I developed a qualitative interview guide based on a previously published procedure (Mason, 2002). I present the qualitative interview index cards in appendix 29. The first step was to specify the two overarching research questions of my study. These questions were developed based on identified gaps in the literature as specified in chapter one. Once I had established my main research questions, I reduced these questions into smaller research questions that appeared to address different aspects of the main research questions. At this stage, I numbered the questions to link the small research questions with the larger questions that they were based on. I present the final version of the big and small research questions of this study in table 2.0
Table 2.0: Big and small research questions for qualitative design
Big research questions Small research questions
1. How do participants experience pressure in their mental health treatment?
1A. What contexts do participants experience as pressurised in their mental health treatment? 1B. How do participants conceptualise pressure? 1C. How do participants experience pressurised contexts?
1D. What features characterise contexts that participants experienced as pressurised? 1E. How do participants experience their
relationship with the people who are involved in the pressurised contexts?
1F. How do these experiences inform the participant’s service user identity?
2. How do participants conceptualise the ethics of the use of pressure on mental health service users?
2A. How do participants conceptualise the
necessity, benefit, harm and justice of pressure? 2B. Depending on their ethical position, how do participants think the use of pressure could be reduced, replaced, prevented and/or otherwise improved in clinical mental health practice?
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Table 2.0 refers to the final version of the big and small research questions. However, these questions were not finalised until after the first five interviews took place. While changing research questions during data collection in quantitative research is generally regarded as unscientific, it is common for qualitative researchers to change their research questions throughout the data collection process. For example, Schutt (2011) states:
“We emphasize placing an interpreter in the field to observe the workings of the case, one who records objectively what is happening but
simultaneously examines its meaning and redirects observation to refine or substantiate those meanings. Initial research questions may be
modified or even replaced in mid-study by the case researcher [...] If early questions are not working, if new issues become apparent, the design is changed.” (Schutt, 2011, p.322)
During the first five interviews, I became aware that some of the assumptions underpinning my original research questions were unhelpful as they restricted the research focus. Specifically, the original research questions inquired about “interactions” rather than “contexts” in which patients felt under pressure. After conducting the first five interviews, I formed the view that while patients did experience pressure during their interactions with others, this was only one possible way of framing the experience of pressure. Rather than imposing this particular emphasis on the experience of pressure as a feature of interactions with others, I modified my research questions to inquire about all and any contexts of pressure so that participants would be free to describe their experience of pressure in terms of contexts that made most sense to them. I believe this modification in research questions opened up the study to a much richer and more in depth exploration of how participants make sense of their lived experience in their own terms.
After I had generated a comprehensive list of large and small research
questions, I focused on how I could ask these questions to participants in a way that they would understand. For example, at this stage I decided to use the word “pressure” instead of “coercion” because I believed that the word
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“pressure” would be more accessible to patients than the word “coercion” based on my experience of interviewing a similar population in previous research projects. This decision was partially influenced by similar decisions of previous researchers. For example, Gardner et al. (1993b) found that patients were not familiar with the word “coercion” during the development of the MacArthur Perceived Coercion Scale. Likewise, in a qualitative study on the topic of leverage in community mental health services Canvin et al. (2013) reported:
“We did not use the somewhat abstract term ‘leverage’ in our interviews with participants: the notion of leverage was operationalised by making reference to experiences of ‘pressure.’” (Canvin et al., 2013, p. 101)
This iterative process continued to a lesser extent throughout the data collection period as I reflected on the interviews and identified questions that appeared to be more accessible to patients. For example, I learned through reflective
practice that asking the question “Based on these experiences, how could the service be tailored to better meet your needs?” appeared to be more accessible and generate richer responses than the question “How do you think the use of pressure could be improved in mental health services?”. The next stage involved cross-referencing all of the interview questions, small research questions and large research questions. This ensured consistency across all three levels and helped to refine the interview questions further. The final stage involved producing individual index cards for each small research question and for the introductory remarks. I developed a set of index cards rather than a script of questions to allow for maximum flexibility and spontaneity within the interview. The index cards allowed me to switch dynamically between topics based on what the participant said during the interview. In addition, the index cards complimented the loose, semi-structured nature of the interview. This supported the participant to shape and guide the interview based on their personal experience of pressure throughout their mental health treatment, which I could not anticipate in advance.
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2.21.2 Audio recording
I used an Olympus digital voice recorder VN-8500PC to record interviews. I also used a Samsung Galaxy SG3 smart phone as a precautionary back up
recording device in case the digital recorder failed.
2.21.3 Data processing
I transferred all recordings from the audio recording device to the research computer. I transcribed recordings by playing the recordings at a reduced speed and typing the conversation into Microsoft word. I transcribed the conversation in terms of conventional sentence structures to optimise the accessibility of the transcripts for analysis. I also created a database that contained the
participant’s anonymised ID and the date on which the interview occurred. I was able to cross reference this information with the raw file of each recording
because the date that the recording was created was recorded automatically in the meta-data of each audio file. I used this cross checking process frequently throughout the transcription process to ensure that all transcripts corresponded with the correct date and participant. I also verified the integrity of the data by manually listening to all recordings and ensuring that they accurately
represented all the transcriptions after I finished transcribing all interviews. I ensured the anonymity of participants in the results section of this thesis by assigning individual codes to all participants and redacting any identifying information such as names and places. As part of the ethics application it was necessary to develop specific protocols for data management and security. Accordingly, the research ethics committee approved the following protocols:
The Research Computer - The audio files, written notes and transcripts will only be stored on an encrypted computer.
Storage of Audio Files - The audio files will be transferred to the research computer immediately after the interview. After the transfer is complete the audio file will be deleted from the audio recording device.
Storage of Written Notes - The written notes will be typed into an MS Word document on the research computer immediately after the
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interview. After the notes have been typed into an MS Word, the written notes will be destroyed by shredding.
Storage of Transcripts - The transcripts generated from each interview will be created and stored on the research computer.
Identity of Participant on Computer Files - The name of the participant will not be stored with the audio files, written notes or transcripts. A numerical code will be assigned to each participant.
Analysis - Analysis of the audio files will consist of transcription (i.e. converting the spoken words during the interview into text) and thematic analysis using computer software. The written notes will be included in the thematic analysis using computer software. Numerical codes will be used to distinguish the participants throughout the analysis process.
Destruction - The data will be stored on the computer in accordance with the Data Protection Act and it will be deleted from the computer after the specified time.