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Methods Of Polio Eradication Health And Social Care Essay

In this chapter, the author will present the methods of providing answers to the research question of the study. The chapter centers on literature review as a methodology, the process of searching for literature, synthesis of findings from the literature search, methods, and critical appraisal tools for evaluating the literature.

3.1 RESEARCH QUESTION

What are the factors that can enhance or hinder polio eradication by immunization in Nigeria?

As stated in chapter one, Nigeria serves as a reservoir of poliovirus re-infecting other countries that once successfully eradicated the disease, and referring to the disputes on the wider health determinants of polio eradication in Nigeria as detailed in chapter 2, the factors enhancing or impeding the success of immunization towards eradicating polio from the country needs to be further clarified so as to propose effective recommendations that will help get rid of the disease from Nigeria, Africa, and the world at large. To achieve this, literature limiting to Nigeria will be searched extensively, evaluated, reviewed and the findings will be presented in a comprehensive manner.

3.2 WHAT IS MEANT BY THE TERM METHODOLOGY?

O’ Leary, (2004) defines methodology as a particular set of principles that provides theoretical explanation to a particular set of modular assumptions needed in conducting a research study. Payne and Payne, (2004) further added that methodology is used to indicate a set of conceptual and philosophical assumptions that justify the use of a particular method. It can also be defined as a system of methods and rules which are used to aid the collection and analysis of data (Hart, 1998). From the above definitions, it can be deduced that methodology provides the basis for critical analysis of the theories and assumptions on the particular topic being researched.

The theoretical perspective of this research is post positivism and the stances are as follows:

Ontology: This takes the view of the critical realist; stating that even though the reality is out there, it can never be fully explored since it is under the control of natural laws that can only be partially understood (Guba, 1990). From the research question, certain factors are responsible for polio being endemic in Nigeria while some are enhancing its eradication by immunization. Therefore, this research study seeks to fully explore these factors.

Epistemology: Objectivity remains a controlling model but this can only be estimated by attributing more importance to external factors such as decisive community and critical tradition (Guba, 1990). An objective stand is maintained throughout this research study and this stand helps to eliminate bias so as to ensure rigour and credibility.

The methodology for this research is a literature review. Literature review has been selected in order to explore the various factors enhancing or hindering the success of immunization towards eradicating polio from Nigeria in a broader perspective from previous studies. The literature review enables easy collection of data from a wide range of sources and the understanding of different views of authors on the topic thereby identifying gaps for further research.

3.3 DEFINITION OF LITERATURE REVIEW

Literature review is defined as a logical, precise and generative procedure for identifying, evaluating and interpreting the existing body of recorded work which have been produced by practitioners, scholars and researchers (Fink, 1998). Similarly, literature review was further defined by Hart (1998), as the act of choosing, examining and evaluation of evidences from selected literatures containing information or data from a particular point of view on a specific topic in relation to the research being carried out. Aveyard, (2007) described literature review as an autonomous methodology because it’s a methodology in its own right and can be used by researchers independently to any other methodology.

Bowling (1997) emphasized that literature review should be thorough and include all the appropriate and well-founded papers, facts of the methods used, and the result of the studies included should be presented in a precise manner. In addition, Wisker (2001) added that literature reviews provides information on the relevant studies present on a particular topic and also provides a platform that enables contribution to the body of knowledge. Likewise they are used in identifying the gaps that exist between current research and present areas of controversies within a particular field of study (Wisker, (2001).

The four main functions of a literature review enumerated by O’ Leary (2004) includes: to give a reason why the subject area is relevant, to provide the reader with an up to date account and discussion of literature on the issues relevant to the topic, to present a conceptual and theoretical context in which the topic under study can be situated, and finally to discuss important research conducted on the same topic or similar topics. Furthermore, O’ Leary (2004) deduced that the scientific reasons for carrying out a literature review are; it plays a role in delineating the research problem, seeks new lines of inquiry, gaining methodological perception, avoids ineffective approaches, seeks support for grounded theory and it helps in identifying recommendations for further studies. Cooper (1998) added that a literature review can be classified according to five basic characteristics which include: focus, objectives, perspective, coverage, organization and audience.

With reference to poliomyelitis in Nigeria, previous studies done on this endemic disease were studied carefully and extensively enabling identification of the gaps and controversies which in turn motivated the choice of the research question. Literature review has also helped in broadening the author’s knowledge on the disease and has provided the platform on which this research study is being carried out. This study will however contribute to the body of knowledge on this illness and impact in no small measure in elucidating the factors responsible for the medical condition to be endemic in Nigeria which if acted upon will reduce the incidence of the disease in the country, Africa and the world at large.

3.4 STEPS OF CONDUCTING A LITERATURE REVIEW

Wisker, (2001) noted that there are five basic steps of reviewing literature these include: choosing an area of research and developing a research question - this aspect is regarded as the most challenging phase of the research being carried out, identification of the sources of information, reading research studies which are relevant to the topic being studied, developing a meaningful and consistent way of organizing the studies and finally writing about the literature and explaining different views of researchers on the topic. Cooper, (1998) upheld this view and commented that the stages of conducting a literature review are: assessing the extent of the problem, collection of relevant data on the topic being researched, evaluation of such data, analyzing and interpretation of the results, and the dissemination of the facts or findings to the public. These steps outlined by Wisker (2001) and Cooper (1998) have assisted the author in planning this research and organizing the information gathered on poliomyelitis in Nigeria.

3.5 SEARCHING FOR LITERATURE

The identification of relevant studies remains an indispensable skill in the field of social research and due to the large amount of research works and information available alongside the increasing complexity of interrelated branches of knowledge; there is a need for an extensive systematic literature search. (Miller & Brewer, 2003)

Literature search was defined by Wisker (2001) as an organised and logical approach aimed at the identification, retrieval and bibliographic management of studies which are usually drawn from published source for the sole aim of finding relevant information on a particular topic, analyzing conclusions, and identifying potential areas for future studies and developing guidelines for future practice. Fink (2005) added that a literature search is an organised, definitive, and reproducible approach for recognizing, analyzing and evaluating the existing body of both completed and recorded studies produced by scholars, practitioners and researchers.

Central to conducting a successful search of the literature include; adequate planning, understanding the form in which relevant information is arranged and made available, keeping records and synthesizing information from sources that are useful including the primary controversies, theories, key concepts and definitions (Hart, 2001).

There are six basic stages in carrying out a literature search these are: identifying an area of interest, carrying out a literature review, generating relevant questions, stating unresolved controversies or hypothesis, finding answers to such problems and documentation of the relevant findings (Burns & Grove, 1993). However, a literature search does not just indicate a distinct step in carrying out a research study because identifying an unsolved controversy inevitably determines the type or category of literature that is appropriate likewise carrying out a literature search helps to identify an unsolved issue (Burns & Grove, 1993).

Miller and Brewer, (2003) emphasized that the foremost consideration in carrying out a valid literature search is to have a clear and concise question, topic or set of issues of interest. This will give the search a clear focus and rationale. The authors added that other options in carrying out a literature search include: consulting colleagues and consultants who have sound knowledge in the subject area being researched in order to request reports and papers, following up references in research publications and using computer based search strategies. Creswell (1994) postulated that a literature search gives the reader background information regarding the subject being researched, shows the understanding of the researcher in the chosen area of interest and how the research work is being carried out contributes to the pool of knowledge on the chosen field of study.

Some research findings are regarded to as non significant and are usually not accepted for publications this form of research works are kept in internal departmental reports and are referred to as “the grey literature” (Chalmers, 1990). Hence it is advised that in carrying out a literature search the researcher needs to be aware of such works and network with other experts in the subject of interest being addressed (Bowling, 1997).

3.6 LITERATURE REVIEW APPROACHES

There are three main approaches in conducting a literature review, these are: narrative reviews, systematic reviews and literature review done in a systematic manner (Aveyard, 2007). Narrative reviews were further explained by Aveyard, (2007) as not having a focused research question, not easily reproducible, not having a specified method, lack systematic approach, and have no focused search strategy. While systematic reviews have a precise research question, well focused search strategy, proper method of appraisal and the methods used are reproducible (Aveyard, 2007). Literature review carried out in a systematic manner is usually less rigorous and more detailed (Aveyard, 2007). In carrying out this literature review a systematic manner was chosen in order to give the research work a logical sequence and to meet up with the time allocated for the completion of this work. Moreover, the use of credible critical appraisal tools will be employed in order to ensure rigour in the study.

3.7 LITERATURE SOURCES

Hart, (2001) suggested that it is better to begin one’s search by exploring the library’s quick reference section where guides to the literature of interest, directories and encyclopedias can be found after which the focus becomes using of books and bibliographies in a more detailed approach or manner. Similarly, Creswell (2003) postulated that the following order is beneficial to researchers when searching for literature on a particular topic: journal articles, books and conference papers. These are further explored below.

Journal articles: are quite relevant but concentrating on peer – reviewed journal is essential but this is not to say that one should avoid periodicals and professional magazines. However it is important to scrutinize articles in credible journals in order to determine their relevance, credibility and validity by other professionals in the field.

Books: it is suggested that one should begin with research monographs which are summaries of the academic literature on the topic being researched before proceeding to look at the complete books on a single topic or ones that contain chapters written by different researchers. However, textbooks should be used in combination with other sources with the aim of improving their relevance and validity because they quickly become dated.

Conference paper: it is important to look at conference papers because they usually contain most recent information and developments in the field of research (Creswell, 2003).

However, Gray (2004) argued that there is no strict order to follow in the process of locating source materials. On the other hand, Rice & Ezzy (1999) classified literature sources into primary, secondary and tertiary sources. Primary sources are regarded to as the raw material of one’s research, secondary sources are books and articles in which the reports on the findings of other researchers can be found based on their primary sources while tertiary sources refer to books and articles in which results are reported based on secondary sources (Rice & Ezzy, 1999).

Gray, (2004) stated that Online Public Access Catalogue (OPAC) of a library serve as the main source of finding books because they often offer access to other online catalogues and gateways which will be useful to researchers and those finding relevant information on a particular subject. In addition, using the internet is an important tool in the field of research as it can help the researcher in accessing libraries and vast sources of information across the world (Rice & Ezzy, 1999). In relation to using the internet; the author employs the use of The World Health Organization and Global Polio Eradication Initiative websites for vital resources. Gray, (2004) added that academic articles written in peer-reviewed journals articles published in professional journals are the two forms of journal articles and using an indexing and abstracting tool makes accessing journal articles easier and faster. It is advised by Hart, (2001) that a proper search of the multi subject indexes and abstract is better done first before subject – specific abstracts (if there are any).

3.8 INCLUSION AND EXCLUSION CRITERIA

Aveyard & Sharp (2009) states that defining the inclusion and exclusion criteria for a particular subject under study supports the researcher in identifying relevant and key literature that address the research question. Bury & Mead (1998) added that the inclusion and exclusion criteria refine the literature search results by separating the required from the un-required literature which in turn enables the researcher to maintain a well-defined focus. In view of these, the set of inclusion and exclusion criteria enumerated below will enable the author maintain a defined focus that will help in addressing the research question.

3.8.1 Inclusion criteria

The inclusion criteria devised by the author include the following: published articles done during 2003 – 2010, studies done and reported in English language, studies that address poliomyelitis, and studies done in Nigeria. Studies that address poliomyelitis and restricted to Nigeria were set in order to assist the author to remain focused on the research question. Studies on poliomyelitis done between the year 2003 and 2010 were selected because Nigeria came into limelight in 2003 when immunization programmes were refused in some parts of the country. Aylward & Maher, (2006) upheld this view and affirmed that the consequences of the setback suffered by immunization in some parts of Nigeria in 2003 led to re-infection of 18 polio free countries and an evolution of a wild strain poliovirus. In addition, due to time constraint, only published works and works reported in English language were selected.

3.8.2 Exclusion criteria

On the other hand, the following are the exclusion criteria: unpublished studies, studies that were carried out and reported in any language other than English, studies on poliomyelitis done before the year 2003, studies done outside Nigeria, and studies that are not related to poliomyelitis.

3.9 CRITICAL APPRAISAL

Critical appraisal was defined by Bury & Mead (1998) as the systematic way of considering the truthfulness of a piece of research, the results as well as their relevance and applicability. Similarly, Creswell (2003) defined critical appraisal as a process that allows the researcher to examine research studies in a thorough and systematic way in order to judge its credibility, value and relevance to the chosen topic under study.

Rychetnik et al, (2004) emphasized that critical appraisal enables a researcher to properly evaluate studies with the aim of closing the gap that exists between research and practice. Hence, its place in the field of research is invaluable. However, the author stated that critical appraisal has been criticized for its time consuming nature and the fact that it does not always provide answers to raised questions.

Despite this MacAuley et al, (1998) revealed that the use of a critical appraisal tool is usually recommended by most researchers in order to make research studies credible. In addition, the Critical Appraisal Skills Program (CASP) aim to assist researchers to develop the necessary skills needed to appreciate scientific evidence (Creswell, 2003).

Critical Appraisal Skills Program (CASP) was designed in 1993 and its use has helped in the development of scientific based approach in health and social care (NHS Public Health Resource Unit, 2007). Bradley & Burls (2000) added that CASP has generated a check list of critical appraisal questions for major study designs. Nevertheless, the authors advised that these critical appraisal check lists are not meant to replace critical thoughts and judgement when reading a research study but should serve as guides to a research. For this reason the critical appraisal skill program (CASP) was used in the critical evaluation of selected literatures on poliomyelitis in Nigeria in order to ensure credibility in this research study.

4.0 THEMATIC ANALYSIS OF LITERATURE FINDINGS

The proposed data analysis method for this research is thematic analysis. This was described by O’Leary (2004), as a means of interpreting raw data by the generation of themes from the collected data. Boyatzis (1998) defined a theme as an outline or pattern of information that explains and brings together possible observations from a collection of data on a particular subject area or topic. Wisker, (2001), stressed that labeling important themes as they appear helps the researcher to draw different conclusions together, and O’Leary (2004) added that this can only be achieved when the researcher engages with the literature. Braun and Clarke, (2006) also inferred that thematic analysis is the widely used method in qualitative research and can assist the researcher in bringing out the truth of the study by making it more understandable.

In this study, similar themes will be allocated into codes to give the work a better understanding, and present it in a simpler and clear manner to all who will have access to it in future for reference. This is in accordance with the view of Pope and Mays (1995) who stated that a research should aim to create an account of method and data that can be independent; so that other researchers can make use of the same data, analyze it in the same manner, and arrive at a conclusion that can produce a coherent explanation of the issue being investigated.

4.1 STRENGTHS AND WEAKNESS OF SECONDARY INFORMATION

Secondary data refer to existing information available on a particular subject of interest (Bury & Mead, 1998). In other words, secondary data are information that the researcher was not responsible for directly collecting as opposed to primary data which is generated originally by the researcher (Burns, 2000).

Hislop (2005) highlighted that the strengths of analyzing secondary data are: providing useful background and historical data on the topic being addressed, useful for exploration, cheap to obtain, not time consuming and it can equip the researcher with the aim of contributing to the body of research.

Considering the time limit for this research, the author found secondary data on poliomyelitis very useful as it saves a lot of time. No funding was required in carrying out this research hence, this form of data is important to researchers as it allows quick analysis at little or no cost.

Conversely, the vast array of secondary data available makes it quite difficult for the researcher to determine which data is relevant for the subject in focus (Hislop, 2005). In addition, there may be bias in the secondary data and a vast majority of the data may be out of date. In addressing these weaknesses of secondary data, the author limited the data obtained by setting inclusion and exclusion criteria and all the studies obtained were critically appraised to ensure rigour in the research. Pope and Mays, (1995) affirmed that a systematic and self conscious research design, data collection, interpretation and communication are the basic strategies in ensuring rigour.

4.2 ETHICAL ISSUES IN LITERATURE REVIEW

Ethics is the foundation of all research (O’ Leary, 2004). The main objective of conducting a research in any field of study is to contribute to the development of systematic and verifiable knowledge (Nachmias and Nachmias, 1992). Furthermore May, (1997) acknowledged that ethical decisions are not dictated by what is beneficial to the researcher of the project being carried out instead they are concerned with what is beneficial to not only the project or its sponsors but also others who are participants of the research being studied.

No ethical approval was required in carrying out this research on poliomyelitis. However, ethical issues inherent in undertaking literature review such as citing references or acknowledging the sources of information and the use of quotation marks where necessary were strictly complied with to avoid verbatim and plagiarism which might render the whole research unethical and valueless. Punch (2006) supported this opinion and expressed that in academic writing, the acknowledgement of the research studies of other authors is an integral and pertinent part of academic integrity.

4.3 METHODS

This section discusses how the researcher carried out the literature search so as to obtain relevant articles for the review.

This was affirmed by (Mc Queen & Knussen, 2002) who stated that research methods refer to the procedures employed by a researcher in order to explain, draw inferences and examine issues on a particular topic. O’ Leary (2004) added that sources of data may vary and the means by which these sources are accessed and gathered may differ but all methodologies depend on data and the basic method and tools that were used in the data collection.

In addressing the factors that can enhance or hinder polio eradication by immunization in Nigeria, the researcher began literature search on this vaccine-preventable disease using the following libraries; Oxford Brookes University Library, the Cairns Library and the Bodleian Library at the University of Oxford. Hard copies of journals and books were obtained from the above Libraries after which bibliographies were consulted. The use of these three Libraries was helpful as literature not found in one was located in others.

Electronic databases from the Oxford Brookes University was also searched extensively and this gave the author most of the literature used in carrying out this study. The databases searched include: Allied and alternative medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System (MEDLINE). Majority of the relevant journals were located via CINAHL and MEDLINE. These databases were used to ensure that the researcher broadens the search in order to ensure that relevant literature on poliomyelitis in Nigeria was not missed. This is in cognizance with Somekh and Lewin (2005) findings who revealed that in the search for relevant literature the researcher should ensure that more than one database is searched as this gives an extensive coverage of the study area.

The following vocabulary search terms were used: polio eradicatio*, poliomyelitis eradicatio*, polio eradication, poliomyelitis eradication, polio immunizatio*, polio vaccinatio*, polio immunization, polio vaccination, Nigeria. The Boolean operators ʽANDʼ and ʽORʼ were used in between the search terms as such; polio eradicatio* OR poliomyelitis eradicatio*, polio immunizatio* OR polio vaccinatio*, polio eradicatio* AND Nigeria, polio immunizatio* AND Nigeria, polio vaccinatio* AND Nigeria. The search was frequently refined so as to obtain relevant literature.

Integrated review was the approach used for this literature review as it enhanced the author to present and summarize the selected articles for addressing factors affecting poliomyelitis in Nigeria. Miles & Huberman (1994) supported the use of integrated reviews by stating that the integrated review method of literature review is the only approach that allows the combination of different methodologies and this enhances the rigour of a research study.

The retrieved articles were critical evaluated using Critical Appraisal Skill Program (CASP) of the NHS, UK and a quantitative studies appraisal tool adapted from the University of Salford, UK after-which the retrieved articles were thematically analysed to have current knowledge on the research topic.

Summary

The research question, methodology, literature review with its steps and approaches, literature search and sources, inclusion and exclusion criteria, critical appraisal, data analysis, strengths and weakness of secondary information, ethical issues inherent in conducting literature review and methods were discussed in this chapter. Convincingly, literature review is the appropriate methodology for this research.

The results of the findings of this research will be presented in the next chapter where factors affecting immunization in Nigeria will be enumerated and explained.

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