3.5 DATA COLLECTION
3.5.2 Data Collection Procedure
The process of data collection took place over a period of one year, from August 2003 to August 2004. This included obtaining permissions to conduct the study as well as for entry into data collection sites. Data collection was staggered and done in two rounds. This was necessary due to the availability of the researcher to collect data in person, as well as due to the availability of respondents.Itwas not possible to predict when adolescent clients would be using maternity services and this meant that the researcher had to spend time at sites waiting for adolescent clients to present
themselves. Work schedules for HCPs and HCps also meant that the researcher had to be flexible and make frequent visits to sites before data could be collected. Collecting data in two rounds also allowed the researcher time to analyse data so that it could direct further data collection.
Prospective participants for all stakeholder groups were informed of the study that was to be undertaken and were then requested to volunteer their participation.Itwas felt that this approach would yield participants who had an interest in the subject under study, therefore, providing richer data. To promote feelings of comfort and freedom from perceptions of prejudice, and to diminish the aspect of fear of reprisal, all categories of participants provided information separately, thereby ensuring homogeneous groups.
Adolescent Maternity Clients (AMC)
After permission to proceed with the study had been granted from the relevant authorities, the institution was approached for permission to enter the site to collect data. HCps working in the maternity department were approached to assist with AMC recruitment. They then identified the AMCs who were using the services on the days of data collection to the researcher, who then approached the AMCs and briefed them on the study and requested their participation. The briefing session also allowed prospective participants the chance to get any questions they might have had, answered by the researcher.
This method of recruitment and collecting data at the same meeting was used, as based on the literature review, made the researcher come to the realization that adolescent maternity clients often commence maternity very late, or not at all, or default on care. Hence, it was felt that trying to arrange another day for data collection may result in decreasing AMC participant numbers. To ensure that adequate
information regarding perceptions of maternity care was collected, all adolescents who showed interest in participating were included and no randomisation was done.
Problems that this might yield are discussed under the limitations of the study.
Health Care Providers (HCp)
The health care providers working in the maternity departments ofthe designated hospital and further data collection sites were informed of the proposed study via the nursing service managers at the sites. All those who showed interest in participating were selected, as the researcher felt that due to duty scheduling and the participants having other responsibilities, it might not have been possible to randomly select
participants. Due to staffmg constraints, it was not possible to use focus group
interviews at some sites, as health care providers could not be freed en mass to attend the focus group interview. Data was also collected from health care providers by means of semi-structured interviews, as permitted by the work allocation and availability of health care providers.
Health Care Planners (HCP)
The nursing service managers involved in maternity care at the research sites were briefed individually on the study and their participation was requested. The same was done for doctors in charge of obstetric and gynaecology services (where applicable at research sites), as well as for individuals from the Department of Health who were responsible for the planning of maternity health care facilities in the Durban
functional region. Those who expressed a willingness to p~cipatewere included in the study. Semi-structured interviews were conducted at the convenience of each of the health care planner respondents in this study.
Focus Group Interviews
Focus groups were homogenous, allowing for more freedom of expression and
increased validity of data provided (Burns and Grove, 2001). Prior to the focus group, members were given an idea of the topics on which the session will focus. This was done during the study briefmg when participants were being recruited (Appendix 2.1, Appendix 2.2, Appendix 2.3), to ensure that they were given time to think about what they would like to say in the focus group session. This allowed for more detailed and well thought out information being provided (Burns and Grove, 2001). However,
topic guides were used merely to help the researcher get the discussion started during focus group interviews, at which point the researcher allowed the discussion to guide itself as data was provided and delimited. During the focus group interviews,
information was constantly fed back to participants by the researcher to verify that it had been correctly understood and interpreted. As codes emerged, these were also fed back to respondents for their confirmation.
A quiet room was provided at each research site to ensure privacy during the focus group interview. Focus group interviews conducted lasted between one and one and a halfhours to ensure adequate and useful data capture. All sessions were tape recorded with the permission of participants. This was done to assist the researcher in making notes and memos and to ensure that no data was lost during the session. Tape
recording was done with the permission of group members and was later transcribed into text by the researcher for the purposes of data analysis.
Semi-structured Interviews
Semi-structured interviews were conducted in a quiet room provided by the health care facility where data collection took place. A topic guide (Appendix 2.1, Appendix 2.2, Appendix 2.3) was used to assist the researcher in guiding the discussion during the interviews; however, the researcher was conscious at all times of not over controlling the process and allowed the interview to follow the direction that the discussion took (Burns and Grove, 2001) towards emergence of the constructs. To aid the discussion, where possible, respondents were informed ofthe topics for discussion prior to the interview. This was done to ensure that the respondents had time to think over the information they wished to share during the interview. All respondents were
briefed on the study and given an opportunity to have their questions regarding the study answered.
During the semi-structured interviews, information was constantly fed back to participants by the researcher to verify that it had been correctly understood and interpreted. Ascodes emerged, these were also fed back to respondents for their confirmation. Interviews lasted between one and one and ahalfhours. All interviews were tape recorded with the permission of the interviewees. Tbis was done to aid the researcher in delimiting the data towards the desired emergence of constructs and to prevent any data from being lost. The recording was then transcribed verbatim into text for analysis.
General Data Collection Procedure
According to Polit and Hungler (1999, p. 247) "the primary purpose of the grounded theory approach is to generate comprehensive explanations of phenomena that are ground in reality". Grounded theory shares many commonalities with
phenomenology. It allows the researcher to move from merely describing a phenomenon to actually attempting to understand the processes that underpin the phenomenon being studied (Burns and Grove, 2001). In keeping with this approach the emerging concepts were fed back to the participants during focus group interviews and semi-structured interviews so that a discussion of concepts took place, allowing for confirmation of the emerging constructs. With the grounded theory approach, data collection and data analysis go hand in hand. As data was being collected it was simultaneously analysed by the researcher and used to direct questioning towards the honing of emerging constructs.
The principle of data saturation was used for all three stakeholder groups, with regards to conducting semi-structured interviews and focus group interviews. This is
"when themes and categories in the data become repetitive and redundant, such that no new information can be gleaned by further data collection" (polit and Hungler, 1999, pA3). Hence data collection ceased for each stakeholder group when the research determined that no new core categories, sub-categories and properties were emerging (Glaser, 1998).
3.5.2Data CollectionSettings
Data collection took place in as naturalistic a setting as possible. Adolescent clients provided data at research sites, with one antenatal participant opting to be interviewed at her home. Permission was sought from the research sites to use facilities on the premises for data collection. The idea was that adolescents who had attended maternity services at these institutions were already comfortable in the hospital settings. Hence, collecting data from them in a private room on the day that they accessed the services was not thought to be problematic. For antenatal clients, data was collected in the antenatal clinics in a private room provided by the research site.
Data was collected from postnatal clients in the postnatal ward, at their bedsides, with permission from both the ward staff and the participants. This variation was also done, so as not to inconvenience respondents, especially those who had recently delivered and were experiencing postpartum pain and who were nursing their infants, and therefore not readily mobile.
For the health care providers, their work environment was considered a natural setting in their day to day lives, as it was a place at which they spent a substantial amount of time. As such, it was assumed that they would feel comfortable within this setting.
Hence, data was collected on site in health care facilities from health care providers.
Once again, with permission from the site authorities, a private room was allocated for the collection of data amongst health care providers. For health care providers working outside the health care facilities, data was collected at either their place of business or their homes, according to their requests.
Nursing service managers, doctors and health care planners were interviewed in their offices, so that they felt comfortable and were able to readily participate since they were not kept away from their work for a very long period of time.