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CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
INTRODUCTION
This chapter reports on the research design and methodology. It outlines the series of steps taken when conducting the research study. These include identification of an appropriate research design, study population, sample selection, data collection and analysis. It also highlights ethical considerations, and measures to ensure reliability and validity.
RESEARCH DESIGN AND METHODOLOGY
This section offers a discussion of the paradigm of the study, including the research approach adopted to address the aim and objectives of the study. Included in this section is also a discussion of the research design of the study.
Research paradigm: post-positivism
Researchers are required to commence research projects with knowledge claims that align with their research strategy (methodology), and methods of data collection and analysis (Creswell 2007:19). The knowledge claims are sometimes called paradigms or worldviews. A paradigm is a set of beliefs and assumptions that guide or shape research projects (Morgan 2007:50). Whilst researchers may use multiple paradigms that are compatible, this study adopts a post-positivists paradigm because it is aligned with its methodology (approach), design, methods of data collection and analysis.
A post-positivists paradigm, like other paradigms, consists of a number of interrelated assumptions. The first assumption is that that knowledge (ontology), is valued and biased, and that true objective knowledge is difficult, or even impossible, to accomplish (Polit & Beck 2008:14–16). This assumption is consistent with the ontological beliefs of the researcher of this study. He claims that it is difficult to achieve absolute reality or truth of a phenomenon (Johnson & Christensen 2012:382). In other words, the absolute truth or knowledge of a phenomenon (Polit & Beck 2008:15), such as competencies of midwives during PNC, can never be fully understood, as there are always many possible explanations for the same. Thus, knowledge established in research is always considered imperfect and fallible, and it is for this reason that researchers who opt for a post-positivists paradigm do not set out to prove a hypothesis, rather they set out to reject or accept a hypothesis (Johnson & Christensen 2012:382).
Given that knowledge established in research are imperfect, post-positivists support probabilistic evidence for learning what the true state of a phenomenon under investigation is probably is, with a high degree of likelihood (Johnson & Christensen 2012:380–382; Polit & Beck 2008:14–16). This paradigm was therefore chosen for the study. The second assumption is that post-positivists reject positivism and claim that knowledge comes from many “realities” rather than one “reality” (Lincoln & Guba 1985:37). Researchers adopting a post-positivist paradigm believe that the knowledge of a phenomenon can be understood or at least an approximation of it by employing multiple complementary data capturing strategies. The adoption of such an approach would ensure comprehensive exploration of a phenomenon under investigation (Polit & Beck 2008:14–16).
The fourth assumption is that an approximate reality or knowledge claim can be achieved by adopting a reductionist approach, which involves the reduction of ideas into small, discrete sets to test variables that comprise hypothesis and research questions (epistemologically) (Johnson & Christensen 2012:382). The researcher has an active role to play in this process, and this involves the use of an instrument, and his/her active involvement in the data collection process. With regard to active involvement, the researcher trained data collectors and also supervised the data collection process and collected data in some of the study sites. The final assumption is that observations are not fixed and are open to change within their contexts, and since reality involves bias and values, post-positivism incorporates subjective research. Post-positivism accepts contact between the researcher and the subject. For this reason, post-positivists support innovations and discovery of knowledge rather than specific, fixed activities, and thus creates a “flexible” research practice (Creswell 2007:19). The instruments used in the present study were complemented or enhanced with some open-ended questions.
Identification of an appropriate research design
A research design is a plan detailing how a research will be conducted. It guides the researcher in planning for and implementing a study. Questions relating to whether qualitative or quantitative design are most appropriate for exploring healthcare issues are well documented, with most discussions focussing on the technical differences between the two e.g. in terms of rigour, validity and reliability. Despite continued counter assertions, there is a general consensus that for each identified strength, there appears to be a corresponding weakness in both qualitative and quantitative research. For example, qualitative approaches have been both subject to criticism and praise for the typically close relationship between the researcher and the respondent.
Some contributors, including Finlay and Gough (2003:33) see the interactive relationship as being a particular benefit as it offers the researcher first hand insights into the experiences of respondents. As a result, data are more likely to be valid. Ramos (1989:75–63) identifies a potential weakness with this relationship and argue that, becoming enmeshed with respondents may result in researchers having difficulties with separating their own experiences from those of respondents. Careful consideration of wider technical research design aspects carried out by some, including Marshall and Rossman (1995:2–11) suggest that, in many respects, qualitative modes of enquiry are just as rigorous, as quantitative methods. For example, in sampling, both qualitative and quantitative approaches promote adherence to research principles in relation to the selection of representative samples. With regard to the often expressed view that qualitative methods have specific limitations that relate to unclear data-analysis procedures, counter views are Silverman (2010:33–37) who points out that, consistent application and close-adherence to standardised qualitative data-analysis procedures offers just as much clarity to the researcher as do quantitative analysis methods.
Despite the ongoing debate about which approach contributes the most to knowledge, a consistent view has been established with a generally accepted acknowledgement that there is a place for both qualitative and quantitative work (Carr 1994:716–721; Corner 1991:718–727; Duffy 1985:225–232). This view appropriately reflects the consensus repeatedly echoed that neither design has all the answers. The choice of design depends on the research question under consideration and as such, investigation of specific issues may be best suited to either qualitative or quantitative enquiry methods.
With regard to postnatal care and midwifery competencies, most predecessor studies are qualitatively biased, and are carried out by paediatrics and focussed on clients and midwives’ perceptions. This is not surprising as qualitative methodologies are increasingly been used in health to answer questions about individuals’ experiences of care. The growing prominence of qualitative enquiry methods within midwifery practice reflects the growing bias towards holism and the acceptance of the importance of the subjective experience of healthcare professionals. Within this, the intention of research is to explore phenomenon through understanding human beings and the nature of their experiences.
Despite its widely acknowledged strengths, qualitative methodology has been associated with a number of shortcomings, including an increased likelihood of the researcher getting immersed with the respondent, leading to a difficulty in separating his/her own experiences and thoughts from those of the clients. On the basis of this, and the aforementioned discussions, a qualitative design is not appropriate for this study. The researcher therefore opted for a quantitative design, as it enabled him to describe and clearly portray the competencies of midwives when rendering immediate PNC to mothers and their infants (Kumar 2011:10). Specifically, this study took the form of a quantitative descriptive non-experimental cross sectional study. Polit and Beck (2004:716) define quantitative descriptive design as research studies that have as their main objective the accurate portrayal of the characteristics of persons, situations or groups and / or the frequency with which certain phenomena occur. Non-experimental element of the design allows the researcher to collect data without introducing an intervention (Polit & Beck 2004:725). In relation to the cross sectional element of the design, this involves the collection of data at one point in time, with no follow-up period (Hulley, Cummings, Browner, Grady & Newman 2007:109). This element of the design was appropriate for describing and identifying gaps in the competencies of midwives during the provision of immediate PNC to mothers and infants. It also involves the manipulation of numerical data. The numerical data were manipulated in this study through statistical procedures for the purpose of describing and identifying gaps in the knowledge and practices of midwives in relation to PNC. The limitations of a quantitative approach are its inability to capture people’s emotions or feelings and opinions (Hulley et al 2007:123).
In other words, quantitative studies focus on people’s overt behaviour, and overlook their feelings or emotions (Johnson & Christensen 2012:30–34) date). In trying to address these challenges, the questionnaire of this study was carefully constructed and worded without any double-barrelness to capture as much data as required (Hulley et al 2007:123). Moreover, it was complemented or enhanced with open-ended questions in order to capture the opinions of respondents in relation to PNC. In addition to the appropriateness of the design to achieve the aim and objectives of the study, the decision to adopt a quantitative design was also influenced by the gap noted in the extant literature on this particular subject, namely poor maternal and newborn assessments and the absence of measurements of vital signs.
SAMPLING
The process of selecting the study units from a population of interest in this study was outlined in this section. One major decision that researchers tend to take in conducting research is to decide on the nature of the data and from where they can be obtained, as the sources of data tend to have profound effects on the ultimate quality of studies (Morse 2002:3–4). Such a decision for identifying and selecting sources of data is what Grbich (2007:234) and Macnee and McCabe (2008:245) refer to as sampling. To be precise, Davis and Scott (2007:155–173) define it as the science and practice of selecting a portion of the population in a manner that allows the entire population to be represented in the same. On examining this definition, it became apparent that a sample is, in essence, a subset of a population. The target population for this study was midwives in maternity units in Swaziland. The accessible population of the study comprised of all eleven maternity units (also known as maternities) in Swaziland, which served as a sampling frame for the study sites. These 11 maternities are found across the Kingdom of Swaziland.
CHAPTER 1 ORIENTATION TO THE STUDY
1.1 INTRODUCTION1
1.2 BACKGROUND OF THE RESEARCH PROBLEM: ITS SOURCE
1.3 THE RESEARCH PROBLEM: ITS SCALE
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF STUDY
1.6 DIFFERENTIAL DEFINITIONS: KEY CONCEPTS AND OPERATIONALI-SATION
1.7 FRAMEWORK: CONCEPTS AND RELAVANCE TO THE STUDY
1.8 RESEARCH METHODOLOGY AND RESEARCH DESIGN
1.9 ETHICAL CONSIDERATIONS
1.10 SCOPE OF THE STUDY
1.11 STUDY LIMITATIONS
1.12 CONCLUSION
CHAPTER 2 LITERATURE REVIES
2.1 INTRODUCTION
2.2 QUANTITATIVE-QUALITATIVE DEBATE
2.3 FOCUS QUESTION
2.4 SEARCH STRATEGY
2.5 APPRAISAL OF IDENTIFIED STUDIES
2.6 EMERGENT THEMES
2.7 CONTINUUM OF CARE FROM PREGNANCY TO MOTHERHOOD
2.8 POSTNATAL CARE COVERAGE AND TRENDS
2.9 ESSENTIAL MIDWIVES’ COMPETENCIES FOR IMMEDIATE POSTNATAL CARE
2.10 EVIDENCE-BASED GUIDELINES IN POSTNATAL CARE
2.11 DOES SWAZILAND HAVE POSTNATAL CARE GUIDELINES? A SYSTEMATIC REVIEW
2.12 CURRENT DEVELOPMENTS IN POSTNATAL CARE
2.13 FACTORS AFFECTING THE QUALITY OF POSTNATAL CARE
2.14 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH DESIGN AND METHODOLOGY
3.4 DATA COLLECTION
3.5 DATA MANAGEMENT AND ANALYSIS TECHNIQUES
3.6 VALIDITY AND RELIABILITY
3.7 ETHICAL CONSIDERATION
3.7 CONCLUSION
CHAPTER 4 PRESENTATION OF STUDY FINDINGS
4.1 INTRODUCTION .
4.2 RESPONDENTS PER STUDY SITE
4.3 CHARACTERISTICS OF RESPONDENTS
4.4 MATERNAL IMMEDIATE POSTNATAL CARE SERVICES RENDERED WITHIN 30 MINUTES AFTER CHILDBIRTH
4.5 IMMEDIATE NEWBORN CARE OFFERED WITHIN 30 MINUTES AFTER DELIVERY
4.6 IMMEDIATE POSTNATAL CARE COUNSELLING WITHIN THE FIRST 30 MINUTES AFTER CHILDBIRTH
4.7 PRE-DISCHARGE POSTNATAL CARE SERVICES FOR MOTHERS
4.8 PRE-DISCHARGE NEWBORN CARE
4.9 PRE-DISCHARGE POSTNATAL CARE COUNSELLING
4.10 CHALLENGES OF POSTNATAL CARE PROVISION
4.11 PREPAREDNESS OF HEALTH FACILITIES TO PROVIDE IMMEDIATE POSTNATAL CARE SERVICES
4.12 HYPOTHESIS TESTING: STATISTICAL FINDINGS
4.13 CONCLUSION
CHAPTER 5 DISCUSSION OF FINDINGS
5.1 INTRODUCTION
5.2 CHARACTERISTICS OF RESPONDENTS
5.3 MATERNAL IMMEDIATE POSTNATAL CARE SERVICES WITHIN 30 MINUTES AFTER CHILDBIRTH
5.4 IMMEDIATE NEWBORN CARE WITHIN 30 MINUTES POST-DELIVERY
5.5 IMMEDIATE POSTNATAL CARE COUNSELLING WITHIN THE FIRST 30 MINUTES AFTER CHILDBIRTH
5.6 PRE-DISCHARGE POSTNATAL CARE FOR MOTHERS
5.7 PRE-DISCHARGE NEWBORN CARE
5.8 PRE-DISCHARGE POSTNATAL CARE COUNSELLING
5.9 GUIDANCE ON POSTNATAL CARE PROVISION
5.10 THE CHALLENGES AND POSSIBLE STRATEGIES FOR IMPROVING POSTNATAL CARE PROVISION
5.11 PREPAREDNESS OF HEALTH FACILITIES TO PROVIDE IMMEDIATE POSTNATAL CARE SERVICES
5.12 CONCLUSION
CHAPTER 6 IMPLICATIONS FOR POSTNATAL CARE IN SWAZILAND, LIMITATIONS, RECOMMENDATIONS AND CONCLUSION
6.1 INTRODUCTION
6.2 GUIDELINES AND CONCEPTUAL FRAMEWORK ADAPTATION PROCESS
6.3 LIMITATIONS OF THE STUDY
6.4 RECOMMENDATIONS
6.5 RECOMMENDATIONS FOR FURTHER RESEARCH
6.6 CONCLUSION
REFERENCES
GET THE COMPLETE PROJECT
THE COMPETENCIES OF MIDWIVES DURING THE PROVISION OF IMMEDIATE POSTNATAL CARE IN SWAZILAND
