Sampling strategies for qualitative methods

4.7.1 Purposive sampling

The major sampling approach used in the study was purposive – that is, information-rich cases were selected 228. This is the most common approach to qualitative sampling whereby, the sampling units are not chosen in a random manner, but on the basis of some of their characteristics. The researcher's practical knowledge of the research area, information available in the literature and from the study itself was strategically used by the researcher to select information rich subjects. Use of purposive sampling strategy allowed the study to include a broad range of participants from service users to policy makers, including participants who have specific experiences (critical case sample of women and men who have experienced IPV) or participants with special expertise (key informant sample).

A subset of purposive sampling according to Paton is homogeneous samples, which involves selecting a small sample with similar attributes228. This strategy was specifically used in this study for community members FGDs. The point here is that sampling for focus groups typically involves bringing together people of similar backgrounds and experiences to participate in a group interview about major program issues that affect them.

The purposive sample of health care workers (including HSAs) were recruited in consultation with departmental managers of QECH and in-charges of the selected health centres (see section 4.3 study setting) and District Health Officers.

Snowball sampling was also used to identify individual interviewees in this thesis. Snowball sampling is defined simply as a method of identifying research subjects that has frequently been used in studies dealing with sensitive issues, possibly concerning a relatively private matter 275. It is particularly useful in identifying social groups whose members tend to hide their identity for moral, legal, ideological and political reasons 228; but may sometimes be used to locate the elite participants who maintain invisibility by choice. It can be both used as

109

an informal method and as a more formal methodology. When used as a more formal method inference about a population of hard to reach individuals can be drawn.

Snowball sampling involves identifying subjects for inclusion in the sample by referral from other subjects. The process begins by asking well-situated people: "Who knows a lot about this? Who should I talk to?" By asking a number of people who else to talk with, the snowball gets bigger and bigger as one accumulates new information-rich cases 228. Some of the contacts and referrals can also be made fortuitously. This does not mean that participants are accessed by chance but tends to demonstrate the researchers increased sensitivity to the study and ability to maximise opportunities.

In this thesis snowball sampling was used to identify additional respondents among policy makers, non-governmental providers of services for IPV and survivors. For policy makers the snowballing sampling technique proved very effective. UNICEF Malawi played a significant role in helping the study identify key relevant health development partners and other policy makers within the Health Ministry. Once identified, key informants were requested by telephone or in person to participate in the interviews at their offices at a time and day that was convenient for them. Key informants were excluded from the study if they consistently failed to honour their appointments. This was the case with three identified key informants. They were also asked to identify other policy makers for interviews. Women and men were purposively selected for in-depth interview on the basis that they had experienced IPV. The challenges in recruitment and selection and potential limitations are discussed in the following section.

4.7.2 Selection of interviewees who had experienced violence

Achieving an adequate sample in sensitive research can be challenging, and recruiting ‘survivors’ of IPV is particularly challenging. Chakwana in the Malawi Demographic Health Survey states that women may not disclose issues of domestic violence as it is regarded as bringing shame to their family and society discourages women from talking about their experiences of domestic violence to maintain respect from the community 346. The researcher used multiple methods of recruiting survivors purposively to maximise the chances of successful recruitment.

A major method of recruiting female ‘survivors’ who had used services was through referral from various services from which they had sought help. Five of the seven women interviewed were selected in this way: one was referred from police, one from non-health GBV services,

110

and three from STI clinics. Survivors who were recruited through the STI clinic were slightly different from the rest of the participants. Unlike the participants above who were approached as known survivors of IPV, those recruited from health services reported for services other than IPV. Based on knowledge gained through literature patients with repeated STIs and those who had problems with partner notification were asked for their experience of IPV. Some women revealed IPV as a problem in their family and agreed to take part in the study.. Two additional women were recruited: one following a community focus group discussion via an HSA; and one through snowballing/participant referrals. Of the five men interviewed, two were referred from non-health GBV services, one via police and 2 were identified through snowballing. Participant referral was not very easy as many of the interviewed participants reported that they did not know anyone else who was experiencing IPV. Those survivors who gave examples of other women who were experiencing violence in their relationships reported that the women they mentioned were divorced or they had gone to the village and some of them reported that those experiences were in the remote past. One survivor reported that she was to bring a friend who had sustained a fracture from IPV but later reported that the woman declined the invitation because she had reconciled with her abusive husband.

The two cases recruited through the police (one male and one female) were identified by the researcher on the basis of their high visibility since they were published in the local media. The researcher was able to trace the survivors through the police following the media reports.

Whilst recruiting participants in this way had its advantages such as facilitating recruitment of participants there were also some disadvantages. Many of the participants recruited had experienced closer to what would be categorised as severe form of violence, since their cases were either visible to other community members or to service providers. This means that voices of the survivors who may have experienced normalised forms of violence and never sought help from these sources were missing in the data. The ramifications of this are discussed further in chapter 8 under limitations of the study.