Ethical

Considerations
in Qualitative
Study
ABSTRACT
The protection of human
subjects through the
application of appropriate
ethical principles is important
in
all research study. In a
qualitative study, ethical
considerations have a

Susan Hepzi
particular resonance due to
the in-
depth nature of the study
process. The existing ethical
guidance for undertaking
qualitative research often
provide general guidelines
rather than focusing on how
to apply it in practice,
particularly when
interviewing vulnerable
group of women. The aim
of this paper is to present
my own experience of
conducting 33 individual face
to face interviews on the
women’s experience of
postnatal depression across
Susan Hepzi
three different cultural
backgrounds in Malaysia. This
paper reflects on the
strategies that can be adopted
by a qualitative researcher to
ensure that their
participants’ identity is
protected throughout
recruitment
and dissemination process, to
deal with participants from
different cultural backgrounds,
and to handle and
manage distress during
interview. The consideration
of ethical issues is crucial
throughout all stages of

Susan Hepzi
qualitative study to keep the
balance between the potential
risks of research and the likely
benefits of the
research.
KEYWORDS: Ethical, Principles,
Qualitative
Siti Roshaidai Mohd Arifin
Special Care Nursing
Department, Faculty of
Nursing, International Islamic
University, Pahang, Malaysia.
INTRODUCTION
The protection of human
subjects through the
application of appropriate
ethical principles is
Susan Hepzi
important in any research
study (1). In a
qualitative study, ethical
considerations have a
particular resonance due to
the in-depth nature of
the study process. The
concern of ethical issues
becomes more salient when
conducting face to
face interview with
vulnerable group of
participants. They may
potentially become
stressed while expressing their
feelings during the
interview session.

Susan Hepzi
The existing ethical
guidance for undertaking
qualitative research often
provide general
guidelines rather than
focusing on how to apply it
in practice, particularly when
interviewing new
mothers with postnatal
depression (PND). The aim
of this paper is to present
my own experience of
conducting individual face to
face interview on
the women experience of
postnatal depression.
There are six important
ethical issues considered
Susan Hepzi
in this study, and these are
discussed below.
INFORMED CONSENT AND
VOLUNTARY
PARTICIPATION
The process of obtaining
Consent consists of the
following: consent should be
given freely
(voluntary), subjects should
understand what is
being asked of them, and
involved persons must
be competent to consent
(2). This means, to
participate in a research
study, participants need

Susan Hepzi
to be adequately informed
about the research,
comprehend the information
and have a power of
freedom of choice to allow
them to decide
whether to participate or
decline (3).
Participant’s agreement to
participation in this
study was obtained only
after a thorough
explanation of the research
process.
All participants were required
to provide written
informed consent. The
potential participants were
Susan Hepzi
approached individually and
given an explanation
of the purpose of the study
and data collection
process. They were given an
appropriate time to
ask questions and address
any concerns. It was
explained that as their
participation was
voluntary, refusing to
participate or withdraw
from the study while it was in
progress would not
affect their care or job in the
respective clinic in
any way.

Susan Hepzi
A patient/participant’s
information sheet was
provided to further explain
the study. The
potential participants were
given appropriate time
(in this case: 24 hours up to
one week) to read the
information sheet and to
decide whether or not
they wanted to be involved
in this study. They
were required to sign the
informed consent form
before the interview to
indicate their permission
to be part of the study and
this signature was
Susan Hepzi
confirmed prior to the
interview session.
An explanation was clearly
given to potential
participants that they had a
right to withdraw
from the study at any time
even after the
informed consent had been
signed. Consent to
record the interview was
also asked from them.
The patient/participant’s
information sheet and
informed consent was
available in two languages:
Malay and English.

Susan Hepzi
ANONYMITY AND
CONFIDENTIALITY
The anonymity and
confidentiality of the
participants was preserved
by not revealing their
names and identity in the data
collection, analysis
and reporting of the study
findings. Privacy and
confidentiality of the interview
environment were
managed carefully during
telephone
communication, interview
session, data analysis
and dissemination of the
findings.
Susan Hepzi
Volume 16 Number 1, June 2017
31
International Journal of Care Scholars
2018;1(2)
TELEPHONE COMMUNICATION
Since the eligible
participants (women with
postnatal depressive
symptoms) were contacted
through phone to know their
decision whether or
not to participate in the
interview study, proper
safeguards were taken.
There were a few cases
where the phone call was
answered by the third
Susan Hepzi
party (husband/ mother). In
this situation, I did
not expose details of the
study. Instead, I
explained that the purpose of
the phone call was
to follow up the information
that had been given
during the previous visit to the
respective clinic. I
left the contact number with
that person and
asked for a better time to call
back.
INTERVIEW SESSION
Each interview was
conducted individually in a

Susan Hepzi
private and quiet room in the
respective clinic or
participant’s home without
access by outsiders. I
am the only one who should
be able to match the
identity of the participants and
voice recordings.
DATA ANALYSIS AND
DISSEMINATION OF THE
FINDINGS
Data transcribing was
conducted in a private room
using earphones to avoid
the possibility of
recordings being heard by
other people. The

Susan Hepzi
identities of the participants
were removed during
data transcription, including
their names or any
significant aspect of identity.
In presenting the
findings of the study, the
participants were
referred to by their
pseudonym names in the
verbatim quotes.
Written consent or any
document which contains
the participants' personal
detail was kept in a
locked cabinet with no
access to anyone other

Susan Hepzi
than myself. This personal
information will be
destroyed in accordance
with the University of
Stirling research governance
procedures.
Participants were however,
notified that their
actual age would be used
for the purpose of
reporting the data from the
interview (4). Data
were shared with the other
two qualitative
researchers for the purpose
of reaching

Susan Hepzi
agreement of the
interpretation without
exposing
the participants’ details at any
interim stage. The
access of the supervisors to
the data was
explained to the participants
and their consent
regarding this matter was
obtained.
This project adhered to the
University of Stirling
Code of Good Research
Practice. The University of
Stirling has adopted the Model
Publication Scheme

Susan Hepzi
(MPS) for Scottish Higher
Education Institutions
(HEIs), which has been
developed by Universities
Scotland. This MPS was
approved by the Scottish
Information Commissioner on
25 March 2004 (5).
Overall responsibility for this
Publication Scheme
resides with the University.
No participants
identifying information will be
included in reports
or publications arising from
this project.
ETHICAL APPROVAL AND
ACCESS TO
Susan Hepzi
PARTICIPANTS
The ethical approval was
sought and granted from
two main research ethics
committees: The School
Research Ethics Committee
(SREC) in the School
of Health Science, University
of Stirling and the
Malaysian Medical Research
Ethics Committee
(MREC).

Upon approval from the SREC,

Susan Hepzi
Research (NIHR) and MREC
were applied through
online registration with the
Malaysian National
Medical Research Register
(NMRR). Prior to this
application, permission from
the respected
authorities of the study
sites was first sought.
Therefore, application letters
were sent to the
Director of Hospital Kuala
Lumpur, and the
Director of Health Department
of Federal Territory
Kuala Lumpur.

Susan Hepzi
Upon getting the permission
from the respected
authorities of each study
site, the online
application was submitted.
The process of
application was monitored at
the NMRR website.
The final decisions were
notified by the MREC
through email to inform the
status of the
application. Approval from
the Economic Planning
Unit, Department of Prime
Minister Malaysia was
also sought to obtain the
research pass as this
Susan Hepzi
research was an application
to conduct research
from outside Malaysia.
Initially, only five MCH clinics
were selected and
approved by MREC.
However, after almost three
months in fieldwork, there
were fewer numbers of
Indian women participating
in the study due to a
low rate of attendance in
the five selected MCH
clinics. For this reason, an
approval to increase
the number of clinics had
been made through

Susan Hepzi
online application at NMRR
website. Three MCH
clinics were added. Upon
getting this approval, I
started visiting the newly
selected clinics and
looking, mainly, for Indian
participants. At the end
of the fourth month of the
study period, it was
decided that there were no
more new concepts
emerging, therefore the data
collection stage was
ended. These experiences
made me reflex that
obtaining ethical approval is
not always a
Susan Hepzi
straightforward process,
instead it requires some
modifications along the study
period.
DATA PROTECTION
Interview Stage
Data analysis was conducted
simultaneously with
the data collection. I
transcribed and analysed the
data independently. The data
was shared with two
qualitative researchers.
Data were stored in
encrypted devices and
password protected. As for
the purpose of cross
Susan Hepzi
checking in data analysis,
the transcripts were
shared with two qualitative
researchers through
password protected email.
The information
storage on the university
computer, personal
computer or laptop, hard
disk and memory sticks
were protected by using
passwords that were only
held by me (4). Hard copies
or written materials
of the data were kept in a
secured cabinet in a
locked room with no access
to others to ensure
Susan Hepzi
adherence to legal
requirements (6) and ethical
guidelines. Both written and
electronic data from
this study will be stored for
five years. However,
the interview recordings will
be disposed once
they are no longer needed.
I was aware that any
unexpected adverse event
which was caused by this
study should be reported
to the MREC and the SREC,
School of Health
Science, University of
Stirling. However, no such

Susan Hepzi
event occurred throughout
the study period. The
results of the study will be
reported and
disseminated through peer
reviewed scientific
journals, conference
presentations, thesis
dissertation, university
library and written
32
International Journal of Care Scholars
2018;1(2)
feedback to research
participants
or relevant community groups.
All anonymised data will be
securely stored for a

Susan Hepzi
period of 10 years in
accordance with the
University of Stirling Code
of Good Research
Practice: the safe and
secure storage of the
primary data will normally
be for at least ten
years, a safe and secure
method of disposal must
be used after this time, and
all accordance with
the requirements of the Data
Protection Acts (6).
Personally, identifiable data
(e.g., the
recruitment log) will be
destroyed as soon as I am
Susan Hepzi
sure that they will not be
needed again.
Cultural and Linguistic Barriers
It is important for researchers
to be fully aware of
the obstacles in their
research and plan for
preventative action, as this
may affect the timing
of the research. Since the
beginning of this study,
I was aware that in some
cultures, women may
need permission from their
husband/partner to
take part in this study.
Therefore, I allowed

Susan Hepzi
adequate time for the
eligible participants to
discuss the decision to
participate with their
husband/partner. In this
case, the women were
allowed to contact me, or I
only contacted the
women with their permission.
Although there was
a case where a woman gave
this as a reason not
to participate, the majority
of the participants
discussed the decision to
participate with their
husband and were allowed
to be involved in this
Susan Hepzi
study.
I was also aware that there
were three different
cultures with different
mother-tongue languages
involved in the interview
session. Given the fact
that Malay is the formal
language in Malaysia, I
assumed that most of
Malaysian women and HCPs
were able to converse and
express their
experiences at the optimum
level using Malay
language. I also included the
ability to converse in

Susan Hepzi
either Malay or English as
one of the inclusion
criteria for this study. This
was to optimise the
understandable
communications between
researcher and participants.
There was one case
where a Chinese woman
was eligible for the
interview session based on
the screening tools (as
this was based on reading in
Malay), but somehow
was found not to be able
to converse fluently
either in Malay or English for
the interview stage.
Susan Hepzi
Therefore, she was excluded
from the study.
There were also some of
the participants who
preferred to be interviewed
in English. This
involved six interviews with
women and three
interviews with HCPs. Due to
limited human and
financial resources, there
were no other versions
of the questionnaire for
screening and the topic
guides used other than Malay
and English.

Susan Hepzi
Handling and Managing
Distress During Interview
The face to face semi
structured interview
technique requires me to
listen and respond to
the participants’ answers or
speech. The act of
my listening may create
unintended harm to the
participants (7). I was aware
that working with a
vulnerable group of people,
the participants may
potentially become stressed
while expressing
their feelings during the
interview session.
Susan Hepzi
Therefore, a woman who
believed herself (or was
considered by the nurse in
charge or by me) to be
severely depressed to the
extent that
participation in the interview
might worsen her
condition, was excluded
from this study. In one
case, a woman was referred
by a head nurse as
having some level of
depression after her last
childbirth. After phone
communication, a meeting
was arranged at the woman’s
home. However, she
Susan Hepzi
was found as not being able to
concentrate in the
interview session, therefore
the interview was
stopped after ten minutes. She
had not developed
any adverse effects, but I
felt that her
descriptions on her
depressive experiences were
in a repetitive manner and
her responses did not
always relate to the questions
being asked. As this
woman was not able to focus,
it was assumed that
she had probably not fully
recovered, therefore I
Susan Hepzi
decided not to introduce
any potential harm to
her and she was excluded
from the study.
As applied to all
participants, they were
advised
to withdraw from the
interview at any point if
they thought answering the
interview questions
and disclosing their feelings
may impact upon
their emotional health
status. Ten out of 33
participants were crying when
sharing some parts

Susan Hepzi
of their experience of PND
during interview
sessions. In this case, I
offered them to
discontinue the interview if
they felt it would
cause any physical or
psychological harm. They
were also given a choice to
stop the interview and
continue once they were
ready to do so. In all
cases, women chose to stop
talking about the
study topic for a few minutes
and continued after
they felt better. During this
‘time break’, I tried
Susan Hepzi
to distract women’s
attention by having
conversation outside the
study scope (e.g., her
child’s name or anything
she likes to do in her
spare time). Stopping the
interview and searching
for possible solutions for the
participants’ distress
indicates that researchers
are aware of the
vulnerability of participants
and their rights (1).
Women were informed that
the additional support
was available as quickly as
they needed it
Susan Hepzi
especially for those who were
interviewed at the
MCH clinics. Offering and
referring participants to
counselling in case they
needed it was regarded
as fulfilling the moral
obligation by ensuring that
they have regained control
of the situation by
talking (1). All women were
informed that the
Counselling Psychology Unit
Department was
available in the Health
Department of the Federal
Territory Kuala Lumpur for
further assistance. All
Susan Hepzi
of the women did not show
any interest in
contacting this unit, although
this was offered.
Recommendations
This paper recommends that
interviewing
participants that come from
different cultural
backgrounds requires not only
basic understanding
of the participants’ culture
but also flexibility in
the interview process. When
dealing with
vulnerable group of people,
qualitative researcher

Susan Hepzi
should aware of potential
harm that can be
imposed to the participants.
These approaches
are important to ensure that
these ethical
principles are applied
throughout all stages of the
research process, thereby
balancing the potential
risks of research against the
likely benefits.
CONCLUSION
This paper has argued that
while ethical
considerations are important
in all research area,

Susan Hepzi
the concern becomes more
salient in qualitative
research, particularly when
involving vulnerable
group of participants. It is
the responsibility of
the qualitative researcher to
ensure participants
to have a power of freedom
of choice to involve
in the study, protect the
participants’ identity
throughout recruitment and
dissemination
process, and promote clear
and honest research
reporting without deception
to readers.
Susan Hepzi
Volume 16 Number 1, June 2017
33
International Journal of Care Scholars
2018;1(2)
Reflecting those strategies
that I have used
during my research made
me aware that ethical
issues in qualitative research
is not as general as
being portrayed in the
literature, instead it might
require some modifications
along the research
process.

Susan Hepzi
Ethical
Considerations
in Qualitative
Study
ABSTRACT
The protection of human
subjects through the
application of appropriate
ethical principles is important
in
all research study. In a
qualitative study, ethical
considerations have a

Susan Hepzi
particular resonance due to
the in-
depth nature of the study
process. The existing ethical
guidance for undertaking
qualitative research often
provide general guidelines
rather than focusing on how
to apply it in practice,
particularly when
interviewing vulnerable
group of women. The aim
of this paper is to present
my own experience of
conducting 33 individual face
to face interviews on the
women’s experience of
postnatal depression across
Susan Hepzi
three different cultural
backgrounds in Malaysia. This
paper reflects on the
strategies that can be adopted
by a qualitative researcher to
ensure that their
participants’ identity is
protected throughout
recruitment
and dissemination process, to
deal with participants from
different cultural backgrounds,
and to handle and
manage distress during
interview. The consideration
of ethical issues is crucial
throughout all stages of

Susan Hepzi
qualitative study to keep the
balance between the potential
risks of research and the likely
benefits of the
research.
KEYWORDS: Ethical, Principles,
Qualitative
Siti Roshaidai Mohd Arifin
Special Care Nursing
Department, Faculty of
Nursing, International Islamic
University, Pahang, Malaysia.
INTRODUCTION
The protection of human
subjects through the
application of appropriate
ethical principles is
Susan Hepzi
important in any research
study (1). In a
qualitative study, ethical
considerations have a
particular resonance due to
the in-depth nature of
the study process. The
concern of ethical issues
becomes more salient when
conducting face to
face interview with
vulnerable group of
participants. They may
potentially become
stressed while expressing their
feelings during the
interview session.

Susan Hepzi
The existing ethical
guidance for undertaking
qualitative research often
provide general
guidelines rather than
focusing on how to apply it
in practice, particularly when
interviewing new
mothers with postnatal
depression (PND). The aim
of this paper is to present
my own experience of
conducting individual face to
face interview on
the women experience of
postnatal depression.
There are six important
ethical issues considered
Susan Hepzi
in this study, and these are
discussed below.
INFORMED CONSENT AND
VOLUNTARY
PARTICIPATION
The process of obtaining
Consent consists of the
following: consent should be
given freely
(voluntary), subjects should
understand what is
being asked of them, and
involved persons must
be competent to consent
(2). This means, to
participate in a research
study, participants need

Susan Hepzi
to be adequately informed
about the research,
comprehend the information
and have a power of
freedom of choice to allow
them to decide
whether to participate or
decline (3).
Participant’s agreement to
participation in this
study was obtained only
after a thorough
explanation of the research
process.
All participants were required
to provide written
informed consent. The
potential participants were
Susan Hepzi
approached individually and
given an explanation
of the purpose of the study
and data collection
process. They were given an
appropriate time to
ask questions and address
any concerns. It was
explained that as their
participation was
voluntary, refusing to
participate or withdraw
from the study while it was in
progress would not
affect their care or job in the
respective clinic in
any way.

Susan Hepzi
A patient/participant’s
information sheet was
provided to further explain
the study. The
potential participants were
given appropriate time
(in this case: 24 hours up to
one week) to read the
information sheet and to
decide whether or not
they wanted to be involved
in this study. They
were required to sign the
informed consent form
before the interview to
indicate their permission
to be part of the study and
this signature was
Susan Hepzi
confirmed prior to the
interview session.
An explanation was clearly
given to potential
participants that they had a
right to withdraw
from the study at any time
even after the
informed consent had been
signed. Consent to
record the interview was
also asked from them.
The patient/participant’s
information sheet and
informed consent was
available in two languages:
Malay and English.

Susan Hepzi
ANONYMITY AND
CONFIDENTIALITY
The anonymity and
confidentiality of the
participants was preserved
by not revealing their
names and identity in the data
collection, analysis
and reporting of the study
findings. Privacy and
confidentiality of the interview
environment were
managed carefully during
telephone
communication, interview
session, data analysis
and dissemination of the
findings.
Susan Hepzi
Volume 16 Number 1, June 2017
31
International Journal of Care Scholars
2018;1(2)
TELEPHONE COMMUNICATION
Since the eligible
participants (women with
postnatal depressive
symptoms) were contacted
through phone to know their
decision whether or
not to participate in the
interview study, proper
safeguards were taken.
There were a few cases
where the phone call was
answered by the third
Susan Hepzi
party (husband/ mother). In
this situation, I did
not expose details of the
study. Instead, I
explained that the purpose of
the phone call was
to follow up the information
that had been given
during the previous visit to the
respective clinic. I
left the contact number with
that person and
asked for a better time to call
back.
INTERVIEW SESSION
Each interview was
conducted individually in a

Susan Hepzi
private and quiet room in the
respective clinic or
participant’s home without
access by outsiders. I
am the only one who should
be able to match the
identity of the participants and
voice recordings.
DATA ANALYSIS AND
DISSEMINATION OF THE
FINDINGS
Data transcribing was
conducted in a private room
using earphones to avoid
the possibility of
recordings being heard by
other people. The

Susan Hepzi
identities of the participants
were removed during
data transcription, including
their names or any
significant aspect of identity.
In presenting the
findings of the study, the
participants were
referred to by their
pseudonym names in the
verbatim quotes.
Written consent or any
document which contains
the participants' personal
detail was kept in a
locked cabinet with no
access to anyone other

Susan Hepzi
than myself. This personal
information will be
destroyed in accordance
with the University of
Stirling research governance
procedures.
Participants were however,
notified that their
actual age would be used
for the purpose of
reporting the data from the
interview (4). Data
were shared with the other
two qualitative
researchers for the purpose
of reaching

Susan Hepzi
agreement of the
interpretation without
exposing
the participants’ details at any
interim stage. The
access of the supervisors to
the data was
explained to the participants
and their consent
regarding this matter was
obtained.
This project adhered to the
University of Stirling
Code of Good Research
Practice. The University of
Stirling has adopted the Model
Publication Scheme

Susan Hepzi
(MPS) for Scottish Higher
Education Institutions
(HEIs), which has been
developed by Universities
Scotland. This MPS was
approved by the Scottish
Information Commissioner on
25 March 2004 (5).
Overall responsibility for this
Publication Scheme
resides with the University.
No participants
identifying information will be
included in reports
or publications arising from
this project.
ETHICAL APPROVAL AND
ACCESS TO
Susan Hepzi
PARTICIPANTS
The ethical approval was
sought and granted from
two main research ethics
committees: The School
Research Ethics Committee
(SREC) in the School
of Health Science, University
of Stirling and the
Malaysian Medical Research
Ethics Committee
(MREC).

Upon approval from the SREC,

Susan Hepzi
Research (NIHR) and MREC
were applied through
online registration with the
Malaysian National
Medical Research Register
(NMRR). Prior to this
application, permission from
the respected
authorities of the study
sites was first sought.
Therefore, application letters
were sent to the
Director of Hospital Kuala
Lumpur, and the
Director of Health Department
of Federal Territory
Kuala Lumpur.

Susan Hepzi
Upon getting the permission
from the respected
authorities of each study
site, the online
application was submitted.
The process of
application was monitored at
the NMRR website.
The final decisions were
notified by the MREC
through email to inform the
status of the
application. Approval from
the Economic Planning
Unit, Department of Prime
Minister Malaysia was
also sought to obtain the
research pass as this
Susan Hepzi
research was an application
to conduct research
from outside Malaysia.
Initially, only five MCH clinics
were selected and
approved by MREC.
However, after almost three
months in fieldwork, there
were fewer numbers of
Indian women participating
in the study due to a
low rate of attendance in
the five selected MCH
clinics. For this reason, an
approval to increase
the number of clinics had
been made through

Susan Hepzi
online application at NMRR
website. Three MCH
clinics were added. Upon
getting this approval, I
started visiting the newly
selected clinics and
looking, mainly, for Indian
participants. At the end
of the fourth month of the
study period, it was
decided that there were no
more new concepts
emerging, therefore the data
collection stage was
ended. These experiences
made me reflex that
obtaining ethical approval is
not always a
Susan Hepzi
straightforward process,
instead it requires some
modifications along the study
period.
DATA PROTECTION
Interview Stage
Data analysis was conducted
simultaneously with
the data collection. I
transcribed and analysed the
data independently. The data
was shared with two
qualitative researchers.
Data were stored in
encrypted devices and
password protected. As for
the purpose of cross
Susan Hepzi
checking in data analysis,
the transcripts were
shared with two qualitative
researchers through
password protected email.
The information
storage on the university
computer, personal
computer or laptop, hard
disk and memory sticks
were protected by using
passwords that were only
held by me (4). Hard copies
or written materials
of the data were kept in a
secured cabinet in a
locked room with no access
to others to ensure
Susan Hepzi
adherence to legal
requirements (6) and ethical
guidelines. Both written and
electronic data from
this study will be stored for
five years. However,
the interview recordings will
be disposed once
they are no longer needed.
I was aware that any
unexpected adverse event
which was caused by this
study should be reported
to the MREC and the SREC,
School of Health
Science, University of
Stirling. However, no such

Susan Hepzi
event occurred throughout
the study period. The
results of the study will be
reported and
disseminated through peer
reviewed scientific
journals, conference
presentations, thesis
dissertation, university
library and written
32
International Journal of Care Scholars
2018;1(2)
feedback to research
participants
or relevant community groups.
All anonymised data will be
securely stored for a

Susan Hepzi
period of 10 years in
accordance with the
University of Stirling Code
of Good Research
Practice: the safe and
secure storage of the
primary data will normally
be for at least ten
years, a safe and secure
method of disposal must
be used after this time, and
all accordance with
the requirements of the Data
Protection Acts (6).
Personally, identifiable data
(e.g., the
recruitment log) will be
destroyed as soon as I am
Susan Hepzi
sure that they will not be
needed again.
Cultural and Linguistic Barriers
It is important for researchers
to be fully aware of
the obstacles in their
research and plan for
preventative action, as this
may affect the timing
of the research. Since the
beginning of this study,
I was aware that in some
cultures, women may
need permission from their
husband/partner to
take part in this study.
Therefore, I allowed

Susan Hepzi
adequate time for the
eligible participants to
discuss the decision to
participate with their
husband/partner. In this
case, the women were
allowed to contact me, or I
only contacted the
women with their permission.
Although there was
a case where a woman gave
this as a reason not
to participate, the majority
of the participants
discussed the decision to
participate with their
husband and were allowed
to be involved in this
Susan Hepzi
study.
I was also aware that there
were three different
cultures with different
mother-tongue languages
involved in the interview
session. Given the fact
that Malay is the formal
language in Malaysia, I
assumed that most of
Malaysian women and HCPs
were able to converse and
express their
experiences at the optimum
level using Malay
language. I also included the
ability to converse in

Susan Hepzi
either Malay or English as
one of the inclusion
criteria for this study. This
was to optimise the
understandable
communications between
researcher and participants.
There was one case
where a Chinese woman
was eligible for the
interview session based on
the screening tools (as
this was based on reading in
Malay), but somehow
was found not to be able
to converse fluently
either in Malay or English for
the interview stage.
Susan Hepzi
Therefore, she was excluded
from the study.
There were also some of
the participants who
preferred to be interviewed
in English. This
involved six interviews with
women and three
interviews with HCPs. Due to
limited human and
financial resources, there
were no other versions
of the questionnaire for
screening and the topic
guides used other than Malay
and English.

Susan Hepzi
Handling and Managing
Distress During Interview
The face to face semi
structured interview
technique requires me to
listen and respond to
the participants’ answers or
speech. The act of
my listening may create
unintended harm to the
participants (7). I was aware
that working with a
vulnerable group of people,
the participants may
potentially become stressed
while expressing
their feelings during the
interview session.
Susan Hepzi
Therefore, a woman who
believed herself (or was
considered by the nurse in
charge or by me) to be
severely depressed to the
extent that
participation in the interview
might worsen her
condition, was excluded
from this study. In one
case, a woman was referred
by a head nurse as
having some level of
depression after her last
childbirth. After phone
communication, a meeting
was arranged at the woman’s
home. However, she
Susan Hepzi
was found as not being able to
concentrate in the
interview session, therefore
the interview was
stopped after ten minutes. She
had not developed
any adverse effects, but I
felt that her
descriptions on her
depressive experiences were
in a repetitive manner and
her responses did not
always relate to the questions
being asked. As this
woman was not able to focus,
it was assumed that
she had probably not fully
recovered, therefore I
Susan Hepzi
decided not to introduce
any potential harm to
her and she was excluded
from the study.
As applied to all
participants, they were
advised
to withdraw from the
interview at any point if
they thought answering the
interview questions
and disclosing their feelings
may impact upon
their emotional health
status. Ten out of 33
participants were crying when
sharing some parts

Susan Hepzi
of their experience of PND
during interview
sessions. In this case, I
offered them to
discontinue the interview if
they felt it would
cause any physical or
psychological harm. They
were also given a choice to
stop the interview and
continue once they were
ready to do so. In all
cases, women chose to stop
talking about the
study topic for a few minutes
and continued after
they felt better. During this
‘time break’, I tried
Susan Hepzi
to distract women’s
attention by having
conversation outside the
study scope (e.g., her
child’s name or anything
she likes to do in her
spare time). Stopping the
interview and searching
for possible solutions for the
participants’ distress
indicates that researchers
are aware of the
vulnerability of participants
and their rights (1).
Women were informed that
the additional support
was available as quickly as
they needed it
Susan Hepzi
especially for those who were
interviewed at the
MCH clinics. Offering and
referring participants to
counselling in case they
needed it was regarded
as fulfilling the moral
obligation by ensuring that
they have regained control
of the situation by
talking (1). All women were
informed that the
Counselling Psychology Unit
Department was
available in the Health
Department of the Federal
Territory Kuala Lumpur for
further assistance. All
Susan Hepzi
of the women did not show
any interest in
contacting this unit, although
this was offered.
Recommendations
This paper recommends that
interviewing
participants that come from
different cultural
backgrounds requires not only
basic understanding
of the participants’ culture
but also flexibility in
the interview process. When
dealing with
vulnerable group of people,
qualitative researcher

Susan Hepzi
should aware of potential
harm that can be
imposed to the participants.
These approaches
are important to ensure that
these ethical
principles are applied
throughout all stages of the
research process, thereby
balancing the potential
risks of research against the
likely benefits.
CONCLUSION
This paper has argued that
while ethical
considerations are important
in all research area,

Susan Hepzi
the concern becomes more
salient in qualitative
research, particularly when
involving vulnerable
group of participants. It is
the responsibility of
the qualitative researcher to
ensure participants
to have a power of freedom
of choice to involve
in the study, protect the
participants’ identity
throughout recruitment and
dissemination
process, and promote clear
and honest research
reporting without deception
to readers.
Susan Hepzi
Volume 16 Number 1, June 2017
33
International Journal of Care Scholars
2018;1(2)
Reflecting those strategies
that I have used
during my research made
me aware that ethical
issues in qualitative research
is not as general as
being portrayed in the
literature, instead it might
require some modifications
along the research
process.
Masinde Muliro University of
Science and Technology

Susan Hepzi
 SCHOOL OF NURSING

MAIN EXAMINATION
FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY IN NURSING

NCN 9121: ADVANCED QUALITATIVE RESEARCH METHODS

Student Name: Susan Hepzi (HNR/H/01-53791/2019)

LECTURER: Dr. Nganyi

Question Three:

With the aid of example discuss the relevance of ethics while carrying out Qualitative
research in nursing ( 20 marks)

Susan Hepzi
Research ethics is the application of moral rules and professional codes of conduct to the collection,
analysis, reporting, and publication of information about research subjects.

The protection of human subjects through the application of appropriate ethical principles is
important in any research study . In a qualitative study, ethical considerations have a particular
resonance due to the in-depth nature of the study process.

The following are the important ethics to be considered in a Qualitative study, they are

 Informed consent and voluntary participation

 Informed Consent And Voluntary Participation

The process of obtaining Consent consists of the following: consent should be given freely
(voluntary), subjects should understand what is being asked of them, and involved persons must
be competent to consent . To participate in a research study, participants need to be adequately
informed about the research, comprehend the information and have a power of freedom of choice to
allow them to decide whether to participate or decline . As the participation is voluntary, refusing
to participate or withdraw from the study while it was in progress would not affect the care or job in
any way. A patient information sheet will provide all the explanation of the study. The subjects
will sign the informed consent form before the interview to indicate the permission . Informed
consent is dynamic in a Qualitative research study.

For example, in studying responses of family caregivers to caring for chronic patients, determining who
needs to give informed consent may be necessary. For example, it may pertain only to caregivers or
consent from patients or other family members may also be required.

 Anonymity And Confidentiality

The anonymity and confidentiality of the participants is preserved by not revealing their
names and identity in the data collection, analysis and reporting of the study findings. Privacy and
confidentiality of the interview environment should be managed carefully during telephone

Susan Hepzi
communication, interview session, data analysis and dissemination of the findings.
As qualitative research is conversational, it is important for data collectors to maintain clear
boundaries between what they are told by participants and what they tell to participants. Conversation
is a social act that requires give and take.
For example, qualitative researchers may be more cautious than
needed when seeking to protect ‘vulnerable’ individuals or groups of people, such as, but not limited to,
people who abuse alcohol, drugs and other substances; people who are victims of abuse; people with
severe cognitive impairments; some children and younger people; and some older frail and vulnerable
people, from harm including the potential disclosure of their actions and identities.

For example, qualitative researchers may be more cautious than needed when seeking to protect
‘vulnerable’ individuals or groups of people, such as, but not limited to, people who abuse alcohol, drugs
and other substances; people who are victims of abuse; people with severe cognitive impairments; some
children and younger people; and some older frail and vulnerable people, from harm including the
potential disclosure of their actions and identities.

 Minimizing The Risk Of Harm

The research should not harm participants. There is the possibility that participants could be harmed or
put in a position of discomfort, there must be strong justifications for this. Such scenarios will also
require (a) additional planning to illustrate how participant harm (or discomfort) will be
reduced, (b) informed consent, and (c) detailed debriefing.

There are a number of types of harm that participants can be subjected to. These include:

 Physical harm to participants.

For example, Researchers conducting studies on emotionally charged issues need to identify potential
participants who might be particularly vulnerable to harm and be prepared to respond to negative
emotional reactions that occur during the course of the research.

 Beneficence

Susan Hepzi
A ethical principle closely linked with research is beneficence—doing good for others and preventing
harm. Beneficence in some situations may be taken to the extreme as paternalism. A paternalistic
approach indicates the denial of autonomy and freedom of choice.

For example, the researcher may want to study the problem of violence among elderly women but may
decide not to include them because they may be too vulnerable. In this case, the researcher is not giving
elderly women the opportunity to decide for themselves and for their experiences to be heard.

 Justice

The principle of justice refers to equal share and fairness. One of the crucial and distinctive features of
this principle is avoiding exploitation and abuse of participants. The researcher’s understanding and
application of the principle of justice in qualitative research studies is demonstrated by recognising
vulnerability of the participants and their contributions to the study.

For example, if researchers during analysis of the data consider that a concept or a heading of the report
will be based on the contribution of a particular participant, ethically the researcher should request
permission to use such a concept or at least discuss the issues with the participant. In this way, the
contributions of that participant are acknowledged. Another way of implementing the principle of justice
is listening to the voices of the minority and disadvantaged groups as well as protecting those who are
most vulnerable, such as children, prisoners, the mentally ill, and the elderly.

Thus following and considering ethics is mandatory in carrying out Qualitative research.

Susan Hepzi