Interviews

Interviewing is a well-established data collection method because the research interview enables meaningful engagement with participants allowing them to share their experiences, thoughts, attitudes and beliefs (Holstein and Gubrium, 2003).Interviews may be structured, unstructured or semi-structured (Robson, 2011) and are typically between thirty and ninety minutes (Petty et al., 2012). The decision to undertake semi-structured interviews was influenced by the study’s overarching aim to explore in depth participants’ experiences and the factors that influence their decision-making for the asthma management. Unlike a structured interview approach, which has similarities with a survey questionnaire that

adheres to a fixed order, the semi-structured interview has some structure but is flexible (Petty et al., 2012). The structured interview is researcher led and usually facilitates limited responses from participants therefore it is unlikely to provide a detailed exploration of child- parent shared decision-making for the management of asthma (Petty et al., 2012; Clifford, 1997). Unstructured interviews differ from semi-structured interviews in the degree topics for discussion are prepared in advance, which for structured interviews are broad, centred around a few key points or an opening question, with subsequent questions developed from participant cues (Petty et al., 2012; Clifford, 1997). A lack of structure and guidance when interviewing children has the potential to create confusion and hinder the depth of data collected (Holloway and Todres, 2003). Mauthner (1997) considered individual interviews to be more suitable for older children and group discussion for younger children. Middle childhood, aged range seven to eleven years respond well with either interviews or a focus group method of data collection (Fraser et al., 2007). There is a perceived unequal power balance between a child participant and an adult researcher (Mauthner, 1997). However, using child participatory techniques such as a drawing exercise recognises the child as social actors in their own right and facilitates the active participation of the child (Christensen and James, 2008; Mayall, 2002).

It was anticipated that a semi-structured interview undertaken with children about shared decision-making for their condition, would facilitate better sharing of their experiences than an unstructured interview. Semi-structured interviewing was congruent with the study aims to explore individual participant’s perspectives (Holstein and Gubrium, 2003). Interviewing is often viewed as the ‘gold standard’ of data collection within qualitative research because interviews facilitate a meaningful engagement with participants (Lambert and Loiselle 2008; Silverman, 2000). In this study, in-depth interviews enabled children and parents to share their experiences, thoughts, attitudes and beliefs about the decision-making process for the management of asthma, an active process and the resultant data was shaped by the

participant and interviewer (Richards and Morse, 2007; Bowling, 2005; Cresswell, 2003; Thomas et al., 2003). The effectiveness of interviewing as a data collection method is based on two assumptions: participants having the skills to express their responses in a way that represents their realities; and the researcher having the skills to facilitate participants to

share their stories and experiences and explore participants’ response in an ethical manner (Lambert and Loiselle 2008; Holstein and Gubrium 2003; Patton 2003). I drew on my wealth of experience and skills from a school nursing role and mother of four children, to effectively engage with the children and their families.

Individual face-to face semi-structured interviews were undertaken to explore child-parent decision-making for several reasons. Within the semi-structured intervieweach participant was encouraged to express their individual views; this was enhanced by undertaking separate child and parent interviews. Separate interviews were important because the parent, in a position of power within the relationship, could potentially dominate when responding to questions and there was a danger the child’s voice would not be heard (Mauthner, 1997). Although it was acknowledged that a parent’s presence in a child’s interview may enrich the child’s narrative through assisting the child in memory recall of decisions (Irwin and Johnson, 2005), it was decided the child’s ‘voice’ was essential to the study aims and individual interviews best achieved this. Indeed, individual interviews have been used to elicit data from children with a long-term condition (Taylor et al., 2009; Newbould et al., 2008; Williams et al., 2007; Buford, 2004; Pradel et al., 2001). Ambiguities within each interview or different perspectives could be clarified and participants’ responses explored. At the same time the semi-structured child and parent interview guides (Appendix 10 and 11), allowed core concepts to be explored within each interview, with the wording of the questions responsive to each participant’s role and recognising the cognitive

development stage of the child, yet facilitated comparisons across the different sample groups and across different families (Smith and Firth, 2011; Holloway and Todres, 2003). The framework approach to data analysis, described in Section 4.8, allowed between and within case analysis of the data.

Individual interviews enabled a child art-based approach to be used with the aim of fostering a rapport to be established between the child and the researcher (Pridmore and Landsdown, 1997). Prior to commencing each interview, time was allowed for general introductions and confirming participants understood the purpose of the interview. In addition to drawing on personal professional experiences as a school nurse working with children and parents in primary health care settings, school and the family home, a range of probing techniques

were used to enhance the quality of the data elicited. This included: allowing silences and thought time; repeating key points and seeking clarification when there were uncertainties about child or parents’ responses; offering encouragement by acknowledging participants experiences; and using probing questions to explore issues further (Taylor et al., 2009; Newbould et al., 2008). Interviews were audio-recorded, with the participant’s consent and immediately uploaded onto a password protected computer and deleted from the audio recorder as a way of ensuring confidentiality.

There are disadvantages to interviewing as a data collection method which include:

interviews are time consuming and information may not be relevant to the study objectives (Lambert and Loiselle, 2008); the topic may be of a sensitive nature and therefore the researcher may be unable to elicit meaningful information (Thomas et al., 2003). The use of prompts was anticipated but care was taken not to interrupt the thought processes that reflect the child or parent thinking which could have limited their response (Miller, 2009). Art based approaches enable a more child-centred method of eliciting data from children (Carter and Ford, 2013). Thereby, commencing the child interview with a drawing activity of ‘what their asthma means to them’, introduced fun into the research and promoted

engagement of the younger child (Carter and Ford, 2013). The child participatory drawing technique was suitable for children of different ages and ability. Participant observation, focus groups, interviews and structured activities have been identified as appropriate

methods of data collection for young children (Danby et al., 2011; Kirk, 2006; Kortesluoma et al., 2003; Punch, 2002; Kennedy et al., 2001). Studies which have adopted such methods obtained ‘rich data’ highlighting child and parent perception and experience of living with a long-term condition; and a child’s knowledge, perceptions and autonomy in managing medication for their asthma (Fereday et al., 2009; Pradel et al., 2001). The researcher was familiar to the child and parent due to the former meeting within clinic and subsequent correspondence. This familiarity facilitated rapport building by actively drawing on information gained in the previous encounter in order to positively reinforce the value placed on participant’s contribution to the research.