1. INTRODUCTION
3.4 DATA COLLECTION
Data collection in this study followed the triangulation method. This was an attempt to reach credibility, validity and reliability. Triangulation refers to the use of two or more data sources, methods, investigators, theoretical perspectives and approaches to analysis in the study of a single phenomenon and then validating the congruency among them ( Kimchi, Polivka, & Stevenson, 1991). In this way the validity of the study is increased. In this study triangulation was done through the use of different methods for data collection, from at least two different places using the same tools, from different topics and at different times.\pata was collected using an interview guide, using two initial meetings, a series of meetings for the establishment of the legal body, checklist tool for the semi experimental project and instruments to measure hypertension.
Sometimes in the meetings there would be new participants who helped in verifying some of the information provided by the primary participants (Brink, 1993). ~
An unstandardized interview was utilized for the major part of the individual interview in order
to obtain systemic data from all groups. Raymond (1997) mentions that in the unstandardized interview, the general nature of the questions is specified in advance, but the specific questions are not. The interviewer keeps the purpose of the research in mind, but determines the specific wording of the questions and their order. This allows for a naturalistic or informal interview in
that the interviewer is free to ask questions in the order and manner that follow the natural flow of the interaction. A list of questions or question guidelines may be prepared, but a formal interview schedule is not generally used. A standardized interview consists of a list of questions with the specific wording and order of the questions predetermined and administered in a standard manner for all the interviewees. Series of meetings were also utilized. The two initial meetings were done to establish the definition of the problem. A series of meetings were utilized
during the implementation of the strategy of legalizing traditional healers. The only principle which was difficult for the researcher to observe was that of the number ofparticipants, hence the planned focus group sessions turned into meetings. It was not easy to tell which traditional healer or client should attend. The number of participants exceeded the number recommended for a focus group. A focus group can be defined as a 'group interview centred on a specific topic (focus) and facilitated and coordinated by a moderator or facilitator, who seeks to generate primarily qualitative data, by capitalising on the interaction that occurs within the group setting. ' It is generally felt that 8 -12 is a suitable number of participants for a focus group .. The idea behind the focus group method is that group processes can help people to explore and clarifY their views in ways that would be less easily accessible in a one to one interview ( Sim, 1998).
The focus group method may encourage a greater degree of spontaneity in the expression of views than alternative methods of data collection. The sense of a safe forum is provided and participants may feel supported and empowered by a sense of group membership and cohesiveness. Data is collected on how they interact with one another (Sim, 1998). In this study the two initial meetings as well as the series of meetings that followed also allowed dialogue to take place between the participants.
A checklist tool was utilized for collection of data, concerning readings or levels of diabetes and hypertension in the clients who utilized only, or combined, western medicines in the semi- experimental study. Data was collected as follows:
3. 4. 1 Stage One: Individual interviews: ProfIle of traditional healers and defining of the problem
Outlining the Profile of Traditional Healers
During the individual interviews with western health care workers, it became clear that it was important to develop a descriptive profile of traditional healers. Western trained health care workers did not know much who traditional healers were and what they practice or treat in order for them to be in a position to collaborate with them. During the interviews, data was then collected about the traditional healers' profile. The profile included their age, type of traditional
healer, number of years as a healer, types of illnesses being treated and how they were trained and by whom as well as their area of residence. Mainly the biographical data of traditional healers was collected.
Defining the problem, exploring its' context, analysing it and developing solutions
An individual interview guide using an audio tape recorder and two initial meetings were utilised
to collect data. Data collected at this stage related to knowledge about chronic illnesses and other illnesses, approach to the management of diabetes and hypertension, the nature of current interaction between traditional healers and western trained health care workers, perceived enhancers and barriers as well as recommended solutions for collaboration in general and in the management of diabetes and hypertension. The respondents were the western trained health care workers, the clients suffering from diabetes and hypertension and the traditional healers. This stage was aimed at collecting data about the analysis of the problem and also initiating the process of change. During this individual interview stage the researcher developed a very good rapport with the participants in preparation for the next stage of two meetings which was a critical one. The
next stage was very critical in that dialogue and ventilation of bottled up feelings between western health care workers and traditional healers was expected, based on responses the researcher received dUring the interview stage.
a) Health care workers and the clients:
Data collection through individual interviews was started in June, 1999, for the nurses in both health care centres. In Sithobela eight (9) nurses and one (I) doctor were interviewed and five (4) nurses and two (2) doctors interviewed from Dvokolwako health care centre. In Sithobela they used the integrated method of health care delivery for all types of patients owing to shortage of manpower.
Clients normally have their checkups on a monthly basis, so the researcher found that per day a lot of clients turned up for their check ups. Hence in Dvokolwako Health Care Centre the researcher managed to interview a larger group of clients since they all come every Thursday. Each client come on Thursday once a month. Each client or health care worker was interviewed alone in a room to avoid interruption and embarrassment as well as to boost his! her confidence and free expression. The researcher would call the sister in charge to make an appointment for her visit to conduct the interviews. This meant that western health care workers and the clients expected that they were going to be interviewed, and this made the interviewing process easier. Extensive data was collected from the clients in Dvokolwako Health Care Centre, but less data collected from Sithobela Health Care Centre. In Sithobela, there was no set date for check ups, client came whenever they felt like. Sometimes there would be no client suffering from diabetes nor hypertension for the whole day or days. This was not easy for the researcher to meet a lot of clients.
b) Traditional Healers:
i) Dvokolwako Health Care Centre
The researcher was assisted to locate the leaders ofthe community by a health inspector.
The chief was contacted who, then through his runners, organized the traditional healers to attend a meeting with the researcher. This was arranged so that the research could be exPlained and to seek consent from each healer to participate in the study. Fifteen traditional healers turned up for the meeting. The purpose of the study and the stages of the study were fully explained to the traditional healers. After the meeting those traditional healers who consented arranged for an appointment to be interviewed, giving a place and time to the researcher. Only seven (7) traditional healers were interviewed and by then the researcher reached the saturation of data. All these traditional healers were interviewed.
To locate their homesteads, the researcher utilized the services of an assistant who knew where to find them The researcher had learned that the chief had ordered that all traditional healers in his area should participate.
Ii) Sithobela Health Care Centre
A traditional healer who is also a member of the Community Health Care Centre Committee assisted the researcher by offering his son as a guide to locate traditional healers. In this community the leaders were not directly contacted, but the traditional healer reported the proposed study to the leaders and he reported that they were giving their permission. A meeting of traditional healers was organized. Only three (3) traditional healers turned up for the meeting. When data was being collected, most traditional healers showed interest. Nine (9) traditional healers were interviewed in their own homes in this community.
3.4.2 Stage Two: Two initial meetings ( defming ofthe problem, exploring it's context and developing strategies)
Two meetings were conducted, one in each centre. This was the stage at which all the stakeholders came together to explore collaboration in the management of diabetes and hypertension and jointly develop strategies for collaboration. The stakeholders were the Ministry of Health and Social Welfare, traditional healers, clients suffering from diabetes and hypertension and western trained health care workers. They explored the problem of collaboration together and identified the strategies or ways by which collaboration could be facilitated.
A dialogue between the stakeholders was facilitated at which there was flaring of emotions, especially from the traditional healers, but as the discussions continued, these emotions settled down. When the Ministry of Health representative gave a report from the Ministry's authorities, the traditional healers expressed dissatisfaction with the statement that the Ministry perceived that collaboration between the traditional healers and the ministry was facilitated. After identification of strategies and solutions by different individuals on how best they could collaborate, ways by which they could be implemented successfully were explored. These decisions involved planning and setting of action plans as to when the strategies should begin to be implemented.
The researcher considered that a group of 15-20 individuals would be enough, but seeing that the research had stimulated extensive interest, especially in one of the communities, it was not easy
to estimate the number who would attend. The other reason was that, in the rural setting it was not easy to select traditional healers to be excluded because of the fear of exceeding the recommended number of participants in a focus group. The researcher ended up with 41 participants in one community, and 58 participants in another. The participants were traditional
healers, clients suffering from diabetes and hypertension, the western health care workers, the Officials from the Ministry of Health and Social Welfare and from the University pf Swaziland.
A neutral person was requested to be the chairperson and to lead the discussions. The researcher planned to involve somebody from the Rural Agricultural Development Department or one of the Rural Leaders who is not part of the participants. It this instance, the leader was a Lecturer from the University who is a Health Inspector under the Department of Environmental Health Sciences.
Stringer (1996) states that a meeting is best led by a neutral chair or facilitator, a person perceived as having no overriding loyalty to any of the stakeholding groups. The health inspector in this case was chosen on the basis that he was a health worker and had been involved in community work, so he had knowledge and skills about how to run community meetings. After each individual interview, the researcher discussed the possibility of a focus group session. Most of the participants interviewed showed interest in attending the meeting. An agenda for the meetings was developed, stating the purpose of the discussions and how discussions would be carried out. This was discussed with the chairperson beforehand. The meetings were held in common rooms of the health care centres. The researcher had planned to hold them in community halls, but that proved to take too long to arrange. In the end, all participants were comfortable with the venues, and the venue provided a conducive environment for traditional healers, clients and western trained health care workers to have a feeling of togetherness.
Stringer (1996, p75) states that the framework for description should have appropriate initiating questions, such as Why are we meeting today? or What is the Pwpose?, What are the problems?, How do they affect our work?, Who is being affected ?, Where are things happening? and When
are things happening? These meetings tried to address such initiating questions. The answers focussed on acts, activities and events related to the problem.
The next stage recommended by Stringer (1996) is the stage of analysis of interpretive accounts by means of which the participants would come up with categories or concepts. In the focussed group session it was expected that the participants would come up with a few strategies from all the discussions. It would be simpler to implement a few major strategies than to have a number of bits and pieces that need to be implemented. In this case there were a lot of strategies that the participants suggested. The problem of collaboration seemed to go deeper than the researcher had thought and this would be reflected in the presentation of results.
3. 4. 3 Stage Three: Process analysis! evaluation and implementation of strategies
Implementation of strategies
a) Experimental survey to establish the efficacy of herbs used by traditional healers vs western medicines for the control of hypertension and diabetes:
The researcher utilized an interview tool and a checklist tool to view the health records of those using only western medicines to control their diabetes and hypertension. The medical records were looked into for comparing subjective and objective data. The levels of glucose in the blood and blood pressure using instruments for the clients who used only traditional medicines to control their diabetes and hypertension were also determined, after having collected the history of the course of the illness.
b) Establishment of a legal office of traditional healers at the Ministry of Health and Social Welfare, establishment of traditional healers council and development of their constitution.
For the initiation of the traditional healers' office, the researcher utilized open discussions with
the traditional healers, leaders of their organizations and the Ministry of Health and Social Welfare Administrators. The Ministry of Health and Social Welfare Administrators were visited initially to try and find out how they viewed the issue of a legal office of traditional healers in the ministry.
A series of meetings were held thereafter with traditional healers, clients and the western health care personnel to discuss these issues further. In these meetings there was a process of action plans, progress and feedback followed by an action plan, progress and feedback and so on.
Accounts of meetings and the ensuring deliberations will be seen under the 'special projects' chapter. In the Ministry of Health and Social Welfare, the meetings were held with the Director of Health Care Services in Swaziland. The two leaders of traditional healers were from the Traditional Healers Organization and from the Tinyanga Temdzabu Organization respectively.
Thereafter, several joint meetings were held either in Sithobela or Dvokolwako Health care centres. The meetings from these centres were followed by meetings held around Swaziland in areas where traditional healers normally meet. This was in order to obtain opinions of all traditional healers concerning these issues before sending the draft to the lawyer who will then put it into legal wording.
In these joint meetings, the researcher gave feedback on the progress of the research. The issue of an office was discussed further. A lot of information was gathered from the clients, traditional healers and western health care workers. Field notes were taken by the researcher. Some traditional
healers assumed the position of chairpersons to lead the discussions.
c) Initiating the exchange of information and skills:
In some of the meetings where the researcher gave feedback and discussed at length the legal traditional healers' office, the other agenda would also be the exchange of information . Each cadre came in with a prepared topic to share with the others as far as heahh issues were concerned. The researcher indicated how far the study had gone to the participants before they lost any track of the research. This was also to assist them to recall and emphasize their roles in facilitating collaboration.