Empowerment for the Right to Health: The Use of the "Most Significant Change" Methodology in Monitoring.

Quantitative evaluations might be insufficient for measuring the impact of interventions promoting the right to health, particularly in their ability to contribute to a greater understanding of processes at the individual, community, and larger population level through which certain results are obtained. This paper discusses the application of a qualitative approach, the "most significant change" (MSC) methodology, in the Philippines, Palestine, the Democratic Republic of the Congo, and El Salvador between 2010 and 2013 by Third World Health Aid and its partner organizations. MSC is based on storytelling through which the central question--what changes occurred?--is developed in terms of, "who did what, when, why, and why was it important?" The approach focuses on personal stories that reflect on experiences of change for individuals over time. MSC implementation over several years allowed the organizations to observe significant change, as well as evolving types of change. Participants shifted their stories from "how the programs helped them" and "what they could do to help others benefit from the programs" to "what they could do to help their organizations." The MSC technique is useful as a complement to quantitative methods, as it is a slow, participatory, and intensive endeavor that builds capacity while being applied. This makes MSC a useful monitoring tool for programs with participatory and empowering objectives.

Children and adolescents' capacity to provide informed consent for participation in research.

Researchers who work with children and adolescents are confronted with a special set of ethical issues regarding informed consent. Federal guidelines generally stipulate that minors cannot provide informed consent for participation in research. Instead parental or guardian permission must be obtained for a minor to participate in research. However the literature in developmental psychology has shown that adolescents are able to make meaningful decisions and advocates for youth have argued that researchers must respect the autonomy rights of children and adolescents. The present review examines the developmental literature on children and adolescents' capacities to make informed, voluntary, and rational decisions to participate in research. The purposes and benefits of assent are identified. Recommendations are offered on how to enhance and respect minors' developing autonomy while protecting them from risks of research.