Interview structure and topic guide

The interviews were guided by a question schedule (Appendix P) developed by the student, with guidance from the research supervisors, prior to any data collection. This interview schedule was developed from an initial topic guide informed by the research questions, the literature review in Chapter 2, the results of the qualitative study, and the previous HELP trial results, which included the following topics of interest:

 Women’s experiences of participating in the HELP trial during pregnancy (also explored in the HELP trial)

 Women’s attitudes towards diet, PA and weight management before, during and after pregnancy

 Women’s behaviours in relation to diet, PA and weight management before, during and after pregnancy (also explored in the HELP trial)

 Perceived barriers and facilitators to health behaviours (also explored in the HELP trial)

 The function of social support in adhering to a healthy lifestyle  Reflections on weight experiences since taking part in the HELP trial

 The wider impact of women’s experiences on parenting and the family environment  Women’s attitudes surrounding their child’s diet, PA and weight at age 24 months

The interview schedule included open ended questions with the avoidance of leading statements, so that participants could construct the meaning in their responses, rather than closed questions which would only allow the interviews to explore the student’s pre-

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conceptions of important issues.(331) To avoid using stigmatising or judgmental language in the interviews, evidence of patients’ preferred terms to discuss ‘overweight’ and ‘obesity’ was consulted.(400) As such, ‘weight’, ‘weight related’, and ‘weight management’ were used in the wording of questions and throughout the interviews.

It is recommended to pilot interview content and the method of data collection in order to refine the question schedule and assess the feasibility of the planned interviews.(331) A pilot session was conducted with a female volunteer from within the student’s workplace. Research topics related to the women’s experiences of weight and health behaviours, were similar to the topics of interest within the HELP trial interviews at six and 12 months postpartum, so the feasibility of exploring these issues had been established. Also, given the specific nature of the participant required for these interviews, i.e. one that had participated in the HELP trial and follow-up at 24 months postpartum, only the content related to exploring issues relevant to the children was piloted. The pilot participant had a child of preschool age which made her suitable to respond to these questions. She was asked to comment on her understanding of the questions asked and her suggestions for missing issues she considered important. Following the pilot session, minor changes to question wording were made to the interview schedule e.g. diet changed to healthy eating. It may have been beneficial to pilot interview content with women from the study population and then discard these interviews if necessary. However, the student decided that this would risk excluding valuable information and reducing the recruitment opportunities for the main study, especially given the limited population from which participants were to be recruited. Using analysis alongside data collection would allow any issues arising in the main interviews to be identified, and the question schedule amended.

The student familiarised herself with the interview schedule prior to each interview in an effort to allow the discussion to flow more naturally.(393) The interview was initiated by an ‘ice-breaker’ question where the participant was asked to describe herself and her family, such as names of children and her occupation. Starting with this discussion, that would be familiar and easy for participants to talk about, was intended to put them at ease in answering further questions. Field notes were recorded, such as the name of the participant’s partner, so that these details could be referred to throughout the interview, to assure the participant that they were being listened to and to aid rapport which is important in terms of encouraging richer accounts.(393) Also, by starting with a less sensitive topic the aim was to build trust before asking women to discuss more sensitive issues related to weight.

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The resulting data from interviews are evidently shaped by the questions asked, as well as the influence of social desirability on participants’ responses.(401) In an attempt to reduce these limitations, neutral techniques to encourage participants to provide more detail on their individual perspectives were employed. The student strategically used silence and sought to limit her interjections as this can be effective in getting respondents to contemplate their responses, talk more, elaborate or clarify.(393) Probes, for example ‘can you tell me more about that’, were used to encourage participants to repeat and extend their responses, and to explore meaning to ensure more in-depth data.(402) To overcome the absence of non- verbal cues in telephone communication, utterances, such as ‘um’ ‘ok’ and ‘yes’, were used to reassure the participant that she was being listened to. Prompts were only employed if the participant failed to understand the initial open-ended question or when a response of interest had been raised in previous interviews and the student sought to explore this further, to establish the participant’s agreement or disagreement with other respondents. To increase interview validity, the student used feedback of her interpretation of participants’ accounts during the interviews, to clarify whether she had understood correctly and to offer participants the chance to disagree or expand on responses.(397) Before ending the interview, the participants were given a chance to sum up or clarify the points they had made, and asked if there was anything further that they would like to discuss. This was important, in case the interview had failed to address issues of importance to the interviewee.(393)

When the interview had concluded, the woman was thanked and the call ended. Participants were subsequently posted a £10 high street shopping voucher as a thank you for their time.

5.5.2 Ethical considerations during data collection

During the interviews, the student asked the participants to enter into a ‘trusting’ relationship which would only last the length of the interview. Yet during that time, the participant was asked to reveal their personal thoughts and feelings related to a sensitive and stigmatised topic. It was, therefore, ethically important to consider the potential impact of participating in the interviews on the women, and for procedures to be in place to ensure that no harm came to the women as a result of taking part. The women were informed at the start of the interview that should the discussions cause upset or distress, or the student have concerns for their wellbeing or the wellbeing of others around them by what was said, that this would be communicated to a healthcare professional who was responsible for their care such as their GP.

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