Summarizing Research Articles
What is the sample size, method of analysis and the major findings in the article by WA Rogers entitled
Ethical issues in public health: A qualitative study of public health practice
Epidemiol Community Health 2004; 58:446–450. doi: 10.1136/jech.2003.013417
This article describes a study where public health professionals in two sites in Scotland UK were interviewed about ethical issues related to their work.
At the Lothian site, 25 'cells' of types of role were identified and individuals were selected at random in each of these cells or categories. Where only one individual was in the category they were automatically selected for interview. A similar collection of data was made at the Glasgow site, where 6 'cells' were identified. Of the 34 letters sent out to individuals at the Lothian site, 24 agreed to be interviewed. At the Glasgow site 9 out of the 15 approached for interview agreed to participate. Therefore 33 out of the 49 invitations led to measured respsonses - a response rate of 67%. The observed sample size was thus 33 individuals.
Being based on data collected from face-to-face interviews, the data were of a qualitative nature and so were naturally put into categories for analysis rather than quantitative measures. 3 central categories were identified - Paternalism, Responsibilities and Ethical Decision Making. Remarks made by interviewees about ethical issues relating to their work were allocated into any of these 3 central categories, although information falling into other smaller categories was also retained. Major trends in the interviewees responses were then identified from the data collated over the 33 individuals. To validate the findings participants were invited to a presentation and discussion (held at 3 venues) about the results of the study after the data had been collected.
The major trends in the 3 categories Paternalism, Responsibilities and Ethical Decision Making were as follows:
Paternalism - community consultation can be paternalistic; no mechanism for obtaining informed consent from communities for new interventions; information should be limited, to avoid causing public fear and anxiety, though this conflicts with the public's desire for transparency in the health system; the challenge of responding to criticism and hype from the media, politicians and the public.
Responsibilities - balancing conflicting responsibilities to stakeholders (the public foremostly, the NHS board, NHS staff, elected representatives ie parliament) whilst upholding professional integrity and personal values (which might also conflict); lack of one-to-one relationships with the public may reduce feelings of responsibility, but this might help in difficult policy decisions, such as allocating limited resources fairly and not expending too much on treatments that are expensive relative to the benefits they give, although they might be lauded by the pharmaceutical industry.
Ethical Decision Making - being open, honest and transparent; adhering to democratic values and fairness; listening to all groups to be inclusive and aware; making decisions analytically ie rationally and systematically for optimal results; taking critical note of scientific and statistical evidence about healthcare; avoiding discrimatory practices and promoting equality.
Overall 'Key Points' - 33 face-to-face interviews with public health professionals show that they are aware that they operate in an ethically complex environment; paternalism and honesty, conflicting responsibilities, pressures on decision making and uncomfortable relations with the pharmaceutical industry were salient topics put forward by the health professionals interviewed.