Data collection was conducted through two separate focus group meetings, one for the School of Medicine graduates and one for the School of Nursing graduates, followed by individual in-depth interviews.
A personalized invitation to participate in the research was initially emailed by a colleague to five randomly selected graduates on the alumni listings from each School.
The colleague then followed up the email invitation with a phone call to ask invitees to check their emails. Bahraini culture favours verbal interpersonal communication over the written word as the culturally accepted norm, discussed further below in section 3.10.1.a. The participants already knew me due to my student-centred role within the university and I separated my researcher role from my professional role through the medium of
reflexivity, previously discussed in section 3.5. To avoid the participants feeling a sense of obligation to participate because they knew me (Oliver, 2003), I placed a deadline for confirmation on the initial invitation to participate; the assumption was that anyone not wishing to participate did not have to be placed in the uncomfortable position of declining, they just did not have to respond. If there were not enough confirmations by the deadline, another invitation would be sent out to a different graduate, and so on, until the total number of ten participants, five from each School, was achieved.
When a participant confirmed, she was sent an information sheet (Appendix 1) and a consent form (Appendix 2) by email, with an invitation to attend an hour long audio-
recorded focus group meeting on campus together with the four other graduates from her School. The participants were advised that following the focus group meeting they would be invited back to attend an audio-recorded individual interview of approximately one hour duration. Participant confidentiality was emphasized, and participants were assigned pseudonyms to protect their identity, with due sensitivity to cultural context being considered in assigning an Arabic pseudonym.
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Below is the list of participant pseudonyms used in this study:
Table 3.2. List of participants’ Arabic pseudonyms
3.8.1 The Focus Groups
Two separate focus group meetings were held, one for the School of Medicine graduates and one for the School of Nursing graduates. Five participants in each group are
considered a satisfactory number for a focus group meeting (Kitzinger, 1995). There were two reasons for holding separate focus group meetings.
The first was that socialized power relations are said to favour the dominance of doctors in healthcare professions globally, indicating a subtle structure of medical hegemony (Burford et al., 2013; Cheng & Yang, 2015; Coombs & Ersser, 2004) which could possibly influence and intimidate the voices (Grebennikov & Shah, 2012) of the nursing
participants in a joint focus group meeting, in particular as the medical graduates would be expected to communicate in English more confidently than the nursing graduates due to their professional training.
School of Medicine • Asal • Shireen • Amal • Hala • Mai School of Nursing • Lulwa • Dana • Sara • Farah • Noor
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Secondly, participants from the School of Nursing were mostly sponsored by the Bahraini government to study nursing, as explained in the Introduction, and would normally come from less affluent socio-economic backgrounds than the privately funded medical
students. A segmentation of focus groups would therefore provide a more comfortable environment for participants in order to encourage response and free expression (Kiener, Green, Ahuna & McCluskey, 2013; Krueger & Casey, 2009; Kvale, 1996).
The objective of the focus group meetings was to encourage interactive exploration of the participants’ experiences of the phenomena of transnational medical and nursing
education, with questions (n=10) (Appendix 3) aimed to stimulate and guide reflection. The participants in the focus groups knew each other previously from their university programme, as total class size by year did not exceed 120 students in either School. Some of the participants still saw each other frequently in their clinical practice, as there are only three key government hospitals in Bahrain. Working with participants who are acquainted can assist with issues of self-disclosure as the participants are already known to each other, they can relate to comments made by others, and can also confirm past shared experiences as valid (Krueger & Casey, 2009). Considered an excellent approach for feminist research (Wilkinson, 1998), the focus groups provided a collectivization of female experiences (Mies, 1983) which offered me insights into aspects of self; both mine and that of the participants. The focus group audio recordings were then transcribed and analysed according to the principles of IPA, explained below in 3.9.a.
3.8.1.a Addressing Groupthink
There was a possibility that as the participants of each School knew each other after having spent between four to six years studying together, ‘groupthink’ may have affected data collected. Groupthink refers to a pattern of thinking adopted by people when they are deeply bound as a member of a cohesive group (Janis, 1982). Although there is still debate whether groupthink is a myth (Fuller & Aldag, 1998), there was a possibility that participant responses might have been influenced according to what was expected of them as a group, according to collective norms.
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I mitigated against possible groupthink by encouraging critically reflective dialogue through questioning techniques in the focus group meetings (De Groot, Endedijk, Jaarsma, van Beukelen & Simmons, 2013), which would challenge any potential groupthink. The participants were also encouraged to interact by asking each other questions, which served to build on comments and confirm, or disconfirm, feelings and
experiences that had been shared (Linville, Lambert-Shute, Fruhauf & Piercy, 2003).
3.8.2 Individual Interviews
Interview questions were developed from the data analysis of the focus groups, which guided the one hour in-depth individual interview sessions (Doody & Noonan, 2013) held on campus. One School of Nursing participant could not attend her interview as her mother became seriously ill, but all the other participants (n=9) attended. I was aware that in-depth interviewing can be unpredictable, with twists and turns, but this style of interviewing is an essential and inductive part of the phenomenological research process (Smith et al., 2009). I drew on my professional training as a cognitive behavioural
therapist for questioning techniques to check understanding and also to assess a participant’s level of comfort during the interview session. By facilitating participants’ reflections (Holloway & Wheeler, 2010), I hoped that the interview process would be a positive and beneficial experience for them.
It was not difficult for me to establish rapport with the participants as I was perceived by them to be an ‘insider’, discussed further below in section 3.11.1, and Bahrainis are very friendly as a culture. A sign that an interview was progressing well was when a
participant would show me a photo on her phone of her husband or child, or share with me a secret wish or thought. Reflective notes were made after each interview and at regular intervals throughout the research process, which I often referred back to in order to confirm my interpretation of data.
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My reflexive log recalls my thoughts after my first participant interview experience in this early stage of the research process:
Sunday, 12 October 2014
Did my first interview with Mai (pseudonym), School of Medicine.
It went well I think. The time went so fast. I enjoyed the connection. I think she enjoyed being listened to. I watched her body language and involved myself in what she was saying. I feel grateful that she shared so much with me, and so easily. I forgot about the recorder - I think she did too. I found that afterwards I needed to sit back, slow down and empty my mind when I listened to the audio recording. It became a different narrative when I was listening to it analytically afterwards and not engaged with it conversationally in the moment. I realize how much we miss, what’s really going on, when we are talking with someone. I was surprised at the depth of data that had been generated. I picked up conflicting points in her narrative that I did not notice as she was speaking - and this is even before I start to transcribe. So this is where meaning comes from. I’m looking forward to the discovery.