| dc.description.abstract |
There is a growing literature documenting the complex realities of consent processes in
the field, and the negotiations and ethical dilemmas involved. Much has also been
written about how gender and power shape household decision-making processes.
However, these bodies of literature have rarely been brought together to inform research
theory and practice in low-income settings. In this paper, qualitative research
(observation, focus group discussions and interviews) were used alongside large clinical
community-based studies conducted on the Kenyan Coast to explore how gender and
power relations within households and communities and between fieldworkers and
communities shape consent processes and interactions. This exploration is embedded in
relevant literature and the implications for community-based health research policy and
practice are considered. Across diverse forms of households, we observed significant
consultation on whether or not to participate in research. Although men are typically
described as household decision-makers, in practice, decision-making processes are often
far more nuanced, with many women using their agency to control, sometimes subtly, the
decisions made. Where decisions are made without adequately consulting women, many
find strategies to exercise their choice, in ways that safeguard important relationships
within households in the longer term. We also found that the gender of field staff who
typically conduct research activities in the field, including consent processes, can
influence household dynamics and decision-making processes with important
implications for the science and ethics of research. It is essential that frontline field staff
and their supervisors are aware of the complex and gendered realities of consent
processes at household level, and their implications, and that they develop appropriate
context-informed approaches that support ethical practice. |
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