Interview Methodology

3.2.1 Participants

A purposive sampling method (Gray 2004) was employed, where the predefined population was healthcare professionals who have experience in paediatric applications of their medical discipline. Contact with a range of potential participants was established through a paediatric surgeon who provided access to other paediatric consultants from a range of medical backgrounds. The drawback of this recruitment method was that personnel

56 from some medical specialisations declined or did not follow up the invitation to be involved in the study and are therefore not represented.

The aims of the study were communicated via the paediatric surgeon and circulated within email correspondence to potential participants. It was explained in the initial invitation to participate that the remit of this study was to elicit the views of paediatricians who specialise in chronic disease management and that there would be particular interest in adolescent patients and their use of medical devices.

Of the clinicians who received the original correspondence the following specialists agreed to meet and discuss their experiences regarding adolescent users of medical devices.

 Consultant Paediatric Endocrinologist (P-e)

 Consultant Paediatric Respiratory Specialist (P-r)

 Consultant Paediatric Neurologist (P-neu)

 Consultant Paediatric Nephrologist (P-nep)

Due to the recruitment method of invitation via a third party paediatrician, the consultants who accepted the invite set the scene for the range of conditions to be examined in the study. This sampling has limitations in that some medical specialisations may not have been issued with an invite or may have declined participation e.g. oncology, haematology, orthopaedics, and mental health disciplines, all which may have relevant adolescent populations.

Additionally some of the healthcare professionals contacted may be of the view that adolescent use of medical devices is not relevant for their patients and as such they were a self selected group.

With an exploratory research such as this it is important that there is ‘buy in’

and co-operation from applicable staff and personnel. Within an organisation such as the NHS where ethics and access to participants play such a crucial part in the success of a research study, the support of staff and relevant parties is particularly useful in navigating the system and gaining access to relevant people. As such, the specialists who demonstrated an immediate interest in the study proved particularly helpful. It was decided to be inefficient

57 to pursue the involvement of staff that had not shown initial enthusiasm and would be unlikely to take part in further research.

3.2.2 Method

Three interviews took place, organised at the convenience of the medical personnel, with the Neurologist and Respiratory Specialists attending the same interview session. A representative of the Hospital Youth Services team (P-hys) and a biomedical engineer were also present for the interviews.

Prior to beginning the interviews the main tenets and aims of the research study were described to the participants. It was emphasised that the focus of the research was to explore the concept of adolescents as users of medical devices and that it was their thoughts and experiences with adolescent patients rather than children which would be most valuable. It was also highlighted that the study was specifically interested in medical devices and less the associated issues of pharmaceuticals. The clinical staff consented to their interview information being used in development of the research study and academic publication. Outside of these constraints the interview protocol was designed not to be prescriptive but to enhance the grounded theory approach of the study. A sample of open ended questions encouraged them to consider a range of issues surrounding adolescent use of medical devices.

 What medical conditions do they think are relevant to adolescents?

 What medical conditions to they think are relevant to adolescents who have to use medical devices?

 What devices are relevant to adolescent users?

 What are their experiences with adolescent users of medical devices?

 Are there any issues associated with adolescents and their use of medical devices?

 Do they think adolescent have different requirements of medical devices than adults and children?

 What are adolescent user requirements of medical devices?

Throughout the interviews the clinician participants were encouraged to discuss without restriction their views about adolescents in healthcare and use of medical devices. When necessary the researcher prompted the participants

58 to provide further detail or expand on their discussion. Follow up questions were used at the end of each topic and at the end of the interview to introduce subjects that had not been raised and to clarify any points. Throughout the interviews and immediately after their completion field notes were written in association with the aims of the study.

3.2.3 Data Analysis

A Grounded Theory approach (Glaser & Strauss 1967) was used to analyse the interview data. This method provides a structure for constant comparison and iteration of qualitative data, where the continual development and reassignment of the data throughout the process led to the development of emergent themes.

The themes were extrapolated through a process of coding the clinician interview data. Figure 3.1 presents a visual representation of the data coding process undertaken.

Figure 3.1 Qualitative data coding process (Hahn 2008)

The clinician interview data were examined and coded into tree nodes and sub-nodes, depicting the breakdown of concepts into issues, attitudes and outcomes. The development of themes was iterative and several reviews of the data and the themes were carried out resulting in some themes being

59 amalgamated with others, whilst others were relegated or promoted based on their prevalence and significance during the data analysis.

The resulting nodes were a mixture of exclusive and inclusively coded themes, whereby some items were allocated to one ‘branch’ of a tree but not others, whilst those that were inclusive could be assigned to multiple branches of the adult node (Gibbs 2002). The coded interview statements were then scrutinised for links with other main and subthemes to link associated ideas through the node classification.

This process led to the identification of eight themes from which inferences could be made regarding adolescent users of medical devices.