We employed three major strategies for recruiting participants in our study. First, we used “formal networks” to recruit an initial list of key stakeholders. Participants of formal networks use particular services or are part of a common community of interest (Hennick, Hutter et al. 2011). In our case, we recruited participants who were connected in some way to the P4HB® program. A similar and well-known recruitment strategy is called purposive sampling, whereby participants are recruited based on selected set of criteria, which in this case would be the involvement in and knowledge of P4HB® (Patton 2008).
We began recruiting participants who were part of Georgia’s state public health and health services community. This list included state DCH (Medicaid) and DPH (Public Health) officials. Due to the researcher’s position at Emory University and past research experience, the research had established relationships with each of these state health agencies. Therefore, this formal network was the most obvious one with which to start recruitment. After introductory emails to prospective informants about the study, initial interviews were scheduled with current Medicaid officials with primary
responsibility and oversight of the P4HB® program. In addition, a few key interviews with advocates were scheduled based on prior knowledge of their P4HB® experience as well.
We used a second recruitment strategy known as the snowball method. “Snowballing” is also known as “chain sampling” whereby participants with specific characteristics who may be difficult to identify or who are unknown to the recruiters can be approached. The snowball strategy involves asking a study participant or key
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informant whether they know anyone else who meets the study criteria and asking them to refer this person to the researcher (Hennick, al., 2011). We used this snowballing method during our interviews with public health contacts and some advocates to help us connect to providers and provider organizations, such as GOGS, GAFP, and local title X providers whom we interviewed. Our contacts at DCH provided linkages as well to each of the three care management organizations (CMOs) that serve P4HB® clients
We employed a third and final recruitment strategy, which was the use of gatekeepers. Gatekeepers are people who have a significant and recognized role in the local community and knowledge about the characteristics of community members. In our case, we sought gatekeepers who had: a) knowledge of P4HB® participants and
providers; and b) access to these participants and can communicate with them on our behalf. The CMOs were one type of gatekeepers that assisted us in recruitment of the focus groups. Each of the CMOs mailed DCH-approved flyers advertising the availability of the focus groups to their current P4HB® enrollees. One CMO was also instrumental in providing access to one of its Resource Mothers who was interviewed for the study. Another type of gatekeeper we used was the state Title X program, which facilitated access to its family planning women’s health coordinators and providers. The Title X women’s health coordinators completed the provider survey as well as assisted with introducing us to providers at the local health departments who managed the local family planning programs. With these connections, we were able to establish sites for six of the focus groups, and to conduct four interviews with local Title X providers.
For the interviews, described in more detail below, we recruited study participants and conducted analyses of the information concurrently. Therefore, we stopped
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recruitment when data saturation was achieved or further recruitment as not possible. Data saturation in qualitative studies occurs when the researchers no longer “hears” or learns new information (Grady, 2003). Indeed, the saturation of our interview data determined our sample size. However, as noted by Charmaz (2006), oftentimes the sample size is determined by the study aims. Since our aims were relatively
straightforward, whereby we asked informants to describe their involvement and experience with the implementation of P4HB®, we achieved saturation rather quickly. Also, as noted in the proposal, we used a stakeholder mapping form to help us keep track of our participant recruitment, (see Appendix B). This form was adapted from the USAID Health Policy Initiative (USAID, 2010). More information about data analysis is
provided below.
Table 3 summarizes data collection for the entire study, which included a total of 21 interviews with 24 informants, six focus groups with 49 participants, surveys from 104 participants, and over 20 document or web-site reviews. The table describes each of the data collection methods by recruitment strategy (where applicable). Following the table is an in-depth description of each data collection method.
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Table 3: Summary of Data Collection, by Recruitment Strategy
Data Collection Method Recruitment Strategy Number of Participants/Observations Informant interviews Formal Networks
Medicaid Title X MCH Advocates Snowball Medicaid Title X MCH Advocates Gatekeepers CMOs
State Title X program
GA OBGYN Society
GA Academy of Family Physicians
21 participants
Focus groups Gatekeepers 6 focus groups with a total of 49 participants
Provider surveys Gatekeepers
CMOs
State Title X program
GA OBGYN Society
GA Academy of Family Physicians
104 participants
Document reviews Formal networks
Medicaid
CMOs
20+ observations including the following:
-P4HB® Concept Paper
-P4HB® marketing plans & budgets -P4HB® outreach/communications plan -P4HB® 2011 and 2012 quarterly reports
-P4HB® website
-Medicaid and CMO P4HB® provider materials
-P4HB® advertising materials (postcards, billboards, flyers)
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