Stage Two Semi-Structured Interviews

Twenty semi-structured interviews with people with type 2 diabetes were conducted in Stage Two. Each interview lasted for approximately 45 to 60 minutes. All interviews were conducted at a time and place of the participants’ choosing (see Appendix 4 for interview schedule). Thirteen interviews were conducted at a hospital, 4 interviews at their GP surgery, and 3 interviews were conducted at a screening centre. All people with diabetes were English speaking and were able to be interviewed in English language as per their preference. A participant information pack which included an invitation letter,

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consent form and participant information sheet were provided by the gatekeepers, either at participants’’ regular visit to their GPs, screening centre or sent out by post or email. Consent forms were signed and dated by participants before they entered the study. Consent forms were then sent to the researcher in a prepaid envelops. One copy of this was be kept by the participant and second copy was kept by the researcher.

The researcher started each interview by greeting the participant and summarizing the purpose of Stage Two. The researcher also spent time addressing participants’ questions to ensure that they understood the information in the participant information sheet and their involvement in the study. Although written consent had been obtained at an earlier date and participants had appropriate time to consider participation, informed consent was gained again to conduct the interview and to audio-record it. Participants were reminded of their right to leave the study at any time without giving reason or it is affecting their treatment. Interviews in Stage Two of the study asked participants to appraise the new risk communication tool. The aim of this stage was to appraise the risk tool (Figure 5.7) and provide risk information about modifiable risk factors associated diabetic retinopathy. Details about the development process of the risk communication tool is discussed in section 7.2.

Various subjects were explored during Stage Two interviews (see Appendix 4). These included their views of the new risk communication tool, perception of risk, the influence of the new tool on diabetes self-care management, and its impact on anxiety level. However, in order to avoid inducing anxiety to people with diabetes, perception of risk was explored using hypothetical blood sugar readings. For example, participants were asked how they perceived the risk of diabetic retinopathy if someone’s HbA1c was in the green zone (HbA1c below 7%), in the amber zone (HbA1c between 7% and 9%), or in the red zone (HbA1c 9% or above) as shown in the Figure 5.6. This information also was used to explore the relationship between perception of risk and its impact on diabetes self-care management and on anxiety level. However, a few of the people with diabetes had performed the self-risk assessment by using their actual HbA1c results. This self-risk assessment was followed by questions about diabetes self-care management. People with diabetes were asked how they would

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respond to a different HbA1c results in order to explore the potential impact of the risk tool on diabetes self-care management and on anxiety level or distress. Background data about people with diabetes, their families and their settings was also collected during the interview to provide a fuller understanding of their lives and to facilitate the discussion about the new tool. Data was also collected from participants to identify what kind of risk information should be presented when communicating risk information about diabetic retinopathy to people with diabetes.

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In Stage Two of the study, the researcher also had the opportunity to ask questions that arose after the data analysis of Stage One, particularly about risk perception, anxiety, and risk communication, which enabled the researcher to fill certain gaps in understanding and to strengthen the analytic categories. Along with the predefined interview questions, the researcher was also keen for people with diabetes to suggest areas that they regarded as pertinent and significant to the research subject. The researcher was open to the idea of including these within subsequent interviews. In addition to the semi-structured interviews, field notes were again collected relating to patient’s reactions and facial expressions during the interviews particularly when they performed self- risk assessment and when the idea of extending the diabetic retinopathy screening intervals was discussed. In addition to the semi-structured interviews, field notes (Glaser, 2001) were again collected such as patient’s reactions to the new risk tool, understanding of different level of risk, facial expressions during the interviews particularly when the people were discussing their own risk. At this stage, the researcher found it easier to write field notes during the interview than was the case during Stage One. The researcher became more confident asking the interview questions, writing field notes at the same time, and keeping the interview informal and conversational (Charmaz, 2006).

The researcher was constantly focused and aware of the research questions by asking questions to appraise the new risk tool. The researcher used different techniques to encourage the participants to talk more about the new risk tool (Charmaz, 2006) starting with simple questions, such as have you used a risk communication tool before? And then asking for details using open-ended such as, Tell me about your experience with the risk communication tool? The people with diabetes were also asked to explain how the tool can impact on their diabetes self-care management.

Writing a case summary as soon as possible after each interview was completed was also a feature of Stage Two (Charmaz, 2006). As with the interviews in Stage One, this started with the fundamentals of the interview; what made it interesting, and also spotting what was unusual or strange about the case (what was frequent and what was different from others?) This helped the researcher to get some initial ideas and thoughts (Charmaz, 2006).

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