Ethical challenges in a randomized controlled trial of peer education among veterans service organizations

Efforts to increase community members' involvement in research may create novel ethical challenges. We describe an ongoing randomized trial of a peer-delivered intervention to encourage hypertension self-management. Community members serving as peer leaders participate in subject recruitment, the informed consent process, and intervention. We describe our experience with several ethical issues that may arise when conducting research in similar settings: (1) coercion of community members, by the community, to participate either as leaders or as study subjects; (2) threats to the privacy of health information; and (3) conflict between peer leaders' roles as community members and study team members.