CHAPTER I

THE PROBLEM AND ITS SETTING

Introduction
In 2006, with approximately one-third of the worlds population estimated to be
infected with the Mycobacterium tuberculosis bacillus, and more than 9 million new
cases and 1! million deaths annually, the "orld #ealth $r%ani&ation declared that
'uberculosis (')* remains one of the most important infectious diseases worldwide
#owe+er, because one-third of the ,2 million people li+in% with #I-./I01 worldwide are
co-infected with Mycobacterium tuberculosis, the #I-./I01 pandemic has %reatly
hindered %lobal efforts to control tuberculosis ("#$, 2006*
') is a ma2or health problem in the 3hilippines It is the sixth leadin% cause of
death and illness In 2011, "#$ estimates there are 260 000 incident cases in the
country and 24 000 die in a year 'he pre+alence of ') is hi%h amon% the hi%h ris5
%roups such as the elderly, urban poor, smo5ers and those with compromised immune
systems such as people li+in% with #I-, malnutrition and diabetes It is estimated that 10
600 patients ha+e multi-dru% resistant ') (M06-')* in 2011 'his situation leads to
substantial socio-economic losses to the country
7ocally, 1urallah, a 1st class, a%ri-industrial municipality in the pro+ince of 1outh
8otabato, 3hilippines, achie+ed a of 99 :detection rate on ') 'he municipality of
1urallah has a population of !4,424, and from this, 6,; patients were examined throu%h
microscopy (1outh 8otabato /ccomplishment 6eport, 2012*
1
#owe+er, the number of patients treated with ') in 1urallah 1outh 8otabato is
not decreasin% "orst, the number of Multi-0ru% 6esistant ') (M06-')* cases is also
increasin%
'o address this issue, the "#$ recommended the ') 0$'1 (0irectly $bser+ed
'reatment 1hort-8ourse* in aim of controllin% the disease Moreo+er, 0$'1 is
recommended because of its %oal of detectin% !0: of all new smear positi+e cases and
its 49: success rate when implemented 1trate%ies which comprise set of actions li5e
sputum smear microscopy amon% symptomatic patients, directly obser+ed treatment
(0$'*, monitored and standardi&ed, re%ular pro+ision of dru%s, information and
re%istration system, and e+en the %o+ernments commitment to prioriti&e ') amon%
health policies are part of the pro%ram to achie+e its %oals ("#$,2010*
#owe+er, despite bein% curable, tuberculosis is still a sti%mati&ed disease <ot
only are ') patients sufferin% due to its clinical manifestations, but also because of
societys pre2udice, embarrassin% situations, and e+en self-discrimination /ccordin% to
3orto (200!*, professionals such as psycholo%ists, anthropolo%ists, sociolo%ists, and ')
analysts ha+e repeatedly indicated that tal5in% about the disease still causes discomfort
and unease in the population, especially within the poorer communities
/ccordin% to "#$ (2006*, In addition to the focus on treatment and cure rates, a
more comprehensi+e approach towards disease control is now ad+ocated, in order to
address po+erty and other social ris5 factors, of which sti%ma is one component
=nderstandin% what ') mean to patients and to all people surroundin% them
enables health wor5ers to deli+er comprehensi+e health mana%ement beyond clinical
2
and con+entional care 3atients lifestyles and thin5in% modes ha+e an effect on how
they respond to healthcare wor5ers inter+entions and actions (>on&ale& et al, 1999*
'he researcher would li5e to elicit data from the experiences of ') patients from
dia%nosis to completion of treatment ?urthermore, this research is rele+ant to better
understand possible health care mana%ement in increasin% their adherence to
treatment, minimi&in% undesirable results, facilitatin% the resumption of their daily li+es,
and promotin% a shared lan%ua%e amon%st health professionals and patients "ith this,
a holistic approach in impro+in% the @uality of life will be achie+ed
'his study aimed to in+esti%ate psychosocial experiences reported by patients who had
successfully under%one 'uberculosis treatment in 1urallah, 1outh 8otabato
Statement of the Probem
'he proposed study is primarily focused in determinin% the life experiences of
patients who ha+e completed 'uberculosis treatment in 1urallah, 1outh 8otabato
1pecifically, it sou%ht answers to the followin% sub problemsA
1 "hat is the profile of patients in terms ofA
a 1exB
b /%eB
c Cducational /ttainmentB
d Marital 1tatus
e 8linical ?orm of ')B
f $ccupationB
% ?inancial 1tatusB and
h 6eli%ionD
2 "hat is the life experiences of ') patients in terms of the followin% cate%oriesA
a 1ufferin% caused by the diseaseB
b Impact to familial and social settin%sB
c 1upport from %o+ernment health ser+icesB
3
d 0eficient cultural 5nowled%eB and
e Implication to post-treatment lifeD
; )ased on the life experiences of patients, what health education pro%ram for
health wor5ers can be de+eloped to impro+e the @uality of life of ') patientsD
Sco!e and Deimitation" of the Stud#
'his research study is limited to the 19 pre-identified patients who ha+e already
completed the 'uberculosis treatment 1urallah, 1outh 8otabato 'he +ariables of the
study are delimited on patients sex, a%e, educational attainment, marital status, clinical
form of '), occupation, financial status and reli%ion ?urthermore, to obtain rele+ant
data on the life experiences of the patients, +ariables such as sufferin% caused by the
disease, impact to familial and social settin%s, support from %o+ernment health ser+ices,
deficient cultural 5nowled%e and implication to post-treatment life are included 'he
result of this study will be utili&ed for the de+elopment of health education pro%ram for
health wor5ers to pro+ide them with enou%h s5ills in addressin% psychosocial issues
with patients with ')
'o %ather rich information, the research will utili&e a @ualitati+e study amon% the
respondents / semi-structured @uestionnaire will aid in collectin% salient themes in the
life experiences of the patients specifically on a* 1ufferin% caused by the diseaseB b*
c* Impact to familial and social settin%sB d* 1upport from %o+ernment health ser+icesB
d* 0eficient cultural 5nowled%eB and e* Implication to post-treatment life
$nly participants who a%reed and si%ned the consent can participate in the study
1ince the study will be conducted on a municipal le+el, the participants will be in+ited for
a %eneral assembly with the coordination with the municipal health office
Si$nificance of the Stud#
8onsiderin% the increasin% number of ') cases in 1outh 8otabato, this study is
important to impro+e the mana%ement of this disease from detection to treatment
4
?urthermore, the result of this study can benefit the Patients with Tuberculosis,
because they are considered the primary recipients of care 'he result of this study will
ha+e a positi+e impact on the de+elopment of patient care mana%ements anchored on
the patients psychosocial aspect
'he Public Health Nurses, throu%h this study, public health nurses will be
5nowled%eable of the appropriate nursin% care which promotes @uality of life amon% ')
patients
'he Municipal Health Office of Surallah, because of the +ast information that
can be ac@uired in this study, there will be opportunities for %rowth and impro+ement in
the deli+ery of health ser+ices pro%rams particularly in the mana%ement of ')
?inally, the result of the study will add to the existin% literature pertainin% to
sti%ma and 5nowled%e of baran%ay health wor5ers on ') and #I-, which may be
beneficial as reference material for future related studies
Definition of Term"
'he followin% are some of the terms used in the study as defined in their
operational context
Life E%!erience"& 'his refers to the obser+ations, personal encounters, or
under%oin% of thin%s %enerally as they occur in the course of treatment period of
'uberculosis
Mode of Tran"mi""ion& 'his refers to the mo+ement or the transmission of
patho%ens from a reser+oir to a susceptible host
5
Sti$ma& 'his pertains to <e%ati+e beliefs that a society or %roup of people ha+e
about ') and #I-
Patient Care Mana$ement& 'his refers to %eneratin%, plannin%, or%ani&in%, and
administerin% medical and nursin% care and ser+ices for patients
Treatment Protoco& 'his pertains to the customs and re%ulations dealin% with
diplomatic formality for carryin% out patients treatment re%imen
CHAPTER II
RE'IE( O) RELATED LITERAT*RE AND ST*DIES
'his chapter presents the conceptual framewor5 of the study It also contains
articles, readin%s, and studies related to the study of sti%ma and 5nowled%e amon% the
)aran%ay #ealth "or5ers of 1urallah, 1outh 8otabato on ') and #I- as basis for the
de+elopment of <ursin% #ealth Cducation 3ro%ram
Conce!tua )rame+or,
'his study will be conducted in order to explore the life experiences of
patients who ha+e completed the treatment re%imen of ') $ne of the ma2or
assumptions of this study is that the demo%raphic profile of patients plays a ma2or role
in their life experiences =sin% @ualitati+e data collection strate%ies, assumptions will be
re+ealed ?urthermore, results of this study will be a basis for the de+elopment of
<ursin% #ealth Cducation 3ro%rams on ') 'his study is therefore aimed to contribute
in the eradication of ') throu%h impro+ement of health ser+ices deli+ery pro%rams of
the local %o+ernment of 1urallah, 1outh 8otabato
6
?i%ure 1 presents the schematic dia%ram of the conceptual framewor5 of the
study

)i$ure -
Conce!tua )rame+or,
Re.ie+ of Literature
'uberculosis in the 3hilippines is still considered a burden not only to the
%o+ernment but as well as to the population, especially to those belon% to the
mar%inali&ed sector /ccordin% to $n% (2011*, ') is the number six leadin% cause of
death, with !; ?ilipinos dyin% e+ery day of ') /n estimated 200,000 to 600,000
7
3rofile of 3atients in
terms ofA
1exB
/%eB
Cducation /ttainment
Marital
1tatus
8linical
?orm of ')
$ccupation
?inancial
1tatus
6eli%ion
7ife Cxperiences
a1ufferin% caused by
the diseaseB
bImpact to familial
and social settin%sB
c1upport from
%o+ernment health
ser+icesB
d0eficient cultural
5nowled%eB and
eImplication to post-
treatment lifeD
7ife
Cxperiences
CO*NSELING S/ILLS ENHANCEMENT PROGRAM
?ilipinos ha+e acti+e ') in which this condition ma5es the person sic5 and conta%ious to
others
"ith most of us 5nowled%eable to the uni+ersal si%ns and symptoms of acti+e ')
which include cou%h, phle%m (sometimes with blood*, unexplained wei%ht loss, fati%ue,
afternoon fe+er, ni%ht sweats, chills, and loss of appetite, data re+ealed that still in 2011,
4! million people were fell with ') and 1, million died from ') (Montoya, 201;*
Moreo+er, $+er 99: of ') deaths occur in low and middle income countries, and
it is amon% the top three causes of death for women a%ed 19 to ,9 ("#$, 201;* 'his
scenario included the 3hilippines in the top 22 hi%h-burden tuberculosis countries in the
world, which ran5s the 3hilippines at number nine worldwide ("#$, 2012*
/t the same time, ') in the country still remains the sixth %reatest cause of
morbidity and mortality in the country /t least !9 ?ilipino dies of ') e+ery day (0i&on,
200!* 'his may be caused by so many factors includin% bud%et allocation by the
%o+ernment
>o+ernment offices by and lar%e are seen to ha+e the mandated policies and
structures to these infections #owe+er, resource limitations remain one ma2or
hindrance to maximi&e these policies and pro%rams ?or example, out of 32,6 )illion
bud%et of 2009, 6!: of it was earmar5ed for pro-poor pro%rams mainly feedin% and
medicines 'he ma2or chun5 of the balance is already earmar5ed for administrati+e
costs, plus the standard allocations to health units and their on%oin% wor5, of which ')
is a new but additional concern (/lfonso, 2010*
7ocated in 1$81E1/6>C< or 6e%ion FII of the Mindanao Island, the
municipality of 1urallah is seated about 20 5m south-west of pro+ince capital city of
Eoronadal and about 1,002 5m south-south-east of 3hilippine main capital, Manila It is
also the fastest %rowin% municipality of 1outh 8otabato (8$MC7C8, 201;*
8
/s economic acti+ities flourished in the area, more people especially
businessmen settled into the place, which contributed to a faster pace of de+elopment
Its functional role is an /lternate 3ro+incial /%ro-industrial 8enter "hile bein% a ma2or
producer of corn and rice, 1urallah has explored its +ast potential for pro%ress
#owe+er, this urbani&ation put its toll on the health of the people /ccordin% to
Mutat5ar (1999*, communicable diseases amon% the urban poor coexist with non-
communicable diseases amon% the comparati+ely affluent, thus, public health and
social problems ha+e arisen lowerin% the @uality of life
'his is e+ident in the increase of number of ') in children in 1urallah, 1outh
8otabato It consisted the 12 : of the total number of ') in 8hildren in 1outh 8otabato
(1outh 8otabato /ccomplishment 6eport, 2012*
$n the other hand, one of the %oals of this research is to determine the
demo%raphic data of selected patients who already completed the treatment re%imen
of ')
?ortunately, se+eral literatures were identified lin5in% socio-demo%raphic and
personal experiences with the default and treatment failure, thus resultin% not only to
the increase in ') cases but as well as in cases of Multi 0ru% 6esistance ')
?or instance, 5nowled%e has been cited as one of the ma2or factors contributin%
to default by most of the studies /ccordin% to )elachew (200,* in his study in Cthiopia,
poor awareness about the disease and inade@uate 5nowled%e about treatment duration
are amon% ma2or reasons for defaultin%
In addition, Eaona (200,* noted that patients in Gambia stop their medication
once they feel better Meanwhile in >ambia, hi%h rates of defaultin% were found amon%
those who were uncertain that their treatment will wor5 ()ah et al, 2009* =ncertainty
about treatment success was found to be a +ery critical factor for defaultin% in the first
90 days of treatment
9
In <epal, #ansen et al (2009* examined the contribution of socio-economic
status to non-adherence to treatment 6esults of their study re+ealed that
unemployment, low status occupation, low annual income, and cost of tra+el to the ')
treatment facility are si%nificantly associated with non-adherence to treatment 'hey
concluded that low socio-economic status and particularly lac5 of money are important
ris5 factors for non-adherence to treatment in a poor country as <epal 8han et al
(200,* in 1in%apore howe+er did not find si%nificant association between employment
status and defaultin% In sum, there seems to be a stron% support in the literature
re%ardin% the predicti+e +alue of inade@uate 5nowled%e and lac5 of social support for
default
In the 3hilippines, )lumfeld et al (1999* loo5ed into the correlations between
socio-demo%raphic and ser+ice factors and the rate of incomplete treatment and found
out that when the infectious nature of the disease and the re@uisite treatment re%imen
were explained clearly to the patient, default rates were decreased as much as 90:
Cddin% (1994* who conducted an inter+entional study in 1ibuco, Gamboan%a del <orte
li5ewise found hi%her compliance in those who recei+ed ') education
'he study of the 36I8$6 pro2ect of =1/I0 in 1999 also noted that compliers
tend to 5now more about the dru% re%imen particularly treatment duration compared to
defaulters /nother factor implicated with defaultin% amon% 0$'1 enrolled ') patients
is the distance of the residence of the patient from the treatment facility ()elachew et al,
200,* 'hose who incurred si%nificant time and money costs tra+elin% to recei+e
treatment are most li5ely to default 0istance of residence from the facility was noted to
be critical 90 days after initiation of treatment ()ah et al, 2009*
'he rele+ance of social support to defaultin% was also tac5led in the literature
'he lac5 of family support was found to be stron%ly predicti+e of default in the study of
10
8han et al (2000* in 1in%apore and /li et al (2002* in Cthiopia In <epal, )am (2006*
noted compliance beha+ior to be closely associated with the social support from family
and friends 1ocial support from health wor5ers howe+er was found to be insi%nificant
In <epal, #ansen et al (2009* examined the contribution of socio-economic
status to non-adherence to treatment 6esults of their study re+ealed that
unemployment, low status occupation, low annual income, and cost of tra+el to the ')
treatment facility are si%nificantly associated with non-adherence to treatment 'hey
concluded that low socio-economic status and particularly lac5 of money are important
ris5 factors for non-adherence to treatment in a poor country as <epal 8han et al
(200,* in 1in%apore howe+er did not find si%nificant association between employment
status and defaultin%
#owe+er, it was pro+ed that the onset of ') is si%nificantly hi%her in children In a
study conducted by Marias (200,*, he stated that disease ris5 after primary infection
with Mycobacterium tuberculosis is %reatest in infants and declines slowly to a lowest
point at a%e 9-10 years 0urin% adolescence, there is a rapid increase in ris5 with a
second pea5 between a%es 20-;0
=nderstandin% the mechanisms that cause this sudden transition are
fundamentally important because lun% ca+itations promotes disease transmission and
on%oin% transmission sustains the epidemicHthe primary e+olutionary bottlenec5 that
must be o+ercome for the patho%en to thri+e in a human population 7ittle is 5nown
about either bacterial or host features that allow transmission / prominent sex-related
difference is the early predominance of adult-type ca+itary lun% disease in women,
which can persist until a%e ;9 years 'he a%e of transition to predominance +aries, but
tends to become earlier as the incidence of tuberculosis declines (0annenber%, 2009*
11
Meanwhile, "#$ (201,* stated that in most of the world, more men than women
are dia%nosed with ') and die from it ') is ne+ertheless a leadin% infectious cause of
death amon% women /nnually, about !00 000 women die of '), and o+er three million
contract the disease, accountin% for about 1! million 0isability /d2usted 7ife Iears
(0/7I* /s tuberculosis affects women mainly in their economically and reproducti+ely
acti+e years, the impact of the disease is also stron%ly felt by their children and families
/ccordin% to >lan& (2009*, @ualitati+e and @uantitati+e analyses indicate that
patient and dia%nostic delays in ') dia%nosis and care are mediated by a constellation
of indi+idual patient factors which include demo%raphics, 5nowled%e, attitudes
beha+iors, beliefs, percei+ed barriers, s5ills, %ender, le+el of education, socioeconomic
status and so on
$lufemi (201;* in his article entitled, Awareness of the Warning Signs, Risk
Factors, and Treatment for Tuberculosis among Urban Nigerians, he stated that
the si%nificant predictors of awareness of ') warnin% si%n were increasin% a%e, bein% a
8hristian, hi%her family income, and education 'he association of increasin% a%e with
awareness of ') si%n may be attributed to increasin% 5nowled%e of ') and lifetime
experiences of close relati+e who had the disease
'he researcher also disco+ered that those who belon% to 8hristian faith were
more li5ely to be aware of ') si%n than others after ad2ustin% for confoundin% +ariable
li5e a%e, sex, income, and le+el of education ?urther sub analysis by stratification of the
reli%ion, was suffice to explain the reli%ious predisposition as 04: of the 8hristians
were uneducated compared with the Muslims that had 204: uneducated sub2ects in
this study
12
$n the other hand, bein% married to a ') positi+e patient put partners into hi%h ris5
of de+elopin% an infection In an article of 'rop Med (2011* entitled,
Married to M Tuberculosis! risk of infection and disease in s"ouses of smear "ositi#e
tuberculosis "atients, describe an extremely hi%h ris5 %roup J spouses of smear
positi+e pulmonary ') patients 'hey ha+e a hi%h pre+alence of #I-, many are
already immunocompromised and they ha+e intense contact with infectious '),
sharin% sleepin% rooms and fre@uently also nursin% the patient 'his intense
exposure and susceptibility is hi%hli%hted by the hi%h rate of initial '1' positi+ity at
baseline compared to a control %roup, the subse@uent additional '1' con+ersions,
the pre+alence of acti+e ') on screenin% and subse@uent ris5 of ')
'here is a +ast and numerous factors which exacerbate the increasin% cases of ')
in a %lobal perspecti+e #owe+er, the most crucial and misloo5ed area is the life
experiences of patients who considered to be the 5ey players of the uni+ersal
mana%ement of ')
/ccordin% to 7on% (1999*, personal experiences, percei+ed etiolo%y of the disease,
sti%ma, beliefs and attitudes associated with ') are important in health-see5in%
beha+ior
In a similar study in -ietnam re+ealed perceptions of '), each contributin% to
dia%nosis delays, to sti%ma and isolation of patients and their families 8hoice of
treatment could depend on the a+ailability of money, and +arious health care
pro+iders 0ecisions are often inKuenced by Lsi%niMcant othersL or lay referral
13
%roups 3roblems arise when health wor5ers and pro%ramme mana%ers fail to
consider social and beha+ioral factors in pro%ramme desi%n
"hen these factors are not addressed, social sufferin% from the disease can be
experienced by the patients 1ti%ma associated with tuberculosis (')* is often
re%arded as a barrier to health see5in% and a cause of social sufferin% 1ti%ma
studies are typically patient-centered, and less is 5nown about the +iews of
communities where patients reside
In a study of /tre (2011*, hestudy clarified features of ')-related sti%ma
8oncealment of disease was explained as fear of losin% social status, marital
problems and hurtful beha+ior by the community ?or the female +i%nette, heredity
was percei+ed as a cause for sti%mati&in% beha+ior Marital problems were
anticipated more for the male +i%nette /nticipation of spouse support, howe+er,
was more definite for men and conditional for women, indicatin% the +ulnerability of
women 8ommunity +iews ac5nowled%ed that both men and women with ') share
a psycholo%ical burden of unfulfilled social responsibilities 'he distinction between
public health ris5s of infection and un2ustified social isolation (sti%ma* was
ambi%uous 1uch a distinction is important for effecti+e community-based
inter+entions for early dia%nosis of ') and successful treatment
'uberculosis is lin5ed with po+erty, because of its relation with wea5ened immune
system due to poor nutrition as well as tendency of li+in% in crowded homes ')
mar%inali&es people both from a social and an economic point of +iew, experiencin%
14
social isolation both within their own family and outside of it In addition, sufferers
encounter sti%ma and discrimination, leadin% to a delayed dia%nosis and treatment
'he sti%ma of disease and the resultant discrimination impacts ') control
pro%rammes, because a patient afraid of bein% identified as a sic5 person is li5ely to
delay proper treatments ()aral N Ear5i, 200!*
'he sti%ma attached to ') has e+en more hostile conse@uences for women, which
may influence the pre+alence and pro%nosis of ') and its social implications (7on%,
Oohansson, 0iwan, N "ind5+ist, 2001* 1ic5 women face the ris5 of di+orce, or they
ha+e to accept their husbands ta5in% a second wife More fre@uently they are
literally ostraci&ed from their families until the end of the treatment )y contrast, men
sufferin% from the same disease are usually pampered by and recei+e care from
their wi+es (#udelson, 1996*
') impacts the economic producti+ity of women as it mainly affects youn% adults
between the a%es of 19-,9 1ocial, economic and cultural factors seem to influence
%ender differentials in the infection rate 'hese factors are related to tradition and
also based on sexual di+ision of labor 8ausin% them to ne%lect their household
chores and parental duties, women sic5ness may impact household routines 1ic5
men mainly worry about a loss of wa%e, while women are concerned about re2ection
and di+orce, and unmarried women worry about their opportunities of marria%e
bein% reduced (#udelson, 1996*
/ study in 'hailand disco+ers how disease-related costs ha+e an impact on ')
dia%nosis and treatment, especially in low-income households (Eamul-ratana5ul,
1awert, Eon%sil, N 7ertmaharit, 1999* 'he authors stron%ly recommend the
15
implementation of free care policies and decentrali&ation of ser+ices in order to
reduce costs for these patients ?loyd, in his article, mentions that impro+in% health
care in %eneral, and controllin% ') in particular, can lead to a positi+e impact on the
economic %rowth and, with a domino effect, conse@uently contribute to increasin%
in+estments in the health sector (?loyd, 200;*
CHAPTER III
RESEARCH DESIGN AND METHODOLOG0
'his chapter presents the +ariables of the study and the procedures that will be
underta5en in %atherin% the rele+ant data and information
Re"earch De"i$n
'he main focus of the study is to explore the life experiences of ') patients in
1urallah, 1outh 8otabato 'o %ather rich source of information, a @ualitati+e research
desi%n will be utili&ed
Re"earch Locae
'his study will be conducted at 1urallah Municipal $ffice in 1urallah, 1outh
8otabato 'his municipality is chosen because of the recommendable detection and
cure rate of the municipality when it comes to ') detection and treatment
16
17
Life E%!erience" of TB Patient" in Suraah1 South
Cotabato
3rofile of the
6espondents
/%e
1ex
Cducational
attainment
Marital 1tatus
8linical ?orm of ')
$ccupation
?inancial 1tatus
6eli%ion
7ife Cxperiences
1ufferin% caused by
the disease
Impact on familial
and 1ocial 1ettin%s
1upport from
%o+ernment health
ser+ices
0efiecient 8ultural
Enowled%e
Implication to post-
treatment life
Research Locale
1urallah Municipal #ealth
8enter
Respondents of the Study
19 patients who
completed 'b treatment
re%imen
Research Instrument
1emi-1tructured inter+iew
?>0
0ata 'reatment
8odin%
#ierarchy method
<etwor5s Method
Identification of 'hemes
HeathEducation Pro$ram on TB
)i$ure 2&
Re"earch De"i$n
Re"earch Partici!ant"
'he respondents of the study are the 19 (6* patients who ha+e completed the 6
months treatment re%imen of ') 'he number represents the total population of the
tar%et respondents, and hence, will pro+ide the complete and reliable data
Sam!in$ Method
1ince %enerali&ation in a statistical sense is not a %oal of @ualitati+e research,
purposi+e samplin% method in selectin% the informants will be utili&ed 3urposeful
samplin% is based on the assumption that the in+esti%ator wants to disco+er,
understand, and %ain insi%ht and therefore must select a sample from which the most
can be learned (Merriam, 2009* 'he lo%ic and power of purposeful samplin% lie in
selectin% information-rich cases for study in-depth Information-rich cases are those
from which one can learn a %reat deal about issues of central importance to the purpose
of the in@uiry, thus the term "ur"oseful sam"ling
3olit and )ec5 (2004* explained that in @ualitati+e studies, sample si&e should be
determined based on informational needs #ence, a %uidin% principle in samplin% is
data saturation that is samplin% to the point at which no new information is obtained and
redundancy is achie+ed 0ata @uality can also affect sample si&e If participants are
%ood informants, who are able to reflect on their experiences and communicate
effecti+ely, saturation can be achie+ed with a relati+ely small sample
18
Ethica Con"ideration
Cthical considerations raised by the present research are concerned with
obtainin% informed consent and maintainin% participants confidentiality Informed
consent is defined as Pthe +oluntary and re+ocable a%reement of a competent indi+idual
to participate in a therapeutic or research procedure, based on an ade@uate
understandin% of its nature, purpose, and implicationsQ (/22awi, and #i%%s, 200!*
Informed consent may be bro5en down into four constituent elementsA disclosure
(pro+idin% ade@uate information*, comprehension (understandin% of information*, and
competence (ability of participants to ma5e a rational decision*, and +oluntariness (no
coercion*
/ll participants will be pro+ided with information sheets detailin% the aims of the
research and the research process 'hese information sheets will be pro+ided to the
participants directly /ll participants shall be %i+en the opportunity to as5 @uestions
about the research, and shall be aware that they could withdraw from this research at
any time without ne%ati+e conse@uences "ritten consent will be obtained from each
+olunteer prior to commencement of data collection 'here shall be no existin% power
relations between the researchers and the participants that could be percei+ed as
coercion
8onfidentiality will maintained throu%h the use of pseudonyms in the research
reportin% and by chan%in% specific contextual details that could re+eal the identity of the
participants
19
Re"earch Too
/ semi-structured sur+ey %uide constructed for this study will be utili&ed to
facilitate the data %atherin% 'he semi-structured sur+ey %uide will consist of close- and
open-ended @uestions to encoura%e elaborati+e discussion #owe+er, more open-
ended @uestions will be reflected $pen-ended @uestions are @uestions that in+ite free
ran%in% responses, sometimes called +erbatim responses 1uch responses are
extremely useful for obtainin% a deep understandin% of the participants +iews and
beha+ior but they are difficult to capture precisely (the respondent may %i+e a lon%
winded answer that is shortened by the inter+iewer* and are time consumin% to analy&e
'hey are only suited to @ualitati+e and small @uantitati+e sur+eys
0urin% the construction of the semi-structured sur+ey @uestionnaire, the
researcher will constantly and critically immerse the main purpose and the pre-defined
research @uestions of the present study 'his will ensure that the semi-structured sur+ey
%uide co+ers all the necessary points and it will %enerate a rou%h topic list which will
e+entually be con+erted into more explicit @uestions
'aidation of the Re"earch Too
8ontent +alidation of the prepared semi-structured sur+ey @uestionnaire will be
done by submittin% it to the research ad+iser for any su%%estion ?ace +alidation will
also be done by as5in% by as5in% fi+e eli%ible informants whether they can clearly
understand what each @uestion is tryin% to assess 'he su%%estions and the
recommendations of the +alidators will be incorporated in the re+ision of the said
20
@uestionnaire / trial inter+iew will be conducted after the face +alidation has been
accomplished
Data Gatherin$ Procedure"
/ co+er letter explainin% the research purpose will be pro+ided amon%
prospecti+e and eli%ible participants 'his will enable them to ma5e informed choices
whether to participate or not in the actual data %atherin% Informed consents will also be
pro+ided upon acceptance of intent to participate
/n inter+iew utili&in% the semi-structured inter+iew %uide will be conducted to
initiate the %atherin% of information Ea2ornboon (2006* explained that the researcher or
the inter+iewer often uses open @uestions durin% in-depth inter+iews 0ata is collected
from the inter+iewee 'he researcher needs to remember the inter+iewers +iews about
the topic are not of importance 'he inter+iewee or informant is the primary source of
data for the study
0urin% the in-depth inter+iews, data will be transcribed in audio tapes to facilitate
re+iewin% of participants experiences durin% the analysis and discussion )ailey (2004*
elaborates that many @ualitati+e studies collect audio or +ideo data (e% recordin%s of
inter+iews, focus %roups or tal5 in consultation*, and these are usually transcribed into
written form for closer study 'ranscribin% appears to be a strai%htforward technical tas5,
but in fact in+ol+es 2ud%ments about what le+el of detail to choose (e% omittin% non-
+erbal dimensions of interaction*, data interpretation (e% distin%uishin% RI donLt, no from
RI donLt 5now* and data representation (e% representin% the +erbali&ation Rhwarryuhh
as R#ow are youD*
21
Data Ana#"i"
In 5eepin% with the methodolo%y adopted in this research, data analysis methods
will be de+eloped from phenomenolo%ical and hermeneutic principles and from
%uidelines in the literature about systematic, useful ways of interpretin% research data
'hrou%hout all sta%es of the data analysis there shall be on%oin% interpretation of the
research text and the phenomenon of learnin% to communicate clinical reasonin% More
specifically, thematic analysis will be implemented in obtainin% and interpretin% the
%athered data
'he first step is to prepare the data for analysis 'he researcher will ensure that
e+ery in-depth inter+iew will be transcribed in audio recordin% media and then into text
and format so that the mar%in could be used for identifyin% indi+idual bits of data 'his
can be done by assi%nin% line numbers as identifiers for cross referencin% 1econd step
is to read the text and notin% items of interest /n inducti+e approach to thematic
analysis allows themes to emer%e from the data, rather than searchin% for pre-defined
themes 0urin% the first readin% the researcher will ma5e note of ma2or issues as they
come to mind in order to ac@uire a sense of the +arious topics embedded in the data
'he third step is to sort items of interest into proto-themes 'his is where themes
be%in to emer%e by or%ani&in% items relatin% to similar topics into cate%ories
8omputers are %reat for pastin% the line references to%ether 'his should be a fluid
process so cate%ories can be modified, de+eloped and new ones allowed to emer%e
freely /t this sta%e 5eepin% the themes as simple as possible assists flexibility in the
cate%ori&ation process whereby any re-orderin% of the clusters of cate%ories can help
create and re-define the initial themes
22
'he fourth step is to examine the proto-themes and attempt initial definitions
'his phase of trawlin% bac5 throu%h the data examines how information was assi%ned
to each proto-theme in order to e+aluate its current meanin% / pro+isional name and
flexible definition should then be created for each emer%in% theme
'he fifth step is to re-examine the text carefully for rele+ant incidents of data for
each proto-theme 'a5in% each theme separately and re-examinin% the ori%inal data for
information relatin% to that theme is a +ital sta%e in the analytic process because human
perception is selecti+e and the rele+ance of data can be easily o+erloo5ed
?urthermore, pieces of data pre+iously assi%ned to a theme may in fact be
contradictory
'he sixth step is to construct the final form of each theme 'his sta%e of re-
contextuali&ation focuses more closely upon the underlyin% meanin% of each theme
'he last step that the researcher will underta5e is the reportin% of each theme
'he researcher will finali&e the name of each theme, write its description and illustrate it
with a few @uotations from the ori%inal text to help communicate its meanin% to the
reader
23
A!!endi% A
SEMI3STR*CT*RED S*R'E0 4*ESTIONNAIRE
Date5 666666666666666666666666666666666666666666666666666666
Time5 666666666666666666666666666666666666666666666666666666
'enue5 66666666666666666666666666666666666666666666666666666
Inter.ie+er5 6666666666666666666666666666666666666666666666666
Orientation
Obecti!e"
'o find explore the counselin% experiences of <otre 0ame of 0adian%as
=ni+ersity >uidance 8ounselor
Acti.it# Pro!er
Note! This should not be less than forty$fi#e %&'( minutes but not more than
ninety %)*( minutes This is to ensure the +uality of the information gathered
Demo$ra!hic Profie of Patient
24
/%eASSSSSSSSSSSSSS
1exASSSSSSSSSSSSSS
Cducational /ttainmentASSSSSSSSSSSSSSSSSSSSSSSSSSSSS
Marital 1tatusASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
8linical ?orm of ')ASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
$ccupationASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
?inancial 1tatusASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
6eli%ionASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
Guide 4ue"tion" 7In"truction"8
1 0id you experience sufferin% durin% the entire treatment re%imenD "hat are some of
these sufferin%sD
2 "hat is the impact of ') in your relationship with your family and societyD
3articularly, how does it affect your
a 1ocial obli%ationB
b ?amily obli%ationB
c OobB
d 1ense of fulfillmentB
e $thersD
; 0id you recei+e any support from the %o+ernment especially durin% the period of
your treatmentD
, 0id you experience bein% sti%mati&ed because of deficient cultural 5nowled%e
towards ')D
5. "hat is the implication of ') to your post-treatment lifeD
Summar# of Di"cu""ion Point"
Co"in$ Remar,"
25
Co"in$ Pra#er
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