According to Barbie (2013:32), anyone involved in social research need to be aware what is proper or improper conduct of social inquiry (research) including informed consent, voluntary participation protection from harm and confidentiality. Therefore; it is important to guard against unethical behaviour which may have an adverse effect on the participants, and reflect poorly on the profession.
In a clinical or health environment the researcher will come into contact with health professionals and their patients, possibly invading their work space, which is normally managed by authorities. Streubert and Carpenter (2011:60) present the following general ethical principles which the researcher should consider. The first is autonomy which has its roots in the categorical imperative and demands the researchers respect the rights, values and decisions of other people. The second is non maleficence which is the avoidance of intentional harm to respondents and beneficence, which stipulates that a
positive obligation to remove existing harm can be identified. Lastly, the principle of justice holds that people who are equal in relevant respects should be treated equally. The research conduct process should not cause harm to the participants and organisations, thereby supporting the principle of beneficence.
For the conduct of action research there are three applicable ethical frameworks namely personal, research and the practice itself. Emphasis is placed on the respect for the individual’s autonomy, informed participation, protection from harm, data storage and utilisation (Townsend 2013:94). The researcher ensured compliance with principles of ethical research throughout the study period by implementing the measures required for conformance with the principles of autonomy, beneficence, justice and informed consent as explained below.
4.8.1 Ethical clearance
Ethical clearance for this study was obtained from the University of South Africa (Annexure A) and approval to conduct the study was obtained from the research committees of the eight Provincial Departments of Health (Annexure B) which is the permission letters from the provinces which were sites in which the research was conducted.
4.8.2 Human rights and principles of justice
Human rights include the right to self-determination, privacy, anonymity, and protection from harm. The principle of justice is concerned with fair treatment, right to privacy, and anonymity (Streubert & Carpenter 2011:65).
4.8.3 Right to self-determination (autonomy)
The prospective participants should have the opportunity to choose whether or not to participate in the study (De Vos, Strydom, Fouché & Delport 2011:116). It is accepted that as the researcher provides participants a choice to participate or not certain types would decline. For this study the potential respondents were not forced or coerced into being part of the research by being promised rewards, but did so with the full
understanding that their contribution might build knowledge for effective health services through improving essential medicine provisioning.
The participants were informed of their right to withdraw at any time or reserve their comments and inputs without being penalised.
4.8.4 Informed consent
According to Polit and Beck (2014:87), informed consent require the researcher obtain the people voluntary participation enabling the power of free choice to decline or consent voluntarily in the study after informing them of potential benefits and risks. This is done to ensure that participants have adequate information regarding the research and are capable of comprehending the information. Grove et al (2013:177) indicate that the potential participants should be informed amongst the critical points about the research purpose, methods, risks and procedures, duration of the study and the manner in which the confidentiality and privacy will be ensured.
For this study, the reasons, benefits, impact, and content of the research, as well as the criteria for being chosen were provided to the potential participants prior to commencing the study. This enabled the participants to decide whether or not to take part in the research. All participants in this study were above the consenting age of 18 years and have basic understanding of the research. The participants also received written requests to voluntarily participate in the research and signed a voluntary consent form for participation in the study on acceptance (Annexure D).
4.8.5 Privacy and confidentiality
Researchers need to consider and provide clear strategies to protect the participants’ privacy and keep the information provided confidential as far as possible (Guest & Namey 2015:76). The participants’ names and personal identifying information will not be used in the records. Instead symbols will be used as codes and personal details will only be accessed by the researcher and the supervisors. Should personal information be necessary for reporting purposes the permission of the affected participant will be sought.
4.8.6 Respect
The participants were not judged for their responses or experiences. All inputs were regarded as valuable; contributing to realising the purpose of the research.
4.8.7 Rights of the institution
The institutional routine and integrity should be respected during the research process (Creswell 2013:58). Integrity was maintained during the conduct of the study through proper arrangements for conducting the research site visits and interviews such that there was no interference with the participants’ routine and the supervisor’s permission was sought.
4.8.8 Permission to conduct research
Ethical clearance for this study was obtained from the University of South Africa and applications to the research committees of the nine provinces were submitted indicating the duration and nature of research to be conducted and was approved in writing by eight of the nine provinces prior to the commencement of the research.
4.8.9 Confidentiality
A research project guarantees the confidentiality when the researcher can identify a given person response but pledges not to divulge the personal details publicly (Barbie 2013:36).
In this study there was no direct mention of the facilities or names of any member of the health care facilities management in order to maintain the integrity, privacy, and image of the district facilities involved.
4.8.10 Integrity
The institutional routine and integrity should be respected during the research process (Creswell 2013:58). Integrity will be maintained during the conduct of the study through proper arrangements for conducting the research interviews, such as that there was no interference with the participants’ routine.