Causas del deterioro de los humedales costeros en España

Data collection will be undertaken in two sequential phases:

10.6.4.1 PHASE ONE (PILOT STUDY)

The aims of the first phase of data collection (the pilot study) will be to demonstrate the feasibility of data collection and analysis by i) testing the design of the interview and focus group processes, including participant recruitment and engagement and the design and functionality of the pre-prepared interview guide and focus group questions, and ii) subjecting data obtained to the process of analysis outlined below.

One-to-one semi-structured interviews with a small sample of members of the general public (it is anticipated that no more than ten interviews will be conducted for this phase of data collection) and one focus group consisting of approximately eight to ten members of the public, will be conducted. Interviews and the focus group will be audio-recorded, transcribed and analysed.

Evaluation of phase one of the study will inform the next phase of data collection.

10.6.4.2 PHASE TWO

Semi-structured interviews will be conducted with a larger sample of members of the public. Interviews will be conducted until interview data achieves 'saturation' i.e.

a point where additional interviews would give rise to minimal new perspectives or concepts (Corbin and Strauss, 2008). Data analysis will be undertaken concurrent with the interviews and it will therefore be possible to identify a point at which saturation is achieved.

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Interviewees will be asked if they are willing to take part in a subsequent focus group. The number of focus groups held will be determined in accordance with the requirement for data saturation, but it is anticipated that a least two focus groups will be held, each consisting of approximately eight to ten members of the public in each group.

Interviews and focus groups will be audio-recorded, transcribed and analysed.

10.6.4.3 INTERVIEWS – PROCESS

Participants will be informed about the nature and purpose of the study and invited to discuss issues related to the distribution of healthcare, priority-setting and the suggestion that responsibility for healthcare need should be considered when healthcare priorities are identified. Terms such as 'QALY-weighting' or 'weighting health benefits' are not in common use and will not be used within the interviews.

However, participants inferred views on weighting will be sought⁵⁹.

An interview guide comprising of open-ended questions, relevant prompts and probes, plus scenarios designed to explore key issues arising from the literature, will be used to guide the discussion rather than as a prescriptive means of eliciting responses (Appendix Two).

The intention will be to generate an adaptable dialogue, with the interviewer questioning, probing, seeking clarification, offering additional information and summarising. Throughout the interview, additional short, open questions (probes) will be used to elicit reasoning and arguments; to verify their consistency and to encourage participants to explain and explore their responses. For example:

 What are your reasons for thinking/believing that?

 Earlier in the interview you stated that you believe 'X' but you have now confirmed that you also support doing 'Y', what do you think of this?

 Can you give me an example?

59 To elicit responses that may indicate a view on weighting health benefits (and not simply a preference to maximise efficiency) the predicted health outcome will be kept the same within questions and scenarios.

Weighting is only applicable in circumstances where the potential health gain is equal. Therefore, if the health gain is not kept the same, the question cannot elicit a view on weighting health benefits. Statements such as "I would give priority to the most severely ill" could be about weighting benefits or may indicate a preference for straightforward efficiency, depending on how the question is framed

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 Are there circumstances where that would not be the case?

 Why do you think such views are held?

 What would you recommend?

 If another person had an opposite view to your own, how would you explain to them why you believe your view to be correct?

To ensure that ethical reasoning may ensure, issues will be presented in terms of an ethical problem (or containing ethically-relevant features) (Holm, 1997: 99).

Participants will be encouraged to explain and defend their views; to provide reasons or evidence to support their position and, in so doing, demonstrate morally reasoned preferences.

It has been noted that the valuations of health increments seem to be affected by whether questions are framed as individual or social choices (Gyrd-Hansen, 2004).

Therefore, in order to avoid discrepancies between individual and social valuations, participants will, where possible, be encouraged to adopt a social decision-making perspective.

Self-contradictory statements or evident conflicts or inconsistencies of reasoning and the extent to which participants sustain logical arguments when challenged will be explored by encouraging participants to reflect on their responses, for example:

Interviewer: Earlier, you said that you think that people responsible for their own ill-health should have lower priority, but you have now stated that you also believe that society shouldn't discriminate against smokers – how do you think decision-makers can resolve such opposing views?

It is acknowledged that formulating and framing sound arguments demands considered, critical thinking, and it has been suggested that general population respondents do not have a readily articulated account of their views on complex healthcare priority-setting issues (Shah, 2009). Therefore, a conversational

approach will be fostered throughout the interview. Participants will be encouraged to 'think aloud', to verbalise their reasoning and express arguments in their own words.

The interviewer will be particularly alert to the development (by the participant) of coherence-focused arguments that do not necessarily accord with the rational, logical process of deductive reasoning (outlined in Chapter 7). Participants will be

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encouraged to reflect upon their initial responses to questions and to develop their evaluation and, ultimately, their ethical arguments. The interviewer will be attentive to the evaluative processes participants employ and will aim to recognise and respond to their use of:

1. moral claims, made either via recommendations ('should', 'ought' etc.) 2. evaluative terms ('right', 'wrong' etc.)

3. adjectives such as 'cruel', 'inhumane', etc.

4. components of ethical evaluation, such as analogies and parallels ("'x' is like 'y' so you should not do 'x'")

5. 'slippery slope' arguments ("if you do 'x' then it will eventually lead to 'y'") (Thomson, 1999).

The interviewer will aim to use these to facilitate the discussion.

Information will be presented verbally and, where necessary, via laminated card or computer laptop screen, and participants' understanding of written information will be established. Interviews will be conducted by the researcher and it is anticipated that each interview will last for approximately one hour. Interviews will be recorded using digital audio equipment and subsequently transcribed.

10.6.4.4 FOCUS GROUPS – PROCESS

Focus groups will be facilitated by the researcher and an experienced co-facilitator.

Focus groups will be structured around a set of predetermined questions to examine issues emerging from interview data. Focus groups will commence with the

facilitator asking one or two questions aimed at engaging participants and subsequent questions will seek to explore issues emerging from interview data.

A key feature of focus groups is the exploitation and active encouragement of group interaction among participants (Webb and Kevern, 2000) and it is anticipated that participants' comments will stimulate and influence the thinking of others. Emphasis will be placed on encouraging participants to talk to one another; asking questions, exchanging anecdotes, and commenting on the others' experiences and points of view.

Focus groups will be recorded using digital audio equipment and subsequently

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10.6.5 RECRUITMENT

The study will seek to recruit English-speaking, adult⁶⁰ 'members of the public'.

However, it is acknowledged that this term is indistinct and that, from a qualitative research perspective, the concept of a 'member of the public' may be unhelpful.

This is obviously of concern with regard to the generalisability of qualitative findings and this issue is addressed in 'Data Trustworthiness' (below).

In a review of public participation in healthcare priority-setting, Mitton et al (2009:

223) defined three distinct categories of members of the public:

1. the public as individual citizens speaking on their own behalf

2. the public as organised interest groups supposedly speaking on behalf of their membership

3. the public as patients or consumers of services, in those relatively few instances where they are asked to speak on issues broader than their own personal experience

In recruiting participants, it is not intended that a 'member of the public' will be specifically defined. The expectation is that participants will be invited as 'individual citizens speaking on their own behalf'. However, it is acknowledged that this may not be possible to confirm.

In accordance with a Grounded Theory approach, the initial participant sample will be obtained from where the phenomenon occurs (Coyne, 1997). Therefore, recruitment to the pilot study will recruit adult members of the general public via advertisements placed within prominent locations (supermarkets, libraries etc.). A study website will also be established to provide further information and the website address will be included within the advertisement. No additional inclusion/exclusion criteria will be applied.

Subsequent recruitment will be based on theoretical sampling, a form of sampling that is controlled by the needs of the emerging theory, not a list of variables (Strauss and Corbin, 1998). It is anticipated therefore that a more focused sampling strategy may emerge as data is analysed.

60 Participants age and language abilities will be checked on recruitment to the study

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Members of the public who express an interest in participating in the study will be sent an introductory letter, Participant Information Sheet and Expression of Interest form plus a pre-paid envelope. Upon receipt of a completed Expression of Interest form, the researcher will contact respondents by telephone to discuss the study further and, if appropriate, to arrange a convenient date and time for their interview.

Each participant will take part in one interview and receive a small payment to cover any travelling expenses.