Understanding STI Transmission and Risks

Chapter One

1.0 Introduction

Sexually transmitted infections (STIs) are ailments that people acquire as a result of sexual contact with others. The microorganisms responsible for the transmission of these diseases are easily passed from one individual to the other and are commonly found in vaginal fluids, semen, and blood (Aral, Fenton, & Holmes, 2007). Despite sexual contact being the most common form of transmission, exceptional cases such as transmission between a mother and an infant as well as blood transfusion are also common. Bearing this in mind, people ought to be cautious; specifically, because most STI infections do not show obvious symptoms and this increases their risk susceptibility (World Health Organization, 2015). A more critical analysis as to what makes sexually transmitted diseases quite dangerous is that having unprotected sex is the most pronounced factor that increases people’s risk of contracting these ailments.

1.1 Background of Study

As of the above description, sexually transmitted diseases are quite disastrous, and this qualifies them as a major issue of concern in the public health sector. Evidence for this is that as of the present situation, approximately half a billion new cases are reported annually; specifically, among individuals between 15 and 49 years (Chadambuka, Chimusoro, Maradzika, JTshimanga, Gombe, & Shambira, 2011). Such high numbers are worrying, which is why understanding the factors that enhance the spread of STIs is essential. For a fact, there are a number of primary factors that render these ailments issues worth public health concern, but lack of adequate treatment is arguably the most disastrous factor. The reason why this is believed to be one of the most pressing issues is that irrespective of there being an approximate 357.4 million cases of curable STIs, the majority of the individuals do not have access to treatment; with the situation being more catastrophic in developing nations (World Health Organization, 2001). The situation in most of the developing nations is one that needs serious attention bearing in mind that STIs account for up to 17 percent of serious health issues that needs appropriate care (Ginindza et al., 2017). For example, STIs are known for increasing the risk of people contracting Human Immunodeficiency Virus (HIV) and since this is one of the major health issues in developing countries understanding some of the factors increasing the spread of STIs need to be addressed accordingly (Ward & Rönn, 2010). Additional to this, STIs are also known to cause other complications such as ectopic pregnancy, pelvic inflammatory disease (PID), premature births, neonatal mortality, as well as male and female infertility.

Considering that sexually transmitted diseases are such catastrophic and the health sector is yet to address their spread, it can only be argued that the true epidemiological situation pertinent to these ailments is yet to be understood (Zenilman & Shahmanesh, 2011). The argument herein is based on the idea that the kind of approaches embraced fail to focus on population-based studies. Hence, since sexually transmitted infections are irrefutably disastrous as they are responsible for increased morbidity and mortality levels, understanding some of the factors that enhance the spread of these infections is of great significance (Menéndez et al., 2010). In fact, health experts interested in these ailments are keen to approach the issue in a way that they can identify some of the factors that increase HIV prevalence as well as identifying measures to embrace in mitigating the increased incidence rates. The reason why approaching the problem from this perspective is crucial is that resurgence of diagnoses of STIs remains to be of great concern. Moreover, the situation among teenagers is quite pronounced as this lot record very high rate of STIs infection. This occurrence is deductively so because the teenagers lead a certain lifestyle that makes their susceptibility to sexually transmitted diseases unmistakably higher than others. Such an understanding according to (Hong, Fang, Zhou, Zhao, & Li, 2011) calls for measures that are linked to human behavior since it proves to be a greater factor that increases the spread of sexually transmissible infections.

Structural factors, which include social, economic, behavioral, and organizational environments, are therefore some of the factors that may increase a person’s vulnerability to transmission of STIs. The reason why this is purported to be so is that studies on factors enhancing the spread of sexually transmitted diseases suppose that STDs are behavioral linked ailments (Hughes et al., 2000). That is, most of the people contract these infections as a result of their sexual lifestyle of having unprotected sex. Thus, from this point of approach, social, behavioral, and biological factors are argued to be the major contributors that increase a person’s likelihood of contracting STDs (Singer et al., 2006). The context in which the risk occurs plays some very great roles in that they determine a person’s acquisition, transmission, and prevalence of sexually transmitted diseases. Recent studies on these factors show that some of the factors that increase a person’s risk to HIV are also the same factors that increase STIs spread rates. That is, like in the case of injection drug users (IDU) as well as sex workers, their lifestyles subject them to increased risk of contracting sexually transmitted diseases. The concept of increased spread of sexually transmitted ailments may also be seen based on the people’s economic status like the street-involved individuals have a higher susceptibility rate compared to the non-homeless peers (Marshall, Shannon, Kerr, Zhang, & Wood, 2010). Why this is supposedly so is because their low economic status increases the possibility of engaging in unprotected sexual intercourse. For instance, youths in the streets have a higher rate of spreading sexually transmitted disease because they engage in survival sex in exchange for shelter, food, and cash (Teasdale, 2015).

1.2 Statement of the Problem

As of contemporary society, despite there being cheap, simple, and cost-effective intervention methods to combat sexually transmitted diseases, very little progress has been made. In affirming this, studies show that an approximate 499 million new cases are reported annually of curable STIs. Thus, despite these new cases being treatable, people are yet to find the best treatment for these ailments (Low, Broutet, Adu-Sarkodie, Barton, Hossain, & Hawkes, 2006). In fact, the situation is more catastrophic bearing in mind that increased spread of sexually transmitted diseases amplifies the possibilities of contracting HIV. The strong connection between STIs and HIV are enough reason for society to be keen on addressing this problem. This might be the case but what the society has done is that they have focused on HIV treatment and this has in a way overshadowed the focus on STIs and their treatment. According to Sonnenberg et al. (2013), the situation is more disastrous in developing nations as they still lag behind in the allocation of resources in treating STIs.

On the same note, increased the spread of sexually transmitted diseases is still a problem considering that the approach embraced in most research tends to elucidate the actual reasons that lead to increased engagement in risky sexual behaviors. For instance, the focus on street-involved individuals is quite unsubstantial as most research predominantly depends on information from individual-level risk factors, which may be misleading (Xian et al., 2017). Focusing on such individual-level characteristics is irrefutably a problem since the key issues of concern include childhood abuse and depression among other factors, which is misinformed approach. The reason behind this is that individual risk level analysis ignores the social structural factors, which are the main determinant factors that subject people to increased risky sexual behaviors (Gott, 2001). When analyzing the factors increasing the spread, focusing on factors such as economic inequalities, policies, laws, as well as systematic discriminations should be crucial as this is the only way STIs prevalence can be mitigated.

1.3 Study Aim

The main aim of this research is to identify the key factors that enhance the spread of sexually transmissible diseases.

1.4 Research Objectives

1. To investigate the risk factors for the spread of STIs

2. To explore the perceptions of medical practitioners towards the spread of STIs

3. To explore possible interventions for the spread of STIs

1.5 Research Questions

1. What are the risk factors for the spread of STIs?

2. What are the perceptions of medical practitioners towards the spread of STIs?

3. What are the possible interventions for the spread of STIs?

Chapter Two

Literature Review

2.0 Introduction

This chapter entails a review of literature selected from secondary sources. Its main aim is to highlight what is already known about the risk factors for the spread of STIs, the existing research gaps, and corroborating findings of previous research studies on the same topic area. Because the review was based on sources with a wide range of methodologies, the researcher decided to take a narrative approach to the literature review.

2.1 Biological Factors

A review of existing literature suggests that STDs are behaviorally linked ailments that are as a result of having unprotected sex (Mayer et al., 2012). By being behavioral ailments, it means that factors such as social and biological factors are key players in causing these diseases. In fact, evidence by Dafesh (2017) show that additional microenvironment factors such as hormonal, microbiological, and immunological factors influence a person’s susceptibility to increased transmission of STDs. However, from a more critical approach, according to Teasdale (2015), the microenvironments are believed to be partially instigated by a person’s substance use, sexual practices, and other health-related behaviors. Based on the observations by Alghabbashi (2016), the said behaviors are in return influenced by other factors such as epidemiological and socioeconomic factors. Therefore, while addressing the factors that increase the spread of sexually transmitted diseases, focusing on the biological factors and structural factors, which include social, economic, behavioral, and organizational environments, should be obligatory (Haley, 2016).

From a general overview, there are several biological factors that contribute to the increased spread of sexually transmitted diseases. From this biological point of approach, according to Hearne (2016), most STDs are believed to be caused by unprotected sex with an infected person. Apparently, as is observed by Ndwanya (2015), when it comes to the transmission of STDs, biological aspects such as gender as well as other preexisting or concurrent sexually transmitted diseases such as HIV infection are major causative agents. From this point of argument, according to Fitch (2018), the noticeable factor that makes biological factors major contributory factors is that most STDs lack conspicuous symptoms and signs; indicating that a person is infected. Hence, the long lag in these infections leads to severe complications. This leads to the summary that failure to have clear symptoms and signs of an infected person as well as gender are the reason why the spread of sexually transmitted diseases is irrefutably high (Whitesitt, 2016).

2.2 Asymptomatic infections

The above overview of biological factors as contributory factors in the spread of STDs shows that since these ailments do not produce clinical signs or acute symptoms, they are the reason why their spread is severe. This is affirmed by Miller et al. (2004) study in most women’s gynecological examinations that found that 79% of the females who tested positive did not show any signs and were unaware of being infected. Bearing this in mind, most researches (i.e. Freeborn 2018, Pokharel 2016, & Sakeah 2017) confirm that the fact that most STDs are asymptomatic infection is the main reason why the spread of infections such as genital herpes, HIV infection, hepatitis B virus infection, and human papillomavirus infections is relatively high.

In fact, HIV infection is a clear illustration of how specific STDs can go for such a long time before they are recognized, and this increases their wide dissemination; particularly before they are detected and tested (Pokharel, 2016). According to Freeborn (2018) failure to understand that most STDs are asymptomatic will, therefore, make people believe that they can tell whether their partner is infected or not and this increases their susceptibility. Consequently, people will not take any caution, like having protected sex, as they are unaware of whether one is sick or not, and this results in increased transmission (Sakeah, 2017). Furthermore, Ghobadzadeh (2017) observes that asymptomatic infections are therefore deductively major biological factors that increase the likelihood of an individual contracting or spreading STDs.

2.3 Age and gender disparities

In terms of gender disparity being a major biological factor that contributes to increased infection, this is supposedly so since the females have a higher chance of contracting STDs compared to the males. The reason behind such an occurrence is argued to be an issue associated with age and gender disparity. That is, according to research, young women and female adolescents are believed to have a higher susceptibility to STD infection as compared to their male counterparts. This is typically an issue of biological disposition and the characters of anatomy that renders the female more susceptible to these infections. According to Dafesh (2017), women at puberty and early adolescent have specific cells, known as columnar epithelium, that are quite sensitive to invasions; specifically, those from sexually transmitted diseases such as gonococcus and chlamydial.

According to Walls (2016), these columnar epithelium cells are found in the inner cervix and extend over the vaginal surface where they are unprotected by the vaginal mucus; hence, increasing the chances of contracting these ailments. However, as these females age, these cells recede into the inner cervix, and this reduces their susceptibility at an older age than when they were young. Also, when focusing on gender and age disparity, the issue of gender stereotyping is typically an issue that increases women susceptibility (Teasdale 2015). The argument in this is that younger females have difficulties in implementing protective behaviors, and this is usually instigated by the overall issue of the power imbalance between men and women. For example, condoms are sure protection against STDs, but in most case, the decision of whether two sexual partners will use condoms is ultimately a man’s decision.

2.4 Other biological factors

Age and gender disparity, as well as asymptomatic infections, may be the main biological factors that increase a person’s susceptibility, but other factors such as the presence of penile foreskin, cervical ectopy, and vaginal douching also increase the risk. From a critical approach, male circumcision is one of the sensitized aspects in reducing the spread of sexually transmitted diseases. The reason behind this sensitization is that lack of male circumcision is believed to increase susceptibility, and this was evident in statistical data that showed a close relationship between the increased spread of STDs and male circumcision. For instance, most uncircumcised males are reported to be more vulnerable to the contraction of HIV infection (Newman et al., 2015). This is purported to be so bearing the fact that uncircumcised males are eight times more likely to become infected with these diseases compared to those who are circumcised. With such statistical evidence, male circumcision should be a must practice if the spread of sexually transmitted ailments among males is to be reduced. What makes an uncircumcised male be at a higher risk of spreading STDs is that the cells in the fold of the penile foreskin may act as a reservoir for pathogens, which in return increases the likelihood of being infected.

2.5 Structural Factors

Structural factors, which include social, economic, behavioral, and organizational environments, are the other major contributing factors that enhance the increased spread of STDs. On a population level, reducing the spread of STDs infection may need biological intervention, but without addressing the social issues, then, the efforts are destined to fail. Social factors are sure major contributing factors in the spread of STDs as they are about societal problems that include, lack of education, poverty, and social inequality, which increases the prevalence of sexually transmitted diseases (Dafesh 2017). Also, the lacks of openness, as well as mixed messages regarding sexuality, are major obstacles in reducing the spread of STDs. Hence, as of this discussion, focusing on the societal norms regarding the spread of sexually transmitted ailments is crucial as this is the only way to make sure that their spread is reduced significantly. In considering that social, economic, and behavioral factors have a role to play, also focusing on access to and provision of health care should be considered herein.

2.6 Racial and ethnic disparities

Historically, certain populations are more vulnerable to sexually transmitted diseases, and this is typically exacerbated by segregation and discrimination. This is evident in the fact that specific racial and ethnic groups such as African-American, Natives, and Hispanics record higher rates of STDs as compared to the white population (Alghabbashi, 2016). A critical analysis of why some ethnic groups are more vulnerable to the spread of STDs is argued to be instigated by factors such as race and ethnicity being associated with the specific economic class. That is, the mentioned minority groups are associated with low economic status, which limits their access to medical care. Additional to this, the poverty levels force the minorities to engage in uncouth behavior such as prostitution, and this amplifies the spread of sexually transmitted ailments among them.

2.7 Healthcare System

Accessing health care services is a major determinant factor in the enhanced or reduced spread of sexually transmitted infections. Such a supposition is apparent in the fact that when individuals have access to health care, they are sure that such infections will be detected early, treatment will be commenced, and behavioral-change counseling will be issued (Alghabbashi, 2016). On this note of access to health care, health insurance coverage are of great significance. The reason behind such significance is that health insurance covers dictate whether a person will receive professional assistance in preventing themselves from exposure to sexually transmitted diseases. Typically, when a person is uninsured, there is the possibility of delayed seeking of medical care, which is why the problem of STDs may take longer to be treated; more so, with the cases of asymptomatic infections (Haley, 2016). For example, individuals with private insurance and who social status is in the poverty level, the possibility of them accessing health care services is very low, and this becomes a problem in terms of the increased spread of STDs. Also, when people are using private health insurance, there is the possibility that they will not get a comprehensive coverage; meaning that there is very little information disseminated to them in terms of understanding the perils of STDs. The situation is even worse considering that in most private health insurance, the health plans do not cover STD-related health services.

2.8 Substance abuse

Apparently, the correlation between the enhanced spread of sexually transmitted diseases and drug abuse is indubitable. This occurrence is supposedly so bearing in mind that drug use alters a person’s behavior and this happens to affect their sexual behaviors drastically; hence, increased epidemic of STDs. When referring to substance use, on a personal level, the focus is usually on people’s use of alcohol and other drugs. Whether one abuses alcohol or other drugs such as cocaine, research established that drug use and increased the spread of STDs co-vary temporarily. Possible reasons behind this relation are that individuals who abuse drugs have a higher chance of engaging in risky sexual behaviors that end up increasing their vulnerability to contracting sexually transmitted ailments. In explaining this, Alghabbashi (2016) purports that drug use undermines a person’s cognitive skills; thus, making them incapable of making sound decisions such as having protected sex. For example, when a person uses low doses of cocaine, they act in a way that their sexuality is heightened and will do anything to have it, and this result in having multiple sexual partners. Also, when one is a drug addict, they are likely to engage in the sex trade as a way of making money to buy the drugs, and this exposes them to having multiple sexual partners and increased possibility of contracting these ailments (Baral et al., 2015).

2.9 Poverty and marginalization

For a fact, sexually transmitted diseases disproportionately affect specific groups of disadvantaged individuals, and this happens to increase their sexual network. Poverty is a major socioeconomic factor that contributes to the spread of STDs. This is because poverty limits a person’s ability to prevent themselves from sexually transmitted diseases, typically because they do not consider themselves in a position to do so. A study by Haley (2016) on these supposition pinpoints that because of poverty, women belonging to some of the poor ethnic group are constantly faced with increased susceptibility to the spread of these infections. Why this is the situation in these poor societies is that the poor women are in competition of surviving; for instance, having shelter at night may drive them to have sex in return for such favors. Also, a traditional approach to this issue shows that passivity and subordination tend to diminish the women’s ability to protect themselves from sexually transmitted diseases adequately.

2.10 Sexual networks and sexuality and secrecy

The stigma associated with most of the sexually transmitted diseases is unmistakably a major social problem that increases the spread of sexually transmitted diseases. That is, the people are usually uncomfortable discussing inmate aspects of their life; specifically, if they have sexually transmitted infections as they view it as a clear illustration of their promiscuity (World Health Organization, 2003). What people fail to understand is that one may have one sexual partner, but if their soul mate belongs to a network of sexual partners, then, they are sure to be more susceptible to the spread of these diseases. Particular attention on individuals aged between 15 and 24 years old is needed as this is the age set when most individuals engage in sexual networks and are at the same time unaware of the risks of STDs (Anderson & Pörtner, 2014). For example, according to a study in Ghana, high prevalence rates of sexually transmitted diseases was witnessed among most adolescents because they do not use condoms or are inconsistent with protecting themselves (Haley, 2016). Since the lot naturally belongs to an age not socially approved for sexual intercourse, these individuals will hardly seek advice on matters of sex and the adults will also not advise them on such matters. The outcome of this is that they end up getting in sexual networks that increase the possibility of getting infected with these ailments.

Chapter Three

3.1 Research Methodology

A research methodology can be defined as the selected plan for carrying out a scientific study that gives details of the techniques, tools, methods, and strategies through which the researcher intends to achieve the research objectives (Best & Khan, 2016). According to Bryyman & Bell (2015), it explains the philosophy adopted by the researcher, as well as other elements of the study, including the sampling method and the ethical considerations made by the researcher. The following section highlights these details for the proposed research.

3.2 Research Philosophy

Burke (2013) defines research philosophy as the researcher’s underlying belief or preferred method of knowledge expansion in the topic area. Also known as the research paradigm, the research philosophy explains the researcher’s choice of a particular research methodology from a philosophical perspective. Against this background, the proposed study will be based on an interpretivist philosophy. According to Creswell (2017), an interpretivist philosophy entails the assessment of a phenomenon from the perspective of the people experiencing it. Ideally, the main aim of the proposed research is to explore the possible risk factors for the spread of STIs, and more importantly to explore the most appropriate ways of reducing the risks factors for the spread of STIs. Hence, the researcher aims to understand the causes of STIs transmission from the perspective of health and clinical experts as well as patients encountering the spread of STIs. Elo & Kyngas (2008) argue that a proper understanding of reality can be achieved when an inquiry is context oriented (i.e., the environment within which people contract STIs). Therefore, this study argues that understanding the environment within which people are predisposed to STIs is a crucial element to understanding the risk factors for STIs. Ideally, this paradigm underpins the concept of holistic nursing, whereby the environment is considered to be significant contributing factors for health and well-being (Gill et al., 2008).

3.3 The Research Approach

In any scientific research, a researcher can adopt two main approaches, namely: inductive or deductive research approach. According to Heaton (2008), the deductive approach entails the use of more general information to determine specific information, while the inductive approach involves the use of more accurate information to derive a theory of a conclusion on the particular topic area. This study will adopt the deductive reasoning because it is qualitative (Hitchcock, 2012). The researcher’s choice of research approach relied on the decision of research philosophy adopted by the proposed study. Ideally, the interpretive research philosophy was selected by the researcher. This philosophy is generally qualitative, and so it can help in understanding the context of a particular phenomenon experienced by the target population (Lewis, 2015). Lewis (2015) further adds that the interpretive paradigm majorly uses research methods that enhance a continuous interaction between the researcher and the respondents, including interviews and observations. These instruments can enable the researcher to understand the phenomenon under investigation from the perspective of the people experiencing it. The main aim of this study is to understand the factors that contribute to the spread of STIs, and this forms the basis for the adoption of qualitative research design. According to Maxwell (2012), a qualitative research methodology enables the researcher to adopt a less structured approach to the inquiry, thereby being able to gather more comprehensive data for understanding the research questions alongside the context within which the object under investigation occurs.

3.4 Research Method

Whereas several research methods can be adopted by researchers to conduct scientific research, the two main research methods are qualitative and quantitative research methods. According to Ormston et al. (2014), quantitative research methods involve the testing of theories by evaluating the relationship that exists between variables. Hence, the instruments used in quantitative research methods are predominantly statistical. Typically, as Palikas et al. (2015) observes, this method is usually appropriate for research studies with hypotheses to be tested. However, because the proposed research takes an inductive approach and does not have hypotheses.

The qualitative research method is often used in the investigation of subjective human experiences using non-statistical data analysis methods (Ragin, 2014). The proposed study seeks to understand the possible risk factors for the spread of STIs from the perspective of physicians and survivors. It is, therefore, possible to argue that this study corresponds to a naturalistic inquiry Savin-Baden & Major (2013), which entails an exploration of complex human experience. Several theoretical underpinnings support the adoption of qualitative research methods into the proposed study. For instance, Bryyman & Bell (2015) argues that qualitative research entails a holistic exploration of the research problem, which enables a unique comprehension of the issue at hand by developing an appropriate theory. Besides, Elo & Kyngas (2008) argues that information generated through qualitative research method can be used to understand human behavioural characteristics, which can be used to develop interventions for behavioural changes. Last but not least, according to Heaton (2008), qualitative research methodologies rarely over-simplify the reality of experiences; neither does it reduce the data into a statistic or a number.

3.5 Data Collection

Data collection is an essential part of any scientific research. Lewis (2015) argues that the accuracy with which a researcher collects influences the study outcome and therefore, a poorly done data collection may lead to invalid results. Ideally, two types of data can be collected in a research study, namely primary data and secondary data. Primary data are those that are obtained directly from the source while secondary data are those collected from already-existing sources (Best & Khan, 2016).

Elo & Kyngas (2008) indicate that some of the most common data sources for qualitative data are observations, interviews, as well as a review of documents. However, Bryyman & Bell (2015) classifies the data sources for qualitative research into four major categories, namely: observations, interviews, audio-visual sources, and documents. However, remarks by Lewis (2015) indicate interviews as the most common technique of data collections in qualitative research. Existing literature shows that there are many ways in which interviews can be done. For instance, literature by Heaton (2008) indicates that interviews can either be open-ended or conversational, semi-structured, or highly structured. However, writings by Lewis (2015) suggest that most researchers prefer more open-ended and less-structured interviews, which present an opportunity for further probing of the interviewee by the interviewer to gather in-depth information. According to Lewis (2015), this is one of the significant advantages of qualitative research methods because as the interviewee is allowed to speak their true voice, researcher bias is reduced. However, a substantial disadvantage of interviews is that it may take much time and resources to gather interviewees and collect data (Gill et al., 2008). In qualitative research, the processes of data collection and data analysis complement each other; so that the researcher alters the research questions to yield the type of information the researcher may be interested in (Best & Khan, 2016). Furthermore, according to Heaton (2008), interviewees can be exercise flexibility by altering the planed interview structure, so that more questions can be asked to gather more information from the interviewee.

Being a semi-structured interview, the researcher will not rely on a predetermined questionnaire of set of research questions, but will be guided by key areas of focus while engaging with employees. As highlighted in appendix 1, the key areas of focus will be the lead data collection tool for the study.

3.6 Study Sampling

The study will target health practitioners who have handled STI patients, or those that work in the STI health and social care departments; as well as STI survivors. Three hospitals will be approached for permission to conduct the study. The targeted practitioners will be those from the respective departments dealing with STIs. The researcher will conveniently sample four respondents from the three hospitals. Convenient sampling is considered an appropriate sampling method for this particular study to enable easier accessibility of the study subjects (Gill et al., 2008). Besides, convenient sampling is selected as the method of choice to allow the researcher to take the shortest time possible in conducting the study, considering that convenient sampling saves time (Best & Khan, 2016). The researcher intends to seek permission from the respective hospital managers before reaching out to any practitioner willing to participate in the research. The interviews will also be conducted when the interviewees are off-their duties so as not to interfere with the normal operations of the organization.

3.7 Data Analysis

Fundamentally, being qualitative research, the researcher intends to conduct a simultaneous collection and analysis of data to allow a proper understanding of the research questions under investigation. According to Bryman & Bell (2015), this process should continue in an iteration until a data saturation point is reached – a point where no more data is collected. However, Elo & Kyngas (2008) agree that this process may yield an overwhelmingly large volume of data, and thus the need for the adoption of a purposeful data analysis technique that considers the researcher’s burden of data analyses. Therefore, the proposed study will adopt a thematic data analysis methodology to achieve its objectives.

3.8 Ethical Considerations

The proposed study will involve human subjects, thus the researcher intends to give high regard to the ethical considerations. This will be accounted for by ensuring that the study maintains a high integrity of the participants. For example, the researcher will keep the identity of the respondents on an anonymous status to uphold their confidentiality. Besides, the researcher intends to ensure that the interviewees participate in the study willingly by signing a letter of consent (sample attached in appendix 2) before participating. Furthermore, the researcher will ensure that no personal information such as name, telephone contacts or email address of the participants are disclosed because according to Bryman & Bell (2015), this ensures that the responses are issued under anonymity.

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