Necessity of bioethics training for health researchers and volunteers engaging in community-based research (CBR)

Abstract

Background: Community-based research (CBR) is increasing in low-income countries, particularly health research. It is primarily driven by recognising the importance of community engagement in effectively addressing local health issues. Conducting ethical research within communities necessitates a deep understanding of complex cultural, socioeconomic, and ethical considerations. This study evaluates the preparedness of health-related researchers and volunteers to ethically engage with diverse communities, highlighting the need for comprehensive training programs. Methods: Surveys were conducted with 21 participants before the workshop and 17 participants afterwards (post-workshop), accessing 3 parameters: knowledge of basic principles in medical research ethics, perceptions of the fundamentals of ethics, and the perception of religious differences, marginalised socioeconomic and cultural in-competency related to community engagement. Normality of the score was checked using Shapiro-Wilk and Kolmogorov-Smirnov normality test. Changes were measured using Wilcoxon Signed Rank test, McNemar test and correlations test was performed using Kendall’s tau-b correlation test, followed by a descriptive analysis of the required parameters. Results: Significant improvements of knowledge in understanding of research ethics (Z-score = 3.089, P = 0.002) and ethical code (P=0.012) were observed among attendees after the attending the workshop. Additionally, the understanding on Nuremberg code (from 50% to 86.7%), Belmont report (from 37.5% to 86.7%), Declaration of Helsinki (from 87.5% to 100%) and ICH-GCP (from 37.5% to 53.3%) were also enhanced though the changes were not statistically significant. The workshop was insufficient to elicit the distinct understanding necessary to change the perspective of researchers in diverse and vulnerable populations-based research setting. Post workshop knowledge on fundamental principle of ethics was significantly negatively correlated with perception of researchers to religion difference, marginalized socioeconomic and cultural in-competency (PRMC) at study site (tau_b= -0.494, p=0.031).

Discussion: The findings emphasise the importance of comprehensive bioethics training for health researchers before they engage with communities. Current workshop was effective in increasing knowledge on basic ethical principles in medical research and significantly enhanced knowledge on the ethical code or standards. Workshops may raise awareness but are insufficient to elicit the distinct understanding necessary to navigate ethical challenges in diverse and vulnerable populations. A one-time intervention may not be sufficient to challenge or alter these complex perspectives. Thus, practical, interactive sessions and continuous learning opportunities are essential to translate theoretical knowledge into ethical practice. The moderate post-workshop shift in attitude among researchers towards cultural understanding and community engagement highlights the need for integrated training approaches that connect ethical codes with real-world applications. Conclusion: While traditional workshops enhance the general knowledge of research ethics, they should consider a more tailored approach with practical skills to prepare researchers for the ethical complexities of community-based research. Community-based bioethics training that includes practical skills, applications, and continuous learning is critical for equipping researchers to conduct ethically sound and culturally competent research outside the usual research environment. Ensuring researchers have relevant knowledge and training before entering communities is essential for ethical engagement, research integrity and protection for researchers and the community they serve. Keywords: Community-Based Research (CBR); Research Ethics; Ethical Training; Cultural Competency; Low-Income Urban communities (LIUC).