Data collection methods

This methodology involves observing participants (in my study with their knowledge) but without actively participating in the activities (Spradley, 1980). My research assistant and I were not clinically trained and thus could not be able to fully participate in the activities of the newborn unit (Wind, 2008). Non-participant observation is used to understand a phenomenon by entering the community or social system involved while staying separate from the activities being observed (Fetterman, 1989). Alongside the observations, informal conversations took place with the mothers and nurses present in the sick newborn units during the course of the study. These day-to-day conversations were unstructured and enabled us to follow up on issues that we observed while in the NBU (Green & Thorogood, 2018). Secondly, as opposed to relying only on interviews, through observations researchers are able to collect data pertaining to what people do as well as what they say (Kiefer, 2006). However, its greatest limitation is that it is time-consuming and as observed by various researchers, people change their behaviour especially when they know that they are being observed, a phenomenon referred to as the hawthorn effect. I was aware about this form of reactivity and thus emphasized the need for building rapport with the mothers while conducting observations in the newborn unit (Creswell, 1998; Green & Thorogood, 2018).

The nonparticipant observations focused particularly on the tasks and roles that the mothers played and the nature of the relationships that existed within the ward. We spent time observing the day-to-day occurrences and care provision in the ward, we wrote short notes during the day which we then expanded at the end of each day either in our field notebooks or typed out on MS word on our computers (Spradley, 1980). Occasionally I kept my own voice diary, where I recorded my personal thoughts and reflections. During these

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observations, we identified mothers whose babies were becoming stable and were likely to be moved onto the less intensive newborn units prior to potential subsequent discharge (within a week or two).

Discharge in-depth interviews

The second method of data collection involved formal semi-structured in-depth interviews with mothers at the time of their baby’s discharge from the hospital. Fetterman describes interviews as “the ethnographer's most important data gathering technique as they explain and put into a larger context what the ethnographer sees and experiences” (Fetterman, 1989). We interviewed 20 mothers from each of the two study hospitals. As alluded to above, this methodology in essence thus allowed me to confirm and follow up on our observations. The interview elicited information on the mother’s roles, perceptions and experiences during her baby’s hospitalization. I used a topic guide to guide these interviews (Appendix B). We asked open-ended questions that were followed up by probes to elicit additional information. Although this is an important method applied in health research, the key limitations of this methodology is that it could potentially generate data relating to what people say, and not necessarily what they actually do. Furthermore, the sample size of people interviewed is in most cases are very small and thus the findings are not generalizable (Green & Thorogood, 2018).

Experience narratives/ storytelling

A final method of data collection that I used was the collection of experience narratives. This method of data collection involves capturing people’s involvement, understanding and feelings about events (in this case coping with their baby being born unwell and being hospitalized) in their own words through the stories they tell about their experiences (S. Ziebland, Coulter, A., Calabrese, J., & Locock, L. (Eds.), 2013). The approach allowed the mothers to share their personal narratives of coping with a sick newborn baby while in hospital and immediately post-discharge. During the discharge interviews, six mothers from each facility were asked their willingness to participate in this last activity. These mothers were purposefully selected on the basis of: ease of conducting house visits post-discharge; likely ability of the mother to narrate her story; and potential feasibility of gathering a coherent narrative. This involved visiting each of the mothers in their own homes around 3- 6 weeks, after their baby had been discharged from the hospital, and asking her to tell the story of her experiences since the birth of their baby. Ziebland points out that as a method, narrative interviewing bears some ethical issues. She observes that since its unstructured nature makes it difficult for the researcher to have prior knowledge of the content of the

interview. Unlike with other methods, in narrative interviews, the content of the interview and follow up questions may not be clear beforehand to both the researcher and the participant. The story flows based on what the participant feels is important to him/her, it is heavily driven by the participant and there are no predetermined structured questions (S. Ziebland, Coulter, A., Calabrese, J., & Locock, L. (Eds.), 2013). Additionally, similar to other forms of qualitative interviews, it also involves a small number of participants and as such, it is not possible to generalize findings drawn from narrative interviews (Anderson & Kirkpatrick, 2016).

While discussing each method used, I have pointed to some of the strengths and limitations of each method. I have further alluded to how each method builds onto and strengthens the other. Gathering information through more than one method of data collection and from more than one standpoint over the period of a baby’s hospitalization and immediate discharge allowed me to map out the social complexity of sick newborn care and provided a thick description of the perceptions and experiences of mothers whose babies were born sick and spent the first few days or weeks of their lives in hospital. Thick descriptions provide detailed accounts of field observations and experiences and as Geertz posits, this makes it possible for readers to evaluate the extent of transferability of the research findings (Geertz, 1973).