The main methods used for this study were: (a) semi-structured, in-depth interviews, (b) focus group discussions (FGDs) and (c) key informant interviews (KIIs). The in-depth interviews were conducted through face-to-face interactions with the participants (PLHIV) so as to generate accounts on the experiences of living with HIV. Through FGDs, people can willingly discuss sensitive topics in a way not possible in the context of a one-to-one interview (Kitzinger, 2005). The FGDs were conducted with the principal investigator (PI) as the moderator and one research assistant as a note-taker and a recorder. The KIIs were used to collect expert information from individuals who were deemed knowledgeable on issues concerning care and support for PLHIV and who understood the various government policies governing such operations. The KIIs were conducted with nurses, community health workers (CHWs) and patient support group (PSG) leaders. Whereas nurses manage the PSCs, the CHWs are volunteers who have received basic health training and serve their communities on various health issues.
2.4.1 In-depth Interviews
In-depth interviews make it possible for study participants to narrate their stories in a way that makes sense to them and in their own words. Moreover, they make it possible for complex issues to be probed and clarified thereby resulting in deeper insights about how individuals experience a particular phenomenon. They also provide a relaxed and comfortable atmosphere in which individuals can tell their stories. Interviews provide the perfect atmosphere that compared to other methods is best suited for capturing individual biographies (Bowling, 2009; Taylor, 2005; Kitzinger, 2005).
In-depth interviews were conducted with the aid of a semi-structured interview guide fitted with appropriate probes to facilitate collection of sufficient data to answer the questions of the study (Taylor, 2005). The interview guides were developed from a synthesis of existing
51 research and theoretical literature that were adapted to the objectives of this study. The key domains that formed the guide were the circumstances of learning about one’s HIV status, the initial reactions and thoughts that PLHIV had at diagnosis, and the process of reconciling with their status. The other main themes comprised the effects of HIV in the lives of PLHIV, the coping strategies they adopted and the key challenges that affected their coping strategies.
An open-ended conversational style was preferred and the interview was started off with an open-ended question and allowed the interviews and discussions to flow. This was to enable the interviewees' voices to be heard (Crabtree and Miller, 1999).
2.4.2 Focus Group Discussions
For this study, FGDs were deemed appropriate since the topic is sensitive as it deals with HIV/AIDS, which is a stigmatized condition (Makoae et al., 2008). The FGD method also makes it possible for participants to bring out feelings and issues that may no longer be clear to their memory. This is because the group process can act as a catalyst to memory.
Moreover, it is possible for participants to build on each other's perceptions (Holloway, 2005a). Each of the sessions was audio-recorded to facilitate development of an accurate transcript of responses to provide a credible basis for data analysis (Bowling, 2009).
This study relied on already existing groups corresponding to the PSGs. Generally, there is the option of conducting FGDs with either pre-existing or newly created groups (Holloway, 1997). However, the essential consideration about these groups—whether they are pre-existing or newly created—is their level of homogeneity. Qualitative researchers are agreed on the need for homogenous groups for various reasons (Juma, 2001). Kitzinger (2005), for instance, asserts that homogenous groups have a higher potential for shared experiences and the members are already familiar with each other. This familiarity, which results from sharing in similar circumstances, facilitates the realization of the social network effect, a key element in the FGDs methodology.
Familiarity within homogenous groups helps to avoid the possibility of disruptive conflict, allows for in-depth exploration of the issues being discussed (Juma, 2001) and creates a conducive atmosphere for the participation of all members (Bowling, 2009). Bloor et al.
(2001) argue that there is a high potential for conflict in cases where heterogeneous groups come together. Homogeneity can be based on gender, age, and education or sharing of certain common characteristics or circumstances such as having a similar chronic illness (e.g.
diabetes, cancer or HIV). The FGDs comprised of between six (6) members for the smallest and thirteen (13) members for the largest group. In total, there were 59 participants for the 8
52 (eight) FGDs coming to an average of 7 participants per group overall. The largest groups were witnessed in St. Joseph's Nyabondo Mission Hospital where one group had 13 members.
The FGDs were conducted with the aid of a semi-structured and flexible FGD guide and they lasted between one and one-and-a-half hours each (Holloway, 1997).The FGD guides were also based on a review of the empirical and theoretical literature as well as the research objectives. The FGD guides were adapted for a group situation, ensuring that the questions did not inquire about the experiences of the participants themselves but inquired about hypothetical cases of people diagnosed with HIV. The key themes, as in the cases of both the in-depth interviews and KIIs, were the main circumstances under which PLHIV learnt about their status, how people normally reacted to diagnosis and the reconciliation process. They were also asked about the effects of HIV on the lives of PLHIV, how PLHIV cope with their status and the difficulties they faced.
2.4.3 Key Informant Interviews
Key informants are people from whom data is collected due to their connection to a particular population or community of interest and due to their wealth of knowledge, expertise and experience regarding the research questions being addressed (Bickman and Rog, 2009;
Patton, 2002; Rubin and Rubin, 1995). In the context of care and support services for PLHIV in Kenya, the people mostly considered as key informants include community health workers, leaders of PLHIV support groups, community liaison personnel and HIV coordinators in the respective jurisdictions. For the purposes of this study, the key informants were the PSC coordinators in the two facilities, leaders of support groups of PLHIV and community health workers who provide care and support to the PLHIV.
The KIIs were conducted using interview guides containing ten different items fitted with appropriate probes. The items encompassed the basic themes as those in the in-depth interview and FGD guides adapted for use for the key informants. The main themes comprised the circumstances under which PLHIV learn about their status, the initial reactions to diagnosis, the reconciliation process and the effects of HIV on the lives of PLHIV. Other themes were the coping strategies adopted and the difficulties faced in coping. The items were modified to suit collection of information based on the experiences of others (PLHIV), even though some of the KIIs participants were themselves PLHIV. It was beneficial for this study to utilize the three methods mentioned above in data collection since each method has strengths and limitations that call for a triangulated approach.
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