SECTION II Literature Review
Chapter 7 Methodology
7.7. Ethical considerations
synergistic co-operation between the researcher and community members. There was much discussion and challenging of the meaning of questions and concepts. At times, there was no clear resolution of these difficulties with the debates acknowledging diversity and ambiguity. Nevertheless, it is believed that this protracted translation process was beneficial in that it (i) evoked much interest among community members; (ii) demonstrated the researcher's genuine search for shared meaning; (iii) was empowering and capacity building for the participants who became the research assistants for the data collection; (iv) served to deepen and equalise relationships between research assistants and the researcher; (v) led to the development of social groups within each community who felt integrally involved, frequently became the driving force behind community-based initiatives, and enrolled as apprentice-facilitators for the SGTP or one of the control conditions; and (vi) was great fun! Most importantly, this process of translation and training of community-based research assistants, powerfully demonstrated a commitment to bi-directional knowledge sharing and understanding between the community members and the researcher.
not discriminate against children on the basis of age, gender, socio-economic status, caste, religion, language, race, ethnicity and capacity. In the current context, the researcher was careful not to use health status as a criterion for selection of subjects, (vii) Involve others who are committed to working with and for children in child-centered participatory research processes, (viii) Emphasise the ethical and conceptual aspects of the learning process while involved in capacity building, (ix) Work to raise awareness of individuals and organisations about child-centred participatory approaches. It is believed that every endeavour was made to adhere to these guidelines and to raise sensitivity to children's needs and rights within the partnering communities.
7.7.2. Autonomous informed consent: The principle of autonomy is basic to all ethical codes (Durrheim
& Wassenaar, 2002; APA, 1992, in McBurney, 2001). The process of obtaining informed consent required the researcher to have an awareness of the political climate and an understanding of power dynamics between stakeholders within the communities (Kelly, 2002). With respect to traditional isiZulu culture, the Amakhozi were regarded as major stakeholders in those communities that fall under tribal authority (the peri-urban and rural areas). However, deferring to the authority of'the Amakhozi could have created an impression that the researcher was aligned to a particular tradition (ibid.) that may not have been accepted by all stakeholders. To pro-actively preempt this potential difficulty, it was decided to use multiple entry points in each community. This had the advantage of establishing networks and mobilising key stakeholders. Every effort was made during all community meetings to ensure that individuals did not feel the need to comply either with the wishes of those who may have been perceived to be more powerful or knowledgeable, nor to conform to majority wishes.
Informed consent was achieved by conducting PowerPoint Presentations in isiZulu and English. These presentations gave an overview of the entire intervention and research programme. Several CMM's were conducted in each of the selected communities, usually with different individuals or community groupings attending each of the meetings (see Appendix B). Participation was strongly encouraged. The objective was to promote discussion about vulnerable children, to outline the nature and purpose of the programme, and to introduce potential roles for volunteers who were willing to commit time and energy to offering PSS. The researcher's expectations of the volunteers were made explicit, with special caution about raising false expectations about personal or community gain. This was especially important in areas where the unemployment rates were extreme.
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After the CMM's, participation in the research programme was discussed in individual interviews
between participants and the researcher or the research assistants. If it seemed that the adult or child understood the implications of participation and their rights to withdraw at any time, they were asked to complete an informed consent form, as appropriate for child, parent/primary-caregiver, community member, or apprentice facilitator (See Appendix D). The process of obtaining informed consent in a manner that ensured adherence to the ethical principle of autonomy was time-consuming, and at times frustrating, as it appeared to delay the implementation of the programme. Nevertheless, it was recognised that this process of negotiation was a key investment. The success of the programme was dependent on the informed autonomous consent of each role-player.
7.7 J . Confidentiality: The fact that the research was conducted within community settings raised issues pertaining to the ethical obligation to ensure confidentiality for participants (Durrheim & Wassenaar, 2002). The focus on vulnerable children (defined as children who were experiencing 'especially difficult lives') served to shift the focus from potentially more stigmatising labels. Efforts were made to conceptualise the difficulties as being external to the child with a simultaneous focus on formulating strengths-based models of resilience (Howard & Dryden, 1999). The programme demanded a strong formal focus on the adherence to ethical behaviours. 'Pledges of Confidentiality' were explained and signed by all research participants, with regular re-visiting of the concept of confidentiality during all stages of the programme. Community gossip was an issue that troubled many of the participants and needed specific attention, by openly discussing the need for strict adherence to confidentiality and training the research assistants using various case vignettes.
7.7.4. Competence: Beneficence: The ethical responsibility of competence (APA, 1992; McBurney, 2001) requires psychologists (and by inference community workers) to only undertake tasks for which they have been adequately trained and supervised. All work was clinically supervised by the researcher, a clinical psychologist with many years of experience in both community and child psychology. On the occasion when an external consult was required, supervision with a colleague was sought - this is consistent with usual clinical practice. The SGTP was conducted by least one qualified and registered psychologist at each community site. The researcher and the qualified psychologists held the ethical and professional responsibility for the well-being of the adult and child subjects. The use of an apprenticeship model of training offered extensive supervision and enabled apprentice-facilitators to grow in competence, gain insight into their own areas of strength, and to confidently acknowledge their own limitations.
7.7.5. Competence: Nonmaleficence: The principle of nonmaleficence implies sensitivity to both acts of omission and commission. The axiom of'least harm' (Boyden & Ennew, 1997, p. 43) requires that participants are not exposed to additional risk and that the advantages of participation outweigh the benefits of non-participation (Clacherty & Associates, 2001). Therapeutic processes can stir up emotions that individuals may prefer to keep suppressed rather than expressed (Moustakas, 1955; Esman, 1983).
It was difficult to explain to community members that children may become angry or tearful, and that this was considered to be good for them. In practice, this required community members to take a leap of faith and trust in the skills of the researcher. This was an onerous responsibility, requiring a process of debriefing for community members on completion of each of the SGTP sessions (Durrheim &
Wassenaar, 2002). Individuals who had participated in the SP had already been exposed to the benefits of expressing their own feelings, instead of the more culturally endorsed practice of "keeping things bottled up."
Working with vulnerable subjects (child or adult members of disempowered communities) in communities that the researcher had labelled as being high HTV7AIDS prevalent raised sensitive issues.
Many of the communities would have been stigmatised and discriminated against by virtue of their race, ethnic and socio-economic status. Involvement in the programme could have led to negative overt or covert repercussions for the participants. Following the guidelines of the major role players in the HTV/AIDS field, the focus was primarily on vulnerable children, as opposed to orphans (Germann, 2002;
Hunter & Williamson, 2002; UNICEF, 2001). Many of the participants were initially unable to discuss HTV/AIDS prevalence in their communities, preferring to rather see the deaths as related to bewitchment or other circumstances. Care was taken not to challenge this denial or belief system. As trust developed, most participants were more able to spontaneously acknowledge that the increase in deaths could be AIDS-related. At this stage, open discussions about the HTV/AIDS pandemic took place.
7.7.6. Reporting procedures: Care was taken to protect the identity of all subjects (communities and individuals) by using a category or numerical system in this and any subsequent publication of research programme.
More detailed descriptions of the methodologies used for each unit of analysis (community and children) are presented in the subsequent two sections. Section 3 will focus on the community unit of analysis.
Section 4 will report the methodology, results and discussion relevant to the summative evaluation of the SGTP.