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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-09-11

AUTHORS

Sara E. Canavati, Cesia E. Quintero, Britt Haller, Dysoley Lek, Sovann Yok, Jack S. Richards, Maxine Anne Whittaker

ABSTRACT

BACKGROUND: In 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. METHODS: Twenty-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. RESULTS: There 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. CONCLUSIONS: Formal 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. More... »

PAGES

362

References to SciGraph publications

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  • 2014-08-09. Beyond mobile populations: a critical review of the literature on malaria and population mobility and suggestions for future directions in MALARIA JOURNAL
  • 2015-11-23. Characterizing Types of Human Mobility to Inform Differential and Targeted Malaria Elimination Strategies in Northeast Cambodia in SCIENTIFIC REPORTS
  • 2011-05-09. Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones in MALARIA JOURNAL
  • 2015-04-12. Community engagement strategies for genomic studies in Africa: a review of the literature in BMC MEDICAL ETHICS
  • 2016-05-20. Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment in MALARIA JOURNAL
  • 2011-05-10. Respondent-driven sampling on the Thailand-Cambodia border. I. Can malaria cases be contained in mobile migrant workers? in MALARIA JOURNAL
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    28 schema:description BACKGROUND: In 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. METHODS: Twenty-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<sup>®</sup> software. Triangulation and critical case analysis was also used. RESULTS: There 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. CONCLUSIONS: Formal 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.
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    35 schema:keywords Cambodia
    36 Field-based research staff
    37 Formal monthly reports
    38 MMPs
    39 NVivo 9
    40 account
    41 addition
    42 analysis
    43 anti-malarial regimens
    44 available transportation
    45 avenues
    46 barriers
    47 bonds
    48 care
    49 careful consideration
    50 case analysis
    51 challenges
    52 clinical care
    53 collection
    54 communication
    55 community
    56 consideration
    57 content analysis
    58 cost
    59 critical case analysis
    60 cultural barriers
    61 daily challenges
    62 data
    63 data collection
    64 delay
    65 demographics
    66 depth interviews
    67 design
    68 development
    69 dilemma
    70 discussion
    71 distance
    72 duty
    73 effectiveness
    74 elimination
    75 elimination settings
    76 ethical dilemmas
    77 experience
    78 extensive experience
    79 fact
    80 field
    81 field research
    82 field research staff
    83 field staff
    84 field study
    85 field study staff
    86 field study staff experiences
    87 field workers
    88 field-based malaria studies
    89 field-based staff
    90 financial costs
    91 focus group discussions
    92 future research protocols
    93 future study designs
    94 group discussions
    95 health solutions
    96 implementation challenges
    97 infection
    98 informal interviews
    99 insights
    100 interviews
    101 issues
    102 key tool
    103 lack
    104 leaders
    105 lessons
    106 logistical barriers
    107 long distances
    108 malaria elimination
    109 malaria elimination settings
    110 malaria studies
    111 malaria-endemic demographic
    112 method
    113 migrant populations
    114 mixed methods
    115 mixed-methods analysis
    116 monthly reports
    117 novel anti-malarial regimens
    118 opinion
    119 order
    120 overlap
    121 participant pool
    122 participant recruitment
    123 perspective
    124 pool
    125 population
    126 potential participant pool
    127 potential solutions
    128 protocol
    129 public health solutions
    130 recommendations
    131 recruitment
    132 regimens
    133 relevant recommendations
    134 report
    135 report fields
    136 research
    137 research field staff
    138 research protocol
    139 research staff
    140 research studies
    141 research study effectiveness
    142 resistance
    143 set
    144 setting
    145 significant logistical barriers
    146 similar challenges
    147 similar implementation challenges
    148 software
    149 solution
    150 specific report fields
    151 spread
    152 spread of resistance
    153 staff
    154 staff experience
    155 strong bonds
    156 study
    157 study design
    158 study effectiveness
    159 study field staff
    160 study staff
    161 study staff experiences
    162 such field studies
    163 systematic way
    164 thematic analysis
    165 tool
    166 transportation
    167 triangulation
    168 understanding
    169 unexpected delays
    170 valuable insights
    171 variety
    172 way
    173 western Cambodia
    174 workers
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