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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.104 n.5 Cape Town May. 2014




Parents' perceptions of HIV counselling and testing in schools: Study methodology deeply flawed



To the Editor: I am responding to the article by Gwandure et al.[1] that appeared in the January SAMJ. The article claims to explore parents' views on the HIV counselling and testing campaign to be conducted in high schools, within an interpretative qualitative paradigm. This is an interesting and important topic. However, the methodology of the study is deeply flawed and unfortunately gives qualitative research a bad name. While the authors' sampling for a qualitative study was acceptable, it is unclear what their 'snowballing' means. Since there are so many parents of children in high school (and it is not a sensitive issue to be such a parent), it is unclear why snowballing was necessary; in fact, it creates an unnecessary clustering of possibly like-minded people. This, however, is not my main objection (nor is their description of 'black' people as one ethnic group). My main problem with the methodology is that all the data that are presented are quantitative. If this was a quantitative study, then of course the sample of 20 and the sampling process would be woefully inadequate. Presenting the numbers in this context has no meaning and is irrelevant. Had this study been a quantitative one with an adequate sample, it might have had some validity. However, it fails on both qualitative and quantative fronts.

The writers present almost no qualitative data and do not contextualise these data in any way. The reader does not know whether the respondent who said something was a woman or a man, and we do not even know how the interviews were conducted, in what language, where and by whom, or how the data were captured and analysed.

Qualitative methodology is a well-documented science. In the health sphere it is used in order to see the social world from the perspective of the actor (in this case the parents), and to understand behaviour in the context of meaning systems used by a particular group (in this case parents in Kathlehong). It aims to be fluid and flexible and encourages discovering novel and unanticipated findings.

'The validity, meaningfulness and insights generated from qualitative enquiry have more to do with the information richness of the cases selected and the observational/analytical capabilities of the researcher than with the sample size.'[2]

In my view the SAMJ should have rejected the article on methodological grounds.


Susan Goldstein

Programme Director, Soul City Institute, Johannesburg, South Africa; Honorary Lecturer, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa


1. Gwandure R, Ross E, Dhai A, Gardner J. Parents' perceptions of HIV counselling and testing in schools: Ethical, legal and social implications. S Afr Med J 2014;104(1):40-42. []

2. Paton MQ. Qualitative Research and Evaluation Methods. 3rd ed. Thousand. Oaks, CA: Sage Publications, 2002.



Gwandure et al. respond: Thematic content analysis is an acceptable method of qualitative research and involves quantifying the number of persons who articulated the various themes. The original study yielded rich qualitative responses from participants which exemplified these themes. However, the restriction on word count precluded inclusion of direct verbatim quotes illustrating these themes in the article. Snowball sampling is also an acceptable sampling method in qualitative research.

The article was based on a much larger research report. Much of what concerns Dr Goldstein is probably a result of what was lost in the process of summarising the research because of the word count limitations of the SAMJ.

Dr Goldstein is welcome to read the full report. It is available at the Wits Institutional Repository environment on DSpace (


R Gwandure
E Ross
A Dhai
J Gardner

Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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