In this study the research ethics can be considered to range from the choice of the research issue to the use to which the results of the study will be put. The issue is ethically legitimate, because every human has a right to good care, especially families during the prenatal period, and health care professionals are obliged to increase their professional skills to ensure that their work is of good quality (ETENE 2010, ETENE 2001). The study can also be justified on the grounds that there is no previous investigation into this subject in Finnish society where the respondents were expectant parents.
In this study, ethical permission was obtained from the organizations where the data collection was conducted. This survey was conducted anonymously and thus the respondents could no be recognized. Voluntarily filling and returning the form was construed as provision of consent to participate in the study (Kuula 2006). The cover letter contained the essential ethical facts of the study. In addition, the studies conducted with survey method are not included in the amended medical research act if the integrity of a human is not involved (Halkoaho et al. 2010).
This study focused on pregnant and breastfeeding mothers who are viewed as a special group in the medical research act.
Pregnant women can participate in a study only if it is not possible to obtain the results from others and if the study will benefit them or other pregnant mothers or newborns. (Ministry of Social Affairs and Health 1999.) These requirements were fulfilled in this study.
In addition, the voluntary participation and consequences are stated in the medical research act. The public health nurses had been provided with written instructions at the onset of the study on how to react if an individual refused to participate in the study. The instructions were given in a non-based manner; there was no attempt to persuade i.e. the parents freely participated.
The parents were informed that refusing to take part in the study would not have any negative consequences for the care they would receive.
This study probably caused some psychological discomfort to those multiparas who had negative previous breastfeeding experiences because these were recalled. Nevertheless, the research scenario may evoke similar feelings (i.e. joy, anger, disappointment and even shame) as encountered in everyday life (National Advisory Board on Research Ethics 2009). The parents received information about this study from the health professionals and thus they had a possibility to discuss their feelings with these individuals at the same time. In addition, some participants wrote long pieces of text about their
could even argue that participation was therapeutic for those individuals (Kuula 2006).
Some health professionals consciously did not inform the vulnerable families in this study. The public health nurses justified this behavior by claiming that these families were at very early stage of their pregnancy or were suffering major social or health problems and they would probably not take part in the study. They also believed that some of the parents were not interested in this topic and therefore the public health nurse did not inform these individuals about the study. Perhaps the intention of the public health nurse was to protect the family and help the parents to focus on using of the available resources.
This raised ethical questions such as “Was the public health nurses’ assessment about the person’s resources correct?” and
“Should an individual decide for her/himself about participation?” In such cases, there is a dichotomy between the autonomy of the respondent and the paternalistic view. The paternalistic approach means that some other individual interferes with to another individual’s autonomy (Pietarinen &
Launis 2005).
The way of cover letters were distributed evoked further questions like “Was the intention to ask everyone to participate in the study the correct decision?” and “Was it necessary to bother all the people with the study?” Clearly, a study is not allowed to harm anyone (Ministry of Social Affairs and Health 1999) and this study probably did not cause any serious distress to the expectant parents. The public health nurses’ intention may have been to protect the parents from the extra work and perhaps from extra stress. It was possible that they thought that this would reduce the researchers’ work as well. However, when the situation is considered from the viewpoint of results, one might speculate that it was intended that only well-coping families were invited to participate in the study. Therefore the results may be too positive especially if there had been many cases to whom information was not distributed about the study.
The data was anonymous and this means that the further development of the BKAC scale is possible since there are no
data-privacy issues involved. The anonymous research data can be utilized in later analyses thus the unnecessary data collection can be avoided (National Advisory Board on Research Ethics 2009).
Financial issues have to be included in the ethics (Pietilä &
Länsimies-Antikainen 2008). The Finnish Cultural Foundation, the Finnish Association of Nursing Research and the Finnish Foundation of Nursing Education supported this study. The results can be exploited in the routine practice. The assessment of the experts emphasized that it is a core issue in nursing science that one seeks to obtain information that can be used in clinical practice (Academy of Finland 2003).
5 Results
5.1 HEALTH PROFESSIONALS’ VIEW OF BARRIERS