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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Perceptions of consent, permission structures and approaches to the community: a rapid ethical assessment performed in North West Cameroon

Authors: Jonas A Kengne-Ouafo, Theobald M Nji, William F Tantoh, Doris N Nyoh, Nicholas Tendongfor, Peter A Enyong, Melanie J Newport, Gail Davey, Samuel Wanji

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Understanding local contextual factors is important when conducting international collaborative studies in low-income country settings. Rapid ethical assessment (a brief qualitative intervention designed to map the ethical terrain of a research setting prior to recruitment of participants), has been used in a range of research-naïve settings. We used rapid ethical assessment to explore ethical issues and challenges associated with approaching communities and gaining informed consent in North West Cameroon.

Methods

This qualitative study was carried out in two health districts in the North West Region of Cameroon between February and April 2012. Eleven focus group discussions (with a total of 107 participants) were carried out among adult community members, while 72 in-depth interviews included health workers, non-government organisation staff and local community leaders. Data were collected in English and pidgin, translated where necessary into English, transcribed and coded following themes.

Results

Many community members had some understanding of informed consent, probably through exposure to agricultural research in the past. Participants described a centralised permission-giving structure in their communities, though there was evidence of some subversion of these structures by the educated young and by women. Several acceptable routes for approaching the communities were outlined, all including the health centre and the Fon (traditional leader). The importance of time spent in sensitizing the community and explaining information was stressed.

Conclusions

Respondents held relatively sophisticated understanding of consent and were able to outline the structures of permission-giving in the community. Although the structures are unique to these communities, the role of certain trusted groups is common to several other communities in Kenya and Ethiopia explored using similar techniques. The information gained through Rapid Ethical Assessment will form an important guide for future studies in North West Cameroon.
Appendix
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Literature
1.
Council for International Organizations of Medical Sciences (CIOMS): International Ethical Guidelines for Biomedical Research Involving Human Subjects. 2002, Avenue Appia 20, CH1211 Geneva 27, Switzerland: CIOMS, c/o WHO
2.
Nuffield Council on Bioethics: The Ethics of Research Related to Healthcare in Developing Countries. 2002, England: Nuffield Foundation, 28 Bedford Square London WC1B 3JS
3.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (NCPHSBBR): The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. 1979, Washington, DC: Department of Health, Education, and Welfare
4.
World Medical Association (WMA): Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. World Med J. 2013, 59 (5): 199-
5.
Tekola F, Bull SJ, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, Davey G: Tailoring consent to context: designing an appropriate consent process for a biomedical study in a low income setting. PLoS Negl Trop Dis. 2009, 3 (7): e482-10.1371/journal.pntd.0000482.CrossRefPubMedPubMedCentral
6.
Malik AY: Physician-researchers’ experiences of the consent process in the socio-cultural context of a developing country. Am J Bioeth. 2011, 2: 38-46.
7.
Akabayashi A, Slingsby B: Informed consent revisited: Japan and the US. Am J Bioeth. 2006, 6: 9-14.CrossRefPubMed
8.
Shaibu S: Ethical and cultural considerations in informed consent in Botswana. Nurs Bioeth. 2007, 14 (4): 503-509.
9.
Ezeome ER, Marshall PA: Informed consent practices in Nigeria. Dev World Bioeth. 2009, 9 (3): 138-148. 10.1111/j.1471-8847.2008.00234.x.CrossRefPubMed
10.
Tindana P, Bull S, Amenga-Etego L, Vries J, Aborigo R, Koram K, Turoldo F: Relational autonomy and muticulturalism. Camb Q Health Care Ethics. 2010, 19: 542-549. 10.1017/S0963180110000496.CrossRef
11.
Chen X, Fan R: The family and harmonious medical decision making: cherishing an appropriate Confucian moral balance. J Med Philos. 2010, 35 (5): 573-586. 10.1093/jmp/jhq046.CrossRefPubMed
12.
Xiaomei Z: Diversified and in harmony, but not identical: harmonising international guidelines with cultural values and national traditions. Asian Bioeth Rev. 2011, 3: 31-35.
13.
United States National Bioethics Advisory Commission (USNBA): Ethical and policy issues in international research: clinical trials in developing countries: Volume I: Report and Recommendations of the National Bioethics Advisory Commission. 2001, Bethesda, MD: National Bioethics Advisory Commission
14.
Molyneux CS, Peshu N, Marsh K: Understanding of informed consent in a low-income setting: three case studies from the Kenyan coast. Soc Sci Med. 2004, 59 (12): 2547-2559. 10.1016/j.socscimed.2004.03.037.CrossRefPubMed
15.
Dawson L, Kass NE: Views of US researchers about informed consent in international collaborative research. Soc Sci Med. 2005, 61: 1211-1222. 10.1016/j.socscimed.2005.02.004.CrossRefPubMed
16.
Sanchez S, Salazar G, Tijero M, Diaz S: Informed consent procedures: responsibilities of researchers in developing countries. Bioethics. 2001, 15 (5–6): 398-412.CrossRefPubMed
17.
Dein S, Bhui K: Issues concerning informed consent for medical research among non-westernized ethnic minority patients in the UK. J R Soc Med. 2005, 98: 354-356. 10.1258/jrsm.98.8.354.CrossRefPubMedPubMedCentral
18.
Joffe S, Cook EF, Cleary PD, Clark JW, Weeks JC: Quality of informed consent: a new measure of understanding among research subjects. J Natl Canc Inst. 2001, 93: 139-147.CrossRef
19.
Krosin MT, Klitzman R, Levin B, Cheng J, Ranney ML: Problems in comprehension of informed consent in rural and peri-urban Mali. West Afr Clin Trial. 2006, 3 (3): 306-313. 10.1191/1740774506cn150oa.CrossRef
20.
Taiwo OO, Kass N: Post-consent assessment of dental subjects’ understanding of informed consent in oral health research in Nigeria. BMC Med Ethics. 2009, 10: 11-10.1186/1472-6939-10-11.CrossRefPubMedPubMedCentral
21.
Nuffield Council on Bioethics: The Ethics of Research Related to Healthcare in Developing Countries. 2005, London, England: Nuffield Foundation
22.
Bull SJ: Consent to research in a Gambian context: legal, social and ethical issues. 2007, London: PhD Thesis Kings College
23.
Bull SJ, Farsides B, Tekola FA: Tailoring information provision and consent processes to research contexts: the value of rapid assessments. J Empir Res Hum Res Ethics Int J. 2012, 7: 37-52.CrossRef
24.
Price EW, Henderson WJ: Endemic elephantiasis of the lower legs in the United Cameroon Republic. Trop Geogr Med. 1981, 33 (1): 23-29.PubMed
25.
Wanji S, Tendongfor N, Esum M, Che JN, Mand S, Tanga Mbi C, Enyong P, Hoerauf A: Elephantiasis of non-filarial origin (podoconiosis) in the highlands of north-western Cameroon. Ann Trop Med Parasitol. 2008, 102 (6): 529-540. 10.1179/136485908X311849.CrossRefPubMed
26.
Marshall PA, Adebamowo CA, Adeyemo AA, Ogundiran TO, Vekich M, Strenski T, Zhou J, Prewitt TE, Cooper RS, Rotimi CN: Voluntary participation and informed consent to international genetic research. Am J Public Health. 2006, 96 (11): 1989-1995. 10.2105/AJPH.2005.076232.CrossRefPubMedPubMedCentral
27.
Kamuya D, Marsh V, Molyneux S: What we learned about voluntariness and consent: incorporating “background situations” and understanding into analyses. Am J Bioeth. 2011, 11 (8): 31-33. 10.1080/15265161.2011.583328.CrossRefPubMed
28.
Luna F: Paternalism and the argument from illiteracy. Bioethics. 1993, 9: 284-290.
29.
Gitanjali B, Raveendran R, Pandian DG: Recruitment of subjects for clinical trials after informed consent: does gender and educational status make a difference?. J Post Grad Med. 2003, 49: 109-113.
30.
Newton SK, Appiah-Poku J: The perspective of researchers on obtaining informed consent in developing countries. Dev World Bioeth. 2007, 7: 19-24. 10.1111/j.1471-8847.2006.00147.x.CrossRefPubMed
31.
32.
Nelson RM, Beauchamp T, Miller VA, Reynolds W, Ittenbach RF, Luce MF: The concept of voluntary consent. Am J Bioeth. 2011, 11 (8): 6-16. 10.1080/15265161.2011.583318.CrossRefPubMed
33.
Marshall PA: “Cultural competence” and informed consent in international health research. Camb Q Health Care Ethics. 2008, 17 (2): 206-215.CrossRef
34.
Gikonyo C, Bejon P, Marsh V, Molyneux S: Taking social relationships seriously: lessons learned from the informed consent practices of a vaccine trial on the Kenyan coast. Soc Sci Med. 2008, 67 (5): 708-720. 10.1016/j.socscimed.2008.02.003.CrossRefPubMedPubMedCentral
35.
Molyneux CS, Peshu N, Marsh K: Trust and informed consent: insights from community members on the Kenyan coast. Soc Sci Med. 2005, 61 (7): 1463-1473. 10.1016/j.socscimed.2004.11.073.CrossRefPubMed
36.
Tekola F, Bull S, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, Davey G: Impact of social stigma on the process of obtaining informed consent for genetic research on podoconiosis: a qualitative study. BMC Med Ethics. 2009, 10: 13-10.1186/1472-6939-10-13.CrossRefPubMedPubMedCentral
Metadata
Title
Perceptions of consent, permission structures and approaches to the community: a rapid ethical assessment performed in North West Cameroon
Authors
Jonas A Kengne-Ouafo
Theobald M Nji
William F Tantoh
Doris N Nyoh
Nicholas Tendongfor
Peter A Enyong
Melanie J Newport
Gail Davey
Samuel Wanji
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1026

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