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BMC Public Health. 2017 May 30;17(Suppl 1):410. doi: 10.1186/s12889-017-4305-9.

When communities are really in control: ethical issues surrounding community mobilisation for dengue prevention in Mexico and Nicaragua.

Author information

1
CIET International, New York, NY, USA. rledogar@ciet.org.
2
CIET Nicaragua, Managua, Nicaragua.
3
Department of Entomology and Nematology, University of California, Davis, CA, USA.
4
Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico.
5
CIET Canada, Ottawa, Canada.
6
Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA.
7
Department of Family Medicine, McGill University, Montreal, Canada.

Abstract

We discuss two ethical issues raised by Camino Verde, a 2011-2012 cluster-randomised controlled trial in Mexico and Nicaragua, that reduced dengue risk though community mobilisation. The issues arise from the approach adopted by the intervention, one called Socialisation of Evidence for Participatory Action. Community volunteer teams informed householders of evidence about dengue, its costs and the life-cycle of Aedes aegypti mosquitoes, while showing them the mosquito larvae in their own water receptacles, without prescribing solutions. Each community responded in an informed manner but on its own terms. The approach involves partnerships with communities, presenting evidence in a way that brings conflicting views and interests to the surface and encourages communities themselves to deal with the resulting tensions.One such tension is that between individual and community rights. This tension can be resolved creatively in concrete day-to-day circumstances provided those seeking to persuade their neighbours to join in efforts to benefit community health do so in an atmosphere of dialogue and with respect for personal autonomy.A second tension arises between researchers' responsibilities for ethical conduct of research and community autonomy in the conduct of an intervention. An ethic of respect for individual and community autonomy must infuse community intervention research from its inception, because as researchers succeed in fostering community self-determination their direct influence in ethical matters diminishes.

TRIAL REGISTRATION:

ISRCTN 27581154.

KEYWORDS:

Autonomy; Camino verde; Community intervention research; Community mobilisation; Socialisation of evidence

PMID:
28699548
PMCID:
PMC5506591
DOI:
10.1186/s12889-017-4305-9
[Indexed for MEDLINE]
Free PMC Article

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