**Transcript of Cyberseminar**

**Timely Topics of Interest**

**Interviewing for Qualitative Data Collection: Eliciting Rich Descriptions (part 1)**

**Presenters: George Sayre, PsyD; Jackie Grimesey Szarka PhD**

**April 22, 2013**

**Interviewing for Qualitative Data Collection: Eliciting Rich Descriptions (part 1)**

**April 22, 2013**

*This is an unedited transcript of this session. As such, it may contain omissions or errors due to sound quality or misinterpretation. For clarification or verification of any points in the transcript, please refer to the audio version posted at http://www.hsrd.research.va.gov/cyberseminars/catalog-archive.cfm or contact:**george.sayre@va.gov*

Moderator:The first of our two presenters is Dr. George Sayre. He’s a Health Services Researcher and Qualitative Research Coordinator at the VA Puget Sound Health Care System HSR&D Center of Excellence, and also an Assistant Professor of Psychology at Seattle University in Seattle, Washington. Joining him today is Jackie Szarka. She is a Staff Psychologist at the PTSB Outpatient Clinic and VA Puget Sound Health Care System, the American Lake Division. I’d like to thank both of our speakers for joining us today. At this time, I would like to turn it over to them.

Dr. George Sayre:Good morning and welcome to you folks watching online. We also have some folks live here in Seattle for their presentations. They may be asked some questions, and we may ask first of all that you repeat them for you folks. Jackie actually has a correction.

Dr. Jackie Grimesey Szarka:Good morning. This is Jackie Grimesey Szarka. I just wanted to point out that I am now Project Coordinator in Health Services Research & Development at VA Puget Sound. I’m no longer with the PTSB Clinic.

Moderator:I apologize for that Jackie. George, can you pull up the “Show My Screen” button?

Dr. George Sayre:Yes. This is part one of a two-part workshop seminar here in Seattle. The second day will be next Monday at the same time. Today I want to cover some key concepts for understanding qualitative data collection in interviewing specifically. Next week Dr. Szarka will talk more about practice and the actual interviewing technique of today. It’s mostly some background and key concepts. Let’s start with the goals of qualitative interviewing. This is a good way to get a sense of what we’re going to be covering. 

The first goal is to elicit rich descriptions. I want to point out that qualitative interviewing is not verbal, whole, or surveyed research. We’re not trying to collect a dichotomous, closed into just yes or no questions that you could get in a survey or that you could get on a poll. We’re trying to get rich data that we can then do analysis with. The second goal of qualitative interviewing is facilitating exploration and unfolding. This is a very important point. In a qualitative interview not only are we trying to get information that the person already has, which is similar to polling information if I were to poll you about who you’re going to vote for or what your favorite ice cream is, we expect that you already have a ready answer for that whether that’s a dichotomous yes or no or on a Lickerd Scale where you’re going to rate it. In qualitative interviewing we expect that the information we get at the beginning is not necessarily ready-at-hand in the participant. We’re going to help them extol that. We’re going to help them to discover what they’re talking about. It’s very process-oriented. It gives a chance to both the researcher and for the participant to explore, extol, and somewhat discover what they think, which goes to the third goal of discovery. 

Qualitative research is trying to discover, not just confirm, what we already expect. That discovery is both from the researchers end, because we go in there not knowing what constructs, what factors are important, and what the person may even want to talk about. Frequently the participants in qualitative research discover things. In qualitative interviewing we’re usually discussing complex phenomena that people may have strong feelings about, but not have thought a lot about. I practice a lot with my students interviewing about the phenomena of falling in love. They all have opinions about this, but they have no idea what the hell they’re talking about. It’s in the process of talking that you discover things. So discovery is both on the researcher’s part and also on the participant’s part. Frequently in good qualitative research, people at the end of the interview will tell you, “That was fascinating, and I learned something myself,” which is quite different than survey research. In survey research you give us information, but you would rarely discover something you haven’t thought about. All of the goals of elicit rich descriptions, facilitating exploration and unfolding and discovery all fall into a couple of categories.

This is about experiences, something to keep in mind with qualitative research. I think at its best we’re not looking for opinions and reflections. That’s something we can do with polling and survey research. The real rich descriptions of actual experiences that people may or may not have thought about or may not have understood themselves. We also are trying to look at perspectives within the data we collected. It’s not only what did they tell us, but from what perspective? How did they see it? What did they find interesting? If two people describe being in a particular waiting room in an emergency room, what did they notice? 

Each person is going to have different perspectives that they bring to this. A phrase that we want to keep in mind is the participant’s “Lifeworld.” When people give descriptions, whether it’s describing going on a drive or falling in love or sitting in an emergency room, they’re not going to just present facts. They’re not camera’s taking pictures. They’re going to describe this in a particular way. They’re going to describe it in a particular timeframe and in particular relational roles. Who did they notice? They’re describing not just the event, but always they’re describing themselves in how they experience things. And lastly is what’s important to them. What do things mean to them? If we ask someone about barriers and facilitators, they’re not just pointing out a fact that parking is a barrier. They’re also describing something about what’s important to them, time. If they talk about how important travel is, what does it mean to have to travel to the VA for a patient? Is that something that they don’t like to do? Is it a tremendously onerous thing for them to do? Does that mean as a mother they’re failing to take care of their kids? So good rich descriptions allow us not just to collect an assortment of facts, but to get a real understanding of how these participants experience the world and what things mean to them.

I want to go over some key terminology for understanding qualitative research. One of the reasons why I want to point this out in this workshop is that interviewing is a huge skill. Again it is not doing a verbal poll or a survey. I think frequently when we ask people to take on interviewing they underestimate the amount of skill involved in doing it well. I’m a psychologist and a family therapist, and a part of my work is training clinicians. I think that learning clinical skills and learning interviewing skills are quite analogist, they are both very, very difficult. So I think having some background in the nature of qualitative research will help you be a better interviewer knowing why are you collecting this data and what’s the purpose. 

There are key concepts in the continuums of qualitative research. One is inductive and deductive. It’s a phrase you’re going to hear a little bit more about as we go on. Both of these things refer to how you seek knowledge. Inductive means we’re looking for information where we don’t know what we expect. Deductive is where you already have perhaps a hypothesis or a theory you want to confirm, and we already know what we expect to find so we can start our research in order to confirm our predictions or expectations. And now it gets to the kinds of questions you’re going to ask. In more inductive research they’re going to be more open. Questions are constructed in such a way that people can talk about anything they want where we don’t know exactly where it’s going to go. Sometimes in research we have very formative ideas. We don’t know what’s important when it comes to a particular treatment or your experience, so we’re going to ask very open ended questions with very little restriction on where the participant may take us. 

In more deductive research we’re going to ask more closed questions. We already have factors that we want to know about. And frequently research is a mix of these. We may want to know how is that particular specialty care process working or what is your experience with reproductive life planning. We want to know in general, but we also want to know what some barriers or facilitators are. So we’ll bring in some key things that we want to make sure people talk about. Most of the research you do will be a mix of these two things. The questions will be a mix where you’ll have some very open-ended questions and then some follow-up questions that can get very focused. We want to make sure that people talk about something in particular. For example, how sustainable would a program be or how acceptable do you think this would be. 

Lastly is process. All qualitative research is going to be somewhere in this continuum regarding the process. Iterative means that data collection and data analysis happens simultaneously. A part of the data collection process is informed and revised by the data analysis. We start out with a particular interview format and content. As we collect data that may be evolving and changing. So as people start to talk about particular things when things emerge, we may revise the interview process in order to chase that down and flush it out, or we may drop some questions because they’re not eliciting useful information. In some qualitative research this is a key part of the process. For example, in grounded theory where you want to make sure that as you’re seeing something emerge that’s possibly related to a possible theory, you can flush that out more.

A more linear data process is one in which you have a set way of collecting the data with an interview script. You start with the data collection, you finish it, and then after you have all the interviews you begin to do an analysis to see what was there. These are important for interviewers to understand, even if you’re not doing the data analysis. As an interviewer a part of your job may not be only to collect interviews, but to give feedback on the interview process. How are these questions going? What are you hearing that we should focus more on? When we’re doing inductive, open, and iterative qualitative research, the interviewer is a part of the research team. They’re not just someone that’s collecting data to hand over to researchers.

Let’s talk a little bit about data analysis. Because of the role that interviewers play on research teams in qualitative research, I think it’s important for you to have some understanding of what’s going to happen with the data that you collect. When we’re collecting interview data, they’ll be a wide variety of methods that will be analyzed. We’re not going to get into that now. We can talk about some generalities about qualitative research. The first one is usually what we’re looking for eventually is we want to find out what themes are. What are people talking about? Themes have to do with concepts, patterns, and categories. We’re not simply looking for content to get a list of things they like and dislike. We’d like to know the kinds of things that they like and dislike, the ways in which they may like or dislike these things, and what they do about them. The data that you collect from the interviews will probably be transcribed; you’ll use audio to do coding. And then there’s going to be coding where people are identifying themes. Again this is important for interviewers as a part of the research team because you’re actually listening to these people. You’re talking to them. So you may be a part of identifying which codes seem important. What’s important for the data team to notice? 

Coding is the process of identifying themes in texts, quotes, and attaching labels to them. Most qualitative research formats are going to have some sort of notion of hierarchical coding. This means that very broad themes are going to be looked at like barriers and facilitators, reasons for relapse, or relationships. Underneath that, we usually start by identifying very specific texts, quotes that people actually say. What do people actually say, and build our way up to broad themes that help conceptualize large phenomena. Most of you who have done qualitative interviewing will have guides that allow you to do probes. If you have some understanding of how this data is going to be collected, the nature of the research study, it’ll give you some guide on what you want to do follow-up questions about and what is not so important.

I’m not going to explain all of these. This would be a whole another series of classes. But I do want to point out that if you’re on a qualitative research project there’s going to be some sort of particular method, most likely a grounded theory, phenomenological, ethnographic, or a content analysis. Content analysis can be either inductive or deductive or both. There’s going to be some sort of method going to be used for this. If you’re doing interviewing, it’s good to understand what are we doing with this? What method are we using? You need to have some sort of understanding of how the data is going to be interpreted, what focus you want in the interviews, and how open are we supposed to be. So I think it’s very important to have a sense of the totality of the research project for the interviewers. 

Let’s move into the types of interviews. I want to spend a fair amount of time today talking about the various types of interviews. To put it in blunt terms you may have structured interviews, semi-structured interviews, or unstructured interviews. These are continuums and not just three categories. In structured interviews, which are going to be the most deductive of all of these, the interviewer is going to ask the respondent the same series of questions. All participants are going to be asked the exact same questions. This means that the follow-up questions are going to be the same. There isn’t going to be any open probes so you can end up asking a question that’s not on the guide. Questions will be created prior to the interview, and they’re going to tend to be fairly close-ended. They’ll be specific information like, “Can you tell me what specific things made it hard to come to the session? Can you tell me when your last drink was? Can you tell me have you ever talked to your doctor about reproductive life planning, and if so, can you list the things that were said?” The question is obviously very standardized. You want very little variance, and the interviewers are going to sound the same. If we were to listen to three interviewers, the way they do that should be very, very similar. 

You’ll also find in that case very little variation in the responses. We’ll find content variation, but not a lot of topic variation. These tend to be highly focused interviews. In this case you might even have response traces provided. This tends to be a very deductive way of catching things if people sometimes don’t have an answer when we ask, “What were the barriers of participating in this program?” If they say, “I don’t know,” we may have a list of choices that they can respond to. In this case the interviewer plays a very neutral role. You’re not doing a lot of helping to unfold and helping the person to explore. You’re just collecting it. You’re providing structured questions in which they will respond. 

This is going to be the most similar to a survey, and is often used if you’re doing categorical rating. It’s where you’re doing qualitative research where you have a construct you’re looking at or a very clear, well-developed model. We’re currently doing some implementation science research where we’re using the Sweeper Model, and a part of that has a fairly structured interview process where we expect people to talk about very specific things like, “How involved is your leadership?” And then we get responses that we can then rate. So if you want to do interviews where you’re going to collect data that you can quantify and turn into ratings, this is the kind that we usually do. These can be fairly self-administered questionnaires. On a number of the surveys that we use including the employee satisfaction survey, there’s going to be some specific follow-up questions where you can write in your answers in a structured way. 

Semi-structured interviews are going to be the kind most of you are doing and are most common. I would even go so far as to say it’s the fairly ubiquitous kind that we do, and the standard thing that’s on every grant proposal. In this case the interviewer and the respondents are going to engage in a formal interview. I put that word “engage” because it’s going to be conversational. One of the goals of doing good interviews is that it doesn’t feel like an interview. Dr. Szarka has a tremendous amount of experience both doing interviewing and in training for interviewing, and we’ll talk some about how we do that. A good semi-structured interview hopefully feels more like a conversation. Even if you have a lot of structure to it with the way that you do your follow-ups, it should feel fairly organic. It shouldn’t feel like you’re being interviewed.

In this case the researchers develop and the interviewer uses a guide like, “This is a list of questions and topics that need to be covered during the conversation.” Sometimes it’s in a particular order, but we’ll talk about the fact that you should always feel free to jump around into something more organic. The interviewer follows the guide, but is able to follow tropical trajectories in the conversation. In other words, as people stray or bring in new information, a semi-structured interview allows you to some degree to follow that. That’s one of the crucial key strengths of qualitative research. People may talk about things you did not expect them to talk about. That’s the whole point of doing open research. People surprise you and go on tangents, and they bring up things that you didn’t expect that fall outside of your theories and outside of your models. The participants should say, “That makes sense to me. That’s what I’ve always known.” When you take it to your audience or patients, they often say, “I’m glad you said that. That’s what I’ve been thinking.” That’s good qualitative research. In this case the interviewer has to have some choices about follow-up questions. A person may give a response and mention family, parking, and television. You’re going to have to follow-up on some of that. There is some subjectivity in what you pick. There should be a guide to how you follow-up. These guides should include protocols for prompts and follow-up questions. I think it’s important not just to say, “We’ll follow-up because we want to be careful not to lead people or to frame their questions in such a way that is affecting how they present their material too much. We don’t want to have too much of our biases lead in. You can follow-up with whatever seems important to the interviewer.

I will point out that we probably don’t do a lot of unstructured interviews in our VA funded research. In these cases the interviewer and respondents engage in a formal interview and they have a scheduled time to speak with each other. So now it’s an interview. It’s not just a conversation. Both the interviewer and the participant understand the focus and the purpose of the interview. A crucial thing in this is that there’s a building of rapport, and these are primarily open-ended questions. Sometimes the research only has one question that we start with. This is true in some of the most open and inducted types of research that are phenomenological, where the entire interview guide may start with one question, “Tell me about your last ER visit.” And then everything else is prompted from there. Or it could be a very basic construct. I did some research where the only pre-planned research question was, “Tell me about being a couple.” From there we just followed up on whatever they asked. There are very strict protocols for how we follow-up within that. We could do interviews that range from forty-five minutes to an hour and forty-five minutes. You’re helping people unfold and you have nothing in particular you want to look at. 

We like to do this kind of interview and this kind of research in a very formative way, in this very formative phenomenon where we don’t have a lot of models for understanding. Especially in those areas where we’re finding that in our research we’re confused by what’s happening. We really have very little understanding of why people are doing what they’re doing. What is this protocol which makes sense to everyone is backfiring? Why is no one adopting this? Why did people get sicker instead of better when you educated them? In those cases where you have very little understanding, we want people to be able to talk about anything to wherever they take us so we can have real rich descriptions. Again we may not have any prompts, specific focus, because we don’t know what to be asking in those cases.

There are going to be little constraints on the informants’ responses in this case. These are challenging interviews to do in that there are very little guidelines on what’s on topic and what’s not. Even though I’m talking about following the participants conversation, in most semi-structured interviews you still have a fairly clear idea of where you want to go and what the limit of the phenomena is. In this case it can be tricky, because you may not know what that’s about. These can be very challenging interviews to do, but I think especially getting cases where we don’t have good research models, conceptual models, we have very little literature on it, or good theories to work off of, these can be very useful kinds of ways to collect data about the experiences our participants are having. 

 Let’s talk about some other key concepts about research interviews. One is that they’re descriptive. I want to talk a little bit more about this focus on description rather than reflection. I think this is very important in good qualitative interviewing and good qualitative data. Sometimes we construct qualitative interview guides as a survey or a quantitative research collection where we’re asking people to provide their opinions or thoughts about things, rather than descriptions. I want to talk more about why we are more interested in qualitative research and description, rather than what I call reflection. When you ask people about opinions, we’d ask, “Why did you drop out of the group?” There are a couple of things about this. One is they’re only going to give their pre-conceptions about why they did that. There are two problems with that. One is that they may not know what the hell they’re talking about. The one thing we know as a psychologist is that we often don’t know why we do what we do. And our opinions about why we do what we do may not be useful. 

That’s true in even quantitative things. If you work in an addiction study you can ask people how much they drink. Their assessment of their numbers may be off. My favorite example is when I teach we do professor evaluations at the end of every quarter. One of the questions they asked is, “How many hours a week do you spend studying?” It’s a terrible question because I don’t think that they know. They don’t have the foggiest idea how much time they do. And even if they were to have a pretty good guess of how much time they sit down, they don’t have a good idea of how much time that they’re studying versus getting their playlists ready. Before you study you have to get your playlists right, and then you’ve got to check your e-mail. Facebook could even pop up. So they think they’ve studied for four hours, but it may only be a half hour of studying in there. 

I like asking students to tell me how many hours they spend studying because that’s always done during finals week. They have this impression they study a hell of a lot. So they go, “I studied a lot last night. I studied for four hours. I study twelve hours a week in this class.” Well I know from their test scores that they don’t do that. So people’s ability to objectively give information tends to be poor. However, people are better describing experiences. So instead of asking how much you study every night, I’d ask, “Tell me about studying. Where do you do that? What do you do? What’s the first thing you do?” We may even hear about how much time they spend checking their Facebook page, because you’ve got to clear that up before you can start studying. Or you can make popcorn and find out that you don’t have the parmesan cheese to go with the popcorn so you have to go downstairs, because how can you study without parmesan cheese popcorn. As we get these descriptions, we only start to get a better idea of what’s really happening, because we don’t go through our lives analyzing and summarizing it very well. It’s certainly not very objectively. So good qualitative research does its best job when you’re eliciting very rich descriptions about what’s happening like, “What’s it like to sit in the waiting room at a VA?” They don’t like to travel, but tell me why. How long does it take to get there? What do you normally do on that Tuesday? Who has to drive you? They might start talking about how the people who have to drive them are pissed about it the whole way. They may talk about how their wife drives them and she hates driving into the big city and that it scares her. We may think it just takes a lot of time, but maybe it’s a terrifying event to drive. They’re not doing anything anyway, but they don’t like being scared of driving downtown Seattle on the way to the VA. So these descriptions are very useful. 

It also allows us to elicit a person’s life world, which is a part of their perspectives and meaning. One reason that descriptions are better is because most of us don’t know why we focus on what we focus on. So if we were to interview people after this workshop, not only will they give us different facts, but they might have focused on different things. Some of them mainly might be thinking about a project proposal that they have. Some of you may actually be thinking of work that you have to do elsewhere. Some of you may notice the other people in the room, and some of you may only focus on the slides. It’s going to be very, very different. Descriptions allow us to get perspectives of why do they focus on what they do. How do they speak about time? Do they speak in the passive or in the active sense? Dr. Szarka helped collect this data where a couple is describing the kind of fight they had. The veteran would say that we had a fight and then there was a hole in the wall. I’d know about the fist through the wall because I interviewed the partner too. But the fact that you described the fist through the wall as, “And then there was a hole in the wall,” tells us a tremendous amount about how you see the world, how you relate to your temper, how you understand your violence, and how you understand your control. Is this happening to you, or is this something that you do? So we don’t’ want to just hear the facts in the matter, but how did they construct the facts. How do they see the world? Descriptions are much, much more effective than asking for opinions and reflections. 

This notion of life world is a phenomenological phrase in terminology, which you don’t have to know anything about phenomenology to get into. But it is something that is a part of all qualitative research in some ways. Again we’re looking at this notion of how people construct their world. So if we’re asking for an experience from a veteran of what’s it like to live out where you do, or we’re asking caregivers what’s it like to have a partner who has diabetes, we’re not just trying to find information, but we’re trying to find out how they see the world and what’s important to them. Keep in mind since we’re focusing on health research that the life world of the patient and the life world of a provider are radically different worlds. You’re in the same room. You know more about diabetes or the endocrine system than they do. They may know some of the facts you do, but the experiences are radically different. You may understand how chemo dialysis works, but they know what it’s like to be hooked up to one of those things and to depend on it for your life. They’d hate the damn thing because it owns them. 

Good interviewing allows people to express not just what they think they’re suppose to know and think, but how they feel, what’s important to them, what things taste like, and what the room is like. This allows us to have a better understanding of what it’s like to be treated, what it’s like to travel, what it’s like to be a veteran, and what it’s like to be married to a veteran. And therefore it allows us to have a better understanding about why people fall through on a treatment, why people don’t, why some treatments work, and why some don’t. When people are talking they’re always describing two qualities of description. They went to the VA and they have to go three times a week. They’re on thirty-two meds, or this one makes them more nauseous than this one does. But they’re always describing their subjective world. They’re always talking about themselves. So if I’m in this room and I say, “There are a lot of people in the room,” and then I’d tell you a fact of how many people are in the room. If there were thirteen people in this room and I said there were thirteen that’s an objective reality I’m telling you. But I’m also telling you that I notice people. There are also pictures in this room, these wonderful pictures of our staff with their pets. Some people might tell you that they’re in a room with these great pictures. Other people might leave here and they never noticed them. If you tell me that that room’s great because there are pictures of pets, you’re also telling me without knowing it, “I’m the kind of person who notices pictures with pets. I’m a person who is really focused on the information.” Another person might have been in this room, and they leave and know nothing about what the room looked or smelled like. They can tell you all the facts from the slides, but they didn’t notice anything. Those are two different kinds of people. Because when you do qualitative research and we’re frequently looking at populations or groups of people with shared experiences, we did want to know what these kinds of people are like. What’s it like to be someone who has to have dialysis? What’s it like to have a partner who has post traumatic stress? What’s it like to be in a violent relationship? What’s it like to be asked by your doctor, “Have you thought about getting pregnant?” Good interviews allow us to get at that information, especially if they’re more and more open.

I also want to touch on this notion of meaning. Qualitative research because we’re looking for descriptions allows us to actually get at what things to people. As a healthcare provider organization, we as providers and researchers have an idea of what things mean. As physicians in the room you’re going to prescribe medication for them. You know that Lipitor does a certain thing. But we don’t always know if it has meaning to the patient that goes beyond that. Does it mean you’re weak? Does it mean you’re strong? Does it mean that you are the man you used to be? Does it mean that somebody cares for you? Does it mean that you’re getting really, really, really old? Meaning has a lot to do with day-to-day, practical health care issues, whether people are going to be compliant with their medications, or whether people are going to check their blood pressure. If checking your blood pressure just reminds you every time you do it of what a failure you are and how bad you are for having high blood pressure, you may be less likely to do that at home. If forgetting your own medication and having your wife remind you, you may want to forget your own medication. I think it’s crucial that we increasingly understand what things mean to our veterans. I would argue that this is especially true with certain underserved populations such as with a Women’s Clinic. 

We have made some changes based on understanding the meaning of that. The VA has done this wonderful thing where there is a separate Women’s Clinic. That’s happening more and more. So what does it mean to be a woman going to the VA prior to that? It’s a radically different experience that affected their actual, practical health care experience, whether they’re going to talk about certain issues, contraceptives, or going to disclose an abuse or a sexual assault. So a part of the richness of qualitative research is that we have an interest, not in facts and concepts, but in what the world means. The phrase like we like to use, particularly in the university where I teach is, “Giving voice to experience.” The job of qualitative research is to give a voice to people who don’t have a forum like we do. And not only to say what they say, but to help them articulate it very well. So we work with a lot of populations, a lot of veterans and their partners and families, who don’t have a lot of voice. A part of our job as researchers is to hear what they have to say and to give voice to their experience and then hand that off to the people who need to hear them, whether that’s their providers, their family, or even sometimes themselves. One of the most gratifying things about qualitative research that I like is that you sometimes get thanked at the end of doing it. I’ve never had that experience in survey research. I’ve taken a survey and wanted to call the people up and say, “Thanks for doing that.” We do a lot of survey research, but it does allow you sometimes to be thanked because people appreciate having someone understand them and to speak for them.

This brings me back to interviewing as a skill. Because you’re giving voice to experience, you have a lot of responsibility. You are speaking for people. You’re not just saying, “Out of this generic population out of all our doctors, eighty-seven said this.” You’re talking to a handful of people and you’re going to go and speak for them. So you better do it really well. This is why that I think that interviewing skills are very skills, because it both allows you to collect that information so you’re being accurate and you’re being grounded, which is a phrase that we like to use. You do it in a way that’s respectful and that you take seriously what they have to say to you. That’s why we’ve taken a lot of steps to train really good interviewers, which we have tons of in the VA. The nice thing about being a qualitative researcher here is that I have lots of people who have a tremendous amount of experience doing interviewing. I’d say almost more importantly is we turned out staff who are very respectful of the population we work with. Everyone I’ve worked with in the VA takes it very seriously that we are serving those who served. So giving voice to them is a very critical thing. This was background to the overall focus of qualitative research, and also some key concepts. We want to open up for some questions pretty quick. I want to repeat that next week Dr. Szarka will be continuing on, and we’re going to go through the rest of the slides which will cover specific issues about how they actually do qualitative interviewing. At this point Molly, I think I’m going to go ahead and turn it over to you to see if there are some questions here. I’ll repeat them and then we can go to online questions.

Moderator:That will work just fine. Can I ask you to leave up either the last slide or some slide on the screen just so that we have something to look at when we’re doing the Q&A?

Dr. George Sayre:Someone here is asking about the difference between grounded theory and phenomenological. I can give you a really quick response that gives you the connection. Grounded theory is a fairly structured way of doing research. It’s going to have very clear focused methodology, and its focus is quite different from phenomenology, which is to develop theory. The grounded theory can focus on processes and change over time. It was originally developed by Glaser and Strauss for when we don’t have an idea of how people deal with grief, how PTSD affects partner relationships, or how it’s related to intimate partner violence. Dr. Szarka and I worked on it together. We knew that the research was quite clear that veterans who suffer from PTSD have much higher rates of intimate partner violence than veterans who don’t, even if they both had combat exposure. We weren’t sure why. It seemed like that made sense, but there wasn’t a model out there. So we did some grounded theory research with a preexistent dataset that we modified in order to have a sense of some of these interviews with, “What happens when PTSD is brought home that would make it more likely that there’s resistance to treatment of intimate partner violence?” The grounded theory is fairly open and more deductive.

Phenomenological research is simply the question of, “What is the experience like?” One of the reasons we don’t do as much in the U.S. as they do in the U.K. in healthcare research is for some researchers the term is just too vague. But the focus on that is not to develop a theory, not to address why anyone does anything, but what us the singular experience like. It’s usually focused on very singular experiences. I mentioned hemodialysis. A colleague and friend of mine in the U.K., Jonathan Smith, does a lot of phenomenological research. He did a really awesome study on what’s it like to be hooked up to that machine. So the focus is not on developing theories, but just on understanding experiences. The phenomenological research is very, very inductive. No more questions here, so Molly it’s all yours.

Moderator:Great. Thank you so much. We do have it looks like a dozen pending questions so we’ll get right to those. The first one that came in and you may have covered this at the beginning is, “What is the best way to code interviews?”

Dr. George Sayre:I’m going to defer on that, because it just seems too big to answer here. It’s too large to describe, because it depends on what message you’re doing. Sometimes you do closed encoding, so that’s a big question. I would refer you to the basic text and a class. One of my pet issues about qualitative research is that it is good to get an education. We have very few researchers running around saying, “I’ve never taken a stats class, but I bought a book.” So I think it’s the same with qualitative research. If you’re going to design studies you should have some experience in it. But if you just want to read about it, Creswell is the classic text for that, and the Stagehand book is a really nice one too. There are a number of them. Jonathan Smith’s survey on Qualitative Research is good too. 

Moderator:Thank you very much. The next question is, “Can you discuss the difference between conducting individual interviews versus focus group formats?

Dr. George Sayre:That’s a great question. I’ve been focused on individual interviews probably just by default. Most of you are familiar with focus groups. Focus groups are where you have a group of people. They’re going to have some different dynamics, because as with individual interviews, in order to do a focus group you’re going to have to also look at the constitution of the group. Focus groups range from very homogenous groups to all the way to where you’re dealing with an existing group. We’re going to be doing some of these shortly. We’re planning these now with interview teams of physicians who use scan echoes. So that’s a preexisting, organically occuring group that’s already out there. That’s going to be different than in an individual interview in that you’re not only talking to several people, but you’re talking to a group which is going to have its own dynamics and processes. So you bring another element of data to the interview which is, “How do they talk to each other? Who do they defer to? Do they suppress descending opinions, or do they enhance them?” Focus groups also sometimes tend to be somewhat heterogeneous or sometimes people have a similar experience but don’t know each other. They don’t have any interaction. At that point focus groups are more like individual interviews in that you’re trying to hear individual experiences, but doing it in a way that’s both efficient and also that other people can bring in some information with some descriptions of how they’ve lived it. I think a good way to look at focus groups is as they are co-interviewers. Other people with the same experience can facilitate exploration. The strength of focus groups is that people can ask questions that didn’t occur to the interviewer, because they may know something about that. So if you’re talking to a group of women veterans who’ve gone through a particular experience like being assaulted, they may ask each other questions that the interviewer would not have known to do like, “Did this happen to you?” It’s useful in that way. A down side of focus groups is that sometimes you get people who are uncomfortable, socially anxious, or have information that’s very sensitive and divergent from the main group. It can sometimes suppress information too. So there’s a tradeoff there. I think a lot of times we do them because in some ways there’s an efficiency issue there too.

Moderator:Thank you very much. The submitter is welcomed to write in if they need further information. We do have a very engaged audience though. I think we’re up to twenty pending questions. Getting right to those, “Can you give an example of an unstructured interview in the very initial stages of qualitative research where there is little literature on the question or topic?”

Dr. George Sayre:Yeah, I think that anything phenomenological would be useful.

Dr. Jackie Grimesey Szarka:This is Jackie Szarka. I’ll give you an example. The question that I used in my dissertation was, “Tell me your experience of living with your veteran who suffers from combat trauma?” And then the participants responded to that question in writing and also in an interview with me, as well as in a focus group. That was done through phenomenology. It was very open and allowed them to explore the experience.

Dr. George Sayre:I did a phenomenological study on being a couple. The question was, “What does it mean to be a couple?” We used video tape and we interviewed the couples together. So we were not only interested in what they told us, but how they looked at each other. We did it in their home. We could see where they normally sat, and how they react to their dog and stuff. We had a fairly structured follow-up format, but we could follow-up on anything that they talked about. Those interviews ran up to over an hour and a half.

Moderator:Thank you both for those replies. The next question is a little bit lengthy, “For unstructured interviews do researchers ever interview people more than once? I can imagine a case where you have no idea what people will say initially, so you may not know which topics to prompt on more. But after a few interviews you start to see a pattern of something, so you want to go back and do some of the previous interviewees and ask them more structured questions about the new things that are emerging. Is that the case?”

Dr. George Sayre:Yes it’s done, sometimes not as often as it should be, because it’s complicated and expensive. That also gets into the discussion of respondent checker where you can actually check out with, “This is what we think you’re saying.” But generally we often do follow-ups. That can be done in one of two ways. Sometimes you visit people you interviewed the first time maybe with some specialty care initiatives that we’re looking at, and we’ve developed a second interview based on what was important, what seemed to emerge, and we’re focusing on those pieces. We’re also looking at change over time. Has it remained the same? Is this part still great? Is it still a problem? So you sometimes not only want to clarify, but you want to see change over time. Sometimes follow-up interviews for various reasons you can’t use the original people. And so you may do a second round of interviews with people in a similar experience to ask more honed in questions. We may not be able to catch the same people we got the first time, but we’re doing refined interviews with the same group or population or people who had the same experience. So it’s a second step of interview, but it’s not the same people. How many points of contact did you have with your participants Jackie?

Dr. Jackie Grimesey Szarka:There were four points of contact in my dissertation research. There was the initial contact and then a written description. After I coded that I followed that up with an individual interview with the participant to check my work. Then I coded the interviews as a group, and then met with all of them as a focus group to check my work. I also did a follow-up with each individual. As George said that is very time consuming. I think that it’s a great way to go about it, but you have to keep in mind your time and money in this kind of an environment.

Dr. George Sayre:You can also combine focus groups and individual interviews. You do focus groups and sometimes you can identify people within the group that you want to talk to more. They seem to have key knowledge or they seem to have not expressed themselves. So frequently you can follow-up and do a sequence of interviews.

Moderator:Thank you both for those replies. The next question is, “For semi-structured or unstructured interviews, does indicating the use of these types of interviews under the study design of the proposal allow for additional flash modified questions that may not be listed on the interview guide, which I assume will be submitted to IRB as an appendix to the proposal?”

Dr. George Sayre:Yes. You’re getting into the fact that it’s iterative. So I think it’s important to explain how we’re going to modify the guide.  You don’t just say, “We’ll change it as we go.” How do we do that? What will be the structure of the prompts? I tend to have fairly structured standardized prompts, which I think are very open so you can ask questions like, “Give me an example of a time?” The main point is that the reviewer IRB folks can look at this and they may not know what exact questions are going to be asked, but they know how you’re going to get there and what kinds of questions. I think having very strict protocols makes the research more trustworthy and it gives comfort to the IRB. I do think it’s good to have broad themes, some specific questions, an example of our initial interview guide, and then descriptions of how we’ll be modifying and how prompts will be asked for follow-up questions. 

Dr. Jackie Grimesey Szarka:In the couple of minutes that we have left, I’d like to give a homework assignment to those who are going to participate in next Monday’s session. On Monday I will be presenting more about actually conducting the interview, what types of characteristics the interviewer should have, and also what types of interview questions to ask and for what purpose. So for those of you, who will be joining next week, go online and go to YouTube and watch some interviews. A couple of good examples are Matt Lauer interviewing Tom Cruise, Michael Moore interviewing Charlton Heston, and there are many others. Try to find some charged interviews if you can, some outspoken interviewers and interviewees and see what they’re doing. Are they getting the information? What kind of responses are they having? We’ll start next week talking about that a little bit.

Moderator:Thank you. And for anybody who hasn’t registered for that yet, simply go to cyber seminars catalog on the HSR&D website and sign up for that session next Monday. The next question is, “What’s the best way to code interviews?”

Dr. George Sayre:Unfortunately I cannot give an answer to that in this space. It would depend on the kind of research you’re doing. There are a variety of methods, so each one is going to have its own approach to coding. I think this is really the type of question that’s good for a class setting. I’m going to again defer on that one.

Moderator:When you want to elicit the meaning of something to the respondent, how do you phrase the question? Is it as simple as what does this mean to you?

Dr. George Sayre:I think that can be an okay question. I would prefer to use the language they’ve already used. So if they were describing a particular experience and said, “It’s like having a bad Monday,” you want to make sure you understand what they mean by that. I think a good way to go about it is to play off of it, “What does a bad Monday mean to you? Can you tell me more about bad Monday’s?” I think it’s very useful staying close to their language, but I also think that people respond to very straightforward questions like that.

Moderator:Okay. The next question, “Do you have advice for those doing their doctoral work in a qualitative study?”

Dr. George Sayre:Yeah, a couple of things I suppose. One would be to make sure that both your institution and your doctorate committee are comfortable with qualitative work. Every once in a while I’ve heard stories of where the committee will say, “Qualitative work is fine,” but then they’ll question why you don’t have a large sample size. Make sure that you have at least a few people in the department who are very good mentors is important. Lastly, make sure that you can take some coursework. We’re doing these workshops, but they’re just little introductions. If you’re going to do a dissertation, make sure you can within your department or outside of your department take at least one full course in qualitative methods. 

Moderator:Thank you. The next question is, “How does one explore context, power dynamics or structural factors, for example in developing competence in the dominant culture versus the participant’s culture?”

Dr. George Sayre:The first thing I’d say is not by asking about power dynamics or structural factors, because that won’t resonate. I think rich descriptions of actual practices with having people describe what happened in a meeting if that’s what you’re looking at. If you’re looking at power structures within the culture, you need to focus on as a part of the methods development instances of our life experiences that you think will capture that. I think having people reflect on abstract concepts doesn’t elicit very useful information, compared to asking people about particular experiences. It helps in our research of what are those points of contact? Tell me about the waiting room? Tell me about getting an appointment? I think that a part of the researcher’s job in designing the study is identifying experiences, situations, and contexts that are very clear and discernible like, “riding a bus.” The factors that you’re looking at will be salient, whether it’s power, inequity, or relationships.

Moderator:Thank you. The next question is, “How do you ensure that all the participants’ opinions are accounted for in group settings? Is it necessary?”

Dr. George Sayre:I’m assuming you’re talking about focus groups. I don’t know if you can totally ensure for that. Some people are more passive, and some people are more compliant. There are two things that you can do. One is to as a part of the focus group process to make sure you try to elicit people’s opinions. You ask questions like, “Does anyone else have anything to say? We haven’t heard from you. What do you think?” I think it’s good to give permission for a diversion of opinions where if there’s a lot of consensus around this to say, “Has anyone had any alternative experiences? Has anyone experienced something other than this?” Another way to do this, which is outside of the group setting, is to sometimes follow-up focus groups with individual interviews. People need to know that’s a part of the process ahead of time. We’re going to be doing some visits coming up this summer that way. So then they know we’re going to come and do focus groups and we’re also going to take a few people for individual interviews later. That way it doesn’t seem like you’re doing this in a reactive way. But then if you have someone who seems uncomfortable or who maybe voiced a diversion opinion and appeared to be shut down, I think you can arrange individual interviews later to do that. 

Moderator:Thank you for that reply. How can someone conducting an unstructured interview prepare for asking follow-up’s or even knowing what to make of respondents responses? It seems the interviewer needs to have knowledge of the underlying subject.

Dr. George Sayre:Yes and no. This is a tricky thing, because it’s a two-headed sword with knowledge about the subject. On the one hand, knowing about the subject allows you to ask informed follow-up questions. But on the other side of the coin is that having too much knowledge about the subject also makes you more leading. So you’re going to be quicker to collapse and close in on particular things, because you have more expectations. It’s hard not to have either conscious or unconscious hypotheses if you were very familiar with the subject matter. So I think that you do have to have a good understanding of the research question as to exactly what it is with the scope of the phenomena we’re trying to find out is about. But I would argue that you don’t always have to have a lot of knowledge about the particular subject. That’s also a hard thing to slice. We’re doing interviews with post traumatic stress disorder veterans, and we don’t have that experience. We have a lot of book experience. We may want to be interviewing women in these relationships, and I don’t know about that. So what you replace the knowledge with is curiosity. I do think you need to have intimate knowledge of the research question of, “What are we looking for here?” You also need the research background to that. 

Secondly you have to have a really good understanding of what kind of prompts you’re going to use so that you don’t have to guess. One of the hardest things for new interviewers is to stick with protocols in doing the follow-up questions. They’ll ask the question in the way that we framed it for the first interview. To follow-up they’ll start guessing at things. That’s where they’re more likely to have problematic interviewing techniques and questions. So I think it’s good to have a structured, “This is how we’ll follow up.” The other thing is that when it comes to understanding the meaning of something, we don’t always get that. So keep in mind that the interviewing is where we’re collecting data. We’re not trying to analyze it at that moment. If a person has a really rich interview, you’re always picking and choosing what you’re going to follow-up on. Even then you’ll lose some data, and they’ll always be things that you could have asked that you didn’t. That’s okay. We can’t guarantee that we ask every right question, but we do want to make sure that the information that we’re getting is grounded. Next week Dr. Szarka talks about interviewing qualities, and knowledgeable is one of them. Interviewers need to be knowledgeable. Material from Stein and Cabal’s speaks of knowledgeable about the research topic, the research project, and the interview itself. It’s not necessarily about the person’s experience. I think that we can do good research when we don’t know necessarily a lot about the material. Sometimes we’re interviewing people at the VA about how they do cath lab work or cardiograms. We certainly don’t know about how those work. 

Moderator:Thank you for that reply. Your audio seems to have gotten a lot quieter. Could you just project your voice as much as possible?

Dr. George Sayre:Is that better now?

Moderator:No, it’s actually quite quiet. Did something change?

Dr. George Sayre:Not that I know of.

Moderator:And you’re not on speaker phone?

Dr. George Sayre:No, I have a headset. Do you want me to try and pick up the handset?

Moderator:There we go with whatever just happened there.

Dr. George Sayre:Is that better?

Moderator:Yeah. The next question is, “Can you tell me your view on structured interview to semi-structured interview to open interview?

Dr. George Sayre:I’m not sure what is meant by “view” there. We covered the differences between them in the discussion. My main view is that you need to make sure that the kind of interview that you do matches the overall research question and agenda. But beyond that I don’t really have views about them. Maybe I’m not sure exactly what the question means. If they have something more in particular in mind they might want to send an e-mail. 

Moderator:Thank you. Can you explain narrative inquiry as a type of qualitative research method?

Dr. George Sayre:No, I’m not that familiar with it. I do know that it’s a method that’s primary used with text. It’s not so much collecting interview data, but with the use of preexisting text. You could do that with a patient’s medical records notes and letters. The exact of how they approach that is something that I’m not all that familiar with it. 

Moderator:Are there mentor flash consultants for this kind of work, especially harnessing the phenomenological approach?

Dr. George Sayre:Yes there are. I’m not sure you want a list of names. You’d want someone local probably, so I think it would depend on where you are in the area. Contact your affiliated universities. Usually there’s someone especially in a public health department or in nursing, maybe even in psychology. Social work or sociology may have someone too. In anthropology they usually have people who teach these courses, and those would be the people you would contact in your area.

Moderator:Thank you. Will you be providing examples of coding, writing, and publishing this kind of research in the next webinar?

Dr. George Sayre:I’m assuming you mean as a follow-up for next weekend. So no, this is all about interviewing.

Moderator:Thank you. Did I miss a beginning statement about taping a flash consent? How would meaning be disconcerted if using transcriptions? It seems very important. Do you have “live codes” that you use in the interview to denote meaning?

Dr. George Sayre:Yes, within the interview you should always have an awareness of getting consent. And you have to get a second consent if you’re recording. So it’s consent to participate and then, “Are you okay with recording?” As far as transcription, transcription is what happens after the interview is done, so you use the live recording. Then transcribing it is when you put it in verbatim text. We don’t call live codes coding because during interviewing your job is not to do analysis. While interviewing you will take notes and you can create what are called memos, where you may have questions about things. I do think as an interviewer it’s very difficult and probably not advisable to be trying to both understand meanings at a higher level and code things. Our job is to listen to the information, which then goes in for data analysis. The interviewer’s job at this point is not to be interpreting what’s being said. I like to when coding transcripts to be also listening to the audio at the same time so I can hear those other kinds of expressions.

Moderator:Thank you. Can you comment on the skill of “reframing” within a qualitative interview?

Dr. George Sayre:I have to confess I’m a family clinician too, and we have another meaning for that. I’m assuming it means putting a question another way. If you ask someone a particular question and they don’t seem to understand it or they respond in a way that shows they didn’t get what you meant, the first issue is that you may want to reconsider that question. And the challenge is how do you present it in another way without leading them. So there’s a challenge with qualitative interviewing about making clear to people what experience we want them to talk about without telling them what they should talk about, or leading them to describe it in a particular manner. If we were to ask people to tell us about riding the bus, “Can you tell me about your last bus ride?” That’s pretty unleading. But if you say, “Can you talk to me about other people bother you on the bus?” At that point they’ll probably rummage around in their memory and find some time in which someone bothered them. It may not be a very crucial point to them. It may not be much of their lived experience about being on buses in general. But if you are looking for that you can find it. So I think the challenge in the skill of reframing is to present a question. If they don’t understand it and you want to come back at it in another way, make sure you’re still presenting that in a fairly neutral way. If you reframe something two or three times and people still don’t understand it, you may be trying to look for an experience that they have not had. Maybe you’re trying to presume too much in the research. Have very simple questions and ones that aren’t too leading. We’re rewriting an interview for some ongoing research. One of the questions one of the interviewers wanted to use and it didn’t work very week is, “Do you feel comfortable in your own skin?” She knows what she’s trying to get at, but it’s a very idiomatic so a lot of people don’t know what she means by that. Also, it’s kind of assuming a particular way of experiencing things that that’s not the way that people look at things. So we dialed back to talking about a comfort level in certain situations. So stay neutral in reframing, and know when to quit.

Moderator:Thank you. This next question has several parts to it. How much time does it take to conduct a qualitative study for example in a semi-structured versus unstructured interviews, and a grounded theory versus content analysis?

Dr. George Sayre:It would totally depend on the nature of the study and how many interviews you’re doing. Are you doing multiple interviews? So maybe a year to five years. That’s not a very good answer. I will say when I’m writing budgets for these things, for interviewing if we’re doing a typical forty-minute to an hour interview, I always want to allow about four hours of time for the interviewer between scheduling and writing their notes. We figure for about every hour of data collected we have at least four. If you’re doing research that’s very open-ended or you’re doing research with populations that are very hard to get a hold of, you may have to call the people ten times, or there’s any kind of travel time that goes up from there, I usually assume at least four hours for every hour of interview. And then I usually assume that for every hour of interview data we’re looking at two hours of coding and an hour of analysis at least. Sometimes it can take up to eight hours to interview the first couple of months, but then it goes down as you get closer to saturation and you can do it much faster. But I think we average all together about three hours we’re spending on data analysis per hour of audio.

Moderator:Thank you. The second part of that question, “Is it difficult to get qualitative studies funded? Is there a difference between HSR&D and RR&D?”

Dr. George Sayre:I don’t know what RR&D is. HSR&D is Health Science Research & Development. It’s a part of the VA. I don’t think there’s any more difficulty with funding as long as it’s appropriate. I have the good fortune of working in a setting where I’m called on to develop qualitative research methods when that’s what’s necessary. I think that’s a little bit different than your qualitative researchers running around trying to find something to do qualitative research on. In the VA it’s much easier to get funding. Increasingly we’re seeing an awful lot of RFP’s coming out. They’re Request Proposals that are specifically requesting either mixed methods or qualitative methods. The office of Patient Centered Care is frequently asking for that. A lot of the evaluation centered stuff we do, there’s a specific explicit request for qualitative methods.

Moderator:Thank you. That is our final pending question. Do you have any concluding comments you’d like to give?

Dr. George Sayre:No. Thank you Molly, you’re always extremely helpful with this. I’m looking forward to hearing next week Dr. Szarka’s concluding parts on doing the actual practice of interviewing. And I’m looking forward to hearing from people next week too.

Moderator:I was very happy to help out, and we appreciate you lending your expertise to the field. I also want to thank our attendees for joining us. Please visit the VA cyber seminar catalog and sign up for next Monday’s session which is part two. That will be at 12:30 to 1:30 pm eastern. We look forward to seeing you there. Thanks again Dr. Sayre and we’ll talk to you next week.

Dr. George Sayre:Thank you and I look forward to it.

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