An Introduction to Qualitative Research & In-depth Interviews

1. An Introduction to Qualitative Research & In-depth Interviews Shira Goldenberg, MSc October 13, 2011

2. Source: Pope & Mays, 1995

3. Use of Qualitative Methods in Public Health Research Research questions regarding ‘what,’ ‘how’ and ‘why’ • Contribute to our knowledge of the human experience • Attitudes, behaviors, and the meanings attributed to health & illness • Context of health and illness • Conditions (e.g., time, place, social setting) under which a health issue occurs • Social context of health behaviors • Understanding process • Intervention development • Program planning and evaluation Source: Pope & Mays, 1995

4. In-depth Interviews • A personal and intimate encounter in which open, direct, verbal questions are used to elicit detailed narratives • One-on-one interview with select group of people • Purposive or theoretical sampling, rather than random • Co-create meaning with interviewees by reconstructing perceptions of events and experiences related to health and health care delivery • Can inform a wide range of research questions • What are the attitudes toward drug use among Mexican migrants residing in the U.S.? • Why do general practitioners prescribe antibiotics for upper respiratory infections? • What are health care providers’ attitudes towards obesity that impact quality of care? • How is living with HIV perceived by HIV+ migrants? Source: DiCiccio-Bloom & Crabtree, 2006

5. Semi-Structured Interviews • Basic research question • Between 5-10 more specific questions to delve into different aspects of the research question • Loose guide: stem/root questions and probes • Iterative process of data collection and analysis • Preliminary analyses coincide with data collection – revise questions as the investigators learn more about the subject • Questions that are not effective at eliciting the necessary information can be dropped and new ones added • Interviewer should be prepared to depart from the interview guide during the interview – can digress to follow the interviewee’s interest and knowledge

6. Reflexivity During the Interview Process • Acknowledging social differences: • Social roles always shape the interview process • Reflexivity: investigator gives thought to his or her own role and that of the interviewee, acknowledging power differentials between them and integrating reciprocity into the creation of knowledge • The goal of finding out about people and establishing trust is best achieved by reducing the hierarchy between interviewees and researchers

7. Building Rapport • Means of establishing a safe and comfortable environment for sharing the interviewee’s personal experiences and attitudes as they actually occurred (Di-Ciccio Bloom, 2006) • Stages of rapport (Di-Ciccio Bloom, 2006) • Apprehension –uncertainty, non-sensitive questions to open up • Exploration –begin to share details, in-depth descriptions • Cooperation –more comfort, participants are not afraid of offending one another, satisfaction in the interview process, opportunity to clarify points and ask sensitive questions • Participation –highest degree of rapport, interviewee takes on role of guiding/teaching researcher

8. Strategies for Developing Rapport • Build a longer-term research relationship • Be prepared to speak about yourself & share information in response to requests • Ensure confidentiality and anonymity s • Create an open, reciprocal environment • Non-judgmental stance: Don’t offer opinions or express strong emotions • Prioritize listening, rather than pressing for distressing information • Accept hospitality, unless it jeopardizes your health or safety

9. Interview Techniques • Use the interview guide informally • Ask the questions in a conversational order • Avoid creating impression that the interview is a cross-examination • Keep the discussion on topic • Ensure that the questions are culturally acceptable and relevant • Listen to the participant until they finish each statement • Ask for clarification and details • Collect as much detail as possible: who, what, where, why • Summarize what you have heard before moving on to the next topic • Be an ACTIVE listener • Stay alert and pay attention - don’t allow your mind to drift • Make sure that the interview is not a therapy session

10. Common Sources of Interviewer Bias • Asking leading questions • Asking questions that include or suggest the desired responses • Offering opinions or forming judgments • These will influence informant’s responses • If forced, wait until after the interview is over • Inadequate listening and interruptions • Failing to listen to the last half of a participants’ response • Interrupting the participant before they finish, especially if they hesitate. A person often hesitates when trying to recollect some fact, and you should allow sufficient time for this to be done • Wait for the respondent to finish before probing • Failing to follow up on topics that the informant introduces • Redirecting the story • Asking multiple questions at once

11. Advance Preparation • Review the interview guide prior to each interview • The key to an informal and conversational interview is your familiarityandcomfort with it • Ensure that you can conduct the interview in a private location, ideally across from the participant • Professional, facilitates notetaking and eye contact • Should take place in an informal and relaxed atmosphere • Confirm the time and place of the interview • Bring a notebook and pen to take notes • Bring sufficient copies of consent forms • Ensure that you have full battery power as well as backups & that your audio recorder is functioning

12. Getting Started • Formally introduce yourself, your role, and the organization you represent • Explain purpose of the interview and why their views are important • Engage in culturally appropriate small talk • Obtain informed consent - collect the signed forms • Ask permission to audiotape and take notes • Make reassurances of confidentiality • Make sure the participant is comfortable and understands what is going to happen • Explain the ground rules for the discussion • You are there to learn from them - they are the expert • All ideas are equally valid • There are no right and wrong answers • The informant’s view will be heard and respected

13. Facilitating the Conversation • Listen to the participant – they are the expert! • Only introduce 5-10 core or “stem” questions • Begin with the general question and then use the sub-questions as probes to facilitate elaboration of opinions and discussion. • To get the informant to elaborate on what they just said: • Use neutral agreement or acknowledgment • Repeat what they have said, phrased as a question • Ask for information(“Can you explain that a little bit more?”) • Ask for clarification of a term • Take notes of what is being said • To keep track and assist in summarizing • Change topics if you detect that the informant is becoming agitated or upset by discussion of a particular topic. • Keep track of time: avoid extending beyond the participants’ willingness/ability

14. Concluding the Interview • Summarize what you have learned from the informant • Ask if there is anything that has not been discussed the informant feels should be discussed • Leave the interview on a positive note • Ensure that you address the participants’ questions and requests for information • Explain what will be done with the information you have collected. • Leave your name and contact information in case they have additional information they may wish to provide at a later date • Offer to make available summaries of what we have found once the project is completed, if they wish to provide contact information