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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
AFRICA
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Thirty individual interviews were conducted and six group
interviews with between two and six participants were facilitated.
Table 1 provides a detailed description of the participants, who
were predominantly male (61%). The study population consisted
of adult interventional cardiologists, paediatric interventional
cardiologists and interventional radiologists, and are referred
to collectively as interventionalists. Adult and paediatric
cardiologists are collectively referred to as cardiologists, unless
otherwise specified.
The participants were purposively selected because they
could contribute to an understanding of the perception of
South African interventionalists on radiation education and
safety training.
15,16
We used targeted sampling in this study,
17,18
and approached specific informants, such as the heads of
departments, to participate in the study.
The purposive selection also ensured that participants
represented the opinions of people with a wide range of
demographic characteristics, including those from different
regions, levels of training, professions, and sectors where they
worked, as shown in Table 1. We therefore attempted to include
the full range of people involved, to get a clear impression of the
overall feeling within South Africa.
We commenced the qualitative data collection in May
2015 and ended in July 2016 when we determined that data
saturation had been reached and there was a representative
spread of all categories of professionals. Data were collected at
several conferences and workshops using an interview schedule.
Participants were asked what they thought the radiation safety
training requirements for their respective disciplines were,
whether the requirements matched their expectations, and if there
was room for improvement, how a change could be executed.
The study was approved by the Human Research Ethics
Committee of the Faculty of Health Sciences of the University
of the Free State (ECUFS 44/2015). Written informed consent
was obtained from all participants. In the discussion groups, the
participants were asked not to divulge their responses outside
the group.
Statistical analysis
Thematic analysis using a deductive and inductive approach was
used.
19,20
The interviews were audio-recorded and transcribed
verbatim. We then checked the transcripts against the audio
recordings for accuracy. Data included the researcher’s field
notes.
Data were analysed as we received it. We used Braun
and Clarke’s steps in the analysis process.
21
The researchers
independently read the transcripts and coded the data. The codes
were organised into categories and the categories were grouped
into themes. We discussed the interpretations that emerged. We
debated the themes and then reached consensus on the findings.
This article explores only the theme of radiation safety, training
and education.
Results
The main themes that were formed included: ‘knowledge and
awareness of radiation effects’, ‘education and training in
radiation safety’, and ‘the role of senior professionals in fostering
a culture of education and training’. In the quotes below (AC)
refers to adult cardiologists, (PC) to paediatric cardiologists and
(R) to radiologists. There was no difference between men and
women in how they responded to the training they received.
Knowledge and awareness of radiation effects
Radiologists generally had a well-informed opinion about how
ionising radiation worked and the effects it could have on
their health and the health of their patients. As one radiologist
reported:
‘I don’t think there is any theory that we’re missing out on [in
training] if you do the proper course work for your primary
exams. I think that covers everything that’s necessary’ (R).
Radiologists often spoke confidently about how radiation
affected health and consistently described the consequences
as ‘stochastic and deterministic effects’ (R). They displayed a
familiarity with the literature on the topic.
This contrasted with the cardiologists whose understanding
resonated with what you would expect from a non-radiologist
doctor. A paediatric cardiology fellow reflected on the effects of
ionising radiation on her health as follows:
‘I haven’t thought about it [laughs] to be completely honest.
We go there [the cath lab] each week and we have our little
[dosimeter] badges. We don’t really think about what’s
happening’ (PC).
Table 1. Demographic characteristics of the participants (
n
= 54)
Parameters
Number (%)
Gender
Male
33 (61.1)
Female
21 (38.9)
Median age (years)
41 (IQR 35–55)
Median years worked
6.5 (IQR 2–20)
Categories of professionals
All interventionalists
54
Radiologists
16 (29.6)
Radiology registrars
13 (24.1)
Adult cardiologists
10 (18.5)
Adult cardiology fellows
6 (11.1)
Paediatric cardiologists
7 (13.0)
Paediatric cardiology fellows
2 (3.7)
Sector worked
Public only
29 (53.7)
Private only
9 (13.0)
Public and private
18 (33.3)
Levels of training
In training
1
21 (38.9)
Junior professionals
2
4 (7.4)
Mid-level professionals
3
12 (22.2)
Senior professionals
4
11 (20.4)
Heads of departments
6 (11.1)
City worked in
Johannesburg
17 (31.5)
Bloemfontein
13 (24.1)
Cape Town
9 (16.7)
Pretoria
5 (9.3)
Other
5
7 (12.9)
Outside of South Africa
6
3 (5.5)
IQR, interquartile range;
1
cardiology fellows and radiology registrars;
2
less than
five years post qualifying;
3
five to 15 years post qualifying;
4
more than 15 years
post qualifying;
5
Durban, Kimberley, Mthatha, Pietermaritzburg;
6
Australia,
New Zealand, United Kingdom.