Browsing by Author "Slack, Catherine May."

Now showing 1 - 5 of 5

Ethical dilemmas in psychological practice : a survey of clinical psychologists.
(1997) Slack, Catherine May.; Wassenaar, Douglas Richard.
This study explored a sample of clinical psychologists' preferred resolutions to a series of hypothetical ethical dilemmas and their primary reasons for these choices. The relationship of various professional characteristics to choices and reasons was assessed. Ethical dilemmas volunteered by respondents were analyzed. Results indicated a general lack of consistency in decision making among psychologists in both actions taken to resolve dilemmas and reasons chosen to justify these actions. On the whole, psychologists with different characteristics did not differ in their choice of response to ethical dilemmas or their reasons for these choices. It is argued that diversity in professional decision making, and the ethical dilemmas volunteered by the profession, may serve as useful indices of those ethical issues that pose difficulties for professionals. These results are discussed in the light of similar findings and in the context of current ethical regulations.
An exploratory study of students' understandings and experiences of vaccination : implications for future HIV vaccine trials in South Africa.
(2004) Masina, Liziwe N. V.; Slack, Catherine May.
As Africa faces the challenges of its renewal or renaissance, the HIV/AIDS epidemic poses the greatest potential barrier to the attainment of this vision (Makgoba, 2001 in Dorrington, Bourne, Bradshaw, Laubscher & Timaeus, 2001). The development of an HIV vaccine that is safe, effective and affordable, has been widely contemplated as a necessary supplement to already established interventions. In preparation for HIV vaccine trials in South Africa the current project aimed to assess students' understanding (knowledge and perceptions) and experiences of vaccination in general, and to explore if these were associated with demographics such as motherhood and gender. A parallel aim was to assess students' knowledge and expectations of HIV vaccination and trial participation. A sample of 33 students was recruited from university residences at the University of Natal, Pietermaritzburg. Participants were interviewed via a semi-structured interview schedule. The data collected was then coded and analysed using content analysis, while Chi - square analysis was used to evaluate if demographics such as gender and motherhood were systematically associated with various responses. The results revealed that the vast majority of participants (97%) knew the purpose of vaccination, stating that it was to promote health and prevent illness. Most participants (67%) knew that vaccination works by mobilising the immune system (vaccination mechanism). The vast majority of participants (91%) could name at least one vaccine preventable disease. Uptake of childhood immunisation was reportedly high (88%) while adult uptake of immunisation was low (33%). A significant minority (36%) reported that they had experienced side effects but understood these to be an integral part of vaccination. Thirty percent of participants stated they were willing to participate (WTP) in a hypothetical vaccine trial, 33 % of participants were not WTP and 15% were not sure. Motivations for trial participation were reportedly influenced most by personal incentives of altruism (39%) and barriers such as perceived significant physical risk (61%). In general, knowledge and experiences of vaccination were not associated with gender or with motherhood. The results suggest that more awareness of HIV vaccine trials is needed. In this regard education should emphasise that the prospective vaccine will be preventive, that only healthy people can volunteer and that the HIV vaccine will not guarantee immunity to HIV infection. Suggestions are made for future research into motivations, barriers and incentives to facilitate an ethical process of vaccine trial participation.
Exploring communication strategies that promote sound informed consent for HIV vaccine trials.
(2017) Matandika, Limbanazo.; Slack, Catherine May.
The development of an HIV vaccine is a foremost universal health priority, necessitating research with human volunteers. It has been internationally accepted that informed consent is a fundamental ethical requirement for all clinical trials, including HIV vaccine trials (HVTs). However prospective trial participants often demonstrate a lack of understanding of information conveyed to them during the informed consent process. Ways of communicating complex concepts may need to be identified and developed to promote understanding. This study had the following aims: (a) To explore communication strategies reportedly implemented by key HIV vaccine trial stakeholders to communicate key concepts (Community Advisory Board or CAB members, Educators, Consent Counsellors) b) To explore correspondence between reported strategies and recommendations from the conceptual and empirical literature, and c) To explore the implications for strengthening informed consent for research in resource- constrained settings. The study comprised an analysis of four Focus Group Discussions with key stakeholders at an HIV vaccine trial site in South Africa, that had been previously conducted by members of the HIV AIDS Vaccines Ethics Group from the University of KwaZulu-Natal (UKZN). These stakeholders included CAB members who interacted with participating-community members; Educators who interacted with interested community members at the site, and Consent Counsellors who interacted with persons interested in enrolment in actual HIV vaccine trials. These transcripts were analysed using Thematic Analysis, informed by aspects of a popular framework for the informing process (the Meerwein model). This study adopted a qualitative approach which was broadly set in an interpretive perspective – focusing on practices, subjective meanings that stakeholders attached to their practices, and the context. Study findings are presented under three main themes. The informational theme describes how site staff reportedly employed numerous strategies to ensure that information presented to potential participants was understandable, such as simplifying, using preferred language, using analogies, using culturally appropriate terms and promoting discussion. The emotional theme describes how site staff implemented several strategies to try respond to emotions of anxiety and to try address feelings of suspicion, such inquiring about and collating suspicions, using trustworthy sources (ex-participants or influential community members) and referring to safe, licensed vaccines. The relational theme describes how site-staff reportedly employed various practices to develop respectful relationships (by creating a friendly environment) that are responsive to cultural norms, such as requesting permission to break cultural norms, and using culturally acceptable terms. The study concludes that strategies employed appear consistent with several key principles of adult learning, and communication, as well as with ethical guideline recommendations for HIV vaccine trials. These findings imply that the individual consent process is best understood as embedded in a larger process of engagement and that consent staff at sites need to have core communicative competencies, need to be sensitive to the emotional aspects of their engagements, and need to be culturally competent. Recommendations are made for key stakeholders such as Research Ethics Committees, CAB members, and ethical guideline developers. Recommendations are made to strengthen the informed consent process for research in resource-limited settings.
Exploring stakeholder perceptions and practices regarding research in provincial health facilties.
(2018) Lutge, Elizabeth Eleanor.; Slack, Catherine May.
This thesis aimed to explore the perceptions and practices of key stakeholders regarding research conducted in provincial public health facilities. Research plays a vital role in improving health and health care globally, as well as in KwaZulu-Natal (KZN), South Africa, where it has resulted in significant health gains particularly in the field of HIV/AIDS. However, in spite of a robust regulatory framework and guiding documents, health research may be fraught with challenges. In KZN, the Provincial Health Research and Ethics Committee (PHREC) is responsible for providing final permission for researchers to access public health facilities to conduct their research, or to recruit potential participants from these facilities. This permission is based on the support of health managers of public health facilities and programmes who provide the first level of permission in the PHREC approval process. This study explored the perceptions and practices of researchers and health managers regarding research conducted in provincial public health facilities, and regarding their inter-stakeholder relationships. A qualitative study design was adopted, using in-depth interviews as the means of data collection. Eighteen interviews were conducted – eight with health managers and ten with researchers. Interviews were analysed using Thematic Analysis. Three important themes were generated from the analysis: varying perceptions around the ‘social value’ of research, strained inter-stakeholder relations, and recommendations for strengthening research and relations. Although all participants agreed that health research was valuable, researchers tended to place more emphasis on its contribution to new knowledge and future beneficiaries, whilst health managers tended to emphasise its concrete and current contribution to the functioning of the healthcare system. Respondents perceived that their relationships were strained at all stages of the research process. Particular concerns included a lack of involvement of health managers in the conceptualization of research questions, frustration of researchers with a prolonged, onerous research application process, and poor feedback of research results to health managers. Important relationship issues included lack of trust, accountability, and transparency. Both stakeholder groups had a shared view regarding how to strengthen both the research process and inter-stakeholder relations. There was strong agreement on, amongst others, improving communication through more regular, formal and informal meetings, and entrenching a culture of research within the KZN Department of Health. The study concludes that researchers and health managers had subtly differing perceptions of what makes health research in provincial health facilities valuable, and that tensions between these groups were perceived across the life-cycle of the research process. The study makes various recommendations on how to build stronger relations between stakeholders, in order to facilitate the conduct of high quality research in such settings, that is valued by affected role-players.
Exploring the ancillary-care experiences of stakeholders in South African HIV vaccine trials.
(2015) Slack, Catherine May.; Lindegger, Graham Charles.
A controversial debate in research ethics comprises the responsibilities of sponsors and researchers to address participants’ medical needs in low-resource settings when this would not service the scientific objectives of the research, nor keep participants safe – their so-called ‘ancillary-care’ responsibilities – particularly when responses might be costly or demanding. The ancillary-care debate partially emerged out of the field of HIV vaccine trials. There has been surprisingly little effort to systematically explore the practices and perspectives of researchers (and other key role-players) regarding ancillary care in such trials. This qualitative study aimed to explore the experiences of key stakeholders involved in HIV vaccine trials in South Africa, specifically: their practices, how such practices are made sense of or understood, and contemporary concerns and complexities. It was funded by the Wellcome Trust Biomedical Ethics Program (087429/Z/08/Z). Semi-structured interviews were conducted with representatives of the coordinating network as well as Research Ethics Committees, Community Advisory Boards and research staff at five sites in the country implementing two HIV vaccine trial protocols. Key documents were obtained, including protocols, informed consent forms and supporting documentation. The study obtained necessary ethical approvals (UKZN BREC BE 241/09) and written consent was provided for study participation. Data was analyzed using Thematic Analysis to develop themes that captured meanings attributed by interviewees to their practices and experiences. Five master themes were developed namely Reciprocating, Engaging, Benefitting; as well as Reconciling, Privileging, Line-drawing, and Partnering. These master themes, and sub-themes, are discussed in terms of the ancillary-care literature. The study sets out implications of stakeholders’ ancillary-care experiences for leading accounts of ancillary care, as well as for current ethical guidelines. Recommendations are made to refine guidance so it is more responsive to the concerns and complexities experienced by stakeholders in the field. Recommendations are made to strengthen the practices of core stakeholders. It is hoped that through refined guidance and strengthened practices this study can contribute to the ethical rigor with which such trials are implemented.