DATA ANALYSIS PROCEDURE AND DISCUSSION OF NASCENT FINDINGS
Step 4: Reviewing themes
177
was a significant factor, when young women with MDR-TB in focus groups were asked about lack of support by intimate partners and experiences of violence to triangulate the finding, many reported being with very supportive partners and explained that being in an intimate relationship was in fact protective and did not compromise their adherence to treatment in any way. While this finding was tracked in subsequent data collection events, less emphasis was placed on its importance by participants than was done initially.
Interestingly, findings from later focus group discussions suggested that expectations of women’s submission in patriarchal societies has protective effects for younger women; especially for those in the 18 to 22 years age range for this study. Many women in this bracket reported completing treatment and having fewer challenges adhering to their regimes, when compared to women aged 23 to 34 years. Younger young women (18 to 22 years) who participated in this research typically lived with their natal families and had an older female treatment supporter, typically a mother or grandmother, who reportedly adopted an authoritarian but caring approach to supporting younger women to take treatment, as illustrated in the quotations below:
When she was going to be hospitalised, I emphasised that she is not alone in this treatment, God is with her. I told her ‘whatever they instruct you to do, do it’ (Precious, mother of MDR-TB patient, 22 years).
When I began my treatment, I went for the injection every day and I had to drink pills before eating in the morning. I remember this one time I fainted on my way to the clinic. I skipped days when it was my clinic days. Sometimes I signed my own card on behalf of the nurses to avoid going there. For two consecutive days I didn’t go, then the DOT supporter came and reported to my mother that I wasn’t going to get my injection. My mother forced me to go, so I went (Busisiwe, 20 years, FGD#2, 21 July 2018).
These findings informed the revision and refinement of research guides to incorporate questions that probed the relationships that young women have with different people around them, and how they impact their abilities to adhere to MDR-TB treatment.
This information helps to address the research question ‘Who in vulnerable young female patients’ lives should be targeted with relevant treatment education for enhanced adherence to MDR-TB medication in eThekwini Metro’, by establishing who has influence over their attitudes and treatment intentions.
178
subsequently cut from the original documents in which they appeared and pasted into a second one, and descriptive headings assigned to each section. This was done to make analysing grouped themes easier, to facilitate identification of more nuanced patterns and associations between the data and to begin planning how the findings would be presented to ensure coherence and flow (Pope et al. 2000). Indexing the data in this way resulted in the creation of numerous ‘fuzzy categories’ or data elements as illustrated in the word cloud in Figure 17.
Figure 18: Reasons for young women's low adherence to MDR-TB treatment in eThekwini Metro
The fuzzy categories were further refined and reduced in number through further grouping of similar categories (Pope et al. 2000). Themes were colour coded and annotated using numerical codes to give them weight. At this stage, however, the identified categories were still too broad and numerous to engage with. This demanded that the data be further narrowed through more grouping of themes and naming them in the penultimate data analysis step, as explained in the section below.
179 Step 5: Defining and naming themes
Step 5 of data analysis was approached with the aim of teasing out the case study- specific reasons for sub-optimal adherence to MDR-TB treatment and retention in care, as the first step to establishing which factors could potentially be impacted through improving health communication about MDR-TB at various levels, and how this could best be done. Several interesting themes arose from this process. The themes illustrated in the word cloud in Figure 18 are significant as they inform and provide the frame for the presentation of comprehensive research findings in Chapters Eight and Nine.
Figure 19: Reasons for sub-optimal adherence to MDR-TB treatment – whittled themes
The whittled themes in Figure 19 were written on individual colour-coded post-it notes that were stuck on a wall where I could easily and constantly see them during the entire period of gathering and analysing data. This strategy allowed for further refinement of categorisation and grouping of themes as I became more aware of possible linkages that could be made. The categories were refined with reference to the original transcripts and notes, the contents of Table 4, flip chart papers, sticky notes, and implementing colour coding and weighting in an iterative process. From my reading of these many data sources it was possible to sift out the broad vulnerability- determined themes that affect whether vulnerable young women aged 18 to 34 years with MDR-TB are able to fully adhere to their treatment in the long-term.
180
As this study utilised inductive thematic analysis in line with Braun and Clarke’s (2006) approach, I was conscious to not try to fit themes into pre-existing frames based on the conceptual framework during the process of coding, or to align them with my analytical preconceptions while writing up the findings. This study adopted an aposteriori thematic approach to the analysis of data, which aimed to identify patterns in and make associations between complex findings strongly linked to data to address the research questions and reach conclusions on the research problem (Merriam 2009; Braun and Clarke 2006; Snape and Spencer 2003). An iterative data analysis and synthesis process was utilised for its utility in supporting production of detailed descriptions and rounded understandings of perspectives presented in the next chapter, which is also Step 6 – writing the report – in Braun and Clarke’s (2006) six- step process.
Summary
This chapter discussed how primary data collected for this research was analysed to emerge with findings presented in Chapters Eight and Nine, and the communication model proffered in Chapter Ten. It explained tentative findings from the data analysis process which took the form of ‘themes, categories, typologies, concepts, tentative hypotheses’ (Merriam 2002) and referenced literature on what is already known about the phenomenon of suboptimal adherence to MDR-TB treatment among vulnerable groups. The chapter discussed several key external events in the TB management field in South Africa and globally which occurred at the same time as data collection and analysis for this study, which potentially impacted the contributions of research participants and, at the same time, the meanings I made from the data. This discussion was supported by the social constructionists’ position that it is important to understand a researcher’s values and beliefs insofar as they influence interactions with participants, the data analysis process and the meanings that are made from the data (Chong and Yeo 2015).
Care was taken to link nascent findings discussed in this chapter to the study’s methodological approach and research epistemology as explained in Chapter Five (Nowell et al. 2017; Berman 2013), to situate the interpretation and presentation of data in this chapter and the ones that follow within a defined framework (Braun and Clarke 2006). What I sought to learn from the research at the outset was also considered (Nowell et al. 2017; Braun and Clarke 2006), with data analysis propelled by the objective of addressing the research questions included in the introduction to this chapter. Advice from scholars to analyse data concurrently with collecting it in
181
order to identify emergent categories and theories from transcripts, and to beginning documenting the findings early in the process was implemented (Merriam 2009; Snape and Spencer 2003; Pope et al. 2000). Data from different research participant was carefully cross-analysed (Snape and Spencer 2003, Merriam 2002). Further, study- specific systems to categorise the voluminous data collected and documented were developed and implemented towards ensuring that the data analysis and report writing approach was efficient and replicable.
The documentation of data discussed in this chapter and the presentation of findings in Chapter Eight, Nine and Ten was approached with the aim of theorising the sociocultural settings and structural circumstances that qualify individual accounts shared (Braun and Clarke 2006), towards the development of an integrated communication model for improving vulnerable patient’s adherence to MDR-TB treatment. This was done within a constructivist framework, which insists that all meaning is socially constructed by individuals in interaction with their contexts (Merriam 2009, Braun and Clarke 2006, van Niekerk 2005). Theories discussed in Chapter Five were applied for guidance in identifying themes and connecting datasets to write-up the findings presented in the next three chapters.
182