Ethical Considerations

Efforts were made throughout the entire research process to ensure the ethical treatment and consideration of participants. The principle of beneficence belies the design of the study, and non-malificence was ensured through the adherence of procedures outlined by various legal, professional, and research bodies. Here follow considerations of issues pertinent to the specific design of the current study, and the overarching principles of ethical conduct for trainee clinical psychologists.

2.10.1 Recruitment

The recruitment procedure is described in detail in section 2.4.2. There was no undue pressure placed upon potential participants and it was made clear that their participation should be entirely voluntary and that they could withdraw from the study at any time without consequence.

2.10.2 Consent

At the start of the face-to-face research meetings, the researcher offered to read the information sheet aloud to participants, and they were offered the opportunity to seek further information and ask questions. Confidentiality and data storage and management were discussed and within this participants were advised that the boundaries of confidentiality would only be breached if information was shared that suggested that they or somebody

67 else was at risk of harm. The associated protocols were discussed and participants were again given the opportunity to ask questions. In instances where participants seemed to understand the information provided, and were happy to proceed, they were asked to sign to indicate their consent to participate in the study, and then interviews commenced.

Participants were made aware that they had the right to withdraw from the study at any time, without consequence, and asked whether they would like to provide member checks and/or receive details of study results at the point of study completion.

2.10.3 Data Collection, Management, and Storage

The tenets of the Data Protection Act (1998) and the Local NHS record keeping and information storage policies were adhered to throughout the study. Best practice guidelines laid out by the British Psychological Society (2010) were also followed for guidance on the ethical collection, management, and storage of participant data.

Interviews were recorded on a digital dictaphone and stored on an encrypted USB memory stick and participant data was anonymised via the allocation of pseudonyms at the point of transcription. Contextual identifiers (e.g. names of other people or places) were also removed to maintain confidentiality and facilitate research dissemination. Data, transcripts, and demographic details were all stored securely and separately to ensure that it would not be possible to link specific individuals with transcribed interviews.

2.10.4 Risk

2.10.4.1 Social Stigma

Bottorff et al. (2005) conducted research with women who had smoked during pregnancy, and found that recruitment was difficult in the context of social stigma. We know from other research that maternal smokers often experience considerable negative social stigma, so much so that even those who have successfully quit smoking can be reluctant to revisit their tobacco reduction experiences.

68 The researcher in the current study was thus mindful of and sensitive to participants’ vulnerability to social stigma, and all interviews and interview arrangements were kept strictly private and confidential.

2.10.4.2 Dyadic Coercion

There are issues that may have arisen because of the study’s inclusion of both members of an intimate dyad. Bottorff et al. (2005) found that non-smokers had a vested interest in participating as a way of reducing their smoking partner’s tobacco consumption and so the researcher in the current study was mindful that hidden motives may have lead either member of a dyad to feel coerced by their partner toward participating in the study. In line with this, the protocol of the current study ensured that informed consent was gained from both members of each dyad, and each individual was offered several opportunities to decline participation in the study.

2.10.4.3 The Home Setting

The potential influence of power inequalities between researchers and participants were given careful consideration. In the context of semi-structured interviews, it has been suggested that informed consent offers limited protection from exploitation to participants of qualitative research, and the situation is complicated further when interviews are conducted within the family home because the informality of the setting allows the researcher to gain maximum disclosure (LaRossa, Bennett, and Gelles, 1981). The power dynamics within familial relationships were also considered as this research was conducted within the home setting.

Together these issues further highlighted the importance of rigorous and informed consent procedures and sensitivity to individual vulnerabilities.

There are also issues around researcher safety to be considered; interviews were only conducted in participant homes in instances where the home had previously been visited

69 and risk assessed by the referring practitioner or another practitioner from the referrer’s organisation or using NHS risk assessment guidelines. Details of the locations and times of interviews were shared with the research supervisor, and safety checks were made via telephone call to the supervisor prior to and following every interview.

2.10.4.4 The Context of Intimate Relationships

LaRossa et al. (1981) suggest that research delving into the private and intimate nature of family life can be ethically problematic as an individual’s family is “both a sanctum and their most precious possession” (p.312). Along the same lines, Bottorff et al. (2005) found that the interviews they conducted, which were focused on tobacco-related behaviours, very quickly evolved into highly personal and sensitive discussions covering topics such as the couple’s finances, childcare issues, relationships with the extended family, past conflicts, and even personal hygiene. The researcher in the current study was mindful of the potential risks to participants of disclosing unexpectedly personal details and thus made no attempt to elicit such details from them.

Bottorff et al. (2005) discovered instances where information about participants was obtained but not actually disclosed by them. For example, one participant described an incident whereby her husband’s flirtatious behaviour led her to smoke an entire packet of cigarettes in front of him in revenge. The husband on the other hand made no mention of this incident and described his wife’s smoking relapse as a slow and steady progression. Although it is difficult to be sure, this difference in descriptions may have been because the husband did not want the researcher to know about the situation which led to the couple’s argument. This possibility again highlighted the importance of strict confidentiality in the current study and drew attention to the impartiality required of the researcher.

2.10.4.5 Vulnerability of Women

Bottorff et al. (2005) speak of the heightened vulnerability of women at this time of family transition with respect to their smoking behaviours. Pregnant smokers are vulnerable to

70 condemnation and vilification from within the home as well as from strangers, and Bottorff’s team reported that five out of nineteen of their participants described significant marital conflict in the context of their smoking behaviours. The current researcher acknowledged that the topic of tobacco use has the potential to exacerbate issues of power and control, and this is why individual interviews, rather than conjoint or group interviews, were conducted. Although joint interviews held the potential to provide great insight into couple dynamics, an individual approach allowed the researcher to ensure confidentiality and minimise risks to the personal safety and well-being of participants.

Careful thought was also given to the scheduling of data collection. On the basis of the Bottorff et al. (2005) findings, partners were interviewed before expectant mothers so as to minimise the potential for suspicion and eliminate the possibility of the partner asking the researcher about the woman’s smoking. In situations where participant disclosures raised questions about safety and/or well-being, participants were telephoned 2-4 days after the interview to thank them for their participation and to see whether the interviews had had any problematic effects within the relationship. Where necessary, the researcher offered resources to both members of the dyad (e.g. contact information for family services, smoking cessation support services, and other relevant local support services).