Qualitative data (Semi structured interview and Focus group)

5.2.1.1 Sample and recruitment

In the qualitative phase of the sequential mixed method design, a purposive, non-probability sampling strategy was used to recruit PHC professionals to participate in the study. The purposive sampling was used to select the participants who, typically, represented the different professions/groups (physicians, nurses, and allied health), as well as to ensure an even distribution of participants, according to the area and size of the PHC (Creswell & Plano Clark, 2011). The inclusion criteria for the sample were designed to select participants who had initially participated in the quantitative data collection and had indicated their preparedness to participate in an interview. The intent of recruiting from these same individuals assisted in providing more explanations about the results from the first phase (Creswell, & Plano Clark, 2011).

Further, the interview questions were extracted from the results of the first phase that the researcher determined needed further explanation. Creswell and Plano Clark (2011), and Teddlie and Tashakkori (2009), explain that the results of the quantitative phase are statistically significant, while the significant predictors guide the second phase in assigning a more detailed explanation of the quantitative data. In other words, the quantitative findings formed the basis of the questions asked in the qualitative interviews.

The sample size, as recommended by Creswell and Plano Clark (2011), was much smaller than the quantitative samples. The sample size recruited for the qualitative data was 11 participants, who represented small and large PHCCs, as recorded by the Directorate General of Primary Health Care Centres in the Asir region (see Table 5.5).

Table 5.5 Qualitative interview participants’ codes

Participant Code Profession Area Experience by years

Code A.1 Physician Large PHCC 1

Code A.2 Physician Large PHCC 3

Code A.3 Physician Small PHCC 5

Code A.4 Nurse Large PHCC 4

Code A.5 Nurse Small PHCC 9

Code A.6 Allied Health Small PHCC 2

Code A.7 Allied Health Large PHCC 20

Code A.8 Allied Health Large PHCC 16

Code A.9 Nurse Small PHCC 3

Code A.10 Nurse Small PHCC 9

Code A.11 Nurse Small PHCC 14

5.2.1.2 Qualitative pilot study

The pilot study, conducted with two PHC professionals randomly selected from the list of eligible participants, allowed the researcher to assess how to cover the needed data and to identify any difficulties with the interview process. There were no changes in the interview process, while the questions were based on the pilot study results. These participants were excluded from the qualitative interview and data.

5.2.1.3 Semi structured interviews

The interview survey participants, who had agreed to be interviewed, and had registered their contact details, were contacted individually, via telephone, to set the time and place for the interviews. The study’s purpose and procedures were explained to the participants. The researcher clarified their right to not participate, or withdraw at any time, and that their participation was voluntary. The confidentiality process was also explained. A time for each interview was made with the participant at the end of the telephone conversation.

The face-to-face semi-structured interviews were conducted in a convenient and quiet conference room in each PHCC. Before the interview, the researcher checked that the recorder was fully charged to avoid any loss of the interview data. After gaining permission from each participant, the interviews were recorded using an electronic recorder (Hansen, 2006). Additionally, the interviewees were reminded of their right to not participate and asked to sign a consent form. Prior to the interview, the researcher also spoke to each participant, in private, explaining the purpose and structure of the interview, while emphasising that confidentiality would be maintained at all-times (before, during, and after the interview). Three participants asked that they be interviewed after their duties and for the interview to be conducted outside the PHCC. An audio recording was made of the participant’s permission to participate, as well as their permission to record the interview.

After the interview, the audio recording was transcribed by a research assistant. The interviews ranged in length from 38 to 62 minutes. The completed transcription was returned, by email, to the participant for them to check, and make the necessary corrections or changes;

this formed the respondent’s validation as member check (Creswell, 2007; Lincoln & Guba, 1985); it also established credibility and verified the trustworthiness of the current study.

The participants were given the contact details of both the researcher and the Research Ethics Office of the Queensland University of Technology, Australia, if they had any questions about the current study.

The in-depth semi-structured interviews were conducted with the 11 participants, who had a mean age of 31 years. The interview included 15 open-ended questions, based on the results of the first phase of the predicted factors, and on the relationships between the variables. The data from the first phase were reviewed by the researcher; each interviewed participant was invited to provide more explanations and clarifications.

5.2.1.4 Focus groups:

The focus group discussion was conducted with the six leaders of the Directorate General of Health Affairs in the Asir region. The focus group allowed the researcher to collect the data from the group discussion, which provided a greater understanding of the data collected in the two previous phases. The researcher contacted the leaders individually to set a time for the group meeting, which was held in a quiet and convenient meeting room. The researcher reminded the participants of their right to refuse to participate; next, they were asked to sign the consent form. Prior to the discussion, the researcher also spoke to all participants, explaining the purpose and structure of the focus group, and how confidentiality would be maintained at all-times (before, during, and after the discussion). After that the researcher asked each participant for their permission to record the whole meeting. The discussion started with a presentation from the researcher about the findings of the first and second phases. The researcher discussed each part of the study, in turn, with the participants. The discussion took four hours.