2.6 Trustworthiness of the study
To ensure the study’s trustworthiness, the key principles of credibility, transferability, dependability, and confirmability were utilised. We engaged participants, including undergraduate and postgraduate students from various schools, deans and heads of departments, and faculty members teaching courses in research methodology, epidemiology, and statistics, to promote data triangulation and provide a broad representation of perspectives. Structured guides were employed to ensure clear, impartial, and relevant data collection, contributing to the study’s credibility. Comprehensive and detailed explanations were provided to enhance the transferability of the findings, ensuring that they could be applied to similar contexts. Field notes were taken to document the research process, allowing the first author to reflect on actions taken.
In my role as a PhD student and the primary researcher responsible for data collection and analysis, I engaged in reflexivity throughout the study to critically consider how my position could shape the research process and interpretation of the findings. Having previously studied at the data collection site as an undergraduate and later worked as a lecturer, while also maintaining ongoing research and capacity-building collaborations with academics in the same field and other health sciences areas, I remained attentive to how my past and current experiences could influence my interpretation of participants’ accounts. While these prior connections provided contextual familiarity with the academic environment, I approached the study as an independent researcher interested in understanding and improving the quality of research training and research ethics practice within the university. I remained attentive to how my background, interests, and expectations could influence both the data collection, analysis and interpretation processes. To support reflexive practice, I revisited my assumptions during coding and interpretation and engaged in regular discussions with supervisors to critically reflect on emerging interpretations. This reflexive engagement helped improve my understanding of the data and encouraged to differentiate participants’ accounts and my own observations of the research ethics practice by University of Rwanda students.
Findings
The participants are identified using anonymised alphanumeric codes to indicate their group affiliation while preserving confidentiality. The codes were constructed as follows: PS refers to postgraduate students, US to undergraduate students, CCL to course coordinators or lecturers, and DH to heads of departments and deans. Undergraduate and postgraduate students are collectively referred as students in the manuscript while deans, heads of departments, lecturers and course coordinators are collectively named faculty. The numerical component is an anonymous identifier assigned to each participant within their respective group (e.g., PS31070, US290050, CCL0005, DH00040).
Three themes were generated to capture participants’ perspectives and experiences of faculty and students on research ethics education approaches, learning, and practices in Rwandan health sciences education. The themes include: (1) research ethics learning context, (2) Superficial understanding of research ethics concepts and principles (3) Barriers to translating knowledge of research ethics into practice. These themes build on one another, starting with research ethics education and learning context, which shape the understanding of ethical concepts and principles, teaching structure, delivery methods, and ultimately influencing the ability to apply the ethics principles in practice, where various challenges and barriers are encountered especially during real word research practice. Detailed sub-themes and illustrative quotes from participants further explain these findings.
Theme 1: Research ethics learning context
Participants highlighted that research ethics learning and education within their respective departments was often limited, fragmented, and secondary to broader research methodology instruction. Students reported minimal opportunities for engagement, reflection, and hands-on practice, while faculty acknowledged constraints in teaching time, expertise, and resources. This theme captures both the approaches used to teach research ethics and participants’ reflections on how learning experiences could be enhanced to better prepare students for ethical research practice.
Subtheme 1.1: Research ethics pedagogy
Interviewed participants described research ethics educational experiences as fragmented, and insufficiently emphasized, leaving them underprepared to apply ethical principles in research. Ethics content was often brief and embedded within broader research methodology courses rather than treated as a substantive area of study.
Participants reported that the time devoted to research ethics was minimal, particularly in comparison to the emphasis placed on research methodology during proposal preparation and during submissions for ethical clearance as participants further elaborate;
“We had a course on research, but it didn’t focus specifically on ethics … The emphasis was more on methodology as we were preparing to start our proposals, focusing on research designs” (PS31070). “It-research ethics - is a unit during research methodology. it is just a simple topic that we inform students few issues concerning research ethics. It’s a course towards ensuring that they will be able to work on their research project for year 4 students. Maybe I can say that it’s just a topic. During year 4, we also organise presentations of their proposals before they go on for applying for ethical clearance. This is when the whole department meets to give feedback to students. (DH00020), and “RE … This is a model that students are taught all matters concerning research such as epidemiology, biostatistics, research proposal among others”-
(DH00040). “The module lasted one month, and the research [ethics training content] was two days” (PS00060). Another participant recalled attending sessions with “more than seven hundred students in a large lecture hall with minimal opportunity for interaction” (PS060030).
Postgraduate students further shared that online and self-directed delivery, which provided minimal opportunities for discussion and clarification, were the most common mode to obtain information on research ethics.
“It [research ethics learning] was an online course, and it was just reading some chapters with no instructors and no guidance” (PS30020). “The module on research ethics was not very effective for me. The lecture was delivered online, and since the material was new to us, it was difficult to follow and ask questions … On-site teaching was more effective, but it only focused primarily on designs and methodologies” (PS31070).
Faculty confirmed that research ethics was rarely addressed in depth, even at advanced levels, often limited to introductory principles:
“For PhD students or even masters, they might need to conduct clinical trials, but we teach nothing about regulatory processes and/or requirements” (DH0004).
Some programs offered seminars while others had modules in which students get introduced to ethics, but these were inconsistently implemented:
… on PhD students they have what we called seminars, there is particular seminar that focus on research ethics, it integrates all those components of ethical conduct, responsible conduct research …” (CCL0008). “We start by teaching them theories about research methodology after that we do some practices where we teach them about a research project, ethical clearance/approval processes and consenting processes as well as other steps such as data analysis and results dissemination”-
(CCL0005).
“At diploma level, students are taught research under a module called health measurement and research. Students are introduced to ethical consideration matters as well. At bachelor level, we have a module on evidence-based project, where students conduct evidence-based practices including conducting research. We teach students formats of proposals, how to apply for permissions and ethical clearance among others. At master’s level, we have what we call advanced research module where they study all of those ones including research project as a dissertation. It’s a module with various topics on research proposal, ethical consideration, statistics and epidemiology as well” (DH00019).
Additionally, during research ethics learning process, a lack of sustained guidance, with supervision often inconsistent or inaccessible due to inadequate training in research ethics for instructors and lecturers. Supervision, when available, was often limited, inconsistent, or inaccessible, and the lack of timely guidance left students uncertain and unprepared to address ethical dimensions in their work. Participants acknowledged that supervisors have different levels of experience, which might have affected students’ engagement with ethical research practice.
“Mostly, the supervisors that we [students] have are not available” (PS60030).
“We completed it in the second year, but it felt limited due to time constraints … I believe the course should be offered annually throughout the program to reinforce understanding” (PS33060).
“I wish every year they should put a topic of research so that people keep updating their knowledge” (PS30020).
Participants further expressed a lack of supervisors’ preparation and consistency, which affected students’ learning experiences, sharing receiving students whose supervisors lacked sufficient awareness of research ethics principles, supervision support, leaving students without meaningful guidance:
“Even supervisors … some of them are not aware of those principles … students come from different groups and the supervisor just tells them, ‘Go and work,’ without real support” (CCL0006).
“…. I think lecturers and supervisors need various training, particularly training on how to handle supervision, training on how to support students …”-
(CCL0008).
Despite some faculty efforts to integrate ethics into proposal and thesis preparation, students continued to perceive ethics learning as abstract and insufficiently applied. These findings indicate that research ethics learning remains largely theoretical, fragmented, and inadequately supported.
Sub-theme 1.2: Research ethics teaching capacity and resources
Participants described multiple constraints that restricted the quality, continuity, and effectiveness of research ethics learning for both undergraduate and postgraduate programs. Faculty accounts, in particular, highlighted shortages in staffing, time, training, teaching materials, and coordination, all of which restricted meaningful engagement with research ethics content and follow-up with students during their learning process. These conditions weakened the depth, consistency, and reinforcement of research ethics learning, contributing to gaps that may later surface during students’ research practice.
Faculty emphasized that insufficient trained staff/faculty and workload pressures reduced opportunities to teach ethics thoroughly and to mentor students effectively. Some participants explained that meaningful ethics teaching requires more time, trained staff, and institutional coordination, yet these were largely absent:
“… exposure to other institutions would help … staff are not enough … need senior staff or professors with PhDs to guide on teaching research ethics … curriculum review takes 5–10 years … integrating ethics fully takes a long time … challenges in classroom space and scheduling” (CCL0005).
“We have several issues that affect the teaching. Time allocated for teaching research ethics is insufficient … increase teaching time or credits for the module … networking is limited … don’t know how others are doing things” (CCL0009).
“I think lecturers also need training, including how to supervise students because it’s all about individual efforts because sometimes students go to present and as a lecturer you are ashamed because you also didn’t have anything to offer to them, to point where you feel like you want to go to hide” (DH00030).
Large class sizes and institutional pressures to increase student intake were also described as barriers to effective ethics learning and supervision due to overcrowding that reduced the ability to support students throughout their research process:
“There are too many students in our programs … this can also affect how we teach research ethics and integrity, including getting enough time to follow up students during their research projects to be able to check if they really follow RE/RI principles” (CCL0001).
It was also found that, the financial constraints created pressures, especially when procedures are seen as inflexible or misaligned with available resources, students may begin to view ethical compliance as optional, bureaucratic, or a burden to be navigated rather than a foundational part of ethical research. Faculty also expressed that financial challenges affect their teaching work, consultation of other research work and enabling a research environment where they can easily guide students.
“…. getting the labs and financial resources needed to invite some patients who might be used during research but also organising simulated patients for instances in that case needs financial resources …”- (CCL0008).
“… As I mentioned that we have a library, but it is still poor, they don’t access all needed materials, so, given the online and even fiscal, what is needed here is research support”-
(CCL0003).
“Undergraduate students … they don’t have funding to do research … that’s why I doubt the compliance of data collection … they tend to have less data and manipulate them”-
(CCL0001).
“Challenge … experimental laboratory equipment is limited … students mainly do observational studies … financial support is lacking to conduct deeper experimental research. Additionally, access to journals and online resources is restricted; not all materials are open access, sometimes requiring payment” – (CCL0005).
Sub-theme 1.3: Learning experience recommendations
Students and faculty emphasized the need for more applied strategies such as interdepartmental collaborations, case-based learning, peer engagements, real-life ethical scenarios, mentorship to enable bridging the gap between acquiring theoretical knowledge and practice during research. Across interviews, students and faculty acknowledged the importance of learning ethics and called for more interactive and practice-based ethics instruction, contrasting it with the largely theoretical or online formats they had experienced.
Participants advocated for
“physical class [es]” and instruction from “someone experienced … to teach students about the research ethics” (PS30020) and emphasized “hands-on training … such as on how you build the consent form, how you apply for ethical clearance” (PS30060).
“Practical components are needed … students are still struggling … when they reach the field, they start wondering how to approach the community. Students are familiar with doing things in the same way; there is no exchange of ideas between departments or exposure to other methods”-
(CCL0005).
Locally contextualised guidelines were identified as a necessity in addition to also training the faculty to be able to guide students.
“It’s not only for students but also lecturers, it is necessary to learn RI/RI because it’s the only way to follow research ethics principles and know how to follow guidelines, it is also necessary to have local guidelines in order to ensure that they are context specific” DH00030.
“For them<students>, they just want to finish the module, and there is this small part called research ethics that is included, so if they get to know that this is a serious issue, that does not end in classroom, but also are practical, we can take it seriously. And these trainers are the one who gives us marks in the field placement or in the thesis, so at least, they need to ask for evidence, like if one is presenting, they ask at least one signed consent, they need to know that it should be emphasized, it can help”-
(PS70040).
“We focus more on clinical practice than research. Research is only mandatory for those interested, and most of us prioritize clinical work. I haven’t had much practical experience regarding research ethics yet”-
(PS31070).
“Students may unintentionally harm the community or give sensitive messages … learning ethics helps prevent conflicts between researchers and participants”-
(CCL0005).
Additionally, multimedia tools, guidelines accessibility and real-world case studies were also strongly recommended as tools that can impact how students learn. Students expressed that “videos on cases that act as an example” (PS70040) and illustrations of real challenges would foster stronger engagement and deeper ethical understanding. Small group formats were also suggested:
“When we are in a class of 10–20 students … the lecturer will easily remember us and engage us” – (US00090); highlighting the perceived benefit of dialogue and peer learning impact on effective ethics of ethics learning to practice.
“There should be policy and guidelines depending on the department or the study level [diploma, graduate or postgraduate]” – (PS30020).
“Students need to request ethical clearance … guided by supervisors … familiar with the process over time. Curricula should be aligned to national and international guidelines … but students still need guidance in practice”-
(CCL0005).
Theme 2: Superficial understanding of research ethics concepts and principles
Students were exposed to some research ethics concepts; however, many demonstrated a partial or superficial understanding, struggling to distinguish between related ethical terms and principles such as informed consent, confidentiality, justice and data protection that all aim at participant protection. This theme captures the dual challenges of conceptual comprehension and procedural familiarity that limit students’ ability to apply ethical principles effectively in research.
Participants frequently demonstrated a superficial understanding of research ethics concepts, often confused with concepts such as plagiarism or general academic honesty. While most students were aware of the term “ethics,” their explanations revealed confusion about core concepts such as informed consent, confidentiality, and risk–benefit assessments.
“I still get confused between research ethics and academic honesty” (PS00010),
while another reflected,
“ethics are moral guidelines… but [another value] is how the person will be honest” (US00040). “Ethics is a policy of making sure that research is conducted the right way,” while differentiating it from “forgery or falsification of data” (PS30060). “Ethics involves gathering the information,”
whereas other values concern obtaining
true data from the true source” (PS60030).
These accounts indicate that, even when terminology is familiar, students have limited conceptual understanding, making it difficult to reason through ethical challenges systematically. The interviewed faculty agreed with this observation, explaining that
“In the course, we try to bring in some topics on research ethics such as ethical clearance, informed consent, confidentiality and privacy, however it’s not something which is really elaborated …” (DH00040).
This is done without deeper engagement, discussions, and the opportunities for practicing the implementation of ethics knowledge outside of research proposal requirements before ethical approval.
There were participants who understood the university institutional ethical review and clearance procedures. However, some participants reported limited awareness of ethical review processes and approval procedures, including the role of ethical review boards including requirements for obtaining ethical approval. The lack of exposure and awareness shows lack of awareness in research ethics practice especially when navigating formal research processes and their confidence in meeting ethical expectations.
“When I was about to select the topic… I didn’t know anyone to contact … I was not aware of the institutional review board or its role” – (US290050).
“Before starting data collection, I must have my proposal approved by the respective Institutional Review Board (IRB). After obtaining approval, I need to conduct the research as structured in my proposal. Additionally, during the publication process, I must respect the guidelines, meaning if I submit my manuscript to one journal, I cannot submit it to another simultaneously”-
(PS33060).
“… .in Rwanda we have an ethical clearance committee, where we apply, there is a website, we find the relevant information and also as students, we can apply at the college level”-
(PS10010).
“We didn’t know the policy of the institution for research ethics in our [program]”-
(PS30020).
“Research ethics is a set of the principles and the guidelines which help the researchers to protect the participants and to keep the research safe, that is the way I can define the research ethics” -(PS29050).
Theme 3: Barriers to translating knowledge of research ethics into practice
The understanding of ethics was often centered around formal principles and procedures, but oftentimes their lived experiences revealed other challenges. This theme captures how community, structural, and financial factors beyond students’ control posed barriers to upholding ethical research conduct. These challenges show students’ ethical preparedness and navigating ethical areas without sufficient support and guidance.
Sub-theme 3.1: Community expectations, dynamics and misconceptions
In this theme participants views indicate that ethical research conduct demands understanding of norms, expectations, building trust with communities, good interpersonal dynamics, and the need for seeking support from experienced researchers. In some cases, ethical violations occurred unintentionally, due to researchers’ unpreparedness for real-world research setting and expectations. Blurs of clinical practice and research; an awareness of privileges gained due to doctor’s status gained in a hospital setting, participants label of being your patients and unintentional potential harm were all possible research experience dynamics.
“In clinical-based data, you’re likely to get the data even if you didn’t have to explain them. They only see you in white coat and think you’re a doctor, giving you all the information” -(PS 70040).
“I saw a student who used that opportunity to just collect data without explaining why, without giving the informed consent because as residents we are always interacting with research participants as our patients”-
(PS 70040).
“I just recorded people without telling them … when we were about to finish, they weren’t happy” (PS60030).
The challenges in effectively practicing informed consent were due to dynamics of navigating real-world research complexities and emotionally sensitive situations. Participants frequently described situations where maintaining confidentiality clashed with social or cultural expectations, generating uncertainty and ethical tension even when they knew the correct course of action.
“There is this guy who was like 20 years old, there was a question asked about their time they had their first sex experience, and he told me that it was when he was about 12 years old and on how many partners he has now. He didn’t even know the number of all sexual partners he has currently, and I know his girlfriend. I was puzzled and asked myself if I can tell his girlfriend or not”-
(US00090).
“… Sharing research participants’ information, can have dire consequences, including putting people’s lives at risk or compromising their privacy. We deal with sensitive health issues, and confidentiality is crucial”-
(PS31070).
“You have to be confidential during research … sometimes I asked myself If I can share the HIV status to the partner or not, because it’s not allowed” -(PS30060).
These moments revealed ethical issues not easily addressed through formal instruction alone, especially in the context where research ethics teaching is not clearly integrated in the medical and health sciences research education. Ethical decision-making in these contexts was not abstract but relational, immediate, and emotionally charged, and not grounded in ethical reflection informed by normative theories or principles.
Students encountered expectations from community members that blurred ethical boundaries. Participants alluded to unspoken assumptions about compensation and reciprocal benefits for participating in research encountered during their fieldwork but were never informed, in classes or textbooks, about how to handle such situations ethically.
“Sometimes you know that if you explain to people about your study and they know that you will not give them anything in return, they refuse to give you the information. Everywhere you go they are asking what are you going to give us, what is the tangible thing we will get; and you know that if you give them money, they will just respond for the purpose of getting money, hence creating bias. So, you’re ask yourself if you do not need to explain all details and just get information you need as you don’t have enough finances to sponsor the research. You don’t want to take them to the advantage, and you’re like am I going to follow the ethics or not, just explain to them all details and just take data”-
(PS70040).
These realities underscore the tension between ethical ideals, clinical and ground-level community expectations, and needs of building ethical practice experience to conduct ethical research.
Sub-theme 3.2: Financial limitations
A recurring barrier to ethical research conduct was the scarcity of funding resources. For many students, conducting research ethically was not just about “doing the right thing” but about whether they had the time, money, and institutional access to do it at all. In Rwanda, most university students are either self-funded or receive funding through government loans, with limited access to additional research grants. This reliance on personal and loan-based funding often restricts the resources devoted to their research projects. A student said:
“Without proper funding, you can’t ensure proper consent or privacy, and sometimes that’s where ethical breaches start” – (US 290050).
“To conduct research without having the finances … it’s not really practical”- (PS60030).
“Sometimes, the review board may request fees that are unaffordable, and the approval process can be lengthy, leading to delays ….” - (PS33060).
