Abstract
BackgroundUnderstanding 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.MethodsThis 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.ResultsMany 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.ConclusionsRespondents 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.
Highlights
Understanding local contextual factors is important when conducting international collaborative studies in low-income country settings
We aimed to explore ethical issues and challenges associated with doing research in North West Cameroon, and in this article, we describe community and health professional perceptions surrounding informed consent, authority structures and approaches to the community
Ndop health district is found in the Ngoketunjia Division which occupies much of the Ndop plain and is located between longitude 10° 20′ and 11° 25′E and latitude 5° 50′ and 5° 59′N
Summary
Understanding local contextual factors is important when conducting international collaborative studies in low-income country settings. When externally sponsored research is conducted in low-income countries, several issues may arise when consent is sought from potential participants. In some communities it is usual (though not in line with national and international guidelines for ethical conduct in research) for male members of the family to make decisions on behalf of wives and adult children [5,6,7,8,9,10]. Questions exist about the type of documentation that is suitable for use in low-literacy communities [18,19,20] In these communities, it may be inappropriate to ask participants to sign consent forms, and witnessed verbal consent may be used instead [21]
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