METHODOLOGY
In the previous chapter, the paper described the literature review on the perceived correlation between the work environment of healthcare workers and their psychological wellbeing. The literature review was keen on factors such as environmental stress, job satisfaction, and the impact of environmental factors on the health and psychological wellbeing of the healthcare workers. This chapter will describe the methodology used in this study. The purpose of the chapter is to discuss the research design, sample instrumentation, and procedures used in data analysis and data collection. According to (Schoonenboom and Johnson (2017), the research design is an aspect of a research paper that contains a flexible set of guidelines connecting the research models and empirical data collection methods and the inquiry strategies. To achieve the study objectives highlighted in chapter 1, it is important to consider both quantitative and qualitative study methods for the collection and analysis of data. The combination of both quantitative and qualitative research is commonly known as a mixed-method approach. To make the research success, the study was conducted in two phases. In the first phase, an investigation was conducted on the effect of environmental factors in affecting the health and psychological wellbeing of healthcare workers. The workers were asked to give their view on the workplace environmental stressors and how these stressors are affecting their psychological wellbeing of workers. Phase one of the study also focused on the mental health conditions particularly the rate of mental diseases among the participants. In phase one, data was collected using a self-reported questionnaire in association with their current working environment. Phase two of the study was about the worker’s perception of the new environment. The participants were interviewed to gauge their willingness to change their professional, the information was to be used to determine the willingness of workers to change their working environment, the readiness of employees to move to another environment. Both self-reported questionnaires and in-depth interviewing were used in phase two of the study. Before going deep into the research questions description approach used in the study, an overview of the research methodology and research philosophy is provided in the study. The methodology starts by investigating philosophical assumptions supporting the study. The philosophical aspect of the research was based on the constructivist and pragmatic point of view. The second section of this chapter discusses the mixed-method approach. The presentation of the methodology is based on the suitability of the study objectives. The mixed-method research approach also emphasizes qualitative and quantitative approaches used in addressing the research questions. The third section of this chapter emphasizes the research approach used and the sampling procedures. Data collection tools used in the research are also discussed including a description of quantitative and qualitative data analysis.
Research Design Philosophy
The accuracy and effectiveness of research largely depend on the data collection and data analysis method used. Therefore, the research seeks an appropriate methodology that includes a critical and exhaustive literature examination. Qualitative and quantitative inquiries are used in reflecting differences based on the philosophical approach and historical roots. The use of the mixed-method approach is favorable as it provides for qualitative research which allows the researcher to investigate the quality of the data collected, it allows for intense investigation into the data collected and how the researcher can become more involved in the process (Lindlof and Taylor, 2017). The quantitative bit involves a thesis and variable testing involved. The use of both qualitative and quantitative combines the benefits of the two and gives the research a better result. According to Gibson (2017), the use of a mixed-method also allows the researcher to handle more technical problems that may arise while conducting the study.
The mixed-method approach is associated with three underlying paradigms including pragmatism, post-positivism, and interpretivism. The method represents the information in a form that can easily be understood by researchers. It emphasizes data collection techniques, it explains various techniques used in the research. The philosophical stance used in the study depends on the objective and the expected outcome. According to Leavy (2017), there are two ways of selecting a research method; that is goal and question oriented approach or theoretical approach. These strategies will guide the researcher on the best method of fitting the study. The philosophical ideology supports the experience and relationship between humans and the environment where they operate. Other important factors of consideration in this study include validity and reliability aspect as well as a subjective experience. The considerations provided are essential as it gives the researcher confidence on the method of data collection and analysis used. The study is given a logical approach that not only allows for a mixed-method but also creates an opportunity for investigating the important factors of the research that can be applied more practically. Based on the logical approach, research occurs in a historical, social, and political context, it takes in various aspects of life to make sure all important factors are taken into consideration. Numerous past studies have incorporated the pragmatist approach in the research methodology particularly the researchers who have opted for mixed methods. Some of the advantageous elements of pragmatist research approach are as follows: It allows the researcher to choose data collection techniques that best suit the study. Prevents possible incompatibility related issues by enforcing the belief that both quantitative and qualitative research methods can be used in a similar study. It explains the purpose of mixing both quantitative and qualitative data. The approach also allows the researcher to present research questions in a more clear form. In addition to that, the method was found to support the traditional term’s avoidance thus separating realism and antirealism and finding a solution that best supports the research question.
According to the pragmatist argument, the “truth” of a proposition is based on the research outcome, whether the researcher has been able to achieve the set goals or not. The truth is not about external reality rather about the study outcome (Creswell and Creswell 2017). Therefore, pragmatists can easily reject mutual exclusivity existing between the subjective or objective points of view. They aim at developing the knowledge required to interpret and answer research questions. As far as the adaptation of paradigm is concerned, research questions are the most important of a research paper based on its guidelines and the directives that need to be followed to fulfill the objectives of the paper. Therefore, research questions can facilitate both data collection and data analysis. The advantage of pragmatism is that it supports the use of both quantitative and qualitative research methods thus forming the foundation for mixed-method research.
Since the main of this study is to develop a clear understanding of the relationship between the healthcare work environment and the psychological wellbeing of workers, a pragmatic approach was essential in determining the quality and the effect of work environment on the health and psychological wellbeing of healthcare workers. The constructivist paradigm was also essential in the study because it was the most appropriate philosophical approach that could be used in exploring individual experiences. The paradigm also supports the fact that there other multiple realities besides the single realities. According to Sovacool et al, (2018), these kinds of reality are constructed socially. The analysis of these approaches is essential in ensuring that the selected method is most appropriate for the research. Having the rightful methodology is key to a successful study. It would not be possible to gather accurate data form the participants if no proper methodology is used. The method used should also capture all the areas in the study to ensure that no omission is recorded. For this study, the method selected was planned to create a detailed, effective and substantial information regarding the perception and experience of the employees within a particular workplace environmental factors and how these factors could eventually the workers’ health and psychological wellbeing.
The Mixed Method Approach
After all the factors have been considered, the research settled on a mixed-methods approach as the most appropriate research method for a study of this kind. The primary aim of this study is to find out the impact of workplace environment on the health and psychological wellbeing of workers. The paper seeks to identify various environmental conditions under which healthcare workers operate and how these conditions affect their wellbeing. The ultimate goal of this research is to be able to come up with a strategic solution for solving the constantly increasing rate of mental health conditions among healthcare workers. As stated earlier, the number of mentally ill healthcare workers has been on the rise in the past decades over what most researchers believe to be caused by tough environmental conditions under which the healthcare workers operate. The advanced technology in the health sector and the increasing number of mental health conditions across the world has been blamed for the fast-growing psychological challenges among the health workers. Therefore, there is a need to develop a research design to respond to the identified questions. The design was expected to data that are appropriate for the study, Racey et al. 2018 believe that the use of the mixed method is beneficial as it creates an automatic response to both explanatory and confirmatory research questions. Qualitative research is branded as explanatory while quantitative research is branded as confirmatory. The study also adopted a balanced and comprehensive research approach to have a better understanding of psychical environmental factors that could affect health and psychological wellbeing. Niederberger and Keller (2018) states, “Mixed method is the type of research in which a researcher or team of researchers combines elements of qualitative and quantitative research approaches (e.g., use of qualitative and quantitative viewpoints, data collection, analysis, inference technique for the broad purposes of breadth and depth of understanding) and corroboration”
According to Khoo-Lattimore (2019), a mixed-method involves analysis or collection of both qualitative and quantitative data in a single study. In a mixed-method approach, data is collected sequentially or concurrently. There are different types of approaches that need to be considered when using mixed-method research. The approaches are labeled as sequential, supplementary, and parallel. Various techniques of mixed method approach can be distinguished based on weight given to both qualitative and quantitative techniques. A priority sequential model was used to create a conceptual framework for combining the two research methods. Either qualitative or quantitative can be given equal weight and act as complementary or supplementary to the other. According to Maxwell (2017), the sequential priorities model refers to a model used for making an important decision regarding research. In this model, data is used in sequential order; it is used in such a way that result extracted from one method can be used as raw data in the other method.
As mentioned earlier, the study was conducted in two phases but with the same participants; the first phase focused on the prevailing conditions of the healthcare workers and the second phase was about the suggested environmental changes. The environmental stressors for both workplaces were taken into consideration to distinguish the environments. In phase one of the study, quantitative data regarding the health status and the psychological wellbeing of healthcare workers were used collected and analyze; this included the perception of the participants regarding their work environment and the relationship between the environment and psychological wellbeing of the workers. In addition to the participants producing personal data regarding mental health conditions, the phase also entailed a purposeful selection of healthcare workers who could participate in phase two of the study. The section of participants selected for phase two was also expected to assist in the implementation of qualitative research. This implies that the qualitative collection of data was dependent on the quantitative data. According to Moser and Korstjens (2018), concurrent collection and analysis of data are common in a qualitative research approach. The author believes that the analysis of qualitative research begins during the data collection process since the ongoing data collection largely depends on the already gathered information.
Based on the sequential operative model, both qualitative and quantitative research methods can work together using three different techniques for undertaking collection and analysis of data. These methods include datasets merging, implanting data at the design level, and connecting data collection methods to data analysis. In datasets merging, datasets from both qualitative and quantitative methods are merged during the analysis, or after separate analysis of data has been done, the results are merged during the interpretation stage. Data embedding occurs at the design stage when a larger data set is embedded in another set of data. In such a scenario, the data collection and analysis can occur sequentially or concurrently depending on the research requirement. The last method entails the connection between data collection and data analysis. Using this method, two sets of data are linked through analysis. An implication that the analysis of a given set of data will lead to an automatic need for the other set of data. Quantitative data can be connected to qualitative data through analysis and vice versa.
In this study, the third method which involves the connection between qualitative and quantitative data sets was used. The approach involved connecting two types of data and building one data form based on the other forms of data. Considering the magnitude of this study and all the factors that needed to be taken into account, an exclusive quantitative or qualitative research method could not be appropriate for the study (Leavy, 2017). The study comprised of diversified features and factors including the working environmental factors, the workers’ experiences, and the perceived association between the work environment and the health and psychological wellbeing of workers. Therefore, it was extremely important to take note of the investigative methodologies used in understanding various environmental factors and how these factors could have an impact on the psychological wellbeing of its occupants. This research paper attempted to complement the quantitative approach contribution with employees’ narratives regarding their experience in the workplace environment and the perceived impact of such an environment.
According to Melnikovas (2018), the use of a mixed-method research design has three main advantages over the mono-methods research approach. These benefits are as follows: Mixed method approach provides a platform for both explanatory and confirmatory investigations. Mixed method design provides a deeper and stronger inference via breadth and depth in exploring complex phenomena. Lastly, the method is supportive of divergent findings because it creates an opportunity for expressing contradicting points of view. Despite the numerous highlighted advantages of using a mixed-method approach, the research method also has some weaknesses that ought to be addressed to ensure that the delivered result is a little bit more accurate. According to Queirós et al. (2017), there are three main weaknesses of using a mixed-method approach in the collection and analysis of research data. These weak points include the following: The method applies a more complex research design and requires more resources and time as compared to mono-methods. Secondly, a researcher using a mixed-method approach is required to have background information regarding different research methods and they can be used together. However, in the case of mono-methods, the researcher may only be required to master one type of research. Lastly, the use of a mixed-method may lead to conflicting results due to the disparities existing between quantitative and qualitative phases. Precisely, just like other research methods, a mixed-method approach has its pros and cons but it was found to be most appropriate for this study. The combination of quantitative and qualitative methods was found to be most suitable for accommodating the collection and analysis of various aspects of data that needed to be collected. For instance, the combination was effective in collecting information about the perception of healthcare workers towards their work environment and the possibilities of such an environment affecting the health and psychological wellbeing of the workers. The use of both methods also made it easy to determine how healthcare workers perceive the effect working environment on their mental health condition.
Harden et al. (2018) argue that the use of a mixed-method approach has more implementation weight as compared to the separate use of qualitative and quantitative techniques. Therefore, the method is more likely to derive extra benefits at the implementation as compared to mono-method. According to the rationale revealed by Berthod et al. (2017), the use of the mixed method is also more dynamic and encompasses numerous processes that could help in handling every bit of the data collection and analysis. The author highlights major rationales for using a mixed-method approach in research including development, initiation, triangulation, expansion, and complementarity. In this study, only two rationales were captured; that is the development and complementarily rationale. The (TABLE to be inserted) below shows the rationales as stated by the author.
Self-Administered Questionnaires (Quantitative method)
Quantitative data were collected by issuing survey questionnaires to the participants. The questionnaires were administered in two phases; phase 1 and 2. The main target of the questionnaires was to help uncover various environmental factors affecting the healthcare workers and to determine how these factors affect their psychological wellbeing. The study also seeks to find out the rate of mental health conditions among the healthcare workers and the number of participants who are willing to change the health profession given an opportunity. The number of participants willing to change their profession would translate to the number willing to change their prevailing work environmental conditions to a better work environment. In addition to these targets, the study was also keen in determining some of the factors which were more likely to affect the employees’ mental health and how the employees perceive such factors. Dealing with the root cause of a challenge is the best way of tackling the challenges. The best way of reducing the rate of mental health conditions among healthcare workers is by addressing environmental stressors which are believed to the main cause of psychological challenges among the health workers. The self-administered questionnaires enabled the recording of participants’ perception as well as contextual information regarding the state of mental health conditions among the healthcare workers who participated in the study.
The self-administered questionnaires were given to the participant via webs and because the questionnaires were web-based, it allowed the participants to respond to the questions at their own time of convenience; this is an extremely essential aspect because most participants are more likely to give accurate results when given humble time to answer questions as compared to when they are forced to respond to questions under pressure. The questionnaires were also administered online to ensure that the process is not tampered with in any way. According to Brace (2018), conducting web-based questionnaires allows the participants to respond to questions at their own time, and also the response rate tends to be higher as compared to the traditional method of administering the questionnaires. The questionnaires had three main sections: Section one entails questions on demographic data, Section two containing questions regarding the work environment, and environmental stressors that are believed to affect the employees. The last section dealing with the Short Form 36 Health Survey. The participants were also asked questions regarding the prevalence of mental health conditions among the healthcare workers particularly the participants. The environment based questionnaires (Environment health quality questionnaires) were used to collect data regarding the participants’ view of the environment and how they perceive the environment to affect their psychological wellbeing. The questionnaire was developed specifically for this study. No standard existing tool was used in the data collection stage. A COPY OF THE QUESTIONNAIRE WILL BE ATTACHED IN THE APPENDIX. To environmental questionnaire was supported by Short Form 36 Health Survey commonly known as SF-36v2. The health survey questionnaire acted as a supplement that provides additional information regarding the health and psychological wellbeing of workers. According to Baron et al. (2019), SF-36v2 refers to a standardized survey instrument that is used in evaluating the perceived health of an individual. It is mostly used alongside environmental health quality questionnaires to enhance a more holistic approach by the study participants.
For this study, a mixed questionnaire approach was used to design and develop environmental health questionnaires. According to Bachnick et al. (2018), the use of a mixed questionnaire is vital in retrieving important information from the participants regarding the healthcare work environment. The questions in the questionnaires were based on the literature review, research objectives, and observations made during the initial stages of the research. Before the questionnaires were issued to the participants, the questions were subjected to validity and reliability test. Past study has shown that a well-structured questionnaire will most likely lead to accurate study findings. The participants’ confidence in the questionnaire is also an issue of concern that ought to be taken into consideration when designing and administering the questionnaire.
The main aim of incorporating SF-36 is to establish a generic health assessment concept that is not associated with treatment group, age, and disease. The tool has been tested extensively and found to be effective in extracting essential health information from the participants. Lins and Carvalho (2016) argue that SF-36 is a vital indicator of health and can be self-administered to participants. The questionnaires aimed at measuring the participants’ general health status including the social, physical, and emotional health. The study however focused on the emotional health of the participants; psychological wellbeing.
Interpretative Phenomenological Analysis (Qualitative Method)
According to Alase (2017), interpretive phenomenological analysis (IPA) refers to an approach that can be used for psychological qualitative research. The purpose of this analysis in qualitative research is to give an insight into how an individual in a given scenario can make sense of a particular phenomenon. This research used Interpretative Phenomenological Analysis for the collection and analysis of qualitative data. IPA was chosen for this study due to the following reasons; Interpretative Phenomenological Analysis is consistent with the objectives of the research and therefore could be used in exploring people’s life experiences. Secondly, the IPA approach can be useful in exploring one’s experience in a form that can easily be understood; it discovers experience in its term and not the one that has been predefined. Besides IPA allowing interpretative analysis of participants’ experience, it relies on the interpretation of the researcher regarding the participant experience. According to Barrington’s argument, interpretive phenomenological analysis originates from both phenomenological and interpretative points of view, and the analysis is used alongside constructionist epistemology (Barrington, 2019). The fact that IPA falls within constructionist epistemology is an indication the analysis is effective in distinguishing the partnership between the physical environmental factors identified and the sample used. That is objective and subjective data respectively. In addition to that, IPA was believed to be appropriate for this study because it provided an individual detailed analysis for the cases presented; such information was crucial in exploring experiences of every participant as well their psychological response to the experience in a given context. Some authors like Eatough and Shaw (2017) have argued that hermeneutical phenomenology has its origin in health psychology and therefore could easily be used to determine perceived psychological impacts of work environment on the health and psychological wellbeing of healthcare workers. With the constantly growing number of models and theories in the research field, the use of hermeneutical phenomenology has widely been used in the occupational psychology field. According to (Heidegger), phenomenology is perceived as hermeneutical when the method used is regarded as interpretive. Instead of becoming descriptive like in the case of transcendental phenomenology. Heidegger claims that the descriptive method is always assumed to be automatically interpreted and therefore every human awareness form is interpretive.
The interview is the integral data collection method for interpretive phenomenological analysis. According to Castillo-Montoya (2016), an interview allows the researcher to explore the minds of its participants and acquire relevant information that is based on participants’ experience. The nature and quality of the interview is also an issue of concern and must be considered when designing interview questions. In past studies, numerous authors have indicated their confidence in conducting interviews as a mode of data collection. Morrison and Flegel (2017) state, a good interview lays open thoughts, feelings, knowledge, and experience not only to the interviewer but also to the interviewee. The process of being taken through a directed, reflective process affects the person being interviewed and leaves them knowing things about themselves that they didn’t know.” The interview design used in this study consisted of semi-structured questions that allow the participants to have their perception and experiences regarding the work environment well spelled out. An in-depth interview was used in this study to create a conducive environment for a healthy conversation between the interviewer and interviewee. The in-depth, interview has been recommended by numerous researchers who believe that it creates an opportunity for a healthy dialogue between the interviewer and the interviewee and the interviewer is in a position to acquire more accurate information. The interview was conducted based on the guidelines provided by (AUTHOR. The author provides interview preparation guidelines, how the interview is to be conducted, and how the interviewer and the interviewee can relate to one another to produce a better result. The accuracy of the interview findings depends on the personality and skills of the interviewer as well as the cooperation of the interviewee. An in-depth interview is specifically appropriate in circumstances where there are a complex subject matter and high-status respondent.
Research Approach
Because the study focused on investigating various factors in a workplace environment that affects the psychological wellbeing of healthcare worker, the study paid close attention to the primary research question which states:
Is there a correlation between the work environment of healthcare workers and their psychological wellbeing as measured by perceived wellness survey carried out among healthcare workers with work experience ranging between 4 and 38 years?
Some questions were generated to facilitate the main research inquiry. The questions are as follows:
- What are specific environmental stressors in the workplace that healthcare workers perceive to have an impact on their psychological wellbeing?
- Is there a correlation between these environmental stressors and the outcome of workers’ psychological wellbeing?
- What are the environmental factors’ impacts on the perceived psychological wellbeing of healthcare workers?
- How do healthcare workers make sense of their psychological wellbeing in association with their workplace environment?
Considering the nature of the study, it was suspected that it would be resource-intensive and time-consuming and therefore a sequential mixed method was recommended for the study. The method provided a well-defined structure for examining various dimensions of workplace environmental factors and how they affect the psychological wellbeing of healthcare workers particularly in respect to study inquiry. Even though the study used both quantitative and qualitative research methods, the study emphasized quantitative inquiry. The quantitative data was first collected followed by qualitative data. The data collection process involved the selection of interviewing sample and qualitative data’ results probing which was conducted by the help of procedures derived from (PLANO and CRESSWELL 2011). The study followed the sequence depicted in the (FIGURE) depicted below
FIGURE: Sequence Explanatory Procedure according to Cresswell and Plano Clark.
Target population
As has been mentioned earlier, the study was conducted in two phases with the first phase focusing on the workplace environmental challenges that the healthcare workers are currently facing and the second phase focusing on the workers’ perception regarding a new workplace environment particularly an environment away from a health facility setup. Since the study aimed at tracking the healthcare workers’ environmental preferences about their current work environment and a new work environment. The study also captured the richness and complexity of healthcare workers’ psychological wellbeing and the state of mental health conditions.
The main target population in this study is the healthcare workers working in both government and private owned health facilities. The research targeted healthcare professionals who have a work experience ranging between 4 years and 38 years. Both governmental and non-governmental organizations were considered in the study to cover health facilities with different work environmental setup. In addition to that, the study also considered demographic factors such as age and gender to gather equitable and well-informed information. The participants were required to consider their current working environment and give their views regarding other working environments, especially in other professionals. The research considered possible cultural changes concerning the working environment; which is abandoning the current environmental conditions and adopting new environmental conditions. About 2200 healthcare workers were surveyed in the study paying close attention to their mental health condition and well their perception of a new working environment. The number of participants was considered adequate as it enabled an easy tracking of employees’ views about their work environment.