120 Chapter 5 2.5 Ethical considerations According to the ‘Act governing research involving human subjects’ in The Netherlands (WMO), formal ethical approval by a research ethics committee is only required for medical research where participants are subject to interventions or procedures, or are required to follow specific, researchrelated rules of behaviour (20). None of these apply to this research. A selfassessment tool from the Medical Ethics committee of Maastricht University, The Netherlands, signalled our study as exempted from formal medical ethical review (21). Written consent was obtained from all participants before participating. 2.6 Data analysis We analysed the data using deductive content analysis (22). The goal of this analysis process was to gain deeper knowledge about the aspects involved in clinical decision-making for the use of interventions in the two groups with a different use of interventions. We used the ASE-model (16) as a theoretical framework, focusing on determinants of knowledge and skills. Throughout data analysis, we found that in the communication skills a distinction could be made between instrumental and affective communication, as identified in theories on healthcare communication (23, 24). Instrumental communication is task-related behaviour and involves skills such as asking questions and providing information, while affective communication is socio-emotional behaviour and involves skills such as reflecting feelings and showing empathy and concern (24). We extended the theoretical framework using these findings complementary to the ASE-model. The first author read and reread the complete transcripts of each interview to identify any descriptions related to the framework. The analysis process was open to identify any new themes that would emerge from the data. The second author conducted a dependability and conformability audit to check the analysis against accepted standards and examine the analysis process and records for accuracy. After nine interviews, we reached saturation on the level of themes and subthemes. We analysed the remaining nine interviews to check whether any codes or themes had been missed and any falsifying findings could be found, also confirming the stated themes. We used the online software program Dedoose version 8.3.17 and recorded the study’s procedure in a logbook. The standards for reporting qualitative research (SRQR) gave guidance to the writing of the current article (25). Results In total, 22 midwives accepted the invitation for an interview. Two midwives were excluded. One midwife because a colleague from the same midwifery practice was already interviewed, and a second midwife because no suitable date or time could be planned. Thirteen midwives worked in a midwifery practice with a low use of interventions and seven in a midwifery practice
RkJQdWJsaXNoZXIy MTk4NDMw