Ahmad El Ouweini
IPSF Pharmacy Education Newsletter Editor 2016-2017
A Guide To Research in Low and Middle-Income Countries for First-Timers An Article published in FIP Pharmacy Education Journal in 2016
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Authors: YARDLEE S. KAUFFMAN (1) *, LAUREN JONKMAN (2), SHARON E. CONNOR (2) 1 Department of Pharmacy Practice and Administration, Philadelphia College of Pharmacy, Pennsylvania 19104, USA 2 School of Pharmacy, University of Pittsburgh, Pennsylvania 15261, USA
oming from the Philadelphia College of Pharmacy, Pennsylvania, Dr. Kauffman and his colleagues at the University of Pittsburg have written an article to guide the pharmacy students and residents who become involved in research in low and middle-income countries for the first time to assure that they utilize the multi-step approach that the authors provide to achieve outstanding and properly designed research projects and lifelong encouraging learning experience.
This article, which was published in the Pharmacy Education Journal of the International Pharmaceutical Federation (FIP), focuses on demonstrating the logistical and ethical issues and challenges associated with conducting research in low and middle-income countries (LMIC). Such issues and challenges include limited resources and poorly developed health systems, further obviating the potential to translate research findings into practice. In addition, it supplements pharmacy students and residents planning to develop and implement a research project in LMIC with a list of valuable guidelines for such decisive projects. The article starts with focusing on the importance of having a well-planned research project in mind. This can be achieved by the researcher through asking few typical questions, such as: What motivated me to do this research? What am I trying to attain with this research? Will my research be of great
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benefit to the society? Will it add a substantial value and knowledge that was not addressed before? Will it lead to a sure-enough change in the target community? Will my research project utilize resources that could have been invested in for other more pressing and critical projects for the society? A deeper next step would be contemplating about all the needed resources for each step of the research project, even for the airfare. This is best accomplished by planning the project in mind and as hard copy on paper. It is highly recommended for the researcher to generate early on a list of the essential items that the project highly demands to avoid the possibility of facing logistical issues later when the project commences. The researcher needs to determine whether these resources will be obtained extramurally or internally. Sometimes, the desired support comes from outside organizations, foundations, university scholarships, or mini-grants. Dr. Kauffman and his colleagues move next to direct the discussion toward the extremely important need to start a powerful data collection method to speed the process of data extraction. It is very paramount, according to the authors, to develop to pilot the research tools before visiting the research local setting. The researcher possibly may need to perform carefully designed and wellplanned interviews to collect feedback from partners piloting the data collection tool form in the research setting.
After that, the article sheds the light on the importance of encouraging and leading the stakeholders in the national communities to fully participate in the success of the research project and its implementation. The authors emphasize on the supreme value of considering the societal needs when developing the aims and hypotheses and the ensuing application of the research results. According to the authors, it is mandatory for the Western researchers to collaborate with local partners and researchers to start continuous training programs that empower their capabilities and skills to be able to independently explore novel pressing research questions and conduct a local research with high standards. The authors state that the types of local stakeholders, whose commitment and perspectives are essential parts of the project implementation process, include "policy-makers, technical experts, representatives from the ministry of health and schools of health sciences, health care providers, and community laypersons of other key groups, such as nongovernmental organizations." Their presence in the study design and plan will ensure full representativeness, sustainability, and worth of the project for the target population because those stakeholders express the concerns of the local community. The following step to consider in conducting the research project as stated in the article deals with the ethical approval process. It is good to know that unfortunately, LMICs have a rapid turnover of staff in the ethical research committees, because those adequately trained people with the required expertise are truly scarce and difficult to employ in the local research settings. Even when they exist, they are usually hired by other global agencies. Consequently, rigorous training programs are required to fulfil the real gap in those countries. Interestingly, the article highlights
the substantial usefulness of considering the exploitation of the research participants when the provided treatment throughout the experiment is stopped after the experiment is over. Their restricted range of resources places them at this vulnerable position, which should therefore be carefully and deeply addressed, especially because most of the times in LMICs they are deprived of declaring and asking for their rights. The authors go on to affirm that when the research deals with human subjects and will be published widely, it is imperative to determine early in the project planning the type and number of ethical committees that are needed to proceed with the research project and ensure synergistic work and output. Examples of such committees include the Institutional Review Board (IRB), ministries of health, some relevant NGOs, and others. When talking about recruiting and preparing the human subjects for the research project, according to the authors: "Consent forms should be concise and provide clear information on the risks and rights to decline participation." This should, certainly, take into consideration the differences in cultural norms that dictate the prior permission of the household for other persons in the house to participate in a study. Doubtlessly, the procedure of taking consent should accommodate all the special conditions and/or restrictions that may be present in the target participants, such as illiteracy, male-dominant cultures, language barriers and the list continues, for which proper and practical solutions should be implemented. The authors present a priceless advice for the researchers in LMICs, be flexible and patient with all the problems and obstacles that they might face on the ground during the study period. They need to be persistent and smart at embarking on lifelong relationships with regional partners, which will ease many barriers that might hinder the proper implementation of
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