Navigating Ethical Complexities in Qualitative Research With Interrelated Persons

Planning Data Generation

Objectives and risks of the interview with interrelated individuals must be clarified prior to beginning data collection. As recommended by Brinkmann and Kvale (2014), it is essential that the researcher carefully considers in advance the ethical dilemmas that may arise during an interview project. Further, the researcher is encouraged to consult experienced members of the research community for critical reflections.

One essential consideration relates to the research objective. The researcher must ensure that participants fully understand that the aim of the interview is to generate knowledge (in line with the research objectives) and that it is not a therapeutic interview intended for discussing distressing events or family relationships and dynamics. In addition, researchers must ensure that participants fully understand what interviews with family members entail and that information from individual interviews will be kept private and confidential.

Conducting interviews with family members offers a unique opportunity to explore interpersonal dynamics and shared experiences. However, it also presents distinct ethical challenges due to the emotional ties and relational complexities between participants. Unlike focus groups, which typically involve individuals without prior relationships, JIs or family group interviews require researchers to carefully consider how the interview process might affect ongoing relationships (Haahr et al., 2014; Margolin et al., 2005). This includes potential risks to their relationships and the emotional impact of discussing sensitive topics together (Beitin, 2008; Margolin et al., 2005; Voltelen et al., 2017).

Documenting Informed Consent, Disclosure, and Reporting Decisions

Another essential ethical consideration in research with interrelated individuals is the obligation to secure informed consent (and assent, if necessary) and uphold the right to withdraw. Informed consent must be extended to address the specific challenges of JIs, including confidentiality, privacy, and the roles of each participant (Bjørnholt & Farstad, 2014; Sohier, 1995). In addition, researchers should consider the motives behind each participant’s involvement, as differing expectations may influence the interview dynamic (Beitin, 2008; Reczek, 2014). Using separate consent forms and conducting individual discussions about the research, emphasizing each participant’s right to make an independent decision about their involvement, helps ensure that participation is voluntary and free from relational influence. Equally important, participants must be able to disengage from the research without fear of relational repercussions.

Researchers should reflect on whether children or adolescents are agreeing to participate in the research because they feel their parent or caregiver wants them to or if they are truly willing to participate. Some children, depending on their temperament or the dynamics of family relationships, may fear a negative response from their parent or caregiver if they do not give assent. Nonverbal cues such as a child’s hesitancy to agree, repeatedly looking back and forth between the parent and researcher or avoiding all eye contact, fidgeting or stiffness should give the researcher pause and may indicate a lack of genuine voluntariness rather than true assent (Mirabella et al., 2025; Roth-Cline & Nelson, 2013).

The availability of confidential channels—such as direct communication with the researcher or anonymous withdrawal forms—should be clearly communicated and easily accessible. In both cases, these approaches reinforce the principle that participation and withdrawal are individual decisions, thereby minimizing the risk of coercion or influence stemming from relational hierarchies or group dynamics within the family (Norlyk et al., 2016). Coercion in family research refers to situations in which participants—either primary participants, family members, or both—feel pressured, obligated, or influenced to participate in a study, potentially compromising voluntary informed consent. In family research, this can be particularly complex because of the interpersonal dynamics among family members (Voltelen et al., 2017). In the context of research interviews with families, participants are encouraged to reflect together prior to the interview on the content and extent of information they wish to share. Such preparatory reflection helps to establish personal and relational boundaries, mitigates potential emotional distress, and promotes participant agency and ethical engagement in the research process (Brinkmann & Kvale, 2014). During interviews with couples where one was diagnosed with heart failure, the researcher spent time preparing the informants by phone before they met for the interview to inform them about the scope and the context of the joint interview to give them time to prepare what to share (Voltelen et al., 2016).

Before the interviews in a study about dementia, a recurring concern among relatives centered on the possibility that their loved one with dementia would say something that might not reflect genuine experience or could cast themselves or their family members in an unfavorable light. This underscored the importance of creating a research environment where participation was voluntary, confidential, and free from relational repercussions. Ensuring that each participant’s decision to engage or withdraw was respected and protected was paramount, particularly in family contexts where relational hierarchies that may arise in the context of cognitive decline may exert subtle pressure.

Informed consent in the focus group interview with individuals with dementia was approached as a continuous process, recognizing that cognitive impairment and language difficulties may affect the ability of participants with dementia to fully comprehend or recall the research purpose. Proxy consent from close relatives was obtained when necessary, supplementing ongoing process consent to safeguard the autonomy and well-being of participants. This dual approach reflected the ethical imperative to balance respect for individual autonomy with the need to avoid exclusion and stigma associated with dementia. Ultimately, the ethical conduct of focus group interviews in family-based dementia research demands a nuanced approach to informed consent, one that is sensitive to relational dynamics, cognitive vulnerabilities, and the imperative to respect and empower all participants (Toubøl et al., 2021).

Composition of Interview Groups

Although vulnerable people often do not have the opportunity for their voices to be heard, the researcher can use several approaches in setting up the interview to ensure participants’ perspectives get attention. Joint and group interviews within the field of dementia care will again be used to emphasize this point. These interview formats provided different, yet complementary, insights into how people living with dementia and their relatives experienced everyday life together. In a qualitative study of the perspectives of dementia-friendly hospitals, all stakeholder groups were invited to participate in focus group interviews. This included families, either as married couples or parents and adult children. In the context of dementia, particularly in focus group settings, the ethical management of informed consent became both complex and essential. The researchers made the decision to separate relatives and people with dementia into two separate focus groups. This decision was guided by concerns that family members might inadvertently dominate, correct, or interrupt the conversation, potentially influencing the autonomy and voice of those living with dementia. The researchers recognized that joint participation could help people with dementia feel secure, but it could also influence their responses.

In a similar way, researchers using event history calendars to interview parent and preschool-aged child dyads about lifestyle habits intentionally considered how to conduct interviews so that parents would allow their child to speak freely. Prior to data collection, training for the researchers included how to work through the event history calendar with the parent and child, approaches to establish rapport, verbal and nonverbal feedback techniques, use of pauses, and knowing when and how to probe for detail. These skills were practiced and reviewed by the team’s research psychologist until reliability in administration was established. Before data collection, parents were asked to allow their child to freely tell their story without corrections or interruptions. The parent and child were then interviewed simultaneously by two different researchers so that they were less inclined to listen to and correct what the other was saying.

Interview Location

As researchers, we are obligated to minimize any potential discomfort that may come from participating in research studies. In a multi-center cardiac research study, the researcher provided the families with different options for the interview location. Families were asked their preferred location, be it at their own home or at a neutral location such as a private room in a public library or the local culture center. Sometimes families preferred to stay at home because they felt more secure there. In this way, the families were allowed to make their own decision and impact the interview environment (Voltelen et al., 2016). Similar feelings of comfort at home were observed from personal experience in research involving the parent and preschool child dyads, as parents often expressed concern that they would not be able to concentrate on the interview in a public place if their child misbehaved and distracted them. Home is where they and their child were most comfortable and could focus the best.

Offering a Calm Environment

During the group interviews, the researchers must learn the importance of setting up a deliberate framework of patience and a slow tempo. This means consciously inserting pauses, allowing silence to unfold, and resisting the urge to fill every gap with words. In dementia research, this intentional slowing down makes it possible for participants with dementia to express themselves at their own pace. In several situations, it became evident that when given time and attention, the person with dementia could articulate their thoughts and emotions more fully than their relatives had expected. Ordinarily, relatives would have stepped in—completing sentences or interpreting what the person “really means.” Within the protected, slower space of the interview, however, this pattern shifted. The relatives became more observant, listening to, rather than speaking for, their loved ones. This change created moving moments in which the person with dementia found language for experiences that had previously remained unspoken. For the families, this was often described as a “joyful surprise”—an encounter that not only deepened understanding but also inspired new patience and attentiveness in their everyday communication.

In the individual and joint interviews in which the researcher met with one or two participants—often a person with dementia and a close family member, the same principle of careful pacing proved essential. Even when there were fewer participants, it became clear that the wider family perspective could be brought into the conversation. Through gentle facilitation, participants were invited to reflect on what other family members might have said or thought about the same situation. An example could be: “How do you think this situation affects <family member>”, or “What would <family member> have answered if they got the same question?” This reflective dialogue often illuminated family dynamics and relationships in ways that extended beyond the immediate dyad.

Both joint and individual interviews revealed that reflection itself could become a relational tool. Through guided conversation, participants began to recognize how their ways of interacting shaped mutual understanding within the family. What started as a research interview often developed into a shared moment of discovery, where family members gained new awareness of how to listen—both to themselves and to the person living with dementia (Busted, 2019; Clemmensen et al., 2019). Other researchers advocate that vulnerable dynamics—such as caregiver-patient roles or gender imbalances—may necessitate reconsidering whether a JI is appropriate (Norlyk et al., 2016; Sakellariou et al., 2013).

Managing Therapeutic and Research Boundaries

Although there is a clear distinction between a research interview and a therapeutic interview, research interviews can still have a therapeutic effect on participants. Most researchers experienced in qualitative interviewing can relate to the typical participant statement that it was pleasant or even healing to have the opportunity to share their narratives. Consequently, this can be considered a beneficial outcome of their participation and is observed across individual interviews, JI in pairs, and interviews involving the entire family unit (Morecroft et al., 2004; Perry & Bigelow, 2020).

Although interviews may have an indirect therapeutic effect, it is nonetheless essential to maintain clear expectations of the research interview, and the focus on data collection. The expectation must be clear that the participants have provided consent to participate in a research study, and researchers must refrain from assuming a therapeutic role (Allmark et al., 2009; Beitin, 2008). In connection with a PhD project aimed at generating knowledge about the experiences and perceptions of family caregivers of service users in forensic mental health care settings, researchers interviewed family members either individually or in joint interviews. The PhD student was a trained nurse and an experienced psychotherapist and thus had substantial experience conducting therapeutic conversations with vulnerable individuals, including those in crisis. However, the student had limited experience with qualitative research interviews and had never conducted research interviews with families in psychiatric settings. As the intention of the research interview was not to produce therapeutic effects, it was critically important for the interviewer to avoid over-involvement and to maintain professional boundaries (Allan, 1980; Beitin, 2008). Consequently, the group of supervisors, all experienced qualitative researchers with extensive experience interviewing family members in mental health settings, engaged the PhD student in critical discussions regarding the interviews. The supervisors listened to interview recordings and provided feedback, all with the intention of ensuring that the interviews remained research-focused rather than therapeutic. The PhD student was able to draw on her expertise to conduct professional and ethically sound research interviews.

Briefing

When interviewing interrelated participants, researchers should follow recommended briefing procedures. This includes explaining the purpose of the interview, obtaining informed consent (and assent as applicable), and providing an opportunity for participants to ask questions. However, when interviewing interrelated family members, a key ethical issue is maintaining confidentiality between participants. Researchers must emphasize that sensitive information shared by one participant will not be disclosed to other family members without their explicit consent. Although the researcher cannot fully control what family members share with each other or with others outside the interview, it is essential that this is clearly communicated during the briefing, highlighting the importance of confidentiality to protect family relationships (Brinkmann & Kvale, 2014).

Ensuring confidentiality can be particularly important when research involves families with older children and adolescents, especially when the research centers on sensitive topics such as drug or alcohol use, intimate partner violence, gender identity, or sexual activity. Confidential interviews with the child/adolescent alone encourage a more honest exchange of information that the young participant may not be comfortable sharing in front of their parent or caregiver (Chung et al., 2024).

On the other hand, a research question that involves the dynamics of the parent–child relationship may necessitate that the dyad be interviewed together to observe their interaction. A power dynamic in the relationship may also affect the accuracy of data collected and can go both ways (Gabbidon et al., 2022). Children/adolescents may fear their parent’s response to their answers to interview questions. Parents who desire their child’s friendship may fear losing credibility in their child’s eyes if they disclose something they think the child will be embarrassed by. In addition, parents of children or adolescents with neuropsychiatric conditions may worry that their child will have an outburst if information is shared that about problem behaviors.

The briefing discussion should be tailored to the characteristics of the family being interviewed, taking into consideration age, educational level, cognitive ability or disability, and relevant cultural factors. For example, when working with families with members who have neurodevelopmental disabilities, the language used in the briefing procedure will need to be simplified and pictures or storyboards may be used to compliment what is being said. Caregivers can often offer insight into the way that their family member learns best and if they seem to understand what they have been told (McFarland et al., 2024). Asking a participant to repeat back in their own words what the researcher has briefed them on can often be a good way to gauge their understanding of the information presented (Jamerson & Shuster, 2023). Participants, however, will need to be made aware of the instances when confidentiality will need to be broken for the safety of those involved, including if a participant makes a threat to their own or another person’s safety, discloses known or suspected abuse, or if public health ordinances require disclosure. Disclosures of this type have the potential to strain family relationships if other members of the family do not feel this information should have been shared with researchers (Tsindos, 2023).

Attention to Verbal and Nonverbal Cues

Equal attention should be given to all participants during the interview to prevent dominance or marginalization. Due to the complexity of group interviews with many people participating at the same time, it may be useful to have more than one interviewer so that the researchers can divide their roles. For example, one researcher may act as the primary interviewer and one or more as observers. In this way, both verbal and nonverbal responses can be recorded and analyzed (Heaphy & Einarsdottir, 2013; Morris, 2001).

Documenting nonverbal cues can be just as useful in qualitative family research as recording the words said by participants, but it is often overlooked (Denham & Onwuegbuzie, 2013). Family members may sneak glances at one another, indicating that they have shared knowledge that is going unspoken, or they may avoid making eye contact with one another or the interviewer, indicating embarrassment or guilt. A participant, particularly a child or cognitively delayed individual, may fidget in their seat or unconsciously play with an object, suggesting discomfort. Even changes in breathing pattern—a sharp intake of breath, holding one’s breath, breathing quickly, or sighing—and the response of family members to this nonverbal cue can provide valuable information. The astute researcher may notice these nonverbal cues and tactfully ask follow-up questions to glean more information or may recognize that additional probing may damage the researcher-participant relationship. It is best to ask follow-up questions in a neutral way, such as “I am picking up on some nonverbal cues. Is there something else you would like to add?” The interviewer could also ask, “Is there something I missed or am misinterpreting?” This can give individuals an opportunity to provide additional information or to say there is nothing more they would like to add, leaving the decision in the participant’s hands. If one participant is dominating the conversation, noting the other participant’s nonverbal cues can provide them with the opportunity to give valuable information. If there is conflict between participants, it is important to remind them that there are no right or wrong answers, and everyone’s perspective provides valuable and possibly different information.

Balancing Participant Voices

During the interview itself, researchers must maintain neutrality and avoid taking sides. Creating a safe and respectful environment is essential, especially when discussing emotionally charged topics such as illness, sexuality, or caregiving burdens (Eggenberger & Nelms, 2007; Margolin et al., 2005; Sakellariou et al., 2013). For example, during the recruitment process for interviews with parents of service users in forensic mental health settings, the interviewer was contacted by a father who expressed interest in sharing his experiences. The interviewer inquired whether the individual had a spouse or partner who was also the mother of the service user. This inquiry was guided by the principle that participants should be offered the choice between joint and individual interviews, with the flexibility to revise their preference should discomfort or unforeseen dynamics arise during the study (Tingleff et al., 2019; Eggenberger & Nelms, 2007; Highet, 2003; Taylor & de Vocht, 2011). Researchers must be vigilant about coercion, where one family member may pressure another to participate or not participate (Neill, 2007; Reczek, 2014). In this case, the father confirmed that he alone wished to be interviewed. However, during the interview, the mother was present in the home and made occasional comments, such as additions to the father’s statements. This informal involvement raised important ethical concerns about consent, informal participation, and the boundaries between formal and informal engagement in qualitative interview research. The mother’s contribution prompted questions about whether such input should be considered part of data collection, particularly given that she was not formally recruited or consented as a participant in the research. Furthermore, her presence may have influenced the father’s responses, potentially shaping the narrative through relational dynamics or perceived expectations (Haahr et al., 2014; Norlyk et al., 2016).

These interactions underscore the critical importance of researcher reflexivity and sensitivity to power dynamics, as they illustrate how fieldwork frequently diverges from controlled or idealized conditions and demands nuanced ethical judgment in situ (Voltelen et al., 2017). During data collection, the interviewer chose not to intervene or discourage the mother’s occasional input, as it appeared that the informant (the father) was not disturbed by her comments. On the contrary, her contributions seemed to reflect a natural aspect of the couple’s interaction. Furthermore, the interviewer opted not to ask the mother whether she wished to participate formally, as she was engaged in various household tasks and had, upon the interviewer’s arrival, explicitly stated that the interview was intended for her husband alone (Tingleff et al., 2019). For these reasons, and in accordance with legal requirements concerning informed consent for the use of research data (WMA Declaration of Helsinki, 2012), the mother’s contributions were not transcribed or included in the analysis. An alternative way of navigating such a situation could have been to ask the mother whether she wished her comments and statements to be included as data. If so, this would have required her informed consent.

Maintaining Anonymity in Relational Settings

In a study aimed at enhancing family caregiver involvement in the care and treatment of individuals within forensic mental health settings, family members were interviewed to explore their perceptions of interactions with both the service user and health care professionals (Vestphal et al., 2024). The recruitment process targeted caregivers through written invitations distributed in inpatient and outpatient facilities, as well as through social media posts shared by carer organizations. Consequently, consent was not obtained from the service users themselves, and the researchers did not provide any information to the service users about the caregivers’ participation. In instances where the service user was aware of the interviews, it was the family members themselves who had conveyed this information (Saunders et al., 2015). This recruitment approach was chosen following critical ethical reflection, as the aim of the study was to illuminate family caregivers’ experiences and the meaning they ascribe to their interactions with service users and health care professionals. Family caregivers of service users in forensic mental health care settings constitute a vulnerable group, often bearing significant responsibilities, encountering challenges in being included and supported by health care professionals, and frequently experiencing heightened caregiver burden (Tingleff et al., 2022). Consequently, it is equally important to give voice to this particularly vulnerable group of individuals whose narratives have been historically neglected in research. Their perspectives are essential for informing policymakers and health care professionals and should be actively incorporated into the design of initiatives and interventions aimed at improving care and support systems. However, when families are understood as systems, it could be argued that focusing solely on interviews with individual family members—whether carers or service users—risks overlooking the relational and systemic nature of family experiences.

On one hand, researchers could have requested consent from service users to interview their family members without disclosing the content of the caregivers’ narratives, in accordance with the requirement to maintain confidentiality between the participants (in this case, the family members) and the interviewer. By safeguarding the confidentiality of the caregiver’s narratives while still respecting the service user’s consent, this approach could balance ethical transparency with relational protection. On the other hand, family members are individuals with the right to autonomy. Just as family caregivers have the opportunity and the right to seek support from health care professionals or caregiver organizations without requiring the patient’s consent, they should also be afforded the opportunity to share their own experiences and express their needs. Crucially, such support must remain focused on the caregiver’s perspective and avoid the disclosure of patient-related information. This distinction underscores the ethical legitimacy of engaging caregivers independently. However, as the above example illustrates, it requires careful consideration of confidentiality and the relational boundaries between family members.

Minimizing Harm Within Families

When interviewing interrelated participants, researchers should follow recommended debriefing procedures. This includes asking participants if they have anything further to share and inquiring about their experience of being interviewed (Brinkmann & Kvale, 2014). In family research, it is paramount to ensure the ongoing relationships within the family unit (Voltelen et al., 2017). This was done in the aforementioned studies after the interview by asking the participants how they felt and giving each the opportunity to contact the interviewer either by phone or by mail several days after the interview. In one of the joint interviews with a couple where the husband was diagnosed with heart failure, the wife had stated during the interview that the illness was primarily affecting her husband and not her. She held back and did not express her own worries even when asked because she wanted the husband’s perspective to take priority in the interview. Two days after the interview, she called the interviewer and said that maybe she should start to “think more about herself and her own needs” because the interview situation had prompted her to view their situation a little differently. Therefore, it is important for the interviewer to stay neutral but alert, and always offer the opportunity to reach out after the interview. If conflicts arise during or after the interview, we recommend reminding participants that there are no right or wrong responses, and different perspectives provide valuable information.

Reporting

Ethical considerations extend to the reporting phase as well. In the context of joint or family group interviews, there are typically one or more participants who are more dominant and different families’ structures and hierarchies are often reflected in the interview situation. This raises ethical considerations, including ensuring that less dominant family members are given the opportunity to contribute, both during the interview and in the reporting of the findings. During interviews, researchers should direct questions to less vocal participants to encourage their contributions and parents or caregivers should be encouraged to allow their child to speak freely and openly without fear of contradiction. In the analysis and reporting phases, ethical rigor requires careful attention to ensure that dominant voices do not overshadow those of less assertive family members.

Another dilemma concerns the requirement for anonymity and confidentiality in reporting. Publishing joint narratives may inadvertently affect participants’ relationships or compromise their privacy (Bjørnholt & Farstad, 2014; Morris, 2001). In a qualitative interview study with parents of service users in forensic psychiatry, participants were interviewed about their perceptions of mechanical restraint episodes (Tingleff et al., 2019). Mechanical restraints are used as a last resort in mental health settings when a service user poses an immediate and serious risk to themselves, others, or property. In addition to the fact that forensic service users constitute a particularly vulnerable group, the use of mechanical restraints is a controversial practice and is associated with numerous ethical dilemmas. The interviews with the parents were emotional and included detailed descriptions of how they, as relatives, experienced the mechanical restraint episodes, some of which had resulted in formal complaints and media attention. Ensuring anonymity and confidentiality in reporting this information required careful ethical consideration among the research team and the management at the psychiatric department, particularly regarding how to present the findings without revealing identifiable information about participants or their relatives. In some cases, information was omitted because there was a risk that others could identify the staff involved.