Walking down the corridor of a dark, mysterious medical centre to find the empty waiting room on a cold January evening, I had many burning questions ready and waiting to jump from my notepad that I couldn’t wait to discover the answers to. I was waiting to carry out my first qualitative interview with Dr. Cole* for my undergraduate psychology research; little did I know the exciting journey that I was about to ignite …
Exploring Doctors’ Experiences in Communicating with Newly Diagnosed Cancer Patients
My first qualitative study involved interviewing General Practitioners (GPs) in Ireland about their experience of communicating with their newly diagnosed cancer patients (Walsh, 2009). These professionals are at the forefront of primary healthcare and all that is happening at present in their field, and therefore are perhaps deemed one of the most important influences on any future implementation of service change in my home country. Personally, this is an area of great interest to me as it allowed me to gain a rich understanding of the health professionals’ perspectives on the psychological aspect of a cancer diagnosis. I like how qualitative research has the goal of realistically understanding the sample rather than generalizing from the sample to the population, as is the focus of quantitative methods in psychology.
A number of factors coincide to make qualitative methods invaluable to psychological researchers. The main focus here is on the technique of using semi-structured interviews in qualitative research. A personal preference for this method comes from the simple process of social interaction with the participant you are interviewing. The face-to-face interaction for an interview setting gives an in-depth overview of the participant group you are trying to investigate.
Not only does it allow you the added insight into their personality, but also, the psychologist can explore the often fascinating bodily cues and facial expressions which accompany the life experiences which are brought to light in the interview. This option to observe participants while using the technique of interviewing in qualitative research is beneficial to the researcher. Even though it may not be incorporated into the actual routine data collection, it gives the researcher an insight into which elements of the topic under question influence or affect the participant most, that subsequently, may lead to the alteration of the interview schedule to include issues the researcher had not previously thought of. This method of re-framing allows for more real-life perspectives which are vital for consideration as they allow the investigator to really get inside the mindset of the interviewee and probe deeper into a specific area that appears to be important in terms of the overall research objectives.
To me, this highlights the value of qualitative research (unlike the limited, more often unchangeable rules of quantitative) as it is lenient enough to allow the slight pushing of boundaries in order to gain a true reflection of the story being told. The element of conversation, in fear of using jargon-like terminology, in qualitative research allows for a purposeful, meaningful and engaging interaction which forms the basis for data of rich content which isn’t easily achievable by many other research methods in psychology.
The interviews I conducted allowed me to delve deeper, from the GP’s perspective, into the reality of what it is like for patients when they first hear they have cancer, their reactions and presenting emotions, as well as their experience of initial supportive services. Many GPs in this study recognized various emotional and cognitive/informational needs of their patients who had recently been given their diagnosis, which were described as “fear, worry and anxiety”, relating to “the future, their treatment and aspects of pain”. One GP gave a realistic description of the experience by explaining that “in the immediate aftermath of a diagnosis…it’s a fearful event.” Other participants identified shock and confusion in their encounters with patients with one stating “when they hear the diagnosis of cancer, they go into a mind-numbing kind of situation.”
This research presented many different opinions surrounding the lack of resources for newly diagnosed cancer patients and the fact that there was a great need for both patient and doctor, yet it appeared that very little was being done about it. With a standard survey or a series of yes/no answer questions typical of quantitative research, this quality of information would not have been achieved. Participants would have merely answered the questions, and the reasons behind their feelings and the current lack of services would not have been portrayed to a desirable level.
Exploring Parents’ Experiences in Living with Children with ADHD
The psychologist in me is fascinated by what it is about people that helps them through adverse life circumstances and encounters. Therefore I really value the opportunity sitting face-to-face with your participant gives in terms of getting inside what their experiences have been regarding the particular topic. My second qualitative study, for my MSc, had its origins in clinical child psychology whereby I chose to investigate the perspectives of parents of children with ADHD to explore what their treatment journeys have been like (Walsh, 2012).
The data collection process here was refreshing as I interviewed mostly mothers, who allowed me into their world by describing what it is like living with ADHD every day. Through this snapshot of their daily struggles with a child who has a challenging behavioural disorder, it was evident that most mothers had been through a period of distress and emotional difficulty and many mothers had very strong opinions on how they ‘manage’ their child’s behaviour and the specific treatment route they took. It was interesting to notice how the mothers were extremely reluctant in the beginning to initiate medication for their child, as most had learned about the undesirable side effects and the unknown future risks connected to medication for the treatment of ADHD. One mother illustrated how “medication was absolutely a last resort. We put it off for years” as another explained: “after about 2 years I got desperate and I did succumb to Ritalin for my son.”
Nearly all mothers initially trialled other forms of psychological therapy and self-help interventions such as having a good daily routine for their child, prior to “giving in” to medication as a last resort when their child’s behaviour was not being adequately controlled. Eventually, parents attributed most value to pharmacological interventions, predominantly psycho-stimulants, to help overcome their child’s behavioural problems and to maximise both the child’s and their families’ quality of life. Additionally, they emphasized the value of self-help interventions in the home and expressive therapies such as playing an instrument or taking part in a team sport. In this way I found out what value some parents placed on medication and others on psychological interventions in the treatment of ADHD. Qualitative methods facilitate ease of getting down to the ‘nitty-gritty’ of the situation and of what it is exactly you are trying to get to the bottom of, which is why this research method is so valuable. Only through qualitative interviews were these authentic, concrete responses attainable, as the interview schedule was flexible and allowed for the use of probe questions and the intuition of the researcher to intervene accordingly to ask ‘how’ or ‘why’ the mother felt the way she did.
Another quality inherent in this method of research is how we, as the researcher, can control the journey of the research through the use of probe questions, especially when the participant mentions something interesting that we would like more elaboration on. This does not mean that you are pre-determining the answers that you wish to discover in your research, but you are dipping in and out of the interview conversation in a way that is valuable and necessary to guide the interviewee in the right direction, in terms of answering the questions being asked (and not going off on a tangent about something irrelevant thus creating excessive data to transcribe than is necessary!). The flexibility that comes with using probes is vital for your interview schedule as you can make immediate changes where you feel necessary.
For example, in some cases, mothers in my study did not understand how much information was required about their son’s treatment plans. Using probes, I was able to encourage them to talk more about this area which was of primary interest to the research question. This facet is a valuable advantage offered by qualitative interviews because open-ended questions allow the researcher to be ‘freer’ and to a lesser extent set-in-stone, as are the often more closed quantitative questions. I believe this should be looked upon as an insightful benefit in research endeavours as it allows for the inclusion or elimination of questions as the interviews progress. In this sense, the study design is iterative as data collection and research questions are adjusted and amended according to what is learned.
The fact that qualitative takes account of the holistic side of things is also of interest to me. Very often, the questions asked by qualitative researchers are of a holistic nature as they are designed to understand the context of behaviour rather than concentrating on narrow aspects of the phenomena/behaviour. This allows the interviewee to expand on various aspects of their life for example drawing from the physical, mental, emotional, spiritual and material aspects that are present in their daily lives. For example, mothers of children with ADHD spoke about the sad reality of the negative public stereotype often labelling them as ‘bad parents’ as the reason for their child having ADHD. It was interesting to hear that the on-going experience of coping with ADHD was difficult for parents in terms of dealing with public misconceptions and judgements about their child’s condition, which mothers attributed to a general ignorance surrounding ADHD. Many participants illustrated this, with one explaining how people thought: “oh he’s just naughty” and “they didn’t believe there was such a condition.” Through this process, participants are given the space required to really express their opinions on topics under question and are encouraged to elaborate on factors from all corners of life resulting in a diverse realistic portrayal of life, as opposed to a ‘tick-the-box’ scenario. Participants may also influence the schedule as their responses can affect how and which questions the researcher asks next, thereby allowing for more spontaneity in the interview, producing a wider range of answers that subsequently contributes to interesting themes at the analysis stage of the study.
I would urge young psychology researchers not to be discouraged by qualitative methods. Yes, they are time-consuming and yes, interviews and transcription are laborious tasks when compared with the ease of handing out 50 quantitative surveys in one go, but think about the research question you are passionate about answering. If you can do this through qualitative methods, you will almost certainly be guaranteed real-life, accurate responses which are a reflection of the thoughts, feelings and experiences of people’s lives. Personally, I can’t think of a better way to study people, than a way that allows for the zoning in on what it is exactly people feel and why things are the way they are, why people think and behave the way they do, and what influences these have on each other.
…Walking out of the medical centre, I had a thirst for more. I couldn’t wait to interview my next participant. Will she have similar opinions as Dr. Cole? Or will she have contrasting views? Whatever their responses to my questions, their unique encounters were sure to contribute something to my knowledge and awareness of a topic I was greatly inspired by.
*actual name has been changed
Walsh, D. (2009). Exploring GP’s perspectives on resources to meet the psychosocial and supportive care needs of newly diagnosed cancer patients. (Unpublished Bachelors dissertation). University College Dublin, Dublin.
Walsh, D. (2012). Exploring what works best for children with Attention Deficit/Hyperactivity Disorder (ADHD); the parent’s perspective. (Unpublished Masters dissertation). Anglia Ruskin University, Cambridge.
Deirdre Walsh is a doctoral student in Counselling Psychology at Trinity College, Dublin. She is a recent MSc Clinical Child Psychology graduate of Anglia Ruskin University, United Kingdom. She has various experiences conducting psychology studies using qualitative research methods. She aspires to be a counselling psychologist, and hopes to apply the knowledge gained from her research experiences into practice.