“The most stress comes from witnessing the abuse of children” —challenges faced by research assistants in community-based research in Mtwara, Tanzania

BACKGROUND: Field workers or research assistants (RAs) are commonly employed within community-based trials. Training provided for RAs, however, is often limited to the technical elements of research, with little-to-no training to help them navigate the ethical challenges they may encounter while working in community-based settings. The main objective of this study was to explore the challenges faced by RAs working as part of a novel housing initiative, to describe the impact these challenges had on their work and wellbeing, and to outline approaches taken by RAs in facing these challenges. METHODS: A qualitative interview guide was piloted and refined for key informant interviews (KIIs) with research assistants (RAs) working on the Star Homes intervention in Mtwara, southern Tanzania. A total of 16 KIIs were conducted with all available RAs. These data were supplemented with 47 documents that comprised 31 case studies and 16 observation notes. The interviews were conducted in Kiswahili, audio-recorded, transcribed verbatim, and translated into English. All transcripts underwent line-by-line coding in NVivo and were analysed using thematic analysis. RESULTS: Principal challenges included difficulties related to RAs' roles and responsibilities, including having to travel long distances for data collection. Most prominent, however, were ethical challenges, including witnessing the suffering of study participants. RAs unanimously expressed being most distressed by encountering children who were neglected or subjected to abuse, including several cases of child sexual abuse (CSA), as part of their work. CONCLUSIONS: Clear engagement strategies with communities and authorities are essential to support RAs in reporting and follow-up. Training and resources are urgently needed to prepare field staff, mitigate moral distress, and protect research participants from harmful behaviours.