Assignment #5 Coding Qualitative Data Assignment Instructions

FUNDAMENTALS OF QUALITATIVE RESEARCH METHODS: INTERVIEWS

This module explores a major qualitative study design in-depth interviews. Just to remind us an overview of the modules, our goal is to enhance our capacity to conceptualize, design, and conduct qualitative research in the health sciences. There are six modules in the series. The first is what is qualitative research? The second focuses on developing an effective qualitative research question. The third, fourth address major qualitative study designs, interviews, and focus groups. The fifth module is an overview of the qualitative data analysis principles and practices. And the last address is scientific rigor in qualitative research. This module examines in-depth interviews as a tool and qualitative study design. So there are a number of qualitative study designs from various traditions. Approaches include in-depth interviews. Or the purpose of them is to explore individual experiences and perceptions in rich detail. The second major approach is focus groups. These generate unique insights into shared experiences and social norms through group discussion, we'll address those in the next module. Observations can be participant observations are non participant observations where we're learning about behaviors and interactions in natural settings. We're studying the cultural aspects of a setting or a particular context. And the last major qualitative study design is document review. This is the purpose of these studies and this method is to identify patterns of communication, describing characteristics of organizations or processes based on in-depth and systematic review of documents related to the program or policy of interest. In this module, we'll examine in depth interviews. I like this phrase by Lofland. I think it characterizes really the essence of with an in-depth interview is, and that is a guided conversation. So this image helps us understand that in an in-depth interview, we may not always know the path that the interview is going to take. And in fact, that's a strength of the method. At the same time as the interviewer, we need to keep offense or some jersey barriers along the edge of the interview so that the respondent doesn't veer off in a direction that's really two tangential. There are a number of ways in which in-depth interviews can illuminate various focal topics. And so we can think about using them. Again when we're interested in understanding individual perspectives and experiences. When we're addressing sensitive topics, it may be that our question of interest has some particular stigma to it, or for some reason maybe sensitive. And we may find that the intimacy and trust and rapport that can be established in an in-depth interview as an asset in addressing a sensitive topic. We can also use in-depth interviews when there are concerns about fear of reprisal. So for instance, our team has done work in looking at different innovative models of care for frail older adults who are on Medicaid, then getting their services through a Medicaid program. And you might imagine that speaking, I say in a focus group setting, might, might be anxiety provoking for the clients and those individuals receiving those services. And so the, again, privacy of an in-depth interview might help address concerns about fear of reprisal. And we can think about interviews, of course, when structured survey approaches don't work, when the topic that we're interested in doesn't lend itself nicely to check boxes enforced choice options on a survey instrument. So let's talk a little bit about sampling for interviews. The aim and it's sampling design for an interview study is to identify key informants. Key and formance is a term that refers to individuals who have knowledge or experience with the phenomenon of interest and they're willing to speak about it. The goal and the sampling approach is breadth. Attaining a broad range of perspectives, a whole across a spectrum. It's not representativeness. So we're not concerned with taking a random sample. Every fifth person on administrative claims list. The size, the sample size varies depending on the complexity of inquiry and it can't be decided in advance. The sample size in qualitative studies and an in-depth interviews in particular, is determined by the principle of theoretical saturation. Theoretical saturation is the point at which no new concepts emerge from the data. And so as we're collecting data, we're hearing no new ideas that emerged from, from that conversation. And then we know that the sample is complete. So it is not possible to identify a sample size in advance. Few minutes on data collection, what does an interview guide look like? We think of an interview guide as a framework for the interviewer. It's not a structured script etch didn't tablet that must be followed in a standard way every time. But rather a framework for the interviewer to use in facilitating the conversation. Interview guides contain a list of main questions and then probes. So specific probes that help the individual understand the intent of the question. Questions are open and non-directive. This harkens back to the principle of qualitative methods being exploratory in nature, non-directional. The interviewer may diverged to pursue an emergent idea in detail. So if we think of that path through the marsh, the interview was encouraged to diverge or move away from the interview guide in order to follow a lead that the respondent may offer up in his or her comments. The interviewer may reword questions, drop or add questions and change the sequence of questions. So for those of us who are quantitatively oriented or trained, this may feel a bit uncomfortable. You know, it's very different than a structured standardized survey instrument in which interrater reliability must be computed and individual interviewers must be trained in order to administer the survey data in the same way every time. This is really much more organic process. So let's look at an example from the literature. This is a study our team here at Yale did looking at top performing hospitals and care of patients who have heart attacks. And we were interested in understanding what the most successful hospitals were doing in order to have better outcomes in their care for patients with heart attacks. And so the design was to include high performing hospitals and low-performing hospitals. Hospitals that did well and not so well on their outcomes for patients with heart attacks. And to go to those hospitals and have in-depth interviews with the key and formance at each hospital. And key informants you remember are people who are close to the phenomenon of interest. So in this instance, it was the key staff in these hospitals who were most directly involved care of patients with heart attacks. So we'll look at the interview guide from this study. So this is the first question and there's a series of questions and we'll review the question itself and then reflect a bit on the purpose of each question. So this is the opening question to the interview guide. You can see very broad. Let's start by having you describe what you do here. The purpose of this question is to provide a comfortable nonthreatening way into the interview. We also can locate the person in the organization from his or her own perspective. They're describing to you what, what they do within that organization. And we can also gain a sense of their role in the larger process of providing care to patients with AMI. So it's really very helpful opening question to both set the stage and to give the interviewer some sense of, of the respondent. So second question, what happens to a patient with AMI, Who comes here? Can you walk me through that process? The purpose of this question is to elicit a description of the hospital processes for AMI care. So we're starting to get to the specific area of interest. We want to know what's happening within that hospital, within the hospital walls as they're caring for patients with AMI. And so they'll begin to describe that process to us. This question also gives the interviewer the opportunity to explore a broad range of factors that the interviewee considers relevant to AMI patient care in this setting, meaning we're turning it over to the respondent. What happens to the patient. And can you walk me through that process as they're describing elements of the process, the interviewer then has the opportunity to explore, to listen carefully and diverge or explore a specific comment or reflection offered by the respondent. Third question in this guide half, there have been efforts to improve the care of patients with AMI here, again, very broad and open. The purpose of this question is to explore the hospital quality improvement efforts broadly conceived, alright, so this doesn't script to the individual and encourage the individual responded to talk only about formal quality improvement initiatives, for instance. But rather wide open door. There might be follow-up probes that we could ask ask the respondent starts speaking. We might want to know, well, what got that started? How does the organization recognize problems or opportunities? Can you describe things that needed ironing out along the way? These kinds of probes can be used to encourage the respondent to keep following a path of commentary. Next question focuses on post hospital discharge. And the question, again, very broad. Now let's hear about what happens to the patient after they leave the hospital. Who do they see? And how does that work? Again, you see how openness is. Here we're encouraging respondents to talk about all aspects of discharge for AMI patients. So what happens to them when they leave the hospital? The things that happened within the hospital and in various post discharge settings. Here this last question, has the process always work this way? And if it's changed, can you tell me about when that happened and how it went? For the purpose of this question is trying to get a sense for the dynamics with you within the institution. How well change is received and initiated, and what kinds of things they do within the organization in terms of processes for implementing improvements there. So let's review together some basic types of probes that the interviewer can use during the conversation in order to elicit more information or to get clarification from the respondent. Then there are range of these techniques available to interviewers. From being silent, being quiet, Eating slowly and listening and just encouraging through to asking various kinds of questions, clarification questions. Now you said the word x. Can you describe what you meant by that? And these probes should be used at the discretion of the interviewer in order to generate richer detail from the respondent as it's appropriate. So conducting interview, what is it like when you get out in the field? You've got your interview guide and you're ready to begin collecting data. So beginning the interview, good rapport is imperative. Clearly you're sitting in a one-on-one interaction. You're going to be asking the respondent about topic that likely has great meaning for him or her. And you're there as the researcher. Establishing rapport happens in the very first few moments of interaction. And so attention to rapport is really imperative. Participants will only talk candidly if they feel comfortable in the space where, where they are. If they trust the interviewer, they feel that the interviewer is from a legitimate organization, that they're genuinely interested in what the respondent has to say. They'll protect, provide confidentiality, and that the interviewer is there really to listen to them and not to judge them. So careful attention to all of these dynamics in the very first seconds of the interaction is really, really very important without good rapport or with some tension in the, in the dynamic or some discomfort on part of the interviewer. It's not likely that they will in fact share the degree of information that you're hoping for. So I want to review a play, some audio tape to give you an illustration of what a live interviewer interview sounds like. And this is an excerpt from an interview, the very beginning, the opening of an interview, where the interviewer is introducing the study and its goals to the respondent. So let's listen. I'm here today. Basically, they tried to me a lot of people to talk about the kind of care that's provided for MI patients. And we're coming because we're trying to understand the differences between places that achieve different levels of performance. And I'm really glad a meeting with you because actually interventional pillow would have a pretty good idea what the reality is. I want to tell you that the way we're organized as I'm recording because it keeps me so I can actually talk to you instead of having to take notes. We transcribe this. We then go through them and try to bring out themes and go, we can learn from what's going on. We don't ever identify the person if you said things and even to the point that we don't identify the site, if we ever use it, we mostly use information to help put together a picture about what's going on. But I want to assure you that your name will never be associated with this. And we do this because we want people to be candidate. It's important for people to be honest, otherwise, we're not going to learn anything. And you can imagine I was talking to a yellow chair of medicine. He wants to know if he says anything candidly that it's not going to be links. And so we take very seriously our responsibility to protect the identities and so forth. Okay. So what did you hear there? Number of things that the interviewer was doing in those very first moments of the interaction. In order to encourage the respondent to feel comfortable in the space, to be clear about why the participant was chosen, and to describe the procedures and the privacy issues related to, related to the study. So let's listen to one more excerpt from an interview. In this exchange, you'll hear three voices. There's the respondent, there's a primary interviewer, and there's a secondary interviewer, a male voice, who's being trained to do qualitative data collection. He's a cardiologist who was on our team and had not done qualitative interviewing before. And so we paired him with a senior researcher on our team. So you'll hear the dialogue between the three of them. So let's listen. She pluses and minuses to this. Am I keeping within 90 minutes? It's been quite a challenge. I mean, you have the same protocol and your institution how a union he's wearing his researcher had today. Then I will take to assemble. We can maybe talk offline email, but what do very well. So what did you hear in that exchange? A few things were going on. You heard the respondent answering a question, but first, initiating a question to the interviewer, how are things going at your institution? And you hear the senior researcher interrupting to say he's wearing is researcher hat today. This redirecting is really very critical in our work. We often have research interviewers out in the field to also have clinical expertise. And so they may have a clinical hat or an administrator hat as well as the researcher hat. And in the context of the interview, it's very important to sort of have your researcher lens on and to be sure that the respondent sees you in that way. The second thing that happened in that exchange was the male interviewer offers to answer the questions later. This is really very important. When a respondent asks a question and you don't want to be perceived as being invasive or, or non-responsive. And so offering to address questions after the interview lets the respondent know that you're, you're willing to to be candid and have that exchange, but later in the conversation. And then focusing at the topic at hand saying, you know, we're mindful of your time. We've got limited time here. This shows respect for the interviewer and also puts bounds around the interview. So in that brief exchange, they accomplished a few different things. So several things we want to avoid when we're doing qualitative data collection through interview techniques. The first is influencing respondents by asking leading questions or conveying one's own view. This seems obvious, maybe and very straightforward. It's much more difficult in practice because we may have leading questions or convey our view implicitly or explicitly through our interactions with the respondent. And so we want always to be thinking about very broad, wide open, non-judgmental kinds of questions, encouraging the responded to both the positive and negative sorts of statements. And so we want to hear all of the things that are going well. We also want to hear some of the things that are not going so well. So inviting the respondent to provide a balanced view. Moving too quickly from one topic to the next. This is very tricky and the only way to really master a sensitivity to this is to, is to do interviews. But the interviewer is in a tricky spot where you want to leave enough time for the respondent to express fully their thoughts. And sometimes people need to pause a moment. And so you don't want to truncate a line of commentary prematurely. At the same time, you don't want them to sort of linger too long. And so the tendency maybe for the interviewer to simply jump to the next topic and we want to be mindful of that potential lost opportunities. Don't want to interrupt the informant. Here's sometimes we do in our own excitement, maybe speak over or asked a probing question or come right back on top of a comment because we're in the momentum of the interview and we're starting to get excited. So we need to exercise a size, some restraint not to interrupt the informant. Tips for a good interview where there were some things that you can do that will ensure a positive interaction and yield very rich narrative data. First, knowing your interview guide and the potential probes, well, this is really very critical. And the interview guides, this is one reason. It's useful if they're simply five to seven broad questions. After doing a couple of interviews, those will be embedded in your mind. It's not very good for an interaction if the interviewer is looking down, reading our paper, sort of stumbling or feeling forced. Really critical part of this is knowing the the informed consent statements that you're very comfortable and casual in your communication of the introduction, the purpose of the study and confidentiality assurances so that the interview feels like a comfortable interaction from the beginning. Rehearse that introduction. Beware of power differentials in the room. This happens when we send large teams of people with various credentials, background, expertise to the field, there are always power differentials that underlie these dynamics and being aware of those insensitive. Those can be really very important to creating a safe space for open dialogue. Put on your qualitative researcher hat. So again, don't bring the kind of clinical knowledge or programmatic knowledge or policy knowledge to the table. But rather, you're open, inquisitive, non-judgmental researcher hat, and be sure that the respondent perceives you in that role, speaking judiciously. So being careful with those probes, while it's helpful to have those potential probes, content probe. So the stylistic probes we reviewed, briefly, it's important to speak judiciously not to use those very, very freely because that has the strong potential to lead the respondent in a specific direction. And then lastly, be comfortable with silence. And so pause. Listen. Let the respond and compose themselves, bring their thoughts to order, and then speak again. And so him being comfortable with silence. The 7 second pause is something that I think all of us struggle with. I know that I do, but it's very important in an interview dynamic.