Study populations for qualitative methods

4.6 Study populations for qualitative methods

The target study populations are outlined in Table 4.1 above. These are discussed in turn in the sections below.

4.6.1 Health care policy makers, non-health care policy makers, programme managers

The challenges of violence prevention demand an inter-sectoral approach 4. This stems directly from the conceptual stand point of the public health approach which namely that working with and learning from other sectors and disciplines is essential in building the type of sustained , inter-sectoral response required to prevent violence 372; and strengthening of referral networks with other IPV service providers is one of the five prongs for implementing a systemic response to IPV 373.

Populations of policy makers were therefore drawn from both the health sector and from outside the health sector. Health policy makers, domestic violence agencies or advocacy groups, government institutions and donor agencies were purposefully selected to participate in key informant interviews. In describing one of the characteristics of key informant interviews Kumar (1989) states that key informant interviews involve interviewing small number of informants, usually in the range of 15-35 individual participants as interviewing fewer than 15 participants may compromise the validity of the findings. The study interviewed 26 Key informants (for details see table 4.3) by which point no new data was being gained by carrying out further interviews.

104

Table 4.3: Policy maker participants

District Services Organization Type Method Number of participants

Blantyre GBV service

providers

NGO/CBO KIIs 6

Police Services Community Police KIIs

Victim Support Units Small

Groups 3

Social work services

City of Blantyre KIIs 1

Health policy makers

Ministry of Health KIIs 2

One Stop Centres KIIs 2

Lilongwe Government Ministry of Gender KIIs 1

Ministry of Health; HIV, STIs, SRH,HMIS,SWAP,NCD and HE

KIIs 7

Private CHAM KIIs 1

Judiciary Legal representative KIIs

Training regulatory bodies

Health Professional Councils KIIs 1

International funding

Donor Agencies KIIs 2

Total 26

4.6.2 Health care workers

Health service providers are assumed to be critically important in improving health sector responses to IPV. They can help to identify women experiencing violence and refer them to specialized services 7, 243. However, their perceptions and attitudes towards intimate partner violence can present as opportunities (supportive attitudes) and barriers (judgemental attitudes or victim blaming) to integrating IPV prevention, care and supportive services into health services 374. This made understanding of their conceptualization of IPV and the role of the health services; and their experiences with service provision important.

Participants included health care workers from the following departments at QECH: emergency departments, outpatient departments, obstetrics and gynaecology, psychiatric clinic, dental, family planning and antenatal clinics, STIs and ARV clinics, paediatric, surgical and medical departments. These departments were identified based on the literature from low and middle income countries describing them as entry points for IPV interventions

7

. Hospital based social workers were included as part of the health team because by the nature of their job, they were likely to be in contact with survivors of violence. In health centres, all types of health care providers were represented: medical assistants, clinical

105

officers, and midwives. Health care providers who spent at least 50% of their time in client service provision were included in the study.

Health care workers were who were recruited, participated in individual interviews (IIs), small group interviews or FGDs. This flexibility allowed views from all the target areas to be included since it was not always possible to convene FGDs. The researcher observed that urban health centres were better staffed than rural health centres where only two to three members of staff served the centres. In such centres it was very difficult to convene a FGD. Bringing HCWs in rural centres to one place for the sake of convening a FGD could have proved costly as these centres are far apart. More importantly it could have raised ethical issues removing them from their work station. In urban areas in Blantyre and all facilities in Lilongwe and Mangochi FGDs were convened by bringing staff of different cadres such as nurses, medical assistants and clinical officers together out of clinic hours so as not to compromise the provision of care. In rural centres in Blantyre only individual interviews were conducted.

Table 4.4: Health care worker participants

District Location Facility type Rural Urban

Method Number of participants

Blantyre QECH Blantyre Referral Hospital Urban FGD

Small group IIs 17 3 7

Limbe Health Centre Urban FGD

II

9 1

Mdeka Health Centre Rural IIs 3

Madziabango Health Centre Rural IIs 3

Ndirande Health Centre Urban FGD 8

Mangochi Mangochi District hospital Urban FGD 9

Namwera Health Centre Rural FGD 5

Malukula Health Centre Rural Small

group

2

Chipalamawamba Village Health Committee

Rural FGD 10

Lilongwe Bwaila Hospital Urban FGD 6

Kawale Health centre Urban FGD 7

Mitundu Rural hospital Rural FGD 8

Mitundu Village health

committee

Rural FGD 10

Grand total 103

Most of the FGDs were mixed genders dominated by female HCWs. The total numbers conducted are provided (see Table 4.4). Shortage of staff precluded the ability to recruit

106

homogenous groups (for example by gender and cadre). As such mixed gender and cadre groups were used. Linhorst observes that FGDs should be prohibited for improper mixed groups 375 (see above), but I argue that our grouping was a proper mixed focus group, following Kim and Motsei who successfully managed to conduct mixed FGDs in a study that explored attitudes and experiences of gender-based violence with primary health care nurses

269

, although all their study participants were nurses. This study took extra care in selecting participants for the health professionals FGDs. Grades of these professionals and not gender acted as a leveling ground where equal discussion was built (nurses, medical assistants, and clinical officers, dental and environmental officers). Very senior staff members were excluded from FGDs. The lowest cadre (VHCs) had their FGDs conducted separately. Health Surveillance Assistants (HSAs) are a cadre of health care workers who reside in the communities and are familiar and trusted. These village level health care workers (see section 3.7) are covered in section 4.6.3 which deals with study populations at community level.

4.6.3 Community members

4.6.3.1 Individuals who had contacted IPV services

Both male and female ‘survivors’ who reported to have experienced IPV were included in the study. Recruitment strategies are discussed in section 4.7 (sampling). Only participants aged 18 years and above (or considered mature minors), had experienced IPV and had sought IPV- related services were recruited for community in-depth interviews (IDIs). The researcher gave preference, to survivors who were not currently in abusive relationships, who were therefore relatively safe and at relatively low risk of retaliation from their abusive partners, thus their safety would not be jeopardised by their participation in the study. However, some participants were in current abusive relationships and additional measures to ensure safety included ensuring no-one know about the interview locations and nature and recruitment materials that were non-specific to IPV. No couple’s interviews were conducted and partners were not aware of interviews going on. Interviewing these individuals was critical to the study because interventions designed to improve health care providers’ response to survivors of abusive relationships must be informed by service users perspectives on how health care providers can help them move toward safety and thus improve their health 376, 377.

The original sample size was 10 women and 5 men. However, only twelve survivors participated in the study: 7 women and 5 men (see Table 4.5). More men were interviewed relative to their representation in the total number of survivors reported nationally and the

107

original sample size was easily met. The total number of women was limited as few volunteered to share their stories due to the silence surrounding issues of IPV and concerns

for safety.

Table 4.5: Community participants

District Location Rural Urban

Method* Number of women

Number of men

Blantyre Blantyre City Urban IDI 7 4

Dziwe Rural 4 FGDs 27 N/A

Limbe Urban 4 FGDs N/A 32

Mdeka Rural 4 FGDs 1Small group IDI 28 3 0 N/A 1

Madziabango Rural 4 FGDs N/A 29

Ndirande Urban 2 FGDs 14 N/A

Grand total 79 67

* IDIs describe in-depth interviews with ‘survivors’

4.6.3.2 General community

A purposive sample of men and women was drawn from the community to participate in FGDs. This was to ensure that all constituents relevant to the phenomenon were captured. Recruitment to FGDs was on the basis of similar age, sex, marital and parental status to create a relatively homogenous sample in each FGD where participants can be free to talk to each other because they share similar characteristics. These allowed for the opportunity to give voice to a wide range of perspectives. Saturation was reached rapidly in focus groups and members commonly talked about IPV as something that they all experienced. The number of FGDs conducted therefore exceeded saturation point but was required to meet the need for male and female participants to be drawn from separate locations for safety issues as recommended by WHO domestic violence ethical guidelines (see ethical issues section). Groups with older people included a large number who were also marriage counsellors. Four FGDs were conducted in each location to allow for disaggregated representation.

4.6.3.3 Community victim support units

Based at community level these trained volunteers are part of the community networks established by the police to support victims of crime. They also deal directly with survivors of violence and members were included in the general community focus groups alongside marriage counsellors. Unlike marriage counsellors, who were ubiquitous among the older population, the community victim support volunteers identified themselves and their role

108

within the group discussion. Each focus group had at least one member of the community victim support unit and some had two.

4.6.3.4 Health Surveillance Assistants

Health Surveillance Assistants (see section 3.7) were also included in the study. Individual health care worker interviews were conducted in the communities at the time of the FGDs.