"I never expected that it would happen, coming to ask me such questions": Ethical aspects of asking children about violence in resource poor settings

Abstract

Background: International epidemiological research into violence against children is increasing in scope and frequency, but little has been written about practical management of the ethical aspects of conducting such research in low and middle-income countries. In this paper, we describe our study procedures and reflect on our experiences conducting a survey of more than 3,700 primary school children in Uganda as part of the Good Schools Study, a cluster randomised controlled trial of a school-based violence prevention intervention. Children were questioned extensively about their experiences of physical, sexual, and emotional violence from a range of different perpetrators. We describe our sensitisation and consent procedures, developed based on our previous research experience and requirements for our study setting. To respond to disclosures of abuse that occurred during our survey, we describe a referral algorithm developed in conjunction with local services. We then describe our experience of actually implementing these procedures in our 2012 survey, based on reflections of the research team. Drawing on 40 qualitative interviews, we describe children's experiences of participating in the survey and of being referred to local child protection services. Results: Although we were able to implement much of our protocol in a straightforward manner, we also encountered major challenges in relation to the response of local services to children's disclosures of violence. The research team had to intervene to ensure that children were provided with appropriate support and that our ethical obligations were met. Conclusions: In resource poor settings, finding local services that can provide appropriate support for children may be challenging, and researchers need to have concrete plans and backup plans in place to ensure that obligations can be met. The merits of mandatory reporting of children's disclosures to local services need to be considered on a case by case basis-in some places this has the potential to do harm. Research teams also must agree on what level of ancillary care will be provided, and budget accordingly. Further practical examples of how to address the challenges encountered in this work are needed, in order to build a consensus on best practices.

Enrolling HIV-positive adolescents in mental health research: A case study reflecting on legal and ethical complexities

“…[32,43] Adolescents report marginal levels of distress when self-reporting violence and suicidality. [44,45] In our study, the overwhelming majority of adolescents expressed relief and gratitude in being able to tell their story and did not report experiencing the interview as stressfulechoing findings in other studies of HIV-affected children. [46][47][48] The African Charter on the Rights and Responsibilities of the Child recognises rights to enjoy the best attainable state of physical, mental and spiritual health and scientific research.…”

Examining the Risks of Engaging in Population-based Surveys on Violence: Follow-up Study of the Individual Deprivation Measure in South Africa

“…As noted in the methods section, information sheets providing contact details for a range of services were provided to all survey respondents and all participants in the follow-up study. Future studies would do well to explore whether the information on referral services provided to participants is useful (Devries et al, 2015). This understanding is essential because service referrals are considered an important measure for enhancing the wellbeing of participants in research focusing on personal and sensitive topics.…”

Child Abuse in the West Bank: Lessons Learnt from a Qualitative Study

“…The lack of adequate referral services in resource‐poor contexts and the ethical challenges this poses to research teams has also been highlighted by Devries et al . (2015) for Uganda. A literature review on adult disclosure of childhood sexual abuse warns that, although disclosure may be beneficial when responses are positive (Easton, 2019), it can also be harmful when responses are negative (Tener and Murphy, 2015).…”