustices that occur as a result of the world order) issues that put HCWs working in areas with high tuberculosis prevalence in ethically untenable positions. Ultimately, appropriate responses to the various ethical considerations explored here must vary based on the setting, but, as this article shows, they require thoughtful reflection and courageous action on the part of governments, policy makers, and managers responsible for national responses to the tuberculosis epidemic.
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Affiliation(s)
- Renaud F Boulanger
- Advisory Committee on Research Ethics, International Development Research Centre, Ottawa, Ontario Biomedical Ethics Unit, McGill University Centre for Interdisciplinary Research in Rehabilitation
| | - Matthew R Hunt
- Centre for Interdisciplinary Research in Rehabilitation School of Physical and Occupational Therapy, McGill University, Montreal, Québec
| | - Solomon R Benatar
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada Bioethics Centre, Faculty of Health Sciences, University of Cape Town, South Africa
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Affiliation(s)
- Sunisha Neupane
- a International Development Research Centre and École de santé publique de l'Université de Montréal
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9
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Hunt M, Tansey CM, Anderson J, Boulanger RF, Eckenwiler L, Pringle J, Schwartz L. The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members. PLoS One 2016; 11:e0157142. [PMID: 27327165 PMCID: PMC4915681 DOI: 10.1371/journal.pone.0157142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/25/2016] [Indexed: 11/22/2022] Open
Abstract
Background Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries. Methods We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques. Results Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process. Conclusion Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough.
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Affiliation(s)
- Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Catherine M. Tansey
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - James Anderson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Renaud F. Boulanger
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Lisa Eckenwiler
- Department of Philosophy & Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, United States of America
| | - John Pringle
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Boulanger RF, Ibarra K, Wagner F. A road map to building ethics capacity in the home and community care and support services sector. Healthc Q 2014; 17:48-53. [PMID: 24844721 DOI: 10.12927/hcq.2014.23778] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are unique ethical issues that arise in home and community care because of its locus and range of service. However, the academic literature on ethical issues in the sector of home and community care and support remains minimal. Opportunities for education, collaboration and exchange among professionals and care providers are also severely limited. Although the proposed solution of developing ethics capacity in the home care setting is over 20 years old, only modest progress had been made until recently. This article introduces the Community Ethics Network (CEN), a replicable network of home and community care agencies in the Greater Toronto Area. Its achievements can be attributed to a commitment to work toward a common approach to ethical decision-making and to a focus on education, case reviews and policy development. CEN has produced numerous positive outcomes; key among these is the development and delivery of standardized training on ethics to more than 2,000 front-line staff of diverse backgrounds/professions and representing over 40 different organizations.
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Affiliation(s)
- Renaud F Boulanger
- Pursuing a master of science degree in bioethics at McGill University, in Montreal, Quebec, where he studies the ethics of conducting research in disaster settings. He worked for the Community Ethics Network as part of a year-long practicum
| | - Kimberley Ibarra
- Program evaluation specialist and ethics consultant at Toronto Central Community Care Access Centre (CCAC) and the University of Toronto Joint Centre for Bioethics, in Toronto, Ontario. In 2008, she led a stakeholder outreach project with the Community Ethics Network, including visioning and priority setting
| | - Frank Wagner
- The bioethicist for the Toronto Central CCAC and the Joint Centre for Bioethics, and an assistant professor in the Department of Family and Community Medicine, at the University of Toronto. Wagner is also a faculty member of the Canadian Medical Associations' Physician Management Institute (PMI)
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Boulanger RF, Seidel S, Lessem E, Pyne-Mercier L, Williams SD, Mingote LR, Scott C, Chou AY, Lavery JV. Engaging communities in tuberculosis research. Lancet Infect Dis 2013; 13:540-5. [PMID: 23531390 DOI: 10.1016/s1473-3099(13)70042-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
According to a growing consensus among biomedical researchers, community engagement can improve the ethics and outcomes of clinical trials. Although successful efforts to develop community engagement practices in HIV/AIDS research have been reported, little attention has been given to engagement with the community in tuberculosis research. This article aims to draw attention to some existing community engagement initiatives in tuberculosis research and to resources that might help tuberculosis researchers to establish and implement community engagement programmes for their trials. One of these resources-the good participatory practice guidelines for tuberculosis drug trials-offers a conceptual framework and practical guidance for community engagement in tuberculosis research. To build momentum and to improve community engagement, lessons need to be shared, and formal assessment strategies for community engagement initiatives need to be developed. To build successfully on the promising activities described in this personal view, research funders and sponsors should show leadership in allocation of resources for the implementation and assessment of community engagement programmes in tuberculosis trials.
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Affiliation(s)
- Renaud F Boulanger
- Ethical, Social and Cultural Program, St Michael's Hospital, Toronto, ON, Canada
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Abstract
Enhancing the effectiveness, efficiency, and fairness of interventions is an increasing source of concern in the field of disaster response. As a result, the expansion of the disaster relief evidence base has been identified as a pressing need. There has been a corresponding increase in discussions of ethical standards and procedures for disaster research. In general, these discussions have focused on elucidating how traditional research ethics concerns can be operationalized in disaster settings. Less attention has been given to the exploration of the ethical implications of heterogeneity within the field of disaster research. Hence, while current efforts to discuss the ethics of disaster research in low-resource settings are very encouraging, it is clear that further initiatives will be crucial to promote the ethical conduct of disaster research. In this article, we explore how the ethical review of disaster research conducted in low-resource settings should account for this diversity. More specifically, we consider how the nature of the project (what?), sociopolitical and physical environment of research sites (where?), temporal proximity to the disaster event (when?), objectives motivating the research (why?), and identity of the stakeholders involved in the research process (who?) all relate to the ethics of disaster research.
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Affiliation(s)
- Matthew R Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Tindana PO, Rozmovits L, Boulanger RF, Bandewar SVS, Aborigo RA, Hodgson AVO, Kolopack P, Lavery JV. Aligning community engagement with traditional authority structures in global health research: a case study from northern Ghana. Am J Public Health 2011; 101:1857-67. [PMID: 21852635 PMCID: PMC3222376 DOI: 10.2105/ajph.2011.300203] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2011] [Indexed: 01/04/2023]
Abstract
Despite the recognition of its importance, guidance on community engagement practices for researchers remains underdeveloped, and there is little empirical evidence of what makes community engagement effective in biomedical research. We chose to study the Navrongo Health Research Centre in northern Ghana because of its well-established community engagement practices and because of the opportunity it afforded to examine community engagement in a traditional African setting. Our findings suggest that specific preexisting features of the community have greatly facilitated community engagement and that using traditional community engagement mechanisms limits the social disruption associated with research conducted by outsiders. Finally, even in seemingly ideal, small, and homogeneous communities, cultural issues exist, such as gender inequities, that may not be effectively addressed by traditional practices alone.
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Affiliation(s)
- Paulina O Tindana
- McLaughlin-Rotman Centre for Global Health, University of Toronto, Canada
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Boulanger RF. Transforming health professionals' education. Lancet 2011; 377:1237; author reply 1238-9. [PMID: 21481700 DOI: 10.1016/s0140-6736(11)60497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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