Building fairer international research systems that minimise and manage moral distress

I will tackle a critical challenge revealed by the ongoing pandemic, recent epidemics and pressing efforts to decolonise global health: How can international research programmes ensure fairer research processes that protect frontline staff from moral distress? Taking these issues seriously requires seeing frontline staff (those who play an essential role in health research through directly interacting with patients, community members and heath facility staff) as at the heart of fair systems, moral distress as resulting from broken or unequal systems, and stronger organisation al systems and support processes as critical to minimizing harm. Failure risks sustaining harm amongst these staff and among the patients/public that health research seeks to benefit. The overall goal is to develop evidence-based guidance that supports fairer conduct of international research, a more inclusive and creative research culture, and a strengthened research system that contributes to health system resilience. Moral distress can be defined as the emotional and cognitive reaction linked to events which upset someone's moral code, values or expectations. It arises where there are moral uncertainties, tensions, conflicts or dilemmas, or when one knows the right thing to do, but institutional constraints and structural inequities make it nearly impossible to pursue the right course of action. In high-income health systems the negative implications of moral distress on staff well-being, 'burnout', team relationships, retention, patient outcomes and system resilience are increasingly recognised, and promising interventions being developed. The moral distress faced by frontline research staff working in LMICs, and particularly how this might be minimized and managed, has not been examined. I will build an international team linked to the Oxford Pandemic Sciences Institute (PSI), Health Systems Global and the World Health Organisation to examine the nature, drivers and consequences of moral distress among diverse frontline research staff, and the functioning of support processes aimed at minimizing moral distress. We will investigate how to establish fairer research practices, share promising support processes with health system colleagues and collaborators, and spread these processes across facilities. The work will involve realist and scoping reviews of relevant guidance and literature, in-depth empirical work in Kenya centred around three research case studies (surveillance work, treatment trials and implementation research), and empirical work (qualitative research, surveys and consultations) with staff working in international research programmes operating across other LMICs. Broadly, years 1-2 will be focused on better characterizing moral distress among frontline research staff, creating typologies and measurement tools, and applying those tools to on-going work. Years 3-4 will build on this knowledge to co-design and interactively implement and evaluate promising interventions. In year 5, approaches and guidance evolved throughout the work will be finalized and (re)disseminated. A new 'frontline staff network' will input and advise throughout the project, including through leading an innovative small grants project and supporting dissemination and impact. This work will inform the PSI and the many UK-LMIC research partnerships so critical to UK's ambition to be a global leader in life sciences. Widespread calls for transformation in global health research underscore its' timeliness.