Jottmal of Advanced Nurstng, 1992,17, 98-103
Ethical issues in interviewing* Lorraine Smith BScN MEd PhD RGN RMN Professor of Nurstng and Head of Department of Nursing Studies, Untverstty of Glasgow, 68 Oakfield Aventte, Gla^ow Gl2 8LS, Scotland
Accepted for publication 8 May 1991
SMITH L (1992) Journal of Advanced Nurstng 17, 98-103 Ethical issues in interviewing A study of the help-seekmg behaviours of alcohol dependent and problem drmkmg women raised a number of ethical issues It had been antiapated that the design of the study and the construction and approval of appropnate consent forms would eliminate the majonty of problems. While this was true, a number of unforeseen points emerged durmg the course of the study related to mterviewmg women, discussmg emotive issues and the responsibihhes of the researcher vts-a-vts their samples This paper ciiscusses the issues raised usmg speafic examples drawn from the research study
INTRODUCTION The vanous pomts made m tbs paper are denved from the expenence of mterviewmg problem dnnkmg and alcohol dependent women Three different grcnips of women were mterviewed representmg three different types of help available m the commumty for problem dnnkmg a selfhelp orgamzahoa Alcohobcs Anonymous, a statutory sector group m the fonn of a hospital out-patient group, and a non-statutory sedor group drawn fTom a regional council of alcoholism A total of 86 women took part m the 2^-year study Each woman was mterviewed once One-tbrdofthe mterviews took place m a hospital out-pahent sethng wble the remammg two-thirds were held m the subjed's home Each mterview lasted approximately 1^ hours and was audio-taped Data collechon methods cc»npnsed a semistructured mterview based on a prompt schedule and a queshonnaire
2
To determme whether alcohol dependent and problem dnnkmg women encounter any cbfficulhes in obtammg help for their dnnkmg, related to their bemg women 3 To draw condusions regardmg strategies to help alcohol dependent and problem dnnkmg women
THEORETICAL BACKGROUND
Given that mterviewmg isfi-equentlyemployed as a data collechon method, there is a surpnsmgly small literature on the etbcal dimaisions The bterature on mterviewmg emphasizes the development of appropnate tcx>k and style There seems to be an underlymg assumphon that, providmg the boundanes are observed, the majonty of potenhal problems can be avoided Likewise, there is a substantial literature concemmg moral behavicnir m the context of health care These texts provide a wide perspechve fi-om wbdi it is possible to extrapolate and conunent on the narrow focus of etbcal dilemmas in research mterviewmg, for example, Nttrstng Ethtcs (Thompson et al 1988) and Healthy Respect (Dowm Purposes of the study &Cabiianl987) Any theorehcal franwwoik for ethrcal mtervtewing The piBpeses of the study were must begm with tiie mterviewer Kcdinke (1982) wntmg 1 To describe the help-seekmg behaviours of alcohol about pahott advocacy says depeoAenk and problem dnnkmg women. 'Jhs paper teas presented at the Royal Cottege cj Nursa^ Researdi Amtud Coi^enncehddm Manchester in 1991
Understamfang why people b ^ v e as tl»y ik) aid nudoe the deasicMis they make l^lps ycninot (Hily to »xept their n ^ t to
Ethical i^ues in mterviewmg
determine their own destinies but also to assess your own readions and to determine your own behaviour Extendmg tbs idea to research methodology, it is clear that the mterpretation of mterview data is never wboUy objedive and dispassionate despite any effort made to be so Data mterpretation is influenced by bfe expenence and mteUectual abibty Balance Another component of etbcal mterviewmg is balance, tbat IS, that the potential good denved fi-om a researdi study must be taken alongside the potential harm done to a dient as a result of partiapation m a projed (Morse 1991) Interviewmg mvolves mteraction between at least two people, botb of wbom enter tbe situahon with tbeir own life bstones Morse (1991) is absolutely correct m her assertion tbat, througbout an mterview, tbe researdier is constantly takmg deasions concermng tbe next queshon and tbe pbrasmg of sucb Semi-structured and unstructured mterviews are by defimtion an acknowledgement of tbs process Tbe extent to wbch the mterviewer encourages, allows and forestaUs affechve matenal is a fundion of balance Tbe queshon must be asked, 'Who looks after the mterviewee's well-bemg once an interview is completed and tbe researcher has witbdrawn from tbe sihiation?' A furtber dimension to ethical mterviewmg is that of complexity Morse (1991) argues that some interviews are more complex than otbers either because of tbeir focus (alcobol consumphon vs television viewmg) and/or because of tbeir scbedulmg (one-off mterviews vs longihidinal mterviews) Consequently, etbcal mterviewmg must give due consideration to the sensitivity of tbe matenal and extended self-disdosure In t b s paper, etbcs and etbcal posihons are taken to mean our abibty to distmguish tjetween nght and wrong and our understanding of duty and obligahon It is recognized that the development of etbcs is influenced by attihides, values and bebefs and tbat tbese contnbute to different etbcal posihons It sbould also be noted that no attempt has been made to cover the entire range of etbcal problems related to research mterviewmg. Tbe focus bere IS on etbcal issues ansmg out of t b s study, with specific reference to problem dnnkmg women
the forms di^red m several key areas For example, hospital out-pahents were referred to as pahents wble nonstatutory sedor subjeds were addressed as dients Anotber example was related to contact pomts, tbat is, bospital out-patients contacted tbe researdier via tbe hospital wble tbe non-statutory group contaded tbe researcber via the umversity Consequently, tbe consent forms refleded tbese differences Tbe self-belp group also agreed and signed tbe same consent form as the hospital out-pahent group Altbougb tbere was no legal necessity to bave t b s group sign a consent form, it was tbought prudent tbat tbey do so It would offer tbe researcber some protechon agamst any possible future claims Tbe consent form provided tbe women witb the researcher's name, position and bnk to a recogmzed researcb mstitution, an outlme of tbe researdi and its purpose, undertahngs regarding tbe confidentiality of tbe mterview data, the lengtb of time required for tbe mterview, and a pronuse tbat a decision to refuse to partiapate would not jeopardize treatment in any way The two forms were then subnutted to and approved by tbe appropnate body, tbat is, tbe bospital out-pahents' form was vetted by tbe bospital's etbics committee and the counselbng staff of tbe non-statutory agency vetted the form to be used witb their dientele Thus, each women signed a form w b d i stated tbat sbe had been fully mformed concemmg tbe researcb and agreed to take part in the study Tbe use of audio-tapes and destruction of the tapes foUowing completion of tbe research was discussed and agreed with each subjed Tbe researdier was aware tbat home mterviews might be problemahc vts-a-vis unwanted mterruphons or the presence of otbers Consequently, great care was taken in sethng tbem up so that pnvacy was mamtamed However, it was perbaps inevitable, given tbe range and number of women mterviewed that some queshons arose wbcb had not t)een foreseen
Infonned consent Tbe mformed consent is considered to be one of tbe means by which a pahent's ngbts are proteded In order to ensure tbe adequacy of informed consents, etbcs committees scrutinize researdi proposals, examme mterview formats and somehmes interview tbe researchers Nevertbeless, etbcs committees are not present m the mterview situahon so tbat m grantmg etbcal approval tbey are m fad recognizing tbe intent of the researdi proposal rather than the PRIOR CONSIDERATIONS A number of etbical points were considered pnor to tbe achons tbemselves Tbe mtent is tbat tbe research wiU do
outset of the study It was necessary to draw up two con- the patient no hann Researchers often sent fomis which reflected the differait charactenshcs of the samples Although similar m design and lnfonmahoa
rely on researdi assistants or professional interviewers to cany out mterviews As sudi, 99
L Sfmth
researcbers have a moral responsibility to ensure that those %hng on tlwir behalf have both the sbU and knowledge to perform adequately. EthrcaUy, tbs raises the queshon of the extent to which researchers have personal knowledge of what their employees are domg on their behalf As noted earber, tbe mformed eonsent should mdude provision for the study subjed to withdraw at any time Fortuitously, no subjeet did withdraw from this research However, these women were mterviewed only once In research requiring several mterviews over a penod of weeks or months, it is almost mevitable tbat some subjeets wiU be lost to the study While it is true that such people can be counted as treatment failures or noted to be lost through attnhon, or eould be stuciied as a separate group, notmg any partieular eommonabhes and/or cMferenees, they nonetheless represent lost hme and effort, and mcieed money This study relied on voltmteers As these subjeds were not bospital m-patients but out-patients or attenders at other eommumty agenaes, tbey were at bberty to attend for treatment or not as tbey wiUed Consequently, it was necessary to enhee them to beeome mvolved m tbe study The author found herself ciiangmg voiee tone and marmer when, after several attempts to gam subjeets, sbe had been less sueeessful than planned In other words, she began to soimd more asserhve, the value of the work to them and others was emphasized Parhapahon was acrhvely eneouraged by saymg how much their help would be appreaated In aU these thmgs, the audience was nrtampulated m order to achieve the sample In providmg people with the choice to parhapate m a study or not,researchersneed to be aware of the level erf their sample If it is proposed that a group of the 'elcierly weU' are mterviewed, it is likely that their choice wiU be made morefreelythan an elderly group which is bedndden ami confined Thus, the behef that subjects are offered a free ehoiee to partiapate m researeh by virtue of tbe informed eonsent begs ethieal queshons of whether there are degrees of eompbanee and whether this is nght or not There is a further issue m that those who ehoose to parhapate may beheve tbat tbey are bemg offered a better treatment deal (MtmhaU & Oiler 1986). In the ease of this researeh, there were some women wbo tbought that parhapahon m the study would be helpful to themselves personaUy It was said that the opportumty to talk might be useful m puttmg evHits and feelmgs mto perspechve
of 'self mto a projed, particularly if theresearcitaddres%s a question about wbicb one feels strongly Researchers may work on a study because tbey are puzzled by a parhcular asped of care or tbeir lmagmations may have been captured m some way Consequently, the hme and effort expended m eombmation witb the degree of personal self mvested may mean that some eomers are cut, there may be a reluctance to be as fortbcormng as tbe mformed consent implies, espeaally if a study could founder on lack of subject co-operahon Researdi supervisors need to be alert to themselves and their students so that the penis of sueh a personal investment are fuUy tmderstood and appreaated Tbe question may be posed as to whether it is eorred to talk about eomer-cuttmg, espeaaUy if it is believed that the honour and mtegnty of researchers is being chaUenged Researcb is demandmg amd methe>dic:al and, m many ways, totally absorbing Nevertheless, there was a time dunng tbe conduct of this researdi when, tired and frustrated by data coUechon, the author tned to reduce the overall sample size by simply cutting out a group Only the fad that this eould not be done praeheaUy kept tbe sample size mtaet In talkmg to others, it is dejir that, despite good mtentions, eomer-cnittmg can and does happen Perhaps the answer bes m the management of studies whereby the projed leader is sufifiaently confident and knowledgeable to say wben enougb is enough Revealing the researdi location
Another ethical considerahon is the deasion to reveal, quite speaficaUy, the icxrahon of the research In discussions with nursmg colleagues, the normaUy conveyed view is that it is suffiaent to give a broad statement as to the locale, for instance a large hospital m the north of England However, m cbscussmg the matter further with other health professionals, a different opmion emerged, that is, not to reveal the lcKahon speafically was unethical unless very speafic condihons made such an option ciiflficult In other words, the posihon was reversed so that not to state the name of the research locahon was seen to be unethical It was argued that, m statmg the locahon, other mveshgators eould then examme and (Question tbe research more effechvely No conhision could exist concemmg the site Any doubts raised regardmg the study sample would refled that particular sample and others with speafic knowledge of the area could then comment more usefuUy In addihon, rephcahon and comparahve stuciies could be managed more easily THE PURSUIT OF KNOWLEDGE It was thought that m circumstances where ihs |HibliThe nature of researcii and the pursuit of knowledge are cahon of mformahon would damage im mshtuhon unjustly relentless masters There may be a ccmsido-able mvestment or could be harmful to fiiture but netxssary research, a 100
Ethtcal issues in intervtewtng
deasion to camouflage the site should be taken This was parhculariy important m resped of undergraduate or taught master's students undertakmg studies, as their study samples tended to be small and unrepresentative It must be stated that the deasion to reveal the research location may have impbcahons for the individuals partiapatmg m the project When broad statements are made concemmg the locale, tt is far less likely that mdividuals can be identified through their comments However, once a site has been identified, then it follows necessanly that more care must be taken m descnbmg any particular event or person so that the confidentiabty promised m the informed consrait remains a reabty
and consuming pattems and observational and cbonological methods such as dianes are recommended (Midamk 1982, Pobch 1982) However, it remams undear from research reports whether mformed consents have been sought which would allow workers to gain uiformahon from other sources Therefore, there are several etbcal queshons wbch anse from the use of interview data First, to what extent has the researcher recogmzed the problems inherent m usmg self-reported data? Second, to what extent has the recognition of the first problem led to the buildmg m of other measures to ensure the validity of the study's results? And, third, to what extent have mformed consents been sought regarding the use of other corroborating evidence?
Using interview data THE I N T E R V I E W E R ' S R O L E Etbcally, any study wbch relies on mterview data must give due consideration to the validity of tbs method of data collection Published results and recommendahons may affect treatment debvery systems If the data source is imrebable, then so too are the findmgs Researchers who rely on human beings as their study populations are soon confronted by the mdividuality of the human expenence Efforts can he made to standardize and control usmg expenmental designs so that results are mterpretable withm these bnuts However, once the decision is made to use verbal reports as data, a greater degree of subjectivity is introduced Factors such as memory decay, the unportance of an event for the individual, the tendency to repress threatening matenal, defects m the ongmal possession of mformahon and lack of understanding all contnbute to the problem of accessmg data from mdividuals (Cannell & Kahn 1968) The validity of self-reported data acquires particular importance m a study of alcohol dependent women because 'denial' of a dnnkmg problem is often considered to be a feature of the disorder Denial is mterpreted as an ego defence mechamsm or as a deliberate attempt either to under or over report speafied behaviours, amounts of alcohol consumed, and events concemtng dnnkmg It is assumed that the process of demal leads people to distort self-reported data, ultimately calbng mto queshon research findmgs (Pobch 1982) Generally, the problem of usmg self-reported data is largely ignored Researdiers tend to note the problem but fail to mtroduce other methods of data colledion mto a study's design wbch would enhance confidence m findmgs In the field of alcobal research, the use of offiaal records, seeking corroborative evidence from sigmficant others, the use of breathalyzers and blood tests, purchasmg
A good mterview necessitates that rapport has been estabbshed between the mterviewer and mterviewee A balance must be sought which facilitates mterachon but also mamtams objechvity In thinkmg about this problem withm the speafic context of problem dnnkmg women, it seemed that the most useful approach would be one that could be descnbed as 'mterested' The tntervtewer's role was one of mvesttgatton She was not there to counsel, educate, sympathtze, exploit or orgamze However, as an 'mterested' outsider, one could bsten, take note of problems and expore It was a tenable posihon, ethically However, occasions may anse dunng an mterview when to withhold mformation which the mterviewer possesses could be interpreted as morally reprehensible In these situations what does the researcher do? The author took the decision to mtervene at a muumum level Justificahon for this adion was based on two grounds First, tt was bebeved to be the 'nght and proper' tbng to do Secondly, the field was not gomg to be contaminated for contmumg research as it would be if one was conducting controlled dimcal trials Thus, when a problem was menhoned wbch caused distress and yet a remedy existed — for example, finanaal hardship in gethng to the hospital because the subject had no knowledge of free bus passes — the researcher would alert the woman to tbs mformation by saymg somethmg like, 'Bus passes are somehmes available if money is short The s o a i worker is the person to ask', and would then leave it to the woman to sort out OccasionaUy, an mterviewee expressed a very strong desire to dnnk agam or remamed concemed about her dnnkmg behaviour havmg completed counsellmg T b s might be commumcated by a dired statement or by usmg 'cues' The researcher would 101
L Smith
then make the opportumty, at some fKMnt dunng the mterview, to remforee available back-up services or would suggest that the woman might see a staff manber The researcher did not mtervene on the respondent's behalf and it IS unknown whether any respondent did m fact approach staff There were occasions when respondents seemed not to be gettmg the required support m respect of demenhng parents or menopausal symptoms The researcher mamtamed a neutral stance and would only offer ideas on obtammg further assistance if aehvely requested As an example, one woman had a mother who seemed to be demenhng The general practihoner appeared to have offered no help and the woman was obviously distressed and under pressure When asked, the researcher suggested she eould use her hospital group to discniss the problem The queshon remams as to whether it was nght to make sueh mtervenhons The researeher must be prepared to take a moral stanee and justify it To behave otherwise eould be eonstrued as unetbeal
exploitation by researcitors She speculates as to why women rmght behave m tbs way First, women are often m the posihon of providu^ professionals with information on themselves aruj theu- famihes m cc»mechon with cjuldbirth, duldren and schcx>L Consequoitly, to do so m a researeh mterview might not be so unfamihar Second, mterviews conducted m the home with an easy mformahty, mduding coffee or tea, may take cm the air erf a fneruily chat encouragmg an unwarranted mhmacy Thefinalreason put forward is that, for women who spend much of their time m the home, the opportumty to talk and discuss their hves may be welcomed Thus, researchers, who mterview people and peihaps particularly women, need an awareness and a sensitivity to the fact that, although a subject may have agreed to take part m a study, it cannot be known for certam what that mterview wiU uncover or give nse to It could be argued that to be aUowed a pnvate view of another person's past or opimons or pam is a pnvilege The author is convmced that tbs view is not communicated sufificiently to students or research assistants
Interviewing women
PUBLICATION OF RESULTS It became dear dunng the course of the mterviews that many women were prepared to talkfi-eelyand m a seemmgly open way about their dnnkmg and the effect it had had on th«n and their hves The women m the study were aU volunteers They therefore had made the choice to parhapate knowmg of and havmg agreed to the proposed cemtent of the mterview Nevertheless, the research design asked subjeets to discniss mhmate as(>ec:ts of their hves with a stranger The eontent of the discussions ranged over many areas and mduded references to events wbch could only be descnbed as bghly personal, emohonaUy charged and, m some cases, tmresolved for example, the givmg up of cblciren for adophon, rape, violence to themselves as weU as being violent towareb others It IS argued here that the researcher has an ethical responsibility to handle such matenal wtth sensihvity and judgement In other words, the researciier ean hsten and aeknowledge the event but she must not probe m sueh a way as to produee and eneourage emohonal pjun To mterview and then leave scHneone m emohcHial distress without aciequate support or safeguards is moraUy wrcmg The role of the researeh mterviewer is not to produce eatharsis, although Morse (1991) notes that catharsis may be stimulated Fmch (1984) believes that women often ex[K>se themselves and their hves m a way that leaves them opai to 102
Can it be nght to obtam informed consents, to mterview subjects, use their time and mvade their hves and then not to pubhsh the results? It would seem that there must exist an obhgahon on the part of researchers to pubhsh and chsseminate results m a way wbch mfonns health care professionals It carmot be nght for researchers to mveshgate a problem using people and then not respect the ccHnmitment shown by subjects Partiapants who have voliuiteered their time and themselves to a study cieserve the samefi'omresearchers who have used subjects' good wiU Otherwise researciiers only exploit There is a further etbcal e>bhgation on the part of mveshgators, that IS, they must honour the contract set up with the mterviewees If one has promised to destroy mterview tapes on the complehon of the research, tbs must be done, or if anon)miity has been promised, then details wbch might idenhfy an individual must be altered Tbs leads to another etbcal queshcm, one wbch is espeaaUy important when one mterviews populations which are under-researched and uni^-represented, as is the case of womoi as study samples m alcohol researcii It is argued that researchers have a responsibihty to ensure that findings are presented m ways wbch represent and do not distort the interests of special groups There is a balance to be adueved between over-promotu^ a case wbdi a researdto- may believe to be ]ust and
Ethical tssues tn tniermewmg
findings wbch may damage what was previously considered to be a just case
CONCLUSION
This paper has raised a number of points denved from a study of alcohol dependent and problem dnnkmg women PERSONAL SAFETY OF INTERVIEWERS However, these issues do not pertam solely to t b s subjed The last etbcal issue to be raised m tbs paper concems the area They are relevant to many other aspects of research It personal safety of research mterviewers biterviews con- IS unlikely that all ethical queshons will be addressed pnor duded witbn hospital confines or other commumty faabhes to the commencement of a study are usually viewed as 'safe', that is, there is always help At the same time, however, it is necessary that thought available should one readme it However, home mterviews be given to possible etbcal dilemmas as weU as considermg do not have the same guarantee of 'safeness' In the case of those aspeds that we know require an ethical stance alcohol dep>endent women, the bterature dearly pomts out that many of these women have alcohobc partners Thus, the queshons are raised m asking mterviewers to condud home References mterviews, what are die nsks to that mdividual m terms of Cannel C & Kahn R. (1968) Interviewmg In The Handbook of personal safety, and what features can be incorporated mto Sociai Psychology vol 2 (Lmdzey G & Aronson E eds), the mterview process to ensure the safety of workers? Addison-Wesley, Massachusetts In conduding home mterviewers, the author made a Dowme R & Caiman K (1987) Healthy Resped Faber and Faber, deliberate dioice to commence them only after spnng had London amved and daylight hours were longer Prachcal steps Finch J (1984) The ethics and pohtics of interviewmg women In mduded someone always knowmg where she was going Soaal Researching (Bell C & Roberts H eds), Routledge and Kegan Paul, London and when she was expeded to retum Care was taken to be Kohnke M (1982) Advocacy C V Mosby, St Louis suffiaently on time and have the car joumey planned so Midamk L (1982) The vahdity of self-reported alcohol consumpthat she did not place herself at nsk by having to ask for hon and alcohol problems A hterature review Bntish foumal direchons ofAddtdton 77,357-382 These may seem like small matters, yet m terms of one Morse J (ed) (1991) Quahtahve Nursmg Research Sage, woman's safety it could make all the difference It is worth London remonbenng that wcnnen, either as students or as pro- Munhall P & Oiler C (1986) Nursing Research A Qf4alttahve fessional mterviewers, may be asked to go mto situahons Perspedive Appleton-Century-Crofts, Norwalk, Cormechcut that in other circumstances they might well avoid Conse- Pohch J (1982) The vahdity of self-reports m alcohohsm quently, it IS the responsibibty of the project du-ector to research foumal ofAddichve Behaviours 7,123-132 ensure that all possible measures to ensure personal safety Thompson I, Meha K & Boyd K (1988) Nurstng Ethtcs 2nd edn Churchill Livmgstone, Edmburgh have been discussed and built mto the study design
103
Ethical issues in interviewing* Lorraine Smith BScN MEd PhD RGN RMN Professor of Nurstng and Head of Department of Nursing Studies, Untverstty of Glasgow, 68 Oakfield Aventte, Gla^ow Gl2 8LS, Scotland
Accepted for publication 8 May 1991
SMITH L (1992) Journal of Advanced Nurstng 17, 98-103 Ethical issues in interviewing A study of the help-seekmg behaviours of alcohol dependent and problem drmkmg women raised a number of ethical issues It had been antiapated that the design of the study and the construction and approval of appropnate consent forms would eliminate the majonty of problems. While this was true, a number of unforeseen points emerged durmg the course of the study related to mterviewmg women, discussmg emotive issues and the responsibihhes of the researcher vts-a-vts their samples This paper ciiscusses the issues raised usmg speafic examples drawn from the research study
INTRODUCTION The vanous pomts made m tbs paper are denved from the expenence of mterviewmg problem dnnkmg and alcohol dependent women Three different grcnips of women were mterviewed representmg three different types of help available m the commumty for problem dnnkmg a selfhelp orgamzahoa Alcohobcs Anonymous, a statutory sector group m the fonn of a hospital out-patient group, and a non-statutory sedor group drawn fTom a regional council of alcoholism A total of 86 women took part m the 2^-year study Each woman was mterviewed once One-tbrdofthe mterviews took place m a hospital out-pahent sethng wble the remammg two-thirds were held m the subjed's home Each mterview lasted approximately 1^ hours and was audio-taped Data collechon methods cc»npnsed a semistructured mterview based on a prompt schedule and a queshonnaire
2
To determme whether alcohol dependent and problem dnnkmg women encounter any cbfficulhes in obtammg help for their dnnkmg, related to their bemg women 3 To draw condusions regardmg strategies to help alcohol dependent and problem dnnkmg women
THEORETICAL BACKGROUND
Given that mterviewmg isfi-equentlyemployed as a data collechon method, there is a surpnsmgly small literature on the etbcal dimaisions The bterature on mterviewmg emphasizes the development of appropnate tcx>k and style There seems to be an underlymg assumphon that, providmg the boundanes are observed, the majonty of potenhal problems can be avoided Likewise, there is a substantial literature concemmg moral behavicnir m the context of health care These texts provide a wide perspechve fi-om wbdi it is possible to extrapolate and conunent on the narrow focus of etbcal dilemmas in research mterviewmg, for example, Nttrstng Ethtcs (Thompson et al 1988) and Healthy Respect (Dowm Purposes of the study &Cabiianl987) Any theorehcal franwwoik for ethrcal mtervtewing The piBpeses of the study were must begm with tiie mterviewer Kcdinke (1982) wntmg 1 To describe the help-seekmg behaviours of alcohol about pahott advocacy says depeoAenk and problem dnnkmg women. 'Jhs paper teas presented at the Royal Cottege cj Nursa^ Researdi Amtud Coi^enncehddm Manchester in 1991
Understamfang why people b ^ v e as tl»y ik) aid nudoe the deasicMis they make l^lps ycninot (Hily to »xept their n ^ t to
Ethical i^ues in mterviewmg
determine their own destinies but also to assess your own readions and to determine your own behaviour Extendmg tbs idea to research methodology, it is clear that the mterpretation of mterview data is never wboUy objedive and dispassionate despite any effort made to be so Data mterpretation is influenced by bfe expenence and mteUectual abibty Balance Another component of etbcal mterviewmg is balance, tbat IS, that the potential good denved fi-om a researdi study must be taken alongside the potential harm done to a dient as a result of partiapation m a projed (Morse 1991) Interviewmg mvolves mteraction between at least two people, botb of wbom enter tbe situahon with tbeir own life bstones Morse (1991) is absolutely correct m her assertion tbat, througbout an mterview, tbe researdier is constantly takmg deasions concermng tbe next queshon and tbe pbrasmg of sucb Semi-structured and unstructured mterviews are by defimtion an acknowledgement of tbs process Tbe extent to wbch the mterviewer encourages, allows and forestaUs affechve matenal is a fundion of balance Tbe queshon must be asked, 'Who looks after the mterviewee's well-bemg once an interview is completed and tbe researcher has witbdrawn from tbe sihiation?' A furtber dimension to ethical mterviewmg is that of complexity Morse (1991) argues that some interviews are more complex than otbers either because of tbeir focus (alcobol consumphon vs television viewmg) and/or because of tbeir scbedulmg (one-off mterviews vs longihidinal mterviews) Consequently, etbcal mterviewmg must give due consideration to the sensitivity of tbe matenal and extended self-disdosure In t b s paper, etbcs and etbcal posihons are taken to mean our abibty to distmguish tjetween nght and wrong and our understanding of duty and obligahon It is recognized that the development of etbcs is influenced by attihides, values and bebefs and tbat tbese contnbute to different etbcal posihons It sbould also be noted that no attempt has been made to cover the entire range of etbcal problems related to research mterviewmg. Tbe focus bere IS on etbcal issues ansmg out of t b s study, with specific reference to problem dnnkmg women
the forms di^red m several key areas For example, hospital out-pahents were referred to as pahents wble nonstatutory sedor subjeds were addressed as dients Anotber example was related to contact pomts, tbat is, bospital out-patients contacted tbe researdier via tbe hospital wble tbe non-statutory group contaded tbe researcber via the umversity Consequently, tbe consent forms refleded tbese differences Tbe self-belp group also agreed and signed tbe same consent form as the hospital out-pahent group Altbougb tbere was no legal necessity to bave t b s group sign a consent form, it was tbought prudent tbat tbey do so It would offer tbe researcber some protechon agamst any possible future claims Tbe consent form provided tbe women witb the researcher's name, position and bnk to a recogmzed researcb mstitution, an outlme of tbe researdi and its purpose, undertahngs regarding tbe confidentiality of tbe mterview data, the lengtb of time required for tbe mterview, and a pronuse tbat a decision to refuse to partiapate would not jeopardize treatment in any way The two forms were then subnutted to and approved by tbe appropnate body, tbat is, tbe bospital out-pahents' form was vetted by tbe bospital's etbics committee and the counselbng staff of tbe non-statutory agency vetted the form to be used witb their dientele Thus, each women signed a form w b d i stated tbat sbe had been fully mformed concemmg tbe researcb and agreed to take part in the study Tbe use of audio-tapes and destruction of the tapes foUowing completion of tbe research was discussed and agreed with each subjed Tbe researdier was aware tbat home mterviews might be problemahc vts-a-vis unwanted mterruphons or the presence of otbers Consequently, great care was taken in sethng tbem up so that pnvacy was mamtamed However, it was perbaps inevitable, given tbe range and number of women mterviewed that some queshons arose wbcb had not t)een foreseen
Infonned consent Tbe mformed consent is considered to be one of tbe means by which a pahent's ngbts are proteded In order to ensure tbe adequacy of informed consents, etbcs committees scrutinize researdi proposals, examme mterview formats and somehmes interview tbe researchers Nevertbeless, etbcs committees are not present m the mterview situahon so tbat m grantmg etbcal approval tbey are m fad recognizing tbe intent of the researdi proposal rather than the PRIOR CONSIDERATIONS A number of etbical points were considered pnor to tbe achons tbemselves Tbe mtent is tbat tbe research wiU do
outset of the study It was necessary to draw up two con- the patient no hann Researchers often sent fomis which reflected the differait charactenshcs of the samples Although similar m design and lnfonmahoa
rely on researdi assistants or professional interviewers to cany out mterviews As sudi, 99
L Sfmth
researcbers have a moral responsibility to ensure that those %hng on tlwir behalf have both the sbU and knowledge to perform adequately. EthrcaUy, tbs raises the queshon of the extent to which researchers have personal knowledge of what their employees are domg on their behalf As noted earber, tbe mformed eonsent should mdude provision for the study subjed to withdraw at any time Fortuitously, no subjeet did withdraw from this research However, these women were mterviewed only once In research requiring several mterviews over a penod of weeks or months, it is almost mevitable tbat some subjeets wiU be lost to the study While it is true that such people can be counted as treatment failures or noted to be lost through attnhon, or eould be stuciied as a separate group, notmg any partieular eommonabhes and/or cMferenees, they nonetheless represent lost hme and effort, and mcieed money This study relied on voltmteers As these subjeds were not bospital m-patients but out-patients or attenders at other eommumty agenaes, tbey were at bberty to attend for treatment or not as tbey wiUed Consequently, it was necessary to enhee them to beeome mvolved m tbe study The author found herself ciiangmg voiee tone and marmer when, after several attempts to gam subjeets, sbe had been less sueeessful than planned In other words, she began to soimd more asserhve, the value of the work to them and others was emphasized Parhapahon was acrhvely eneouraged by saymg how much their help would be appreaated In aU these thmgs, the audience was nrtampulated m order to achieve the sample In providmg people with the choice to parhapate m a study or not,researchersneed to be aware of the level erf their sample If it is proposed that a group of the 'elcierly weU' are mterviewed, it is likely that their choice wiU be made morefreelythan an elderly group which is bedndden ami confined Thus, the behef that subjects are offered a free ehoiee to partiapate m researeh by virtue of tbe informed eonsent begs ethieal queshons of whether there are degrees of eompbanee and whether this is nght or not There is a further issue m that those who ehoose to parhapate may beheve tbat tbey are bemg offered a better treatment deal (MtmhaU & Oiler 1986). In the ease of this researeh, there were some women wbo tbought that parhapahon m the study would be helpful to themselves personaUy It was said that the opportumty to talk might be useful m puttmg evHits and feelmgs mto perspechve
of 'self mto a projed, particularly if theresearcitaddres%s a question about wbicb one feels strongly Researchers may work on a study because tbey are puzzled by a parhcular asped of care or tbeir lmagmations may have been captured m some way Consequently, the hme and effort expended m eombmation witb the degree of personal self mvested may mean that some eomers are cut, there may be a reluctance to be as fortbcormng as tbe mformed consent implies, espeaally if a study could founder on lack of subject co-operahon Researdi supervisors need to be alert to themselves and their students so that the penis of sueh a personal investment are fuUy tmderstood and appreaated Tbe question may be posed as to whether it is eorred to talk about eomer-cuttmg, espeaaUy if it is believed that the honour and mtegnty of researchers is being chaUenged Researcb is demandmg amd methe>dic:al and, m many ways, totally absorbing Nevertheless, there was a time dunng tbe conduct of this researdi when, tired and frustrated by data coUechon, the author tned to reduce the overall sample size by simply cutting out a group Only the fad that this eould not be done praeheaUy kept tbe sample size mtaet In talkmg to others, it is dejir that, despite good mtentions, eomer-cnittmg can and does happen Perhaps the answer bes m the management of studies whereby the projed leader is sufifiaently confident and knowledgeable to say wben enougb is enough Revealing the researdi location
Another ethical considerahon is the deasion to reveal, quite speaficaUy, the icxrahon of the research In discussions with nursmg colleagues, the normaUy conveyed view is that it is suffiaent to give a broad statement as to the locale, for instance a large hospital m the north of England However, m cbscussmg the matter further with other health professionals, a different opmion emerged, that is, not to reveal the lcKahon speafically was unethical unless very speafic condihons made such an option ciiflficult In other words, the posihon was reversed so that not to state the name of the research locahon was seen to be unethical It was argued that, m statmg the locahon, other mveshgators eould then examme and (Question tbe research more effechvely No conhision could exist concemmg the site Any doubts raised regardmg the study sample would refled that particular sample and others with speafic knowledge of the area could then comment more usefuUy In addihon, rephcahon and comparahve stuciies could be managed more easily THE PURSUIT OF KNOWLEDGE It was thought that m circumstances where ihs |HibliThe nature of researcii and the pursuit of knowledge are cahon of mformahon would damage im mshtuhon unjustly relentless masters There may be a ccmsido-able mvestment or could be harmful to fiiture but netxssary research, a 100
Ethtcal issues in intervtewtng
deasion to camouflage the site should be taken This was parhculariy important m resped of undergraduate or taught master's students undertakmg studies, as their study samples tended to be small and unrepresentative It must be stated that the deasion to reveal the research location may have impbcahons for the individuals partiapatmg m the project When broad statements are made concemmg the locale, tt is far less likely that mdividuals can be identified through their comments However, once a site has been identified, then it follows necessanly that more care must be taken m descnbmg any particular event or person so that the confidentiabty promised m the informed consrait remains a reabty
and consuming pattems and observational and cbonological methods such as dianes are recommended (Midamk 1982, Pobch 1982) However, it remams undear from research reports whether mformed consents have been sought which would allow workers to gain uiformahon from other sources Therefore, there are several etbcal queshons wbch anse from the use of interview data First, to what extent has the researcher recogmzed the problems inherent m usmg self-reported data? Second, to what extent has the recognition of the first problem led to the buildmg m of other measures to ensure the validity of the study's results? And, third, to what extent have mformed consents been sought regarding the use of other corroborating evidence?
Using interview data THE I N T E R V I E W E R ' S R O L E Etbcally, any study wbch relies on mterview data must give due consideration to the validity of tbs method of data collection Published results and recommendahons may affect treatment debvery systems If the data source is imrebable, then so too are the findmgs Researchers who rely on human beings as their study populations are soon confronted by the mdividuality of the human expenence Efforts can he made to standardize and control usmg expenmental designs so that results are mterpretable withm these bnuts However, once the decision is made to use verbal reports as data, a greater degree of subjectivity is introduced Factors such as memory decay, the unportance of an event for the individual, the tendency to repress threatening matenal, defects m the ongmal possession of mformahon and lack of understanding all contnbute to the problem of accessmg data from mdividuals (Cannell & Kahn 1968) The validity of self-reported data acquires particular importance m a study of alcohol dependent women because 'denial' of a dnnkmg problem is often considered to be a feature of the disorder Denial is mterpreted as an ego defence mechamsm or as a deliberate attempt either to under or over report speafied behaviours, amounts of alcohol consumed, and events concemtng dnnkmg It is assumed that the process of demal leads people to distort self-reported data, ultimately calbng mto queshon research findmgs (Pobch 1982) Generally, the problem of usmg self-reported data is largely ignored Researdiers tend to note the problem but fail to mtroduce other methods of data colledion mto a study's design wbch would enhance confidence m findmgs In the field of alcobal research, the use of offiaal records, seeking corroborative evidence from sigmficant others, the use of breathalyzers and blood tests, purchasmg
A good mterview necessitates that rapport has been estabbshed between the mterviewer and mterviewee A balance must be sought which facilitates mterachon but also mamtams objechvity In thinkmg about this problem withm the speafic context of problem dnnkmg women, it seemed that the most useful approach would be one that could be descnbed as 'mterested' The tntervtewer's role was one of mvesttgatton She was not there to counsel, educate, sympathtze, exploit or orgamze However, as an 'mterested' outsider, one could bsten, take note of problems and expore It was a tenable posihon, ethically However, occasions may anse dunng an mterview when to withhold mformation which the mterviewer possesses could be interpreted as morally reprehensible In these situations what does the researcher do? The author took the decision to mtervene at a muumum level Justificahon for this adion was based on two grounds First, tt was bebeved to be the 'nght and proper' tbng to do Secondly, the field was not gomg to be contaminated for contmumg research as it would be if one was conducting controlled dimcal trials Thus, when a problem was menhoned wbch caused distress and yet a remedy existed — for example, finanaal hardship in gethng to the hospital because the subject had no knowledge of free bus passes — the researcher would alert the woman to tbs mformation by saymg somethmg like, 'Bus passes are somehmes available if money is short The s o a i worker is the person to ask', and would then leave it to the woman to sort out OccasionaUy, an mterviewee expressed a very strong desire to dnnk agam or remamed concemed about her dnnkmg behaviour havmg completed counsellmg T b s might be commumcated by a dired statement or by usmg 'cues' The researcher would 101
L Smith
then make the opportumty, at some fKMnt dunng the mterview, to remforee available back-up services or would suggest that the woman might see a staff manber The researcher did not mtervene on the respondent's behalf and it IS unknown whether any respondent did m fact approach staff There were occasions when respondents seemed not to be gettmg the required support m respect of demenhng parents or menopausal symptoms The researcher mamtamed a neutral stance and would only offer ideas on obtammg further assistance if aehvely requested As an example, one woman had a mother who seemed to be demenhng The general practihoner appeared to have offered no help and the woman was obviously distressed and under pressure When asked, the researcher suggested she eould use her hospital group to discniss the problem The queshon remams as to whether it was nght to make sueh mtervenhons The researeher must be prepared to take a moral stanee and justify it To behave otherwise eould be eonstrued as unetbeal
exploitation by researcitors She speculates as to why women rmght behave m tbs way First, women are often m the posihon of providu^ professionals with information on themselves aruj theu- famihes m cc»mechon with cjuldbirth, duldren and schcx>L Consequoitly, to do so m a researeh mterview might not be so unfamihar Second, mterviews conducted m the home with an easy mformahty, mduding coffee or tea, may take cm the air erf a fneruily chat encouragmg an unwarranted mhmacy Thefinalreason put forward is that, for women who spend much of their time m the home, the opportumty to talk and discuss their hves may be welcomed Thus, researchers, who mterview people and peihaps particularly women, need an awareness and a sensitivity to the fact that, although a subject may have agreed to take part m a study, it cannot be known for certam what that mterview wiU uncover or give nse to It could be argued that to be aUowed a pnvate view of another person's past or opimons or pam is a pnvilege The author is convmced that tbs view is not communicated sufificiently to students or research assistants
Interviewing women
PUBLICATION OF RESULTS It became dear dunng the course of the mterviews that many women were prepared to talkfi-eelyand m a seemmgly open way about their dnnkmg and the effect it had had on th«n and their hves The women m the study were aU volunteers They therefore had made the choice to parhapate knowmg of and havmg agreed to the proposed cemtent of the mterview Nevertheless, the research design asked subjeets to discniss mhmate as(>ec:ts of their hves with a stranger The eontent of the discussions ranged over many areas and mduded references to events wbch could only be descnbed as bghly personal, emohonaUy charged and, m some cases, tmresolved for example, the givmg up of cblciren for adophon, rape, violence to themselves as weU as being violent towareb others It IS argued here that the researcher has an ethical responsibility to handle such matenal wtth sensihvity and judgement In other words, the researciier ean hsten and aeknowledge the event but she must not probe m sueh a way as to produee and eneourage emohonal pjun To mterview and then leave scHneone m emohcHial distress without aciequate support or safeguards is moraUy wrcmg The role of the researeh mterviewer is not to produce eatharsis, although Morse (1991) notes that catharsis may be stimulated Fmch (1984) believes that women often ex[K>se themselves and their hves m a way that leaves them opai to 102
Can it be nght to obtam informed consents, to mterview subjects, use their time and mvade their hves and then not to pubhsh the results? It would seem that there must exist an obhgahon on the part of researchers to pubhsh and chsseminate results m a way wbch mfonns health care professionals It carmot be nght for researchers to mveshgate a problem using people and then not respect the ccHnmitment shown by subjects Partiapants who have voliuiteered their time and themselves to a study cieserve the samefi'omresearchers who have used subjects' good wiU Otherwise researciiers only exploit There is a further etbcal e>bhgation on the part of mveshgators, that IS, they must honour the contract set up with the mterviewees If one has promised to destroy mterview tapes on the complehon of the research, tbs must be done, or if anon)miity has been promised, then details wbch might idenhfy an individual must be altered Tbs leads to another etbcal queshcm, one wbch is espeaaUy important when one mterviews populations which are under-researched and uni^-represented, as is the case of womoi as study samples m alcohol researcii It is argued that researchers have a responsibihty to ensure that findings are presented m ways wbch represent and do not distort the interests of special groups There is a balance to be adueved between over-promotu^ a case wbdi a researdto- may believe to be ]ust and
Ethical tssues tn tniermewmg
findings wbch may damage what was previously considered to be a just case
CONCLUSION
This paper has raised a number of points denved from a study of alcohol dependent and problem dnnkmg women PERSONAL SAFETY OF INTERVIEWERS However, these issues do not pertam solely to t b s subjed The last etbcal issue to be raised m tbs paper concems the area They are relevant to many other aspects of research It personal safety of research mterviewers biterviews con- IS unlikely that all ethical queshons will be addressed pnor duded witbn hospital confines or other commumty faabhes to the commencement of a study are usually viewed as 'safe', that is, there is always help At the same time, however, it is necessary that thought available should one readme it However, home mterviews be given to possible etbcal dilemmas as weU as considermg do not have the same guarantee of 'safeness' In the case of those aspeds that we know require an ethical stance alcohol dep>endent women, the bterature dearly pomts out that many of these women have alcohobc partners Thus, the queshons are raised m asking mterviewers to condud home References mterviews, what are die nsks to that mdividual m terms of Cannel C & Kahn R. (1968) Interviewmg In The Handbook of personal safety, and what features can be incorporated mto Sociai Psychology vol 2 (Lmdzey G & Aronson E eds), the mterview process to ensure the safety of workers? Addison-Wesley, Massachusetts In conduding home mterviewers, the author made a Dowme R & Caiman K (1987) Healthy Resped Faber and Faber, deliberate dioice to commence them only after spnng had London amved and daylight hours were longer Prachcal steps Finch J (1984) The ethics and pohtics of interviewmg women In mduded someone always knowmg where she was going Soaal Researching (Bell C & Roberts H eds), Routledge and Kegan Paul, London and when she was expeded to retum Care was taken to be Kohnke M (1982) Advocacy C V Mosby, St Louis suffiaently on time and have the car joumey planned so Midamk L (1982) The vahdity of self-reported alcohol consumpthat she did not place herself at nsk by having to ask for hon and alcohol problems A hterature review Bntish foumal direchons ofAddtdton 77,357-382 These may seem like small matters, yet m terms of one Morse J (ed) (1991) Quahtahve Nursmg Research Sage, woman's safety it could make all the difference It is worth London remonbenng that wcnnen, either as students or as pro- Munhall P & Oiler C (1986) Nursing Research A Qf4alttahve fessional mterviewers, may be asked to go mto situahons Perspedive Appleton-Century-Crofts, Norwalk, Cormechcut that in other circumstances they might well avoid Conse- Pohch J (1982) The vahdity of self-reports m alcohohsm quently, it IS the responsibibty of the project du-ector to research foumal ofAddichve Behaviours 7,123-132 ensure that all possible measures to ensure personal safety Thompson I, Meha K & Boyd K (1988) Nurstng Ethtcs 2nd edn Churchill Livmgstone, Edmburgh have been discussed and built mto the study design
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