Key considerations when interviewing children

There has been an increase in familycentred care within health (Coyne et al., 2011; Coyne and Harder, 2011; MacDonald and Greggans, 2008; Alderson, 2006a) and childhood studies, which acknowledge the child as having an important ‘voice’ in all matters affecting them (Tisdall and Punch, 2012; Percy-Smith and Thomas,2010). Research with children

acknowledge the methodological similarities and differences when working with children and adults (Alderson and Morrow, 2011; Tisdall et al., 2009; Thomson, 2008; Kortesluoma et al.,2003); such as developing innovative child friendly methods and tools to collect data from children (Thomson, 2008), enabling flexibility to facilitate cognitive and linguistic ability of each child (Greig and Taylor, 2005). I was respectful that researching with children is different to researching with parents and utilised published guidance relating to working directly with children (Alderson and Morrow, 2011; Tisdall et al., 2009). Good practice guidelines have facilitated the inclusion of hearing the voice of children within research (Moules, 2009; Kirk, 2006; Alderson, 2006a;DH and DfES, 2004). Indeed, in response to the government policy of including children within health decisions that affect them (DH, 2003), research with children informs ethical issues (Alderson and Morrow, 2011); and a better understanding of the extent of a child’s active participation (Tisdall et al., 2009). Additional challenges when interviewing young children included obtaining consent, ensuring privacy but not placing the child in a vulnerable situation and ensuring confidentiality (Danby et al., 2011; Kirk, 2006;Mauthner, 1997; Mayall, 1994). Although it has been argued the concept of ‘vulnerability’ is not unique to researching with children and that if the child is considered competent to participate and engage with the researcher, using the term vulnerability underestimates the child’s agency (MacDonald and Greggans, 2008; Morrow and Richards, 1996). In this study a decision was made to interview the child without parental presence to ensure the child’s perspective was heard (Gardner and Randall, 2012; Schiller and

Einarsdottir, 2009), although the parent was in an adjoining room and was able to enter the room should child or parent desire. The phrasing of questions reflected the age range of the children who participated. Questions were quality checked for clarity and understanding by a child outside of the study, who seven years of age, read through the child’s interview guide to confirm questions were understandable.

To maintain consistency within each family interview, the child was always interviewed first. The rationale was primarily to prevent the child waiting to be interviewed and consequently losing interest in participating within the study (Fraser et al, 2004) and to reduce the

possibility of the parent remaining within the room, if the child was interviewed following the parent. The aim of the researcher when undertaking the interview was to ensure quality data was obtained (Danby et al., 2011). Research suggests that the researcher has at least one interaction with the child prior to the interview because this assists in developing a rapport with the child in the interview setting (Fontana and Frey, 2000). Cues noted in the asthma clinic where appropriate were used to initiate conversation when meeting the child for the second time. For example one of the children talked about their dog; on attending the family home to undertake the interviews, the child was pleased I had remembered her dog’s name and initiated a dialogue about other pets. This facilitated the development of an effective child-researcher relationship that was harnessed during the interview.

Developing an interactive relationship with the child can also be facilitated through playing with the child prior to an interview (Kortesluoma et al., 2003). For example: helping to feed a pet guinea pig, was particularly effective in establishing rapport with an initially quiet child and ‘humanised’ my role as a researcher. In addition innovative methods of data collection, such as drawing, have been used to increase effective child-researcher rapport (Carter and Ford, 2013), often used in health research settings with young children under twelve years of age (Kennedy et al., 2001; Pridmore and Bendelow, 1995; Williams et al., 1989). Children perceive drawing to be fun and non-threatening (Carter and Ford, 2013; Coad et al., 2009) and this activity was used in this study as an ‘ice-breaker’ (Fereday et al., 2009; Backett- Milburn and McKie, 1998; Pridmore and Landsdown, 1997), without detracting the child’s attention from the proceeding interview (Kennedy et al., 2001). Children were issued with paper, pencils and coloured pencils and asked to draw a picture about their asthma.

Analysing the content of children’s art work to find meaning is a highly skilled technique and must have a clear purpose (Backett-Milburn and McKie, 1998). No attempts were made to analyse the children’s drawings; the art work was referred to in an opening question, but the drawings did not form part of data collection. All of the children appeared to enjoy this

activity and either drew pictures of their medications or of participating within a leisure activity.

The relationship between the researcher and child commenced when the child provided informed consent to participate within the study. Interviewing children within a qualitative study particularly children under eleven years of age, is dependent upon the skills,

experience and knowledge of the researcher to engage meaningfully with the child

(Kortesluoma et al., 2003). My extensive experience as a school nurse informed how a child’s needs differ from their parent, within the interview. In addition, the child interview style was guided by research undertaken by Kortesluoma et al. (2003) who advocated:

 Not making a judgement or responding if a child misinterprets a question, but make a mental note to revisit the question or ask it in a different way;

 Maintaining the child’s interest and be mindful not to ask too many or too few questions; resulting in confusion by the child or loss of their attention;

 Using an appropriate tone of voice and age appropriate language;

 Maintaining a calm and relaxed atmosphere within the interview as this could directly affect the progress of the interview and ultimately the quality of data obtained;

 Gaining the child’s confidence by actively engaging with the child in relation to their experience and knowledge of the topic;

 Avoiding under prompt/over prompt allowing the child to articulate their perspective on asthma management decisions.