Maximizing research study effectiveness in malaria elimination settings: a mixed methods study to capture the experiences of field-based staff
Maximizing research study effectiveness in malaria elimination settings: a mixed methods study to capture the experiences of field-based staff
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DOI：
10.1186/s12936-017-2016-4
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发表时间：
2017-09-11
期刊：
影响因子：
3
通讯作者：
Whittaker, Maxine Anne
中科院分区：
文献类型：
--
作者：
Canavati, Sara E.;Quintero, Cesia E.;Whittaker, Maxine Anne
背景：在像西柬埔寨这样的耐药和消除疟疾的环境中，实地研究对于制定新的抗疟疾方案和监测耐药性传播和消除感染所需的公共卫生解决方案至关重要。此类实地研究经常面临各种类似的实施挑战，但很少以系统的方式捕获这些挑战，也很少用于优化未来可能克服类似挑战的研究设计。实地研究人员通常具有丰富的经验，可以就这些问题提供有价值的见解，但他们的观点和经验很少被记录下来，也很少被纳入未来的研究方案。这种混合方法分析旨在了解在柬埔寨西部抗青蒿素和消除疟疾环境中实地研究工作人员每天遇到的挑战。在此过程中，本研究试图了解如何捕捉实地工作人员的经验和意见，并将其用于未来的研究设计。方法：利用内容分析对在柬埔寨西部开展的6项实地疟疾研究的22份报告进行了审查，以确定开展研究的挑战。此外，实地研究人员亦进行非正式访谈、焦点小组讨论及深入访谈。使用Nvivo 9 (R)软件对数据进行专题分析。三角法和关键案例分析也被使用。结果：现场工作人员缺乏正式的途径来报告进行疟疾研究时遇到的挑战。实地研究人员在招募参与者和收集数据方面面临着重大的后勤障碍，包括缺乏可用于长途运输的交通工具，以及由于随访方面的挑战，流动人口和移民人口通常被排除在研究之外。沟通上的文化障碍也阻碍了参与者的招募，造成了意想不到的延误。现场工作人员经常付出身体、情感和经济上的代价，超出了他们的职责，以保持研究的进行。结论：实地研究人员填写的正式月度报告可能是有效获取实地研究人员经验的关键工具，但需要特定的报告领域，以鼓励工作人员概述其挑战并提出潜在的解决方案。与社区及其领导人建立牢固的联系可以改善沟通，减少招募参与者的障碍。研究设计应使mmp参与可行；除了增加潜在的参与者之外，这将确保在研究中考虑到最流行疟疾的人口。临床护理和研究之间的重叠给研究人员带来了道德困境，这一事实值得仔细考虑。从研究现场工作人员那里获得的经验教训应用于创建一套与当地相关的建议，以便为未来的研究设计提供信息。
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 (R) 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.