ETHICAL CONSIDERATIONS

This part of the chapter discusses the ethical considerations of the first phase of this study, which will then lead to the research design for this phase.

3.3.1 Harm

Recognition of doing harm to participants is necessary throughout the data collection process. This research process would not cause any physical harm, but may cause psychological harm. Awareness of women being upset or distressed when recalling their childbirth experiences was an important aspect of this process for me. I decided to use a semi-structured interview schedule to allow women to choose themselves if they wanted to discuss aspects that may distress them. I was aware of professionals and groups that I could refer any of the participants to if I felt they needed further help to deal with their experiences, Cribb (2003) acknowledges this as an important consideration in the research process. A rigid schedule may have forced them into answering questions that they felt uncomfortable with. I ensured that my approach to the focus groups discussion was open, friendly and confidential, to allow the participants to build up an element of trust with me.

3.3.2 Consent

Clear written and verbal information on the nature and purpose of the study is essential to ensure participants understand what the study will entail for them (Manning 2004). It is also important that the researcher ensures the information is in a form that participants can understand. Translation needs to be considered depending on the demographic information of the population that the sample will be extracted from. Within the population for the focus group samples the majority of the population are geographically static within the area, they are white and they are generally from vulnerable groups, as the Index of Multiple Deprivation (IMD) Quintile is identified at 4 and 5. Due to the increased likelihood of the participants suffering deprivation there is a risk of increased vulnerability of the sample. It was therefore essential that any information was easy to read and that all information was verbally discussed to ensure participants with poor reading and writing skills understood what participating in the study would involve.

Consent was gained by the hospital trust and from the research ethical committee for the study to go ahead. I met with all of the community midwives two weeks before this phase of the study commenced to discuss the study and their role in identifying potential participants for the purposive samples I had chosen. I gave them written information to refer to, regarding the sample required. The community midwives then selected and gave written information to potential participants about the study. The women contacted myself, as the researcher directly if they decided to participate. The community midwives discussed the study with potential participants and answered any questions that they had. I informed the community midwives when 10 women for each focus group had contacted me. I had therefore reached saturation of the sample.

At the focus group locations all of the women were given another information leaflet on attendance to the group and given time to read it. I ensured they had read and understood the information leaflet they had been given and answered any further questions prior to them signing the consent form. I obtained consent from the participants thirty minutes before recording commenced. Reinforcing the information at different stages of the process would help to ensure they are comfortable with the implications of taking part in the study. Consent was not

only signed to participate in the study, but a second consent form had to be completed for the use of quotations obtained and used in research reports, as specified by the research ethic’s committee.

3.3.3 Confidentiality

Due to the small sample size the participants are at a greater risk of being identified, therefore confidentiality is important to obtain anonymity and confidence of trustworthiness within the group. Murphy et al (1998) discuss how confidentiality is at a high risk of being breached during publication and dissemination of the research findings. The use of pseudonyms was used throughout this study to protect their confidentiality within the process of analysis. The participants could choose one or were allocated one by myself, as the researcher. I reimbursed travel expenses to the participants who attended the groups. At the beginning of the focus groups the importance of confidentiality was discussed, all of the participants agreed to keep the discussions within the focus groups as confidential and not divulge any identification of participants. The focus groups were recorded using audiotape. The tape was transcribed verbatim by myself as soon as possible following the focus groups to assist recall. It was made clear in the information and verbally that they were able to withdraw from the study at any time and that this would not affect the care they were receiving. Data was kept within a locked cabinet on NHS premises. To protect participant confidentiality all data were stored and collected by myself.

3.3.4 Ethical Committee Experience

Many British ethics committees until recently (Department of Health 2001) have not had any members with qualitative research expertise. Ethics committees have been stuck within a realist’s objective pursuit of truth and validity, but are now required to show understanding of different types and styles of research. The process has changed over my time on this journey; therefore my experiences in the first phase were different to those experienced in the second phase of this research study. My study became considerably delayed, as I had to endure application to the Ethics Committee on two occasions for the first phase. My experience is discussed in Appendix 4.