CHAPTER THREE METHODOLOGY
3.6 Methods and Instruments of Data Collection
Both quantitative and qualitative instruments were used for data collection, namely, questionnaires, IDIs, FGDs, case studies and patients‘ medical history records.
3.6.1 Semi- structured Questionnaire
The questionnaire was designed by the researcher with some items and scales adapted from the Adult AIDS Clinical Trial Group (AACTG) Adherence Base-line Questionnaire (Chesney, et al., 2000). It was validated in a pre-test with a similar group of patients to the ones who were actually studied. The questionnaire contained 11 sections labelled A to K. Section A generated information on socio-demographic characteristics such as age, sex; marital status and level of
UNIVERSITY OF IBADAN LIBRARY
69 education (see Appendix I for details). Other variables that the questionnaire also covered were as follows:
Knowledge of HIV and Tb treatment and the implication of adherence (section B): Knowledge of treatment was measured using 17 items which had highest obtainable scores of 17 points.
A composite score of these items was computed and categorised poor (≤ 8) and good (> 8) knowledge.
Adherence to treatment (section C): This section generated data on patients‘ levels of adherence to treatment and contained 14 items which were computed to obtain scores for each respondent. Composite scores obtained from the computation were used to categorised adherence as high (0-1), Moderate (2-7) and Low (>7). Whereas the WHO lumps all those who do not meet 95% of their medicine as non-adherence, this study contends that for proper intervention to scale up adherence, there is the need to adopt different approaches for the different level of non-adherence.
Perception of self and medical efficacy (section D): Self efficacy had five items in the scale with options coded from 0-2 point each. Self-efficacy was categorised from the computation of these items as low (≤5) and high (>5). On the other hand, medical efficacy was measured with two items with maximum obtainable scores of four points; with score ≤2 considered as low.
Interaction with treatment centres (section E): Patients interaction and relationship with the health care professional was measured with 25 questions with some having a ‗yes‘ or ‗no‘.
Questions under this question included whether patients had confidence in the ability of the health professional and if they are informed properly about their treatment.
Costs (section F): Information on distance to health facility and cost of transportation and feeding while in the facility and missing work, among others, were collected in this section.
Reasons for missing drugs (section G): Apart from the researcher-provider reasons for why respondents may miss their medications, this section also collected information reasons provided by the respondents without prompting from the interviewer.
Anxiety (section H): Anxiety was measured with the AACTG Base-line Adult Questionnaire.
Five items on a 0-3 scale were used to measure level of anxiety with the highest obtainable score of 15. Respondents who scored zero (0) were coded as ‗not anxious at all‘; those who
UNIVERSITY OF IBADAN LIBRARY
70 scored from the 1-7 were regarded as ‗somewhat anxious‘ while those who scored above the mean were categorised as ‗very anxious‘.
Alcohol Use (section I): Alcohol use and abuse may influence adherence to medication, thus, information on patients consumption of alcohol was collected in this section with questions such as the frequency of alcohol consumption within the last 30 days and the quantity taken.
Social support (section J): eight questions were asked to generate data on social support that respondents have received during the course of their treatment, including a question on the type of support they had received and two on the satisfaction with the support received.
Social support was classified into two categories: little or none and adequate support.
Self-stigma (section Ka): The concept of self-stigmatisation was measured using a 9-item instrument. Each item had a score of 1-5 highest obtainable score of 45 point. All respondents who obtained a score of ≥ the mean score were categorised as low level of self stigma while those who score above the mean were coded as high.
Social stigma (section Kb): Social stigma was tested using a 9-item instrument with ‗yes‘ or
‗no‘ responses coded as 1 and 0 respectively. Thus, the maximum obtainable score was 9. All respondents whose total score on social stigma after computation was 0 were categorised as
‗no stigma at all‘ while those with a score of ≥ 1 points were regarded as having had ‗some level of stigma‘ directed at them.
3.6.2 In-depth interviews
A total of 24 interviews were conducted. This comprised interviews with nine health care workers (two doctors, three nurses, three counsellors and a pharmacist), four Christian religious leaders, four treatment support groups and four family members or friends. Two interviews each were conducted with family and friends of adherent and non-adherent patients. The interviews with family and friends were sanctioned by patients before hand to avoid status disclosure where this had not been done. The in-depth interview guide covered key areas such as knowledge of HIV and Tb co-infections and their treatment, community attitude to HIV and Tb, social stigma, social support and cultural values and beliefs about HIV and TB. Two interview guides, one for health care workers (details in Appendix II, page 190) and the other for family and friends (Appendix III) were used to collect data.
UNIVERSITY OF IBADAN LIBRARY
71
3.6.3 Focus Group Discussions
Six FGDs were conducted. Discussants were HIV and Tb co-infected patients. Each FGD was made up of eight discussants. The inclusion of the FGDs was borne out of the fact that the social element of the group situation produces more information than interviewing a single individual.
There were three FGDs each for males and females. The FGDs focused prominently on the cultural and community beliefs, attitude and behaviour towards people who are infected, and are on drugs (details in Appendix IV).
3.6.4 Case Histories
Four case histories were conducted with two each for patients found to be adherent and non-adherent to treatment, and with both male and female patients. The case histories retrospectively constructed the patient‘s treatment experiences and behaviour from the time of diagnosis to the time of the interview. The aim was to uncover significant influences during the case management that may be responsible for explaining the observed patterns in patient‘s treatment behaviour (Appendix V has details).
3.6.5 Health Records
Secondary data from the treatment centres on patients‘ records of follow-up appointments were also collected, as a means of determining how consistent they kept appointments after being on drugs for a period of time (see Appendix VI for details). This method of measuring adherence has been used in a study of 26 perinatally HIV-infected children, where having no missed appointments in a six-month interval was associated with positive virologic response (Farley, et al., 2003). Records of appointments were compared with participants‘ self-reported levels of adherence, and thus provided a clearer picture of patients‘ adherence to their treatments.