Piloting the topic guide

A focus group discussion and two pilot interviews were conducted to pilot the topic guide for the in-depth interviews.

2.6.5.1 Focus group discussion

A focus group discussion was conducted in February 2010 to pilot the vignettes that were developed to examine willingness to notify partners of STI and use various partner notification methods in the future. A purposive sample of 7 HIV positive MSM was recruited from amongst the members of the clinic’s HIV positive patients’ network with the help of the clinic’s patient representative. Using members of an existing group was considered likely to facilitate discussion due to familiarity. An attempt was made to select participants who varied in age, ethnic background, years since HIV diagnosis, cART status, and sexuality (gay or bisexual). All the participants were given a focus group discussion study information sheet (Appendix 13) and were asked to provide written consent (Appendix 14).

The discussion was audio-recorded with the participants’ consent. Participants were provided with snacks and beverages as a token of gratitude for participating in the focus group discussion. Six of the seven participants were White, and one participant was Black Caribbean. While some participants were living with HIV for more than fifteen years, some men were diagnosed 2-4 years ago. All but two of the participants were receiving cART. I facilitated the focus group discussion and read out the vignettes to the group.

The focus group discussion indicated the feasibility of using the vignettes for initiating discussion on attitudes to partner notification for STI and towards using various methods of partner notification. It also highlighted that some vignettes needed further clarification. Some topics not included in the topic guide came up frequently during the discussion: for example, the role of internet in meeting sexual partners among HIV positive MSM. The topic guide was modified based on the feedback received during the focus group discussion.

2.6.5.2 Pilot in-depth interviews

Two pilot in-depth interviews were conducted using the revised topic guide to reassess the comprehension of the concepts discussed, the feasibility of using vignettes and the acceptability and degree of comfort for the participants in discussing these topics during a face-to-face interview with me. These pilots were also conducted to assess the approximate time needed for the interviews and acceptability of audio recording the interviews. Written informed consent was used from both the participants (appendix 15 and 16). The pilot interview participants were a White British man in his early fifties and a Black Caribbean man in his mid-twenties and were recruited with the help of the clinic staff. They provided written consent and their interviews were audio-recorded with their consent.

The interview with the White British participant indicated that he was able to share his experiences of HIV partner notification. However, he had never been diagnosed with STI except at the time of his HIV diagnosis. He therefore found it difficult to respond to the vignettes on partner notification for STI. In addition, he was very sure that he would never need to notify his sexual partners for STI. He was nevertheless asked to comment on the clarity of the vignettes. He was able to understand the scenarios presented in the vignettes and his interview lasted for approximately 50 minutes.

The interview with a young Black Caribbean participant was challenging. He responded to the ‘softer’ questions like “how long have you been using the services of this clinic?” However, despite being informed of the nature of the interview and agreeing to participate in the interview, he responded ‘decline to answer’ to every subsequent question related to HIV diagnosis or sex behaviour. I thus stopped the interview and discussed with the participant if he was comfortable with the interview process. At this stage, he revealed that he had never spoken to anyone, including the clinic health advisors, counsellors or his family members about his HIV diagnosis, which was 3 years ago. He was angry with himself, and experienced tremendous guilt due to his sexual behaviour and blamed himself for his diagnosis. I offered the participant the option to terminate the interview and referral either to the clinic’s psychology team or the patient representatives and offered him some time to reflect on these options. However, he decided to continue with the interview but declined referral to the psychologists or patient representatives. After this point the interview went well but took approximately 85 minutes. The participant was able to understand the vignettes and terms used in the topic guide.

Both the participants were specifically asked about their experience of being interviewed by me, a young Asian female. The older participant said that my gender or ethnicity did not affect the accuracy or the extent of the information he shared. He, however, mentioned being cautious about using gay slang. The younger participant mentioned that my gender or ethnicity was not a concern for him. He felt reassured when I stopped the interview to re-check if he was willing to participate in the interview and found it easier to talk about his emotions because I am a female.

2.6.5.3 Modification of the sampling criteria based on the pilot results

I discussed the pilot results with both my PhD supervisors and we decided to modify the quota sampling criteria to reflect the pilot results. The purposive quota sampling criteria was modified to integrate an additional inclusion criterion, i.e., recent STI diagnosis, which was defined as being diagnosed with any STI (not HIV) in the three months prior to the date of being approached for the interview. The clinic staff in-charge of informing the patients of their recent STI test results and inviting them to the clinic for treatment if they tested positive flagged up the clinic notes of these men with a participant information sheet (appendix 15). This served as a reminder for the clinic nurses to invite those men recently diagnosed with STI to participate in the study.