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CHAPTER 3 Research methodology
INTRODUCTION
This chapter discusses the research methodology in four phases. The first phase describes the research methods that were applied during the review of ANC records for the adolescent mothers; the second phase discusses the process of eliciting data from pregnant adolescents, and the third from those adolescent mothers who delivered their babies without attending ANC. The fourth phase describes the data collecting process from the midwives working in the maternity settings of Bulawayo, Zimbabwe.
The chapter will describe triangulation, including the types of triangulation appropriate for the study. The descriptive research design for this study was applied in all four phases. Analyses of the findings for each of the four phases were done using triangulation in order to obtain diverse views about the utilisation of ANC services by adolescent mothers in Bulawayo (Burns & Grove 2005:229). This chapter will also outline the plan for data presentation and analysis. The actual analysis and discussion of the research results will be presented in subsequent chapters of this thesis; chapters 4-7 will analyse and discuss the results of phases one to four respectively. The results obtained during the four phases of the study will be compared and contrasted in chapter 8 of this thesis.
SCOPE OF THE STUDY
The study was conducted in Bulawayo, the second largest city in Zimbabwe. Bulawayo has an estimated population of 864 232 (City of Bulawayo 2004:1). In Bulawayo, health care services, including ANC, are provided by the PHC clinics, government hospitals, private hospitals, surgeries and nursing homes. This study focused on ANC services that are rendered at the 18 local government PHC and the two government hospitals. All 18 PHC clinics provide ANC services, but only four of them, together with the two government hospitals, provide delivery services. The two government hospitals provide specialist services to pregnant women with health risks that require the services of obstetricians, physicians, paediatricians and intensive midwifery care. These women are referred from the PHC clinics and provincial hospitals in Matebeleland South, as well as in the Midlands and Masvingo regions of Zimbabwe. The study also focused on adolescent mothers who did not attend ANC but delivered their babies at the four PHC clinics and the two government hospitals that conduct deliveries. A total of 3 777 booked adolescent mothers and 965 unbooked adolescent mothers delivered their babies at the four PHC clinics and the two government hospitals during 2005 (MOHCW 2005:1).
DESIGN OF THE STUDY
A research design is an overall plan or picture of the study that spells out basic strategies and efficient methods that are used to obtain data about a specific phenomenon (Polit & Beck 2004:162). The research design is also defined as a complete strategy that provides the plan for the overall structure that the researcher follows, namely the data collected and the data analyses conducted. Decisions on methods to be used should aim at achieving greater control over factors that may interfere with the validity and reliability of the study findings. (Burns & Grove 2005:211; Brink & Wood 2001:99; Leedy & Ormrod 2001:91).
Quantitative research design
Qualitative research designs involve the collection of data using narrative descriptions, while quantitative designs involve the investigation of phenomena in a rigorous and controlled design using precise measurement (Polit & Beck 2006:508). The study utilised a quantitative non-experimental design in all four phases of the methodology. According to Brink and Wood (2001:99), the purpose of a design is to provide a plan for answering research questions and to specify control mechanisms. The quantitative nature of the research design is concerned with measurement and statistical analyses of data where the investigation of a phenomenon involves rigorous and controlled design as well as the use of both deductive and inductive reasoning (Cormack 1996:135; Polit & Hungler 1995:712). A quantitative research design provides a broad view of a large sample through using a representative sample (Mouton 2001:152).
According to Polit and Beck (2006:179), quantitative designs can be experimental, quasi-experimental or non-experimental and they use descriptive or inferential statistics. They can be cross-sectional in nature or longitudinal over an extended period of time. This study utilised non-
experimental and cross-sectional designs because data were collected at specific points in time 39
and there was no experimental manipulation of the subjects. Data were collected from the natural environments, namely ANC records, the ANC clinics and the postnatal wards.
Non-experimental research design
Non-experimental designs are often used in nursing studies because some human characteristics are not subject to experimental manipulation because of ethical implications (Polit & Beck 2004:188). Non-experimental research designs are categorised into two broad classes: the ex-post facto correlational design and the descriptive research design (Polit & Beck 2004:192). Ex-post facto or correlational research is designed to explore the causal relationships and can be either retrospective or prospective. Retrospective designs link observed existing phenomena to the phenomena that occurred in the past, while prospective correlational designs attempt to link the presumed cause to the presumed future effect (Polit & Beck 2006:188). The non-experimental descriptive design was used in all four phases of the study in order to observe, describe and document factors influencing pregnant adolescents’ utilisation of ANC services. None of the ANC records of the adolescent mothers in phase one, the pregnant adolescents in phase two and
the adolescent mothers in phase three or the midwives working in the ANC clinics and postnatal wards were subjected to any experimental manipulation in this attempt to understand the pregnant adolescents’ utilisation of ANC services in Bulawayo.
Descriptive research design
Descriptive designs are used to obtain information about the characteristics of phenomena within a particular field of study. Descriptive designs can be used to develop a theory, identify problems in current practice, justify current practice, make judgments and determine what others are doing in similar situations (Burns & Grove 2005:232). Descriptive designs can be used in both qualitative and quantitative approaches. A quantitative descriptive research design was used in the study because it provides detailed information about the variables under study, namely pregnant adolescents and ANC utilisation (Brink & Wood 2001:108). According to Burns and Grove (2005:232) and Polit and Beck (2004:193), the purpose of the descriptive design is to provide a true picture of situations as they naturally happen by observing, describing and documenting. The descriptive design was expected to yield a true picture of ANC services in Bulawayo, identify challenges influencing the pregnant adolescents’ utilisation of ANC services in Bulawayo and make recommendations on ANC services that would meet the pregnant adolescents’ needs.
TRIANGULATION
Triangulation is defined as the collection of data from a variety of sources in a study of the same phenomenon (Burns & Grove 2005:224). The purpose of using triangulation is to minimise the limitations that stem from using a single method (Ziyani et al 2004:12). The hypotheses are tested using a series of complementary methods which increase the reliability and validity of the findings.
Denzin (1989) in Burns and Grove (2005:225) identifies the following types of triangulation:
• Data triangulation, which involves the collection of data of the same foci from multiple sources in order to obtain diverse views of the phenomenon under study and for the purpose of enhancing validity (Burns & Grove 2005:225). Data triangulation was appropriate for this study as data were collected from subjects of different characteristics and different backgrounds, but the focus was on the utilisation of ANC services by pregnant adolescents. Data were collected from four categories of subjects of different characteristics. Data sources comprised the adolescent mothers’ antenatal records; the pregnant adolescents attending ANC; the adolescent mothers who delivered in the postnatal wards without attending ANC; and the midwives working in the maternity settings of Bulawayo. Cross-tabulation of data using the Statistical Package for Social Sciences (SPSS) version 10 computer program was done in order to compare the findings about pregnant adolescents’ utilisation of ANC services in Bulawayo. Different types of sources provide insights about the same phenomenon; provide an enriched explanation of the problem and assist in validating conclusions (De Vos, Strydom, Fouche & Delport 2005:362).
• Time triangulation, which involves gathering data at different times of the day or at different times of the year (Polit & Beck 2004:431). In this study data from ANC records were collected between December 2006 and January 2007, interviews with pregnant adolescents and the adolescent mothers who had delivered their babies without attending ANC were conducted between February 2007 and April 2007, while the self-administered questionnaires were distributed to midwives during July 2007. Time triangulation is similar to test-retest reliability because it determines the congruence of the phenomenon across time (Polit & Beck 2004:431).
• Space triangulation, which aims to validate the data by testing them for consistency by gathering data of the same phenomenon from multiple sites (Polit & Hungler 1995:428). In this study data were collected from the PHC clinics and the central hospitals.
• Person triangulation, which involves collecting data from people of different types and different levels for the purpose of validating multiple perspectives on the phenomenon (Polit & Beck 2004:431). Data in this study were collected from the adolescents’ ANC records, the pregnant adolescents attending ANC, the adolescent mothers who had delivered their babies in hospitals without attending ANC and from the midwives working in the maternity settings of Bulawayo.
• Investigator triangulation, which refers to a situation where two or more investigators with diverse backgrounds examine the same phenomenon and each one of them has a specific role in the study. This method removes the potential for bias which might occur if there is only one investigator (Burns & Grove 2005:225). The researcher utilised two trained research assistants for conducting interviews with pregnant adolescents in phase two and with adolescent mothers in phase three of the research. This reduced potential bias during the data collection stage because the research assistants were not involved in the other stages of the study.
• Theoretical triangulation, which uses all the theoretical interpretations that could be applied to a given phenomenon and critically examines them from different theoretical points of view (Polit & Beck 2004:431). Theoretical triangulation was not used in this study as only one theoretical framework the HBM was used to contextualise this study.
• Methodological triangulation, which refers to the use of two or more research methods in a single study to address a problem (Polit & Beck 2006:333). This study did not utilise this method as only one research design, the quantitative approach, was used in all four phases.
• Analysis triangulation, which uses two or more different analysis techniques in order to evaluate similarity of findings (Burns & Grove 2005:226). This study used the SPSS version 10 computer program to analyse data from closed questions, while simple descriptions were used to analyse data from open-ended questions of the interview schedule and the self administered questionnaires. Thus analysis triangulation was not used in this study.
ORGANISATION OF THE STUDY IN FOUR PHASES
The study was conducted in four phases. Phase one describes the procedure of collecting data from the adolescent mothers’ ANC records, phases two and three deal with data collection procedures from the pregnant adolescents attending ANC and those adolescent mothers who delivered their babies without attending ANC, while phase four addresses the data collection process from midwives working in the maternity centres of Bulawayo. The research steps followed in these four phases are described according to the following areas:
Phase 1: Checklists: Adolescents’ ANC records
• Population and sampling
• Research instrument and data collection procedure
• Validity
• Reliability
• Ethical considerations
• Method of data analysis
Phases 2 and 3: Structured interviews conducted with pregnant adolescents and post partum unbooked adolescent mothers
• Population and sampling
• Research instrument and data collection procedure
• Validity
• Reliability
• Ethical considerations
• Method of data analysis
Phase 4: Self-administered questionnaires for midwives
• Population and sampling
• Research instrument and data collection procedure
• Validity
• Reliability
• Ethical considerations
• Method of data analysis
PHASE 1: CHEKLIST FOR THE ADOLESCENTS’ ANC RECORDS
Phase one describes the data collection process from adolescent mothers’ ANC records using a quantitative, non-experimental and descriptive method. The findings attempted to assess the nature of recorded ANC provision in Bulawayo. The adequacy, quality and effectiveness of ANC provision might influence the utilisation of ANC services by pregnant adolescents in Bulawayo.
Chapter 1 Introduction to and background information about the study
1.1 INTRODUCTION
1.2 BACKGROUND TO AND INFORMATION ABOUT THE STUDY
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 PURPOSE OF THE STUDY
1.5 RESEARCH QUESTIONS
1.6 RESEARCH OBJECTIVES
1.7 SIGNIFICANCE OF THE STUDY
1.8 THEORETICAL FRAMEWORK
1.9 DEFINITION OF KEY CONCEPTS
1.10 ORGANISATION OF THE THESIS
1.11 SUMMARY
Chapter 2 Literature review
2.1 INTRODUCTION
2.2 PURPOSE OF THE LITERATURE REVIEW
2.3 ANTENATAL CARE AND PREGNANT ADOLESCENTS: A GLOBAL PERSPECTIVE
2.4 CONCEPTUAL FRAMEWORK
2.5 VARIABLES AFFECTING THE LIKELIHOOD OF PREGNANT ADOLESCENTS’ UTILISATION OF ANC SERVICES
2.6 SUMMARY
Chapter 3 Research methodology
3.1 INTRODUCTION
3.2 SCOPE OF THE STUDY
3.3 DESIGN OF THE STUDY
3.4 TRIANGULATION
3.5 ORGANISATION OF THE STUDY
3.6 PHASE 1: CHECKLIST FOR THE ADOLESCENTS’ ANC RECORDS
3.7 PHASE 2: STRUCTURED INTERVIEWS CONDUCTED WITH PREGNANT
ADOLESCENTS WHO UTILISED ANC SERVICES
3.8 PHASE 3: STRUCTURED INTERVIEWS CONDUCTED WITH POSTPARTUM
ADOLESCENT MOTHERS WHO DID NOT ATTEND ANC
3.9 PHASE 4: SELF-ADMINISTERED QUESTIONNAIRES FOR MIDWIVES WORKING IN MIDWIFERY DEPARTMENTS
3.10 SUMMARY
Chapter 4 Analysis and discussion of the research results: Phase 1: Audit of adolescents’ ANC records
4.1 INTRODUCTION
4.2 DATA ANALYSIS: PHASE 1
4.3 OVERALL ANC DOCUMENTATION
4.4 MODIFYING FACTORS
4.5 INDIVIDUAL PERCEPTIONS
4.6 KNOWLEDGE AND PERCEIVED BENEFITS OF HEALTH PROMOTION AND PROPHYLACTIC TREATMENT
4.7 SUMMARY OF RESULTS OBTAINED FROM ANC RECORDS
4.8 DISCUSSION OF THE FINDINGS IN THE RESULTS OF PHASE 1
4.9 SUMMARY OF THE DISCUSSION OF PHASE 1’s RESEARCH RESULTS
Chapter 5 Analysis and discussion of the research results of Phase 2: interviews conducted with pregnant adolescents who attended antenatal care in Bulawayo
5.1 INTRODUCTION
5.2 PURPOSE OF PHASE 2 OF THE STUDY
5.3 MODIFYING FACTORS
5.4 INDIVIDUAL PERCEPTIONS OF RESPONDENTS IN PHASE 2
5.5 SOCIO-ECONOMIC AND CULTURAL FACTORS OF RESPONDENTS IN PHASE 2 ….92
5.6 STRUCTURAL VARIABLES (KNOWLEDGE) IN PHASE 2
5.7 PERCEIVED BENEFITS IN PHASE 2
5.8 PERCEIVED BARRIERS IN PHASE 2
5.9 STRATEGIES TO ENHANCE UTILISATION OF ANC SERVICES IN PHASE 2
5.10 SUMMARY OF PHASE 2
5.11 DISCUSSION OF THE RESULTS IN PHASE 2
5.12 SUMMARY OF THE DISCUSSION IN PHASE 2
CHAPTER 6 Analysis and discussion of the results of phase 3: interviews conducted with adolescent mothers who delivered their babies without attending antenatal care
6.1 INTRODUCTION
6.2 PURPOSE OF THE STUDY IN PHASE 3
6.3 MODIFYING FACTORS IN PHASE 3
6.4 INDIVIDUAL PERCEPTIONS IN PHASE 3
6.5 SOCIO-ECONOMIC FACTORS IN PHASE 3
6.6 KNOWLEDGE OF ANC IN PHASE 3
6.7 PERCEIVED BENEFITS IN PHASE 3
6.8 PERCEIVED BARRIERS IN PHASE 3
6.9 STRATEGIES TO ENHANCE UTILISATION OF ANC SERVICES IN PHASE 3
6.10 DISCUSSION OF RESULTS IN PHASE 3
6.11 SUMMARY
Chapter 7 Analysis and discussion of the research results Phase 4: questionnaire responses from midwives
7.1 INTRODUCTION
7.2 PURPOSE OF THE STUDY IN PHASE 4
7.3 DEMOGRAPHIC VARIABLES OF MIDWIVES
7.4 QUALITY, ADEQUACY AND EFFICACY OF ANC AS INFLUENCED BY THE GOAL-ORIENTED APPROACH
7.5 MODIFYING AND SOCIO-CULTURAL FACTORS AS PERCEIVED BY MIDWIVES
7.6 INDIVIDUAL PERCEPTIONS OF PREGNANT ADOLESCENTS AS REPORTED BY THE RESPONDENTS (MIDWIVES)
7.7 PREGNANT ADOLESCENTS’ KNOWLEDGE OF ANC AS PERCEIVED BY MIDWIVES
7.8 MIDWIVES’ OPINIONS ABOUT PERCEIVED ANC BENEFITS ON THE PART OF PREGNANT ADOLESCENTS
7.9 MIDWIVES’ OPINIONS ABOUT PERCEIVED BARRIERS AFFECTING PREGNANT ADOLESCENTS’ UTILISATION OF ANC SERVICES
7.10 STRATEGIES TO ENHANCE UTILISATION OF ANC SERVICES
7.11 SUMMARY OF THE RESULTS OBTAINED FROM THE MIDWIVES IN PHASE 4
7.12 DISCUSSION OF THE RESULTS OF PHASE 4
7.13 SUMMARY OF THE DISCUSSION IN PHASE 4
Chapter 8 Summary, conclusion, implications, limitations and recommendations
8.1 INTRODUCTION
8.2 SUMMARY OF THE STUDY
8.3 CONCLUSIONS
8.4 IMPLICATIONS FOR MIDWIFERY PRACTICE, EDUCATION, RESEARCH AND
POLICY ISSUES BASED ON THE FOUR PHASES OF THIS STUDY
8.6 RECOMMENDATIONS
8.7 COMPARATIVE CONCLUSIONS AND RECOMMENDATIONS BASED ON THE FOUR PHASES OF THE STUDY
8.8 CONCLUDING REMARKS
BIBLIOGRAPHY
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