RESEARCH DESIGN

A postmodern, constructivist philosophy of science undergirded the research design of this study. Postmodernism is a philosophy of science that came into existence after modernism (Kuntz, 2012:885) and is the most prevalent mode of thinking.

Postmodernism asserts that no truth about any aspect of existence is possible, it can only be constructed (Patton, 2015:124). According to this philosophy of science, truth is dependent on language, which is constructed socially by the people speaking it and thus cannot provide reality (De Vos, et al. 2015:10). Postmodern thinking essentially puts more emphasis on the value of deconstruction – taking old ideas and structures apart – and reconstruction – putting together ideas and structures in novel ways (Polit & Beck, 2012:12). Researchers who ascribe to the postmodern philosophy of science evaluate their work through multiple methods such as dialogues with participants, personal responsibility, an ethic of caring, and emotionality (Denzin & Lincoln, 2011:9). De Vos, et al. (2015:10) explicate that postmodern research permits the researcher to provide an explanation and interpretation of observed behaviour patterns and the narratives of participants in the research project.

Constructivism is a paradigm, which is often referred to as the naturalistic paradigm (Polit & Beck, 2012:12), and is the basis of naturalistic inquiry (LoBiondo-Wood &

Haber, 2010:134). The naturalistic paradigm began with the writings of Weber and Kant, mainly as a countermovement to positivism (Polit & Beck, 2012:12).

Constructivism adopts and embraces a relativist ontology, a transactional epistemology and a hermeneutic, dialectical methodology (Denzin & Lincoln, 2011:92). The relativist ontology postulates that the authority for truth, the premise of right or wrong, and standards of reasoning are confined to the context that gave rise to it (Stanford Encyclopaedia of Philosophy, 2015:1). The transactional epistemology assumes that the researcher cannot separate him/herself from what he or she knows. The researcher and the participant in transactional epistemology are

36 inextricably linked since the manner in which they understand the world is central to how they understand the self, others and the world (Soini, Kronqvist, & Huber, 2011:9). According to McCaffrey, Raffin-Bouchal and Moules (2012:214), hermeneutics, as a research practice, involves the appraisal, interpretation and reinterpretation of text.

Constructivism posits that reality is constructed by the human mind and therefore reality is a subjective phenomenon (Mieke, 2017:4). This means that views of reality are socially and mentally constructed, and as such, are constructed differently by different people. Hence, constructivists value transactional knowledge (Denzin &

Lincoln, 2011:92). Constructivism asserts that knowledge is viewed as bound to time and space, thus the reluctance to generalise findings of inquiry (Patton, 2015:126).

Constructivism suggests that each individual has a way of making sense of the world. Thus, individual interpretations are worth considering. With this in mind, the participants selected for constructivism inquiry become active and involved in the process of data collection, analysis and interpretation (De Vos, et al. 2015:7).

The primary assumptions of constructivism, as laid down by Guba (1989 in Patton, 2015:123), include:

• “Truth” is essentially a matter of agreement among those individuals who were involved in its construction, and there is no need to correspond it with objective reality.

• “Facts” hold no meaning except when explained and described within a certain framework and or context, and therefore cannot be used as an objective assessment to any proposition.

• Causes and effects do not exist except in instances where there is imputation.

• Phenomena can only be understood within the context in which they are studied;

hence, findings from one context cannot be generalised to another context.

Likewise, problems and solutions in another context cannot be generalised from one setting to another.

• Data produced within the science of constructivism represent a construction that needs to be taken into consideration in the move towards consensus.

37 Research conducted based on the constructivist paradigm is guided by the ontological view that there are multiple realities that exist, and these are influenced by the culture and the context in which they are created (LoBiondo-Wood & Haber, 2010:134). The traditional positivist criteria of internal and external validity are replaced by terms such as trustworthiness and authenticity (Denzin & Lincoln, 2011:92).

According to Andrew, Pedersen and McEvoy (2011:12), there are multiple ways of generating knowledge in the constructivist paradigm. These include emerging approaches, open-ended questions, and text or image data. To generate knowledge through research undergirded by the constructivist approach, the researcher is positioned within the context in order to study the participants’ context and collect data as generated by the participants (De Vos, et al. 2015:7). Data collected from participants is interpreted and validated for accuracy. The constructivist paradigm assumes that knowledge acquisition is maximised when the distance between the researcher and the participant is minimised; hence, findings from a constructivist inquiry are the product of the close interaction between the researcher and the participants (Polit & Beck, 2012:12).

A research design is defined as a blueprint for conducting a study (Burns & Grove, 2013:43-44). It provides strategies on how a study is to be conducted. It is also defined as the overall plan for obtaining answers to the research questions a researcher has (Polit & Beck, 2010:254). As a plan, the research design provides a step-by-step guide on the whole research process; that is to say, it specifies the selection of participants, data collection methods and analysis. According to Denzin and Lincoln (2011:243), there are five basic questions that structure the issue of the research design, and these are:

• How will the design connect to the paradigm or perspective being used?

• How will empirical materials allow the researcher to speak to the problems of praxis and change?

• Who or what will be studied?

• What strategies of inquiry will be used?

38

• What methods or research tools for collecting and analysing data will be used?

A qualitative, exploratory, descriptive and contextual design was used to explore the experiences of female adolescents living with HIV and their grandmothers who care for them in Phase One of the study.

2.4.1 Qualitative

Qualitative research is described as a systematic and subjective approach used to describe the life experiences and situations of individuals and further give them meaning through the process of interpretation (Burns & Grove, 2013:57; Holloway &

Galvin, 2017:18). According to Denzin and Lincoln (2011:8), qualitative research emphasises the qualities of entities, processes and meanings that cannot be experimentally examined in terms of quantity, amount, intensity or frequency.

Qualitative research is conducted in a natural setting (Denzin & Lincoln, 2011:8; Polit

& Beck, 2010:281) whereby the researcher does not manipulate the environment in any way and is aimed at exploring and answering the research questions as well as promoting the understanding of the phenomena under investigation (Turner, 2010:754). This means that the focus of qualitative studies is on understanding the social context or settings of individuals experiencing a certain phenomenon to facilitate exploration of relationships and human experiences (Moule & Goodman, 2014:175). Hence, qualitative research is also called ‘naturalistic inquiry’ (Ritchie, Lewis, Nicholls, & Ormston, 2014:3).

Qualitative research is appropriate for exploring phenomena which are not yet fully understood or exploring phenomena for which information is not available. Hence, qualitative researchers emphasise the value-laden nature of the inquiry (Denzin &

Lincoln, 2011:8). The applicability of qualitative research in studying new phenomena lies in its emphasis on the quality and depth of data (Creswell, 2013:69) as opposed to the breadth of information which is the focus of quantitative studies.

Qualitative researchers are concerned with the individual’s perspective or point of view, so they get closer to the participant by way of human interaction through detailed interviews and observations (Denzin & Lincoln, 2010:9).

39 The characteristics of qualitative research as outlined by Taylor, Bogdan and DeVault (2016:7) involve the concern about people attaching meaning to the situations in their lives. To emphasise, the qualitative researcher is concerned with interpreting the meaning of participants’ experiences (Galvin & Holloway, 2017:42) by setting aside preconceived ideas through the process of bracketing (Burns &

Grove, 2013:60). As such, the qualitative researcher views people and their settings in a wholistic manner (Polit & Beck, 2010:259) by studying factors in the people’s past as well as the current situations they are experiencing (Silverman, 2016:53). As a consequence, how people think and act is worthy of being studied using qualitative approaches.

Additionally, Holloway and Galvin (2017:3) state that the data produced by qualitative research needs to be understood first and foremost by the researcher.

The researcher does this by immersing him/herself in the data, and the natural setting of the participants from where the data came. Likewise, Polit and Beck (2012:12) elucidate that the product of a naturalistic inquiry lies in the closeness and interaction between the researcher and the participants experiencing the phenomenon being studied.

Uniquely, qualitative research is inductive in nature (Taylor, et al. 2016:8). To clarify, the qualitative researcher develops concepts and insights from the data as it is analysed rather than assessing preconceived models. The qualitative researcher moves from the specific concepts to general views and conclusions (Burns & Grove, 2013:6). The inductive process allows the qualitative researcher to integrate information in order to provide a description that helps illuminate the phenomenon under study (Polit & Beck, 2012:15). The research plan in qualitative studies can change as the research progresses since it is flexible, evolving and systematic (Burns & Grove, 2013:7).

Another key point is that in qualitative research, the researcher is a key instrument for data collection (De Vos, et al. 2015:65). The participants’ experiences and feelings are mediated through the researcher and are interpreted by the researcher.

That is why reflexivity and bracketing are the most important aspects of the qualitative research process (Symon & Cassel, 2012:73). According to Symon and

40 Cassell (2012:73), reflexivity is what has been thought and done in a qualitative research project, and it assists in locating the researcher in the research project.

Inductive and deductive reasoning (Ritchie, et al. 2014:7) is used as the researcher analyses and attaches meaning to participants’ data. According to Creswell (2013:22), the procedures for conducting a qualitative study are inductive and are shaped and influenced by the researcher’s experience. This study is qualitative because it aimed to explore the experiences of both female adolescents living with HIV and their grandmothers as they manage HIV on a daily basis. This study also sought to gain an understanding of self-management of HIV among female adolescents.

Research participants in qualitative research are called ‘participants’ or ‘informants’

and are seen as an active part of the research in constructing realities of the situations they are experiencing (De Vos, et al. 2011:320). The results of a naturalistic inquiry are based on the voices and interpretations of the participants (Polit & Beck, 2012:12) as presented by the researcher.

During the inquiry, the researcher spent substantial time in the field with participant contact because of the use of multiple case studies. Thus, the researcher had to bracket her preconceived ideas about living with HIV in order to understand the phenomenon through the perspectives and interpretations of the participants.

Bracketing was specifically important for the researcher because of her personal experience of having a younger sister who lived with HIV. The process of bracketing and intuiting will be discussed in detail in Sections 2.6.1.1 and 2.6.1.2.

2.4.2 Exploratory design

According to Polit and Beck (2010:15), exploratory studies are undertaken when minimal information is available on an area of interest or when a new area is being investigated. Qualitative studies can be exploratory for a number of reasons. Firstly, if the phenomena under investigation have not been studied in a certain population group; for example, the female adolescent group in this study, an exploratory design can be used. Secondly, if a more intensive study will be implemented at a later date, and lastly to develop methods that will be used in a subsequent study (Burns &

41 Grove, 2013:45). This study was exploratory because self-management of HIV has not previously been explored among female adolescents living with HIV and their grandmothers caring for them in Eswatini.

The researcher paid attention to the exploration of the world of female adolescents living with HIV and their grandmothers who care for them with the purpose of exploring this rather unknown phenomenon of what it feels like to live with HIV and care for a female adolescent living with HIV. Since this study paid attention to a territory that is not quite understood but still has a deeper meaning to it, the researcher had to use the process of intuiting and was receptive to new ideas that emerged as the study unfolded. To facilitate the exploratory process, the researcher scheduled interviews with both the female adolescents and their grandmothers to explore insights on their experiences of living with HIV and caring in HIV. With qualitative research, as the researcher sifts through information received from participants, new insights are gained and new questions emerge; further clarification is then sought to amplify or confirm the insights (Polit & Beck, 2012:15).

2.4.3 Descriptive design

Descriptive studies aim to gain more information about the characteristics of a phenomenon under investigation (Polit & Beck, 2010:236). The main objective of descriptive research is the accurate portrayal of people’s circumstances (Polit &

Beck, 2012:725). According to Beukes (2013:46), the focus of descriptive research is the ‘how’ and ‘who’ questions which include ‘how did it happen?’ and ‘who was involved?’

The study is descriptive since it aimed to describe the aspects of the experiences of female adolescents living with HIV and their grandmothers caring for them. The researcher intended to provide a clearer picture of the experiences as they occur within the context of where the adolescent and the grandmother lived.

To facilitate the description of the phenomenon, accurate data were collected, and a descriptive analysis of the results was obtained by exploring the deeper meaning units that female adolescents had of their life experiences in relation to living with

42 HIV and their grandmothers’ experiences in caring for them. A conceptual framework was developed from the findings of the phenomenological interviews. It formed the basis of the strategies for community health nurses to facilitate self-management of HIV among female adolescents living with HIV and their grandmothers caring for them in Eswatini.

2.4.4 Contextual design

The strategies for HIV self-management are for a specific context in Eswatini; it was thus important for the researcher to include a contextual design. The focus of contextual studies is on studying human beings in their natural habitat in order to foster an understanding of the dynamics of human beings (Babbie, 2016:90). Both social and personal contexts are important in qualitative research (Holloway &

Galvin, 2017:4). De Vos, et al. (2015:65) state that qualitative researchers collect their data in a contextually bound setting where the participants experience the issues or problems under study. As Burns and Grove (2013:213) explain, a research problem occurs within a particular context, so to foster an understanding of the problem, the researcher must conduct the study within the context where the problem occurs. The study was contextual as it was conducted in the rural Manzini region, specifically at Mliba and Mafutseni areas, in the homes of the participants.

The reason for selecting the rural area as the context of the study relates to the availability of grandmothers who were caring for female adolescents living with HIV.

This was done to understand the events within the natural context in which they occurred.

This study did not aim to generalise the findings to a larger population but to enhance the understanding of the meaning of living with HIV from the perspective of female adolescents living with HIV and their grandmothers who care for them so that an understanding of similar phenomena in similar situations could be enhanced. The study was also aimed at fostering understanding of the caregiving role in the context of HIV infection by including grandmothers caring for female adolescents living with HIV in this study.

43 2.5 REASONING STRATEGIES

Reasoning is described as processing and organising ideas in order to reach a conclusion (Burns & Grove, 2013:6). Using reasoning as a source of creating knowledge enhanced the formulation of the conclusions of this study. Utilising reasoning was particularly important in the data analysis phase and in the development of nursing strategies for self-management of HIV by female adolescents living with HIV and their grandmothers caring for them. The reasoning strategies used during the unfolding of the study warrant further elaboration and are outlined next.

2.5.1 Inductive reasoning

Inductive reasoning is defined as the process whereby the researcher develops generalisations from specific observations (Polit & Beck, 2012:11). Moule and Goodman (2014:175) discuss induction as a process that starts with observations and details pertaining to an experience that are, in turn, used to develop a general understanding of a phenomenon. This kind of reasoning strategy moves from the specific to the general (Burns & Grove, 2013:7). As an illustration, if various aspects of experiences from different participants in a study are observed to be related to one broad phenomenon, it can be concluded that such experiences are related to the phenomenon.

In this study, the inductive reasoning strategy was used during the data collection phase, where one central question was asked. The researcher came from the premise that there could be certain experiences associated with being adolescent, female, and living with HIV. Another specific premise was that there are specific experiences associated with being a grandmother and caring for a female adolescent living with HIV. This reasoning strategy was used during fieldwork when interviews were conducted. One broad question was asked during data collection to facilitate the process of induction. To female adolescents, the broad question was:

How is it for you to live with HIV? And for the grandmothers, the question was: How is it for you to care for a female adolescent living with HIV? When the question was asked, the researcher used inductive reasoning to establish the multiple realities

44 associated with the female adolescents’ and the grandmothers’ experiences of living with HIV.

2.5.2 Analysis

Data analysis is the process of organising and synthesising data in order to provide structure and bring meaning to the vast collected data (Polit & Beck, 2012:719). In the analysis process, the researcher carefully studies the data in search of meaning and understanding. This reasoning strategy entails contrasting and comparing the data to determine the patterns that emerge (Brink, van der Walt & van Rensburg, 2014:122). The process of ‘coming up’ with themes and categories from the data means that the researcher divides the whole data set into parts that can be better understood. In qualitative data analysis, the researcher clarifies, verifies and modifies concepts and statements (Silva & Merces, 2018:1196).

In this research study, analysis as a reasoning strategy was used during the data collection phase and analysis of the data to produce concepts that were used in developing the conceptual framework. Also, analysis was used during the cross-case validation when the researcher engaged in the process of contrasting and comparing data among the cases. Lastly, analysis was used during the breakdown of the conceptual framework for the purpose of describing the framework.

2.5.3 Synthesis

Synthesis is defined as a process by which the researcher puts data back together in new ways in order to make new connections and a meaningful whole (Walker &

Avant, 2011:107). This is a process whereby the researcher constructs a whole out of the parts (De Vos, et al. 2015:251). The constructivist researcher first deconstructs and then reconstructs to make new concepts from the data (Polit &

Beck, 2012:12). During synthesis, the researcher creates patterns from the data that

Beck, 2012:12). During synthesis, the researcher creates patterns from the data that