Data Collection

5.5.5.1 Structured telephone interviews

Telephone interviews are suitable for obtaining factual, straightforward information such as nursing students’ education, training and assessment of aseptic technique. Telephone interviews were considered to be the most cost effective and efficient

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way to survey HEIs that are geographically spread than face to face interviews (De Vaus 2002; Bowling 2009). Telephone interviews are considered to be just as effective as face to face interviews in national surveys using structured interviews (Midanik and Greenfield 2003). Telephone interviews allowed for a rapport to be developed and two-way communication between the researcher and programme manager/HEI staff member. Better quality responses and more meaningful data can be produced from telephone interviews compared to a web based survey or postal questionnaire, as non-response and data entry or response errors are less likely and questions can be clarified (De Vaus 2002; Bryman 2016).

5.5.5.2 Use of a structured interview schedule

Structured telephone interviews were conducted using a structured interview

schedule (see Appendix 4). Structured interviews are appropriate for use in a survey intending to measure variables in a large population (Bryman 2016). The use of a structured interview schedule ensured a standardised approach, with the same questions being asked of each HEI in the same way and order (Oppenheim 2005; Bowling 2009; Maltby et al. 2010). This was important as up to this point no comprehensive picture of when, what and how aseptic technique was taught and assessed had been undertaken. The interviewer/researcher operated within the confines of ‘stimulus equivalence’ by not manipulating questions, the order of questions or emphasising particular aspects so that every participant understood the questions in the same way, thus limiting interviewer bias (Oppenheim 2005). This was considered to be important in terms of reliability and making comparisons in data across HEIs. Structured interviews are less flexible and lead to less in-depth data being gathered (Oppenheim 2005; Bowling 2009). The emphasis was upon breadth rather than depth of data within the survey of aseptic technique education in pre-registration programmes. In-depth data would come from phase two of the study.

The structured interview schedule (see Appendix 4) was designed to ask standardised closed questions with pre-coded fixed response answers (Bowling 2009). An interview schedule differs to that of an interview guide which identifies broad areas for discussion rather than specific questions (Maltby et al. 2010). During the development of the interview schedule the mode of telephone

interviewing was taken into account. This took cognisance of the number of fixed response answers to questions to avoid issues of recall and retention by

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(De Vaus 2002; Oppenheim 2005). The interview schedule was constructed with a navigable layout and clear instructions to assist the researcher to conduct the telephone interviews with ease and code responses at the same time (De Vaus 2002; Oppenheim 2005). The interview questions were developed to answer research questions 1-4. Background information was collected about each undergraduate, pre-registration adult nursing programme. Both research supervisors had experience in quantitative research and survey construction

(Camerino et al. 2006; Hasselhorn et al. 2006; Stordeur et al. 2007; Courtenay et al. 2017).

5.5.5.3 The expert panel

Face and content validity of the structured interview schedule were obtained by the use of an expert panel consisting of nine individuals. There were four lecturers, a clinical teacher, a skills tutor, a researcher and two infection prevention and control experts involved in the development, testing and review of questions in the

structured interview schedule (Oppenheim 2005; Bowling 2009). These individuals were selected based on their expertise in nurse education, clinical skills

development or infection prevention and control. Seven panel members were selected by the researcher and one panel member was the researcher’s supervisor. There was one external and independent panel member, who was an infection prevention and control expert from another HEI. The independent panel member was recommended by the researcher’s supervisor and approached by the researcher.

The lecturers, skills tutor and clinical teacher all had experience of teaching aseptic technique and supporting students in clinical practice. Two lecturers also had experience as programme managers for the undergraduate pre-registration programme. This was seen as advantageous as they would have greater insight into whether a programme manager would have any difficulties answering the questions. This allowed the questions to be tested and reviewed by individuals who were similar to the target audience. The structured interview schedule was piloted in three phases by the researcher.

5.5.5.4 Internal Pilot - Phase one

In the first phase, six members of the expert panel reviewed the content, wording, interpretation and understanding of questions and appropriateness of responses to questions (De Vaus 2002; Oppenheim 2005). The structured interview schedule

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was emailed to these panel members for comment. Respondents were asked to comment on the appropriateness of the questions from a UK perspective, the phrasing and sequencing of questions and the available response categories. All questions were evaluated for response variation, meaning, redundancy and non- response (De Vaus 2002).

Some minor changes were made to the wording and labelling of questions to improve clarity. One question about the ANTT assessment of qualified staff was omitted as this was difficult for HEI staff to answer. Feedback from three members of the expert panel identified that participants would require some pre-warning of the interview questions in order to access and prepare the relevant information to be able to answer some questions. In response to this, pre-interview information was developed which included some sample interview questions to be sent out prior to interviews. Following final approval by the expert panel, pilot work was undertaken to robustly test the survey questions, interview schedule and telephone interview process (Oppenheim 2005).

5.5.5.5 Internal Pilot - Phase two

The second phase of the pilot, pre-tested the interview schedule and interview process (van Teijlingen and Hundley 2001; Lancaster et al. 2004). This could not have been achieved by the use of an expert panel alone (Oppenheim 2005). An internal pilot study was conducted in the researcher’s own HEI. Pilot telephone interviews were conducted with two HEI staff. They were both programme managers for the undergraduate, pre-registration, adult nursing programme. The telephone interviews were conducted using the structured interview schedule as they would in the main study. The internal pilot had the purpose of identifying any potential issues or problems (Bryman 2008). This included checking the layout, sequencing of questions and routing instructions within the interview schedule (Oppenheim 2005). Filter questions were tested to make sure they worked and did not skip questions erroneously. The range of responses to answers was checked to ensure that they were exhaustive and pre-coded. The flow, timing, and respondent interest during the pilot telephone interviews was also monitored (De Vaus 2002). Scrupulous care was taken to refine the survey tool and procedures based on the feedback from the internal pilot. In one pilot interview, the participant could not answer some questions as they were not directly involved in the teaching of aseptic technique. This highlighted that HEI staff who were involved in teaching aseptic

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technique were better placed to respond to the survey. The same participant asked for greater guidance upon what information was needed in the survey. However, they admitted to only briefly reading the participant sheet and pre-interview information where this guidance was given. No changes were made to the pre- interview information or the participant information sheet in response. An email prompt, ahead of interviews to remind participants to access the relevant

information was identified as a solution to be tested in the external pilot interviews. A follow-up email or phone call to retrieve any missing information during the

telephone interview was another strategy added following the internal pilot to ensure completeness of data. This would only occur in the event of missing data and with the agreement of the participant at the end of the telephone interview. The duration of internal pilot interviews was recorded and was approximately 20-30 minutes. This was congruent with the approximate duration of the telephone interviews stated in the phase one participant information sheet. A final check of the layout of the structured interview schedule was made in readiness for the external pilot.

5.5.5.6 External Pilot - Phase three

Two pilot sites were chosen from the small finite population of HEIs (n=72) that run NMC approved pre-registration adult nursing programmes in the UK. Only two HEI sites were chosen for the external pilot in the event of needing to exclude these from the main study. The structured interview schedule was piloted with two HEI lecturers involved in the delivery of infection prevention and control teaching in the pre-registration undergraduate adult nursing programme. Testing data collection instruments and questionnaires to make sure that questions are comprehensive and well understood is a key objective of an external pilot study (Lancaster et al. 2004). The duration of the external pilot telephone interviews was 25-30 minutes which was in accordance with the duration of internal pilot interviews. Feedback from the external pilot interviews suggested that the questions were comprehensive and logical in sequence. The two interviewees pre-empted the questions probably as a result of receiving pre-interview information. The interviewer managed this by going with the natural flow of dialogue and re-capping on information previously provided. This was also necessary for the interviewer to keep up with documenting the responses. As a result, one of the interviewees thought that there was some

repetition. Both interviewees agreed that the pre-interview information was essential in preparing them for the interview and preventing information being lost from the

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study. The interview allowed good opportunity for dialogue about aseptic technique education. This was highlighted in one interview where the interviewee voiced that aseptic technique had been lost from the curriculum and was no longer a core skill that was didactically taught or demonstrated.

One interviewee expressed difficulty gaining access to lesson plans due to individuals having ownership rights and module materials being placed in virtual learning environments such as Blackboard. They considered that retrieving and forwarding lesson plans, learning materials and module documents would place too great a burden on respondents. The researcher did not want to make any

assumptions about how HEIs organise themselves and their preparedness to share learning and teaching materials as this might vary. The pre-interview information therefore still encouraged respondents to access and forward module documents, lesson plans and learning and teaching materials to enhance the quality of data. No major modifications were made to the structured interview schedule or interview process following the external pilot study to prevent data from the pilot sites being included in the main study. Data from a pilot study should not usually be included in the main study or analysis of data to avoid the risk of contamination (van Teijlingen and Hundley 2001; Oppenheim 2005). The risk of contamination was not a concern in this study as participants in the external pilot were not exposed to an intervention, only the interview questions. Completeness of the dataset was considered very important.

5.5.5.7 Conduct of the telephone interviews

Telephone interviews were conducted with the programme manager or nominated staff member from each participating HEI. Only participants in HEIs who agreed to take part were contacted and interviewed by telephone (De Vaus 2002). Pre- arranging the date and time of interviews ensured that participants made

themselves available to complete the telephone interview, limiting the effect of non- response that might occur in general population surveys (De Vaus 2002). Although time had been set aside there was no guarantee that participants were free from work distractions and fully focused upon the interview taking place. This was a limitation of using telephone interviews in comparison to face to face interviews (Jackle et al. 2006). Not being able to pick up on non-verbal cues during telephone interviews was not seen as a major disadvantage as the survey was designed to elicit factual information rather than personal and sensitive information from

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participants (Bryman 2016). The influence of the interviewer and researcher, being an academic from another university upon the interviews cannot be overlooked. Participants may have felt compelled to provide socially desirable responses that put their HEI in a good light in terms of educational provision in this area (De Vaus 2002). Alternatively, participants might have perceived competition and withheld information.