Given this study’s questions and objectives, and as highlighted above the two methods selected as part of the mixed-methods protocol were 120 self-administered questionnaires and 10 in-depth, semi-structured interviews. Babbie and Mouton (2001) assert that questionnaires are multifaceted and can be utilised for several types of research such as descriptive, explanatory and exploratory studies. Therefore, this exploratory study employed 120 (109 BMSM) self-administered questionnaires with the purpose of gaining data to establish the generalisable awareness, attitudes and perceptions of BMSM towards PrEP, which would inform the investigation that results in the in-depth, semi-structured interviews. It was decided that the questionnaires method was the best to adopt for this investigation when considering the ethical advantage, they present. Melody Mentz (2012) contends that questionnaires provide the greatest possibility for anonymity because respondents do not need to complete any personal details on the survey. This sensitivity that questionnaires have towards anonymity was a foremost consideration for a study that deals with a hidden population that values anonymity.
The self-administered questionnaire consisted of 29 closed-ended questions that covered a range of topics.
Before completion, respondents were asked to confirm willingness to voluntarily fill in the questionnaire, hence the consent form attached in front of the questionnaire (see appendix 2). Taking cognisance of the ontological perspective of the transformative paradigm relating to the role that language plays in privileging whose reality is understood as well as the power relations that are inherent in the endorsement of certain languages over others. This was particularly crucial in developing a transformative understanding of social reality, hence the questionnaire was made available in IsiZulu, which is the main indigenous language of KwaZulu-Natal. The data collection instrument (questionnaire) also had an English version.
However, all the respondents recruited using the RDS strategy preferred completing the English version of the questionnaire. Understanding was facilitated by reading out each question for each respondent and offering them a chance to answer questions before they attempted answering the questionnaire. The measures used in the questionnaires to collect information included, demographics; here respondents were asked to report their age, ethnicity, level of education attained, employment status, income, and finally how they identified their sexual orientation, whether they identified as gay, bisexual, straight, or curious. This data
enabled for the creation of a profile of not only an MSM in Msunduzi Local Municipality but more specifically, what was characteristic of BMSM in the study setting. Sexual risk behaviour and HIV perceptions required respondents to report on their relationship status, sexual role, awareness of HIV status and HIV testing behaviours i.e. last HIV test. The focus of this section was to establish risky sexual behaviours. Therefore, the respondents reported on sexual activity with a male sexual partner, the number of male sexual partners in a 12-month period, condom use with male sexual partners and finally their perceived risk of HIV transmission. This generated data that would be statistically tested for relationships between behaviours, and risk perceptions as well as PrEP Adoption Intention (see results in Chapter Five). The most crucial measures in the questionnaire were those of PrEP Awareness and PrEP Adoption Intention. In this section, respondents were required to answer questions such as; ‘‘Do you know about Pre- Exposure Prophylaxis?”, “If yes, where did you find out about it?” “Which statement best describes your awareness of PrEP?”, “Have you ever used PrEP?”, “Would you be willing to take PrEP daily to protect against HIV transmission?”, “What would motivate you to take PrEP?”, “What would prevent you from taking PrEP?” using a Likert scale. These questions collected the fundamental data to answer the study’s central research questions and to meet the research objectives of establishing awareness, and attitudes towards PrEP. This section is the most crucial in the questionnaire.
Data on health communication amongst peers and the saliency of these conversations were collected through respondents’ reports on the existence of these conversations, who was involved in these conversations, the motivators for having these conversations with the chosen person/people. Furthermore, the frequency of these conversations, the topics discussed in these conversations and finally, the saliency of these conversations for influencing sexual health behaviours was collected. Due to the intention to conduct statistical testing, checking for frequencies and analysis, the questionnaire used only closed-ended questions. This form of questioning is understood to be most structured because it requires minimal human involvement in documenting, quantifying and presenting the responses. In support of this notion, Babbie and Mouton (2001) state that closed-ended questions, encourage uniformity and make it easy for data processing. Although they are disadvantaged by not allowing depth, for this study, the depth was generated from interview data. Hence, the data generated from questionnaires informed the construction of the in-depth, semi-structured interview with the intention to confirm notions presented and to establish that which inform the sexual risk behaviours, attitudes and perceptions towards PrEP.
It was on the basis of the above that questionnaires were administered for initial data generation, I intended planning the in-depth, semi-structured interviews according to data that emerged as crucial in the questionnaires. Following the analysis of the questionnaire data, the in-depth, semi-structured interview guide was refined from preliminary planned versions considering the salient data categories that were emergent from the quantitative analysis. This was intended to elaborate, clarify and further develop on emergent responses from the questionnaire. This kind of an integrated mixed method approach is described by Greene, Caracelli, and Graham (1989:259) as, “complementarity, which seeks to elaborate, enhance, illustrate, clarify the results of the one method with the results from the other”.
The integrated mixed method approach helps to explain emergent categories in the other data. This approach is specifically salient for a qualitative method such as in-depth, semi-structured interviews because as commented by Du Plooy (2009), qualitative methods explore areas that have limited or no prior information.
It can describe behaviours, themes, trends attitudes or relations that are relevant to the item being analysed.
Therefore, the interviews had the potential to better illuminate the data that was generated through the questionnaire. Each interview lasted for approximately an hour, which included the signing of the informed consent form (see Appendix 4) since participation was voluntary.
The data collection instrument was an interview guide and included an array of guiding questions. The design of the interview guide took cognisance of language and the role that it plays in understanding the social reality of individuals. Therefore, the interview guide was made available in IsiZulu as well as English. With the interviews, one interview was completed fully in IsiZulu and was transcribed and interpreted into English for analysis, whilst most interviewees opted to code switch between IsiZulu and English, which was possible as the researcher was competent in both languages.
During the interview, as an introduction, participants were requested to discuss and expand on their positionality with regards to being a black MSM. This discussion expounded on individual’s resonance with the category and their preferred ways of identification. Mertens (2007), comments that when using a transformative perspective from a methodological standpoint, the dangers of the fallacy that groups are homogenous must be exposed, further arguing that transformative research endeavours to better understand
the important dimensions of diversity. This act of reflection avoids causing additional harm to marginalised and subjugated populations by ascribing them labels that are humiliating and self-defeating. Correspondingly, as stated in Chapter 3, the decolonial project and transformative work cannot be divorced from each other completely. A decolonial research argument for self-determination presented by Smith (2012) can be applied to this train of thought. Ultimately, if research is to contribute to the sustainable change in any community, particularly marginalised communities such as black men who have sex with men (BMSM), the agency of that community to name itself and own its name is important.
In light of the above, the interview allowed participants to explore the contestations of naming. This is also relevant for communicating preventative methods to at-risk populations. Education and communication campaigns need to interpolate these individuals which is extremely difficult if they are not using non- contextual terms of reference. Subsequent to this, HIV risk and the factors were explored to better understand the risk factors that influence the development of attitudes and perceptions that BMSM hold about PrEP.
Participants were required to engage on their PrEP awareness, intentions to adopt PrEP or their lack of intention as well as the motivators, and barriers that influence their overall outlook on PrEP. This data would enable the researcher to identify if there were any synergies with the responses provided in the questionnaire and to establish the influencers of attitudes and perceptions of BMSM towards PrEP. Finally, were a set of questions engaging respondents about the health communication and its role the formation of their sexual health behaviour.