Cultural Competence : Cultural Competence A Case Study
Slide2 : You are the principle investigator of a study on postpartum depression that will include in-depth open-ended interviews with women who are recent immigrants from Mexico and first generation Mexican-American women who have been diagnosed with moderate postpartum depression. The informed consent process and all interviews will be conducted in Spanish by a Latina co-investigator who is a 2nd generation Mexican-American and has extensive experience working with this population in research and outreach settings.
Slide3 : The interview will include sensitive questions regarding depression, anxiety, confusion, suicidal ideation, and thoughts about motherhood. However, the sensitivity of the research topic does not seem to be a major barrier to recruiting participants. Approximately 20 women have responded to flyers that have been placed in a community mental health clinic, but only 3 have been enrolled.
Slide4 : In many cases, after the study has been explained and participants are asked to sign the consent form, women have said either, “I have to ask my husband first before I sign anything” and then do not return to the clinic with the signed form, or, “I don’t think my husband would like me to participate in this study.” When asked why, some participants (especially the more recent immigrants) remarked that generally they do not sign any forms without first discussing the matter with their spouses.
Slide5 : Several potential participants also mentioned that because the topic involves not just themselves but their child and family, they do not feel comfortable excluding their husbands from the decision.
How should you address this problem?
Racist Research? : Racist Research? A Case Study
Slide7 : Based on previous research experience and studies reported in the literature, a researcher proposes the theory that African-American males diagnosed with behavior disorders (BD) (oppositional defiant disorder and conduct disorder) suffer from early childhood deprivation of attention by the male parent. She proposes to interview African-American males diagnosed with BDs and compare them to a control group of males without any diagnosis of mental illness matched on SES, intact versus disrupted family, and presence versus absence of alternative male figures as well as age and race.
Slide8 : In response to recruitment materials, which were approved by the university IRB and posted throughout African-American neighborhoods near the university, representatives from a community-based organization file a complaint with the university claiming that the study is racist, harmful to the reputations of the families involved, and designed to discredit the African-American community. They also argue that the university’s IRB did not have the right to approve the research without first asking community members for input.
Slide9 : The original proposal was approved by the IRB without any questions or problems. The researcher had proposed appropriate measures for informed consent and human subjects protections. The issue of harm to the community was not addressed by the researcher or the IRB during the study approval process.
The research insists that the project is not racist and could be highly beneficial to the community. If the data support her hypothesis, the researcher plans to apply for funding to continue her work with the aim of developing a program to help develop male role models for African-American youth.
As a member of the IRB, how would you seek to resolve this issue?
Case Development Exercise : Case Development Exercise Drawing from your own experiences, try to develop a case that involves an ethical challenge that arises from a cultural, historical, ethnic or linguist context