3.1 Research design.
In the previous section I have noted the deficiency of research on the experiences of young adults with diabetes, in terms of their education and employment and also with regard to their social and family relationships. One of the hypotheses to be tested in the present study was that the presence of diabetes may in some way influence level of self-esteem in young adults. A further hypothesis was that these two factors (ie. IDDM and self-esteem), either separately or together might affect the life-chances of these young people, in particular their educational and employment experiences.
In order to test this hypothesis, a sample of young adults with IDDM was required. The age-range of 16 to 25 years was decided upon because this would incorporate many of the major changes young people experience, such as examinations, leaving school, employment and developing close relationships. Two local hospital out-patient
clinics served by the same diabetic liaison sister, were able to provide a list of all the registered patients with IDDM.
Many of the previous studies reported in the literature have suffered in their design from the absence of a control group and so a local general practice was approached for the purpose of selecting
The use of a control group was important to this study, in order to be able to test the hypothesis that it was the presence of chronic disease that influenced education and employment, rather than other factors. To ensure that differences in age and sex did not affect the findings of the proposed study, the control subjects were matched with each diabetic subject on the basis of these two
variables. Obviously, other demographic and social factors might play an important role in educational achievement and employment experiences, and these would need to be considered during the analysis of the findings.
Different psychosocial factors such as self-esteem or social support could influence state of health within the two groups of subjects. For example, for those with IDDM glycaemic control could be related to the presence of social or family supports. It was also important to assess the presence of any past or present illness in the healthy control group, as this could influence the findings of the study. This data was available in the form of subjects' case-notes, either from their diabetic out-patient clinic or from their general practice. Information was collected on past medical history, and detailed information was recorded for the year prior to interview.
The methods employed to obtain information from the participants in the present study were chosen for their appropriateness in relation to the nature of the data that was to be collected. Most previous studies in this area of research have used checklist measures, which were not suitable in this case for the eliciting of detailed information about different aspects of self-esteem.
They also did not facilitate the recording of information on subjects' thoughts and feelings about education, employment and social relationships. Earlier childhood experiences may be important
for those whose diabetes was diagnosed at an early age, and could influence metabolic control and/or the development of complications. Information on these experiences was unlikely to be obtained satisfactorily by a questionnaire, even if it was extremely lengthy, so a semi-structured interview was deemed to be more appropriate. In order to collect this in-depth information interviews had to be tape-recorded and transcribed later.
The collection of both qualitative and quantitative data was possible in this study; an approach that can be very useful. These two methods are often thought of as entirely separate, however
sometimes they are combined, often with one method accorded greater prominence over the other (Bryman 1990). From a quantitative standpoint, qualitative data can be used to illustrate the findings of a study; on other occasions the findings of a predominantly qualitative study may be presented in a quantified form.
In addition, researchers have sometimes used structured interviews in order to simultaneously collect both types of data (Bryman 1990). Silverman (1985) suggested that the use of quantitative data, or
'simple counting procedures', helps to avoid the temptation to use
"merely gobbets of information" (ie. qualitative data) in order to support the researchers' interpretation of the findings. The use of quantitative data gives the findings of the whole sample in a
summary form and can encourage further qualitative analysis (Silverman 1985).
The specific instrument I proposed to use in my investigation was a semi-structured in-depth interview schedule. Interviews would take several hours and would have to be tape-recorded. This method had both advantages and disadvantages attached to it. The main disadvantage was the lengthy nature of the interviews, and the time- consuming method of transcribing the verbal responses of each subject after the interview had taken place.
However, although this might mean a smaller sample size would have to be used, these disadvantages were compensated for by the amount of detailed information actually obtained. The interview schedule
that was used for the study was an appropriate one as it had been recently modified for use with teenagers, and it included sections on self-esteem, education, employment and social relationships. Extra questions specifically related to diabetes would have to be
Before I could use this instrument however, I first had to be