O19 Reflections on dyadic research in healthcare

Background Although healthcare provision typically occurs within the context of clinician/service user relationships, and there is increasing recognition of the role and importance of families, qualitative data collection typically focuses on individuals (e.g. through interviews) rather than dyads. Dyadic interviewing has a long history in social research, and is now being used in health research to enable a unique exploration of healthcare experiences and relationships. Aims To reflect on the use of dyadic interviewing in two studies, commenting on utility and potential pitfalls. Methods The two studies will be described: both employed separate, confidential interviews, one with clinicians and service users on talking therapy assessments, the other with perinatal women and a family member on experiences of mental health services. Responses were compared and contrasted through a focus on ‘versus’ and ‘consensus’ coding. This meant that the integrity of individual accounts was retained, with an analysis of convergence and divergence within and between dyads generating a third, etic perspective.1 Results Dyadic interviewing in healthcare raises a number of practical and ethical issues: 1) recruitment can be slow, for example because clinicians need the confidence to consent to their therapeutic relationships being scrutinised 2) consent is plural, with participants consenting to their own participation and that of the other member of the dyad 3) interviews are conducted separately, with the researcher comparing and contrasting responses. Reflexivity regarding the interplay between researcher standpoint and data interpretation is critical 4) the researcher must carefully maintain confidentiality between dyads and 5) reporting findings with contextualising quotes without breaching confidentiality becomes an ethical challenge. Conclusions The presentation will conclude with a discussion of the potential wider utility of and notable cautions regarding dyadic approaches in healthcare research. Reference Eisikovits Z and Koren C. Approaches to and outcomes of dyadic interview analysis. Qualitative Health Research2010;20:1642–1655.

Background Randomised controlled trials (RCT) are widely considered to be the 'gold standard' for evaluating health interventions. Qualitative methods are often perceived as an 'add-on' to robust quantitative intervention evaluations.
The current status of qualitative methods within trials undermines the enormous insights qualitative approaches contribute to our understanding of the impact interventions have on human health. Objectives This presentation examines the 'state of the art' of qualitative methods currently used within trials of complex health interventions. Methods In early 2018, we completed a rapid review of innovative qualitative methods mentioned in the RCT protocols of complex health interventions for a commentary to a special issue of Qualitative Health Research. 'Innovative' was used to refer to qualitative methods beyond atheoretical interviews or focus groups with trial participants. We generated a list of 189 qualitative research methods from a search of 27 qualitative methodology journals using the terms 'innovat* new novel emerg*', and then used this list as key terms to search protocols published since 2012 and registered with the ISRCTN trial database. Results Our search showed that while 1452 of the registered trial protocols mentioned some form of qualitative research, only 34 of these discussed more innovative qualitative methods. Qualitative methods were most often employed during trial process evaluations or as formative research in the pretrial phase. Protocols rarely went into depth about the details of the methods used or explained how their analysis would contribute to the trial results. Conclusions These gaps significantly undermine the potential of qualitative methods to improve understandings of the successes and failures of interventions in different contexts. We will discuss these gaps and their implications for health intervention evaluation in detail, and also point to some areas of good practice arising from the special issue that we hope will push the field forward. Background Although healthcare provision typically occurs within the context of clinician/service user relationships, and there is increasing recognition of the role and importance of families, qualitative data collection typically focuses on individuals (e.g. through interviews) rather than dyads. Dyadic interviewing has a long history in social research, and is now being used in health research to enable a unique exploration of healthcare experiences and relationships. Aims To reflect on the use of dyadic interviewing in two studies, commenting on utility and potential pitfalls. Methods The two studies will be described: both employed separate, confidential interviews, one with clinicians and service users on talking therapy assessments, the other with perinatal women and a family member on experiences of mental health services. Responses were compared and contrasted through a focus on 'versus' and 'consensus' coding. This meant that the integrity of individual accounts was retained, with an analysis of convergence and divergence within and between dyads generating a third, etic perspective. 1 Results Dyadic interviewing in healthcare raises a number of practical and ethical issues: 1) recruitment can be slow, for example because clinicians need the confidence to consent to their therapeutic relationships being scrutinised 2) consent is plural, with participants consenting to their own participation and that of the other member of the dyad 3) interviews are conducted separately, with the researcher comparing and contrasting responses. Reflexivity regarding the interplay between researcher standpoint and data interpretation is critical 4) the researcher must carefully maintain confidentiality between dyads and 5) reporting findings with contextualising quotes without breaching confidentiality becomes an ethical challenge.
Conclusions The presentation will conclude with a discussion of the potential wider utility of and notable cautions regarding dyadic approaches in healthcare research. The internet has become an increasingly popular source for information about health conditions. Parents raising a child with an ongoing health condition may be more likely to seek information via internet forums. Perhaps more so where there are few accessible support groups. Applying qualitative methodology to research internet forums is likely to increase in the future.
Aims Firstly, gain insight into issues parents ask about having a child with Glue Ear (GE); secondly, develop reliable information for them from early childhood educators, medical and paramedical professionals and disseminate empirically-based and accessible information to parents through the internet. GE affects 80% of young children worldwide and is the most common cause of medical appointments for children under the age of 7 years. However, online support groups for parents of children with GE are scarce, not monitored, and often parents' questions go unanswered. Knowledge about GE's psychosocial impact on parents and families is limited.
For the qualitative researcher, internet forums provide naturalistic data which is produced by 'participants' without researcher's intervention or shaping of the topics investigated. Such forums also provide insight into the questions of concern to patients/carers, thus increasing involvement in care and providing more personalised medicine.
Inductive content analysis was used to explore the parents' concerns about their child's GE since the information in internet forums is naturally fragmentary. This method provides a robust and theoretically systematic approach adding credibility to the findings. The nature of forum postings is that they are of a manageable size to maintain understanding of the context and implicit and explicit meaning. The first post was coded jointly to ensure consistency with subsequent posts coded independently before making comparisons. We used a detailed, written reviewing process at all stages of analysis to maintain transparency. The focus here is on the methodology and choice of data.
Introduction The BOOST (Better Outcomes for Older adults with Spinal Trouble) Randomised Controlled Trial is evaluating a physical and psychological intervention for older adults with neurogenic claudication. Embedded within the trial is a longitudinal qualitative study, exploring participants' experiences and beliefs about ageing and rehabilitation, and how these change over time.
Methods Sixty participants were purposively recruited into the qualitative study from the main trial (n=438), to ensure a representative sample of age, gender, ethnicity, and treatment allocation. Interviews are being conducted at three time points (immediately post-randomisation; approximately one month post-intervention; and approximately 12 months post-randomisation). Twelve-month data collection will be completed in June 2019. Initial interviews are conducted face-face, and follow-up interviews via telephone. Excellent participant engagement and low attrition has generated a large volume of richly descriptive qualitative data; presenting a challenge to analyse data in an efficient and meaningful way within project deadlines. Results To facilitate the analysis of this large data set, we have adapted the Framework Method to enable longitudinal withinand cross-case analysis. Individual pen portraits were written from Time 1 interview transcripts of six participants, and a 6category analytical framework developed. This framework was used as a template for pen portraits of the participants' Time 2 and Time 3 interview transcripts, with new categories added and existing categories expanded as required. The framework was further developed over consecutive participant transcripts, until no further changes were required. Data was then charted into the framework matrix, and longitudinal trajectories analysed. Discussion The volume of data collected in this large-scale, embedded qualitative study necessitated a novel approach to analysis. Adaption of existing approaches has resulted in a Longitudinal Framework Method, enabling the exploration of participants' experiences and beliefs of aging and rehabilitation over time. Outcomes will inform future implementation of the physical and psychosocial management of this patient group.  Background Sexual assault in adolescence and adulthood is a pervasive crime often resulting in trauma to survivors. Despite its considerable consequences, relatively few survivors disclose