Maximizing research study effectiveness in malaria elimination settings: a mixed methods study to capture the experiences of field-based staff

Abstract

BackgroundIn a drug-resistant, malaria elimination setting like Western Cambodia, field research is essential for the development of novel anti-malarial regimens and the public health solutions necessary to monitor the spread of resistance and eliminate infection. Such field studies often face a variety of similar implementation challenges, but these are rarely captured in a systematic way or used to optimize future study designs that might overcome similar challenges. Field-based research staff often have extensive experience and can provide valuable insight regarding these issues, but their perspectives and experiences are rarely documented and seldom integrated into future research protocols. This mixed-methods analysis sought to gain an understanding of the daily challenges encountered by research field staff in the artemisinin-resistant, malaria elimination setting of Western Cambodia. In doing so, this study seeks to understand how the experiences and opinions of field staff can be captured, and used to inform future study designs.MethodsTwenty-two reports from six field-based malaria studies conducted in Western Cambodia were reviewed using content analysis to identify challenges to conducting the research. Informal Interviews, Focus Group Discussions and In-depth Interviews were also conducted among field research staff. Thematic analysis of the data was undertaken using Nvivo 9® software. Triangulation and critical case analysis was also used.ResultsThere was a lack of formalized avenues through which field workers could report challenges experienced when conducting the malaria studies. Field research staff faced significant logistical barriers to participant recruitment and data collection, including a lack of available transportation to cover long distances, and the fact that mobile and migrant populations (MMPs) are usually excluded from studies because of challenges in follow-up. Cultural barriers to communication also hindered participant recruitment and created unexpected delays. Field staff often paid a physical, emotional and financial cost, going beyond their duty in order to keep the study running.ConclusionsFormal monthly reports filled out by field study staff could be a key tool for capturing field study staff experiences effectively, but require specific report fields to encourage staff to outline their challenges and to propose potential solutions. Forging strong bonds with communities and their leaders may improve communication, and decrease barriers to participant recruitment. Study designs that make it feasible for MMPs to participate should be pursued; in addition to increasing the potential participant pool, this will ensure that the most malaria-endemic demographic is taken into account in research studies. Overlaps between clinical care and research create ethical dilemmas for study staff, a fact that warrants careful consideration. Lessons learned from study field staff should be used to create a set of locally-relevant recommendations to inform future study designs.Electronic supp...

A systematic review on ethical challenges of ‘field’ research in low-income and middle-income countries: respect, justice and beneficence for research staff?

“… 17 18 When data collection is carried out in highly deprived settings, research participants may seek support from research staff. 19–22 Here, included studies pointed to cases of participants asking for food, 23–25 medical treatment, 26 27 financial support 25 28 29 or simply seeking to establish a form of friendship with the research staff. 26 28 30 Two studies discussed occasions in which non-local researchers were beseeched to adopt participants’ children.…”

“… 19–22 Here, included studies pointed to cases of participants asking for food, 23–25 medical treatment, 26 27 financial support 25 28 29 or simply seeking to establish a form of friendship with the research staff. 26 28 30 Two studies discussed occasions in which non-local researchers were beseeched to adopt participants’ children. 31 32 In light of this, research staff may feel a moral obligation to take on additional roles beyond the scope of their research, for instance by essentially acting in the role of social or aid workers, advocates or counsellors.…”

“… 31 32 In light of this, research staff may feel a moral obligation to take on additional roles beyond the scope of their research, for instance by essentially acting in the role of social or aid workers, advocates or counsellors. 26 32–35 This mechanism is likely amplified when the study targets vulnerable populations such as orphans or survivors of natural disasters, wars and violence. 36 37 Participatory research forms may be most prone to provoking such role conflicts due to the greater emotional proximity between participants and researchers.…”

“…Several included studies highlighted security risks associated with harsh weather conditions and natural disasters. 18 64 65 Included studies also pointed to risks associated with travelling to research sites, including traffic accidents, 26 becoming caught up in political protests, 57 66 or being stopped and interrogated by soldiers or rebels. 62 67 Data collection can be particularly dangerous when implemented in settings with high levels of crime, 33 68 gang violence, 33 57 terrorism incidents, 69 70 or in postconflict contexts exerting elevated levels of political instability.…”

Scientific Research on Malaria: A Bibliometric Analysis in Latin America, 2011-2020

“…Despite progress to eradicate malaria, in recent years control of the disease has stopped, as reported by the World Health Organization (WHO, 2021). Likewise, the understanding of the disease is limited by the scattered knowledge about the biology of Plasmodium and by the complex relationships between human populations and the multiple species of mosquitoes and parasites (Canavati et al, 2017).…”