semi structured interviews for qualitative research

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The use of semi-structured interviews in qualitative research: strengths and weaknesses

What needs to be considered before collecting data through semi-structured interviews? How does thinking about analysis before questioning help or hinder interviewing practice? How should the strengths and weaknesses of the method be evaluated? To cite this paper: Newton, Nigel (2010) The use of semi-structured interviews in qualitative research: strengths and weaknesses. Paper submitted in part completion of the requirements of the degree of Doctor of Philosophy, University of Bristol. Retrieved online at http://www.academia.edu/1561689/The_use_of_semi-structured_interviews_in_qualitative_research_strengths_and_weaknesses on [date accessed]

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Buckley and Chiang define research methodology as “a strategy or architectural design by which the researcher maps out an approach to problem-finding or problem-solving.”[ 1 ] According to Crotty, research methodology is a comprehensive strategy ‘that silhouettes our choice and use of specific methods relating them to the anticipated outcomes,[ 2 ] but the choice of research methodology is based upon the type and features of the research problem.[ 3 ] According to Johnson et al . mixed method research is “a class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, theories and or language into a single study.[ 4 ] In order to have diverse opinions and views, qualitative findings need to be supplemented with quantitative results.[ 5 ] Therefore, these research methodologies are considered to be complementary to each other rather than incompatible to each other.[ 6 ]

Qualitative research methodology is considered to be suitable when the researcher or the investigator either investigates new field of study or intends to ascertain and theorize prominent issues.[ 6 , 7 ] There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation.[ 7 ]

Interviewing

This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[ 8 ] As no research interview lacks structure[ 9 ] most of the qualitative research interviews are either semi-structured, lightly structured or in-depth.[ 9 ] Unstructured interviews are generally suggested in conducting long-term field work and allow respondents to let them express in their own ways and pace, with minimal hold on respondents’ responses.[ 10 ]

Pioneers of ethnography developed the use of unstructured interviews with local key informants that is., by collecting the data through observation and record field notes as well as to involve themselves with study participants. To be precise, unstructured interview resembles a conversation more than an interview and is always thought to be a “controlled conversation,” which is skewed towards the interests of the interviewer.[ 11 ] Non-directive interviews, form of unstructured interviews are aimed to gather in-depth information and usually do not have pre-planned set of questions.[ 11 ] Another type of the unstructured interview is the focused interview in which the interviewer is well aware of the respondent and in times of deviating away from the main issue the interviewer generally refocuses the respondent towards key subject.[ 11 ] Another type of the unstructured interview is an informal, conversational interview, based on unplanned set of questions that are generated instantaneously during the interview.[ 11 ]

In contrast, semi-structured interviews are those in-depth interviews where the respondents have to answer preset open-ended questions and thus are widely employed by different healthcare professionals in their research. Semi-structured, in-depth interviews are utilized extensively as interviewing format possibly with an individual or sometimes even with a group.[ 6 ] These types of interviews are conducted once only, with an individual or with a group and generally cover the duration of 30 min to more than an hour.[ 12 ] Semi-structured interviews are based on semi-structured interview guide, which is a schematic presentation of questions or topics and need to be explored by the interviewer.[ 12 ] To achieve optimum use of interview time, interview guides serve the useful purpose of exploring many respondents more systematically and comprehensively as well as to keep the interview focused on the desired line of action.[ 12 ] The questions in the interview guide comprise of the core question and many associated questions related to the central question, which in turn, improve further through pilot testing of the interview guide.[ 7 ] In order to have the interview data captured more effectively, recording of the interviews is considered an appropriate choice but sometimes a matter of controversy among the researcher and the respondent. Hand written notes during the interview are relatively unreliable, and the researcher might miss some key points. The recording of the interview makes it easier for the researcher to focus on the interview content and the verbal prompts and thus enables the transcriptionist to generate “verbatim transcript” of the interview.

Similarly, in focus groups, invited groups of people are interviewed in a discussion setting in the presence of the session moderator and generally these discussions last for 90 min.[ 7 ] Like every research technique having its own merits and demerits, group discussions have some intrinsic worth of expressing the opinions openly by the participants. On the contrary in these types of discussion settings, limited issues can be focused, and this may lead to the generation of fewer initiatives and suggestions about research topic.

Observation

Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.[ 11 ]

Research can be visualized and perceived as painstaking methodical efforts to examine, investigate as well as restructure the realities, theories and applications. Research methods reflect the approach to tackling the research problem. Depending upon the need, research method could be either an amalgam of both qualitative and quantitative or qualitative or quantitative independently. By adopting qualitative methodology, a prospective researcher is going to fine-tune the pre-conceived notions as well as extrapolate the thought process, analyzing and estimating the issues from an in-depth perspective. This could be carried out by one-to-one interviews or as issue-directed discussions. Observational methods are, sometimes, supplemental means for corroborating research findings.

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http://orcid.org/0000-0002-2660-3358 Melissa DeJonckheere 1 and
Lisa M Vaughn 2 , 3
1 Department of Family Medicine , University of Michigan , Ann Arbor , Michigan , USA
2 Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
3 Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
Correspondence to Dr Melissa DeJonckheere; mdejonck{at}med.umich.edu

Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.

qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/fmch-2018-000057

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Introduction

Semistructured interviews can be used by family medicine researchers in clinical settings or academic settings even with few resources. In contrast to large-scale epidemiological studies, or even surveys, a family medicine researcher can conduct a highly meaningful project with interviews with as few as 8–12 participants. For example, Chang and her colleagues, all family physicians, conducted semistructured interviews with 10 providers to understand their perspectives on weight gain in pregnant patients. 1 The interviewers asked questions about providers’ overall perceptions on weight gain, their clinical approach to weight gain during pregnancy and challenges when managing weight gain among pregnant patients. Additional examples conducted by or with family physicians or in primary care settings are summarised in table 1 . 1–6

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Examples of research articles using semistructured interviews in primary care research

From our perspective as seasoned qualitative researchers, conducting effective semistructured interviews requires: (1) a relational focus, including active engagement and curiosity, and (2) practice in the skills of interviewing. First, a relational focus emphasises the unique relationship between interviewer and interviewee. To obtain quality data, interviews should not be conducted with a transactional question-answer approach but rather should be unfolding, iterative interactions between the interviewer and interviewee. Second, interview skills can be learnt. Some of us will naturally be more comfortable and skilful at conducting interviews but all aspects of interviews are learnable and through practice and feedback will improve. Throughout this article, we highlight strategies to balance relationship and rigour when conducting semistructured interviews in primary care and the healthcare setting.

Qualitative research interviews are ‘attempts to understand the world from the subjects’ point of view, to unfold the meaning of peoples’ experiences, to uncover their lived world prior to scientific explanations’ (p 1). 7 Qualitative research interviews unfold as an interviewer asks questions of the interviewee in order to gather subjective information about a particular topic or experience. Though the definitions and purposes of qualitative research interviews vary slightly in the literature, there is common emphasis on the experiences of interviewees and the ways in which the interviewee perceives the world (see table 2 for summary of definitions from seminal texts).

Definitions of qualitative interviews

The most common type of interview used in qualitative research and the healthcare context is semistructured interview. 8 Figure 1 highlights the key features of this data collection method, which is guided by a list of topics or questions with follow-up questions, probes and comments. Typically, the sequencing and wording of the questions are modified by the interviewer to best fit the interviewee and interview context. Semistructured interviews can be conducted in multiple ways (ie, face to face, telephone, text/email, individual, group, brief, in-depth), each of which have advantages and disadvantages. We will focus on the most common form of semistructured interviews within qualitative research—individual, face-to-face, in-depth interviews.

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Key characteristics of semistructured interviews.

Purpose of semistructured interviews

The overall purpose of using semistructured interviews for data collection is to gather information from key informants who have personal experiences, attitudes, perceptions and beliefs related to the topic of interest. Researchers can use semistructured interviews to collect new, exploratory data related to a research topic, triangulate other data sources or validate findings through member checking (respondent feedback about research results). 9 If using a mixed methods approach, semistructured interviews can also be used in a qualitative phase to explore new concepts to generate hypotheses or explain results from a quantitative phase that tests hypotheses. Semistructured interviews are an effective method for data collection when the researcher wants: (1) to collect qualitative, open-ended data; (2) to explore participant thoughts, feelings and beliefs about a particular topic; and (3) to delve deeply into personal and sometimes sensitive issues.

Designing and conducting semistructured interviews

In the following section, we provide recommendations for the steps required to carefully design and conduct semistructured interviews with emphasis on applications in family medicine and primary care research (see table 3 ).

Steps to designing and conducting semistructured interviews

Steps for designing and conducting semistructured interviews

Step 1: determining the purpose and scope of the study.

The purpose of the study is the primary objective of your project and may be based on an anecdotal experience, a review of the literature or previous research finding. The purpose is developed in response to an identified gap or problem that needs to be addressed.

Research questions are the driving force of a study because they are associated with every other aspect of the design. They should be succinct and clearly indicate that you are using a qualitative approach. Qualitative research questions typically start with ‘What’, ‘How’ or ‘Why’ and focus on the exploration of a single concept based on participant perspectives. 10

Step 2: identifying participants

After deciding on the purpose of the study and research question(s), the next step is to determine who will provide the best information to answer the research question. Good interviewees are those who are available, willing to be interviewed and have lived experiences and knowledge about the topic of interest. 11 12 Working with gatekeepers or informants to get access to potential participants can be extremely helpful as they are trusted sources that control access to the target sample.

Sampling strategies are influenced by the research question and the purpose of the study. Unlike quantitative studies, statistical representativeness is not the goal of qualitative research. There is no calculation of statistical power and the goal is not a large sample size. Instead, qualitative approaches seek an in-depth and detailed understanding and typically use purposeful sampling. See the study of Hatch for a summary of various types of purposeful sampling that can be used for interview studies. 12

‘How many participants are needed?’ The most common answer is, ‘it depends’—it depends on the purpose of the study, what kind of study is planned and what questions the study is trying to answer. 12–14 One common standard in qualitative sample sizes is reaching thematic saturation, which refers to the point at which no new thematic information is gathered from participants. Malterud and colleagues discuss the concept of information power , or a qualitative equivalent to statistical power, to determine how many interviews should be collected in a study. They suggest that the size of a sample should depend on the aim, homogeneity of the sample, theory, interview quality and analytic strategy. 14

Step 3: considering ethical issues

An ethical attitude should be present from the very beginning of the research project even before you decide who to interview. 15 This ethical attitude should incorporate respect, sensitivity and tact towards participants throughout the research process. Because semistructured interviewing often requires the participant to reveal sensitive and personal information directly to the interviewer, it is important to consider the power imbalance between the researcher and the participant. In healthcare settings, the interviewer or researcher may be a part of the patient’s healthcare team or have contact with the healthcare team. The researchers should ensure the interviewee that their participation and answers will not influence the care they receive or their relationship with their providers. Other issues to consider include: reducing the risk of harm; protecting the interviewee’s information; adequately informing interviewees about the study purpose and format; and reducing the risk of exploitation. 10

Step 4: planning logistical aspects

Careful planning particularly around the technical aspects of interviews can be the difference between a great interview and a not so great interview. During the preparation phase, the researcher will need to plan and make decisions about the best ways to contact potential interviewees, obtain informed consent, arrange interview times and locations convenient for both participant and researcher, and test recording equipment. Although many experienced researchers have found themselves conducting interviews in less than ideal locations, the interview location should avoid (or at least minimise) interruptions and be appropriate for the interview (quiet, private and able to get a clear recording). 16 For some research projects, the participants’ homes may make sense as the best interview location. 16

Initial contacts can be made through telephone or email and followed up with more details so the individual can make an informed decision about whether they wish to be interviewed. Potential participants should know what to expect in terms of length of time, purpose of the study, why they have been selected and who will be there. In addition, participants should be informed that they can refuse to answer questions or can withdraw from the study at any time, including during the interview itself.

Audio recording the interview is recommended so that the interviewer can concentrate on the interview and build rapport rather than being distracted with extensive note taking 16 (see table 4 for audio-recording tips). Participants should be informed that audio recording is used for data collection and that they can refuse to be audio recorded should they prefer.

Suggestions for successful audio recording of interviews

Most researchers will want to have interviews transcribed verbatim from the audio recording. This allows you to refer to the exact words of participants during the analysis. Although it is possible to conduct analyses from the audio recordings themselves or from notes, it is not ideal. However, transcription can be extremely time consuming and, if not done yourself, can be costly.

In the planning phase of research, you will want to consider whether qualitative research software (eg, NVivo, ATLAS.ti, MAXQDA, Dedoose, and so on) will be used to assist with organising, managing and analysis. While these tools are helpful in the management of qualitative data, it is important to consider your research budget, the cost of the software and the learning curve associated with using a new system.

Step 5: developing the interview guide

Semistructured interviews include a short list of ‘guiding’ questions that are supplemented by follow-up and probing questions that are dependent on the interviewee’s responses. 8 17 All questions should be open ended, neutral, clear and avoid leading language. In addition, questions should use familiar language and avoid jargon.

Most interviews will start with an easy, context-setting question before moving to more difficult or in-depth questions. 17 Table 5 gives details of the types of guiding questions including ‘grand tour’ questions, 18 core questions and planned and unplanned follow-up questions.

Questions and prompts in semistructured interviewing

To illustrate, online supplementary appendix A presents a sample interview guide from our study of weight gain during pregnancy among young women. We start with the prompt, ‘Tell me about how your pregnancy has been so far’ to initiate conversation about their thoughts and feelings during pregnancy. The subsequent questions will elicit responses to help answer our research question about young women’s perspectives related to weight gain during pregnancy.

Supplemental material

After developing the guiding questions, it is important to pilot test the interview. Having a good sense of the guide helps you to pace the interview (and not run out of time), use a conversational tone and make necessary adjustments to the questions.

Like all qualitative research, interviewing is iterative in nature—data collection and analysis occur simultaneously, which may result in changes to the guiding questions as the study progresses. Questions that are not effective may be replaced with other questions and additional probes can be added to explore new topics that are introduced by participants in previous interviews. 10

Step 6: establishing trust and rapport

Interviews are a special form of relationship, where the interviewer and interviewee converse about important and often personal topics. The interviewer must build rapport quickly by listening attentively and respectfully to the information shared by the interviewee. 19 As the interview progresses, the interviewer must continue to demonstrate respect, encourage the interviewee to share their perspectives and acknowledge the sensitive nature of the conversation. 20

To establish rapport, it is important to be authentic and open to the interviewee’s point of view. It is possible that the participants you recruit for your study will have preconceived notions about research, which may include mistrust. As a result, it is important to describe why you are conducting the research and how their participation is meaningful. In an interview relationship, the interviewee is the expert and should be treated as such—you are relying on the interviewee to enhance your understanding and add to your research. Small behaviours that can enhance rapport include: dressing professionally but not overly formal; avoiding jargon or slang; and using a normal conversational tone. Because interviewees will be discussing their experience, having some awareness of contextual or cultural factors that may influence their perspectives may be helpful as background knowledge.

Step 7: conducting the interview

Location and set-up.

The interview should have already been scheduled at a convenient time and location for the interviewee. The location should be private, ideally with a closed door, rather than a public place. It is helpful if there is a room where you can speak privately without interruption, and where it is quiet enough to hear and audio record the interview. Within the interview space, Josselson 15 suggests an arrangement with a comfortable distance between the interviewer and interviewee with a low table in between for the recorder and any materials (consent forms, questionnaires, water, and so on).

Beginning the interview

Many interviewers start with chatting to break the ice and attempt to establish commonalities, rapport and trust. Most interviews will need to begin with a brief explanation of the research study, consent/assent procedures, rationale for talking to that particular interviewee and description of the interview format and agenda. 11 It can also be helpful if the interviewer shares a little about who they are and why they are interested in the topic. The recording equipment should have already been tested thoroughly but interviewers may want to double-check that the audio equipment is working and remind participants about the reason for recording.

Interviewer stance

During the interview, the interviewer should adopt a friendly and non-judgemental attitude. You will want to maintain a warm and conversational tone, rather than a rote, question-answer approach. It is important to recognise the potential power differential as a researcher. Conveying a sense of being in the interview together and that you as the interviewer are a person just like the interviewee can help ease any discomfort. 15

Active listening

During a face-to-face interview, there is an opportunity to observe social and non-verbal cues of the interviewee. These cues may come in the form of voice, body language, gestures and intonation, and can supplement the interviewee’s verbal response and can give clues to the interviewer about the process of the interview. 21 Listening is the key to successful interviewing. 22 Listening should be ‘attentive, empathic, nonjudgmental, listening in order to invite, and engender talk’ 15 15 (p 66). Silence, nods, smiles and utterances can also encourage further elaboration from the interviewee.

Continuing the interview

As the interview progresses, the interviewer can repeat the words used by the interviewee, use planned and unplanned follow-up questions that invite further clarification, exploration or elaboration. As DiCicco-Bloom and Crabtree 10 explain: ‘Throughout the interview, the goal of the interviewer is to encourage the interviewee to share as much information as possible, unselfconsciously and in his or her own words’ (p 317). Some interviewees are more forthcoming and will offer many details of their experiences without much probing required. Others will require prompting and follow-up to elicit sufficient detail.

As a result, follow-up questions are equally important to the core questions in a semistructured interview. Prompts encourage people to continue talking and they can elicit more details needed to understand the topic. Examples of verbal probes are repeating the participant’s words, summarising the main idea or expressing interest with verbal agreement. 8 11 See table 6 for probing techniques and example probes we have used in our own interviewing.

Probing techniques for semistructured interviews (modified from Bernard 30 )

Step 8: memoing and reflection

After an interview, it is essential for the interviewer to begin to reflect on both the process and the content of the interview. During the actual interview, it can be difficult to take notes or begin reflecting. Even if you think you will remember a particular moment, you likely will not be able to recall each moment with sufficient detail. Therefore, interviewers should always record memos —notes about what you are learning from the data. 23 24 There are different approaches to recording memos: you can reflect on several specific ideas, or create a running list of thoughts. Memos are also useful for improving the quality of subsequent interviews.

Step 9: analysing the data

The data analysis strategy should also be developed during planning stages because analysis occurs concurrently with data collection. 25 The researcher will take notes, modify the data collection procedures and write reflective memos throughout the data collection process. This begins the process of data analysis.

The data analysis strategy used in your study will depend on your research question and qualitative design—see the study of Creswell for an overview of major qualitative approaches. 26 The general process for analysing and interpreting most interviews involves reviewing the data (in the form of transcripts, audio recordings or detailed notes), applying descriptive codes to the data and condensing and categorising codes to look for patterns. 24 27 These patterns can exist within a single interview or across multiple interviews depending on the research question and design. Qualitative computer software programs can be used to help organise and manage interview data.

Step 10: demonstrating the trustworthiness of the research

Similar to validity and reliability, qualitative research can be assessed on trustworthiness. 9 28 There are several criteria used to establish trustworthiness: credibility (whether the findings accurately and fairly represent the data), transferability (whether the findings can be applied to other settings and contexts), confirmability (whether the findings are biased by the researcher) and dependability (whether the findings are consistent and sustainable over time).

Step 11: presenting findings in a paper or report

When presenting the results of interview analysis, researchers will often report themes or narratives that describe the broad range of experiences evidenced in the data. This involves providing an in-depth description of participant perspectives and being sure to include multiple perspectives. 12 In interview research, the participant words are your data. Presenting findings in a report requires the integration of quotes into a more traditional written format.

Conclusions

Though semistructured interviews are often an effective way to collect open-ended data, there are some disadvantages as well. One common problem with interviewing is that not all interviewees make great participants. 12 29 Some individuals are hard to engage in conversation or may be reluctant to share about sensitive or personal topics. Difficulty interviewing some participants can affect experienced and novice interviewers. Some common problems include not doing a good job of probing or asking for follow-up questions, failure to actively listen, not having a well-developed interview guide with open-ended questions and asking questions in an insensitive way. Outside of pitfalls during the actual interview, other problems with semistructured interviewing may be underestimating the resources required to recruit participants, interview, transcribe and analyse the data.

Despite their limitations, semistructured interviews can be a productive way to collect open-ended data from participants. In our research, we have interviewed children and adolescents about their stress experiences and coping behaviours, young women about their thoughts and behaviours during pregnancy, practitioners about the care they provide to patients and countless other key informants about health-related topics. Because the intent is to understand participant experiences, the possible research topics are endless.

Due to the close relationships family physicians have with their patients, the unique settings in which they work, and in their advocacy, semistructured interviews are an attractive approach for family medicine researchers, even if working in a setting with limited research resources. When seeking to balance both the relational focus of interviewing and the necessary rigour of research, we recommend: prioritising listening over talking; using clear language and avoiding jargon; and deeply engaging in the interview process by actively listening, expressing empathy, demonstrating openness to the participant’s worldview and thanking the participant for helping you to understand their experience.

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14 Unstructured and Semi-Structured Interviewing

Svend Brinkmann, Department of Communication & Psychology, University of Aalborg

Published: 01 July 2014
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This chapter gives an introduction to qualitative interviewing in its unstructured and semistructured forms. Initially, the human world is depicted as a conversational reality in which interviewing takes a central position as a research method. Interviewing is presented as a social practice that has a cultural history and that today appears in a variety of different formats. A number of distinctions are introduced, which are relevant when mapping the field of qualitative interviewing between different levels of structure, numbers of participants, media of interviewing, and also interviewer styles. A more detailed exposition of semistructured life world interviewing is offered because this is arguably the standard form of qualitative interviewing today.

Qualitative interviewing has today become a key method in the human and social sciences and also in many other corners of the scientific landscape from education to the health sciences. Some have even argued that interviewing has become the central resource through which the social sciences—and society—engages with the issues that concern it ( Rapley, 2001 ). For as long as we know, human beings have used conversation as a central tool to obtain knowledge about others. People talk with others in order to learn about how they experience the world, how they think, act, feel, and develop as individuals and in groups, and, in recent decades, such knowledge-producing conversations have been refined and discussed as qualitative interviews. 1

This chapter gives an overview of the landscape of qualitative interviewing, with a focus on its unstructured and semistructured forms. But what are interviews as such? In a classic text, Maccoby and Maccoby defined the interview as “a face-to-face verbal exchange, in which one person, the interviewer, attempts to elicit information or expressions of opinion or belief from another person or persons” ( Maccoby & Maccoby, 1954 , p. 449). This definition can be used as a very general starting point, but we shall soon see that different schools of qualitative interviewing have interpreted, modified, and added to such a generic characterization in many different ways.

I begin this chapter by giving an introduction to the broader conversational world of human beings in which interviewing takes place. I then provide a brief history of qualitative interviewing before introducing a number of conceptual and analytical distinctions relevant for the central epistemological and theoretical questions in the field of qualitative interviewing. Particular attention is given to the complementary positions of experience-focused interviewing (phenomenological positions) and language-focused interviewing (discourse-oriented positions).

Qualitative Interviewing in a Conversational World

Human beings are conversational creatures who live a dialogical life. Humankind is, in the words of philosopher Stephen Mulhall, “a kind of enacted conversation” ( Mulhall, 2007 , p. 58). From the earliest days of our lives, we are able to enter into proto-conversations with caregivers in ways that involve subtle forms of turn-taking and emotional communication. The dyads in which our earliest conversations occur are known to be prior to the child’s own sense of self. We are therefore communicating, and indeed conversational, creatures before we become subjective and monological ones ( Trevarthen, 1993 ).

Of course, we do learn to talk privately to ourselves and hide our emotional lives from others, but this is possible only because there was first an intersubjective communicative process with others. Our relationships with other people—and also with ourselves—are thus conversational. To understand ourselves, we must use a language that was first acquired conversationally, and we try out our interpretations in dialogue with others and the world. The human self exists only within what philosopher Charles Taylor has called “webs of interlocution” ( Taylor, 1989 , p. 36). Our very inquiring and interpreting selves are conversational at their core; they are constituted by the numerous relationships we have and have had with other people ( Brinkmann, 2012 ).

Unsurprisingly, conversations are therefore a rich and indispensable source of knowledge about personal and social aspects of our lives. In a philosophical sense, all human research is conversational because we are linguistic creatures and language is best understood in terms of the figure of conversation ( Mulhall, 2007 ). Since the late nineteenth century (in journalism) and the early twentieth century (in the social sciences), the conversational process of knowing has been conceptualized under the name of interviewing . The term itself testifies to the dialogical and interactional nature of human life. An interview is literally an inter-view , an interchange of views between two persons (or more) conversing about a theme of mutual interest ( Kvale & Brinkmann, 2008 ). Conversation in its Latin root means “dwelling with someone” or “wandering together with.” Similarly, the root meaning of dialogue is that of talk ( logos ) that goes back and forth ( dia- ) between persons ( Mannheim & Tedlock, 1995 , p. 4).

Thus conceived, the concept of conversation in the human and social sciences should be thought of in very broad terms and not just as a specific research method. Certainly, conversations in the form of interviewing have been refined into a set of techniques—to be explicated later—but they are also a mode of knowing and a fundamental ontology of persons. As philosopher Rom Harré has put it: “The primary human reality is persons in conversation” ( Harré, 1983 , p. 58). Cultures are constantly produced, reproduced, and revised in dialogues among their members ( Mannheim & Tedlock, 1995 , p. 2). Thus conceived, our everyday lives are conversational to their core. This also goes for the cultural investigation of cultural phenomena, or what we call social science. It is fruitful to see language, culture, and human self-understanding as emergent properties of conversations rather than the other way around. Dialogues are not several monologues that are added together but the basic, primordial form of associated human life. In the words of psychologist John Shotter:

[W]e live our daily social lives within an ambience of conversation, discussion, argumentation, negotiation, criticism and justification; much of it to do with problems of intelligibility and the legitimation of claims to truth. ( Shotter, 1993 , p. 29)

The pervasiveness of the figure of conversation in human life is both a burden and a blessing for qualitative interviewers. On the one hand, it means that qualitative interviewing becomes a very significant tool with which to understand central features of our conversational world. In response to widespread critiques of qualitative research that it is too subjective, one should say—given the picture of the conversational world painted here—that qualitative interviewing is, in fact, the most objective method of inquiry when one is interested in qualitative features of human experience, talk, and interaction because qualitative interviews are uniquely capable of grasping these features and thus of being adequate to their subject matters (which is one definition of objectivity).

On the other hand, it is also a burden for qualitative interviewers that they employ conversations to study a world that is already saturated with conversation. If Mulhall is right that humankind is a kind of enacted conversation, then the process of studying humans by the use of interviewing is analogous to fish wanting to study water. Fish surely “know” what water is in a practical, embodied sense, but it can be a great challenge to see and understand the obvious, that with which we are so familiar ( Brinkmann, 2012 ). In the same way, some interview researchers might think that interviewing others for research purposes is easy and simple to do because it employs a set of techniques that everyone masters by virtue of being capable of asking questions and recording the answers. This, however, is clearly an illusory simplicity, and many qualitative interviewers, even experienced ones, will recognize the frustrating experience of having conducted a large number of interviews (which is often the fun and seemingly simple part of a research project) but ending up with a huge amount of data, in the form of perhaps hundreds or even thousand pages of transcripts, and not knowing how to transform all this material into a solid, relevant, and thought-provoking analysis. Too much time is often spent on interviewing, whereas too little time is devoted to preparing for the interviews and subsequently analyzing the empirical materials. And, to continue on this note, too little time is normally used to reflect on the role of interviewing as a knowledge-producing social practice in itself. Due to its closeness to everyday conversations, interviewing, in short, is often simply taken for granted.

A further burden for today’s qualitative interviewers concerns the fact that interviewees are often almost too familiar with their role in the conversation. As Atkinson and Silverman argued some years ago, we live in an interview society , where the self is continually produced in confessional settings ranging from talk shows to research interviews ( Atkinson & Silverman, 1997 ). Because most of us, at least in the imagined hemisphere we call the West, are acquainted with interviews and their more or less standardized choreographies, qualitative interviews sometimes become a rather easy and regular affair, with few breaks and cracks in its conventions and norms, even though such breaks and cracks are often the most interesting aspects of conversational episodes ( Roulston, 2010 ; Tanggaard, 2007 ).

On the side of interviewers, Atkinson and Silverman find that “in promoting a particular view of narratives of personal experience, researchers too often recapitulate, in an uncritical fashion, features of the contemporary interview society” in which “the interview becomes a personal confessional” ( Atkinson & Silverman, 1997 , p. 305). Although the conversation in a broad sense is a human universal, qualitative interviewers often forget that the social practice of research interviewing in a narrower sense is a historically and culturally specific mode of interacting, and they too often construe “face-to-face interaction” as “the primordial, natural setting for communication,” as anthropologist Charles Briggs has pointed out ( Briggs, 2007 , p. 554).

As a consequence, the analysis of interviews is generally limited to what takes place during the concrete interaction phase with its questions and responses. In contrast to this, there is reason to believe that excellent interview research does not simply communicate a number of answers to an interviewer’s questions (with the researcher’s interpretive interjections added on), but includes an analytic focus on what Briggs has called “the larger set of practices of knowledge production that makes up the research from beginning to end” ( Briggs, 2007 , p. 566). Just as it is crucial in quantitative and experimental research to have an adequate understanding of the technologies of experimentation, it is similarly crucial in qualitative interviewing to understand the intricacies of this quite specific knowledge-producing practice, and interviewers should be particularly careful not to naturalize the form of human relationship that is a qualitative research interview and simply gloss it over as an unproblematic, direct, and universal source of knowledge. This, at least, is a basic assumption of the present chapter.

The History of Qualitative Interviewing

This takes us directly to the history of qualitative interviewing because only by tracking the history of how the current practices came to be can we fully understand their contingent natures and reflect on their roles in how we produce conversational knowledge through interviews today.

In one obvious sense, the use of conversations for knowledge-producing purposes is likely as old as human language and communication. The fact that we can pose questions to others about things that we are unknowledgeable about is a core capability of the human species. It expands our intellectual powers enormously because it enables us to share and distribute knowledge between us. Without this fundamental capability, it would be hard to imagine what human life would be like. It is furthermore a capacity that has developed into many different forms and ramifications in human societies. Already in 1924 could Emory Bogardus, an early American sociologist and founder of one of the first US sociology departments (at the University of Southern California) declare that interviewing “is as old as the human race” ( Bogardus, 1924 , p. 456). Bogardus discussed similarities and differences between the ways that physicians, lawyers, priests, journalists, detectives, social workers, and psychiatrists conduct interviews, with a remarkable sensitivity to the details of such different conversational practices.

Ancient Roots

In a more specific sense, and more essentially related to qualitative interviewing as a scientific human enterprise, conversations were used by Thucydides in ancient Greece as he interviewed participants from the Peloponnesian Wars to write the history of the wars. At roughly the same time, Socrates famously questioned—or we might say interviewed —his fellow citizens in ancient Athens and used the dialogues to develop knowledge about perennial human questions related to justice, truth, beauty, and the virtues. In recent years, some interview scholars have sought to rehabilitate a Socratic practice of interviewing, not least as an alternative to the often long monologues of phenomenological and narrative approaches to interviewing (see Dinkins, 2005 , who unites Socrates with a hermeneutic approach to dialogical knowledge) and also in an attempt to think of interviews as practices that can create a knowledgeable citizenry and not merely chart common opinions and attitudes ( Brinkmann, 2007 a ). Such varieties of interviewing have come to be known as dialogic and confrontational ( Roulston, 2010 , p. 26), and I return to these later.

Psychoanalysis

If we jump to more recent times, interviewing notably entered the human sciences with the advent of Sigmund Freud’s psychoanalysis, emerging around 1900. Freud is famous for his psychoanalytic theory of the unconscious, but it is significant that he developed this revolutionary theory (which, in many ways, changed the Western conceptions of humanity) through therapeutic conversations, or what he referred to as the talking cure . Freud conducted several hundred interviews with patients that used the patients’ free associations as a conversational engine. The therapist/interviewer should display what Freud called an “even-hovering attention” and catch on to anything that emerged as important ( Freud, 1963 ).

Freud made clear that research and treatment go hand in hand in psychoanalysis, and scholars have more recently pointed to the rich potentials of psychoanalytic conversations for qualitative interviewing today (see Kvale, 2003 ). For example, Wendy Hollway and Tony Jefferson have developed a more specific notion of the interview that is based on the psychoanalytic idea of “the defended subject” ( Hollway & Jefferson, 2000 ). In their eyes, interviewees “are motivated not to know certain aspects of themselves and... they produce biographical accounts which avoid such knowledge” (p. 169). This, obviously, has implications for how interviewers should proceed with analysis and interpretation of the biographical statements of interviewees and is a quite different approach to interviewing compared to more humanistic forms, as we shall see.

Many human and social scientists from the first half of the twentieth century were well versed in psychoanalytic theory, including those who pioneered qualitative interviewing. Jean Piaget, the famous developmental researcher, had even received training as a psychoanalyst himself, but his approach to interviewing is also worth mentioning in its own right. Piaget’s (1930) theory of child development was based on his interviews with children (often his own) in natural settings, frequently in combination with different experimental tasks. He would typically let the children talk freely about the weight and size of objects, or, in relation to his research on moral development, about different moral problems ( Piaget, 1932/1975 ), and he would notice the manner in which their thoughts unfolded.

Jumping from psychology to industrial research, Raymond Lee, one of the few historians of interviewing, has charted in detail how Piaget’s so-called clinical method of interviewing became an inspiration for Elton Mayo, who was responsible for one of the largest interview studies in history at the Hawthorne plant in Chicago in the 1920s ( Lee, 2011 ). This study arose from a need to interpret the curious results of a number of practical experiments on the effects of changes in illumination on production at the plant: it seemed that work output improved when the lighting of the production rooms was increased but also when it was decreased. This instigated an interview study, with more than 21,000 workers being interviewed for more than an hour each. The study was reported by Roethlisberger and Dickson (1939) , but it was Mayo who laid out the methodological procedures in the 1930s, including careful—and surprisingly contemporary—advice to interviewers that is worth quoting at length:

Give your whole attention to the person interviewed, and make it evident that you are doing so.

Listen—don’t talk.

Never argue; never give advice.

what he wants to say

what he does not want to say

what he cannot say without help

As you listen, plot out tentatively and for subsequent correction the pattern (personal) that is being set before you. To test this, from time to time summarize what has been said and present for comment (e.g., “is this what you are telling me?”). Always do this with the greatest caution, that is, clarify in ways that do not add or distort.

Remember that everything said must be considered a personal confidence and not divulged to anyone. ( Mayo, 1933 , p. 65)

Many approaches to and textbooks on interviewing still follow such guidelines today, often forgetting, however, the specific historical circumstances under which this practice emerged.

Nondirective Interviewing

Not just Piaget, but also the humanistic psychologist Carl Rogers had influenced Mayo and others concerned with interviewing in the first half of the twentieth century. Like Freud, Rogers developed a conversational technique that was useful both in therapeutic contexts (so-called client-centered therapy), but also in research interviews, which he referred to as the “non-directive method as a technique for social research” ( Rogers, 1945 ). As he explained, the goal of this kind of research was to sample the respondent’s attitudes toward herself: “Through the non-directive interview we have an unbiased method by which we may plumb these private thoughts and perceptions of the individual.” (p. 282). In contrast to psychoanalysis, the respondent in client-centered research (and therapy) is a client rather than a patient, and the client is the expert (and hardly a “defended subject”). Although often framed in different terms, many contemporary interview researchers conceptualize the research interview in line with Rogers’s humanistic, nondirective approach, valorizing the respondents’ private experiences, narratives, opinions, beliefs, and attitudes.

As Lee recounts, the methods of interviewing developed at Hawthorne in the 1930s aroused interest among sociologists at the University of Chicago, who made it part of their methodological repertoire ( Lee, 2011 , p. 132). Rogers himself moved to Chicago in 1945 and was involved in different interdisciplinary projects. As is well known, the so-called Chicago School of sociology was highly influential in using and promoting a range of qualitative methods, not least ethnography, and it also spawned some of the most innovative theoretical developments in the social sciences, such as symbolic interactionism (e.g., Blumer, 1969 ).

As the Rogerian nondirective approach to interviewing gained in popularity, early critiques of this technique also emerged. In the 1950s, the famous sociologist David Riesman and his colleague Mark Benney criticized it for its lack of interviewer involvement (the nondirective aspects), and they warned against the tendency to use the level of “rapport” (much emphasized by interviewers inspired by therapy) in an interview to judge its qualities concerning knowledge. They thought it was a prejudice “to assume the more rapport-filled and intimate the relation, the more ‘truth’ the respondent will vouchsafe” ( Riesman & Benney, 1956 , p. 10). In their eyes, rapport-filled interviews would often spill over with “the flow of legend and cliché” (p. 11), since interviewees are likely to adapt their responses to what they assume the interviewer expects from them (see also Lee, 2008 , for an account of Riesman’s surprisingly contemporary discussion of interviewing). Issues such as these, originally raised more than fifty years ago, continue to be pertinent and largely unresolved in today’s interview research.

Classic Studies on Authoritarianism, Sexuality, and Consumerism

The mid-twentieth century witnessed a number of other large interview studies that remain classics in the field and that have also shaped public opinion about different social issues. I mention three examples here of such influential interview studies to show the variety of themes that have been studied through interviews: on authoritarianism, sexuality, and consumerism.

After World War II, there was a pressing need to understand the roots of anti-Semitism, and The Authoritarian Personality by the well-known critical theorist Adorno and co-workers controversially traced these roots to an authoritarian upbringing ( Adorno, Frenkel-Brunswik, Levinson, & Sanford, 1950 ). Their study was based on interviews and employed a combination of open qualitative interviews and much more structured questionnaires to produce the data. Although important knowledge of societal value may have been produced, the study has nonetheless been criticized on ethical grounds for using therapeutic techniques to get around the defenses of the interviewees in order to learn about their prejudices and authoritarian personality traits ( Kvale & Brinkmann, 2008 , p. 313).

Another famous interview study from the same period was Kinsey’s Sexual Behavior in the Human Male ( Kinsey, Pomeroy, & Martin, 1948 ). The research group interviewed about 6,000 men for an hour or more about their sexual behaviors, which generated results that were shocking to the public. In addition to the fascinating results, the book contains many interesting reflections on interviewing, and the authors discuss in great detail how to put the interviewees at ease, assure privacy, and how to frame the sequencing of sensitive topics (the contributions of Adorno and Kinsey are also described in Platt, 2002 ). As Kinsey put it in the book:

The interview has become an opportunity for him [the participant] to develop his own thinking, to express to himself his disappointments and hopes, to bring into the open things that he has previously been afraid to admit to himself, to work out solutions to his difficulties. He quickly comes to realize that a full and complete confession will serve his own interests. ( Kinsey et al., 1948 , p. 42)

The movie Kinsey , from 2004, starring Liam Neeson, is worth seeing from an interviewer’s point of view because it shows these early interviewers in action.

As a third example, it can be mentioned that qualitative interviewing quickly entered market research in the course of the twentieth century, which is hardly surprising as a consumer society developed ( Brinkmann & Kvale, 2005 ). A pioneer was Ernest Dichter, whose The Strategy of Desire (1960) communicates the results of an interview study about consumer motivation for buying a car. Interestingly, Dichter describes his interview technique as a “depth interview,” inspired both by psychoanalysis and also by the nondirective approach of Rogers. Market and consumer research continue to be among the largest areas of qualitative interviewing in contemporary consumer society, particularly in the form of focus groups, and, according to one estimate, as many as 5 percent of all adults in Great Britain have taken part in focus groups for marketing purposes, which certainly lends very concrete support to the thesis that we live in an “interview society” ( Brinkmann & Kvale, 2005 ).

Contemporary Conceptions of Qualitative Interviewing

Along with the different empirical studies, academics in the Western world have produced an enormous number of books on qualitative interviewing as a method, both in the form of “how to” books, but also in the form of more theoretical discussions. Spradley’s The Ethnographic Interview (1979) and Mishler’s Research Interviewing: Context and Narrative (1986) were two important early books, the former being full of concrete advice about how to ask questions and the latter being a thorough theoretical analysis of interviews as speech events involving a joint construction of meaning.

Also following from the postmodern philosophies of social science that emerged in the 1980s (e.g., Clifford & Marcus, 1986 ; Lyotard, 1984 ), in the past couple of decades there has been a veritable creative explosion in the kinds of interviews offered to researchers (see Fontana & Prokos, 2007 ), many of which question both the idea of psychoanalysis as being able to dig out truths from the psyche of the interviewee and that the nondirective approach to interviews can be “an unbiased method,” as Rogers had originally conceived it.

Roulston (2010) makes a comprehensive list of some of the most recent postmodern varieties of interviewing and also of more traditional ones (I have here shortened and adapted Roulston’s longer list):

Neo-positivist conceptions of the interview are still widespread and emphasize how the conversation can be used to reveal “the true self” of the interviewee (or the essence of her experiences), ideally resulting in solid, trustworthy data that are only accessible through interviews if the interviewer assumes a noninterfering role.

Romantic conceptions stress that the goal of interviewing is to obtain revelations and confessions from the interviewee facilitated by intimacy and rapport. These conceptions are somewhat close to neo-positivist ones, but put much more weight on the interviewer as an active and authentic midwife who assists in “giving birth” to revelations from the interviewee’s inner psyche.

Constructionist conceptions reject the romantic idea of authenticity and favor an idea of a subject that is locally produced within the situation. Thus, the focus is on the situational practice of interviewing and a distrust toward the discourse of data as permanent “nuggets” to be “mined” by the interviewer. Instead, the interviewer is often portrayed as a “traveler” together with the interviewee, with both involved in the co-construction of whatever happens in the conversation ( Kvale & Brinkmann, 2008 ).

Postmodern and transformative conceptions stage interviews as dialogic and performative events that aim to bring new kinds of people and new worlds into being. The interview is depicted as a chance for people to get together and create new possibilities for action. Some transformative conceptions focus on potential decolonizing aspects of interviewing, seeking to subvert the colonizing tendencies that some see in standard interviewing ( Smith, 1999 ). In addition, we can mention feminist ( Reinharz & Chase, 2002 ) and collaborative forms of interviewing ( Ellis & Berger, 2003 ) that aim to practice an engaged form of interviewing that focuses more on the researchers’ experience than in standard procedures, sometimes expressed through autoethnography, an approach that seeks to unite ethnographical and autobiographical intentions ( Ellis, Adams, & Bochner, 2011 ).

It goes without saying that the overarching line of historical development laid out here, beginning in the earliest years of recorded human history and ending with postmodern, transformative, and co-constructed interviewing, is highly selective, and it could have been presented in countless other ways. I have made no attempt to divide up the history of qualitative interviewing into historical phases because I believe this would betray the criss-crossing lines of inspiration from different knowledge-producing practices. Socrates as an active interviewer inspires some of today’s constructionist and postmodern interviewers (as we shall see), whereas Freud and Rogers—as clinical interviewers—in different ways became important to people who use interviewing for purposes related to marketing and the industry. Thus, it seems that the only general rule is that no approach is never completely left behind and that everything can be—and often is—recycled in new clothes. This should not surprise us, because the richness and historical variability of the human conversational world demand that researchers use different conversational means of knowledge production for different purposes.

An Example of Qualitative Interviewing

Before moving on, here I introduce an example of what a typical qualitative interview may look like, taken from my own research, to illustrate more concretely what we are talking about when we use the term “qualitative interviewing.”

The following excerpt is from an interview I conducted about ten years ago. It was part of a research project in which I studied ethical dilemmas and moral reasoning in psychotherapeutic practice. The project was exploratory and sought an understanding of clinical psychologists’ own experiences of ethical problems in their work. The excerpt in Box 14.1 is not meant to represent an ideal interview, but rather to illustrate a common choreography that is inherent in much qualitative interviewing across the different varieties.

These few exchanges of questions and answers follow a certain conversational flow common in qualitative interviews. This flow can be divided into (1) question , (2) negotiation of meaning concerning the question raised and the themes addressed, (3) concrete description from the interviewee, (4) the interviewer’s interpretation of the description, and (5) coda . Then the cycle can start over with a new question, or else—as in this case—further questions about the same description can be posed.

The sequence begins when I pose a question (1) that calls for a concrete description, a question that seems to make sense to the interviewee. However, she cannot immediately think of or articulate an episode, and she expresses doubt concerning the meaning of one of the central concepts of the opening question (an “ethical dilemma”). This happens very often, and it can be quite difficult for interviewees (as for all of us) to describe concretely what one has experienced; we often resort to speaking in general terms (this characterizes professionals in particular, who have many general scripts at their disposal to articulate). There is some negotiation and attunement between us (2), before she decides to talk about a specific situation, but even though this is interesting and well described by the interviewee (3), she ends by returning (in what I call the coda) to a doubt about the appropriateness of the example. Before this, I summarize and rephrase her description (4), which she validates before she herself provides a kind of evaluation (5). After this, I have a number of follow-up questions that ask the interviewee to tell me more about the situation before a new question is introduced, and a similar conversational flow begins again.

The uncertainty of the interviewee about her own example around (2) illustrates the importance of assuring the interviewee that he or she is the expert concerning personal experience. The interviewer should make clear that, in general, there are no right or wrong answers or examples in qualitative interviewing and that the interviewer is interested in anything the interviewee comes up with. It is very common to find that participants are eager to be “good interviewees,” wanting to give the researcher something valuable, and this can paradoxically block the production of interesting stories and descriptions (although it did not in the present case).

In this case, a key point of the study became the term “ethical dilemma” itself; a term that is currently a nodal point in a huge number of different discourses with many different meanings, and it was thus interesting to hear the respondents’ immediate understandings of the term. Their widespread uncertainty concerning the referents of the term (which was shared by the interviewer!) was not only understandable, but actually conducive to developing my ideas further about (professional) ethics as something occurring in a zone of doubt rather than certainty (as otherwise stressed by some of the standard procedural approaches to ethics).

At the time of the interview, the interviewee was in her early fifties and had been a practicing psychologist for about twenty-five years. The interview was conducted in Danish, and I have translated it into English myself.

After some introductory remarks and an initial briefing, I, the interviewer (SB), go straight to a question that I had prepared in advance and ask the interviewee (IE) for a description of a concrete ethical dilemma (the numbers in square brackets refer to elements of the conversation that are addressed in the text):

SB: ( 1 ) First, I’d like to ask you to think back and describe a situation from your work as a psychologist in which you experienced an ethical dilemma... or a situation that in some way demanded special ethical considerations from you. IE: ( 2 ) Actually, I believe I experience those all the time. Well... I believe that the very fact that therapeutic work with other people demands that you keep... I don’t know if it is a dilemma—that’s what you asked about, right?—well, I don’t know if it’s a dilemma, but I think I have ethical considerations all the time. Considerations about how best to treat this human being with respect are demanded all the time... with the respect that is required, and I believe that there are many ethical considerations there. Ahm... When you work therapeutically you become very personal, get very close to another human being, and I think that is something you have to bear in mind constantly: How far are you allowed to go? How much can you enter into someone else’s universe? But that is not a dilemma, is it? SB: I guess it can be. Can you think of a concrete situation in which you faced this question about how close you can go, for example? IE: ( 3 ) Yes, I can. I just had a... a woman, whose husband has a mental disorder, or he has had a severe personality disorder, so their family life is much affected by this. And she comes to me to process this situation of hers, having two small children and a husband, and a system of treatment, which sometimes helps out and sometimes doesn’t. And it is very difficult for her to accept that someone close to her has a mental disorder or is fragile, it’s actually a long process. She is a nurse and family life has more or less been idyllic before he... before the personality disorder really emerged. So it is extremely difficult for her to accept that this family, which she had imagined would be the place for her children to grow up, is not going to be like that. It is actually going to be very, very different. And she tries to fight it all the time: “It just might be... if only... I guess it will be...” And it is never going to be any different! And there lies a dilemma, I think: How much is it going to be: “This is something you have to face, it is never going to be different!” So I have to work to make her pose the question herself: “What do you think? How long time... What are your thoughts? Do you think it will be different? What do they tell you at the psychiatric hospital? What is your experience?” And right now she is getting closer to seeing... I might fear that it ends in a divorce; I am not sure that she can cope with it. But no one can know this. I think there is a dilemma here, or some considerations about how much to push and press forward. SB: ( 4 ) Yes, the dilemma is perhaps that you—with your experience and knowledge about these matters—can see that the situation is not going to change much from its current state? IE: It certainly won’t. SB: And the question is... IE: ... how much I should push, for she does actually know this intellectually. ( 5 ) We have talked about it lots of times. But emotionally she hasn’t... she doesn’t have the power to face it. One day I told her: “I don’t think you develop, I don’t think anything happens to you, before you accept emotionally that he is not going to change.” I put her on the spot and she kept evading it and so on, but it...“You don’t accept it; I can tell that you don’t accept it. You understand it intellectually, but you still hope that it passes.” I pushed her a lot then. But I don’t know if this is an ethical dilemma, I am not sure...

When I first set out to conduct this study, I had something like a neo-positivist conception of interviewing in mind, in Roulston’s sense, believing that there were certain essential features connected to the experience of ethically difficult situations. When working further with the theme, and after learning from my interviewees, I gradually grew suspicious of this idea, and I also came to appreciate a more constructionist conception of interviewing, according to which the interview situation itself—including the interviewer—plays an important role in the production of talk.

Other things to note about the example in Box 14.1 include the asymmetrical distribution of talk that can be observed between the two conversationalists: the interviewer poses rather short questions, and the interviewee gives long and elaborated answers. This is not always so (some respondents are more reluctant or simply less talkative), but this asymmetry has been highlighted as a sign of quality in the literature on qualitative interviewing (e.g., Kvale & Brinkmann, 2008 ). There is also quite a bit of dramatization in the interviewee’s talk in the excerpt; for example, when she uses reported speech to stage a dialogue between herself and her client, which signals that she is capable with words and a good storyteller. On the side of the interviewer, we see that no attempts are made to contradict or question the interviewee’s account, and the part of the interview quoted here thus looks quite a bit like that recommended by Mayo in the 1930s and by later nondirective interviewers: the interviewer listens a lot and does not talk much, he does not argue or give advice, and he plots out tentatively (in [4]) what the interviewee is saying, which is commented on and verified (cf. Mayo, 1933 , p. 65).

Different Forms of Qualitative Research Interviews

The semistructured, face-to-face interview in Box 14.1 is probably very typical, but it merely represents one form an interview may take, and there is a huge variety of other forms. Each form has certain advantages and disadvantages that researchers and recipients of research alike should be aware of. I here describe how qualitative interviews may differ in terms of structure, the number of participants in each interview, different media, and also different interviewer styles.

It is common to draw a distinction between structured, semistructured, and unstructured interviews. This distinction, however, should be thought of as a continuum ranging from relatively structured to relatively unstructured formats. I use the word “relatively” because, on the one end of the continuum, as Parker (2005) argues, there really is no such thing as a completely structured interview “because people always say things that spill beyond the structure, before the interview starts and when the recorder has been turned off” (p. 53). Utterances that “spill beyond the structure” are often important and are even sometimes the key to understanding the interviewee’s answers to the structured questions. One line of criticism against standardized survey interviewing actually concerns the fact that meanings and interpretive frames that go beyond the predetermined structure are left out, with the risk that the researcher cannot understand what actually goes on in the interaction.

We might add to Parker’s argument that there is also no such thing as a completely unstructured interview because the interviewer always has an idea about what should take place in the conversation. Even some of the least structured interviews, such as life history interviews that only have one question prepared in advance (e.g., “I would like you to tell me the story of your life. Please begin as far back as you remember and include as many details as possible”), provide structure to the conversation by framing it in accordance with certain specific conversational norms rather than others. Another way to put this is to say that there are no such things as nonleading questions. All questions lead the interviewee in certain directions, but it is generally preferably to lead participants only to talk about certain themes , rather than to specific opinions about these themes.

So, it is not possible to avoid structure entirely nor would it be desirable, but it is possible to provide a structure that it flexible enough for interviewees to be able to raise questions and concerns in their own words and from their own perspectives. Anthropologist Bruno Latour has argued that this is one definition of objectivity that human and social science can work with, in the sense of “allowing the object to object” ( Latour, 2000 ). Latour pinpoints a problem in the human and social sciences related to the fact that, for these sciences and unlike in the natural sciences “nothing is more difficult than to find a way to render objects able to object to the utterances that we make about them” (p. 115). He finds that human beings behave too easily as if they had been mastered by the researcher’s agenda, which often results in trivial and predictable research that tells us nothing new. What should be done instead is to allow research participants to be “interested, active, disobedient, fully involved in what is said about themselves by others” (p. 116). This does not imply a total elimination of structure, but it demands careful preparation and reflection on how to involve interviewees actively, how to avoid flooding the conversation with social science categories, and how to provoke interviewees in a respectful way to bring contrasting perspectives to light ( Parker, 2005 , p. 63).

In spite of this caveat—that neither completely structured nor completely unstructured interviews are possible—it may still be worthwhile to distinguish between more or less structure, with semistructured interviews somewhere in the middle as the standard approach to qualitative interviewing.

Structured Interviews

Structured interviews are employed in surveys and are typically based on the same research logic as questionnaires: standardized ways of asking questions are thought to lead to answers that can be compared across participants and possibly quantified. Interviewers are supposed to “read questions exactly as worded to every respondent and are trained never to provide information beyond what is scripted in the questionnaire” ( Conrad & Schober, 2008 , p. 173). Although structured interviews are useful for some purposes, they do not take advantage of the dialogical potentials for knowledge production inherent in human conversations. They are passive recordings of people’s opinions and attitudes and often reveal more about the cultural conventions of how one should answer specific questions than about the conversational production of social life itself. I do not address these structured forms in greater detail in this chapter.

Unstructured Interviews

At the other end of the continuum lie interviews that have little preset structure. These are, for example, the life story interview seeking to highlight “the most important influences, experiences, circumstances, issues, themes, and lessons of a lifetime” ( Atkinson, 2002 , p. 125). What these aspects are for an individual cannot be known in advance but emerge in the course of spending time with the interviewee, which means that the interviewer cannot prepare for a life story interview by devising a lot of specific questions but must instead think about how to facilitate the telling of the life story. After the opening request for a narrative, the main role of the interviewer is to remain a listener, withholding desires to interrupt and sporadically asking questions that may clarify the story. The life story interview is a variant of the more general genre of narrative interviewing about which Wengraf’s (2001) Qualitative Research Interviewing gives a particularly thorough account, focusing on biographical-narrative depth interviews. These need not concern the life story as a whole, but may address other, more specific storied aspects of human lives, building on the narratological insight that humans experience and act in the world through narratives. Narratives, in this light, are a root metaphor for psychological processes ( Sarbin, 1986 ). With the more focused narrative interviews, we get nearer to semistructured interviews as the middle ground between structured and unstructured interviews.

Semistructured Interviews

Interviews in the semistructured format are sometimes equated with qualitative interviewing as such ( Warren, 2002 ). They are probably also the most widespread form of interviews in the human and social sciences and are sometimes the only format given attention to in textbooks on qualitative research (e.g., Flick, 2002 ). Compared to structured interviews, semistructured interviews can make better use of the knowledge-producing potentials of dialogues by allowing much more leeway for following up on whatever angles are deemed important by the interviewee; as well, the interviewer has a greater chance of becoming visible as a knowledge-producing participant in the process itself, rather than hiding behind a preset interview guide. And, compared to unstructured interviews, the interviewer has a greater say in focusing the conversation on issues that he or she deems important in relation to the research project.

One definition of the qualitative research interview (in a generic form, but tending toward the semistructured format) reads: “It is defined as an interview with the purpose of obtaining descriptions of the life world of the interviewee in order to interpret the meaning of the described phenomena” ( Kvale & Brinkmann, 2008 , p. 3). The key words here are purpose, descriptions, life world , and interpretation of meaning :

Purpose : Unlike everyday conversations with friends or family members, qualitative interviews are not conducted for their own sake; they are not a goal in themselves, but are staged and conducted to serve the researcher’s goal of producing knowledge (and there may be other, ulterior goals like obtaining a degree, furthering one’s career, positioning oneself in the field, etc.). All sorts of motives may play a role in the staging of interviews, and good interview reports often contain a reflexive account and a discussion of both individual and social aspects of such motives (does it matter, for example, if the interviewer is a woman, perhaps identifying as a feminist, interviewing other women?). Clearly, the fact that interviews are conversations conducted for a purpose, which sets the agenda, raises a number of issues having to do with power and control that are important to reflect on for epistemic as well as ethical reasons ( Brinkmann, 2007 b ).

Descriptions : In most interview studies, the goal is to obtain the interviewee’s descriptions rather than reflections or theorizations. In line with a widespread phenomenological perspective (explained more fully later), interviewers are normally seeking descriptions of how interviewees experience the world, its episodes and events, rather than speculations about why they have certain experiences. Good interview questions thus invite interviewees to give descriptions; for example, “Could you please describe a situation for me in which you became angry?,” “What happened?,” “How did you experience anger?,” “How did it feel?” (of course, only one of these questions should be posed at a time), and good interviewers tend to avoid more abstract and reflective questions such as “What does anger mean to you?,” “If I say ‘anger,’ what do you think of then?,” “Why do you think that you tend to feel angry?” Such questions may be productive in the conversation, but interviewers will normally defer them until more descriptive aspects have been covered.

Life world : The concept of the life world goes back to the founder of phenomenology, Edmund Husserl, who introduced it in 1936, in his book The Crisis of the European Sciences to refer to the intersubjectively shared and meaningful world in which humans conduct their lives and experience significant phenomena ( Husserl, 1954 ). It is a prereflective and pretheorized world in which anger, for example, is a meaningful human expression in response to having one’s rights violated (or something similar) before it is a process occurring in the neurophysiological and endocrinological systems (“before” should here be taken in a logical, rather than temporal, sense). If anger did not appear to human beings as a meaningful experienced phenomenon in their life world, there would be no reason to investigate it scientifically because there would, in a sense, be nothing to investigate (since anger is primarily identified as a life world phenomenon). In qualitative research in general, as in qualitative interviewing in particular, there is a primacy of the life world as experienced, as something prior to the scientific theories we may formulate about it. This was well expressed by Maurice Merleau-Ponty, another famous phenomenologist, who built on the work of Husserl:

All my knowledge of the world, even my scientific knowledge, is gained from my own particular point of view, or from some experience of the world without which the symbols of science would be meaningless. The whole universe of science is built upon the world as directly experienced [i.e., the life world], and if we want to subject science itself to rigorous scrutiny and arrive at a precise assessment of its meaning and scope, we must begin by re-awakening the basic experiences of the world of which science is the second order expression. ( Merleau-Ponty, 1945/2002 , p. ix)

Objectifying sciences give us second-order understandings of the world, but qualitative research is meant to provide a first-order understanding through concrete description. Whether interview researchers express themselves in the idiom of phenomenology, or use the language of some other qualitative paradigm (discourse analysis, symbolic interactionism, ethnomethodology, etc.), they most often decide to use interviews to elicit descriptions of the life world—or whatever term the given paradigm employs: the interaction order (to speak with Erving Goffman, an exponent of symbolic interactionism), the immortal ordinary society (to speak with Harold Garfinkel, the founder of ethnomethodology), or the set of interpretative repertoires that make something meaningful (to speak with Jonathan Potter and Margaret Wetherell, significant discursive psychologists). 2

Interpret the meaning : Even if interviewers are generally interested in how people experience and act in the world prior to abstract theorizations, they must nonetheless often engage in interpretations of people’s experiences and actions as described in interviews. One reason for this is that life world phenomena are rarely transparent and “monovocal” but are rather “polyvocal” and sometimes even contradictory, permitting multiple readings and interpretations. Who is to say what someone’s description of anger signifies? Obviously, the person having experienced the anger should be listened to, but if there is one lesson to learn from twentieth-century human science (ranging from psychoanalysis to poststructuralism) it is that we, as human subjects, do not have full authority concerning how to understand our lives because we do not have—and can never have—full insight into the forces that have created us ( Butler, 2005 ). We are, as Judith Butler has argued, authored by what precedes and exceeds us (p. 82), even when we are considered—as in qualitative interviews—to be authors of our own utterances. The interpretation of the meanings of the phenomena described by the interviewee can favorably be built into the conversation itself (as I tried to do at point (4) in the excerpt in Box 14.1 ) because this will at least give the interviewee a chance to object to a certain interpretation, but it is a process that goes on throughout an interview project.

In my opinion, too rarely do interview researchers allow themselves to follow the different, polyvocal, and sometimes contradictory meanings that emerge through different voices in interviewee accounts. Analysts of interviews are generally looking for the voice of the interviewee, thereby ignoring internal conflicts in narratives and descriptions. Stephen Frosh has raised this concern from a discursive and psychoanalytic perspective, and he criticizes the narrativist tendency among qualitative researchers to present human experience in ways that set up coherent themes that constitute integrated wholes ( Frosh, 2007 ). Often, it is the case that the stories people tell are ambiguous and full of gaps, especially for people “on the margins of hegemonic discourses” (p. 637). Like Butler, Frosh finds that the human subject is never a whole, “is always riven with partial drives, social discourses that frame available modes of experience, ways of being that are contradictory and reflect the shifting allegiances of power as they play across the body and the mind” (p. 638). If this is so, it is important to be open to multiple interpretations of what is said and done in an interview. Fortunately, some qualitative approaches do have an eye to this and have designed ways to comprehend complexity; for example, the so-called listening guide developed by Carol Gilligan and co-workers and designed to listen for multiple voices in interviewee accounts (for a recent version of this approach, see Sorsoli & Tolman, 2008 ).

To sum up, the “meanings” that qualitative interviewers are commonly looking for are often multiple, perspectival, and contradictory and thus demand careful interpretation. And there is much controversy in the qualitative communities concerning whether meanings are essentially “there” to be articulated by the interviewee and interpreted by the interviewer (emphasized in particular by phenomenological approaches) or whether meanings are constructed locally (i.e., arise dialogically in a process that centrally involves the interviewer as co-constructor, as stressed by discursive and constructionist approaches). Regardless of one’s epistemological standpoint, it remains important for interviewers to make clear, when they design, conduct, and communicate their research, how they approach this thorny issue because this will make it much easier for readers of interview reports to understand and assess what is communicated.

I have now introduced a working definition of the relatively unstructured and semistructured qualitative research interview and emphasized four vital aspects: such interviews are structured by the interviewer’s purpose of obtaining knowledge; they revolve around descriptions provided by the interviewee; such descriptions are commonly about life world phenomena as experienced; and understanding the meaning of the descriptions involves some kind of interpretation . Although these aspects capture what is essential to a large number of qualitative interview studies now and in the past (and likely many in the future as well), it is important to stress that all these aspects can be and have been challenged in the methodological literature.

In relation to qualitative interviewing, as in qualitative research in general, there is never one correct way to understand or practice a method or a technique because everything depends on concrete circumstances and on the researcher’s intentions when conducting a particular research project. This does not mean that “anything goes” and that nothing is never better than something else, but it does mean that what is “better” is always relative to what one is interested in doing or knowing. The answer to the question “What’s the proper definition of and approach to qualitative interviewing?” must thus be: “It depends on what you wish to achieve by interviewing people for research purposes!” Unfortunately, too many interview researchers simply take one or another approach to interviewing for granted as the only correct one and forget to reflect on the advantages and disadvantages of their favored approach (sometimes they are not even aware that other approaches exist). These researchers thus proceed without properly theorizing their means of knowledge production.

Individual and Group Interviews

It is not only the interviewer’s agenda and research interests that structure the interaction in an interview. Unsurprisingly, the number of participants also plays an important role. As the history of interviewing testifies, the standard format of qualitative interviewing is with one person interviewing another person. This format was illustrated in the example in Box 14.1 , and although this chapter is not about group interviews, I briefly mention these to illustrate how they differ from conventional forms of qualitative interviewing.

Group Interviews

There is an increasing use of group interviews. These have been in use since the 1920s but became standard practice only after the 1950s, when market researchers in particular developed what they termed “focus group interviews” to study consumer preferences. Today, focus groups dominate consumer research and are also often used in health, education, and evaluation research; they are in fact becoming increasingly common across many disciplines in the social sciences.

In focus groups, the interviewer is conceived as a “moderator” who focuses the group discussion on specific themes of interest, and she or he will often use the group dynamic instrumentally to include a number of different perspectives on the give themes ( Morgan, 2002 ). Often, group interviews are more dynamic and flexible in comparison with individual interviews, and they may be closer to everyday discussions. They can be used, for example, when the researcher is not so much interested in people’s descriptions of their experiences as in how participants discuss, argue, and justify their opinions and attitudes.

The standard size for a focus group is between six to ten participants, led by a moderator ( Chrzanowska, 2002 ). Recently, qualitative researchers have also experimented with groups of only two participants (sometimes referred to as “the two-person interview,” although there are literally three people if one counts the interviewer), mainly because it makes the research process easier to handle than with larger groups, where people will often not show up. The moderator introduces the topics for discussion and facilitates the interchange. The point is not to reach consensus about the issues discussed but to have different viewpoints articulated about an issue. Focus group interviews are well suited for exploratory studies in little-known domains or about newly emerging social phenomena because the dynamic social interaction that results may provide more spontaneous expressions than occur in individual interviews.

Individual Interviews

Individual interviews with one interviewer and one interviewee may sometimes be less lively than group interviews, but they have a couple of other advantages: First, it is often easier for the interviewer in one-on-one interviews to lead the conversation in a direction that is useful in relation to the interviewer’s research interests. Second, when studying aspects of people’s lives that are personal, sensitive, or even taboo, it is preferable to use individual interviews that allow for more confidentiality and often make it easier for the interviewer to create an atmosphere of trust and discretion. It is very doubtful, to take a rather extreme example, that Kinsey and his colleagues could have achieved the honest descriptions of sexual behaviors from their respondents had they conducted group rather than individual interviews. And there are obviously also certain themes that simply demand one person telling a story without being interrupted or gainsaid by other participants, such as in biographical research.

Although late-modern Western culture now looks on the individual, face-to-face interview as a completely common and natural occurrence, we should be very careful not to naturalize this particular form of human relationship, as I emphasized earlier. Briggs (2007) has argued that this form of relationship implies a certain “field of communicability,” referring to a socially situated construction of communicative processes (p. 556). This construction is an artefact of cultural-historical practices and is placed within organized social fields that produce different roles, positions, relations, and forms of agency that are frequently taken for granted. There are thus certain rights, duties, and a repertoire of acts that open up when entering the field of communicability of qualitative interviewing—and others that close down. Much about this field of communicability may seem trivial—that the interviewer asks questions and the interviewee answers, that the interviewee conveys personal information that he or she would not normally tell a stranger, that the interviewee is positioned as the expert on that person’s own life, and so on—but the role of this field in the process of knowledge production is very rarely addressed by interview researchers. We too seldom stop and consider the “magic” of interviewing—that a stranger is willing to tell an interviewer so many things about her life simply because the interviewer presents herself as a researcher. Rather than naturalize this practice, we should defamiliarize ourselves with it—like ethnographers visiting a strange “interview culture”—in order to understand and appreciate its role in scientific knowledge production.

Interviewing Using Different Media

Following from Briggs’s analysis of the communicability of interviewing, it is noteworthy that the otherwise standardized format of “face-to-face interaction” was named as late as the early twentieth century by the sociologist Charles Horton Cooley but was since constructed as “primordial, authentic, quintessentially human, and necessary” ( Briggs, 2007 , p. 553). It is sometimes forgotten that the face-to-face interview, as a kind of interaction mediated by this particular social arrangement, also has a history. Other well-known media employed in qualitative interviewing include the telephone and the internet, and here we briefly look at differences among face-to-face, telephone, and internet interviews.

Face-to-Face Interviews

In face-to-face interviews, people are present not only as conversing minds, but as flesh-and-blood creatures who may laugh, cry, smile, tremble, and otherwise give away much information in terms of gestures, body language, and facial expressions. Interviewers thus have the richest source of knowledge available here, but the challenge concerns how to use it productively. In most cases, how people look and act is forgotten once the transcript is made, and the researcher carries out her analyses using the stack of transcripts rather than the embodied interaction that took place. This is a problem especially when a research assistant or someone other than the interviewer transcribes the interview because, in that case, it is not possible to note all the nonverbal signs and gestures that occurred. If possible, it is therefore preferable for the interviewer herself to transcribe the conversations, and it is optimal to do so relatively soon after the conversations are over (e.g., within a couple of days) because this guarantees better recollection of the body language, the atmosphere, and other nontranscribable features of the interaction.

Telephone Interviews

According to Shuy (2002) , the telephone interview has “swept the polling and survey industry in recent years and is now the dominant approach” (p. 539). It often follows a very structured format. In a research context, the use of telephone conversations was pioneered by conversation analysts, who were able to identify a number of common conversational mechanisms (related to turn-taking, adjacency pairs such as questions–answers, etc.) from the rather constricted format that is possible over the telephone. The constricted format may in itself have been productive in throwing light on certain core features of human talk.

Shuy emphasizes a number of advantages of telephone interviewing, such as reduced interviewer effects (important in structured polling interviews, for example), better interviewer uniformity, greater standardization of questions, greater cost-efficiency, increased researcher safety ( Shuy, 2002 , p. 540), and—we might add—better opportunities for interviewing people who live far from the interviewer. In qualitative interviewing, however, it is not possible (nor desirable) to avoid these “interviewer effects” because the interviewer herself is the research instrument, so only the latter couple of points are relevant in this context. However, Shuy also highlights some advantages of in-person interviewing versus telephone interviewing, such as more accurate responses due to contextual naturalness, greater likelihood of self-generated answers, more symmetrical distribution of interactive power, greater effectiveness with complex issues, more thoughtful responses, and the fact that such interviews are better in relation to sensitive questions (pp. 541–544). The large majority of interviews characterized as “qualitative” are conducted face-to-face, mainly because of the advantages listed by Shuy.

Internet Interviews

E-mail and chat interviews are varieties of internet interviewing, with e-mail interviewing normally implying an asynchronous interaction in time, with the interviewer writing a question and then waiting for a response, and chat interviews being synchronous or occurring in “real time” ( Mann & Stewart, 2002 ). The latter can approach a conversational format that resembles face-to-face interviews, with its quick turn takings. When doing online ethnographies (e.g., in virtual realities on the internet), chat interviews are important (see Markham, 2005 , on online ethnography). One advantage of e-mail and chat interviews is that they are “self-transcribing” in the sense that the written text itself is the medium through which researcher and respondents express themselves, and the text is thus basically ready for analysis the minute it has been typed ( Kvale & Brinkmann, 2008 , p. 149).

Disadvantages of such interview forms are related to the demanded skills of written communication. Not everyone is sufficiently skilled at writing to be able to express themselves in rich and detailed ways. Most research participants are also more comfortable when talking, rather than writing, about their lives and experiences. However, as the psychiatrist Finn Skårderud has pointed out, there are some exceptions here, and Skårderud emphasizes in particular that internet conversations can be useful when communicating with people who have problematic relationships to their bodies (e.g., eating disorders). For such people, the physical presence of a problematic body can represent an unwanted disturbance ( Skårderud, 2003 ).

In concluding on the different media of interviewing, it should be emphasized that all interviews are mediated, even if only by the spoken words and the historical arrangement of questioning through face-to-face interaction, and there is no universally correct medium that will always guarantee success. Interviewers should choose their medium according to their knowledge interests and should minimally reflect on the effects of communicating through one medium rather than another. That said, most of the themes that qualitative interviewers are interested in lend themselves more easily to face-to-face interviewing because of the trust, confidentiality, and contextual richness that this format enables.

Different Styles of Interviewing

We have now seen how interviews may differ in terms of structure, number of participants, and media. Another crucial factor is the style of interviewing; that is, the way the interviewer acts and positions herself in the conversation. In relation to this, Wengraf (2001) has introduced a general distinction between “receptive” interviewer styles and assertive styles (or strategies, as he calls them), with the former being close to Carl Rogers’s model of psychotherapy and the latter being more in line with active and Socratic approaches to interviewing (both of which were addressed earlier). Here, I describe these in greater detail as two ends on a continuum.

Receptive Interviewing

According to Wengraf, a receptive style empowers informants and enables them to have “a large measure of control in the way in which they answer the relatively few and relatively open questions they are asked” ( Wengraf, 2001 , p. 155). Much of what was said earlier on the historical contributions of Elton Mayo and Carl Rogers and on semistructured life world interviewing addressed the receptive style in a broad sense; this is often thought of as self-evidently correct, so that no alternatives are considered. Therefore, I devote more space to articulate the somewhat more unusual assertive style, which is attracting more and more attention today.

Assertive Interviewing

Wengraf states that an assertive style may come close to a legal interrogation and enables the interviewer “to control the responses, provoke and illuminate self-contradiction, absences, provoke self-reflexivity and development” (2001, p. 155), perhaps approaching transformative conceptions of interviewing to use Roulston’s terminology mentioned earlier.

A well-known and more positive exposition of the assertive style was developed by Holstein and Gubrium in their book on The Active Interview ( Holstein & Gubrium, 1995 ). They argued that, in reality, there is not much of a choice because interviews are unavoidably interpretively active, meaning-making practices, and this would apply even when interviewers attempt a more receptive style. In this case, however, their role in meaning-making would simply be more elusive and more difficult to take into account when analyzing interview talk. A consequence of this line of argument is that it is preferable for interviewers to take their inevitable role as co-constructors of meaning into account rather than trying to downplay it.

Discourse analysts such as Potter and Wetherell (1987) have also developed an active, assertive practice of interviewing. In a classic text, they describe the constructive role of the interview researcher and summarize discourse analytic interviewing as follows:

First, variation in response is as important as consistency. Second, techniques, which allow diversity rather than those which eliminate it are emphasized, resulting in more informal conversational exchanges and third, interviewers are seen as active participants rather than like speaking questionnaires. ( Potter & Wetherell, 1987 , p. 165)

Variation, diversity, informality, and an active interviewer are key, and the interview process, for Potter and Wetherell, is meant to lead to articulations of the “interpretative repertoires” of the interviewees, but without the interviewer investigating the legitimacy of these repertoires in the interview situation or the respondent’s ways of justifying them. This is in contrast to Socratic and other confronting variants of active interviews, which are designed not just to map participants’ understandings and beliefs, but also to study how participants justify their understandings and beliefs.

To illustrate concretely what a confrontative assertive style looks like, we turn to a simple and very short example from Plato’s The Republic , with Socrates as interviewer (discussed in Brinkmann, 2007 a ). The passage very elegantly demonstrates that no moral rules are self-applying or self-interpreting but must always be understood contextually. Socrates is in a conversation with Cephalus, who believes that justice ( dikaiosune )—here “doing right”—can be stated in universal rules, such as “tell the truth” and “return borrowed items”:

“That’s fair enough, Cephalus,” I [Socrates] said. “But are we really to say that doing right consists simply and solely in truthfulness and returning anything we have borrowed? Are those not actions that can be sometimes right and sometimes wrong? For instance, if one borrowed a weapon from a friend who subsequently went out of his mind and then asked for it back, surely it would be generally agreed that one ought not to return it, and that it would not be right to do so, not to consent to tell the strict truth to a madman?” “That is true,” he [Cephalus] replied. “Well then,” I [Socrates] said, “telling the truth and returning what we have borrowed is not the definition of doing right.” ( Plato, 1987 , pp. 65–66)

Here, the conversation is interrupted by Polemarchus who disagrees with Socrates’ preliminary conclusion, and Cephalus quickly leaves to go to a sacrifice. Then Polemarchus takes Cephalus’s position as Socrates’ discussion partner and the conversation continues as if no substitution had happened.

The passage is instructive because it shows us what qualitative interviewing normally is not . Socrates violates almost every standard principle of qualitative research interviewing, and we can see that the conversation is a great contrast to my own interview excerpt in Box 14.1 . Socrates talks much more than his respondent, he has not asked Cephalus to “describe a situation in which he has experienced justice” or “tell a story about doing right from his own experience” or a similar concretely descriptive question probing for “lived experience.” Instead, they are talking about the definition of an important general concept. Socrates contradicts and challenges his respondent’s view. There is no debriefing or attempt to make sure that the interaction was a pleasant experience for Cephalus, the interview is conducted in public rather than private, and the topic is not private experiences or biographical details, but justice, a theme of common human interest, at least of interest to all citizens of Athens.

Sometimes, the conversation partners in the Platonic dialogues settle on a shared definition, but more often the dialogue ends without any final, unarguable definition of the central concept (e.g., justice, virtue, love). This lack of resolution— aporia in Greek—can be interpreted as illustrating the open-ended character of our conversational reality, including the open-ended character of the discursively produced knowledge of human social and historical life. If humankind is a kind of enacted conversation, to return to my opening remarks in this chapter, the goal of social science is perhaps not to arrive at “fixed knowledge” once and for all, but to help human beings improve the quality of their conversational reality, to help them know their own society and social practices, and debate the goals and values that are important in their lives ( Flyvbjerg, 2001 ).

Interviews can be intentionally assertive, active, and confronting (good examples are found in Bellah, Madsen, Sullivan, Swidler, & Tipton, 1985 , who explicitly acknowledge a debt to Socrates), but the assertive approach can also be employed post hoc as a more analytic perspective. Consider, for example, the excerpt in Box 14.2 from a study by Shweder and Much (1987) , discussed in detail by Valsiner (2007 , pp. 385–386). The interview is set in India and was part of a research project studying moral reasoning in a cross-cultural research design. Earlier in the interview, Babaji (the interviewee) has been presented with a variant of the famous Heinz dilemma (here called the Ashok dilemma), invented by moral developmental psychologist Lawrence Kohlberg to assess people’s moral capabilities ( Kohlberg, 1981 ): a man (Heinz/Ashok) has a wife who is ill and will die if he does not steal some medicine from a pharmacist (who refuses to sell the medicine at a price that the man can afford). According to Babaji’s Hinduism, stealing is not permitted, and the interview unfolds from there (see Box 14.2 ).

According to Valsiner (2007) , we see in the interview how the interviewer (Richard Shweder), in a very active or assertive way, does everything he can to persuade Babaji to accept the Western framing of the dilemma and see the tension between stealing for a moral reason and stealing as an immoral act. But Babaji fails to, or refuses to, see the situation as a dilemma and first attempts to articulate other possibilities in addition to stealing/not stealing (viz. give shamanistic instructions) before finally suggesting that Ashok sells himself in order to raise the money. As such, the interview flow is best understood as an active and confrontational encounter between two quite different worldviews that are revealed exactly because the interviewer acts in a confronting, although not disrespectful, way. 3

Furthermore, the excerpt illustrates how cross-cultural interviewing can be quite difficult—but also extremely interesting—not least when conducted in “noninterview societies” ( Ryen, 2002 , p. 337); that is, in societies where interviewing is not common or recognized as a knowledge-producing instrument. All qualitative interviewing is a collaborative accomplishment, but this becomes exceedingly visible when collaborating cross-culturally.

Analytic Approaches to Interviewing

Before closing this chapter, I give a very brief introduction to different perspectives on how to analyze interviews. Obviously, I cannot here cover the immense variety of phenomenological, discursive, conversation analytic, feminist, poststructuralist, psychoanalytic perspectives, so instead I present a simplified dichotomy that should really be thought of as a continuum. The dichotomy has already played an implicit role earlier because it implies a distinction between interview talk as primarily descriptive (phenomenological) reports (concentrating on the “what” of communication) and interview talk as primarily (discursive) accounts (chiefly concerned with the “how” of talk). Phenomenological approaches to interviewing in a broad sense (exemplified in my exposition of semistructured life world interviewing) try to get as close as possible to precise descriptions of what people have experienced, whereas other analytical approaches (found, e.g., in certain schools of discourse analysis and conversation analysis) focus on how people express themselves and give accounts occasioned by the situation in which they find themselves. The two approaches are contrasted in Table 14.1 , with “what” approaches on the left-hand side and “how” approaches on the right-hand side.

Interviewer: Why doesn’t Hindu dharma permit stealing? Babaji: If he steals, it is a sin—so what virtue is there in saving a life. Hindu dharma keeps man from sinning. Interviewer: Why would it be a sin? Isn’t there a saying “On must jump into fire for others”? Babaji: That is there in our dharma—sacrifice, but not stealing. Interviewer: But if he doesn’t provide the medicine for his wife, she will die. Wouldn’t it be a sin to let her die? Babaji: That’s why, according to the capacities and powers which God has given him, he should try to give her shamanistic instructions and advice. Then she can be cured. Interviewer: But, that particular medicine is the only way out. Babaji: There is no reason to necessarily think that that particular drug will save her life. Interviewer: Let’s suppose she can only be saved by that drug, or else she will die. Won’t he face lots of difficulties if his wife dies? Babaji: No. Interviewer: But his family will break up. Babaji: He can marry other women. Interviewer: But he has no money. How can he remarry? Babaji: Do you think he should steal? If he steals, he will be sent to jail. Then what’s the use of saving her life to keep the family together. She has enjoyed the days destined for her. But stealing is bad. Our sacred scriptures tell that sometimes stealing is an act of dharma. If by stealing for you I can save your life, then it is an act of dharma. But one cannot steal for his wife or his offspring or for himself. If he does that, it is simply stealing. Interviewer: If I steal for myself, then it’s a sin? Babaji: Yes. Interviewer: But in this case I am stealing for my wife, not for me. Babaji: But your wife is yours. Interviewer: Doesn’t Ashok have a duty or obligation to steal the drug? Babaji: He may not get the medicine by stealing. He may sell himself. He may sell himself to someone for say 500 rupees for six months or one year. ( Shweder & Much, 1987 , p. 236)

My inspiration for slicing the cake of qualitative interviewing in this manner comes from Talmy (2010) and Rapley (2001) , who builds on a distinction from Clive Seale between interview-data-as-resource and interview-data-as-topic.

Interviews as Research Instrument

Researchers working from the former perspective (corresponding to the left-hand side of Table 14.1 ) believe that interview data can reflect the interviewees’ reality outside the interview and consequently seek to minimize the interviewer’s effects on coloring interviewees’ reports of their everyday reality. The interview becomes a research instrument in the hands of interviewers, who are supposed to act receptively and interfere as little as possible with the interviewee reporting. The validity of the interviewees’ reports becomes a prime issue when one approaches interviewing as a research instrument. And because interviews normally concern things experienced in the past, this significantly involves considerations about human memory and about how to enhance the trustworthiness of human recollections.

In one of the few publications to discuss the role of memory in interviewing, Thomsen and Brinkmann (2009) recommend that interviewers take the following points into account if they want to help interviewees’ improve the reporting and description of specific memories:

Allow time for recall and assure the interviewee that this is normal.

Provide concrete cues; for example, “the last time you were talking to a physician/nurse” rather than “a communication experience.”

Use typical content categories of specific memories to derive cues (i.e., ongoing activity, location, persons, other people’s affect and own affect).

Ask for recent specific memories.

Use relevant extended time line and landmark events as contextual cues; such as “when you were working at x” to aid the recall of older memories.

Ask the interviewee for a free and detailed narrative of the specific memory (adapted from Thomsen & Brinkmann, 2009 ).

Following such guidelines results in interviewee descriptions that are valid (they are about what the researcher intends them to be about) and close to the “lived experience” of something, or what was earlier referred to as “life world phenomena.” Although phenomenology is one typical paradigm to frame interviews analytically as research instruments, many other paradigms do so as well, for example grounded theory, developed by Glaser and Strauss (1967) with the intent of developing theoretical understandings of phenomena grounded in empirical materials through meticulous coding of data.

A typical goal of qualitative analysis within a broad phenomenological perspective is to arrive at an understanding of the essential structures of conscious experience. Analysts can here apply an inductive form of analysis known as meaning condensation ( Kvale & Brinkmann, 2008 , p. 205). This refers to an abridgement of the meanings articulated by the interviewees into briefer formulations. Longer utterances are condensed into shorter statements in which the main sense of what is said is rephrased in a few words. This technique rests on the idea in phenomenology that there is a certain essential structure to the way we experience things in the life world, and this constitutes an experience as an experience of a given something (shame, anxiety, love, learning something new, etc.).

A specific approach to phenomenological analysis has been developed in a psychological context by Amedeo Giorgi (e.g., Giorgi & Giorgi, 2003 ). Giorgi breaks the analytic process down into four steps: (1) obtain a concrete description of a phenomenon (through an interview) as lived through by someone; read the description carefully and become familiar with it to get a sense of the whole, (2) establish meaning units in the description, (3) transform each meaning unit into expressions that communicate the psychological sense of the data, and (4) based on the transformed meaning units, articulate the general structure of the experience of the phenomenon (p. 170).

A large number of books exist on how to do a concrete analysis (e.g., Silverman, 2001 ), so I will refer the reader to these and also to relevant chapters of this handbook.

Interviewing as a Social Practice

In contrast to those approaches that see interviewing as a research instrument designed to capture the “what” of what is reported as accurately as possible, others working from more constructionist, localist, and situated perspectives have much greater analytic focus on the “how” of interviewing. They view interviewing as a social practice, as a site for a specific kind of situated interaction, which means that interview data primarily reflect “a reality constructed by the interviewee and interviewer” ( Rapley, 2001 , p. 304). The idea of obtaining valid reports that accurately reflect a reality outside the conversational situation is thus questioned, and the main challenge becomes instead how to explain the relevance of interview talk. That is, if what is said in an interview is a product of this social practice itself, why is it relevant to conduct interviewing? Postmodern interviews, emphasizing performative and transformative aspects of interviewing, attempt to meet this challenge by arguing that if interviews do not concern a reality outside themselves, they can instead be used to perform or facilitate social change.

People subscribing to the right-hand side of Table 14.1 believe that interview talk should be conceived of as accounts. Unlike reports, which refer to experiences from the interviewee’s past that can be articulated when prompted, accounts are answers that are “normatively oriented to and designed for the questions that occasion them” ( Talmy, 2010 , p. 136). If interviewee talk is best understood as accounts, it must be seen as a kind of social action that has effects and does something in the situation of which it is a part. This perspective on interviewing is shared by some discourse and conversation analysts who limit themselves to analyzing interview talk as situated interaction.

Readers may wonder if these approaches are mutually exclusive. My own pragmatic answer is that they are not, but that none of the approaches should be brought to an extreme: it is true that huge problems are associated with viewing the interview as a site for pure, “unpolluted” reports of the past (we know too much about the constructive role of human memory and of how the social practice of interviewing mediates what is said to take this seriously). But it is also true that there are problems associated with denying that we can use our communicative powers to refer more or less accurately to past experiences. Those who follow the right-hand side of Table 14.1 to the extreme and deny that data can be resources for understanding experiences of the past still believe that their own communicative practice, materialized in their texts, are about matters outside this specific text. So, taken to extremes, both approaches become absurd, and I believe that it is now time for the two (sometimes opposed) camps to learn from one another and realize that they need not exclude one another. In my view, some of the most interesting interview studies are those in which analyses of the “what” and the “how” fertilize each other in productive ways. I end this chapter with a brief illustration of this, taken (rather shamelessly!) from a paper co-authored by myself ( Musaeus & Brinkmann, 2011 ) that shows how an analytic look at interviews can employ perspectives from both sides at the same time. The two forms thus need not exclude each other, and some interviews can favorably be analyzed using a combination of the two broad analytic approaches.

First a little contextualization to render the example meaningful: my colleague, Peter Musaeus, conducted in their home a relatively unstructured group qualitative interview with four members of a family that was receiving family therapy. We were interested in understanding the effects of the therapeutic process on the everyday life of the family. In the excerpt in Box 14.3 , we meet Maren and Søren, a married couple, and Maren’s daughter Kirstina, who was thirteen years old at the time (and we also see the interviewer’s voice). 4 In the following extract, Maren (the mother) has just made a joke about the movie The Planet of the Apes (a science-fiction movie telling the story of how apes are in control of the earth and keep humans as pets or slaves), and they have talked about the scene where the apes jokingly remark that females are cute, just as long as you get rid of them before puberty.

Toward the end of this sequence Søren, the father of the family, denies—as he does throughout the interview—that Maren is hitting her daughter, and he uses what the family calls a “stop sign” (line 17), which they were taught to employ in their therapy sessions. The verbal sign “STOP” (said in a loud voice) is supposed to bring the conflict cycle to a halt before it accelerates. In the interview, however, the stop sign (like other similar signs from therapy that have been appropriated by the family members) sometimes function counter-productively to raise the conflict level because it is almost shouted by family members. The sudden question in line 20 is actually much more effective in defusing the conflict by diverting the participants’ attention from the problem.

I have here just provided a glimpse of our analysis, which tries to bring forth the role of semiotic mediation—the use of signs (like the stop sign and other therapeutic tools)—in regulating social interaction in a troubled family. The point is, however, that the interview both contains family members’ descriptions of their problems and challenges, thus giving us their reports of what they experience; but we also see the persons’ shared past being formative of the present in the interview situation itself, resulting in quite significant accounts occasioned by the social episode itself. In short, the two analytic perspectives on interviewing (both as a resource providing reports and also as a topic in its own right, i.e., a social practice providing accounts) are mutually reinforcing in this case and have given us what we (as authors of the paper) believe is a valid analysis. Rather than just hearing people describing their problems, the interviewer is in fact witnessing the family members’ problems as they play out in their interaction, in front of him so to speak, thus offering him a chance to validate his analysis. The “what” and the “how” here intersect very closely.

Maren: And the comment that followed was: “Get rid of it before... ha, ha = “

Interviewer: Before it becomes a teenager?

Maren: Because it simply is so hard.

Interviewer: Yes, right, but it =

Kirstina: Should you also simply get rid of me?

Interviewer: Ha, ha.

Maren: No, are you crazy, I love you more than anything. But it’s really hard

for all of us sometimes, I think.

Kirstina: Are you also in puberty when you hit me?

Maren: No, I am in the menopause, that is different.

Søren: You don’t hit, do you? You say “when you hit”? Your mother doesn’t

Kirstina: She has hit me today and yesterday.

Maren: I probably did hit her but well =

Kirstina: Yes, but still, you may say that it isn’t hitting, when you miss.

Søren: STOP Kirstina, it isn’t true. Your mother hasn’t hit you and you don’t

Kirstina: No, no let’s just say that.

Maren: Does anyone want a cream roll?

In this chapter, I have given a broad introduction to qualitative interviewing. I have tried to demonstrate that the human world is a conversational reality in which interviewing takes a privileged position as a research method, at least in relation to a number of significant research questions that human and social scientists want to ask. Qualitative interviewing can be both a useful and valid approach, resulting in analyses with a certain objectivity in the sense that I introduced earlier. Throughout the chapter, I have kept a focus on interviewing as a social practice that has a cultural history, and I have warned against unreflective naturalization of this kind of human interaction (i.e., viewing it as a particularly natural and unproblematic way of staging human relationships).

Furthermore, I introduced a number of distinctions that are relevant when mapping the field of qualitative interviewing (e.g., between different levels of structure, numbers of participants, media of interviewing, and also interviewer styles). I also provided a detailed presentation of semistructured life world interviewing as the standard form of qualitative interviewing today.

I finally gave particular attention to two broad analytic approaches to interviewing: on the one side, experience-focused interviewing that seek to elicit accurate reports of what interviewees have experienced (in broad terms, the phenomenological positions), and, on the other side, language- and interaction-focused interviewing (discourse-oriented positions) that focus on the nature of interview interaction in its own right. In my eyes, none of these is superior per se, but each enables researchers to pose different kinds of questions to their materials. Too often, however, interviewers forget to make clear what kinds of questions they are interested in and also forget to consider whether their practice of interviewing and their analytic focus enable them to answer their research questions satisfactorily.

Future Directions

In the future, the field of qualitative interviewing is likely to continue its expansion. It is now among the most popular research tools in the human and social sciences, and nothing indicates that this trend will stop. However, a number of issues confront qualitative interviewing as particularly pressing in my opinion:

Using conversations for research purposes is close to an everyday practice of oral communication. We talk to people to get to know them, which—in a trivial sense—is also the goal of qualitative research. Will the focus on interviewing as a “method” (that can be articulated and perhaps spelled out procedurally) be counterproductive when the goal is human communication and getting to know people? Are we witnessing a fetishization of methods in qualitative research that is blocking the road to knowledge? And are there other ways of thinking about interviews and other “qualitative methods” than in the idiom of “methods”?

Qualitative interviewers can now find publication channels for their work, but has the practice of interviewing become so unproblematic that people are forgetting to justify and theorize their means of knowledge production in concrete contexts? In my view, more work should be done to theorize interviewing as a social practice (the “how”), as essential to what goes on in interview interactions.

When reporting qualitative analyses, researchers too often decontextualize interviewee statements and utterances. What person A has said is juxtaposed with the statements of person B, without any contextual clues. If an interview is a form of situated interaction, then readers of interview reports need to be provided with temporal and situational context in order to be able to interpret the talk (What question was this statement an answer to? What happened before and what came after?).

Some qualitative researchers remain convinced that they are “on the good side” in relation to ethical questions. They “give voice” to individuals, listen to their “subjective accounts,” and are thus against the quantitative and “objectifying” approaches of other, more traditional researchers. However, qualitative interviewers should, in my view, be aware that very delicate ethical questions are an inherent part of interviewing. They should avoid the “qualitatative ethicism” that sometimes characterizes qualitative inquiry, viz. that “we are good because we are qualitative.” Especially in an “interview society,” there is a need to think about the ethical problems of interviewing others (often about intimate and personal matters), when people are often seduced by the warmth and interest of interviewers to say “too much.”

The first journalistic interviews appeared in the middle of the nineteenth century ( Silvester, 1993 ), and social science interviews emerged in the course of the twentieth century (see the history of interviewing recounted later in this chapter).

Obviously, these traditions are not identical, nor are their main concepts, but I believe that they here converge on the idea of a concretely lived and experienced social reality prior to scientific abstractions of it, which Husserl originally referred to as the life world and which remains central to most (if not all) paradigms in qualitative research.

Confronting interviews are sometimes misunderstood to imply a certain aggressive or disrespectful attitude, which, of course, is a misunderstanding. An interviewer can be actively and confrontingly curious and inquiring in a very respectful way, especially if she positions herself as not-knowing (ad modum Socrates in some of the dialogues) in order to avoid framing the interview as an oral examination.

Kirstina has an older sister, who no longer lives at home, and Søren is not the biological father of the girls. He has two children from a previous marriage. One of them has attempted suicide, which, however, is not the reason for the family’s referral to therapy. The reason, instead, is Maren’s violent behavior toward her daughter Kirstina.

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Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

P. Gill 1 &
J. Baillie 2

British Dental Journal volume 225 , pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

You have full access to this article via your institution.

Interviews in the social sciences

semi structured interviews for qualitative research

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Published : 05 October 2018

Issue Date : 12 October 2018

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Textbooks, Guidebooks, and Handbooks

The Ethnographic Interview by James P. Spradley “Spradley wrote this book for the professional and student who have never done ethnographic fieldwork (p. 231) and for the professional ethnographer who is interested in adapting the author’s procedures (p. iv). Part 1 outlines in 3 chapters Spradley’s version of ethnographic research, and it provides the background for Part 2 which consists of 12 guided steps (chapters) ranging from locating and interviewing an informant to writing an ethnography. Most of the examples come from the author’s own fieldwork among U.S. subcultures . . . Steps 6 and 8 explain lucidly how to construct a domain and a taxonomic analysis” (excerpted from book review by James D. Sexton, 1980).
Fundamentals of Qualitative Research by Johnny Saldana (Series edited by Patricia Leavy) Provides a soup-to-nuts overview of the qualitative data collection process, including interviewing, participant observation, and other methods.
InterViews by Steinar Kvale Interviewing is an essential tool in qualitative research and this introduction to interviewing outlines both the theoretical underpinnings and the practical aspects of the process. After examining the role of the interview in the research process, Steinar Kvale considers some of the key philosophical issues relating to interviewing: the interview as conversation, hermeneutics, phenomenology, concerns about ethics as well as validity, and postmodernism. Having established this framework, the author then analyzes the seven stages of the interview process - from designing a study to writing it up.
Practical Evaluation by Michael Quinn Patton Surveys different interviewing strategies, from, a) informal/conversational, to b) interview guide approach, to c) standardized and open-ended, to d) closed/quantitative. Also discusses strategies for wording questions that are open-ended, clear, sensitive, and neutral, while supporting the speaker. Provides suggestions for probing and maintaining control of the interview process, as well as suggestions for recording and transcription.
The SAGE Handbook of Interview Research by Amir B. Marvasti (Editor); James A. Holstein (Editor); Jaber F. Gubrium (Editor); Karyn D. McKinney (Editor) The new edition of this landmark volume emphasizes the dynamic, interactional, and reflexive dimensions of the research interview. Contributors highlight the myriad dimensions of complexity that are emerging as researchers increasingly frame the interview as a communicative opportunity as much as a data-gathering format. The book begins with the history and conceptual transformations of the interview, which is followed by chapters that discuss the main components of interview practice. Taken together, the contributions to The SAGE Handbook of Interview Research: The Complexity of the Craft encourage readers simultaneously to learn the frameworks and technologies of interviewing and to reflect on the epistemological foundations of the interview craft.
The SAGE Handbook of Online Research Methods by Nigel G. Fielding, Raymond M. Lee and Grant Blank (Editors) Bringing together the leading names in both qualitative and quantitative online research, this new edition is organised into nine sections: 1. Online Research Methods 2. Designing Online Research 3. Online Data Capture and Data Collection 4. The Online Survey 5. Digital Quantitative Analysis 6. Digital Text Analysis 7. Virtual Ethnography 8. Online Secondary Analysis: Resources and Methods 9. The Future of Online Social Research

ONLINE RESOURCES, COMMUNITIES, AND DATABASES

Interviews as a Method for Qualitative Research (video) This short video summarizes why interviews can serve as useful data in qualitative research.
Companion website to Bloomberg and Volpe's Completing Your Qualitative Dissertation: A Road Map from Beginning to End, 4th ed Provides helpful templates and appendices featured in the book, as well as links to other useful dissertation resources.
International Congress of Qualitative Inquiry Annual conference hosted by the International Center for Qualitative Inquiry at the University of Illinois at Urbana-Champaign, which aims to facilitate the development of qualitative research methods across a wide variety of academic disciplines, among other initiatives.
METHODSPACE An online home of the research methods community, where practicing researchers share how to make research easier.
SAGE researchmethods Researchers can explore methods concepts to help them design research projects, understand particular methods or identify a new method, conduct their research, and write up their findings. A "methods map" facilitates finding content on methods.

The decision to conduct interviews, and the type of interviewing to use, should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Structured:

Structured Interview. Entry in The SAGE Encyclopedia of Social Science Research Methodsby Floyd J. Fowler Jr., Editors: Michael S. Lewis-Beck; Alan E. Bryman; Tim Futing Liao (Editor) A concise article noting standards, procedures, and recommendations for developing and testing structured interviews. For an example of structured interview questions, you may view the Current Population Survey, May 2008: Public Participation in the Arts Supplement (ICPSR 29641), Apr 15, 2011 at https://doi.org/10.3886/ICPSR29641.v1 (To see the survey questions, preview the user guide, which can be found under the "Data and Documentation" tab. Then, look for page 177 (attachment 8).

Semi-Structured:

Semi-Structured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Lioness Ayres; Editor: Lisa M. Given The semi-structured interview is a qualitative data collection strategy in which the researcher asks informants a series of predetermined but open-ended questions. The researcher has more control over the topics of the interview than in unstructured interviews, but in contrast to structured interviews or questionnaires that use closed questions, there is no fixed range of responses to each question.

Unstructured:

Unstructured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Michael W. Firmin; Editor: Lisa M. Given Unstructured interviews in qualitative research involve asking relatively open-ended questions of research participants in order to discover their percepts on the topic of interest. Interviews, in general, are a foundational means of collecting data when using qualitative research methods. They are designed to draw from the interviewee constructs embedded in his or her thinking and rationale for decision making. The researcher uses an inductive method in data gathering, regardless of whether the interview method is open, structured, or semi-structured. That is, the researcher does not wish to superimpose his or her own viewpoints onto the person being interviewed. Rather, inductively, the researcher wishes to understand the participant's perceptions, helping him or her to articulate percepts such that they will be understood clearly by the journal reader.

Genres and Uses

Focus groups:.

"Focus Groups." Annual Review of Sociology 22 (1996): 129-1524.by David L. Morgan Discusses the use of focus groups and group interviews as methods for gathering qualitative data used by sociologists and other academic and applied researchers. Focus groups are recommended for giving voice to marginalized groups and revealing the group effect on opinion formation.
Qualitative Research Methods: A Data Collector's Field Guide (See Module 4: "Focus Groups")by Mack, N., et al. This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

In-Depth (typically One-on-One):

A Practical Introduction to in-Depth Interviewingby Alan Morris Are you new to qualitative research or a bit rusty and in need of some inspiration? Are you doing a research project involving in-depth interviews? Are you nervous about carrying out your interviews? This book will help you complete your qualitative research project by providing a nuts and bolts introduction to interviewing. With coverage of ethics, preparation strategies and advice for handling the unexpected in the field, this handy guide will help you get to grips with the basics of interviewing before embarking on your research. While recognising that your research question and the context of your research will drive your approach to interviewing, this book provides practical advice often skipped in traditional methods textbooks.
Qualitative Research Methods: A Data Collector's Field Guide (See Module 3: "In-Depth Interviews")by Mack, N., et al. This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

Folklore Research and Oral Histories:

In addition to the following resource, see the Oral History page of this guide for helpful resources on Oral History interviewing.

American Folklife Center at the Library of Congress. Folklife and Fieldwork: A Layman’s Introduction to Field Techniques Interviews gathered for purposes of folklore research are similar to standard social science interviews in some ways, but also have a good deal in common with oral history approaches to interviewing. The focus in a folklore research interview is on documenting and trying to understand the interviewee's way of life relative to a culture or subculture you are studying. This guide includes helpful advice and tips for conducting fieldwork in folklore, such as tips for planning, conducting, recording, and archiving interviews.

An interdisciplinary scientific program within the Institute for Quantitative Social Science which encourages and facilitates research and instruction in the theory and practice of survey research. The primary mission of PSR is to provide survey research resources to enhance the quality of teaching and research at Harvard.

Internet, Phone, Mail, and Mixed-Mode Surveysby Don A. Dillman; Jolene D. Smyth; Leah Melani Christian The classic survey design reference, updated for the digital age. The new edition is thoroughly updated and revised, and covers all aspects of survey research. It features expanded coverage of mobile phones, tablets, and the use of do-it-yourself surveys, and Dillman's unique Tailored Design Method is also thoroughly explained. This new edition is complemented by copious examples within the text and accompanying website. It includes: Strategies and tactics for determining the needs of a given survey, how to design it, and how to effectively administer it. How and when to use mail, telephone, and Internet surveys to maximum advantage. Proven techniques to increase response rates. Guidance on how to obtain high-quality feedback from mail, electronic, and other self-administered surveys. Direction on how to construct effective questionnaires, including considerations of layout. The effects of sponsorship on the response rates of surveys. Use of capabilities provided by newly mass-used media: interactivity, presentation of aural and visual stimuli. The Fourth Edition reintroduces the telephone--including coordinating land and mobile.

User Experience (UX) and Marketing:

See the "UX & Market Research Interviews" tab on this guide, above. May include Focus Groups, above.

Screening for Research Site Selection:

Research interviews are used not only to furnish research data for theoretical analysis in the social sciences, but also to plan other kinds of studies. For example, interviews may allow researchers to screen appropriate research sites to conduct empirical studies (such as randomized controlled trials) in a variety of fields, from medicine to law. In contrast to interviews conducted in the course of social research, such interviews do not typically serve as the data for final analysis and publication.

ENGAGING PARTICIPANTS

Research ethics .

Human Subjects (IRB) The Committee on the Use of Human Subjects (CUHS) serves as the Institutional Review Board for the University area which includes the Cambridge and Allston campuses at Harvard. Find your IRB contact person , or learn about required ethics training. You may also find the IRB Lifecycle Guide helpful. This is the preferred IRB portal for Harvard graduate students and other researchers. IRB forms can be downloaded via the ESTR Library (click on the "Templates and Forms" tab, then navigate to pages 2 and 3 to find the documents labelled with “HUA” for the Harvard University Area IRB. Nota bene: You may use these forms only if you submit your study to the Harvard University IRB). The IRB office can be reached through email at [email protected] or by telephone at (617) 496-2847.
Undergraduate Research Training Program (URTP) Portal The URTP at Harvard University is a comprehensive platform to create better prepared undergraduate researchers. The URTP is comprised of research ethics training sessions, a student-focused curriculum, and an online decision form that will assist students in determining whether their project requires IRB review. Students should examine the URTP's guide for student researchers: Introduction to Human Subjects Research Protection.
Ethics reports From the Association of Internet Researchers (AoIR)
Respect, Beneficence, and Justice: QDR General Guidance for Human Participants If you are hoping to share your qualitative interview data in a repository after it has been collected, you will need to plan accordingly via informed consent, careful de-identification procedures, and data access controls. Consider consulting with the Qualitative Research Support Group at Harvard Library and consulting with Harvard's Dataverse contacts to help you think through all of the contingencies and processes.
"Conducting a Qualitative Child Interview: Methodological Considerations." Journal of Advanced Nursing 42/5 (2003): 434-441 by Kortesluoma, R., et al. The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described.
"Crossing Cultural Barriers in Research Interviewing." Qualitative Social Work 63/3 (2007): 353-372 by Sands, R., et al. This article critically examines a qualitative research interview in which cultural barriers between a white non-Muslim female interviewer and an African American Muslim interviewee, both from the USA, became evident and were overcome within the same interview.
Decolonizing Methodologies: Research and Indigenous Peoples by Linda Tuhiwai Smith This essential volume explores intersections of imperialism and research - specifically, the ways in which imperialism is embedded in disciplines of knowledge and tradition as 'regimes of truth.' Concepts such as 'discovery' and 'claiming' are discussed and an argument presented that the decolonization of research methods will help to reclaim control over indigenous ways of knowing and being. The text includes case-studies and examples, and sections on new indigenous literature and the role of research in indigenous struggles for social justice.

This resource, sponsored by University of Oregon Libraries, exemplifies the use of interviewing methodologies in research that foregrounds traditional knowledge. The methodology page summarizes the approach.

Ethics: The Need to Tread Carefully. Chapter in A Practical Introduction to in-Depth Interviewing by Alan Morris Pay special attention to the sections in chapter 2 on "How to prevent and respond to ethical issues arising in the course of the interview," "Ethics in the writing up of your interviews," and "The Ethics of Care."
Handbook on Ethical Issues in Anthropology by Joan Cassell (Editor); Sue-Ellen Jacobs (Editor) This publication of the American Anthropological Association presents and discusses issues and sources on ethics in anthropology, as well as realistic case studies of ethical dilemmas. It is meant to help social science faculty introduce discussions of ethics in their courses. Some of the topics are relevant to interviews, or at least to studies of which interviews are a part. See chapters 3 and 4 for cases, with solutions and commentary, respectively.
Research Ethics from the Chanie Wenjack School for Indigenous Studies, Trent University (Open Access) An overview of Indigenous research ethics and protocols from the across the globe.
Resources for Equity in Research Consult these resources for guidance on creating and incorporating equitable materials into public health research studies that entail community engagement.

The SAGE Handbook of Qualitative Research Ethics by Ron Iphofen (Editor); Martin Tolich (Editor) This handbook is a much-needed and in-depth review of the distinctive set of ethical considerations which accompanies qualitative research. This is particularly crucial given the emergent, dynamic and interactional nature of most qualitative research, which too often allows little time for reflection on the important ethical responsibilities and obligations. Contributions from leading international researchers have been carefully organized into six key thematic sections: Part One: Thick Descriptions Of Qualitative Research Ethics; Part Two: Qualitative Research Ethics By Technique; Part Three: Ethics As Politics; Part Four: Qualitative Research Ethics With Vulnerable Groups; Part Five: Relational Research Ethics; Part Six: Researching Digitally. This Handbook is a one-stop resource on qualitative research ethics across the social sciences that draws on the lessons learned and the successful methods for surmounting problems - the tried and true, and the new.

RESEARCH COMPLIANCE AND PRIVACY LAWS

Research Compliance Program for FAS/SEAS at Harvard : The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

Harvard Global Support Services (GSS) is for students, faculty, staff, and researchers who are studying, researching, or working abroad. Their services span safety and security, health, culture, outbound immigration, employment, financial and legal matters, and research center operations. These include travel briefings and registration, emergency response, guidance on international projects, and managing in-country operations.

Generative AI: Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.

Privacy Laws: Be mindful of any potential privacy laws that may apply wherever you conduct your interviews. The General Data Protection Regulation is a high-profile example (see below):

General Data Protection Regulation (GDPR) This Regulation lays down rules relating to the protection of natural persons with regard to the processing of personal data and rules relating to the free movement of personal data. It protects fundamental rights and freedoms of natural persons and in particular their right to the protection of personal data. The free movement of personal data within the Union shall be neither restricted nor prohibited for reasons connected with the protection of natural persons with regard to the processing of personal data. For a nice summary of what the GDPR requires, check out the GDPR "crash course" here .

SEEKING CONSENT

If you would like to see examples of consent forms, ask your local IRB, or take a look at these resources:

Model consent forms for oral history, suggested by the Centre for Oral History and Digital Storytelling at Concordia University
For NIH-funded research, see this resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use.

POPULATION SAMPLING

If you wish to assemble resources to aid in sampling, such as the USPS Delivery Sequence File, telephone books, or directories of organizations and listservs, please contact our data librarian or write to [email protected] .

Research Randomizer A free web-based service that permits instant random sampling and random assignment. It also contains an interactive tutorial perfect for students taking courses in research methods.
Practical Tools for Designing and Weighting Survey Samples by Richard Valliant; Jill A. Dever; Frauke Kreuter Survey sampling is fundamentally an applied field. The goal in this book is to put an array of tools at the fingertips of practitioners by explaining approaches long used by survey statisticians, illustrating how existing software can be used to solve survey problems, and developing some specialized software where needed. This book serves at least three audiences: (1) Students seeking a more in-depth understanding of applied sampling either through a second semester-long course or by way of a supplementary reference; (2) Survey statisticians searching for practical guidance on how to apply concepts learned in theoretical or applied sampling courses; and (3) Social scientists and other survey practitioners who desire insight into the statistical thinking and steps taken to design, select, and weight random survey samples. Several survey data sets are used to illustrate how to design samples, to make estimates from complex surveys for use in optimizing the sample allocation, and to calculate weights. Realistic survey projects are used to demonstrate the challenges and provide a context for the solutions. The book covers several topics that either are not included or are dealt with in a limited way in other texts. These areas include: sample size computations for multistage designs; power calculations related to surveys; mathematical programming for sample allocation in a multi-criteria optimization setting; nuts and bolts of area probability sampling; multiphase designs; quality control of survey operations; and statistical software for survey sampling and estimation. An associated R package, PracTools, contains a number of specialized functions for sample size and other calculations. The data sets used in the book are also available in PracTools, so that the reader may replicate the examples or perform further analyses.
Sampling: Design and Analysis by Sharon L. Lohr Provides a modern introduction to the field of sampling. With a multitude of applications from a variety of disciplines, the book concentrates on the statistical aspects of taking and analyzing a sample. Overall, the book gives guidance on how to tell when a sample is valid or not, and how to design and analyze many different forms of sample surveys.
Sampling Techniques by William G. Cochran Clearly demonstrates a wide range of sampling methods now in use by governments, in business, market and operations research, social science, medicine, public health, agriculture, and accounting. Gives proofs of all the theoretical results used in modern sampling practice. New topics in this edition include the approximate methods developed for the problem of attaching standard errors or confidence limits to nonlinear estimates made from the results of surveys with complex plans.
"Understanding the Process of Qualitative Data Collection" in Chapter 13 (pp. 103–1162) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.
Survey Methodology by Robert M. Groves; Floyd J. Fowler; Mick P. Couper; James M. Lepkowski; Eleanor Singer; Roger Tourangeau; Floyd J. Fowler coverage includes sampling frame evaluation, sample design, development of questionnaires, evaluation of questions, alternative modes of data collection, interviewing, nonresponse, post-collection processing of survey data, and practices for maintaining scientific integrity.

The way a qualitative researcher constructs and approaches interview questions should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Constructing Your Questions

Helpful texts:.

"Developing Questions" in Chapter 4 (pp. 98–108) of Becoming Qualitative Researchers by Corrine Glesne Ideal for introducing the novice researcher to the theory and practice of qualitative research, this text opens students to the diverse possibilities within this inquiry approach, while helping them understand how to design and implement specific research methods.
"Learning to Interview in the Social Sciences" Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659 - 660.
Qualitative Research Interviewing: Biographic Narrative and Semi-Structured Methods (See sections on “Lightly and Heavily Structured Depth Interviewing: Theory-Questions and Interviewer-Questions” and “Preparing for any Interviewing Sequence") by Tom Wengraf Unique in its conceptual coherence and the level of practical detail, this book provides a comprehensive resource for those concerned with the practice of semi-structured interviewing, the most commonly used interview approach in social research, and in particular for in-depth, biographic narrative interviewing. It covers the full range of practices from the identification of topics through to strategies for writing up research findings in diverse ways.
"Scripting a Qualitative Purpose Statement and Research Questions" in Chapter 12 (pp. 93–102) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.
Some Strategies for Developing Interview Guides for Qualitative Interviews by Sociology Department, Harvard University Includes general advice for conducting qualitative interviews, pros and cons of recording and transcription, guidelines for success, and tips for developing and phrasing effective interview questions.
Tip Sheet on Question Wording by Harvard University Program on Survey Research

Let Theory Guide You:

The quality of your questions depends on how you situate them within a wider body of knowledge. Consider the following advice:

A good literature review has many obvious virtues. It enables the investigator to define problems and assess data. It provides the concepts on which percepts depend. But the literature review has a special importance for the qualitative researcher. This consists of its ability to sharpen his or her capacity for surprise (Lazarsfeld, 1972b). The investigator who is well versed in the literature now has a set of expectations the data can defy. Counterexpectational data are conspicuous, readable, and highly provocative data. They signal the existence of unfulfilled theoretical assumptions, and these are, as Kuhn (1962) has noted, the very origins of intellectual innovation. A thorough review of the literature is, to this extent, a way to manufacture distance. It is a way to let the data of one's research project take issue with the theory of one's field.

McCracken, G. (1988), The Long Interview, Sage: Newbury Park, CA, p. 31

When drafting your interview questions, remember that everything follows from your central research question. Also, on the way to writing your "operationalized" interview questions, it's helpful to draft broader, intermediate questions, couched in theory. Nota bene: While it is important to know the literature well before conducting your interview(s), be careful not to present yourself to your research participant(s) as "the expert," which would be presumptuous and could be intimidating. Rather, the purpose of your knowledge is to make you a better, keener listener.

If you'd like to supplement what you learned about relevant theories through your coursework and literature review, try these sources:

Annual Reviews Review articles sum up the latest research in many fields, including social sciences, biomedicine, life sciences, and physical sciences. These are timely collections of critical reviews written by leading scientists.
HOLLIS - search for resources on theories in your field Modify this example search by entering the name of your field in place of "your discipline," then hit search.
Oxford Bibliographies Written and reviewed by academic experts, every article in this database is an authoritative guide to the current scholarship in a variety of fields, containing original commentary and annotations.
ProQuest Dissertations & Theses (PQDT) Indexes dissertations and masters' theses from most North American graduate schools as well as some European universities. Provides full text for most indexed dissertations from 1990-present.
Very Short Introductions Launched by Oxford University Press in 1995, Very Short Introductions offer concise introductions to a diverse range of subjects from Climate to Consciousness, Game Theory to Ancient Warfare, Privacy to Islamic History, Economics to Literary Theory.

CONDUCTING INTERVIEWS

Equipment and software: .

Lamont Library loans microphones and podcast starter kits, which will allow you to capture audio (and you may record with software, such as Garage Band).
Cabot Library loans digital recording devices, as well as USB microphones.

If you prefer to use your own device, you may purchase a small handheld audio recorder, or use your cell phone.

Audio Capture Basics (PDF) - Helpful instructions, courtesy of the Lamont Library Multimedia Lab.
Getting Started with Podcasting/Audio: Guidelines from Harvard Library's Virtual Media Lab for preparing your interviewee for a web-based recording (e.g., podcast, interview)
Camtasia Screen Recorder and Video Editor
Zoom: Video Conferencing, Web Conferencing
Visit the Multimedia Production Resources guide! Consult it to find and learn how to use audiovisual production tools, including: cameras, microphones, studio spaces, and other equipment at Cabot Science Library and Lamont Library.
Try the virtual office hours offered by the Lamont Multimedia Lab!

TIPS FOR CONDUCTING INTERVIEWS

Quick handout: .

Research Interviewing Tips (Courtesy of Dr. Suzanne Spreadbury)

Remote Interviews:

For Online or Distant Interviews, See "Remote Research & Virtual Fieldwork" on this guide .
Deborah Lupton's Bibliography: Doing Fieldwork in a Pandemic

Seeking Consent:

Books and articles: .

"App-Based Textual Interviews: Interacting With Younger Generations in a Digitalized Social Reallity."International Journal of Social Research Methodology (12 June 2022). Discusses the use of texting platforms as a means to reach young people. Recommends useful question formulations for this medium.
"Learning to Interview in the Social Sciences." Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659-660.
"Slowing Down and Digging Deep: Teaching Students to Examine Interview Interaction in Depth." LEARNing Landscapes, Spring 2021 14(1) 153-169 by Herron, Brigette A. and Kathryn Roulston. Suggests analysis of videorecorded interviews as a precursor to formulating one's own questions. Includes helpful types of probes.
Using Interviews in a Research Project by Nigel Joseph Mathers; Nicholas J Fox; Amanda Hunn; Trent Focus Group. A work pack to guide researchers in developing interviews in the healthcare field. Describes interview structures, compares face-to-face and telephone interviews. Outlines the ways in which different types of interview data can be analysed.
“Working through Challenges in Doing Interview Research.” International Journal of Qualitative Methods, (December 2011), 348–66 by Roulston, Kathryn. The article explores (1) how problematic interactions identified in the analysis of focus group data can lead to modifications in research design, (2) an approach to dealing with reported data in representations of findings, and (3) how data analysis can inform question formulation in successive rounds of data generation. Findings from these types of examinations of interview data generation and analysis are valuable for informing both interview practice as well as research design.

Videos:

The way a qualitative researcher transcribes interviews should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

TRANSCRIPTION

Before embarking on a transcription project, it's worthwhile to invest in the time and effort necessary to capture good audio, which will make the transcription process much easier. If you haven't already done so, check out the audio capture guidelines from Harvard Library's Virtual Media Lab , or contact a media staff member for customized recommendations. First and foremost, be mindful of common pitfalls by watching this short video that identifies the most common errors to avoid!

SOFTWARE:

Adobe Premiere Pro Speech-To-Text automatically generates transcripts and adds captions to your videos. Harvard affiliates can download Adobe Premiere in the Creative Cloud Suite.
GoTranscript provides cost-effective human-generated transcriptions.
pyTranscriber is an app for generating automatic transcription and/or subtitles for audio and video files. It uses the Google Cloud Speech-to-Text service, has a friendly graphical user interface, and is purported to work nicely with Chinese.
Otter provides a new way to capture, store, search and share voice conversations, lectures, presentations, meetings, and interviews. The startup is based in Silicon Valley with a team of experienced Ph.Ds and engineers from Google, Facebook, Yahoo and Nuance (à la Dragon). Free accounts available. This is the software that Zoom uses to generate automated transcripts, so if you have access to a Zoom subscription, you have access to Otter transcriptions with it (applicable in several languages ). As with any automated approach, be prepared to correct any errors after the fact, by hand.
Panopto is available to Harvard affiliates and generates ASR (automated speech recognition) captions . You may upload compatible audio files into it. As with any automatically generated transcription, you will need to make manual revisions. ASR captioning is available in several languages . Panopto maintains robust security practices, including strong authentication measures and end-to-end encryption, ensuring your content remains private and protected.
REV.Com allows you to record and transcribe any calls on the iPhone, both outgoing and incoming. It may be useful for recording phone interviews. Rev lets you choose whether you want an AI- or human-generated transcription, with a fast turnaround. Rev has Service Organization Controls Type II (SOC2) certification (a SOC2 cert looks at and verifies an organization’s processing integrity, privacy practices, and security safeguards).
Scribie Audio/Video Transcription provides automated or manual transcriptions for a small fee. As with any transcription service, some revisions will be necessary after the fact, particularly for its automated transcripts.
Sonix automatically transcribes, translates, and helps to organize audio and video files in over 40 languages. It's fast and affordable, with good accuracy. The free trial includes 30 minutes of free transcription.
TranscriptionWing uses a human touch process to clean up machine-generated transcripts so that the content will far more accurately reflect your audio recording.
Whisper is a tool from OpenAI that facilitates transcription of sensitive audiovisual recordings (e.g., of research interviews) on your own device. Installation and use depends on your operating system and which version you install. Important Note: The Whisper API, where audio is sent to OpenAI to be processed by them and then sent back (usually through a programming language like Python) is NOT appropriate for sensitive data. The model should be downloaded with tools such as those described in this FAQ , so that audio is kept to your local machine. For assistance, contact James Capobianco .

EQUIPMENT:

Transcription pedals are in circulation and available to borrow from the Circulation desk at Lamont, or use at Lamont Library's Media Lab on level B. For hand-transcribing your interviews, they work in conjunction with software such as Express Scribe , which is loaded on Media Lab computers, or you may download for free on your own machine (Mac or PC versions; scroll down the downloads page for the latter). The pedals are plug-and-play USB, allow a wide range of playback speeds, and have 3 programmable buttons, which are typically set to rewind/play/fast-forward. Instructions are included in the bag that covers installation and set-up of the software, and basic use of the pedals.

NEED HELP?

Try the virtual office hours offered by the Lamont Multimedia Lab!
If you're creating podcasts, login to Canvas and check out the Podcasting/Audio guide .

Helpful Texts:

"Transcription as a Crucial Step of Data Analysis" in Chapter 5 of The SAGE Handbook of Qualitative Data Analysisby Uwe Flick (Editor) Covers basic terminology for transcription, shares caveats for transcribers, and identifies components of vocal behavior. Provides notation systems for transcription, suggestions for transcribing turn-taking, and discusses new technologies and perspectives. Includes a bibliography for further reading.
"Transcribing the Oral Interview: Part Art, Part Science " on p. 10 of the Centre for Community Knowledge (CCK) newsletter: TIMESTAMPby Mishika Chauhan and Saransh Srivastav

QUALITATIVE DATA ANALYSIS

Software .

Free download available for Harvard Faculty of Arts and Sciences (FAS) affiliates
Desktop access at Lamont Library Media Lab, 3rd floor
Desktop access at Harvard Kennedy School Library (with HKS ID)
Remote desktop access for Harvard affiliates from IQSS Computer Labs . Email them at [email protected] and ask for a new lab account and remote desktop access to NVivo.
Virtual Desktop Infrastructure (VDI) access available to Harvard T.H. Chan School of Public Health affiliates

CODING AND THEMEING YOUR DATA

Data analysis methods should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these). Some established methods include Content Analysis, Critical Analysis, Discourse Analysis, Gestalt Analysis, Grounded Theory Analysis, Interpretive Analysis, Narrative Analysis, Normative Analysis, Phenomenological Analysis, Rhetorical Analysis, and Semiotic Analysis, among others. The following resources should help you navigate your methodological options and put into practice methods for coding, themeing, interpreting, and presenting your data.

Users can browse content by topic, discipline, or format type (reference works, book chapters, definitions, etc.). SRM offers several research tools as well: a methods map, user-created reading lists, a project planner, and advice on choosing statistical tests.
Abductive Coding: Theory Building and Qualitative (Re)Analysis by Vila-Henninger, et al. The authors recommend an abductive approach to guide qualitative researchers who are oriented towards theory-building. They outline a set of tactics for abductive analysis, including the generation of an abductive codebook, abductive data reduction through code equations, and in-depth abductive qualitative analysis.
Analyzing and Interpreting Qualitative Research: After the Interview by Charles F. Vanover, Paul A. Mihas, and Johnny Saldana (Editors) Providing insight into the wide range of approaches available to the qualitative researcher and covering all steps in the research process, the authors utilize a consistent chapter structure that provides novice and seasoned researchers with pragmatic, "how-to" strategies. Each chapter author introduces the method, uses one of their own research projects as a case study of the method described, shows how the specific analytic method can be used in other types of studies, and concludes with three questions/activities to prompt class discussion or personal study.
"Analyzing Qualitative Data." Theory Into Practice 39, no. 3 (2000): 146-54 by Margaret D. LeCompte This article walks readers though rules for unbiased data analysis and provides guidance for getting organized, finding items, creating stable sets of items, creating patterns, assembling structures, and conducting data validity checks.
"Coding is Not a Dirty Word" in Chapter 1 (pp. 1–30) of Enhancing Qualitative and Mixed Methods Research with Technology by Shalin Hai-Jew (Editor) Current discourses in qualitative research, especially those situated in postmodernism, represent coding and the technology that assists with coding as reductive, lacking complexity, and detached from theory. In this chapter, the author presents a counter-narrative to this dominant discourse in qualitative research. The author argues that coding is not necessarily devoid of theory, nor does the use of software for data management and analysis automatically render scholarship theoretically lightweight or barren. A lack of deep analytical insight is a consequence not of software but of epistemology. Using examples informed by interpretive and critical approaches, the author demonstrates how NVivo can provide an effective tool for data management and analysis. The author also highlights ideas for critical and deconstructive approaches in qualitative inquiry while using NVivo. By troubling the positivist discourse of coding, the author seeks to create dialogic spaces that integrate theory with technology-driven data management and analysis, while maintaining the depth and rigor of qualitative research.
The Coding Manual for Qualitative Researchers by Johnny Saldana An in-depth guide to the multiple approaches available for coding qualitative data. Clear, practical and authoritative, the book profiles 32 coding methods that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldaña discusses the methods, origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. Essential reading across the social sciences.
Flexible Coding of In-depth Interviews: A Twenty-first-century Approach by Nicole M. Deterding and Mary C. Waters The authors suggest steps in data organization and analysis to better utilize qualitative data analysis technologies and support rigorous, transparent, and flexible analysis of in-depth interview data.
From the Editors: What Grounded Theory is Not by Roy Suddaby Walks readers through common misconceptions that hinder grounded theory studies, reinforcing the two key concepts of the grounded theory approach: (1) constant comparison of data gathered throughout the data collection process and (2) the determination of which kinds of data to sample in succession based on emergent themes (i.e., "theoretical sampling").
“Good enough” methods for life-story analysis, by Wendy Luttrell. In Quinn N. (Ed.), Finding culture in talk (pp. 243–268). Demonstrates for researchers of culture and consciousness who use narrative how to concretely document reflexive processes in terms of where, how and why particular decisions are made at particular stages of the research process.
The Ethnographic Interview by James P. Spradley “Spradley wrote this book for the professional and student who have never done ethnographic fieldwork (p. 231) and for the professional ethnographer who is interested in adapting the author’s procedures (p. iv) ... Steps 6 and 8 explain lucidly how to construct a domain and a taxonomic analysis” (excerpted from book review by James D. Sexton, 1980). See also: Presentation slides on coding and themeing your data, derived from Saldana, Spradley, and LeCompte Click to request access.
Qualitative Data Analysis by Matthew B. Miles; A. Michael Huberman A practical sourcebook for researchers who make use of qualitative data, presenting the current state of the craft in the design, testing, and use of qualitative analysis methods. Strong emphasis is placed on data displays matrices and networks that go beyond ordinary narrative text. Each method of data display and analysis is described and illustrated.
"A Survey of Qualitative Data Analytic Methods" in Chapter 4 (pp. 89–138) of Fundamentals of Qualitative Research by Johnny Saldana Provides an in-depth introduction to coding as a heuristic, particularly focusing on process coding, in vivo coding, descriptive coding, values coding, dramaturgical coding, and versus coding. Includes advice on writing analytic memos, developing categories, and themeing data.
"Thematic Networks: An Analytic Tool for Qualitative Research." Qualitative Research : QR, 1(3), 385–405 by Jennifer Attride-Stirling Details a technique for conducting thematic analysis of qualitative material, presenting a step-by-step guide of the analytic process, with the aid of an empirical example. The analytic method presented employs established, well-known techniques; the article proposes that thematic analyses can be usefully aided by and presented as thematic networks.
Using Thematic Analysis in Psychology by Virginia Braun and Victoria Clark Walks readers through the process of reflexive thematic analysis, step by step. The method may be adapted in fields outside of psychology as relevant. Pair this with One Size Fits All? What Counts as Quality Practice in Reflexive Thematic Analysis? by Virginia Braun and Victoria Clark

TESTING OR GENERATING THEORIES

The quality of your data analysis depends on how you situate what you learn within a wider body of knowledge. Consider the following advice:

Once you have coalesced around a theory, realize that a theory should reveal rather than color your discoveries. Allow your data to guide you to what's most suitable. Grounded theory researchers may develop their own theory where current theories fail to provide insight. This guide on Theoretical Models from Alfaisal University Library provides a helpful overview on using theory.

MANAGING & FINDING INTERVIEW DATA

Managing your elicited interview data, general guidance: .

Research Data Management @ Harvard A reference guide with information and resources to help you manage your research data. See also: Harvard Research Data Security Policy , on the Harvard University Research Data Management website.
Data Management For Researchers: Organize, Maintain and Share Your Data for Research Success by Kristin Briney. A comprehensive guide for scientific researchers providing everything they need to know about data management and how to organize, document, use and reuse their data.
Open Science Framework (OSF) An open-source project management tool that makes it easy to collaborate within and beyond Harvard throughout a project's lifecycle. With OSF you can manage, store, and share documents, datasets, and other information with your research team. You can also publish your work to share it with a wider audience. Although data can be stored privately, because this platform is hosted on the Internet and designed with open access in mind, it is not a good choice for highly sensitive data.
Free cloud storage solutions for Harvard affiliates to consider include: Google Drive , DropBox , or OneDrive ( up to DSL3 )

Data Confidentiality and Secure Handling:

Data Security Levels at Harvard - Research Data Examples This resource provided by Harvard Data Security helps you determine what level of access is appropriate for your data. Determine whether it should be made available for public use, limited to the Harvard community, or be protected as either "confidential and sensitive," "high risk," or "extremely sensitive." See also: Harvard Data Classification Table
Harvard's Best Practices for Protecting Privacy and Harvard Information Security Collaboration Tools Matrix Follow the nuts-and-bolts advice for privacy best practices at Harvard. The latter resource reveals the level of security that can be relied upon for a large number of technological tools and platforms used at Harvard to conduct business, such as email, Slack, Accellion Kiteworks, OneDrive/SharePoint, etc.
“Protecting Participant Privacy While Maintaining Content and Context: Challenges in Qualitative Data De‐identification and Sharing.” Proceedings of the ASIST Annual Meeting 57 (1) (2020): e415-420 by Myers, Long, and Polasek Presents an informed and tested protocol, based on the De-Identification guidelines published by the Qualitative Data Repository (QDR) at Syracuse University. Qualitative researchers may consult it to guide their data de-identification efforts.
QDS Qualitative Data Sharing Toolkit The Qualitative Data Sharing (QDS) project and its toolkit was funded by the NIH National Human Genome Research Institute (R01HG009351). It provides tools and resources to help researchers, especially those in the health sciences, share qualitative research data while protecting privacy and confidentiality. It offers guidance on preparing data for sharing through de-identification and access control. These health sciences research datasets in ICPSR's Qualitative Data Sharing (QDS) Project Series were de-identified using the QuaDS Software and the project’s QDS guidelines.
Table of De-Identification Techniques
Generative AI Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.
Harvard Information Security Quick Reference Guide Storage guidelines, based on the data's security classification level (according to its IRB classification) is displayed on page 2, under "handling."
Email Encryption Harvard Microsoft 365 users can now send encrypted messages and files directly from the Outlook web or desktop apps. Encrypting an email adds an extra layer of security to the message and its attachments (up to 150MB), and means only the intended recipient (and their inbox delegates with full access) can view it. Message encryption in Outlook is approved for sending high risk ( level 4 ) data and below.

Sharing Qualitative Data:

Repositories for Qualitative Data If you have cleared this intention with your IRB, secured consent from participants, and properly de-identified your data, consider sharing your interviews in one of the data repositories included in the link above. Depending on the nature of your research and the level of risk it may present to participants, sharing your interview data may not be appropriate. If there is any chance that sharing such data will be desirable, you will be much better off if you build this expectation into your plans from the beginning.
Guide for Sharing Qualitative Data at ICPSR The Inter-university Consortium for Political and Social Research (ICPSR) has created this resource for investigators planning to share qualitative data at ICPSR. This guide provides an overview of elements and considerations for archiving qualitative data, identifies steps for investigators to follow during the research life cycle to ensure that others can share and reuse qualitative data, and provides information about exemplars of qualitative data

International Projects:

Research Compliance Program for FAS/SEAS at Harvard The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

Finding Extant Interview Data

Finding journalistic interviews: .

Academic Search Premier This all-purpose database is great for finding articles from magazines and newspapers. In the Advanced Search, it allows you to specify "Document Type": Interview.
Guide to Newspapers and Newspaper Indexes Use this guide created to Harvard Librarians to identify newspapers collections you'd like to search. To locate interviews, try adding the term "interview" to your search, or explore a database's search interface for options to limit your search to interviews. Nexis Uni and Factiva are the two main databases for current news.
Listen Notes Search for podcast episodes at this podcast aggregator, and look for podcasts that include interviews. Make sure to vet the podcaster for accuracy and quality! (Listen Notes does not do much vetting.)
NPR and ProPublica are two sites that offer high-quality long-form reporting, including journalistic interviews, for free.

Finding Oral History and Social Research Interviews:

To find oral histories, see the Oral History page of this guide for helpful resources on Oral History interviewing.
Repositories for Qualitative Data It has not been a customary practice among qualitative researchers in the social sciences to share raw interview data, but some have made this data available in repositories, such as the ones listed on the page linked above. You may find published data from structured interview surveys (e.g., questionnaire-based computer-assisted telephone interview data), as well as some semi-structured and unstructured interviews.
If you are merely interested in studies interpreting data collected using interviews, rather than finding raw interview data, try databases like PsycInfo , Sociological Abstracts , or Anthropology Plus , among others.

Finding Interviews in Archival Collections at Harvard Library:

In addition to the databases and search strategies mentioned under the "Finding Oral History and Social Research Interviews" category above, you may search for interviews and oral histories (whether in textual or audiovisual formats) held in archival collections at Harvard Library.

HOLLIS searches all documented collections at Harvard, whereas HOLLIS for Archival Discovery searches only those with finding aids. Although HOLLIS for Archival Discovery covers less material, you may find it easier to parse your search results, especially when you wish to view results at the item level (within collections). Try these approaches:

Search in HOLLIS :

To retrieve items available online, do an Advanced Search for interview* OR "oral histor*" (in Subject), with Resource Type "Archives/Manuscripts," then refine your search by selecting "Online" under "Show Only" on the right of your initial result list. Revise the search above by adding your topic in the Keywords or Subject field (for example: African Americans ) and resubmitting the search.
To enlarge your results set, you may also leave out the "Online" refinement; if you'd like to limit your search to a specific repository, try the technique of searching for Code: Library + Collection on the "Advanced Search" page .

Search in HOLLIS for Archival Discovery :

To retrieve items available online, search for interview* OR "oral histor*" limited to digital materials . Revise the search above by adding your topic (for example: artist* ) in the second search box (if you don't see the box, click +).
To preview results by collection, search for interview* OR "oral histor*" limited to collections . Revise the search above by adding your topic (for example: artist* ) in the second search box (if you don't see the box, click +). Although this method does not allow you to isolate digitized content, you may find the refinement options on the right side of the screen (refine by repository, subject or names) helpful. Once your select a given collection, you may search within it (e.g., for your topic or the term interview).

UX & MARKET RESEARCH INTERVIEWS

Ux at harvard library .

User Experience and Market Research interviews can inform the design of tangible products and services through responsive, outcome-driven insights. The User Research Center at Harvard Library specializes in this kind of user-centered design, digital accessibility, and testing. They also offer guidance and resources to members of the Harvard Community who are interested in learning more about UX methods. Contact [email protected] or consult the URC website for more information.

Websites

User Interviews: The Beginner’s Guide (Chris Mears)
Interviewing Users (Jakob Nielsen)

Books

Interviewing Users: How to Uncover Compelling Insights by Steve Portigal; Grant McCracken (Foreword by) Interviewing is a foundational user research tool that people assume they already possess. Everyone can ask questions, right? Unfortunately, that's not the case. Interviewing Users provides invaluable interviewing techniques and tools that enable you to conduct informative interviews with anyone. You'll move from simply gathering data to uncovering powerful insights about people.
Rapid Contextual Design by Jessamyn Wendell; Karen Holtzblatt; Shelley Wood This handbook introduces Rapid CD, a fast-paced, adaptive form of Contextual Design. Rapid CD is a hands-on guide for anyone who needs practical guidance on how to use the Contextual Design process and adapt it to tactical projects with tight timelines and resources. Rapid Contextual Design provides detailed suggestions on structuring the project and customer interviews, conducting interviews, and running interpretation sessions. The handbook walks you step-by-step through organizing the data so you can see your key issues, along with visioning new solutions, storyboarding to work out the details, and paper prototype interviewing to iterate the design all with as little as a two-person team with only a few weeks to spare *Includes real project examples with actual customer data that illustrate how a CD project actually works.

Videos

Instructional Presentations on Interview Skills

Interview/Oral History Research for RSRA 298B: Master's Thesis Reading and Research (Spring 2023) Slideshow covers: Why Interviews?, Getting Context, Engaging Participants, Conducting the Interview, The Interview Guide, Note Taking, Transcription, File management, and Data Analysis.
Interview Skills From an online class on February 13, 2023: Get set up for interview research. You will leave prepared to choose among the three types of interviewing methods, equipped to develop an interview schedule, aware of data management options and their ethical implications, and knowledgeable of technologies you can use to record and transcribe your interviews. This workshop complements Intro to NVivo, a qualitative data analysis tool useful for coding interview data.

NIH Data Management & Sharing Policy (DMSP) This policy, effective January 25, 2023, applies to all research, funded or conducted in whole or in part by NIH, that results in the generation of scientific data , including NIH-funded qualitative research. Click here to see some examples of how the DMSP policy has been applied in qualitative research studies featured in the 2021 Qualitative Data Management Plan (DMP) Competition . As a resource for the community, NIH has developed a resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use. It is important to note that the DMS Policy does NOT require that informed consent obtained from research participants must allow for broad sharing and the future use of data (either with or without identifiable private information). See the FAQ for more information.

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Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License , which allows anyone to share and adapt our material as long as proper attribution is given. For details and exceptions, see the Harvard Library Copyright Policy ©2021 Presidents and Fellows of Harvard College.

Online Semi-structured Interviews to Better Capture Generational Media Actions: The Relevance of Relaxed, Participative and Reflexive Approaches

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First Online: 01 June 2024
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Maria José Brites ORCID: orcid.org/0000-0002-9840-9554 26 ,
Margarida Maneta ORCID: orcid.org/0000-0001-8424-6910 26 ,
Mariana S. Müller ORCID: orcid.org/0000-0002-3993-384X 26 &
Inês Amaral ORCID: orcid.org/0000-0003-4929-4866 27 , 28

Part of the book series: Lecture Notes in Computer Science ((LNCS,volume 14725))

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International Conference on Human-Computer Interaction

This paper presents thoughts on the use of online semi-structured interviews in a participatory format. On one hand, in the process of interviewing and on the other by using complementary methods such as media diaries and its associated online ethnography techniques. One of the challenges of audience research is the capture of the “audiencing” [ 1 ] process, in this paper we rely on two research projects to better discuss and consider forms of doing it, in arid research contexts, such as online and with a (inter)generational dimension.

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Q-methodology is a quantitative/qualitative social science method [ 27 ] considered well-suited for media reception and use [ 26 ]. It allows us to analyze individuals’ subjective perceptions of an area of experience and aggregate these perceptions through a factor analysis. As a result, the Q-methodology provides both qualitative and quantitative findings, creating a typological pattern of differences and similarities between the participants’ perceptions [ 27 ]. Q-methodology is applied in a card-sorting activity with a think-out-loud protocol structured based on the research questions. Participants have to place and rank these cards in a pyramid according to their daily use or importance in their lives. On each card is a statement or the particular sociocultural phenomenon being investigated [ 27 ], usually defined in a previous stage of the research. This activity has a dialogical potential and allows participants to reflect on their choices during the process. “When informants have completed the card placing process, accompanied by dialogical negotiation, they have self-analyzed their subjective news consumption universe, whose internal architecture is moreover relational” argues Schrøder [ 27 ].

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Acknowledgements

This article was developed within the scope of the project “YouNDigital - Youth, News and Digital Citizenship” (PTDC/COM-OUT/0243/2021), funded by FCT — Foundation for Science and Technology, I.P. DOI https://doi.org/10.54499/PTDC/COM-OUT/0243/2021 . https://youndigital.com and of the project “MyGender - Mediated young adults’ practices: advancing gender justice in and across mobile apps” (PTDC/COM-CSS/5947/2020), funded by FCT — Foundation for Science and Technology, I.P. DOI https://doi.org/10.54499/PTDC/COM-CSS/5947/2020 .

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Lusófona University, CICANT, Porto, Portugal

Maria José Brites, Margarida Maneta & Mariana S. Müller

Faculty of Arts and Humanities, University of Coimbra, Coimbra, Portugal

Inês Amaral

Centre for Social Studies, University of Coimbra, Coimbra, Portugal

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Correspondence to Maria José Brites .

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Brites, M.J., Maneta, M., Müller, M.S., Amaral, I. (2024). Online Semi-structured Interviews to Better Capture Generational Media Actions: The Relevance of Relaxed, Participative and Reflexive Approaches. In: Gao, Q., Zhou, J. (eds) Human Aspects of IT for the Aged Population. HCII 2024. Lecture Notes in Computer Science, vol 14725. Springer, Cham. https://doi.org/10.1007/978-3-031-61543-6_1

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Published: 29 May 2024

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

Samina Idrees 1 ,
Gillian Young 1 ,
Brian Dunne 2 ,
Donnie Antony 2 ,
Leslie Meredith 1 &
Maria Mathews 1

BMC Health Services Research volume 24 , Article number: 680 ( 2024 ) Cite this article

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Person-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.

We conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.

We interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.

Conclusions

The person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Peer Review reports

The community-care sector facilitates the coordination and administration of in-home and community-based health and social services. Community-care services include supports for independent living, residential services, complex medical care, and community-participation services to support personal and professional goals (e.g., education, employment, and recreation-based supports) [ 1 ]. There is substantial heterogeneity in the clinical and demographic characteristics of the community-care population, including individuals with physical and developmental disabilities, and complex medical needs [ 2 ]. We refer to the individuals served by these organizations as ‘persons-supported’ in line with person-first language conventions [ 3 , 4 ].

In recent decades, governments across the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery [ 5 , 6 , 7 , 8 ]. Person-centred care encompasses a broad framework designed to direct care delivery, as opposed to a singular standardized process. In the context of community-care, person-centred planning refers to a model of care provision in which programs and services are developed in collaboration with persons-supported and tailored to their unique needs and desired outcomes [ 9 , 10 ].

In Ontario, Canada, community-care services are funded by the Ministry of Health (MOH) and the Ministry of Children, Community and Social Services (MCCSS). Service agreements between these ministries and individual agencies can be complex and contingent on different factors including compliance with a number of regulatory items and policies [ 7 , 11 ]. MOH provides funding for health-based services including in-home physiotherapy, respiratory therapy, and personal support services, among several others. MOH funds Home and Community Care Support Services (HCCSS), a network of organizations responsible for coordinating the delivery of in-home and community-based care in the province. MCCSS funds social service agencies including those providing community participation and residential support for people with intellectual and developmental disabilities (IDDs).

Several tools and resources have been developed to aid organizations in providing person-centred care and organizations may differ in their use of these tools and their specific approach. Although regional mandates provide a framework for directing care delivery, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. In addition, as noted by a recent scoping review, there is limited literature on the implementation process and impact of person-centred planning on individual outcomes [ 12 ]. Using a pragmatic, qualitative, descriptive approach [ 13 ], we outline how community-care organizations enact a person-centred approach to care and the factors that shape their enactment. By describing existing practices in the context of the community-care sector, we aim to provide insight on how to optimize care delivery to improve outcomes and inform current policy. This study is part of a larger, multi-methods project examining the implementation of person-centred care plans in the community-care sector. This project encompasses qualitative interviews with representatives from different community-care organizations, as well as staff and persons-supported at a partner community-care organization. This paper focuses on analyzing data from interviews with representatives from different community-care organizations.

We conducted semi-structured interviews with administrators from community-care organizations in Southwestern Ontario (roughly the Ontario Health West Region) between October 2022 and January 2023. We included community-care organizations funded by MOH or MCCSS. We excluded organizations that did not provide services in Southwestern Ontario. We identified eligible organizations and participants by searching online databases, including community resource lists, as well as through consultation with members of the research team.

We used maximum variation sampling [ 14 ], to recruit participants from organizations with a wide range of characteristics including location (i.e., urban, rural), organization type (i.e., for-profit, not-for-profit), and types of services provided (e.g., residential, recreation, transportation, etc.) We contacted eligible organizations via email, providing them with study information and inviting them to participate. We recruited until the data reached saturation, defined as the point at which there was sufficient data to enable rigorous analysis [ 14 , 15 ].

In each interview, we asked participants about their organization’s approach to developing and updating individual service agreements or person-centred care plans, and the supports and barriers (e.g., organizational, funding, staffing, etc.) that facilitate or hinder the implementation of these plans (Supplementary Material 1 : Interview Guide). We also collected information on relevant participant and organizational characteristics, including participant gender, position, years of experience, organization location, type (i.e., for-profit, not-for-profit), services offered, years in operation, and client load. The interviews were approximately one hour in length and conducted virtually via Zoom (Zoom Video Communications Inc.) or by telephone. The interviews were audio-recorded and transcribed verbatim. Interviewer field notes were also used in data analysis.

We analyzed the data thematically [ 16 ]. The coding process followed a collaborative and multi-step approach. Initially, three members of the research team independently reviewed and coded a selection of transcripts to identify key ideas and patterns in the data, and form a preliminary coding template. We then met to consolidate individual coding efforts. We compared coding of each transcript, resolving conflicts through discussion and consensus. In coding subsequent transcripts and through a series of meetings, we worked together to finalize the codebook to reflect more analytic codes. We used the finalized template to code all interview transcripts in NVivo (QSR International), a software designed to facilitate qualitative data analysis. We refined the codebook on an as-needed basis by incorporating novel insights gleaned from the coding of additional transcripts, reflecting the iterative nature of the analysis.

We increased the robustness of our methodology by pre-testing interview questions, documenting interview and transcription protocols, using experienced interviewers, and confirming meaning with participants in interviews [ 14 , 15 , 16 ]. We kept detailed records of interviews, field notes, and drafts of the coding template. We made efforts to identify negative cases and provided rich descriptions and illustrative quotes [ 17 ]. We included individuals directly involved in the administration of community-care services on our research team. These individuals provided important context and feedback at each stage of the research process.

This study was approved by the research ethics board at Western University. We obtained informed consent from participants prior to the onset of interviews. We maintained confidentiality through secure storage of interview data (e.g., audio recordings), password-protection of sensitive documents, and the de-identification of transcripts.

Positionality

The authors represent a multidisciplinary team of researchers, clinicians, and community-care leaders. The community-care leaders and clinicians on our team provided key practical expertise to inform the development of interview questions and the analysis of study findings.

We interviewed administrators across 12 community-care organizations in Southwestern Ontario. The sample included representatives from seven organizations that received funding from MCCSS, three organizations that received funding from MOH, and two organizations that received funding from both MCCSS and MOH (Table 1 ). Eleven organizations were not-for-profit, one was a for-profit agency. The organizations provided care in rural ( n = 3), urban ( n = 4), or both rural and urban populations ( n = 5). Seven of the 12 participants were women, nine had been working with their organization for more than 11 years, and all had been working in the community-care sector for more than 12 years (Table 2 ).

We identified three key categories or processes relating to organizational characteristics and their impact on the design and delivery of person-centred care plans: (1) organizational context, (2) organizational culture, and (3) the development and implementation of person-centred care plans.

Organizational context

Organizational context refers to the characteristics of persons-supported, and the nature of services provided. Organizational context accounts for the considerable heterogeneity across organizations in the community-care sector and their approach to person-centred care plans.

Populations served

The majority of organizations included in the study supported individuals with IDDs: “all of the people have been identified as having a developmental disability. That’s part of the eligibility criteria for any funded developmental service in Ontario.” [P10]. Participants described how eligibility was ascertained through the referral process: “ the DSO [Developmental Services Ontario] figures all of that out and then refers them to us .” [P08]. These descriptions highlighted a common access point for publicly-funded adult developmental services in the province. Accordingly, these organizations were primarily funded by MCCSS. Other organizations focused on medically complex individuals including those with acquired brain injuries or those unable to access out-patient services due to physical disabilities: “the typical reason for referral is going to be around a physical impairment… But, with this medically complex population, you’re often seeing comorbidities where there may be some cognitive impairment, early dementia.” [P04]. In these organizations, eligibility and referral were usually coordinated by HCCSS. These insights highlighted the diverse characteristics of community-care populations, emphasizing the need to consider both physical and cognitive health challenges in care provision approaches.

Services offered

The characteristics of persons-supported informed the context of care and the type of services offered by the organization. The different dimensions of services offered within this sector include social and medical care, short and long-term care provision, in-home and community-care, and full and part-time care.

Nature of care: social vs. medical

Many organizations serving individuals with IDDs employed a holistic, psychosocial model of care, designed to support all areas of an individual’s life including supports for independent-living, and community-based education, employment, and recreation services to support personal and professional goals: “we support people in their homes, so residential supports. We also support people in the community, to be a part of the community, participate in the community and also to work in the community.” [P06]. These descriptions reflect a comprehensive approach to care, aiming to address needs within and beyond residential settings to promote active participation within the broader community. In contrast, some organizations followed a biomedical model of care, designed to support specific health needs: “We provide all five therapies… physiotherapy, occupational therapy, speech, social work, and nutrition. In some locations we provide visiting nursing, at some locations shift nursing. We have some clinic-nursing… and we provide personal support and home-making services in a number of locations as well.” [P04]. These organizations adopted a more clinically-focused approach to care. In either instance, the care model and the nature of services offered were largely determined by an organization’s mandate including which gaps they aimed to fill within the community. Many organizations described providing a mixture of social and medical care for individuals with complex needs. However, the implementation of care plans could be impacted by the lack of integration between social and medical care sectors, as some participants spoke to the importance of “[integrating] all of the different healthcare sector services… [including] acute care and public health and home and community care and primary care, and mental health and addictions.” [P04].

Duration of care: short-term vs. long-term

The duration of care also varied based on the needs of persons-supported. Organizations serving individuals with IDDs usually offered support across the lifespan: “We support adults with developmental disabilities and we support them from 18 [years] up until the end of their life.” [P06]. Some organizations provided temporary supports aimed at addressing specific health needs: “For therapies – these are all short-term interventions and typically they’re very specific and focused on certain goals. And so, you may get a referral for physiotherapy that is authorized for three visits or five visits” [P04], or crisis situations (e.g., homelessness): “Our services are then brought in to help provide some level of support, guidance, stabilization resource, and once essentially sustainability and positive outcomes are achieved—then our services are immediately withdrawn.” [P12]. One organization employed a model of care with two service streams, an initial rehabilitation stream that was intended to be short-term and an ongoing service stream for individuals requiring continuing support.

In-home vs. community-based care

Many organizations provided in-home care and community-based supports, where residential supports were designed to help individuals lead independent lives, and community-based supports encouraged participation in community activities to further inclusion and address personal and professional goals. One participant spoke about the range of services offered in the home and community:

“There’s probably two big categories of [services we offer]: community support services—so that includes things like adult day programs, assisted living, meals on wheels, transportation, friendly visiting … and things like blood pressure clinics, exercise programs… and then on the other side we do home care services. In the home care basket, we provide personal support, and we also provide social work support.” [P05].

Likewise, another participant spoke in further detail on the types of services that allow individuals to live independently within their homes, or in community-based residential settings (e.g., long-term care facilities):

“We provide accommodation supports to about 100 people living in our community—which means that we will provide support to them in their own homes. So, anywhere from an hour a week to 24 hours a day. And that service can include things from personal care to home management to money management, cooking, cleaning, and being out and about in communities—so community participation. We also provide supports for about 50 people living in long-term care facilities and that is all community participation support. So, minus the last 2 and a half years because of the pandemic, what that means is that a person living in a long-term care facility with a developmental disability can have our support to get out and about for 2 or 3 hours a week, on average.” [P10].

Full-time vs. part-time support

The person-supported’s needs also determined whether they would receive care within their homes and if they would be supported on a full-time (i.e., 24 h a day, 7 days a week) or part-time basis:

“ It really does range from that intensive 24- hour/7 day a week support, which we actually do provide that level of intense support in the family home, if that’s needed. And then, all the way through to just occasional advocacy support and phone check-in.” [P01].

Organizational Culture

Organizational culture was described as a key influence in the development and implementation of person-centred care plans. The culture of the organization includes their perceptions, attitudes and beliefs surrounding persons-supported; their model of care provision; as well as their willingness to evolve and adapt service provision to optimize care delivery.

Perceptions, attitudes, and beliefs regarding persons-supported

Participants described their organization’s view of persons-supported, with many organizations adopting an inclusionary framework where persons-supported were afforded the same rights and dignities as others in the community. This organizational philosophy was described as being deeply intertwined with an organization’s approach to personalizing programs and services:

“…an organization needs to be able to listen to the people who are receiving the service… and support them, to learn more, figure out, articulate, whatever it is, the service or the supports that they need in order to get and move forward with their life.” [P10].

The focus on the person-supported, their needs, likes, and dislikes, was echoed across organizations, with an emphasis on the impact of “culture and trying to embed for each person who delivers service the importance of understanding the individual.” [P05]. Participants also described their organization’s approach to allowing persons-supported to take risks, make mistakes, and live life on their own terms:

“You have to go and venture out and take some [risks]… We try to exercise that philosophy - people with disabilities should have the same rights and responsibilities as other people in the community. Whether that’s birthing or education, getting a job, having a house they can be proud of, accessing community supports, whether that be [a] library or community centre, or service club, whatever that is.” [P03].

Model of care provision

The model of care provision was heavily influenced by the organization’s values and philosophy. Several organizations employed a flexible model of care where supports were developed around the needs, preferences, and desired outcomes of the person-supported:

“…if we don’t offer [the program they want], we certainly build it. Honestly, most of our programs were either created or built by someone coming to us [and] saying ‘I want to do this with my life,’ or …‘my son would like to do art.’” [P02].

Although there were similarities in models across the different organizations, one participant noted that flexibility can be limited in the congregate care setting as staff must tend to the needs of a group as opposed to an individual:

“Our typical plan of operation outside of the congregate setting is we design services around the needs of the person. We don’t ask them to fit into what we need, we build services for what they need. Within the congregate care setting, we have a specific set of rules and regulations for safety and well-being of the other people that are here.” [P11].

Evolving service orientation

In organizations serving individuals with IDDs, many described shifting from program-based services to more individualized and community-based supports: “The goal was always to get people involved in their community and build in some of those natural supports … [we] are looking to support people in their own communities based on their individual plans.” [P07]. One participant described this model as a person-directed approach as opposed to person-centred, citing the limitations of program-based services in meeting individual needs:

“[Persons-supported] couldn’t [do] what they wanted because they were part of a bigger group. We would listen to the bigger group, but if one person didn’t want to go bowling … we couldn’t support them because everybody had to go bowling.” [P06].

The focus on individualized support could potentially lead to increased inclusion for persons-supported in their communities:

“… people go to Tim Horton’s, and if they go every day at 9 they probably, eventually will meet other people that go at 9 o’clock and maybe strike up a conversation and get to know somebody and join a table … and meet people in the community.” [P02].

By creating routines centred on individual preferences, the person-supported becomes a part of a community with shared interests and values.

Person-centred care plans

Community-care organizations enacted a person-centred approach by creating person-centred care plans for each person-supported. Although all participants said their organization provided person-centred services, there was considerable variation in the specific processes for developing, implementing, and updating care plans.

Developing a person-centred care plan

The development of a care plan includes assessment, consultation, and prioritization. The initial development of the care plan usually involved an assessment of an individual’s needs and goals. Participants described agency-specific assessment processes that often incorporated information from service referrals: “ In addition to the material we get from the DSO [Disability Services Ontario] we facilitate the delivery of an intake package specifically for our services. And that intake package helps to further understand the nature and needs of an individual.” [P12]. Agency-specific assessment processes differed by the nature of services provided and the characteristics of the population. However, most organizations included assessments of “not only physical functioning capabilities, but also cognitive.” [P01]. Assessment also included an appraisal of the suitability of the organization’s services. In instances where persons-supported were seeking residential placements or independent-living support, organizations assessed their ability to carry out the activities of daily living:

“[Our internal assessment] is an overview of all areas of their life. From, ‘do they need assistance with baking, cooking, groceries, cleaning, laundry? Is there going to be day program opportunities included in that residential request for placement? What the medical needs are?’” [P02].

In contrast, the person-supported’s community-based activities were primarily informed by their interests and desired outcomes: “We talk about what kinds of goals they want to work on. What kind of outcomes we’re looking for…” [P06].

The development of the care plan also included a consultation phase, involving conversations with the person-supported, their family members, and potentially external care providers: “We would use the application information, we’d use the supports intensity scale, but we’d also spend time with the person and their connections, their family and friends, in their home to figure out what are the kinds of things that this person needs assistance with.” [P10]. Participants described the person-supported’s view as taking precedence in these meetings: “We definitely include the family or [alternate] decision-maker in that plan, but the person-supported ultimately has the final stamp of approval.” [P08]. Many participants also acknowledged the difficulty of identifying and incorporating the person-supported’s view in cases where opinions clash and the person-supported has difficulty communicating and/or is non-verbal: “Some of the people we support are very good at expressing what they want. Some people are not. Some of our staff are really strong in expressing what they support. …And some of the family members are very strong. So you have to be very careful that the [person-supported] is not being lost in the middle of it.” [P06].

Participants also noted that some persons-supported preferred not to have a care plan:

“Some of the people say ‘I hate [the plans] I don’t want to do them’…. we look at it in a different way then. We’ll use graphic art, we’ll use video, we’ll think outside the box to get them to somehow—because at the end of the day when we’re audited by MCCSS every [person-supported] either has to have [a plan]… or there has to be [an approval of] why it wasn’t completed.” [P02].

Plan development may also include a prioritization process, particularly in cases where resources are limited. A person-supported’s goals could be prioritized using different schemas. One participant noted that “the support coordinator takes the cue from the person-supported - … what they’ve identified as ‘have to have’ and ‘nice to have’. … because the ‘have to haves’ are prioritized.” [P09]. Likewise, the person-supported’s preference could also be identified through “[an] exercise, called ‘what’s important for and what’s important to .’” [P06]. This model, based on a Helen Sanderson approach [ 18 ], was described as being helpful in highlighting what is important to the person-supported, as opposed to what others (i.e., friends, family, staff, etc.) feel is important for them.

Several organizations updated care plans throughout the year, to document progress towards goals, adapt to changing needs and plan for future goals: “We revisit the plan periodically through the year. And if they say the goal is done, we may set another goal.” [P06]. Organizations may also change plans to adapt to the person-supported’s changing health status or personal capacity.

Implementing a person-centred care plan

The implementation of care plans differed based on the nature of services provided by the organization. The delivery of health-based or personal support services often involved matching the length and intensity of care with the individual’s needs and capacity:

“Sometimes that is a long time, sometimes it’s a short time, sometimes it’s an intervention that’s needed for a bit, and then the person is able to function.” [P05].

In contrast, the delivery of community-based services involved matching activities and staff by interests: “[if] a person-supported wants to go out and be involved in the music community, then we pull the staff pool in and match them up according to interest.” [P06].

Broad personal goals were broken down into smaller, specific activities. For example, one participant described their organization’s plan in helping a person-supported achieve his professional goal of securing employment:

“[The person-supported] said ‘Okay, I want a job.’ So for three weeks he was matched up with a facilitator. They came up with an action plan in terms of how to get a job, what kind of job he’s looking for, where he wants to go, where he wants to apply, how to conduct an interview. And after three weeks he got a job.” [P09].

Organizations that provided residential services focused on developing independent-living skills. One participant described their organization’s plan to empowering persons-supported by allowing them to make their own financial decisions:

“If one month they’re looking after their own finances, and they’ve overspent. Well, maybe we help them out with a grocery card or something and say ‘okay, next month how are you going to do this?’ [The person-supported may say], ‘well, maybe I’ll put so much money aside each week rather than doing a big grocery shop the first week and not having enough money left at the end of the month.’” [P03].

The participant noted that “a tremendous amount of learning [happens] when a person is allowed to [take] risks and make their own decisions.” [P03].

Likewise, participants representing organizations that provided residential services described tailoring care to the persons-supported’s sleeping schedule and daily routine:

“We develop a plan and tweak it as we go. With [the person-supported] coming to the home, what worked well was, we found that he wanted to sleep in, so we adjusted the [staff] time. We took a look at his [medication] times in the morning… and [changed] his [medication] times. We found that he wanted to sleep [until] later in the day, so he would get up at 10 o’clock, so then instead of having breakfast, lunch, and supper he would just have a bigger brunch. Just really tailoring the plan around the person-supported, and it’s worked out well.” [P08].

These examples highlight how organizational context and culture influence how organizations operationalize person-centred care plans; the same individual may experience different approaches to care and engage in different activities depending on the organization they receive services from.

In this paper, we described key elements of the person-centred planning process across different community-care organizations in Southwestern Ontario. We also identified that the context and culture of an organization play a central role in informing the process by which services are personalized to an individual’s needs. These findings shed light on the diversity of factors that influence the implementation of person-centred care plans and the degree to which organizations are able to address medical and social needs in an integrated fashion. They also inform future evaluations of person and system-related outcomes of person-centred planning.

There are regulations around individualizing services delivered by community-care organizations, whereby care providers must allow persons-supported to participate in the development and evaluation of their care plans. HCCSS or MOH-funded services are largely focused on in-home rehabilitation or medical care. In contrast, MCCSS-funded organizations often focus on developing independent living skills or promoting community participation, thus highlighting the role of the funding agency in determining organizational context as well as the nature of services and personalization of care plans.

We also identified organizational culture as a key influence in the person-centred planning process. In previous reports, organizational culture, and specifically the way in which staff perceive and view persons-supported and their decision-making capabilities can impact the effective delivery of person-centred care [ 19 ]. Staff support, including their commitment to persons-supported and the person-centred process, has been regarded as one of the most powerful predictors of positive outcomes and goal attainment in the developmental services sector [ 20 , 21 ]. Moreover, in order to be successful, commitment to this process should extend across all levels of the organization, be fully integrated into organizational service delivery, and be reflected in organizational philosophy, values and views of persons-supported [ 22 , 23 , 24 ].

MCCSS mandates that agencies serving individuals with IDDs develop an individual service plan (ISP) for each person-supported, one “that address[es] the person’s goals, preferences and needs.” [ 7 ]. We reference ISPs as person-centred care plans, as is in line with the view of participants in interviews. There are a series of checklists designed to measure compliance with these policies, and the process is iterative, with mandated annual reviews of care plans and active participation by the person-supported [ 25 ]. In our study, the agencies funded by MCCSS adhered to the general framework outlined by these regulations and informed service delivery accordingly. However, participants also described areas for improvement with respect to the implementation of these policies in practice. These policies, while well-intentioned, may imply a one-size-fits-all approach and appear more as an administrative exercise as opposed to a meaningful endeavor designed to optimize care. Participants spoke about individuals who preferred not to have an ISP, and how that in and of itself is a person-centred approach, respecting the person’s wishes. Additionally, we heard about how the goal-setting process may not be realistic as it can be perceived as unnatural to have goals at each point in one’s life. Moreover, participants noted challenges in implementing person-centred care in shared residential settings (e.g., group homes) or in cases where persons-supported had difficulty communicating.

Prior research indicates that individuals living in semi-independent settings fare better across several quality-of-life measures relative to individuals living in group homes, including decreased social dissatisfaction, increased community participation, increased participation in activities of daily living, and increased empowerment [ 26 ]. Furthermore, a recent study by İsvan et al. (2023) found that individuals living in the community (e.g., own home, family home, or foster home) exhibit greater autonomy in making everyday and life decisions, and greater satisfaction with their inclusion in the community [ 27 ]. These findings may be indicative of a reduced focus on person-centred care plan development and implementation in congregate care settings, where limited staff capacity can make it difficult to tend to the needs of everyone in the home. However, poor outcomes may also be explained by potentially more complex health challenges or more severe disability in persons-supported living in congregate care settings. The challenges described in our study are consistent with calls to improve the quality of care provided in residential group home settings [ 28 , 29 ].

In line with our findings, previous literature also describes challenges in implementing person-centred planning for individuals who have difficulty communicating or are non-verbal [ 19 , 30 , 31 , 32 ]. Communication has also been identified as a barrier to patient-centred care for adults with IDDs in healthcare settings [ 33 , 34 ]. Other reports have identified a need for increased training and awareness of diverse communication styles (including careful observation of non-verbal cues) to aid staff in including persons-supported in the development of care plans [ 35 , 36 , 37 ]. Importantly, these methods take substantial time which is often limited, and compounded by staffing shortages that are widespread across the sector [ 38 ]. Similar barriers were identified in interviews with staff and persons-supported at a partner community-care agency within our larger project [ 39 ]; other papers from the project examine strategies used by the organization to overcome these barriers.

Limitations

The findings from this study should be interpreted in the context of the following limitations. There is a risk for social desirability bias, whereby participants may feel pressure to present their care plan process in a more positive light due to societal norms and expectations [ 40 ]. Additionally, the experiences and views of community-care organizations may vary by region and organization type (i.e., for-profit vs. not-for-profit). In this study, we limited participation to agencies providing services in Southwestern Ontario and we were only able to interview one for-profit agency, despite concerted recruitment efforts. Consequently, we may not have fully captured how financial pressures, or different contextual and cultural components of an organization impact their implementation of care plans.

The person-centred planning process in community-care organizations is largely informed by the characteristics of the population served and the nature of services offered (i.e., organizational context). This process usually involves initial and continued consultations with persons-supported to tailor plans to their specific needs and desired outcomes. There are ongoing challenges in the implementation of person-centred planning, including a need for increased adaptability and clarity in current regulations. In some areas, there may be benefit to incorporating nuance in the application of policies (e.g., in cases where a person-supported does not want to have a formal plan in place). In other areas, it may be helpful to have increased guidance on how to optimize care delivery to improve outcomes (e.g., in cases where a person-supported has difficulty communicating, or is residing in a group home). Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Data availability

The datasets generated and analyzed in the current study are not publicly available to maintain participant confidentiality, however access may be granted by the corresponding author upon reasonable request.

Abbreviations

Acquired Brain Injury

Disability Services Ontario

Home and Community Care Support Services

Intellectual and Developmental Disabilities

Individual Service Plan

Ministry of Children, Community and Social Services

Ministry of Health

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Acknowledgements

The authors thank Ruth Armstrong, from PHSS - Medical & Complex Care in Community, for her valuable feedback and support throughout the research process.

This research was funded by the Canadian Institutes of Health Research. The funding agency had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

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S.I. conducted the interviews, developed the coding template, coded the data, thematically analyzed the data, and prepared the manuscript. G.Y. helped develop the coding template, and reviewed and approved the final manuscript. B.D. and D.A. helped conceptualize the study, aided in the interpretation and analysis of study findings, and reviewed and approved the final manuscript. L.M. coordinated research activities, aided in the interpretation and analysis of study findings, and reviewed and approved the final manuscript. M.M. conceptualized the study, supervised its implementation, and was a major contributor in reviewing and editing the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Maria Mathews .

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Idrees, S., Young, G., Dunne, B. et al. The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada. BMC Health Serv Res 24 , 680 (2024). https://doi.org/10.1186/s12913-024-11089-7

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Published: 31 May 2024

Overdose responses among rural people who use drugs: A multi-regional qualitative study

Robin Baker 1 , 13 ,
Rob J Fredericksen 2 ,
Abby E Rudolph 3 ,
Thomas J Stopka 4 ,
Suzan M Walters 5 ,
Monica Fadanelli 6 ,
Rebecca S Bolinski 7 ,
Adams L Sibley 8 ,
Erin Stack 9 ,
Heidi M Crane 10 ,
P Todd Korthuis 11 &
David W Seal 12

Harm Reduction Journal volume 21 , Article number: 107 ( 2024 ) Cite this article

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Efforts to distribute naloxone have equipped more people with the ability to reverse opioid overdoses but people who use drugs are often reluctant to call 911 due to concerns for legal repercussions. Rural communities face unique challenges in reducing overdose deaths compared to urban communities, including limited access to harm reduction services as well as greater concerns about stigma and privacy.

The Rural Opioid Initiative was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural US communities and consists of eight studies spanning ten states and 65 counties. Each study conducted semi-structured qualitative interviews with people who use drugs to understand contextual factors influencing drug use and health behaviors. We analyzed qualitative data from seven studies with data available at the time of analysis to understand peer response to overdose.

Of the 304 participants interviewed, 55% were men, 70% were white, 80% reported current injection drug use, and 60% reported methamphetamine use. Similar to what has been found in studies focused on urban settings, people who use drugs in rural communities use a range of strategies to reverse overdoses, including non-evidence-based approaches. Several reported that multiple doses of naloxone are needed to reverse overdose. Three themes emerged around the willingness to call 911, including (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement.

People who use drugs employ multiple strategies to attempt overdose reversal, including non-evidence-based approaches. Greater education about the most effective and least harmful strategies is needed. Reluctance to call 911 is rooted in concerns about potential legal consequences as well as perceptions about law enforcement officers, which may be heightened in rural communities where people who use drugs are more easily identified by law enforcement. People who use drugs will go to great strides to connect their peers to needed medical services, suggesting that comprehensive interventions to reduce interactions with law enforcement officers and eliminate legal consequences for reporting overdoses are critical.

Introduction

Opioid-related overdose rates have steadily increased since 2000. Provisional data from the CDC’s National Center for Health Statistics indicate that there were an estimated 77,766 opioid overdose deaths in the US during the 12-month period ending in December 2021, an increase of 12.6% from the 69,061 deaths during the 12-month period ending in December 2020 [ 1 ]. Of the 77,766 opioid overdose deaths reported in 2021, almost 88% involved synthetic opioids, primarily fentanyl [ 1 ]. While rates of overdose deaths are higher in urban settings, rural communities face unique challenges related to opioid use disorders due to reduced access and greater distances to behavioral health services and providers, limited public transportation, greater experience with stigma, and more concerns about privacy [ 2 , 3 , 4 , 5 ]. People who use drugs are well positioned to serve as first responders in the event of overdose [ 6 , 7 ]. However, research also suggests that most people who use drugs do not call 911 when witnessing an overdose [ 8 , 9 ]. Common reasons include fear of law enforcement officer involvement [ 8 , 10 ] and the belief that emergency medical services (EMS) are not needed [ 8 ]. One study found that overdose location may be an important factor, with people who use drugs more likely to call 911 when overdoses occur in public settings versus private residences or locations with active drug dealing and open drug use [ 11 ].

As of 2021, 47 states and Washington, D.C., have Good Samaritan laws (GSL) in place, which aim to protect bystanders from arrest or conviction when calling 911 to report an overdose [ 12 ]. Studies demonstrate that GSL have addressed some of the obstacles associated with calling 911 to report overdoses; however, limitations of GSL protections exist [ 13 , 14 , 15 ]. These include the narrow scope of protection that some GSL provide, a lack of awareness and understanding of the law among both people who use drugs and law enforcement officers, perceptions of and experiences among people who use drug with law enforcement officers disregarding the law [ 10 , 13 , 14 , 15 ].

Efforts to increase the capacity of people who use drugs to respond appropriately to overdoses include overdose education and naloxone distribution (OEND) programs [ 16 ]. Commonly recommended strategies to rescue people from opioid overdoses include sternum rubs, rescue breathing, naloxone administration, placing the person in the recovery position, and calling 911 [ 16 ]. Calling 911 is important because once the reversal effects of naloxone wear off, overdoses can reoccur, particularly as fentanyl and its analogs become the leading cause of overdose [ 17 ]. The increasing availability of naloxone through pharmacies, harm reduction agencies, health departments, and other community-based programs can equip people who use drugs with the tools needed to reverse opioid overdoses [ 16 , 18 ]. While several studies have demonstrated that distributing naloxone and training people who use drugs to administer naloxone reduces overdose mortality in communities [ 19 , 20 , 21 ], reluctance or hesitancy to call 911 persists. Most studies on overdose responses have focused on urban settings [ 10 , 22 , 23 ].

Studies focused on rural communities have similarly found that rural people who use drugs fear the legal consequences of reporting overdose, even in states with GSL [ 24 ]. As with urban communities, people who use drugs often report experiencing stigma related to drug use in rural communities [ 11 , 25 , 26 , 27 ]. In addition, rural communities also have limited access to substance use and harm reduction resources [ 3 , 5 ] and a larger proportion of overdose deaths involving psychostimulants (e.g., cocaine, methamphetamine) [ 28 ]. Limited access to OEND programs and increased rates of psychostimulant-involved overdose deaths is particularly concerning as previous studies have found that some people who use drugs mistakenly believe that psychostimulants can reverse opioid overdoses [ 29 , 30 ]. These unique challenges and factors may influence how rural people who use drugs respond to overdoses. This qualitative study builds on the existing literature by characterizing overdose response patterns and the interplay of factors influencing EMS involvement in a geographically diverse multi-regional U.S. sample of people who use drugs.

Materials and methods

The Rural Opioid Initiative (ROI) was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural parts of the United States ( http://ruralopioidinitiative.org/ ). ROI consists of eight study regions spanning ten states and 65 counties [ 31 , 32 ]. The initiative included qualitative and quantitative data collection, with harmonized data collection instruments, as well as epidemiologic, policy, and legal scans [ 33 , 34 ]. Each study region conducted semi-structured individual qualitative interviews with people who use drugs to better understand contextual factors, life history, and circumstances influencing drug use and health behavior.

Study settings

This manuscript reports on findings from seven study regions: Illinois (IL), Kentucky (KY), North Carolina (NC), Northern New England (NE; Vermont, New Hampshire, Massachusetts), Ohio (OH), Oregon (OR), and Wisconsin (WI). West Virginia was excluded due to lack of complete data at the time of analysis. Each study region focused on rural communities with high rates of hepatitis C virus (HCV) infection and opioid overdose fatalities. All study regions included counties that were identified in 2016 by the Centers for Disease Control and Prevention (CDC) as experiencing or at risk of experiencing increases in HCV infection due to injection drug use and several included counties that were identified as among the most vulnerable counties in the US for HIV/HCV outbreaks linked to injection drug use, including Illinois, Kentucky, North Carolina, Northern New England, and Ohio [ 35 ]. Among the nine states included in this manuscript, all but Oregon had higher opioid overdose death rates than the national opioid overdose death rates in 2018 and 2020, and most saw an increase in opioid overdose death rates from 2018 to 2020 [ 36 ]. In 2019 and 2020, three of the nine states had higher estimated rates of past-year methamphetamine use among individuals aged 18 years and older compared to the national estimate of under 1%; Oregon had nearly double with over 2% [ 37 ]. Six states had higher estimates of past year cocaine use among individuals aged 18 years and older compared to the national estimate of just over 2%; New Hampshire and Vermont had almost 3% [ 37 ].

Interview guide development

The interview guide was developed collaboratively by ROI researchers with expertise in qualitative methods, representing all ROI study regions, who comprised the ROI Qualitative Methods Workgroup. The development of a standardized interview guide ensured uniformity of primary content across studies. The interviews included but were not limited to topics related to illegal opioid and other drug use and access to and use of harm reduction, substance use, mental health, and health care services. Of particular interest for this study were questions related to observations of overdose. Participants were asked, “Tell me about your most significant experience with someone else overdosing?” Common follow-up questions probed for the overdose location; other people’s responses; the participant’s response; whether 911 was called; who arrived first (i.e., law enforcement or EMS); whether the person went to the hospital; if naloxone was used, and if so, by whom; and which drugs were involved. Probes varied across studies to enable investigators within each study region to follow-up on issues specific and relevant to their location and communities. Each study received approval from a local institutional review board and participant privacy was protected by a federal certificate of confidentiality.

Participant recruitment and data collection

Between 2018 and early 2020, we recruited people who used drugs to participate in interviews ranging from 60 to 90 min. Across all studies, qualitative interview participants had to reside in the study area and be at least 18 years old. Most sites required participants to report opioid use “to get high” or injection drug use in the past 30 days. Other eligibility criteria varied across sites due to regional differences in drug use and drug-related harms. For example, Ohio specifically recruited people who recently transitioned to injection drug use and women with experiences of neonatal opioid withdrawal, North Carolina focused on people who injected painkillers or heroin, and Wisconsin recruited people who injected opioids in the past month. All studies recruited participants from community-based programs and in some cases used street outreach. Trained ualitative researchers, many of whom had extensive training and experience, conducted the interviews, which were digitally recorded and transcribed verbatim. Participants were consented per the study IRB protocols and compensated with an incentive ranging from $25–50 depending on the study.

Identifying information was redacted from the transcripts. Each transcript was assigned a unique identification number and uploaded to a qualitative software program for data management, coding, and analyses (Dedoose, Los Angeles, CA). The Qualitative Core of the University of Washington ROI Data Coordinating Center conducted preliminary coding to categorize data by interview topic areas and lines of inquiry to facilitate retrieval of relevant data from the larger multi-study dataset. Upon retrieval of the data related to overdose in the preliminary coding round, we developed a data-driven thematic coding scheme that was iteratively refined by the writing team following principles of grounded theory analysis [ 38 , 39 ]. We analyzed the data to identify recurring themes, focusing on better understanding overdose experiences and responses. The writing team held regular meetings to discuss new thematic categories or codes that emerged in the data and to ensure consistency in coding/thematic definitions and application. This iterative process continued until we achieved thematic saturation and stabilized the organization of the findings. Nonverbal utterances were removed to improve the readability of the quotes.

A total of 304 participants completed a qualitative interview. The mean age was 36 years and 55% of the participants were men. Among the 169 for whom race data were available, 70% were white. 32% had a high school diploma or GED, 20% had some college, and 18% had less than a high school diploma or GED. 80% reported current injection drug use and 60% reported methamphetamine use. See Table 1 for demographic characteristics of interview participants, by study.

Rural people who use drugs in our study reported using multiple strategies, and often in combination, to attempt overdose reversal. Participants reported sternum rubs, rescue breaths, naloxone, application of ice or cold water, CPR, chest compressions, and inflicting pain by slapping or hitting their peers.

He was just completely out. It was really crazy. We had to jump out and pull him out of the car and slap him a little bit and throw cold water on him. (28-year-old man, OR) Chest compressions…anything I could think of to do…blow in their mouth…CPR…I carried a 180-pound man into a shower before and threw him in cold water, and that’s what got him out. (23-year-old woman, NE)

Of particular concern, some participants also reported using psychostimulants to reverse overdose (i.e., methamphetamine in OR, OH, IL, and NC; crack or cocaine in NE). In many of these cases, participants indicated that they used psychostimulants after other overdose reversal strategies did not work.

I tried giving him CPR and it didn’t work…I took his needles and put methamphetamine in it and shot it in his hand. Within about, probably 20 to 30 s, he jumped up and ran out the door. I know for a fact that if I hadn’t shot that speed into him, his heart would have stopped, because [his] face [was] blue, lips white…and [he was] breathing real funny and puking on himself and stuff. (30-year-old man, OH)

Finally, while participants reported using naloxone to reverse overdoses, notably, several talked about the need for multiple doses of naloxone, sometimes as many as 3–7 doses.

We tried Narcan three times. It didn’t work. (Cries)…Hours passed and finally…I had to go ask for help, I didn’t know what to do. And they called the ambulance to come get her. We tried the cold shower, we tried everything…it didn’t work. (38-year-old woman, NE)

In addition, multiple themes emerged regarding the decision to call 911. These included (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions of, or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement.

Hesitancy to call 911

Among those participants who considered calling 911 to report witnessing an overdose, they shared conflicted feelings about calling 911 because they were concerned about the potential legal consequences. For example, many participants discussed their fear of losing child custody, getting arrested, or going to jail. Several participants also reported that they did not call 911 because they were respecting the wishes of the person who overdosed. In some cases, participants indicated that their peers made it known that they did not want 911 called if they overdosed. In other cases, participants indicated that they wanted to call 911 after they revived their peer, but the peer said no.

We probably should have [called 911], but we didn’t…we were scared of getting into trouble. We were doing drugs, which is really not an excuse. We should’ve called 911, but luckily, I was able to bring her back. (29-year-old man, KY) I’m a single mom, and my daughter was in the other room… I was afraid to go to jail… I would’ve called 911 if we couldn’t have gotten him to come through…but I did avoid it because I didn’t want to lose my kid and I didn’t want to go to jail for attempting murder. (36-year-old woman, WI) I didn’t call 911 because he refused it. I told him I was going to call, but he refused. So I didn’t call. (26-year-old woman, KY)

Perceptions of law enforcement officers and emergency medical services in small towns

A few participants reported perceptions of law enforcement or EMS that decreased their willingness to call 911. For example, one respondent noted that the local law enforcement officers are corrupt, while another noted that their local EMS is less likely to respond in a timely fashion for overdoses.

The cops are shit…they treat people like they’re dirt, you know. (60-year-old woman, IL)

They [police] are involved in a lot of the stuff that goes on…Prostitution and stuff like that…I just don’t trust anyone down there. That is another reason why like I would be scared to call the law if someone overdosed. I mean, I would do it, I would, but I understand why people are scared because of that. (33-year-old woman, OH) The few times that EMS has been called, they take their time. We’re told not to even tell them that it’s an overdose. Tell them there’s an emergency, but don’t tell them that, because they’ll take their time. Small towns are like that. It is a very who you know and who you are, and if you do drugs, you’re automatically same category as a murder. (38-year-old woman, NC)

Obtaining medical intervention while avoiding identification and law enforcement involvement

Despite expressing a reluctance to call 911, several participants reported efforts to connect their peers with medical intervention while minimizing the chance of law enforcement involvement. These included driving to a public place before calling 911, driving the person to the hospital, or calling 911 and leaving the vicinity.

I called the ambulance and took off…I called them and said that there’s somebody sitting in there and I didn’t know what to do. I told them her name…told them she was alone in her house and she needs somebody to come and I was gone. (43-year-old woman, NC) Her mother overdosed, and…the guy that owned the house, was like, ‘get him out of here.’ We’re going to call the cops and we’re going to call the ambulance. [They said, ] ‘Oh, no you’re not,’ so we carried this woman outside and put her in a car and I drove to a bar that was a block away and…I called the cops and I called the ambulance. (44-year-old man, WI)

Interviews with people who use drugs in rural communities revealed a range of barriers to accessing emergency care and a range of strategies to reverse overdoses, including naloxone, slapping or hitting, ice or cold water, psychostimulants, CPR, chest compressions, and rescue breathing. Complex and interconnected factors influenced whether and how people responded. Hesitancy to call 911 or to remain with the peer after calling 911 was common, largely due to fear of legal repercussions, particularly among those with prior criminal justice involvement. Another factor that influenced whether people called 911 was negative perceptions of or prior interactions with local law enforcement or EMS. As a result, some participants reported workarounds to connect their peers with medical services while reducing law enforcement involvement.

The use of multiple strategies demonstrates that rural people who use drugs proactively respond to reverse an overdose and persist if the first intervention is not successful. It is important to note that there are some variations in recommendations for overdose response. SAMHSA and the World Health Association recommend rescue-breathing, while the American Heart Association does not [ 40 ]. These differences in recommendations are, in part, based on differing perceptions of the ability of laypersons to correctly identify overdose, respiratory or cardiac arrest symptoms, and carry out the appropriate intervention [ 40 ]. However, some strategies reported by participants, such as inflicting pain and using ice or water, are not recommended and can either cause additional injury or delay the implementation of safer and potentially more effective overdose strategies [ 22 ]. The reported folk method of using methamphetamine, crack, and cocaine to reverse overdoses highlights persistent system failures in ensuring that people have access to comprehensive overdose reversal education and access to naloxone. In 2018, nearly three-quarters of all cocaine overdose deaths and half of all methamphetamine overdose deaths also involved opioids [ 41 ], and co-use is associated with an increase in the risk of overdose in rural communities [ 42 ]. Expanding OEND programs and partnering with trusted community-based organizations and people who use drugs in rural communities may be an effective way to disseminate evidence-based overdose strategies directly to people actively using drugs. Further research is needed to understand the underlying systemic issues contributing to the use of psychostimulants to reverse overdoses and to identify strategies to increase overdose reversal education and the distribution of naloxone.

Many participants reported that multiple doses of naloxone were often needed to reverse overdose. Several studies have found that higher doses of naloxone are needed to reverse overdose caused by synthetic opioids [ 43 , 44 , 45 ]. Given the rise in overdose deaths attributed to fentanyl and related analogs, further overdose reversal research is warranted while counseling people to continue dosing naloxone as needed and call 911 [ 46 ]. The method of administration may make a difference. While intranasal naloxone has become popular because of ease of administration and increased accessibility, a randomized clinical trial found that clients at a Canadian overdose prevention site who received injectable naloxone were significantly less likely to need an additional rescue dose than clients who received intranasal naloxone [ 47 ]. One possible strategy to explore is the distribution of injectable naloxone both to people who use drugs who are comfortable with injections and EMS personnel. This could provide a cost-effective method and facilitate more efficient single doses of naloxone with a decreased need for additional doses. It is also critical to increase the quantity of naloxone, regardless of the mode of administration, distributed to rural people who use drugs and EMS and wherever fentanyl or other analogs are prevalent. Given reports among participants that it sometimes takes more than three doses of naloxone to reverse overdose, it is important that people have access to multiple naloxone kits so that they are better equipped to respond to an overdose. In addition, in rural communities where there may be long driving distances between the overdose location and the closest hospital [ 48 ], multiple doses of naloxone may be necessary in case the reversal effects of naloxone wear off before the person is connected to EMS.

These findings highlight the impact that fear of law enforcement involvement has on responses among those witnessing overdose. Concerns about legal consequences inhibit the ability of rural people who use drugs to respond appropriately. These concerns may be compounded by the relative lack of anonymity in rural communities [ 49 ]. The likelihood that rural people who use drugs are well known and easily identified by law enforcement officers is substantially increased compared to urban communities due to tighter interconnected social networks, lower population density, and smaller population counts [ 26 ]. These concerns may be heightened in small towns, as some participants shared perceptions of their local law enforcement officers and EMS that decreased their willingness to call 911, such as the perception that GSL would not be enforced.

While 47 states and Washington D.C. have GSL, there is significant variation in the protections they offer [ 10 ]. For example, of the nine states included in our study, only Ohio offers protections against the arrest, charge, and conviction for possession of illegal substances, and it limits immunity to only two instances, and only three states (Illinois, Massachusetts, and Vermont) provide provisions that allow reporting an overdose to be considered a mitigating factor in sentencing with significant variation in which crimes are permitted for mitigation [ 50 ]. In Ohio, the parole board or court has the discretion to mitigate the penalty [ 50 ]. However, ROI participants reported fear of legal repercussions across all studies, regardless of the presence or absence of GSL or the scope of protections. More research partnering with rural people who use drugs and law enforcement officers regarding awareness of existing GSLs and understanding of the protections and limitations of the GSL across settings is needed. Given that several participants shared the perception that small-town law enforcement officers are corrupt, it is possible that even if law enforcement officers are aware of an existing GSL, people who use drugs in rural communities may worry that the law would not be enforced. Persistent fear of legal repercussions and limitations of GSL protections underscore the need to explore policies that decrease the threat of legal action for consequences of drug use. Given recent efforts in other countries, such as Canada [ 51 , 52 , 53 , 54 ], to prevent and reduce overdose death, additional research on interventions such as overdose prevention sites and safer supply on overdose outcomes is needed.

Finally, another strategy could include the development of dedicated overdose call-in centers or emergency phone lines, like those established for suicide prevention [ 55 ], and potentially modeled after the “never use alone” crisis hotline ( https://neverusealone.com/ ) [ 56 , 57 ]. This could eliminate or significantly reduce law enforcement involvement with overdoses and directly connect people with needed medical services for overdoses. This would necessitate infrastructure development to ensure consistent Wi-Fi and cellular service, particularly in rural US communities [ 58 , 59 ].

Our findings demonstrate that there is need for greater access to existing evidence-based interventions such as syringe exchange and drug checking services, distribution of naloxone, and medications for opioid use disorders. Overdose prevention requires a multi-faceted approach that includes increasing overdose reversal education, eliminating legal consequences of reporting an overdose, and providing direct pathways for people who use drugs to access medical assistance. Integrating harm reduction principles into the design and execution of these strategies could empower people who use drugs, often the true first responders, to save lives and significantly reduce overdose.

Limitations & strengths

The study’s large sample size, and its diversity in geography (9 states and 58 counties) and age, offers the most comprehensive qualitative data on overdose responses among people who use drugs known to date. That said, our sample is largely white and cisgender, and the limited racial and gender diversity may limit the transferability of our findings to other settings and populations. In addition, study differences in drugs used, mode of drug administration, recruitment criteria, and follow-up probing questions may have influenced variation in responses. For example, the prevalence of methamphetamine use in some study locations may have provoked the use of methamphetamine as an overdose reversal strategy. Furthermore, while GSLs were in effect in all states included in the study at the time of data collection, participants’ retrospective recalls of overdose experiences may include overdoses that predate these laws, and such past decisions around medical intervention may have occurred in circumstances where legal protections were not yet afforded. Finally, this sample of rural people who use drugs is comprised mostly of persons who are engaged in harm reduction, who may have experiences that are unique from their peers who are not connected to such services.

Conclusions

People who use drugs are well-situated to serve as first responders to reduce overdose deaths. This study confirmed that like people who use drugs in urban communities, the responses when witnessing overdoses in rural communities may be impacted by widespread fear of legal consequences, which heavily influences decision-making regarding whether, how, and when to access emergency care. In the face of this fear, and in the urgency of the moment, people who use drugs employ a wide range of strategies to attempt overdose reversal. Greater education is needed to ensure that people are well-informed about the most effective and least harmful opioid overdose reversal strategies. Access to naloxone should be increased among people who use drugs and first responders, including EMS and fire and police departments, particularly in rural communities. However, it is critical to remove barriers that prevent people who experience an overdose from receiving appropriate medical care. One of the main barriers, hesitancy to call 911, is rooted in concerns about the potential legal consequences of law enforcement involvement. These concerns may be heightened in rural communities where people who use drugs may be more easily identified by law enforcement officers. Our findings demonstrate the great strides people who use drugs in rural communities will take to reverse overdoses and save lives as well as the need for comprehensive interventions that eliminate legal consequences and expand harm reduction strategies for responding to overdose.

Data availability

To respect the confidentiality of participants in this study, data is not publicly available. However, we welcome collaboration and encourage mentorship and the use of the ROI data stripped of all protected health information (PHI) to enable early investigators to address meaningful questions with support to help ensure their success. Additional information can be obtained at the ROI website: ruralopioidinitiative.org or by contacting the ROI DCC at [email protected]. Follow the Rural Opioid Initiative on Twitter @ruralopioids.

Abbreviations

Good Samaritan laws

Emergency medical services

Opioid Education and Naloxone Distribution

Rural Opioid Initiative

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Acknowledgements

This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-site study with a common protocol that was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). The views and opinions expressed in this manuscript are those of the authors only and do not necessarily represent the views, official policy or position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies, or those of the Appalachian Regional Commission. The authors thank the other ROI investigators and their teams, community and state partners, and the participants of the individual ROI studies for their valuable contributions. A full list of participating ROI institutions and other resources can be found at http://ruralopioidinitiative.org .

Research presented in this manuscript is the result of data harmonization and was supported by grant U24DA048538 (Crane, Tsui) from NIDA. This research was funded by the National Institute on Drug Abuse (NIDA), in partnership with the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA), grant numbers: UG3DA044830, UH3DA044830 (Friedmann, Stopka); K01DA053159 (Walters); P30DA01104 (Hagan); UG3DA044829, UH3DA044829 (Pho, Jenkins); UG3DA044825, UH3DA044825 (Feinberg, Smith); UG3DA044831, UH3DA044831 (Korthuis); UG3DA044822, UH3DA044822 (Miller, Go); UG3DA044826, UH3DA044826 (Westergaard, Seal); UG3DA044798, UH3DA044798 (Cooper, Young); UG3DA044823, UH3DA044823 (Zule); and U24DA044801 (Crane, Tsui). Data collection at the Oregon site was supported by UL1TR002369.

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OHSU-PSU School of Public Health, Portland, OR, USA

Robin Baker

Department of Medicine, University of Washington, Seattle, WA, USA

Rob J Fredericksen

Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA

Abby E Rudolph

Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA

Thomas J Stopka

Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA

Suzan M Walters

Rollins School of Public Health, Emory University, Atlanta, GA, USA

Monica Fadanelli

Southern Illinois University, Carbondale, IL, USA

Rebecca S Bolinski

The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Adams L Sibley

Comagine Health, Portland, OR, USA

University of Washington, Seattle, WA, USA

Heidi M Crane

School of Medicine, Oregon Health & Science University, Portland, OR, USA

P Todd Korthuis

Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

David W Seal

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D.W.S, H.C., P.T.K devised and supervised the methodology; R.B., R.J.F., A.E.R. conceptualized the paper; R.J.F. prepared the table; R.B., R.J.F, A.E.R. led the formal qualitative analysis, R.B., R.J.F., A.E.R. wrote the original draft; R.J.F., A.E.R, T.J.S., S.M.W., R.S.B., A.L.S., E.S., D.W.S., H.C., P.T.K. provided review and substantial editing.

Corresponding author

Correspondence to Robin Baker .

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Ethics approval and consent to participate.

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Boards appropriate for each study: Baystate Health IRB (2017); University of Chicago and Southern Illinois University (IRB17-1630, 05/16/2018); University of Wisconsin IRB (2017 − 0866); Oregon Health & Science University IRB (STUDY00017233, 08/09/2017); University of Kentucky (protocol code 43,520, 3/20/2018).

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Baker, R., Fredericksen, R.J., Rudolph, A.E. et al. Overdose responses among rural people who use drugs: A multi-regional qualitative study. Harm Reduct J 21 , 107 (2024). https://doi.org/10.1186/s12954-024-01007-9

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Introduction

Purpose of semistructured interviews

Designing and conducting semistructured interviews

Steps for designing and conducting semistructured interviews

Step 2: identifying participants

Step 3: considering ethical issues

Step 4: planning logistical aspects

Step 5: developing the interview guide

Supplemental material

Step 6: establishing trust and rapport

Step 7: conducting the interview

Beginning the interview

Interviewer stance

Active listening

Continuing the interview

Step 8: memoing and reflection

Step 9: analysing the data

Step 10: demonstrating the trustworthiness of the research

Step 11: presenting findings in a paper or report

Conclusions

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14 Unstructured and Semi-Structured Interviewing

Qualitative Interviewing in a Conversational World

The History of Qualitative Interviewing

Ancient Roots

Psychoanalysis

Nondirective Interviewing

Classic Studies on Authoritarianism, Sexuality, and Consumerism

Contemporary Conceptions of Qualitative Interviewing

An Example of Qualitative Interviewing

Different Forms of Qualitative Research Interviews

Structured Interviews

Unstructured Interviews

Semistructured Interviews

Individual and Group Interviews

Group Interviews

Individual Interviews

Interviewing Using Different Media

Face-to-Face Interviews

Telephone Interviews

Internet Interviews

Different Styles of Interviewing

Receptive Interviewing

Assertive Interviewing

Analytic Approaches to Interviewing

Interviews as Research Instrument

Interviewing as a Social Practice

Future Directions

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Overview of qualitative research

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Box 1: Example of a topic guide

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