A reflection on ethical and methodological challenges of using separate interviews with adolescent-older carer dyads in rural South Africa

Abstract

Background This article discusses our reflections on ethical and methodological challenges when conducting separate interviews with individuals in dyads in the uMkhanyakude district, South Africa. Our work is embedded in an ethnographic study exploring care relationships between adolescents and their older carers in the context of a large-donor funded HIV programme. We use these reflections to discuss some of the challenges and present possible management strategies that may be adopted in conducting dyadic health research in resource-poor settings. Methods Drawing from the relational agency, three rounds of separate interviews and participant observation were undertaken with dyads of adolescents aged between 13 and 19 and their older carers aged 50+ from October 2017 to September 2018. A reflexive journal was kept to record the interviewer's experiences of the whole research process. We identified methodological and ethical challenges from these data during the thematic analysis. Results A total of 36 separate interviews were conducted with six pairs of adolescent-older carer dyads ( n = 12 participants). Five themes emerged: recruitment of dyads, consenting dyads, confidentiality, conducting separate interviews with adolescents and older carers, and interviewer-dyad interaction. We also illustrated how we dealt with these challenges. Conclusions Results from this study can guide the recruitment, consenting and collecting data for health studies that employ a similar form of enquiry in LMICs. However, ethical and methodological challenges should be recognised as features of the relationships between cross-generation dyads rather than weaknesses of the method.

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“…A major pre-requisite for men and women to develop greater interest in biomedical information about implants rests on the assumption that current perspectives amongst young people remain unchanged and do not become indoctrinated by changing social roles over time. Using dyad interview techniques provided richness to our analysis around shared decision making but our ability to represent the data using direct quotes was challenged by the well described ethical constraints of exposing participant identity [51]. Importantly our study findings are based on participant recounts rather than observed behaviours and we should be circumspect in interpreting these findings and extrapolating their longitudinal impact.…”

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“…Eligible participants needed to (1) be aged between 18 and 39 years; (2) self-identify as lesbian, gay, or bisexual; (3) reside in Taiwan, holding citizenship or permanent residency; and (4) agree to refer a parent to take part in an interview. In light of the challenges in recruiting both LGB individuals who are "hard-to-reach, stigmatized, [and] hidden" (Guest et al, 2006) and consenting dyads (Gumede et al, 2019), purposive sampling was undertaken via multiple recruitment sites. We distributed: (1) recruitment flyers to LGBrelated service agencies such as Tongzhi Hotline Association (in Taipei), Sunshine Queer Centre (in Kaohsiung), and Taichung G-Di (in Taichung); (2) recruitment advertisements on social media (e.g., Facebook) and smartphone communication applications frequented by LGB individuals (e.g., Grindr, Jack'd, Blued).…”

“…All interviews were audio-recorded, and audio recordings were encrypted and stored on a password-protected computer accessible only to the PI and research assistant who guaranteed to protect participants' personal identity and information throughout the research process, including in any resultant reports or publications. Dyadic interviews may raise particular ethical concerns regarding confidentiality and the relationship between dyads and may possibly undermine the freedom of narration (Bjornholt & Farstad, 2014;Gumede et al, 2019). In response, we conducted interviews with LGB participants and their parents separately and reassured participants that their accounts would not be disclosed to the other party.…”

“…In response, we conducted interviews with LGB participants and their parents separately and reassured participants that their accounts would not be disclosed to the other party. When a narrative discrepancy between dyads arose, the interviewers neither confronted the participant about this nor introduced the competing account but rather sought the participant's individual interpretation (Gumede et al, 2019).…”