A framework and practical approach to identify and address ethical issues arising in interventional public health research
1
1 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
2
2 Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
Popul. Med. 2026;8(Supplement Supplement 1):A3696
ABSTRACT
BACKGROUND:
Current research ethics discussion and guidance focuses on the protection of research participants and communities, and – increasingly – on safeguarding and the promotion of fairness between institutions. The emotional well-being and justice-related concerns of frontline staff who play vital roles in public health research is largely overlooked. Working in constrained health systems and communities, often with precarious employment and little power in research programmes, these staff can experience significant ethical dilemmas leading to moral distress.
METHODS:
Building on our past research, and literature on debriefs, reflective learning, ethics reflection groups and moral case deliberations, we evolved an approach to holding regular structured ethics debriefs to discuss and agree upon how to handle ethical issues experienced during ‘fieldwork’. We have documented this approach across two very different studies in Kenya: a clinical observation study and an interventional embedded health systems study.
RESULTS:
Numerous dilemmas were shared by research staff in our debrief fora. In our most recent iteration of our ethics debrief approach we grouped ethical issues encountered into 1) ‘bystander’ issues (defined here as background issues impacting health system functioning, facility staff, patients or families that were not caused or exacerbated by our research activities), 2) issues for those groups that were ‘research imposed’ and 3) issues related to the ‘comfort and well-being of research team members’. There was constant moral labour involved in considering responsibilities for action, which ranged from immediate action from a safety perspective, through rethinking how the research was conducted, to various forms of engagement and feedback across a web of stakeholders.
CONCLUSIONS:
The approach we developed offers a framework to assist research team members with the significant ethical dilemmas and challenges that arise over the course of conducting studies. We suggest activities to support working prospectively through emerging ethical dilemmas in future studies.
Current research ethics discussion and guidance focuses on the protection of research participants and communities, and – increasingly – on safeguarding and the promotion of fairness between institutions. The emotional well-being and justice-related concerns of frontline staff who play vital roles in public health research is largely overlooked. Working in constrained health systems and communities, often with precarious employment and little power in research programmes, these staff can experience significant ethical dilemmas leading to moral distress.
METHODS:
Building on our past research, and literature on debriefs, reflective learning, ethics reflection groups and moral case deliberations, we evolved an approach to holding regular structured ethics debriefs to discuss and agree upon how to handle ethical issues experienced during ‘fieldwork’. We have documented this approach across two very different studies in Kenya: a clinical observation study and an interventional embedded health systems study.
RESULTS:
Numerous dilemmas were shared by research staff in our debrief fora. In our most recent iteration of our ethics debrief approach we grouped ethical issues encountered into 1) ‘bystander’ issues (defined here as background issues impacting health system functioning, facility staff, patients or families that were not caused or exacerbated by our research activities), 2) issues for those groups that were ‘research imposed’ and 3) issues related to the ‘comfort and well-being of research team members’. There was constant moral labour involved in considering responsibilities for action, which ranged from immediate action from a safety perspective, through rethinking how the research was conducted, to various forms of engagement and feedback across a web of stakeholders.
CONCLUSIONS:
The approach we developed offers a framework to assist research team members with the significant ethical dilemmas and challenges that arise over the course of conducting studies. We suggest activities to support working prospectively through emerging ethical dilemmas in future studies.
| eISSN: | 2654-1459 |
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