Organisation scheme

This section outlines the organisation and categorisation scheme utilised in this review to allow for systematic analysis and consistent processes as required of a systematic review. Furthermore, the scheme was important in ensuring that only information relevant to and appropriate for the meeting of the study objectives was utilised.

➢ Date of publication

The date of publication was categorised numerically from 1 to 6. The use of a one-digit numerical value allowed for ease of data capturing and analysis in Statistica (v.13.3). Table 4.3 lists the date of publication and the numerical value used to represent it in the data analysis process.

Table 4.3: Date of publication and the representative numerical value

Source: Own compilation ➢ Methodology employed

The second research design element studied was the methodology employed in the articles. Three methodologies were considered in this study and were given numerical values to allow for statistical processing. Table 4.4 lists the study methodology and its representative numerical value.

NUMERICAL VALUE DATE OF PUBLICATION

1 2013 2 2014 3 2015 4 2016 5 2017 6 2018

Table 4.4: Study methodology and its representative numerical value

Source: Own compilation ➢ Data collection method

The data collection methods for each article were recorded and then thematically grouped using a constant comparative method. The constant comparative method is described by Parry (2011:181) as a data analysis process used to categorise data according to similar properties. In this case, the data collection methods were reviewed and categorised as each article was reviewed, and the researcher either categorised the method according to an existing category or created a new discrete category. At the end of the review process, each thematic collection category was given a single-digit numerical value for ease of data capturing and analysis using Statistica (v. 13.3). Table 4.5 lists the data collection methods and their representative numerical values.

Table 4.5: Data collection methods and their representative numerical values

NUMERICAL VALUE DATA COLLECTION METHOD

1 Survey/Questionnaire 2 Interview/Focus Group 3 Document Study/Review 4 Case Study 5 Observation 6 Test/Evaluation/Experiment

Source: Own compilation

NUMERICAL VALUE STUDY METHODOLOGY

1 Quantitative

2 Qualitative

➢ Data analysis method

The data analysis methods of the articles in the dataset were categorised using the same processes as the categorisation of the data collection methods. Table 4.6 lists the data analysis methods and their representative numerical values.

Table 4.6: Data analysis methods and their representative numerical values

Source: Own compilation

The final two research elements included in the review were critical to the meeting of the primary study objective. To determine the extent to which academic literature had the same focus as practice-orientated research and documentation in the field of rural health development in South Africa, the outcomes and recommendations of the sample set of academic articles were thematically categorised using the constant comparative method to be compared to the information gathered in the literature review process. The thematic categories were once again given a single-digit numerical value for the purposes of data capturing and analysis using Statistica (v. 13.3) and are listed in Table 4.7.

➢ Outcomes of the research

The outcomes of the articles within the dataset highlight the focus of each study on rural health development in South Africa. The outcomes of these studies were thematically categorised using the constant comparative method according to the major findings of each study. Each outcome theme was coded using a single-digit numerical value to be captured and analysed

NUMERICAL VALUE DATA ANALYSIS METHOD

1 Broad/Descriptive Statistical Analysis

2 Regression Analysis 3 Thematic Analysis 4 Content Analysis 5 Framework Analysis 6 Reviews 7 Sequential Analysis 8 Other (Outliers)

using Statistica (v. 13.3) and briefly described. Table 4.7 lists the outcome themes and their representative numerical values.

Table 4.7: Outcome themes and their representative numerical values NUMERICAL

VALUE OUTCOME THEME

1 Education/ Training Required

This code was ascribed to an article if the outcome(s) related to the requirement of specialised education, training or professional development opportunities for rural health practitioners. This included outcomes such as the recognition of the need for rural healthcare to be given more attention in medical training curricula and the need for specific continuous professional development (CPD) courses for rural health practitioners. This code also pertained to articles, which found that further study on the topic was required.

2 Social Cohesion as an important factor in self-reported and measured health

This code was ascribed to an article if its outcome(s) related to the effect of an individual’s social environment to their health outcomes.

3 Managerial/ Organisational issues

This code was ascribed to an article if its outcome(s) concerned issues regarding the management, human resources or funding schemes within rural health. It included findings regarding monitoring and evaluation systems, governance and human resource distribution.

4 Technology in healthcare

This code was ascribed an article if its outcome(s) concerned findings regarding the use of technology in rural health settings. This would include findings that suggested the streamlining of organisational systems through the use of technology. There might be cases where themes would overlap, or when an article would present more than one outcome theme.

Source: Own compilation

The final research design element of interest in the review process were the recommendations of the academic articles in the dataset. The use of the recommendations in the review was crucial, as the recommendations made by researchers highlighted the major issues of concern according to academics based on their own research.

➢ Recommendations

The need for evidence-based policymaking and practice (Hammersley, 2015:98-99) in public policy arenas make the use of study recommendations crucial in systematic reviews. These by

NUMERICAL

VALUE OUTCOME THEME

5 Integrative healthcare initiatives

This code was attributed to an article if its outcome(s) concerned findings regarding the efficiency of integrating healthcare in collaboration with other initiatives or groups. This would include initiatives that see healthcare practitioners collaborating with traditional healers or churches being involved in counselling services. This pertained to positive or negative outcomes.

6 Patient satisfaction as an important metric of health system functioning

This code was ascribed to an article if its outcome(s) concerned the importance of patient satisfaction in evaluating health system functioning. 7 Issues regarding access to healthcare services

This code was ascribed to an article if its outcome(s) concerned the issue of access as it relates to receiving healthcare in rural areas. This included findings that suggested that health outcomes were hindered by the lack of transportation options from remote rural areas to hospitals and clinics. This code would also apply when studies found an inequitable distribution/allocation or access to healthcare based on race, gender or diagnosis.

their nature are the synthesis of a large body of information from a wide variety of studies to present researchers and practitioners with a big picture view of the research done in a particular field, on a particular topic.

The recommendations cited in the dataset were analysed and categorised in the same manner as the outcome themes to allow for the statistical analysis, and later qualitative analysis of the various recommendation themes. As with the outcome themes, the recommendations were presented with their single-digit numerical value as well as a brief description of each thematic category or code. Table 4.8 lists the recommendation themes and their representative numerical values.

Table 4.8: Recommendation themes and their representative numerical values NUMERICAL

VALUE RECOMMENDATION THEME

1 Training and further study

Articles were given this code when they recommended training or education initiatives and/or further study on the particular topic with minor amendments to be made, for example, use in a larger sample. 2 Funding-related issues

Articles were given this code when they recommended changes in funding formulae and/or financial resource distribution.

3 Improved governance

This code pertained to articles which recommended revision of governing schemes where they concerned rural health. It covered governance issues from local level (administration and leadership at municipal/hospital/clinic level) to issues of governance at national level.

4 Managerial/ Organisational issues

Articles were given this code when they recommended initiatives aimed at the improvement of managerial and/or organisational issues. This included human resource distribution and monitoring and evaluation systems.

Source: Own compilation

The importance of study recommendations lies in their guidance to future researchers based on their own study. Rural health development in South Africa is a growing field consisting of various discrete areas of interest including rural health policy and rural development. The synthesis of academic literature as well as grey literature (policy documents, practitioner research and articles, which did not pass the eligibility criteria), would provide researchers and policymakers with a broad overview of research outputs in their field of practice.

NUMERICAL

VALUE RECOMMENDATION THEME

5 Community/ Stakeholder involvement

This code was given to articles which recommended initiatives aimed at involving stakeholders in the planning of healthcare policy and initiatives as well as involving other organisational structures in the provision of healthcare services (e.g. the involvement of churches in counselling services).

6 Accessibility

This code pertained to articles which recommended initiatives aimed at increasing the accessibility of health services to rural communities. This included efforts such as transportation services to healthcare facilities and increased operation hours of these facilities.

7 Efforts to increase cohesion

This code pertained to articles that recommend efforts to increase social cohesion of communities through campaigns involving community members and/or public figures. This code also applied to articles that recommended the addressing of relationships in the healthcare context, for example, an initiative aimed at facilitating better communication between patient and doctor.

8 Policy/ Strategy adaptation

Articles were given this code when their recommendations concerned the adaptation of healthcare and/or development policy in an effort to improve health outcomes in rural communities.

Section 4.4 concern the synthesis of the data following the analysis processes as discussed in Chapter Three. The analysis process is briefly outlined, but the synthesis of the data mainly concerned the discussion of the findings in three distinct synthesis processes as shown in Figure 4.1 (quantitative synthesis, qualitative synthesis and the integration of the findings, driven by the primary research/ review objective).

The first synthesis process concerned the quantitative findings of the systematic review process. This quantitative synthesis process allowed the researcher to highlight the various trends in rural health development research in South Africa according to research design elements included in the eligibility criteria described in Sections 4.3.1 to 4.3.3. The quantitative data analysis processes are briefly outlined, and the findings discussed with the use of statistical tables and graphs (where appropriate).