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forms for the system. At the same time, the CDC and the MoH
were coordinating their efforts to obtain the necessary technical
resources. During the third phase, participants conducted several
training sessions to train Saudi public health practitioners on how
to use the system and operate the advanced mobile devices used
with it. They also pilot-tested the system during Umrah—an
Islamic ritual performed at Makkah anytime of year. In the final
phase, participants deployed the system and formed one team to
ensure the effective functioning of the MDSS via timely and
accurate data analysis, and reported the results to top-level
management during the days of the Hajj.
During the four phases of the Hajj-MDSS implementation,
participants exchanged a variety of content. Table [4] lists the
content exchanged among participants, and specifies the content
type. Content type is identified based on the extent to which
content was expressed in written form, the extent to which it
adhered to formal procedures, and the extent to which it
conformed to explicitly stated techniques.
Table 4. Content exchanged during Hajj-MDSS adoption
Phase Content (Type)
Preparation
Technical resource
acquisition and forms
development
Training and pilot
testing
Execution
Information about the context of
the Hajj (Explicit.)
Proposal (Explicit &Tacit)
Forms Design (Tacit)
Systems Requirements
(Explicit)
Training materials (Explicit & Tacit)
Installations (Tacit)
System implementation and
troubleshooting (Tacit)
System’s data (Explicit)
After five months of technical exchange, professional visits, and
joint work, the Hajj-MDSS made its official debut during the
2009 Hajj. The system provided public health officials in KSA
with access to timely and accurate information. They were also
able to monitor nine distinct infectious diseases, and make timely
decisions in responding to unexpected situations. By the end of
the 2009 Hajj, only 73 cases of pilgrims with confirmed pandemic
influenza A (H1N1) were reported, and the Hajj was declared a
success [24].
4. RESEARCH METHODS
This research explores exchange activities in TPSKNs and
identifies the factors which might influence the achievement of
participants’ goals and objectives in TPSKNs. The goal of the
study is to extends the current knowledge-base regarding TPSKNs
into a new transnational context, and a new policy domain, public
health. This is achieved by relying on case study methods to
identify the factors influenced the collaboration between the US
CDC and SA’s MoH leading to the adoption of the Hajj-MDSS in
2009. Given the goal of this research and the Hajj-MDSS case
being introduced, the case study approach is most appropriate, as
its main strength lies in its attempts to efficiently reconcile
complexity, detail, and context [25].
Qualitative data has been collected from in-depth, semi-structured
interviews conducted in person, as well as various secondary data
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sources, including: government documents, participants’ official
websites, training materials, system manuals, news articles, and
related publications. Nine government officials working for the
Saudi MoH, along with three government officials working for the
US CDC, participated in this study. All participants played critical
roles in the project, and most were involved in all phases of the
project’s implementation. Participants also represent different
management levels, and organizational departments and units. A
purposive sampling using a snowball method was used to identify
individuals for interviews, starting with a single manager at the
Saudi MoH.
Two CDC participants preferred to respond in writing; interview
questions were sent to them, and they responded in writing to the
interview questions. Each in-person interview lasted from 1 to 2
hours. Several participants were contacted later, by phone, to
obtain additional information and for the purposes of clarification.
As all Saudi-side participants being interviewed are native Arabic
speakers, all such interviews were thus conducted in Arabic, as
was the interview conducted with one participant from the CDC
who is native Arabic speaker. The two CDC experts who
preferred to respond in writing received an English version of the
research questions and responded in English.
The unit of analysis of the study is the collaboration aimed at
ensuring the successful implementation of the Hajj-MDSS. The
unit of observation of the study is the individual organizations
who participated in this collaborative effort. The interview data
was transcribed and analyzed in Arabic, and the data collected
from the written response of CDC participants, along with the
aforementioned secondary data sources, were analyzed in English.
All collected data was coded and analyzed with an inductive
approach.
In the course of conducting data analysis, the qualitative software
tool (Atlas-ti) has been used to support coding and analysis
activities. Coding was conducted following two separate
approaches proposed by Strauss and Corbin [26], open coding and
axial coding. Open coding refers to the process of reducing the
data to a small set of themes which appear to describe the
phenomenon being studied. In the context of this research, codes
were added to the coding book when data pointed to any new
concept that could refer to an actor, a product, a process, or a
factor influencing the sharing activities in TPSKNs. The outcome
of this step was a series of different concepts representing the
meaning of the data. After completing the open coding, an axial
coding approach was applied. This process involves putting data
together in new ways by making connections between the already
identified concepts. This was achieved by organizing the initial
codes into different categories which reflected the questions of
interest to this research.
5. FACTORS INFLUENCING TPSKNS
Within the case study, a number of factors influenced technical,
knowledge, and information exchange during the collaboration
toward the adoption of the Hajj-MDSS were identified. This
section discusses these factors in four broad contexts:
technological; knowledge and information; organizational; and
national contexts.
5.1 Technological Context
The collaboration toward adopting the Hajj-MDSS was influenced
by several technical factors as the collaboration involves transfer
of a system to suit a new context. Ease of use, the ability to meet