This study adopted a qualitative approach, using individual, semi structured interviews with patients and clinicians, non-participant observations and video-recorded consultations. As the impact on patients of viewing their own 3D images within clinical consultations is relatively unknown, with little prior research exploring this practice to date, an exploratory study was required. Qualitative data collection methods such as interviews and observations are widely used in exploratory research (Bryman, 2012).
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Interviewing patients and clinicians provided two accounts of the consultation allowing insight from both parties participating in the interaction. Consultations were also observed by the researcher and video-recorded. Data collected from the video-recordings enabled confirmation of some of the themes raised by patients and clinicians at interview. Data collected through the non-participant observations was used to inform the interviews. Using different data sources enabled triangulation of data and increased confidence in the conclusions drawn from the data (Flick, 2004).
The rationale for selecting each method will now be discussed in turn starting with non- participant observation, followed by interviews and then video-recordings.
3.3.1. Non-participant observation
Non-participant observation, an ethnographic method, is used to understand “the social meaning and activities of people in a given field or setting” (Brewer, 2000, p.11). Behaviours and interactions are observed within naturally occurring settings which allows the research to understand how the field is experienced (Murchison, 2010). Non-participant observation can allow access to details that those within the field may not find noteworthy or that those within the field may be unaware of (Gobo, 2008). Non-participant observation can also overcome what Mays and Pope (1995) describe as “the discrepancy between what people say and what they actually do” (Mays & Pope, 1995, p.183). Individual accounts of their own behaviour are often inherently biased with individuals wishing to present themselves in the best possible light. In this study for example, clinicians may believe that the researcher considers sharing medical images with patients to be good practice, which could lead to them exaggerating their use of medical images at interview. Observing consultations, in contrast, allows the researcher to learn exactly how and to what extent images are used in the consultation. Furthermore, unlike other data collection methods, such as interviews,
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observation is not reliant on participants’ memory of an event and could therefore capture more details than participants are able to recall (Mays & Pope, 1995).
Non-participant observation allowed understanding of how 3D images are used within the consultations and informed interviews. During the consultation, observation notes were made. They focused on: how and when the images were used; the patients’ initial reaction to viewing the image and their subsequent behaviour and language and how the clinician spoke about the image. This provided access to details that patients and clinicians might have been unaware. All but one of the consultations were observed and so the interviews commenced with the shared knowledge that the researcher was present. This allowed questions to be tailored to ensure they were relevant. Non-participant observation also allowed the researcher to begin developing a rapport with the participants as they became more familiar with the researcher before their interview.
3.3.2. Interviews
Qualitative interviews are used to gain an in depth understanding of the interviewee’s perspective on a phenomenon of interest as they allow the interviewee to talk freely without their ideas being confined (Fontana & Frey, 2008). They are widely used in exploratory research. As little is known about patients’ experience of viewing their own 3D images an exploratory study is required, where interviewees have the opportunity to describe their experience using their own words as opposed to fitting their ideas into predefined categories. Face to face, semi-structured, individual interviews were deemed most appropriate for this study.
Face to face interviews were sought, where possible, as they can help the interviewer build rapport with interviewees. They can also allow the interviewer to view facial expressions and gestures that may reveal further information about the interviewees’ experience (Bryman, 2012). A final benefit of face to face interviewing is the ability for the interviewer to detect
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signs of the interviewee becoming distressed more easily (Bryman, 2012). As this research is exploring a relatively sensitive topic, this is important and will allow the researcher to adapt the questions or offer more reassurance or comfort to the interviewee.
Semi-structured interviews were selected as the most appropriate method of interviewing for this study to ensure that the research questions were addressed within the interview and to allow flexibility to explore issues raised by the interviewees. During semi-structured interviews, the researcher asks open-ended questions to gain a rich insight into interviewees’ experience and opinions (Bryman, 2012). In semi-structured interviews an interview guide, which contains a brief list of specific topics to be covered reflecting the research questions, is used (Fontana & Frey, 2008). Semi-structured interview guides are flexible; the structure can be altered if required and additional questions can be added in response to the interviewee’s views. This allows exploration of ideas which participants find particularly meaningful (Fontana & Frey, 2008). Furthermore, in order to address all of the research questions in this study, several questions may need to be asked. It is unlikely that the response to one or two broad questions will sufficiently answer all of the research questions. The researcher will also be eager to gain an understanding of other ways that the interviewee feels 3D images impact upon them, either positively or negatively, that had not been foreseen and hence not included in the interview questions.
Individual interviews were selected over group interviews due to the nature of the topic to be discussed at interview. This research is seeking to understand the interviewee’s individual account of their experience of viewing their own 3D images and therefore a group interview may not provide true accounts of each individual’s experience. Participants of group interviews may be led by others within in the group (Bryman, 2012). They may also feel uncomfortable presenting opinions that differ from those of the other participants. Additionally, there could be an increased risk of distress to interviewees when conducting a
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group interview as the individual interviewee will not be able to control the direction of the conversation and focus on areas that are most relevant to them (Bryman, 2012). An area that is particularly important to one interviewee may be greatly distressing or of little relevance to others. Conducting individual interviews allows the researcher to follow the direction that is most appropriate for the individual interviewee’s experience.
3.3.3. Video-recording
Video-recordings are increasingly used to investigate clinical communication. They can reveal detail and important insight into clinical practice that could be difficult to access using other research methods (Parry et al., 2016). Video-recording a phenomena of interest, in this case clinical consultations, may also remove some of the bias that are introduced by the observer during non-participant observation (Mays & Pope, 1995). During observations researchers aim to record exactly what happens, however it is not possible to capture everything that occurs in the setting (Mays & Pope, 1995). The researcher’s own thoughts and responses to what they observe can influence the aspects deemed most salient or the way in which the aspects of the phenomena are perceived, potentially introducing bias to the data. Video-recording consultations can also result in a more complete data set as note- taking during or after observations can result in some data being missed. If the researcher records their notes after observation their memory may be impaired, but the researcher could miss important aspects of the interaction if notes are made during it (Corbetta, 2003). For this study, consultations were video-recorded for several reasons. Video-recorded consultations were analysed using the themes that emerged from the interview data, allowing confirmation of conclusions drawn from the interview data. Video-recordings allowed understanding of how images were integrated within the consultations and how patients responded to their images during their consultation. Points raised during the interviews were also clarified, when required, by re-watching the consultations. Data
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collected from the video-recorded consultations were also used in study two (as presented in Chapter Four).