Ministry of Health
Oman Specialized Nursing Institute
Health Services Management Program
2015-2016
Research Methodology for Health Sciences I
Identification of Causes and Consequences of Work- Related Stress among Midwives in South Al-Sharqia Region
4. Methodology
Research design
This study will employ a descriptive design to address the study questions. In this case, the researcher will conduct a survey to obtain data from the study participants. A descriptive design is used in studies that do not involve the manipulation of the study variables by the researcher (Valencia-GO, 2015, p. 97). This study seeks to identify the factors associated with work-related stress (WRS) and its consequences among the midwives working in the South Al-Sharqia region. Work-related stress (WRS) serves as the dependent variable while there are several other independent variables in the study. The study seeks to investigate the factors that co-vary with WRS in the study area under the normal conditions. The researcher of the study must not manipulate the conditions under which the midwives in the study area operate since it will result in findings that do not represent the real situation of the study area. The need to obtain findings that portray the actual situation of the study area explains why descriptive design is the most appropriate design to be used in this study.
The data being sought in the proposed study can be obtained in two ways: using a case study approach and using a survey. If case study approach is used in the study, the researcher will be required to focus on a group of the subjects of the study and use the data obtained from them to make deductions. On the other hand, if a survey is used, data will be solicited from a sample of subjects that represent the entire targeted population. A sample population is recruited from the targeted population using methods that minimize bias. Consequently, a survey can help in recruiting participants that represent the targeted population more effectively than a case study. This analysis leaves survey as a more suitable design than a case study for this research. Therefore, this study will employ a survey technique to address the study questions.
Setting
This study will be conducted in health facilities that offer maternity services across the south of Al-Sharqia region in Oman. Precisely, this study will be conducted in the Ash Sharqiyah South Governorate. Ash Sharqiyah South Governorate is divided into five wilayat namely Sur, Jaalan Bani Bu Hassan, Masirah, Al Kamil W’al wafi, and Jaalan Bani Bu Ali. The participants of the study will be recruited from the various health care facilities offering maternity services across Ash Sharqiyah South Governorate. In this case, all health facilities providing maternity services will be involved in the study.
The government is the main provider of health care services in the Sultanate of Oman. Therefore, the majority of health care workers are employed in the government-run facilities. Indeed, 85.3% of nurses working in the country are employed in the facilities that are run by the government (World Health Organization, 2006, p. 36). On the other hand, nurses employed in the country’s private sector make up 7.5% of the total nursing workforce (World Health Organization, 2006, p. 36).
Population
Midwives working in various health facilities across Ash Sharqiyah South Governorate are the target population for the study. Only midwives working in labor wards across the study area will be eligible to take part in the study. Therefore, the midwives working in different departments will not qualify for inclusion in the study. Furthermore, eligible prospective participants of the study will be required to have worked as a midwife in the study area for a period that is not less than six months.
Individual midwives undergoing any known domestic-related stress at the time of the study will not be eligible for inclusion in the survey. All the prospective participants will also be required to have the same responsibilities and roles in their respective organizations. This condition is important in this study since it will help ensure that all the participants have almost equal level of exposure to the conditions associated with WRS. This condition will be met by making sure that participants are all working in labor wards where they engage in tasks whose demands are almost equal.
Sample and sample size
A sample size of 52 midwives working in various labor wards in different health facilities in the study area will be recruited into the survey. This sample will be selected from 570 midwives in the whole of Sultanate of Oman. The recruitment exercise will be conducted as follows. First, a list of health facilities operating in the study area will be prepared. Next, the contact information of all the facilities in the list will be obtained. The researcher will then visit the facilities to solicit information concerning whether the facilities provide maternity services and the number of midwives in each. Information about the number of midwives who will be working in the labor wards at the time this study will be conducted will also be sought.
Having gathered all the necessary information concerning each facility initially identified and included in the list, the researcher will determine the facilities that meet the requirements for inclusion in the study. For instance, facilities that will be found not to be offering maternity services will not be included in the study. Besides, the facilities that will not be operating at the time of the recruitment exercise will also be excluded from the survey. The final list containing the health care facilities that meet the conditions for inclusion in the study will be prepared. The list will also contain the total number of midwives working in the labor wards in each facility.
Stratified sampling technique will be used to recruit the participants in this study. In this case, the targeted population will be divided into five units (strata) according to the five wilayat constituting Ash Sharqiyah South Governorate. Next, each health facility included in the list discussed above will be classified according to the Wilayat where it falls. The number of midwives that will be assigned to labor wards in each wilayat at the time of the study will then be determined. Next, the number of participants to be recruited from each facility within any given wilayat will be determined. This number will depend on the percentage of the total number of midwives working in labor wards at the time of the study in any particular wilayat for which each facility in the wilayat accounts. For instance, let us assume that facility A operates in Masirah (one of the wilayat constituting Sharqiyah South Governorate). If the facility accounts for 20% of all midwives in Masirah that qualify to participate in the study, then the number of participants to be recruited from the facility will form 20% of all the participants recruited from Masirah. The number of participants to be recruited from each wilayat will be determined in the same way.
Next, a list of all eligible midwives in each elected facility in each wilayat will be obtained. A predetermined number of participants will then be selected from the list using simple random sampling method. In total, 52 participants will be recruited to participate in the study. Stratified sampling technique involves dividing the entire study population into various subgroups called strata and then selecting a sample from each stratum separately using simple random sampling method (Kumar, 2003, p. 43). While using this technique, the researcher is required to have some information about the population targeted by the study to enable the researcher to form appropriate strata (Kumar, 2003, p. 43). The technique should be used in cases where the stratification method leads to the formation of homogenous groups (strata consisting of members that have something in common). The use of stratified sampling technique improves the overall estimate of the sample size. Stratified sampling technique also involves the use of proportional sampling in selecting a sample from each stratum. Proportional sampling is highly beneficial because it exhibits a high degree of representation of the target population. In other words, if a sample from each stratum is selected on the basis of proportionality, there are high chances that the characteristics of all individual members of the target population will be represented in the final sample.
The stratified random sampling technique exhibits several advantages. First, stratified random sampling method prevents the overrepresentation of underrepresentation of certain population segments. Therefore, each segment in the population receives proper representation. By minimizing the overrepresentation and underrepresentation of any segment of the population, the technique helps in minimizing bias in the selection of the study sample. Unlike simple random sampling technique, stratified sampling method saves time.
Recruitment and Training of Research Assistants
Tow research assistants, recruited from among the students pursuing Health Service Management program, will take part in the data collection exercise. Their role will involve delivering the questionnaires to the respective respondents and informing them how to fill them. They will also explain various aspects of the questionnaires to the respondents. Research assistant s will also help in cleaning the data and analysis of the data. The potential research assistants will be required to have knowledge in data analysis sing SPSS software. The research assistants will be trained the various aspects of the instruments to be used in the study for collecting data. With this training, they will be able to help the respondents understand and fill the questionnaires appropriately.
Data collection measurement and tools
The data will be collected using a total of five tools. These tools include the following: Job Stress Survey (JSS), Maslach Burnout Inventory, Ilfeld’s psychological distress index, and IlFeld's psychosomatic symptoms. Job Stress Survey (JSS) will be used to evaluate the causes of WRS among the study participants. JSS measures thirty factors that can be sources of stressors. Some of the factors measured by this tool include the following among the remaining others:
Being assigned tasks that are not in one’s job description
Inadequate salary
Working overtime
Excessive paperwork
Being excluded from participation in policy-making exercises
Difficulty getting along with the supervisor
Excessive paperwork
Inadequate supervision
Lack of advancement opportunity
Inactivity periods
Interdepartmental conflicts
JSS also measures the average level of the perceived severity and frequency of the occurrence of the thirty stressor events measured by the instrument. JSS also assesses the overall stress level based on the combined ratings of severity and frequency of all the thirty stressors. JSS uses a 9-point rating scale for the assessment of the perceived severity of the stressors.
Maslach Burnout Inventory (MBI) will be used in the study to measure burnout. The tool has been used over the last several decades. In general, MBI measures burnout in three dimensions: emotional exhaustion, personal achievement, and depersonalization (Kaya, 2008, p. 13). Emotional exhaustion refers to the “diminished interest for work and fatigue due to being emotionally overextended and drained by others” (Schaufeli and Greenglass, 2001 cited in Kaya, 2008, p. 13). On the other hand, personal achievement refers to the negative attitudes towards clients and insensitive reactions to the customers (Kaya, 2008, p. 13). Concerning personal accomplishment dimension, MBI assesses people’s level of feeling of being useful and competent in their jobs (Kaya, 2008, p. 13). Ilfeld’s psychological distress index and IlFeld's psychosomatic symptoms will be used to measure psychological distress and psychological symptoms respectively.
Validity and Reliability
All the tools to be used in the study have high construct and content validity and high reliability. The validity of all the tools has been proven in various studies. For instance, in the study conducted by Schutte and colleagues (2000) to investigate the factorial validity of Maslach Burnout Inventory among various employees working in multinational companies in the forest industry, the internal consistencies of all the subscales of the tool were found to be satisfactory.
A pilot study will be conducted one week before the start of the data collection exercise to identify logistical challenges that might emerge during the actual data collection exercise. Besides, the research assistants will take the opportunity to familiarize themselves with the data collection instruments. The data collection exercise will be held at the premises of the various health facilities included in the study. All the participants in the survey will be contacted three times before the data collection date: one week before the start of the exercise. This will help keep the participants prepared for the exercise. Once the research assistants arrive at the premise set for the exercise, the assistant will report to the management and inform them of the exercise. The respondents will then be contacted. The questionnaires will be self-administered. However, the participants will be shown how to fill the questionnaires appropriately. Besides, the research assistant will explain the purpose and all aspects of each questionnaire to the participants. Self-administration is advantageous because it gives the respondents the opportunity to plan when they can fill them. However, it is prone to inaccuracies since the respondent may provide inaccurate responses due to failure to comprehend the items. Some respondents may also procrastinate until they fail to complete administering the questionnaires. The participants will be given four days to complete all the questionnaires before submitting them. The questionnaires will be available in print forms and electronic form. The electronic questionnaires will be submitted via email. For print questionnaires, the researcher will visit the premises after the fourth day to collect them.
Data management and data analysis
The data collected from the field will be revised and cleaned before subjecting them to analysis. Various dummy tables will be used to present the variables of the study and the study results. Bivariate logistic regression analysis will be performed to determine the association between the each independent variable measured in the survey and WRS. A multivariate logistic regression analysis will then be performed on variables that will be found to be significantly associated with WRS in the bivariate logistic regression analysis. SPSS version 20 for windows will be used in these two analyses. Bivariate logistic regression will be used in this study because it is suitable for use in cases where the dependent variable is dichotomous. In this study, the dependent variable, presence of WRS or absence of WRS, is binary and dichotomous. The bivariate logistic regression was also performed first to determine the extent to which each independent variable measured in the experiment explained the dependent variable. A multivariate logistic regression was then conducted to find out the extent to which each predictor (independent) variable explained the dependent (outcome variable, which is WRS) in the presence of the potential confounding variables.
Ethical Considerations
An approval will be sought from the University’s institutional review board before starting the study. Once the approval is obtained, the subsequent activities related to the study will be conducted. All the participants will be informed of the purpose of the research before being asked to participate in the study. Participation in the study will be voluntary. The participants will be given a consent form to sign as an evidence for their consent to be included in the study. The consent form will be signed voluntarily by the actual potential participants. In other words, the people who will sign the consent forms will be the people who will actually take part in the study. Nobody will sign on behalf of another person. The participants’ confidentiality will be safeguarded by allowing them to administer the questionnaires on their own. Secondly, the questionnaires will be submitted directly to the researcher without having to pass through a third party. Many benefits can be derived from this study. First, it may provide the basis on which policies for improving the workplace environments can be made. Secondly, it may also inform changes in organizational practices in various health care facilities in the study area.
Limitations and constraints of the Study
This study focuses on midwives working in Ash Sharqiyah South Governorate. The study also focuses exclusively on midwives working in the region. Therefore, its findings are limited to the target population. The study will also focus exclusively on work-related stress. Therefore, any stress or psychological problems caused by other factors will not fall within the scope of this study. The study is likely to face various challenges. One of the potential challenges is that some respondents may not return the filled questionnaires due to busy schedules. In this case, the respondents who fail to submit filled questionnaires in time will be added more time. Furthermore, any respondent who will need assistance with any aspect of the questionnaires will be assisted promptly.
Bibliography
Kaya, O., 2008. Inclusion and burnout examining general education teachers' experiences in Turkey. Dissertation Abstracts International. 69-08. [Bloomington, Ind.], Indiana University. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3319885.
Kumar, A., 2003. Research methodology in social science. New Delhi, Sarup & Sons.Top of Form
Ministry of Information Sultanate of Oman, 2015. Oman 2015. [online] Available at: < http://omaninfo.om/english/files/oman_english/files/OmanBook%20Eng.pdf > [Accessed 1 May 2016].
Schutte, N., Toppinen, S., Kalimo, R. and Schaufeli, W., 2000. The factorial validity of the Maslach Burnout Inventory‐General Survey (MBI‐GS) across occupational groups and nations. Journal of Occupational and Organizational psychology, 73(1), pp.53-66.
Valencia-GO, G.N., 2015. Research Success A Q&A Review Applying Critical Thinking to Test Taking. FA Davis.
World Health Organization, 2006. Health System Profile Oman. [Online] Available at: <http://apps.who.int/medicinedocs/documents/s17304e/s17304e.pdf > [accessed 1 May 2016]. Top of Form
