There are a number of issues which could potentially limit participation
or introduce bias to the results. The first of these may arise because HCEs were initially concerned that any data collected as part of this study might be used
against the HCE to assess official penalties or to jeopardise the image of HCE. To address this concern, a series of meetings was organized with appropriate authorities from the HCE and with the selected respondents to reassure them that confidentiality would be strictly observed, and that the data was to be collected only for academic research purposes. Following this process, HCEs generally agreed to participate; a substitution procedure (as described in Patwary et al. (2009a) was adopted for those HCEs (7) for which consent could not be obtained.