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The responsibility to protect and the need to affect change:  undocumented migrants, research ethics and methodology Migra...
Overview <ul><li>Background to the study; </li></ul><ul><li>Policy-oriented research; </li></ul><ul><li>Study aims – appro...
Policy-oriented research <ul><li>Designed in response to reports of health access challenges that  go against existing leg...
Policy-oriented research <ul><li>The responsibility to  protect …….. </li></ul><ul><li>and </li></ul><ul><li>………… the need...
Policy-oriented research <ul><li>Generate  appropriate, useful, new knowledge  that will  affect positive change : </li></...
Study aims <ul><li>To understand the extent to which  different categories of migrants  are able to  access ART  in Johann...
Methodology <ul><li>Methodology in response to aims ; </li></ul><ul><li>The need for  comparisons : </li></ul><ul><ul><li>...
Methodology <ul><li>Desk-based  literature and policy review ; </li></ul><ul><li>Semi-structured interviews  with  health ...
Sampling <ul><li>Lack of an appropriate sampling frame; </li></ul><ul><li>Purposive and random sampling : </li></ul><ul><u...
Government site NGO site Study sites
A vulnerable group? <ul><li>Concept of ‘ doubly vulnerable ’ group (Moore & Miller, 1999); </li></ul><ul><li>Migrants  (le...
Research Ethics Committees (RECs) <ul><li>Responsible for reviewing research protocols and study tools; </li></ul><ul><li>...
 
<ul><li>Policy-oriented research: </li></ul><ul><li>the opportunity (and responsibility?) to test common assumptions….. </...
Health migrants? <ul><li>These individuals are  not health migrants : </li></ul><ul><ul><li>Discovered their status in Sou...
International migrant clients are no more likely than South Africans to not collect or not take their ART (Chi-squared;  p...
<ul><li>Only 22% of all non-citizens interviewed were accessing ART at government sites; </li></ul><ul><li>The difference ...
Dissemination <ul><li>The responsibility to protect…… </li></ul><ul><ul><li>Individuals; and </li></ul></ul><ul><ul><li>Si...
Summary <ul><li>Methods and ethics are linked; </li></ul><ul><li>Consider the “politics and processes of producing and con...
Acknowledgements <ul><li>All study participants, both healthcare providers and ART clients </li></ul><ul><li>Study sites <...
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The responsibility to protect and the need to affect change: undocumented migrants, research ethics and methodology

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The responsibility to protect and the need to affect change: undocumented migrants, research ethics and methodology

  1. 1. The responsibility to protect and the need to affect change: undocumented migrants, research ethics and methodology Migration Methods Workshop 4 th July 2008 Jo Vearey [email_address] http://migration.org.za/ University of the Witwatersrand Forced Migration Studies Programme
  2. 2. Overview <ul><li>Background to the study; </li></ul><ul><li>Policy-oriented research; </li></ul><ul><li>Study aims – appropriate methods; </li></ul><ul><li>A vulnerable group? </li></ul><ul><li>Research Ethics Committees; and </li></ul><ul><li>Dissemination. </li></ul>
  3. 3. Policy-oriented research <ul><li>Designed in response to reports of health access challenges that go against existing legislation . </li></ul>
  4. 4. Policy-oriented research <ul><li>The responsibility to protect …….. </li></ul><ul><li>and </li></ul><ul><li>………… the need to affect positive change . </li></ul>
  5. 5. Policy-oriented research <ul><li>Generate appropriate, useful, new knowledge that will affect positive change : </li></ul><ul><ul><li>Comparisons between different groups and across different sites; </li></ul></ul><ul><ul><li>Representative . </li></ul></ul><ul><li>Prevent misuse of data ; and </li></ul><ul><li>Make limitations of data explicit . </li></ul><ul><ul><li>(Jacobsen & Landau, 2003; Landau & Jacobsen, 2004) </li></ul></ul>
  6. 6. Study aims <ul><li>To understand the extent to which different categories of migrants are able to access ART in Johannesburg and the barriers that may hinder their access. </li></ul><ul><ul><li>To provide recommendations to institutions and Provincial Department of Health (DoH) . </li></ul></ul><ul><ul><li>To test common assumptions that relate to the presence of international migrants in South Africa: </li></ul></ul><ul><ul><ul><li>Health migrants? </li></ul></ul></ul><ul><ul><ul><li>Adherence? </li></ul></ul></ul>
  7. 7. Methodology <ul><li>Methodology in response to aims ; </li></ul><ul><li>The need for comparisons : </li></ul><ul><ul><li>Between citizen and non-citizen; </li></ul></ul><ul><ul><li>Between different non-citizen groups; </li></ul></ul><ul><ul><li>Between different sites: government, NGO. </li></ul></ul><ul><li>Requires statistical analysis . </li></ul>
  8. 8. Methodology <ul><li>Desk-based literature and policy review ; </li></ul><ul><li>Semi-structured interviews with health care providers (n = 34); </li></ul><ul><li>1 focus group discussion with 8 refugee HIV counsellors; and </li></ul><ul><li>Cross-sectional survey questionnaire conducted with a random sample of citizen and migrant ART clients (n = 449). </li></ul>
  9. 9. Sampling <ul><li>Lack of an appropriate sampling frame; </li></ul><ul><li>Purposive and random sampling : </li></ul><ul><ul><li>4 ART sites in Johannesburg inner-city were purposively selected from migrant dense areas: 2 government sites; 2 non-governmental; </li></ul></ul><ul><ul><li>Clients were randomly selected . </li></ul></ul>
  10. 10. Government site NGO site Study sites
  11. 11. A vulnerable group? <ul><li>Concept of ‘ doubly vulnerable ’ group (Moore & Miller, 1999); </li></ul><ul><li>Migrants (legal status) AND HIV positive ; </li></ul><ul><li>Methodological and ethical challenges ; </li></ul><ul><li>Selection of participants: currently well and receiving treatment . </li></ul>
  12. 12. Research Ethics Committees (RECs) <ul><li>Responsible for reviewing research protocols and study tools; </li></ul><ul><li>Aim: </li></ul><ul><li>“ to provide ethical advice to researchers so as to assist decision making on the adequacy of proposed research projects, with respect to the protection of potential and actual human research participants” </li></ul><ul><li>(Dhai, 2005:79) </li></ul>
  13. 14. <ul><li>Policy-oriented research: </li></ul><ul><li>the opportunity (and responsibility?) to test common assumptions….. </li></ul>
  14. 15. Health migrants? <ul><li>These individuals are not health migrants : </li></ul><ul><ul><li>Discovered their status in South Africa (80%); </li></ul></ul><ul><ul><li>Mostly first tested for HIV in South Africa (76%); </li></ul></ul><ul><ul><li>Came to South Africa for other reasons </li></ul></ul><ul><ul><ul><li>Qualitative follow up study; </li></ul></ul></ul><ul><ul><li>Have been here for a period of time before discovering their status. </li></ul></ul>
  15. 16. International migrant clients are no more likely than South Africans to not collect or not take their ART (Chi-squared; p = 0.404)
  16. 17. <ul><li>Only 22% of all non-citizens interviewed were accessing ART at government sites; </li></ul><ul><li>The difference between the two government sites can be explained by the differences in institutional policy . </li></ul>International migrants are accessing ART in the non-governmental sector Government sites Non-governmental
  17. 18. Dissemination <ul><li>The responsibility to protect…… </li></ul><ul><ul><li>Individuals; and </li></ul></ul><ul><ul><li>Sites. </li></ul></ul><ul><li>The need to affect change…… </li></ul><ul><ul><li>Positive change; </li></ul></ul><ul><ul><li>Appropriate data for your audience; </li></ul></ul><ul><ul><li>Prevent misuse of data. </li></ul></ul><ul><li>Participatory dissemination process </li></ul>
  18. 19. Summary <ul><li>Methods and ethics are linked; </li></ul><ul><li>Consider the “politics and processes of producing and consuming knowledge” (Landau & Jacobsen, 2004:7); </li></ul><ul><ul><ul><li>Plan dissemination process from the start. </li></ul></ul></ul><ul><li>Be transparent: limitations of data collection and conclusions; </li></ul><ul><li>Comparability; and </li></ul><ul><li>RECs…. </li></ul>
  19. 20. Acknowledgements <ul><li>All study participants, both healthcare providers and ART clients </li></ul><ul><li>Study sites </li></ul><ul><ul><li>Support to the research and dissemination </li></ul></ul><ul><li>Forced Migration Studies Programme </li></ul><ul><li>Lawyers for Human Rights </li></ul><ul><li>Ford Foundation </li></ul>

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