The Problem with Rapport in Interview-Based Studies

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two-article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.

BackgroundChoosing a suitable sample size in qualitative research is an area of conceptual debate and practical uncertainty. That sample size principles, guidelines and tools have been developed to enable researchers to set, and justify the acceptability of, their sample size is an indication that the issue constitutes an important marker of the quality of qualitative research. Nevertheless, research shows that sample size sufficiency reporting is often poor, if not absent, across a range of disciplinary fields.MethodsA systematic analysis of single-interview-per-participant designs within three health-related journals from the disciplines of psychology, sociology and medicine, over a 15-year period, was conducted to examine whether and how sample sizes were justified and how sample size was characterised and discussed by authors. Data pertinent to sample size were extracted and analysed using qualitative and quantitative analytic techniques.ResultsOur findings demonstrate that provision of sample size justifications in qualitative health research is limited; is not contingent on the number of interviews; and relates to the journal of publication. Defence of sample size was most frequently supported across all three journals with reference to the principle of saturation and to pragmatic considerations. Qualitative sample sizes were predominantly – and often without justification – characterised as insufficient (i.e., ‘small’) and discussed in the context of study limitations. Sample size insufficiency was seen to threaten the validity and generalizability of studies’ results, with the latter being frequently conceived in nomothetic terms.ConclusionsWe recommend, firstly, that qualitative health researchers be more transparent about evaluations of their sample size sufficiency, situating these within broader and more encompassing assessments of data adequacy. Secondly, we invite researchers critically to consider how saturation parameters found in prior methodological studies and sample size community norms might best inform, and apply to, their own project and encourage that data adequacy is best appraised with reference to features that are intrinsic to the study at hand. Finally, those reviewing papers have a vital role in supporting and encouraging transparent study-specific reporting.

To explore the challenges of engaging men with penile cancer in qualitative interview research. Qualitative interviewing offers an ideal tool for exploring men's experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researcher's experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researcher's experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.

Nobel laureate Albert Szent-Gyorgyi’s field of scientific discovery was that of biochemistry; however, his reflection on the nature of research could not be more apt for the qualitative researcher. In qualitative research, the researcher is not only the scientist but also the instrument of measurement. Observations and conversations provide the dataset that must be sampled, recorded, organized, and analyzed in a systematic fashion. It is this deliberate approach to the everyday that separates the qualitative researcher from the casual observer and permits scientific enquiry into matters that cannot be meaningfully investigated by more familiar methodology. Qualitative research is ideally suited to real-world observations of complex situations involving human interactions with other people or their environment. The role of the anesthesiologist is often conveniently summarized as the ‘‘applied physiologist and pharmacologist’’, but these are merely the basic foundations of a profession that requires considerable skill pertaining to communication, situation awareness, teamwork, leadership, and teaching, to name but a few examples. These nontechnical aspects of anesthesia have attracted increasing attention in recent years, and it is in the investigation of these concepts that qualitative research is most valuable. Despite the clear relevance of qualitative research, it continues to account for a small minority of medical publications. Accordingly, Bould et al.’s manuscript in this edition of the Journal represents something of a rarity. Their paper reports on an interview-based study in which faculty participating in an international educational initiative to provide training to anesthesia providers in Zambia describe their experiences. Amongst Bould et al.’s findings, it was apparent that participants had significant logistical and educational challenges to overcome, and that anesthesia in a resource-poor environment requires the ability to use antiquated drugs and equipment, to cope with unexpected shortages of basic supplies, and to reconcile the risks of proceeding with surgery in problematic circumstances with those of doing nothing at all. Consequently, participating in this project involved a great deal of learning for the faculty as well as for the students. These insights are doubtless of much interest to any anesthesiologist involved in teaching overseas, and those who are considering planning such a project have much to learn from Bould et al.’s findings. But how are the results of this paper any more useful than simply chatting to a colleague who has recently returned from such a venture? In order to address this question, we examine herein the qualitative research methods that Bould et al. employed, namely, interviews and thematic analysis, and consider the markers of rigour in qualitative research. An interview is a conversation between a researcher and one or more participants. Though many variations on the principle exist, they can usually be classified as ‘‘structured’’, ‘‘semi-structured’’, or ‘‘in-depth’’. Structured interviews follow a strict routine of closed questioning in order to provide standardized data. While they are simple to undertake, they seldom provide in-depth information as they do not permit the researcher to pursue any cues offered by the participant. Semi-structured C. Shelton, MBChB (&) Wythenshawe Hospital, Manchester, UK e-mail: Cliff.Shelton@NHS.net

BackgroundThe literature suggests that although adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations. U.S. children’s hospitals also undertake population health programs, but less is known about how they define population health. The purpose of this study is to understand how U.S. children’s hospitals define population health, and how institutions are adjusting to new preventive health care models.MethodsWe conducted semi-structured interviews with key stakeholders at ten hospitals with the highest amount of staff time dedicated to population health activities as reported in the 2016 Children’s Hospital Association’s population health survey. Using a semi-structured interview guide, we interviewed representatives from each hospital. Verbatim interview notes were coded and analyzed using the data analysis software Dedoose. Data analysis followed a modified constructivist grounded theory approach.ResultsOur results suggest that even population health innovators employ a variety of approaches that span both population health management and public health. We present further evidence that U.S. children’s hospitals are actively debating the definition and focus of population health.ConclusionsDefinitional debates are ongoing even within children’s hospitals that are dedicating significant resources to population health. Increased clarity on the conceptual boundaries between population health and population health management could help preserve the theoretical differences between the two concepts, especially insofar as they mark two quite different long-term visions for health care. Without agreement about the meaning of population health within and among institutions, hospitals will not be able to know whether projects aimed at addressing the social determinants of health are likely to improve the health of populations.

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Motivated by researcher reflexivity, the author sought to learn from participants about the sensitive, ethical issues of the qualitative research process. The current study followed up with eight women who had previously participated in an interview-based study about sexual assault disclosure. Multiple sources of qualitative data were triangulated, including interviews, follow-up interviews, interviews from the original study, and participant checks. Phenomenological analysis yielded five themes: (a) Meaning of Participation, (b) Trust in the Researcher, (c) Connection with the Other Participants, (d) Changing Comfort, and (e) Recommendations to Increase Participants’ Comfort. Based on these results, recommendations are provided for researchers conducting reflexive qualitative research practices.

The qualitative approach encompasses a wide range of methodological viewpoints; consequently, the levels of study conducted vary. This study analyzes qualitative studies in tourism at the methdological level in order to contribute to a better understanding of qualitative research. On papers published in the Journal of Tourism Sciences, a detailed exploration of qualitative research using content analysis was carried out over two phases. In the initial phase, the publication status of qualitative and quantitative studies according to their research strategy and data collection and analysis method was determined. The results demonstrated that interview-based research was utilized most frequently. The second phase identified the level of qualitative approach in the interview-based studies, based on 1) the applied research paradigm, 2) the degree to which trustworthiness was considered, and 3) the evolutionary level based on the development stages of qualitative research. The findings revealed that the papers employing grounded theory or phenomenology used a more advanced level of qualitative approach. A future orientation for qualitative research in the field of tourism was discussed with the results that provided a window into the dynamics of qualitative research.

Qualitative Research in CKD: How to Appraise and Interpret the Evidence

BackgroundUK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs’ leaving behaviour in the workforce...

This article considers responsibilities and challenges inherent in the research relationship, from the position of a researcher who is also a counselling practitioner. It draws on my experience of undertaking a qualitative interview-based doctoral research study with adult survivors of childhood sexual abuse, engaging critically with the debates in the research literature concerning researcher-practitioner role boundaries and comparable (and distinct) areas of practice between research and counselling. I suggest that within well-held, monitored boundaries, practitioner identities and contextual knowledge are invaluable to the research relationship and that a collaborative fluidity can operate between researcher and professional (in this case, counsellor) identities rather than them being in conflict. Though the issues addressed here arise from the researcher as counselling practitioner, I believe they have a wider relevance for all qualitative researchers. What happens in the research relationship is complex, involving the various identities (personal and professional selves), emotions, and subjectivities of both researchers and research contributors. Our personhood in research can help to generate rich sources of understanding and at the same time demands our critical reflexivity to interrogate our subjectivities and their influence. In undertaking research which asks individuals to reflect in detail and depth on intimate areas of their lives, researchers need to be prepared for the potential emergence of distress and feel equipped, through training, support, and contextual-based knowledge, to be able to respond appropriately. It calls for reflexive relational competence at the heart of qualitative research.

PurposeThe aim of this review paper is to identify the methodological practices and presentational styles used to report interview-based research in “leading” management and organisation journals.Design/methodology/approachThis paper reviews a sample of 225 articles using qualitative interviews that were published in management, human resource management, organisational behaviour and international business journals listed in the Financial Times 50 list between 2009 and 2019.FindingsThe review found diversity and plurality in the methodological practices used in these studies and the presentational styles used to report interview research.Practical implicationsThe findings are expected to help doctoral students, early career scholars and those new to using qualitative interviews to make decisions about the appropriateness of different methodological practices and presentational styles. The findings are also expected to support editors, reviewers, doctoral examiners and conference organisers in making sense of the dissensus that exists amongst qualitative interview researchers (Johnson et al., 2007). These insights will also enable greater “paradigmatic awareness” (Plakoyiannaki and Budhwar, 2021, p. 5) in the evaluation of the quality of interview-based research that is not restricted to standardised criteria derived from positivism (Cassell and Symon, 2015).Originality/valueTo make sense of this plurality, the authors map these practices and styles against the onto-epistemological paradigms identified by Alvesson (2003, 2011). The paper contributes to calls for philosophical diversity in the evaluation of qualitative research. The authors specifically articulate concerns about the use of practices in interview-based studies that derive from the positivistic logic associated with quantitative research.

Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. UK NHS burns services. Interviews and the pilot trial were run in seven burns services. Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone treatment, stretching and other exercises. Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, adherence with treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6-18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. Current Controlled Trials ISRCTN34483199. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 36. See the NIHR Journals Library website for further project information.

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change.