Assignment on METHODOLOGY OF EXPLORE HEALTHCARE PROFESSIONALS’ PERCEPTIONS AND EXPERIENCES ABOUT OPPORTUNITIES FOR LEVERAGING HEALTH INFORMATION TECHNOLOGY

.1. Chapter Outline of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

This chapter discusses the study design and the research approach. It begins with a review of the underpinning approach, then justifies the study design, addresses the sampling and data collection techniques, and finally explains the analysis procedures. It will end with the ethical considerations that were considered in this work.

3.2. Research Approach of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

This research is qualitative (100-103) in nature, explicitly adopting the use of an exploratory case study method (102-104). The primary data source was a series of face-to-face, in-depth, semi-structured interviews (100, 101) with healthcare professionals. Qualitative research aims to describe the lifeworld “from the inside out,” considering the point of view of the people who participate (105). In contrast to the quantitative paradigm, qualitative research brings an in-depth, first-hand knowledge of participants and social groups in their natural settings. Thus, qualitative research is one way to explore experiences, opinions, feelings, and human behaviour. In a healthcare setting, this can be one approach to know and understand the perceptions and descriptions of healthcare professionals by gathering accounts of their thoughts and experiences in face-to-face interviews conducted in their natural environments.

Qualitative methods can supply unique perspectives on health and illness. We can conduct qualitative research from a variety of approaches, depending on the method. A phenomenology approach focuses on participants' experiences and the nature of human consciousness whereas, in a grounded theory method, the focus is on developing a theory “that originates from data in the field instead of utilising evidence to validate the theory” (106). As a novice in health research, the researcher did not feel comfortable with the latter method. In action research, the participants are in partnership with the researcher (107) and solve problems mutually. Although increasingly used in healthcare, action research data can be both qualitative and quantitative. This approach was also disregarded, as the researcher was interested purely in qualitative data and envisaged significant limitations in trying to collect quantitative data. Ultimately, a case study approach was selected as its objectives sought to examine small groups, institutions, and individuals (108).

3.3. The Case Study of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Researchers have defined “Case Study” in several ways (109). A consistent descriptor in them all is that it facilitates the consideration of multiple perspectives in answering a research question. These perspectives can be crucial in understanding the area of interest. This research aims to explore the challenges and opportunities of leveraging MHAs to engage patients with diabetes from the perspective of healthcare professionals in the State of Kuwait. The researcher believes that this topic is worth exploring because of the prevalence of the disease and a lack of innovation in Kuwait (110). The researcher’s specific interest is in exploring the barriers and enablers in this context.

Stake (109) distinguished a case study as the intrinsic, the instrumental, and the collective. Yin (111) identified three categories of case study, namely descriptive, explanatory and exploratory. According to Bassey (112),  an exploratory case study is a theory seeking, and an explanatory study is theory testing. An exploratory case study investigates a phenomenon in the data that interests the researcher. This exploratory case study explores the challenges and opportunities of leveraging MHAs to engage patients with DSM from the perspectives of healthcare professionals.

A case study method can be used to deeply probe to gain insight into phenomena that are new, unexamined, or not understood. The case study can help the researcher explore the how and why of events, situations, and problems in a way that does not require the control of those circumstances (113). A case study positioned as being “instrumental” provides an insight into the issues or refinement of theory (113).

The exploratory case study approach will enhance understanding by gaining insight into the participants’ perceptions and assumptions. The researcher will explore the challenges and opportunities of leveraging MHAs at the Dasman Diabetes Institute (DDI), in contrast to a holistic case study carried in one environment. According to Yin, an exploratory case study approach supplies a flexible environment in which the researcher can explore the issue in depth. Participants can express and describe their knowledge of the subject in their own words. By asking open-ended questions, the researcher can refine the developing theory. This way, the researcher can address the intricacies of a complicated issue that would be challenging to explore using a standard survey method (114).

An exploratory case study approach is particularly advantageous when events under evaluation have no clear, single set of outcomes (115). The more the researcher interacts with the participants, the more their feelings and beliefs can be deduced, which might enable the researcher to understand the actual perceptions of the participants. However, one drawback is that the researchers’ values and beliefs can influence the production and analysis of the data; Thus, great care has been taken to identify and bracket (103, 116) knowledge that already existed. This was ensured by working in a detached manner, leaving behind any earlier conceptions so as not to be biassed or prejudiced. In doing so, the researcher has been mindful of the importance of reflexivity within this work (117, 118). The unit of analysis refers to the “what” or “who” understudy. Usually, the unit of analysis might include individuals, groups and organisations, and documents. In this study, the unit of analysis was the individuals (healthcare professionals).

3.4. Study Context of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

This study was conducted at the DDI. DDI has served the diabetic Kuwaiti population since 2006; its primary mission is to address the diabetes epidemic in Kuwait. The healthcare professionals within DDI belong to different nationalities including Kuwaiti, Egyptians, Indians, and Filipinos. Face-to-face interviews were planned and conducted between July 2018 and September 2018.

3.5. Participant Recruitment of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

A purposive selective sampling (101) was used to recruit study participants who can provide relevant insights into the study’s topic. The inclusion criteria was based on being a practising healthcare professional working at DDI. This included physicians and nurses engaged in providing care to patients with diabetes some of whom are specialised in diabetes care and management. Participants were recruited from all genders and nationalities. For the convenience of transcribing, clinicians who had a good command of the English language were recruited. The researcher recruited participants based on their relevance to the study (102). In a qualitative study, the sampling size is small due to the complexity of the data, the time required, and because of a primary aim to gain rich insights and understanding of the social setting (101). The aim was to continue with data collected until saturation was achieved (119).

3.6. Data Collection of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Data collection was performed via in-depth semi-structured face-to-face interviews (100, 102) (see Appendix 4) using open-ended questions as per Whiting (119), utilising sub-questions (probing questions) depending upon the flow of the interview and how the interviewee responded (120). All interviews were audio-recorded after obtaining informed consent. The researcher used the interview guide and piloted the questions with his colleagues at the workplace to ensure that the participants could understand the questions asked. Necessary demographic information was collected before commencing the interviews. The researcher conducted interviews face-to-face at a location convenient for each participant.

The researcher commenced with open-ended questions to encourage the participants to freely express their perceptions, feelings, experiences, and practice (103). The researcher remained conscious of ideas emerging during the interview; nonverbal cues were observed to complement the verbal information obtained from the participants. Checks for relevance and accuracy were made via follow-up questions and probes to extract more in-depth knowledge (103). The researcher conducted the interviews at the convenience of the participants, considering their work schedule and privacy. The interviews ranged from 15 to 45 minutes in duration and were conducted at a time and place convenient for the participants. To keep the interviews flowing and focused on the topic, the researcher used the interview guide (103).

The semi-structured questions were changed after the pilot test was conducted. Piloting the interview guide gave the researcher confidence in carrying out the interviews; pilot data have not been included in the analysis. The researcher contacted participants in advance and informed them about the aims and objectives of the study. Before each interview, time was spent to explain the process and build rapport with the participant. According to Polgar and Thomas, to comprehend personal beliefs and experiences, the interviewer should understand the participants under study (121). The researcher aimed to avoid barriers to communication such as being unfocused, judgmental, or providing them with answers.

3.7. Data Analysis of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

The researcher transcribed the interview recordings verbatim and pursued a constant comparison method of sampling and data analysis (122, 123). Digital audio recordings were transcribed and annotated as soon as the data was collected so as not to lose the context. The researcher reviewed the transcripts repeatedly to become familiar with the data and gain a more in-depth insight into the perceptions, feelings, and experiences conveyed. Similar ideas and thoughts were identified and placed under initial headings (nodes), which appeared to fall into the same categories (themes) (122, 123).

The researcher coded interview transcripts with markings and supplementary creation of notes (122) to identify and label nodes using a process of open coding (124, 125) to identify the patterns, then arranged the data into categories (axial coding). These categories were further refined and reduced in number by grouping them and forming themes. Themes are the essence of the text coming together to address the issue. The notes and codes from each interview were compared to the nodes and codes developed from the previously coded transcripts to compare ideas (126). The merging of comparable themes made it possible to summarise the data and allow the possibility of generating theory inductively (103, 114).

The researcher started transcribing and coding the data as soon as the first interview was completed. Having completed the transcripts and summarised the findings, the researcher returned the data to the participants via email after the interview transcript for “member-checks” and validation purposes. The researcher did not use any software, (e.g., NVivo, Dedoose, etc.) first because the data was not massive and second due to the researcher’s interest in engaging with the data directly to identify emerging themes and patterns.

3.8. Data Reliability of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

To ensure the reliability member checking was done, the researcher presented the data transcripts back to some of the participants to invite comments (127). This method is useful in authenticating the data and involving the participants in the research. Member checking goes back to the study of Lincoln and Guba (128). It can be conducted at two levels. First, after transcription of the data, the transcripts can be sent back to the participants to verify whether the transcript matches what they intended to say. Second, the participants can be asked to check the initial or final findings of the study to validate the findings of the researcher. In this study, the researcher sent the initial transcripts for verification to the participants but did not perform this verification for the research findings, as Morse proposes that “the researcher's background in theory and research methods must [lead them to] outrank the participant as a judge of the analysis” (129).

Given the unstructured and massive data set that can arise from interviews, one issue of qualitative research is that the researcher’s personal views might cloud the collected data. While receiving the information, sometimes it is not possible to remain neutral. The researcher might unintentionally influence the responses and results of the study (130). Thus, the social interaction between the researcher and the participant was kept in mind during the study.

An acknowledgement of the misperception through reflexive research helped the researcher to build an interview guide for the study participants which clarified the researchers’ understanding of the outcomes (131). Reflexivity is a concept that puts focus on the underlying threat to the validity and reliability of the research outcomes.

According to the recommendations of Lincoln and Guba, one can improve validity and reliability by asking participants whether their observations are reliable. Secondly, extensive interaction with the participant can remove the biased influence due to their presence. Triangulation is another tool that helps with crosschecking the data (120) but was not carried out and reasons are explained in the limitation section. Documentation of the entire work was done which ensures that the process can be repeated (111) and also measures reliability if another researcher using the protocol, arrives at the same results and conclusions (112).

3.9. Ethical Considerations of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

The research design was approved by the Ethical Review Committee of the DDI as the study involved healthcare professionals. Prior to the study beginning, it was important for the researcher to know of ethical standards not just at a local level but also nationally.  Subsequently, the British Educational Research Association's ethical guidelines were considered (British Education Research Association, 2018). The researcher obtained consent from the participants (see Appendix 1). The participants invited to take part in the study were informed of the title of the study, its purpose, time commitment, and their right of termination of participation.

The researcher considered the confidentiality of the participants’ viewpoints (132). It was indicated that data collected would be anonymised, ensuring that the transcripts could not reveal the identity of the participants and would be stored securely on the researcher's laptop protected by a password. The researcher assured participants that no identifiable information would be used in any form of publication or presentation (see Appendix 2). Ethical approval was successful (see Appendix 3).