CHAPTER 3: METHODS
3.9 D ATA S OURCES
3.9.1 Measuring Instruments
Questionnaires were used to collect quantitative data (Phase 1). A semi-structured interview guide was used to conduct the in-depth interviews (Phase 2) with key role players. Using themes that emerged from the in-depth interviews, a focus group discussion guide was developed and used for facilitating the focus group discussions (Phase 3).
41 3.9.2 Data Collection
Data for the study was collected in three phases.
3.9.2.1 Phase 1
Quantitative data on the profile of human resources (number of EHPs in each local municipality), the package of environmental health services being provided in
relation to the newly defined municipal health services in each local municipality, and workload were collected using structured self-administered questionnaires
(Annexure A). This phase involved collecting data from managers responsible for environmental health services from the three municipalities that have Environmental Health Practitioners in their employ, as well as from the Environmental Health
Manager from the Provincial Department of Health (n = 4).
Information letters on the study and informed consent forms were faxed to the study participants. Questionnaires were electronically distributed via e-mail, with telephonic follow-up. Responses were returned via e-mail to the researcher. The researcher checked questionnaires for any discrepancies or missing data, printed them and locked them away until analysis.
3.9.2.2 Phase 2
Qualitative data for the study was collected through conducting face-to-face, semi- structured in-depth interviews with municipal managers, and managers responsible for EH Services – a possible sample size of 13 (Annexure B). A total of three people were interviewed and a point of data saturation was reached. The researcher
scheduled appointments with the study participants.
Data was collected in the interviews under the following headings:
1. Knowledge of the integration process
2. History of and preparation for the integration process
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3. Perceptions of benefits of the proposed integration 4. Perceived challenges to the integration process
5. How these challenges to the process have impacted on environmental health service delivery in the district
6. Suggestions for change in the manner in which the integration was planned (What could have been done differently?).
During Phase 2, documents on planning and policy, legislation, and minutes of meetings held were also reviewed to establish the policy framework and guidelines for the process of integration.
3.9.2.3 Phase 3
Themes or issues identified during the semi-structured interviews (Phase 2) were explored further in two focus group discussions (Annexure C). The groups consisted of EHPs and each group lasted approximately two hours. Focus group discussions were audio-recorded with the permission of the participants. It was emphasised that the identity of participants would remain anonymous, and that participants could withdraw from the study at any time.
3.9.3 Data Handling
3.9.3.1 Quantitative Data
Once received, data was checked for any discrepancies or missing data. Data from the self-administered questionnaires was locked in an office, accessible only to the researcher, for safekeeping. This data was analysed descriptively using frequency tables and graphs.
43 3.9.3.2 Qualitative Data
The sound files from the digital recording device were copied onto a password- protected computer. The audio-taped in-depth interviews and focus group
discussions were transcribed verbatim. Thematic analysis was used as the primary analytic strategy. Thematic analysis is a search for themes that emerge as being important to the description of the phenomenon (Daly, Kellehear & Glicksman, 1997). This process involves the identification of themes through “careful reading and re-reading of the data” (Rice & Ezzy, 1999, p. 258).
In seeking to analyse data, thematic analysis can either identify the themes pertaining to a particular research question (deductive analysis) or it can identify themes that are observed across the entire data range (inductive analysis) (Braun &
Clark, 2006). Inductive thematic analysis occurs when the researcher observes themes from the data without having had a particular preconception of the various themes that would emerge. Deductive thematic analysis on the other hand, is guided by the researcher’s particular thematic interest and seeks to analyse a specific area of the data.
The present study followed an inductive thematic analysis approach. Transcripts were coded by the principal investigator and a fellow researcher. After reading a transcript, the analysis team collaboratively developed a codebook of themes around the main topics. The second transcript was then reviewed to add additional topic areas and themes that emerged. This process was then repeated with the final transcript to arrive at a final coding scheme. Data were entered into QSR
International’s NVivo 8 qualitative data analysis software (QSR International, 2008) and coded per the resulting coding scheme. NVivo is a useful organizational tool which allows the researcher to index segments of the text to particular themes, carry out complex search and retrieval operations quickly, and link research notes to coding. However, software remains an aid to the organization of the material and is not in itself an interpretive device (King, 2004). The coding team met regularly throughout the process to discuss coding, modifying the coding scheme and maintaining fidelity to the coding scheme, until consensus was reached. Weber (1990, p.12) notes: “To make valid inferences from the text, it is important that the
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classification procedure be reliable in the sense of being consistent. Different people should code the same text in the same way”.
3.9.4 Validity and Reliability
The researcher employed certain strategies to ensure trustworthiness of the data.
The basic question addressed by the notion of trustworthiness, according to Lincoln and Guba (1985, p. 290), is simple: "How can an inquirer persuade his or her
audiences that the research findings of an inquiry are worth paying attention to?"
Lincoln and Guba specify four criteria for ensuring trustworthiness, namely:
credibility, transferability, dependability and confirmability.
Attention was given to credibility (checking the true value of findings) by means of independent coding. Transferability was established by thoroughly describing the research context and the assumptions that were central to the research. The person who wishes to "transfer" the results to a different context is then responsible for making the judgment of how sensible the transfer is. The researcher also needs to provide sufficient information that can then be used by the reader to determine whether the findings are applicable to the new situation (Lincoln and Guba, 1985).
To this end the researcher has included a number of quotes from the verbatim transcriptions.
Dependability was maintained through keeping of the raw material, giving a full description of the research method, and applying the same procedure throughout.
Conformability was established through analyst triangulation - two analysts reviewed and analysed data independently and then compared their findings.