期刊论文详细信息
BMC Medical Ethics
A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya
Paula Braitstein5  Michael Scanlon6  Peter Gisore2  Samuel Ayaya2  Lukoye Atwoli8  Winstone Nyandiko2  David Ayuku7  Allan Kamanda1  Eunice Kamaara3  Rachel Vreeman4 
[1] Moi Teaching and Referral Hospital, Nandi Road, P.O. Box 3, Eldoret, 30100, Kenya;Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya;Departments of Philosophy and Religious Studies, Moi University, P.O. Box 3990, Eldoret, 30100, Kenya;Regenstrief Institute, Inc., 410 W. 10th St., Suite 2000, Indianapolis, IN, 46202-3012, USA;Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, EH 317, Indianapolis, IN, 46202, USA;Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN, 46202, USA;Department of Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya;Department of Mental Health, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
关键词: Kenya;    Informed consent;    Ethics;    Sub-Saharan Africa;    Community-based research;   
Others  :  800026
DOI  :  10.1186/1472-6939-13-23
 received in 2012-06-19, accepted in 2012-09-03,  发布年份 2012
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【 摘 要 】

Background

International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings.

Methods

We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts.

Results

Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent.

Conclusions

Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research.

【 授权许可】

   
2012 Vreeman et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Varmus H, Satcher D: Ethical complexities of conducting research in developing countries. N Engl J Med 1997, 337(14):1003-1005.
  • [2]Shapiro HT, Meslin EM: Ethical issues in the design and conduct of clinical trials in developing countries. N Engl J Med 2001, 345(2):139-142.
  • [3]Benatar SR, Singer PA: A new look at international research ethics. BMJ 2000, 321(7264):824-826.
  • [4]Hutton JL: Ethics of medical research in developing countries: the role of international codes of conduct. Stat Methods Med Res 2000, 9(3):185-206.
  • [5]Macklin R: After Helsinki: unresolved issues in international research. Kennedy Inst Ethics J 2001, 11(1):17-36.
  • [6]Ashcroft RE, Chadwick DW, Clark SRL, Edwards RHT, Frith L, Hutton JL: Implication of socio-cultural contexts for the ethics of clinical trials. In Health Services Research Methods: A guide to best practice. edn. Edited by Black N, Brazier J, Fitzpatrick R, Reeves B. British Medical Journal, London; 1998.
  • [7]Angell M: The ethics of clinical research in the Third World. N Engl J Med 1997, 337(12):847-849.
  • [8]Lurie P, Wolfe SM: Unethical trials of interventions to reduce perinatal transmission of the human immunodeficiency virus in developing countries. N Engl J Med 1997, 337(12):853-856.
  • [9]Glantz LH, Annas GJ, Grodin MA, Mariner WK: Research in developing countries: taking "benefit" seriously. Hastings Cent Rep 1998, 28(6):38-42.
  • [10]Wilmshurst P: Scientific imperialism. BMJ 1997, 314(7084):840-841.
  • [11]Bhutta ZA: Beyond informed consent. Bull World Health Organ 2004, 82(10):771-777.
  • [12]UNAIDS: Ethical Considerations in HIV Preventive Vaccine Research: UNAIDS Guidance Document. Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland; 2000.
  • [13]Emanuel EJ, Wendler D, Killen J, Grady C: What makes clinical research in developing countries ethical? The benchmarks of ethical research. J Infect Dis 2004, 189(5):930-937.
  • [14]Tangwa GB: Between universalism and relativism: a conceptual exploration of problems in formulating and applying international biomedical ethical guidelines. J Med Ethics 2004, 30(1):63-67.
  • [15]Weijer C, Miller PB: Protecting communities in pharmacogenetic and pharmacogenomic research. Pharmacogenomics J 2004, 4(1):9-16.
  • [16]Sharp RR, Foster MW: Involving study populations in the review of genetic research. J Law Med Ethics 2000, 28(1):41-51. 43
  • [17]Gikonyo C, Bejon P, Marsh V, Molyneux S: Taking social relationships seriously: lessons learned from the informed consent practices of a vaccine trial on the Kenyan Coast. Soc Sci Med 2008, 67(5):708-720.
  • [18]Diallo DA, Doumbo OK, Plowe CV, Wellems TE, Emanuel EJ, Hurst SA: Community permission for medical research in developing countries. Clin Infect Dis 2005, 41(2):255-259.
  • [19]International Ethical Guidelines for Biomedical Research Involving Human Subjects. Council for International Organizations of Medical Sciences, Geneva; 2002.
  • [20]Hutton JL: Are distinctive ethical principles required for cluster randomized controlled trials? Stat Med 2001, 20(3):473-488.
  • [21]Fitzgerald DW, Marotte C, Verdier RI, Johnson WD Jr, Pape JW: Comprehension during informed consent in a less-developed country. Lancet 2002, 360(9342):1301-1302.
  • [22]Krosin MT, Klitzman R, Levin B, Cheng J, Ranney ML: Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clin Trials 2006, 3(3):306-313.
  • [23]IJsselmuiden C, Faden RR: Research and informed consent in Africa--another look. N Engl J Med 1992, 326(12):830-833.
  • [24]Hutton JL, Ashcroft RE: Some popular versions of uninformed consent. Health Care Anal 2000, 8(1):41-53.
  • [25]Molyneux CS, Wassenaar DR, Peshu N, Marsh K: 'Even if they ask you to stand by a tree all day, you will have to do it (laughter)…!': community voices on the notion and practice of informed consent for biomedical research in developing countries. Soc Sci Med 2005, 61(2):443-454.
  • [26]Marsh VM, Kamuya DM, Mlamba AM, Williams TN, Molyneux SS: Experiences with community engagement and informed consent in a genetic cohort study of severe childhood diseases in Kenya. BMC Med Ethics 2010, 11:13. BioMed Central Full Text
  • [27]Appelbaum PS, Roth LH, Lidz C: The therapeutic misconception: informed consent in psychiatric research. Int J Law Psychiatry 1982, 5(3–4):319-329.
  • [28]Bosk CL: Obtaining voluntary consent for research in desperately ill patients. Med Care 2002, 40(9 Suppl):V64-V68.
  • [29]Jegede AS: Understanding informed consent for participation in international health research. Dev World Bioeth 2009, 9(2):81-87.
  • [30]DeCosta A, D'Souza N, Krishnan S, Chhabra MS, Shihaam I, Goswami K: Community based trials and informed consent in rural north India. J Med Ethics 2004, 30(3):318-323.
  • [31]Hutton JL, Eccles MP, Grimshaw JM: Ethical issues in implementation research: a discussion of the problems in achieving informed consent. Implement Sci 2008, 3:52. BioMed Central Full Text
  • [32]Hyder AA, Wali SA: Informed consent and collaborative research: perspectives from the developing world. Dev World Bioeth 2006, 6(1):33-40.
  • [33]Strauss RP, Sengupta S, Quinn SC, Goeppinger J, Spaulding C, Kegeles SM, Millett G: The role of community advisory boards: involving communities in the informed consent process. Am J Public Health 2001, 91(12):1938-1943.
  • [34]Nuffield Council on Bioethics: The ethics of research related to healthcare in developing countries; Follow-up discussion. Nuffield Council on Bioethics, London; 2005.
  • [35]Council for International Organizations of Medical Sciences (CIOMS): International Ethical Guidelines for Biomedical Research Involving Human Subjects. Council for International Organizations of Medical Sciences, Geneva; 2002.
  • [36]Tindana PO, Singh JA, Tracy CS, Upshur RE, Daar AS, Singer PA, Frohlich J, Lavery JV: Grand challenges in global health: community engagement in research in developing countries. PLoS Med 2007, 4(9):e273.
  • [37]Molyneux CS, Peshu N, Marsh K: Understanding of informed consent in a low-income setting: three case studies from the Kenyan Coast. Soc Sci Med 2004, 59(12):2547-2559.
  • [38]Leach A, Hilton S, Greenwood BM, Manneh E, Dibba B, Wilkins A, Mulholland EK: An evaluation of the informed consent procedure used during a trial of a Haemophilus influenzae type B conjugate vaccine undertaken in The Gambia, West Africa. Soc Sci Med 1999, 48(2):139-148.
  • [39]Lynoe N, Hyder Z, Chowdhury M, Ekstrom L: Obtaining informed consent in Bangladesh. N Engl J Med 2001, 344(6):460-461.
  • [40]Preziosi MP, Yam A, Ndiaye M, Simaga A, Simondon F, Wassilak SG: Practical experiences in obtaining informed consent for a vaccine trial in rural Africa. N Engl J Med 1997, 336(5):370-373.
  • [41]Sidle JE, Were E, Wools-Kaloustian K, Chuani C, Salmon K, Tierney WM, Meslin EM: A needs assessment to build international research ethics capacity. J Empir Res Hum Res Ethics 2006, 1(2):23-38.
  • [42]Naanyu V, Sidle JE, Frankel RM, Ayuku D, Nyandiko WM, Inui TS: Rooting inquiry in tradition: the health baraza as a tool for social research in Kenya. Qual Health Res 2011, 21(1):14-26.
  • [43]Tindana PO, Rozmovits L, Boulanger RF, Bandewar SV, Aborigo RA, Hodgson AV, 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(10):1857-1867.
  • [44]Inui TS, Nyandiko WM, Kimaiyo SN, Frankel RM, Muriuki T, Mamlin JJ, Einterz RM, Sidle JE: AMPATH: living proof that no one has to die from HIV. J Gen Intern Med 2007, 22(12):1745-1750.
  • [45]Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, Quigley F, Mamlin JJ: Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med 2007, 82(8):812-818.
  • [46]Einterz RM, Kelley CR, Mamlin JJ, Van Reken DE: Partnerships in international health. The Indiana University-Moi University experience. Infect Dis Clin North Am 1995, 9(2):453-455.
  • [47]Strauss A, Corbin J: Basics of qualitative research: Grounded theory procedures and techniques. SAGE Publications, Newbury Park, CA; 1990.
  • [48]Dickert N, Sugarman J: Ethical goals of community consultation in research. Am J Public Health 2005, 95(7):1123-1127.
  • [49]Quinn SC: Ethics in public health research: protecting human subjects: the role of community advisory boards. Am J Public Health 2004, 94(6):918-922.
  • [50]Cox LE, Rouff JR, Svendsen KH, Markowitz M, Abrams DI: Community advisory boards: their role in AIDS clinical trials. Terry Beirn Community Programs for Clinical Research on AIDS. Health Soc Work 1998, 23(4):290-297.
  • [51]Morin SF, Maiorana A, Koester KA, Sheon NM, Richards TA: Community consultation in HIV prevention research: a study of community advisory boards at 6 research sites. J Acquir Immune Defic Syndr 2003, 33(4):513-520.
  • [52]Mbiti J: African Religions and Philosophy. Heinemann, Nairobi; 1969.
  • [53]Weijer C, Emanuel EJ: Ethics. Protecting communities in biomedical research. Science 2000, 289(5482):1142-1144.
  • [54]Marshall PA: Informed consent in international health research. J Empir Res Hum Res Ethics 2006, 1(1):25-42.
  • [55]Marsh VM, Kamuya DK, Parker MJ, Molyneux CS: Working with Concepts: The Role of Community in International Collaborative Biomedical Research. Public Health Ethics 2011, 4(1):26-39.
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