Population and Study Sample 3.6
3.7 Instruments for Data Collection Questionnaire: Structure and Content
3.7.1
The questionnaires used for collecting data in the current study were developed by the researcher to address the research questions. These questionnaires were designed for different participants (parents of deaf with/without CIs, teachers of deaf pupils with CIs and clinicians). The questionnaire was first written in English and then translated into Arabic. Standard Arabic was used in order to avoid double negatives and abstractions which are often difficult for participants to understand (Mowbray & Yoshihama, 2001).Copies of all questionnaires are provided in the Appendices.
Parents of pupils with CIs: The questionnaire comprised five parts:
Part 1: General Information contained a number of items that relate to the parents and deaf children taking part to obtain background information, as follows:
Student’s age (date of birth) Student’s study stage
The hearing grade of the parents
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Rehabilitation programme before joining the school
The period of time the cochlear implant (microphone and sound processor) is used at school
Communication approaches at school Educational setting
Parents’ qualifications (education level)
Part 2: Questions regarding experiences towards the benefit of cochlear implants upon the Educational progress.
Part 3:Questionseducational progress at school by academic report.
Part 4: Questions regarding perceptions towards the benefits of CI upon inclusive education.
Part 5: Questions regarding perceptions towards factors that might affect benefit from cochlear implants.
Parents without CIs:The questionnaire comprised three parts:
Part 1: General Information contained a number of items that relate to the parents and deaf children taking part to obtain background information.
Part 2: Questions regarding parents perceptions towards cochlear implants surgery. Part 3: Questions regarding educational progress at school by academic report. Teachers of deaf pupils with CIs: The questionnaire comprised four parts:
Part 1: General Information contained a number of items that relate to the teachers taking part to obtain background information such as educational qualification, years of experience and kind of service training they have received.
Part 2: Questions regarding experiences towards the benefit of cochlear implants upon the Educational progress.
Part 3: Questions regarding perceptions towards the benefits of CI upon inclusive education.
Part 4: Questions regarding perceptions towards factors that might affect benefit from cochlear implants.
Clinicians: The questionnaire comprised three parts:
Part 1: General Information contained a number of items that relate to the clinicians taking part to obtain background information such as educational qualification, training and years of experience.
Part 2: Questions regarding experiences towards the benefit of cochlear implants upon the Educational progress.
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Part 3: Questions regarding perceptions towards factors that might affect benefit from cochlear implants.
It is significant to point out that gender was originally one of the elements of the participants’ profile information. However, due to difficulties facing the researcher, this study focused on male pupils, rather than both male and female, because the education system in Saudi Arabia segregates boys and girls in different schools. Therefore, the researcher could not have access to all-female schools in order to conduct a wider study. Although the questionnaire could have been distributed to girls’ schools by post, the researcher might have needed to visit a school to explain the study instrument or additional data might have been needed by the researcher and it would have been impossible for the researcher to undertake such a visit.
How Questionnaires Items Relate to Research Questions 3.7.1.1
Research Q1: The parental decision-making process regarding whether to have a CI for their deaf child
This question was asked in order to explore the parental decision-making process and perceptions and expectations of PW (parents of deaf pupils with CIs) and PWO (parents of deaf pupils without CIs) who decided to have/not to have CIs regarding the benefit of such surgery for deaf pupils. The question had the aim of exploring the role of these pre-perceptions and expectations upon the decision for both PWs and PWOs. Moreover, the question enquired about the sources of information that PWs relied upon when the decision was made, andfor PWOs the reasons for not having CIs for their children.
With respect to PWs, the information resources that were used by parents to inform their decision regarding CIs are the hospital, the internet, relatives who have
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experience and the media. These parents were also asked whether they had been made aware of negative outcomes of CIs.Parents were also asked if they were made aware of the range of potential benefits of cochlear implant surgery. The level of parents’ expectations of CI outcomes was also explored. It is claimed that parents who have high expectations could enhance their child’s outcomes (Hyde et al., 2011). The PWO group were asked their reason(s) for their decision to not have the intervention. Would they have liked to pursue CI intervention but could not due to their ability to make the decision for any reason? If that was the case, this was considered an indication of their support for the surgery. Another reason could be that there is not enough information and awareness provided by the different authorities for parents to be able to make the decision with confidence. It might also be the case that risks to health as consequences of the surgery are considered a reason, even though there is a positive outcome.
Perceptions of the outcomes and benefits that might come with having CIs was also included within this section of the questionnaire, in order to complete the picture of parents of deaf pupils without CIs. All of these issues contribute to an exploration of the benefit of implants for educational progress and inclusive education. For example, by knowing that many parents took decision not to pursue CI surgery, not because CIs are unhelpful but for other reasons, does not diminish the importance of CIs as an intervention.
Research Q2: The Benefit of CIs for child’s Educational Progress
To answer the second main research question regarding the benefit of cochlear implants for educational progress, two different approaches were included within the questionnaire. Firstly, open questions asked about the experiences of parents of
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pupils with CIs, teachers and clinicians regarding the benefit of CIs for educational progress. These questions were also asked in order to evaluate the current situation concerning the significant number of CIs undertaken in SA in terms of advantages and disadvantages, as well as the benefit of such surgery for deaf pupils for parents of pupils with CIs, teachers and clinicians. Moreover, these questions were asked in order to compare the experience and knowledge of the participants’ perspectives with existing scientific research and whether the current situation is positive or negative. Furthermore, this perspective was used to identify the extent of the success of the surgery in terms of a positive impact upon educational progress and inclusive education for deaf pupils, as well as any reasons for not taking advantage from the viewpoint of the parents themselves towards the particular case of their child, so that a specific case could be explored.
Secondly, the Saudi National Assessment of Educational Progress (Ministry of Education, 2013), standardised for use in primary schools, was used in order to identify differences between pupils with/without CIs in terms of educational progress in all subjects. This system was designed to follow-up the skills in all subjects during a school year and is divided into two semesters with four periods of testing: two in each semester. The first period is in the middle of the first semester, the second is at the end of the first semester, the third is in the middle of the second semester, and the last is at the end of the second semester, which is the end of the school year (which was chosen by the researcher to be the period in which to conduct the main study).
During each academic semester, the student evaluation record aims to:
a. Distribute the skills belonging to a subject during the four calendar periods. b. Follow up a student to establish the extent of his/her mastery of a skill.
c. Place a if the student has mastered the skill and a × if s/he has not shown his/her mastery of it.
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d. Use written tests, which are one of the most important tools of the evaluation system, in the assessment of the knowledge and skills required along with other evaluation tools, such as oral and practical tests and observation.
e. Assess the range of elements that each subject has in relation to knowledge and skills. This includes the identification of minimum skills, which represent the most basic knowledge of each subject.
At the end of each of the four periods of testing, all pupils are assisted by their teachers in terms of achieving the required skills. Teachers then record the levels of pupils’ achievements using specific methods (see Table 7) and issue an academic report that is given to the pupils’ parents. The parents of pupils with/without CIs recorded results of this report on questionnaire.Participants were asked to circle the appropriate level of the student and complete this form with respect to their child’s educational achievements. The levels in the questionnaire represent the level of the student in the subject (with numbers assigned from 1 to 4).
Table 7: Educational progress based on school academic report
Student’s level Statement
Number
1 2 3 4 The level of the student in mathematics is
1
1 2 3 4 The level of the student in reading and writing is
2
1 2 3 4 The level of the student in religion is
3
1 2 3 4 The level of the student in science is
4
1 2 3 4 The level of the student in social science is
5
1 2 3 4 The level of the student in art is
6
1 2 3 4 The level of the student in physical education is
7
Key: Explanation of level of attainment in table 7:
1-is that the student has mastered all the skills prescribed in the course.
2- is that the student has mastered 66% of the prescribed skills or more, including the minimum required skills.
3-is that the student has mastered at least the minimum required skills. 4- is that the student has not mastered all the minimum required skills.
Table 7 shows the typical layout of school academic reports four times a year sent home to pupils’ parents at primary school in Riyadh. It is crucial to point out that the curricula provided for deaf pupils both with and without CIs are the same. However,
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there is some adjustment to the skills required for each subject. This adjustment is due to the nature of hearing disability, which has already been taken into consideration within this study (see the data analysis section in this chapter). An illustration of this is that a deaf pupil without a CI would be asked by teachers to master a lower number of the minimum required skills in a subject, whereas a deaf pupil with a CI is required to master the standard minimum required skills. The minimum required skills must be achieved by the pupil in order for him/her to be moved to the next academic year.
Perceptions of Factors that Affect Cochlear Implants
This sectionof the questionnaire aims to identify factors concerning parents of deaf pupils with CIs, teachers and clinicians, that might be seen as an obstacle for benefits from implants with respect to the educational progress of a student.
A scale of factors (Table 8) was included within the survey based on two approaches: firstly, according to the literature review, different factors were identified that might affect users of CI; secondly, the researcher followed a ‘think-aloud strategy’ and contacted the most eminent doctor in SA who carries out cochlear surgery for deaf children at a hospital in Riyadh. He was pleased to cooperate and help in terms of developing the pilot study and gathering the main data from clinicians. A meeting was arranged at the hospital, where there is a large group of surgeons and speech and audiology specialists. The researcher gave a presentation of the project and then discussed the possibility of cooperation with the hospital staff.
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Table 8: Factors included within the questionnaire
Items Item number
Age of implantation 1
Early intervention 2
Rehabilitation programmes 3, 4, 10
Family awareness 5, 6, 9
Teamwork 7, 8
Presence of more than one hearing-impaired individual in a family
11
Laws and regulations 12
Using a hearing aid 13
Approaches to communicating with students 14, 15, 16
It was stated by the staff that a Treatment Centre has been established for cochlear implants in Riyadh, conducting between 400 and 600 CI surgical operation a year. Many of factors that were included in the questionnaire in this study that could influence the benefit of CIs were provided by the team at the hospital. It is believed that this step is significant because this contribution comes from the study context and from the most important clinical centre within that community.
In addition, academic reports giving attainment levels for reading, writing and mathematicsfor pupils with CIs were examined using variables of these pupils and their parents in analysing the data collected for this section. Hence, variables which might affect educational outcomes, such as the parents’ hearing status, having more than one member in the family who is deaf, early intervention using a hearing aid for the whole of the school day, and the communication approach, were examined by tabulating the pupils’ results in these subjects and these variables. A few questions related directly to CIs were also included, such as when the child’s cochlear implant surgery took place and whether the child has a cochlear implant in one ear only or in both (unilateral and bilateral respectively).
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Research Q3 Experiences and Perceptions of the Benefits of Cochlear Implants for Educational Placement
The benefit of CIs for educational placement is the focus of the third main question in this study. This question was used to explore the benefit of CIs for the educational placement of pupils with CIs. The focus was on exploring the current situation of these pupils’ educational settings and the perceptions and experiences of parents and teachers towards the impact of CIs on enhancing inclusive education for these pupils. The role of the environment in educational placement for these students was also considered. In this section, both the quantitative (questionnaire) and qualitative (interviews) data were used in light of the benefits of CIs for the educational placement of deaf pupils in primary schools in Riyadh.
The Current Educational Placement of Deaf Pupils with CIs
The types of educational settings attended by deaf pupils before and after CI surgery were investigated. The status of pupils in the various settings before having CIs and then situations to which they were moved after treatment were also investigated. This investigation had the aim of exploring the current educational settings, as well as the extent of the change that was observed in pupils with CIs and their educational setting after having CI intervention. Parents of deaf pupils with CIs were asked to indicate their child’s educational setting from a list of different types of provision. Table 9 shows how the educational settings of deaf pupils before and after having CIsare identified on questionnaire.
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Table 9: Educational settings of deaf pupils before and after having CI surgery
Educational setting Before CI
surgery
After CI surgery
Hearing impaired unit in a mainstream school --- --- Hearing impaired unit with part of the day in a
mainstream classroom
--- ---
Mainstream classroom .--- ---
Deaf unit with part of the day in a mainstream classroom
--- ---
Deaf unit in a mainstream school --- ---
Deaf school --- ---
Surgery before school age --- ---
Total --- ---
Perceptions and Experiences of CIs for Enhancing Inclusive Education for Deaf Pupils with CIs
The perceptions and experiences of parents and teachers towards the impact of CIs on enhancing inclusive education for these pupils was explored by 11 closed questions. Parents and teachers of pupils with CIs were asked to circle the number which represented their response to statements based on their experience and perception, ranging from ‘Strongly agree’ to ‘Strongly disagree’ on a Likert scale. The scale was graded with the highest score being 5 to the lowest score of 1 (see Appendix for an example of the questionnaire). There were five basic aspects: relationships, independence, participation and competition, student voice and academic ability. These aspects are considered to be factors that could enhance inclusive education. Thus, the aim was to explore to what extent these aspects might be influenced by cochlear implants so that pupils with CIs can be included in
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mainstream classrooms. Table 10 shows how these aspects were included within the questionnaire when dealing with the impact of CIs upon inclusive education for deaf pupils with CIs.
Table 10: Aspects relating to impact of CI on inclusive education for deaf pupils
Aspect that could enhance inclusive education for deaf pupils with CIs
Item number
Relationships 1
Independence 2, 3
Participation and competition 4, 5, 6
Student voice 7, 8
Academic ability 9, 10, 11
The survey items were generated by the researcher using secondary data and a think- aloud strategy with experts in the field of special education. This study deals with a community context: a City that has a speciality in terms of the number of cochlear implant surgical operation undertaken annually. There is also a very limited number of such studies, either in SA or in the context of another Arabic country. Therefore, the survey items had to be created by the researcher. While following the think- aloud strategy, the researcher met the Head of the Special Education Department and two supervisors at the General Education Administration Department at the Ministry of Education in Riyadh. During this meeting, different aspects that could affect the inclusive education of deaf pupils with CIs were developed and discussed.