PaCHAPTER 3: METHODOLOGY
3.1 Introduction
This chapter describes the research design and methods used, as well as measures to ensure the research considers ethical issues. It deals with the study site and population, study variables, study design, sampling techniques, sample size determination, sampling procedures, data collection instruments and procedure, quality assurance (validity and reliability) and data analysis.
3.2 Study design
A study design is a specific plan or protocol for conducting the study which encompasses qualitative and quantitive methods.
A descriptive cross-sectional design was used where interviews and structured questionnaires were administered to a sample of participants. A descriptive study involves the systemic collection and presentation of data to give a clear picture of a particular situation. In a descriptive study design, the subject is observed in a completely natural, unchanged environment and hence it was appropriate in providing useful insight into the issue of adherence. A cross-sectional study encompasses conducting a survey of a sample of population elements at one point in time. It was appropriate for the study because it provided a quick snapshot of what was going on with the variables of interest for the research problem.
3.3 Study site
The study was conducted at Muthara Sub-County Hospital, Meru County. The hospital offers various health services like antenatal, curative in-patient services, curative outpatient services, family planning, growth monitoring and promotion, HIV counseling and testing, prevention of mother to child transmission of HIV, tuberculosis and hypertension treatment. Muthara Sub-County Hospital has a bed capacity of 17, 3 cots and operates on a 24-hour basis including on weekends. The hypertension clinic attends to an average of 150 clients per week. Muthara Sub-County Hospital is located in Muthara ward which has an area coverage of 305.70km2 and a total population of 39,028 (2009, national census). Miraa (Khat) – an herbal plant, which turned a lucrative cash crop for the locals, is grown on a wide scale.
3.4 Study variables
3.4.1 Dependent variables
The dependent variable is adherence to hypertension medication; that is whether a client adhered or failed to adhere to hypertension medications, even once.
3.4.2 Independent variables
These are the socio-demographic factors (illiteracy, age, poverty), structural factors (poor patient- provider relationship, poor medication distribution systems, office visit time limitations, limited access to care, overworked heath care providers, provision of care by multiple physicians, prescription of complex drug regimen) and cultural/economic factors (norms, beliefs, poor economic status) which influence adherence to hypertension medication.
3.5 Study population
The study targeted clients enrolled for hypertension medication at the hypertension clinic in Muthara Sub-County Hospital.
3.6 Sampling techniques and sample size
3.6.1 Sampling techniques
A sampling technique is that part of the research plan that indicates how cases are to be selected for observation. The concept of sampling involves taking a fraction of the population, making observation in this smaller group and then generalizing the findings to the larger population. Muthara ward was purposely chosen due to the high prevalence of hypertension cases there. Clients for questionnaire administration were systematically sampled. All clients on hypertension medication visiting the hypertension clinic had a chance to be sampled. There was an average of 150 clients visiting the hypertension clinic per week (MOH Records-Meru, 2016), translating to 50 clients seen per day (the hypertension clinic is open to clients three days per week).The study used 2 as the nth number. If the sampled client declined to participate, the next exiting client was sampled.
3.6.2 Sample size
The desired sample size was determined using the formula of Fisher et al (1991):
n = z2pq
d2
Where-:
n – The desired sample size (assuming the population is greater than 10,000)
z – The standard normal deviation, set at 1.96, which corresponds to 95% confidence level
p – The proportion in the target population estimated to have a particular characteristic. If there is no reasonable estimate, then use 50 percent (the study used 0.50).
q = 1.0 ��� p
d = the degree of accuracy desired, here set at 0.05 corresponding to the 1.96.
In substitution, n= 1.962 x 0.5 x (1-0.5) = 384
0.052
3.7 Quality assurance (validity and reliability)
Validity refers to how well a test measures what it is purported to measure while reliability is the degree to which an assessment tool produces stable and consistent results (Cozby, 2001). They enhance quality assurance i.e. through piloting which includes pretesting data collection tools.
The research tools were pre-tested by administering them to hypertensive patients at St John of God Hospital, Meru County which also has a hypertension clinic.
3.8 Data collection techniques
3.8.1 Data collection procedure
The study used an introduction letter from the University for Administrative Approval. The study was carried out in phases where the research assistants were first trained on data collection. The data collection tools were also pretested before proceeding to administer the structured questionnaires. Interviews using the questionnaires were conducted through physical visits to the Muthara Sub-County Hospital and undertaking personal interviews with the selected respondents. This was to clear some of the concepts to the respondents who needed help.
The structured questionnaire was used to collect quantitative data and it consisted of a set of categorized questions. Key informant interview was employed to get data from personnel who are knowledgeable in the area of study.
5 personnel were selected and interviewed using the key informant interview guide. Last but not least, desk review was used to gather secondary data concerning the study subject where documents at the facility as well as the reference made to library and the internet were reviewed. Clients��� medical records and hospital drugs dispensing records were reviewed and the required data obtained.
3.8.2 Data collection instruments
Data collection is a term used to describe a process of preparing and collecting data (Faceman & Haddow, 2008). A formal data collection process is necessary as it ensures data gathered is both defined and accurate. The data collection tools that were used in this study include key informant interview guide and structured questionnaires. Face to face interview was the primary data collection instruments for this study in order to provide a good means of probing for information.
3.8.2.1 Structured questionnaires
Structured questionnaire method is a research method which uses closed-ended questions. There exists a low level of involvement of the person who is conducting the questionnaire and high level of involvement of the person who is answering the questionnaire. This aided in accumulating large amounts of valuable data that gave deep insight into the minds of a large number of people who answered the questions.
3.8.2.2 Key informant interview
Key informants interviews are in-depth interviews with people who have knowledge on hypertension and constituted health professionals.
The purpose of key informant interviews was to collect information from a wide range of people who have firsthand knowledge about the issue under study. These included nurses, pharmacists, doctors and records officer at the hypertension clinic.
3.8.2.3 Desk review
The desk review aids in collecting, organizing and synthesizing available information in order to gain an understanding of the issues in the management, control and treatment of hypertension. This helped in identifying and addressing various gaps for example on adherence.
3.9 Ethical consideration
Clearance to carry out this research was sought from the Kenyatta University Ethical Review Committee and the local Medical Officer of Health. The hospital administration was assured that the research was purely for academic purpose. The participants of the study were informed of the procedure, purpose and benefits of the study to obtain their consent. In addition, all the respondents were treated with respect without forcing them to participate. They were assured that they would not be exposed to any risk or benefit during the study. Every respondent was also assured of confidentiality and privacy in that their IDs or names were not needed for the study.
3.10 Data analysis
Quantitative data was coded, entered into a database statistical computer programme (SPSS). The data was analyzed using Chi-square tests to obtain the association between variables and descriptive statistics to obtain frequencies and percentages.
ste your text in here…