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Abstract

Methodological challenges of qualitative research involving people considered vulnerable are widely prevalent, for which many novice researchers are not well equipped or prepared for. This places great physical and emotional demands on the researchers. However, a discussion to bring to light the issues related to the researchers’ experiences and practical concerns in the field remains largely invisible in the literature. This article presents the reflective accounts of a doctoral researcher’s fieldwork experience, particularly in relation to the methodological challenges encountered in carrying out research with vulnerable women in rural and northern Thailand. Four of these challenges pertain to selecting a field site and acquiring access, recruiting and building trust, maintaining privacy and confidentiality, and being vulnerable as a researcher. Suggestions from the literature and practical strategies the researcher employed to deal with such challenges and real dilemmas are discussed. This article calls for more formal safeguards during the research process and suggests that researchers reflect upon their experiences and emotions in undertaking a field research, making the accounts of their research journey heard and beneficial to other novice and/or experienced researchers.

Keywords

focused ethnography community-based research methods in qualitative inquiry narrative ethnography

Introduction

There has been a growing interest in the experiences of those whose voices have been absent from health research and policy discourse, such as vulnerable and disadvantaged groups (Bonevski et al., 2014; Derose, Gresenz, & Ringel, 2011; Liamputtong, 2007; Von Benzon & Van Blerk, 2017). This is because the burden of disease and rates of ill-health fall more heavily and frequently on these groups in comparison to the general population (Derose et al., 2011; Liamputtong, 2007; Szczepura, 2005; Tang, Browne, Mussell, Smye, & Rodney, 2015; World Health Organization [WHO], 2015). Women from ethnic minority communities, in particular, are among the most disadvantaged and vulnerable members of society and are more likely to bear a disproportionate burden of disease and social discrimination (Binder-Finnema, Lien, Hoa, & Målqvist, 2015; Browne, 2010; Defo, 1997; Jose, Sarkar, Kumar, & Kar, 2014; WHO, 2015). The need for the development of knowledge from the perspectives of these women has been part of a move toward an inclusive approach and toward the use of research as a means for the elimination of poverty, marginalization, social exclusion, and social justice (Hankivsky, 2012; Hankivsky & Cormier, 2009).

Conducting research with people who are considered vulnerable presents unique challenges and requires special attention from researchers (Liamputtong, 2007; Von Benzon & Van Blerk, 2017). Specifically, research ethics boards (REBs) are more likely to put particular requirements on researchers intending to include participants from vulnerable groups. These may include the meaningful inclusion of key members of the groups being studied from the earliest stages of conception and planning, through to the generation of research findings, or a careful consideration of issues relating to weighing risks and benefits of a study, fairness, and power inequalities and inequities (Liamputtong, 2007; Medeiros, 2017; Von Benzon & Van Blerk, 2017).

While methodological challenges of qualitative research involving vulnerable populations are well recognized, many novice researchers are often not well equipped or prepared for the responsibilities (Liamputtong, 2007; McCosker, Barnard, & Gerber, 2001; Medeiros, 2017). Without adequately attending to a range of methodological and practical concerns associated with the conduct of research, novice researchers can be overwhelmed by the magnitude of the challenges, while simultaneously damaging their creditability and professional standing if released to the fields unprepared (Ballamingie & Johnson, 2011; Iphofen, 2015; Li, 2018). Li (2018), for example, shared her embarrassing and unexpected circumstances while collecting data in the field, for which she was not prepared. In her naivety as a novice researcher, Li (2018) revealed, “I thought that once I had gained permission from the research ethics committee to use an audio recorder, I took it for granted that I had a passport for everything else” (p. 24). Yet participants refusing to give consent for recording left her feeling downhearted and treated as an unwanted outsider (Li, 2018). The researcher later realized when writing her research diary that consent required an ongoing process of discussion and renegotiation of trust throughout the research process (Li, 2018).

It is important to acknowledge that many of the issues and challenges that arise when employing qualitative research methods are not sufficiently addressed or accounted for by existing REBs’ guidelines (Ballamingie & Johnson, 2011; Block, Warr, Gibbs, & Riggs, 2013; Woodgate, Tennent, & Zurba, 2017). Thus, this requires careful consideration, planning, skills, and continuing vigilance on the part of researchers (Tisdale, 2004). These challenges and issues can place great physical and emotional demands on researchers and possibly be a daunting task for those who are novice researchers (Tisdale, 2004). I argue that it is important, therefore, to make explicit the potential experiences, the potential challenges faced, and the practical strategies and safeguards employed when carrying out research with people who are considered vulnerable. By doing so, it has great potential to address the unresolved or unexpected challenges, identify resources and support, and increase research capacity (Ballamingie & Johnson, 2011; Dickson-Swift, James, & Liamputtong, 2008; Liamputtong, 2007; McAreavey & Das, 2013; Van Maanen, 1988, 2011).

Reflections on the experiences and practical concerns of researchers in the field, however, are often not standard practice and therefore remain largely invisible in the literature (Ballamingie & Johnson, 2011; DeMarrais, 1998; Iphofen, 2015; Liamputtong, 2007). Drawing upon the fieldwork experiences of a doctoral researcher who conducted research with women who belong to ethnic minority groups in northern and rural Thai village, this article attempts to address this gap. By explicitly outlining some of the methodological challenges (both anticipated and emerging), as well as those specifically encountered at the earliest stages of conception and planning through to the collection of data, practical strategies are identified that can be used to mitigate and/or resolve such challenges. These insightful considerations that maintain the integrity of the research process are discussed. The following three sections provide the definition of terms “vulnerability” and “vulnerable groups,” a brief overview of the study, and researcher positionality.

Defining Vulnerability and Vulnerable Groups

There is no single universal definition of the term vulnerability as this notion is mostly socially constructed (Liamputtong, 2007). Vulnerability in general is related to “susceptibility” and refers to “at risk for health problems” when applied to health care in particular (De Chesnay & Anderson, 2016, p. 3). Within the context of health research, vulnerable people can cover individuals and groups who are “…susceptible to being harmed, wronged, exploited, mistreated, discriminated against or taken advantage of…” (Ganguli-Mitra & Biller-Andorno, 2011, p. 239). These individuals are more likely to experience discrimination, social exclusion, and limited access to resources and services (Ebert, Bellchambers, & Ferguson, 2011; Wilkinson & Marmot, 2003). It is important to note that the term “vulnerable” is often used interchangeably with such terms as “disadvantage” (Bonevski et al., 2014; Tisdale, 2004; Vinson, 2007) and the “hard to reach” (Bonevski et al., 2014; Hancock & Flanagan, 2010), particularly in the discourse of health and social inequalities.

Vulnerable groups most commonly identified in the literature include but are not limited to children, Indigenous peoples, ethnic minorities, people experiencing disabilities, drug users, prisoners, and the homeless. There are other groups to which the description applies including women (Adams et al., 2013), people living in rural areas (Ebert et al., 2011), refugees, and asylum seekers (Von Benzon & Van Blerk, 2017), as well as undocumented or illegal persons (Birman, 2005). Some vulnerable groups experience multiple influences that diminish their capabilities to ensure their rights, further marginalizing and rendering them “doubly vulnerable” (Liamputtong, 2007). The doubly vulnerable populations, according to Liamputtong (2007), may include women of low socioeconomic status and ethnocultural backgrounds. This applies to the research participants in my study who are female members of an ethnic minority group and at greater risk of economic hardship.

According to Ebert and colleagues (2011), women from vulnerable and disadvantaged groups have limited power to act freely, exercise their rights, and fulfill their potential as full and equal human beings. When these populations are involved in research, they are likely to be vulnerable to coercion or undue influences and thus require special protections or appropriate additional safeguards (DeMarrais & Crowder, 2002; Liamputtong, 2007; Stone, 2003; Tisdale, 2004). Although conducting research with vulnerable populations can be a complex process and often requires extra thought and effort (DeMarrais & Crowder, 2002; Tisdale, 2004), knowledge produced from such research can be used by health-care providers and government officials to develop programs and policies that reduce health inequities (Bonevski et al., 2014; Hancock & Flanagan, 2010). This led the researcher to carefully plan and consider procedures within this current research study, which was similar to concerns raised by Tisdale (2004) who was a PhD researcher working with emotionally disturbed participants.

The Study Context: A Focused Ethnography With Indigenous Women

As in other countries, Thailand is a nation where health inequities exist and continue to pose significant challenges, especially among ethnic minorities (Lutvey, 2014). This situation is of particular concern among Indigenous peoples, as they often live in rural and remote areas where access to health care is limited or simply not available (Dhir, 2015). Specifically, Indigenous women in northern Thailand tend to bear a greater burden of ill health and experience compounding forms of discrimination and oppression, stemming both from their Indigenous identity and gender, a so-called double burden (Lutvey, 2014) or “double vulnerability” (Liamputtong, 2007); creating an even greater barrier that limits their ability to obtain the care they need. The health inequities and limited access experienced by Indigenous women in northern Thailand are often ignored; thus, is an underresearched topic (Dhir, 2015; Indigenous Women’s Network of Thailand, 2014; Lutvey, 2014), despite the fact that it is clearly a social concern that requires a national government response.

The purpose of the focused ethnographic study was to gain deeper insight into, and provide rich accounts of, the experiences of Indigenous women accessing health-care services within their unique cultural context. As the aim of the study was to research cultural beliefs and practices, I determined a qualitative research method was the most suitable tool, particularly when undertaking research with Indigenous peoples, because it “provide[s] congruence and cultural safety for the tenets of Indigenous worldview” (Denzin & Lincoln, 2000, p. 14). Focused ethnography was considered a methodological fit, given it seeks to unveil a distinct inquiry within a particular cultural group (Roper & Shapira, 2000). Following a focused ethnographic approach (Roper & Shapira, 2000), study data were gathered through 21 in-depth interviews with women living in a mountainous, rural village of Northern Thailand. The interviews were semistructured, with some prepared open-ended questions that were developed based on the ethnographic interview (Spradley, 1979), which focused on participants’ past and current experiences with the health-care system.

Researcher Positionality

The researcher is a Thai registered nurse and has considerable experience caring for Indigenous women within the Thai health-care system. Although the researcher does not have an Indigenous background, she grew up and lived in the poor and culturally diverse community and shares some of the same linguistic, religious affiliation (Buddhist), and cultural background with the study population. As a female researcher who shares the same gender as the researched, this helped in facilitating discussion of issues concerning Indigenous women in a more open and meaningful way (Few, Stephens, & Rouse-Arnett, 2003). With respect to social class, the researcher is conscious about the class differences between herself as a researcher and the Indigenous women who are participants in the study. Although the researcher may be viewed or considered as someone who stands in stark contrast to the potential participants, she did grow up in an impoverished community for 20 years; thus, she was receptive to sharing such experiences with them if it helped to develop meaningful relationships. This is an important consideration, particularly when conducting research with minority groups. Throughout the study, the researcher continued to examine and engage in the reflexive nature of conducting qualitative research, in part by creating transparency and maintaining research integrity—holding true to capturing the participant’s point of view and then documenting it in a reflexive journal. The following sections reveal four main methodological challenges the researcher encountered in carrying out research with Thai indigenous women in the field and discuss the strategies used to address these challenges.

Reflections on the Methodological Challenges

The methodological challenges that were experienced when undertaking this research with women in the field include issues related to (1) selecting a field site and acquiring access, (2) recruiting and building trust, (3) maintaining privacy and confidentiality, and (4) being vulnerable as a researcher. The strategies used to mitigate and/or resolve these challenges are understood through the discussion of firsthand fieldwork experiences and suggestions from existing literature. The excerpts from my research journal, which captured a record of my thoughts, emotions, questions, dilemmas, and interactions as I engaged with people, are used to provide a picture revealing some of the challenging moments of being in the field.

Selecting a Field Site and Acquiring Access

This section discusses the challenges in selecting and gaining access to a field site, which includes considerations of gatekeeping networks and/or obstacles, overresearched issues, and burden to the participants and community. Strategies used to overcome the challenges include initial contacts to identify gatekeepers and the study feasibility trip.

Choosing an appropriate study site and gaining access is a key part of the research process; yet is one of the greatest drawbacks to successfully conducting research (Johl & Renganathan, 2009; Kondowe & Booyens, 2014). It involves a combination of careful planning; academic knowledge; practical research experience; researcher knowledge, skills, and commitment; and luck (Kondowe & Booyens, 2014). Research has shown that negotiating access and gaining entry to the field can pose a challenge, and in some situations be quite problematic, particularly in groups who are often excluded or difficult to reach (Liamputtong, 2007; Sixsmith, Boneham, & Goldring, 2003). This, in part, is due to the lack of trust in researchers and/or past abuses of research (Liamputtong, 2007; Suzanne, Vanessa, & Sara, 2008). The success of the research then depends greatly on the researcher’s ability to gain access to the setting, as well as build and maintain trusting relationships in the field (Johl & Renganathan, 2009; Kondowe & Booyens, 2014; Sixsmith et al., 2003).

There are a range of factors that a researcher should take into account, especially when selecting a field site, such as gatekeeping obstacles, overresearched issues, and burden to the participants and community (e.g., need for resources; Angrosino, 2007). I selected a northern and rural Thai village located in the second most northern and mountainous province of Thailand, bordering with Burma. This was because I had personal contacts in the village with a trusted member of the community (Angrosino, 2007). Specifically, the women residing in this northern and rural village had been identified as the most ignored and underresearched group compared to other ethnic groups in Thailand (Cadchumsang, 2011).

Entry to the research field was established and negotiated through informal phone calls to familiar people (e.g., schoolteachers) in the village (Johl & Renganathan, 2009). After the initial contact, gatekeepers at various levels were identified and approached. A study feasibility trip was then conducted prior to the development of a research protocol and submission of ethics applications, in order to meet with the village leader—the “formal gatekeeper” (Liamputtong, 2007; Roper & Shapira, 2000). This person held a position of authority and high respect, enabled community access, and introduced me to group members and potential participants (Caine, Davison, & Stewart, 2009; Liamputtong, 2007; Roper & Shapira, 2000). It is important to note that research access to the Indigenous women required gaining the trust of respected community leaders who were the gatekeepers (Liamputtong, 2007; Roper & Shapira, 2000). The study feasibility trip allowed me to (1) engage with the village leader and key members of the group (e.g., schoolteachers) and (2) to share research questions and discuss the research project (including purposes, methods, intended use of the research, risks, and benefits) in a positive, clear, and respectful manner (Caine et al., 2009; Kelly, 2006; Roper & Shapira, 2000). This is reflected in my personal narrative and supervisor response below:

Met the village head, key members, and some women. Felt immediately connected and welcomed. They agreed and were happy for me to start. I felt relieved. They would identify potential participants for me when I returned for data collection. (Research journal; Thummapol, 2017)

It sounds like you are making great progress in this regard. Thanks for sending along the pictures. It really brings it to life (Supervisor e-mail).

Given that gaining trust and enlisting the help of gatekeepers is not an easy task, I volunteered at the village school, being visibly present among village members, and dressing in the manner of most Indigenous women during the time I spent in the field (Rodney, Colleen, & Barbara, 2016). Hammersley and Atkinson (2007) acknowledge the importance of being aware and sensitive to self-presentation and clothing choices, with consideration of the cultural norms, as it can positively or negatively influence relationships that develop during the research process.

After the study feasibility trip, the village leader granted access and agreed to introduce me to village members. One schoolteacher agreed to be my Indigenous mentor and assisted with recruitment (Bonevski et al., 2014; Liamputtong, 2008; Roper & Shapira, 2000; Wilson & Neville, 2009). By experiencing the study feasibility trip and spending considerable time (one month) in the setting, I was provided with greater opportunity to develop a deeper understanding of the social and cultural norms, become familiar with the setting and local people, and establish trust and rapport with potential participants (Caine et al., 2009; Liamputtong, 2008). Although I was given the green light to start my data collection, I felt that it was in knowing A [A is my friend who is a trusted community key member] who really gave me credibility in the community and assisted me to win their trust, as my journal below reveals:

Permission granted by the village head. I wondered, though, would these lovely people be so receptive and eager to support me if I did not know my friend A, I don’t think so. (Research journal; Thummapol, 2017)

Recruiting and Building Trust

This section highlights the challenges in the recruitment and retention of research participants, as well as in trust building, detailing impact of characteristics of participants, and power relations. Strategies used in recruitment and retention include the use of gatekeepers, face-to-face meetings, study posters, purposive sampling, snowballing, and token of gifts. Techniques used to build and maintain trust and rapport with study participants include providing adequate information, ensuring participants’ understanding regarding their rights and participation, member checking, flexibility in scheduling interviews, and acknowledgment of partner expertise.

Recruiting and retaining participants can be challenging and time-consuming (Liamputtong, 2008). It is a gradual process that depends on the skill of the researcher in communicating, negotiating, and building a sense of trust and mutual respect with each participant (Roper & Shapira, 2000). This is particularly important when undertaking research with disadvantaged and vulnerable women. According to Smith (2008), there is a need for substantial and consistent support and encouragement for women to participate in studies. Therefore, the relationship with research participants must be carefully managed, as it can affect participation and retention (Liamputtong, 2007). This requires the researcher to thoroughly consider how participants are selected and encouraged to participate or remain in a research project and are assisted to withdraw from participation if so desired (Iphofen, 2015). However, this process is not straightforward and requires careful consideration of the researcher in order to maintain integrity and carry out their research successfully. To achieve these goals, researchers need to be upfront about expectations and intentions, highlight the benefits for participants and their communities, take into account the cultural nuances, and ensure confidentiality.

During the study feasibility trip, I took time to form trusting relationships with potential participants by maintaining visibility in the village, engaging in conversations, and listening to village members (Liamputtong, 2007; Suzanne et al., 2008). I was amazed at how quickly I established relationships and rapport with people. I became increasingly familiar with many in the village, their language and local accent, and felt at ease with living in the village. Some of the women started to talk to me in a friendly and caring manner and offered me food and beverage. I felt I was well received by the women and village members, as my journal below testifies:

Making myself known and appreciated. Starting to make some friends and talk to a few women. They were very friendly and welcoming and offered me food and beverage whenever I went visiting! Did not realize until later how much I had been absorbed by people’s lives—I was able to speak in their local accent and interact with women in their unique way! Or so it seemed to me at the time. (Research journal; Thummapol, 2017)

Through personal networks and the study feasibility trip, I felt I had been accepted and welcomed with open arms. I was confident that I could build on these relationships when I returned to the field for data collection. To create and maintain reciprocity and respect for participants, strategies used included flexibility in scheduling interviews, member checking (allowing participants to read the transcription of their recorded interviews if desired), and acknowledgment of partner expertise (recognizing that they were the experts of their experience and of the elements that shape those experiences (Bonevski et al., 2014; Liamputtong, 2007; Suzanne et al., 2008).

It is widely acknowledged that the quality and quantity of the data shared with researchers depends in part on the relationship that develops between research parties. As Duncombe and Jessop (2012) point out, close rapport enables participants to disclose their experiences and speak more freely, enhancing the gathering of detailed and rich data. Yet it brings ethical dilemmas concerning the potential abuse of the researcher’s power of persuasion, using what Duncombe and Jessop (2012) refer to as shared “womanhood” or “friendship” to facilitate access to information. As Duncombe and Jessop (2012) explain, qualitative (female) researchers are armed with skills of “doing rapport” through their gendered subordination and socialization, in order to achieve disclosure with women participants.

On further reflection, while taking into account the power the researcher holds, I became aware that participants are not necessarily powerless. Participants hold some power, as they are in possession of the knowledge and lived experience of the phenomenon of interest; are in control of what, and to what extent, personal knowledge is shared; and are able to withhold their participation at any time with no further obligations (Duncombe & Jessop, 2012). However, I reflected upon the idea if participants actually recognized this shift in power or genuinely felt able to refuse participation in the research. To assess and ensure participants’ understanding regarding their rights and participation in the study, I asked the potential participant to briefly describe the purpose of the study, what the participant needed to do, the risks and benefits of participation, and how the participant may withdraw. Inconsistencies were discovered and corrected at this time. If the potential participant was able to relate this information back to me, then understanding of the project had been demonstrated, and they were invited to participate in the study. I informed all of my participants prior to the interviews that they were free to refuse to answer any questions or withdraw from the study at any time without giving any reason. While there was no evidence of participant discomfort or withdrawal from the study, I was concerned that permission obtained from the village leader to conduct the research may have created obligations for participants. This resonates with a cross-cultural study conducted in rural districts of Lao People's Democratic Republic, suggesting that agreement to participate in research may be given as a means to show respect to the local leaders (Durham, 2014). The following narrative in my journal recorded this observation:

Sensed there was tension of some sort amongst the women, especially when being introduced by the village head. Wondered if they were interested in participating or just felt obligated to do so? (Research journal; Thummapol, 2017)

Participants were identified and recruited using multiple recruitment strategies guided by the literature, including purposive sampling (Higginbottom, Pillay, & Boadu, 2013; Roper & Shapira, 2000), the researcher’s personal networks (Liamputtong, 2007), an Indigenous mentor (Higginbottom et al., 2013; Roper & Shapira, 2000), face-to-face meetings (Sixsmith et al., 2003), study posters (Sixsmith et al., 2003), and network sampling (Higginbottom et al., 2013; Sixsmith et al., 2003). I initially described the research questions, purpose, the process of the study, and provided study flyers to my personal networks and Indigenous mentor. Potential participants identified through informal gatekeepers (i.e., personal networks and an Indigenous mentor) were contacted in person to provide further information about the study and ascertain their willingness to participate. Participants were also recruited face-to-face at the village’s grocery shops where people commonly gathered. Study flyers were placed at various locations such as the village center, school, and grocery shops. Network sampling was used to enhance variety within the sample (Sixsmith et al., 2003). At the end of the interview, all recruited participants were asked if they had friends or acquaintances who met the inclusion criteria who could be referred to the study (Higginbottom et al., 2013). A token gift (i.e., a scarf that was equivalent to CAD$2 [1.37 CAD = US$1, rates on April 30, 2017]) was provided to all participants, in order to value their contribution, knowledge, and time. The provision of gifts or financial incentives is a controversial issue and can raise ethical problems. Many researchers argue that compensation for participating in research, particularly with vulnerable groups, is appropriate and should be seen as a way to honor and recognize participants’ contributions (Beauchamp, Jennings, Kinney, & Levine, 2002; Holt & McClure, 2006; Liamputtong, 2007; Umana-Taylor & Bámaca, 2004). With these efforts, 21 women agreed to participate in the study.

Among the different methods used to recruit participants, the use of personal networks and an Indigenous mentor, as well as snowball sampling, worked effectively and efficiently as a result of having established trust and rapport between parties. This reflects the importance of considering and integrating cultural values when recruiting culturally diverse populations. Research suggests that the use of gatekeepers in the recruitment process is particularly beneficial for research involving ethnic minorities or underserved groups (Bonevski et al., 2014; McAreavey & Das, 2013; Roper & Shapira, 2000; Wilson & Neville, 2009).

Maintaining Privacy and Confidentiality

This section presents the challenges involving privacy and confidentiality, due to the characteristic of familiarity in rural life and small community. Strategies used to maintain privacy and confidentiality include the selection of direct quotations, use of pseudonyms, and pragmatic considerations, including choosing interview sites and taking into account the context of the situation.

Privacy and confidentiality are essential in research; however, it is extremely important when undertaking research with vulnerable groups who are at great risk of abuse and exploitation (Liamputtong, 2007; Wilson & Neville, 2009). Therefore, the researcher’s commitment to honor the inherent rights of research participants as human beings, while protecting their privacy and confidentiality, is of particular importance (Liamputtong, 2007; Wilson & Neville, 2009). Maintaining privacy and confidentiality of research participants can pose unique challenges, particularly for qualitative researchers working (in the field where they are identified as the “researcher”) with specific, small, and easily identified groups, to be able to ensure confidentiality and maintain anonymity (Dickson-Swift et al., 2008; Liamputtong, 2007).

There were two particular issues pertaining to privacy and confidentiality that I faced while working in the field. First, I encountered ethical questions about confidentiality because the village was small and participants knew each other. Some participants had a close relationship with health-care staff (in the village) and/or had negative experiences of discrimination and unfair treatment, so their stories were easily identifiable. I chose not to provide quotations from some stories, although they were incredibly poignant, in the interests of ensuring confidentiality. Further, pseudonyms were used to identify participants, so that they would not be recognizable to health-care professionals, the village leader, and participants who will read the research findings.

Second, although efforts were made to arrange the interviews in settings that afforded as much privacy as possible, the interview locations determined (as safe and most comfortable) by participants posed a particular challenge. The majority of the interviews took place in the afternoon and evening and were held either in the living area or on the balcony of each dwelling. At times, uninvited people (e.g., family members, children, and neighbors) showed up or came along to listen, in addition to village distractions (e.g., noises from loud vehicles/mopeds and telephones). In the village context, it was common for uninvited people to be present or come onto the balcony of the interviewee’s house without obtaining permission. A challenge here was how to continue with the interview during interruptions and distractions, as my journal below testifies:

Gosh, what a crowd! What on earth are they doing here? What am I going to do? Felt frustrated. But I could read from her [my participant] eyes that she did not mind. (Research journal; Thummapol, 2017)

I am aware that the presence of others may affect a participant’s ability to disclose information in an honest manner; however, asking people to leave would have been culturally inappropriate and offensive. It was difficult to determine an “ethical line” in this instance. Although the women did not seem concerned about talking in the presence of family members or neighbors, I found this particularly frustrating as I was concerned about potential breaches of privacy and confidentiality. I chose to pause the interviews and ask whether the women wanted to carry on or reschedule the interviews to a date and time that worked for them. All participants agreed to carry on and I chose to respect their choice and continued with the interviews. Evidence of these concerns and the action I took is evident in my journal below:

I felt awkward after five minutes of being distracted by uninvited people. Though she [my participant] carried on talking, I could not keep up with our conversation. I said to her: “I don’t know what the best way is, do you want me to come back later?” as I hinted that it would be easier if we could reschedule the interviews. She looked at me with a smile on her face and said: “oh no we’re good.” I learned then I had to be more open and flexible to cultural values from the women’s unique perspectives. (Research journal; Thummapol, 2017)

In light of these encounters, it seems fair to suggest that although ensuring confidentiality is essential, researchers need to take into account the context of the situation (e.g., the nature of research topics, the needs, and concerns of participants), make sound judgments, and choose responses that are considered ethically and culturally appropriate (Woodgate et al., 2017). This resonates with a study conducted by Durham (2014) in rural villages, where the author faced ethical dilemmas regarding respecting the social and cultural norms, while maintaining confidentiality. Research suggests that in cases where the research is deemed “sensitive,” special consideration and comprehensive strategies (e.g., development of a clear protocol or safety plan, sufficient support, and preparatory training) need to be put in place and be taken seriously to mitigate risks generated by undertaking such research (Durham, 2014; McCosker et al., 2001). According to Liamputtong (2007), sensitive research topics may include sexual preferences, the use of drugs and abuse, intimate partner violence, illegal activities, and death. While I was not asking questions about these issues, as a researcher, I was still concerned about privacy and confidentiality. As a result of these experiences, I am left with questions about whether confidentiality and privacy can be assured alongside maintaining sensitivity to cultural norms. Although it may be difficult at times, awareness of, and sensitivity to the community values and culture in rural setting is important for, and should be a part of the researcher–participant discussion to make a shared decision regarding how a study participant’s privacy, protected information may or may not be communicated.

Being Vulnerable as a Researcher

This section discusses challenges and issues related to researcher vulnerability, particularly pertaining to potential physical and psychological dangers of the researcher when working in the field. Strategies used to overcome these challenges include preparing the safety plan, writing a research journal, and having a regular meeting with supervisors.

Much of the discussion in the literature seems to concentrate on issues pertaining to risks, harm, and emotional experience of participants (Guelder, Geraldine, & Terwilliger, 2012; Liamputtong, 2007; Medeiros, 2017; Preethi, 2013; Seidman, 2013). Conducting research involving marginalized and vulnerable groups, however, can present a number of threats to the physical, psychological, and emotional safety of researchers, particularly novice and/or student researchers (Liamputtong, 2007; McCosker et al., 2001; Medeiros, 2017). The need for support for researchers is evident in the literature, yet there is a paucity of research discussing challenges and issues related to researchers who may be in vulnerable positions; and even less information related to preventing or mitigating researcher vulnerability (Ballamingie & Johnson, 2011; Booth, 1999; McCosker et al., 2001; Medeiros, 2017; Sherry, 2013).

In reflecting on my experience carrying out this research, I was surprised by the degree of vulnerability encountered as a doctoral student during the research process. In this study, institutional review board human ethics approval of the study proposal was received in both Canada and Thailand. I clearly explained how I was going to manage and minimize any potential physical or psychological risks and discomforts, mitigate harm, and ensure confidentiality and anonymity and how I would provide opportunity for a debriefing session after each interview and/or assist with a referral to counseling if necessary. Each aspect of the paperwork required detailed steps to ensure that the research did not harm the safety, dignity, or privacy of any vulnerable research participant. While I agree with the need for a thorough process and consideration to protect the participants as a primary focus, I felt what was missing was a section that asked me to consider any potential risks, discomfort, and harm to myself as a student researcher. I wondered if a researcher’s safety and vulnerability is taken for granted. Few researchers have explored this issue or alerted researchers to prepare for physical and emotional dangers that may arise in the fields (Ballamingie & Johnson, 2011; Dickson-Swift et al., 2008; Liamputtong, 2007; McAreavey & Das, 2013).

The study site was located in a remote and mountainous area, bordering Thailand and Burma. Concerns for my safety prompted me to anticipate the dangers I could encounter and to discuss how I would respond to them with my supervisors prior to entering the field (Kondowe & Booyens, 2014; Paterson, Gregory, & Thorne, 1999). One of the strategies used to maintain safety in the field was to always make sure someone (who I could trust and contact easily) knew where I was and the timing of my interviews (Jamieson, 2000; Paterson et al., 1999). Not only did I give them details, but I called them before and after each interview and instructed them to call me at a specified time if I had not called first. I had a fully charged cell phone with me at all times (Boynton, 2002; Jamieson, 2000). There was one occasion when the interview went longer than expected and I could not make a call to my friend (a contact person) due to a power outage, disrupting the network for the phone service. As expected, he showed up at the interviewee’s house to make sure I was safe, as my journal below testifies:

I was not cautious about time nor did I know the power went off. To my utter embarrassment, however, I learned that no matter how careful I planned or prepared, things could still go wrong and I had to be more aware of certain things and their consequences, and abandon any taken-for-granted thoughts/assumptions (e.g., my friend would show up). A [my friend in the village] reiterated his full support for me. Felt safe and reassured. This is what I needed. (Research journal; Thummapol, 2017)

Despite having adequate supervisors’ guidance and support (through e-mail, Skype, and telephone), my fieldwork in a rural and northern village (alone) was an emotionally challenging experience. Although I became familiar with the setting and participants, working in relative isolation with no fellow researchers to discuss at a given moment (due to the time difference between Canada and Thailand), and without breaching confidentiality was a lonely experience. My vulnerability became increasingly evident during the interviews in which I often struggled with emotional responses while listening to women’s narratives (Liamputtong, 2007; Melrose, 2002; Sherry, 2013; Von Benzon & Van Blerk, 2017). I chose to document my emotional experiences in a research journal (e.g., my thoughts, reactions to people and the setting, dilemmas, personal feelings and emotions, setbacks, and challenges), describing how I was affected by the field relationships, some of which I shared in this article (Liamputtong, 2007; Ortlipp, 2008; Roper & Shapira, 2000). The following excerpt reflects my emotional investment:

Mixed feelings after listening to a participant’s story. She [my participant] got yelled at by health-care workers and was refused care when taking her son to the community clinic. I felt anger at those stakeholders who seemed to be very insensitive, and at the same time, I felt very sorry for my participant that her concerns were falling on deaf ears. I wish I could do something to help now. Hope when I take these findings back there, they are going to change how they serve and treat Indigenous women. (Research journal, Thummapol, 2017).This “debriefing” process (as in writing a research journal) allowed me to express my emotions and release them in a timely and effective manner (Sherry, 2013). In addition, this journal was used as a means to create transparency and maintain integrity of the research, particularly when analyzing and writing the research text (Ortlipp, 2008; Roper & Shapira, 2000).

In addition to journaling, I found that regular meetings with my supervisors were effective in helping me cope with my emotions. Sherry (2013) proposes that quality supervision is essential, as it brings researchers’ emotions to center stage during the course of fieldwork and assists with professional development. The (Skype) meetings were done on a regular basis (biweekly) to discuss issues or concerns raised by the interviews, plans for subsequent interviews, any support needed, and to debrief (Jewkes, Penn-Kekana, & Rose-Junius, 2005; Meadows, Lagendyk, Thurston, & Eisener, 2003; Sherry, 2013). At times, I was reluctant to acknowledge and express my true feelings and chose to pretend that I was not emotionally affected by the process for fear of being seen as vulnerable, unprofessional, or inappropriate (Melrose, 2002; Thomson & Walker, 2010). It was only later that I realized the stress of suppression of my emotions had affected my health, as manifested by headaches and occasional sleepless nights. A similar feeling of emotional denial or suppression was experienced by Thomson and Walker (2010), more so when they realized that acknowledging and expressing emotions enhanced the quality of the research and facilitated the research journey.

Despite the emotional challenges I experienced, there were some very positive aspects of undertaking research with women who are considered to be doubly vulnerable (Liamputtong, 2007). I became increasingly aware of the inequality and oppression around me and learned to appreciate things I previously took for granted. These positive aspects included even little things, such as having a hot shower to being a legal Thai citizen (which allows access to a lot of resources). The support I received throughout the study and the certain privileges I have made me aware of the lack of support in the lives of my participants, many of whom were living in poverty and dealing with multiple disadvantages (Melrose, 2002; Sherry, 2013). Often times, I felt a sense of purpose, being able to help people who I have privilege over, and having their stories and voices heard. These feelings have been reported in previous studies (Dickson-Swift, 2005; Liamputtong, 2000; Sque, 2000), highlighting the positive experiences gained from doing research with vulnerable and underserved people.

Admittedly, early in the research, I found myself constantly thinking about how to make the best of my time in the field and successfully get the research done (Kondowe & Booyens, 2014). However, as the process unfolded, I became more engrossed in it, appreciated some of the challenges, and committed to supporting and giving it my best. Were there times when I felt like giving up? Yes, as my journal below reveals:

I felt lost and unsure about how far I should go with my data collection. It was so lonely and felt isolated here. I wanted to leave the field. (Research journal; Thummapol, 2017)

The stress of completing my PhD was boiling daily in my mind. Felt like coming to a dead end. Must turn around real quick! (Research journal; Thummapol, 2017)

Yet the emotional investment I had in the study acted as a positive force that motivated me and kept me going. Profoundly, I left the field with feelings of gratitude to these women who had opened up and shared with me, many intimate experiences of their lives (Liamputtong, 2007).

Conclusion

This reflective account of fieldwork experiences provides a glimpse into methodological issues central to any (doctoral and qualitative) research project, yet is often overlooked or taken for granted. The need for discussion centered on the challenges encountered in carrying out research with vulnerable Thai women through employment of key tenets of focused ethnography. Some of these challenges, such as researcher safety and vulnerability, are not sufficiently accounted for by the REBs approved protocols; thus, such considerations require researchers’ broader competence, and moral and ethical judgments, as well as reflexivity. This article addressed the emotional aspects (good and ill) that surfaced during the research process, which often is not written and less spoken about in the literature.

This article does not present the full spectrum of methodological challenges and practical strategies, but a few significant experiences for those undertaking qualitative research in similar fields. While I strived to discuss, candidly, the challenges and strategies used to successfully overcome them, it was important to acknowledge that they are contextual and based on personal experiences. I believe this reflective account, alongside suggestions from the literature, can be used as a resource for novice or student researchers planning and conducting research, as well as for those responsible for supervising the studies, particularly among vulnerable people in the field.

There is an argument that one can never anticipate all the possible challenges and issues prior to undertaking fieldwork (Yu & Gatua, 2014). Although the authors fully agree with these statements, there are ways in which novice or student researchers may be better prepared to deal with both anticipated and emerging methodological challenges that may arise in the field. I propose that researchers should consider and reflect on their research journey, particularly in relation to difficult or challenging experiences and emotions generated by fieldwork. Writing a reflective account of research experience not only serves as a researcher’s (final) self-debrief and therapeutic self-reflection but may help and urge other novice and experienced researchers working in similar circumstances to be more reflective and reflexive in their research practices, better prepared to anticipate and manage such phenomena, as well as to avoid unsuspecting pitfalls (Sherry, 2013; Thomson & Walker, 2010).

Footnotes

Authors’ Note

In this study, institutional review board human ethics approval of the study proposal was received in both Canada and Thailand. Onouma Thummapol is now affiliated with Faculty of Nursing Science, Assumption University, Bangkok, Thailand.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Onouma Thummapol

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Methodological Challenges Faced in Doing Research With Vulnerable Women: Reflections From Fieldwork Experiences

Abstract

Keywords

Introduction

Defining Vulnerability and Vulnerable Groups

The Study Context: A Focused Ethnography With Indigenous Women

Researcher Positionality

Reflections on the Methodological Challenges

Selecting a Field Site and Acquiring Access

Recruiting and Building Trust

Maintaining Privacy and Confidentiality

Being Vulnerable as a Researcher

Conclusion

Footnotes

Authors’ Note

Declaration of Conflicting Interests

Funding

ORCID iD

References