2.1 Study setting and context
The evaluation was conducted within the 11 mainland Scottish territorial Health Boards where the FNP programme is currently being delivered, these included: NHS Ayrshire & Arran, NHS Borders, NHS Dumfries & Galloway, NHS Fife, NHS Forth Valley, NHS Highland, NHS Grampian, NHS Greater Glasgow & Clyde, NHS Lanarkshire, NHS Lothian, and NHS Tayside.
Due to infection control restrictions in place at the time of the research, all data were collected remotely using telephone and digital methods.
The evaluation took place from August 2020 to March 2021 (rapid systematic review). Primary data collection (one-to-one interviews, focus groups and survey) began in January until March 2021. During data collection, participants were asked to reflect on their experiences of delivering and receiving the FNP service following the COVID-19 outbreak in March 2020 up until the point of data collection. This time period encompassed the introduction of a range of public health measures and restrictions in response to the COVID-19 outbreak. After a period of strict national lockdown, introduced from 24th March until 28th May 2020, restrictions were gradually eased in phases until regional level restrictions were implemented across Scotland on 1st November 2020. From January to April 2021 a second national lockdown was introduced. It is important to convey that participants' responses may have been influenced by their duration of enrolment (clients), employment (family nurses) and overall experiences of local and national restrictions during this time. Where possible we have indicated information about the stage clients were at when they took part in the evaluation.
2.2 Data Collection
A mixed-methods approach incorporating interviews, focus groups and a survey were used to gather primary data across all 11 Health Boards. These are detailed below in Table 1.
|1-1 Semi-structured interviews
- Family nurses
- Clients (enrolled before or during the COVID-19 pandemic)
|- Family nurses
|Online staff survey
|- Family nurses
2.2.1 Data Collection Instruments
Semi-structured qualitative topic guides and survey questions were developed using existing programme theory, key documents and literature-based findings. The tools were then refined through discussion with key stakeholders (Scottish Government and the National Clinical Lead for FNP) and testing by the research team. Please see Appendix 2 for a full list of survey questions.
2.2.2 Qualitative Interviews & Focus Groups
Family nurses were initially contacted by local team leads who distributed invitation letters and information sheets via email. Due to the research being conducted remotely, informed consent was obtained via Qualtrics using an online data form.
Clients were contacted and recruited by their family nurses. Family nurses were provided with recruitment materials and information they should share with clients in various formats (i.e., text message, email, or verbal conversation). Clients were then able to contact the research team directly by completing an online Qualtrics data form which contained a participant information sheet and informed consent form.
The online form also allowed clients the option of choosing a preferred time and day for a telephone interview as well as the ability to request a female researcher or additional support from their family nurse, if required. All clients were offered a £20 high-street e-voucher as a thank you for their participation.
All interviews and focus groups were recorded using an encrypted digital audio recorder and then transcribed verbatim. All transcripts were anonymised and pseudonymised prior to analysis.
Family nurses were contacted by their local team leads, who distributed the links to the Qualtrics survey and information sheet. Informed consent was received via Qualtrics using an online data form. The family nurses' participation in the survey was anonymous.
2.2.4 Data Analysis
188.8.131.52 Qualitative Data
Initial deductive coding frameworks were used to code staff and client transcripts devised using main thematic categories and sub-categories drawn from existing programme theory, literature, programme document and stakeholder discussion. The frameworks were tested independently by three members of the research team on identical transcripts to ensure adequacy and consistency. Transcripts were coded categorically and thematically using NVivo software. New codes were included following discussion with team members. A number of transcripts were periodically cross-checked and double coded by team members to further ensure consistency. No notable disagreements in coding were identified and minor differences were resolved through discussion.
Three researchers undertook thematic analysis of the qualitative data. Emergent themes were iteratively refined and discussed by the research team (Braun and Clarke, 2006).
The qualitative data findings are represented by regional areas in the findings to maintain anonymity of participating study sites and staff. The regions are grouped as East, North and West and include the following health boards – East Region: NHS Borders, NHS Fife, NHS Lothian; North Region: NHS Grampian, NHS Highland, NHS Tayside; West Region: NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Forth Valley, NHS Greater Glasgow & Clyde, NHS Lanarkshire.
184.108.40.206 Survey Data
Survey data has been analysed descriptively, using graphs and tables to present findings. Text field data was also analysed thematically by three researchers. Emergent themes were refined and cross-checked by team members to ensure consistency. A marked-up questionnaire can be found in Appendix 2.
Due to moderate sample sizes, all data is presented at an aggregated level across all Health Board areas in order to preserve anonymity and proportionate representation. Findings from the qualitative research and survey have been triangulated and reported based on themes or topics.
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