HEALTH PROMOTION IN THE SOUTH AFRICAN CONTEXT
PHASE 1: CURRENT SITUATION WITH REGARD TO HEALTH PROMOTION Research Design
A case study design was chosen for this phase because, according to Yin (2003, p. 97), the case study design allows the investigator an opportunity to use many different sources of evidence.
Case studies are used by researchers in order to explore in depth a program, an event, an activity, a process or one or more individuals, but families, groups, institutions and other social units may also be the focus (Creswell 2003, p. 15; Polit & Hungler 1999, p.250). Yin (2003, p.
3) argues some researchers believe that case studies are appropriate only for the exploratory phase of an investigation but he maintains that case studies can also be utilized in the explanatory and causal inquiry.
Tellis (1997 (a), p.l) classified case studies into exploratory, explanatory and descriptive in nature. Case studies aim to answer specific research questions such as "what", "why", "who",
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"how" and "where" (Mariano, in Munhall & Oiler 2000, p. 311). Yin (2003,p. 6) suggests that exploratory case studies aim to answer the questions "what" and "how", therefore, research questions that seem to answer the question "what" should be considered to be exploratory in nature. In the first phase of this study the main question was "What characteristics do work settings have which have influence on health promotion activities?" The first phase of this study was therefore an exploratory case study.
Case study research strategy, with multiple case study designs, was used in this phase. Multiple cases were identified so as to obtain data from different sources of evidence. Yin (2003) argues that using multiple sources of evidence strengthens case study findings, as findings become more convincing and accurate if based on several different sources of information. This phase involved exploration of the context. The existence of health promotion policies, health
promotion programs and other related activities in the identified workplaces were explored.
After data analysis in phase 1, the findings that emerged were used in the next phase of the study (phase 2), which is aimed at development of health promotion policy guidelines.
According to Burns and Grove (1995, p. 255) a case study is likely to use both qualitative and quantitative elements. Qualitative measures were therefore combined with the quantitative approach in the first phase. In addition to the qualitative methods used, quantitative methods were used to gather descriptive information about the characteristics of an organization and its health promotion activities. The researcher believed that using quantitative methods would result in qualitative findings being understood in a broader context, an argument supported by Polit and Hungler (1999, p. 266).
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Case protocol
This section of the study outlines the case protocol which was used to guide the first phase of the study. According to Yin (2003), the case protocol has to include (a) an overview of the case study project, (b) project objectives, (c) data collection procedures, and (d) guide for the report (Yin 2003, p. 69, Yin 1994, p. 64).
The presence of the case study protocol is another way to increase the reliability of the case study and is a requirement in the multiple case study design (Yin 2003). This case study protocol was used to guide the study and is based on the first phase of the study. The protocol was designed as follows:
The first part of the protocol focused on the overview of this case study project, and research activities are briefly discussed in this section. The second part of the protocol focuses on the project objectives. In the third part of the protocol the researcher discusses data collection procedures and access to sites. The research question and the conceptual framework are also discussed in this part of the protocol.
An overview of the case study project Unit of Analysis
The unit of analysis is a critical factor in the case study (Tellis 1997 (a), p.2). The case has to be defined in terms of the unit of analysis. A case in this study was a workplace or an
organization, with all its embedded health promotion activities. There were multiple cases with several units of analysis, embedded in each case, namely staff profile, the characteristics of an
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organization, health promotion activities offered by the organization, health promotion models, objectives of health promotion activities and stakeholders.
Sampling
Yin (1994 cited in Tellis 1997 (b)), argued that case studies do not need to have a minimum number of cases or to select cases randomly, but that researchers need to be called upon to work with the situation that presents itself in each case.
According to Feagin, Oram and Sjoberg (1991 cited in Tellis 1997 (a)) case studies are multi- perspectival analyses and require the researcher to consider not just the voice and perspective of actors but also of the relevant groups of actors and the interaction between them. These authors argue that this inclusion makes the case study method give voice to the powerless and voiceless.
In order to involve as many actors as possible and to acquire as much data as possible about the state of health promotion interventions in the organisations, the researcher utilized multiple sites and different participants within these sites. The involvement of multiple sites also ensured a larger, more diverse, and more representative sample. It has been argued that case study designs do allow such flexibility during data collection (Polit & Hungler 1999, p. 155).
Different sampling methods were used since the researcher had to sample the cases and also the participants. These sampling methods are discussed separately below.
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