Investigating a Qualitative Research Study Exploring the Experiences of Patients with HIV and Type 2 Diabetes (T2D): Qualitative Research Case Study, NUS, Singapore

Task overview

For this task, you will be investigating a qualitative research study exploring the experiences of patients with HIV and Type 2 Diabetes (T2D) multimorbidity in Cape Town (Republic of South Africa). Your investigation aims to use interview transcripts from this study to answer the following research question:

• How do patients with HIV & Type 2 Diabetes (T2D) experience health services in Cape Town, and how do they perceive their needs?

Interview transcripts to analyze

For the purposes of this case study you are going to analyze two interview transcripts:

1. Participant P4 – 55-60-year-old male – See attached.
2. Participant P6 – 50-55-year-old female –See attached.

How to approach the task

1. Critique the methods – read the information provided about how the study was designed and conducted. Evaluate the strengths and potential weaknesses or limitations of the study design and methods used, in the context of a qualitative study. Support the points that you make with reference to relevant sources, e.g. qualitative research methods textbooks or journal articles.

2. Conduct a thematic analysis of the interview transcripts provided. This process is explored in detail in the qualitative research teaching materials.

3. Some issues you may wish to consider when undertaking the thematic analysis include:

• Your approach to coding: are you taking a deductive approach applying codes from the theory underpinning the study (the Complex Cumulative Model – see study methods), or an inductive approach deriving codes from the data or a combination of the two?
• Clear definition of your codes and themes: ensure that they are unambiguous and distinct from one another. Themes should be logically constructed from the underlying codes and data quotes.
• Consider visualizing the final thematic structure to aid the reader in understanding your findings: e.g. in a ‘code tree’ or word cloud

4. Interpret your findings

• summarise the key themes that you have identified from the data, relate these to the existing literature, and explain what you have found in your own words, in the context of the original study question.

5. Draw a conclusion

• what are the implications of these findings? Recognize the subjective nature of qualitative analysis (reflexivity): to what extent has your involvement and perceptions of the topic influenced your analysis and interpretation of the data? What assumptions and biases may have influenced your research process?

Advice on writing up this patch

You have 1250 words for this patch. Whilst you are free to present the work in whichever way you wish, we recommend the following structure:

1. Evaluation and critique of the qualitative methods and research processes used in the study, in the context of this research question (approx 500 words)
2. Presentation and interpretation of your qualitative thematic analysis of the interview transcript, leading to an overall conclusion (Approx 750 words)
3. References using the Harvard system: not included in the word count

Overview

Current South African health policy proposes the integration of primary healthcare chronic services for better outcomes for chronic conditions. However, there is little data on how patients with chronic multi-morbidities (i.e. multiple chronic health conditions) experience health services, and what their perceived needs are so that the management of their conditions can be enhanced. In this study, HIV and Type 2 Diabetes (T2D) multi-morbidity was used to illustrate the complexities faced by ineffective management of the conditions by patients. HIV and T2D are the top two causes of mortality in Western Cape Province. A mix of phenomenology and grounded theory underpinned the study.

Sampling

Participants were selected using purposive sampling from two public sector clinics situated in Khayelitsha, a peri-urban, largely informal township of predominantly black, Xhosa-speaking South Africans in Cape Town.

• Ubuntu clinic provides HIV & tuberculosis services
• Site B community health clinic provides primary health care for all other diseases, including type two diabetes

Inclusion criteria for patient participants included:

• Having both HIV and T2D multi-morbidity
• Having initiated antiretroviral therapy (ART) and also on treatment for T2D
• Aged 35-65 years old (those below 35 years old have a higher chance of having type 1 diabetes, and those above 65 are the least affected in this setting)
• Capable and willing to provide informed consent
• Willing to be interviewed in simple English

Fourteen patients were approached, and 10 patient-participants (5 male and 5 female) provided consent and were recruited to the study. (To keep the dataset manageable for this task, you are only required to analyse 2 of the interview transcripts – see the Task overview for details of which interview transcripts to use).

Interviews

Participants took part in in-depth, one-on-one, semi-structured interviews that drew subjective lived experiences and perspectives of managing HIV and T2D multi-morbidity.

Interviews were guided by a semi-structured questionnaire based on the themes of the Complex Cumulative Model (Shippee et al, 2012), exploring the concepts of “patient workload” and “patient capacity”. The interview schedule is shown below:

• Please tell me a story of what happens on a day you visit the clinic – from the time you wake up until you leave the clinic.
• What do you like best? How can things be done differently for you to be satisfied during your clinic visit?
• May you tell me how you are managing/handling your health at home.
• What can you think of, that can make it less difficult/easier to manage your health?
• How well do you think you are managing your health along with the other everyday responsibilities you have? What would you say is working well for you? And what is not working so well? Please explain and give your reasons.
  F. If you have had any side effects to the medication, can you explain one of your experiences? What may have happened and what helped you to pull through?
  OR
  If you have had no side effects to the medication, can you explain what may have helped you to stay healthy?
• Since having these health problems what would you say to any other person who also has chronic conditions?
• Is there anything else you would like to tell me about your health and how you are coping with caring for yourself?

Each interview was face to face, held in confidence in a private room, audiotaped, and lasted for approximately an hour. A translator was present in each patient-participant interview to provide translation assistance when the participant needed to ask or answer questions in the vernacular (i.e. their first language of Xhosa). Interviews’ transcriptions were done verbatim and in English. After every interview, field notes were made to identify areas that may need further probing in subsequent interviews.