3.3.3Health Care Planners(Hep)
The third target population group that this study obtained infonnation from were the people responsible for the planning of maternity health care. As such, the nursing service managers and doctors in charge of obstetric and gynaecology services in the same institutions from which the adolescent participant population were drawn, were approached to participate in this study. They were joined by individuals responsible for the planning of matemal, child and women's health services for the Durban functional region. This category was included, since, without the input of health care planners, any model of action for adolescent-friendly maternity care that was
obtained, might prove to be unrealistic and not feasible within the present health care system.
For Glaser (1998), theoretical sampling is a means of data collection, which allows for codes to emerge from the raw data collected. As codes emerge, they are used to direct the researcher in further data collection. Questions constantly change, guided by the emerging theory, in the pursuit of theoretical fullness. This inturnleads to saturation and integration of codes into an emerging theory (Gbrich, 1999). Hence, as data was collected at the first research site, the researcher simultaneously analysed the data to detect emerging codes and by delimitation used these codes to determine where next to collectdata and from whom. Gaps in information were used to alert the researcher to new informants that had to be approached for furtherdata collection and clarification of emerging codes and concepts. The idea behind theoretical sampling is not necessarily to increase the sample size, but instead to use sampling as a tool to refine ideas for the sake of clarity and an emerging theory (de Vos, Strydom, Fouche
& Delport, 2002). Theoretical sampling continued until the researcher was satisfied that no new categories ofdata were emerging and theoretical saturationhadbeen achieved.
A further snowballing sampling approach was instituted to recruit adolescent participants, with participants being asked to inform people who had had similar experiences of adolescent pregnancy or parenting, of the proposed study. The thinking was that adolescent clients are likely to know other adolescents who were or had been in a similar predicament to themselves. These individuals were then contacted and invited to participate.
As mentioned, sampling commenced at a provincial hospital in the eThekwini Metropolitan area, and data was collected from maternity health care planners
(nursing and medical), maternity health care providers (nursing and medical), and adolescent maternity clients (antenatal and postnatal). Data analysis and coding, lead the researcher to the Department of Health, where data was collected from health care planners (nursing) responsible for maternity care in the Durban functional region.
Data collection from the provincial hospital also led the researcher to collect data from individuals working in private maternity services, namely doulas and a midwife in private practice. Analysis from data collected at the Provincial Hospital also revealed the need for further data collection from doctors responsible for community maternity services. Contact was made with the individuals concerned via the
necessary authorities and their participation was requested. However, none of the individuals contacted chose to respond to the communication. This added a further limitation to the results of this study.
Data collection at the Department of Health indicated the need for views from outlying maternity services to be included in the study. So data collection then proceeded at a polyclinic's maternity department, where data was collected from health care planners (nursing), health care providers (nursing) and adolescent
maternity clients (antenatal). This clinic fell under the jurisdiction of the Department of Health. Another polyclinic was included as a site on the recommendation from the Department of Health. Data was collected here from adolescent maternity clients (antenatal). This clinic was under the jurisdiction of City Health, eThekwini
Metropolitan area. Data collection ended here as analysis revealed that data saturation had been achieved.
Data was taken to be saturated when interviews with respondents were found to be revealing no newinformatio~and a consensus appeared to have been reached from the content of the data supplied by the participants. Saturation was achieved for the three stakeholder groups independently, as their views of the phenomenon under study were from different angles. Each stakeholder group's input was based on a different experience of the concept of adolescent-friendly maternity services, namely, that of client, provider and planner. An example of data saturation amongst
adolescent client,canbe seen in the statements below:
"They shout when you have got something wrong. "
(Antenatal Polyclinic I AMC)
"In front ofeverybody they will shout at us, like you crazy like.n
(Antenatal Polyclinic2AMC)
"And they scream and they scream and they talk and you know, rude.n
(postnatal Hospital AMC)
"If
you there alone, they are going to run you down, make you look like a fool because ofyour age.n(Antenatal Hospital AMC Ascan be seen by the above statements, AMC respondents from allthreesites where data was collected, provided and corroborated information on what they perceived to be an unfriendly manner in which HCps addressed them. This is an example of how the researcher made decisions regarding when aspects of the data was found to be saturated.