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Abstract

The protection of human subjects through the application of appropriate ethical principles is important in all research study. In a qualitative study, ethical considerations have a particular resonance due to the in-depth nature of the study process. The existing ethical guidance for undertaking qualitative research often provide general guidelines rather than focusing on how to apply it in practice, particularly when interviewing vulnerable group of women. The aim of this paper is to present my own experience of conducting 33 individual face to face interviews on the women’s experience of postnatal depression across three different cultural backgrounds in Malaysia. This paper reflects on the strategies that can be adopted by a qualitative researcher to ensure that their participants’ identity is protected throughout recruitment and dissemination process, to deal with participants from different cultural backgrounds, and to handle and manage distress during interview. The consideration of ethical issues is crucial throughout all stages of qualitative study to keep the balance between the potential risks of research and the likely benefits of the research.
30
International Journal of Care Scholars 2018;1(2)
* Corresponding Author
Email address: roshaidai@iium.edu.my
Tel: +6095707296
Siti Roshaidai Mohd Arifin
Kulliyyah of Nursing, International Islamic
University Malaysia, Jalan Hospital Campus,
Kuantan, Pahang, Malaysia.
Ethical Considerations in Qualitative Study
ABSTRACT
The protection of human subjects through the application of appropriate ethical principles is important in
all research study. In a qualitative study, ethical considerations have a particular resonance due to the in-
depth nature of the study process. The existing ethical guidance for undertaking qualitative research often
provide general guidelines rather than focusing on how to apply it in practice, particularly when
interviewing vulnerable group of women. The aim of this paper is to present my own experience of
conducting 33 individual face to face interviews on the womens experience of postnatal depression across
three different cultural backgrounds in Malaysia. This paper reflects on the strategies that can be adopted
by a qualitative researcher to ensure that their participants identity is protected throughout recruitment
and dissemination process, to deal with participants from different cultural backgrounds, and to handle and
manage distress during interview. The consideration of ethical issues is crucial throughout all stages of
qualitative study to keep the balance between the potential risks of research and the likely benefits of the
research.
KEYWORDS: Ethical, Principles, Qualitative
Siti Roshaidai Mohd Arifin
Special Care Nursing Department, Faculty of Nursing, International Islamic University, Pahang, Malaysia.
INTRODUCTION
The protection of human subjects through the
application of appropriate ethical principles is
important in any research study (1). In a
qualitative study, ethical considerations have a
particular resonance due to the in-depth nature of
the study process. The concern of ethical issues
becomes more salient when conducting face to
face interview with vulnerable group of
participants. They may potentially become
stressed while expressing their feelings during the
interview session.
The existing ethical guidance for undertaking
qualitative research often provide general
guidelines rather than focusing on how to apply it
in practice, particularly when interviewing new
mothers with postnatal depression (PND). The aim
of this paper is to present my own experience of
conducting individual face to face interview on
the women experience of postnatal depression.
There are six important ethical issues considered
in this study, and these are discussed below.
INFORMED CONSENT AND VOLUNTARY
PARTICIPATION
The process of obtaining Consent consists of the
following: consent should be given freely
(voluntary), subjects should understand what is
being asked of them, and involved persons must
be competent to consent (2). This means, to
participate in a research study, participants need
to be adequately informed about the research,
comprehend the information and have a power of
freedom of choice to allow them to decide
whether to participate or decline (3).
Participants agreement to participation in this
study was obtained only after a thorough
explanation of the research process.
All participants were required to provide written
informed consent. The potential participants were
approached individually and given an explanation
of the purpose of the study and data collection
process. They were given an appropriate time to
ask questions and address any concerns. It was
explained that as their participation was
voluntary, refusing to participate or withdraw
from the study while it was in progress would not
affect their care or job in the respective clinic in
any way.
A patient/participants information sheet was
provided to further explain the study. The
potential participants were given appropriate time
(in this case: 24 hours up to one week) to read the
information sheet and to decide whether or not
they wanted to be involved in this study. They
were required to sign the informed consent form
before the interview to indicate their permission
to be part of the study and this signature was
confirmed prior to the interview session.
An explanation was clearly given to potential
participants that they had a right to withdraw
from the study at any time even after the
informed consent had been signed. Consent to
record the interview was also asked from them.
The patient/participants information sheet and
informed consent was available in two languages:
Malay and English.
ANONYMITY AND CONFIDENTIALITY
The anonymity and confidentiality of the
participants was preserved by not revealing their
names and identity in the data collection, analysis
and reporting of the study findings. Privacy and
confidentiality of the interview environment were
managed carefully during telephone
communication, interview session, data analysis
and dissemination of the findings.
Volume 16 Number 1, June 2017
31
International Journal of Care Scholars 2018;1(2)
TELEPHONE COMMUNICATION
Since the eligible participants (women with
postnatal depressive symptoms) were contacted
through phone to know their decision whether or
not to participate in the interview study, proper
safeguards were taken. There were a few cases
where the phone call was answered by the third
party (husband/ mother). In this situation, I did
not expose details of the study. Instead, I
explained that the purpose of the phone call was
to follow up the information that had been given
during the previous visit to the respective clinic. I
left the contact number with that person and
asked for a better time to call back.
INTERVIEW SESSION
Each interview was conducted individually in a
private and quiet room in the respective clinic or
participants home without access by outsiders. I
am the only one who should be able to match the
identity of the participants and voice recordings.
DATA ANALYSIS AND DISSEMINATION OF THE
FINDINGS
Data transcribing was conducted in a private room
using earphones to avoid the possibility of
recordings being heard by other people. The
identities of the participants were removed during
data transcription, including their names or any
significant aspect of identity. In presenting the
findings of the study, the participants were
referred to by their pseudonym names in the
verbatim quotes.
Written consent or any document which contains
the participants' personal detail was kept in a
locked cabinet with no access to anyone other
than myself. This personal information will be
destroyed in accordance with the University of
Stirling research governance procedures.
Participants were however, notified that their
actual age would be used for the purpose of
reporting the data from the interview (4). Data
were shared with the other two qualitative
researchers for the purpose of reaching
agreement of the interpretation without exposing
the participantsdetails at any interim stage. The
access of the supervisors to the data was
explained to the participants and their consent
regarding this matter was obtained.
This project adhered to the University of Stirling
Code of Good Research Practice. The University of
Stirling has adopted the Model Publication Scheme
(MPS) for Scottish Higher Education Institutions
(HEIs), which has been developed by Universities
Scotland. This MPS was approved by the Scottish
Information Commissioner on 25 March 2004 (5).
Overall responsibility for this Publication Scheme
resides with the University. No participants
identifying information will be included in reports
or publications arising from this project.
ETHICAL APPROVAL AND ACCESS TO
PARTICIPANTS
The ethical approval was sought and granted from
two main research ethics committees: The School
Research Ethics Committee (SREC) in the School
of Health Science, University of Stirling and the
Malaysian Medical Research Ethics Committee
(MREC).
Upon approval from the SREC, the ethical approval
from the Malaysian National Institute of Health
Research (NIHR) and MREC were applied through
online registration with the Malaysian National
Medical Research Register (NMRR). Prior to this
application, permission from the respected
authorities of the study sites was first sought.
Therefore, application letters were sent to the
Director of Hospital Kuala Lumpur, and the
Director of Health Department of Federal Territory
Kuala Lumpur.
Upon getting the permission from the respected
authorities of each study site, the online
application was submitted. The process of
application was monitored at the NMRR website.
The final decisions were notified by the MREC
through email to inform the status of the
application. Approval from the Economic Planning
Unit, Department of Prime Minister Malaysia was
also sought to obtain the research pass as this
research was an application to conduct research
from outside Malaysia.
Initially, only five MCH clinics were selected and
approved by MREC. However, after almost three
months in fieldwork, there were fewer numbers of
Indian women participating in the study due to a
low rate of attendance in the five selected MCH
clinics. For this reason, an approval to increase
the number of clinics had been made through
online application at NMRR website. Three MCH
clinics were added. Upon getting this approval, I
started visiting the newly selected clinics and
looking, mainly, for Indian participants. At the end
of the fourth month of the study period, it was
decided that there were no more new concepts
emerging, therefore the data collection stage was
ended. These experiences made me reflex that
obtaining ethical approval is not always a
straightforward process, instead it requires some
modifications along the study period.
DATA PROTECTION
Interview Stage
Data analysis was conducted simultaneously with
the data collection. I transcribed and analysed the
data independently. The data was shared with two
qualitative researchers.
Data were stored in encrypted devices and
password protected. As for the purpose of cross
checking in data analysis, the transcripts were
shared with two qualitative researchers through
password protected email. The information
storage on the university computer, personal
computer or laptop, hard disk and memory sticks
were protected by using passwords that were only
held by me (4). Hard copies or written materials
of the data were kept in a secured cabinet in a
locked room with no access to others to ensure
adherence to legal requirements (6) and ethical
guidelines. Both written and electronic data from
this study will be stored for five years. However,
the interview recordings will be disposed once
they are no longer needed.
I was aware that any unexpected adverse event
which was caused by this study should be reported
to the MREC and the SREC, School of Health
Science, University of Stirling. However, no such
event occurred throughout the study period. The
results of the study will be reported and
disseminated through peer reviewed scientific
journals, conference presentations, thesis
dissertation, university library and written
32
International Journal of Care Scholars 2018;1(2)
feedback to research participants
or relevant community groups.
All anonymised data will be securely stored for a
period of 10 years in accordance with the
University of Stirling Code of Good Research
Practice: the safe and secure storage of the
primary data will normally be for at least ten
years, a safe and secure method of disposal must
be used after this time, and all accordance with
the requirements of the Data Protection Acts (6).
Personally, identifiable data (e.g., the
recruitment log) will be destroyed as soon as I am
sure that they will not be needed again.
Cultural and Linguistic Barriers
It is important for researchers to be fully aware of
the obstacles in their research and plan for
preventative action, as this may affect the timing
of the research. Since the beginning of this study,
I was aware that in some cultures, women may
need permission from their husband/partner to
take part in this study. Therefore, I allowed
adequate time for the eligible participants to
discuss the decision to participate with their
husband/partner. In this case, the women were
allowed to contact me, or I only contacted the
women with their permission. Although there was
a case where a woman gave this as a reason not
to participate, the majority of the participants
discussed the decision to participate with their
husband and were allowed to be involved in this
study.
I was also aware that there were three different
cultures with different mother-tongue languages
involved in the interview session. Given the fact
that Malay is the formal language in Malaysia, I
assumed that most of Malaysian women and HCPs
were able to converse and express their
experiences at the optimum level using Malay
language. I also included the ability to converse in
either Malay or English as one of the inclusion
criteria for this study. This was to optimise the
understandable communications between
researcher and participants. There was one case
where a Chinese woman was eligible for the
interview session based on the screening tools (as
this was based on reading in Malay), but somehow
was found not to be able to converse fluently
either in Malay or English for the interview stage.
Therefore, she was excluded from the study.
There were also some of the participants who
preferred to be interviewed in English. This
involved six interviews with women and three
interviews with HCPs. Due to limited human and
financial resources, there were no other versions
of the questionnaire for screening and the topic
guides used other than Malay and English.
Handling and Managing Distress During Interview
The face to face semi structured interview
technique requires me to listen and respond to
the participantsanswers or speech. The act of
my listening may create unintended harm to the
participants (7). I was aware that working with a
vulnerable group of people, the participants may
potentially become stressed while expressing
their feelings during the interview session.
Therefore, a woman who believed herself (or was
considered by the nurse in charge or by me) to be
severely depressed to the extent that
participation in the interview might worsen her
condition, was excluded from this study. In one
case, a woman was referred by a head nurse as
having some level of depression after her last
childbirth. After phone communication, a meeting
was arranged at the womans home. However, she
was found as not being able to concentrate in the
interview session, therefore the interview was
stopped after ten minutes. She had not developed
any adverse effects, but I felt that her
descriptions on her depressive experiences were
in a repetitive manner and her responses did not
always relate to the questions being asked. As this
woman was not able to focus, it was assumed that
she had probably not fully recovered, therefore I
decided not to introduce any potential harm to
her and she was excluded from the study.
As applied to all participants, they were advised
to withdraw from the interview at any point if
they thought answering the interview questions
and disclosing their feelings may impact upon
their emotional health status. Ten out of 33
participants were crying when sharing some parts
of their experience of PND during interview
sessions. In this case, I offered them to
discontinue the interview if they felt it would
cause any physical or psychological harm. They
were also given a choice to stop the interview and
continue once they were ready to do so. In all
cases, women chose to stop talking about the
study topic for a few minutes and continued after
they felt better. During this time break’, I tried
to distract womens attention by having
conversation outside the study scope (e.g., her
childs name or anything she likes to do in her
spare time). Stopping the interview and searching
for possible solutions for the participantsdistress
indicates that researchers are aware of the
vulnerability of participants and their rights (1).
Women were informed that the additional support
was available as quickly as they needed it
especially for those who were interviewed at the
MCH clinics. Offering and referring participants to
counselling in case they needed it was regarded
as fulfilling the moral obligation by ensuring that
they have regained control of the situation by
talking (1). All women were informed that the
Counselling Psychology Unit Department was
available in the Health Department of the Federal
Territory Kuala Lumpur for further assistance. All
of the women did not show any interest in
contacting this unit, although this was offered.
Recommendations
This paper recommends that interviewing
participants that come from different cultural
backgrounds requires not only basic understanding
of the participants culture but also flexibility in
the interview process. When dealing with
vulnerable group of people, qualitative researcher
should aware of potential harm that can be
imposed to the participants. These approaches
are important to ensure that these ethical
principles are applied throughout all stages of the
research process, thereby balancing the potential
risks of research against the likely benefits.
CONCLUSION
This paper has argued that while ethical
considerations are important in all research area,
the concern becomes more salient in qualitative
research, particularly when involving vulnerable
group of participants. It is the responsibility of
the qualitative researcher to ensure participants
to have a power of freedom of choice to involve
in the study, protect the participantsidentity
throughout recruitment and dissemination
process, and promote clear and honest research
reporting without deception to readers.
Volume 16 Number 1, June 2017
33
International Journal of Care Scholars 2018;1(2)
Reflecting those strategies that I have used
during my research made me aware that ethical
issues in qualitative research is not as general as
being portrayed in the literature, instead it might
require some modifications along the research
process.
CONFLICT OF INTEREST
The author declares no conflict of interest.
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... Doing research that involves human beings as the subjects need to consider ethical issues. Particularly with qualitative research where the researchers need to interview the subjects, ethical issues may arise during the interview, perhaps due to stress and fatigue (Arifin, 2018). Ethics are moral principles, guiding conduct, which are held by a group or a profession (Wellington, 2000, as cited in Abed, 2015). ...
... All participants should give their consent to join the research. They needed to understand what they were asked to do and they were illegible for giving consent (Arifin, 2018). Because this research was performed on minors (students), their parents had to give their consent. ...
... They were asked about their feelings and opinions toward the intervention. Interviews had to be done individually in a closed room to protect the participants (Arifin, 2018). This way also ensured the protection of students from the risks that might happen. ...
... According to the University of Stirling code of good research practice research governance guidelines; this personal information will be deleted. On the other hand, we are informed that their actual age would be utilized in reporting the results of the interview (Arifin, 2018). ...
... The data were sent to another two researchers who are following the qualitative methods for agreeing on the interpretation and identity information of the participants was not shared with two researchers. The parties using the data were informed or revealed to all participants, and the university has overall responsibility for this publication scheme (Arifin, 2018). No personally identifiable information about participants will be published in any reports or publications resulting from this research. ...
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