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CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
INTRODUCTION
This chapter outlines and elaborates on the methodological aspects and processes which were used to evaluation of the impact of information-motivation-behavioural skills model of adherence to antiretroviral therapy in Ethiopia.Aspects of the methodological issues such as research design, sampling, data collection methods and analysis used, validity of the data and ethical considerations undertaken during the research will be discussed.
Four main topics are discussed:
- research design
- sampling
- methods of data collection
- methods of data analysis
As part of data analysis, issues around internal and external validity of data were considered. Lastly, the summary of the chapter is given.
RESEARCH DESIGN
A research design is a blueprint for conducting the study that maximises control over factors that could interfere with the validity of the findings (Burns & Grove 2013:195). Quantitative design will be adopted for this study. Stommel and Wills (2004:3) refers to quantitative research as “the systematic development of new knowledge via a process of assembling empirical evidence”, and Burns and Grove (2013:54) point out that quantitative studies seek to describe variables, investigate relationships among variables, and determine cause and effect relationships between variables.
Rationale for choosing a quantitative cross-sectional design
Study design refers to the structured approach followed by researchers to answer a particular research question (Joubert & Ehrlich 2007:77). This study will be a quantitative, analytical, observational, cross-sectional, institution-based study. A cross-sectional study is the simplest variety of descriptive or observational epidemiology that can be conducted on representative samples of a population. It is used as a useful way to gather information. Like cohort and case-control studies, the goal of analytical cross-sectional study is to examine the relationship between an exposure and an outcome. Unlike cohort and case-control studies, however, a cross-sectional study does not assess and compare occurrence of incident cases in two groups, rather, it assesses and compares the prevalence of exposure or outcome across the two groups (Joubert & Ehrlich 2007:84). This characteristic of cross-sectional study makes it a preferable design for conducting this study because the researcher has time pressure, and resources and financial constraints to conduct a study.
RESEARCH METHODOLOGY
Research methodology refers to the practices and techniques use to sample the population size and how data was processed and analysed (Vaus 2001:143). According to Khothari (2004:7), a research methodology may be defined as academia’s established framework for the collection and evaluation of existent knowledge for the purpose of arriving at, and validating new knowledge. Also the importance of research methodology emanates from its definition of activities of a specified research, its procedural methods, strategies for project measurements and criteria for research success (Kothari 2004:7).
Study setting and period
Ethiopia is a low-income country in East Africa, with a total population of 73.8 million according to the 2007 population and housing census (Central Statistical Agency (CSA) 2012:3). The overall adult HIV prevalence in Ethiopia has remained low and according to the 2011 Ethiopian Demographic and Health Survey (EDHS 2011), the HIV prevalence among adults aged 15 to 49 is 1.5% and women have a higher HIV prevalence (1.9%) as compared to 1.0% among men. For both women and men the HIV prevalence increases substantially as the number of lifetime sexual partners increases (CSA 2012:234).
This study was conducted at one of the public referral hospitals in Amhara regional state, located in Bahir Dar town. The hospital is 55 years old with a catchment population of 7 million people in 2014. The hospital has a total of 800 staff including 14 general practitioners, 10 general surgeons, 4 gynaecologists, 4 internists, 3 paediatricians, 1 orthopaedic surgeon, 1 ophthalmologist, 1 urologist, 4 radiologist, 1 dermatologist, and 4 psychiatric specialists. It has an outpatient department and, obstetrics and gynaecology, chronic care, surgery, ophthalmologic, psychiatric, orthopaedic, ICU, pharmacy, emergency, inpatient serving, paediatrics, physiotherapy unit, and central laboratory units, and a blood bank. The hospital has its own ART team and a clinic led by a physician, nurses, health officers, laboratory technicians, data clerks, case managers and adherence counsellors.
The hospital provides general outpatient and in-patient services, including surgical and obstetric emergency care. Infectious diseases account for most of the inpatient and out-patient visits. The hospital has been providing voluntary counselling and testing (VCT) services for more than a decade and provider initiated testing and counselling (PITC) services for the past 8 years. Free ART services were started in January 2006. According to the 2011 EDHS (CSA 2012:235), the adult HIV prevalence among women and men aged 15 to 49 who were tested in the Amhara region was 1.6%.The study period was six weeks between 1st September and 12 October 2014.
Below is the map of Ethiopia and the study site, Felege Hiwot hospital is located in Bahir Dar town.
Sampling, sampling procedure, sample size and the population and sample selection
Sampling
Sampling involves selecting a group of people, events, behaviours or other elements from a larger population or universe, with which to conduct a study. The objective of sampling is to determine mathematically the most effective way of acquiring a group of participants that would accurately reflect the population under study. A probability sampling plan better ensures precision in the accurate estimation of the population parameters, thus reducing sampling errors (Burns & Grove 2013:357). For the current study, a sampling procedure was designed to ensure representation of the study population.
Sampling procedure
The concept of systematic sampling was applied in this study when selecting participants for the structured interviews. Systematic sampling refers to selecting, from a population list or “sampling frame,” every kth individual, using a starting point selected randomly. The population size is divided by the desired sample size, giving k, the size of the gap between elements selected from the list. For this study, Felege Hiwot referral hospital was selected conveniently as it is the most nearby hospital with adequate population size. The participants were only included if they fulfilled the criteria, i.e. patients who are 15 years of age and older and who have been on ART for a period of 12 months or more. These participants were recruited when they came into the clinic to collect their medication or had doctors’ appointments by using systematic random sampling.
The sampling frame (adult appointment calendar/logbook) contains names of patients on ART who were expected to attend the health facility in the time period decided to collect data. The sampling frame contains all the patients on ART and each patient is given an appointment for follow-ups every month.
Using systematic random sampling, the first participant was selected randomly. Then, each 6fh individual attending an appointment at the ART clinic was included in the study.
Sample size
Patients meeting the inclusion criteria were selected until the required sample size was obtained. The sampling interval is: K=Sampling frame (N)/Sample size (n)=5785/400 =14.4≈14.The starting participant was selected randomly and every 14th person on the list was included in the sample. The health facility, Felege Hiwot referral hospital, where the study was carried out, at the time of the data collection had 5785 registered patients who were on ART.
The sample was determined using the single population proportion formula as described by Le (2003:452). The assumptions are that the sample is representative; the sampling error is small, the sample is viable in the context of funds available for the research study, systematic bias is controlled in a better way and results from the sample study will be generalisable.
CHAPTER 1 ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND
1.3 RESEARCH PROBLEM
1.4 RESEARCH PURPOSE
1.5 RESEARCH OBJECTIVE
1.6 FOUNDATIONS OF THE STUDY
1.7 DEFINITION OF KEY CONCEPTS
1.8 SIGNIFICANCE OF THE STUDY.
1.9 ETHICAL CONSIDERATIONS
1.10 OPERATIONAL DEFINITIONS
1.11 ORGANISATION OF THE THESIS
1.12 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 BACKGROUND
2.3 THE INFORMATION-MOTIVATION-BEHAVIOURAL SKILLS MODEL
2.4 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHOD
3.1 INTRODUCTION
3.2 RESEARCH DESIGN
3.3 RESEARCH METHODOLOGY
3.4 INTERNAL AND EXTERNAL VALIDITY OF THE STUDY
3.5 CONCLUSION
CHAPTER 4 PRESENTATION AND DESCRIPTION OF THE RESEARCH FINDINGS
4.1 INTRODUCTION
4.2 DATA MANAGEMENT AND ANALYSIS
4.3 RESEARCH RESULTS
4.4 OVERVIEW OF RESEARCH FINDINGS
4.5 CONCLUSIONS
CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS
5.1 INTRODUCTION
5.2 SUMMARY AND INTERPRETATION OF THE RESEARCH FINDINGS
5.3 CONCLUSIONS
5.4 RECOMMENDATIONS
5.5 CONTRIBUTIONS OF THE STUDY
5.6 LIMITATIONS OF THE STUDY
5.7 CONCLUDING REMARKS
LIST OF REFERENCES
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EVALUATION OF THE IMPACT OF THE INFORMATION-MOTIVATION-BEHAVIOURAL SKILLS MODEL OF ADHERENCE TO ANTIRETROVIRAL THERAPY IN ETHIOPIA
