On-line ethics training: experiences of a health systems researcher

‘For protocols to be reviewed, all the listed Principal Investigators (PIs) and Co –PIs need a certificate as proof of having done an online ethics course’ or ‘all applications must be accompanied by a certificate of completion from an online ethics course’.

As health researchers we often read these kind of statements with great trepidation and angst, perhaps even more so as health systems researchers as opposed to biomedical researchers.  But I think that although there are some problems and limits with these on-line courses, they can also contribute to our understanding and thinking about some key ethical concerns in our work, so they are worth considering… but as a start rather than end point.

Examples of ethics courses

There are quite a number of easily accessible on-line ethics courses out there, including: NIH Research Ethics; TRREE (Training and Resources in Research Ethics Evaluation); CITI (Collaborative Institutional Training Initiative); FHI360 Research Ethics Training Curriculum, etc. All of these courses include a range of modules on research ethics, including information sessions followed by multiple choice knowledge tests.  Those who pass the knowledge tests receive a certificate, valid for a certain period of time.

Why do an on-line course?

When I’ve faced a requirement to do an on-line course, I have often wondered if these courses are really necessary for the type of work I do: as a social scientist I only seek to gather information from participants through interviews, review existing data or document reviews; no samples are taken, no drugs or injections are administered.  But the basic principles governing research ethics are universal (even if the way they are applied in different situations differs hugely), and at the end of doing the modules I have always felt that I have learnt a lot about ethical issues and challenges that I would not have otherwise have known.  This has been to my work and has also helped me understand more about ethical issues in other people’s research too.

How to choose an on-line ethics course?

You may be required to do a specific course or set of modules.  But where there are no specifications, my colleagues have often advised that one of the shortest, easiest and most relevant for qualitative or health systems researchers is the CITI course.  It takes about ten hours altogether, which can be spread over time.  We’ve found it interesting to do it in pairs to discuss each module as we go.  We like it because it’s straightforward and user friendly, recognised by many institutions, has relatively clear and unambiguous questions, and most importantly has a social and behavioural research module.  Problems with it are that it is quite US focused, and biomedical research orientated, but it’s certainly the best I’ve done so far.

Applying an ethical lens to my work

I have found elements of on-line training useful to applying an ethical lens to some of the issues/challenges I encounter in my day to day running of studies.  For instance, deciding if and how much to pay a participant for a 3-4 hour interview or focus group discussion is at least as much of an ethical issue as a budgetary or logistical one.  Researchers can easily undercompensate participants, which can be harmful, especially where participants rely on subsistence forms of livelihoods and where taking significant time can have implications for their ability to feed their family for that day. Conversely, paying too much might make participating difficult to refuse and can cause jealousies in the community over those who get chosen to participate and those who miss out.

Moving forward, I think the crux of the matter is in the application of what has been learnt into practice and keeping a keen eye on how we can best respect the rights of our participants and local communities.  On-line ethics courses is one tiny step in helping us to think through this. There are many other guidelines and papers that can help too (See resource document: The ethics of health systems research:  illustrative guidelines and empirical studies).  It would be great to hear from others about on-line courses they have done, and ultimately have one developed specifically on the ethics of social science research.  I understand there is a social science on-line training course being developed by members of the Global Health Bioethics Network to be put on the Global Clinical Trialsplatform, so watch this space!!!

Maureen Njue is a Research Officer at Department of Public Health Research within the KEMRI/Wellcome Trust Research Programme, Kilifi. Her main roles include: supporting research ethics policy and practice at the research programme level, and coordinating the Research Ethics Group within the Department.

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