Background of the study

Discuss about the Qualitative Interview And Challenges For Clinicians Undertaking.

1. What is the health issue that provides the focus of this study?

Chronic obstructive pulmonary disease (COPD) was the main focus of this research study.

1. Generally, what have been the results of previous studies of this issue?

In previous studies, it has been established that it was difficult for the patient to understand the term COPD. Patients used clinical markers for the identification of exacerbations of COPD. Patietns followed COPD symptoms for contacting the healthcare providers. Patients exhibited deficiency of knowledge about the visible and invisible symptoms for the understanding and recognisation of COPD exacerbatiosn. Few of the patients considered COPD exacerbations as the bad day (Polastri, Pisani, Dell’Amore et al., 2017; Brien et al., 2018). After completion of this study it was evident that patients were able to distinguish between bad day and COPD exacerbations.

1. What is the significance of this study?

Patient’s knowledge and understanding of the COPD exacerbations were being assessed in this intervention. Knoeledge about the COPD exacerbations among patietns can be helpful in early identification of the disease. It can be helpful in implementing early intervention for prevention, treatment and management of COPD. Patients were able to verbalise both subjective and objective symptoms of COPD.

1. What was the aim of the research?

Main aim of this study is to explore patients’ current understanding and experience in managing and identifying COPD exacerbations at home.

1. What research design was used?

Research design implemented in this study was interview based qualitative study.  

1. Describe the main characteristics of the research design identified.

Main characteristics of the interview based qualitative study design was sampling of the participants. Main focus of interview based qualitative study design should be participats because its outcome is significantly based on the expression of participants. Participants should express and verbalise their knowledge, opinion and experiences about the issue. Interview questions design is very important aspect in this study design because outcome of this study completely depends on interview questions. In this study design, semi-structured interviews were carried out (Morris, 2015; Bell, 2014).

1. How did the research design chosen meet the aim(s) of the study?

Aim of this study was to identify understanding and knowledge of patient’s about recognisation of the COPD exacerbations, patient’s experiences and patient’s self-management strategy by the patietns. Interview questions incorporated in this study also addressed all these aspects. Hence, it reflects this research design can be helpful to meet aim of the study.

1. What were the characteristics of the participants in this study ?

In this qualitative study, 27 male and 17 female participants were recruited. These patients were with average age of 71 years with range between 55 – 85 years. According to GOLD, COPD can be calssified into different classes based on severity of COPD. Number of patietns recruited with varied severity of COPD were : GOLD stage II, GOLD stage III and GOD stage IV with 14, 21 and 9 patients respectively. Recruited patients were associated with COPD patietns since 1 – 25 years. 15 and 29 patients were living alone and living with their spouses or other family mmebrs respectively.

1. What were the inclusion and exclusion criteria of the sample ?

Overview of research design

Inclusion and exclusion criteria for the recruitment of the participants were as follows : Age >40 years. A forced expiratory volume in 1s (FEV1) post-bronchodilator ?80% and predicted ratio of FEV1 to forced vital capacity (FVC) ?0.70. Smoking history >10 pack years.  MRC dyspnoea scale ?2. Registered with a general practice and with an exacerbation of COPD requiring home treatment or hospital admission in the previous year or referred for pulmonary rehabilitation. Absence of other signi?cant lung disease. Absence of chronic heart failure de?ned by the New York Heart Association classi?cation system as severe (Grade IV). Able to give informed consent. Life expectancy of 43 months. Able to adequately understand written and verbal English.

1. Why is it important to identify these criteria before recruitment starts ?

Inclusion and exclusion should be incorporated in the sample selection because it can define sample universe. Deciosn making in sample selection can be improved and patient characteristics can be identified by incorporating inclusion and exclusion criteria. In COPD patients severity of disease, potential risk factors and co-morbid conditions are important factors. All these factors can be identified by incorporating inclusion and exclusion criteria. It can also be helpful in obtaining robust and valid output and reducing variability in the outcome  (Isaacs, 2014; Braun et al., 2014).

1. What sampling technique was used in this study?

Purposive sampling is a popular method of sampling in which samples are being selected according to the preselected criteria with respect to aims of the study. In this study, samples with history of COPD were selected which meet aim of the study; hence, this sampling method can be considered as purposive sampling method (Morris, 2015; Fisher, 2011).

1. How was this sample appropriate for meeting the research aim?

Aim of this study was to understand patient’s knowledge about COPD. In this study COPD patients were recruited. Hence, patient’s undersranding and information about COPD can be collcted from the recruited patients. As recruited patients can provide information required to meet aim of the study, it can be concluded that this sample was appropriate for meeting research aim.

1. How were the data collected?

Data was collected by conductiong in-depth interview at patient’s home.

1. What, specifically, did the researchers do?

Experienced and trained researchers need to be involved in the data collection and in this study also experienced and trained researchers were recruited. These researchers designed semi-structured type of questions and these questions were specific to the aim of the study. These questions addressed patient’s experience, knowledge, ability to recognise and manage COPD. These researchers conducted interviews for each of the participant between 20 to 55 minutes and this interview process was audio-recorded. These audio-records were useful in getting details of interview, correct analysis and monitoring of the interview process. Few of the patients were not able to express their knowledge about COPD; hence family members of six members were involved in the interview process (Levickis et al., 2013).  

1. How did data collection fit the aims of this study?

Sampling

Aim of this study was to understand the knowdge of patients about COPD. Collected data provided information about the patient’s experience and knowdge about COPD. Hence, it indicate data collection fit the aim of the study. Research can be considered as evidence based research, if collcted data fulfil requirement to achieve aim of the study.

1. What might have been some advantages and disadvantages of this method of data collection?

Accurate data can be collcted in the interview based data collection because during interview process patients can not provide incorrect data about age and gender. In this type of data collection, extent of knowledge and ease of expression can be easily accessed because both verbal and non-verbal ques can be obtained. Accurate data can be obtained, if there is no distraction during the interview process. In interview based data collection, distractions can be effectively avoided. In interview based data collection assessment and recording of emotions and behaviour are possible.

High cost can be considered as the significant limitation for the home-based interviews because it is necessary for interviewer to visit each patient’s home for conducting interview. Less number of participants should be recruited. As more number of participants would require recruitment of more number of researchers for conductiing interviews (Morris, 2015; Erlingsson & Brysiewicz, 2013).  

1. From your understanding of the weekly readings, what if any, are some alternative methods of data collection that these researchers could have chosen?

In qualitative research, interview-based data collection is the most acceptable and accurate method of data collection. However, other methods of data collection like observations and textual or visual analysis (eg from books or videos) could have been implemented in the data collection. These types of data collection would have been given more insight of emotional and behavioural aspects of patients (Morris, 2015; Dean et al., 2016).

Multiple steps were involved in the data analysis. In the initial steps, collected data was stored and organised in easily accessible manner. Audio-recorded data were transcribed into the verbatim and anonymised transcripts were imported into the NVIVO 10 (qualitative software data programme). Grounded theory approach and constant comparative method were implemented in the data analysis. Bias was eliminated from the outcome obtained by implementing open, axial and selective coding. 

In this study, grounded theory approach was used for the analysis of data because in this analysis human actions and interactions can be studied. In this study, also patient’s interaction with the COPD was being evaluated (Morris, 2015; Fisher, 2011).

Coding system can be implemented for improving rigour and validity of the outcome of the study. Expereinced researcher performed coding who was not involved in the study. It helped in reducing biasness. Coding and elimination of the biasness helped in improving transparency of the study. Memo-writing was implemented in the data analysis which helped in improving theoretical links and concepts from the collected data. Extensive discussion was being carried out among researchers for effective analysis and interpretation of the collected data. Recruitement of experienced researchers and discussion among themselves helped in improving credibility of the outcome (Bloomer et al., 2013).

Data collection

After the completion of the study, patients were able to idnentify COPD excerbations through visible and invisible symptoms associated with clinical parametres and experimental knowledge respectively. Patients with past history of COPD exacerbations, identified signs and symptoms of COPD exacerbations, were able to recognise time of COPD exacerbations. Patients acquired and understood self-management techniques like breathing techniques. Patients recognised importance of antibiotic and steroid administration. Patients agreed that they can identify and recognise COPD exacerbations and seek assistance from care providers for management of COPD exacerbations. This timely intervention can be helpful in reducing deterioration of the patient. Findings of this intervention were in accordance to the aim of the study because findings demonstrated that patients can recognise and identify COPD exacerbations. 

These findings can be implemented in the long duration care facilities like diabetes and obesity because identification of these disesase are based on the visible and invisible symptoms (Harreveld et al., 2016).

References:

Bell, E. (2014). Rethinking quality in qualitative research. Australian Journal of Rural Health, 22(3), 90-1.

Bloomer, M.J., Doman, M., and Endacott, R. (2013). How the observed create ethical dilemmas for the observers: experiences from studies conducted in clinical settings in the UK and Australia. Nursing & Health Sciences, 15(4), 410-4.

Braun, K.L., Browne, C.V., Ka’opua, L.S., Kim, B.J., and Mokuau, N. (2014). Research on indigenous elders: from positivistic to decolonizing methodologies. Gerontologist, 54(1), 117-26.

Dickens, A.P, Kendrick, T., Jordan, R.E., Adab, P., and Thomas, M. (2018). Independent determinants of disease-related quality of life in COPD – scope for nonpharmacologic interventions? International Journal of Chronic Obstructive Pulmonary Disease,  13, 247-256.

Dean, W., Sophie, D., & Isabel, H. (2016). Common qualitative methods. In Z. Schneider, D. Whitehead, G. LoBiondo-Wood & J. Haber (Eds.), Nursing and midwifery research: Methods and appraisal for evidence based practice (5^th ed., pp. 93 – 109). Chastwood : Elsevier Australia.

Erlingsson, C., & Brysiewicz, P. (2013). Orientation among multiple truths : An introduction to qualitative research. African Journal of Emergency Medicine, 3(2), 92 – 99.

Fisher, K. (2011). The qualitative interview and challenges for clinicians undertaking research: a personal reflection. Australian Journal of Primary Health, 17(1), 102-6.

Harreveld, B., Danaher, M., Celeste, L., Knight, BA., and Busch, G. (2016). Constructing Methodology for Qualitative Research: Researching Education and Social Practice. Springer.

Isaacs, A. (2014). An overview of qualitative research methodology for public health researchers. International Journal of Medicine and Public Health, 4(4), 318.

Levickis, P., Naughton, G., Gerner, B., and Gibbons, K. (2013). Why families choose not to participate in research: feedback from non-responders. Journal of Paediatrics and Child Health, 49(1), 57-62.

Morris, A. (2015).  A Practical Introduction to In-depth Interviewing. SAGE.

Polastri, M., Pisani, L., Dell’Amore, A., and Nava, S. (2017). Revolving door respiratory patients: A rehabilitative perspective. Monaldi Archives for Chest Disease, 87(3):857.