CAPÍTULO IV: ANALISIS E INTERPRETACIÓN DE LOS RESULTADOS
4.2. Acoso escolar
To select a sample of HCPs to participate in the ES part of the study, I returned to the original list that I compiled for the PNES part of the study. During the PNES part of the study, it became evident that GPs play a significant role in the diagnosis and treatment of seizures due to the lack of available specialists. Whereas I sought GPs with specializations in the PNES part of the study based on the demographics of previous studies performed on PNES, this seemed less crucial for the part of the study that would to focus purely on seizures and specifically ES. Due to the nature of ES and its organic pathology, it was deemed less likely that patients would be diagnosed by mental healthcare practitioners. For this reason, psychologists and psychiatrists were not included in the ES part of the study. I subsequently reviewed the original list by updating some entries, adding some new ones and deleting the ones that were undeliverable or not applicable.
Once the list of possible service providers had been compiled, I identified the
participants who would be invited to participate in the qualitative and quantitative phases of the data collection process for ES. Interview participants were identified by being accessible in and around the major towns in Namibia due to logistical and time constraints.
The final list consisted of 71 candidates who were invited to complete the survey and 20 candidates who were invited to participate in the interview phase of the study. Data collection started during May 2017 and was completed by August 2017.
3.5.1 HCP perceptions of and experiences with the management of ES.
Twenty HCPs were invited to participate in the qualitative phase of the ES part of the study. This included two neurologists, one gynaecologist and 17 GPs. I was given an opportunity to present the results of the PNES part of the study at a Continuous Professional Development (CPD) event for HCPs. The CPD event allowed me the opportunity to invite HCPs to participate in the ES part of the study. The event was attended by 95 people from various disciplines, of which approximately 20 were GPs. During this event, seven HCPs indicated their willingness to participate in interviews for the ES part of the study. These candidates were contacted
telephonically to arrange a meeting at a time and place that suited them. In five cases, documentation packs were hand-delivered to their offices before the arranged date of the
(2) informed consent form (see Appendix C2), (3) biographical questionnaire (see Appendix B2), (4) semi-structured interview questions (see Appendix C3) and (5) ES survey for HCPs (see Appendix C4). In two cases the HCPs practised in other towns and the information was e-mailed to the HCPs. The remaining 13 HCPs who had been identified as possible candidates for
interviews, were first contacted telephonically to enquire whether they would consider participating in the study. In cases where the answer was favourable, the same procedure was followed as described above. Documentation packs were hand-delivered before the interview if the HCP was located in Windhoek and it was e-mailed if they were practising outside of
Windhoek. All HCPs were contacted by telephone to ensure that the relevant documentation was received in good order and to confirm the appointment. All the HCPs were interviewed at their consulting rooms.
Ultimately, semi-structured interviews were conducted with 15 participants. The total number of interviews depended on data saturation, and by the fifteenth interview themes started repeating and no new information was emerging (Lincoln & Guba, 1985).
Before conducting the interview, the relevance and purpose of the study were explained to the HCP and questions regarding the research were answered. The HCP was then asked to read and sign the informed consent form (see Appendix C2) and to complete the biographical questionnaire that explored the HCP’s qualification, speciality (if any), years in practice and location (see Appendix B2). Permission was requested from the HCP to record the interview for transcription purposes. Once permission had been obtained from the HCP, the researcher commenced with the interview (see Appendix C3). The semi-structured interview consisted of broad, open-ended questions that are based on the ES survey for HCPs, which was developed to explore the diagnostic and treatment practices of HCPs. I aimed to gather more detailed
information and personal opinion regarding the diagnosis and treatment practices used for specifically ES in Namibia. Participants were prompted to elaborate on their perceptions and experiences during the interview process.
The following questions were used to guide the interviews: 1. Tell me about your work with patients with seizures.
2. What are the complexities involved in making a diagnosis and treating seizures? 3. What are the general attitudes/reactions when people are diagnosed with epilepsy? 4. What do you think is the role of THPs in the management of seizures?
5. What would you say one should focus on in a study of this nature?
Probing techniques were used during the interviews to obtain as much information as possible from each participant. Interviews lasted approximately 40 minutes. Each interview ended by thanking the HCP for their time and willingness to participate in the study. Participants
were informed that a transcript of the interview would be e-mailed to their personal e-mail address to enable them to verify and correct any information.
3.5.2 Current diagnostic and treatment practices for ES in Namibia.
After enquiring from leading researchers in the field of PNES and ES, I was informed that the ILAE does not have a survey for ES that is similar to the ILAE PNES TF Survey for HCPs. After collaborating with my promoter, I decided to adapt the ILAE PNES TF Survey for epilepsy. The main structure of the survey was retained. However, it was shortened from 38 to 27 questions as HCPs felt that the PNES version was very long and sometimes overly
complicated. Questions were further ratified to incorporate ES terminology and aetiology. A question regarding THPs was added in line with the research aims of the present study. In essence, the survey still aimed to gather information on diagnostic techniques and treatment practices used by HCPs in the management of seizures (see Appendix C4). The purpose of the questionnaire was to collect data for descriptive purposes and it is therefore not standardized. The original PNES survey is available in the public domain. The multi-item scales were retained and the questionnaire measures the following five dimensions: (a) the professional role of the HCP and their exposure to ES; (b) diagnostic services for patients with ES; (c) management of ES; (d) aetiological factors; and (e) problems accessing healthcare.
The first round of invitations was e-mailed to 43 GPs across the country and one neurologist. The mail included a description of the purpose and relevance of the study and explained how the HCP could access the electronic survey, which was created on Survey Monkey (see Appendix C5). The official letter of invitation to HCPs re ES (see Appendix C1) was attached to the mail and indicated the link to the electronic survey. The electronic survey included two sections that covered the informed consent section of the questionnaire (see Appendix C2). The informed consent was divided across two sections in the electronic survey due to word limits in Survey Monkey. Participants were also given the option of printing and mailing the questionnaire if it could not be completed electronically. Seven of the e-mails were undeliverable, and two responses were received from the remaining 36 invitations.
At the CPD event for HCPs, 15 questionnaires were distributed of which 11 were completed. Another 20 questionnaires were hand-delivered to various HCP practices across Windhoek, as well as Rehoboth and Okahandja, the two towns closest to Windhoek. Of these, 12 were completed, bringing the total to 71 questionnaires distributed and 25 completed, a response rate of 35.21 per cent.
3.5.3 THPs’ perceptions of and experiences with the management of seizures.
Finding THPs to participate in the semi-structured interview phase of the study proved challenging. THPs were not asked to complete the questionnaires as the survey focused on the
biomedical services available to seizure patients in Namibia and aimed to gather information on the healthcare infrastructure in the country. As a result of failure to establish contact with the two informal THP organizations, I had to resort to alternative measures to identify possible
participants. It became evident from the interviews with the HCPs and some of my Oshivambo colleagues that the healers seem to be more active in the rural areas. This can be explained by the near absence of biomedical facilities in the rural regions as well as the prevailing cultural beliefs in the less populated areas of Namibia. Seeing that Windhoek is mainly urban, biomedical facilities are more accessible, and popular beliefs tend to be more westernized. Although traditional healers regularly advertise in local newspapers, I was sceptical to contact the
advertisers, as the healer fraternity is sometimes fraught with impostors (Insight Namibia, 2006). Instead, I had to rely on my social and professional contacts in an attempt to identify possible participants. This proved both laborious and time-consuming.
The process of identifying THPs was truly a process of snowball sampling. The first lead on a healer came via an Oshivambo friend. This healer supplied a telephone number of one other healer, who was in turn able to supply me with a list of other healers and telephone numbers. Many of the numbers were unreachable, but some worked and I was able to arrange meetings with some of them. These healers again provided names of other THPs who I contacted with varying degrees of success. Some agreed to participate subsequent to a telephone call, others were sceptical and suspicious and appointments were often not kept or the THP could not be reached on the day of the appointment. Possible participants were invited telephonically and the purpose of the study was explained verbally.
Ultimately, of the 36 healers identified, 21 were telephonically contacted, appointments were scheduled with 16 and eventual interviews conducted with 11. If the THP agreed to take part in the study, a meeting was arranged at a time and place that suited the THP. All the participants were met at their homes. In some cases I was accompanied by a healer who had a good command of the English Language and who was able to assist in clarifying some of the terms used during the interviews. The total number of interviews ultimately depended on
theoretical saturation, and by the eleventh interview, various themes started had repeating and no new information was emerging (Lincoln & Guba, 1985).
Before conducting the interview, the relevance and purpose of the study were explained to the THP and questions regarding the research were answered. The THP was then asked to read and sign the informed consent form (see Appendix D1) and to complete the biographical
questionnaire that explored the THP’s qualification (if any), speciality, years in practice and location (see Appendix D2). Permission was requested from the THP to record the interview for purposes of transcription. Once permission had been obtained from the THP, the researcher commenced with the interview (see Appendix D3). The semi-structured interview consisted of
broad, open-ended questions that explored the diagnostic and treatment practices of THPs regarding seizures. It aimed to gather detailed information and personal opinion regarding the diagnosis and treatment practices used for seizures among THPs in Namibia. Participants were prompted to elaborate on their perceptions and experiences during the interview process.
The following questions were used to guide the interviews:
1. What do you classify as a seizure and what do you think are the possible causes? 2. How do you explain the seizures to the patient and what is their reaction? 3. How do you treat seizures? How successful is it?
4. What kind of contact do you have with western doctors or hospitals and do you think Western medicine can work for seizures?
5. In your opinion, what problems do people with seizures experience?
Probing techniques were used during the interviews to obtain as much information as possible from each participant. Interviews lasted 30 minutes in some cases and up to two hours or more in others. Each interview ended by thanking the THP for their time and willingness to participate in the study.
3.6. Quantitative Data Analysis
The internet-based survey platform, Survey Monkey, was used to collect responses. Data from the Survey Monkey compilation software were reformatted as an MS Excel spreadsheet. Questionnaires where more than 50 per cent of the items were incomplete were excluded from the analyses. In preparation for analysis, the data were coded, entered and cleaned. The data were analysed using descriptive statistics. Frequencies and percentages were tabulated for the
categorical variables. Continuous variables were reported as means and ranges. Findings were reported in the form of frequency distributions and percentages, as well as means and ranges, to summarize the current diagnostic and treatment regimens used by HCPs in Namibia.
Descriptive statistics were used to arrive at conclusions regarding the following aims and objectives:
1. the nature of the conventional diagnostic and treatment services available to patients suffering from seizures in Namibia;
2. post-diagnostic instructions to patients diagnosed with seizures; and
3.