We invited young women aged 18–24 years from underserved urban communities to participate in a co-creation workshop which aimed to develop user-friendly, self-sampling intervention for STI diagnosis for women. We conducted one, in-person NGT with eight young women from underserved urban communities in the eThekwini District Municipality, KwaZulu-Natal Province, South Africa.
Participant recruitment
Young women were purposively sampled from family planning and youth clinics in primary healthcare clinics. The study was explained to prospective research participants, and young women who were interested were screened for eligibility before participation. The following eligibility criteria were used to select participants:
Inclusion criteria
-
Young women aged 18–24 years old.
-
Young women residing in underserved urban communities.
-
Sexually active young women.
Exclusion criteria
-
Women who did not fall in the stipulated age bracket.
-
Women who were not sexually active.
-
Women who did not reside in underserved urban communities.
-
Women who were deemed unsuitable due to their mental capacity to comprehend the study.
All eligible young women were then invited to the NGT which was held at a venue outside of the public health clinic on a day different from that of recruitment. Written informed consent was obtained before study participation. All identifiers were removed from the collected data before analysis.
Participant recruitment and NGT scheduling challenges
The process of recruiting participants and scheduling of the NGT workshop presented Participant recruitment and the scheduling of the Nominal Group Technique (NGT) workshop presented unexpected challenges which led to the delay in data collection. Below is an account of the challenges experienced and the action taken to address them:
Initial NGT workshop scheduling:
For the initial NGT, 12 young women had been recruited and confirmed for attendance. However, on the day of the scheduled NGT, all the young women did not show up. Some reported unavailability on the morning of the scheduled NGT and some were unreachable on the day. As such, cancellation of the NGT workshop was inevitable for that day. Consequently, this meant participant recruitment had to be redone and the NGT workshop rescheduled.
Second NGT workshop scheduling:
After re-recruiting, a total of 15 young women confirmed their attendance to the rescheduled NGT session. However, only 8 of them showed up on the day of the session. Nevertheless, since the minimum number of participants required for a productive NGT is 8, the session proceeded, and data collection was conducted accordingly.
Study design
The NGT is a qualitative exploratory research method that combines the concept of idea generation with problem solving in a group setting [36, 37]. This technique uses structured small group discussions comprising 6–12 participants [38]. It has been used to identify priorities in healthcare and in research [39, 40], and to identify key attributes for DCEs [41]. The NGT approach generates a wide range of ideas and obtains consensus by promoting participation from all individuals, including those who often withhold their ideas out of fear [36, 39]. There is a smaller risk of confident participants dominating the knowledge creation process, Multiple responses to the research question are generated. Finally, all participants then rank all contributions according to their perceived priority. The NGT consists of three main stages, including silent generation during which participants consider a question and pen their responses; round-robin sharing, recording and discussing individual responses; followed by ranking of contributions.
Procedure
The NGT was conducted on February 17, 2023. The co-creation workshop was performed in four consecutive phases. Phase 1 focused on determining barriers to accessing current STI management and treatment services. Phase 2 focused on determining the key features of an efficient delivery method for self-sampling STI diagnostics. Phase 3 focused on presenting ideas to all participants. Phase 4 comprised of ranking the contributions of all study participants.
The research questions for the NGT were as follows:
Question 1
What are the barriers that prevent or limit young women from accessing current STI healthcare management services?
Question 2
What would be the key strategies to deliver self-sampling for STI diagnosis among young women to mitigate the barriers to access?
The participants were divided into two groups with four participants each. Participants’ responses were written on a flip chart. A representative from each group presented their contributions to the rest of the participants. The NGT was facilitated by the principal investigator and a researcher who was responsible for taking notes. Participant responses that were transcribed were cross-checked against what was written on the flip charts before being ranked.
Data processing and analysis
Results were analyzed separately for each question. The PI and the researcher grouped the results according to themes. Thereafter the participants ranked each response according to importance from their personal perspectives. The young women ranked each of the responses on a scale of 1–7 with “1” being low priority and “7” being high priority. Data were cross-checked to ensure that results were captured appropriately.