ArticlePloS one2015
"The one who chases you away does not tell you go": silent refusals and complex power relations in research consent processes in Coastal Kenya.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review.Tropical medicine & international health : TM & IH · 2019Pooled it
- House screening for malaria control: views and experiences of participants in the RooPfs trial.Malaria journal · 2022Trial
- Through the eyes of the participant: using photovoice to understand the experiences and effects of ivermectin MDA in the context of the BOHEMIA clinical trial in Kwale, Kenya.Malaria journal · 2025Article
- Barriers to and facilitators of linkage to care following hypertension and diabetes screening among health workers in Zimbabwe: A mixed method study.PLOS global public health · 2025Article
- Ethical preparedness of data monitoring committees (DMCs) to oversee international clinical trials: a qualitative descriptive study.BMJ global health · 2024Article
- Unfair knowledge practices in global health: a realist synthesis.Health policy and planning · 2024Article
- The challenges and potential solutions of achieving meaningful consent amongst research participants in northern Thailand: a qualitative study.BMC medical ethics · 2023Article
- Considering Risks to Researchers and Staff in Low-Resource Settings during Public Health Crises: A Proposed Conceptual Model.Children (Basel, Switzerland) · 2023Article
- Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border.PLOS global public health · 2023Article
- Doing 'reciprocity work': The role of fieldworkers in a mass drug administration trial in the Gambia.Global public health · 2022Article
- Ethical Issues in Conducting Cross-Cultural Research in Low-Income Countries: A Pakistani Perspective.Asian bioethics review · 2022Article
- A critical examination of research narratives 'rumours' and passive community resistance in medical research.BMJ global health · 2022Article
- 'Working relationships' across difference - a realist review of community engagement with malaria research.Wellcome open research · 2022Review
- Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya.BMJ global health · 2021Article
- Vulnerability, Agency, and the Research Encounter: Family Members' Experiences and Perceptions of Participating in an Observational Clinical Study in Kenya.Journal of empirical research on human research ethics : JERHRE · 2021Article
- Pioneering Informed Consent for Return of Research Results to Breast Cancer Patients Facing Barriers to Implementation of Genomic Medicine: The Kenyan BRCA1/2 Testing Experience Using Whole Exome Sequencing.Frontiers in genetics · 2020Article
- Article
- Bioethical reflexivity and requirements of valid consent: conceptual tools.BMC medical ethics · 2019Article
- Dilemmas of Ethics in Practice in Longitudinal Health Research: Identifying Opportunities for Widening Participation of Residents.Frontiers in sociology · 2019Article
- Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why?Social science & medicine (1982) · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
Consent processes have attracted significant research attention over the last decade, including in the global south. Although relevant studies suggest consent is a complex negotiated process involving multiple actors, most guidelines assume consent is a one-off encounter with a clear 'yes' or 'no' decision. In this paper we explore the concept of 'silent refusals', a situation where it is not clear whether potential participants want to join studies or those in studies want to withdraw from research, as they were not actively saying no. We draw on participant observation, in-depth interviews and group discussions conducted with a range of stakeholders in two large community based studies conducted by the KEMRI Wellcome Trust programme in coastal Kenya. We identified three broad inter-related rationales for silent refusals: 1) a strategy to avoid conflicts and safeguard relations within households, - for young women in particular-to appear to conform to the wishes of elders; 2) an approach to maintain friendly, appreciative and reciprocal relationships with fieldworkers, and the broader research programme; and 3) an effort to retain study benefits, either for individuals, whole households or wider communities. That refusals and underlying rationales were silent posed multiple dilemmas for fieldworkers, who are increasingly recognised to play a key interface role between researchers and communities in many settings. Silent refusals reflect and reinforce complex power relations embedded in decisions about research participation, with important implications for consent processes and broader research ethics practice. Fieldworkers need support to reflect upon and respond to the ethically charged environment they work in.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.