MOTHERS’ FEELINGS ABOUT THE FLASH-HEAT (FH) METHOD OF INFANT FEEDING

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CHAPTER 3 RESEARCH DESIGN AND METHODS

INTRODUCTION

Chapter 2 discussed literature on infant feeding techniques and a model by Backer (2001:18) called The Theory of Individual and Group Change. Chapter 3 discusses the method used to conduct the research. It specifically addresses the research design, sample and sampling technique for both the quantitative and qualitative research methods. Thereafter it looks into the procedure followed when conducting the research and the measuring instruments used. This chapter concludes with the ethical considerations for the study.

RESEARCH PURPOSE AND OBJECTIVES

Purpose of the study
The purpose of the study is to develop practical guidelines for promoting supplementary infant feeding techniques for HIV-positive mothers.
Research objectives
The objectives of this study are to:

- explore and describe the factors influencing HIV-positive mothers on the choice of feeding technique
- formulate practical guidelines based on the research findings and literature support for HIV-positive mothers promoting supplementary infant feeding techniques
- What is the mode of feeding HIV-positive mothers at Tembisa Hospital choose for their infants?
- How could the research be used to support HIV-positive mothers in making the correct infant feeding choice?
- What are the characteristics of HIV-positive mothers to whom supplementary feeding techniques could be promoted?identify the profile of HIV-positive women that can be targeted for promotion of a supplementary infant feeding technique termed flash-heat

Research questions
In light of the above objectives, three specific questions are addressed in this study:

What is the mode of feeding HIV-positive mothers at Tembisa Hospital choose for their infants?
How could the research be used to support HIV-positive mothers in making the correct infant feeding choice?
What are the characteristics of HIV-positive mothers to whom supplementary feeding techniques could be promoted?

RESEARCH DESIGN

Burns and Grove (2005:296) define research design as the supporting structure of a study. Others suggest that it is the method in which the study was conceived, implemented and presented (Mouton 2000:56).
Quantitative research
Non-experimental research design
This study utilised a non-experimental research design in order to gain an understanding of the infant feeding behaviour of HIV-positive mothers. The quantitative approach enabled the researcher to understand the characteristics of new mothers who would use the flash-heat technique. There was no need to establish causality as the research design employed was not experimental (Howell 1999:1). In addition, there was no control or manipulation of the independent variables (Howell 1999:1). The non-experimental design was also employed in order for the researcher to make inferences regarding possible relationships between variables.
The research was conducted in two phases over the period 3 May to 10 June 2011. The first phase consisted of quantitative data collection with HIV-positive mothers on their infant feeding choices. The second phase included the collection of qualitative data with the same cohort of women. Questionnaires were administered by the researcher with the quantitative approach
Qualitative research
The researcher aimed to explore the participants’ perceptions of their ability to adopt the flash-heat technique of infant feeding. Therefore a qualitative approach was utilised for this research study. Qualitative research has the following characteristics among other:

The researcher is mainly concerned with the process of the research, followed by the outcomes (Merriam 1991:110).
The researcher becomes the primary research instrument (McCaslin &Scott 2003:453).
Qualitative research is strategically conducted yet is flexible and contextual (Mason 2001:110) meaning that the researcher should be cognisant of the sensitivity of changing contexts and situations of the research environment.
Qualitative research will produce culturally specific information about the values, opinions and social contexts of a sub-set of a population (Mack et al 2005:1).

The qualitative research design aided the researcher in exploring why HIV-positive mothers would or would not engage in this feeding technique. It allowed the researcher to explore in detail the phenomena studied (Neill 2008:1).
Descriptive research
The purpose of utilising a descriptive research design was to document the perceptions/feelings of HIV-positive women on adopting the flash-heat technique of infant feeding. Merriam (1991:110) so aptly states that the interview seeks a “holistic description and explanation” of the subject under study. 3.3.2.2 Contextual research Lincoln and Guba (1985:44) suggest that a phenomenon be studied in its natural setting because individuals draw meaning of situations from their context. It is for this reason that the researcher conducted the interviews in the two postnatal wards at Tembisa Hospital.
Explorative research
In addition to descriptive research, the researcher utilised an exploratory research method. This method was used in order for the researcher to familiarise herself with the concepts of the problem under study to facilitate development of insights (Howell 1999:1).

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RESEARCH METHOD

Study area
Quantitative and qualitative studies
The research was conducted in the two postnatal wards at Tembisa Hospital which is a regional hospital located in the Northern Service Delivery Region in Ekurhuleni. The two wards admitted mothers and infants who were delivered either via Spontaneous Vertex Delivery (SVD) or via Caesarean Section (C/S) for observation and management of possible puerperal complications prior to discharge. The daily number of SVD and C/S varied between 20 and 30. The patients’ HIV status was known to them and staff on admission to the postnatal wards and participation in the study was subject to the researcher confirming the patients’ HIV status with hospital records. All HIV-positive postnatal mothers were eligible for participation in the study and were subsequently recruited.
The two postnatal wards had four units of eight beds occupying 32 patients each, when at full capacity. Ward staff included registered nurses and midwives, a family planning counsellor, an obstetrician, dietician, administration staff and cleaners.
Antenatal women were given health education talks (at every visit as a group) which include two main methods of infant feeding which is exclusive formula feeding or exclusive breastfeeding. Tembisa Hospital provided formula for infants in the postnatal wards as part of the national PMTCT strategy (National Department of Health (NDoH) 2001). Parlagon was the brand of choice.

CHAPTER 1 ORIENTATION TO THE RESEARCH PROBLEM
1.1 INTRODUCTION
1.2 BACKGROUND
1.3 EXCLUSIVE BREASTFEEDING
1.4 SUPPLEMENTARY FEEDING
1.5 OVERVIEW OF THE FLASH-HEAT TECHNIQUE
1.6 STATEMENT OF THE PROBLEM
1.7 PURPOSE OF THE STUDY
1.8 RESEARCH OBJECTIVES
1.9 CONCEPTUAL FRAMEWORK
1.0 OPERATIONAL DEFINITIONS OF IMPORTANT TERMS
1.11 RESEARCH OVERVIEW
1.12 QUALITATIVE ANALYSIS
1.13 ETHICAL CONSIDERATIONS
1.14 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 WOMEN AND HIV IN SOUTH AFRICA
2.3 MANUAL EXPRESSION OF BREAST MILK
2.4 PASTEURISATION METHOD OF DEACTIVATING HIV
2.5 EXCLUSIVE BREASTFEEDING
2.6 INFANT FEEDING CHOICES HIV-POSITIVE MOTHERS MAKE
2.7 THEORETICAL FRAMEWORK
2.8 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION
3.2 RESEARCH PURPOSE AND OBJECTIVES
3.3 RESEARCH DESIGN
3.4 RESEARCH METHOD
3.5 DATA COLLECTION
3.6 DATA ANALYSIS
3.7 LIMITATIONS OF THE RESEARCH
3.8 ETHICAL CONSIDERATIONS
3.9 CONCLUSION
CHAPTER 4 REPORTING STUDY FINDINGS AND DATA ANALYSIS METHODS
4.1INTRODUCTION
4.2 CONSTRUCTION OF STUDY
4.3 ACCESSING THE PARTICIPANTS
4.4 PROFILE OF STUDY PARTICIPANTS
4.5 CONTEXT OF STUDY LOCALE
4.6 CONDUCTING IN-DEPTH INTERVIEWS
4.7 DATA PROCESSING AND MANAGEMENT
4.8 OVERVIEW OF DATA ANALYSIS
4.9THEME 1: MOTHERS’ FEELINGS ABOUT THE FLASH-HEAT (FH) METHOD OF INFANT FEEDING
4.10 THEME 2: MOTHERS’ VIEWS ON A REASONABLE PERIOD FOR USING THE FLASH-HEAT METHOD AND INTRODUCTION OF SUPPLEMENTARY DIET
4.11 THEME 3: REPORTS FROM MOTHERS CONCERNING DIFFERENT FEEDING METHODS
4.12 THEME 4: MOTHERS’ PERCEPTIONS OF SIGNFICANT OTHERS ON FLASH-HEAT IMPLEMENTATION
4.13 THEME 5: MOTHERS’ DESCRIPTIONS OF HOME CIRCUMSTANCES AND THE FEASIBILITY TO FLASH-HEAT
4.14 THEME 6: MOTHERS’ CHOICE OF PREFERRED FEEDING OPTION
4.15 CONCLUSION
CHAPTER 5 PRESENTATION OF FINDINGS OF QUANTITATIVE DATA
5.1INTRODUCTION
5.2 DESCRIPTIVE STATISTICS
5.3 INFERENTIAL STATISTICS
5.4 LOGISTIC REGRESSION ANALYSIS
5.5 CONCLUSION
CHAPTER 6 DISCUSSION OF FINDINGS
6.1INTRODUCTION
6.2 RESEARCH FINDINGS
6.3 THEME 1: MOTHERS’ FEELINGS ABOUT THE FLASH-HEAT METHOD OF INFANT FEEDING
6.4 THEME 2: VIEWS ON THE NUMBER OF MONTHS MOTHERS FEEL COMFORTABLE USING THE FLASH-HEAT METHOD AND INTRODUCTION OF SUPPLEMENTARY DIET
6.5 THEME 3: COMPARISON OF FEEDING METHODS
6.6 THEME 4: PERCEPTIONS OF SIGNIFICANT OTHERS ON FLASH-HEAT IMPLEMENTATION
6.7 THEME 5: MOTHERS’ PERCEPTIONS OF HOME CIRCUMSTANCES AND THE FLASH-HEATTECHNIQUE
6.8 THEME 6: CURRENT FEEDING OPTION
6.9 DISCUSSION OF QUANTITATIVE FINDINGS
6.10 CONCLUSION
CHAPTER 7 PRACTICAL GUIDELINES FOR PROMOTION OF FLASH-HEAT IMPLEMENTATION IN HIV-POSITIVE MOTHERS IN PUBLIC HEATLH FACILITIES IN SOUTH AFRICA
PART A: BACKGROUND AND THEORETICAL FRAMEWORK
7.1 INTRODUCTION
7.2 DEFINITIONS
7.3 BACKGROUND OF THE STUDY
7.4 FLASH-HEAT METHOD OF INFANT FEEDING
7.5 THEORY APPLICATION
7.6 APPLICATION OF CONCEPTUAL FRAMEWORK TO THE DEVELOPMENT OF GUIDELINES
7.7 RATIONALE FOR DEVELOPING GUIDELINES PROMOTING SUPPLEMENTARY INFANT FEEDING TECHNIQUES AMONG HIV-POSITIVE MOTHERS
7.8 PRACTICAL GUIDELINES FOR PROMOTING SUPPLEMENTARY INFANT FEEDING TECHNIQUES AMONG HIV-POSITIVE MOTHERS DEVELOPMENT PROCESS
7.9 APPLICATION OF THE THEORETICAL FRAMEWORK TO THE DEVELOPMENT OF THE GUIDELINES
7.10 GUIDELINES FOR PROMOTING SUPPLEMENTARY INFANT FEEDING TECHNIQUES AMONG HIV-POSITIVE MOTHERS
7.11 CONCLUSION
CHAPTER 8 CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS
8.1 INTRODUCTION
8.2 STUDY OBJECTIVES
8.3 PREDICTIVE VARIABLES IN QUANTITATIVE STUDY
8.4 LIMITATIONS OF THE STUDY
8.5 RECOMMENDATIONS
8.6 CONCLUSION
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GUIDELINES FOR PROMOTING SUPPLEMENTARY INFANT FEEDING TECHNIQUES AMONG HIV-POSITIVE MOTHERS