Conducting Qualitative Research in/on Health Systems: Ethical Tensions, Confounders, and Silences
This chapter focuses on the authors’ experiences of doing qualitative research in and on health systems and complexities. The relationship between researchers and research participants, set in a widely prevalent positivist mind set, with researchers often having to struggle to get across the message that there is not one correct answer or “complete” information that is being sought, but often subjective perspectives, are elaborated. Tensions in the design and conduct of research in health systems in India, including the difficulty in maintaining the rigour of in-depth interviews and focus group discussions sometimes, and dissonances encountered at times between certain accepted (Western) tenets of ethics, e.g. individual autonomy and privacy, in certain research and practice situations in the field are not uncommon and go to the heart of researching ethically and in a rigorous manner. In view of the fact that research is conducted into problems, and most data are of problems, dysfunction, and inequity, the researcher may often feel the disparity in the conditions of the researcher and the researched, and may frequently have to consciously disengage and recharge. We will elucidate the dynamic nature of the researcher’s experience, and highlight the importance of reflexivity when using qualitative research approaches in doing health policy and systems work.
KeywordsHealth policy and systems research, ethics committees Research relationships Perceptions of roles of researchers Informed consent Power differentials
The chapter draws on data collected as part of the project based in the Public Health Foundation of India between 2014 and 2016 when we were working there as members of the research team on “Accountability at the Frontlines: Posting and Transfer Practices in the Health System, Strategic Health Partnership for Universal Health Coverage (Governance and Regulation)”. We are grateful to the research participants, who stimulated many of these perspectives, as well as to the field assistants with whom we had several conversations that led to the insights that we have presented here. We would like to acknowledge Gupteswar Patel, Bhaskar Purohit, and Kabir Sheikh from the research team conducting this study. We appreciate the collegiality in the Health Governance Hub, which nurtured our meditations on ethics in the conduct of HPSR. The reflections shared in this chapter are personal and our own.
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