Choosing methods and determining sample size

As discussed in section 5.1.1 above, I decided to use a mixed methods

approach. Therefore, for the quantitative questions I needed a power calculation for the sample size required for a statistical significance of 0.05. This calculation showed an effect size which came to 300-600 mothers. This sample size was beyond the capacity of the present study, given the time and resource limitations.

Likewise, I planned to collect qualitative data as well as quantitative data, so I ultimately concluded that it would be better to conduct an exploratory study. I needed a sample that would be as large as possible while still allowing for the more in-depth qualitative research. I therefore decided to recruit 50 white British mothers and 50 South Asian mothers, focusing on the Keighley area for participant

114 recruitment. This study design was intended to gather information on several aspects of infant thermal care and provide the groundwork for future larger scale and/or more in-depth studies using qualitative and quantitative methods.

One advantage of a mixed methods approach was that specific questions were more appropriate to either quantitative or qualitative methods. For instance,

demographic information and information on the amount of insulation used for infants at night were best suited to quantitative measures. More involved

responses, such as those related to mothers’ beliefs about the dangers of cold and heat, were best achieved through qualitative methods. Since this particular topic has not previously been explored, qualitative methods were particularly relevant for the present study since the mothers’ answers could not be anticipated enough to provide them with a choice of pre-selected responses. I used my experiences gained while conducting fieldwork in Guatemala, coupled with the results of the pilot study, to inform the questions used in the larger study. I decided what information I hoped to collect from the participants, and then determined which questions were best suited to structured quantitative methods and which to unstructured or loosely structured questions using qualitative methods. I also planned to use participant observation as far as I could whilst talking to the mothers and arranging access to participants. I decided to explore mothers’ reports related to the following topics:

clothing and bedding choices in winter and summer; environmental conditions in the room the infant slept in; how mothers judged that their infants were not too hot or too cold; and how mothers believed heat or cold could harm their infants. I did not expect South Asian mothers to talk explicitly about humoral beliefs. Rather, I predicted that both groups would express preferences about thermal care practices and that they would give reasons for these preferences. The interview questions are given in appendix 12.

115 5.3 Data collection methods for main study

5.3.1 Recruitment

When I approached organisations in Keighley to help me find mothers, they were overwhelmingly helpful. They commented on people rarely bothering to come out as far as Keighley to do research. This was in contrast to the over-researched Sure Starts in inner-city Bradford. Most understood the significance of the research and were very keen to be involved. One Sure Start did assist with publicity and outreach in order to recruit their clients for this study. For ethical reasons, all of the organisations I worked with elected to contact their clients directly, rather than allowing me to access them on my own. Because of this indirect communication, it was almost impossible to get permission to go to mothers’ houses directly. However, one Sure Start arranged for a handful of mothers to come to their centre where they provided a room for the interviews. I found another handful of mothers at a toddler group, but the subsequent

recruitment process resulted in a total of only seven mothers. This caused me to question my capacity to recruit an additional 93 mothers, and led me to conclude that the snowball method of recruitment was not practical for research involving mothers of young infants.

5.3.1.1 Recruitment in the shopping centre

As I examined other possible avenues for participant recruitment, I considered other possible locations where mothers of young infants might

congregate, such as at toddler groups, at houses of friends or family members, or at baby clinics. I considered approaching schools, but excluded this option since it was likely to produce a sample that had few first-born infants. Fortuitously, while spending a day in Keighley I went to the local shopping centre to buy a sandwich and was struck by the sheer number of pushchairs and prams in sight. I walked around for 30 minutes counting babies in pushchairs, and calculated that there were at least three infants an hour in the centre. It appeared that I had found a substantial concentration of potential participants in a community location where I could access mothers directly without encountering problems with data protection.

116 This small shopping centre was popular mainly with white British mothers.It provided a dry, warm environment to walk round to shop, to bump into friends and acquaintances, and to gain a connection with the outside world in contrast to the social isolation of looking after an infant at home. I requested permission from the Airedale Shopping Centre management in Keighley to interview mothers on their premises, and found that they werevery cooperative. They could not offer a fixed place for a table or stand, so I had to carry all my paperwork and gifts on me.

However, this degree of mobility had its advantages since I could choose where to stand at any given time, selecting quieter spots for interviewing, or entrances to shops popular with mothers which were good places for recruiting.

5.3.1.2 Recruitment in South Asian homes

Although I did recruit seven South Asian mothers in the shopping centre, they were rarely present at that location. I occasionally saw South Asian mothers with pushchairs, but almost all the time the passengers were toddlers. On the few occasions where I did see a South Asian mother with an infant and I approached the family, they often declined to enter into any conversation and would pass by quickly, smiling and shaking their head before I had even opened my mouth.

By the time I had interviewed 51 white British mothers, I had only

interviewed 15 South Asian mothers recruited through the shopping centre, Sure Start, toddler groups, and through community workers arranging home visits to their relatives who had infants. Therefore, I had to change my tactics in order to recruit another 35 South Asian mothers. A mother and community worker at one of the organisations I had contacted explained why I was not finding South Asian mothers in the shopping centre. She said that South Asian mothers with babies usually look after babies and do housework in the morning, and then go out in the afternoon if they want leaving the babies at home sleeping under the care of a relative. She recounted that when her own children were small, she never had to take her babies with her because she had been able to leave them at home with her mother-in-law during their afternoon naps. For South Asian babies where the often family gets up later in the morning, the afternoon nap may be the first nap of the day. Also, South Asian mothers are more reluctant to take their infants out in the

117 cold and disrupt their sleeping and feeding routines, especially if they are ill or could become ill by being taken outside.

Despite the stereotype that South Asian mothers have access to constant help with childcare because of other female family members living in the same house or nearby, the South Asian mothers in my sample found it hard to get someone else to look after their infant if they were not napping, making it very difficult to arrange a time and place to meet the mothers outside their homes. The difficulty in

interviewing mothers outside their homes is illustrated by the following example. I had arranged (with an interpreter) to meet a mother at her in-laws’ material shop at midday. We were told repeatedly for two hours while we waited that she was “just on her way,” only to be told eventually that the woman was a “lazy person.” The mother did not want us to go to her house, and kept insisting she was just leaving.

She eventually arrived, apologising for the delay, saying that she had been trying all that time to get her baby to sleep so that her mother-in-law could look after her while she went out. This illustrates not only that South Asian mothers needed me to go to their homes, but also that I needed a facilitator, not just an interpreter, to help me access South Asian mothers in their homes.

I considered several methods of accessing South Asian mothers in their own homes. Accompanied by the interpreter, we tried knocking on the doors of houses with infant clothing hung out to dry in the yard. Despite windows being open and TV’s and radios on, nobody would open the door. On the one occasion someone did answer, we were asked to call back another time and were given an incorrect mobile number to call. I eventually found that a facilitator or intermediary,

especially ones who spoke one or more South Asian languages, who used his or her own personal contacts, was the only way I could recruit South Asian mothers in their homes. A more in depth discussion of the issues involved in interpreting is given below in section 5.3.3. For a participant to agree to an interview, there

therefore had to be a person known mutually to the participant and me. Cold calling never worked. Even with interpreters who were members of the South Asian

community, there still needed to be a direct connection between the interpreter and the participant, such as an older lady who introduced us to her neighbours. It was

118 not a question of not trusting a member of the white British community, such as myself, but a question of not trusting anyone they did not know either directly or indirectly. The success of my research with the South Asian community was dependent on the people who were willing to help me find South Asian mothers and to build trust with the mothers to facilitate the research. This commitment was largely outside my control, but luckily I did find it. The facilitators from the South Asian community who assisted with this study included a male community worker, female community workers, the mothers that were interviewed, the interpreter’s mother, and a friend of the interpreter’s mother. The facilitators that introduced me to mothers and helped me gain their trust are listed in appendix 13.

5.3.2 Interviewing

5.3.2.1 Interviewing in shopping centre

Once I had established that I would recruit mothers in the shopping centre mostly on weekday mornings, I developed a routine where I let the centre’s

management office know I had arrived each day, and then went down to the mall. I judged who to approach by looking at the age of the infant in a pushchair/pram and the mother. Spotting a very young baby was easy, as they were usually lying down or in a pushchair with the smaller 0-6 month size car seat attached to it. The behaviour of young infants was also noticeably different from older babies. They were less mobile, sleepier, cried differently, played differently, were small, and made no word-like noises. Distinguishing between a baby approaching a year and those over a year was much more difficult.

I avoided approaching women who were in deep conversation with friends or family, were on the phone, or were having difficulties dealing with the infant or older siblings. Some mothers were obviously avoiding my path by cutting quickly across to the other side of the mall and avoiding eye contact, and some I could not approach because of other shoppers who were obstructing the path. I also chose not to pursue mothers in situations that would have required running after them, since I did not want to make potential participants feel like I was hounding them.

119 Once I had approached mothers, I explained briefly what I was doing.

Approximately one in three mothers I spoke to agreed to participate. I apologised to mothers who I could not include, usually because their infant was over a year or they were not white British or South Asian. Mornings were the most productive times for interviews in the shopping centre. This was when mothers were more willing to stop and talk and were not in a hurry. Mothers in the afternoon tended to be rushing through the shopping centre to pick up school-aged children. Some mothers did find their time restricted towards the end of the interview, especially if the baby or other children were in need of attention. I tried to be as sympathetic as I could to their needs, asking them if they were willing to continue, and reminding them that they were free to discontinue participation at any time.

Providing privacy for the interviews in the shopping centre was difficult.

Wherever possible, I attempted to stand out of earshot of stall sellers, other shoppers who were passing by or sitting on benches, and the shopping centre’s security guards. If being out of earshot was unavoidable, I asked participants were comfortable with continuing where we were or if they wanted to move. For example, a male security guard came and stood nearby during one interview, and the mother said she would prefer to move to a bench, which she did, and she did not mind that she was then within earshot of an older lady and her grandchildren.

5.3.2.2 Interviewing in South Asian homes

Acquiring the trust and commitment of facilitators is not necessarily compatible with research plans or deadlines, but the quality of the research achieved by gaining access to appropriate participants depended on these

facilitators. Trust had to be earned, which required a level of care and commitment beyond the limited purpose of simply collecting data. An understanding had to be reached between research staff and participants in order to allay any fears that participants would be stereotyped negatively or criticised for certain infants care practices, such as overwrapping. Trust is rarely gained where there is a suspicion of being judged or where inauthentic motives are perceived, so I had to be genuine in my willingness to put the needs of participants first. Help from the facilitators was

120 essential to gaining participants’ trust necessary for them to allow me into their homes and to feel comfortable with the questions I was asking.

Purdah (the social rules regarding separation of men and women) was obviously a consideration when visiting South Asian households. Men usually opened the door to us but quickly disappeared once showing us to where the women were. On a few occasions, husbands of the participants stayed in the room to listen to some of the questions I asked, leaving when they seemed reassured the research was genuine and I was not asking questions that were too revealing about their family.

The interviews were usually carried out in the company of other family members for several reasons, including the fact that the room we were using was the only warm room in the house, or because of curiosity, distrust, or a desire to make us feel welcome. On a few occasions, either a sister-in-law or mother-in-law or even a daughter appeared to be interfering with the answers, but only on one occasion was a mother unable to answer without the reassurance of her sister-in-law for each answer. A list of others present in some of the interviews is given in appendix 14.