**3. Methodology**

experiences for all involved [2]. The model of intimacy as shown in Figure 1 shows the comprehensive conceptualization of intimacy that encompasses individual, interactional and

The majority of midwifery work involves intimate knowledge of another's body, which normally includes physical contact. Nevertheless, according to [2], contemporary midwifery

**•** Changes in the organization of care, with an emphasis on continuity and the potential increase in the emotional aspect of workMidwives often work in situations where there is a high level of expressed emotionMidwifery work is intimate and involves acknowledge‐

**•** Midwives often work with women who are experiencing intense painThe division of labour

In the literature, various terms have been used to describe intimate touch. Intimate physical touch is defined as involving 'inspection of, and possible physical contact with those parts of the body whose exposure can cause embarrassment to either the patient or the midwife' [4]. O' Lynn and Krautscheid [5] went into details and defined intimate touch as oriented touch to areas of a patient's body – genitalia, buttocks, perineum, inner thighs, lower abdomen and breasts, as well as other areas, depending upon the patient, nurse or midwife, that may produce feelings of discomfort, anxiety or fear. Women, during pregnancy, birth and postpartum, are often compelled in situations when several different health professionals, consciously or unawares, invade their intimate and personal sphere. Procedures like vaginal and rectal

within maternity care results in additional emotion management.

relationship qualities [3].

68 Sexology in Midwifery

**Figure 1.** The model of intimacy [1]

ment of sexuality

work is much broader and has several key features:

In this chapter, the study aim and the research question are presented. The research method‐ ologies, specifically qualitative methodology and grounded theory, are described and dis‐ cussed. This chapter also discusses the methods of study used to investigate the research question. The main ethical considerations are discussed. A description of the selection of participants is provided, and a discussion of the data collection follows. Finally, a summary is presented about the process of data collection, management and analysis.

### **3.1. Study aim**

The process of this research started with identification of the research problem and conse‐ quently forming the research question that demarcates the phenomenon to be studied. The primary focus of this research and at the same time the research question of this study therefore is: What are midwifery students' perceptions of intimate touch in clinical practice?

**•** The aim of this study isTo explore the concepts of midwifery students' perception and experience of intimacyTo capture the students' most typical experiences of intimate touch in clinical practice

### **3.2. Qualitative methodology**

Qualitative methodology guided this research study and therefore formed the basis for the research procedures and strategies. The main attraction of this perspective is that it is person centred and holistic, and, as Rees [12] describes, it concentrates on an individual's perceptions, experiences and personal insights. Furthermore, it attempts to encourage people to express their perceptions of situations or feelings in their own words [12].

### **3.3. The grounded theory approach**

For the purpose of this study, it seemed the most appropriate to adopt the grounded theory approach to close the gap in knowledge about the midwifery student's perception on intimate touch in clinical practice. According to Straus and Corbin [13], grounded theory is a creative process that facilitates the development of a new theory and therefore is an appropriate approach to use when there is a lack of knowledge about a topic. Understanding how mid‐ wifery students interact and the factors that influence their behaviour is an important aspect of midwifery care. Furthermore, as Hall et al. [14] pointed out, grounded theory is ideal for capturing the complexity of midwives' and midwifery students' therapeutic exchanges with expectant mothers.

Grounded theory was originally developed by Glaser and Strauss in the 1960s, and it means to make possible the 'systematic discovery of theory from the data of social research' [15]. Strauss and Corbin [13] showed that the purpose of using a grounded theory approach is to develop a theory about phenomena of interest that is faithful to, and illuminates, the area under study.

As Morse [16] pointed out, grounded theory is an important qualitative method which makes major contributions to nursing and therefore also midwifery research. This method offers a systematic approach through the clarification of varied responses and therefore focuses on the social meaning people attach to the world around them.

In grounded theory, the researcher drives a general, abstract theory of a process, action or interaction grounded in the views of participants [17]; therefore, it is important to understand, as also Douglas [18] pointed out, that grounded theory acknowledges the role of the researcher as part of the research but also demands from the researcher to interfere as minimally as possible.

### **3.4. Ethical considerations**

Every aspect of this research study was guided by ethical research standards which are informed consent, confidentiality and anonymity, voluntary participation and the right to withdraw [19].

### *3.4.1. Informed consent and voluntary participation*

**•** The aim of this study isTo explore the concepts of midwifery students' perception and experience of intimacyTo capture the students' most typical experiences of intimate touch

Qualitative methodology guided this research study and therefore formed the basis for the research procedures and strategies. The main attraction of this perspective is that it is person centred and holistic, and, as Rees [12] describes, it concentrates on an individual's perceptions, experiences and personal insights. Furthermore, it attempts to encourage people to express

For the purpose of this study, it seemed the most appropriate to adopt the grounded theory approach to close the gap in knowledge about the midwifery student's perception on intimate touch in clinical practice. According to Straus and Corbin [13], grounded theory is a creative process that facilitates the development of a new theory and therefore is an appropriate approach to use when there is a lack of knowledge about a topic. Understanding how mid‐ wifery students interact and the factors that influence their behaviour is an important aspect of midwifery care. Furthermore, as Hall et al. [14] pointed out, grounded theory is ideal for capturing the complexity of midwives' and midwifery students' therapeutic exchanges with

Grounded theory was originally developed by Glaser and Strauss in the 1960s, and it means to make possible the 'systematic discovery of theory from the data of social research' [15]. Strauss and Corbin [13] showed that the purpose of using a grounded theory approach is to develop a theory about phenomena of interest that is faithful to, and illuminates, the area under

As Morse [16] pointed out, grounded theory is an important qualitative method which makes major contributions to nursing and therefore also midwifery research. This method offers a systematic approach through the clarification of varied responses and therefore focuses on the

In grounded theory, the researcher drives a general, abstract theory of a process, action or interaction grounded in the views of participants [17]; therefore, it is important to understand, as also Douglas [18] pointed out, that grounded theory acknowledges the role of the researcher as part of the research but also demands from the researcher to interfere as minimally as

Every aspect of this research study was guided by ethical research standards which are informed consent, confidentiality and anonymity, voluntary participation and the right to

their perceptions of situations or feelings in their own words [12].

social meaning people attach to the world around them.

in clinical practice

70 Sexology in Midwifery

expectant mothers.

study.

possible.

withdraw [19].

**3.4. Ethical considerations**

**3.2. Qualitative methodology**

**3.3. The grounded theory approach**

In the current study, prior to informed consent being obtained, verbal and written explanations were given to participants regarding the study. This was done when the researchers presented the study to the potential participants. The researchers spoke about the purpose of the study, the procedures and the conditions of consent as well as answered questions. The researchers also spoke about how confidentiality or anonymity for the participant will be ensured. The information sheet was given after the presentation to all students that attended the presenta‐ tion. Those that showed interest in participating were given a gap of 48 hours between receiving the information and consenting. Two days after the presentation, the researcher got in touch (personally) with the interested participants to find out if they had decided to participate in the study. All 13 students who decided that they wished to participate were given a consent form to sign.

Informed consent is important, as it allows participants to make an informed and voluntary choice to participate or refuse to participate [20]. As Holloway [21] pointed out, the process of informed consent is based firmly within the principle of respect for autonomy and means that participation is voluntary. The participants were made clear that the consent in qualitative research, as Holloway and Wheeler [22] pointed out, is an ongoing process and if they decided to withdraw their consent at any stage during the study, either before or during the interviews, they were free to do so. It was clearly expressed in the written and verbal details that no reason or explanations were required if participants chose to withdraw from the study. However, none of the participants withdrew from participating in the study.

### *3.4.2. Anonymity and confidentiality*

Bluff (2004) [23] points out that ethical issues of anonymity and confidentiality are somewhat unique with grounded theory research, especially when the sample size is small, as in the current study. Furthermore, as Cheek [24] stressed, when the research is conducted in a specific setting, among a specified group of people, as in the case of the current study, anonymity might be difficult to ensure. The researchers therefore paid special attention to protect the anonymity and confidentiality of the participants. To protect anonymity of the participants, pseudonyms were used throughout the research process and in the final report of the study. Assurances were given to participants by the researchers that any information gained during the interview would be held in the strictest confidence. In addition, the researchers guaranteed the ano‐ nymity of participants in any reports or publications generated as a result of this study.

Confidentiality between the participants and the researchers was assured by meeting the participants in a safe environment. The time of the interviews was always scheduled to suit the participants. All data were dated and labelled with pseudonyms to avoid identification of participants or in the event of loss or theft. The data were kept in a password- protected computer, and all tapes and written notes generated were placed in a locked cabinet, the key being held by the researchers.

### **3.5. Data collection, management and analysis**

The aim of this research study was discovering a phenomenon in a social context; therefore, to gather rich data in order to generate a strong grounded theory, unstructured interviews were found as the most appropriate data collection technique, as it permits exploration of how midwifery students perceive intimate touch in clinical practice. The inclusion criteria for the participants were the following: third year midwifery student at the University of Ljubljana and Faculty of Health Sciences who finished all clinical practice. Each participant was a volunteer. McNamara [25] points out that interviews are particularly useful for getting the story behind a participant's experiences and that the interviewer can pursue in-depth infor‐ mation around the topic. Face- to- face interviews were conducted over the period of 2 months that consisted of nine in- depth and open-ended questions. The interviews lasted from 15 to 25 minutes and were audio taped from the beginning till the end. The tapes were labelled using the participants' pseudonyms. After the interview, researchers relistened to the recorded conversations, and the interviews were transcribed as verbatim as possible.

In grounded theory (as described by Liehr and LoBiondo – Wood) [26], data analysis proceeds through several levels and comprises several distinctive features which assist the research process. They are theoretical sensitivity, theoretical sampling and saturation, coding and categorizing the data and theoretical memos.

As Bluff [23] describes, the sample size in a grounded theory study tends to be small. According to Straus and Corbin [13], the key to grounded theory is to generate enough in-depth data that can illuminate patterns, concepts, categories, properties and dimensions of the given phe‐ nomena. Theoretical saturation occurs when no new or relevant data seem to emerge regarding a category, and, as Strauss and Corbin [13] pointed out, the category is well developed in terms of its properties and dimensions, demonstrating variation and the relationship among categories, which are well established and validated. In the current study, the saturation occurred with the sample size of nine participants. Data collection and analysis were ongoing throughout the research and involved three steps: open coding to find categories, axial coding to find links between the themes/categories and selective coding to find the core category which explained the phenomenon that was emerging from the study.
