Research Ethics in Qualitative Health Research

This special issue focuses on topical ethical issues in qualitative research. In qualitative research, there are ethical issues surrounding, amongst others, the inclusion of potentially vulnerable research participants, the investigation of sensitive research topics, the use of potentially intrusive or emotionally burdening interview questions, difficulties with obtaining informed consent from research participants and ethics approval from the responsible research ethics committee due to open and dynamic research designs, and the possibility of privacy breaches due to difficulties with the anonymization of the data. In reaction to such issues, there exists now a vast literature on the ethics of qualitative research.

One issue that has been discussed extensively is whether qualitative research conducted within health settings or with a specific health focus should be subject to review by a research ethics committee. Qualitative research carried out within the health sector will typically be reviewed by a research ethics committee focused predominantly on biomedical research. Critics have argued that the ethical review criteria and procedures of such research ethics committees are incompatible with qualitative research approaches because they are liable to be molded after quantitative biomedical research (Dingwall, 2008; Israel, 2015; Van den Hoonaard, 2011; Van den Hoonaard & Hamilton, 2016). Incompatible features include the explorative nature of qualitative research designs and the lack of predefined hypotheses as well as the fact that research questions, sample, and study interventions purposely change during data collection and analysis.

Indeed, many critics have regarded current review criteria and procedures as too rigid and static to be able to provide suitable ethical guidance to qualitative research in general (Gillam et al., 2009; Guillemin & Gillam, 2004; Pollock, 2012; Stevenson et al., 2015), and some have even concluded that current research oversight merely hinders scientifically and socially useful qualitative research without offering research participants genuine protection (Allbutt & Masters, 2010; Øye et al., 2007). Other authors have maintained that the incompatibility between ethics review criteria and procedures and qualitative research is exaggerated and premised on an overly bureaucratic and regulatory model of research ethics oversight (Carniel et al., 2023; Jennings, 2012; Wassenaar et al., 2012). Alternative models of ethics review have been proposed that seem better suitable to accommodate for the flexible and dynamic nature of qualitative research, including health-focused research (Emanuel & Grady, 2007; Friesen, 2023).

Both sides of the debate would agree that independent research oversight does not, as such, guarantee that qualitative research is carried out in an ethically justifiable way. Independent ethics review must be complemented with ethical commitment and competence on the part of the researchers who carry out the study. Guillemin and Gillam (2004), for example, refer to the process of handling ethical issues that occur during the research process as “ethics in practice” and argue that researchers should cultivate ethical “reflexivity” to be able to identify and address these issues.

Spring School on the Ethics of Qualitative Health Research

The articles collected in this special issue present results from the international and interdisciplinary spring school “Research Ethics in Qualitative Health Research.” Qualitative health research consists of the systematic investigation of personal health, health services, and public health by means of qualitative methods (Green & Thorogood, 2018). The aim of the spring school was to foster an exchange of best practice examples in addressing challenges in the ethics review and practice of qualitative health research developed in various disciplines and countries. Subtopics covered included principles of research ethics, ethical review practices, concepts of vulnerability, and the relationship between researchers and research participants.

The spring school was hosted by the Institute of Medical Ethics and History of Medicine of the Ruhr University Bochum and funded by the German Federal Ministry of Education and Research (grant no. 01GP2191). It took place in March 2022 via Zoom. The spring school brought together early-career and senior researchers from various countries and disciplines and included both expert presentations and presentations of participants’ own work. Expert presentations were given by Kristin Margrete Heggen, Professor of Health Science (University of Oslo); Henrika Jormfeldt, Professor of Nursing (Halmstad University Sweden); Michael Schönhuth, Professor of Social Anthropology (University of Trier); and Hella von Unger, Professor of Sociology (Ludwig-Maximilians-University Munich).

A unique feature of the spring school was that it included collaborative brainstorming and writing workshops to reflect on subtopics covered during the spring school. Given that participants were not yet acquainted with each other, the first workshop aimed to foster an exchange about individual academic backgrounds, research interests and expertise, and to carve out ideas for joint publication projects. We used Miro (https://miro.com) to facilitate this exchange. Miro is an online collaboration tool that can serve as a whiteboard for multiple users to brainstorm simultaneously. We prepared a board comprising several subsections aligning with the abovementioned subtopics. Participants were split into small groups in which they rotated successively through the various subsections of the Miro board, discussed their ideas on the respective subtopic, and documented the result of their discussion using sticky notes. In this way, each group was able to build on and add to the ideas of previous groups. In a plenary session after this brainwriting exercise, each group presented a summary of the ideas that had been collected under the subtopic on which they worked last.

The aim of the second workshop was to identify potential research questions and to form author groups around selected questions. To facilitate this process, we provided a shared document in which each participant could present ideas that they would like to pursue further. Other participants could comment on these ideas and indicate shared interests. Four small groups were formed in this way. During the three following workshops, each group was given the opportunity to carve out their ideas in more detail, start distributing tasks among coauthors, and plan the collaborative writing process. Each of these workshops started with a short plenary session in which each group gave a brief update on their progress and could receive feedback from the other groups. The groups continued their collaborative writing process independently after the spring school. The organizers of the spring school facilitated this process by making the arrangements for the special issue, setting intermediate deadlines, and providing feedback on each manuscript before submission to the journal.

Overview of the Special Issue

In the article “Decision criteria for the ethically reflected choice of a member check method in qualitative research: A proposal for discussion” Erdmann and Potthoff review five different member check methods from an ethical point of view. Member checking describes a procedure in which data or findings (e.g., derived categories or hypotheses) are returned to research participants to enable them to verify whether their experiences are adequately represented and, if necessary, to provide further information. Different member check methods involve different ethical issues, and the authors argue that these issues must be considered when deciding which member check method to use. Building on core ethical principles within research ethics (i.e., informed consent, beneficence, non-maleficence, justice, and scientific quality), the authors propose seven decision criteria to guide researchers’ choices around selecting a suitable member check method for their study.

The article “Dimensions of researcher vulnerability in qualitative health research and recommendations for future practice” reflects on the dimensions of researchers’ vulnerability in the context of qualitative health research. Sterie and colleagues use an autoethnographic approach to analyze their own experiences as qualitative health researchers in fields like mental health care and palliative care, and contexts characterized by poverty, social inequalities, and structural violence. The article focuses on the vulnerability of researchers. Rather than presenting a full range of possible dimensions of researchers’ vulnerability, it exemplifies a methodology (autoethnography) which other researchers can employ to reflect on unique dimensions of vulnerability as well as on dimensions that generalize across contexts. The authors close their article by giving recommendations designed to address challenges along the dimensions of researchers’ vulnerability. These recommendations focus on researchers’ reflexivity as a cornerstone of ethical qualitative health research practice, requiring qualitative health researchers to acknowledge and address their own vulnerability and positionality.

The article “Of newcomers and supervisors: Ethical issues in supervising newcomers in qualitative health research” pursues the issue of researchers’ vulnerability further but adds a focus on ethical issues that can occur in teaching qualitative methods and supervising qualitative health research. Burner-Fritsch and Schwertel reflect on their experiences as teachers and supervisors using the method of qualitative reflexive case vignettes. These case vignettes go beyond being mere illustrations of more abstract ideas and form the basis for an interpretative analysis that connects reflections on the case vignettes with personal experiences and sensibilities. The authors present qualitative reflexive case vignettes related to ethical issues surrounding the selection of topics by students and junior researchers (e.g., personally sensitive topics or topics that potentially put researchers at risk), the transition from a trainee in qualitative methods to a qualitative health researcher and the ethical competencies this requires, and contingencies in the research field that can draw students and junior researchers in emotionally burdensome situations. The authors argue for an ethics-based and reflexivity-focused teaching and supervision framework within qualitative health research and submit their own experiences and reflections to sketch the outlines of such a framework.

Future Directions

We are very happy to see the results of our spring school coming together in this special issue and see it as a sign that researchers from a variety of national and disciplinary backgrounds can collaborate and contribute to shaping an ethical practice of qualitative health research. The spring school and the special issue demonstrate the importance and fruitfulness of a dialogue between peers on ethical challenges in qualitative health research that go beyond those related to ethics review. The results presented in this special issue point towards the need to develop teaching and training modules and materials to improve the ethical reflexivity of qualitative health researchers and the ethical quality of their research practice.