HEALTH PROMOTION MODEL (HPM)

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CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY

 INTRODUCTION

This chapter describes the research design and methodology including the research site, population and sample, data collection and analysis, scientific rigour and ethical considerations. The purpose of the study was to explore and describe the positive values of masculinity and the role of a man in the prevention of HIV and AIDS and teenage pregnancy in a rural sub-district in KwaZulu-Natal, South Africa in order to develop a health education handbook for young Zulu men. Research objectives are “specific accomplishments researchers hope to achieve by conducting the study” (Polit & Beck 2017:69). The objectives of this study were to
• identify expectations of a man of essence/positive values of masculinity
• describe the man’s role in the prevention of HIV and AIDS and teenage pregnancy
• develop a health education handbook for young men in developing positive values of masculinity Research questions are queries to be answered to address the research problem (Polit & Beck 2017:69). In order to achieve the purpose and objectives, the study wished to answer the following questions:
• What are the expectations of a man of essence?
• What is the role of a man in the prevention of HIV and AIDS and teenage pregnancy?
• What health education can be developed for young men in developing positive values of masculinity?

 RESEARCH APPROACH AND DESIGN

A research approach is a plan and procedure for research that is informed by the philosophical assumptions the researcher brings to the study, the nature of the research problem, the researcher’s personal experiences and the audiences for the study (Cresswell 2014:3).
There are three approaches to research namely: quantitative, qualitative and mixed methods. The quantitative and qualitative methods are the ends of a continuum and the mixed methods are the middle of a continuum.
Quantitative research collects data in the form of numbers using closed-ended questions. Qualitative research collects data in the form of words using open-ended questions. Mixed methods research collects both quantitative and qualitative data (Cresswell 2014:4).
In this study the researcher chose the qualitative approach because the researcher intended to collect data in the form of words – descriptions of a man of essence and how they protect themselves and others from HIV and AIDS and impregnating a girl.
The decision to do a qualitative study was based on the purpose of the study, questions to be asked and type of data to be collected. Creswell (2014:5) refers to research approaches as philosophical assumptions that a researcher brings to the study. A qualitative research approach is a way of exploring the meaning that persons or communities attach to a social or human problem (Creswell 2014:246). This was an explorative study to obtain data in the form of words rather than numbers, asking open-ended rather than closed question. Data analysis was inductive, building from particular to general themes, rather than using statistical procedures and the report was flexible.
The reason for a qualitative study was to explore and describe the participants’ positive values of masculinity and how they applied them in the prevention of HIV and AIDS and teenage pregnancy. A qualitative approach was suitable to capture the description of masculinity by the participants themselves. A natural setting, the researcher as key instrument, multiple sources of data, participants’ meanings, and reflexivity are characteristics of qualitative research (Creswell 2014:185):
Natural setting: Data was collected in the natural setting of the participants’ homes at times that suited them, by means of semi-structured interviews.
Researcher as key instrument: The researcher personally conducted the interviews with the help of a research assistant.
Multiple sources of data: The semi-structured interviews were audio-recorded with two digital voice recorders, and the researcher and research assistant kept field notes with reflective and reflexive notes and policy documents around HIV and AIDS and fertility regulation on which the handbook was also to be based. The researcher reflected on successes and what needed to be improved in future interviews and the challenges such as the need to add columns to the field notes form, whether the clients were interrupted by interjection or noise. Reflexivity involved thoughts and feeling during the interview, professional, religious and social background and whether it affected or guided the probing or not.
Participants’ meanings: This study relied on the participants’ perceptions and descriptions of the positive values of masculinity and how they applied them in the prevention of HIV and AIDS and teenage pregnancy.
Reflexivity: Reflexivity is critical reflection about one’s biases, and preconceived ideas and values and those of participants that can influence the study (Polit & Beck 2014:390). The researcher critically reflected on the potential of her personal background, culture and values (as a Christian), professional (nurse) and social identity to influence data collection and interpretation of results. Accordingly, the researcher kept reflexive notes on her personal thoughts and feelings, preconceptions, assumptions, reflections, and progress. The researcher also validated her interpretation of what the participants said by paraphrasing and repeating and asking for clarity in order to achieve credibility.
The choice of the research methods is normally determined by research questions that the researcher asks. The design is determined by the type of research strategy (Botma 2014:189). This argument implies that the research procedure a study should follow needs to be problem-oriented, aiming to answer its research questions. That means that the researchers must identify a fully-justified design to complete their research and achieve their research purpose, in order to satisfy the expectation of the potential audiences of their research.
A research design is a type of a study within a quantitative, qualitative or mixed methods approaches. Quantitative designs include experimental (true and quasi) and non-experimental designs such as surveys. According to Polit and Beck 2014:153), true experiments are characterized by doing something to some participants (intervention/treatment), control into the study usually, a control group that does not receive the intervention, and assignment of participants to a control or experimental group (randomization). Quasi experiments (trials without randomization) lack randomization and some even lack control groups (Polit & Beck 2014:157). Non-experimental/observational studies such as survey “provide numeric descriptions of trends, attitudes or opinions” of a sample
A number of qualitative methodologies broadly classified as interpretive exist namely: phenomenology, ethnography, grounded theory, critical action, feminist and narrative research. The aim of interpretive methodologies is to describe and understand the phenomena. The choice is determined by the emphasis and data collection methods. For instance, emphasis for phenomenology is exploring “lived experiences”, cultural rule for ethnography, empowering women for the feminist, generating theory for grounded theory and change in practice for action research. Observation is the gold standard data collection method for ethnography, in-depth interviews for phenomenology, multiple stages of data collection for grounded theory.
First, masculinity can be regarded as a phenomenon experienced by young men. Therefore, phenomenology may be a more suitable methodology to consider because it aims to identify human experiences about a phenomenon as described by the participants. Percy describes phenomenology as studying the “felt qualities” of a phenomenon such as what anger feels like. The participants would have to describe “experiencing” or what the experience of a being a man is like, such as how it feels to be a man. The generic qualitative inquiry investigates the experience of or what happened or describes occurrences in the participants’ lives such as being angry and not what it feels like to be angry (Percy et al 2015:78). This study investigated whatmakes a man, what is expected of a man, not what it feels like to be a man. So phenomenology did not fit.
Narrative enquiry focuses on stories to explore how people interpret events in their lives. The researcher studies the lives of people by asking them to tell their stories. It requires the three voices namely, that of the narrator, which is represented by the tape or text and the theoretical framework which provides the concepts and tools for interpretation. During analysis, the focus may be on content or the interpretation of the story which includes the words used, the feeling evoked by the story, the style of the narrative (Botma 2014:193). Investigating adolescents’ and young adults’ masculinity requires telling of individual stories of masculinity, so narrative research might be helpful to obtain individual mascunility stories of their lives. A study with different possible research designs of looking at masculinity requiring different qualitative methods, suggests that it is difficult to adopt any single traditional qualitative methodology. Moreover, they cannot be simply mixed in one study, due to the ontological and epistemological differences in these methodologies.
Grounded theory does not begin with a focused research problem. The problem and the solution to the problem emerge from the data. It uses data from people to develop and explain the theory. Grounded theory was not suitable because this study was not intended to develop a theory. It was a descriptive not explanatory study.
Ethnography is concerned with description and interpretation of culture and cultural behaviour of people. It varies from broad culture (macroethnography) to small units of culture (microethnography). It includes language (words) actions (behaviour) and products of group members such as food and clothes. It involves a lot of fieldwork to learn the words, actions and products of a group. The typical data collection strategy is participant observation, which involves daily observation of people in their natural setting. Ethnographers also use key informants to help them understand and interpret events and activities observed. It requires a long time, months to years of observation (Polit & Beck 2014:267). The population for the study was young Zulu men in context predominantly occupied by Zulus, so it could be ethnography. However, ethnography is concerned with description and interpretation of culture and cultural behaviour of people. It varies from broad culture (macroethnography) to small units of a culture (microethnography). It would seem suitable for this study, however, it was not suitable because the researcher did not want to investigate culture and cultural behaviour and beliefs of a group, but was interested in an account of masculinity that is not determined by culture alone but a complex of other factors such as religious, socio-economic factors etc. The researcher was interested in the complex, controversial and personal nature of information about the phenomenon (masculinity) and semi-structured interviews were the suitable for obtaining a thick description of complex, controversial and personal information about a phenomenon (masculinity) in their homes (natural setting). (Botma 2010:190).
A case study is “an in-depth analysis of case” such as an event, programme one or more individuals (Cresswell 2014:14). Positive values of masculinity are not a case. A case is bound by time and activity. This research was not intended to study a case because there are many masculinities as constructed by participants.
Participatory action research aims not only to produce knowledge but also actions and conscious raising of marginalised groups and oppressed people to change their lives and those of the researchers. It is collaboration between the researcher and participants. The seven key features of participatory action research are that it is critical, reflective, emancipatory, practical, collaborative, a social process, and aims to transform theory and practice. The researcher did to aim to raise consciousness of the oppressed and bring in terms of the action participatory research but to develop a health education handbook to develop positive values.
However, this study did not fit the traditional qualitative designs namely phenomenology, ethnography, grounded theory, participatory action research or feminism. It did not fit the mixed methods approach because it was not the intention of the researcher to mix quantitative and qualitative approaches and methods. The study design was generic qualitative descriptive, exploratory and contextual.

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Generic qualitative

According to Percy (2015:78), a generic qualitative inquiry is suitable:
• For investigating “people’s reports of subjective opinions, attitudes, beliefs or reflections on their experiences”.
• When the proposed research problem and question requires qualitative or mixed methods.
• When the content of the desired information does not fit the traditional qualitative research designs such as phenomenology, ethnography and grounded theory and case study.
The generic approach was selected based on two reasons: the study did not fit the qualitative traditional designs as it has already been explained above. Second, this study investigated people’s reports on their experiences as men.
Thus the generic approach seems to be much more flexible. This means that no matter how the young men understand the positive values of masculinity, this approach can always fit this study because generic qualitative researchers want to obtain a “rich description of a phenomenon” that is being studied (Kahlke 2014:39).

CHAPTER 1  ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 SOURCE OF THE RESEARCH PROBLEM
1.4 STATEMENT OF THE RESEARCH PROBLEM
1.5 PURPOSE AND OBJECTIVES OF THE STUDY
1.6 SIGNIFICANCE OF THE STUDY
1.7 THEORETICAL FOUNDATIONS OF THE STUDY
1.8 RESEARCH DESIGN
1.9 ETHICAL CONSIDERATIONS
1.10 DEFINITIONS OF KEY CONCEPTS
1.11 OUTLINE OF THE STUDY
1.12 CONCLUSION
CHAPTER 2  THEORETICAL FOUNDATION AND FRAMEWORK
2.1 INTRODUCTION
2.2 HEALTH PROMOTION MODEL (HPM)
2.3 PREVALENCE OF HIV AND AIDS
2.4 TEENAGE PREGNANCY
2.5 MASCULINITY
2.6 CONCLUSION
CHAPTER 3  RESEARCH DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH APPROACH AND DESIGN
3.3 RESEARCH METHODOLOGY
3.4 SCOPE OF THE STUDY
3.5 CONCLUSION
CHAPTER 4  DATA ANALYSIS AND INTERPRETATION, AND FINDINGS
4.1 INTRODUCTION
4.2 DATA MANAGEMENT AND ANALYSIS
4.3 RESEARCH RESULTS
4.4 FINDINGS
4.5 DISCUSSION
4.6 CONCLUSION
CHAPTER 5  FINDINGS, LIMITATIONS AND RECOMMENDATIONS
5.1 INTRODUCTION
5.2 PURPOSE AND OBJECTIVES OF THE STUDY
5.3 FINDINGS
5.4 LIMITATIONS OF THE STUDY
5.5 SIGNIFICANCE OF THE STUDY
5.6 RECOMMENDATIONS
5.7 CONCLUSION
CHAPTER 6  HIV/AIDS AND TEENAGE PREGNANCY PREVENTION: A HANDBOOK FOR YOUNG MEN IN DEVELOPING POSITIVE VALUES OF MASCULINITY
6.1 INTRODUCTION
6.2 CONTRIBUTIONS OF THE STUDY
6.3 DEVELOPING AND COMPILING THE HANDBOOK
6.4 THE DESIGN OF THE HANDBOOK
6.5 CONTENTS OF THE HANDBOOK
6.6 EVALUATION OF THE HANDBOOK
6.7 PROPOSED PLAN FOR IMPLEMENTATION OF THE HANDBOOK
6.8 CONCLUSION
LIST OF REFERENCES
ANNEXURES
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