Cooper Tarni Louisa, Kirino Yumi, Alonso Silvia, Lindahl Johanna, Grace Delia
Food Safety and Zoonoses Program, Mara House, International Livestock Research Institute, Naivasha Road, Postal Box 30709-00100, Nairobi, Kenya.
Food Safety and Zoonoses Program, Mara House, International Livestock Research Institute, Naivasha Road, Postal Box 30709-00100, Nairobi, Kenya; Interdisciplinary Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 1-1 Gakuen-Kibanadai-Nishi, Miyazaki 889-2192, Japan.
Prev Vet Med. 2016 Jun 1;128:135-41. doi: 10.1016/j.prevetmed.2016.04.008. Epub 2016 Apr 22.
With the rise of the One Health paradigm, ethicists have called for new research approaches, considering the interdependent relationships of humans, animals, and their environment. These relationships can be particularly complex within resource-poor, smallholder livestock systems, necessitating a rigorous informed-consent process. Little has been published on informed consent beyond human-subject research. This paper outlines two studies on informed consent, for research identifying diseases of animal and human importance, within smallholder livestock value chains. Firstly, a randomized independent-group study compared three communication tools (written, cartoons, and photographs) for informing 22 Tanzanian livestock-keepers before seeking their consent. A significant difference in comprehension and engagement in the informed-consent process was found between tools, and cartoons had the highest (i.e. best combined comprehension and engagement) scores. Most (21 out of 22) farmers answered half or more the questions correctly, but none were able to answer all questions. Comprehension testing allowed identification of common misunderstandings, such as immediate benefits the farmers would receive and the process to be used for relaying research results. Dialogue stimulated by cartoons and photographs allowed researchers to determine and respond to participants' varied relationships with their livestock. The second study assessed preferred methods for indicating consent among informal-sector milk vendors in Nairobi, Kenya. Of consenting participants, 61% (140/230) indicated consent verbally, 39% (90/230) signed consent and none chose thumbprint. There was a significant enumerator-effect on both overall consent and the methods chosen. Several of these findings echo those published in human-medical research. Additionally, highlighted here is the importance of facilitating dialogue during the informed-consent process in One Health research, for a more nuanced understanding of relationships between humans, animals, and their environment. Also discussed is how a requirement to sign consent forms might limit consent among workers in informal markets, which are commonly studied in One Health research. We suggest expansion of these, and development of further, studies towards improving consent processes in One Health research.
随着“同一健康”范式的兴起，伦理学家呼吁采用新的研究方法，考虑人类、动物及其环境之间的相互依存关系。在资源匮乏的小农户畜牧系统中，这些关系可能特别复杂，因此需要严格的知情同意程序。除了人体研究之外，关于知情同意的文献很少。本文概述了两项关于知情同意的研究，这两项研究是针对小农户畜牧价值链中识别对动物和人类具有重要意义的疾病的研究。首先，一项随机独立组研究比较了三种沟通工具（书面材料、卡通和照片），以便在征求22名坦桑尼亚畜牧养殖户的同意之前向他们提供信息。研究发现，不同工具在知情同意过程中的理解和参与度存在显著差异，卡通的得分最高（即理解和参与度综合最佳）。大多数（22人中的21人）农民正确回答了一半或更多问题，但没有人能够回答所有问题。理解测试有助于识别常见的误解，如农民将获得的直接利益以及用于传达研究结果的过程。由卡通和照片引发的对话使研究人员能够确定并回应参与者与他们的牲畜之间的不同关系。第二项研究评估了肯尼亚内罗毕非正规部门牛奶供应商表示同意的首选方法。在同意参与的参与者中，61%（140/230）口头表示同意，39%（90/230）签署了同意书，没有人选择按手印。在总体同意和所选择的方法方面都存在显著的调查员效应。其中一些发现与人体医学研究中发表的结果相呼应。此外，本文强调了在“同一健康”研究的知情同意过程中促进对话的重要性，以便更细致入微地理解人类、动物及其环境之间的关系。还讨论了签署同意书的要求可能如何限制非正规市场工人的同意，而这些工人通常是“同一健康”研究的研究对象。我们建议扩大这些研究，并开展更多研究以改进“同一健康”研究中的同意程序。
