TAXONOMIA 1 SISTEMATICA

Basic ethical principles were considered in the data collection process. The principles that were followed were autonomy, justice, beneficence and non-maleficence as discussed below. The researcher made every effort to ensure that this is applied to the participants and the study institutions during the process of data collection.

Obtaining ethics approval is a standard practice in any research and reflects on the ability of the researcher to approach the participants with due respect and sensitivity. It might not determine, but reflect favourably on the credibility of the findings (Guyatt et al 2008). Any Research requires formal research ethics board approval to examine the research protocol and consent process. This procedure minimizes the potential risks for the participants such as loss of confidentiality, interview burdens, incentives

undermining voluntary consent, truthfulness of information provided to the participants, researcher‟s interference and the possibility of psychological trauma (Guyatt et al 2008).

The researcher first received an ethical clearance certificate from the University of South Africa (UNISA) health studies higher degree committee college of Human Science (Annexure A). Based on the ethical clearance certificate obtained from UNISA, the researcher formally requested the Addis Ababa City Health Bureau for support letters to the hospitals that were selected for the study (Annexure B). After reviewing the research proposal, the City Health Bureau wrote support letters to the hospitals (Annexure C). The letter from the City Health Bureau was given to each hospital to be endorsed by the management for the participation of their staff members in the research.

After endorsement, the list of all care healthcare providers providing direct patient care was obtained from all hospitals and the respondents were randomly selected from the list. Each selected respondent was contacted by the senior nurse data collector who explained the purpose of the study and the data collection instrument before administering the questionnaires. The participants were ensured that all the information they had provided would be kept confidential.

A written consent (Annexure D) was attached to each questionnaire which must be agreed before starting to complete the form. The participants freely decided to participate in the research study.

The main discomfort that would be expected was the busy time schedule of the health care providers. Most of them were not fully comfortable to handle activities which could disrupted their routine clinical care. However, the respondents were given sufficiently flexible time schedule for completion and return of the forms.

Respect for human dignity is the second ethical principle articulated in the Belmont report (National commission for Protection of Human subjects of Biomedical and Behavioral Research, 1979) (Joubert and Ehrlich 2007). The two main ethical conventions establishing respect for persons are treating individuals as autonomous agent and protecting persons with diminished autonomy. Autonomy ensures that human subjects are treated as autonomous agent and have the right to self-determination and the right to full disclosure (Joubert and Ehrlich 2007, Polit and Beck 2008)

The researcher ensured that the respondents had received adequate information on the purpose of the study as partial fulfillment of the requirement for Master of Public Health, the objective of the study, its importance to the healthcare systems and their right to withdraw. The study participants read the consent paper which is in a printed format and were able to freely decide either to participate or not to participate in the study without any pressure. They were also informed that they would not be prejudiced or harmed in any way if they decided not to participate. The consent was further reaffirmed during the reviewing and the administration of uncompleted questionnaires.

Beneficence is a fundamental ethical principle that seeks to maximize benefits and avoid or minimize harm upon study participants and requires that interviews that may result in emotional trauma to the respondents must be ended and appropriate intervention such as counseling and referral should be taken (Streubert and Carpenter 2007, Polit and Beck 2008). It was guaranteed that no information provided by the respondent was released to avoid harm to relationships with other staff members, favourable working environment and job security of the respondent.

Anonymity is the most secure means of protecting information and ensuring the right to confidentiality and privacy (Polit and Beck 2008). The researcher guaranteed anonymity by avoiding the identifying information like the names of the respondents and using coded questionnaires (Polit and Beck 2008). Upon completion, the questionnaires were checked for completeness and consistency and respondents returning uncompleted questionnaires were immediately supported to complete or correct on the spot (Polit and Beck 2008). A separate record was kept for the codes and identifiers. After data collection, all the questionnaires were kept with the researcher in a locked file and access to codes was restricted by keeping it separate from the questionnaires (Polit and Beck 2008). Privacy was ensured during data collection by distributing the forms individually, advising the respondents to complete the forms privately at a convenient location and time. The respondents were advised to complete the forms independently.

Justice refers to fairness in distribution to what is deserved and the principle of justice is violated when some benefit to the person who is entitled is denied without a good reason or some burden is imposed unduly (Joubert and Ehrlich 2007). The researcher informed the participants would not receive any material and financial benefits by being participating in the study. The participants were told that completing the questionnaire may take some 30 – 45 minutes, which could be a significant amount of patient care or

private activities. They were kindly requested to complete it at a more appropriate time that would not harm the patient or that would not significantly affect their private activities or their income.

As part of protecting the rights of the institutions, the hospitals were provided with formal requests from the city health bureau and the participation of their staff in the study was approved by the management. The study was undertaken at a convenient time and in a way that it does not negatively affect the workflow of the hospital.