The best magazine
Methods
Setting and Participants
Thirteen primary care clinicians – 12 medical doctors and 1 nurse practitioner – were recruited from 3 Brigham and Women's Primary Care Practice-Based Research Network-clinics in Boston. The clinics consisted of 1 hospital-based practice and 2 urban community health centers with approximately 175 clinicians which all serve a socioeconomically, racially, and ethnically diverse patient population. Clinicians were recruited via emails sent by study staff to practice medical directors of the 3 clinics who, in turn, forwarded the request to primary care clinicians. If clinicians expressed interest in participating, study staff contacted the clinicians and obtained consent to participate. Interviews took place during March 2011. Clinicians were internal medicine physicians or internal medicine nurse practitioners, 69% female, with a mean age of 43, and an average of 14 years of experience. Clinicians received US$20 for their participation. The Brigham and Women's Human Research Committee approved the study protocol.
Interview Guide Development
The interview guide was developed as part of an iterative process between our team and a consulting Ph.D.-level, qualitative researcher with extensive training and 12 years of research experience in mixed methods design, field methods, and analysis. We used conceptual models of guideline adherence and appropriate antibiotic prescribing to develop the interview guide, ensuring that a range of concepts would be included. The guide focused on the following goals and domains (Appendix 1):
Understand clinicians' contemporary views on acute bronchitis guidelines and antibiotic prescribing;
Identify what clinicians felt were the main barriers to antibiotic guideline adherence;
Seek clinicians' ideas and suggestions for methods of improvement for the management of acute bronchitis, clinic workflow, and patient education materials.
Interview Conduct
Interviews were conducted by a medical anthropologist with a Masters Degree in Applied Socio-Cultural Anthropology and 17 years experience in conducting qualitative research interviews. Interviews were completed over the phone and lasted between 30 and 60 minutes. The interviewer obtained IRB-approved verbal informed consent to conduct and record the interview as well as use the content of the interview for analysis and publication. The interviewer generally followed the interview guide, asked open-ended questions, but also improvised questions to elicit additional responses or clarify prior responses. If the participant did not offer solutions for domain 3, the interviewer mentioned specific potential interventions included in the interview guide. We conducted 13 interviews to collect general assessments of attitudes regarding acute bronchitis, reasons for antibiotic prescribing, and solutions to reduce antibiotic prescribing for acute bronchitis. Preliminary analysis of the interviews suggested we were approaching thematic saturation after 12 interviews.
Data Collection and Analysis
Each interview was recorded, transcribed verbatim, and analyzed according to a conventional comprehensive qualitative analysis method. We used a two-stage coding process: structural coding (Level 1) and thematic coding (Level 2). Structural coding followed the structure of the interview guide: every question received a structural code that was applied to the appropriate text. Thematic coding was based on themes that arose from the structural coding, and was applied in a second-pass analysis. Thematic analysis was inductive and followed the structure of the interview. The thematic content analysis was at the question level, such that themes emerged from the questions. We resolved differences in interpretation through discussion. We used NVivo (Version 8, QSR International) to code, categorize, search, retrieve, attach analytical memos and create conceptual relationship networks in our textual data that had been taxonomically coded. Once the 2-stage coding process was completed and reviewed by the entire research team, we generated a comprehensive thematic analysis summary report, including exemplary quotes. The analysis was performed and the summary report was written and delivered by the same experienced qualitative researcher that completed the interviews.
In this manuscript, we organized themes by decreasing number of participants who discussed each theme. While this provides quantitative impression of the frequency with which participants discussed each theme, we do not mean to imply that themes with a higher number of discussants are necessarily more important.
Source: ...