Ethical Considerations

Ethical issues were strictly observed during data collection, data analysis and presentation of findings in this research to respect the rights and dignity of the participants, to avoid harm to both participants and researchers and to ensure research credibility and integrity (Denscombe 2007).

5.5.1 Ethical Approval

Prior to starting the data collection, ethical approval was sought from the University of Leeds Institute of Health Sciences Ethical Committee (Appendix M) and Ministry of Health and Population through Medical Research Council of Malawi (Appendix N). However, there were some variations on the definitions and application of ethics from University of Leeds and Ministry of Health and Population in Malawi. While the Malawi Government had same ethical requirements for all children, United Kingdom applied adult ethical requirements for 17 years old children. This resulted in dropping orphans aged 17 years from the research to avoid applying two ethical requirements as per United Kingdom requirements. The approvals were obtained after four months from submission date. In addition, a permission letter was obtained from the Principal Secretary for the MoGCCS to access information from the service providers and policy makers. A permission letter from the Blantyre District Commissioner granted access to participants from the community.

5.5.2 Informed Consent

During recruitment, participants were informed about ethics protocols to help them make informed decision about participating in the research. Informed consents were collected from service providers, policy makers and service users (appendices O, P and Q). Before deciding to participate in the study, participants were provided with information sheet where the purpose of research, participant’s involvement and expectations were explained. To ensure voluntary participation, the right to withdraw before, during and after data collection if participants felt distressed or uncomfortable was discussed. Withdrawal meant that any information collected from participants could not be used in the study. No one withdrew from this study.

The idea of children providing consent in research has been a contentious concept in the literature (Coyle 2010; France 2004; Alderson, Sutcliffe and Curtis 2006; Goodenough et al. 2003). However, in this study consent for children age 13-16 was observed by combining consent of the child and their parent or caregiver where possible. In the absence of parents or caregivers, the local chief provided consent. This happened in two cases. There is evidence that gate keepers in the form of school or local authority may provide consent on behalf of parents (Greene and Hill 2005). The children in this study were given one to two weeks prior to the date of the interview to decide whether they wanted to take part in the study. The actual consent was taken on the date of the data collection, prior to commencing interviews. The information was read out from the information sheet in local language and children were asked to give consent verbally and this was audio taped. A copy of the information sheet is provided in appendix E and joint consent information for orphans and caregiver is shown in appendix Q.

5.5.3 Confidentiality and Anonymity

The participants were informed that the information they provided would be confidential and only used for purposes of this research. To maintain anonymity and confidentiality, different measures were taken. Transcripts used pseudonyms rather than participants’ true identities and during data analysis, codes were used as participant identifiers. Participant demographic information and data were kept in separate files in the computer and were saved in a university computer under a password. The transcripts were kept in locked cabinet. During the reporting of findings, names of organisations were used in the quotations and not names of officers who provided the information. Wherever necessary, for sensitive issues, umbrella organisations were used instead of names of organisations. Handling confidential government policy issues and documents demands realisation of sensitivity and confidentiality to both researcher and policy participants.

Renzetti and Lee (1993) argue that sensitive research raises many concerns to the researcher which include technical, ethical, legal, methodological and political concerns. In addition to measures put in place by the researcher to protect

confidentiality, some participants made specific requests during data collection and the researcher observed these. For instance, one girl asked the male research assistant to go away and not to record her episode of a sexual relationship. As a result, no quotation was documented regarding that particular sexual experience.

5.5.4 Protection from harm

Finally, the researcher took precaution to ensure that the research process did not cause any harm and danger to participants, research assistant or researcher. As much as possible interviews in the community were done during daytime. Reliable transport was used and there was good communication, using cell phones among the research team. Since field work was done in remote areas, clear and safe places were used for discussions (Goodwin 2006). However, since the data was collected during rainy season when grass was tall, use of male research assistant and volunteers helped to give the researcher company and provide security. The participation of community police officer in the FGD also provided a safety precaution and their local office were made aware of our visits. Participation in a risk assessment course prior to fieldwork helped the researcher to become aware of and to deal with all issues of protection.

During the data collection period, we worked in close collaboration with the District Social Welfare Officer who is trained to provide counselling to distressed people. It was uncommon for adult male caregivers to express visibly their grief on the consequences of caring for orphans during interviews. However, the presence of the male research assistant helped to console the males because the involvement of the female researcher would culturally embarrass the males, since men are expected to be strong and to contain their emotions and challenges. Men’s emotional reaction was interpreted as evidence of psychosocial needs or negative effects of the situation and challenges they faced.

5.5.5 Gaining Access to Community Participants

Culturally in Malawi, rural community leaders require some protocols and procedures to feel respected and to accept visitors. The following measures were followed. The chiefs were contacted with an introductory letter from the District Commissioner, briefed about the research, and asked to inform to their subjects about the research.

As a female researcher, my dressing code was adjusted to suit the rural poor community and their culture. For example, as a form of respect for the local tradition, I did not wear pairs of trousers and at times, I had to cover my hair to be accepted in some parts of the community. However, sitting arrangement was negotiated to allow men and women to feel equal and to promote fruitful FGD, as traditionally men would sit on chairs and women would sit on the floor if chairs were insufficient. According to Hennink (2007), such type of sitting arrangement create power imbalance and inhibit free participation.