Strengthening ethics committees for health-related research in sub-Saharan Africa: a scoping review.

OBJECTIVE: Health-related research in sub-Saharan Africa (SSA) has grown over the years. However, concerns have been raised about the state of research ethics committees (RECs). This scoping review examines the literature on RECs for health-related research in SSA and identifies strategies that have been applied to strengthen the RECs. It focuses on three aspects of RECs: regulatory governance and leadership, administrative and financial capacity and technical capacity of members. DESIGN: A scoping review of published literature, including grey literature, was conducted using the Joanna Briggs Institute approach. DATA SOURCES: BioOne, CINAHL, Embase (via Ovid), Education Abstracts, Global Health, Google Scholar, Jstor, OpenEdition (French), Philosopher's Index, PsycINFO, PubMed, Science Citation and Expanded Index (Web of Science), reference lists of included studies and specific grey literature sources. ELIGIBILITY CRITERIA: We included empirical studies on RECs for health-related research in SSA, covering topics on REC leadership and governance, administrative and financial capacity and the technical capacity of REC members. We included studies published between 01 January 2000 and 18 February 2022 and written in English, French, Portuguese or Swahili. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened the records. Data were extracted by one reviewer and cross-checked by another. Owing to the heterogeneity of included studies, thematic analysis was used. RESULTS: We included 54 studies. The findings show that most RECs in SSA work under significant administrative and financial constraints, with few opportunities for capacity building for committee members. This has an impact on the quality of reviews and the overall performance of RECs. Although most countries have national governance systems for RECs, they lack regulations on accountability, transparency and monitoring of RECs. CONCLUSIONS: This review provides a comprehensive overview of the literature on RECs for health-related research in SSA and contributes to our understanding of how RECs can be strengthened.

Strengthening ethics committees for health-related research in sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: Health research in low-income and middle-income countries, which face the greatest burden of disease, is a vital component of efforts to combat global health inequality. With increased research, there has also been concern about ethical and regulatory issues and the state of research ethics committees, with various attempts to strengthen them. This scoping review examines the literature on ethics committees for health-related research in sub-Saharan Africa, with a focus on regulatory governance and leadership, administrative and financial capacity, and conduct of ethical reviews. METHODS AND ANALYSIS: We will use the methodological approach proposed by Arksey and O'Malley and adapted by Levac et al and the Joanna Briggs Institute. Inclusion and exclusion criteria are based on the 'Population-Concept-Context' framework. Literature (from January 2000 to December 2020) will be searched in multiple databases including Embase and PubMed and websites of relevant organisations. All records will be screened by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review flowchart: two reviewers will independently screen titles and abstracts, and full text of included records. Using an inductive approach, we will synthesise the literature, identify best practice and gaps in evidence on strengthening research ethics committees. ETHICS AND DISSEMINATION: Ethical approval is not required as the review will include only published literature. The findings will be published in a peer-reviewed journal and presented at stakeholder meetings and conferences.

Mini-MEND: an obesity prevention initiative in a children's centre.

Student health visitors led a Mini-MEND project for families with young children as part of their public health nursing course. The project gave a framework for the students and staff members from the children's centre to stimulate an awareness of health needs and facilitate health enhancing activities in terms of healthy eating and parenting. Reflection on the initiative identified application of the principles of health visiting and the domains of specialist community public health nursing, yet the pressures of current health visiting workloads mean that having developed public health skills to use with groups and communities, they may not be used by newly-qualified health visitors.

Challenges in health visitor prescribing in a London primary care trust.

In this primary care trust there was limited health visitor prescribing. A case study approach sought to identify reasons for this, to lead to recommendations and changes to develop health visitor prescribing. The situation was examined using qualitative methods to consider the opportunities and challenges in health visitor prescribing. Semi-structured interviews with eighteen health visitors and managers explored their views of health visitor prescribing and its position within the PCT. The findings demonstrated only three health visitors prescribed; yet the majority were positive about prescribing, both for clients and health visitor development. Practitioners recognised their difficult working context and felt that organisational systems were not supportive of prescribing. A culture of prescribing was not felt to be in evidence, but was seen as a realistic possibility. Recommendations for change focused on the organisation and practitioners, with improved communication and structures supportive of prescribing. There was a need for practitioners to be active in learning so that they could share knowledge, experience and commitment to prescribing in locally based groups.

Advancing practice by developing a primary care nursing programme.

The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.

Why do nurses enter community and public health practice?

Current policy places much emphasis on public health and care outside hospital. To provide this requires a qualified work force but a large number of community nurses are approaching retirement. While there is a commitment to recruit and retain such nurses, there is little information available on community nurses' career trajectories, or on why staff choose to work in the community and why they undertake community specialist practice (CSP) programmes. This paper reports the findings of a survey of community specialist practice students--community children's nurses (CCNs), community mental health nurses (CMHNs) district nurses (DNs), health visitors (HVs), practice nurses (PNs), school nurses (SNs)--in a large London based programme. They were asked why they had entered community practice and why they had undertaken a community specialist practice programme. Findings were not categorical; the reasons for entering community work included increased initiative, more autonomy and preferred hours. Scope for initiative, autonomy and increased independence were reasons for undertaking the CSP programme, as well as better promotion prospects. Differences were evident in response by age of respondent and by whether they had dependent children. All types of respondents saw themselves as public health practitioners. Practice nurses stood out as different from the others, seeing hours as significant, but not promotion prospects despite expecting higher grades on completion of the programme. The study raises various questions, which could be explored after refinement of the study tool and using students in different locations throughout the country.

Evaluation of a child development centre in a rural area.

In this article we discuss the setting up of a child development centre for children with a developmental delay in a rural market town away from a tertiary centre. The process was evaluated by a variety of methods including analysis of centre activity, preliminary questionnaires to parents at the end of their child's assessment, reflections by the centre team and in the final year of the project, a survey of all parents who had used the service, professionals who worked in it and other agencies in the centre town and a comparison town. Parents and staff reported high levels of satisfaction in relation to multidisciplinary working, venue, communication, and a child/family friendly approach. Further work is needed in developing links with social services and the voluntary sector.