Working with Community Health Workers as 'volunteers' in a vaccine trial: practical and ethical experiences and implications

Vibian Angwenyi, Dorcas Kamuya, Dorothy Mwachiro, Vicki Marsh, Patricia Njuguna, Sassy Molyneux

    Research output: Contribution to JournalArticleAcademicpeer-review


    Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on 'performance'. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time.

    Original languageEnglish
    Pages (from-to)38-47
    Number of pages10
    JournalDeveloping world bioethics
    Issue number1
    Publication statusPublished - Apr 2013


    • Clinical Trials as Topic
    • Community Health Workers
    • Community-Based Participatory Research
    • Employment
    • Humans
    • Interpersonal Relations
    • Kenya
    • Motivation
    • Narration
    • Salaries and Fringe Benefits
    • Vaccination
    • Volunteers
    • Journal Article
    • Research Support, Non-U.S. Gov't


    Dive into the research topics of 'Working with Community Health Workers as 'volunteers' in a vaccine trial: practical and ethical experiences and implications'. Together they form a unique fingerprint.

    Cite this