DATA ANALYSIS PROCEDURE AND DISCUSSION OF NASCENT FINDINGS
Step 1: Immersion in and familiarisation with the findings
Step 1 of data analysis spanned from early March to early May 2018, during the preliminary fieldwork phase. In this reading and early coding stage I familiarised myself with the collected data by transcribing interview notes, reading and re-reading typed transcripts and analysing them for nascent themes and tentative associations in a recursive process (Chong and Yeo 2015; Simmons 2014). Interviews were transcribed within a few days of collecting data and simultaneously analysed for findings as I typed them up. I also began keeping a reflective journal at this stage.
Familiarising myself with the findings as they were collected was helpful for establishing knowledge and perceptions of the magnitude of the MDR-TB problem in eThekwini Metro and the contribution of low adherence to the scale of the epidemic. Through this process, nascent ideas about the relevance of communication as a viable response among participants to this study were read. Key participants in these early interviews explained that in KwaZulu-Natal,
Eleven people die each day of a preventable, treatable disease; that tells you something. It tells you that people don’t know the signs and symptoms because as soon as anyone has any of those symptoms, they should immediately think TB… why don’t they know the signs and symptoms?
Because it’s [information] not out there. In the early days of HIV, we had a lot of money for education, and we did so much with it. That’s what we should be doing for TB now (R. Page, Deputy Director: Advocacy,
Communication and Social Mobilisation, Provincial TB Control Programme of the KwaZulu-Natal Provincial Department of Health, Interview, 6 March 2018).
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Although the numbers for DR-TB are not as huge as those for drug-sensitive TB … it [DR-TB figure] is above the national target of where we should be.
I think its way above where it should be; the target is that we should have less than five per cent of [patients] lost to follow-up. But at this point we are at more than five per cent (N. Ngomane, Clinical/Technical Advisor,
Tuberculosis Control Programme, KwaZulu-Natal Department of Health, Interview, 10 April 2018).
These insights helped to validate the study’s viability as they substantiated the premise in this thesis that the intersection of sub-adherence to MDR-TB treatment and insufficient health communication in eThekwini Metro is worth researching.
Data analysed in Step 1 was derived from six lengthy and broad interviews with three KwaZulu-Natal Department of Health staff and three nurses at King Dinuzulu Hospital. As explicated later, data collection became narrower and more focused as the research progressed. It is important to explain that because of the homogeneity of roles of nurses at different grades in the DR-TB Unit at King Dinuzulu Hospital, commonalities in the information they provided and themes emerging from their contributions were already evident at this stage. The research achieved theoretical saturation in understanding how nurses educate MDR-TB patients about treatment early on. This finds explanation in that treatment education is meagre and informed by a consent form that patients sign to agree to MDR-TB treatment. Nurses did not indicate referring to any standardised content, for instance that in the National Tuberculosis Treatment Guidelines (2014), a copy of which was observed in the matron’s office where interviews were occurred at King Dinuzulu Hospital.
Saturation of information from nurses was also reached quickly because nurses spend very little time communicating with patients. Volunteer health educators do this work, although there is still low emphasis on educating patients to adhere to treatment.
There are counsellors outside on clinic days. They’ve got an electronic flipchart that they use on the TV. And if they have pamphlets, they give those out as well. They first explain what TB is; signs and symptoms, and then they show how the patient is supposed to cough and close the bottle (Nurse #2, Interview, 7 March 2018).
We use the TV in the area outside to give information about how to produce sputum and how long treatment is. We also counsel outside. It happens in groups (Nurse #1, Interview, 7 March 2018).
Finding out about the more significant involvement of volunteer health educators in communicating with MDR-TB patients necessitated the expansion of the respondent list to include someone in this role. This was important to the study’s aim of identifying persons or categories of persons within health facility settings able to knowledgeably
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discuss how and what sort health communication happens with patients via interpersonal communication in healthcare facilities as this influences how strategies in the communication model proffered in Chapter Ten can be practicably implemented.
Keeping track of initial ideas
A system to keep track of initial thoughts and ideas about the research findings and emerging themes was developed. Themes were linked to each other and to the content in the literature review and conceptual framework chapters and analysed in the context of the extent to which they helped address research questions 1 and 2 initially. Core theoretical concepts were thematically identified, and weak connections made between central ideas and existing literature at this point (Simmons 2014). As illustrated in the screen grabs in Figure 17, I conducted textual content analysis (Allan 2003; Pope et al. 2000), noting early observations in the reflexive journal and the margins of typed research transcripts.
Figure 17: Preliminary reading of transcripts, data analysis and coding
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Typing up notes, observations and embryonic analyses in the margins of transcripts and writing in the reflexive journal during the early stages, while the interviews were still fresh in my mind, primed me for writing up the findings, with detailed analyses and associations made in Step 6 (Braun and Clarke 2006). Data was analysed as soon as it was collected and, adopting a repetitive approach, I read transcripts of newer interviews together with earlier ones to re-familiarise myself with the contents and make more tentative linkages between findings. The writing process itself often highlighted other patterns or themes worth scrutinising or pursuing through more fieldwork, as discussed later in this chapter.
The approach to scrutinising data illustrated in Figure 17 supported the incorporation of new lines of inquiry into the research guides that were used with young women and their household contacts from late May to late September 2018. Analysing data and writing up the findings occurred cyclically, with early reviews pointing to new strands of inquiry to follow and suggesting themes to look for in subsequent data collection events (Research Methods Knowledge Base no date). Some research tools were extensively revised to respond to unanticipated themes that emerged from the first round of data collection. The quotation below was among these; a key participant shared:
You would not believe how many people now, 20 years after democracy, have no schooling. And we are talking young people. I was shocked by that, I thought everybody had to go to school. There are a lot of people who’ve
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never been to school and they are only in their early teenage years or their 20s (R. Page, Interview, 6 March 2018).
This insight prompted the revision of questions in the research guides that were too technical and/or pitched at too high an academic level and, therefore, inaccessible to the ‘typical’ vulnerable young women with MDR-TB in eThekwini Metro as described in Chapter Four. The possibility that unnecessarily complicated language would alienate participants and affect participation was considered. This led to contemplation that nuances in MDR-TB biomedical and technical terms in English would not translate well into isiZulu and that I, a non-isiZulu-speaking researcher, would struggle to expound unclear questions without interpretation during focus group discussions.
Some questions were consequently simplified to abridge and elucidate lines of enquiry in the research guides. Furthermore, questions deemed superfluous to the task of gathering sufficient information to address the research questions were excluded altogether at this stage.