Coding procedures and development of themes

As mentioned previously, I did not use a Computer Assisted Qualitative Data Analysis Software tool to assist with data management and analysis. Instead I manually reduced the extensive data to a more manageable format. Data reduction refers to a process of selecting, focusing, simplifying, abstracting and transforming the data that appear in written transcripts (Hancock & Algozzine, 2006; Myles & Huberman, 2004; O’Dwyer, 2004). This information management system, although seemingly simplistic, was laborious but essential. I disassembled and reassembled the data, breaking them into sections which I then grouped and placed in a table with headings added to clarify the contents of each column. This forced me to make judgments about the meanings of the text for a system of coding to be applied. Being able to revisit the electronic and hard copy transcripts multiple times meant no relevant data was missed.

Creswell (2009) advises to look for codes that are not anticipated, unusual, and that address larger theoretical perspectives. Sometimes there is a significant meaning in a single occurrence, but usually the important meanings are those that are repetitive. It is not uncommon in qualitative analysis that a single text segment may fit into more than one code (Braun & Clarke, 2006). Where this occurred in this study I placed them under all of the codes to which they related. I repeated this process with each interview and focus group. Likewise, some of the text was not assigned to any code and was placed in a one off code box if relevant. Only a very small amount of text did not “fit” into the codes that emerged from the raw data. Each data item was given equal attention in the coding process.

I tested the robustness of the codes, continually revising and refining the coding system. I looked for relationships between codes, an overlap of codes, contradictory points of view and new insights. There was no overt sequence to the coding although they were closely linked and comparative with each other.

The revision and refinement processes continued until I was comfortable with the results. An example of the coding is provided in Table 3. The key to understanding the excerpts is as follows:

 The capital letter in brackets identifies that the quotation was provided either by a middle or senior manager (I) or from a nurse in one of the five focus groups (FG)

 The number that follows the capital letter signifies the order in which that interview or focus group took place.

 For auditability the p. represents the page number that this quotation can be found on the typed transcripts.

Table 3. Coding of data

Code Label Description of code

Text associated with code

The Primary Health Care Strategy Participant knowledge and understanding of the Primary Health Care Strategy

It’s interesting because I don’t believe that the primary health care sector, I think they accepted the Strategy as opposed to believe the Strategy. (I.5, p.1)

May I ask what is the Primary Health Care Strategy, can we get that right in my head. (FG.1, p.1) Nursing leadership Primary health care nursing leadership in Tairawhiti

In our organisation we have some really great leaders. But they don’t step up to the leadership role because they have already got enough bricks on their head. (FG.1, p.8)

I do think it will be through leadership and having that voice, things may change in the future. ( I.3, p.5)

Once the data has been initially coded and collated the next process is to refocus the analysis (Braun & Clarke, 2006). Braun and Clarke (2006) state this phase re-focuses the analysis at the broader level of themes rather than codes. It involves sorting the different codes into potential themes, and

authors state the theme should cohere around a central idea or concept. I concentrated on identifying patterns within the data and the different ways these patterns related to each other. As a result of this process a synthesis of the data emerged and produced a new understanding that allowed me to search for nuances in the way each concept was used. From this, I developed a thematic map as illustrated in Figure 9.

Figure 9. Thematic map showing original themes

These themes were reviewed until three key themes were defined and named and formed the basis of the data presentation chapters: making sense of the Strategy, multiple layers of resistance and primary health care nursing investment. Making sense of the strategy was influenced by the diffusion process, the flaws contributed to the negative receptive context for change. This then influenced the attitude toward the strategy resulting in significant resistance. The changes that took place related to primary health care nursing investment. All relevant extracts for each theme were collated. Themes were also checked against each other and back to the original data set.

The analysis should show how all the evidence has been accommodated and address all major rival interpretations and most significant aspects of the case (Yin, 2003). Attention to detail increases the clarity of the reasoning (Zucker, 2001). The strong preference is to demonstrate an awareness of current

Making sense of the Strategy

Flaws in the diffusion process

Receptive context for change

Attitude toward the strategy as the

innovation Changes that took

thinking and discourse about the case study topic. Trustworthiness of the study is discussed next.