RESEARCH METHODOLOGY
3.8 DATA COLLECTION TECHNIQUES AND PROCESS
3.8.1 Focus group discussions
Stewart and Shamdasani (1990) explains that this method of data collection was developed in the field of market research and is a useful tool to elicit information on complex topics that is
71 exploratory in nature. Becoming increasingly popular in health sciences, focus group interviews are used to explore what individuals believe, feel and experience with regards to a particular phenomenon related to health outcomes. Moreover the FGD method of data collection is often used for the development and evaluation of programmes, in-depth exploration of experience, and thoughts about an issue (Holloway, 2005; Rabbie, 2004). As the name suggests, a focus group discussion comprises of a selection of participants, purposively selected by the researcher, who have similar characteristics or personal or socio-economic attributes in terms of the background for the phenomenon of interest. Moreover, participants in a FGD come together to provide in- depth group discussions on a focused topic and are comfortable discussing the topic with the interviewer and each other (Rabbie, 2004; Creswell, 2003; Morse and Field, 1995). In this study, the FGDs were used as a form of group discussion and reflective discourse sessions at both research settings to elicit the process of the participant’s development in critical reflective skills and group dynamics in the developing CoP. The discussions were focused as participants were required to share information and experiences in terms HIV nursing care to assess whether critical reflection played a part in the development of their skills.
Because the participants were all registered nurses/professional nurse practitioners working in the discipline of HIV/Aids and working in the maternal and child health department wherein PMTCT care is provided, this created a platform for sharing like-minded and similar experiences in terms of HIV nursing care and challenges thereof, as well as relating to shared practices. This similarity in clinical background also made participants feel comfortable to share among each other and with the researcher. Kitzinger, in Holloway (2005), notes that the group size for FGDs can be between 3 to 15 participants, but cautions that too many or too few may lead to problems, such as minimal contribution from all participants. The author recommends that a group of
72 between 6-8 participants is ideal for group cohesion. In this study, the FDGs/reflective discourse sessions, which formed the primary medium within which data was collected and theoretically relevant concepts emerged through the process of constant comparison, were made up of 8-10 nurse practitioners.
At the beginning of each session, participants were reminded of general group norm rules that were collaboratively created and agreed upon by the participants and researcher, some of which included confidentiality of all information and being reminded that what is shared in the group remains in the group. Participants were also reminded that the sessions were audio-recorded and all information yielded from the recorded session was to be aggregated for the generation of a collective meaning, Moreover, due to the nature of reflective practice that sometimes unearths intense emotions of the participants, particularly those infected with HIV/Aids, participants were reminded that they could request to have their input deleted from the audio recording.
Although the role of the researcher in the FGDs/ reflective discourse sessions was to moderate and facilitate the discussions, during the first three to six sessions of the data collection process, the researcher assumed a more teacher focused role and shared information on HIV related topics to fill certain gaps that had been identified by the participants. Being mindful of the threat of external bias that the researcher (as the initial facilitator) could infer on the nature of the FGDs, the use of Flanagan’s (1945) critical incident technique was used. This technique fostered greater ownership of sharing clinical experiences by the participants. Moreover in terms of initiating the practice of critical reflection among the participants, during this period, the researcher encouraged members of the group to be reflective and share experiences that had happened to them, using Flanagan’s (1945) critical incident technique to guide the reflective discourse
73 sessions and process. To stimulate discussion of clinical experiences and evoke reflective discourse on experiences, the researcher facilitated the sessions by asking general questions such as “Can you share with me what happened during an HIV related experience either in the ward or in your workplace?” “What did you do during this experience?” How did you feel about your action or behaviour or your skill during that event or experience?” “What do you think you will do differently if you had to be faced with a similar experience?” “What information or knowledge would you need to change that outcome if presented with the same experience?”
It became evident from the fifth or sixth session to the last session (i.e. sessions 10-13), that the group dynamics had changed, and there was more familiarity, trust, friendship and group cohesion among the participants. The facilitator assumed a less teacher centered role and became more of an observer of the process of reflective discourse and group autonomy within the CoP.
Participants gained greater proficiency in reflective discourse and were able to share their issues and solutions regarding HIV among their peers. Moreover, the group dynamics among the participants facilitated greater autonomy and independence in their role of steering the group process. The researcher, therefore, served as observer of the group process and facilitated in asking probing questions related to the theoretical constructs that emerged, as opposed to promoting the reflective process. Each reflective discourse/FGD session lasted between 90-180 minutes. After the reflective discourse sessions, the data from both groups was analysed and compared to assess for emerging theoretical concepts on the study’s phenomenon. All reflective discourses shared within the medium of the FGDs were audio-taped and transcribed verbatim;
refer to Appendix 1 for a sample of a FGD/reflective discourse session.
74 3.8.2 Individual in-depth interviews
Interviews, which can be semi or unstructured, are used widely in qualitative research approaches, and grounded theory is one such design that uses in-depth, face to face interviews to capture the richness and density in the data regarding the phenomenon from the participant’s (Creswell, 2003; Crabtree and Miller, 1999; Merriam, 1998). Referred to as a focused or purpose driven conversation between the interviewee and the interviewer (Merriam, 1998; Morse and Field, 1995), in-depth, face to face interviews were used in this study to increase the density of the data collected and to verify concepts, categories, dimensions and properties that emerged from the FGDs/reflective discourse sessions. The interview sessions were open and promoted open sharing from the participants regarding the phenomenon. Probing questions were used to guide the interview in cases where further clarification on the identified theoretical concepts that were identified from the FGDs/reflective discourse sessions were needed.
The in-depth interviews were also used to explore how the participants perceived their learning process in terms of critical reflection skill development and their involvement within the CoP.
The interview schedule, thus, had a formal introductory section, where the nature and purpose of the interview was explained to the participants, and this was followed by probing questions.
Each interview lasted between 25-35 minutes. The interviews were audio taped and transcribed verbatim. The constant comparison technique (Strauss and Corbin, 1990) was employed on the data after each interview, to assess for deeper insight and understanding on the participants’
experiences within the developing CoP, the learning process and the use of critical reflective skills on their HIV nursing practice. Refer to Appendix 2 for a sample of an individual interview.
Saturation of the theoretical concepts regarding the participants’ experiences was achieved after six interviews from the total eighteen participants in the study.
75 3.8.3 Document analysis of reflective journals
Premised on Schön’s (1987; 1983) seminal work on the epistemology of reflective practice and experiential learning, reflective journals were used as a medium to assess the process of critical reflective development as participants documented their reflections “in and on action” in their daily clinical experience of HIV nursing. A hardcover note book was furnished to each participant, wherein their daily reflections could be documented. A presentation and demonstration on the use of the reflective journal was initially provided by the researcher who served as a facilitator in the developing CoP. Participants were encouraged to make use of the journals in different ways in light of their own comfort and creativity, being mindful of addressing the core aspects of describing an experience, i.e. what the participant did during that even/experience, the outcome and what action/s may have been taken or could be taken to change the outcome of the experience or event. The reflective journals were collected after every third to fifth reflective sessions to facilitate the researcher in conducting document analysis of the reflective journals. During the interim, where the participants were without their reflective diaries, a substitute diary was given to them. Some chose not to use another hardcover note book and chose to use loose pieces of paper which they attached to their diary upon its return. The journals were only kept with the researcher for a maximum of four days for data analysis and then returned to their owners. Appendix 3 provides an example of the reflective journals.
Discussed by Bowen (2009), document analysis is often used as a systematic procedure for reviewing and evaluating documents and may encompass files, letters, journals, meeting minutes, to name a few. Adding to the usefulness of document analysis, Atinkinson and Coffey (1997), cited in Bowen (2009), add that documents are “social artifacts” as they capture socially organized ways and meanings as they are produced and shared by the creator of the document.
76 Guided by Corbin and Strauss (2008) and Bowen (2009) document analysis was used to interpret and elicit meaning and gain an understanding of how the participants were processing the concept of critical reflection and applying it to their clinical practice. Moreover, it also allowed the researcher insight into the socially constructed and organized manner in which each participant uniquely documented, produced and created the journal entries. The reflective journals were thus analyzed concurrently in relation to the FGDs/reflective discourse sessions and individual interviews to saturate theoretically relevant concepts.