Abstract:
Background: Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have
multiple vulnerabilities in relation to participation in research. These require additional considerations that are
responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of
respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of
adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.
Methods: As part of three interrelated research projects in western Kenya, we created procedures to address
SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical
considerations and solutions in relation to community engagement, equitable recruitment, informed consent,
vulnerability to coercion, and responsibility to report.
Results: Substantial community engagement provided input on SCCY’s participation in research, recruitment, and
consent processes. We designed an assent process to support SCCY to make an informed decision regarding their
participation in the research that respected their autonomy and their right to dissent, while safeguarding them in
situations where their capacity to make an informed decision was diminished. To address issues related to coercion
and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided
access to care regardless of research participation.
Conclusions: Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be
managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in
reducing inequities and advancing their health and human dignity.
