Meaningful Health Research Articles

Enhancing Students’ Understanding of Health Disparities and Social Determinants of Health Through a Community and Research-Based Project

The complex health demands of society emphasize the need for future health professionals to gain a deeper understanding of social determinants of health (SDOH) and provide meaningful health outcomes. Seventeen undergraduate and graduate students enrolled in a cross-listed public health elective course in Winter 2020 completed a remote application-based course project. This project was conducted to expand students’ comprehension of SDOH as underlying factors contributing to health disparities and inequities. It also sought to increase their awareness of tools and resources in the community to aid populations in overcoming determinants. Last, it aimed to provide them with experience applying population health concepts and enhancing their research skills. The course project utilized a real-world application approach as it consisted of students (1) developing a Detroit-focused community resource guide, (2) creating a related resource map, and (3) composing two manuscripts on the course project and learning experience. Students’ deliverables included a developed community resource guide and related interactive map and the construction of the manuscripts on the project and their learning experience, which was separated into two manuscripts. Students completed a journal reflection, which was used to assess their learning experience. Students’ journal reflections were examined using NVivo12 to identify the six themes in their learning experience. The project effectively met the course learning outcomes while aiding students in recognizing Detroit’s health disparities and the influence of SDOH. It also provided students with deliverables.

A systematic review and meta-analysis of the long-term effects of physical activity interventions on objectively measured outcomes

BackgroundAlthough physical activity interventions are frequently reported to be effective, long-term changes are needed to generate meaningful health benefits. There are criticisms that evaluations of physical activity interventions mostly report short-term outcomes and that these are often self-reported rather than measured objectively. This study therefore aimed to assess the long-term (at least 24 month) effectiveness of behavioural interventions on objectively measured physical activity.MethodsWe conducted a systematic review with a meta-analysis of effects on objectively measured physical activity. We searched: Cochrane CENTRAL, EMBASE, PsychInfo, CINAHL and Pubmed up to 10th January 2022. Studies were included if they were in English and included a physical intervention that assessed physical activity in the long-term (defined as at least 24 months).ResultsEight studies with 8480 participants were identified with data suitable for meta-analysis. There was a significant effect of interventions on daily steps 24 months post baseline (four studies, SMD: 0.15, 95% CI: 0.02 to 0.28) with similar results at 36 to 48 months of follow up (four studies, SMD: 0.17, 95% CI: 0.07 to 0.27). There was a significant effect of interventions on moderate-to-vigorous physical activity 24 months post baseline (four studies, SMD: 0.18 95% CI: 0.07 to 0.29) and at 36 to 48 months (three studies, SMD: 0.16 95% CI: 0.09 to 0.23). The mean effect size was small. However, the changes in moderate-to-vigorous physical activity and steps per day were clinically meaningful in the best-performing studies.ConclusionThis review suggests that behavioural interventions can be effective in promoting small, but clinically meaningful increases in objectively measured physical activity for up to 48 months. There is therefore a need to develop interventions that can achieve greater increases in long-term physical activity with greater efficiency.

Experiencing restraint: A dialogic narrative inquiry from a service user perspective.

In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's 'quest narrative'. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].

Meaningful Work, Well-Being, and Health: Enacting a Eudaimonic Vision.

Work is one of the most enduring and consequential life domains regarding how meaning and purpose impact health and well-being. This review first examines scientific findings from the MIDUS (Midlife in the U.S.) national longitudinal study that have linked work to well-being and health. Most have focused on adverse work or work conditions as influences on poor health, with a few recent findings investigating links to purpose and other aspects of eudaimonic well-being. Organizational scholarship is then selectively reviewed to show how meaningful work is often linked to motivation, performance, and commitment. Paradoxically, meaning can also lead to the exploitation and erosion of health and well-being when managed without regard for decent working conditions. Recent workplace phenomena known as the Great Resignation and Quiet Quitting underscore the societal consequences of work without meaning or adequate working conditions. Both the scientific and organizational literature are enriched by a vision of meaningful work rooted in Aristotle's writings about virtue, ethics, and the realization of potential. Evidence-based practices tied to these eudaimonic ideals are examined at multiple levels, including the societal context (public policy), organizational conditions (culture, human resource practices, leadership), and individual strategies to find meaning, engagement, and fulfillment in work. A concluding section highlights strengths and omissions in the scientific and organizational literature and, going forward, calls for greater interplay among researchers, practitioners, and policymakers in enacting eudaimonic ideals.

Unlock digital health promotion in LMICs to benefit the youth.

As digital technologies such as smartphones and fitness bands become more ubiquitous, individuals can engage in self-monitoring and self-care, gaining greater control over their health trajectories along the life-course. These technologies appeal particularly to young people, who are more familiar with digital devices. How this digital transformation facilitates health promotion is therefore a topic of animated debate. However, most research to date focuses on the promise and peril of digital health promotion (DHP) in high-income settings, while DHP in low- and middle-income countries (LMICs) remain largely unexplored. This narrative review aims to fill this gap by critically examining key ethical challenges of implementing DHP in LMICs, with a focus on young people. In the existing literature, we identified potential impediments as well as enabling conditions. Aspects to consider in unlocking the potential of DHP include (1) addressing the digital divide and structural injustice in data-related practices; (2) engaging the target population and responding to their specific needs given their economic, cultural, and social contexts; (3) monitoring the quality and impact of DHP over time; and (4) improving responsible technology governance and its implementation. Addressing these concerns could result in meaningful health benefits for populations lacking access to more conventional healthcare resources.

Influence the Performance of Midwives in Conducting Early Detection Low Birth Weight Infants (LBWI)

Obstetrics services are an intensive part of health activities focused on maternal, newborn, and child health to realize meaningful family health. Maternal and child health is a national agenda that deserves top priority because it determines the quality of human resources for the next generation. This research method is analytical with a cross-sectional study design. The study sample consisted of 88 midwives. Data analysis was performed using regression analysis and the Results of bivariate. The results of the bivariate test found a relationship between knowledge (p=0.003), motivation (p=0.033), and leadership (p=0.000) with obstetric performance. Furthermore, although there is no relationship between attitudes (p=182) and obstetric performance, the variables of supervision, reward, and training show satisfactory results. The results of the multivariate analysis show that leadership is the most dominant factor in determining obstetric performance, with a p-value of 0.000 and OR. 180. Request the Aceh Besar Health Office to increase supervision not only from the supervising coordinating midwife but also from the abscess and the health office.

Supporting implementation science and health equity in cancer prevention and control through research networks

The Cancer Prevention and Control Research Network (CPCRN) is a national network of academic, public health, and community organizational partners across multiple geographic sites who collaborate to reduce the cancer burden in diverse communities. Given key recommendations that suggest the need for cross-disciplinary collaboration in cancer prevention and control, we sought to explore the historical and contemporary evolution of health equity and disparities research as an area of focus within the CPCRN over time. We conducted 22 in-depth interviews with former and current leaders, co-investigators, and other members of the network. Several key themes emerged from data that were analyzed and interpreted using a constructivist, reflexive, thematic analysis approach. Nearly all participants reported a strong focus on studying health disparities since the inception of the CPCRN, which offered the network a distinct advantage in recent years for incorporating an intentional focus on health equity. Recent law enforcement injustices and the inequities observed during the COVID-19 pandemic have further invigorated network activities around health equity, such as development of a health equity-focused workgroup toolkit, among other cross-center activities. Several participants noted that, in terms of deep, meaningful, and impactful health equity-oriented research, there are still great strides for the network to make, while also acknowledging CPCRN as well-aligned with the national dialogue led by federal agency partners around health equity. Finally, several future directions were mentioned by the participants, including a focus on supporting a diverse workforce and engaging organizational partners and community members in equity-focused research. Findings from these interviews provide direction for the network in advancing the science in cancer prevention and control, with a strengthened focus on health equity.

Health change awareness and its association with weight loss following bariatric surgery.

Patients' ability to judge health change over time has important clinical implications for treatment, but is understudied in longitudinal contexts with meaningful health change. We assess patients' awareness of health change for 5 years following bariatric surgery, and its association with weight loss. Participants were part of the Longitudinal Assessment of Bariatric Surgery (N = 2,027). Perceived health change for each year was assessed by comparing it to self-reports of health on the SF-36 health survey. Participants were categorized as concordant when perceived and actual self-reported health change corresponded, and as discordant when they did not correspond. Year-to-year concordance between perceived and actual self-reported health change occurred less than 50% of the time. Discordance between perceived and actual health was associated with weight loss following surgery. Discordant-positive participants who perceived their health change as more positive than was warranted lost more weight post-surgery and thus had lower body mass index scores than concordant participants. Conversely, discordant-negative participants who perceived their health as worse than what was warranted lost less weight post-surgery and thus had higher body mass index scores. These results suggest that recollection of past health is generally poor and can be biased by salient factors during recall. Clinicians are advised to use caution when retrospective judgments of health are utilized. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

(116) Comorbidity Profile Network Analysis of Men with Erectile Dysfunction

Abstract Introduction The modern understanding of the comorbidities associated with erectile dysfunction (ED) has been shaped by the findings of decades-old survey-based epidemiologic studies. The demographic structure and comorbidities of the United States population have since changed. A contemporary assessment of the comorbidity profile of men with ED is timely and indispensable for the efficient care of these men. Objective The objectives are to describe the comorbidity profile of a contemporary cross-section of men with erectile dysfunction, to identify clinically meaningful health trends, and to evaluate whether clusters of men with distinct comorbidity profiles can be discerned. Methods A cross-sectional analysis of the MarketScan® administrative claims database from 2008 to 2019 was performed. Inclusion criteria were men 18 to 64 years of age with a diagnosis of ED or phosphodiesterase type 5 inhibitor (PDE5i) prescription with at least 1 year of enrollment before the index date, as well as age-matched controls without an ED diagnosis or related prescription. Comorbidities were extracted by ICD-9/10 diagnosis codes and categorized by the Elixhauser Comorbidity Index. The trends in prevalence of comorbidities and odds of comorbidity diagnosis, overall and by age group, were analyzed. To elucidate the relationships between common comorbidities, a novel comorbidity network was performed with comorbidity strength estimated by observed-to-expected ratio (OER) of disease (prevalence > 0.01) in pairs with a comorbid prevalence > 0.001. Results The prevalence of all comorbidities in men with and without ED increased over the study period. The five most prevalent comorbidities (and percentage increase) among men with ED were hypertension (108%), diabetes without complication (78%), obesity (357%), chronic pulmonary disease (124%), and depression (164%) (Figure 1). The association of ED with comorbidities such as complicated diabetes and paralysis tended to be more pronounced among men in the younger cohort (18-45 years of age, vs 46-64 years of age) (Figure 2). Between 2008 and 2014, a generalized increase in the strength of association of ED with prevalent comorbidities is observed (Figure 3). Conclusions The comorbidity profile of men with ED has evolved since its initial characterization nearly 30 years ago. Increases in comorbidities associated with obesity and metabolic syndrome, as well as mental health disorders, are particularly notable. The findings illustrate the complex interplay of chronic health conditions in men with ED, and serve to justify the comprehensive evaluation of men of all ages who present with ED. Disclosure No

Gaps in the Identification of Child Race and Ethnicity in a Pediatric Emergency Department.

Race and ethnicity are social constructs that are associated with meaningful health inequities. To address health disparities, it is essential to have valid, reliable race and ethnicity data. We compared child race and ethnicity as identified by the parent with that reported in the electronic health record (EHR). A convenience sample of parents of pediatric emergency department (PED) patients completed a tablet-based questionnaire (February-May 2021). Parents identified their child's race and ethnicity from options within a single category. We used chi-square to compare concordance between child race and ethnicity reported by the parent with that recorded in the EHR. Of 219 approached parents, 206 (94%) completed questionnaires. Race and/or ethnicity were misidentified in the EHR for 56 children (27%). Misidentifications were most common among children whose parents identified them as multiracial (100% vs 15% of children identified as a single race, P < 0.001) or Hispanic (84% vs 17% of non-Hispanic children, P < 0.001), and children whose race and/or ethnicity differed from that of their parent (79% vs 18% of children with the same race and ethnicity as their parent, P < 0.001). In this PED, misidentification of race and ethnicity was common. This study provides the basis for a multifaceted quality improvement effort at our institution. The quality of child race and ethnicity data in the emergency setting warrants further consideration across health equity efforts.

Leisure Education and Leisure Counseling in Adult Stroke: A Systematic Review

Engagement in leisure is difficult for many community-dwelling adults post-stroke, resulting in increased sedentary and solitary leisure activity, and reduced leisure engagement and satisfaction. This, in turn, impacts long-term recovery, health, and quality of life. The aim of this study was to review the efficacy of in-home and community-based leisure education and leisure counseling on meaningful activity engagement and health outcomes for this population. A systematic review of the literature from 2005-2020 resulted in 2,017 references of which three met the inclusion criteria. Findings indicate that leisure education and leisure counseling improved quality of life, leisure satisfaction, autonomous leisure engagement, and leisure competence, as well as reduced depression and perceived barriers. Clinical implications and future research recommendations are provided.

Evaluation of mpox vaccine dose-sparing strategies.

The spring-summer 2022 mpox outbreak had over 50,000 cases globally, most of them in gay, bisexual, and other men who have sex with men (MSM). In response to vaccine shortages, several countries implemented dose-sparing vaccination strategies, stretching a full-dose vaccine vial into up to five fractional-dose vaccines. Recent studies have found mixed results regarding the effectiveness of the mpox vaccine, raising the question of the utility of dose-sparing strategies. We used an age- and risk-stratified mathematical model of an urban MSM population in the United States with ∼12% high-risk MSM to evaluate potential benefits from implementing dose-sparing vaccination strategies in which a full dose is divided into 3.5 fractional doses. We found that results strongly depend on the fractional-dose vaccine effectiveness (VE) and vaccine supply. With very limited vaccines available, enough to protect with a full dose approximately one-third of the high-risk population, dose-sparing strategies are more beneficial provided that fractional doses preserved at least 40% of full-dose effectiveness (34% absolute VE), projecting 13% (34% VE) to 70% (68% absolute VE) fewer infections than full-dose strategies. In contrast, if vaccine supply is enough to cover the majority of the high-risk population, dose-sparing strategies can be outperformed by full-dose strategies. Scenarios in which fractional dosing was 34% efficacious resulted in almost three times more infections than full dosing. Our analysis suggests that when mpox vaccine supply is limited and fractional-dose vaccination retains moderate effectiveness, there are meaningful health benefits from providing a smaller dose to a larger number of people in the high-risk population. These findings should inform the public-health response to future mpox outbreaks.

Barriers to Meaningful Participatory Mental Health Services Research and Priority Next Steps: Findings From a National Survey.

A growing consensus has emerged regarding the importance of stakeholder involvement in mental health services research. To identify barriers to and the extent of stakeholder involvement in participatory research, the authors undertook a mixed-methods study of researchers and community members who reported participation in such research. Eight consultative focus groups were conducted with diverse groups of stakeholders in mental health services research (N=51 unique participants, mostly service users), followed by a survey of service users, family members, community providers, and researchers (N=98) with participatory research experience. Focus groups helped identify facilitators and barriers to meaningful research collaboration, which were operationalized in the national survey. Participants were also asked about high-priority next steps. The barrier most strongly endorsed as a large or very large problem in the field was lack of funding for stakeholder-led mental health services research (76%), followed by lack of researcher training in participatory methods (74%) and insufficiently diverse backgrounds among stakeholders (69%). The two most frequently identified high-priority next steps were ensuring training and continuing education for researchers and stakeholders (33%) and authentically centering lived experience and reducing tokenism in research (26%). These findings suggest a need for increased attention to and investment in the development, implementation, and sustainment of participatory methods that prioritize collaboration with direct stakeholders, particularly service users, in U.S. mental health services research. The findings also underscore the presence and potentially important role of researchers who dually identify as service users and actively contribute a broader orientation from the service user-survivor movement.

Introduction to the Special Track on Artificial Intelligence and COVID-19

The human race is facing one of the most meaningful public health emergencies in the modern era caused by the COVID-19 pandemic. This pandemic introduced various challenges, from lock-downs with significant economic costs to fundamentally altering the way of life for many people around the world. The battle to understand and control the virus is still at its early stages yet meaningful insights have already been made. The uncertainty of why some patients are infected and experience severe symptoms, while others are infected but asymptomatic, and others are not infected at all, makes managing this pandemic very challenging. Furthermore, the development of treatments and vaccines relies on knowledge generated from an ever evolving and expanding information space. Given the availability of digital data in the modern era, artificial intelligence (AI) is a meaningful tool for addressing the various challenges introduced by this unexpected pandemic. Some of the challenges include: outbreak prediction, risk modeling including infection and symptom development, testing strategy optimization, drug development, treatment repurposing, vaccine development, and others.

Local administration of vancomycin powder in orthopaedic fracture surgery: current practice and trends.

Surgical site infections in orthopaedic trauma are a significant problem with meaningful patient and health care system-level consequences. Direct application of antibiotics to the surgical field has many potential benefits in reducing surgical site infections. However, to date, the data regarding the local administration of antibiotics have been mixed. This study reports on the variability of prophylactic vancomycin powder use in orthopaedic trauma cases across 28 centers. Intrawound topical antibiotic powder use was prospectively collected within three multicenter fracture fixation trials. Fracture location, Gustilo classification, recruiting center, and surgeon information were collected. Differences in practice patterns across recruiting center and injury characteristics were tested using chi-square statistic and logistic regression. Additional stratified analyses by recruiting center and individual surgeon were performed. A total of 4941 fractures were treated, and vancomycin powder was used in 1547 patients (31%) overall. Local administration of vancomycin powder was more frequent in open fractures 38.8% (738/1901) compared with closed fractures 26.6% (809/3040) (P < 0.001). However, the severity of the open fracture type did not affect the rate at which vancomycin powder was used (P = 0.11). Vancomycin powder use varied substantially across the clinical sites (P < 0.001). At the surgeon level, 75.0% used vancomycin powder in less than one-quarter of their cases. Prophylactic intrawound vancomycin powder remains controversial with varied support throughout the literature. This study demonstrates wide variability in its use across institutions, fracture types, and surgeons. This study highlights the opportunity for increased practice standardization for infection prophylaxis interventions. Prognostic-III.

Patient-Reported Outcomes and Surgical Quality.

Delivering high-quality surgical care requires knowing how best to define and measure quality in surgery. Patient-reported outcomes (PROs) enable surgeons, health care systems, and payers to understand meaningful health outcomes from the patient's perspective and can be measured using patient-reported outcome measures (PROMs). As a result, there is much interest in using PROMs in routine surgical care, to guide quality improvement and to inform reimbursement pay structures. This chapter defines PROs and PROMs, differentiates PROMs from other quality measures such as patient-reported experience measures, describes PROMs in the context of routine clinical care, and provides an overview of interpreting PROM data. This chapter also describes how PROMs may be applied to quality improvement and value-based reimbursement in surgery.

‘What I really want is academics who want to partner and who care about the outcome’: findings from a mixed-methods study of evidence use in local government in England

Background:Local government (LG) is ideally placed to influence the determinants of public health (PH) and reduce inequalities, but opportunities are routinely missed. Aims and objectives:The aim of the Local Authority Champions of Research (LACoR) study was to explore ways to embed a culture of evidence use in LG. Methods:Five linked work packages were undertaken using mixed methods. In this paper, we report data from semi-structured interviews with UK local authority (LA) staff (n=14). Findings:Findings show a changing culture of LG: embedded researchers can enhance connectivity and interaction, build linkages, use levers of influence, and learn alongside LG navigators. Understanding the diverse microcultures of evidence use in LG is critical. Research champions can help to navigate the social, financial, political and regulatory context of LG and academia, influencing change dynamically as opportunities emerge. Discussion:Changing organisational subcultures is ambitious and unpredictable given the complexities of, and variability in, local contexts. Cumulative changes appear possible by recognising existing assets, using relational approaches to respond to LG priorities. In-house capacity remains underestimated and underutilised in efforts to embed evidence use in LG decision making. Co-located embedded researchers can use contextually specific knowledge and relationships to enhance evidence use in LG in collaboration with system navigators. Conclusions:There is a need for academics to adapt their approach, to take account of the context of LG to achieve meaningful health and social impacts with LG and test the contribution of embedded approaches to wider system change.

The NIH childhood adversity portfolio: unmet needs, emerging challenges.

Despite the significant increase in pediatric funding, an important question is whether recent changes in the burden of disease and conditions (child and adolescent mortality and nonfatal health loss) are reflected in the National Institutes of Health's (NIH) allocation process. As it sets future priorities, NIH acknowledges "a need to scan the landscape for unmet needs and emerging challenges" so that supported "research translates into meaningful health benefits." Our focus is to scan the pediatric budgetary landscape, report research funding for childhood adversity and adverse childhood experiences, and to illuminate gun violence, suicide, and drug abuse/overdose as prime examples of pediatric unmet needs and emerging challenges. Our findings suggest that pediatric researchers must reconceptualize gun violence as a form of childhood adversity and adverse childhood experiences, as we also need to do for other leading causes of child and adolescent mortality such as suicide and drug abuse/overdose. As it relates to the leading cause of death for children and adolescents, pediatric-related gun violence research spending remains only 0.0017% of the NIH pediatric portfolio. IMPACT: New data on NIH spending on ACEs and childhood adversity. New data to assess the relationship of spending to pediatric burden of disease. New data on pediatrics-related gun violence, suicide and drug abuse/overdose spending.

The impacts of cash transfers on household energy choices

AbstractThere are sizeable energy access deficits in the developing world. Leveraging panel data from the experimental impact evaluations of three unconditional cash transfer programs in Malawi and Zambia, we investigate how ultra‐poor households in rural areas adapt their energy portfolios when experiencing exogenous increases in income. Households make several changes to the primary fuel sources that they use on a regular basis after receiving 3 to 4 years of transfers—moving from fires to torches for lighting purposes and reducing collected firewood use for cooking purposes. In general, households are more likely to make income‐induced adjustments to lighting fuels than to cooking fuels. While facilitating some movement away from firewood (arguably the most inferior energy source), the unconditional cash transfers rarely enable households to completely abandon this fuel. This is understandable given the range of pressing needs facing the beneficiary households—such as food security, the enhancement of which is the primary purpose of the transfer programs. Although recipient households are able to meet a greater share of their energy needs with relatively improved fuels (such as charcoal/coal in Zambia) and obtain assets for generating solar power, the observed impacts are unlikely to be large enough to lead to meaningful health impacts (such as lower respiratory disease via reductions in indoor air pollution). However, the cash transfers appear to enhance well‐being in other ways through the energy use channel—for example, by reducing the time households spend foraging for fuel resources.

Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations.

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.