Ethical Issues when Using Digital Platforms to Perform Interviews in Qualitative Health Research

Abstract

Qualitative studies have become increasingly common and have been used in different fields such as economics, politics, psychology, sociology and health research for different purposes. Instead of collecting numerical data, qualitative research’s goal is to gather information from participant’s experiences and perceptions. One of the tools to get data related to the participants’ experiences in qualitative research is through interviews. One tool that may be helpful for researchers today are digital and video platforms that fall under the domain of the internet-mediated research. The aim of this work is to identify and describe some ethical controversies when using videoconferencing platforms in qualitative health research for interview purposes. Four cases related to the use of digital platforms (videotelephony systems) to conduct interviews in qualitative research were discussed. Rather than give solutions, we reflect upon the possibility and plausibility of using these telecommunication technologies when using the technique of interviews in qualitative research. The ethical issues that may arise when using these technologies are related to privacy, confidentiality, accuracy of information and expertise when using the platforms. We think that the researcher is committed to making the best decisions in favor of the participant when using digital tools to gather information. In this regard, qualitative researchers may be benefited by the reflections we present insofar they may consider these possible scenarios that may rise ethical issues when collecting data. The activity of research needs to be escorted by constant ethical deliberations to protect participants’ rights during the collection of data phase.

Introduction

Research is one of the human activities performed to get knowledge. Two main branches are quantitative and qualitative research each of one having their own philosophical perspective of what it means to get knowledge and the methods to obtain it (Bruce et al., 2008). One of the issues frequently discussed is the type of evidence that each epistemological approach gets through investigation (Pope et al., 2007). In health research both, quantitative and qualitative research, has been done because there is not a single way to carry out investigations and the selection of the approach and methods depends on the purpose and aim of the investigation (Bauer et al., 2000; Burce et al., 2008; Gray et al., 2007; Peat, 2001; Green & Thorogood, 2004; Quinn, 2002).

Qualitative studies have become increasingly common (Quinn, 2002; Tenny et al., 2022; Yin, 2011). The phenomenological approach in qualitative research allows the investigator to understand experiences as perceived by participants more broadly and deeply and it is becoming a philosophical approach widely used in health disciplines (Englander, 2016; Kleiman, 2004; Kim et al., 2020).

Recently, qualitative research has been used in the field of health research for different purposes. For instance, studies have captured the persons’ experiences when suffering from an addiction highlighting the meaning of living with this condition (Jones, 2020; Sibley et al., 2020). Likewise, better knowledge of how patients relate and adhere to medication were explored to develop diabetes management interventions from a qualitative research standpoint (Huang et al., 2020; Jeragh-Alhaddad et al., 2015). Qualitative research emphasizes the participants’ experiences specially when data is extracted by interviews.

A variety of themes in health research like parents’ experiences of Down syndrome diagnosis in their children (Clark et al., 2020), mothers’ emotional experiences on deafness in their child’s diagnosis of deafness (Majorano, et al., 2020), experiences from healthcare seeking migrants in Dheli (Mathew & Nambiar, 2020), the stigma experienced by youth with anxiety or the experiences of young people living in a family affected by a neurological condition, among others, have been recently explored from the qualitative research angle. This means that qualitative research is been performed to answer questions in the field of health research to offer understanding and different solutions not to one single theme but to many subjects and problems traditionally studied from a quantitative research standpoint.

Instead of collecting numerical data, the goal of qualitative research is to gather data related to experiences and perceptions lived and narrated by the participants (Tenny et al., 2022). In the field of health, peoples’ stories about their illness are considered important to better understand the case at hand (Corbally & O’Neill, 2014).

One of the tools to get data related to the participants’ experiences in qualitative research is through interviews (Flick, 2022; Roulston, 2018; Roulston & Choi, 2018). Specifically, in the field of research, interviews are regarded as a communicative process between persons in face-to-face or other forms of verbal interchange (telephone, internet) where one person tries to elicit information from another person to produce knowledge. Interviews may be structured, unstructured or semistructured (Cassell, 1980; Corbin & Morse, 2003; Flick, 2022; Fontana & Frey, 1998). They are also conducted from different accounts (ethnographic, narrative, or phenomenological) and paradigms (neopositivist, romantic, constructionist). They are not just casual conversations but a communication process with purposes to obtain descriptions and interpret meanings. Finally, interviews integrate dialogue, empathy, and intimacy (Britten, 1995; Brinkmann, 2014; Brinkmann, 2018; Dicicco-Bloom & Crabtree, 2006; Halcomb & Davidson, 2006; Howitt, 2010; Kvale, 2007; Kvale, 1996; Parker, 2005; Roulston & Choi, 2018).

Health researchers employ interviews as a common method of data collection in a wide range of themes and cases (Britten, 1995; Dicicco-Bloom & Crabtree, 2006; Peters & Halcomb, 2015). Just to mention a few, Albaek et al. (2020) explored emotional experiences from children in Norway; Abendschein et al. (2021) explored the experiences of couples negotiating their relationship after a stroke; experiences surrounding in-home companion robot pets with adults after the COVID-19 pandemic were also explored (Abendschein et al., 2022); Tafjord (2021) explored nurses’ experiences of personal emotion when approaching parents with cancer; finally, Guerra-Reyes et al., (2021) explored the complexities of sexual and reproductive health access for Latinas. These studies conducted interviews to understand from a qualitative point of view important subjects in health research.

With the advances in technology, qualitative research has integrated tools (i.e., devices, media) to enhance the quality of the research. One of the devices frequently used is audio recorders due to the very nature of methods to gain data (for example, interviews, observations) (Quinn, 2002). Researchers use these devices to better record the information for further analysis. Nevertheless, when using recorders ethical issues may arise. To mitigate some of these issues, the informed consent provided to the participants explain how the researcher will use the recorder as well as the recorded data and how he will destroy it once it has been used for the analysis. Other ethical and methodological implications when using recorders are yet to be discussed (Al-Yateem, 2012; Halcomb & Davidson, 2006; Maldonado-Castellanos & Mora-Magaña, 2020).

Due to the increasing advances in technology, another tool that may be helpful for researchers today are digital and video platforms that fall under the domain of the internet-mediated research (Dicks et al., 2005; Hewson, 2014). Recently, digital platforms pertaining to the category of communications technologies providing telecommunication services with live video and audio known as videotelephony are available to researchers (i.e., Krouwel et al., 2019). These systems allow the participants to have a meeting in real time from distant places. Accessible videotelephony services we could list are the following Microsoft Teams (Microsoft Teams, n.d.), Zoom (Zoom, n.d.), Google Meet (Google Meet, n.d.), FaceTime (FaceTime, n.d.) among others. These platforms may serve as a tool to gather information when face-to-face interviews are not possible (Hurley-Wallace et al., 2022; Kaufmann et al., 2021; Keen et al., 2022; Khan & MacEachen, 2022; Kobakhidze et al., 2021; Oliffe et al., 2021; Oates et al., 2022).

Past research has highlighted the relevance to reflect upon and make visible the ethical issues in qualitative research (Reid et al., 2018) particularly when using these tools in qualitative research (Morgan et al., 2001; Tiidenberg, 2018). In this context, the aim of this work is to identify and describe some ethical controversies when using videoconferencing platforms in qualitative health research for interview purposes.

Ethical Controversies in Qualitative Health Research when Using Digital Platforms

Values refer to things of importance to people. They are personal and vary across cultures and societies (Iphofen & Tolich, 2018a; Hammersley, 2018). An ethical controversy may appear when the researcher’s aim is to get knowledge through qualitative research raises a conflict between participants’, researchers’, founders’, society, or others’ values involved in the research (Green & Thorogood, 2004; Iphofen & Tolich, 2018a; Hammersley, 2018; Mertens, 2018).

Due to the varied nature of methods in qualitative research, continual efforts to provide researchers with ethical guidelines are being offered (Franzke et al., 2020). Those guides and codes serve as moral maps to guide scholars through different phases of the study (Sanjari et al., 2014). Nevertheless, it is important to accentuate that there are no rigid or universal rules on how to resolve ethical issues in qualitative research (Green & Thorogood, 2004; Iphofen & Tolich, 2018b; Taquette & Borges da Matta Souza, 2022). Ethics deals with a constant deliberation between cases, principles, codes, norms, laws, values, etc. In this regard, in the following section we identify four categories where an ethical issue may appear when conducting interviews in qualitative research while using digital platforms to obtain information. We do not want to provide solutions to solve each of the ethical problems presented. Instead, we wanted to identify and reflect upon the possible scenarios insofar ethics is not a normative discipline in a broader sense but a reflective discipline.

Following this ideas, qualitative research presents different ethical issues by its own nature in different stages of the study, from designing to reporting, where responsibility needs to be displayed by the researcher (Burles & Bally, 2018; Sanjari et al., 2014). Tracy (2010) proposes four categories to guide thinking under the domain of ethics in research. According to these categories–procedural ethics, situational ethics, ethical relationships, ethical issues in exiting the study–the present investigation pertains to the categories of situational ethics and ethical relationships. This means that the researchers must constantly reflect, critique, and question their decisions during the investigation while considering the consequences of their actions on the participants’ values (Tracy, 2010; Reid et al., 2018).

As stated earlier, there are no inflexible or unblemished rules to address ethical issues in qualitative research (Marzano, 2012). They are not black and white, reflections are needed (Burles & Bally, 2018; Heggen & Guillemin; 2012; Ryen, 2012). For example, Iphofen & Tolich (2018b) have made a strong effort by compiling conflicting ideas on ethics when performing qualitative research giving social scientists guidance and perspectives rather than solutions when using techniques such as ethnography, interviews, or observations, among others.

Finally, based on the work of Maldonado-Castellanos (2021) we selected topics to reflect upon the ethical issues when performing interviews when using digital platforms in qualitative research. It is virtually impossible to identify every single ethical scenario when performing digital interviews. Bearing this in mind, this paper seeks to identify just some of the possible scenarios that fall under the following four categories: privacy, confidentiality, accuracy of information and technology literacy.

This work will provide a set of reflections on hypothetical scenarios rather than studying one single case due to the complexity of qualitative research and its wide range of topics covered by it. Past research has presented similar structure (Potter & Hepburn, 2012). Additionally, works on ethical issues when conducting qualitative research like informed consent (Marzano, 2012), privacy (Lobe et al., 2022; Matzner & Ochs, 2019), confidentiality (Heggen & Guillemin; 2012; Kaiser, 2012), the interviewing process itself (Ryen, 2012) and the approval procedures by the Institutional Review Boards (Miller-Day, 2012) have been examined and discussed.

Privacy

When the research project is approved by the Institutional Review Board, the investigator presents the informed consent to the potential participants to disclose every procedure that assures their free choice to enroll in the study. When performing an interview, the health researcher may use some devices to better record the participant’s narratives and experiences. One relevant information revealed through the process of informed consent associated with the use of these devices, is privacy. Privacy refers to freedom of thought, control over the body, control of personal information or protection of one’s reputation (Westin, 1967). Additionally, privacy is the claim of what, when or to what extent the information is shared (Lowrance, 2012).

In the section of privacy, the health researcher explains through informed consent how the privacy is going to be assured when performing the interview. For instance, the protocol and the informed consent, may state that the interview is going to take place in an isolated room where privacy may be guaranteed (Peter, 2015). Nevertheless, privacy when using digital platforms may be threatened (Hammersley & Traianou, 2012; Tiidenberg, 2018). Some ideas are next to be discussed.

Problems with security and data privacy on the digital age (i.e., safe browsing, picking passwords, cyberattacks, vulnerabilities in cloud technologies), have been previously identified and highlighted (Bernal, 2014, 2018, 2020; De, 2021; Fox, 2021; Herschel & Miori, 2017; Liu & Li, 2021; Murphy & Rocchi, 2021; Pilton et al., 2021; Prasanthi et al., 2021). The discussion has focused on how the personal data provided by the internet user in different platforms and software may be protected or threatened by attackers (Cherry, 2014; De, 2021; Prasanthi et al., 2021).

Themes like safe browsing, picking passwords or cyberattacks have been addressed in previous studies that focus on prevention and solutions of these problems (De, 2021; Prasanthi et al., 2021). Despite this, the domain of qualitative research when using digital platforms, may still raise other themes related to privacy. For instance, how will the researcher ensure nobody can listen to the conversation? This question is not about the internet or the cyberattacks themselves (Prasanthi et al., 2021; Fox, 2021), but how the researcher will take all the possible precautions to impede that other people may listen to the conversation, which includes personal information (Lowrance, 2012), while the interview is occurring.

In this regard, it could be possible that the interview is taking place at the researcher’s laboratory or office where people may enter and listen to the information provided by the participant. In face-to-face interviewing, this can be controlled, and the participant could notice almost immediately that the privacy has been violated. Nevertheless, when using digital platforms or videoconference software, the participant may not be aware that someone has entered the space where the researcher is using his device (i.e., laptop, mobile phone) to perform the interview.

With this in mind, should the health researcher always use headphones to lessen the probability of someone listening to the interview? Should the researcher show the space where the interview is taking place to the participant through the video camera? Information like these may be stated in the informed consent where the researcher could explain that he is going to put all the necessary efforts to thwart that anyone could listen to the private conversation.

Participants may still be dubious on the vulnerability they may suffer, preventing them from disclosing relevant material (i.e., personally identifiable data) for the research purposes (Hammersley & Traianou, 2012). They may think they could be exposed to embarrassment, defamation, stigmatization, harassment, extortion, identity theft, financial fraud among others (Lowrance, 2021). This may challenge the validity of the information gathered through the interview, raising epistemological, methodological, and ethical debates on the use of digital platforms or videoconference software to interview participants. In this case, the value of privacy and the advancement of research are confronted (Lowrance, 2012; Brinkmann, 2018).

Another question related to this is the incapability of the researchers to assure the participant that the information is protected from cyberattacks insofar the researchers have no control over every single potential cyber threat. These issues may be also stated in the informed consent to empower the participant to better decide whether to enroll in the project or not.

Confidentiality

When conducting a research project, scholars and academics are encouraged to protect participants’ confidentiality by different means. In this case, “Confidentiality is the respectful handling of information disclosed within relationships of trust, especially as regards further disclosure” (Lowrance, 2012, p. 33). Confidentiality refers to protecting rather than disclosing information (Hammersley & Traianou, 2012). For instance, researchers should not disclose information that could identify the participants when presenting the results. Additionally, they may clearly state in the informed consent how the information is going to be protected to impede that unconnected people to the research team may access personal and sensitive information (Lowrance, 2012). Despite the necessary precautions taken by the team, information could be accessed or retrieved (i.e., either the researcher’s computer or the files are somehow stolen).

As previously stated, when using digital platforms to perform interviews in qualitative health research, ethical issues associated with confidentiality may arise. For instance, where is the data shared through the videotelephony system? Is it somehow stored in the cloud technology? How can the participant be sure that nobody may access the information disclosed in the interview? How could the researcher assure confidentiality?

In this case, the researcher is confronted to protect the confidentiality of the information shared by the participant in a digital world where information may be threatened by cyberattacks. The researcher may ask, can a hacker or a third-party access this information when using this specific videotelephony tool? How can I protect the personal information of the participant if I use this digital platform? What is the best videoconference platform to accomplish this goal (protect participants’ confidentiality)?

In summary of the first two concerns (privacy and confidentiality) is that data gathering should be accompanied by privacy and confidentiality obligations (Lowrance, 2012) and researchers need to constantly reflect insofar is virtually impossible to list all the privacy and confidentiality issues and controversies in qualitative health research.

Accuracy of Information

Digital era and its advances provide a better flexibility to reach scientific purposes nevertheless privacy and confidentiality may still be issues to consider when selecting digital platforms to conduct interviews (Lowrance, 2012; Tiidenberg, 2018). Additionally, epistemological and methodological issues are linked to ethical issues. For example, Guba and Lincoln (1989) have identified five criteria for ethical conduct in qualitative research linked to epistemology and methodology (Mertens, 2018). These criteria are credibility, transferability, dependability, confirmability and authenticity.

These five standards refer to the accuracy of findings, applicability of findings to other contexts, access to data that demonstrates the emergence in hypothesis and understandings, the ability to link the data with the reached conclusions and the provision of multiple and balanced perspectives (Mertens, 2018). In other words, the discussion is about the quality of information gathered and its implications.

In this scenario, we may ask, to what extent the information provided by the participant could be accurate when knowing it is extracted through a digital platform? This question is linked to an old critique in qualitative research from the positivist standpoint, which is whether the information is reliable or how much quality it has (Barbour, 2018; Potter & Hepburn, 2012; Mertens, 2018). To put it another way, the information gathered through videoconference systems may be an object of critique insofar the participants may be reluctant to share accurate information to the interviewer due to the vulnerabilities the platforms may have. In this case, there could be many reasons why the participant may feel threatened or uncomfortable when sharing information compromising the accuracy of the data, something that happens when using recorders (Al-Yateem, 2012). Here the reliability of information and the trustworthiness of the participant are two confronted values.

Quality of data collection and data reliability in qualitative research have been previously discussed (Barbour, 2018). Nevertheless, in this case, the accuracy of information is related to the device or medium from where it is gathered, that is, the videotelephony systems that may prevent participants from express freely and from disclose authentic, accurate or detailed information as it happens when recorders are present in the research setting (Al-Yateem, 2012). The researcher may decide if it is plausible to perform the interview to collect data through digital platforms taking into account the research purpose (Barbour, 2018) and practicality of the tool when collecting information with hard-to-reach groups (Chamberlain & Hodgetts, 2018).

Technology Literacy

Technology is part of the daily lives of many people around the world (Pacey, 2014; Winner, 2014). Despite this, citizens are not well prepared to think critically about technology or to comprehend how technology works, in short, people may not be technologically literate. (National Academy of Engineering & National Research Council, 2002; Sandler, 2014). As stated earlier, digital technologies shape and influence the experience of everyday life (Gregory, 2017; Winner, 2014) and in particular the research process (Dicks et al., 2005).

Following the discussion, participants in the research may not know how to use the platform or may not have sufficient expertise with the internet (Tiidenberg, 2018). Interesting questions may arise. For example, does the researcher need to know that the participant understands how to use the digital platform? Does the researcher need to perform a test to assure that? Should the statement about the enough expertise to use the platform by the participant be declared in the informed consent? Is it necessary? What are the ethical implications for not knowing how to use the device or the digital system of communications?

These kinds of questions challenge the researcher to behave responsibly (Jonas, 1984, 1995, 2014; Coyne, 2021). For instance, the participant may want to enroll in the research project while at the same time not knowing how to use the telecommunication platform. In this case, the responsibility to use the emergent telecommunications systems to conduct the interview must be followed by the understanding of the participants’ technology literacy. The researcher may ask, to what extent the participant knows how to use the platform and how much does the participants need to know about the telecommunication system.

Information about the platform and the appropriate use of the videotelephony systems could be disclosed in the informed consent which is better regarded as a constant communication process (Faden & Beauchamp, 1986; Menikoff, 2006). Here the participants are better informed to take into account that they need to understand the implications when not knowing how to use these technological systems. Nevertheless, the researchers may assume the responsibility to evaluate the participants’ literacy before they start the study.

The fourth scenario confronts two values. On one hand, the researchers’ responsibility to impede the participants to enroll in the investigation when they are not sure how to use the videotelephony system and the researcher’s responsibility to teach the potential participants to use these technologies.

In summary, the ethical issues like minimization of harm, respect for individual autonomy, or the preservation of privacy, are central when conducting interviews in qualitative research (Traianou, 2014; Tiidenberg, 2018). Reflecting on ethical issues in qualitative research is important to identify potential harms and benefits for the participants by both the Research Ethics Committees, and researchers (Peter, 2015; Hunter, 2018; Carpenter, 2018). As we discussed, the researchers are constantly challenged when conducting the interview through telecommunications systems. They must consider and reflect upon the four discussed scenarios where ethical issues may arise to become responsible researchers through the lifecycle of the project (Carpenter, 2018).

In addressing the presented scenarios serving as context for reflection, researchers may state some ethical implications in the informed consent, which is an unavoidable communication process during the investigation, when pursuit socially valuable research to empower potential participants with sufficient information and allow them to make autonomous decisions (Faden & Beauchamp, 1986; Menikoff, 2004, 2006; Miller, 2014) when using digital platforms.

Despite having work on this matter (i.e., Battles, 2010; Burles & Bally, 2018; Engward et al., 2022; Newman et al., 2021; Roberts et al., 2021; Topping et al., 2021; Wilkerson et al., 2014), to our knowledge, this is the first article that classifies in groups possible scenarios when using computer assisted technologies when gathering data in qualitative research. Interviews is a flexible process requiring the researcher to constantly reflect by including cases, principles, codes, norms, laws, values, and methodological designs where uncertainties, ambivalences and challenges arise during the study to make ethical decisions (Heggen & Guillemin; 2012).

These four categories represent a relevant contribution to classify ethical issues when conducting interviews concretely through digital platforms. We know that more categories to reflect upon may emerge as advances in digital technology appear in the future for example, the use of artificial intelligence, virtual reality, or augmented reality, to mention just a few. That is, these categories are not definitive or conclusive. They are in constant change which is in the very nature of ethical reflection. Qualitative research community may be benefited from these reflections when designing, planning, conducting, and reviewing qualitative research.

Conclusions

Four cases related to the use of digital platforms (videotelephony systems) to conduct interviews in qualitative research were discussed. Rather than give solutions, we reflect upon the possibility and plausibility of using these telecommunication technologies when using the technique of interviews in qualitative research. The ethical issues that may arise when using these technologies are related to privacy, confidentiality, accuracy of information and expertise when using the platforms.

We think that the researcher is encouraged to constantly consider and reflect on the potential problems when employing videoconference technologies to collect data from participants. It is virtually impossible to state every situation with the informed consent, but the researcher may disclose some ideas to empower the participant who is going to decide whether to enroll in the research project or not. The researcher is also committed to make the best decisions in favor of the participant, that is the researchers should ask themselves “what is the right thing to do?” considering these and other reflections when carrying on the investigation.