Japón

3.5.1 Sampling

Choosing a study sample is an important step in any research project since it is rarely practical, efficient or ethical to study whole populations (Marshall, 1996:522).

The choice between quantitative and qualitative research methods should be determined by the research question. The aim of the quantitative approach is to test pre-determined hypotheses and produce generalizable results. Such studies are useful for answering more mechanistic 'what?' questions. Qualitative studies aim to provide illumination and understanding of complex psychosocial issues and are most useful for answering humanistic 'why?' and 'how?' questions, (Byrne, 2001: 494).

The study adopted random sampling as a method for sampling in responding to the research question. In a random sample the nature of the population is not defined and all members have an equal chance of selection (Marshall, 1996: 522).

In selecting the sample, there was no criterion used to purposefully include or exclude participants in terms of age, sex, race and educational history to determine whether they would form part of the study. This sampling method can be contrasted with purposive sampling where participants in a research study are hand-picked subjects on the basis of

specific characteristics and are excluded if there is a deviance from these characteristics, (Black, 1999: 188).

The only criterion used in the study is that participants had to be above the age of 18. The age of 18 is the age of full legal capacity in South African and therefore this was considered in order for participants to give legal consent for them to participate in the research study.

Participants formed part of the study because they visited the places which had been identified as research sites. No demographic data was recorded. The rationale behind this is because the study is not concerned with the existence and effects on language barriers in the healthcare system on a particular grouping but rather whether these exist in general, across racial and linguistic groups, and if language barriers do exist, the circumstances under which these occurred, regardless of the biographical make-up of the patient.

The healthcare providers who participated in the research study were from primary healthcare facilities in Grahamstown and Cofimvaba. All healthcare providers at the respective healthcare facilities were asked to avail themselves for interviews. They were requested to avail themselves by virtue of their profession as healthcare providers which formed the basis for the study. They were also selected based on the area in which they worked in as healthcare providers e.g. Out Patients Unit, Emergency Room, Counselling Centre, Dispensary etc. this was done in order to cover most or all areas within the healthcare facilities.

The study was explained to them and they were requested to give their consent to be interviewed. Out of the doctors requested to avail themselves, only one doctor at Settlers Hospital in Grahamstown refused to be interviewed citing her busy schedule. Another doctor, also at Settlers Hospital, also in Grahamstown, had availed himself but had a change of schedule and had to go on leave during the time I was conducting the interviews at this research site. The inclusion criterion of the healthcare providers was based on their willingness and availability to form part of the study. There was no exclusion criterion for any of the healthcare providers.

The healthcare providers who participated in the study were asked questions related to their language proficiency and their ranking within the medical hierarchy.

The language proficiency of the healthcare providers was asked to determine the languages spoken or used by healthcare providers in these two healthcare facilities. This question also helped draw out the home language of the healthcare provider in relation to that of the patients and whether these could affect their ability to provide healthcare service successfully to their patients. Factors such as the doctor's experience in medicine, hierarchy in the organization and level of interaction with patients were perceived as possibly affecting the doctors' communication with their patients.

Patients were approached while waiting for consultation with their healthcare providers in the selected primary healthcare facilities in Grahamstown and Cofimvaba. Others were approached after medical consultations. The study was explained to them and they were requested to give their consent to become participants in the research study. None of the patients approached refused to be participants in this research study. The only criterion for the participation of patients was their willingness and availability.

Patients participating in the study were asked questions related to their home language and language proficiency in other languages such as English which were commonly used languages in the healthcare sector and how that affected their ability to access their healthcare services.

3.5.2 Sample Size

In Cofimvaba the sites were the Sabalele Clinic, the Banzi Clinic and the Cofimvaba Hospital, and in Grahamstown fieldwork was conducted at the Rhodes University Health Centre, Settlers Day Hospital and Settlers Hospital.

a. Cofimvaba

I conducted 15 semi-structured interviews with 20 participants in Cofimvaba. Below is a summary of the interviews conducted at this research site:

Table 1: Interviews conducted in Cofimvaba Healthcare

facility

Healthcare providers

Patients Total participant

interviews

Sabalele Clinic 2 2 4

Banzi Clinic 1 2 3

Cofimvaba hospital

7 1 focus group interview of (6)

participants

8

Total 10 10 15

Seven of the 15 interviews were done at the local community healthcare centres. Four at Sabalele clinic (two nurses and two patients) and I conducted three interviews in Banzi which consisted of one nurse and two patients. The hospital itself is serviced by only four doctors, of which I could interview three. I also interviewed four nurses and six patients in a focus group interview. This brings the total number of interviews to 15 covering 20 participants.

a. G ra h a m sto w n

I conducted 20 semi-structured interviews with 26 participants in Grahamstown. Below is a summary of the interviews conducted at this research site:

Table 2: Interviews Conducted in Grahamstown

Healthcare facility Healthcare providers Patients Total participant interviews

RU Healthcare center 1 Focus group interview of (4) participants

2 3

Settlers Day Hospital 1 Focus group interview of (4) participants

1 2

Settlers hospital Four doctors, three nurses and one pharmacist (8)

7 15

Fifteen of these interviews were conducted at the Settlers Hospital (Four doctors, three nurses, one pharmacist and seven patients). I conducted one focus group interview at the Rhodes University (RU) Healthcare Centre and another focus group at the Settlers Day Hospital. Both these focus groups comprised four healthcare providers. Two patients were interviewed at the Rhodes University (RU) Healthcare Centre and one patient at the Settlers Day hospital. This brings the total number of interviews to 20 covering 26 participants.

There were, therefore a total of 35 interviews conducted, covering 46 participants for this study. Of the total of 46 participants, 26 were from Grahamstown and 20 were from Cofimvaba.

One of the first questions experimental researchers need to consider in planning a study is the sample size. The availability and feasibility of collecting data from the sample is of prime consideration. The cost of collecting data and the number of units required will set the outer limit on the sample size (Marshall, 1996:523).

The first category is whether the research question is about an overall indicator (an omnibus) or targeted effect. The second category is whether the goal is to determine a point estimate that requires the calculation of statistical power or if it is a confidence interval that requires the calculation of accuracy. In the second category a power estimate is needed to test the null hypothesis i.e. that a specific value is different from zero (Marshall, 1996: 523).

Two major factors affected the sample size. Firstly it was the availability of potential participants and the willingness of potential participants to take part in the study as research subjects. All patients who were approached were willing and available to participate in the study. Some interviews therefore took place while a patient is waiting to be assisted and in some cases, interviews took place as patients come out of seeing the doctors or healthcare providers. Other interviews took place while patients were in their patient wards.

No attempt was made in this study to correlate language or illness with age, class, occupation or any other sociological factor. Rather, the goal was to achieve a rich description of the barriers to care that are experiences by participants. However, it is acknowledged that no qualitative data acquired from a small group can be assumed to represent any other group fully.

This number of language interviews enabled a representative sample of the major problems which the participants face in their quest to access their healthcare. The sample size however is not sufficient to define subgroups within the groups to look at which factors may make it more difficult or easier for a subgroup to get good medical care.

The demographic data on the concerned areas of the healthcare facilities is presented in the next section. This information is provided to be able to draw conclusions of the findings on language and its effects in accessing critical social services in the two different demographic settings selected for this study. The demographic data which was collected focused on the population size of the areas, the languages spoken, socio-economic conditions and state of the public healthcare are presented in order for readers to be able to draw conclusions on language issues in these areas based on their demographics.