taking communities seriously: reflecting on ethical, social and cultural issues
TRANSCRIPT
University Health Network and University of Toronto
Taking Communities Seriously: Reflecting on Ethical, Social and Cultural Issues
By Paulina Onvomaha TindanaBy Paulina Onvomaha Tindana
WELLCOME TRUST INTERNATIONAL WELLCOME TRUST INTERNATIONAL PUBLIC ENGAGEMENT WORKSHOPPUBLIC ENGAGEMENT WORKSHOP
December 3rd 2008Somkhele, South Africa
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Introduction
• There is a growing increase in the number of research activities in the developing countries.
• Introduction of new health technologies to communities i.e. GCGH.
• Increased recognition that communities can also suffer research-related harms and exploitation.
• With the emphasis placed on individual autonomy, research endeavors fail to recognize the importance of communities
• Community engagement (CE) an important ethical requirement
in health research.
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Cost of Not Taking Communities Seriously
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What is Community Engagement?
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Why Communities Matter in Research
ETHICS• To ensure the relevance of research (NBAC, Nuffield)• To avoid exploitation by ensuring a fair distribution of the benefits of research
(Emanuel et al., 2004)• To take into account the ethical hazards that may be part of the social, economic
and political landscape of the community (Crouch et al., 1998)
CO-OPERATION, EFFECTIVENESS, & IMPACT• To respect the community’s values, culture, traditions, and social practices (Emanuel
et al., 2004)• To assess that relevant research is culturally and practically acceptable in the
context it is intended (CIOMS)• To create a more co-operative atmosphere for change in attitudes, behaviour, etc.
of community members (Campbell et al., 2000)• To ensure that community disruption is minimized, i.e., avoiding the displacement
of local medical staff from pressing local needs (Lavery et al., 2006)
ACCEPTANCE• To ensure that the community feels some sense of ownership and is able to take
appropriate responsibility and authority for the study (NHRC)• To enhance the likelihood of acceptability and adoption of the resultant technology
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Research Process
Informed consentResults
Dissemination
CollectionAnalysis
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What constitutesEFFECTIVENESS
in community engagement in research?
ESC Global Case Studies
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CE Global Case Studies –Rationales
1. Discussions with the GCGH Principal Investigators
2. Interviews with key informants from developing world
3. Review paper
No robust guidance available
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Navrongo Case Study
The Kassena-Nankana district (KND) is one of the administrative districts in the Upper East region of Ghana.
The Navrongo Health Research Centre is based the Kassena-Nankana district started as a field site for a Vitamin A Supplementation Trial (VAST) in 1989.
The majority of the Centre’s research has been in communicable diseases such as malaria, HIV/AIDS, diarrhoea, meningitis and lymphatic filariasis.
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5-stage framework for engagement
Community Entry
Community Durbar
Compound/Household
Individual Consent Process
–Feedback Meetings (During and After the Research)
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• A set of activities through which investigators are formally admitted to the community with the permission of leaders of the community, i.e. the Paramount Chiefs
• Provides an opportunity for researchers to dialogue with the community leaders
• Gives researchers the opportunity to get to know more about the community, its social norms and practices (i.e. cultural education) since the community leaders are the custodians of the traditions and practices of the community
Community Entry Process
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• A traditional gathering of various groups of people within the community to discuss issues concerning the community as a whole
• A channel for information dissemination to the various groups of the community
• An effective way of engaging communities
Community Durbar
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Recommended Key Points _______________________
• Start CE early
• Knowledge of community, its diversity, and its changing needs
• Understand Community perceptions and attitudes
• Establish relationships, build trust, seek commitments from formal and informal authorities
• Maximize opportunities for stewardship/ownership/control by community
• Ensure adequate opportunities and respect for dissenting opinions
• Review and evaluate engagement strategies
• Feedback to the community
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Thank You!
Thank You!