CHAPTER FOUR
4.1 RESEARCH DESIGN
Research design necessitates the arrangement of conditions for the collection and analysis of data in a manner that aims to combine relevance to the research purpose, with economy in procedure (Selltiz, Wrightman and Cook 1976:90). Babbie (1992:89) defined research design as a layout strategy for discovering something, adding that:
Although the special details vary according to what you wish to study, there are two major aspects of research design. First, you must specify precisely what you want to find out. Second, you must determine the best way to carry out what you want to do (Babbie 1992:89).
The research was planned to gather and analyse data pertaining to the use of ICTs by medical professionals in the management of health information. Among other things, the study sought to determine the type of health information sources available to medical professionals and how often these information sources were used. It looked at the way health information was captured, stored and exchanged as well as the factors that impede information exchange at the hospitals. It sought to look at the availability of ICT equipment and infrastructures at the government hospitals. It also attempted to seek the type of ICT training acquired and required by medical professionals to enhance the management of health information.
Considering the nature of the research problem, the study adopted the survey research methodology (Terre Blanche and Durrheim 1999) as its principal research design to investigate the use of ICTs by medical professionals in the government hospitals in Yaounde. According to Busha and Harter (1980:62), survey research is capable of collecting background information and hard-to-find data, where the researcher would have no opportunity to motivate or influence the respondents' responses. Saunders, Lewis and Thornhill (2000:94) correctly noted that the suitability of the survey methodologies when they observed that "they allow the collection of alarge amount of data from asizeable population in a highly economical way... ".
Furthermore, the survey methodology was chosen as it permits the researcher to work independently and at her own time, to decide on an appropriate survey instrument to use and also gives the researcher the ability to be in more control over the research process. That is, the ability to decide when to design, to pre-test and administer the survey instrument.
The advantage of the survey method is that it generalises from a sample population so that inferences can be made about some characteristics, attitudes or behaviour of the whole population (Creswell 1994:11). It relies upon observation in the acquisition of data. The method is suitable for the present research because it can produce quantitative information about people's beliefs, opinions and characteristics and past and present behaviour (Neuman 1994:221). This is useful for the present research in drawing conclusions on the use of ICTs among medical professionals.
Survey methodology shares similar characteristics common to other research methods, but has some important differences. For example, survey research is used to collect contemporary data, while historical research is concerned primarily with past data (PoweIl1997:58). It is also less rigorous than experimental research.
4.1.1 Data collection instrument
Powell (1997: 117) states that questionnaires, interviews and observations are among the regular and conventional data collection instruments used in the social sciences. Interviews are structured and observations mean "to watch attentively in a scientific or systematic manner". In an observational study, the current status of aphenomenon is determined not by asking but by observing.
The main data collection instrument used in the present study was the questionnaire. Informal meetings, discussions and observations were used to collect supplementary data. The questionnaire is suited to study alarge number of cases that are geographically dispersed.
Added to the above advantage, questionnaires also enable respondents to feel more at ease to answer questions even of a personal nature and they can afford to be more open and honest. Mailed questionnaires can remove or limit the element of bias, as observed by Bailey (1982:350), which can occur "".when an interviewer influences a person's response to a question through what the interviewer says, his or her tone of voice or demeanour."
As apopular research tool, the questionnaire was used to solicit information from medical professionals (doctors and nurses) who were required to provide answers to the same set of questions (Saunders, Lewis and ThornhiIl2000:278).
The questions reflected the research objectives and research questions of this investigation. Data on the major research areas as determined by the research questions and the research objectives were collected. The questionnaire was considered suitable for this research because it was geared towards establishing the respondents' awareness on the problem under investigation. In addition, the questionnaire is avaluable instrument, especially for a population that is literate. Such a population should be reasonably able to deal with the items contained in the questionnaire. In the present study, medical doctors and nurses completed the questionnaires. This was important for the study in that they were knowledgeable and professionally experienced. The researcher was thus confident that both these groups were capable of completing the self-administered questionnaires and providing useful and relevant information on the subject under study.
4.1.1.1. Designing of the questionnaire
Being unable to locate similar studies to adapt questionnaires already used, the researcher designed aquestionnaire guided by the objectives and a review of the literature, as well as by a combination of other ideas gathered from the survey of information and communication usages and needs in health facilities (Irlam:2002) and the survey of the health information resource centre (Zielinski 2001). The questionnaire, consisting of 30 questions/items, was designed to collect the necessary data for the study (Appendix 1a). The questions/items were organised into six parts and the questionnaire was structured in the following order.
Section One: Questionnaire items 1 - 4
This section was intended to provide the researcher with basic general information on the population of the study.
Such information is important because it provides important working knowledge of the respondents.
Section Two: Questionnaire items 5 - 6
This part provided the health information sources available and the manner in which information is captured and stored in the hospitals surveyed. The responses gave the researcher the extent to which information is managed to support decision-making.
Section Three: Questionnaire items 7 - 13
The focus in this section was the medium used to exchange information and the obstacles medical professionals might encounter. These questions helped the researcher to understand the medium used to exchange information and solutions to overcome the problems they might encounter.
Section Four: Questionnaire items 14 - 22
This section dealt with existing ICT equipment and their uses. These questions were important, as they provided the researcher with a broad view of the types of ICTs available at the disposal of respondents in the hospitals surveyed.
Section Five: Questionnaire items 23 - 26
Part five covered the availability of Internet facilities, examined the uses of the Internet and also endeavoured to establish the awareness of the respondents regarding Internet resources. These questions helped the researcher to complement the information obtained in part Two.
Section Six: Questionnaire items 27 - 30
Section Six looked at the skills, knowledge and training of the respondents, with regard to Internet facilities. These questions determined the type of skills and training needed by the respondents concerning the use of Internet resources.
4.1.1.2 Structure of the questions
The questions were both closed and open-ended, with closed questions forming the majority of the questions. The
"Likert-style" format formed the basis of most of the closed questions. The "Likert-style" is aformat that provides the respondents with a rating scale, that is to ask the respondents, for example, to strongly agree, agree or disagree with a particular statement (De Vaus 1986:88; Bailey 1978:358). The choice of the type of questions was influenced by many factors. Among them were the length of the questionnaire and the time constraints of the respondents. De Vaus (1986:86) cautions that where the questionnaire is long, people's motivation to answer is low. Most often, closed questions are useful, since they take a short time to answer. By virtue of the nature of their jobs, medical doctors and nurses are busy and this was taken into consideration. The open-ended questions were used to provide the respondents freedom in framing the answers, in order to obtain more detailed information on the issues being investigated.
The questions were both closed and open-end, with closed questions forming the majority of the questions. The
"Likert-style" format formed the basis of most of the closed questions. The "Likert-style" scale helps to develop more valid measure.
Finally, the questionnaire was originally written in English. Considering the bilingual nature of Cameroon, which is French-dominated, the questionnaire was translated into French (Appendix 1b). This was to accommodate the French- speaking medical professionals. The translation from English to French was done by translators at the Ministry of Public Health, Yaounde, Cameroon.
4.1.1.3 Informal meetings and observation
Informal meetings and observation were conducted to seek more information and to obtain personal views on the problem. The researcher had informal meetings with directors, general supervisors, nurses, doctors, librarians and also the patients of the hospitals. She observed the actual state of health information and the application of ICTs in the hospitals during the distribution and collection of the questionnaires. This gave the researcher an opportunity to gather information that would otherwise have been impossible to obtain.