title: Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya.
abstract: BACKGROUND
  There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya.
  
  
  METHODS
  Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors' experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial.
  
  
  RESULTS
  Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period.
  
  
  CONCLUSIONS
  A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa.
  
  
  BACKGROUND
  National Institute of Health NCT00878007.
authors.affiliation: Health Systems Department, Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya. gokello@kemri-wellcome.org
authors.forename: George
authors.initials: G
authors.lastname: Okello
authors.forename: Caroline
authors.initials: C
authors.lastname: Jones
authors.forename: Maureen
authors.initials: M
authors.lastname: Bonareri
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Ndegwa
authors.forename: Carlos
authors.initials: C
authors.lastname: McHaro
authors.forename: Juddy
authors.initials: J
authors.lastname: Kengo
authors.forename: Kevin
authors.initials: K
authors.lastname: Kinyua
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Dubeck
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Halliday
authors.forename: Matthew C H
authors.initials: MC
authors.lastname: Jukes
authors.forename: Sassy
authors.initials: S
authors.lastname: Molyneux
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Brooker
mesh_terms: D002648:Child; D002652:Child Behavior; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D003906:Developing Countries / Q000191:economics; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057828:Informed Consent By Minors / Q000941:ethics; D033183:Interdisciplinary Communication; D007630:Kenya; D008288:Malaria / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D010353:Patient Education as Topic; D011203:Poverty / Q000191:economics / Q000941:ethics / Q000523:psychology; D036301:Qualitative Research; D012107:Research Design; D035842:Research Subjects / Q000191:economics / Q000523:psychology; D012572:School Health Services / Q000941:ethics; D013334:Students / Q000523:psychology; D020458:Third-Party Consent / Q000941:ethics