CHAPTER THREE: METHODS

3.0 Introduction

This chapter presents the methodology that this study used in order to obtain the data that was used to answer the research questions. The chapter includes a description of the study design, the study area, the study population, sample size calculation and sampling procedures. The chapter also includes a description of data collection methods, data collection tools quality control measures that were used, the data analysis plan ethical considerations and a dissemination plan.

3.1 Study design

This study adopted a quantitative approach, in which objective, systematic processes implemented to obtain numerical data for understanding aspects of the world. Quantitative research processes are objectively constructed and its findings are replicable and generalizable (Parahoo 2006). A quantitative research design was selected because the phenomenon (factors associated with compliance to infection control precautions) was studied by way of precise measurement and quantification involving rigor and a controlled design. Particularly, a descriptive cross sectional research design was used, in which a sample of persons from a defined population is enrolled to examine the possible relationship between the exposure and the outcome/event, phenomenon, problem, attitude or issue by taking a snap-shot or cross-section of the population (Joubert et al 2007). A cross-sectional study involves looking at people who differ on one key characteristic at one specific point in time. The data is collected at the same time from people who are similar on other characteristics (health workers) but different on a key factor of interest such as individual characteristics. In addition to enabling the researcher to analyze relationships between variables, the descriptive component of the design also allowed for the profiling of respondents in terms of their demography, compliance characteristics, individual characteristics and views about institutional characteristics.

3.2 Study population

A population is an entire group of individuals, events or objects having common characteristics that conform to a given specification (Mugenda & Mugenda, 2012). In this study, the population was health workers working at Al-Shabbah hospital, Juba – South Sudan.

3.2.1 Eligibility

Inclusion

The study included;

• Health workers who had worked at the hospital for at least 3 months, on the presumption that by that time they would be very much acquainted with the characteristics of the institution and in position therefore to provide valid information related to the institution.

Exclusion

• The study excluded health workers who were not available for interview on more than two occasions of contact.

3.4 Sample size calculation

This study was interested first and foremost determining the level of compliance to infection control precautions, there was therefore need to determine the numerator (those compliant) and the denominator (total population). That implies that there was need to determine the sample size for this study, based on the estimated number of health workers. Therefore since the population size was to be used, a formula by Krejcie and Morgan (1970) was the most suitable, and was used as follows;

s = X² NP (1-P) ÷ d² (N-1) + X² P (1-P)

Where;

s = required sample size

X² = the table value of chi-square (1 degree) of freedom at desired confidence level (3.841).

N = the population size = number of health workers at Al-Shabbah hospital = 70

P = the population proportion (assumed to be .50 since this would provide the maximum sample size).

d = the degree of accuracy expressed as a proportion (.05).

s = 3.8416 × 72 x 0.5 (1- 0.5) ÷ (0.05)² (72-1) + 3.8416 × 0.5 (1-0.5)

s = 3.8416 × 72× 0.25 ÷ 0.0025 × 71 + 3.8416 × 0.25

s = 59 health workers

3.5 Sampling procedures

In this, study, sampling was done at two stages, one at hospital level and the second at health worker level. Al- Shabbah hospital was purposively sampled because of one main reasons, one is that it is one of the hospitals in Juba that have had rampant reports of both nosocomial infection and needles stick injury incidence among health workers.  With that it was a suitable location for the conduction of a study assessing factors associated with compliance to infection control precautions.

At the hospital, it was noted that the difference between the total available population of health workers (72) and the sample size of this study (59) was not so significant and so the researcher could not us random sampling methods to sample the health workers since that would have resulted in the non-obtainment of the sample size. Non obtainment of sample size would have happened because random sampling involves the elimination of one item and sampling of another based on probability, which would have resulted in a sample of 36 health workers, instead of 72.

Therefore, consecutive sampling was used  instead, which is a type of sampling in which one unit is sampled followed by another consecutively for as long the unit meets the eligibility criteria of the study. With that sampling method, the researcher obtained all necessary permissions at the hospital sampled the health workers one after another, assessing eligibility at each instance and engaging those eligible in interviews.

3.6 Data collection methods

This study used structured interviews to collect quantitative data. The structured interview is a form of interview in which the interviewer asks a question to the interviewee and follows it up with response options from which the respondent can choose. It is basically a close ended type of interview. This type of interview was used in this study because of its major advantage of being relatively quicker to conduct and being less taxing to a respondent, both of which were key in this study given the nature of the study population. All the potential respondents were found at in on duty, and so there was need for a data collection that could be executed in a fast but efficient manner in order to enable return to their duties, hence the use of the structured interviews. The interview method allowed the researcher to explain the purpose of the interview so as to gain cooperation which was essential in order to get the required information from the respondents. The interviewees were informed of the details of the study and any potential ethical issues related to the study.

3.7 Data collection tools

For quantitative research designs, structured tools are used to generate numerical data and statistics are used to organize and interpret the data collected (Grove et al 2013). Therefore, in this study, a self-designed, structured self-administered questionnaire in English was used to collect data. A questionnaire is a document used to gather self-report data via self-administration of questions. The use of structured questionnaires in research enhances the objectivity and support statistical analysis (Polit & Beck 2012). The respondents complete the instrument for themselves on a paper -and-pen instrument or directly onto the computer, responding to a series of pre-determined questions by the researcher (Polit & Beck 2012). Structured questionnaires were used in this study because they would enable the researcher to gather information from a large number of participants that can be easily quantified and analyzed.

The researcher developed the questionnaire (Appendix B), with the questions that were formulated were guided by the objectives of the study outlined in the first chapter of the study as well as the literature review presented in Chapter 2. The questionnaire was designed to capture information on biographical and data factors associated with compliance. The questionnaire comprised the following sections:

3.8 Quality control

Training of research assistants

Given that the sample size of this study was so large, only two research assistants with experience in collecting field data were recruited and trained for a day on issues pertaining to the study and its objectives, participant  handling  skills  such  as  interviewing  skills,  content  and  meaning  of  questions, correct recording of responses,  and orientation to study objectives and procedures. The training also covered ethical considerations when handling participants, especially confidentiality of responses.

Pretest

Pre-testing of an instrument was carried out to determine its feasibility and validity. In this present study, the researcher pre-tested the questionnaire prior to data collection to enhance its validity. The pretest was done among a sample of 10 health workers at Juba Teaching Hospital; since the health workers there had similar characteristics as those that were the main study population. The pretest was done in order to determine the comprehensibility of the questions, ability of the questions to elicit the required data, and to detect any ambiguity in the questions. After the pretest, slight modifications were made on the tool, and they included, removal of two questions which were soliciting for similar responses, and the paraphrase of one question in the parental characteristics section.

Reliability

In this present study, the instrument was subjected to reliability testing after completion of data collection. The researcher will calculate the Cronbach’s Coefficient Alpha scores. The Cronbach’s Coefficient Alpha was calculated to test the reliability of the questionnaire, with specific reference to its internal consistency. This was done to determine whether the researcher concentrates only on the one trait, which was measured in each individual section. The following table was used to indicate the Cronbach’s Coefficient Alpha scores of the various sections of the instrument.

3.9 Measurement of variables

Compliance to infection control precautions

Compliance to infection control precautions was measured using a composite score that was obtained after obtained using a 13 questions assessment form (Appendix B, section B). The questions in this section where designed using a 4 point scale format, that is Always, Sometimes, Rarely, and Never. These options were score as follows; Always = 3, Sometimes = 2, Rarely = 1 and Never = 0. Therefore, since there were 13 questions, the total score was 39 (13 x 3), and that was the cut off for compliance considered in this study. This was so because compliance requires that a practice is “Always” done. Therefore a health worker was considered to be compliant if they always practices all the 13 infection precautions that were asked.

3.10 Data Processing and analysis

The data handling exercise will start with field editing to check the appropriateness, consistency and accuracy of the information provided by respondents. Serial numbers were then assigned to the individual edited questionnaires for the purpose of easy identification during the coding process and rechecking of information on the questionnaire during the data entering exercise. The computer software Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data. This is because SPSS is the most widely used statistical Software in the Social Sciences. At univariate level, frequency tables and statistical figures were used in the analysis and interpretation of the data.

Bivariate analysis was used to execute the first step of relationship analysis between the independent variables and the dependent variable (compliance). This was done using the Chi Square (X²) tests. Significance was determined based on an alpha level of 5%, were statistical significance was established if the p value is less than 0.05. Statistical significance at this level was determined at an alpha level of 5%, meaning that p values that are less than 0.05 was considered significant.

3.11 Ethical considerations

Ethical clearance

The research proposal was submitted to the ethical review committee of Cavendish University. An ethical clearance letter was issued and the permission to conduct the study was provided by the hospital administration

Informed consent

Consent is an explicit permission given the study participants, indicating their willingness and agreement to take part in the study. Informed consent means that participants have adequate information regarding the research, they comprehend the information given, and they have the capacity or competency to make decisions and they make the decisions voluntarily, without coercion. The study participants have the right of free choice which enables them to consent, decline and to withdraw from participating in the research (Polit & Beck 2012).

A detailed explanation of the purpose and nature of the study and the importance of participation were given to the study participants in a letter that accompanied the questionnaire. The participants were informed that participation in the study was voluntary and that they had the right to refuse to participate or to withdraw from it at any point without explanation or consequences even after they had already signed a consent form (Polit & Beck 2012). Consent to participate in the study was sought from the health workers, all of whom were 18 years and above. The consent for participation in a research study is included as Appendix A.

Anonymity and confidentiality

Confidentiality means that the information that the researcher obtains about and from the research participants should not be divulged to other people without their permission. Anonymity, on the other hand, means that the researcher should ensure that no participant in the study can be identified from any of the responses that they have given. The following measures were taken to ensure anonymity and confidentiality:

• The participants were requested not to write their names on the questionnaire.
• The identity of the hospital where the study was conducted was protected and they were not disclosed in any way.
• The raw data were kept safe and confidential, locked up with unauthorised access.
• Data were reported in a manner that did not identify or link the participants with the information.

Justice

According to Polit and Beck (2012), the research participants have the right to be treated fairly and equally unless there is reasonable justification to treat them differently. The principle of justice means that the research strategies and procedures must be fair and just. In order to uphold this principle, the researcher made use of the eligibility criteria to select participants for the study to ensure proper representation in the research samples and respect for diversity in terms of age and gender.

3.12 Limitations

Compliance to infection control precautions was measured based on only self-reports, and not observations of the health workers. Therefore, the level of compliance obtained might be a bit inflated. Nonetheless, the researcher endeavored to obtain accurate self-reports from the health workers by assuring them of confidentiality.