Our Side of the Story - VSO

Our Side of the Story: The lived experience and opinions of Ugandan health workers3. Research design and methodsThis chapter first describes the three-stage approach to the research.Outlines of the qualitative research methodology and sampling design, datacollection and data analysis follow. The chapter concludes with an overviewof the health worker participants. Further details are in Appendix A.3.1 The research stagesThe research was conducted in three main stages: consultationwith local stakeholders on the draft protocol to be submittedfor ethical approval 98 ; focus groups and individual interviewswith health facility staff and managers; and stakeholderfeedback on draft findings.In June 2010, VSO Uganda and HEPS-Uganda held a researchworkshop with support from VSO International. Fourteenrepresentatives of organisations concerned with health workerissues in Uganda attended, including healthcare providerorganisations, professional associations, regulatory councilsand consumer and health worker advocacy organisations.Participants explored practical challenges in gathering anddisseminating the views of health workers. The workshopstarted to build an alliance of interested stakeholders to takeforward the research findings.Main-stage fieldwork was carried out from late June 2010 toFebruary 2011. From June to August 2010, the Valuing HealthWorkers researcher, a VSO volunteer, joined forces with asecond VSO volunteer who had in February 2010 begun similarresearch with nurses as an independent initiative. The two topicguides were combined, and a small number of interviews andfocus groups already conducted in the nursing research projectwere amalgamated with the Valuing Health Workers data.VSO produced a report of interim findings to coincide with theGlobal Health Workers Forum in Bangkok in January 2011. 99A roundtable discussion at a VSO-led side meeting at theForum followed a presentation of selected findings from theValuing Health Workers research in Uganda. Ugandan andother participants shared their perspectives on the issuespresented and put forward promising solutions. In January andFebruary 2011, interim findings were shared with stakeholdersin Uganda through one-to-one meetings and a stakeholderworkshop organised by HEPS-Uganda. The workshop broughttogether 16 representatives of organisations includingprofessional associations and unions, regulatory councils andhealth and human rights organisations. The workshop servedboth to validate the findings and to elicit suggestions forcoverage of additional aspects in the final report.3.2 Qualitative research methodologyand the purposive sampling designQualitative research aims to provide an in-depth understandingof the social world of research participants through learningabout their social and material circumstances, experiences,perspectives and histories. 100 Qualitative research is not basedon statistically representative samples and so does not producestatistically significant findings. Participants are selectedin a non-random way, according to characteristics of mostinterest to the particular study. This is known as purposivesampling. The criteria used to select participants are moreimportant than the number of people taking part. Indeed,qualitative research is often based on a small number of cases.In reporting, qualitative research does not use numbers; anyexperience or perspective has value, regardless of how often orseldom it appears.The research sampled facility-based health workers whoseprime role is treating or caring for patients, and facility-basedmanagers: nursing assistants, nurses, midwives, clinical officersand medical doctors. The study design thus excluded otherprofessional groups.In achieving the health worker sample it was first necessaryto ensure that all regions were included, as although notan administrative grouping, region has social and politicalimportance in Uganda. The strategy was to select one localgovernment district in each of the Central, West, SouthWest, North, North East and East regions, and also to includethe capital city. It was felt important to include a range ofdistricts in terms of how far they were deemed easy or hardto serve. Within each district in the sample, one hospital(where one existed) and at least one health centre were tobe selected, covering urban and rural facilities. Among theselected facilities, the aim was for a spread of level of hospitaland health centre, and inclusion of not-for-profit and privatefacilities as well as government facilities.98. The study protocol was approved by Makerere University School of Public Health Higher Degrees, Research and Ethics Committee and by the UgandaNational Council for Science and Technology.99. VSO 2011100. Ritchie and Lewis 200325