Respect for Autonomy

Beauchamp and Childress (2013, p.101) define personal autonomy as something that ‘encompasses self-rule that is free from both controlling interference from others and limitations that prevent meaningful choice, such as inadequate understanding.’ The right to self-determination and autonomy includes the right to full disclosure enabling participants to make voluntary, informed decisions about whether to take part in research. Full disclosure of the expectations and commitment required for participants in this research was achieved by basing discussions, which included answers to any questions asked about taking part, and on a detailed information sheet (Appendix 11 and 12). There must be an absence of coercion to take part for a voluntary decision to be made, ensuring the ability to decide freely without the risk of prejudicial treatment by others based on that decision (Polit and Beck 2012). The right to withdraw at any time without giving a reason and to refuse to answer a question put to the participants as a part of the research was made explicit when consent was obtained and re-established before every data collection episode in this research. Informed consent for the observation of clinical encounters was also established with the clinicians before the observation took place. Impartial gatekeepers, who had no further

involvement in the recruitment process for the research, were used to make initial contact with potential participants in an attempt to avoid any potential coercion. By making the initial contact with potential participants, the

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gatekeepers ensured that I could not use any professional or personal contacts to persuade an expression of interest. It was made clear to all potential

stakeholder participants that the Heads of Midwifery would not know who had expressed an interest. Participation in order to impress these senior midwives professionally could not be used. In the women’s part of the study (phase three) any desire to gain preferential treatment or care was also avoided and anonymity preserved for all those who expressed an interest and those who decided to take part in the research.

Full disclosure involves providing a great deal of information to a potential participant, which can be overwhelming (Foster and Lasser 2011). The information needs to be understood and considered before any decisions regarding consent to take part in a study can be made. Informed consent was seen as a process in which a decision was made over time (Miller and Bell 2012). I encouraged the potential participants who requested further

information about the research to ask questions and discuss with others about the commitment required to take part before any decision was made.

Participants were given at least a week’s ‘cooling off’ period to consider whether to consent to participate in this study. Informed consent with full disclosure was then revisited before each data collection episode, as

continuing consent to be involved in this research by any participant could never be assumed.

4.7.4 Justice

The principle of justice, which includes the right to fair treatment and the right to privacy, is defined by Beauchamp and Childress (2013 p.13), as ‘issues of diversity, equity and egalitarian distribution of resources’.

One aspect of fair treatment concerns the inclusion criteria of who is to be invited to take part in a study, in that participant selection should be based on the study objectives rather than on the power that the researcher holds over a particular group (Polit and Beck 2012). The inclusion criteria for all three

phases of the research were based solely on the specific research objectives. I was known to the stakeholders to be a midwife, which raised the potential

issue of differing power balances between the practitioners and my changing role from clinical practice to researcher. In an attempt to address these imbalances, I made sure that the stakeholders were aware that my interest was in their own views and experiences concerning the delivery of maternity care at the CMUs and that there were no right or wrong answers to my open questions at the interviews. Whilst conducting the research at the CMUs, I treated all the staff in the same way with respect and integrity, whether they chose to take part or declined the opportunity.

I introduced myself to the women who had expressed an interest in taking part in phase three as a researcher. Respect for the different habits, lifestyles and beliefs was also an important issue regarding the principle of justice and this was addressed by showing tact and courtesy to all people that I came into contact with.

The need to effectively safeguard all the research participants’ right to privacy regarding the confidentiality of any information held as part of this research remained a continuous priority. Anonymity was addressed in phase one of this study by removing any identifiable information from the data collected from the maternity records to protect the privacy of the women whose records had been accessed. The stakeholders who participated in phase two were assigned pseudonyms and any identifying information removed from the interview transcripts. Their roles were categorised into non-midwife, midwife, manager and strategic when quotes were used within the findings chapters of this thesis to allow the reader to understand the context of their words. The women in phase three were also assigned pseudonyms and any identifying information removed from their interview transcripts. When using quotes from the women in this thesis, their pseudonym, parity and stage of pregnancy were noted to allow the reader to understand the context of their comments.

Confidentiality was addressed by keeping the electronic data collected in all phases of the study in password protected files on a secure university H-drive. The identity of the participants and the data collected during observation and interviews was known only to me and discussed when necessary within the supervisory team. Participants at the focus groups were each made aware

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during the re-establishment of informed consent of the need to show respect for each other’s confidentiality before each discussion. Whilst I did not discuss any information given by the women, the midwives or obstetricians caring for them knew that they were participating in the research as two of their clinical consultations were observed. Pseudonyms for the women and numbers for the stakeholders were used to maintain each of the participants’ privacy

throughout the research and this has included, and will continue to include, their use during presentations and papers written to disseminate the findings.