U.S. trainees’ experiences of ethical challenges during research in low- and middle-income countries: A mixed methods study

ABSTRACT

High-income country (HIC) trainees are participating in research in low- and middle-income countries (LMIC) in increasing numbers, yet the ethical challenges they face have not been well described. We conducted a mixed methods study of U.S. graduate and undergraduate students who conducted research in LMIC, including an online survey and semi-structured interviews. Among 123 online survey respondents, 31% reported ethical challenges and nearly two-thirds of respondents did not feel well prepared to deal with ethical challenges. Qualitative analysis of the 17 semi-structure interviews and narrative survey responses revealed many themes of ‘ethics in practice’: challenges in setting research priorities, navigating relationships with host country partners, scope of research practice, and human subject protections. Respondents reported that pre-departure trainings were not reflective of ethical frameworks or research contexts in LMIC, and few described seeking host mentor help in addressing ethical challenges. These results suggest a need for improvements in training, oversight and mentorship of trainee researchers, and to further engage both HIC and LMIC institutions, educators and researchers in addressing ethical issues.

KEYWORDS:

• Global health ethics
• research ethics
• pre-departure training
• trainees
• ethics in practice

Acknowledgements

The authors thank Elizabeth Bradley, Jane Edwards, Leslie Curry, Ross Linden-Fraser, and all of the trainees who took part in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).