Qualitative Interviewing

Qualitative interviews can be classified into three broad types, structured, unstructured and semi structured interviewing (I-TECH, 2008). In structured interviews researchers ask the same set of questions, in the same order, using the

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same words, to different interviewees and they are convenient for comparing different interviewees‟ answers to the same questions and when a team of researchers is involved in conducting interviews” (Oka and Shaw, 2000:15). In unstructured interviewing, normally there are no structured questions, but the interviewer starts the interview with one single question prepared. Here the interviewee is allowed to answer freely and the interviewer is able to expand in relation to the response. According to Bryman (2004), unstructured interviews are very similar in characteristic to a conversation. In this research my aim was to focus the interviewee‟s attention to several specific areas, related to the research topic, rather than limiting the interviewees to a set of rigid questions or letting the interviewee express their ideas on one given point. In this sense, this research did not utilise either structured or unstructured interview methods, but employed semi- structured interviewing with the use of interview guides (Appendices 8, 9, 10), which contains a list of fairly specific topics to be covered. These topics were basically identified from the literature and adjusted to incorporate them into the conceptual and theoretical framework.

Semi Structured Interviewing

As Oka & Shaw (2000:15) describe:

Semi-structured interviews: sometimes called guided interviews, these are somewhere between structured and unstructured interviews in format in that the researchers prepare interview guides that consist of a set of questions. The guides allow researchers to generate their own questions to develop interesting areas of inquiry during the interviews.

Fetterman (2010:36) explains “First the ethnographer must ask the right questions for a given research study. The best way to learn how to ask the right questions – beyond the literature search and proposal ideas-is to go into the field and find out what people do day to day”. This is a good theoretical as well as a practical idea for any ethnographic research; however with this research it was not possible to wait until the beginning of fieldwork to think of the questions to ask, as I had to submit the interview guides to the RECs for ethical approval before commencing the fieldwork. I prepared three different interview guides, to match my research sample one for MHSWs and AMHPs, one for all the other mental health professionals with the teams and the third for service users. However the interview guides were piloted

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after the beginning of fieldwork (as described below) and some revisions were made consistent with Fetterman‟s (2010) criteria.

Piloting the interview guide

As explained above, three interview guides were prepared at an early stage of the research, to meet the requirements of the REC, to find answers to the research questions and to address the research aims. Once the interview guides were

approved by the RECs, my main focus was on piloting them. The delay in getting the ethical approval (see 4.5.1) subsequently affected my time plan to start the field work. This also influenced the time period given for my fieldwork by the honorary contract with NHS as I received ethical approval approximately six months after I received the honorary contract. This made me feel obliged to start the fieldwork as soon as possible and I decided to pilot the interview guides after starting the field work, to keep with my time schedule. These circumstances persuaded me to use the first two interviews, which I had with a MHSW and a CPN, who were the professions common to most CMHTs. As these two interviews proceeded smoothly, without any new suggestions from the interviewees, I decided to move ahead with the same interview guides. Hence these two pilot interviews gave me an early opportunity to clarify some issues regarding the team‟s structure and also helped me to develop my style of questioning.

Piloting the interview guide for the service users was done with the support of the care coordinators. There had been some changes to the teams‟ structures, as a result of the reconfiguration, and this led me to make some changes to this interview guide for service users. From what I observed and learned from the staff members, AMHPs, MHSWs, CPNs or OTs are not known to their clients by their professional titles, but known only as their care coordinators. Also, as I previously explained, the design of care packages was different from my earlier assumptions and, in this sense; the interview guide did not match the changes in how the teams functioned. So after discussions with the staff members and my supervisor, I made substantial changes to the interview guide for the service users, to match the present situation.

120 Planning the interviews

Planning the interviews at the beginning of the fieldwork became an important issue with the staff members‟ busy work routine, where they spent half their time visiting service users and the other half in the office. To address this issue, when scheduling the interviews I explained that my fieldwork plan was to spend six months with them so that they could give me any date for an interview, within the first five months of my stay. This suited the busy time schedules of the staff members and also helped me in rescheduling the interviews cancelled due to unforeseen circumstances, such as staff members responding immediately to a client in crisis.

It was also important to consider the length of the interview, once again taking their busy work schedules into consideration. Robson (2001) argues that an interview which is less than half hour duration is likely to be no value, but anything over an hour could be unreasonable for busy interviewees. With this point in mind, all the semi-structured interviews in this research were limited to forty five to sixty minutes in duration. In most cases, when I invited a staff member to be interviewed, their first question was „how long does it take?‟ And when I confirmed it would be less than one hour they all seemed reassured, which in turn made me feel confident about my decision of the duration of the interview. This is important both for the interviewer and interviewee, because if the interview is too long it might affect the quality and value of the process.

As a sojourner to English culture, I was also mindful of some misunderstandings which could occur in interpreting language and non verbal expressions. Some verbal as well as non-verbal explanations can have different meanings to those from my own culture and what I have learned through the past few years in England. As Denzin and Lincoln (1994:80) explain:

The interview is a conversation, the art of asking questions and listening. It is not a neutral tool, for the interviewer creates the reality of the interview situation. In this situation answers are given. Thus the interview produces situated understandings grounded in specific interactional episodes. This method is influenced by the personal characteristics of the interviewer, including race, class, ethnicity and gender.

The above point was crucial in interviewing both staff members and service users, as they were from different ethnic, cultural, religious and employment back grounds to

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mine. Hence, I always explained my back ground to the interviewees at the beginning of the interviews. This initial explanation helped me to avoid some of the difficult situations I might have faced during the interview, such as understanding the slang, colloquial language and some non verbal expressions (like nodding the head which means „yes‟ in some cultures and „no‟ in others). Also the interviewees got the opportunity to stop me and ask any questions if my questions were unclear. Fortunately, none of the interviewees found my accent difficult to understand and all the interviews ran very smoothly. There were some instances where I found it difficult to understand some terms and, in almost all these cases, I asked them to explain it to me in easier terms. This worked very well throughout the research period, however when it came to transcribing I still found some difficult places where I had to ask for the help of an English friend to explain the terms to me. This was done without revealing the interviewee‟s names, the team‟s name or their position with the team, so that there were no concerns about confidentiality.

Flexibility in interviews

In the literature on qualitative interviewing, there is much greater interest in interviewer‟s point of view. As Bryman (2004:320) describes one advantage of qualitative interviewing is the flexibility of the schedule.

In qualitative interviewing, interviewers can depart significantly from any schedule or guide that is being used. They can ask new questions that follow up interviewer‟s replies and can vary the order of questions and even the wording of questions. As a result qualitative interviewing tends to be flexible, responding to the direction in which interviewee take the interview and perhaps adjusting the emphases in the research as a result of significant issues that emerge in the course of interviews.

A very good example of this is how one staff member described the stigma attached to the social workers as “nurses are seen as angels and social workers are seen as child catchers” (CPN 2). This statement helped me in the later interviews to discuss the possible stigma attached to the social workers with other staff members. The literature describes how not having a set of relatively rigid questions had been very helpful for qualitative researchers throughout the past. As an example of this Beardsworth and Keil (1992:261-262), cited by Bryman (2004:321), explain how this has been helpful in their research on vegetarianism where they carried out 73 relatively unstructured interviews.

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The interview programme was not based upon a set of relatively rigid pre- determined questions and prompts. Rather the open ended, discursive nature of the interviews permitted an iterative process of refinement, whereby lines of thought identified by earlier interviewees could be taken up and presented to later interviewees.

As the research progressed, through frequent observation and what I already learned from the interviews, I was more aware of the functioning of the teams and the roles of the staff members. This helped me to slightly change my interview guides with social work professionlas and other mental health professionals and develop later interviews with them, to explore the concept of integrated teams and issues with the new MHA. Some data collected from the earlier interviews was also used in moderating the questions. As Fetterman (2010:39) explains this process “slowly but surely, the questions become more refined as the researcher learns what questions to ask and how to ask them”.

Through meeting and greeting the staff members during my stay with the teams, I understood that as any other individuals, the team members have different perspectives and their own values. My growing familiarity with the team members helped me in using different approaches for each interviewee. For example, there were staff members who were extremely helpful and greeted me personally whenever they saw me and insisted that I asked them for any help I needed. When interviewing these staff members, I had more opportunity to explore some areas that I felt less clear about and felt free to ask any questions I had. Another tactic was listening to the interviewees‟ more interesting personal accounts of their experiences, sometimes after the interview or while travelling with them, to and from home visits.

Overcoming the Disadvantages of Qualitative Interviews

As Schwartzman (1993:58) explains a disadvantage of ethnographic interviewing can be the interviewer trying to interpret in his or her own terms what is said by the interviewees. “The ethnographic interviewer should avoid translating what an informant says into the researcher‟s own theories or terms, or telling the informant what he or she is feeling or experiencing, or interrupting an informant during his or her response to a question” (Schwartzman, 1993:58). I took this advice into consideration throughout the fieldwork process and always used it as a guide to

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leading the interviews without being biased and interrupting the interviewees in any way.

The Overall Progress with the Interviews

Using the sampling techniques (described in 4.2.2.3), by the end of my field work I had interviewed 24 staff members from both teams. I managed to interview almost all the social workers within the two teams, which is seven in number, except for two social workers who cancelled the appointments without any information and another social worker who joined the team during the last few days of my field work. All the three AMHPs with the two teams were interviewed, including one of those AMHPs working as an Expert Practitioner as well. I also managed to interview seven CPNs, (including one of those working as an Advanced Practitioner and another one

working as a Nurse Consultant), and two OTs working as care coordinators (one OT is also a Day Services Manager), who were all from health service. The interview sample also included a team manager, a consultant psychiatrist, a clinical

psychologist, a support worker and a link worker, all NHS employees (see table 4.3).

I faced many constraints in finding service users for the interviews, as described earlier. However by the end of my fieldwork, I managed to interview two service users. These two service users are very important in this study as they both have had CPNs as their care coordinators previously and now have AMHPs as their care coordinators. This provided me with an excellent opportunity to explore the similarities and differences between social work professionals and CPNs as care coordinators, from the perspectives of service users. Their participation also provided me with the opportunity to clarify and develop a thorough understanding to the data I collected on the roles and responsibilities of AMHPs, through interviewing and observing the AMHPs. It was valuable to hear about social work professionals‟ contribution from this very different perspective.

Finally, it is worth mentioning here, that all these interviews gave me a very rich understanding of different perspectives of the social work professionals‟ roles in the multi disciplinary mental health teams.

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