Three phase process interview strategy

Semi-structured (in-depth) interviews was the main method used to collect data. A semi- structured (in-depth) interview, unlike the structured interview, relies on general topics to be covered as opposed to a list of formal questions (Fontana & Frey, 2008). The goal of a semi-structured interview is “to explore a topic more openly and to allow interviewees to

express their opinions and ideas in their own words” (Esterberg, 2002, p. 87). This enables the generation of depth information about lived experiences and their meanings (Denzin & Lincoln, 2005). The rich and vivid material that an interview turns up is one of its most positive features (Gillham, 2000). In-depth interviews are very good for exploring a topic in detail or for constructing theory (Esterberg, 2002). This research was exploratory in

nature and intended not only to explore in detail the CAM consumer’s experience but

understand how value is created.

As previously outlined each participant (case) in this research was interviewed up to 3 times over a period of approximately 3 to 12 months; some took longer due to the personal circumstances of the participant. The reason for this semi-longitudinal approach was to explore how value emerges over time; this was considered a particularly important aspect in the consumption of health care services where therapeutic relationships and treatment programmes take time. The stance taken in this research is that value is determined by the consumer during the consumption experience (Vargo & Lusch, 2008). It was assumed that the value of CAM health care is built up over the consumption period and beyond. This

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included the experience of the CAM consumer at various points in the treatment programme both in clinic and at home, and the relationship that developed with the CAM practitioner (assuming multiple visits). Multiple interviews also allowed for greater depth and the ability of the researcher to create rapport with the individual participants. Researchers who spend more time with participants are more likely to have a greater knowledge and better personal relationship with their interviewee than a one-time encounter where the relationship is more likely to be impersonal (Esterberg, 2002). Fontana and Frey (2008) argue that there is a growing realization that “interviewers are increasingly seen as active participants in an interaction with respondents, and interviews are seen as negotiated accomplishments of both interviewers and respondents that are

shaped by the contexts and situations in which they take place” (p. 144).

3.5.4.1 Triangulation and trustworthiness

Importantly the three phase process allowed for triangulation whereby the use of multiple methods over multiple time periods enabled deeper understanding and dependability of data (Woodside, 2010). Figure 8 provides an outline of the research process implemented to collect data for this research along with the approximate timeframes. To ensure trustworthiness of the data the majority of the first and second phase interview transcripts were member checked and any changes to the data were made. Member-checking involved the interview transcripts from phase 1 and 2 being sent to each participant via email and then verified at the beginning of each subsequent interview, for example, phase 1 interview transcripts were checked at the beginning of interview 2 and so on. Phase 3 interviews were not member checked because this interview was primarily in itself a form of member checking for phase 1 and 2, therefore it was deemed unnecessary.

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Recruit

•Approached various CAM clinics in Auckland region (North Shore & Auckland central) •Obtained permission to advertise research on clinic noticeboards and leave fliers •Placed adverts asking interested participants to email researcher

•Researcher emailed information sheet and provided a contact phone number for potential participants to call

Screen

•Screened potential participants over the phone •16 participants recuited who met the criteria

•First phase interviews were set up in mutually agreed place

Phase 1

•Conducted story-telling interview (within approx 2 weeks of recruitment) •Instructed participant on the photo/image collection exercise

•Phase 1 interview transcrived and member checked - participant sent and asked to review first phase transcript prior to phase 2 interview

Phase 2

• Images/pictures taken and collected by participants and sent to researher (took approx 4-12 weeks) •Conducted photo/image elicitation interview (conducted within 2-3 weeks of receiving the images)

• Phase 2 interview transcribed and member checked - participant sent and asked to review second phase transcript prior to phase 3 interview

Phase 3

•Initial analysis of Phase 1 & 2 completed and short powerpoint presentation prepared •Conducted 3rd phase interview (approx 6-8 weeks after phase 2 inteview)

Figure 8: Research process and approximate timeframes

3.5.4.2 Phase 1: Story-telling interview

The first phase of this research involved a ‘story-telling’ interview whereby each of the 16 participants had an opportunity to tell their story about his or her experiences of CAM health care. The aim of this interview was to investigate and explore the participant’s experience of CAM where emergent themes on consumer value were expected to surface.

The interview began with: “Tell me your story of what has led you to use CAM.” This

allowed the participant to express their story in their own words (Esterberg, 2002), enabling the generation of depth information about lived experiences and their meanings (Denzin & Lincoln, 2005). Discussions flowed like a conversation with deeper questions

asked such as “tell me about the treatment you are getting” and “what benefits have you

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their health care experiences further. The use of ‘probes’ helped clarify and extend the

participants response and encouraged participants to say what they think and helped steer

them in the right direction (Gillham, 2000). Essentially the ‘interview’ ran like a

conversation which was subtly directed by the researcher (Esterberg, 2002). See Appendix G for the interview guide. Each interview took place shortly after recruitment at a time and place convenient to the participant. Interviews ranged from 40 to 90 minutes in length. At the end of each interview participants were given instructions about phase 2 – the photograph/image collection exercise and second interview - including an instruction sheet explaining the process. Refer to Appendix H for the instruction sheet.

3.5.4.3 Phase 2: Photograph/image collection and image elicitation interview

Phase 2 of this research was the most complex and time consuming. Fourteen of the original 16 participants completed this phase. Of the two participants that didn’t complete this phase, one participant did not respond to follow-up emails and texts and the other participant pulled out due to ill health and time commitments. Participants were given two weeks to provide a minimum of 12 and a maximum of 20 photographs, pictures and/or images that represented what they thought and felt about their experiences of complementary and alternative medicine. However, this phase took longer than originally anticipated with the majority of participants taking 4-6 weeks to complete this task. One took 8 weeks and another took nearly 12 weeks. The key barrier for completing this phase

from the participant’s perspective was time constraints. All of the participants involved in this phase sent the pictures/images through to the researcher via email. On receipt of the pictures and images the researcher arranged a second interview with each participant. These were conducted within 2-3 weeks of receiving the pictures. Interview times in this phase ranged from 30 to 70 minutes with the majority ranging between 35 and 50 minutes. The second phase interview used the simplified ZMET technique, as outlined in section 3.4.4. Refer to Appendix I for a copy of the interview schedule. Prior to the interview the images/pictures were placed in a word document with approximately three images per page and printed. The pictures were individually cut out and taken along to the interview.

The number of images/pictures taken or collected by participants ranged from 9 to 17. Interestingly eight participants provided less than the stated minimum requirement of 12.

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These participants commented that finding more than 12 images was difficult and some felt they were beginning to repeat (i.e. finding images that meant the same thing). Of the fourteen participants only three provided their own photographs. One participant was a graphic designer and photographer, one was a teacher of visual arts and the third used a couple of personal photographs he had taken previously. All the other participants found images off the internet primarily using Google Images. Given the choice the majority of

participant’s preference was to gather images than take their own photographs due to ease and time.

3.5.4.4 Phase 3: Feedback interview

The third phase of this research involved a final interview with thirteen of the participants with the primary aim of gaining feedback on findings from the previous two phases as well as understanding the process of value co-creation. Refer to Appendix J for the interview guideline. Interviews were scheduled with participants approximately 6-8 weeks after the phase 2 interview. Due to time commitments one participant did not complete the final phase, demonstrating the difficulty of semi-longitudinal research in terms of participant involvement. Participants during this interview were firstly asked to reflect back on their experiences of CAM and recall any key incidents that were significant in their journey. The majority of the interview was devoted to getting participants’ feedback on preliminary findings. Please note due to the longitudinal and inductive nature of the research three participants were presented with their individual case analysis (i.e. analysis of their phase 1 and 2 interviews) to give feedback on in the phase 3 interview, because these participants completed phase 1 and 2 early on in the research process. However, later in the research process the researcher decided to present the other ten participants initial cross-case analyses; this was done via a very short power-point presentation (Appendix K). This proved to be more fruitful in terms of gaining feedback on overall findings, enabling the researcher to refine key results.