The Therapeutic Misconception and Expectations of Benefit in Public Health Research in Rural Uganda: A Qualitative Study

The therapeutic misconception—the tendency for research participants to conflate research procedures with clinical care and to expect direct therapeutic benefit from participation—has been extensively documented in clinical trials. However, less is known about how this phenomenon manifests in public health research, where interventions are designed to benefit populations rather than individuals. This qualitative study explored how community members in rural Uganda conceptualize the benefits of public health research participation and the extent to which expectations of direct benefit shape their willingness to consent. Data were collected through 12 focus group discussions (FGDs) comprising of 7 participants each and 15 in-depth interviews (IDIs) involving 89 participants, including community members, local leaders, religious leaders, Village Health Team (VHT) members, and a woman leader . 10 of the 15 key informants also participated in FGDs. Participants were recruited from urban and rural sub-counties in Bushenyi District, Southwestern Uganda. Thematic analysis identified four major themes. First, conflation of research with clinical care: participants described research participation as a pathway to accessing medical treatment they could not otherwise afford. Second, expectations of tangible community development: participants expected research to deliver visible infrastructure such as boreholes, clinics, or roads. Third, educational value as a legitimate benefit: participants valued research that taught them about disease prevention and health practices. Fourth, frustration and mistrust from unmet expectations: participants expressed anger and disappointment when anticipated benefits failed to materialize, leading to reluctance to participate in future studies. Community members in rural Uganda commonly hold expectations of direct personal or community benefit from public health research participation. Expectations of direct treatment reflect a form of therapeutic misconception adapted to the public health context, whereas expectations of feedback, education, reciprocity, and appropriate benefit sharing represent legitimate ethical expectations. Researchers must distinguish research from clinical care transparently, manage benefit expectations realistically, and commit to providing non-therapeutic benefits such as health education and feedback as ethical obligations.