There is a growing literature documenting the complex realities of consent processes in the field, and the negotiations and ethical dilemmas involved. Much has also been written about how gender and power shape household decision-making processes. However, these bodies of literature have rarely been brought together to inform research theory and practice in low-income settings.

In this paper, qualitative research (observation, focus group discussions and interviews) were used alongside large clinical community-based studies conducted on the Kenyan Coast to explore how gender and power relations within households and communities and between fieldworkers and communities shape consent processes and interactions. This exploration is embedded in relevant literature and the implications for community-based health research policy and practice are considered.

Across diverse forms of households, we observed significant consultation on whether or not to participate in research. Although men are typically described as household decision-makers, in practice, decision-making processes are often far more nuanced, with many women using their agency to control, sometimes subtly, the decisions made. Where decisions are made without adequately consulting women, many find strategies to exercise their choice, in ways that safeguard important relationships within households in the longer term. We also found that the gender of field staff who typically conduct research activities in the field, including consent processes, can influence household dynamics and decision-making processes with important implications for the science and ethics of research.

It is essential that frontline field staff and their supervisors are aware of the complex and gendered realities of consent processes at household level, and their implications, and that they develop appropriate context-informed approaches that support ethical practice.

New findings:

  • Applying a gender lens to consent processes helps us to understand how multiple layers of power interact with gender; and how power is exercised across different levels – within households and between participants and research staff.
  • We demonstrate that fieldworkers’ behaviours and roles shape ethics in practice, exhibiting simultaneous positions of institutional power and social vulnerability.

Recommendations for policy:

  • All research interactions are imbued with overt and subtle relations, which a gender lens can help unpack.
  • One approach to supporting frontline research staff us through reflective processes of building ethical mindfulness, an area that needs further theoretical and empirical investigation. 
  • A commitment to gender equity in employment of frontline research staff requires policies that address structural factors that disadvantage women and/or men.

Available at:

BMJ Global Health 2017; 2:e000320. doi:10.1136/ bmjgh-2017-000320