Evidence map›Paper›PMID 34861869›Full record

Trial reportBMC medical ethics2021

Examining study participants' decision-making and ethics-related experiences in a dietary community randomized controlled trial in Malawi.

Limbanazo Matandika, Kate Millar, Eric Umar, Edward Joy, Gabriella Chiutsi-Phiri, Joseph Mfutso-Bengo

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in BMC medical ethics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Limbanazo MatandikaCenter for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi. limbamindiera@gmail.com.
Kate MillarCentre for Applied Bioethics, Schools of Biosciences and Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.
Eric UmarHealth Systems and Policy Department, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi.
Edward JoyFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Gabriella Chiutsi-PhiriFaculty of Life Science and Natural Resources, Natural Resources College, Lilongwe University of Agriculture and Natural Resources, P.O Box 143, Lilongwe, Malawi.
Joseph Mfutso-BengoCenter for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of high-quality research. When participants make a fair, informed, and voluntary decision to enroll in a study, they agree to fulfill their roles. However, supporting study participants to fulfill study requirements is an important ethical obligation for researchers, yet evidenced as challenging to achieve. This paper reports on participants' motivations to volunteer and remain part of a dietary study conducted in Kasungu District, Malawi.

methodsWe conducted twenty in-depth interviews (with chiefs, religious leaders, trial participants, and health surveillance assistants), five systematic ethnographic observations, and fourteen focus group discussions with trial participants and their partners. Interviews were audio-recorded and transcribed verbatim. We used a grounded theory methodology to analyse data that included coding, detailed memo writing, and data interpretation.

findingsThe findings reveal that many participants had concerns during the trial. Thematically, experiences included anxieties, mistrust of researchers, rumours, fears of exploitation, and misconceptions. Anonymous concerns collected from the participants were reported to the trial team which enabled the researchers to appropriately support participants. Despite initial concerns, participants described being supported and expressed motivation to take up their role.

conclusionThese findings highlight a diverse map of multiple notions of what is ethically relevant and what can impact participation and retention within a study. The study has revealed how embedding a responsive approach to address participants' concerns and ethical issues can support trust relationships. We argue for the need to employ embedded ethics strategies that enhance informed consent, focus on participants' needs and positive experiences, and support researchers to fulfill their roles. This work highlights the need for research ethics committees to focus on the risks of undue influence and prevent exploitation especially in settings with a high asymmetry in resources and power between researcher and participant groups.

trial registrationThe Addressing Hidden Hunger with Agronomy (Malawi) trial was registered on 5th March 2019 (ISCRTN85899451).

Indexed as

Ethics Committees, ResearchInformed ConsentHumansMalawiMotivationQualitative ResearchResearch PersonnelCommunity randomized control trialEmbedded ethicsEthical rolesInformed consentMalawiRumoursSelf-efficacyVoluntarily

Identifiers

PMID34861869
PMCPMC8642889

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.