PREGNANT WOMEN’S ACCESS TO BASIC ANTENATAL CARE IN MPUMALANGA PROVINCE, SOUTH AFRICA

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CHAPTER 3 DISCUSSION OF RESEARCH FINDINGS AND LITERATURE CONTROL

INTRODUCTION

The previous chapter dealt with the research context, research design, population and sampling, data collection, data analysis and trustworthiness of the study. This chapter discusses the findings from the first phase of the study and serves as a platform on which phase 2 of the research is based, as described in chapter 4.
The chapter provides the analysis of the participants’ interview transcripts as well as the recorded observational and personal notes which are the researcher’s experiences and reflections from the data collection period.
The aim of the empirical phase was to explore and describe the various factors to promote community participation and local accountability for the health system so that pregnant women can access basic antenatal care in Bushbuckridge sub-District, Mpumalanga Province. The empirical phase of the research elucidates the needs, perceptions and experiences of pregnant women, healthcare providers and community leaders regarding antenatal care services and the role, functionality and accountability of governance structures for support of basic antenatal care by the participants in the selected area.

DATA COLLECTION AND ANALYSIS

In this section, the methods for data collection and how data was analysed will be described.

Data collection

To generate the data, the researcher personally conducted focus group and face-to-face in-depth individual interviews with pregnant women, community leaders, midwives and members of the governance structures. Interviews were conducted until saturation was reached. The participants were selected purposively due to their involvement in antenatal care, as described in Chapter 2.
In phase 1 of the study, five focus group interviews were conducted with pregnant women, forming thirty-four participants. Eighteen face-to-face in-depth individual interviews were conducted wherein seven were held with community leaders, four face-to-face in-depth individual interviews with members of local governance structures and eight face-to-face in-depth individual interviews with midwives. The focus group discussions and the in-depth interviews were based on the following research questions: What factors can promote community participation and local accountability for basic antenatal care and what barriers exist that might hamper access to and uptake of basic antenatal care services in Bushbuckridge sub-District, Mpumalanga Province?
Participants were asked to respond in the language that they were most comfortable with. They responded in Tsonga, Sotho, Swazi and Zulu. However, some participants also used English mixed with the local languages, which was later translated into English during transcription. Quality control of the translated verbatim responses was done to verify correctness of the translation from the local languages to English.

Data analysis

Data analysis was conducted using the three steps (transcribing, developing category scheme, coding) of qualitative data management and organization as outlined in Polit and Beck (2012:557-560), which is data transcription, developing category scheme and coding the data. The steps which resulted in the development of themes, categories and sub-categories. Themes are a recurring regularity of concepts, ideas, phrases that emerge from analysing qualitative data used in creating headings when reporting findings (Botma et al., 2010:225; Polit & Beck, 2012:744). Categories are the groupings of concepts into identified units that represent meaning of sets of related topics which act as a quick reminder of its referent (De Vos, 2002:347; McMillan & Schumacher, 2010:485). Subcategories are subsets of the categories and the details are discussed in chapter 2.
During data analysis, eleven themes emerged that were used to create the study’s findings. Twenty-one categories were identified which represent the meaning of the related themes that were further subdivided into subcategories. The findings of the study are described in the themes, categories and subcategories.
The content of this chapter consists of the descriptive data analysis of the following data sets: pregnant women, community leaders, members of the governance structures and midwives which culminated to various themes and phenomena related to promoting community participation in and local accountability for basic antenatal care and the existing barriers that hamper access to and uptake of basic antenatal care services in Bushbuckridge.
Data analysis is the process of critically examining the data collected to find meaningful answers into the research question under investigation (Mc Millan & Schumacher, 2010: 367; Polit & Beck, 2012:557).
Qualitative data analysis process was followed which is defined by Morse and Field (as cited in Polit & Beck, 2012:557) as a “process of fitting data together, of making the invisible obvious, of linking and attributing consequences to antecedents. It is a process of conjecture and verification, of correction and modification, of suggestion and defence”. Data was systematically fitted together, coded, categorized and put into broad themes, categories and subcategories. It was then synthesized and interpreted to make meaning about the barriers and the factors to promote community participation and local accountability for basic antenatal care in Bushbuckridge. The analysis of the data was conducted concurrently with data collection. The various themes that emerged during the course of the study will be discussed in the research findings and discussions below.

Population

The following tables 3.1 to 3.4 outline significant details for the four population groups involved in the study.
The specific objectives of the study guided the discussion of the findings. These objectives are to explore and describe the:

• Factors associated with pregnant women’s access to antenatal care services.
• Factors associated with community participation in and accountability of local governance structures for antenatal care services.
• Perceptions of health workers about community participation in supporting pregnant women to access antenatal care;
• Perceptions of local health workers about the accountability of local governance structures for antenatal care.
• Functionality and accountability of governance structures in health within local communities.

RESEARCH FINDINGS AND DISCUSSION

Three datasets were developed for pregnant women, midwives, and community leaders and governance structures which resulted in the identification of themes, categories and sub-categories. The identified themes are authenticated by the categories and their sub-categories. These summarize and represent the factors associated with pregnant women’s access to antenatal care services and the factors associated with community participation and local accountability for antenatal care services.
The research findings are linked with the objectives of the study as stated above. The discussion addresses the study’s major findings. The literature that supports or differs from the major findings is interwoven throughout the discussion. The similarities and differences are indicated to demonstrate the extensive knowledge on the subject and are tied with the other sections of the report to provide meaning. In conclusion, the implications of the results to the profession are emphasized and recommendations for further research are made (Botma et al., 2010:312).
Table 3.4 contains a summary of the themes, categories and subcategories that emerged from the study. Further tables will provide summaries of themes, categories and subcategories per objective. In this section, the verbatim quotations of participants will be presented using italics.

Factors associated with pregnant women’s access to antenatal care services

The first objective of the study: To explore and describe factors associated with pregnant women’s access to antenatal care services is summarised with all the identified themes, categories and subcategories that emerged from the analysis in Table 3.5.

Theme 1: Perceptions of antenatal care attendance

The first theme identified is perceptions of antenatal care attendance. Out of the theme, one category on knowledge and benefits of antenatal care emerged. It focused on four subcategories which determine mother and baby’s health, health education and counselling, determine progress of the pregnancy, date of birth and delivery mode and preventative care, disease screening and treatment.
Table 3.6 shows the theme, category and the subcategories which emerged from the theme on perceptions of antenatal care attendance.

Knowledge and benefits of antenatal care

The category knowledge and benefits of antenatal care focused on four subcategories which are to determine mother and baby’s health; health education and counselling; determine progress of the pregnancy, date of birth and delivery mode; and preventative care, disease screening and treatment. Each subcategory is discussed below.

Determine mother and baby’s health

Related to the determination of the mother and the baby’s health, the participants knew that some of the reasons for attending antenatal care were to assess the health of the mother and the baby and treat identified problems: Their comments included “To check if the baby and the mother’s health is good…”. “To check for any health problems from the mother and baby….” The nurses check the mother to identify illnesses and also check if the baby’s heart is beating well: “Last Sunday I came several times because the baby was not playing well and they checked me and said the baby is well’.
The participants knew that some of the reasons for attending antenatal care were to assess the health of the mother and the baby and treat identified problems. “…Check what can affect both of them to ensure she gets a live baby….” “…. Know how the baby is growing, detect problems early and have a successful delivery”. The nurses check the mother to identify illnesses and also check if the baby’s heart is beating well. “To check if the baby’s heart is beating well”.
The above quotes show women’s understanding of the reasons for attending antenatal care and the benefits by indicating that the care they receive helps to determine the health of the mother and the baby, which is similar to what was indicated by Mail et al. (2013:10). Ha et al. (2015: 699) confirms by indicating that when women attend antenatal care, they get interventions such as deworming, immunization, vitamin supplements which should reduce maternal and new born mortality. Further to that, Simkhada et al. (2007: 245) indicate that antenatal care determines safe delivery and it is a good strategy for reducing maternal mortality; yet millions of women do not receive it in developing countries.

DECLARATION
ACKNOWLEDGEMENTS 
ABSTRACT 
TABLE OF CONTENT 
LIST OF TABLES 
LIST OF FIGURES
LIST OF ANNEXURES 
LIST OF ABBREVIATIONS AND ACRONYMS 
CHAPTER 1 BACKGROUND OF THE STUDY AND PROBLEM STATEMENT 
1.1 INTRODUCTION
1.2 RATIONALE
1.3 PROBLEM STATEMENT
1.4 SIGNIFICANCE OF THE STUDY
1.5 RESEARCH QUESTIONS .
1.6 AIM AND OBJECTIVES OF THE STUDY
1. 7 CONCEPT CLARIFICATION
1.8 RESEARCH PARADIGM AND PHILOSOPHICAL ASSUMPTIONS .
1.8.1 Research paradigm
1.8.2 Philosophical assumptions
1.8.3 Conceptual framework
1.9 DELINEATION
1.9.1 Geographical demarcation
1.9.2 Focus on BANC
1.10 RESEARCH DESIGN AND METHODOLOGY
1.10.1 Phase 1 : Exploration and description of perceptions, experiences and needs to basic antenatal care to reduce mortality and morbidity in Mpumalanga Province
1.10.1.1 Methodology
1.10.1.2 Context .
1.10.1.3 Study population and sampling
1.10.1.4 Data collection
1.10.1.5 Data analysis and interpretation
1.10.1.6 Trustworthiness .
1.10.1.7 Ethical considerations
1.10.2 Phase 2 : Developing guidelines to promote community participation and local accountability for pregnant women’s access to basic antenatal care in Mpumalanga Province
1.10.2.1 Objective
1.10.2.2 Research design
1.10.2.3 Population and sampling
1.10.2.4 Data collection .
1.10.2.5 Data analysis of guidelines
1.11 ORGANISATION OF THE REPORT .
1.12 SUMMARY
CHAPTER 2  METHODOLOGY OF THE STUDY
2.1 INTRODUCTION
2.2 RESEARCH DESIGN AND METHOD
2.3 PHASE 1
2.3.1 Qualitative design
2.3.2 Exploratory design
2.3.3 Descriptive design
2.3.4 Contextual design
2.4 THE SETTING / CONTEXT
2.5 POPULATION AND SAMPLING
2.6 DATA COLLECTION
2.6.1 Focus group discussions.
2.6.2 In-depth interviews
2.6.4 The interview process
2.6.6 Reflexivity.
2.6.7 Use of tape recorder
2.6.8 The use of the interview guide
2.6.9 Focus group interview process
2.6.10 In-depth individuel interviews process .
2.7 DATA ANALYSIS
2.7.1 Transcribing qualitative data
2.7.2 Developing category schemes
2.7.3 Coding qualitative data
2.8 TRUSTWORTHINESS OF THE STUDY
2.8.1 Credibility .
2.8.2 Transferability
2.8.3 Dependability
2.8.5 Authenticity
2.9 PHASE 2
2.10 THE PROCESS OF GUIDELINE DEVELOPMENT
2.11 GUIDING ATTRIBUTES USED TO APPRAISE THE GUIDELINES .
2.12 RESEARCH DESIGN AND METHOD FOR GUIDELINE DEVELOPMENT .
2.13 SUMMARY
CHAPTER 3  DISCUSSION OF RESEARCH FINDINGS AND LITERATURE CONTROL
3.1 INTRODUCTION
3.2 DATA COLLECTION AND ANALYSIS
3.3 RESEARCH FINDINGS AND DISCUSSION
3.4 DISCUSSION OF FIELD NOTES
3.5 CONCLUSION
CHAPTER 4  DISCUSSION OF EMPIRICAL FINDINGS OF THE RESEARCH WITH REFERENCE TO THE COMPREHENSIVE COMMUNITY AND HOME-BASED HEALTH CARE (CCHBHC) MODEL
4.1 INTRODUCTION
4.2 DESCRIPTION OF THE COMPREHENSIVE COMMUNITY AND HOME-BASED HEALTH CARE (CCHBHC) MODEL
4.3 THE REASONS FOR CHOOSING THE CCHBHC MODEL
4.4 COMMENTS AND DEBATES ABOUT THE MODEL
4.5 SUMMARY ON THE APPLICATION OF THE CCHBHC MODEL
4.6 SUMMARY
CHAPTER 5  DEVELOPMENT OF GUIDELINES TO PROMOTE COMMUNITY PARTICIPATION IN AND LOCAL ACCOUNTABILITY FOR PREGNANT WOMEN’S ACCESS TO BASIC ANTENATAL CARE IN THE MPUMALANGA PROVINCE, SOUTH AFRICA
5.1 INTRODUCTION
5.2 BRIEF DESCRIPTION OF THE MODIFIED CCHBHC MODEL
5.3 DEVELOPMENT AND BENEFITS OF GUIDELINES
5.4 ATTRIBUTES TO BE USED WHEN APPRAISING DEVELOPED GUIDELINES .
5.5 THE METHODOLOGY OF GUIDELINE DEVELOPMENT USING THE DELPHI TECHNIQUE
5.6 DEVELOPED GUIDELINES
5.7 TRUSTWORTHINESS IN GUIDELINES DEVELOPMENT .
5.8 GUIDELINES DISSEMINATION AND IMPLEMENTATION .
5.9 REVIEW OF GUIDELINES
5.10 SUMMARY
CHAPTER 6  REVIEW AND SUMMARY OF FINDINGS, DESCRIPTION OF THE GUIDELINES, LIMITATIONS, IMPLICATIONS, RECOMMENDATIONS AND CONCLUSIONS
6.1 INTRODUCTION .
6.2 SUMMARY OF FINDINGS
6.3 THE PROCESS OF GUIDELINE DEVELOPMENT
6.4 DESCRIPTION OF DEVELOPED GUIDELINES
6.5 RECOMMENDATIONS FOR THE DEPARTMENT OF HEALTH
6.6 RECOMMENDATIONS FOR FURTHER RESEARCH
6.7 IMPLICATIONS
6.8 LIMITATIONS
6.9 CONTRIBUTION TO THE EXISTING NURSING KNOWLEDGE
6.10 SUMMARY AND CONCLUSIONS
REFERENCES .
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