Phase two: Quantitative component

The quantitative phase of this research comprised of the administration of questionnaires to high school students. Using the questionnaire as a data collection tool was considered useful for probing their views and perceptions regarding their decision to opt for nursing as a career. This quantitative phase of the research was designed to do the following:

• Further explore and quantify the factors influencing the decision to choose nursing as a profession among high school students in Riyadh.

• Investigate and gain further insight into the perceptions of the nursing profession and how the public image of nursing impacts the shortage of a local nursing workforce in Riyadh.

4.6.2.1 Selection of the questionnaire

This section briefly reviews the questionnaire selection process. It discusses the rationale for utilising a questionnaire survey.

4.6.2.1.1 Rationale for using questionnaires

The survey, as a method of collecting information from people about their ideas, feelings, beliefs, attitudes, needs, motivations and behaviour, has been widely used in social science research (Fink, 2003). According to Gillham (2000), questionnaires have the following advantages: they are effective in terms of time and money; participants can complete the questionnaire when it suits them; there is less pressure for an immediate response; there is a lack of interviewer bias; and it allows for the anonymity of the participants. Questionnaires provide a mechanism for collecting measurable data when known variables are present (Gall, Gall, & Borg, 2007). An already tested questionnaire was selected for use in this research, and permission was asked from the original author (Appendix 2: Written Approval From the Author to Use the Original Questionnaire). This questionnaire was specifically selected because it was designed to explore the relationship between the respondents’ demographic characteristics and their views, while also incorporating short answer questions about the society’s and students’ attitudes toward the nursing profession in Riyadh; that is, their reasons to or not to study nursing; intention to study nursing; the image of nursing as a profession; and work conditions. This questionnaire also had an open-ended question that fed into the qualitative aspect of this research, providing an opportunity to the respondents to express themselves in a more elaborate way. However, some modifications and a rewording of the statements was applied when necessary.

4.6.2.1.2 The final questionnaire

A cover letter was attached to the final questionnaire that explained the reasons for the survey (Jankowicz, 2005). The cover letter that accompanied the questionnaire is provided in Appendix 3.

The items in the final questionnaire were sensitively worded so that participants would feel comfortable answering all the questions. To enable rapid completion of the questionnaire, thereby increasing the return rate, most of the answers took the form of selecting from multiple choices. Moreover, the items were brief, to the point and arranged in a sequence to ensure that the respondents remained interested throughout the process of filling out the questionnaire. It has been reported in the literature that the layout of the questionnaire should be attractive to encourage the respondent to complete it, and the questionnaire should not be

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too long. The best way of obtaining optimum responses is to keep both the visual appearance of the questionnaire and the wording of each question simple (Saunders, 2003).

The questionnaire was administered in Arabic because this was the mother tongue language of the study participants. The final questionnaire consisted of 52 items over four pages, and the questionnaire cover letter was two pages long and was presented with each questionnaire (Appendix 6: The Questionnaires’ Arabic Version). This questionnaire contains three parts, as follows:

• Eight personal question items were developed to collect data related to the demographic characteristics of the students, such as their age, gender, family members working in nursing, family income, number of family, friends working in nursing, intention to study nursing and their advice given to friends. These demographic characteristics were selected to explore whether there are age and gender differences in relation to the participants’ decision to choose nursing. Moreover, it was also anticipated that having someone in the family or a friend who is already in this profession could influence the participant’s own career choice. Finally, family characteristics, such as size and income, were also expected to have an impact on the students’ decision of whether to choose nursing.

• Sixteen Likert-scale question items, multiple choice items and questions requiring short answers were given. This part was divided into three subscales; Subscale 1: Intention to study nursing (Items 22, 27, 23, 10, 26 and 17), where all items in this subscale were about the students’ intention to study nursing and choosing nursing as a career. Subscale 2: Family community attitude toward nursing and their influence on nursing as a profession (Items 13, 15, 24, 21 and 20), where all the items in this subscale were about negative family and community attitudes toward nursing as a profession. Subscale 3: Work-related barriers (Items 43, 42, 41, 14 and 36), where all the items in this subscale were about the work-related barriers that could prevent students from choosing nursing.

• One open-ended question was included at the end of the questionnaire to allow respondents to expand upon their answers and provide more in-depth responses (Rattray & Jones, 2007).

4.6.2.2 Distribution of the questionnaire

4.6.2.2.1 Permission to distribute the questionnaire

An official letter was sent to the Ministry of Education in the KSA, asking for approval to distribute the questionnaires to secondary students in Riyadh schools (Appendix 7: Written Permissions to Access the Selected Schools). The minister’s office referred the application and the questionnaire to the Ethical Committee of Scientific Research in the ministry. The committee approved conducting the study and distributing the questionnaires.

4.6.2.2.2 Sampling and setting

The study’s population was secondary school students in the Riyadh area. Participants had to meet the following inclusion criteria to be eligible for participation in the study:

(1) Be a Saudi citizen who was born and raised in Riyadh (2) Be a high school student

(3) Can easily read and write in Arabic

• Data collection

Initially, the questionnaire, information sheet and the consent form were given to 100 students who met the inclusion criteria, and they were asked to return the questionnaires the following work day; this was done as an attempt to evaluate the distribution process.

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Unfortunately, the response rate was very low (15%). After consulting with teachers and school principals. Permission was given for students to complete the questionnaire Physical Education lessons for male students, and Art lessons for female students.

In keeping with cultural traditions where males cannot enter a school for females, a female relative of the researcher assisted with the administration of the questionnaires in these schools.

The information sheet indicated that the return of a completed questionnaire would be interpreted as consent in cases where the participants did not want to complete the consent form and wanted to remain completely anonymous. Gay et al. (2009) indicated the importance of allowing participants an adequate time frame to respond within.

In total, the questionnaire was distributed to 639 students, of which 554 completed the questionnaire, indicating a response rate of 86.6%. Several other factors improved the response rates (Gay & Airasian, 2009). These included notifying respondents before giving them the survey, including a covering letter and an easy return method, setting a specific deadline and limiting the overall survey’s length. The researcher had also mentioned the estimated time of filling the questionnaire (about15–20 minutes) in the cover letter.

4.6.2.3 Analysis of the quantitative data

The data were tested using various statistical tests. The researcher intended to use principal component analysis (factor analysis) to standardise the research items and categorise them into different groups, the resulting factors (groups of items) were tested for internal reliability (through Cronbach’s alpha) and then descriptively analyzed using descriptive statistics such as mean, percentage and frequency; this helped with describing the distribution of the data and determining an idea of the general answers produced. This was followed by inferential statistics based on the overall averages of each of the determined factors; inferential statistics are based on an alpha level of 5% (0.05). Probabilities below that score determine if the outcomes are significant. Inferential statistics was conducted to measure the effects of all the demographic variables and general information (e.g., gender, age, family income, etc.) on the

main factors. This study used an independent samples t-test to measure the difference between the two independent groups (e.g., male vs. female). Furthermore, an independent sample one-way analysis of variance (ANOVA) was used to measure the difference between the three independent groups of participants (e.g., family income). Finally, a Pearson’s

correlation coefficient test was conducted to test the relationships between all the factors. Overall, inferential tests that are significant show there are significant effects of one variable on another or a correlation between one variable and another (depending on the test type). Such statistics allowed the researcher to make inferences from the samples used in this study to the larger population (Field, 2013). All statistics were conducted through SPSS (Statistical Package for Social Science).

Factor analysis:

Principal Component Factor Analysis (PCFA) is helpful and useful for placing variables into meaningful categories. Factor analysis can thus be used in the analysis of the validity of an instrument. There are two main factor analysis techniques which are: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) (Tabachnick & Fidell, 2001). “Confirmatory Factor Analysis is much more sophisticated technique used in advanced the stage of the research process to test theory about latent process. CFA is most often performed through structural equation modelling.” (Tabachnick, 2013, p. 662). EFA was conducted on the Nursing Career Choice-Saudi Arabia (NCC-SA) scale used in this study. EFA is used to discover the number of factors (subscales) influencing variables and to analyse which variables are grouping together (Child, 2006).

Factor Analysis (FA) was useful in condensing the items on the questionnaires into more meaningfully linked construct dimensions. These dimensions were later used to enable easier examination of any potential statistical relationships among these underlying dimensions which FA had produced, along with other important variables in the study.

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This chapter revolved around the use and discussion of the appropriateness of the choice of pragmatism as the methodological backbone of this study. Given the nature of the topic under research and the complexity of the research questions, the views of the participants (students, parents and nurses) needed to be captured because information about their opinions, choices and decisions are essential. Furthermore, the analysis of the available literature on this topic showed there is an absence of research on this specific topic, especially in conservative societies such as Saudi Arabia.

Uncomplicatedness was specifically chosen as the methodological foundation of this study, with an aim of incorporating both a qualitative and a quantitative phase that together could capture the views of the participants as accurately as possible. The chapter explained each of the two data collection phases thoroughly while also giving due thought to sampling and ethical considerations. A focus group discussion, followed by a survey, were used to collect data about the participants’ perceptions of nursing. The next chapter presents the qualitative findings and outlines the findings of the focus group discussion.

Figure 2: The mixed-methods sequential research design

Review literature and generate a list of factors that contribute to

Present factors to focus groups for discussion and elicit more

Focus Groups

Nurses Parents of High

High

Analyse data and identify main themes from focus group

Offer the questionnaire to sample

Analyse the data

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Chapter 5:

R

IYADH COMMUNITY

’

S PERCEPTION OF NURSING AND

NURSING AS A CAREER

:

QUALITATIVE DATA

5.0 Introduction

This chapter presents the findings of the three focus group discussions (high school students, parents of high school students and nurses) and the three key themes drawn from the data analysis, which are supported by narrative quotations for the themes and sub-themes.

This chapter begins with a description of the focus group participants' demographic characteristics. The three themes in section one are the following: What is nursing? The contradictions; social challenges; and Influence on the students’ decision to choose nursing as a career.

The two themes in section two are the following: Experiences in career choice and a view of nursing in the Riyadh community, and their subthemes are presented in depth. Because there was similarities among the findings for the students and parents, it was decided to present these findings together. This chapter is arranged into two main sections with the following associated themes and subthemes:

• Saudi students’ and parents’ perceptions of nursing and career choice. There were three themes in this section: What is nursing? The contradictions; social challenges; and influence on the students’ decision to choose nursing as a career.

• Local nurses’ experiences of choosing nursing as a career and the community’s view. There were two themes in this section: Experiences in career choice and a view of nursing in the Riyadh community.