Interview Administration and Data Collection

Patients and physicians were interviewed by telephone. The interviewer who conducted all of the interviews was a pharmacist who had previous experience performing semi-structured

interviews, but was not a member of the research advisory committee, and was not involved in the MAC program service delivery.

Patient and physician participants who met the inclusion criteria were contacted by phone by the interviewer to request their participation. Potential physician participants were sent a fax a few days prior to the initial phone contact to inform them that the interviewer would be calling to request their participation in the study. Using an Invitation to Participate script, the

interviewer obtained verbal informed consent from participants prior to starting the interview. A copy of the Invitation to Participate script is included in Appendix D (patient invitation) and Appendix E (physician invitation). The interviewer also collected the participants’ mailing addresses so that detailed information about the study, along with investigator contact information could be sent to participants. See Appendix F for the Patient Participant

Information sheet and Appendix G for the Physician Participant Information sheet. Participants who provided informed consent and completed an interview were mailed a $20 gift card as a token of appreciation for their participation.

In order to ensure the quality and standardization of the interviews, the interviewer was informed about the details of the study and the purpose of the interviews. To ensure that the interviewer was asking the interview questions correctly, and probing interviewees appropriately, the investigator and her academic advisor reviewed the transcriptions of the first patient and physician interviews to ensure the interviewer was following the expected interview protocol.

Feedback was provided to the interviewer, prior to completing subsequent interviews, to ensure he was eliciting the appropriate information through further questioning and probing.

To protect the confidentiality of the patients and physicians, each interview was recorded and a transcribed verbatim externally, but with the removal of any identifiers such as names and locations.

MAC Staff

MAC staff members were contacted directly by the investigator (who was also a MAC staff member) and asked to participate. See Appendix H for the MAC Staff Participant

Information sheet. MAC staff interview participants received a copy of the interview guide prior to the interview to allow them to review and reflect upon their responses. The MAC staff

convenient for the participants. The interviews were audio recorded and transcribed verbatim by the investigator. The investigator, as a MAC staff member, responded to her interview questions in writing.

3.3.4 Data Analysis

Thematic analysis was used to identify common themes from the three sets of interview transcripts. The first step in the analysis was to reduce the quantity of information through thematic coding.⁵⁹ The purpose of the coding was to better understand the interaction of stakeholders with the MAC program by reducing the interview data into themes that explained the stakeholder experience.

Various transcript analysers manually coded the transcripts using highlighters to identify key statements and common themes. Three individuals, one of whom was always the

investigator, independently reviewed each group of stakeholder interviews. Patient and physician interviews were reviewed by the investigator, the MAC program director, and a member of the faculty of the College of Pharmacy and Nutrition (who was not a member of the research team or involved in MAC program service delivery). The MAC staff interviews were reviewed by the investigator, the interviewer from the patient and physician interviews, and the same faculty member who reviewed the patient and physician interviews. This mix of analysts was chosen based on their varied experience and expertise. Three of the analysts were

pharmacists, each with varying clinical experience. The investigator and the MAC program director provided a familiarity of the program in the analysis of the transcripts; the faculty member, who was a non-pharmacist, provided a non-clinical perspective along with qualitative research expertise.

All three transcript analysers read through the transcripts independently, highlighting the relevant or emerging themes in categories of interest that related back to the research questions.

The transcript analysers were asked to identify text that related to: (1) what worked well; what could be improved and what challenges were identified; (2) suggestions made for improvements;

and, (3) any other emerging themes that the analyst felt were relevant, but that were not captured by the previous three categories (see Appendix I for Instructions for Interview Transcript

Analysers). This thematic analysis was performed using open coding and line-by-line analysis.

This form of coding involves a close examination of data, phrase-by-phrase and sometimes

word-by-word, with a comparison of the data for similarities and differences related to the pre-defined categories.⁶⁵ Data that were found to be conceptually similar in nature or related in meaning, were then grouped into major categories of information, ^64,65 for example, identifying what worked well or did not work well related to the CMM service.

This process left the transcript analysers with transcripts containing text that was highlighted in various colours each signifying different categories (or themes) of information.

Once the transcript analysers had completed the coding of the transcripts, they met as a group to discuss their findings and to develop and agree on the final common themes. During the

discussion, the transcript analysers revealed the themes they had each independently identified in the transcripts. If all three analysers had identified the same theme, that theme was then

accepted. If not all three analysers identified the same theme, a discussion ensued to determine if, upon further review, a consensus could be reached regarding the existence of each theme or the wording of the theme. If all three transcript analysers agreed to accept the debated theme, the theme was then accepted. If all three transcript analysers did not agree that the theme was an accurate reflection of the interviewees’ comments, then it was discarded. The process was repeated for each of the three stakeholder groups and a list of identified themes and sub-themes was generated.

Once themes were defined within each stakeholder group by the transcript analysers, the investigator, along her academic advisor reviewed the interview transcripts comprehensively.

The purpose of this review was to audit and verify the identified themes. These two individuals read through all the transcripts to determine if the previously identified themes were accurate and unanimously agreed to any adjustments that needed to be made to the themes. Once this process was complete, the investigator and her academic advisor generated the final list of themes along with their sub-themes (where applicable).