Module-5

Specific Learning Objectives:

• To describe the ethical obligation to disseminate the findings of implementation research (IR);

• To describe the ethical implications of the sustainability of interventions studied in IR.

Learning Methodology:

Interactive lecture with illustrations.

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
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MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

Ethics in Implementation research

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 2

Ethical Considerations in the Post-Research Phase of Ir

To describe:

• The ethical obligation to disseminate findings of implementation research

• The ethical implications of sustainability of interventions studied in implementation research

Learning Objectives

Ethical Considerations in the Post-Research Phase of IR

Slide 2

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 3

Ethical Considerations in the Post-Research Phase of Ir

Session Outline

• Ethical obligations of implementation research to disseminate research findings

• Role of implementation research in research capacity building and health system strengthening

• Post- implementation research access to interventions

• Ethical obligation to translate implementation research findings into policy and practice

Ethical Considerations in the Post-Research Phase of IR

Slide 3

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 4

Ethical Considerations in the Post-Research Phase of Ir

Case Study

• A PI has just concluded an implementation research - study A; contrary to expectation, analysis revealed that the new service tested did not yield favourable results.

• He proposes to move forward with study B as he has recently won a big grant.

• Considering the outcome of study A was not favourable, he has decided neither to publish the findings nor feedback to the community.

• Instructed his team to devote their time instead to study B.

Concerns? Opinions?

Ethical Considerations in the Post-Research Phase of IR

Slide 4

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 5

Ethical Considerations in the Post-Research Phase of Ir

Ethical Obligation to Disseminate Implementation
Research Findings

• Implementation researchers have ethical obligation to disseminate research findings:

• The data emerged from the community

• Justice requirement to give back to community

• Empowerment of community with knowledge

Ethical Considerations in the Post-Research Phase of IR

Slide 5

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 6

Ethical Considerations in the Post-Research Phase of Ir

To Whom Should Information be Disseminated?

• Health-system officials

• Local community health workers

• Local communities

• Larger communities

• Global community

• Other researchers

• Policy-makers

Ethical Considerations in the Post-Research Phase of IR

Slide 6

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 7

Ethical Considerations in the Post-Research Phase of Ir

How Should Information be Disseminated?

• In a language and manner understandable to the intended target audience

• Use of different media to target lay people as well as technical

• Persuasive language of activism vs. honesty

Ethical Considerations in the Post-Research Phase of IR

Slide 7

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 8

Ethical Considerations in the Post-Research Phase of Ir

Data Ownership and Dissemination

• In donor-initiated research, the donors determine nature and method of dissemination of findings and regulate the process.

• Whether donors disseminate the data or not may depend on the findings and whether it is favourable to the donor.

• Irrespective of donor preferences and irrespective of study results, all implementation research findings should be disseminated – good governance is required.

Ethical Considerations in the Post-Research Phase of IR

Slide 8

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 9

Ethical Considerations in the Post-Research Phase of Ir

Donor Influences on Dissemination of Implementation Research Findings

• An implementation research project done by a group of researchers in a low- and medium-income country (LMIC) was sponsored by an international donor.

• The implementation research assessed a particular guideline for treatment of an infectious disease of importance in the country.

• The implementation research concluded that the recommended treatment was innefective and not practical in the local context

• However, when an attempt was made to publish this research the donor raised serious concerns.

Ethical Considerations in the Post-Research Phase of IR

Slide 9

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 10

Ethical Considerations in the Post-Research Phase of Ir

Role of Implementation Research in Research Capacity Building & Health System Strengthening

• Usually funding of implementation research does not support long-term interventions

• Long-term and system-level interventions will build implementation research capacity as well as strengthen the system

• Vertical programmes tend to weaken the health system

• Apart from strengthening the health system, implementation research should also strengthen the local capacity to conduct, monitor and evaluate research

Ethical Considerations in the Post-Research Phase of IR

Slide 10

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 11

Ethical Considerations in the Post-Research Phase of Ir

Post- Implementation Research Access to Interventions

• The interventions in implementation research are usually system wide

• Ensuring post-research access to the intervention can be challenging

• Post-research access may involve cost-intensive system-wide changes

• The researchers may not by themselves be able to bring about policy change, but should engage with political stakeholders at the beginning of the implementation research

• There is an ethical obligation to ensure the research participants benefit because of the intervention

Ethical Considerations in the Post-Research Phase of IR

Slide 11

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 12

Ethical Considerations in the Post-Research Phase of Ir

Ethical Obligation to Translate Implementation Research Findings into Policy and Practice

• There is a documented delay in translation of research to practice

• However implementation research is a special form of research which is done to study the best method of delivering intervention

• There is an ethical obligation to adopt implementation research into practice

• Having a policy adoption plan at the beginning of implementation research is very important and therefore stakeholder engagement is useful

Ethical Considerations in the Post-Research Phase of IR

Slide 12

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 13

Ethical Considerations in the Post-Research Phase of Ir

Scalability and Sustainability

• If implementation research introduces an intervention into a system there is an ethical obligation to scale up the intervention.

• There is also an ethical obligation to sustain the intervention.

• Community engagement at the beginning of the implementation research helps in ensuring sustainability.

• Stakeholder engagement in terms of the public health system helps in scalability and sustainability.

Ethical Considerations in the Post-Research Phase of IR

Slide 13

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 14

Ethical Considerations in the Post-Research Phase of Ir

Challenges in Scalability and Sustainability

• Sometimes donor-initiated research may not have provision for long-term sustainability.

• Local health system may not be able to afford to take over and sustain the intervention.

• In such situations, should the research be done? Is it ethically right to conduct implementation research where scale up and sustainability is a challenge?

• Are there justice implications to anyway conduct such implementation research to generate knowledge?

• Will political priorities and policy circumstances change and make the implementation research knowledge usable at a later date?

Ethical Considerations in the Post-Research Phase of IR

Slide 14

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 15

Ethical Considerations in the Post-Research Phase of Ir

Key Messages

Ethical Considerations in the Post-Research Phase of IR

Slide 15

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 16

Ethical Considerations in the Post-Research Phase of Ir

References and Reading Materials

• Dowdy DW. Partnership as an ethical model for medical research in developing countries: the example of the "implementation trial". J Med Ethics. 2006;32:357−60.

• Hyder AA, Pratt B, Ali J, Kass N, Sewankambo N. The ethics of health systems research in low- and middle-income countries: a call to action. Global public health. 2014;9:1008−22.

• Hyder AA, Rattani A, Krubiner C, Bachani AM, Tran NT. Ethical review of health systems research in low- and middle-income countries: a conceptual exploration. Am J Bioethics. 2014;14:28−37.

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies

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