3.2 PARÁMETROS A CONTROLAR
3.2.3 CUARTO OSCURO Y PROCESADORA
A semi-structured telephone interview was chosen as the most suitable method of
capturing the health experiences of travellers abroad, to compare with the content
of their pre-travel consultation. Whereas the video consultation represents the
pre-travel part of the participants’ pathway, and the diary represents their during-
travel pathway, the telephone interview completes the cycle of their health
experiences by exploring the post-travel pathway. The aim of the interview
method was to answer three aspects of the research questions:
1. How did the participant use (or disregard) the contents of their pre-travel
consultation?
2. What coping or prevention strategies did participants use to manage their
health?
3. How did they acquire that knowledge, skill or attitude?
This will contribute to the knowledge of health issues from travellers’ perspectives,
a concept that is currently fragmented and poorly understood within the literature.
Interviews with travellers offered an opportunity to check the validity of the
researcher’s findings and interpretations of the consultation recordings and diaries
used in methods three and four. The semi-structured interview met a need of the
research to explore themes arising from previous methods, yet allow for new,
perhaps unanticipated concepts to be aired. Careful design, administration and
1997). By loosely following an interview schedule the researcher can gain specific
data to answer the research questions, but is also free to explore arising topics in
depth, and to encourage the participant to talk about the factors that were
important to them. The research participant is therefore active in jointly setting the
agenda, although it is acknowledged that this is within the parameters set by the
researcher (Clarke, 1999). Emerging themes can be compared with those arising
from the wider literature, the documents analysed in method one, and themes
emerging from previous methods. Other advantages include potential access to
emotions, experiences and feelings, an access point to sensitive issues, and the
production of data that Denscombe (2003) refers to as ‘privileged information’,
which might not be available through any other means of data collection.
However, the apparent simplicity of recording a structured ‘conversation’ is a
potential hazard for researchers, requiring careful planning and constant
awareness of the sensitive and complex paths of human interaction. The risks of
getting it wrong include the production of poor and invalid data, and negative
impacts upon participants (e.g. a sense of invaded privacy, or wasted time). There
are other factors affecting the nature and progress of an interview that might not
always be apparent, and yet exert an influence upon the results. These include
age, gender, social and ethnic differences between the researcher and the
participant. To counteract this, Denscombe (2003) suggests the researcher
adopts a passive and neutral manner, including their dress and appearance,
although this can be contested: what is ‘neutral’ to one person, for instance a grey
suit, is loaded with authoritarian values to another individual. Although such visual
cues are absent from telephone interviewing, the voice and accent cannot be
considered ‘neutral’, as Denscombe would imply. Ethical boundaries also need to
with a participant’s viewpoint, which could risk appearing antagonistic or partial.
The interpersonal skills required by the researcher are manifold, and well
documented elsewhere (Parahoo, 1997; Cormack, 2000; Sim and Wright, 2000;
Denscombe, 2003). The salient skills needed within these interviews include:
• attentiveness
• the appropriate management of silences
• the use and timing of prompts and probes
• using paraphrasing or mirroring of what the participant has said in
order to check understanding of their intended meaning
• clarifying information and seeking examples
• avoiding leading questions
• the purposeful use of open or closed questions.
Participants may feel awkward or intimidated knowing the discussion is being
recorded, and the researcher has an ethical duty to allow time to put the
participant at ease, to explain how confidentiality and anonymity will be
maintained, and to avoid coercion (Oliver, 2003).
The possible advantages of conducting a face-to-face interview over a telephone
interview include the ability to pick up on non-verbal cues by the participant. On
balance, this was considered to be relatively less of an advantage in this phase of
the study than the practical benefits offered by the telephone technique. As
written, informed consent had already been achieved when first meeting the
participant at the surgery, continuing consent was checked verbally at the start of
the telephone interview. This method also enhanced the ability of the researcher
to conduct the interview at a time that was most convenient for the participant,
pragmatic considerations must be balanced with methodological rigour in a single-
handed, self-funded study such as this PhD.
Sampling and recruitment
The sample set were the same travellers who consulted with practice nurses in
the AV recordings and completed travellers’ diaries (n = 32).
Tools and piloting
The design of the interview schedule was informed by several factors relating to
the content, the order of questioning, and interviewing techniques. The content
and choice of topics arose from the literature and findings and interpretations from
previous methods. Findings and themes from the video-recorded consultation
(method three) and the traveller’s diary (method four), also contributed to question
formation in the interview schedule, e.g. whether products recommended by the
nurse were used. Findings from the official guidance documents were influential in
deciding on interview topics, and the schedule reflects their key categories such
as infectious disease prevention, bite protection, food and water hygiene, and sun
exposure.
The logical ordering of topics was derived from the literature on patient education
and communication skills – for instance, the requirement to move from simple to
complex issues, neutral to potentially invasive or embarrassing topics, is
propounded by various authors (Nelson-Jones, 1996; Burnard, 1999; Quinn,
2000; and Redman, 2001).
Interviewing techniques (such as managing silence, or the use of closed or open
questions), are well articulated in research literature (Parahoo, 1997; Bowling,
2002; Weinberg, 2002). These were applied and checked in the pilot study and as
Appendix 8 contains the generic interview tool, but there were slight variations
during data collection because the semi-structured nature of the design allowed
participants to develop lines of discussion relevant to their experiences. For
instance, the interview tool contains lists of possible topics to discuss, e.g. malaria
prevention. If the participant had not visited a malarial region, this question was
omitted.
The design of the interview schedule applied the following principles:
• An introductory phase to establish the ground rules for the interview;
• An ice-breaking phase to set the participant at ease and to start the interview
process;
• The main questioning phase, moving from simple to complex, non-threatening
topics to potentially more sensitive ones (e.g. discussion of sunburn came
before diarrhoea, and diarrhoea before sexual health), unless the participant
freely changed this taxonomy of questioning;
• A clarification phase: the participant was invited to offer any further topics that
had not been discussed, or to ask questions. The researcher summarised their
understanding of the main issues and checked for accuracy with the
participant;
• A closure phase for the researcher to thank the participant for their time,
confirm arrangements for feedback and provision of a book token.
The interview schedule, equipment and technique were piloted on two travellers
who were not included in the final sample. The following changes were made as a
• Electronic feedback problems were eliminated by re-positioning the recorder
further away from the telephone;
• Reflexive separation of the roles of nurse and researcher within the principal
investigator. There was a temptation to ask the traveller about their health, as if
they were consulting with the investigator as a nurse. The pilot recordings
honed the interview technique to avoid blurring these roles;
• Questions were added to the interview schedule to facilitate greater depth of
answers, to ask about perceptions of risk, and to align the questions with the
categories of risk identified through the documentary analysis.
Data collection and analysis
Data collection took place between September 2007 and July 2008. Travellers
received a pre-arranged telephone call at a time and number preferred by the
participant, and at the researcher’s expense. This was timed to be approximately
two weeks after their return from travel, a period of time judged to be early enough
to reduce recall bias further, but late enough to allow any travel-related problems
such as jet lag or minor infections to have resolved or been diagnosed.
Arrangements were made for the researcher to call again if the planned interview
was at an inconvenient moment for the participant. At the end of the interview
travellers were thanked for their participation and sent a book token in recognition
of their time.
An automatic two-way telephone conversation recorder was used (Phonapart
TL1076) with a new 90-minute tape cassette for each participant. Interview
recording was conducted within the Office of Communications (OFCOM, 2007)
guidelines, notably informing the participant on tape that the interview was being
The tapes were transcribed in an environment that ensured the participant’s
confidentiality, using the conventions and style previously described for the
transcription of the AV consultation recordings. Analysis of interview transcripts
followed the framework used in the interview schedule to identify:
1. episodes of ill health or health problems
2. how the traveller managed and dealt with that problem
3. how they knew how to manage that problem
4. whether they had specifically employed advice given to them in their
consultation
5. whether they had chosen not to act on advice received in their consultation.
Points four and five required comparative analysis between advice given by the
nurse in the AV recordings of consultations and evidence of the traveller acting in
accordance (or not) with that advice. A final element of analysis was thematic, to
search the data for evidence to support or refute themes that had emerged from
previous methods, or for any new themes. The findings are presented in Chapter
6, Phase Three: What do travellers say and do?