CHAPTER 3 RESEARCH DESIGN AND METHODS
The previous chapter focused on the literature reviewed in relation to the research topic. It also provided an overview of the Health Belief Model, which forms the theoretical framework for this study. This chapter describes the research approach, design and methodology that was used to address the lack of a coherent and focused communication strategy, with the aim of designing and implementing guidelines which will lead to a measurable impact on HAST within a provincial context.
In this chapter the discussion focuses on how the study unfolded in two phases and illustrates sampling of the study populations, the collection of data and how both the integrity and the rigor of the study were maintained. The nature of the data obtained and the analysis thereof will be discussed in detail in Chapter 4.
The study followed a mainly qualitative approach in the development of a communication strategy for the Province. Qualitative research implies the investigation of phenomena, typically in an in-depth and holistic fashion, through the collection of rich narrative material using a flexible research design (Polit and Beck, 2012:739). This approach is relevant to this study because the views of the people need to be explored in order to discover the elements of a relevant, acceptable and appropriate strategy to address HAST.
The Characteristics of Qualitative Research
Natural setting: Qualitative researchers tend to collect data in the field at the site where participants experience the issue or the problem under investigation (Creswell, 2014:186). In this study the researcher moved from one district to the other to collect data and also from office to office were the managers are working, to conduct personal interviews. The focus group interview was conducted in the Mayor’s boardroom where District AIDS Council meetings are held.
Researcher as key instrument: Qualitative researchers collect data themselves through examining documents, observing behaviour or interviewing the participants (Creswell, 2014:186). The researcher conducted the focus group interview and personal interviews by herself, in order to gather data.
Multiple sources of data: Qualitative researchers typically gather multiple forms of data, such as interviews transcriptions, observations, documents and audio-visual material, rather than relying on a single data source (Creswell, 2014:186). In this study, the multiple data sources utilised included interviews, observations and documents.
Inductive and deductive data analysis: Qualitative researchers build patterns, categories and themes from the bottom up by organising the data into increasingly more abstract units of information. This induction process involves working back and forth between the themes and the database until the researcher has established a comprehensive set of themes. Then, deductively, the researcher will look back at the data from the themes to determine if more evidence can support each theme or whether additional information needs to be gathered. Thus, while the process begins inductively, deductive thinking also plays an important role as the analysis moves forward (Creswell, 2014:186).
Participants’ meaning: During the entire qualitative research process, the researcher keeps a focus on learning the meaning that participants hold about the problem or issue, not the meaning that the researcher brings to the research or the meaning that the authors express in the literature.
Emergent design: The research process for qualitative researcher is emergent. This means that the initial plan for research cannot be tightly prescribed and some or all phases of the process may change or shift after the researcher enters into the field and begins to collect data (Creswell, 2014:186).
Reflexivity: In qualitative research, the inquirer reflects on how their role in the study and their personal background, culture and experience holds potential for shaping their interpretation of information gathered, such as the themes they advance and the meaning they ascribe to the data. This aspect of the research method is more than merely advancing biases and values in the study, but how the background of the researcher may actually shape the direction of the study (Creswell, 2014:186).
Holistic account: Qualitative researchers try to develop a complex picture of the problem or issue under study. This involves reporting multiple perspectives, identifying the many factors involved in the situation and generally sketching the larger picture as it emerges. A visual model of many facets of a process or a central phenomenon aids in establishing this holistic picture (Creswell, 2014:186).
Application of qualitative approach to the study
Qualitative research methods guide the nursing practice, through the evidence generated by its findings (LoBiondo-Wood and Haber, 2006:151). In this study, the communication strategy developed for mitigating HAST will guide nursing practice as health care personnel become aware of the approaches and the strategies to be utilised in addressing issues of HAST. It will also guide nursing practice by using personal stories to enlighten and enrich understanding of everyday health experience (LoBiondo-Wood and Haber, 2006:151). In this study no personal stories were required, only the work experiences of the Deputy Directors working in HAST were used.
The researcher used an exploratory research design. Exploratory research design is a sequential design in which qualitative data are collected with the aim of collecting rich data to the point of saturation (Polit and Beck, 2012:727). In the study the personal and focus group interviews used explored the views of the Deputy Directors and the community members to the point of saturation.
CONTEXT OF THE STUDY
The study was conducted in the Limpopo Province, the demography; socio-economic profile and cultural context are discussed as follows:
Demography of the Province
Limpopo Province is situated in the northern part of South Africa, with an estimated population at 5.56 million people. The Province accounts for 11% of the total population in the Republic of South Africa, which is estimated at 51 million. This makes Limpopo the fourth most populated province in the country, after Gauteng, KwaZulu-Natal and the Eastern Cape, respectively. From a district perspective, the Limpopo Province consists of five districts, namely, Capricorn, Mopani, Sekhukhune, Vhembe and Waterberg. The Province’s population is unevenly distributed throughout the five districts (Department of Health, 2011:14). Close to half of the Province’s population (47%) is found in the Capricorn and Vhembe Districts, while the Waterberg District accounts for the smallest proportion of the population (13%) in the Province. When it comes to gender structure, districts generally emulate the provincial picture, with females out numbering males (Department of Health, 2011:14). According Statistics SA (2014:15) Limpopo has a total population of 5 630 464, made up of 2 649 113 males and 2 981 351 females. Figure 1 below shows the 5 districts that make up the Province of Limpopo and the concentration of agricultural activities in the Province, which is the main economic activity in the Province, followed by mining (Department of Health, 2011:14)
The population of the Limpopo Province is youthful, with 35% (1.93 million) made up of children under the age of 15 years. Six out of 10 people in the 15 to 64 year age group (3.3 million) are economically active, while elderly people are in the minority, making up 5% of the Province‘s population. Females constitute the majority, accounting for 54% (3 million) of the Province’s population. It is, therefore, critical that the youth and women, including young girls, are prioritised for service delivery, together with key populations (Department of Health, 2011:15).
Socio-economic profile of the province
The rural nature of the Province, unemployment, gender inequality and illiteracy are some of the major factors that affect the Limpopo Province (Department of Health, 2011:16). Approximately 80% of the Limpopo Province is rural, with a 19% unemployment rate. Available information shows that one in three people (33.4%) aged 20 and older has had no formal education. The highest proportion of people in this category (39%) is found in Vhembe District, while Capricorn District has the lowest percentage (9%) (Department of Health, 2011:16).
The rate of unemployment has a direct impact on economic growth in the Province. The unemployment rate in the Limpopo Province is estimated at 22.6%, which compares unfavourably to unemployment in other provinces in the country, such as the Western Cape (21.8%) and KwaZulu-Natal (20.8%) (Department of Health, 2011:16).
Cultural Context of Limpopo
The common languages in the Province are: Afrikaans, English, isiNdebele, Sepedi, Tshivenda and Xitsonga. However, all of South Africa’s official languages, plus the South African sign languages, receive proper respect. In terms of effective communication this may imply that all material must be translated into the different languages of clients in the Province (Limpopo Provincial Government, 2009:7).
Kings/chiefs still play an important role in the community and involving them in government communication programmes is highly emphasised. The involvement of other stakeholders, such as the faith groups, business and civic associations should also be emphasised. Cultural practices, such as ritual killings and witchcraft, are still rife in some parts of the Province (Limpopo Provincial Government, 2009:7).
Cultural groups like Ndebele, Tshonga, North Sotho and Vhenda, are mostly Christians but many people also believe that the ancestors or spirits of family members who have died play a powerful role in their lives (Limpopo Provincial Government, 2009:7). When communicating with people in this Province one must be aware of their beliefs and be sensitive to their beliefs and culture. The use of relevant language and tone of voice to show respect is very important. Respect is the key when addressing elders, especially about sex and sexuality-related topics. An adult should address them, not a teenager. There are topics, like medical male circumcision, that only males can address other men on and a tribal gathering (Dikgoro) is the relevant place to have such conversations. A man who has undergone initiation at an initiation school is the only person who is allowed to address other men at the tribal office. When following these cultural norms and beliefs it becomes easy to reach all communities in the Province.
The research method is discussed in relation to the two phases of the study, i.e. phase one of situational analysis and phase two of communication strategy development.
Phase 1: Situational analysis.
This section will discuss the research population, sample and sampling procedure, research setting, ethical considerations and limitations. The study methodology was guided by the major tenets of the Health Belief Model as discussed in Chapter 2. These major tenets, which guided the research process, involve modifying factors, individual beliefs and action.
The study was conducted in the Limpopo Province. The social, cultural and geographic context of Limpopo is described in Chapter 3.4. The context of the study assisted the researcher in understanding the modifying factors as it highlighted the aspects of demography, socio-economic profile, cultural context and structure of health system. All these factors have an impact on perceptions towards HAST.
The study involved multiple populations based on the data collected. For purposes of the literature review, all HAST and communication strategy material was considered. The study population for the focus group interview was made up of civil society members, who were drawn from the database of representatives of the Capricorn District AIDS Council. The following representatives were included in the focus group interview: members of the House of Traditional Leaders, traditional health practitioners, males, participants from the disability sector, faith organisations working within the HIV and AIDS Partnership, people living with HIV and AIDS and older persons. This sample population was also chosen to further identify the modifying factors, individual beliefs and actions. This population assisted further in clarifying modifying factors and actions. The participants were recruited during a District AIDS Council meeting.
Non-probability purposive sampling was also done in relation to specific data collection methods, while considering which sources were able to yield relevant information in relation to the modifying factors, individual beliefs and action. For the purposes of the literature review, the inclusion criteria are set out in Chapter 2, section 2.1. Selection of the focus group interview sample population was based on the following criteria: being an active member of the Capricorn District AIDS Council civil society for at least six months and being able to speak Sepedi, which is one of the languages spoken in the Limpopo Province, specifically in the Capricorn District.
All the HAST Deputy Directors at district and provincial level were recruited to participate in the individual interview part of the study during a Provincial meeting. The inclusion criteria included involvement at district or provincial level in HAST projects. These HAST projects included: Advocacy, Communication and Social Mobilisation for HAST; Tuberculosis; HIV Counselling and Testing; Prevention of Mother to Child Transmission of HIV and AIDS; Comprehensive Care Management and Treatment, Care and Support; TB and HIV Integration, Sexually Transmitted Infections, High Transmitted Areas; Medical Male Circumcision and Condom Logistics. After explaining the purpose of the study, all the managers where provided with an interview schedule in order for them to know what the study was all about. Each interview schedule was accompanied by a covering letter (see Annexure D) identifying the person undertaking the research and providing a brief description of the purpose of the study. The name, address and telephone number of the researcher appeared on the covering letter so that respondents could contact the researcher should they wish to do so for whatever reason.
Follow-up individual discussions were also undertaken, followed by a telephonic appointment. All managers agreed to participate. However, only 18 participants were interviewed. The sample size was determined by data saturation.
TABLE OF CONTENT
TABLE OF CONTENT
LIST OF TABLES
LIST OF FIGURES
LIST OF ABBREVIATIONS
LIST OF APPENDICES
TABLE OF CONTENT
CHAPTER 1 ORIENTATION TO THE STUDY
1.2 THE BACKGROUND TO THE RESEARCH PROBLEM
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 DEFINITION OF KEY CONCEPTS
1.7 THEORETICAL GROUNDING OF THE RESEARCH
1.8 THEORETICAL FOUNDATION OF THE STUDY
1.9 RESEARCH METHODOLOGY
1.11 ETHICAL CONSIDERATIONS
1.12 SCOPE OF THE STUDY
1.13 STRUCTURE OF THE THESIS
CHAPTER 2 THE CONTEXT OF THE STUDY AND LITERATURE REVIEW RELEVANT TO THE
2.2 INTERNATIONAL AND NATIONAL TRENDS OF PREVALENCE OF HIV AND AIDS, STIs AND TB (HAST)
2.3 LIMPOPO PROVINCE TRENDS OF THE PREVALENCE OF HIV AND AIDS, STIs AND TB (HAST)
2.4 FACTORS INFUENCING THE PREVALENCE OF HAST
2.5 NATIONAL AND PROVINCIAL LEGISLATIVE FRAMEWORK
2.6 MONITORING OF HAST PROGRAMMES
2.7 COMMUNICATION STRATEGIES IN HEALTH
2.8 A THEORETICAL FRAMEWORK FOR THE STUDY
CHAPTER 3 RESEARCH DESIGN AND METHODS
3.2 RESEARCH APPROACH
3.3 RESEARCH DESIGN
3.4 CONTEXT OF THE STUDY
3.5 RESEARCH METHODS
3.7 ETHICAL CONSIDERATION
3.8 LIMITATION OF THE STUDY
CHAPTER 4 DATA ANALYSIS AND DISCUSSION
4.2 ANALYSIS OF DATA
CHAPTER 5 COMMUNICATION STRATEGIES: DRAFTING AND PILOTING
5.2 DRAFT HAST COMMUNICATION STRATEGY
5.3 PILOTING OF THE DRAFT COMMUNICATION STRATEGY
CHAPTER 6 CONCLUSION, LIMITATIONS AND RECOMMENDATIONS
6.2 RESEARCH OBJECTIVES
6.3 RESEARCH DESIGN AND METHOD
6.4 PHASE1: SITUATIONAL ANALYSIS
6.5 PHASE 2: DEVELOPMENT OF THE HAST COMMUNICATION STRATEGY
6.7 RECOMMENDATIONS FOR FURTHER RESEARCH
6.8 MEETING THE RESEARCH OBJECTIVES
6.9 CONTRIBUTION OF THE STUDY
6.10 LIMITATION OF THE STUDY
LIST OF SOURCES
GET THE COMPLETE PROJECT