SOCIAL WELFARE AND SOCIAL WORK SYSTEMS IN AN INDEPENDENT NAMIBIA

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CHAPTER 3: THE RESEARCH METHODOLOGY

INTRODUCTION

In the preceding chapter, I reviewed literature concerning social workers’ perceptions of their roles in providing palliative care to patients with life-limiting illnesses and discussed the symbolic interactionism perspective as the theoretical framework applicable to this study. In this chapter, I provide an overview and rationale of adopting the qualitative research methodology. In addition, I describe how the study was executed and the chapter gives a concise description of the grounded theory method based on the early work of Glaser and Strauss (1967), and subsequent works of Glaser (1967 & 1998); Strauss and Corbin (1990) and Charmaz (2002, 2006 & 2009). This chapter discusses the research design and sampling procedure and the data collection methods with attention place on qualitative field interviews. It discusses ethical considerations where ethical principles and protocols are adhered throughout the study. The last part of the chapter concludes with a reflection on the role and position of the researcher.

APPLYING GROUNDED THEORY

The study embraced grounded theory as a qualitative method examining social workers’ perceptions of their roles providing palliative care to patients with life-limiting illnesses. The grounded theory methodology was applied to place my study in an appropriate theoretical context. Grounded theory aims to generate theory from face-to-face field interviews (in this study) on real life experiences (inductive theory) as they are occurring in a given situation. In grounded theory studies there are no existing hypothesis and it is considered a dynamic process which aims to make sense and attach meaning to human relationships (Charmaz, 2006; Corbin & Strauss, 2008; Hallberg, 2006; Birks & Mills, 2011). These meanings may be through symbolic interaction (interactions happen between individuals) and is influence by personal knowledge, experience and external factors (Cowley, 1991).
Grounded theory is concerned with the ‘pragmatic application of results’ (of research) as opposed to the absolute ‘truth’ as this may not exist (Annells, 1996). Grounded theory permits the gathering of rich data and allows initial analysis, which guides further data collection and allows flexibility (Strauss & Corbin, 2008). Both the initial and later review of literature aim to answer the main research question that seeks to investigate: How do social workers in primary care settings in Namibia perceive their roles in providing palliative care to patients with life-limiting illnesses? The literature review was guided by the following related sub-questions, namely: How do social workers understand palliative care? What conditions hinder social workers’ abilities to provide palliative care to patients with life-limiting illnesses? What conditions strengthen social workers’ abilities to deliver palliative care to patients with life-limiting illnesses? How does social work education and training in palliative care contribute to social workers’ competency in the provision of palliative care to patients with life-limiting illnesses? The study applied the grounded theory methodology, as it gives credit to qualitative research approaches for gaining deeper insights and generating theory on social workers’ perceptions (Goulding, 2005).

The origins of grounded theory

Marshall and Rossan (2010) refer to the grounded theory method “as an interactive enquiry process between the researcher and the participants. It values participants’ perspectives and is primarily descriptive and reliant on people’s words”. The grounded theory (GT) approach is based on the early work of sociologists Glaser and Strauss (1967), who became the original founders of grounded theory when they promoted the concept of qualitative approach to research and the subsequent works of Glaser (1978 & 1998). In grounded theory, Glaser (1979) had a strong qualitative background and Strauss (1990), brought the perspective of symbolic interactionism (a sense of self through interaction with others and through shared experiences and creative meanings that influence collective behaviour) (Strauss & Corbin, 1990). They (Glaser and Strauss, 1967) maintained that the systematic collection and analysis of data could lead to robust generation of theory which was ‘grounded’ in data (Cooney, 2010), thus making it more applicable to reality. However, Glaser and Strauss later parted ways and developed two opposing views of GT.
Research revealed (Glaser, 1992; Strauss & Corbin, 1998) conflicting views on Glaser and Strauss’ development of grounded theory where after Strauss formed a new allegiance with Corbin, whilst Glaser continued to protect the original grounded theory tenets maintaining that Strauss was ‘forcing the data’ and was no longer true to grounded theory. According to Kelle (2005), Glaser argued researchers could form a grounded theory using emerging ad hoc themes. Kelle (2005) further stated that Corbin and Strauss then introduced a coding paradigm to help researchers organize the data from which Glaser argued that Corbin and Strauss’ approach “forced” themes to emerge. However, contemporary versions of grounded theory began to emerge, most prominently that of Charmaz (1983 and 2006), which suggests that flexibility in using different approaches to grounded theory is enormously beneficial (Birks & Mills, 2011). This flexibility enabled me as the researcher to consider all approaches by exploring underlying principles, processes and analytical methods of grounded theory and it led to determining which would be the most applicable for my study.

Constructivist grounded theory

Charmaz (2002) defines grounded theory “as a qualitative method of which the purpose is to generate theory that advances the understanding of people’s behaviour in terms of underlying meaning and change in varying circumstances and over time”. According to Charmaz (2002), grounded theory by its method and intent is to generate theory directly related to the data from which it has been develop. According to Hall, Griffiths and McKenna (2013), constructivist grounded theory (CGT) makes provision for the possibility to consider multiple meanings and understandings of reality which is influenced by many contextual factors and constantly redefined through interaction with others (Fisher & O’Connor, 2012). It embraces an emic (insider) stance, which merges with the researcher’s personal understanding and input, as well as providing an interactive approach to data collection and analysis (Charmaz, 2006). This suggests that the researcher is a ‘co-producer’ of the research which can add depth and meaning to the process (Mills et al., 2006a & 2006b). It proposes that the researcher needs to be able to enter the participants’ world and discover how they interpret their perceptions and experiences, thus focussing on their lived experiences (Jeon, 2004).
Constructivist grounded theory will thus be the most applicable approach for this study, because, as the researcher, I will embrace an emic stance in being “the primary instrument of data collection and analysis” (Merriam, 2009: 29), on social workers’ perceptions of their role in providing palliative care to patients with life-limiting illnesses. The study “assumes an inductive (as opposed to a deductive) stance and strives to derive meaning from the data” (Merriam, 2009: 29), that is generated and ‘co-produced’ by me as the researcher. Social work and grounded theory focus on the interactions of individual and society. I was hoping that using the constructivist approach could provide a constructivist grounded theory about how social workers navigate their role in palliative care, and that it can be test in social work practice. Developing such a theory can be used to guide social work practitioners.

Rationale for choosing constructivist grounded theory

In this study, I chose to apply the constructivist approach to grounded theory. This allowed me situate myself within the research and form a part of the understanding from my own perceptions and experiences, which would create meaning between me, as the researcher and the participants. My study is in line with Charmaz’ (2006), discoveries which is concerned with beginning the research journey by identifying the ‘constructs’ which make up the meaning, (as opposed to ‘facts’) and building on these as the data collection progresses (Charmaz, 2006). The reality of palliative care social work practice, education and training mean that constructivist grounded theory and its tenets suit the main research question, its subsequent questions, the research design and permits self-disclosure, contrary to a detachment that may cause the participants to avoid open conversations (Wilde, 1992). This study was concerned with examining social workers’ perceptions of their role in providing palliative care to patients with life-limiting illnesses and it was able to explain and interpret the participants’ perceptions and experiences as opposed to merely describing them (Baker et al., 1992). The aim was to develop a deeper understanding and insight of those experiences and then inductively create a theory, which can be utilising to optimise the role of the social worker. This led to constructivist grounded theory being the choice for this study.

THE CHOSEN RESEARCH DESIGN

This study adopts a qualitative research design because the nature of the research problem and the stated objectives demand an idiographic, case-based approach (Denzin & Lincoln, 2003: 28). My ontological stance in this study is constructivist, thus agreeing there can be various interpretations and not just one reality, all of which are
influenced by context, in this case the participants’ perceptions and experiences (Charmaz, 2009) of their roles in providing palliative care to patients with life-limiting illnesses. It is imperative that understanding of the social workers’ perceived roles in providing palliative care is considered by forging strong links with the data and context and that the honesty of participants’ perspectives, opinions and experiences are respected and presumed valid. My study sits within my worldview of a naturalistic and constructivist paradigm, where research is undertaken in natural settings and human experience is examine and meaning extracted (Mills et al., 2006a & 2006b). A constructivist paradigm assumes that “theories grounded in data are interpretative explorations (lived experiences) of the area explored, but do not provide a precise and accurate picture” (Charmaz, 2006: 10). This paradigm would enable me as the researcher to gain a better understanding of social workers’ perceptions and lived experiences of their roles because it seeks to build on theory, explore this phenomenon and yield in-depth meaningful information. At the time of this study, there was a lack of knowledge and research in the area of social work practice within the Namibian context. In particular, examining how social workers perceive their roles, conditions that hinder or strengthen their abilities to deliver palliative care and how social work education and training influence their competencies to deliver care.
The study did not begin with a hypothesis about the phenomenon to be studied (as in quantitative, theory testing research), but applied an inductive approach or theory-building research method. The study was exploratory in nature and was guide by loose and broad research questions with no limiting hypothesis. It instead remained open to emerging theory (through the induction process) from the generated data (Glaser & Strauss, 1967 and Straus & Corbin, 1990). In this study, I hold a subjective, interpretivist stance, where knowledge is not ‘discovered’, but constructed and then interpreted through many lenses (Hall et al., 2013) and my active involvement in this process is inevitable and necessary (Mills et al., 2006a & 2006b). I was aware of the
fact that I had some existing knowledge on palliative care and life-limiting illnesses and therefore felt it important not to disconnect that from the process of learning through research. It was important for me to acknowledge and embrace what I am bringing to the research and how I might influence it (Licqurish & Seibold, 2011). It felt inappropriate to attempt to “bracket off” my knowledge, thoughts and experience. I instead in following research protocol, openly acknowledged my experiences in the research process and considered how it would enhance what was learn from the participants. This lends itself well to the grounded theory approach. My experiences in practicing and teaching social work led to the initial notion that palliative care social work can be a beneficial intervention for both the patient and the family. Therefore, a study with the aim to examine the perspectives of social workers’ roles in providing palliative care to patients with life-limiting illnesses thought to be an appropriate avenue of exploration. The study happened in the following six social work offices; namely Katutura and Windhoek Central hospitals, the Oshakati social work office, Gobabis; Swakopmund and Keetmanshoop social work offices, respectively. The research methodology was guide by the aims and objectives of the study.

METHODOLOGICAL FRAMEWORK

I utilized grounded theory as a qualitative research approach in order to gain an in-depth understanding of how twenty (20) social workers perceived their roles in providing palliative care to patients with life-limiting illnesses. According to Lietz et al., (2006:445) qualitative research design offers the opportunity to seek an in-depth understanding of complex experiences. Denzin and Lincoln (2003) note that because qualitative researchers seek answers to questions that stress how social experiences create and given meaning, this type of research is value-laden. In order to obtain detailed, varied and extensive data in this study, I kept the interview conversation open and let the participants lead (Glaser, 1998). This accomplish by using in-depth, face-to-face and open-ended interviews. The intention was also to reveal conditions that hinder or strengthen social workers’ abilities to provide palliative care. The in-depth, face-to-face interviews used to examine the ways in which social work education and training in palliative care contributes to social workers’ competencies in providing this care.
The insights from this would form a backdrop to further uncovering aspects of social work education and training within this specialised care. Data-gathering used a narrative approach in which a sample of twenty (20) social workers who volunteered were asked to narrate their experiences and, hence, describe their perceptions of their roles of providing palliative care. The study intended to investigate how social workers perceive their roles and the specialised treatment of providing palliative care to patients with life-limiting illnesses. Interviews were tape recorded with prior consent from the participants. The narrative nature of the interviews made accurate transcription very important. I preferred to transcribe each of the tape-recorded interviews manually to gain a richness of detail as it emerged from the collected data.
During and after the interviews, I kept memoranda by recording field notes about the reactions, and observations of both the participants and the interviewer. The memos assisted me in analysing the field notes line by line to identify key issues applying traditional grounded theory coding techniques, as outlined by Strauss (1987) and Strauss and Corbin (1990), which identify human action and behaviours. An interpretative field of inquiry locates me as the researcher in the world I am exploring (Denzin & Lincoln, 2000), and lends itself well to generating theory, thus following inductive reasoning (Bryman, 2008).
Inductive reasoning: Observation Pattern Tentative / Emerging Theory
This qualitative study is concerned with service providers’ view on health care delivery and services, which informed policy at local and national levels. My study sits within the qualitative methodology and it aims to examine and interpret social workers’ perceptions of their role in providing palliative care to patients with life-limiting illnesses and encourages theory development. I was actively involved in the entire research process (i.e. data collection, analysis, interpretation and theory generation). In addition, embracing an interactive relationship was vital in producing a transparent understanding and account of the perceptions, experience and emerging theory (Carr, 1994).

ACCESS, NEGOTIATION AND SAMPLING TECHNIQUES

The actual processes of preparation, negotiation, permission and access to conduct research with twenty social workers based at six primary care hospitals in Namibia are discussed below:
Preparation and negotiation for fieldwork (data collection) took place over five months from January to May 2016. Hospital-based social workers were invited via the regional chief social workers in Namibia, in the Karas region (Keetmanshoop); the Omaheke region (Gobabis) the Khomas region (Windhoek) the Erongo region and the Oshona region (Oshakati) to voluntarily partake in the interviews. Information about the research and the implementation process was included in an electronic letter accompanied by a broad set of questions e-mailed to prospective participants. Individual follow-up telephone calls allowed the social workers to express whether they were interested in taking part in the research. A participant information sheet was use (Appendix 2). I received twenty forms. The overall selection was on geographical location and a mix of work settings in an endeavour to ensure that the sampling population was as diverse as possible to add to the meaningfulness of perceptions in the Namibian context. Appointments were made for the first round of interviews, based on geographical proximity and twenty interviews were held between May and July 2016.

Permission to conduct the research

Permission was obtain from the following institutions and persons in order to conduct research with the respective social workers; the University of South Africa (UNISA), Department of Sociology Ethics Committee, the Research Ethics Committee of the Ministry of Health and Social Services in Namibia, and the regional Chief Social Workers in Namibia.

Sampling

Purposive non-probability sampling was used which resulted in twenty in-depth, face-to-face interviews. For the purpose of this explorative study, volunteer social workers were accepted based on their geographical location to participate (i.e. all of who was approach). The sample exhibited the following characteristics: 1) aged between 25 and 50+ years old, 2) full time employed as social workers and 3) each had a minimum of 2 years of work experience as social workers. The inclusion criteria included qualified social workers who had two plus years of work experience. During the recruitment process, social workers younger than 25 years did not meet the inclusion criteria of two years of work experience. The study could have benefitted from interviewing social work educators at the University of Namibia under objective five of this study, however the primary aim at the outset of the study was to explore social workers’ perspectives of their roles in providing palliative care and to investigate how social work education and training contribute to their competencies in delivering palliative care from the perspectives and views of the social workers, and not from social work educators. The study therefore did not include the social work educators. In addition, the study deliberately also did not interview key informants on the multi-disciplinary team, such as nurses and doctors, because it primarily focussed on the social workers’ perceptions of their role in providing palliative care from their view. The inclusion of both the social work educators as well as key informants might have altered the construction of the emergent, grounded theory.
The sample based on their geographical location provided diverse social workers in order to add depth and variation to the meaning of the phenomenon of palliative care provision to patients with life-limiting illnesses. As opposed to random or convenience sampling Wengraf (2001) suggests purposeful sampling of selecting participants which is for interpretive research studies. The participants interviewed represent diverse ethnic backgrounds and geographical locations in Namibia including Katutura and Windhoek Central Hospital (central Namibia), Oshakati (northern Namibia) social work office, Gobabis (eastern Namibia) social work office, Swakopmund (western Namibia) social work office and the Keetmanshoop (southern Namibia) social work office. Each of the participants was treating with anonymity and each given a pseudonym.

DATA COLLECTION AND ANALYSIS

In grounded theory, data collection and analysis are conducted interchangeably, but in tandem and this process is referred to as theoretical sampling. The theoretical sampling process was applied throughout this study. Theoretical sampling according to Strauss and Corbin (1998: 202) “is a process of searching for concepts relating to ‘incidents, events or happenings’ which appear frequently and which influence outcomes”. This can happen over a period of time whilst building codes. In this study I began creating codes and later refined those codes to contribute towards theory building. In order to ensure the codes were an appropriate fit for my data, I sent the transcripts and the codes to the participants of the study whereby I requested their input as to the validity of the codes and to comment on the codes. Finally, after receiving input from the research participants, the coding was also conducted with NVIVO 10 software.

Data Collection Procedures

The primary data collection method used in this study was in-depth, face-to-face interviews (see Appendix 3 for Interview Guide on broad research questions). Yin (2014: 110) reiterates “… interviews will resemble guided conversations rather than structured queries”. In addition, in-depth interviews cater for privacy between the researcher and the research participant.

In-depth face-to-face qualitative interviews

Twenty qualitative interviews were conducted with participants (social workers). According to Warren and Karner (2010:2) qualitative interviewing involves present-time, face-to-face interaction. I used face-to-face interviews as a primary data collection technique for this study. It followed an unstructured format. Interviews were allowed to flow naturally based on information obtained from the participants. The in-depth interviews were conducted on a dyad basis (one interviewer and one respondent), ascribed by Warren and Karner (2010: 2). This enabled me to focus entirely on one participant at a time. I kept the interview conversation open and guided by the participant as suggested by Glaser (1967). The participants were given complete freedom to build a narrative from their experiences (Patton, 1990 & Riessman, 1993).
Hospital based social workers have hectic work schedules, making it difficult for them to leave their offices for extended periods. All interviews therefore were conducted in their offices at their requests and in English. Before and during the first interview, I gave each participant the informed consent form to read in an English translation (see Appendix 2). I guided them through the informed consent agreement until all the important issues were explored. After the participants reviewed it, I asked them to sign the informed consent agreement in duplicate form. Upon signing, each participant received a copy of the agreement and I kept a copy. The first interview included demographic background information and lasted between twenty (20) to thirty (30) minutes. Given the fact that the hospital-based social workers were also involved in another national survey on suicide in Namibia, they requested both the first and second interviews to happen on the same day. Agreeing to their request, both interviews were conduct on the same day with a five-minute break between the first and second interviews. To be able to provide descriptive illustrations of concepts that would arise, I in agreement with the participants tape-recorded the second interview. During the second interview, I asked the participants to provide pseudonyms for themselves and significant others. The pseudonyms were used in all communications and documents related to the study. I conducted, transcribed and reviewed all interviews myself. Upon completion of both interviews, email and telephone consultations took place where I applied member checks in order to verify with the participants and to allow them to comment. The participants did not give any comments.

TABLE OF CONTENTS 
DECLARATION
ACKNOWLEDGEMENTS
SUMMARY
TABLE OF CONTENTS PAGE
LIST OF TABLES
LIST OF ACRONYMS AND ABBREVIATIONS
GLOSSARY
CHAPTER 1: ORIENTATION TO THE RESEARCH PROBLEM
1.1 INTRODUCTION TO THE STUDY
1.2 BACKGROUND AND SOCIOLOGICAL SIGNIFICANCE
1.3 RESEARCHER’S INTEREST IN THE RESEARCH: FROM PERSONAL JOURNEY TO PROFESSIONAL INPUT
1.4 PROBLEM STATEMENT
1.5 THE RESEARCH QUESTION
1.6 THE AIMS AND OBJECTIVES OF THE STUDY
1.7 THE RATIONALE FOR THE STUDY
1.8 OPERATIONALISATION OF CONCEPTS
1.9 OUTLINE OF CHAPTERS
CHAPTER 2: LITERATURE REVIEW AND THEORETICAL FRAMEWORK
2.1 INTRODUCTION AND BACKGROUND TO THE STUDY
2.2 CONTEXTUALIZATION OF SOCIAL WORK AND PALLIATIVE CARE
2.3. SOCIAL WELFARE AND SOCIAL WORK DURING THE SOUTH AFRICAN COLONIAL ERA
2.4 SOCIAL WELFARE AND SOCIAL WORK SYSTEMS IN AN INDEPENDENT NAMIBIA
2.5 THE GLOBAL CONTEXT OF PALLIATIVE CARE
2.6 THE CONTEXT OF PALLIATIVE CARE IN AFRICA
2.7 THE CONTEXT OF PALLIATIVE CARE IN NAMIBIA
2.8 DEMAND AND NEED FOR PALLIATIVE CARE
2.9 SOCIOLOGICAL SIGNIFICANCE OF STUDYING SOCIAL WORKERS IN PROVIDING PALLIATIVE CARE
2.10 THE RELEVANCE AND APPLICABILITY OF SYMBOLIC INTERACTIONISM IN THE STUDY
2.11 SUMMARY
CHAPTER 3: THE RESEARCH METHODOLOGY
3.1 INTRODUCTION
3.2 APPLYING GROUNDED THEORY
3.3 THE CHOSEN RESEARCH DESIGN
3.4 METHODOLOGICAL FRAMEWORK
3.5 ACCESS, NEGOTIATION AND SAMPLING TECHNIQUES
3.6 DATA COLLECTION AND ANALYSIS
3.7 ISSUES OF TRANSFERABILITY
3.8 REFLECTION ON THE ROLE AND POSITION OF THE RESEARCHER
3.9 ETHICAL CONSIDERATIONS
3.10 SUMMARY
CHAPTER 4: PRESENTATION OF THE FINDINGS AND ANALYSIS
4.1 INTRODUCTION
4.2 PRESENTATION OF THE FINDINGS AND DATA ANALYSIS
4.3 SOCIAL WORKERS’ PERCEIVED ROLES IN THE PROVISION OF PALLIATIVE CARE
4.4 SOCIAL WORKERS’ UNDERSTANDING OF PALLIATIVE CARE
4.5 SOCIAL WORKERS’ PERCEPTIONS AND EXPERIENCES IN PROVIDING PALLIATIVE CARE
4.6 CONDITIONS THAT HINDER SOCIAL WORKERS’ ABILITIES TO PROVIDE PALLIATIVE CARE
4.7 CONDITIONS THAT STRENGTHEN SOCIAL WORKERS’ ABILITIES TO DELIVER PALLIATIVE CARE
4.8 SOCIAL WORK EDUCATION AND TRAINING IN PALLIATIVE CARE
4.9 BIOGRAPHICAL DETAILS OF THE RESEARCH PARTICIPANTS
4.10 SUMMARY
CHAPTER 5: ~ ‘Being here’ – Creating a constructivist grounded theory of social workers’ multi-dimensional roles in providing palliative care
5.1 INTRODUCTION
5.2 MULTI-DIMENSIONAL ROLES OF THE SOCIAL WORKERS IN PROVIDING PALLIATIVE CARE
5.3 SOCIAL WORKERS’ UNDERSTANDING OF PALLIATIVE CARE
5.4 SOCIAL WORKERS’ PERCEPTIONS AND EXPERIENCES ABOUT PROVIDING PALLIATIVE CARE
5.5 CONDITIONS THAT HINDER SOCIAL WORKERS’ ABILITIES TO PROVIDE PALLIATIVE CARE
5.6 CONDITIONS THAT STRENGTHEN SOCIAL WORKERS’ ABILITIES TO DELIVER PALLIATIVE CARE
5.7 SOCIAL WORK EDUCATION AND TRAINING IN PALLIATIVE CARE . 242
5.8 THE SOCIOLOGICAL SIGNIFICANCE OF SOCIAL WORKERS’ ROLE IN PROVIDING PALLIATIVE CARE
5.9 INTERPRETATION OF THE FINDINGS ON IMPLICATIONS FOR PRACTICE
5.10 CONCLUSION
CHAPTER 6: CONCLUSIONS AND RECOMENDATIONS
6.1 RECOLLECTING THE STUDY OBJECTIVES
6.2 SUGGESTIONS ON HOW TO IMPROVE THE FIELD OF PALLIATIVE CARE SOCIAL WORK
6.3 STRENGTHS AND LIMITATIONS OF THE STUDY
6.4 RECOMMENDATIONS ON HOW TO STRENGTHEN POLICY, PRACTICE AND RESEARCH
6.5 FINAL REMARKS
LIST OF SOURCES
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