title: Challenges to obtaining parental permission for child participation in a school-based waterpipe tobacco smoking prevention intervention in Qatar.
abstract: BACKGROUND
  Involving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.
  
  
  METHODS
  A random sample of 40 schools in Doha, Qatar was selected for inclusion in the original intervention. Permission forms were distributed to parents for approval of their child's participation. The permission forms requested that parents indicate their reasons for non-permission if they declined. These were categorized into themes. In order to understand reasons for non-permission, interviews with parents were conducted. Phone numbers of parents were requested from the school administration; 12 of the 40 schools (30%) agreed to provide the contact information. A random sample of 28 parents from 12 schools was interviewed to reach data saturation. Thematic analysis was used to analyze their responses.
  
  
  RESULTS
  Reasons for non-permission documented in both the forms and interviews included: poor timing; lack of interest; the child not wanting to participate; and the child living in a smoke-free environment. Interviews provided information on important topics to include in the consent forms, parents' decision-making processes regarding their child's participation, and considerations for communicating with parents. Many parents also indicated that this was the first time they had been asked to give an informed consent for their child's participation in a study.
  
  
  CONCLUSIONS
  Results indicate that more attention needs to be given to the informed parental consent process. Researchers should consider enhancing both the methods of communicating information as well the specific information provided. Before embarking on recruitment of children for studies, formative research on the parental consent process is suggested.
authors.forename: Rima T
authors.initials: RT
authors.lastname: Nakkash
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al Mulla
authors.forename: Lena
authors.initials: L
authors.lastname: Torossian
authors.forename: Roubina
authors.initials: R
authors.lastname: Karhily
authors.forename: Lama
authors.initials: L
authors.lastname: Shuayb
authors.forename: Ziyad R
authors.initials: ZR
authors.lastname: Mahfoud
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Janahi
authors.forename: Al Anoud
authors.initials: AA
authors.lastname: Al Ansari
authors.affiliation: Faculty of Health Sciences, American University of Beirut, PO Box 11-0237 Riad El Solh, Beirut 1107 2020, Lebanon. ra15@aub.edu.lb.
authors.forename: Rema A
authors.initials: RA
authors.lastname: Afifi
mesh_terms: D000328:Adult; D018912:Arabs; D001290:Attitude; D035843:Biomedical Research / Q000941:ethics; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D033282:Parental Consent; D010290:Parents; D018579:Patient Selection; D011780:Qatar; D035842:Research Subjects; D012574:Schools; D000074606:Smoking Prevention; D014026:Nicotiana