2.2 Study Design and Data Collection
We adopted a qualitative cross-sectional approach where we engaged NHIF members through focus group discussions (FGDs) across the two counties. FGDs were preferred as opposed to other approaches such as in-depth interviews to help us gain insights into the general perspectives of NHIF members’ choices around facility selection and to reach many members over a shorter period. We collected data from registered NHIF members who had NHIF membership cards. Initially, in the first county, we obtained a list of all registered NHIF members and made phone calls to invite them for FGDs. However, this approach failed, as 1) most of the numbers could not go through, for instance, because members had changed phone numbers thus reaching different people, and 2) people were not living within the county during the study period. Consequently, we resorted to using community health volunteers (CHVs) to mobilise NHIF members from rural and urban areas. The CHVs reached out to households within their community through door-to-door and invited willing household members who were NHIF members (had an NHIF card) to participate in the FGDs on a selected date and venue. The researcher (JK) and the CHVs utilised the maximum variation sampling approach to purposefully include gender variation and age distribution of participants included in each of the FGDs.
The FGDs were conducted using a semi-structured topic guide which was developed around factors conceptualised to affect the choice of an outpatient facility among NHIF members. Evidence from other settings had shown that patients’ or a population’s choice of health facilities is often influenced by the cost of care 24-27, availability of medical equipment and drugs 28-30, distance to the facility 28, 31, 32, the quality of services provided 24, 32-34, waiting time and consultation time 24, 29, 33, and the staff attitudes26, 30, 32. These were categorised as individual and facility-level factors (Figure 1). We collected data from a total of 148 NHIF members through 15 FGDs – each taking between 40 to 90 minutes. Out of the 15 FGDs, eight were conducted in Makueni county (4 in rural and 4 in urban areas) while 7 were conducted in Nyeri county (4 in urban and 3 in rural areas). Out of the 148 NHIF members, 96 were women and 52 were men. The average age of the participants was 52.6 years but ranged from 23 to 74 years.
The FGDs were conducted in English and Swahili and audio recorded. All FGDs were conducted in a central area selected by the participants in both rural and urban centers and were facilitated by JK. Data collection stopped when data saturation was achieved. Data collection was conducted between July and December 2021.