Community perceptions, trust, and experiences of malaria clinical research and participation in rural Cambodia

Understanding community perspectives on malaria treatment and research participation is important for designing ethically appropriate community engagement strategies, strengthening informed consent, and improving the conduct of clinical research while supporting disease control. This study explores treatment-seeking behaviours, perceptions of malaria, and experiences of research participation among community members in the catchment area of a rural research clinic run by the Mahidol-Oxford Tropical Medicine Research Unit (MORU) in Siem Pang district, Cambodia.

This qualitative study was conducted between July and September 2025. We conducted 15 semi-structured interviews and five focus group discussions (FGDs) with 40 purposively selected participants using maximum diversity sampling, including 19 participants previously enrolled in malaria clinical trials and 21 community members familiar with MORU's research clinic within the Siem Pang Health Centre compound. All interviews and FGDs were conducted in Khmer, the national language of Cambodia. Interviews were audio-recorded, translated into English, transcribed verbatim, and analysed thematically. Transcripts underwent thematic analysis exploring knowledge of malaria, pathways to treatment, perceptions about research staff, and experiences of research participation.

Respondents reported heterogeneous understandings of malaria and its transmission, which were reflected in their explanatory models and accounts of treatment-seeking behaviour. We found that treatment choices were influenced by accessibility, cost, and perceived quality. Respondents perceived MORU's research clinic as a specialized malaria treatment centre. Some described clinical trials as routine treatment services. Respondents reported staff as caring, cautious and thorough in treatment and follow-up. Participants generally described the research activities in the Siem Pang research clinic as trustworthy, effective, and compassionate. Participants reported that research participation provided improved access to care, and close follow-up, and viewed it as contributing to malaria elimination. Participants expressed strong support for the researchers' continued presence and expansion into broader health research and education.

Participants perceived the research unit as providing high-quality clinical care, reflecting their experiences of sustained interactions with the research clinic and its procedures. Participants' narratives suggested features consistent with therapeutic misconceptions and may have promoted respondents' liberal trust and participation. Researchers should be aware of the unintended consequences of ethical research practices in remote communities. Acknowledging misplaced trust could enable wider discussion for managing community members' perceptions of clinical trials.