NAME OF INSTITITION HARARE INSTITUTE OF

TECHNOLOGY

NAME OF SCHOOL ALLIED HEALTH SCIENCES

NAME OF DEPARTMENT RADIOGRAPHY

CANDIDATE COURAGE MLAMBO

REG NUMBER H210288W

Evaluation of psychological experiences and coping mechanism of women who went

through pregnancy termination due to fetal anomalies and fetal demise

1.0 Introduction

Diagnosis of fetal anomalies is an unexpected event and causes severe emotional harm to women

(Zuleika , et al., 2021). Ultrasound (US) is primarily used to detect abnormalities and monitor the

growth of the fetus (Zuleika , et al., 2021). During pregnancy, the maternal can visit the

radiology department during the first, second, and third trimesters for continuous growth

monitoring of the fetus and evaluation of possible anomalies. The role of the scans is to evaluate

the growth and access abnormalities of the fetus (ISUOG, 2013). Receiving a diagnosis of fetal

anomalies during routine ultrasound scans can be a profoundly challenging experience for

women. The news of a significant abnormality in their unborn child disrupts their expectations

and dreams, giving rise to a myriad of uncertainties, fears, stress, and anxieties (Kornelea , et al.,

2020). Understanding the impact of this diagnosis on women's psychological well-being and

exploring the coping mechanisms they employ is of utmost importance in providing appropriate

support and interventions.

According to Chaloumsuk, (2021) Pregnancy termination for fetal abnormality (TFA) has

significant psychological consequences. Most previous research has focused on measuring TFA's

psychological outcomes, and little is known about the coping strategies involved (Bahareh , et

al., 2023). According to a study done in Iran by Bahareh et al., in 20220 coping mechanisms

comprised four structures, consistent across time points: support, acceptance, avoidance, and

meaning attribution (Bahareh , et al., 2023). Women mostly used adaptive coping strategies but
reported inadequacies in aftercare, which challenged their resources (Keefe-Cooperman, 2015).

The study's findings will indicate the need to provide sensitive, nondirective care rooted in the

acknowledgment of the unique nature of TFA. Findings from the study concluded that enabling

women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting

the potential value of spending time with the baby, and providing long-term support (including

during subsequent pregnancies) might promote psychological adjustment to TFA (Zuleika , et

al., 2021).

1.1 Background

Broad advances in diagnostic technologies and the widespread and early application of imaging

techniques have led to early diagnosis of pregnancy and maternal-fetal attachment (Leuthner &

Jones, 2017). Diagnosis of fetal anomalies is an unexpected event and causes severe emotional

harm to women (Keefe-Cooperman, 2015). Loss of self-esteem due to a feeling of physical

inadequacy in giving birth to a healthy child, assuming moral responsibility for deliberate fetal

death, and the stress due to fear of social judgment lead to greater loneliness and vulnerability in

these women (Chaloumsuk, 2021). Studies showed that women with pregnancy termination due

to fetal anomalies do not receive adequate support, and cannot even mourn the death of their

child due to a lack of public awareness of this type of loss (Keefe-Cooperman, 2015). Even if the

decision to terminate pregnancy is the best choice for the current situation, it will have many

psychological consequences for the parents. Maguire et al. showed that 17% of women

experienced symptoms of post-traumatic stress for 2 to 7 years after pregnancy termination due

to fetal anomalies (Kornelea , et al., 2020).

Studies revealed that the majority of these women have symptoms of depression, sleep

disturbances, restlessness, and nutritional problems, and approximately 14% of them suffer from
symptoms of severe depression (Kornelea , et al., 2020). Even mild psychological reactions

during this critical period significantly predict long-term adverse psychological consequences

(Kornelea , et al., 2020). There are currently no specific support systems for this group of

women. Although there are presently online groups in some countries to support women

experiencing pregnancy termination due to fetal anomalies, it is not yet clear whether this form

of support fully fits the needs and desires of this population (Leuthner & Jones, 2017).

Qualitative research is an approach to discovering and describing people’s experiences and

conceptualizing them which leads to increased insight, understanding, and awareness about

human experiences. Considering the different dimensions of the experience of pregnancy

termination due to fetal anomalies, conducting a study, particularly a qualitative study can

provide a deeper understanding of the psychological experiences of these women in their social-

cultural context. Understanding these psychological experiences can be used in designing and

implementing care based on the needs and desires of these women. Therefore, the present

qualitative study is to be conducted to explore the psychological experiences of women with

pregnancy termination due to fetal anomalies.

1.3 Problem statement

Ideally, understanding the psychological effects and coping mechanism experienced by women

diagnosed with fetal anomalies and fetal demise during prenatal scans is of utmost importance,

however, there is a paucity of research in this area in Zimbabwe hindering the development of

targeted interventions and support systems to alleviate their emotional distress.

1.4 Aim
The present study aims to explore the psychological experiences and coping mechanisms of

women with pregnancy termination due to fetal anomalies and fetal demise.

1.5 Objectives

a) To assess the psychological impact experienced by women who are about to do pregnancy

termination after a diagnosis of fetal anomalies and fetal demise.

b) To evaluate the coping mechanisms employed by women facing pregnancy termination due to

diagnosed fetal anomalies and fetal demise.

1.6 Justification of the study

The research will focus on exploring the physiological effect on women who will have

pregnancy termination therefore enhancing support systems, improving maternal mental health,

and informed decision-making. This also deals with psychosocial support to women with fears of

the community and traditional factors for example someone may be seen as a social outcast due

to pregnancy termination. Therefore, coping mechanisms and support systems will be

implemented to overcome this problem.

1.7 Chapter Summary

This chapter explains the problem the researcher will dwell on and the study's objectives. The

main aim of this study is to explore the psychological experiences and coping mechanisms of

women with pregnancy termination due to fetal anomalies and fetal demise. This helps to

improve the coping strategy that will be employed for the woman who undergoes pregnancy

termination due to fetal anomalies.

Chapter 2 literature

2.0 Introduction

This chapter summarizes existing research literature concerning women’s experiences of

miscarriage and women’s experiences of termination of pregnancy for fetal anomaly and fetal

demise. The literature included in this review covers both quantitative and qualitative studies

related to the issue of pregnancy termination due to fetal anomalies and fetal demise. This

chapter is intended to give an overview of the current knowledge of these issues of pregnancy

termination. Finally, gaps in the knowledge and the need for further research will be identified.

2.1 Roles of Ultrasound During Fetal Assessment

Routine ultrasonography is a follow-up exam that is performed on pregnant women, from a week

of conception to the day of delivery (Aghakhani, et al., 2018). The examination is usually carried

out once or twice during every trimester of pregnancy and it is performed by sonographers

(Chaloumsuk, 2021). According to Gammeltof, (2007) this exam enables the evaluation of the

state of the pregnancy, such as the monitoring of the cardiac activity of the fetus, gestational age,

placental localization, assessment of the amniotic fluid, and the assessment of fetal anatomical

structures and movement. In addition, routine obstetric ultrasonography is considered a vital part

of antenatal care because it reveals fetal biometrics which are important for the evaluation of

fetal growth, improving the management of pregnancy complications when compared with

selective use for specific indications such as after clinical complications for example bleeding in

early pregnancy (Leuthner & Jones, 2017). Furthermore, ultrasound scan improves antenatal

care when there is availability of accurate information for expectant couples, adequate education
with regards to obstetric ultrasonography, and proper antenatal health care provision and

guidelines (Keefe-Cooperman, 2015).

2.2 Fetal demise

In America, Intrauterine fetal demise (IUFD) is a common adverse pregnancy outcome, affecting

approximately 1 in 160 deliveries (Bolluk, et al., 2024). Diagnosis of intrauterine fetal demise

(IUFD) is made by ultrasound confirmation of lack of fetal cardiac activity during a routine

ultrasound scan (Noroozi, et al., 2021). This can be confirmed by either official ultrasound or

direct visualization of bedside ultrasound by two physicians (Lafarge , et al., 2017).

Documentation for a bedside ultrasound must include the names of the physicians who

confirmed the IUFD and the time and date the IUFD was confirmed (Keefe-Cooperman, 2015).

The note must be signed by the attending physician before initiation of management of IUFD.

Full biometry should be attempted to provide the best estimate of gestational age, and

measurements documented in the note, and placental location should be documented.

2.2.1 Counselling after diagnosis

According to a protocol developed in Iran by Chaloumsuk in 2021 for women diagnosed with

fetal demise is as follows (Chaloumsuk, 2021). Firstly, break the news clearly to women, in a

compassionate way, preferably in a private environment (Keefe-Cooperman, 2015). Secondly,

take time to provide immediate emotional support and allow the patient to call a partner, family

member, or friend (Chaloumsuk, 2021). The main aim is to support maternal/parental choice

regarding further management. Lastly, provide written information on management options if

necessary and if the mother is clinically stable, allow time for grieving.

2.3.0 Fetal anomalies that cause pregnancy termination

Globally, a routine ultrasound scan is an established part of antenatal care if resources are

available and access is possible (Salomon, 2011). It is commonly performed in the second

trimester (week 14 to week 24), although routine scanning is offered increasingly during the first

trimester, particularly in high-resource settings (Deter, et al., 2019). Ongoing technological

advancements, including high-frequency transvaginal scanning, have allowed the resolution of

ultrasound imaging in the first trimester to evolve to a level at which early fetal development can

be assessed and monitored in detail (Pizzi , et al., 2010)

2.3.1 Role of the second trimester

The second-trimester ultrasound is commonly performed between 14 and 26 weeks of gestation

(Durand, et al., 2010). Historically, the second-trimester ultrasound was often the only routine

scan offered during pregnancy and was so expected to provide information about gestational age,

fetal number and type of multiple pregnancies, placental position and pathology, as well as

detecting fetal abnormalities (Altshuler & Nguyen, 2016). During the second trimester scan, it is

possible to deduce the gender of the fetus. Many patients have several ultrasound scans during

their pregnancy with the first trimester nuchal translucency assessment becoming particularly

common. The second-trimester ultrasound is now less often required for dating or detection of

multiple pregnancies but remains very important to detect placental pathology and despite

advances in first-trimester anomaly detection, remains an important ultrasound for the detection

of fetal abnormalities (Andersson, et al., 2024). To maximize detection rates there is evidence

that the ultrasound should be performed by operators with specific training in the detection of

fetal abnormalities (Bethune, 2015). Routine use of the second-trimester anomaly scan to

calculate downs syndrome risk in women who were not screened earlier is likely to have a low

detection rate.
2.3.2 Role of third-trimester scanning

At this stage of pregnancy, the fetus has all vital organs fully developed and the period of fast

growth and maturity continues. The main objective of a third-trimester obstetric ultrasound

examination is to provide accurate diagnosis information in order to optimize antenatal care and

improve outcomes for the mother and fetus (Molander, 2010). The examination typically focuses

on fetal growth, the position of the placenta, fetal anatomy, and the assessment of amniotic fluid.

It is generally known that an ultrasound examination performed beyond 28 weeks of gestation is

considered in the third trimester and the assessment of fetal growth is commonly initiated

between weeks 28 and 36 in risk pregnancies (Salch, 2017). Fetal anatomy is still done because

many fetal malformations may not appear until later in gestation and some abnormalities may

have been missed on prior ultrasound examinations.

2.4 Psychological Experiences of Women Diagnosed with Fetal Anomaly

The diagnosis of a fetal anomaly during pregnancy can have profound psychological effects on

women (Bahareh , et al., 2023). It initiates a complex emotional journey characterized by various

experiences and responses (Coleman , 2024). By exploring the psychological experiences of

women diagnosed with fetal anomalies, researchers and healthcare professionals can gain

valuable insights into the unique challenges they face. This understanding can inform the

development of targeted interventions, support systems, and counseling approaches to promote

psychological well-being and enhance coping strategies (Durand, et al., 2010). According to

Durand et., (2010) psychological experiences include the following:

Emotional Responses:
Women diagnosed with fetal anomalies commonly experience a range of intense emotions

(Sridhara , et al., 2018). Shock, disbelief, and sadness are often immediate reactions upon

receiving the diagnosis. Many women also report feelings of guilt, self-blame, and a profound

sense of loss for the envisioned healthy pregnancy (WHO, 2021). Anxiety and fear about the

future, the well-being of the baby, and the challenges that lie ahead are prevalent (Altshuler &

Nguyen, 2016). B) Grief and Loss: The diagnosis of a fetal anomaly can trigger a grieving

process for women, as they mourn the loss of the expected healthy baby and the dreams

associated with a typical pregnancy. This grief can manifest in various ways, including feelings

of sadness, emptiness, and longing for the pregnancy experience they had envisioned.

c) Anxiety and Stress: Women diagnosed with fetal anomalies often experience heightened

levels of anxiety and stress. Uncertainty about the prognosis, potential complications, and the

impact on the baby's long-term health can contribute to persistent worry and anxiety. The

ongoing medical appointments, tests, and decision-making processes further exacerbate stress

levels.

D) Impact on Body Image and Self-Esteem: The presence of a fetal anomaly can affect a

woman's body image and self-esteem. Physical changes associated with the anomaly, such as

visible deformities or the need for medical interventions, can lead to feelings of self-

consciousness and a negative impact on body image. This in turn may affect a woman's overall

self-esteem and confidence.

2.5 Psychological Effects on Partners and Family Members:

The psychological impact of a fetal anomaly diagnosis extends beyond the woman herself.

Partners and family members also experience a range of emotions, including shock, sadness, and
anxiety. They may undergo their processes of grief and struggle with how best to support the

woman during this challenging time. Understanding the psychological experiences of partners

and family members is essential for providing comprehensive support to the woman and her

support network 2.6 Coping Mechanisms

Women diagnosed with fetal anomalies employ various coping mechanisms to navigate the

emotional challenges they face. These coping strategies are crucial for their psychological well-

being and resilience throughout the journey of managing a pregnancy with a fetal anomaly.

Understanding these coping mechanisms can provide insights into effective support strategies

and interventions. The following are some commonly observed coping mechanisms:

1. Seeking Social Support: Many women rely on social support from their partners, family

members, friends, and other individuals who have experienced similar situations. Sharing their

emotions, concerns, and fears with trusted individuals can provide a sense of validation, comfort,

and understanding. Social support networks can serve as a source of encouragement, guidance,

and practical assistance during this difficult time.

2. Engaging in Information-Seeking Behaviors: Women often engage in active information-

seeking behaviors to gain knowledge about the specific fetal anomaly, available treatment

options, and the long-term implications for their baby. Seeking information empowers women to

make informed decisions, understand the prognosis, and feel a sense of control in an otherwise

uncertain situation. Healthcare providers play a vital role in providing accurate and reliable

information to support women's decision-making processes.

3. Participating in Support Groups or Online Communities: Support groups and online

communities specifically tailored for women facing fetal anomalies can provide valuable
emotional support and a sense of belonging. These platforms allow women to connect with

others who share similar experiences, exchange information and offer mutual encouragement.

Participating in these groups can help normalize their feelings, reduce isolation, and provide a

safe space for expressing emotions.

4. Utilizing Personal Resources: Women may draw upon personal resources such as spirituality,

faith, or creative outlets to cope with the emotional challenges of a fetal anomaly diagnosis.

Engaging in prayer, meditation, or other spiritual practices can provide solace and a sense of

connection to something larger than themselves. Creative outlets, such as journaling, art, or

music, allow women to express their emotions and process their experiences in a meaningful

way.

5. Seeking professional counseling and psychological interventions: Many women benefit from

professional counseling and psychological interventions tailored to their specific needs.

Individual therapy, couples counseling, or group therapy sessions can help women explore their

emotions, develop coping strategies, and navigate the complexities of decision-making.

Cognitive-behavioral therapy (CBT), relaxation techniques, and mindfulness-based interventions

have shown promise in reducing anxiety and improving overall well-being. It is important to

note that coping mechanisms can vary among individuals, and what works for one person may

not work for another. Women may employ a combination of coping strategies based on their

unique circumstances, personal preferences, and available resources. Healthcare professionals

should adopt a holistic approach, acknowledging and supporting the coping mechanisms that

align with each woman's needs and preferences.

2.7 Effectiveness of Different Coping Mechanisms

Understanding the effectiveness of different coping mechanisms employed by women diagnosed

with fetal anomalies is essential for healthcare professionals and support services to provide

appropriate guidance and intervention. While the effectiveness of coping strategies can vary

among individuals, several commonly observed coping mechanisms have shown positive

outcomes:

1. Social Support: Seeking social support has been consistently associated with improved

psychological well-being and emotional adjustment in women facing fetal anomalies. Studies

have found that women who have access to a strong support network, including partners, family

members, and friends, report lower levels of distress, increased resilience, and enhanced coping

abilities. The validation, empathy, and assistance received from these sources can help alleviate

feelings of isolation and provide a sense of comfort and understanding.

2. Information-Seeking Behaviors: Engaging in active information-seeking behaviors has been

found to empower women and enhance their ability to cope effectively. Access to accurate and

reliable information about the specific fetal anomaly, available treatment options, and long-term

prognosis plays a crucial role in reducing uncertainty and promoting informed decision-making.

Women who are well-informed about their situation tend to experience lower levels of anxiety

and increased feelings of control over their circumstances.

3. Support Groups and Online Communities: Participation in support groups and online

communities tailored for women facing fetal anomalies has shown promise in promoting

emotional well-being and reducing feelings of isolation. These platforms provide opportunities

for women to connect with others who share similar experiences, exchange information and

advice, and offer emotional support. Studies have reported that women who engage in such

groups experience a sense of validation, reduced distress, and improved coping skills.
4. Personal Resources: Utilizing personal resources, such as spirituality, faith, and creative

outlets, can be effective in promoting emotional well-being for women diagnosed with fetal

anomalies. Engaging in spiritual practices or utilizing personal beliefs can provide a source of

comfort, hope, and meaning-making during challenging times. Similarly, creative outlets such as

art, music, or writing allow women to express their emotions, engage in self-reflection, and find

solace. 5. Professional Counseling and Psychological Interventions: Seeking professional

counseling and psychological interventions can be highly beneficial for women navigating a

pregnancy with a fetal anomaly. Studies have shown that individual therapy, couples counseling,

and group interventions tailored to the specific needs of women facing fetal anomalies can

improve emotional adjustment, reduce anxiety and depression symptoms, and enhance coping

strategies. Cognitive-behavioral therapy (CBT) and mindfulness-based interventions have

demonstrated effectiveness in promoting psychological well-being and resilience.

2.8 Women's Awareness of Fetal Anomalies

Awareness among women about fetal anomalies is a crucial aspect of prenatal care and decision-

making. Understanding the level of awareness women have regarding fetal anomalies can help

healthcare professionals tailor their communication strategies, provide appropriate information,

and support women in making informed choices (Brown, 2017). The following factors may

influence women's awareness of fetal anomalies:

1. Cultural and Educational Background: Cultural and educational factors play a significant role

in shaping women's awareness of fetal anomalies. Different cultures have varying levels of

openness and discussion surrounding pregnancy and prenatal health. In some cultures, there may

be taboos or social stigmas associated with discussing fetal anomalies, leading to limited
awareness. Additionally, educational background and access to healthcare information can

influence a woman's understanding of fetal anomalies and their associated risks.

2. Preconception and Prenatal Education: Preconception and prenatal education classes or

programs can play a vital role in enhancing women's awareness of fetal anomalies. These

educational initiatives provide information about prenatal health, the importance of prenatal

screenings, and the potential risks and implications of fetal anomalies. Women who participate in

such programs often have a higher level of awareness and knowledge regarding fetal anomalies.

3. Healthcare Provider Communication: The quality and effectiveness of communication

between healthcare providers and pregnant women significantly impact awareness levels. Clear

and comprehensive discussions about prenatal screenings, diagnostic tests, and the possibility of

detecting fetal anomalies can help increase women's awareness. Healthcare providers who take

the time to explain the conditions, answer questions, and provide resources can positively

influence women's understanding of fetal anomalies. 4. Personal Experiences and Information-

Seeking Behaviors: Personal experiences, such as a family history of fetal anomalies or previous

pregnancies affected by such conditions, can heighten a woman's awareness and knowledge.

These experiences may prompt women to seek information actively, engage in online research,

or participate in support groups where they can learn from others' experiences and gain a deeper

understanding of fetal anomalies.

5. Media and Online Resources: Media and online platforms play a significant role in

disseminating information about fetal anomalies. Television programs, documentaries, websites,

and social media platforms can contribute to women's awareness by providing accessible and

easily understandable information. However, it is important to note that the accuracy and

reliability of information from these sources can vary, and healthcare professionals should guide
women toward reputable and evidence-based resources. Assessing the level of awareness among

women regarding fetal anomalies is crucial for developing effective educational initiatives and

support systems. By understanding the factors that influence awareness, healthcare providers can

tailor their communication strategies, provide targeted education, and address any

misconceptions or gaps in knowledge

CHAPTER 3: METHODOLOGY

3.0 Introduction

The chapter describes the research design, setting, population, sample size, and sampling method

that the researcher is going to use while doing the study. It will also cover how the data will be

collected and analyzed. Lastly, the validity and reliability of the study and ethical considerations

will be considered. The present study aims to explore the psychological experiences and coping

mechanisms of women with pregnancy termination due to fetal anomalies and fetal demise.

3.1 Research design

This study will utilize a qualitative research design to evaluate the psychological effects and

coping mechanisms of women who were diagnosed with fetal anomalies and fetal demise during

an ultrasound scan in Zimbabwe. Qualitative research is well-suited for gaining in-depth insights

into the experiences and beliefs of participants, allowing for a nuanced understanding of the

topic. This study is going to be a retrospective study where records of women diagnosed with

fetal anomalies who also underwent pregnancy termination are reviewed and the researcher will
have a follow-up interview. The goal of the researcher is to obtain a snapshot of the population's

perspectives or experiences at a particular moment. Participants responded to a structured

questionnaire comprising closed-ended questions, Likert scales, and occasionally open-ended

questions.

3.2 site of study

The research is going to be carried out in the Harare metropolitan province with three hospitals

named Parirenyatwa Group of Hospitals, Sally Mugabe Central Hospital, and Chitungwiza

General Hospital. The reason for the study is that most fetal anomalies are referred to central

hospitals in Harare from rural areas like Murehwa Center for further management. Therefore, the

site will be suitable for a large sample size, and management by a gynecologist with a

multidisciplinary approach is important.

3.3 Target population

A population is a complete set of objects or people that have common characteristics that are of

interest to the researcher (Kohn, et al., 2021). This study will target women who were diagnosed

with fetal anomalies from 1 January 2023 to 31 December 2024 and who underwent pregnancy

termination. The study only targets the pregnant termination process that was done at the hospital

after fetal anomalies or fetal demise diagnoses from the above period.

3.4.1 Inclusion criteria

- Women who are diagnosed with intrauterine fetal demise during a routine ultrasound scan

-Women who are diagnosed with fetal anomalies and are to undergo pregnancy termination

-Women who are willing to participate

-Women who underwent pregnancy termination at government hospitals and private hospitals

3.4.1 Exclusion criteria

Woman without fetal anomalies confirmed by a radiologist

-Women who are not willing to participate in the study

A woman who has pregnancy termination which is not confirmed by the doctor to have the

pregnancy terminated.

3.5 Sample Size and Sampling

Sampling is a technique of selecting individuals, events, or other elements with which to conduct

a study (Aghakhani, et al., 2018). It is important to select a sampling method that provides a

good representation of the population and can also be carried out in the shortest time possible,

whilst being within the researcher’s financial capabilities. The researcher is going to use

purposive sampling (non-random sampling technique).

Sample size calculation

The researcher is going to use Sloven's formula to calculate the sample size as shown below

N
n= 2
1+ N e

Where n = sample size

N = population size

.e= acceptable margin of error which was 5% at a 95% confidence level

Therefore, n =100/ (1+{100e2})

 =80 participants

However, participants will have to sign the consent form before participation as a way of seeking

consent from them. Therefore, this will reduce the number of participants by a certain figure.

3.6 Data collection procedure

Data will be collected through semi-structured interviews with women having confirmed fetal

anomalies. The interview questions will be designed to explore the psychological effects and

coping mechanisms of these women. Interviews will be conducted either in person or via virtual

platforms, based on participant preferences.

Interview Process: Participant Selection: patients will be purposively selected. A diverse sample

of participants with different fetal anomalies will be sought to capture a range of perspectives.

Interview Design: A semi-structured interview guide will be developed based on the research

objectives. The guide will include open-ended questions to allow participants to freely express

their thoughts and experiences. Interviews: Interviews will be conducted either in person at a

mutually convenient location or via virtual platforms such as video calls. The interviews will be

audio-recorded with the participant's consent for accurate data collection.

Data Collection: During the interviews, patients will be asked about their experiences,

challenges, beliefs, and perspectives on fetal anomalies. They will also be asked about their

coping mechanisms throughout the experience. Follow-up: Probing questions may be asked to

delve deeper into specific topics or to clarify responses. This will ensure a comprehensive

understanding of the participants' perspectives.

Data Validation: To ensure data accuracy and credibility, participants may be provided with a

summary of their key points for validation and feedback after the interviews.
3.7 Data analysis

Thematic analysis will be used to analyze the interview data. Transcripts of the interviews will

be coded and categorized into themes and sub-themes based on recurring patterns and topics.

This analysis approach will allow for a comprehensive exploration of the psychological effects

and coping mechanisms. 16 Transcription: The interview recordings will be transcribed verbatim

or through detailed note taking for analysis. Coding: Transcripts will be coded systematically to

identify recurring themes and patterns. Theme Development: Themes and sub-themes will be

developed based on the coded data to organize and categorize the findings. Interpretation: The

researchers will analyze the themes to interpret the data and draw meaningful conclusions about

the psychological effects and coping mechanisms of women diagnosed with fetal anomalies

during ultrasound scans.

3.8 Data cleaning

Data cleaning will be done to detect and correct inaccurate information from a set of compiled

data. The researcher is going to use the capability of Microsoft Excel spreadsheet functions to

assist in identifying errors. The researcher will review the highlighted data and make corrections

where necessary.

3.9 Data storage

During data collection, information gathered from radiographers is going to be stored in

researcher’s laptop away from the reach of the public. Only the researcher and the supervisor

will have access to the study results. The personal computer that will be used is going to have

password to denial access from unauthorized users. The data is going to be backed up in the

researcher’s iCloud since the researcher is expected to keep the findings for at least two years

after the research is completed.

3.9.1 Validation

Data validation will enlighten how well the collected records will cover the actual area under

investigation.

3.10 Ethical consideration

Autonomy and informed consent

The participants had the right to autonomy. This is the right to make their own decisions. The

researcher will explain the aim of the study to the participants, the benefits and the dangers

associated with the study. The researcher will allow participants to make their decision on

whether or not to participate and they signed a consent form when they agreed to participate. The

researcher will have consent form signed before they can participate. The participants will be

informed that they had the right to stop participating whenever they felt like doing so.

Protecting anonymity and confidentiality

Confidentiality of the participants will be insured and information concerning the participant will

not disclosed by the researcher. This study will not collect any personally identifiable

information from participants. Numbers will be assigned to each participant for identification

purposes during data collection hence, the data that will be collected by the researcher had no

direct link to the identification of the participant in any way.

Minimizing risk of harm

No physical harm will be inflicted on the participants. Approval from the Medical Research

Council of Zimbabwe (MRCZ) will be obtained before the study was carried out. Approval from

the HOD to the Department of Medical Physics and Imaging Sciences was obtained before

carrying out the study 30

3.11Chapter Summary

In this chapter, the researcher explained how the study is going to be carried out from the sample

size to the methods of data collection. An outline of how the data is going to be collected,

managed and analysis is provided.

Gannty chart

Time 10 August 10 11 October 12 5 January 15

to 15 September to 15 November to 15 February

September to 15 November to 15 February to 28

Activities October December February

Problem

identification

Literature

review

Random

survey

Ethical

Clearance

(MCRZ)

Data

collection

Data analysis

Conclusion

and
 discussion

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