Evaluation of the studies and justification for the PhD study

The aim of this section is to critically analyse the 18 studies identified in the literature review and present the justification for the research conducted for, and reported in, this thesis. For this process, the five additional studies were not included in the process of developing the research questions of the current study.

The majority of studies used a purposive sampling approach (Pitter, 2016; Mauri

et al., 2015; Shamu et al., 2013). The intention of these qualitative research studies

was to inform and enrich the understanding of various midwives’ experiences, knowledge and attitudes regarding IPV among pregnant women. Purposive sampling was therefore appropriate for these studies as this method enabled the researchers to select midwives who were rich with information about their experiences of IPV during pregnancy and who were responsible for providing the majority of care to pregnant women throughout their pregnancies (Burns & Grove, 2003).

A significant weakness found in this scoping review is the use of volunteer and convenience sampling. Four qualitative studies employed volunteer sampling. The explanation given by some authors about their sampling method was not clear and potential bias was not identified (Lauti & Miller 2008; Stenson et al., 2005; Eustace et al., 2016; Hindin, 2006). Volunteer sampling has the potential for bias with the result that study outcomes can be influenced and the sample’s ‘representativeness’ of the target population is decreased (Parahoo, 2014). In this review, midwives who volunteered to participate in the studies might have felt very strongly about IPV during pregnancy and may not even have had existing experience of IPV. This kind of sample bias can reduce the validity of the findings of a study. The findings of these studies from volunteer samples may also not reflect those

of other midwives who did not participate in the study. Two studies (Stenson et

al., 2005; Hindin, 2006) revealed a participation bias as most of the participants in

the studies were older (42-62 years; median age 54 years) than non-volunteers. Thus the findings of these studies might show little or nothing of the views and experiences of midwives who were younger than the volunteers. In addition, the reasons for taking part in a study of midwives, such as a feeling of moral obligation and a fear of being labelled as uncooperative, might be influential and might create selection bias. The volunteer recruitment method is considered to be the weakest form of sampling for both qualitative and quantitative studies (Parahoo, 2014). Two quantitative studies in the review sample (Furniss et al., 2007; Deoisres & Peomsook, 2013) used the convenience sampling method to select participants. The participants recruited by the convenience sampling method are selected simply because they are the easiest to recruit for the study or because the topic of the study cannot be examined by probability sampling (Burns & Grove, 2007). Convenience sampling has limitations: these studies cannot ascertain that all the answers were reliable because of the low external validity.

Another strength is in the sample size of the research. The nine qualitative studies in this review ranged in number of total participants per study from six to 36 (Lauti & Miller, 2008; Finnbogadottir & Dykes, 2012; Stenson et al., 2005; Eustace et al., 2016; Pitter, 2016; Mauri et al., 2015; Shamu et al., 2013; Taylor et al., 2007; Hindin, 2006). The sample size of each study seemed adequate because data saturation was reached by interviewing. For focus group discussion methods, the group sizes of three studies were small for a focus group; there were only two to three participants in each group (Lauti & Miller, 2008; Finnbogadottir & Dykes, 2012; Stenson et

The ideal number of participants for a focus group is six to ten participants, although four or five participants are acceptable when discussing a sensitive topic (Burns & Grove, 2007; Pitter, 2016). Nevertheless, these three qualitative studies increased the validity of the acquired data by conducting multiple focus groups. This method increases validity by enhancing confidence in focus group findings and allowing the researcher to compare and identify emerging themes from each discussion (Burns & Grove, 2005; Kidd & Parshall, 2000).

The method of data collection was clearly described in all of the reviewed studies. Using interview and focus group discussion for a qualitative study seemed appropriate. The strength in this area is that the aim of the focus group was achieved in all studies (Lauti & Miller, 2008; Finnbogadottir & Dykes, 2012; Stenson et

al., 2005; Pitter, 2016; Shamu et al., 2013; Taylor et al., 2007). Nevertheless, a

weakness was identified in the focus group discussions because of potential acquaintance bias. All of the focus group discussions were limited by establishing groups in which the participants already knew each other. These studies were therefore particularly prone to acquaintance bias, which could have affected the study findings. For example, Lauti and Miller’s (2008) focus group’s participants consisted of five midwives and two obstetricians who worked in the same hospital (Dunedin Public Hospital). Additionally, the reliability of the questionnaire in most studies was carried out after administering a pilot test. Piloting a study helps the researchers to identify what methods are best for pursuing it, to test the research instrument, to identify potential problems, to estimate the time and cost for the project and to know exactly what procedure to follow for the subsequent main study. Conducting a pilot study is therefore one of the most important stages in a research project. Even so, a successful pilot study does not necessarily guarantee success in

the main study (Furniss et al., 2007; Lazenbatt et al., 2009; Edin & Hogberg, 2002; Deoisres & Peomsook, 2013).

The strength of the data analysis of all studies depended on the statistics which they used being appropriate for quantitative analysis and that the thematic analysis was appropriate for a qualitative study. For qualitative research, only one study reported that a phenomenological-hermeneutic design had been used and that the research question which required an examination of the experiences of midwives related to IPV during pregnancy was addressed. So this particular methodology was considered appropriate for that study (Mauri et al., 2015). The analysis processes were clearly explained in most of the qualitative studies (Lauti & Miller, 2008; Finnbogadottir & Dykes, 2012; Stenson et al., 2005; Eustace et al., 2016; Pitter, 2016; Mauri et al., 2015; Taylor et al., 2007) and the mixed-method studies (Kaye et al., 2005; Edin & Hogberg, 2002). Four qualitative studies also employed a strategy which established trustworthiness in order to ensure the quality of findings (Eustace

et al., 2016; Mauri et al., 2015; Finnbogadottir & Dykes, 2012; Stenson et al., 2005).

These studies employed a strategy which involved the use of more than one researcher to analyse the data and to develop and test a coding scheme.

The designs of the studies included in the review were qualitative, quantitative or mixed methods and all of the studies were appropriate to answer the research questions. The purpose of each study was clearly described. The strength of the qualitative approach is the ability to investigate the richness of the motivations, the feelings or experiences of homogeneous or diverse groups of people (Parahoo, 2014). Thus an in-depth understanding of HCPs’ thinking and experiences was revealed in these qualitative studies. They provide rich data which might be transferable to other settings. The strength of the quantitative technique as a survey

approach is that the findings obtained through this approach could be generalised. At the same time, however, these data might not be strong enough to explain complex issues, especially, in this case, IPV during pregnancy. Using a mixed- method approach can also improve the weaknesses of both the qualitative and the quantitative methods. Two studies (Kaye et al., 2005; Edin & Hogberg, 2002) employed a mixed-method study design and consequently achieved both a deeper and a broader understanding of HCPs’ experiences and views regarding IPV among pregnant women. However, the weaknesses of these two methods employed in a mixed methodology were also identified. One study failed to explain the type of mixed-method research design adequately and also failed to make it clear that the results had been achieved through the combined use of the qualitative and quantitative approaches (Kaye et al., 2005).

The final weakness of the studies in this review is the geographical location and recruitment site of the research. Most of the studies in this review had been conducted in western countries, so these studies were limited in that it might not be possible to transfer their findings to other countries, especially developing countries. The majority of the qualitative, quantitative and mixed-method studies in this review sought to explore HCPs’ experiences of managing IPV and their views on the barriers to IVP management (Lauti & Miller, 2008; Finnbogadottir & Dykes, 2012; Eustace et al., 2016; Pitter, 2016; Mauri et al., 2015; Shamu et al., 2013; Roelens et al., 2009; Lazenbatt et al., 2009; Kaye et al., 2005; Edin & Hogberg, 2002; Deoisres & Peomsook, 2013). Nevertheless, all of these studies had been conducted in maternity units or in obstetric units. Some of the HCPs in these units reported that they had no clinical experience of responding to IPV or had never met a victim of IPV during their professional career (Finnbogadottir & Dykes. 2012;

Mauri et al., 2015). So any information which was discussed and reflected on the basis of the theoretical knowledge from these participants might not reflect any real experience of responding to IPV. One possible reason why some HCPs had never met a victim of IPV is partly due to their lack of knowledge and effective tools and to a hospital’s policy for IPV screening. So setting up specific services in hospitals for women who are the victims of violence and ensuring a fully trained emergency department to recognise IPV victims is another good way for a researcher to obtain more information about HCPs’experience of responding to IPV during pregnancy. This is because most women who attend these centres choose to identify themselves as victims of violence and to seek support or assistance from the centre. Moreover, female victims of domestic violence are more likely to seek emergency care for injuries related to abuse (Boyle & Todd, 2003; Mayer, 2000; Hewins et al., 2013). There is therefore a need for further research to explore the experiences of HCPs who are working in other healthcare settings than maternity and obstetric units. This will form the basis of my research in this current study.