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Research Involving Health Providers and Managers: Ethical Issues Faced by Researchers Conducting Diverse Health Policy and Systems Research in Kenya

机译：涉及卫生提供者和管理者的研究：在肯尼亚进行各种卫生政策和系统研究的研究人员所面临的伦理问题

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There is a growing interest in the ethics of Health Policy and Systems Research (HPSR), and especially in areas that have particular ethical salience across HPSR. Hyder et al (2014) provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers and providers were key participants. All three studies involved qualitative work including observations and individual and group interviews. Many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential ‘solutions’ to dilemmas often lead to new issues and complications. Our experiences support the value of research ethics frameworks, and suggest that these can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. Many of these essential relational elements of ethical practice, and of producing quality data, are given stronger emphasis in social science research ethics than in epidemiological, clinical or biomedical research ethics, and are particularly relevant where health systems are understood as social and political constructs. We conclude with practical and research implications.
机译：人们对卫生政策和系统研究（HPSR）的道德规范越来越感兴趣，尤其是在整个HPSR具有特殊道德显着性的领域。 Hyder等人（2014）提供了一个初步的框架来考虑这一点，并呼吁进行更多的概念和实证研究。在本文中，我们通过研究在肯尼亚进行的三项HPSR研究过程中出现的伦理问题对研究人员进行了回应，其中健康管理者和提供者是主要参与者。这三项研究均涉及定性工作，包括观察以及个人和小组访谈。研究人员面临的许多道德困境仅在田野调查过程中或完成时才出现，并且与在健康/研究系统中处于不同级别或职位的个人之间的相互作用和关系有关。两难困境揭示了这些形式的HPSR面临的重大道德挑战，并表明两难解决的潜在“解决方案”通常会导致新问题和复杂性。我们的经验支持研究伦理框架的价值，并建议通过将对上下文嵌入的社会关系的仔细考虑纳入研究计划和行为中，可以丰富这些伦理框架。与流行病学，临床或生物医学研究伦理相比，社会实践研究伦理更加重视伦理实践和产生高质量数据的许多基本关系元素，在将卫生系统理解为社会和政治建构的情况下尤其重要。我们以实践和研究意义作为结论。

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