Diary and interview schedule development

Due to the nature of osteoarthritis patients, their symptoms relate to difficulty in movement. To capture these aspects, a diary was also used with a sub-group of the main element in order to collect participant experiences and views which were taken every day in a convenient and pragmatic way. Following the diary return and analysis, face to face interviews were conducted to confirm and further explore critical points from the diary.

The diary structure and format has been subject to iterative review by the research team and is designed to illicit a broad range of experiences and opinions from the participants.

The interview schedule (Appendix 8) is dependent on the content of individual diaries and responsive to the comments made therein.

3.2.1 Aim and objectives

This development aimed to design the appropriate diary and schedule of interviews according to qualitative approaches. To achieve this aim, two objectives were realised as set out below:

1. To explore the experience of patients undergoing THR and design suitable open-ended questions considering this experience;

2. To design appropriate questions of interview schedule related to critical points from the diary.

3.2.2 Diary development

Recent literature was reviewed in order to scope questions about pain experiences from qualitative pain diary research in hip osteoarthritis and hip surgery. All relevant articles were selected in order to explore the impact of pain and THR on daily activities. The researcher designed the format, instruction and open-ended questions in the diary which covered a two-week period. The research team suggested comments to improve face and content validity. Finally, the diary was amended again following the other expert opinions.

Seven existing studies were included to explore the relevant aspects of pain experience.

Their period of data collection covered end-stage hip osteoarthritis to recovery after hip surgery. Three qualitative approaches -focus group, interview and diary- were utilised in these studies. Related topics covered daily activities105,107,190, weakness¹⁹⁰,

feeling104,107,110,190 including fear¹⁹⁰, pain level98,103,107,110, difficult movement^98,103–

105,107,110,190, pain and difficult movement management98,103,104,107,190, support from other people (health professionals and family members)^98,110, social aspect¹⁰⁴, sleep ability¹¹⁰ and expectations for improvement¹⁰⁷. First of all, these topics were clustered in four groups comprising of daily activities and feeling, pain symptoms and management, mobility and social interaction including sleep ability and other health related factors such as news, specific advice, decisions, and thoughts.

Following review by the research team, rearrangement of clustered topics, amendment of instruction and format were undertaken. Most of them were grouped together for every day questions in terms of pain symptoms, daily activities, feeling, mobility, social interaction, and other factors to look at the overall health of participants and pain symptoms rather than dividing each group question into each day. Pain management and sleeping ability were looked at via an additional three-day of questions in order to reduce the daily amount of time focusing on coping with pain and its effects at night. This categorisation is shown in Table 8. In addition, some instructions were emphasised as bold text and the response to questions about sleeping ability were changed from a tick box of yes or no answer to one which required the participant to descriptively write an answer.

Three open-ended questions were used in the diary, varying across the two week period.

Questions about pain symptoms, daily activity, feeling, mobility, social interaction, and other factors were included on day 1 and day 7. A question of pain coping asked the participants to describe their management on day 2, 5, 8, 11 and 13, whilst the other question of sleep ability was included on day 3, 6, 9, 12 and 14. Prior to diary use, there were two comments of further review by a community pharmacist. First, one page each day was increased to two pages to encourage the participant to give more written information. Second, a question about the important things relating to participants’ health was changed from ‘news, specific advice, decisions, thought, etc.’ to ‘news items, advice you have been given, any decisions you have made, or any thoughts you have had’ to allow for ease of communicate to the layperson.

Table 8: Groups of topics from previous qualitative research related to hip osteoarthritis and THR

Questions in diary Topics from previous research Pain symptoms, daily activity,

feeling, mobility, social interaction

and other factors

 pain and symptoms

 daily activities

 weakness

 feeling including fear

 difficult movement

 difficult movement management

 support from other people

 social aspect

 expectations for improvement

Pain management  pain management

Sleep ability  sleep ability

Throughout the development process the diary was validated to check it was suitable to use with patients undergoing THR. Due to the relative ease and lack of time pressure for participants to write in the diary at home, this was considered as a one-way communication that might need more clarification of some ambiguous issues. Accordingly, a critical incident approach, using a semi-structured interview, was selected and the interview schedule was developed, which is described in next part.

3.2.3 Interview schedule development

The interview schedule was developed and assessed for face validity by the research team.

The final schedule was constructed in three parts: introduction; probes; and closing session. The introduction part explained the aim of the study and the role of participants during the interview. Next, the probes part consisted of exploring, reflection and expanding critical points from data in the returned diary. Finally, the closing session asked the participants about their comments in the diary and interview as well as any views that they had. The final question asked participants to confirm continual participation in further questionnaires, diaries and interviews (Table 9).

Table 9: Three main parts of interview schedule

Interview schedule Introductory session

 Introduce the interviewer

 Explain the purpose of the study and questions in the interview Main

session:

Probes

Explore situations

 Could you tell me a bit more about … situation? (positive or negative critical incidents from the diary)

 How did it come about?

 What happened afterwards?

 How did you feel about it?

 Was there something that you or someone else could have done to stop it happening?

Reflect (Confirm the meaning of critical incidents)

 Could you read this section again? Looking back on it now, what do you think?

 Would you put something different with hindsight?

Expand (Explain the meaning of critical incidents)

 What did you mean by this?

 Could you clarify what the issue was here?

Closing session

 Thank participants and explain what will happen after the interview

 Confirm transcript of the interview

 Confirm their interests for taking part in further diaries and interviews

3.3 Summary

All research instruments were developed iteratively and validated for face validity. A single questionnaire was developed through the review process and cognitive interviews as well as diary and interview schedule were created by the research team. All of them were approved by the NRES Committee, LJMU Research Committee, and Research department of relevant hospitals prior to conducting the Questionnaire Survey and Diary and Interviews.