Integrated Interview and Observation Data Analysis

Transcription

1 Integrated Interview and Observation Data Analysis Presenter Shannon K Bolon, MD, MPH Assistant Research Professor Department of Family and Community Medicine University of Cincinnati bolonsk@fammed.uc.edu Useful Basic Definitions Iterative process repeated evaluation of methods and results throughout data collection and analysis; creates flexibility and allows qualitative studies to adapt throughout the research process Data trustworthiness interpretation of data is valid relative to its intent; a unique qualitative research concept is necessary because reliability and validity do not directly translate from quantitative research Triangulation multiple data sources and methods used to answer one research question Multimethod study concurrent use of multiple data collection strategies Sequential methods stepwise implementation of data collection strategies Immersion and crystallization repeated cycles of intense, prolonged exploration of the data followed by a period of reflection from which the analyst emerges with an intuitive understanding of the data Editing method coding categories are generated by the data A priori coding categories coding categories are determined prior to data collection and analysis Saturation additional data collection generates no new data or ideas

2 Creating an Interview Guide Interviews preferred method to understand stories and cognitive processes As a group, write 3 interview questions to explore how physicians describe the intensity of their work. What data will be most helpful to understand work intensity from a physician s perspective? How can the interview be structured and questions phrased to most efficiently gather that data? Observations Observations examine a phenomenon in its natural setting, exploring behaviors, activities, and conversations Resources Miller, W. and B. Crabtree, eds. Doing Qualitative Research, 2 nd Edition Sage Publications, Inc. Thousands Oaks, CA. Bernard, H.R. Handbook of Methods in Cultural Anthropology Alta Mira, CA. Elder, N. and W. Miller. Reading and evaluating qualitative research studies. The Journal of Family Practice (3): 279.

3 Observation Transcript Instructions Please spend 5 minutes independently reading this excerpt from a transcript of field notes collected during direct observation of a family physician during one clinic session. Note data that may be useful in describing physician work intensity. What contextual information is helpful or missing? Next, as a group, reach consensus on what observation data presented here may be useful in describing physician work intensity. What data could complement the interview guide that we created today? How could the observation data collection and documentation be improved? Notes

4 Transcript Excerpt 12:50:00 Arrived at clinic. WAITING ROOM Mixed residential business neighborhood about 4 blocks from medical center. 3 patients waiting to be seen for clinic starting at 1:00 pm. Dr. X and other staff still at lunch. Waiting room is divided into two areas separated by a partial wall. TV on in one room. Patient s cell phone rings very loudly in pocket for about a minute before it is turned off as a child is brought in sleeping (approximately 3 4 years old) in his mother s arms. Two receptionists are working in an adjacent room, answering telephone calls. 1:00:00 First patient called. 1:02:00 Second patient called. 1:04:00 Nurses station with counter, two laptops labeled with doctors names, both closed. 1:07:00 Dr. X arrives and begins completing paper forms while standing at counter. She introduces the 3 rd year medical student working with her to the first patient. Then, she continues to work on forms. 1:15:00 Finishes paperwork. 1:18:00 Dr. X spends 3 minutes describing EMR advantages and disadvantages and light schedule today to observer. Mentions that she needs to get letters and other follow ups hopefully done by end of the day. 1:21:00 Dr. X explains observer s presence. How are you? Sitting close to patient, laptop at 45 degree angle. Patient talks for one minute about a medication question and about being older. Husband states, She is old! Laughter. 1:23:00 How s new medicine? Patient describes medication use and problems standing up for 1.5 minutes. 1:24:30 Dr. X explains ideal BP in this case is over Provides education and recommends purchasing home BP cuff. Patient s age revealed to be 75 years old. 1:26:00 Back and forth questions, laughter.

5 1:27:00 Physical exam. BP check. Silence. Dr. X uses patient s BP cuff. While automatic cuff inflating, Dr. X working in EMR. 1:29:00 Patient asks about discarded med. It makes me wobbly. Patient education. 1:30:00 Patient has questions about insurance. Then husband chimes in. Patient makes comment about how her BP increases when dealing with bills. 1:32:00 Dr. X takes 1 minute writing down instructions for patient. Follow up plans made. Goodbyes. 1:33:00 Dr. X asks for next patient to be brought back. Working in EMR. Makes call to hospital to get records. Student presents first patient to Dr. X. 1:37:00 Dr. X sits and gathers history about patient s pregnancy. Complains of dizziness and spotting. 1:39:00 Working in EMR while continuing history taking. 1:40:00 Patient education about prenatal vitamins provided using gentle but firm manner. 1:41:00 Patient consents with some reservations. Dr. X working in EMR, then shows patient laptop screen and discusses due date. Med student, standing back, reiterates due date. 1:42:00 Patient education using computer. 1:44:00 Diagnosis of cause of spotting and treatment discussed. 1:45:00 Physical exam begins. Dr. X standing: examines fetal heartbeat and patient s head and neck. 1:47:00 Patient education. Dr. X exits to get patient s vitamins. 1:49:00 Nurse asks Dr. X for 3 signatures. 1:50:00 Further patient education provided. Follow up plans made. Goodbyes.

6 1:51:00 Patient walks down hall and leaves through door. Dr. X working in EMR while discussing next case with student. Also reviewing paper forms. Tests student s knowledge, adds to answers referencing EMR. 1:52:00 Introductions made. Patient, an older woman, presents with daughter. 1:53:00 Dr. X sits, scoots close to patient and daughter. Daughter talks about patient s forgetfulness. Dr. X addresses patient s memory problems. Patient describes frustration. Family history is taken. 1:56:00 Dr. X has her hand on patient s leg, expressing sympathy and concern. 1:58:00 Dr. X mentions an insurance policy. The mood is sad. Dr. X touching patient, talking about emotions. It s not ok not to accept help. 2:00:00 Patient describes goal of staying in home. Home situation is discussed. Mood lightens. There is laughter. 2:03:00 Dr. X is problem solving with patient s daughter. 2:04:00 Daughter continues to speak, Dr. X moves stool closer to seat of daughter to see papers under discussion. 2:05:00 Dr. X reinforces some decisions to which the patient and daughter have agreed. Working in EMR. Looking at EMR and reading living will to daughter. 2:07:00 Dr. X, referencing EMR, talks about recent test results. Discusses need for more blood tests and a work up for anemia. 2:09:00 Daughter raises concerns about patient s anxiety. History taken. 2:12:00 Medication offered. Patient declines. Discussion ensues. 2:14:00 Dr. X adopts a closing tone. Go home, have fun. Patient discusses birthday dinner last night. Follow up plans made. Goodbyes. 2:15:00 Dr. X working in EMR, humming along with music.