Study Design
The research design of this project was Hospital based Cross-sectional with a qualitative approach in the practice of a Focused Group Discussion (FGD) was chosen. FGD is a qualitative research method whereby the initiator pretenses a question to the interviewees, thus generating a chance for stimulating info about a matter through group discussion. It boosts the participants to launch collaboration and exchange facts about their understandings/opinions (8,11)
Study Participants
The participants were diabetic patients who receive care in the selected diabetic clinics. The researcher (AM) used purposive sampling with criterion sampling technique by preparing a list of the volunteered patients with their names and contact information than selected the patients based on their medical information and by observing maximum variations in terms of the type of diabetes, age, sex, oral drug consumption or insulin injection, duration of diabetes, and a history of diabetes complications, including retinopathy, nephropathy, neuropathy, cardiovascular diseases, and presence of DFU. The investigator clarified the study and the purpose of the research to the patients. Once the patients declared their interest in take part in the FGD, the investigator organized the time and place for holding the FGD at the clinic.
Study Setting
The study took place in Zanzibar Islands in four diabetic clinics which were Tunguu, Makangale, Kivunge and Chakechake. Zanzibar is found in 25 miles of the East Africa coast it is part of Republic of Tanzania and is encompassed of two main Islands, Unguja (1,464km2) and Pemba (868km2) and number of many Islets beside it.
Informed consent papers were attained; the participants were requested to appear in the meetings at the pre-set time. The meetings were held in a special room found in the selected clinic. The participants were asked to sit in a round, and they were well-versed that their voice was recorded via voice recording tools. The sessions were held on working days, from 10 a.m. to 12 noon. At the inauguration of each session, the moderator (AM) explicated the purposes of the study to the participants, displayed how the activity would be carried out and how the data would be managed. The co-moderators (AK, DJ) helped in recording the talks, witnessed group interactions, took notes and subsidized through expounding questions
Data Collection
Two FGD sessions were set; the researcher started by introducing herself and informed the participants of the goal of the session. The participants were requested to note the rules of the meeting which were described to them at the beginning of each session. The rules were as follows:
- Each member should present him/herself at the opening of the session. Though, they could introduce themselves with a codenamed.
- The time part for each member to discuss a precise topic is managed by the moderator/co-moderator.
- The members must not interrupt each other.
The discussion began by posturing open-ended questions about service delivery for DFU prevention and care. The questions were focused on:
- What are your prospects to the healthcare providers concerning DFU prevention and care?
- What was your experience of care and treatment provision previously to the existence of foot ulcer or in the first stages of bump into the ulcer
The researcher cheered the participants to detailed their thoughts and expose their view points and understandings about the topic under discussion. In this concern the other questions were not planned; fairly, they were grounded on the participants’ answers.
Exploratory questions such as “What do you mean? Could you explain more? Could you give an example? Is there something missing that you’d like to mention?” were questioned to improve the data.
The participants’ answers were recorded via a recorder and by taking notes. There were two FGD meetings; which persisted for 80 and 60 min, correspondingly. Ten patients participating in the first session and six patients attend the second session, respectively.
The members can express their opinions about DFU prevention and care and comment vital points about their attachment with the healthcare team. At this stage, we exasperated to depend on participants’ statements regarding their experiences, without any elucidation or verdict. At the end of the meeting, the participants were requested to express other points that thought necessary.
Data Analysis
All interviews were transcribed verbatim by a transcription assistant done by (DJ) he has a health background and has also been expert in qualitative data collection. And then, the translation of the transcript from Kiswahili into English version was conducted by an expert to ensure the quality and original data a preserved. All records and data related to this phase of the research were stored in a locked file cabinet in the office of the researcher.
Analysis of the data followed the guide for data analysis provided by Creswell (12). Initial open coding of the data gave way to axial coding, wherein codes were organized and sorted into categories based on their properties and similarities. Constant comparison was used throughout the coding process between participant responses and the coding, coding and categories, and categories and participant responses. Thematic analysis was applied using Nvivo 12.0 to manage the coding, categories, and generation of the themes.
Reliability
Reliability is a vital aspect of qualitative studies. According to Guba and Lincoln, four criteria of reliability include credibility, transferability, consistency, and conformability (13)which was considered in the current study.
Credibility was achieved by creation of good bond, allocate enough time, and garner the trust of the participants for data collection. The outcomes were returned to the members for checking and ensuring the exactness of the collected data. The investigation team also had in-depth and extended rendezvous with the qualitative data.
To abide by transferability, we tried to skirt picking homogenous participant by devising extreme diversity in selection of participants, covering mixture in the type of diabetes, receiving healthcare services from primary healthcare centers, age, sex, taking oral drugs or insulin injection, duration of diabetes, and history of diabetes complications.
Consistency, all the phases and procedures of research were recorded and reported as precisely as possible.
To enrich conformability, the patrician check process was used, and extracted codes and themes were autonomously reviewed by two research members in order to reach an agreement about the codes and classification of the themes. The codes and classifications for which there was no agreement were reviewed again in the FGD transcripts until agreement was achieved.