The most important part for undertaking research with human beings are ethical considerations (Parahoo, 2006). These should be considered throughout the entire research process from choosing the topic step till publication of the result of the study (Parahoo, 2014). Holloway and Wheeler (2013) stated that ethics for health professional/researchers is concerned with guiding professional to protect and safeguard the interest of clients. The following ethical considerations have been included in the research study: consent, anonymity, privacy, withdrawing and exploitation. The researchers prepared two information sheets, which were given to the control group and the obese groups. The information sheet included title of the study, a full explanation about aims and objectives of the study, name, telephone number and email address of researcher, supervisors and local adviser. They were informed that attending the study and educational programme were voluntary. Those invited to attend focus group sessions were informed about the process of the interviews and agreed to being audiotaped. Once informed consent was obtained, the consent form was signed. Participants were also informed that the audiotapes would be destroyed after use. During the focus group, some women requested to leave, so the researcher let them go but they offered to attend the focus group another time.
3.6.1 Consent:
It was crucial to confirm that all participants gave their full informed consent to participate in the study and/or to have access to their medical records. Potential participants were identified at the initial visit, which occurs around 12 weeks of gestation. The researcher, with the help of health care providers, verbally brought to the potential participant’s attention the study and provided an information sheet and a written consent
form which explained the purpose of the study for women and requested their consent to participate. The researcher provided verbal information about the study, its aims and mode of conduct. Throughout the study the researcher was willing to answer any questions by participants. At this meeting women who were interested in participating then met with the researcher to discuss any further questions before agreeing to participate. Thus, ensuring that participants were able to give their full and informed consent.
3.6.2 Educational sessions and focus group at primary health centre
Primary health centres were provided a suitable venue for the researcher to run the educational programme. The researcher requested administrative staff at the respective health centres to schedule their sessions to avoid overlapping of events at the centres. During the sessions, the researcher considered the women’s feelings because obesity is a sensitive subject. For instance, the researcher did not refer to the women as ‘obese’ or use the word ‘obesity’. Instead, the word ‘overweight’ was used during sessions. According to the literature, in Western countries, obesity is described as a stigma and sensitive concept (Puhl and Heuer, 2009), and hence should be discussed carefully. In Kurdish culture, obesity is predominantly perceived as a sign of beauty and health. Stigmatisation regarding obesity in Kurdish culture is not so obvious. During the lectures, at the start of data collection, the researcher, in consideration of these different perceptions, mostly refrained from using the term ‘obesity’. Instead, the researcher used ‘weight gain’ and ‘overweight’. It became evident during the course of data collection, that research participants used the term ‘obesity’ as a signifier for health and to express pride in some occasions. The researcher refrained from using the term throughout the lectures. 3.6.3
In the beginning of the study the researcher informed all participants that they were allowed to withdraw from the study without having to give their reasons, and that the decision to withdraw would not affect current and future care that they received from the respective centres.
Research with human subjects should ensure that they are not exposed to harm in a situation neither to a situation for which they were not prepared for. In the current study, the participants were informed that the results of the study would not be used against them, but to fulfil the aims of this project.
3.6.4 Confidentiality and anonymity.
All questionnaires were anonymous. Each questionnaire was ordered according to a coding system, which included date and the number of the questionnaire in the same date e.g. 1 January 2012/ Q1, 1 January 2012/ Q2. When transcribing these files, names were not transcribed. All data were stored in a locked filing cabinet only available to the lead researcher. All electronic data were stored on a passwordprotected computer. When writing papers for publication, any means of identifying participants were removed. The audio and transcripts of the focus groups together with questionnaire data are to be kept for a period of five years and then destroyed.
3.6.5 Benefit/ Risk Ratio
Mainly, the basic benefits of the study to participants are according to (Polit and Beck, 2008): Access to an intervention to which they might otherwise not have access (all participants had the same likelihood of being selected for intervention through randomization). Gratification in being able to discuss their situation or problem with a non-judgmental and friendly person. Increased knowledge about themselves or their conditions, either through opportunity for introspection and self-reflection or through
direct interaction with the researcher. Direct monetary or material gains through stipends or other incentives. As this study comprised an intervention programme, the likely risks would be associated with disagreements with cultural norms. As an example, the conflict between women thinking that obesity is good and the researcher tell them in not. Or having a big baby valued among women in this region.
3.11.6 Protection of Human Rights
In the current study the following rights have been considered:
- Right to self- determination: participants were assigned consent form which included all relevant information.
- Right to Privacy and Dignity: Privacy means persons freedom to decide on circumstance, time and extent under which their privation during sharing with others. While human dignity is the right to make informed decision and volunteer to participate in the study. In the current study, the researcher made the participation days flexible for women, but the time was fixed. Participants also left behind their telephone numbers if they were interested in attending, time allowing them.
3.6.6 Data storage
All participants were informed about the aims of data collection and recording tapes. Participants were assured that the data would be confidential. Furthermore, they were informed that their data was anonymised so that they would not be recognisable directly and indirectly. No names were used in entire the study and each participant was given a unique code number. All raw papers documents were stored in a lock and key box at researchers home and the room in which the boxes were kept is locked. The participants were informed that the documents would be kept for five years then destroyed. The
primary data and the soft copies data were stored on CD, memory sticks and the computer network at De Montfort University (DMU). In order to prevent any damage or loss, a special password for each data storage was provided.