Phase two analysis concerns the use of the contextual themes acknowledged as being of importance in McLafferty’s (2001) development work on MAST, identified through principal components analysis. This approach was used to answer the applicable secondary question.
Individual items have been grouped according to these themes (table 3.3) in order to answer the secondary questions. This will allow investigation of how the contextual conditions within the CLE influenced the operation of programme mechanisms (Schuman and Presser, 1996).
These groupings reflect elements of the context of the CLE, some of which were identified within the review of the literature; as Bhaskar (1978) notes, ‘contexts’ amount to much more than just where programmes are situated. The mean of the attitude scores from those sampled at each DP, for individual MAST items, was
125 used to characterise attitudes in this phase. Hence, the potential spread of scores seen is between one (lowest possible score) and five (highest possible score).
Table 3.3 Contextual themes and MAST item groupings (McLafferty, 2001).
Factor Contextual theme MAST item groupings
1 Student learning opportunities 2, 10, 20 and 28 2 Interpersonal/communication skills 15, 29 and 30 3 Skill and knowledge required for care of
the elderly
5, 11 and 16
4 Labelling older adults 4, 12, 14, 17 and 25
5 Lecturers’ influences 7, 13, 18 and 23
6 Looking after older adults 1, 3, 8, 19, 22 and 24 7 Interpersonal relationships 6, 9
8 Categorising nurses 21, 26 and 27
McLafferty (2001) purposefully included a middle category in the Likert scale which makes up MAST, in recognition of the idea that it can give information about the intensity of the attitude, in relation to individual questionnaire items (Schuman and Presser, 1996). Scoring an item a ‘three’ suggests that the respondent does not feel strongly enough in either direction to declare a definite position in relation to that item. In this situation, the middle category would be large. However, it should not be presumed that because the size of the middle category is larger at a particular DP that an item is of no consequence. A larger middle category can indicate that students are not sure about where they stand in relation to that item (Schuman and Presser, 1996). This may be of particular interest in the post-programme period, as PG students approach qualification.
If the majority of respondents at a particular DP opt for either of the extreme scores in relation to a particular item (one or five), the number choosing the middle category
126 would be smaller, indicating that the respondents feel more strongly about that particular item; intensely enough to take a stance. However, the role of social desirability response bias should not be ignored for these items, as it can confound the interpretation of mean score trends (Oppenheim, 2000). Respondents may opt for one of the extremes, because they believe that it casts them in a ‘better light’, rather than their response corresponding to their own beliefs. This will be borne in mind in this phase of the analysis.
Extremes of scores in this phase must also be considered in relation to the particular MAST item, and whether its Likert Scaling indicates a positive or negative bias; it should not be assumed that a mean score of ‘one’, a low score, suggests that students are either negative in relation to that item, or that it equates to ‘strongly disagree’ on the Likert Scale. For example, item two on MAST is as follows:
“Most nursing students have little idea what to expect in care of the older adult settings”.
For this item, a mean score of ‘one’ would indicate that all students sampled ‘strongly agree’ with it; knowledge of the item’s Likert Scaling allows student responses to be seen in the correct perspective.
The mean score, coupled with the size of the middle category was used to identify mechanisms which could have made the CLE inhospitable to the operation of programme mechanisms in this phase. Where the mean score in relation to an item indicates a positive bias, and is coupled with a small middle category, these are not viewed to make the CLE inhospitable8. Where the score in relation to an item indicates a negative bias, and is coupled with a small to medium-sized middle category, these may have made the CLE ‘hostile’8
to the working of the programme
8
The words ‘hostile’ and ‘inhospitable’ are used intentionally, in line with the work of realist evaluators, Pawson and Tilley (1997). These are the terms they use to describe contexts in which programmes have been ineffective.
127 mechanisms, because the milieu of the CLE failed to influence students, in a positive way, about particular items on MAST. Larger-sized middle categories in relation to mean scores that indicate a negative bias may also provide further detail about how students were influenced by aspects of the CLE, measured by MAST, particularly when compared with the pre-programme period. The students were approaching qualification toward the end of the time-series, and more definite responses, showing smaller sized middle categories, to items indicating a negative bias might have been expected in relation to these items, in particular.
There will inevitably be structural and agential mechanisms in relation to the particular context, ‘which pre-exist and endure through programs’ (Pawson and Tilley, 1997, p. 70), affecting how agents react to them. Phase two analysis may also reveal mechanisms within the context of the CLE, not measured directly by MAST, which contribute to the maintenance of negative attitudes toward the care of ill older people (Pawson and Tilley, 2004).
3:10 Summary
This chapter set out to make the decisions and procedures which underpin the study design explicit. The phased approach to data analysis was also examined. Particular strategies aimed at demonstrating LMCV were discussed in detail, as these were central to the study design in countering criticisms of previous attitude change research in the field, and to be in a position to fill the gaps in knowledge and in the evidence base identified within the review of the literature.
Chapter four will present demographic data for both the PG and CG, followed by findings from both phases of analysis, in order to address the research hypothesis, and answer the applicable secondary questions.
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