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CHAPTER 3 METHODOLOGY
INTRODUCTION
The main purpose of this study was to develop a strategy for a more effective TBCT to reduce further the transmission of TB and mortality rates in Botswana. This is in relation to the TBCT strategies that do not trace, screen, treat all the TB contacts and significantly reduce incidence (WHO 2015:19).
This chapter presents the research methodology used in the study. Topics covered in the chapter include the research design, research paradigm, population and sample selection, data collection, data collection tools and procedures. The reliability and validity of the research instrument is discussed as well. The chapter also discussed ethical considerations and research methods preferred for data collection.
RESEARCH DESIGN
Research design refers to a strategy or structured approach followed by researchers to answer a particular research question (Burns & Grove 2012:252). The research design involves a plan, structure and strategy of the study. These three research design concepts guide a researcher in writing the research questions, conducting the project, and in analysing and evaluating the data (Burns & Grove 2012:252; Creswell 2014:209).
The current study employed a quantitative, cross-sectional design as it was found to be most appropriate and convenient for investigation of TBCT in Botswana. The design was chosen because it was economical and the data generated from this design are helpful in assessing the health care needs of the TB contacts. It is useful for investigating variables that are fixed characteristics of individuals such as gender, age, socio-economic status, education level and how they affect a phenomenon. The design was chosen to describe the association between these variables and TBCT and determine the gaps, challenges and needs. It described the perceptions and knowledge of TB and TBCT. It also described utilisation of TBCT by the PTB patients and the HCWs. Further, it described the interrelationships between TBCT strategies and practices and the risk of contracting PTB infection and related mortality.
However, when using cross-sectional design, it is not easy to assess the reasons for the association between the characteristics under study.
RESEARCH METHODOLOGY
Research methodology refers to the researcher’s general approach to the research study (Polit & Beck 2014:12). It describes the steps, procedures and strategies for gathering and analysing the data (Polit & Beck 2014:12). This section discusses the study setting, population and sample selection.
Study setting and context
Figure 3.1 shows the map of Botswana where the study was conducted. Botswana is a landlocked country in southern Africa with a total land area of 582,000 km2. The country shares borders with Zambia, Namibia, South Africa, and Zimbabwe.
Study population
Pulmonary tuberculosis patients, tuberculosis contacts and health care workers
A study population is an aggregate of elements sharing some common set of criteria (Grove, Grey & Burns 2014:366). The population is described in terms of the target population, inclusion criteria, and sampling method. The target population in this study was the PTB patients and the TB contacts. In order to get to the PTB patients and their contacts the researcher audited files in the selected TB clinics to identify PTB patients, their contacts and other characteristics such as age and gender and place of residence and the time they have been on TB treatment. They also provided information concerning the number, age and relationship with their household and workplace TB contacts. This also allowed the researcher to get to the possible contact persons who provided information on whether they have been contact-traced. Health care workers working in the Good Hope and Lobatse districts in the respective TB clinics also formed part of the population. They provided information on the type of the TBCT strategies used in each TB clinic. Besides, they provided information regarding the TB contacts.
Sample size, sampling and sampling procedure
This section presents the sample size and the sampling process. In addition, it presents the sampling procedures.
Sample size
Sample size for tuberculosis patients and tuberculosis contacts
A study sample is a subset of the eligible target population (Polit & Beck 2014). Thus, the first step in selecting a sample is to define the population of interest. In this study, the population of interest was the PTB patients and eligible contacts. According to Fitzner and Heckinger (2010:701-707), calculation of the sample size is pivotal to producing scientifically valid results that are generalizable to the population from which it was drawn. Conversely, an inadequate sample size can result in Type I and Type II errors, which can subsequently result in rejecting or accepting the assumption when the opposite is true (Kadam & Bhalerao 2010).
There are several approaches to determining sample size. One can use a census for a small population, replicating the sample size of prior research studies, using published sample size tables, applying any one of the several formulae or using statistical software. Most of the population-based surveys often determine the sample size using the estimated prevalence of the variable of interest, the desired level of confidence and the acceptable margin of error.
Sampling
Sampling is a process of selecting a portion of the designated population to represent the entire population (Polit & Beck 2014:339). Similarly, a sample is a subset of people or objects from a population often referred to as elements. An element is the most basic unit about which information is collected (Burns & Grove 2012:545)
Sampling of pulmonary tuberculosis patients and tuberculosis contacts
The study used systematic sampling technique (Berzofsky, Williams & Biemer 2013:270; Polit & Beck 2011:340) to select the PTB patients who participated in the study. The study used the TB clinic registers in the participating clinics to extract identification numbers of the PTB patients. A checklist was used to identify relevant information needed by the researcher.
Sample frame for pulmonary tuberculosis patients
The TB clinics and the TB registers provided the sample frame for the PTB patients. Through a written and verbal communication, the researcher formally requested the TB clinic site authorities for permission to peruse the TB register. Its quality was that, through direct element sampling, it enabled the identification and follow-up of the PTB patients and contacts to be included in the sample. The names of the PTB patients, their personal characteristics and addresses, TB diagnosis, type and phase of treatment, contact information and tracing addresses and other relevant information were expected to be available in the register. In some study sites, the TB register had entry errors such as incomplete data for the PTB patient. Most of the errors included missing information for the TB contacts. Some clinics had illegible information.
Inclusion criteria
This section discusses inclusion criteria. That means inclusion of the PTB patients and the TB contacts who qualify in terms of legal status and ethics as units of analysis.
The PTB patients and selected contacts aged 21 years and above in the Good Hope Sub District and the Lobatse Health District. In Botswana, only people aged 21 years and older can give sole, legal consent.
The PTB patients and contacts who gave informed consent, thus ensuring autonomy, in the Good Hope Sub District and the Lobatse Health District.
The PTB patients and contacts with had no diagnosis of mental illness were included since they were able to provide competent information through informed consent.
Ambulant PTB patients and TB contacts that travelled to and from the TB clinics.
The PTB patients in the TB clinic register who resided in the study sites. The study determined their addresses and the TBCT actions.
All the HCWs who worked fulltime in the TB clinics in the Good Hope Sub District, and the Lobatse Health District were included. Their consistent presence in the TB clinics potentially ensured the reliability of information they had about the TBCT activities in their areas of coverage.
The study extracted and analysed the complete information from the TB registers and the PTB patients’ contact tracing forms. However, it noted information on the incomplete records in the analysis.
CHAPTER 1ORIENTATION TO THE STUDY
1.1 INTRODUCTION AND BACKGROUND
1.2 STATEMENT OF THE PROBLEM
1.3 CONTEXT OF THE RESEARCH PROBLEM
1.4 RESEARCH QUESTIONS
1.5 RESEARCH ASSUMPTIONS
1.6 RESEARCH PURPOSE
1.7 OBJECTIVES
1.8 SIGNIFICANCE OF THE STUDY
1.9 RATIONALE OF THE STUDY
1.10 THE RESEARCH APPROACH
1.11 DEFINITION OF KEY TERMS
1.12 ORGANISATION OF THE THESIS
1.13 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 THE CONTEXT OF TUBERCULOSIS CONTACT TRACING IN HEALTH BELIEF MODEL
2.3 FACTORS ASSOCIATED WITH INTENTION TO PARTICIPATE IN TUBERCULOSIS CONTACT TRACING IN RELATION TO HEALTH BELIEF MODEL
2.4 SUMMARY
CHAPTER 3 METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH DESIGN
3.3 RESEARCH METHODOLOGY
3.4 DATA COLLECTION AND DATA COLLECTION INSTRUMENTS
3.5 DATA COLLECTION PROCEDURE
3.6 ETHICAL CONSIDERATION
3.7 DATA ENTRY AND ANALYSIS
3.8 CONCLUSION
CHAPTER 4 ANALYSIS, PRESENTATION AND DESCRIPTION OF RESEARCH RESULTS
4.1 INTRODUCTION
4.2 DATA MANAGEMENT AND ANALYSIS4
4.3 RESEARCH RESULTS
4.4 OVERVIEW OF RESEARCH RESULTS
4.5 CONCLUSION
CHAPTER 5 STUDY DISCUSSION
5.1 INTRODUCTION
5.2 SUMMARY OF THE RESEARCH FINDINGS
5.3 MAJOR FINDINGS ON UTILISATION OF TUBERCULOSIS CONTACT TRACING
5.4 CHALLENGES OF TUBERCULOSIS CONTACTS
5.5 NEEDS OF TUBERCULOSIS CONTACTS
5.6 CONCLUSION
CHAPTER 6 PROPOSED STRATEGY FOR TUBERCULOSIS CONTACT TRACING
6.1 INTRODUCTION TO EVIDENCE BASED GUIDELINES
6.2 A STRATEGY FOR TUBERCULOSIS CONTACT TRACING
6.3 RATIONALE FOR INTEGRATION OF COMPREHENSIVE TUBERCULOSIS CONTACT TRACING INTO OTHER TUBERCULOSIS PROGRAMMES
6.4 ALTERNATIVE STRATEGY FOR INTEGRATED COMPREHENSIVE TUBERCULOSIS CONTACT TRACING
6.5 RECOMMENDATIONS FOR THE RESEARCH
6.6 STRENGTHS, CONTRIBUTION AND LIMITATIONS OF THE STUDY
6.7 CONCLUSION
REFERENCES
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A STRATEGY FOR EFFECTIVE TUBERCULOSIS CONTACT TRACING IN BOTSWANA
