Investigating the adoption of electronic health records amongst physicians
3. Research Methodology
It has been stated by Ryhtä et al., (2020)that qualitative description is one of the most effective research designs in the field of health because factual responses are provided by this design. On the other hand, qualitative descriptive research focuses on low interference description for increasing the likelihood of agreement of a number of researchers. The principle of naturalistic inquiry indicates that the researcher needs to observe, describe and interpret actions and experiences of certain individuals or a group of individuals in cultural and societal contexts as well (Kim, Sefcik and Bradway, 2017).
In this present study, a phenomenon is studied in its natural state without showing any interference in the ordinary manner. In this context, an extensive mixture of data collection, sampling, and data analysis methods are used to obtain significant results. In this way, it would become possible to collect enough data as per requirement by delivering true understanding of the method. Taking it into consideration, it would also become possible to perform thematic analysis based on the collected textual data.
The research philosophy refers to the way of developing the assumption of a research along with its nature and knowledge in terms of research plan (Vat, Ryan and Etchegary, 2017). In other words, research philosophy is considered as a belief regarding the way through which in a research data is needed to be gathered, managed, analysed and used. There are a range of research philosophies such as positivism, interpretivism, post-positivism philosophies and so on. In this current study, interpretivist research philosophy is followed. This particular research philosophy has been developed on a principle that the researcher plays a specific role to observe the social world. As per the interpretivist research philosophy, a study depends on the interests and observations of the researcher (Alharahsheh and Pius, 2020). Following this philosophy, research is conducted in a manner in which individuals experience the social world. In this current research, the researcher needs to deal with several perspectives related to the health care industry and electronic health records in a social world context, interpretivist philosophy is suitable here.
On the contrary, certain issues can also be associated with the use of this research philosophy in this research. For instance, it is not possible to collect and analyse data to generalise the findings to the whole population and due to this reason, the perceptions and views of the researcher would take place in this research. It also directly influences the selection of themes and codes. Therefore, issues related to bias can be associated with the final outcomes of this research.
Research approach is defined as the plan that includes the steps in which data would be collected, managed, analysed and interpreted in a research (Bevir and Blakely, 2018). It is directly influenced by the nature of the problem focused in the research. There are mainly three types of research approaches that show success of studies in different ways which include inductive, deductive and abductive research approaches. An inductive approach has been followed in this research to support or deny any existing theories. Focusing on this aspect, this study has begun with the observations of a range of theories and at the end of a research, it is determined based on the research results whether the theories are supported or not. Through this research approach, the patterns theories are searched through observation and based on it, a number of theories are developed through different hypotheses. On the other hand, the researcher is not restricted from using relevant existing theories and knowledge and learning from experiences to formulate the research questions for further exploration (Woiceshyn and Daellenbach, 2018). Apart from that, an inductive research approach helps to test hypotheses and territories and as for this reason, it can be suitable for this current research. Moreover, in this research, the required data has been collected only from the specific KSA context and because of this reason, the overall research as well as result cannot be generalised in a broader context.
Population/ Sampling and Recruitment
In the context of research, Sample is defined as a group of objects, items or people taken from a larger population for performing measurements as per the requirements of the research (Vachon et al., 2019). The selected sample is needed to be representative of the target population to ensure that the findings from the samples can be generalised to that population as a whole. The sampling process refers to the selection of the groups of samples from exactly which the required data are collected (GhaljaieNaderifar and Goli, 2017). The researcher has used the purposive sampling method for this context for conducting the descriptive analysis, which is a non-probabilistic method of analysis. The purposive sampling has allowed to select the participants in the survey with having proper knowledge regarding the research topic. Moreover, the sampling process has helped in reducing the number of targeted population as well as the sample size of the survey. The population of survey is represented by the sample and the targeted population of the sample is physicians of hospitals in Saudi hospitals.
Sampling/Population and Recruitment
Sample size is considered as the number of observations or participants included in a research. It has been seen that the selection of sample size significantly influences two statistical properties in a study. For instance, the precision of the estimates and the power of the research in drawing proper conclusions are influenced by the specific sample size considered in that study. In this particular context, the researcher needs to provide consideration whether adequate data is collected for meeting the aims of the study (GhaljaieNaderifar and Goli, 2017). On the other hand, data saturation refers to the specific point in a research process when from the data analysis, no new significant information is discovered and it further indicates that the data collection can come to end (Vachon et al., 2019). On the other hand, it has been argued by Woiceshyn and Daellenbach(2018) that data saturation is considered as a standard to be measured against selecting sample size enabled by the sample saturation. It has also been stated by Sharma(2017), that often-reported saturation is rarely demonstrated in the reports of qualitative descriptive research. Focusing on this aspect, the ‘information power’ concept is used in this current study to determine the sample size by the available information instead of considering the participant number. According to GhaljaieNaderifar and Goli(2017), the sample size is needed to be determined based on the information amount instead of the number of participants. Taking it into account, it has been understood that the participant number is needed to be 10 for an interview in this current study.
In this study, an inclusion criterion is followed to limit the participants to the physicians working in electronic health records in King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. On the other hand, following the exclusion criterion, the participants who are not working in the above-mentioned organisations. Apart from that, the physicians who are still studying in this hospital are also excluded from this study.
Method of Recruitment
In this study, only the King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia is considered to recruit participants for this research. This healthcare organisation is responsible for maintaining a database of detailed information regarding the physicians’ speciality, experience, content and so on. As for this particular reason, this hospital is chosen in this study to select participants. Before conducting the interview, a letter mentioning the reason and other information of this current study and the researcher’s background was sent to the Administration Department of this hospital. This letter is also attached in this study and that includes a permission request to the hospital’s administration department to identify participants who are eligible based on the above-mentioned exclusion and inclusion criteria. Apart from that, the administration department has also been requested to share the emails and names of the participants and send the contact information template card along with a text message as the consent letter to the participants. In this way, it can be known whether the participants are comfortable to share information about their contacts. However, the application was successful as it was approved by the hospital administration department and the hospital agreed to assist the researcher to recruit the participants. After collecting the Email Ids of the participants, the researcher has delivered several important documents relevant to this study including, participation information sheet (PIS), invitation letter and consent forms.
One week has been given to the participants to go through all the provided documents properly, fill the forms and confirm that they agree to participate in this study. In this context, no participants have been forced to be a part of this study. After reading, filling and doing signature the forms, they would send back the documents via email. Apart from that, if any participants would have any questions regarding their participation or this study, those would also be conveyed through mail. Whenever, the potential participants would say that they are in understanding the details and requirements of the study, the researcher would proceed to plan a suitable time and date for the online interview. The invitation letter, consent form, PIS and interview questions would be provided in two different languages including Arabic and English by translating with the help of a professional translator. In this way, it would be possible to make every participant understand the questions and other documents appropriately.
As per the study of Prada-Ramallal et al. (2018), the data collection method is of different types in qualitative descriptive study while all of the methods intend to find out the ‘what’, ‘where’ and ‘who’ phenomena. On the other hand, it has been posited by Xu and Zammit(2020) that individual semi-structured face-to-face interviews are one of the most effective and appropriate ways of data collection in such studies. Focusing on this aspect, it is planned to conduct a semi-structured survey among the participants to collect required data. On the contrary, due to certain limitations, online interviews would be conducted in this current study. It has been pointed out by Prada-Ramallal et al.,(2018) that in research, a number of limitations related to face-to-face interview can be overcome by the implication of online interview. As in the Covid-19 pandemic crisis, self-isolation is important to protect health, in this crisis period, online interview is one of the most safe and effective ways of data collection in primary qualitative descriptive research. Apart from thought, focusing on the extended geographical scope, it can also be stated that the online interview is suitable for this study.
As per the inclusion criterion, only the participants would be included in this study who have above three years of experience in work based on electronic health records. It is expected that every interview would last for 30 to 45 minutes and after obtaining permission and consent from the participants, the audio of the online interview would be recorded. In order to perform semi-structured interviews, a set of important open-ended questions would be developed and distributed to the participants to obtain their responses in a detailed manner. These questions would be developed aiming to gather information about the experience of the participants in the selected hospital regarding electronic health records. An addition to that, it could also be asked about the range of challenges they have faced in handling electronic health records. The questions would also focus on how the physician’s role whose work is connected with electronic health can be improved and enhanced in the future. However, in this research an online platform, Skype for conducting the online interview as creation restrictions have been found in physical movement. As for this reason, in the invitation letter, the potential participants would be requested to install this application as it is free of cost and helps in effective communication.
As per the findings of the Rampioni et al., (2021), thematic analysis is one of the most effective ways of identifying, analysing and provisioning of pattern reports within data. On the other hand, it has been stated by Prada-Ramallal et al. (2018) that thematic analysis is one of the most commonly used data analysis methods in qualitative descriptive research.
On the other hand, thematic analysis also does not require in-depth technological or theoretical knowledge and as for this reason, in this present research, using thematic analysis method can be a good approach. In thematic analysis a detailed account of data is analysed to obtain key findings based on the specific questions of a research (Rampioni et al., 2021). This data analysis process is performed in six steps. These steps include data familiarisation, initial code generation, search of themes, reviewing themes, defining and naming the themes and report production (Xu and Zammit, 2020).
In the first step of thematic analysis, knowledge is gathered about the collected data. It is crucial to properly know about data before starting analysis of the theme. In this step, a range of qualitative data are collected from the concerned sources to further extract themes. In the initial code generation step, the collected data is coded that means highlighting the important sections, words or phrases. In the next step, based on the coded data, specific themes are developed for further analysis. In the theme review step, with the supportive and contradicting secondary data, the developed themes are analysed or reviewed to identify the key findings. On the basis of the review result, the themes are defined and named in the next step. However, in the final step, the key findings are extracted from the overall, thematic analysis based on the specific aim, objectives and questions of the research (Rampioni et al., 2021).
Following each step, in this current study, thematic analysis would be performed based on the primary qualitative data collected from the semi-structured interview. From the detailed responses of the participants in the online interview, themes would be developed, defined, reviewed and analysed to obtain the significant research outcomes. From this point of view, it becomes possible to identify different aspects of adopting electronic health records. Therefore, thematic analysis is the most suitable data analysis method for this current research.
In order to maintain the quality of a study, it is required to focus on four specific criteria including transferability, dependability, credibility and confirmability (Johnson, Adkins and Chauvin, 2020). In the context of dependability, it is needed to make use of audit trail for further ensuring that the researcher’s activities are well traceable and documented by the independent reviewers. On the other hand, transferability can be ensured by giving sufficient evidence to the readers that the results of the research can be transferred to other situations or contexts. In the context of credibility, self-reflection models can be used by the researcher to avoid personal bias. Moreover, confirmability can be ensured by providing information about the way in which findings could be confirmed and collaborated by others (Vat, Ryan and Etchegary, 2017).
In this present research, a detailed information about the entire data collection, analysis and management is provided. Apart from that all the activities of the researcher are also mentioned in this research. From this point of view, it can be stated that the quality of this present research is maintained properly.
Ethical and Governance Considerations
In this research, the researcher intends to make sure that it is able to meet the specific ethical requirements. In this study, the key principles of anonymity, confidentiality, voluntary participation, transparency and harmlessness would be strictly maintained in this study. In this research, confidentiality would be maintained by ensuring that all the collected data would be used only for academic and scientific processes and not for any commercial purposes. Apart from that anonymity would be confined by interpreting a number of names to mark each collected data related to the selected participants. On the other hand, in order to ensure harmlessness and voluntary participation, in this current study, the participants would not be forced to participate in the interview and response. There would also be no ethical or legal consequences in such cases where any participant decides to stop the interview and take them out of the research. In order to ensure transparency, the audio would be recorded and the transcripts would be written with the permission of the participants. No manipulation would be done in the transcripts related to the interview responses.
Before conducting this research, ethical approval would be collected from the Healthcare Sciences Ethics Committee of Cardiff University. The framework of the Research Integrity and Governance Code of Practice established by Cardiff University would be adhered to in this research. On the contrary, no ethical approval would be collected from the King Abdulaziz City for Science and Technology because in this research, no personal data of the participant would be collected. Apart from that, no confidential information related to the hospital would also not be used in this study.
As discussed above, all the selected participants would be provided with an electronic copy of the information sheet before conducting the interview. In this information sheet, important information about the study, such as the aim, possible outcome of the study, procedure, and potential risks of this study would be provided. After considering such information, the participants would provide concepts by filling and signing the provided consent form. It would also inform the participants about their rights to withdraw their information and names from this study. Hence, it can also be stated that ethical consideration would be maintained in this research.
The guidelines of the Data Protection Act 2018 would also be followed in this study. Additionally, the guidelines of the Cardiff University’s Records Management (2015). Apart from that the audio would be collected from the interview after getting permission of the participants, would be stored in only an encrypted digital database which can only be accessed by the research supervisor and the researcher. The personally identifiable information would be stored on a password protected server of the university based on the compliance of the Data Protection Act 2018. In this research, pseudo data would also be collected and used for the purposes of analysis. On the basis of the ethical requirements, the selected participants would also be allowed to discontinue the interview due to any stress or comfort issue if they want. Taking all above aspects into consideration, it can be said that specific ethical fulfilment would be met in this research in a systematic manner.
Strengths and Limitations
Focusing on the designing of the research, it is expected that a number of issues faced by the physicians in working with Electronic health records in King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia would be uncovered. The originality of this study can also be considered as the strength of this present research because it explores many scopes for further conducting in this field. On the contrary, it is possible to consider this study as a small-scale approach in the grand scheme of things and it is a key limitation of this study.
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