van Rijssen et al. BMC Public Health 2010, 10:666 http://www.biomedcentral.com/1471-2458/10/666 a consensus meeting was held. If there were any differ- ences of opinion, the original data were reconsidered until consensus about codes and relationships was estab- lished. The data-collection and analysis continued until saturation of information was established, e.g. the tran- scripts of the meetings provided no new information. Three focus group meetings were enough to achieve saturation. Results Participants A total of 22 social insurance physicians participated in the three focus group meetings. The focus groups con- sisted of eight, six, and eight physicians, respectively. Their mean age was 47 years and 9 months (SD = 7 years and 8 months), on average they had been working as a social insurance physician for 14 years and 2 months (SD = 6 years and 2 months), 14 were male and 8 were female. All the participants currently held medi- cal disability assessment interviews, which was a prere- quisite for participation. Only one group reacted to the content of the sum- mary provided for them to check. In their comments they stressed the importance of certain issues and opi- nions, and asked for some remarks to be clarified. Their comments were taken into account in the results. The content of stereotypes After generalizing the responses of the physicians to a still higher level of abstraction (deduction to fewer cate- gories), two dimensions on which physicians classify claimants finally remained. Firstly, a dimension concern- ing the physician-claimant relationship was identified from the combined responses of the physicians. The physicians indicated that they consider the communica- tion of the claimants to be pleasant if they provide clear information, keep a low profile (i.e. do not argue with the physician, show no hostile behaviour), and the assessment takes very little time. This indicates a rela- tionship of respect and acceptance between the physi- cian and the claimant. “Open claimants, people without a hidden agenda - who say I feel this, I can or can’t do that - with that person you think ‘this is true’, you don’t have to ask yourself: is this correct, is this consistent or not? People like that.” (male, 50 years old, social insur- ance physician for 17 years) Respecting, accepting claimant behaviour is on the one end of the relationship dimension. On the other end, there are claimants who show a lack of respect for the physician and do not accept the physician’s role and position. Secondly, a dimension concerning the Page 4 of 13 claimant’s influence on the interview was identified. This dimension comprises of dominating and control- ling claimant behaviour in the communication during the assessment interview on the one end, and obedient and compliant behaviour on the other end. Examining these two dimensions, we found that the content of the dimensions bared resemblance to the content of the two orthogonal axes of the interpersonal circumplex (a model for conceptualising and assessing interpersonal behaviour, also known as the Leary circle), because the one dimension concerned solidarity, friend- liness, and warmth, and the other dimension concerned status, power, and control. In the literature, different authors name the dimensions on these two axes differ- ently [20-22]. We chose the naming that most closely resembled our findings and is the most appropriate in the context of disability assessments. Thus, we described the dimension on the horizontal axis of our circumplex as running from critical to respecting/accepting and the dimension on the vertical axis as running from dominat- ing to submissive. Next, we placed our findings within the circumplex, resulting in a communication behaviour typology of eight octants that best matches the physician responses. The two dimensions in the interpersonal circumplex and the typology were fine-tuned and validated by look- ing (again) at the findings of the individual focus group meetings (following the repetitive process of analysis according to the grounded theory and principle of con- stant comparison). The typology is presented in Figure 1, and more details are provided in Table 2. On the ‘mutual respect and acceptance’ side of the rela- tionship dimension (the half on the right side of the circle in Figure 1), four claimant characteristics are located: actively coping with disabilities, motivated behaviour during the interview, a clear physical diagnosis ("When it’s a piece of cake, the physical complaint is just a knee complaint, without much mental fuzz. However, you always have to be open minded because it could be more than just a physical complaint, just a painful knee”), and anxiousness. The physicians also stated that the majority of the claimants they meet are ‘common’ claimants with no ‘striking’ characteristics and with ‘average’ behaviour, and that they usually establish a relationship of respect and acceptance with such claimants. The opposite side of the relationship dimension (i.e. a relationship based on other things than respect and acceptance) contains opposite characteristics: passively coping with disabilities, unmotivated behaviour during the interview, and a mental or unclear diagnosis. Com- munication problems (e.g. hearing problems, intellectual disabilities) can also be found there. On the dimension of the claimant’s influence on the interview, these char- acteristics are all on the more ‘submissive’ side (the