Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
Vysnova Partners Inc., Washington, DC, USA.
Malar J. 2017 Sep 11;16(1):362. doi: 10.1186/s12936-017-2016-4.
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.
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.
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.
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.
在柬埔寨西部这样一个耐药性疟疾消除环境中，现场研究对于开发新的抗疟方案以及监测耐药传播和消除感染所需的公共卫生解决方案至关重要。此类现场研究通常面临各种类似的实施挑战，但这些挑战很少以系统的方式进行捕捉，也很少用于优化可能克服类似挑战的未来研究设计。基于现场的研究人员通常具有丰富的经验，并能就这些问题提供宝贵的见解，但他们的观点和经验很少记录下来，也很少纳入未来的研究方案中。这项混合方法分析旨在了解在柬埔寨西部抗疟消除环境中从事现场研究的工作人员日常面临的挑战。通过这样做，本研究旨在了解如何捕捉现场工作人员的经验和意见，并将其用于为未来的研究设计提供信息。
对在柬埔寨西部进行的六项现场疟疾研究的 22 份报告进行了内容分析，以确定开展研究的挑战。还对现场研究人员进行了非正式访谈、焦点小组讨论和深入访谈。使用 Nvivo 9 软件对数据进行了主题分析。还使用了三角分析和关键案例分析。
现场工作人员报告开展疟疾研究时遇到的挑战缺乏正式途径。现场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，包括缺乏覆盖长途的交通工具，以及由于难以进行随访，流动和移徙人口（MMPs）通常被排除在研究之外。沟通方面的文化障碍也阻碍了参与者的招募，并造成了意外的延误。现场工作人员经常付出身体、情感和经济上的代价，超越职责范围以维持研究的进行。
现场研究人员填写的正式月度报告可能是有效捕捉现场研究人员经验的关键工具，但需要具体的报告字段来鼓励工作人员概述他们的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关系可能会改善沟通，并减少参与者招募的障碍。应追求使 MMP 能够参与的研究设计；除了增加潜在的参与者群体外，这还将确保研究考虑到最疟疾流行的人群。临床护理和研究之间的重叠给研究人员带来了伦理困境，这一事实值得仔细考虑。从研究现场工作人员那里吸取的经验教训应被用来制定一套符合当地情况的建议，为未来的研究设计提供信息。
