Are ethnic inequalities in the UK’s maternity services causing higher morbidity and mortality rates for BAME women – A literature review

DISSERTATION
Are ethnic inequalities in the UK’s maternity services causing higher morbidity and mortality rates for BAME women – A literature review
Please decide the best research question for searching, using PICO if a quantitative approach is considered best.

Choosing papers for inclusion
Once you have completed your searches you are likely to have found a number of papers. So how do you narrow them down to the ones you will ultimately include?
As you have searched on a number of databases, you will have some duplicates of papers. Check and exclude any duplicates first.
Review on title. Scan the titles of the papers and see if they match your search inclusion/exclusion criteria. If they don’t, then exclude them.
Review on abstract. Read the abstracts of the remaining papers and see if they match your search inclusion/exclusion criteria. If they don’t, then exclude them.
Review full paper. The papers you are left with you will need to read in full to determine whether or not they meet your search criteria. This is the point at which you will determine the papers to include.

How many papers do I need for the review?
This largely depends on the quality and content of the papers. There is no hard and fast rule, but on average around 8-12 papers will be enough. You are unlikely to have enough to discuss with less than 6 papers. Similarly, if you have too many (15 or more) you will have too much to cover and not enough words available to do this in your review.

How do I know my papers are suitable?
You need to include original research papers only. This excludes opinion papers or commentaries.
You will often find review papers when searching; these are published literature reviews. These can be useful for background, substantiation etc. However, you are conducting your own review and need to reach your own conclusions about the published literature. Your review question may be different to those in published reviews or you may review different literature, so do not be concerned that your conclusions may be different.

PRISMA flowcharts please use the 3rd one on the list
PRISMA flowcharts are a common and clear method of displaying results from your searches. Here is the link to the PRISMA website with the interactive flow diagram. http://www.prisma-statement.org/PRISMAStatement/FlowDiagram
You can download word examples from the website.

http://www.prisma-statement.org/PRISMAStatement/FlowDiagram
When referencing this new PRISMA flow diagram, please use the following paper: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

What is research ethics?

Research ethics are practices to ensure that research conducted on human subjects, or their tissues organs or data, is carried out in a way that protects the safety, dignity, rights, and well-being of research participants.

Why do we need ethics in research?

To protect the public (participants) from harm.

Nuremburg Code 1947 Originally established after the Second World War to protect individuals from harm and prevention of research being completed without consent. This followed allegations of enforced non-consensual research experiments on concentration camp prisoners, leading to harm or death of the individuals concerned. Ten key points were introduced, the main one being that of informed consent. See the link here for the ten principles. (University login required off campus)

Declaration of Helsinki 1964 The World Medical Association established recommendations guiding biomedical research involving human subjects. The Declaration governs international research ethics and defines rules for “research combined with clinical care” and “non-therapeutic research.” This guidance has been subsequently amended and can be found here.

General ethical principles

It is important to consider ethical principles in designing your research study and incorporate these throughout. In order to be successful in gaining ethical approval, the researcher must consider the following general ethical principles.

Beneficence – This is the principle that research should be aimed at ‘doing good’ and be of benefit to participants. Research may not be of obvious benefit to the participants, but could be of benefit to society/health in general or in the future. Participants’ wellbeing should be considered and catered for.

Non-malfeasance – This principle relates to avoiding harm. The researcher should not set out to intentionally cause participants harm. Any risk of harm should be avoided/minimised as far as possible. Researchers must consider risk v benefit of research.

Equity & Justice – Participants should be treated equally and fairly.

Autonomy – Participants should be free from coercion and be able to make their own decision to participate or not, without risk of prejudice to their care.

Informed consent – Participants should be given sufficient information for them to make a decision whether or not to participate. This is usually in the form of a participant information sheet, asking questions of the researcher and receiving clear answers and also be given sufficient time to decide whether they wish to participate are important in the consent process. Generally, written consent is required. Examples of participate information sheet, consent forms and information about them is available on the HRA website.

Confidentiality – This provides for privacy of the participant. Identifying information is not revealed and is known by researchers only. Participants are usually allocated a study number for the duration of the study. Identifying information is kept separately from data.

Anonymity – Again provides protection of privacy for the participant. When reporting data relating to an individual, for example a quote, these are anonymised to protect participant identity.

Research within the NHS

Research with participants from the NHS is closely monitored with ethical approval and adherence to ethical principles essential.

The UK Framework for Health and Social Care Research (HRA 2017) currently provides guidance on the principles of good research governance for healthcare.

The Health Research Authority (HRA) now governs research within the NHS. The main aim of the HRA is to:

Promote and protect the interests of patients in health research.
Their website is a very useful source of information.

Ethics and your dissertation

You need to consider two things:

What are the ethical issues related to your proposal?
Do you need to consider ethical approval?

Ethical issues related to your proposal

Consider issues in relation to recruitment, consent, data collection, confidentiality.

Consider if your topic is sensitive and whether participants may suffer distress. If so, you would need to consider a distress policy; for example suspending interview, access to independent counselling etc.

Consider if it is possible issues related to practice, such as poor practice, bullying in the workplace may be raised. If so, you would need to consider if and how you would manage this; for example, raise with research supervisor, supervisor of midwives etc if necessary.

The ESRC have some helpful information on building ethics into your research design. See their ethics guidebook.

In terms of data management, the Data Protection Act 2018 is also relevant.The ERSC have an overview in their ethics guidebook, or see the Data Protection Act itself.

Do you need ethical approval?

All research proposals involving human participants have to be reviewed and approved by an independent research ethics committee (REC).

University of Manchester ethical approval – Yes, for all studies.

NHS (HRA) approval – check the current guidance (It does change from time to time) on the HRA website. HRA approval is obtained by completing the Integrated Research Application System (IRAS).

If participants are patients in NHS (or accessed through the NHS) then you need HRA (IRAS) approval.

If participants are staff in the NHS, then generally you do not need HRA (IRAS) approval.

Rigour
Addressing rigour in your dissertation

Rigour is embedded throughout research design. As your write your dissertation consider some of the points related to rigour.

Your study design must be appropriate to answer your research question/aim/hypothesis. i.e. is a quantitative or a qualitative approach more appropriate?
Make sure your study methods are appropriate to meet your research aim. This includes:

Sampling – If quantitative, is the sample randomised, is a sample size calculation considered, is there a pilot study planned? If qualitative, is the method suitable, e.g. purposive sampling and is the sample size reasonable for a qualitative study.
Data collection – Is this suitable to answer the question? If quantitative, are the measures appropriate? If qualitative, give justification for your choice of data collection method – are interviews, focus groups, observation etc suited to your methodology?
Analysis – Must be relevant to your methodology. If quantitative, you will be measuring and hence producing statistics. If qualitative, the analysis method needs to be suitable for the methodology; e.g. in a grounded theory study you will be using constant comparative analysis techniques.

Useful papers

The links below relate to papers you may find helpful. If you are off campus, you may need to log in via shibboleth using your university user name and password.

Reliability and validity in quantitative research

Heale R. and Twycross A. (2015). Reliability and validity in quantitative studies. Evidence Based Nursing. 0:0.

Trustworthiness and credibility in qualitative research

Noble H. and Smith J. (2015). Issues of validity and reliability in qualitative research. Evidence Based Nursing, 18(2), 34-5.

Thomas E. and Magilvy J.K. (2011). Qualitative Rigor or Research Validity in Qualitative Research. Journal for Specialists in Pediatric Nursing. 16, 151–155.

Holloway, I. & Wheeler, S. (2010). Chapter 18: Establishing Quality: Trustworthiness or Validity. In Holloway, I & Wheeler, S. Qualitative Research in Nursing and Healthcare. pp. 297-314, Chichester: Wiley-Blackwell.