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Background and Objectives Snowball sampling is applied when samples with the target characteristics are not easily accessible. This research describes snowball sampling as a purposeful method of data collection in qualitative research. Methods This paper is a descriptive review of previous research papers. Data were gathered using English keywords, including “review,” “declaration,” “snowball,” and “chain referral,” as well as Persian keywords that are equivalents of the following: “purposeful sampling,” “snowball,” “qualitative research,” and “descriptive review.” The databases included Google Scholar, Scopus, Irandoc, ProQuest, Science Direct, SID, MagIran, Medline, and Cochrane. The search was limited to Persian and English articles written between 2005 and 2013. Results The preliminary search yielded 433 articles from PubMed, 88 articles from Scopus, 1 article from SID, and 18 articles from MagIran. Among 125 articles, methodological and non-research articles were omitted. Finally, 11 relevant articles, which met the criteria, were selected for review. Conclusions Different methods of snowball sampling can be applied to facilitate scientific research, provide community-based data, and hold health educational programs. Snowball sampling can be effectively used to analyze vulnerable groups or individuals under special care. In fact, it allows researchers to access susceptible populations. Thus, it is suggested to consider snowball sampling strategies while working with the attendees of educational programs or samples of research studies.
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Strides Dev Med Educ. 2017 September; 14(3):e67670.
Published online 2017 September 30.
doi: 10.5812/sdme.67670.
Research Article
Snowball Sampling: A Purposeful Method of Sampling in Qualitative
Mahin Naderifar,1Hamideh Goli,2and Fereshteh Ghaljaie3,*
1Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, IR Iran
2Department of Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
3Community Nursing Research Center, Faculty of Nursing and Midwifery,Zahedan University of Medical Sciences, Zahedan, Iran
*Corresponding author: Fereshteh Ghaljaie, Community Nursing Research Center, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran.
Received 2016 November 29; Revised 2017 May 03; Accepted 2017 June 25.
Background and Objectives: Snowball sampling is applied when samples with the target characteristics are not easily accessible.
This research describes snowball sampling as a purposeful method of data collection in qualitative research.
Methods: This paper is a descriptive review of previous research papers. Data were gathered using English keywords, including “re-
view,” “declaration,” “snowball,” and “chain referral,” as well as Persian keywords that are equivalents of the following: “purposeful
sampling,” “snowball,” “qualitative research,” and “descriptive review.” The databases included Google Scholar,Scopus, Irandoc, Pro-
Quest, Science Direct, SID, MagIran, Medline, and Cochrane. The search was limited to Persian and English articles written between
2005 and 2013.
Results: The preliminary search yielded 433 articles from PubMed, 88 articles from Scopus, 1 article from SID, and 18 articles from
MagIran. Among 125 articles, methodological and non-research articles were omitted. Finally, 11 relevant articles, which met the
criteria, were selected for review.
Conclusions: Different methods of snowball sampling can be applied to facilitate scientific research, provide community-based
data, and hold health educational programs. Snowball sampling can be effectively used to analyze vulnerable groups or individ-
uals under special care. In fact, it allows researchers to access susceptible populations. Thus, it is suggested to consider snowball
sampling strategies while working with the attendees of educational programs or samples of research studies.
Keywords: Purposeful Sampling, Snowball, Qualitative Research, Descriptive Review
1. Background
Qualitative research is an organized method of de-
scribing people’s experiences and internal feelings (1). It
can be said that qualitative research provides a thorough
and deep overview of a phenomenon through data col-
lection and presents a rich description using a flexible
method of research. In this method, qualitative informa-
tion, which is gathered in the form of non-numerical data,
is presented (2).
There are different methods to collect the required
data, including interviews, observations, focus groups,
narratives, notes, reports, and review of archives. The
researcher chooses the information with respect to the
questions, sensitivity of the subject, research samples, and
availability of resources (3). To determine the characteris-
tics of a community, it is possible to gather data by sam-
pling or census reports.
Sampling is the process of choosing a part of the popu-
lation to represent the whole. If the researcher considers a
part of the population as a representation of the whole, the
analysis will be more comprehensive (4). In many research
studies, factors such as lack of human resources, lack of
precision, high expenses, inadequate equipment, and pop-
ulation dispersion prevent researchers from studying the
entire population. In this case, it is preferable to study only
a part of the population (5).
Researchers should plan the sampling process and de-
termine the method of study. Sampling is performed in
two general ways: probability and nonprobability. In prob-
ability sampling methods, the rules of probability are ap-
plied, and as their main feature, each sample has a chance
to be selected. In these methods, the researcher’s opin-
ion or community members do not influence the selection
of samples. The selected sample is a representative of the
population, and the researcher can generalize the findings
to the whole population. Probability sampling methods
include simple random sampling, systematic sampling,
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stratified sampling, and cluster sampling.
On the other hand, nonprobability methods of sam-
pling involve samples that are available to the researcher
or are selected by the researcher. In these methods, not ev-
eryone has an equal chance of being selected, and it is not
clear who will be included in the final sample. Regarding
the sampling method, generalization of the findings to the
entire population is not clear either, and one cannot calcu-
late the rate of error in the sampling. Different methods of
nonprobability sampling include convenience, purpose-
ful, and quota sampling. In quantitative research, proba-
bility sampling is normally applied, whereas in qualitative
research, nonprobability sampling is selected (1).
The convenience sampling method includes members
of the population who are available to the researcher. For
instance, a lecturer who distributes questionnaires among
students has in fact used this method. Asking questions
from passers-by on the street is another example of this
method of sampling. This method is also called “acciden-
tal sampling” (1). Snowball sampling is a convenience sam-
pling method. This method is applied when it is diffi-
cult to access subjects with the target characteristics. In
this method, the existing study subjects recruit future sub-
jects among their acquaintances. Sampling continues un-
til data saturation (6).
As stated by Polit-O’Hara and Beck, this method, which
is also called the “chain method,” is efficient and cost-
effective to access people who would otherwise be very
difficult to find. In this method, the researcher asks the
first few samples, who are usually selected via convenience
sampling, if they know anyone with similar views or situ-
ations to take part in the research. The snowball method
not only takes little time but also provides the researcher
with the opportunity to communicate better with the sam-
ples, as they are acquaintances of the first sample, and the
first sample is linked to the researcher (7). This type of net-
working is particularly useful for finding people who are
not willing to reveal their identities (e.g., addicts and crim-
inals) (4).
In another definition, snowball sampling may be less
reliant on a reference sample, but it is still suitable to find
unattainable populations. For example, when the research
is aimed at a group of illegal immigrants or addicts, meet-
ing the first group of samples will probably lead to other
samples; thus, the study sample grows like a rolling snow-
ball (5).
Generally, snowball sampling is a gradual process, and
time influences the selection of samples. Sampling usu-
ally continues until data saturation. On the other hand,
convenience sampling is the weakest method of sampling.
The risk of bias is low when the population is homoge-
neous in terms of the target characteristic under question,
whereas in nonhomogeneous populations, this method of
sampling has a higher risk of error (1).
In recent decades, qualitative research has become
more popular in nursing studies. Despite the growing
body of qualitative research in the past few decades, there
have been debates about these types of studies due to lack
of detailed information on the methods and processes.
Most published qualitative papers do not provide enough
information about the characteristics of the samples, re-
search, and sampling methods. In qualitative research,
sampling is determined by the type of research, while most
published literature has not determined the type of re-
search (8).
Consecutive sampling is one method of purposeful
sampling in qualitative research. In this method, instead
of selecting a fixed sample, every subject who meets the cri-
teria is selected until the required sample size is achieved.
This method is classified into three types, one of which is
snowball sampling. This type of sampling is a nonprob-
ability method, which involves random selection of sub-
jects. This method is most effective when the members
of the population are not easily accessible (e.g., homeless
people, illegal immigrants, and addicts). The researcher
first identifies a group of people, and after gathering data,
he/she asks them to recommend similar cases for the study.
The purpose of qualitative research is to gain a deeper
understanding of a phenomenon, rather than to general-
izing the findings. Therefore, careful selection of research
samples can help us conduct a more thorough evaluation.
The purpose of this study was to review the available qual-
itative research in nursing, which applied the snowball
sampling method.
2. Methods
This research is a thorough and descriptive review of
the snowball sampling method, based on articles pub-
lished in national and international journals, as well as dis-
sertations. The articles were selected from Cochrane, Pro-
Quest, Science Direct, SID, MagIran, Medline, Irandoc, Sco-
pus, and Google Scholar databases in both Persian and En-
glish languages between 2005 and 2013. Data were gath-
ered using English keywords, including “review,” “declara-
tion,” “snowball,” and “chain referral,” as well as Persian
keywords that are equivalents of the following: “purpose-
ful sampling,” “snowball,” “qualitative research,” and “de-
scriptive review.”
First, all articles related to qualitative research in Iran
were gathered. The articles, which contained the afore-
mentioned keywords in the abstract, were included in our
preliminary list, while the rest of the articles were dis-
carded. Then, a checklist was used to document all the
2Strides Dev Med Educ. 2017; 14(3):e67670.
Naderifar M et al.
required information, including the title, location, time,
scope, and method of sampling; this checklist was used for
the final evaluation. Two individuals separately searched
and gathered the data.
3. Results
In the preliminary search, 423 articles from PubMed,
88 articles from Scopus, 1 article from SID, and 18 articles
from MagIran were selected. Dissertations approved be-
tween 2005 and 2013 were also reviewed. After limiting the
search to articles with full text, the total number of the ar-
ticles reached 125. In addition, dissertations that were not
available to the researchers were eliminated.
The remaining articles were reviewed, and those with
a theoretical framework, as well as non-research articles,
were omitted. Finally, 11 articles were found eligible for the
review and were selected for their relevance to the purpose
of this study. The methods and content of these papers
were thoroughly reviewed to determine the characteristics
of snowball sampling and methods of implementation (Ta-
ble 1).
4. Discussion and Conclusions
One main challenge of qualitative research is selecting
the samples, determining the sufficient sample size, and
explaining the sampling procedure. Although many quali-
tative research experts believe that data saturation is a sub-
jective phenomenon, there is also the view that more ob-
servations and interviews do not affect the interpretation
of the results.
Review of the literature showed that a few research
studies have accurately explained the snowball sampling
method. In most of them, the main method of sampling
was sufficient, and they have not presented clear expla-
nations about its implementation. On the other hand, in
some studies, the snowball sampling method did not suf-
fice and was only used to complete the data. It should be
mentioned that the snowball sampling method is fully ex-
plained in only one study, which has fully clarified its dif-
ferent aspects.
Different variations of snowball sampling can be ap-
plied in the development of community-based informa-
tion, dissemination efforts related to health education pro-
grams, and research studies. These methods can be effec-
tively used to choose samples from fragile populations or
people under specialized care. Adaptation of the snowball
sampling method helps researchers gain access to the tar-
get population.
Adaptations of snowball sampling strategies should be
considered when recruiting participants for educational
programs or research studies. In snowball sampling, the
fragile population is selected in a social context and in a
multi-stage process. After gaining access to the prelimi-
nary samples, the samples begin to introduce other people
to take part in the research. This process will continue in
a semi-automatic and chain-like manner until data satura-
tion (9).
Nurses have different responsibilities, including clini-
cal care, education, and research. In many cases, it is dif-
ficult to identify or contact care-seekers. Human immun-
odeficiency virus (HIV) positive patients, abused women,
drug addicts, sex workers, and people with homosexual
or asexual tendencies are examples of these fragile popu-
lations (10). The snowball sampling method has been de-
rived from different concepts of social marketing. How-
ever, people who are involved in research studies and have
educational opportunities should always consider individ-
ual rights and privacy.
Snowball sampling is a method of gathering informa-
tion to access specific groups of people. The advantages
and limitations of this research method should be eval-
uated to select the best strategy. A researcher aiming to
perform health interventions should consider people’s pri-
vacy concerns (both for preliminary samples and samples
in the target community). Additionally, anonymity and
confidentiality of the data should be guaranteed by the re-
searcher (11).
The limitations of this study, which are mostly related
to its design (review study), include lack of homogeneity in
the measurement methods and lack of explanation about
the exact sampling method in most papers. Researchers
interested in qualitative research are recommended to
choose a method of sampling that is not only more accu-
rate but also saves time and money.
Supplementary Material
Supplementary material(s) is available here [To read
supplementary materials, please refer to the journal web-
site and open PDF/HTML].
The researchers would like to thank our research col-
leagues in Zabol University of Medical Sciences and Za-
hedan University of Medical Sciences, for their coopera-
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Table1. General Data Gathered from the Selected Articles on the Snowball Sampling Method
Reference Title Data Collection Method Findings
Walsh et al. (12)Attitudes and subjective norms:
Determinants of parents’ intentions to
reduce childhood fever with
Three methods: newspaper
advertisement, face-to-face interview,
and snowball sampling
The snowball method was implemented
by a network of researchers and
respondents. All the attendees were
given a package containing an
introduction letter, information
overview sheet, questionnaire, and
return envelope. After completing the
forms, the information was collected.
Charkazi et al. (13)Explaining smoking among students at
Golestan University of Medical Sciences
based on BASNEF model
Snowball sampling (The researcher
identified some smoking students, and
after explaining the purpose of the study
and obtaining oral consent, they were
asked to introduce some other smoker
students to recruit a larger sample.)
Abstract norms and enabling factors are
among the most important factors in
smoking. Therefore, these points should
be considered for preventing and
organizing recovery programs.
Heshmati Nabavi et al. (14)Barrier to forming and implementing
academic service partnership in
nursing: A qualitative study
Purposeful sampling, snowball
sampling, and interview (First,
purposeful sampling was applied, and
then more samples were identified
using the snowball method. This process
continued until data saturation.)
The identified themes were
“organizational divergence,” “invisible
wall,” and “overemphasis on theoretical
knowledge.” The most important
barriers impeding cooperation between
educational and clinical institutes are
ambiguities in the organizational
structure of institutes, responsibilities
of employees of each institute in
relation to others, overemphasis on
theoretical knowledge, and ignoring of
practical knowledge and clinical
performance of nurses. Development of
academic service partnership can be
facilitated by defining a formal
organizational relationship between
academic and service institutes,
clarifying roles and responsibilities of
each institute regarding clinical
education, defining clinical practice
roles for nursing faculty members, and
emphasizing the importance of nursing
clinical practice.
Swallow et al. (15)Pan-Britain, mixed-methods study of
multidisciplinary teams teaching
parents to manage children’s long-term
kidney conditions at home: Study
Purposeful sampling was applied
considering the child’s age, diagnosis,
ethnicity,and need for clinical care.
Snowball sampling was implemented to
identify staff members who were
involved in the care of the child.
It is essential to educate the parents on
long-term care for children at home. It is
also essential to understand that parents
of children with chronic renal diseases
need to receive specialized education.
Sasson et al. (16)A qualitative study to identify barriers to
local implementation of pre-hospital
termination of resuscitation protocols
First, a focus group was determined, and
then using snowball sampling, more
samples entered the study. Emergency
room doctors, paramedics, emergency
room authorities, and nurses were also
A method Focus group was used instead
of a response package to have a better
understanding of how emergency
systems manage resuscitation protocols
and which practical factors impede the
implementation of resuscitation
Zaghloul and Alsokair (17)Constructing a nurse appraisal form: A
Delphi technique study
Delphi technique and snowball
sampling method
A standardized nurse appraisal form was
designed and implemented in the
hospitals of the eastern states of Saudi
Arabia, which are covered by health
organizations. The nurses’ ideas about
the appraisal form were used to
determine different aspects of a nurse’s
performance. In each hospital, the first
head nurse was introduced to other
head nurses to participate in the study.
This process continued until enough
head nurses and supervisors were
Strides Dev Med Educ. 2017; 14(3):e67670. 5
Naderifar M et al.
Zareipour et al. (18)Effective factors on smoking based on
BASNEF model in male students in
Tehran Medical Sciences University in
Snowball sampling method (The
researcher met a smoking person, and
after attaining oral consent, he was
asked to complete a questionnaire.
Then, he was asked to invite other
smoker friends to take part in the study.
The researcher recruited the samples
and collected the questionnaires.)
Based on this model, the importance of
normative, enabling, and observational
factors in smoking behaviors was
determined, and the need for
authorities’ attention was highlighted.
Improvement of social and life skills,
including resistance against peer
pressure (saying “no”), and of the sense
of responsibility and self-confidence in
the youth can be effective. The youth
smoke out of fear of humiliation and
shame. However, through building
confidence, they can influence their
Lagu et al. (19)Content of weblogs written by health
Modified snowball sampling method The domain and content of medical
weblogs were reviewed to determine
how much the writer of these posts had
revealed facts about the patient,
breached the doctor-patient
confidentiality,or outlined the
shortcomings of care for the patient. The
researchers defined medical weblogs as
web pages, which have medical content
and are written by healthcare
professionals. Weblogs are a developing
part of the medical profession’s public
face. In these weblogs, doctors and
nurses can share their opinions.
However, they can also jeopardize their
career by revealing confidential
information in their content.
Schreiber and MacDonald (20)Keeping vigil over the profession: A
grounded theory of the context of nurse
anesthesia practice
Purposeful and snowball sampling
Management of registered anesthesia
nurses in different cultural-political
backgrounds of patient care was
studied. The grounded theory was used
to observe the performance of
registered and certified anesthetic
nurses. The grounded theory was used
to find procedures in different social
backgrounds. The grounded theory was
used since the researchers were
interested to show the process using
which the nurses performed their role.
Mishima et al. (21)Assistance in family health from the
perspective of users
Snowball sampling method (chain
sampling) according to the location of
the original interviewed group that met
the inclusion criteria
Family health services were evaluated
from the perspective of clients in San
Paolo and Riviera Porto, Brazil, in a wide
range of primary healthcare services
and specialized care services at different
Cataldo and Malone (22)False promises: The tobacco industry,
“low-tar” cigarettes, and older smokers
Snowball sampling The role of tobacco industries in
marketing and damage from tobacco
addiction were assessed among old
smokers and infants. The researcher
sought to find documents from the
tobacco industry,which was
Sadler et al. (9)Recruiting hard-to-reach United States
population sub-groups via adaptations
of snowball sampling strategy
Snowball sampling to recruit subgroups
that were not easily accessible
Variations of the snowball sampling
strategy can be applied in the
development of community-based
information, health education
programs, and research studies. This
strategy is effective in enlisting the
involvement of members from
vulnerable populations. These strategies
find individuals, who have the desired
characteristics, and use that person’s
social networks to recruit similar
subjects in a multi-stage process. This
semi-automatic process continues until
enough samples have been recruited.
6Strides Dev Med Educ. 2017; 14(3):e67670.
... During the first contact, the author outlined the ethical issues regarding the study as well as informing them of their right to withdraw at any point. A further six participants were recruited through snowball sampling and theoretical sampling whereby the author sought future participants among the existing study subjects' acquaintances (Naderifar et al., 2017), in particular those who could elaborate on concepts derived from previous data analysis (Glaser & Strauss, 1967). ...
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... In qualitative research, purposeful sampling is commonly used to identify and select participants that would willingly represent cases of a particular phenomenon (Palinkas et al., 2015). Due to the current situation, the researcher also applied snowball sampling as prior subjects refer to other participants that answered the difficulty of finding samples for the study (Naderifar et al., 2017). In line with the sampling technique, co-researchers were selected using the following inclusion criteria: should be a junior/senior high school rural teacher 30-55 years old; should be teaching science in the school year 2020-2021; and should be willing to express and share their experiences. ...
Teaching science in distance learning has severely challenged the educators in maintaining a quality learning experience during the pandemic. This also opened to new experiences for science teachers to facilitate learning in a new normal setting, especially in rural schools. This qualitative phenomenological study aimed to describe the lived experiences of rural science teachers during the new normal learning. Ethical standards on trustworthiness and rigor were followed. Five (5) participants were purposively chosen through criterion sampling with the following criteria: 1) should be a junior/senior high school rural teacher 30-55 years old. 2) Should be teaching science in the school year 2020-2021. 3) Should be willing to express and share their experiences. Data were collected from unstructured interviews. Narratives were transcribed word for word and reflectively analyzed using Braun and Clarke’s (2006) thematic analysis. Analyzed data revealed four (4) dominant themes: (1): 4A’s of New Normal: Accept, Arrange, Adjust, and Adapt. (2) Dare to Teach: Agents of Learning, Frontliners of Teaching. (3) Facing New Variants of Students. (4) A Dose of Hope: Educators’ Response to Learning Emergency. The findings of the study contributed to a deeper understanding of the experiences of rural science teachers as they facilitate learning amidst the pandemic. Implications were derived based on the findings. It is challenging for science teachers to grasp students’ attention in learning through a modality away from the instructors. Meaningful learning in science has been facilitated using the teachers’ interventions through localized experiments, modified activities, and demystified lessons.
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A growing number of studies indicate that university students and especially international students are prone to experiencing food insecurity (FI). Still, few studies have investigated forms of FI among international students in Europe. Thus, this qualitative study aims to explore experiences regarding FI among international university students in Oslo. Sixteen semi-structured interviews were conducted between May and June 2022 and analyzed using a thematic approach. The sustainable livelihood approach (SLA) was used as a framework for analyzing and interpreting the data. The students experienced food prices as being high and found food variety at the grocery stores to be low, resulting in struggles to fulfil their food preferences and keep a varied diet. Particularly, social aspects of eating were affected due to high dining prices or inadequate cooking facilities in student homes. However, no student openly reported skipping meals and many mentioned attention for healthy eating. Considering our results, it seems of importance to give more attention to cultural and social aspects related to FI when assessing FI among international students. As the number of international students is increasing, knowing more about this phenomenon can support the promotion of initiatives addressing FI in this population.
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Objetivo: compreender a vivência do enfrentamento da COVID-19 e as possibilidades para promover a saúde, na percepção dos professores do ensino fundamental. Método: estudo qualitativo, tipo ação participante, tendo como guia metodológico o Itinerário de Pesquisa de Paulo Freire, que integra três etapas: Investigação Temática; Codificação e Descodificação; Desvelamento Crítico. Participaram do Círculo de Cultura 14 professoras do ensino fundamental, atuantes em escolas particulares e públicas de diferentes estados brasileiros. Resultados: dialogaram sobre dois temas geradores: 1) Desafios no enfrentamento da COVID-19; 2) Possibilidades para promover saúde em tempos de COVID-19. Conclusão: a situação pandêmica repercutiu na necessidade de os professores trabalharem em casa, gerando intenso trabalho, estresse, ansiedade, medos, preocupações, insegurança, saudades da escola e dos estudantes. Para promover saúde, as professoras buscam apoio da família, organizando tempo para cuidar de si e aliviar a ansiedade por meio de leitura de livros, filmes e prática de exercícios físicos.
Conference Paper
The study highlights the importance of orchestras being able to respond to the changing needs of consumers and adapt to changes in the world. Such a change is, for example, the current coronavirus epidemic, which poses especially great difficulties for organizations of the cultural sector that deal with performing arts, as concerts and performances – providing the basis of their operation – have become impossible. In order to gain “immunity” to the virus, business model innovation and exploiting opportunities offered by digitalization are essential. Furthermore, similar cases can occur at any time for which orchestras have to be prepared. As a result, orchestras (and in a broader sense all kinds of organizations) need to fundamentally rethink their business models. After conducting secondary research and interviews with 10 symphony orchestra managers and 10 symphony orchestra musicians, I have identified some novel aspirations, attempts and projects selected from international and Hungarian symphonic orchestral life to provide excellent examples of how the business model can be redefined and how the expectations of the 21st-century audience can be met. These examples show that there are orchestras which have understood that responding to the changing demands of consumers and utilizing the opportunities given by technology is essential, although it is still a question of how many more “coronavirus waves” are needed to make it clear for all orchestras that fundamental changes are necessary to preserve a market-leading position or become a market leader.
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The purpose of this study is to analyze the market structure and controller of beef cattle prices in North Sulawesi. The location of the research was purposively determined, namely Manado City, Tomohon City, and Regency of Minahasa as the trade center of beef cattle in North Sulawesi. Furthermore, respondents were determined by the snowball sampling, started by obtaining information about breeders of beef cattle as business consumers and, also, the end consumers through the Department of Agriculture and Animal Husbandry in the three research areas. Through the snowball technique, 120 respondents consisted of 10 end-consumers/business consumers of beef cattle, 10 intermediate traders, and 100 breeders of beef cattle. The data, then, were analyzed using the concentration ratio model and Hirscman-Herfindahl Index to measure the market structure and asymmetric price transmission analysis to detect the controllers of beef cattle prices. The result shows that the structure of the beef cattle market in North Sulawesi led to an oligopoly with the highest concentration; while, the controllers of beef cattle prices were the end-consumer as business consumers of live beef cattle.
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Prefabricated construction techniques have lately attracted housing builders' attention around the world due to their sustainable performance in building housing. However, this doesn’t mean that it is a successful strategy in all countries. In Egypt, there isn't any clear vision about the performance of using prefabricated construction methods in building housing. This study aimed to examine the decision to adopt prefabricated construction methods for building Egyptian housing. To achieve the aim of the study, two questionnaires were conducted targeting Egyptian housing construction practitioners. Through questionnaires, twenty-eight performance criteria under economic, social, environmental, and technical categories were developed to evaluate the performance of using prefabricated and the traditional on-site frame construction methods in building Egyptian housing. The multicriteria decision-making approach based on Order of Preference by Similarity to the Ideal Solution technique (TOPSIS) and the Importance Performance Analysis tool (IPA) were used finally to contextualize the final findings.
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Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using:i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statisticsii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth studyPhase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will provide signed consent; data gathering will involve a combination of: minimally-obtrusive observations in the clinical setting and families' homes; de-briefing interviews with participants to obtain views on selected interactions; focussed 'verbatim' field-notes, and case-note reviews. Data gathering will focus on communication between parents and professionals as parents learn care-giving skills and knowledge. Interviews will be digitally recorded and transcribed anonymously. This study involves an iterative-inductive approach and will provide a unique, detailed insight into the social context in which professionals teach and parents learn; it will inform professionals' parent-educative roles, educational curricula, and health care policy.
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Medical weblogs ("blogs") have emerged as a new connection between health professionals and the public. To examine the scope and content of medical blogs and approximate how often blog authors commented about patients, violated patient privacy, or displayed a lack of professionalism. We defined medical blogs as those that contain some medical content and were apparently written by physicians or nurses. We used the Google search term "medical blog" to begin a modified snowball sampling method to identify sites posting entries from 1/1/06 through 12/14/06. We reviewed five entries per blog, categorizing content and characteristics. We identified 271 medical blogs. Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Individual patients were described in 114 (42.1%) blogs. Patients were portrayed positively in 43 blogs (15.9%) and negatively in 48 blogs (17.7%). Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves. Three blogs showed recognizable photographic images of patients. Healthcare products were promoted, either by images or descriptions, in 31 (11.4%) blogs. Blogs are a growing part of the public face of the health professions. They offer physicians and nurses the opportunity to share their narratives. They also risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions. The health professions should assume some responsibility for helping authors and readers negotiate these challenges.
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The study was conducted with the aim to construct a unified nurse appraisal format to be used at hospitals performing under different healthcare organizations in the Eastern Province in the Kingdom of Saudi Arabia. The study included hospitals representing different healthcare organizations within the Eastern Province. The target population included Hospital head nurses and nurse supervisors and the snowball sampling technique was employed to select the panel subjects. The final draft resulted into the agreed upon performance dimensions which included namely; quality standards, work habits, supervision/leadership, staff relations and interpersonal skills, attendance and punctuality, problem solving, oral communication, productivity results, coordination, innovation, record keeping. Nurse managers have to continuously assess competence of practicing nurses to assure qualified and safe patient care. A nurse appraisal form was constructed concurrently with this study results and was proposed to be used at all Eastern Region hospitals. This study is considered an initial step for further efforts and studies to be conducted to reach both national and international nursing appraisal dimensions and unify them for the sake of best health promotion.
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Background Nurse anaesthetists in the US have faced continued, repeated challenges to their profession. Regardless, they have met these challenges and have established themselves as major anaesthesia care providers. In this paper we address the research question: How do certified registered nurse anaesthetists (CRNAs) manage the socio-political context in which they provide care for their patients? Methods Grounded theory was used to explore how nurse anaesthetists protect and promote their profession. Purposive, snowball, and theoretical sampling was used and data were collected through participant observation and interviews conducted at a conference of the professional association, an educational program, by telephone, email exchanges, and time spent in operating rooms and an outpatient surgical clinic. Analysis included coding at increasingly abstract levels and constant comparison. Results The basic social process identified was Keeping Vigil Over the Profession, which explains how nurse anaesthetists protect and promote their profession. It is comprised of three contextual categories: Establishing Public Credibility through regulatory and educational standards, Political Vigilance and taking action in governmental and policy arenas, and Tending the Flock through a continuous information loop between local and administrative/political levels. Conclusions From our study of the context of nurse anaesthesia practice, it is clear that CRNAs are dedicated to protecting their ability to provide high quality patient care by maintaining constant vigilance over their profession.
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This descriptive exploratory study analyzed user satisfaction with the care received at a Family Health Unit in Ribeirão Preto, Brazil. In total, 40 users from families registered in the FHU were selected, using key informants and the snowball sampling technique, and interviewed. Thematic content analysis was used to analyze the empirical material. Interviewees were mostly female, over 50 years, resident in the catchment area of the unit for 10-30 years, had incomplete primary education and also did not perform work outside the home. The analysis identified three themes: access, team-user interaction and organization of work in the FHU. The subjects of this study expressed satisfaction with the accessibility provided together with the caring attention given to them, marked by a team-user interaction that takes place in a friendly and patience manner. Although not totally satisfied, the majority of users would recommend the health service to someone due to its quality.
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Despite the existence of national American Heart Association guidelines and 2 termination-of-resuscitation (TOR) rules for ceasing efforts in refractory out-of-hospital cardiac arrest, many emergency medical services agencies in the United States have adopted their own local protocols. Public policies and local perceptions may serve as barriers or facilitators to implementing national TOR guidelines at the local level. Three focus groups, lasting 90 to 120 minutes, were conducted at the National Association of Emergency Medical Services Physicians meeting in January 2008. Snowball sampling was used to recruit participants. Two reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. We identified 3 distinct groups whose current policies or perceptions may impede efforts to adopt national TOR guidelines: payers who incentivize transport; legislators who create state mandates for transport and allow only narrow use of do-not-resuscitate orders; and communities where cultural norms are perceived to impede termination of resuscitation. Our participants suggested that national organizations, such as the American Heart Association and American College of Emergency Physicians, may serve as potential facilitators in addressing these barriers by taking the lead in asking payers to change reimbursement structures; encouraging legislators to revise laws to reflect the best available medical evidence; and educating the public that rapid transport to the hospital cannot substitute for optimal provision of prehospital care. We have identified 3 influential groups who will need to work with national organizations to overcome current policies or prevailing perceptions that may impede implementing national TOR guidelines.
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Fever is a natural protective response of the host organism. Mild to moderate fevers, up to 40.0ºC, have immunological benefits and do not need to be reduced. However, parents regularly reduce fever with medications to prevent perceived harmful outcomes. This study identified the determinants of parents’ intentions to reduce childhood fever with medications. A community-based crossectional survey was conducted with 391 Australian parents of children aged between 6-months and 5-years. Recruitment was through advertising, face-to-face, and snowball methods. The survey targeted constructs of the Theory of Planned Behavior: attitudes, subjective norms, perceived behavioral control, intentions and previously identified background factors. Structural equation modeling identified 69% of the variance in intentions. The strongest influences were from non-scientifically based attitudes (phobic) (β=.55) and subjective norms (husband/partner and doctors) (β=.36). Attitudes (β=.69) and subjective norms (β=.52) were strongly determined by child medication behaviour (whether the child took medications easily when febrile) which had a total effect on intentions of β=.66. Perceived control, education and number of children had minimal influence on intentions. There is an urgent need for 1) the education of both parents in the benefits of fever and 2) for doctors to consistently provide parents with evidence-based information.
Background & Aims: Smoking as a health risk behavior endangers not only the individual but also community health and is one of the preventable causes of death. This risk behavior is growing among educated young people. This study was aimed to investigate effective factors leading to smoking based on BASNEF Model in male students in Tehran Medical Sciences University in 2009. Materials & Methods: This descriptive analytical study was performed on 200 male students that were selected by snowball sampling method. The data were collected using a questionnaires based on BASNEF Model. The data were analyzed by Chi-square tests, and Pearson correlation coefficient. Results: The survey results showed that the most frequent causes of smoking were easy access to cigarettes (80%) and peers smoking (82%). Considering the attitude of the samples 33.5% had a positive, 19.5% neutral and 47% had a negative attitude toward smoking. There was a significant association between positive attitude to smoking and students’ years of study or parental education. There also was a significant relationship between age at onset of smoking with either parents or peers smoking. There was a relationship between low price cigarettes and the number of cigarettes smoked per day. The average number of cigarettes smoked per day and students age and cigar costs per month showed a positive correlation. Conclusion: The importance of attitudes, subjective norms, and factors affecting smoking are highlighted in the study and health officials must urge to pursue structural interventions to prevent them.
Nurse researchers and educators often engage in outreach to narrowly defined populations. This article offers examples of how variations on the snowball sampling recruitment strategy can be applied in the creation of culturally appropriate, community-based information dissemination efforts related to recruitment to health education programs and research studies. Examples from the primary author's program of research are provided to demonstrate how adaptations of snowball sampling can be used effectively in the recruitment of members of traditionally underserved or vulnerable populations. The adaptation of snowball sampling techniques, as described in this article, helped the authors to gain access to each of the more-vulnerable population groups of interest. The use of culturally sensitive recruitment strategies is both appropriate and effective in enlisting the involvement of members of vulnerable populations. Adaptations of snowball sampling strategies should be considered when recruiting participants for education programs or for research studies when the recruitment of a population-based sample is not essential.