Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya

Trials

Simon J Brooker²  Sassy Molyneux⁹  Matthew CH Jukes¹  Katherine E Halliday²  Margaret M Dubeck⁷  Kevin Kinyua⁶  Juddy Kengo³  Carlos Mcharo³  Sarah N Ndegwa⁴  Maureen Bonareri⁴  Caroline Jones⁵  George Okello⁸ 

[1] Graduate School of Education, Harvard University, Cambridge, MA, USA;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Health and Literacy Intervention Project, Ukunda, Kenya;Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya;Department of Public Health & Primary Care, University of Oxford, Oxford, UK;Ministry of Public Health and Sanitation, District Medical Officer of Health, Msambweni, Kenya;Department of Teacher Education, College of Charleston, Charleston, SC, USA;Health Systems Department, Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

关键词: Kenya;    School-based research;    Community engagement;    Consent;    Cluster-randomized trial;    Malaria;   

Others  :  1093981
DOI  :  10.1186/1745-6215-14-142

 received in 2012-10-09, accepted in 2013-04-18,  发布年份 2013

【 摘 要 】

Background

There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya.

Methods

Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors’ experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial.

Results

Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period.

Conclusions

A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa.

Trial registration

National Institute of Health NCT00878007

【 授权许可】

   
2013 Okello et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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