Secuencia de actividades

The Bournemouth University Ethics Board, the Institutional Review Board (IRB) at the researcher’s home institution in the US and the IRB at the case study site granted ethical approval for this study. The following section describes the emergent ethical issues within this study and describes how these issues were addressed. Particular attention has been paid to the unique issues that arise when using the specific approaches adopted in this study; qualitative research, case study design, semi-structured interviews, and document analysis.

Use of a single case site raises particular threats to confidentiality (Stake 2000). The rich and detailed description of the study site that is a key component of case study research exposes an innate risk of identifying the study site and in so doing risks the confidentiality of the study participants (Houghton et al. 2010). Careful attention has been directed towards ensuring that the name and location of the study site have not been disclosed. Throughout the transcription, document analysis, and writing process careful attention has been paid to protect the confidentiality of the university, the clinic, and participants. Pseudonyms were used to replace the names of people and institutions and organization.

The position of the gatekeeper in relation to potential participants can influence the selection of individuals by controlling access. There may also be a risk for coercing participants into

taking part in the study, and for the gatekeeper to influence the responses of participants. To ameliorate these risks the site gatekeeper was only used to identify a pool of potential participants.

The use of semi-structured interviews in this study carries potential ethical issues that relate specifically to autonomy, voluntariness, privacy, confidentiality, disclosure, capacity and informed consent. The right of participants to fully exercise their autonomy was addressed through the process of obtaining informed consent; ensuring all participants were aware that their participation was voluntary and they may withdraw from the study at any time without risk of penalty. Participants were informed about the study through a participant information sheet that identified the purpose and process of the study (disclosure). This information was written to ensure participants could both understand the information provided and form a reasonable judgment on the consequences of their decision to participate or not (capacity) and they were provided at least a week to review the information.

On commencement of the interview participants were assured that if there were any questions that they would prefer not to answer during the interview they should let the interviewer know and the interview would be stopped or would move on to the next question, dependant upon the preference of the participant (right to withdraw).

Potential ethical issues related to audio recording for the purpose of transcription and summarization relate primarily to the issue of privacy. Privacy concerns the right to not be identified and addresses both anonymity and confidentiality (Whiting 2008). Polit and Beck (2006, p.714) describe confidentiality as: 'Protection of study participants such that

individual identities are not linked to information provided and are never publicly divulged”. To address these issues each participant was assigned a pseudonym to protect his or her identity and confidentiality this was used in all identifiers for both the recording and transcripts. Any documents with potential to link the participant's name to the pseudonym were kept in a locked filing cabinet in the researcher's office and on a password-protected computer and were only accessed by the researcher. All transcripts and recording were stored in a different password-protected computer in the researcher's office. As per the requirements of the researchers IRB, the audio recordings will be destroyed five years after the study has been completed.

While the methods employed in this study held no potential to physically endanger the participants, there was potential for psychological harm in the form of embarrassment or discomfort for participants. Participants were being asked to open up their work in the clinic, their reasoning processes and decision making to the researcher this holds potential for participants to feel that their work was being scrutinised or critiqued and could potentially lead to discomfort or embarrassment. The potential for such psychological harm was

addressed by ensuring all participants were fully informed regarding the intent of the study, maintaining their confidentiality, and protecting their identity in all data sources.

3.6. Chapter summary

This chapter has presented the ontological, epistemological and methodological stance of this study and has described and provided the rationale for the selection of the applied study methods. It has identified the aspects of the study design that were deliberately selected and applied to address the realist underpinning of this study. Including the approach to developing and conducting realist interviews and a unique approach to retaining the connected threads of contexts, mechanisms, and outcomes throughout the data analysis process.

The next chapter begins the presentation of the study findings by presenting the case, the interprofessional SRC, describing its structure and context along with key information regarding the study participants.

Chapter 4: The Case

Introduction

This chapter presents a description of the case, the IP student-run clinic, which is the focus of this study and the location where data were gathered.

The aim of this chapter is to provide the reader with sufficient detail on the contextual setting of the study by providing a thick description of the case. It is hoped this will afford the opportunity for the reader to consider the applicability or relevance of the study findings to the current literature within the field, as presented in chapter 2, and to their own contextual setting. It provides information about the study participants and then describes the IP student-run clinic and the community setting within which it is situated.