III. The Outcome component
3.2 Research design
Research design may be defmed as the overall plan for addressing a research question, which includes specifications for enhancing the study's integrity by Polit and Beck (2004). Meanwhile, Trochim and Donnelly (2006) described it as the glue that holds the research project together and Brink (2006) indicated further that the best design is always
the one that is most appropriate to examine the research problem and purpose. Zach (2006) indicates further that the research design structures the research, and show how all of the major parts of the research can work together to address the central research questions.
The purpose of this study was to explore and describe residential care for the elderly in specific locations in eThekwini Municipality in terms of its residents, staff &
organizational structure, aimed to make recommendations for residential care in the eThekwini. Thus, selecting the best research design was critical to achieving the study's objectives. Terre Blanche and Durrheim (2004) suggest that the choice of a research design be based on the purpose of the research. To this end, the theoretical paradigm should inform the research, the context or situation within which the research is carried out, the application of the research techniques to collect and analyze the data. Based on the above statement, a descriptive explorative case study design, using both quantitative and qualitative approaches was adopted as the best design for this study.
Case studies provide a relatively richer and more vivid picture of the phenomena under study than other designs (Zach, 2006). Through this design, the researcher was able to know about her research participants' condition, thoughts, feelings, actions (past and present), intentions, and environment (Polit & Beck, 2004). The need for this design was born from the researcher's desire to describe and explore the three dimensions of the study's conceptual framework; the structure, process and outcome of residential care.
Case study approach is also useful in providing significant amounts of descriptive
explanation about the 'why', 'how' and 'what' (Yin, 2003) of a study. In addition, the infonnation obtained through this design, together with the literature was used to make recommendations for residential care for the elder in the four facilities studied.
The crucial aspect in justifying the use of both quantitative and qualitative research approaches is that each methodology has strengths and weaknesses (Bums & Groves, 2001). Philosophically, quantitative research is underpinned by a positivist paradigm that proposes that scientific truths exist, and these truths can emerge from what can be observed and measured or studied as objects (Gerrish & Lacey, 2006). Methods which minimize or are free from bias are used to do this so that greater confidence can be given to any findings. This approach is often referred to as the scientific or empirical method.
On the other hand, qualitative research fits more neatly within an interpretive approach based on the assumptions that in order to make sense of the world, human behavior should be interpreted in interaction with others (Gerrish & Lacey, 2006). Since it is not always possible to recognize all these characteristics in either quantitative or qualitative research approach, the researcher utilized both paradigms so that the weakness of one method can balance out the other (Gerrich & Lacy, 2006).
The mixed method can also ensure data triangulation by the use different data sources (numbers and words), to increase the type of infonnation obtained from participants, and produce a more holistic picture that infonnation (Gerrich & Lacy, 2006). Since many variables are involved in the study of ReFs, Yin (2003) emphasized the need for researchers to rely on multiple sources of evidence to ensure triangulation; which come largely from interviews, documents review, direct observations, participant observation
and physical artifacts (Yin, 2003). Case study design is lacking in rigour, and Yin (2003) further emphasized the use of mixed methods to enhance its strength.
During data collection, the researcher utilized direct observation, focus group discussion, semi-structured interview, document review and questionnaire to ensure triangulation. As it is not always easy to collect quantifiable data for all variables, (Brink, 2006) cautioned that variables such as the number of caregivers, number of resident education, etc can be readily expressed in numerical terms, but other variables such as staff attitude and philosophy of life are not so easily quantified. Such variables lend themselves more appropriately applied to qualitative measures, such as detailed verbal descriptions, than numerical summaries (Zach, 2006). According to Creswell (2003) qualitative data often capture the subjective "human" side of a question in a way that is not possible through the use of quantitative methods alone. This type of information can provide examples of important conceptual phenomena and nuances, the full impact which may not be conveyed solely through quantitative data.
Utilizing the mixed method can be challenging to researchers as interviews usually yield rich data, details and new insights about the research problem and provides an opportunity for the researcher to explore topics in depth. Due to the flexible nature of interviews, the interviewee may distort some information through recall error. Moreover in a document review, gaining access to or locating suitable documents for review and analysis of the documents may be difficult and time consuming. These are some the challenges that researchers utilizing mixed methods encounter.
The study was a "four-case" or "multiple-case" study. Case studies can be one case, where one subject is studied in depth, or multiple cases, where more than one subject is examined repeatedly in order to enhance the validity and reliability of the findings (Yin, 2003; Zach, 2006). The design was appropriate to explore the phenomena under study through the use of a replication strategy, which was recommended by Yin (2003) as useful when variables as well as differences between or among two or more programs are present. The study design was used to explore and describe residential care for the elderly in eThekwini Municipality in terms of its residents, staff and organizational structure and determine ways in which those factors influenced elder care on a comparative basis using four RCFs.
In multiple-case studies design, there are no rigid rules about how many cases are required to satisfy the requirements of the replication strategy. However, Yin (2003) suggested that if the results turn out as predicted, then the number of cases chosen is sufficient to "provide compelling support for the initial set of propositions" (p. 46). As the multiple-case studies approach does not rely on the type of representative sampling logic used in survey research, Yin (2003), noted that the criteria regarding sample size are irrelevant" (p. 50); instead, sample size should be determined by the number of cases required to reach saturation. The sample participants should be selected explicitly to encompass instances in which the phenomena under study are likely to be found.
3.2.1 Components of case study
Yin (2003) suggested that a case study design must have five components: the research questions, proposition of the study (if any), unit of analysis, logic linking the data to the propositions and criteria for interpreting the findings.
3.2.1.1 The research questions: The research questions were directed at the structure, process and outcome of the conceptual framework (Donabedian, 1980), using "how",
"what" and "why" questions as proposed by Yin (2003).
3.2.1.2 The study's propositions if any: The study design is focused on exploring and describing residential care for the elderly, and not on formulating propositions. Moreover, the rationale for undertaking the study was supported by the review of relevant literature of the phenomenon under study.
3.2.1.3 Unit of analysis: Bless, Higson-Smith and Kagee (2006) describe the unit of analysis as the person or object from whom the researcher collects the data. Yin (2003) suggests that operationally defining the unit of analysis can assist with replication and efforts at comparison. For instance, individuals, groups, artifacts (books, photos &
newspapers), geographical units (town, census tract, state) and social interactions could be defined as units of analysis. In this study, the unit of analysis was the facility as measured by administrative and nursing staff of the study's four ReFs, the elderly residents, as well as physical infrastructure and documents as part of the material resources. Specific persons and objects within the programmes provided relevant data about the structure, process and outcome of each nursing home.
3.2.1.4 Logic linking the data to the propositions: The conceptual framework guided the process of data collection and laid the foundation for data analysis and the reporting phase; it also helped to create linkages within the study.
3.2.1.5 Criteria for interpreting the findings: The structure, process and output of the study's conceptual framework formed the basis for comparing and interpreting the fmdings from the four ReFs. These five components of the case study were applied to the relevant sections of the study.