Fundamentals of Qualitative Research Methods: Interviews (Module 3)

hi welcome back to our series on qualitative research methods this module explores a major qualitative study design in depth interviews just 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 through six modules in the series the first is what is qualitative research the second focus is on developing an effective qualitative research question the third and 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 addresses scientific rigor and qualitative research this module examines in-depth interviews as a tool in qualitative study design so there are a number of qualitative study designs from various traditions approaches include in-depth interviews 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 in social norms through group discussion will address those in the next module observations can be participant observations or 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 in 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 this module will examine in depth interviews I like this phrase by Lofland I think it characterizes really the essence of what an in-depth interview is that is a guided conversation so this image helps us understand and then 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 too 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 may be 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 than 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 checkboxes and force choice options on a survey instrument so let's talk a little bit about sampling for interviews the aim in its sampling design for an interview study is to identify key informants key informants is a term that refers to individuals who have knowledge of or experience with the phenomenon of interest and they're willing to speak about it the goal in the sampling approach is breath attaining a bra odd range of perspectives a hole across a spectrum it's not representativeness so we're not concerned with taking a random sample you know every fifth person on administrative claims list the size the sample size varies depending on the complexity of the inquiry and it can't be decided in advance the sample size in qualitative studies and an in-depth interviews in in particular is determined by the principle of theoretical saturation the 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 emerge 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 a 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 each tin 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 diverge to pursue an emergent idea in detail so if we think of that path through the marsh the interview is encouraged to diverge or move away from the interview guide in order to follow a lead that the respondent may offer up 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 it's very different than a structured standard survey instrument in which innovator Reliability must be computed and individual interviewers must be trained in order to administer the survey in the same way every time this is really a 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 in 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 informants at each Hospital the 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 in the 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 non-threatening 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 a mi so it's a really very helpful opening question to both set the stage and to give the interviewer some sense of the respondent so second question what happens to a patient with a MI 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 a mi 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 you know 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 have there 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 right so this doesn't script the individual and encourage the individual respondent 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 as 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 a ironing out along the way these kinds of probes can be used to encourage the respondent to keep following a path of commentary the next question it 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 open this 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 happen within the hospital and in various post discharge settings here this last question has the process always worked this way and if it's changed can you tell me about when that happened and how it went the purpose of this question is trying to get a sense for the dynamics within that in 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 a range of these techniques available to interviewers from being silent being quiet and nodding 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 a 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 an interaction and so attention to rapport is really imperative participants will only talk candidly if they feel comfortable in the space 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 predict 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'll in fact share the degree of formation that you know you're hoping for so I want to review 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 to try to meet a lot of people to talk about the kind of care that's provided for my patients and we're coming because we're trying to understand the differences between places that achieve different levels of performance right and I'm really glad I'm meeting with you because actually interventional pebbel would have a pretty good idea what the reality is I want to tell you that the way we're organized is I'm recording because it keeps me so I can actually talk to you instead of having to take notes we transcribe these we then go through them and try to bring out themes and what we can learn from what's going on we don't ever identify the person who said things and even to the point that we don't identify the site if we ever use it we mostly use the 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 you know this and we do this because we want people to be candid it's important for people to be honest otherwise we're not going to learn anything like and you can imagine I was talking to you know chair of Medicine he wants to know that if he says anything candidly that it's not going to be linked and so you know we take very seriously our responsibility to to protect the identities and so forth of the people okay so what did you hear there there are a 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 pride marry 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 and so you'll hear the dialogue between the three of them so let's listen um we have actually pluses and minuses I mean if you go first to this bus protocol to the am i keeping within 90 minutes has been quite a challenge I mean how you have the same protocol at your institution how are you doing ah he's wearing his researcher hat today but even so I'm just giving our cousin I will old mother the negatives as well not to take too much time we can maybe talk offline on an email but we're doing very well so what did you hear in that exchange a few things were going on you heard of 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 his researcher hat today this redirecting is really very critical in our work we often have research interviewers out in the field who 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 lands 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 evasive or or non-responsive and so offering to address questions after the interview lets the respondent know that you're you know you're willing to to be candid and have that exchange but later in the 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 a respondent and so we want always to be thinking about you know very broad wide open non-judgmental kinds of questions and encouraging the respondent to both you have positive and negative sorts of statements since 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 just 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 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 may be 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 sometimes we do in our own excitement maybe speak over or ask 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 some restraint not to interrupt their informant tips for a good interview there were some things that you can do that will ensure a positive interaction and yield a 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 there it's useful if there's 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 their 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 you know 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 sensitive that if 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 your 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 probes or 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 respondent compose themselves bring their thoughts to order and then speak again and so in being comfortable with silence the seven second pause is something that you know I think all of us struggle with I know that I do but it's very important in an interview dynamic so thank you for your attention

Channel: YaleUniversity

Views: 167,712

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Keywords: Dr. Leslie Curry, Qualitative Research, Research (Industry)

Id: 6PhcglOGFg8

Length: 22min 17sec (1337 seconds)

Published: Tue Jun 23 2015