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Open Access Research article

A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya

Rachel Vreeman11023*, Eunice Kamaara4, Allan Kamanda5, David Ayuku6, Winstone Nyandiko27, Lukoye Atwoli28, Samuel Ayaya27, Peter Gisore27, Michael Scanlon1 and Paula Braitstein239

Author Affiliations

1 Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN, 46202, USA

2 USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya

3 Regenstrief Institute, Inc., 410 W. 10th St., Suite 2000, Indianapolis, IN, 46202-3012, USA

4 Departments of Philosophy and Religious Studies, Moi University, P.O. Box 3990, Eldoret, 30100, Kenya

5 Moi Teaching and Referral Hospital, Nandi Road, P.O. Box 3, Eldoret, 30100, Kenya

6 Department of Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya

7 Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya

8 Department of Mental Health, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya

9 Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, EH 317, Indianapolis, IN, 46202, USA

10 Children’s Health Services Research, Health Information and Translational Sciences Building, Suite #1000, 410 W. 10th St., Indianapolis, IN, 46202, USA

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BMC Medical Ethics 2012, 13:23  doi:10.1186/1472-6939-13-23

Published: 25 September 2012

Abstract

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.

Keywords:
Community-based research; Sub-Saharan Africa; Ethics; Informed consent; Kenya