How do Kenyan research fieldworkers conceptualize the consenting process? implication for training in health research ethics.

Abstract

Fieldworkers are an important cadre of research staff due to the critical roles they play in health research not just in Africa but globally. In Africa, most international research centres employ fieldworkers to provide support in seeking informed consent; collecting basic samples and maintaining good relationships with communities involved in research. Seeking informed consent is an especially important role. It does not only ensure the promotion of autonomy for those involved in the research but has an important implication on the quality and reliability of data collected from research participants. According to most international ethical guidelines, ensuring potential research subjects voluntarily participate in research after fully understanding all key elements of the research they are involved in is essential. Although research in most international research centres is overseen by highly qualified and renowned researchers and scientists, the influence of fieldworkers, who are the cadre of health research staff involved in the day to day operationalization and ground application of this important ethical principle, has received little focus and continues to be understudied. Understanding how fieldworkers conceptualize the informed consent process can provide important insight on fieldworkers’ ethical practices and how ethical guidelines are operationalized on the ground. We conducted four Focus Group Discussions (FGDs) with health research fieldworkers and eight In-depth Individual Interviews with field managers/supervisors at the Kenya Medical Research Institute (KEMRI-Wellcome Trust Programme (KWTRP) to develop an in-depth understanding of how this cadre of staff conceptualize the process of informed consent. Data were captured using digital recorders and transcribed before being analyzed thematically. The results indicate a good understanding of health research for both fieldworkers and field managers. The relationship between KWTRP and the community was described to be of mutual benefit sharing, with the community benefiting from new interventions and improved health care while KWTRP got research subjects from the community. Informed consent was described as an important part of getting people to participate in research voluntarily. There was, however, some mixed attitude and perceptions regarding the value and key elements of the informed consent process. Several factors were said to influence informed consent process, including the environment where consenting was done, recruitment targets, support and supervision and the training that was given to fieldworkers. Fieldworkers perceived their work as critical in health research. However, lack of recognition, capacity building and clear approaches for professional development affected their motivation and attitude about their roles. The findings support the need for further research to identify specific mechanisms for supporting fieldworkers to undertake their roles more effectively.