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Data were collected from the participants recruited via the CMHT using semi-structured interviews. Ideally, each member of the dyad took part in both a one to one and a joint interview with the researcher. The rationale for semi-structured interviews will be first discussed, followed by a discussion of the method (one to one and joint interviews) and then the process of data collection.

Table 5.1 Demographic information for interview participants (NB all names are pseudonyms)

IPA research, like other phenomenological research methods, commonly uses the semi-structured interview to explore the life experiences of the chosen participants. Kvale and Brinkmann (2009) state “Conversation is the basic mode of human interaction” (p.xvii) and therefore if one wants to understand another person’s lifeworld one should talk to them and listen to their stories. Indeed

Age Ethnicity Carer Relationship Age of

carer Ethnicity

Phinney (2006) suggests that most research exploring the experiences of people with dementia are based upon loosely structured interviews or conversations. Semi-structured interviews are said to provide this loose structure and perceived to be the middle ground “between consistency and flexibility” (Langdridge 2007, p.65), where a topic guide is used to inform the conversation, but not to control it, so that unforeseen topics can emerge.

5.4.4.1 Planning the interviews

When involving older people with dementia in non-therapeutic research such as this study, it was important to ensure non-maleficence (Holloway and Wheeler 2010). Therefore, various decisions were made to minimise any anxiety or burden to both the person with dementia and carer. These related to where the interviews would take place and how they would occur.

The decision to interview participants in their own homes was made for several reasons. It was considered that this would give them some control within the data collection and that they would feel more secure, comfortable and better orientated in the familiar environment of their own home. Other issues such as dealing with potential fatigue and discomfort could be more easily addressed in the home environment and transport difficulties for those potential participants with mobility problems could be avoided. These decisions mirror those made by Davies et al (2010), in their study of frail older people, and reflect recommendations, to provide a safe context for data collection with older people with dementia made by Pratt (2002).

How the interviews would take place, was also deliberated. It was decided to use a format similar to that used in practice within the NHS trust and the researcher’s own clinical practice. This entailed carrying out both individual interviews with each member of the dyad, followed by a joint interview with both the older person with dementia and the carer. The rationale for carrying out individual interviews with both the person with dementia and the carer, as well as a joint interview was that from a life-world perspective these individuals would have differing experiences of the same event(s), as well as collaborative

accounts. Therefore, the aim of the separate and joint interviews was not to privilege one account over another, neither was it to seek verification or ‘truth’.

5.4.4.2 Issues of confidentiality

Issues of comfort and confidentiality also needed to be considered when carrying out the interviews. As the individual and joint interviews for the dyad took place during one appointment, it was important to minimise fatigue for the participants. Therefore, it was planned that interviews should last approximately 30 minutes each, with a break in between these for the participants.

Whereas individual interviewing allows the participants to voice their own understanding and account of an experience such as their fall, the researcher was also aware that they could disclose information that they did not wish the other member of the dyad to know. Consequently, the researcher reminded participants at the beginning of each interview that they had the right to disclose only what they wished and that anything they discussed within the interview would be kept confidential to the research team. The aim of the joint interview was slightly different in that it allowed for a collaborative account of the falls experience, where the memory of one participant (usually the person with dementia) may have been prompted by the other member of the dyad, or where the experience may have been elaborated upon by either participant. However, the aim of the joint interview was for a co-construction of the falls experience and not verification of truth or facts by the carer.

Participants were also given the choice of whether they wanted to be interviewed individually and jointly. In two instances, carers declined taking part in an individual interview and reasons for this were environmental and concern for the person with dementia. For example, one person with dementia had mobility problems and there was nowhere else for the researcher and carer to sit for the individual interview. In another instance, it would seem that the carer was concerned at leaving the person with dementia unattended, during his or her own interview.

Other issues were of concern to the researcher and her clinical colleague. As experienced practitioners, they were unfortunately aware of the possibility of

older abuse amongst the participants. They therefore knew that if anything untoward was disclosed to them, that they would have to follow local policy to safeguard the individual concerned. Even though the researcher and physiotherapy colleague were not present in their capacity as the individuals’

allocated health professional, they were still registrants with the Health Professions Council (HPC), and were bound by their professional code of ethics and professional conduct (HPC 2008). Therefore, this was made clear on the information letters given to both members of the dyad before the interview (see appendix C).

The head physiotherapist who carried out some of the interviews in the primary study was also seeing clients within the NHS trust in her professional capacity.

It was agreed that she would only interview people who lived outside of her catchment area and therefore were not known to her in her capacity as a physiotherapist.

5.4.4.3 How the interviews were carried out

It was considered important that the interviews were arranged at the best time to suit the person with dementia and the carer, so that once again, the dyad had some control over the process and that they were not inconvenienced. The interview date and time were agreed by telephone, during the initial contact made by the researcher (see figure 5.2). Even though there was a brief explanation about the study on the initial consent form given to the participant by the key worker, the purpose of the study was given again and the approximate length of time required for the interviews. At this point, they were asked to identify a specific fall that they might want to discuss at the interview.

This could have been their most recent fall or one they both identified that they wished to discuss. As the only contact the researcher or physiotherapy colleague had had with the dyad prior to the interview was by telephone, it was important to establish rapport with the dyad before starting the data collection.

Clarke and Keady (2002) describe the use of a “lead-in” phase to establish rapport when interviewing people with dementia to reduce any anxiety or concerns. Therefore, the interview was always preceded by both members of

the dyad being seen together, with a general informal discussion (about the weather, garden, room) and an acceptance of offered cups of coffee before more complete information about the study and written consent were given. The fall that the dyad had decided to discuss was also confirmed at this point.

Permission to use the audio recorder was also asked at this point, and it was explained that by using this, the interviewer could concentrate on what the participant had to say. The recorder was left on during the whole of the interview and participants quickly forgot that this was being used. None of the participants asked for the recorder not to be used or turned off during the interview.

The same topic guide was used for the individual and joint interviews, and although this could be considered as repetitive, it allowed for further elaboration and collaboration within the joint interview (see appendix D). The use of general and more descriptive questions at the beginning of the interview were used to help the participants feel less anxious about talking. These questions included asking them their age, how long they had lived in their home, and how long they had been together. These quickly changed to prefixing these questions with

“when” rather than “how long”, as these questions were easier for the majority of people with dementia to answer.

At the beginning of each interview, participants were asked to describe what they thought a fall was. This was asked in order to orientate the rest of the interview, as there are many perceptions and definitions of what a fall is (Hauer et al 2006). The main topics that the researcher wanted to explore were what participants were doing before their fall, the falls experience itself and the consequences and experiences following the fall. The topic guide in appendix D presents the overall topic areas and possible questions and prompts. It was hoped that these probes or prompts, or questioning by the interviewer would not all be necessary and that the initial questions would be open enough to facilitate the participant to talk (Smith et al 2009). However the researcher was also aware that for some participants more questioning or prompting would be required, because of concentration problems, short term memory or language difficulties and this was also observed by Kirkevold and Bergland (2007). It was

considered that some people with dementia might deny or not remember that they had had experienced a fall (even though this had been identified at the beginning of the interview); therefore, the interviewer would ask them their opinion of other people’s falls experiences. This happened with one participant but in this instance, the participant then went on to discuss his/her own fall.

As already stated, the participants were reminded that they should only discuss what they wished to in the interviews, including the joint interview. This was aided by the use of open-ended questions or minimal prompts by the interviewer so that the participants mainly instigated the discussion.

At the end of the interview, the participants were thanked for their contribution to the research and given either a small gift of either some chocolates or biscuits as a thank you. In the same way that it was important to spend some time talking to the participants before the interview, it was also considered important to spend some time talking informally afterwards. A thank you card was also sent to the dyad after the interview.

5.4.4.4 The pilot interviews

As previously discussed, a physiotherapy colleague contributed to the data collection in this stage of the research. Even though she was an experienced practitioner and had expertise in interviewing people with dementia as part of her clinical practice, she had no research experience. My previous research experience was in quantitative research and so I had minimal qualitative research interviewing experience as well. It was therefore deemed important to prepare for and “rehearse” carrying out research interviews. Therefore, the two interviewers “interviewed” each other to rehearse the format and practice using the recording equipment, as well as trying to ensure that the style of interviewing was appropriate to encourage rich description and discussion by participants.

The decision was made that the first four interviews with the dyads would be pilot interviews, involving both the researcher and her physiotherapy colleague, with one observing the other during the interview. The aim of the pilot interviews was to observe the content and process of the interview and the technique of

the interviewer (Robson 2002). This was explained to the participants before the interview so that they could choose whether they wanted this to take place or not. It was also clarified that the observer was observing the person who was interviewing them and not the participants themselves.

As a result of the pilot interviews, some issues were confirmed and others needed slight modification. The content of the topic guide seemed to be appropriate, however as already stated some of the warm up questions needed a minor modification; so for example, if we had asked “how long” or “how old”, we replaced this with “when did you come to this house” and “when were you born”. These questions were not always necessary because of the general discussion before the interview. However, it was felt that it was quite useful to still ask for a definition or description of a fall at the beginning of each individual interview to “set the scene”. We also became more confident in allowing the participants to “travel and wander” a little more in their accounts, even if this seemed to be going “off topic” (Kvale and Brinkmann 2009). Other aspects of the process, such as not hurrying to start the interview and better positioning of the microphone nearer to the person with dementia were identified. Initially we gave the participants the choice of who would be interviewed first. However after one of the pilot interviews, the decision was made that if the participants did not have a preference, it was preferable to interview the person with dementia first. This gave them more of a rest period between their individual and the joint interview. It was also more difficult sometimes to bracket off what the carer had said in their interview, with a temptation to provide prompts to the person with dementia especially when they struggled to share their perspectives of events, which the carer had already shared with the interviewer.

The use of the joint interview was reinforced, as it was observed that by using the same topic guide, not only was the carer able to prompt and facilitate the memory of the person with dementia, but that the accounts of both were elaborated upon and different meanings and experiences were expressed.

As a consequence of the pilot interviews it was concluded that the topic guide provided appropriate prompts for the interviews, and that these four interviews could be included in the data analysis, which is acceptable in qualitative

research (Holloway 2008). It was also reinforced that the planned procedure could be followed, with a preference for interviewing the person with dementia first.