Research Methodology: The Road Map in Academic and Healthcare Research

3.1 INTRODUCTION

The research methodology is an integral part of every systematic study. It is used to differentiate the major elements of an inquiry—e.g. the research design, data evaluation and interpretation, ethical issues etc (Abou Samra., 2021). The methodology is also useful for organizing the subject matter of research and explaining the scope. Thus, this third chapter of the research titled ‘Innovative Health Management Strategies for Enhancing the Primary Health Care Delivery in Nigeria’ provides an insight into the key methodologies adapted to examine concepts (such as innovation, primary care, health providers, policymakers, care users, healthcare management etc) and analyse social phenomena relating to the Nigerian health care sector.

3.1 RESEARCH PHILOSOPHY

Research philosophy is one of the focal areas in methodologies. It refers to theoretical leanings, experience, values or ideas that influence a researcher’s world view and choice of strategy (Iovino & Tsitsianis., 2020). Therefore, based on the aims and objectives of this study, the researcher adapts a mix of philosophical positions such as interpretivism and realism (Bigiriman., 2017).

The realist research philosophy aligns with the methodology adapted in this study. The realist methodology was chosen because it broadens understanding of the linkage between human ideas (such as innovation and healthcare management) and social reality (e.g. quality of health care delivery, life span, quality of life etc). Realism seeks answers to social problems and is most suitable for analysis human-related organizational problems (Bryman., 2008)

Similarly, interpretivism focuses on identifying the differences between humans who are considered as social actors within social systems (groups, organizations and societies). On this premise, the interpretivist method was adapted to understand the human factor—rather than the impact of technology or other abstract elements—on the performance of healthcare innovation ecosystems. This philosophical approach, thus, examines and interprets social roles within health systems using a set of concepts and/or terminologies (such as innovation, primary care, healthcare management etc) (Garrett., 2018).

3.3 RESEARCH APPROACH

A researcher’s approach to any academic inquiry depends on his philosophical leaning (Bryman & Bell., 2011). The research approach can also vary depending on the context and scope, as well as the research aims, objectives and questions. However, the research on ‘Innovative Health Management Strategies for Enhancing Primary Health Care Delivery in Nigeria’ is qualitative in nature, and for this reason, the researcher will adapt an inductive approach to analyse empirical reality (i.e. concepts and theories in the practical domain) observed from interviews and focus groups.

3.4 RESEARCH STRATEGY

The chosen research strategy for this study aligns with the deductive approach as well as research objectives and questions. Thus, the research strategy adapted to gather information, analyse data and present research results includes: (a) case study (c) grounded theories (d) survey and (e) action research. The case study helps understanding of real-life situations and the relationship between variables. Surveys involve use of focus group, semi-structured interviews, and observation to gather information (Iovino & Tsitsianis., 2020). Theories provides basis for analysing concepts and their applicability whereas action research explores current, past and future trends in the system being studied (Abou Samra., 2021).

3.5 RESEARCH DESIGN

Primary and secondary data collected for this study is subjective and non-numerical. Therefore, the qualitative research design will be applied because it enhances exploration of social/natural reality by giving clear interpretation of context and variables—in line with the interpretivist and realist philosophies (Bryman., 2008). The qualitative research design does not focus on the relationship between variables. Instead, it aims at identifying more variables and other contextual factors in order to offer deeper understanding of the phenomena being studied (Bryman & Bell., 2011). This highlights the level and relevance of the researcher’s involvement in the study. However, ethical standards will be observed during data collection, analysis and presentation to eliminate bias (Bigiriman., 2017).

3.6 RESEARCH METHODS

Data sources

The study on ‘Innovative Health Management Strategies for Enhancing the Primary Health Care Delivery in Nigeria’ requires an extensive quantitative survey. Primary data will be randomly collected from employees at primary health care (PHC) facilities, nursing schools, medical centres and university teaching hospitals. Healthcare administrators at the federal, state and local government levels who are in charge of conceptualising, formulating and implementing health management strategies were also considered as primary sources of data.

Secondary sources of data include health journals, public libraries, books, websites, annual reports from reputable organizations etc.

Survey Instruments

The three basic survey instruments for gathering primary data are as follows:

i) Healthcare Facility Survey: This survey involves interaction with top management staff at health facilities. Semi-structured interviews, focus group and observation were used to obtain information on general facility characteristics and care services provided.

ii) PHC Staff Survey: This survey also involves use of focus group, semi-structured interview and observation. Survey respondents at health facilities include healthcare employees in different departments and career levels who agreed to provide information on the general characteristics of service, working environment, and incentives.

iii) Individual/Household Survey: This survey is focused on the experience, needs and aspirations of care users (i.e. individuals and households living in communities near primary health centres and/or care facilities). Data collected from individuals and households is related to their personal characteristics, functionality of care facilities, frequency of usage, and level of satisfaction gained from health care services.

3.7 DATA COLLECTION

Research participants who are Nigeria-based healthcare professionals had direct contact with a large number of respondents at the local, state and federal levels of health care delivery. Primary data sourced from a sample population of doctors, nurses, health providers and care users were collected through various communication channels such as telephone and email.

Data collection was conducted between June and July 2021.

3.7.1 Sampling of the Population

A non-probability sampling was used to gather unbiased and reliable input from volunteers (employees in the health sector) and care users in rural communities. The researcher ensured that the volunteers are individuals (male and female) who meet one or more of the following criteria: (a) adequate educational qualifications and/or training (b) proper knowledge of the work/care delivery process (c) understanding of the concepts used in this study (d) previous short- and long-term interaction with health providers (e) professional experience on healthcare management and (f) knowledge of new trends in the healthcare industry. There was no categorization based on gender, location, position or department.

3.7.2 Sampling Procedures

The study used a stratified, multistage random sampling method to assess performance of health facilities and weigh results/perceptions from interactions between care users and health providers in different local government areas (LGAs) of Anambra state, Nigeria. To efficiently conduct household surveys in local government areas within the state, a three-stage procedure was applied. First, a list of all LGAs was prepared and then separated according to urban, semi-urban and rural area based on government classification of LGA type. Using the random sampling method, the researcher chose one (1) rural, one (1) urban, and one (1) semi-urban LGA. Then, using proportional allocation, the sample population was sub-divided into three (3) based on the total number in the chosen urban/semi-urban/rural LGAs.

The researcher also prepared a list of the households near health facilities in locations within the selected Enumeration Areas (EAs). The average distance from health facilities is about 10 kilometres because the 10-kilometre radius is considered an adequate catchment area for health workers. Households were selected via same procedures as in the health facility survey because the methodology enables assessment of PHC performance with respect to the care users rather than the overall perception of ‘accessible health care’ held by individuals across the state.

3.7.3 Focus group, interview and observation

The researcher used focus group, semi-structured interview and observation to gather primary data needed for this study. Based on the theoretical outline, the format and basic structure of interview was developed on completion of the literature review. The focus groups were interviewed between June – July 2021 and a total of 200 interviews were completed using the interview guide. Interview questions were prepared based on the theoretical outline, university-approved interview guide, and research questions on innovation, work process, primary care approach, healthcare management, performance of PHC facilities etc. Specific questions about organizational strategy and concepts used in the study were directed at the top management staff whereas healthcare administrators and senior staff at health centres, medical centres and teaching hospitals provided answers to tactical questions about strategy implementation.

3.7.4 Conclusion on research limitations

There are always challenges to every research involving humans. The study on ‘Innovative Health Management Strategies for Enhancing Primary Health Care Delivery in Nigeria’ requires the researcher—a student in the UK—to communicate regularly with survey participants in Nigeria whose understanding of the research concepts and objectives may not be properly utilized during direct contact with interviewees. Moreover, challenges from fluctuating telecom networks and the huge financial cost of communicating with contacts in Nigeria are some of the major setbacks experienced by the researcher. To reduce bias and increase reliability of primary data, the scholar relied on assistance from family and friends working in the health industry.

3.8 DATA ANALYSIS

Primary data collected from survey participants were analysed with a thematic method that involves use of NVivo software to code interview text and connect related codes for the purpose of creating higher order data/themes. This enabled grouping of common themes and easy identification of relationships between variables. The NVivo software was basically used to develop, record, and organise attributes as well as store nodes, links and models from available data.

Through automated node development or manual coding, the NVivo’s text-editing tools enhanced the process of analysing transcript from interview data. Hence, the researcher used both data evaluation methods to catalogue and categorize the nodes in order to develop subcategories required for grouping cases and themes into different sections. This methodology made it easy to group opinion and streamline individual opinion as well as their representation of various theories of innovation, models of care, strategies in health management, and performance of innovative healthcare ecosystem in Nigeria.

3.9 ETHICAL CONSIDERATIONS, RELIABILITY AND VALIDITY OF RESULTS

The study on ‘Innovative Health Management Strategies for Enhancing Health Care Delivery in Nigeria’ involves collection, analysis and publication of large amounts of data that may pose direct or indirect risks to survey participants. The author has therefore evaluated all potential ethical issues and ensured that these would not pose a problem for people connected to the study—in accordance with approved University guidelines. Any critical issues were discussed with the supervisor for clarity and confirmation, particularly on matters regarding handling of sensitive information from survey respondents due to its implication for their organizations/employers.

To allay concerns for the privacy of third parties involved in the research process, as well as to ensure validity and reliability of results, all data collected from primary sources were stored in password-protected systems under the author’s control. Research respondents were also briefed on the nature of the study, including its aims, objectives and methods. None of the participants was coerced into providing answers to the interview questions.

Additionally, the respondents were offered the choice of refusing to participate or skip any question considered to have negative implications for their professional, religious or socio-cultural ideals. All survey participants had the opportunity to withdraw their consent during the research process and each of them was ensured anonymity and confidentiality. No classified/sensitive material was exposed to the public. Moreover, all sensitive data was destroyed after the research.

References

Abou Samra, A. (2021), “The debates of methodology and methods: reflections on the development of the study of international relations”, Review of Economics and Political Science, Vol. ahead-of-print No. ahead-of-print

Bigirimana, S. (2017), “Beyond the thinking and doing dichotomy: integrating individual and institutional rationality”, Kybernetes, Vol. 46 No. 9, pp. 1597-1610.

Bryman, A. (2008), “Of methods and methodology”, Qualitative Research in Organizations and Management, Vol. 3 No. 2, pp. 159-168.

Bryman, A. and Bell, E., (2011) Business Research Methods, 3rd ed, pp. 36-39. Oxford University Press: New York

Garrett, B. (2018), “Social Science: Scientific Realism, Alternative Frameworks and the Rise of Postmodern Thought”, Empirical Nursing, Emerald Publishing Limited, Bingley, pp. 69-130.

Iovino, F. & Tsitsianis, N. (2020), “The Methodology of the Research,” Changes in European Energy Markets, Emerald Publishing Limited, Bingley, pp. 79-95.