INTERVIEWING FOR QUALITATIVE RESEARCH Qualitative Methods for Global

INTERVIEWING FOR QUALITATIVE RESEARCH Qualitative Methods for Global Health Research (GH 701. 0) October 19, 2016 Hannah Gilbert

Where We Are in the Course Trajectory Conceptualization Design • Develop A Research Idea Through A Concept Sheet • Types of qualitative design • Sampling • Combining qualitative & quantitative methods • Rigor in qualitative research • Focus groups Data Collection • Interviewing techniques • Designing an interview guide

What is a Qualitative Interview? • Guided conversation between two individuals • Face-to-face, phone, Skype, etc. – Interviewer and respondent • Yields narrative data • Words, not numbers

Why do we do interviews in qualitative research? To understand a research topic from the points of view of persons with direct experience To elicit firsthand accounts of events and experiences

Advantages of Qualitative Interviews • Technique for collecting detailed, in-depth data • Sensitive topics • An inductive approach: starting with the individual • Flexible

Types of Qualitative Interviews Medicine & Public Health Semi-structured: “Minimally”structured “Unstructured” But there is structure in all interviews Questions are standardized, answers are unspecified Interview topics are standardized, questions (and answers) are unspecified Only the general topic of the interview is specified

The Interview Respondent Is… • The “expert” on the subject • A partner in helping us better understand the topic

The Interviewer Is… • The learner • Knowledgeable about the topic but not an expert on the respondent’s situation • “Naïve, ” humble, but CURIOUS!

Building Rapport What is rapport? • Interpersonal connection, positive feelings between interviewer and respondent • Initial impressions are important • Be non-judgmental, interested, respectful, genuine – friendly • Rapport reduces social distance

What Are the Responsibilities of the Interviewer? • Lead the conversation, maintain the focus • Introduce questions using an interview or topic “guide” • “Probe” for greater depth • Evaluate unfolding discussion (for data quality)

Interview Guides • Introduce topics to be explored based on study objectives • Ensure the interaction is focused • Same topics for variety of informants • Allows systematic discussion of multiple topics • …Yet flexible • Not all questions specified in advance • Follow up on concepts of individual importance

How Do We Know We Are Getting Good Data? Specific and Concrete: Especially, Stories

Example: Lack of Specificity I: How do you feel about the requirement of treatment supporters? “Treatment supporters are very good. ”

Example: Specificity & Concreteness I: Could you tell me how you feel about this treatment supporter requirement? “So if someone is weak and s/he has no treatment supporter, it will be a bit difficult for this person to continue with the drugs especially when these complications appear; the forgetfulness, some develop anemia and some develop some swellings. So if the client is alone at home, these complications might kill him/her. So that’s why they say when you have a treatment supporter who is observing all these it is good especially for one who is unstable and can not inform the clinic of these him or herself. For example we had a client who was lost to follow when she went back home and her children read on her tin of drugs and they saw the instructions that said, “do not drink”. So they did not understand what it meant and they told the mother that it says, “do not take the drugs” so immediately she stopped. So because the treatment supporter was on hand, he came and informed the clinic that his client had stopped the drugs because her children had read what was on the label that, “do not drink” but he could not afford to bring the client to the clinic because he was from far. But because the treatment supporter was nearby, he could keep on helping with money and other essentials though she was not taking the drugs. ” Stories: The most specific data

The quality of the data depends on the quality of the interview guide and on the skills of the interviewer…

Interviewing & Interview Guides An interview guide is not a substitute for “mindful” interviewing. The interviewer must listen actively …and THINK!

Active Listening • Careful listening needed for mindful interviewing • Probing • Keeping track of what has been answered, where gaps are • Make the respondent feel “heard” • What are good listening skills? • Don’t talk too much • Be interested, pay attention • “Follow the thread”

Being Neutral • Be open-minded, non-judgmental • Avoid assumptions • There are no “right” or “wrong” answers • React neutrally – tone of voice and in body language

Interviewing for Research vs. Interviewing for Intervention • Clinical Interviewing Make an intervention, Take action • Research Interviewing Understand the respondent’s experience relevant to the research topic

QUALITATIVE INTERVIEWING TECHNIQUES

Qualitative Interview Techniques • Use open-ended questions • Avoid leading questions • Probes • “Directing” the conversation

Open-ended Questions … Avoid suggesting answers or limiting the scope of possible answers • permit free, spontaneous responses • allow for in-depth information, stories • define the territory to be explored while allowing the participant to take any direction

Open-ended Questions Open-ended questions are used in qualitative research because they… • permit free, spontaneous responses • allow for in-depth information, stories • define the territory to be explored while allowing the participant to take any direction

Open-ended Questions • Allow for probing into topics of interest • Can gain new insights – issues not previously considered • Participant’s own words

Close-ended Questions • Close-ended questions define or limit responses. • Yes/ No responses • Multiple choice • Leading

Closed vs. Open-Ended Closed • Do you have a good relationship with your supervisor? • Is your doctor a good listener or a bad listener? • Are you interested in a career in research? Open • Tell me about your relationship with your supervisor. • Tell me about how your doctor listens to you. • What are your career interests?

Leading Questions What is a leading question? • Contains an assumption • Suggests an answer

Sample Leading Questions You don’t seem to care about being punctual for clinic appointments, do you? Assumption: Doesn’t Care Were you at the library over the weekend? Suggests answer: Was at the library How well do you get along with your housemates? Contains assumption Suggests answer

Leading Questions Re-Phrased • You don’t seem to care about being punctual for clinic appointments, do you? • Were you at the library over the weekend? • How well do you get along with your housemates? • How do you feel when you are late for a clinic appointment? • Where were you over the weekend? • Tell me about your living situation.

Directing the Conversation • Interview guide creates an overall structure, but you can never anticipate how each conversation will evolve • • Interviewer’s responsibility to direct the conversation “Mindful Interviewing” - are you learning what you want to know? • Don’t be a slave to the interview guide: follow curiosity, trust your instincts

Strategies for Directing the Conversation • When respondent is “off” track… • “That’s an interesting point. How are you linking it to… ____? ” • It is ok to interrupt …. but be polite, diplomatic • When answers are vague • Use probes to follow-up • Clarify what you do not understand

Strategies for Directing the Conversation • “Circle back” to topics of interest • When the discussion stops or slows down • Pauses or silence are ok • Refer to what respondent has said earlier • When topic is exhausted, transition to the next but first ask if there is anything else they want to add.

Types of Interview Questions Probes

Questions • Pre-designated questions prepared in advance • Posed to every respondent • Translate the research question into questions that can be answered

Probes • Techniques to add detail on primary questions without influencing the response • Encourages respondents to talk more • Yield more detail, obtain new information without changing focus • Keep respondents “on topic”

Sample Probes • Silent Probe • “Uh-huh” Probe • Echo Probe • Suggested Probes • “Would you tell me more about that…? ” • “How so? In what ways? • “How do you mean? ” • “What was that like for you? ” • “How is that different from…? ” • “Anything else? ”

When to Probe… • Answer is unclear or incomplete – further clarification or detail needed • The response feels “superficial”, not enough depth or detail • The respondent hasn’t answered the question

Initial response I: I would like you to tell me what happened on that day you were circumcised. R: When I accepted to be circumcised, the [NGO] Counselor gave me a form which he told me to take to [clinic] that it’s where I would be circumcised from. I kept the form for this time because by then I was working in town. When I came back this side, I went there.

Second response - with probe I would like you to explain properly what happened on that exact day you went for circumcision. I: R: I left home with my brother on a motorcycle, we came to [clinic], for him he was already circumcised. He took me to the counselor at the Health Center because he knew him. He asked my brother if he had already recovered and my brother said yes. He had told him the previous day that he would take me to the Health Center for circumcision. The counselor took me to the Doctor and he asked me why I wanted to circumcise, I told him that I wanted to do it to prevent myself against STDs and HIV. He asked me whether I was married, I told him that I had just married, he asked me if we were first tested for HIV before marriage and I told him that we are both safe. After, he took me to a room and he worked on me.

Common Interviewing Pitfalls Making assumptions & Asking Closed Questions Accepting answers at face value Following interview guide too closely Not probing enough Results in superficial, “surface-level” data

Solving Common Problems 1. Reluctant respondent 2. “Wandering” respondent (strays from topic) 3. Vague respondent 4. When answers don’t feel authentic (social desirability) 5. Respondent experiences strong emotions 6. Respondent requests help and/or advice

1. The Reluctant Respondent • Encouraging someone who seems reluctant to speak freely • Put yourself in their shoes “I understand a lot of people have a hard time …” • Remind of confidentiality • Hypothetical questions

2. The Wandering Respondent • Someone who frequently strays from the topic • Use effective body language – i. e. , stop eye contact • Interrupt diplomatically • Try changing the topic --“Thank you for sharing these ideas, now I’d like to move on to …? ”

3. The Vague Respondent • Someone who speaks only in general terms • Respondent may not understand the question or the research topic well enough • Re-phrase question – different way of asking the same question • Probe

4. Lack of Authenticity • When it feels like the respondent may be telling you what he/she thinks you want to hear (social desirability bias) • Remind respondent there are no “right” or “wrong” answers, no negative consequences • Express your desire to understand “real” experience • Pose hypothetical questions

5. Respondent Experiences Strong Emotions • When a respondent experiences strong emotions your options are: • Allow respondent time to experience and control emotions • Ask the respondent whether s/he wishes to continue • Make the decision to stop the interview • Refer interviewee to appropriate resources

6. Requests for Help • When the respondent asks you for help or advice with their problem • Be clear about your role – researcher, not helping professional (even though you may be a health professional) • Refer respondent to appropriate source of help

Interviewing Logistics • Setting • Audio-recording • Note taking

Choosing The Interview Setting • Location is important: impacts data quality • Comfortable and relaxing – i. e. , a place where people are able to speak freely about topic under • • study Accessible… not too far or difficult to get to Private (confidentiality) Quiet and safe environment Participant’s choice

Interviews can be field-based…

Or in a clinic or offices…

Recording Your Data • Data analysis depends on capturing exactly what the respondent says • Audio-recordings (verbal) and notes (written) from the interviewer

Using a Translator • Translators do the following • Provide literal translation (no edit or summary) • Keep key terms in local language • Must understand the purpose of research • Interviewer speaks directly to informant • Interviewer keeps eye contact with informant • Interviewer/Translator completes raw note after interview

Audio-recording • Ensures accuracy in data collection and completeness of data • Not required for participation • Concerns about recordings • Audio-recordings are confidential

Tips for Audio-recording • Quiet setting • Place the microphone near the respondent • Speak clearly, slowly • Test your equipment (bring extra batteries)

Note-taking • Possible equipment failure • Useful in formulating follow up questions • Keeping “track” of ideas and questions • Capture description of contextual details • Strong reactions to questions, body language, reluctance to answer • Shows interest to respondent (what they say is “noteworthy”)

What Have We Covered? • Principles of qualitative interviewing • Techniques of qualitative interviewing • Common problems in interviewing and how to solve them • Logistics

NEXT Practice Interviewing Skills

DESIGNING INTERVIEW GUIDES FOR SEMI-STRUCTURED INTERVIEWS

The Goals include • A second interviewing practice opportunity • Presentation on interview guide development • Group Work: Practice interview guide development • Introduce Assignment

Practice exercise • 20 minutes to interview partner from last week • 5 minutes to debrief in ‘interview pairs’ • Report-out • General questions

In-class practice • Minimally-structured interview • No set interview questions • Rely on pre-designated topics • Skill Development: Practice spontaneous generation of questions

Types of Qualitative Interviews Semi-structured: “Minimally”structured “Unstructured” • But there is structure in all interviews Questions are standardized, answers are unspecified Interview topics are standardized, questions/answers unspecified Only the “purpose” (general topic) of the interview is specified

Role of interviewer • Pose open-ended questions • Practice follow-up questions • Practice probes • Demonstrate interest and neutrality

Practice Topic: Experiences of first-year students in GHD and Med. Ed programs • Their learning priorities while in the program (what matters to them) • Everyday experience of program thus far • Key people who feature in program experience • Their assessment of the quality of the program

Class Debrief Discussion • What did the interviewer do well (comportment, body language, probes, eliciting stories? ) • What could have been improved? In what ways? • What questions worked well? • What questions were difficult to ask/answer? • How would you contrast the experience of a semi-structured (last week) versus minimally structured (this week) interview?

Development of a Interview Guide • Structure and components • Translating topics into questions • Case example • Tips and suggestions

Types of Qualitative Interviews Semi-structured: “Minimally”structured “Unstructured” • But there is structure in all interviews Questions are specified, answers are not Interview topics are standardized, questions (and answers) are unspecified Only the “purpose” (general topic) of the interview is specified

Semi-Structured Interview Guides • Introduce topics to be examined • Ensure the interaction is focused • Same topics for variety of informants • Allows systematic discussion of multiple topics • …Yet flexible • Not all questions need be specified in advance • Follow up on concepts of individual importance

Research Questions and Interview Questions RESEARCH QUESTION INTERVIEW QUESTION Research question must be translated into specific interview questions

Ndayizigiye Research Question on Contraceptive Uptake in Burundi What are the barriers to modern contraceptive use among women in rural Burundi? Qualitative research aim: “To identify and describe possible social, psychological, economic, and political barriers to contraceptive uptake in the two study districts”

Research question must be operationalized – translated into interview questions that are relevant, and. . ANSWERABLE

Answerable questions are… • Relevant to the respondent’s knowledge and/or experience • Made up of simple words (used in conversation) • Concrete and specific • Contain one idea (not double-barreled) • Short

The Interview Guide Design Pyramid TRANSLATION Research PROCESS Question Interview Topics Interview Questions General Specific

How to Start? • Research Question to Topics • What kinds of topics are there? 1. Experience and behavior 2. Opinion and Values 3. Feelings 4. Knowledge 5. Personal History/Characteristics Questions

Topics to Interview Questions: Examples of Questions about Experiences of Contraceptive Uptake • What contraceptive methods have you used? (elicit complete list) • What method did you use most recently? • What was good about this method? • What problems did you have about this method? • Tell me a story about a time you felt a contraceptive did or did not work for you. • Of the methods you have used, which did you like best? Why did you like this method best? • Why have you not used contraception?

Topics to Interview Questions: Examples of Questions about Knowledge of Contraceptives • What is the purpose of contraceptives? • What methods of contraceptive have you heard of? (elicit complete list) • Let’s take [XXX], how does that method work? • What about [YYY], how does that method work?

Topics to Interview Questions: Examples of Questions about Feelings about Contraceptives • How do women around here feel about contraceptives? Why do you think they feel that way? • How do you feel? Why? • How does your husband feel about your using contraceptives? • How do men around here feel about women using contraceptives?

Adding Probes Research Question Interview Topics Interview Questions PROBES

Probes • Techniques to add detail on primary questions without influencing the response • Encourage respondents to talk more • Yield more detail, obtain new information without changing focus • Keep respondents “on topic”

Generic Probes • Silent Probe • “Uh-huh” Probe • Echo Probe • Suggested Probes • “Would you tell me more about that…? ” • “How so? In what ways? • “How do you mean? ” • “What was that like for you? ” • “How is that different from…? ” • “Anything else? ”

Adding Probes to Interview Questions • What is the purpose of contraceptives? (R: “To prevent babies from being born…”) • “Tell me more about that…” Generic Probe • How do you feel about using contraceptives? (R: “Afraid. ”) • “What do you mean, ‘afraid’”? • “Why do you feel afraid? ” Individualized Probe • What contraceptive methods have you used? • (elicit complete list) Also a Probe

The Interview “Arc” “Warm-up” Core Questions (“Essential”) “Wrapup”

Structure of the Interview Guide Structure Follows the… “Interview Arc”

Structure of the Interview Guide • Introduction …. Comes before warm -up • Thank the respondent for willingness to interview • Tell the respondent your name • BRIEF statement of the purpose of the research • State that the interview will be confidential (and tell the respondent what that means) • Give the respondent an opportunity to ask a question before the interview begins

Obtaining Informed Consent • Often happens at the interview session before the interview begins • Separate from the interview itself • Review major elements of consent with the respondent • Try to ensure the respondent feels free to decline as well as accept • Time for questions

Structure of the Interview Guide • Warm-up questions • Get the respondent comfortable talking • Establish the territory to be explored • Build rapport Tip: Don’t put your most important or most challenging questions in the Introduction!

Structure of the Interview Guide • Core questions • Most closely related to the research question • Most important to the research • Placed after the respondent is “warmed up” but before s/he is tired • From general to more specific • More sensitive questions come later in the core sequence • Include probes!

Structure of the Interview Guide • Wrap-up … --Signals to the respondent the interview is winding down --Examples: -Is there anything else I should know to understand [XXXX] well? -Do you have any questions about the interview? • Includes an indication of next steps

Overall Order of Activities • Introduction • Consent • Interview Process -Warm-up questions --Probes -Core questions --Probes -Wrap-up questions

Evaluate the First Draft • Ask yourself: • What am I trying to find out with this question? • Will this question get me that kind of data? • Does this help me to answer my research question? • What will it feel like to ask this question? • What would it be like to respond to this question? • Is this question meaningful for my intended interviewee? • Is this really important? (“need to know” or “nice to know”)

Pilot Testing • Always pilot test interview guides before data collection and make necessary revisions • Are the questions/ topics clearly understood by respondents? • Do the questions yield the kind of data you intended? • Are there issues with translation or meanings of words? TIP Have Someone Interview You Using Your Interview Guide

Using the Interview Guide • Don’t let the interview guide rule you! • Allow for evolving discussion on topics and personally relevant themes • Feel free to pose different questions • Not necessary to follow the order of questions or use all probes • Mindful interviewing • Active listening

PRACTICE EXERCISE Research Question: What are the Study Habits of Harvard Graduate Students?

What are the Study Habits of Harvard Graduate Students? INCLUDE • Experience/behavior • Knowledge • Opinions/Values • Feelings DECIDE Which topics must be covered for you to best answer the research question

TOPICS • Attitudes toward studying • Time spent on daily reading • Useful tricks and techniques • Knowledge of study styles • Study/life balance INTERVIEW QUESTIONS • How do you feel about studying? • Walk me through your study schedule.

Assignment: Design an Interview Guide Using your research questions/ concept sheets, draft a semi-structured interview guide. The guide should be about 1 to 1 ½ pages long, with approximately 7 main interview questions, and possible follow up questions/ probes. Your guides should include: Brief introduction/welcome Introductory questions Main, topic-focused questions Possible follow up questions and probes (open-ended) Closing questions An example interview is provided here (provide one from the TB project)