Tipo de investigación

Purposive sampling was used in order to gain information and understanding of living with COPD and of treating patients with COPD. This type of sampling aims to ensure that the sample obtained can purposefully inform an understanding of the research problem and the phenomenon that is central to the study (i.e. COPD). The COPD patient group (n=9) comprised individuals with a diagnosis of COPD who were recruited from those attending a Pulmonary Rehabilitation (PR) group, a psychological therapy clinic for people with long-term conditions, a Breathe Easy

89 support group and a local GP practice. The group contained five male participants and four female participants. Their ages ranged from 57 years to 81 years, with a mean age of 69.7 years.

The healthcare professionals group (n=10) was made up of people currently, or previously, employed by the NHS, who were working with, or had previous experience of caring for, people with COPD. The healthcare participant group contained professionals with current or recent experience of working in primary care, the community, hospital inpatient wards, PR clinics and a hospital psychological therapies outpatient unit. All healthcare professionals and all but one COPD patients were recruited in the North-West of England. The process employed in the present study, as in most qualitative studies, whereby data collection and analysis are carried out concurrently eventually leads to a point where no new categories or themes emerge. This is defined as data saturation and, at this point, recruitment was completed and no new data collected (Di Cicco-Bloom & Crabtree, 2006).

Recruitment of patient participants took place as follows. The researcher contacted a local Breathe Easy support group in October 2012 and began attending monthly meetings at the invitation of the committee. Although the original purpose of these visits was to gain an insight into the purpose of the group and how it contributed to the care of people with COPD, it became apparent that members of the group were interested in the study and would be willing to take part in the interviews. Initially, informal contacts were made with members at these meetings and subsequently a short talk was given by the researcher, presenting the study to the members. Following the talk, information sheets were given out and individuals who expressed their interest in taking part, and met the inclusion criteria, were subsequently recruited to the study. The researcher continued to attend the Breathe Easy meetings until summer 2014 in order to ensure that participants felt she had a genuine interest in their views and their contributions had been valued. Of five members of the group who expressed an interest in taking part in the study, three were subsequently excluded because they had been diagnosed with a respiratory disease other than COPD. One of these people kindly offered to take part in a pilot interview after being

90 given a full explanation of what his contribution would involve. Two members of the Breathe Easy group were fully recruited to the study.

Recruitment from the PR group followed a similar method whereby the researcher contacted the group facilitator, who acted as gatekeeper, and was invited to attend one of the sessions. At a second visit to the PR group, the researcher gave a short presentation explaining the purpose of the study and what would be involved in taking part. Letters of introduction and information sheets were given out and interested individuals subsequently made contact with the researcher, through the gatekeeper, and were recruited if they met the inclusion criteria. One participant who contacted the researcher was recruited to the study from the PR group.

Further participants were recruited to the COPD group from those attending a psychological therapies clinic at the local hospital, which specialised in treating people with respiratory disease and comorbid anxiety. They were introduced to the study by one of the therapists, acting as gatekeeper, who gave out letters of introduction and information sheets to those who were interested in taking part. Those who subsequently contacted the researcher, and met the inclusion criteria, were asked if they would agree to take part in the study. Of the six people who expressed an interest in the study, two were subsequently too unwell to take part and a further two people declined. Two participants were recruited to the study from the psychological therapies group.

Having carried out interviews with participants from the Breathe Easy group and the PR group, it was necessary to continue recruitment until the point of data saturation was met. Further COPD patients were then recruited through a GP contact using the practice’s Quality and Outcomes Framework register of patients with COPD. Patients were told of the study by the GP who gave those who expressed an interest, letters of introduction and information sheets. Those who wished to then contacted the researcher to receive further information. If the inclusion criteria were met, they were asked if they would agree to take part in the study. Four people contacted the researcher with a view to taking part in the study. One person was later too unwell to be interviewed and three participants were recruited to the study. One final

91 participant was recruited as a personal contact of a member of staff at MMU, who acted as gatekeeper.

Healthcare professionals were recruited through individual contacts with those working in the PR and psychological therapies teams in the local CCG area, local GP surgeries and the Faculty of Health, Psychology and Social Care at Manchester Metropolitan University (MMU). Of the fourteen healthcare professionals initially contacted by email, post or telephone, three did not respond, one declined due to work commitments and ten were recruited to the study.

Prior to recruitment, all individuals were given, or sent (by post or electronically), a letter of introduction to the patient or healthcare professional (Appendix 1 and Appendix 2), a copy of the study information sheet, for either COPD patient or healthcare professional (Appendix 3 and Appendix 4) and consent form (Appendix 5). The information sheet and consent form were developed in accordance with the British Psychological Society (BPS) Code of Human Research Ethics (2014) guidelines. Prospective participants were informed of their right to withdraw from the study at any point and were assured of their anonymity and confidentially of their data. A period of at least two days was left between receipt of this information before a follow-up contact, by telephone or email, was made to arrange a time and day for the interview. Spare copies of the information sheet and consent form were brought to all interviews and each participant was given an opportunity to ask questions about the study before giving their signed, informed consent to take part in the study. A detailed description of the procedure for the collection of study data is contained in the following section of this chapter.