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Weekly UpdatesNew caregivers of stroke survivors participated in a bimonthly research interview process for a year-long intervention study. The purpose of this current project was to describe the telephone interview experience for those in the study's control group. We purposively selected 14 participants to answer a telephone survey. The following themes emerged: (a) looking forward to talking with someone, (b) feeling helped and staying connected, (c) being busy caregiving and taking care of business, (d) helping others, and (e) being ambivalent or negative about the interview process. Orem's self-care deficit nursing theory was then applied to reflect upon these themes. 'It is important for nurse researchers to remember that interviews used for data collection are not neutral or noninteractive.
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Interviews are frequently used as a method for collecting research data (Lowes & Prowse, 2001; Speziale & Carpenter, 2007). The purpose of the interview is to understand the worldview of the interviewee" on the topic of interest (Hiller & DiLuzio, 2004, p. 6). The interview process provides an opportunity for participants to not only discuss their thoughts but also to reflect (Hiller & DiLuzio, 2004). However, research interviews can have effects on the participants that have more to do with the interview process than the topics discussed because data are gathered during interviews (Shamai, 2003). In other words, "hearing the voice of the participant is not the same as understanding how the interviewee perceives the research process" (Fontana & Frey, 2000, p. 4). It has been suggested that therapeutic effects can emerge from participation in research interviews (Colbourne & Sque, 2005; Gale, 1992; Hutchinson, Wilson, & Wilson, 1994; Shamai, 2003). In this regard, the research interview begins to resemble the therapeutic interview, with similar effects on the participants, such as greater self-awareness or venting of repressed emotions (Colbourne & Sque, 2005).
There is limited knowledge, however, as to the potential therapeutic benefits of the research interview for the interviewee. Indeed, discussions of the benefits of the research interview have generally been "limited to the potential for generating knowledge" (Hutchinson et al., 1994, p. 164). The research interview is usually discussed from the perspective of the researcher and the objectives of the research study rather than the perspective of the person being interviewed (Gibson, 1998; Hiller & DiLuzio, 2004). The purpose of this project was to describe the experience of caregivers of stroke survivors who participated in a telephone interview process during a year-long intervention study.
Research about caregivers is crucial because people are increasingly finding themselves in this role. Eighty percent of persons who survive a stroke return to their community and rely on family caregivers for assistance (Anderson, Linto, & Stewart-Wynne, 1995; Grant, Elliot, Weaver, Bartolucci, & Giger, 2002). Caregivers can be thrust into the care-giving role abruptly (Kerr & Smith, 2001), and caregivers may experience high levels of burden (Scholte op Reimer, de Haan, Rjinders, Limburg, & van den Bos, 1998). For these reasons, the experiences of caregivers participating in interviews for research are significant to healthcare professionals and researchers who work with caregivers and stroke survivors.
Year-Long Intervention Study
Web-based assistance called Caring~Web, an education and support intervention (Steiner & Pierce, 2002) and now available at http://caringweb.utoledo. edu/, was provided to new caregivers during the first year of caring for stroke survivors in the home in this study. Differences in outcomes between caregivers randomized to the Web intervention group (n = 51) and those in a control group (n = 52) that pertained to their experience of caring (caregivers' well-being and stroke survivors' healthcare service use) were examined using a mixed-model design (Pierce, Steiner, Khuder, Govoni, & Horn, 2009). In addition, this study explored caregivers' perceived problems and successes with caring (Pierce, Steiner, Govoni, Thompson, & Friedemann, 2007).
Seventy-three participants (n = 36 in the intervention group and n = 37 in the control group) completed this study during which they received bimonthly telephone interviews over the course of 1 year. Structured quantitative surveys using standard tools were read verbatim to the participants to gather information on the caregivers' well-being (depression and life satisfaction) at baseline and every 3 months. The participants were also queried about the stroke survivors' use of healthcare services every 2 weeks. In addition, qualitative open-ended questions pertaining to caregivers' problems and successes in caring were asked by the interviewers every 2 weeks, and they used probes to obtain as much information as possible about the caregivers' experiences. Most interviews took 20 to 30 minutes to complete.
Methods
Only the control group participants, who completed this year-long study and who met the inclusion criteria for this project of never having spoken with this particular project interviewer, were selected as potential participants with university institutional review board approval. This interviewer worked on the research team for the year-long study, and purposeful selection was important to prevent any bias between the interviewer and participants who had extensive contact during the year-long study. In addition, control group participants were only chosen so that the Web-based intervention would not influence the participants. Of the 37 participants in the control group, 21 participants met these criteria, and they were telephoned to ask if they would be willing to answer a one-time survey about the experience of participating in the year-long study's interview process. If the participant verbally consented to participate, it was recorded on the survey form, and a date and time to conduct the survey was arranged. However, if the participant was prepared to continue at the time of this telephone call, the survey was administered. The survey took about 10 to 20 minutes to complete.
Data Collection Materials
Predetermined open-ended questions were developed by the four researchers/authors and used with the participants during the one-time telephone survey. Open-ended questions were appropriate because they require more than a simple yes-or-no answer (Egan, 2002). The goal of this approach was to gather detailed data rather than simple yes-or-no answers. The survey tool consisted of four primary questions, beginning with "Can you describe what it was like being interviewed by telephone every two weeks for the year-long research study? Please tell me about that." Second, the participant was asked, "Can you tell me what it was like for you on a day when you received a call from your interviewer? What were you thinking or feeling?" If the participant was not forthcoming, the interviewer added, "Just before the call?/Just after the call?" Third, the participant was asked, "Can you tell me what it was like for you on a day when you did not receive a call from your interviewer? What were you thinking or feeling?" Finally, "Is there anything more that you would like to tell me about your research interview experience that we have not talked about?" The interviewer also had a list of seven probes from which to choose to interject and encourage the participant to continue the conversation, such as, "Please tell me more about ..." and "Can you give me some examples?" In addition, the interviewer had the discretion to use prompts like "I see," "Sure," and other verbal affirmations. The goal of prompts and probes was to keep the story going without influencing the subject matter (Norwood, 2000).
Content validity of the survey was established by having it reviewed by registered nurses who held master's degrees and worked on the year-long study. In addition, the project interviewer who was a licensed social worker had the opportunity to contribute input to the survey tool. After this review, the tool was made clearer by adding an introduction that explained why the participants were asked to participate in the survey.
The anonymity and confidentiality of the participants were respected and protected, and participation in this survey was voluntary. The participants were free to refuse or end the discussion at any time. An identification number was assigned to the participants' survey responses to keep their identities anonymous.
Data Analysis
These data were then analyzed using Norwood's (2000) eclectic approach to qualitative analysis that consists of three phases: deductive, inductive, and integrative. The deductive phase entailed converting the data from narrative form to more manageable units. The researchers read all transcripts of the telephone survey data in their entirety to establish a baseline impression of the whole dialog. By repeatedly reading the data, the significant statements were clustered into themes.
Then, the inductive and integration phases of analysis began (Norwood, 2000). In the inductive phase, we individually labeled themes that emerged. These themes were then discussed as a group until consensus was reached, which helped establish credibility of the findings. In the integration phase, relationships between themes and variations within themes were identified and woven together. An audit trail was constructed to provide transparency such that other individuals could reasonably expect a similar result, if they followed the same process of data collection and analysis. Having the researchers involved in content clarification, refinement, and consensus strengthened the data interpretation and further enhanced the trustworthiness of the findings.
The analysis of the transcribed interview data was completed using only the information that was communicated by the participants without allowing the researchers' preconceived ideas to bias the information. In fact, both the interviewer who conducted the survey and the researchers who analyzed the data used bracketing prior to data collection to identify self-assumptions and set them aside to isolate pure phenomena that were free from preconceived notions. The aim of bracketing was to examine prejudices and commitments on the part of the interviewer and researchers and suspend all judgments or ideas about interview processes or "bracket" them out so that the experience of the caregivers could be seen as it is and not as reflected through others' preconceptions (Cohen, 1987; Munhall & Boyd, 2001). The following beliefs were bracketed: being interviewed about the caregiving experience is therapeutic and beneficial; caregiving is valuable and appreciated by the individual being cared for and by society in general; caregiving is difficult, has economic value, and requires commitment; and people participating in research genuinely desire to participate with honesty and openness.
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