Research Instruments

Interactive qualitative inquiry is an in-depth study that uses the face-to-face technique to collect data from people in their natural settings (Creswell, 2007). Various data collection techniques were employed, as defined by (De Britto, Raj, & Chelliah, 2008). In the case study methodology, these techniques include observation and interviews. Recent studies indicate that the use of qualitative research methods (QRMs) is becoming increasingly widespread in medical informatics. QRMs are used to learn about the needs of users, their work, and the success or failure of IT applications in healthcare (M. Berg, Aarts, & van der Lei, 2003; Friedman & Wyatt, 1997, 2006; B. Kaplan, 2001; Weßel, Weymann, & Spreckelsen, 2006).

In the data collection stage of this study, data was primarily collected through observation and semi-structured interview instruments. An observation instrument was used as a method to easily collect qualitative data from respondents. The main advantage of the observation as mentioned in (J. W. CRESWELL, 2011a) is that the researcher can record information as it occurs in a research site and can examine behaviours that cannot be manipulated. The interview instrument was considerably more interactive, which allowed the researcher to clarify questions for the respondents and obtain valuable qualitative data from them (Alan Bryman, 2008; Bonnie Kaplan, Truex, & Wastell, 2004). This data collection procedure helped the researcher to clarify in-depth information and to extract the requirements needed to develop the proposed CHIMS model.

To compile, design, and develop the data collection instrument of this study (i.e., semi- structured interviews), a careful process of collecting and gathering the required information was conducted in a number of ways. On one hand, the research instruments were constructed after a thorough review of the available published literature, such as Samuel (2009), Shahmoradi et al. (2007), and Raddy and Jansen (2008) (M. C. Reddy & Jansen, 2008; Samuel, 2009; Shahmoradi, Ahmadi, & Haghani, 2007), consultation with local experienced physicians, and reflection upon the knowledge and professional experience of the researcher. On the other hand, the researcher conducted a thorough literature review to familiarize himself with the conceptual foundations. Recent literature reviews, such as Collins et al. (2011), Li and Yao (2006), and Reddy and Jansen (2008) addressed the issue of collaboration among medical staff (i.e., physicians) in sharing information using qualitative instruments (Collins, et al., 2011; K. Li & Yao, 2006; M. C. Reddy & Jansen, 2008). Furthermore, the research instruments were then tested to evaluate their validity and reliability through expert validation followed by a

pilot test (Alan Bryman, 2008). The following subsections describe each technique that is most relevant to the case study.

3.2.8.1 Observation

Observation is the systematic documentation of nonverbal as well as verbal behaviour and communication. The key benefit of the observation technique is that the technique allows the recording of the behaviour without relying on reports from the respondents (Zikmund, 2003). Observation is the process of gathering open-ended and first-hand information by observing people and places at a research site. As a form of data collection, observation has advantages and disadvantages. Its advantages include the opportunity to record information as it occurs in a research site and examine behaviours that cannot be manipulated. Observation is a time-consuming technique; nevertheless, the information obtained is generally more accurate. According to (P.D. Leedy & J.E. Ormrod, 2005), observations, such as the observations made within the selected Egyptian hospital, can offer a tool to record information in great detail and capturing the numerous ways participants act and interact. This aspect will provide an integrated idea of how participants spend their time. According to Hannan (2006), the distinctive feature of observational techniques is their ability to record the flow of interaction or the dynamics of behaviour (Hannan, 2006). Behaviour in the selected Egyptian hospital was informally observed before conducting this study. This observation laid the groundwork for the study to access the selected Egyptian hospital before conducting this study. The researcher conducted a previous postgraduate study on medical informatics in the same Egyptian hospital from 2008 to 2010. The researcher visited the hospital numerous times to obtain medical data for the previous study. These visits provided the researcher a significant opportunity to observe the hospital environment of the selected hospital. This opportunity also enabled the opportunity to understand the culture of the medical

staff using the HIS, as well as to determine some of the obstacles that the medical staff encounters in HIS adoption and management of patient information in the hospital environment.

Throughout the 2010-2011 academic year, the researcher began to undertake official steps to obtain permission to conduct the study in the selected Egyptian hospital. The routine procedures followed in the selected Egyptian hospital and the long waiting periods involved to obtain approvals required to conduct a study enabled the researcher to observe the environment of the selected Egyptian hospital. The researcher had an opportunity to understand the culture of the staff and the attitude of the administration regarding the use and adoption of the HIS, and to identify certain obstacles faced by medical staff and researchers. This informal observation also allowed for development of a more formal checklist to guide the observation during the actual study period in order to better understand medical staff behaviours. The main themes identified for the formal observation during the study included (1) the nature work among specialists within selected hospital (collaboration), (2) how HIS is used in the selected hospital with regard to the sharing of healthcare information (technology acceptance), (3) identifying the factors and obstructions that affect the HIS adoption in this environment, (4) researchers activity, and (5) the CHIMS requirements needed in the selected hospital from the user perspective.

3.2.8.2 Interview

Interviews offer a means to record the responses of research participants of open-ended questions. The interview is a verbal questionnaire. The researcher can ask questions, listen to the responses, observe behaviour, and record responses, allowing for “nuanced and rich data” (Creswell, 2005), especially when the interview occurs in a one-to-one situation in which the researcher asks questions and records answers from only one

participant (Creswell, 2005). Interviews are used to interactively collect data from the subjects. In the present study, interviews were conducted individually and in the Arabic language. The information was recorded on individual copies of the interview form for each interviewee.

This research employed a semi-structured format for the interview because the outcomes (both attitudes and ideas) are obtained from the perspective of the interviewee, which will assist the researcher to set new questions during the interview session (Yin Robert, 1994). Moreover, semi-structured interviews have an open format that compels the participants to reveal the truth, as they cannot predict questions beforehand and will be unable to formulate answers in advance. Therefore, a semi- structured interview is an important instrument in qualitative research.

All of the interviews were conducted by the researcher to maintain consistency of responses. The researcher conducted the in-depth interviews with 12 participants, including 10 physicians and two medical informatics experts from selected hospital for this study (see Table 3.2). The in-depth interviews were useful to study the issues comprehensively. The researcher used a guide to conduct the interviews. The interview guide is a set of interview questions developed based on the objectives of the study and observation findings. The open-ended questions used during the interview process were based on recommendations from existing literature, anecdotal information, and conversations with the expert cancer colleagues of the researcher (Alan Bryman, 2008). Overall, 20 questions were asked during the interviews, and each interview session took approximately one to two hours. The Arabic and English languages were used in the interviews (see Appendix B).

The interviews continued until data saturation was achieved (i.e., no new opinions were raised) (Alan Bryman, 2008). Data was recorded, written, and summarized with the

permission of the participants. This data was then translated into English, transcribed, and analysed based on themes (Miles & Huberman, 1994). The transcription process involved the transfer of the recorded interview files from the voice recorder to the personal computer of the researcher. This procedure was followed by the word-by-word transcription of the interviewee data. The transcription process was then followed by the subsequent data reduction in an Excel format. In this context, the issues were classified based on the codes of the participants, as shown in Table 3.2. This approach assisted the researcher to sort the data easily, transcribe, and display the data in accordance with themes depending on the objectives of the study.

Participants were also informed of the recording of the interviews. During the interview, the researcher took notes as the interviewees talked. A brief explanation was introduced first to ensure a clear understanding of the research aim, research question, and confidentiality of their identities. Finally, to maintain confidentiality, this research used code names to replace all the names of the people and the organization. To keep an informal conversational atmosphere, the researcher agreed to whatever the interviewees said.

3.2.8.3 Documents

A valuable source of information in qualitative research can be documents. Documents consist of public and private records that qualitative researchers obtain about a site or participants in a study, and they can include newspapers, minutes of meetings, personal journals, and letters. These sources provide valuable information in helping researchers understand the central phenomena in qualitative studies (J. W. Creswell, 2011b). Documents represent a good source for text (word) data for a qualitative study. They provide the advantage of being in the language and words of the participants, who have usually given thoughtful attention to them. They are also ready for analysis without the

necessary transcription that is required with observational or interview data (J. W. Creswell, 2011b).

The researcher used document analysis for data collection in order to answer the research questions, the main themes identified from the documents during the study included, the nature of work among specialists within the selected hospital (collaboration), how HIS is used in the selected hospital with regard to sharing of healthcare information technology acceptance based on privacy preservation, identify the factors and obstructions that affect the HIS adoption in this environment, researchers activity, and the CHIMS requirements needed in selected hospital to improve the collaboration in sharing healthcare information using HIS based on privacy preservation. The researcher used materials such as web site data to illustrate both public and private documents included the hospital research department publications, and they represent a growing data source for qualitative researchers (J. W. Creswell, 2011b).

The researcher adopted the Creswell (2011) guideline procedures for collecting useful documents (J. W. Creswell, 2011b), which are as follows: (1) Identify the types of documents that can provide useful information to answer research questions, (2) seek permission to use documents from the appropriate individuals in charge of the materials, (3) Examine documents for accuracy, completeness, and usefulness in answering the research questions in your study. Additionally, record information from the documents. This process can take several forms, including taking notes about the documents or scanning documents to form a qualitative text database.