1.10.1 Design chosen
As it is the blueprint or a detailed plan for how a research study is conducted (Guest &
Namey 2015:37-103), the research design was developed to meet the unique requirements of the study. A retrospective mixed study design, combining both qualitative and quantitative methods was used to make an in depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths, for theory generation has been conducted within the context of Ethiopian community maternal and newborn care (Chinn & Kramer 1991:79-120; Mouton 1996:103-109; Mouton & Marais 1990:43). Many definitions of mixed methods are available in the literature (Johnson, Onwuegbuzie & Turner 2007:112-133;
Creswell, Klassen, Clark & Smith 2012:27). For the purposes of this study, mixed methods research is defined as a research approach or methodology employing rigorous quantitative research assessing magnitude and frequency of constructs and rigorous qualitative research exploring the meaning and understanding of constructs (Creswell et al 2012:27).
The research design for developing a community-based model for averting maternal mortality and newborn death was developed through three phases in accordance with the objectives of the study namely:
Phase 1. Explore and describe maternal and newborn care in Ethiopia (empirical study).
Phase 2. Concept analysis of community-based maternal and newborn care.
Phase 3. Develop a community-based model for averting maternal mortality and newborn death in Ethiopia.
1.10.2 Phase 1: Research methodology
In this phase, research methodology used including quantitative and qualitative paradigms, population, sampling, data collection; data analysis, ethical measures and trustworthiness of data were presented.
As Polit and Beck (2004:731) described it, research methodology refers to techniques used to structure a study and gather and analyse information in a systematic way. The methods used are described comprehensively, including the context in which the data collection took place particularly the relationship between the research question and data collected (De Vos, Strydom, Fouché & Delport 2005:252).
1.10.3 Phase 2: Concept analysis
The empirical perspectives of the study laid the foundation for this phase and led to the syntheses and identification of the core theme known as community-based care. As main part of this chapter, using Walker and Avant (2005:28) method, concept analysis of community-based care were conducted in order to analyse and generate descriptions, definitions and to further explore the meaning of this concept in the context of preventing maternal mortality and newborn death. The concept analysis together with the empirical perspectives of the study and six aspects of Dickoff et al (1968:422) facilitated the development of a model for community-based prevention of maternal mortality and newborn death in Ethiopia.
1.10.4 Phase 3: Model development
A model was developed according to Chinn and Kramer’s (1995:81) approach to theory generation: initially, based on the empirical perspectives of the study which includes analysis and interpretation of the testimonies and experiences of survived newborn mothers', family members of the deceased mothers, traditional birth attendants and health workers, concept analysis was conducted embracing concept identification as well as concept definitions and classification. This was followed by, the identified concepts were compared to each other to show interrelationships and the classification of central and relational concepts was used as a framework for the model. Then, the structure and process of a model to reduce maternal mortality and newborn death were described; and, six survey list of Dickoff et al (1968:422) namely; agent, recipients, context, terminus, procedure and dynamics formed the basis for development and description of a model for reduction of maternal mortality and newborn deaths in Ethiopia. Description for operationalising the model for use was simultaneously presented.
1.10.5 Ethical considerations
1.10.5.1 Obtaining informants consent before the study begins
Participation to the study was completely voluntary and free from any form of coercion.
Individuals or families to be approached to participate in the study will first be fully briefed on the purpose of the study and as well as their roles. It will also be explained to them that shall they decide not to participate or decide to withdraw during the process no penalty was levied against them. All the explanations was done comprehensively in a language that the individual or family can speak or understand. It is upon this that a verbal/written consent was sought. However, a verbal consent was primarily used in this study as in Ethiopia generally people felt reluctant to sign or thumb print even among literates for various reasons (Tekola, Bull, Farsides, Newport, Adeyemo, Rotimi
& Davey 2009:482-486). They are more comfortable with giving verbal consent.
1.10.5.2 Confidentiality
The researcher will ensure the subjects for the confidentiality of the data obtained.
Moreover, different strategies such as allowing the informants not to write name, appropriate control on data collection, etc. was made.
1.10.5.3 The culture
The researcher has a good experience of the study area’s culture and hence all attempts was made to respect the cultural values, traditions or taboos valued by the informants.
1.10.5.4 Obtaining ethical clearance
To undertake this study, Ethical clearance was sought from the University of South Africa then from Ethiopian Government Science and technology Ethical Committee.
Permission to access health facility kept records was requested from the Director of Medical Services of the Ethiopian government Ministry of Health (MoH).