CHAPTER THREE
IN-DEPTH INTERVIEWS
This chapter focuses on the use of in-depth interviews as an applied
qualitative method in drug use studies. It begins with a brief overview of the
technique and continues with a description of the various steps involved in
carrying out an applied qualitative study using the in-depth interview method.
3.10:
Overview
3.11:
What is an In-Depth Interview?
An in-depth interview is a qualitative research technique that allows person to person discussion. It
can lead to increased insight into people's thoughts, feelings, and behavior on important issues. This
type of interview is often unstructured and therefore permits the interviewer to encourage an
informant (respondent) to talk at length about the topic of interest.
The in-depth interview uses a flexible interview approach. It aims to ask questions to explain the
reasons underlying a problem or practice in a target group. You can use the technique to gather
ideas, to gather information, and to develop materials for drug use interventions.
3.12:
Use of In-Depth Interview in Drug Use Studies
One effective way to understand the reasons underlying problem behaviors is in-depth analysis. In
drug use studies, areas in which the method can be used include:
!
In pilot studies to generate ideas.
!
To obtain greater depth of information on a topic of interest as a supplement to data received
from other methods, e.g., structured questionnaire.
!
To evaluate the impacts of interventions on attitudes or beliefs.
This section will consider only how in-depth interviews are used to gather data to prepare for
interventions.
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3.20. Steps in Using In-depth Interview to Study Drug Use Problems
The activities involved in using in-depth interview to study drug use problems can be organized into
a series of steps. These are summarized below. A detailed discussion of each step follows the
summary.
TABLE 3.1: Summary of Key Steps in Conducting In-depth Interview
Step 1: Plan how you will conduct the in-depth interviews.
Step 2: Decide who your respondents will be.
Step 3: Prepare interview guide for each category of informants.
Step 4: Select your interviewers.
Step 5: Train the interviewers.
Step 6: Conduct the actual interviews.
Step 7: Analyse the data.
Step 8: Write a report and recommend intervention(s).
3.21. STEP 1: Plan How You Will Carry out the In-depth Interview
Once the decision to use in-depth interview has been taken, very important planning decisions and
preparations are needed. These include designing the study, identifying the target group, preparing
for the fieldwork, and collecting and analysing the data.
a.
Consider the Need for a Resource Person
Because the technique may be new to most health oriented professionals, one of the first planning
decisions to consider is the need for a resource person, particularly if the investigator is not confident
enough with the application of the method. Other things to consider before you decide to seek the
assistance of a resource person are the size of the study and the resources available to it.
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In a small exploratory study with limited resources, you could rely on a colleague who had used the
method before. However, in a big study to ascertain the reasons for some observed problem
behaviour, you may need the assistance of a social scientist who is well experienced in the actual use
of the method.(See Section 2.10 for more tips on qualities to consider when in need of a resource
person).
b.
Role of a Resource Person
Essentially, the role of any resource person at this stage will be to assist in planning the technical
details of the study. This will include:
!
how to obtain the study informants;
!
development of interviewing guides;
!
how to proceed with the field work;
!
training of interviewers and other field staf;
!
guidance in subsequent analysis of the field data.
These aspects of the study are very important, and such professional support needs to be seriously
considered if the principal investigator is not too confident about the method.
3.22. STEP 2: Decide Who Your Informants (Respondents) Will be
Identifying respondents from whom you can obtain the information you need is a very important part
of the study since the sources of information affects the quality of data obtained. You must therefore
identify key informants who can provide useful information for the study.
a.
Determining Who to Select for the In-Depth Interviews
The first thing to bear in mind is that in-depth interviews take much more time than structured
questionnaires. It is therefore not usually practicable to interview a large sample. A typical study
might include 3-4 interviews with respondents in each of 4 subgroups of interest, for a total of less
than 20 interviews. To account for the small sample size, those selected for the in-depth interview
must be people who are well informed about the issue to provide relevant information. Usually
informants are selected for in-depth interviews in a purposive manner, that is, people with specific
demographic/social characteristics are chosen to represent a defined subgroup.
This involves identifying individuals from the target groups who are and must be knowledgeable
about the study topic. Depending upon the nature of the problem and composition of the target
population, respondents are selected from various identifiable subgroups. Respondents selected
must be fairly representative of the various groups in the study population for this technique to be
useful.
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b.
Selecting Informants: Some Examples
Let us consider a study about the overuse of antibiotics in the treatment of ARI in children. After
deciding to use in-depth interviews, a study team may have identified the following target groups:
!
prescribers working in primary, secondary, and/or tertiary health care facilities;
!
dispensers working in these same health care facilities;
!
mothers with children under the age of five in the community;
!
operators of drug outlets in the private or informal sector.
The following example (Figure 3.1) describes two ways in which participants could be selected to
represent these target groups.
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Figure 3.1:
Example 1:
Examples Showing How Respondents May Be Selected
To identify representative prescribers in public health facilities:
!
List the names and locations of all health facilities in the district separately
according to levels, i.e., all community clinics, all health posts/centers, all
district hospitals.
!
Select a small number of facilities in which the interviews are to be conducted,
e.g., 2 community clinics, 2 health centers, 1 hospital.
!
In each facility, choose one health worker in each category to be interviewed,
e.g., village health worker, officer-in-charge, paramedic, dispenser, or pediatric
specialist.
If the information from the selected respondents is not consistent, additional facilities and
respondents can be chosen in the same way until the reasons for the inconsistency are
understood.
Example 2:
To identify representative mothers of children under the age of five
recently treated for ARI:
!
Contact the selected health facilities in the study district.
!
Get a list of children under the age of five treated for recent episodes of ARI
(ideally within two weeks preceding the study to enhance recall by mothers
who will be interviewed).
!
Decide on reasonable number of mothers to be interviewed, e.g. 2 mothers
treated at each of five facilities.
!
Contact the mothers in their homes and arrange interviews.
If it is not feasible to identify mothers from clinic records, it may be necessary to draw the
sample in the community. Village elders or local administration after have lists of families
and family members. Families should be visited until two recent cases of ARI are identified.
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c.
Hints for Selecting Informants for In-Depth Interviews
Some hints to consider when making your final selection of key informants are:
!
The informants should be unknown to the interviewers, if at all possible, in order not
to increase the likelihood of their giving biased responses.
!
They should not have previous knowledge of the specific issue of study.
!
A conscious attempt should be made to select different categories of individuals in
each target group, for example, by age, gender, status, education.
3.23. STEP 3: Prepare an Interview Guide for Each Category of Respondents
The guide consists of a list of questions or topics to be discussed by interviewers with respondents in
the field. The quality of data obtained depends to a large extent on the quality of questions in the
guide. A good guide uses general, non-directive questions or phrases instead of direct
questions that may end up in "Yes" or "No" answers. The task of the investigator or team of
investigators involves reviewing the study topics to develop questions that will yield relevant
responses. Following are suggested stages in developing the interview guide:
a.
Framing the Questions
1.
List the most important topics to be explored in the study.
For example, for a study investigating the overuse of antibiotics in the treatment of ARI in
children, we could list some of the specific topics for in-depth interviews with health workers:
2.
!
which particular antibiotics are being used;
!
symptoms associated with perceived need for antibiotics;
!
reasons for prescribing antibiotics for the common cold;
!
reported patient preference for drugs;
!
sources of information about antibiotics.
Identify relevant subtopics for each of the study topics
Each major topic can be broken into specific subtopics that can be explored during the
interviews. For example, in relation to reasons for prescribing antibiotics to treat common colds,
we can list the following sub-themes:
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!
beliefs about respiratory infections;
!
efficacy of antibiotics in treating infections.
3.
Make a draft of possible questions that could be explored with respondents about
these sub-topics.
4.
Check each question against the overall study questions and take out those that are
not needed to answer one or more of the study questions.
5.
Check the questions again to ensure that they can help initiate discussion.
Ensure that your questions are:
!
clear and unambiguous;
!
simple and easy to understand;
!
!
b.
not answerable by a simple Ayes@ or
Ano@;
reasonable and within the experience of the targeted respondents.
Construction of Probes
When writing the guide, build in useful "probes" to assist the interviewer. Probes are devices
used to prompt a respondent to speak further when an initial question fails to elicit the
desired information. Suppose in our antibiotic illustration the following question is asked of a
prescriber:
What would your reaction be if you were advised by the District Medical Officer
to stop the use of antibiotics in the treatment of ARI in children?
Answer: Well, I guess we'll have to wait and see what happens when the time
comes.
Here the respondent avoided answering the question. If his answer is accepted, his attitude about
a policy against the use of antibiotics in treating ARI will not be known. It is helpful to
anticipate this difficulty, and to construct "probe questions" in advance to cater for these
situations.
An example might be:
How would you feel about the DMO issuing such a directive?
The creation of appropriate probes brings a measure of control to a potentially haphazard form of
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questioning.
c.
Sequence of Topics
In general, the order of topics in in-depth interviews is never rigidly defined. Rather this is left at
the discretion of the interviewer and is determined by the flow of the discussion. This is one of
the reasons why interviewers need to be well trained in the art of interviewing.
Design the guide in such a way that similar types of information will be elicited from all
respondents. However, the particular phrasing of questions and their order or sequence may be
re-defined to fit the characteristics of each interview.
Example of Interview Guide
Figure 3.2. shows a list of questions that may be asked in an in-depth interview to investigate the
use of antibiotics by prescribers in treating ARI in children. The interview may not necessarily
follow this order. More examples of in-depth interview guides are provided in annexes.
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FIGURE 2:
Example of Interview Guide
Use of Antibiotics in the Treatment of
common cold (ARI) in Children.
Interview Guide for Prescribers
Introduction: Self introduction, name and general affiliation
Purpose of Interview
We are aware that common cold (ARI) is one of the common health problems of children
in this community. We are interested in knowing your views about this problem and how
it is managed. It will be appreciated if we could spend some time together to discuss this
issue.
Interview Begins
Clinic Experience
How long have you been working as a (doctor, paramedic, etc.)?
How long have you been working at this clinic?
How many patients do you see in a day?
How many of these patients are under the age of five?
Diagnosis
Could you please describe how respiratory infections present themselves in children in this
community?
How do you decide on severity of case?
What are some of the symptoms of severe respiratory infection?
Is it hard to recognize these symptoms?
Treatment
How do you usually treat mild respiratory infection in children?
Do you always treat coughs this way or do you sometimes treat them differently?
If yes: How do you decide on how to treat a cough?
Do mothers sometimes ask for particular medicines?
Use of Antibiotics
When should someone prescribe an antibiotic for a child with common cold?
Which antibiotics are the best to prescribe?
and so forth
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3.24.
STEP 4: Select Your Interviewers
The success of an in-depth interview depends in large part on the qualities of the interviewer.
Much more communication skill is required than would be needed for administering ordinary
questionnaire interviews.
The role of the interviewer is to keep a discussion going by asking useful questions until he or
she gets an appropriate response. This demands certain qualities in those selected for the task.
The following qualifications are useful to consider:
!
Formal training in social science or interviewing is an advantage though not a prerequisite.
!
When social scientists are not available, people with secondary education in healthrelated areas such as nurses and community development workers or social workers with
some experience in interviewing may also be suitable.
Good interviewers are people who easily gain peoples= confidence and cooperation, speak
clearly, and are good listeners. Additional qualities to consider are:
!
knowledge of drug use issues;
!
self confidence;
!
ability to establish rapport;
!
confident but not pompous;
!
unassuming personality;
!
politeness;
!
articulate enough to prompt respondents to talk.
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3.25. STEP 5: Train the Interviewers
Training provides an opportunity to prepare the field team for their task. All field workers
involved in a study attend a common training session so they can start with a common
understanding of study objectives and procedures. Even experienced interviewers need to be
trained, since each study will have its unique objectives, target groups, and study instruments.
a.
Duration of Training
Training should be long enough to allow all aspects of the study to be tackled before the actual
field work. The length of time may vary depending upon the size of the study and calibre of the
field team. In general, however, this may take two to three days.
An ideal location free from interference with the daily work routine of the field team must be
secured for the training sessions. In order not to disrupt the sessions all materials and provisions,
including snacks and lunch, should ideally be provided on site.
b.
Training Sessions
At the beginning of the training, materials such as the study guides, protocols, and handouts
should be given to the interviewers so that they can study them and raise any general queries
during the training. The trainer must explain and discuss these materials with the interviewers.
The discussion of each material should be allotted reasonable time to make it effective. The
trainer should encourage a friendly and conducive atmosphere for free exchange of comments
and questions.
The training program can be organized in stages with specific objectives. Prepare an agenda
before assembling the interviewers. Sessions will be needed on both theoretical and practical
aspects of the study. The theoretical aspects cover topics including:
!
outline of the goals and objectives of the study;
!
overview of in-depth interviews;
!
how to conduct in-depth interviews, i.e., starting, moderating, and ending the
interview;
!
how to take notes during interviews;
!
outline of possible implementation problems;
!
how to analyze the data and write a report.
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The practical aspects of the training involve:
!
role plays;
!
pilot testing.
Role Play:
Provide an opportunity for each interviewer to role play the interview to gain experience before
going to the field. Such role plays are also a great help in evaluating the effectiveness of
individual interviewers. Go over the interview guide as many times as there are questions and
comments raised by interviewers.
Pilot Testing
Before the actual fieldwork, you should plan to conduct a pilot test in a group similar to the target
group in terms of study characteristics. This exercise affords an opportunity for the investigator
and the study team to evaluate the appropriateness of the interview guides. It also enables
interviewers to put into practice the skills they have learned before the actual interview.
After the pilot test the study team should meet to discuss the experience in the field. Problems
relating to the appropriateness, clarity, or ambiguity in the use of the guide, as well as others
relating to respondents and the study environment, can then be fully discussed.
Discuss any issues of translation of guides and/or notes at the training sessions. To avoid later
problems, ensure that all translations are thoroughly reviewed before the group moves into the
field.
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TABLE 3.3: Tips on How to Conduct an In-depth Interview
The "Dos"
!
!
!
!
!
!
!
Begin interview with a friendly and familiar greeting.
Listen with attention to capture every piece of information from
respondents.
Explore key words, phrases, idioms, terms as they occur in the
discussion.
Listen to impressions, topics avoided by informant, deliberate distortions
and misconceptions or misunderstandings. Take prompt action to
explore each of these. Where appropriate, use "probes."
Ensure a natural flow of discussion by guiding informant from one topic
to the next.
"Play dumb"(be silent) to give the respondent plenty of room to talk.
Be open to unexpected information.
"The Don'ts"
!
!
!
!
Influence or bias responses by introducing one's own perceptions or
asking leading questions which encourage a particular response.
Move too quickly from one topic to the next
Interrupt the informant.
Do not mislead about the subject matter in order to obtain information.
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c.
Outline Procedures for Subsequent Data Analysis
You can use the opportunity provided by the field test to outline procedures for the subsequent
data analysis. This involves the following steps:
!
Create teams (about two for this purpose) to discuss the questions to be answered.
!
Review notes of the interviewer=s observations.
!
Review each sub-theme in the interview guide for all groups of respondents, e.g.,
prescribers, mothers.
!
Write out key findings from each subtopic for subsequent analysis. This may
include the following:
-
demographic and socio-economic characteristics of this category of
respondents;
-
major points of agreement across all interviews;
-
substantial points of disagreement between interviews;
-
any conclusions or implications for the design of an intervention.
-
group's suggestions on what to do to reduce overuse of antibiotics.
3.26. STEP 6:
Conduct the Actual Interviews
After completing the pilot test, you are ready to start the actual data collection. Before moving
into the field, however, you need to make preparations to ensure that the field work proceeds well
without any logistical problems.
a.
Preparing for the Interviews
Preparations should include the following:
!
The target respondents must be contacted and a definite appointment made with
them before the actual interview. It is usually best for interviews to be held in a
neutral place away from any health facility or the respondent=s home where
distractions are likely. Make sure that respondents will be available at the
scheduled time.
!
If the interview process will involve travel by the field team, arrangements for
transport must be made early to ensure that the team arrives at the location on time
on the day of the interview.
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!
b.
Besides identification cards and letters of introduction, interviewers should check
to ensure they have all that is required in the field. This may include: interview
guide, pen/pencil, notebook, tape recorder, batteries, cassettes, snacks, and water.
Conducting the Interview
On the day of the interview, the interviewer should arrive early to ensure that all arrangements
are ready. When both interviewer and informant are seated, the interview can proceed as
follows:
1.
Introduction
The respondent must be made to feel completely at ease and uninhibited in order to make
the interaction enjoyable. In his/her introduction, the interviewer should:
2.
!
introduce him/herself and affiliation;
!
explain the general purpose of the interview to the informant (e.g., for prescribers:
to investigate the treatment of ARI in children; for mothers: to find out how ARI
is affecting children in the community.
!
impress upon the respondent that his/her opinion is important. This can be
repeated during the interview. People enjoy expressing their opinion about an
issue once they are assured that it is important and legitimate.
!
ask informant to introduce him/herself;
!
establish rapport and assure the informant of the confidentiality of the interview.
Interviewing
The interview is directed at understanding the issues outlined in the guide. Begin with
less sensitive issues, and move to specific issues when the informant is sufficiently
relaxed.
Remain alert to both verbal information and non-verbal behavior. If necessary, the
respondent may be allowed to attend to office or home distractions during the interview.
The interviewer can take advantage of such breaks to read his/her notes or check the
guide to ensure adequate focus of the interview. Watch for time constraints on the part of
respondent and apologize for time taken, with assurance to finish the interview on time.
The interviewer should also try to adopt techniques to persuade the respondent to:
!
elaborate on points, e.g., "What happens next? Can you please elaborate?"... etc.
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3.
!
clarify issues: "What year did you join this clinic?"
!
focus on new dimensions of the issue: "Can we talk about other drugs used apart
from penicillin?@
Wrap-Up
The interview should be concluded by thanking the respondent and allowing a few
minutes for free discussion. Once the interview is formally completed, the interviewer
should:
c.
!
Go over his/her field notes quickly to make any on-the-spot corrections and seek
necessary clarifications before leaving. More complete notes can be made at a
later time.
!
If a tape recorder was used, check and label tapes before departing the interview
site. A new tape should be used for each interview.
Managing the Field Data
The data from each interview must be managed appropriately to facilitate subsequent analysis.
The following tasks are involved:
1.
Field editing
At the end of each interview, interviewers should review their notes and verbatim reports
to make sure that they make sense in relation to the study questions. Comments or any
observations made during the interview can also be added or clarified.
Before leaving the field, interviewers should complete short summaries of the discussion,
ensuring that any additional notes on the interview are included.
2.
De-briefing
At the end of each field trip or on a regular basis during a long study, the field supervisor
or study coordinator should interview the interviewers to find out their experiences in the
field. This de-briefing should cover any problems encountered in administering the guide
as well as any new themes or findings from the field. While the field work lasts, it is
possible to make changes in the guide to incorporate new ideas. Irrelevant questions
should also be removed from the guide.
3.
Transcribing
If the interviews are taped, the tapes used should be transcribed verbatim or in
summarized form depending upon the purpose of the study and the experience of the
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person doing the analysis. Afterwards, the points that are important to the study topic
should be underlined. This material should then be reconciled with field notes and
comments of interviewers.
3.27. STEP 7:
Analyze the Data
Data analysis begins with the field note-taking of the interviewers. As a first step, therefore, the
study coordinator must ensure that all field data including notes, comments, and recordings (if
any) are recovered from the interviewers.
The analysis can be done by hand or by computer depending upon your skill and the resources
available to you. Most in-depth studies can easily be analyzed by hand though there are various
computer programs that have been developed to assist this process. The assistance of an
experienced resource person is especially important during data analysis.
a.
Analyzing the Data
Many different strategies have been developed for analyzing the data from a series of in-depth
interviews. A simple way of approaching the analysis involves the following steps:
1.
Categorize interview material into various sub-topics.
This is commonly described as the cut and paste process, and involves sorting out notes
and transcriptions into the broad topics or sub-topics used in the guide, or adding any new
themes from the interviews. For example, suppose during an interview with a prescriber
the question is asked "How do you usually treat severe respiratory infection in a child?"
Besides talking about drugs, the prescriber may mention problems mothers have in paying
for treatment. Such information can be "cut and pasted" under a sub-topic,
"Affordability of Treatment." This procedure ensures that "scattered pieces of
information" on the same sub-topic are put together for a complete review.
2.
Label each category using appropriate headings.
For example, under reasons for prescribing antibiotics, responses may include delays in
reporting for treatment due to inability to pay, multiple health problems, difficulty in
monitoring patient compliance, patient expectation, and a pill for every illness. These
categories of response can be assigned labels such as economic, social-cultural, and so
on. For example, "patient expectation" and "a pill for every illness" can be put under
socio-cultural reasons. This step is very useful for intervention design.
3.
Describe and interpret the major findings
Analysis consists of considering responses in each topic as group, and drawing
interpretive conclusions about commonly held beliefs, attitudes, or opinions.
Implications for interventions should always be considered. You can also report findings
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by the proportion of various sub-groups interviewed giving their reasons under each
category, the apparent strength with which certain attitudes are held, or issues on which
there is substantial difference of opinion..
b.
Using a Data Sheet for the Analysis
Sometimes a data sheet can be used to organize the analysis. A data sheet lists the major topics
and sub-topics of the interview guide in order to record responses in a logical manner. A data
sheet for a health provider=s interview, for example, may contain the following categories:
!
Personal Data of Informant: i.e., sex, age, education, etc;
!
Common Presenting Complaints at Out-Patient Clinics;
!
Drugs Used in Treating ARI;
!
Factors Influencing the Decision to Use Antibiotics;
!
Cost of Treatment;
!
Dispensing Process;
!
Other Comments, Suggestions, etc.
For each of the sub-topics mentioned, responses of each informant are recorded from the cut and
pasted material assembled from transcriptions, interviewers' notes, comments, and observations.
The data sheets from the individual interviews can then be combined in an overall analysis as
described above.
3.28. STEP 8:
Write a Report and Recommend Interventions
By the time the data analysis steps have been completed, the major findings of the study should
be apparent. It will become clear which data should go into a final report. The responsibility for
the report writing rests with the principal investigator(s), but if a resource person is involved, his
or her skills are also most valuable at this stage.
a.
Outline of Report
The first step in report writing is to develop an outline, bearing in mind the objectives of the
study. Such an outline might contain the following sections:
!
title of study;
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!
objectives and methods, including data analysis;
!
major findings in line with significant broad topics of the guide;
!
discussion;
!
conclusions;
!
recommendations for interventions.
All material from the field should be reviewed together and findings organized by topic and in
conformity with the report outline.
You should bear in mind that the results of a qualitative study using only a few in-depth
interviews are difficult to generalize because of their restricted scope. However, some form of
generalization can still be made, depending on the type and number of respondents. Hypotheses
can also be formulated on the basis of the major findings, which can then be validated by use of
other more quantitative methods such as structured questionnaires.
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