Validity

According to Polit and Beck (2008:373–377), validity is the degree to which a research instrument measures what it is supposed to measure. In the context of research designs, validity is about the approximate truth of an inference or reality (Johnson & Christensen 2012:245–247). This means that the notion of validity is relative; it is about degrees or levels, such as high, medium or low rather than one of presence or absence. There are variants of validity (Johnson & Christensen 2012:253–270). Content validity

refers to the extent to which a measure represents all facets of a given construct (Polit & Beck 2008:373–377). In this study the data colleting tools were tested for content validity. They were given to midwives at Dvokolwako Health Centre and midwifery lecturers at the Southern African Nazarene University and the University of Swaziland to obtain their input. They were also given to an independent expert to check for conceptual and investigative bias, as advised by Nxumalo (2011:77). A single proportion sample size formula was used to determine the number of midwives to be included in the study sample.

The internal validity is the degree to which the study findings represent a true reflection of the exposure–outcome association in the target population (Polit & Beck 2008:287). In other words, internal validity is the degree to which observed changes in a dependent variable can be attributed to changes in an independent variable (Johnson & Christensen 2012:250). This was not applicable in this study, as there was no manipulation of variables. However, to enhance its quality, interviewers were trained and the researcher closely monitored the data collection process. The data collection instruments were tested before application in the main study.

External validity concerns the representativeness of samples used in studies. This was a vital concern for the researcher of this study, as he aimed to determine not only the competencies of midwives in Swaziland during the provision of immediate PNC, but also to adopt evidence-based guidelines for the implementation of PNC. In this study, the sample was randomly selected, and its size was determined using a significance level or error rate of 0.05 (95%), meaning there was a 95% chance of obtaining the same or similar results if the study is repeated (Johnson & Christensen 2012:234). Sufficient data were collected using the minimum sample size of 88 (Johnson & Christensen 2012:234). Taking into account the sampling approach used and the representativeness of the sample, the findings of the study could be generalised to populations similar to that from which the sample was obtained.

3.6.2 Reliability

Reliability refers to the repeatability of a measurement or study findings and whether the same findings would be obtained if the study were repeated (Joubert & Ehrlich 2010:79). In other words, reliability relates to the degree of consistency or accuracy with

which an instrument measures the attribute it is designed to measure (Johnson &Christensen 2012:253). To ensure reliability, this study utilised a structured questionnaire as a data collection method. Because reliability is a multi-component concept, researchers need to decide in advance aspects of reliability (internal consistency, stability or equivalence) when selecting instruments for their studies (Joubert & Ehrlich 2010:79). In this study, all these aspects were important. The instruments used in this study were tested on similar populations, and their reliability using some of these aspects was evaluated. Starting with internal consistency, an instrument is said to be internally consistent or homogenous if its items measure the same trait (Johnson & Christensen 2012:250). Internal consistency is actually the extent to which the items measure the same trait.

The reliability of the tools of this study was tested using Cronbach’s coefficient alpha (Johnson & Christensen 2012:142–143). The coefficient alpha of the questionnaire ensured that no parts of the questionnaire had to be eliminated based on the reliability scores for individual items (Johnson & Christensen 2012:142–143). Cronbach’s alpha for the tools of this study was 0.6. Stability of measurements or tools relates to the extent to which similar scores or results are obtained when applied separately on different occasions (Johnson & Christensen 2012:142–143). Stability of measurements is really an estimate of the correlation coefficient of two sets of scores, test–retest (Johnson & Christensen 2012:506). The test-retest was not performed in this study. The final reliability measure that was applied in this study was equivalence (Johnson & Christensen 2012:142–250). In essence, equivalence is about inter-reliability or agreement (Jonson & Christensen 2012:250). Equivalence is also about agreement or degrees between two items of a scale or measure. Measures of agreement were established in this study using kappa statistics.

3.7 ETHICAL CONSIDERATION

When humans are to be used as study respondents, care must be exercised that the rights of the respondents are protected. The present researcher was guided by and adhered to this element and all other aspects of the Swaziland research code of ethics. The approval to conduct the study was obtained from the Ministry of Health in Swaziland (Swaziland Ethics Committee) (Annexure D), and management team of the study sites. The consent of all respondents who took part in the study was sought and

obtained before interviews. The signed consent forms were securely kept in a locked cupboard together with completed questionnaires and were only accessible to the research team (Annexure A and E).

3.7.1 Autonomy

The principle of autonomy means that research respondents were to be provided with sufficient information to enable them to decide whether to participate in a study (Coughlin, Beauchamp & Weed 2009:26). The purpose of the study, including its benefits, was fully explained to respondents. The researcher respected the autonomy, rights and dignity of the research respondents at all times during the course of the research. Respondents were informed that they had a right to choose either to participate or not to participate in the research. Study respondents were encouraged to act independently and were free to choose whether they wanted to participate in the study.

3.7.2 Beneficence

Hulley et al (2007:225) state that respondents must be treated in such a way that harm is prevented or removed. The researcher strived to minimise all types of harm and discomfort and to achieve as far as possible a balance between the potential benefits and risks of using respondents. Respondents were not coerced to answer any questions. Interviews were conducted at the pace of the respondents. The researcher took all necessary steps to avoid exposing respondents to any form of physical and psychological harm. These included maintaining the privacy and confidentiality of respondents. Names of respondents were not recorded at any phase of the study; only codes were used.

3.7.3 Justice

Justice refers to fair treatment of study respondents (Coughlin et al 2009:117). The purpose, benefits and risks of the research were fully discussed with the respondents, and they were given the option to withdraw from the research if they so wish, without any negative effect on their well-being. The researcher upheld ethical standards of

research planning, implementation and reporting (Coughlin et al 2009:118). The findings of the study are fully reported in this thesis.