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In-Depth Interviews: Techniques and Best Practices
A workshop in conjunction with the ACEHP Annual Conference
Friday, January 17, 20144:15pm-6:15pm
Wendy Turell, DrPH, CCMEPPresidentContextive Research [email protected]
Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, [email protected]
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OverviewLearning Objectives: After participating, learners will be able to:
• Develop, pilot, and administer an interview guide for an IDI series
• Demonstrate optimal interviewer skills and techniques to encourage full feedback from interviewees
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The qualitative approach
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Search for objective, universal truths using standardized data gathering techniques
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Naturalistic/interpret-ative approach
Focus on how people perceive their worlds and interpret experience
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Data: What vs WhyQuantitative Data:A 37% drop-off was observed in adherence to post surgery medication regimens
Qualitative Data“After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
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Relevance to CEHP
Needs assessment
Formative evaluation
Outcomes evaluation
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Why Interview?• It’s good to talk
o Provides depth + context to other data
• Lopsided conversation• Relies on interaction
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What Defines an Interview?
A tool to direct or guide a conversation between 2 or more people towards a particular outcome.
Frey and Oishi (1995:01) define Interview as “a purposeful conversation in which one person asks prepared questions (interviewer) and another answers them (respondent).”
Examples: • Journalistic• Clinical• Research• Occupational
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Activity 1: Core Components of Interviews
• What went well in this interview?
• What did not work?
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Debrief
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Interview Planning
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Components of an Interview
• Opening/building rapport
• Language (word choices) and tone
• Body language
• Empathy
• Questions that will elicit deep response
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The Interview Guide
• Keeps you on track
• Ensures material/research question coverage
• Establishes sequence
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Question Order
sensitive
more serious
Small chat/ice-breaker
conversation
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Types of Questions
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Question Types• Open ended, neutral, sensitive, clear to
respondent
Patton, MQ. How to use qualitative methods in evaluation. London: Sage, 1987.
1. Main questions2. Probes3. Various follow up questions
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Main/Introducing
• “Tell me about….?”
• “Do you remember an occasion when…?”
• “What happened when you...?”
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Prompts + Probes• Extensions of main question
• Aimed to encourage respondents to share more information and touch on areas they did not initially address
• May reflect statements or use vocabulary of respondent
“You mention patients come into visits with opinions from these ads. How does that impact the interaction?”
“Could you say something more about that?”
“Can you give a more detailed description of what happened?”
“Do you have further examples of this?”
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Specifying
• “What did you think at that point?”
• “What did you actually do when you realized he had this side effect?”
• “How did your colleagues react when you started the new program?”
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Direct/Indirect
Direct Indirect“In what ways do you
implement these guidelines post
diagnosis? “
“How do you believe other physicians view
these guidelines?”
“Describe ways in which you support your
patients’ adherence efforts”
“What do you think are the reasons behind your
patients’ lack of adherence?”
AH: I made the examples more CME specific. Do these still fit as good examples of direct/indirect questions in your opinion?
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Interpreting “When you use the term ‘uncontrolled’ disease, are you referring mainly to A1Cs?”
“So do you mean that the patients have literacy challenges?”
“Is it correct to say that you are typically unable to chose your ideal treatment due to these barriers?”
“Does the expression ‘trying to keep up’ describe what you have just expressed?”
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More about Questions• Use vocabulary of respondent• Appropriate tone• (make sure order/sequence is in deck
somewhere)• What open ended q looks like• Language that may invoke defensiveness• Leading questions
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Time to Craft Some Questions
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Activity 2: Your Mission…• As CME Director of Main Street Community Hospital,
you and your team have been asked to interview 20 recently discharged patients who received joint replacement surgery. The hospital administration would like to learn about patient satisfaction during their stay as part of an education program designed to reduce readmission rates.
• Develop 5-7 questions that will help hospital leadership better understand more about “patient satisfaction”.
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Activity Debrief
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Interview Presence
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Face-to-face ‘live’
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WHAT ARE YOU REALLY SAYING?
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Telephone
Pros + cons
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Optional Webcam-
enabled images
Text based chat &
audio capable
Online: Virtual Interview Room
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Skype video call
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Activity 3: Revisit Your Questions
• As CME Director of Main Street Community Hospital, you and your team have been asked to interview 20 recently discharged patients who received joint replacement surgery. The hospital administration would like to learn about patient satisfaction during their stay as part of an education program designed to reduce readmission rates.
• Develop 5-7 questions that will help hospital leadership better understand more about “patient satisfaction”.
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Administering an interview
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Interviewer Behavior• Active Listening – Be ‘in the moment’
o Patience, okay with silence
• Encourage respondento Give appropriate verbal and non-verbal feedback
• Stay neutralo Avoid presenting your perspective (bias interview)o Avoid counseling, teaching
• Reflectingo Paraphrase/reflect back
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Capturing Informationo Audio Recording
• Digital RecorderoConference linesoPhone apps (e.g., italk)
• Video recording• Pen and paper notetaking
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Activity 4: Interviewing with partners
• 1:1 pairing• Practice using revised questions• Chose one partner to share information on
experience
REMEMBER:Active ListeningReflect back to respondentStay neutral
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Interview Disadvantages
• Time intensive
• Bias (researcher + interviewee)
• Skill requires practice!
• Lack of generalization
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Subjects
• Recruitment• Screening
o participants/inclusion criterion
• Subject preparationoWhat to expecto Institutional Review Boards (IRBs)o Informed Consent
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Questions?
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Follow-up Questions?Contact Us
Wendy Turell, DrPH, CCMEPPresidentContextive Research [email protected]
Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, [email protected]
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Resources
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Software Resources: Coding & Organization
• Free (QDA Miner Lite)o http://provalisresearch.com/products/qualitative-data-analysis-software
/freeware/
• Low Cost: dedoose ($10 per month)o http://www.dedoose.com/
• Bells and Whistles software: Nvivo or Atlas Tio http://www.qsrinternational.com/products_nvivo.aspxo http://www.atlasti.com/index.html
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Resources Cont.• Hopkins Open Coursework: http://ocw.jhsph.edu/• Qualitative course materials:
o http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/qualitativedataanalysis/coursePage/index/
• Online Qual. Textbook: http://onlineqda.hud.ac.uk/Introduction/index.php
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Resources Cont.• Cater JK. SKYPE: a cost-effective method for
qualitative research. Rehab, Counselors + Educators Journal. 20011;4:
• Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6:331-339.
• Curry L, Nembhard IM, Bradley EH. Qualitative and
mixed methods provide unique contributions to outcomes research. Circulation. 2009. 119:1442-1452.
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Appendix
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Conversation vs. InterviewConversation Interview
Respondent Friend/Acquaintance
Recruited respondent
Who provides Questions/Answers
Generally equal questions/answers among participants
Lopsided
Tone Share true feelings, reactions to what you hear
Maintain objective tone, non judgmental, non reactionary
Focus Typical focus on immediate outcome (e.g.: how was the game?)
Process, cause/consequences, context, search for patterns
Depth Most often a range of issues, not always deep
Narrow range of issues, greater depth
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Qualitative Research
Quantitative Research
Type of Questions
Probing “below the surface”; immediate follow up & adjustment
Limited probing; pre-determined questions NOT adjusted
Sample Size Small Any size including large
Information per respondent
Much Varies; Limited to answer choices
AdministrationRequires skilled researcher
Fewer specialist skills required
Type of Analysis
Follows structured steps; subjective and interpretative
Statistical; objective
Type of ResearchExploratory, descriptive Descriptive or Causal
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White Board Exercise example
Which drug class do you prefer to use in patients who fail on oral monotherapy?
DPP4 Inhibitors
SGLT2 inhibitors
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