Interviews are one of the most commonly applied qualitative methods. They are a pre-prepared and guided form of conversation, and are probably the most common source of qualitative data for healthcare researchers (Green and Thorogood, 2009).
The study used semi-structured interviews with doctors, midwives and nurses. The semi-structured interview allows participants to most readily describe specific behaviour, and it is useful for supplementing data collected using other tools and for exploring the meaning of events in depth from participants’ perspectives. When investigators require more specific information a semi-structured rather than totally unstructured format is used (Bowling, 2014). A semi-structured interview was chosen in this case as actual information was required to describe practice in conjunction with the collection of data to assess how healthcare professionals feel about interventions during the second stage of labour and their own personal experience of second stage practice. This approach provided some structure, while allowing healthcare professionals to discuss the issues they found most relevant in second stage intervention in a more narrative style. In this way the uniqueness of each individual healthcare professional’s experience was acknowledged.
The interviews were conducted using a semi-structured interview topic guide (see Appendix 11). Many of the key areas to be explored were identified before the interviews took place, ensuring consistency across the interviews. Questions were
190
open-ended, and there was an opportunity for issues that were not part of the original list of key areas to be added into the interviews, if they were found to have particular significance. Some of the key areas explored, which were based around seven themes, are listed below (see Table 14). These themes were developed through discussion with my supervisors, from reading literature on the second stage of labour and by drawing on my personal experiences in terms of both practice and education.
Interviews conducted in the early phase of data collection confirmed the appropriate themes, with minimal amendment required to the structure of some of the questions.
Specific key points to be explored within these themes developed as the project progressed.
Table 14 : Seven themes in the semi-structured interview topic guide
1. Professional’s background information such as nationality and current post.
2. Information regarding healthcare professional’s training prior to qualifying as an obstetrician, midwife or nurse.
3. Routine practices during the second stage of labour: descriptive account 4. Healthcare professionals’ perceptions and their own explanations of what
influences practice and encourages the healthcare professional to use medical interventions during the second stage of labour.
5. Healthcare professional’s feelings regarding interventions during the second stage of labour and their personal/professional values regarding childbirth and the second stage of labour.
6. Storytelling about a time when the healthcare professional needed to use intervention during the second stage of labour.
7. Hospital policy and guidelines on the second stage of labour management.
191
I began by asking the healthcare professionals to talk about their general practice during the second stage of labour and then, using prompting, guided them to provide more detail. This led to the collection of detailed descriptions about practice in the healthcare professionals’ own words, with similar themes explored during each interview, whilst allowing for flexibility in the course of the discussion as theoretical concepts emerged. The length of the individual interviews varied between 20 and 60 minutes, and all the participants were assured of anonymity and confidentiality. The interview focus progressed from description of usual practices through to professionals’ perspectives and opinions and then their feelings.
The time and place for the semi-structured interviews were decided based on convenience for the participants: either a private office or empty labour room at government hospital premises, where there would be no interruptions. Comfortable seating was arranged so that both the participant and I sat at the same level facing each other, to ensure eye contact between us. The tape recorder and my phone, as a backup, were placed on a desk or table to the side of the researcher out of the direct line of vision of the interviewee to avoid distraction. All interviews were tape recorded, with the permission of participants, using an Olympus WS 650S DNS digital voice recorder machine. Tapes were then labelled with a research ID code and date. To ensure confidentiality, a record of the names of the interviewees and their place of work was kept along with their identifying number in a separate place from the tapes, in a locked filing cabinet. All interviews were then transcribed, in line with the belief that an accurately transcribed audiotape is the most reliable record of an interview (Green and Thorogood, 2009).
I transcribed the majority of the audiotaped interviews verbatim and the remainder were done by a transcription company that provided me with a confidentiality
192
agreement. I listened again to the interviews with the transcripts to make sure the latter were correct. I found transcribing the tapes myself more beneficial as the process provided me with an opportunity to immerse myself in the data collected.
This facilitated analysis of the data, as the theoretical concepts began to emerge as I transcribed. In the case of the interviews with the staff whose first language is Arabic, the interviews were conducted in English according to their preference, but I had to elaborate on some questions in Arabic for clarity of understanding, which was possible because my first language is Arabic. This elaboration did not apply to the medical terminology, which was spoken of and understood in English, as this is the official language used in the hospitals for speaking and documentation.
Informal interviews were also an option. This happened with the two midwives who refused to be interviewed formally and to be recorded. I recorded their comments and responses in my field diary and where used them in my analysis to sensitise and improve my understanding of the data.