Research and Health Care provision with trafficked populations: understanding ethical complexities and mitigation strategies

Dangerous migration pathways, such as human trafficking, increase as legal options for migration become scarce. Human trafficking carries high risk of negative health outcomes for those exploited and research is vital to understand risks and outcomes to inform public health responses. Currently, there is no ethics guidance for health research/provision with trafficked populations. The aim of this thesis was to understand ethical complexities and mitigation strategies involved in research and health care provision with trafficked populations. The objectives of this thesis were 1) conduct a systematic review of associated health consequences of human trafficking, 2) conduct a qualitative review of ethical complexities inherent in human trafficking research, 3) utilize data collected from fifteen in-depth interviews with researchers (9) and health care providers (6) to investigate identification and interpretation of ethical challenges, and 4) make recommendations regarding application of findings to future research. Constructivism was used to reconstruct identification and interpretation of ethical challenges from the viewpoint of researchers and health care providers. Qualitative Content Analysis was used for analysis. Six main categories of themes emerged from conducted interviews: evidence generation, equality and fairness, research procedures, autonomy, harmful practice, and environment. Emergent themes were temporally bound to stages of research and health care provision. An architectural blueprint of a house was used to visualize the research process and health care interactions. Health research with trafficked populations carries multiple ethical challenges at all stages of research and health care provision. Human trafficking is a complex phenomenon influenced by multiple external factors that complicate ethical challenges. Understanding how researchers and health care providers identify and interpret ethical challenges, along with examples of mitigation strategies will allow health research to be conducted to a high ethical standard, and enable development of a valid and reliable evidence base that can inform needed public health responses.