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Hello and welcome to this podcast on the messy reality of qualitative health research.

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My name is Dr. Anne-Marie Boylen and I'm the director of the Postgraduate Certificate

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in Qualitative Health Research Methods here at the University of Oxford.

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Today, I'm joined by Dr Laura Griffith, a former academic who now works in public health.

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Hello, Laura Alé, welcome. It's good to have you.

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Thanks for having me. Laura and I have both worked in health research for quite a long time now.

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We've both done research about people's experiences of health and illness conditions. That's published on Health Toksvig.

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Between us, we've studied mental health, motherhood, disability, smoking cessation,

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research processes and patient feedback leading to quite varied curves.

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So, Laura, you've an interesting history with qualitative research. How did you originally come to it?

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So I actually came to qualitative research at PhD level, so I had to sort of swapping from an,

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I mean, critical theory and then coming into to in anthropology.

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So I was doing that and I thought I've had to do a lot of catching up and in terms of essential research and social research methodology,

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and I did my study about the experiences of Bangladeshi mothers in the east end

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of London say that required a period of language learning in Bangladesh itself,

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and that was also useful sort of circumstantially. And then a period of about eight years fieldwork in London and writing that up.

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And the research itself was initially going to be much more narrowly focussed on the experiences of postnatal depression amongst Bangladeshi mothers.

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But it expanded from that question.

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I think it to look at how the mental health and wellbeing of Bangladeshi mothers was conceived of by the women themselves who are going through

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childbirth and post-natal period by health visitors and health programmes that were working with them by the Strategic Health Authority,

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as well as in the literature. So it sort of took place natal depression as a focus and then went into lots of different areas,

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people and organisations, to see how that was interpreted. So that was my sort of first brush.

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And I knew that I came into fieldwork and very sort of quickly and early.

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And it was a bit of a trial by fire, I think. How did you come into what was your first experience of qualitative research?

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Well, it was similar to yours, actually. So I started my PhD after a period of time being a music teacher.

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So doing something completely unrelated. And my background is in psychology.

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So I started this PhD in social psychology that involved developing a quantitative measure of social exclusion in children with acquired brain injury.

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But as soon as I started, it became apparent that there was no real justification for that.

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There had been no qualitative research done really to sort of explain why that was

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needed or even to to explore social exclusion in children with brain injuries.

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So I decided to turn the thing on its head and do a completely qualitative piece of work that was about social inclusion, actually,

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because we decided that starting from a more positive point of view would be helpful for the people that were involved in the research

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and started to use the phenomenological approach to interview children with brain injuries and their mothers about their experiences.

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Unlike you, it was a complete baptism of fire and it was something that I really valued and wanted to do well.

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And I think that sort of being able to be flexible about the research that you're doing was something that was really,

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really important to me as one of the things that I valued in qualitative research.

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So being able to determine the course of things wasn't going in the way that I could do.

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And changing the focus of it was really, really helpful.

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And I think where we're already getting into some of these messy realities of a qualitative research,

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what are the things you said there was about having to change your research question?

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Sort of similar to what I did as you went along.

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And I think that's one of the kind of messy realities of qualitative research, isn't it,

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that you think you're doing one thing, but you get out into the field and find out that you're actually doing another?

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That's exactly right, and I think how you phrase and focus the research question really very often, for example,

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and postnatal depression is the concept itself wasn't known amongst a lot of first

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generation by whether he might or was certainly wasn't related to on a personal level.

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But I was interested then in a lot of areas around that.

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So people's ideas of what, say, postnatal depression was vary greatly from health visitors to,

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you know, sort of health policy versions of it and so on. Similarily and attitudes to breastfeeding.

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There was a low rates of exclusive breastfeeding amongst the Bangladeshi population,

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but a higher rate of mixed feeding at six months than the UK mean.

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And there were similar sorts of suppositions about what the Bangladeshi population

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was like by various people who worked in the health services and so on.

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And that was therefore relating to this complex reality.

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And I think there's a danger, particularly saying that anthropology of producing in this sort of a cultural fashion,

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that all your behaviour is based on culture with a capital C,

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rather than just this messy reality of where breastfeeding services are located,

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your living arrangements, you know, the practicalities of breastfeeding work on those sorts of things.

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And the initial very focussed question I was on had a series of very connected issues around it,

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which I find it much more useful then to go off and investigate.

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And so it was much more helpful to me to be doing an ethnographic approach and observation,

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one that could then include connected observations that would help me provide the context for my initial 40 focussed research question.

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Did you have that? Did you have any problems? I think changing the methodology of your research as you went along?

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Yeah, I did. I think one of the things that I initially had to do was convince my supervisors that it was a good idea.

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So I had to do the groundwork for the study that I was never going to do to prove that it couldn't

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be done and or not that it couldn't be done that but that wasn't the time for it to be done.

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There needed to be other work done in advance of it. So I had to do that.

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And the other thing was that I had to reconceptualized how I thought about research as well,

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because at that stage I was approaching things from quite a positive stance,

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you know, and I was always going to be doing some interviews with children to develop this measure.

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But they weren't going to be kind of in depth phenomenological interviews, which is what I ended up doing.

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So I had to change my entire view of how things are in the world and basically what constitutes knowledge and what can we know,

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you know, and how can we go about knowing it? And I think the other thing was that sort of coming from a psychological point of view for

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quantitative research is definitely kind of more prioritised than qualitative research.

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It certainly was back then, and I think it's better now. And I was surrounded by people who were doing much more quantitative things and, you know,

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sort of felt like I was stepping outside of my discipline a little bit in what I was doing.

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But I think the the value of what I did was huge.

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Both in terms of of sort of the what I was studying, but also what I learnt as a qualitative researcher,

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I think there's if you want to learn to be a good interviewer,

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you should start by interviewing children because they do not conform to the traditional.

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You know, I sit across from you, I ask questions and you answer them.

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And they definitely sort of made me change how I viewed interviewing for the positive, you know, definitely.

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Definitely for the better. I mean, I think the same for me, really.

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I think a lot of the situations that came up when I was doing ethnography, for example,

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I was visiting the family in London of a family I knew in Bangladesh, and they knew that I was doing my research and so on.

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And then there was, you know, daughter in law there, etc. and they said, oh, you know, she'll tell you about, you know, X, Y, Z.

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And I was thinking, you know, oh, gosh, I've been through an ethics committee.

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I've got Potts's, but I haven't got any of my work. But people were just telling me about their experiences and my worry.

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I think as a young, inexperienced researcher, he would only just you know,

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I didn't have much institutional support exports, say, from applying to an NHS Research Ethics Committee as it was then.

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And and if there was a worry that, you know, you weren't doing this properly, that, you know,

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there was this very strict process that you had to adhere to and people were sort of just

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telling you information and not paying attention to the guidelines that you have written down.

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And so if you got some information or you experienced something or you will wear something

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that you didn't necessarily have the ethical set out to record in your research,

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what do you do with that information?

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And so I think that in in one sense, it's very useful coming at qualitative research first from an ethnographic point,

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because there were more flexible boundaries around that and there were different ways of including that information.

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So I couldn't include that information, for example, in an interview format, even though I did interview someone.

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But I could include it as context. And I think that was really helpful for me.

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But suddenly being confronted with doing an interview in somebody's home when you didn't think you were doing an interview,

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etc., those sorts of messy realities,

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I think a very common both by doing, you know, I think qualitative interviews in a formal sense suit some populations more than others and saved.

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Likewise, you're saying if you're interviewing children sitting down face to face for an hour who may not be the most appropriate methodology.

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Likewise, if you're doing community work etc, then you a level of sort of informal interaction is really helpful.

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But there are ethical considerations around both of those. Yeah, absolutely.

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And I think if you've touched upon something there as well,

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which is about how you build rapport with people and how you sort of become a good qualitative researcher when you're in the field,

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because one of the things that we say when we're sort of filling in ethics applications or things like that is about building rapport.

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And it's certainly something that's seen as crucial to developing relationships with

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participants so that they will sort of give honest and fulsome accounts of their experiences.

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But it's not it's not something that's that you follow a formula to do is that, you know, there's there's simple ways of doing it.

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What are your thoughts on building rapport? I think early on, certainly when I was doing that fieldwork school was built,

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say, by the fact that I could speak Feleti and that was relatively unusual.

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And therefore that was positively viewed by a number of participants that I was young and inexperienced and that I was asking about motherhood.

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That wasn't a mother at that stage. And so people were eager to tell me.

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And as you know, from an older person, sometimes at least a more experienced presence to an experienced person, what it was like.

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So I think rapport in that situation was built partly on my helplessness,

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like if I am a psychiatrist, they were keen to help a young researcher with their work.

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And sometimes I felt a bit disingenuous because I think they were thinking that they were just departing,

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you know, sort of instructing me about the way things were,

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whereas I was actually also interrogating that information and thinking about your thinking about the same,

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you know, concepts, post-natal depression from all these multiple angles, etc. So I think in that instance, the report was built by my inexperience.

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And then later on in my career, I think the rapport was more built by my knowledge of a particular situation.

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So, for example, the research I did with the Health Experiences Research Group is about experiences of psychosis.

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And by that time I had worked quite a long time in and with people who'd been diagnosed to.

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The acute mental health difficulties and the rapport was built by the facts that

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say talking about voices or psychotic experiences wasn't the usual thing to do,

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but the fact that I knew about it had talked to people about it for years and so on.

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I think some of it was built there because of the lack of information.

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You didn't have to explain for the first time what it was like to hear a voice.

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And I think that some of that was destigmatizing. So and I think some of that helps as well.

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And then perhaps later on, I think it was built by the fact that I could perhaps influence a policy system,

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something that that might be helpful towards them. So it was a knowledge exchange, I think, in that sense.

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So I think it really dramatically has varied during the course of my career.

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What about you? Do you think it's similar in that sense as it got in this sort of linear trajectory where you seemingly helpless?

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I certainly felt differently about it when I started. You know, and the the very first piece of research I did was, I mean,

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outside of sort of undergraduate projects was an interview study with people about their perceptions of brain injury.

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So, you know, what did they think that people were with brain injury were like?

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And that was really interesting because I kind of I sort of approached it as this quite structured thing.

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So I was there to ask questions and they were there to answer them. The questions were, well, predefined.

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I wasn't very good with flexibility and the iterative approach that I have later kind of come to develop and see the importance of.

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And I think that the rapport that I built in that study certainly left a lot to be desired.

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There's probably I probably could have done a lot better. And then when it came to doing my PhD and working with children,

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it's very difficult to build rapport with children as an adult because, you know, adults are are in a position of authority.

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They're used to their parents telling them what to do, their teachers telling them what to do.

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And for children with brain injuries, there's a whole raft of services involved, charities, occupational therapists, physiotherapists, the whole lot.

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So, you know, here was me, yet another person who was in authority,

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even though I knew nothing about the experience and really had no authority to speak of.

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But I drew on my experience from teaching and sort of rolled up my sleeves and got on with it.

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I spent time getting to know the children and coming to see them a couple of times before I interviewed them.

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And then I would literally get on the floor with them, play games with them, you know,

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and that's not the sort of thing you do with adults or it's not as overt in terms of what you do with adults.

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But I think the other thing was you you said there the part of the rapport building

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was the impression that you could make change at a policy level or whatever.

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And I know that I certainly interviewed people before who have thought that I have more authority than I do.

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And that's a tricky one because I never wanted to lead them to believe I was anything more than I was.

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So I think part of the rapport building there was having honest conversations about what I couldn't do, you know,

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just being frank and honest about the limits of the research and about the limits of how it could be disseminated

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and focussing on what I was intending to do with that rather than what they hoped I was intending to do with it.

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But having a conversation around how I wish I could do more, I think as a researcher,

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sometimes you feel helpless, don't you, about what you can and can't do?

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Is that something you identify with? Certainly. I think I felt more helpless as I've gone along in that aspect.

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And I think early on I thought I genuinely thought and perhaps arrogantly, that, you know,

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if I knew this situation was happening, for example, you needed more money for therapeutic services and mental health.

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Now, this is hardly no rocket science. Most people know that you need more talking therapy, more therapy, etc.

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And I think I thought if I just told people that at the end of my research, then it would happen.

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And I think as I've gone on and hopefully got less stupid about that and that realising the more interesting question is,

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well, if everybody knows that, what's keeping things the same, why?

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Why is change not happening? So I think the the mistake in my research is saying, therefore, we must need change.

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And describing and I think therefore it is particularly and I think I think research as a philosophy about

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creating the sort of static reality rather than one which I am now much more interested in interrogating change.

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So looking at the policy rollouts and see what works.

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And what doesn't work within that and being helpful partner in that rollout,

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for example, one of my later pieces of research, which was own consultancy,

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was about a project which was called Air Raid, which is now I'm going to have to remember that rapid assessment interface and discharge.

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And it was about picking people up and would come to any in crisis and a mental

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health crisis and getting much more effective intervention and support.

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Now, it was sold as a cost saving measure. So, you know, that's an expensive way for some people to enter the service and so on.

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And actually, when I spoke to clinicians and people, it designed the service and rolled out in different areas.

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And that was going to be different in an inner city area than it was in, say, Herefordshire and so on.

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Actually, a lot of the interventions that had come around that were helpful in lots of different ways.

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For example, they were much more helpful in in a generalist elderly care would and much less skilled people,

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much more in talking about mental health and in a general level. So it wasn't it was aimed as a sort of specialist intervention,

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and it actually helped much more general conversations about how to approach mental health.

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And I think that was really interesting just to reflect that back.

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So it was looking at something in motion, a policy rollout in motion, rather than just saying at the beginning, well,

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it's difficulty when people present any with a mental health crisis because everybody is very apparent

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to the people who are presenting any and it's very apparent to the clinicians who work with them.

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So I think that that's the bit that's changed and sort of messy reality is trying to

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look at something in change rather than trying to falsely describe a static reality.

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And tell me this this this sort of notion of trying to improve things with research on the limits stuff we have.

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And you know what you've just described there. Do you think there's any benefit to you being a qualitative researcher and looking in on that problem?

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I think, again, the benefit of the flexibility in the approach.

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So I think core and so anthropological approaches, which is essentially what I was trained in, what I was looking at,

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when and if I showed you sort of from de familiarisation what people said they did and what they actually did and having that flexibility.

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And that's not to catch people out, but having to look at the complexity.

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And as I said in my last example, sometimes you you can capture something which isn't captured elsewhere.

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So, for example, in a lot of the public health outcomes framework captures a version of reality of health,

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improving indicators which do genuinely matter. But a lot of policies might be implemented or health improvement measures which are of benefit.

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But that benefit might be complex.

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So alongside that then and you get it aimed at population better, you get the ways of working captured more accurately.

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So if it's difficult or not for clinicians and support workers and so on to to deliver and

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I think you just get a much fuller version of what it is and isn't doing as a policy.

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So I think it matters who commissions the research,

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who do the research with and where the research and ends up in terms of and its methodology, its usefulness and so on.

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And I always find, I think that you start off wanting to do everything at the beginning of research project,

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you know, produce an academic output, influence policy. You may make things be useful to patients in the public, but we ran out of time somehow.

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You ran out of money. And who's commissioned the research?

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And the way it works really makes a difference to both of the key outputs from your research and say,

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do you have any examples of who you've worked with making a difference to what you produce in the way you work?

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And that's a good question. I did some research about patient and public involvement that I think probably comes closest to getting to this issue.

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And so patient and public involvement is a relatively recent thing.

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Quotative researchers have been doing it for decades in the form of participatory action research.

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And although it's not quite the same thing, they've been doing, that kind of version of it for a long time.

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And then there was a move within health research to involve patients and members of the public in health research as experts in their own experience,

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to sort of try and democratise research and to make it something that's a bit more palatable for people to take part in.

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And I suppose to humanise research, really.

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And along with Louise Lowcock, I worked on a project where I interviewed patients and members of the public who worked in health research and.

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They also interviewed researchers who involved patients and members of the public,

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and that was quite interesting because I, as a researcher interviewing other researchers was an experience,

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you know, and there were some who were more junior than I was some who were maybe about the

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same career stage and then others who were much more senior and experienced.

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And I think the thing was I was speaking to them about something that had been imposed on the way they work.

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And for some that was really positive and they could easily see the benefits of it.

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And for others it wasn't as positive. And it was something that made work a little bit more difficult.

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And I think that for them to sort of say that in a professional setting, in something that was going to be published in professional journals,

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and especially with the potential for being identified in qualitative research, it was it was quite a big thing.

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And and I find that quite challenging to be able to reconcile how I felt about patient and public involvement and how they had engaged with it,

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and then to speak to people who maybe had differing views to me,

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who ultimately always asked me what I thought as well, you know, so I sort of had to navigate that.

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So if somebody was very smart and I was quite pro and then it was something that I felt, you know,

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I had to have a quick think about how will this affect the rapport if I divulge how I feel about what they've been telling me.

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And so, yeah, that was quite interesting. And, you know,

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ultimately that research showed that patient and public involvement was something that was often

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done more by qualitative researchers and multidisciplinary teams and more often than not,

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by women. I thought that was quite interesting because the narrative around it and, you know, for women and for qualitative research,

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but it's back to those old tropes about how we as women and qualitative researchers can more readily talk to people,

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which I think is another one of those kind of complexities that we face in our research.

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And but, yeah, I think that was in terms of sort of having to negotiate who the audience was for what I was writing when it came to the paper,

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but also the kind of the navigating the power dynamics between myself and the

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participants who were essentially the same as me was quite an interesting experience.

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It's very interesting. What are you picking up then, when you asked for your opinion about something?

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And I was thinking about sort of what feels inside and outside the research,

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and I think sometimes that's much more clear when you have an interview study before the interview,

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during the interview, you sometimes get to different accounts.

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And so ethnographic research can be more easily edited because you are yourself doing that.

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So you edit your field notes whether you might think, whether or not you edit the mistakes that you do in the field, you know,

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and looking at an ethnographic research, you know, people have had relationships with participants and so on, famously anthropological studies.

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And those have been astounding. And obviously you get a feel motivation.

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And this is the personal diary version in quite famous anthropological studies.

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But if you're kept if you're trying to look at something which isn't very easily spoken about,

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so, for example, MPI, generally, that's supposed to be a good idea.

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People are surprised and welcome with me and encourage it and so on.

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So I'm guessing that you get sometimes to different accounts of the official version of, yes, we should be doing it and encouraging it.

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This is it's quite time consuming and expensive and it's being imposed on me.

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And then I think with my research looking at ethnic inequality and the experiences of racism,

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I found hugely challenging to think about ways, ways of documenting that.

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And I think one of the first things I did was about ethnic inequalities in acute psychiatric services,

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and it was very difficult to produce the evidence that we will innocense knew was cheap,

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that there were huge inequalities in mental health services,

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but that was mainly looking at structural inequalities, and that's very hard to get from an individual account.

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So we had some accounts of somebody being abused for wearing hijab and so on like that.

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But those weren't the kind of individual instances that they were more likely to be on it.

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And a compulsory treatment regime is more likely to be rapidly tranquillised.

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And those sorts of things, which we knew from the figures, were much more likely to happen.

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And it was very, very difficult to get an individual accounts which recognised the structural inequality.

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And I found that enormously challenging. But in a more sort of straightforward sense,

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I think when I was doing interviews about people's experiences and carers of people who'd been through psychotic episodes,

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I remember very clearly interviewing a woman who was and an older white woman, which is about 70.

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And she was the. From the experiences of her husband being admitted to a psychiatric ward, and she was clearly saying in the interview,

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it was very difficult because, you know, we felt that we couldn't understand the doctors there and so on.

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And we we felt and very disenfranchised. And she is quite sort of long with formal language and so on.

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When we were making a cup of tea in the movie, she said that the problem was there are lots of black people in the wards there,

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that it was quite a terrifying experience and we couldn't understand the doctors because they were all Indian.

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And there's no way she would have told me that in the interview.

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Rapport worked in in a slightly different way.

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Then I think she was sort of envisaging a level of camaraderie and similarity with me that wasn't there.

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And so it was a really difficult position for me to think, you know,

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normally if that was a straightforward personal conversation, I would call out the racism immediately.

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But in order to then continue on in the interview, you know what?

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What do you do ethically? You know, and I think I was very much working at the time, so listening to people's experience and accepting that reality.

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But if their reality was something that I was actually therefore deeply uncomfortable with, what do you do?

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And I think that that is a question that's really hard to satisfy in that sense.

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Yeah, I'm nodding along furiously here because I recognise so much of this from my own work as well.

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But also, I don't know about you and I.

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I've sort of had sexist comments directed at me and other sort of anti Irish comments as well, which are quite interesting.

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And I think that's the thing that you said there about sort of just sort of being there to accept their version of reality.

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That's not a direct quote. But, you know, that's sort of your role as a researcher isn't to challenge, you know,

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so I find myself laughing along with these things quite often and then going away feeling like I wish I could have said something,

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which, of course, you can't. It's not what you're there for. And the other thing was that I can't think of any study I've done where a participant

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didn't give me some sort of confidential information outside of the recording,

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you know, and sometimes that me that would have made a big difference to the type of data or to the to the story.

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And at other times, it's sort of supplemented what they told me already, but was just maybe a juicier version of something.

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And and I always thought that that's really, really interesting. And it would be amazing to do a study on what kind of things?

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What are the types of things that people tell you when they don't think you're recording or when they don't want you to to record.

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And of course, one of the really messy aspects of what we do,

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and you already talked about this a little bit, is that you can't separate these things out of your brain.

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So what's data versus what you know about the experience from the charts?

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You know, while someone's making you a cup of coffee or, you know,

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you're sitting on their sofa and putting their cat and talking about their kids and then they reveal something else, you know?

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And it's quite an interesting tension, isn't it?

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Because you can't you can't separate that in the analysis, can you know?

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And also, I think what they know about you and I think that that varies much more.

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I think in an ethnography, they know a lot more about you.

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They have a continuous, possibly longitudinal relationship with you.

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That may be friendship as well as work. And I think in qualitative interview studies, it's a bit of both.

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They have a sort of relationship with you. You may be friends.

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You know, sometimes I have interviewed friends for studies or colleagues, but it's a sort of halfway house.

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And also I think there's a different relationship,

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I think kind of different as I've gone along to what you reveal about yourself and the questions that they ask,

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you say and, you know, being put in a sort of uncomfortable situation, what do I call out, racism or not commonly in mental health?

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First question I say I would ask you, have you ever experienced mental health difficulties yourself?

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And in ethnography, I would speak quite openly about mental health.

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And, you know, if it was a conversation that was just being recorded for me or and I was notetaking or something,

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I think that situation necessarily changes when it's being recorded on a database by your employer and so on.

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And you ask for all sorts of things, like I've been asked about mental health and drug use, I've been asked about criminal records, etc.

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And you think now I think I've come to the position, if it's a much more formal,

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you know, consented process in an interview that actually we are doing.

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And, you know, they've consented to the interview. You haven't.

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And so I have got more closed, at least in the sort of formal section of the interview.

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And I have put sort of clearer boundaries, I think, as as I have gone on.

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Have you ever had any of that kind of boundary disruption? Yeah, I absolutely have.

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And part of it was, you know, that the participants wanted to know that I was legitimate,

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so it wasn't just a case of I was some random person who had come in to steal their story and take it away and use it for my own benefit.

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And so I was often asked about what my experience with brain injury was, and that was also by recruiting organisations as well as participants.

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And I don't have personal experience of it, but I have family members who have experience of it.

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So I had that lived experience of knowing somebody and watching how they lived their day to day lives to be able to draw on and use this reassurance.

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But, you know, I haven't been asked anything as exciting as you about criminality or drug use.

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I have been asked about my marital status and and also if I could get somebody a job, which were interesting.

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I did not. But I did spend some time talking to them about how I had sort of progressed in my career, which is,

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again, one of those kind of messy things because I wasn't there as the careers adviser or anything else.

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But I think that's that's one of the things when you do research outside of a lab, you know, or work where it involves interaction between humans,

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you have to acknowledge your humanity and be able to sort of talk to people in in a

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way that convinces them that you are genuine and can understand their experience.

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But it is it's very interesting what you say about the the things that you feel you have to be bindery to in a professional sense.

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And I think that definitely more experience leads you to feel confident in what you're not sharing as well as what you feel you have to share.

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Because this kind of it's an interview mimics a conversation, doesn't it?

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So, you know,

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you sometimes feel like the participant is expecting you to turn around and say what your experiences of the thing you've just asked them.

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And of course, that's not how it's done, but. I can smell the irony of this principle.

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Well, that's going to be the key thing that I learnt when I was working at Oxford was how not to interrupt, she said, interrupting you.

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It was just how different the interview experience was.

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And to do a conversation experience and I think doing ethnography,

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I didn't have to think about that as much because they were conversations and I felt it was sort of more ethical.

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You know, if you are sort of coup participants in that sense that they knew about your life and you knew about them and so on.

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And that change, this is how it is, I say, by having a more professional interaction,

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but then also by learning this basic put to it's a very practical scale of genuinely listening,

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saying I have the experience when I first joined Oxford of people listening really,

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really intently to my interviews and then asking me questions about them.

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And I've had people listen to my interviews before. That was no problem, but it was all my friends equivalent of analysis of where I left spaces,

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whether I laughed or not, you know, those sorts of things. And I think it genuinely changed and why it's being so.

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I mean, sometimes my conversational style has an impact actually on how I even listen to my friends,

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because I realised that there was a time when I was sort of I was waiting to speak rather than

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listening and then changing my response and has all sorts of implications beyond research.

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But it was that really close listening to your interview technique, that makes a difference.

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So I think and philosophically and epistemologically, I was very concentrated on the broad world outside,

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you know, who they think you are and how you reflect on your identity, the purpose of your research and so on.

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But then actually, you know, thinking about the interview doesn't matter in a sense that much.

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But then actually doing this level of work about your interview technique is hugely important and I think can be very revealing.

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Do you feel the same as your interview technique? How has your technique?

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Because I'm sure it would have done. Oh, it absolutely has done.

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Well, it hasn't. It hasn't.

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And in some senses and I think the well, two things I'll tell you a little bit about how it hasn't hasn't changed in the second.

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But the sort of the difference between a conversation and an interview is the amount for me anyway,

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is the amount of reflection that you do afterwards and also the amount of planning you do in advance.

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And I think that that's something that can be quite a surprise to people who

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are new to this or people who don't really understand qualitative research,

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because it's not just a chart, is it? You know, it's something much more than that.

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But I think there's a level of expertise that you gain over the years in terms of doing what we call semi structured interviews.

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So these things that you do quite heavily plan in advance.

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But the idea is that the participant takes the lead and gives their version of events.

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And you may not ask the questions you have predefined in advance.

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And I think that that sort of thing where you put a lot of effort into planning and reflecting

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on your interview is really critical in terms of how you learn to do qualitative research.

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So one of those things is about being a good reflective learner and being reflexive

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about the impact you have on your research and your research participants.

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But, yes, I told you briefly earlier about the very first set of interviews I did, which was absolutely embarrassing, Laura.

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It was just horrendous thinking back on it. But it was quite a structured approach.

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And there was a prompt that I used after each question was, and is there anything else you'd like to tell me about that?

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And I kept asking this after each question because I really wanted to make sure

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that the participants really did tell me everything about what they wanted to.

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And I didn't know how else to do it. And it became very sort of repetitive and formulaic and felt uncomfortable.

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As you know, for me as a researcher,

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I don't know how the participants felt about it because they didn't dare ask them in case they told me I was doing a terrible job,

386
00:39:06,950 --> 00:39:14,870
you know, but that taught me so much. So when I came to do my PhD interviews and in every interview that I've done since,

387
00:39:14,870 --> 00:39:20,510
that echoes around in my head about how uncomfortable I felt with not sort of

388
00:39:20,510 --> 00:39:26,840
thoughtfully thinking about the questions and also not really listening properly.

389
00:39:26,840 --> 00:39:31,880
I mean, I was listening and I was trying to ask questions based on what they told me.

390
00:39:31,880 --> 00:39:36,890
But the whole time I was thinking, I really need to get everything from them that I can handle this prompt of.

391
00:39:36,890 --> 00:39:42,290
Is there anything else you'd like to tell me? You know, and any time in an interview where I've said the words.

392
00:39:42,290 --> 00:39:44,150
Is there anything else you'd like to tell me?

393
00:39:44,150 --> 00:39:50,150
I should have been thinking about the time when I used it, you know, sort of forty times in one interview.

394
00:39:50,150 --> 00:40:01,490
But I think, you know, it's it's it has changed. In terms of what I feel confident about asking as well, so in some of the projects that I was doing,

395
00:40:01,490 --> 00:40:06,950
like I did a project with people with life changing injuries and that included people who had brain injury,

396
00:40:06,950 --> 00:40:10,820
spinal injuries, limb loss burns, pain conditions.

397
00:40:10,820 --> 00:40:17,210
You know, there was a whole gamut of things there. And I remember thinking when I was doing that project that I felt very uncomfortable

398
00:40:17,210 --> 00:40:21,860
about asking people about some of the things that were no regular part of their lives.

399
00:40:21,860 --> 00:40:28,800
And it took some reflection and some practise to be able to say these are things that are important to these people.

400
00:40:28,800 --> 00:40:35,480
I'm the vessel through which they share them. It's not about me, you know, but that was something I had to learn.

401
00:40:35,480 --> 00:40:42,570
You know, I find that really hard. It's not being about me. Still, I have a lesson I have to learn.

402
00:40:42,570 --> 00:40:48,410
I think you're exactly right. And I think you can get a very practised in a particular area.

403
00:40:48,410 --> 00:40:53,960
So the McCain interview seems sort of naturalistic is a skill.

404
00:40:53,960 --> 00:40:57,740
So at first, when you're learning how to do something, remembering all the different areas,

405
00:40:57,740 --> 00:41:00,680
especially if you're doing so semi structured interviews and you have to cover

406
00:41:00,680 --> 00:41:06,050
particular areas or questions and but making it seem like a conversation can be very,

407
00:41:06,050 --> 00:41:11,070
very difficult. But then I think you can get very comfortable with an area.

408
00:41:11,070 --> 00:41:14,930
So I was quite comfortable, for example, with doing interviews about mental health.

409
00:41:14,930 --> 00:41:18,050
And then I went to do some interviews about smoking cessation.

410
00:41:18,050 --> 00:41:23,210
And rather arrogantly, I assume these will be very different, quite short interviews compared to,

411
00:41:23,210 --> 00:41:29,240
you know, some of these experiences of childhood trauma and, you know, psychosis and so on.

412
00:41:29,240 --> 00:41:36,290
But actually, it was took me such an important lesson, I think, in terms of with qualitative research,

413
00:41:36,290 --> 00:41:40,130
you don't ever just nail down the subject to the subject only.

414
00:41:40,130 --> 00:41:46,310
So people, of course, have stopped smoking in various different situations in their lives.

415
00:41:46,310 --> 00:41:49,220
Some people had stopped smoking when they'd become a father,

416
00:41:49,220 --> 00:41:58,130
and that related it very strongly to that another person had stopped smoking because a close relative had died of lung cancer and and so on.

417
00:41:58,130 --> 00:42:02,430
And other people's smoking journeys have been connected entirely to their mental health.

418
00:42:02,430 --> 00:42:09,470
So it was both the media narratives in some sense. I think it was a lesson I should have known before that I thought I was going

419
00:42:09,470 --> 00:42:13,460
to be talking about nicotine replacement and smoking cessation services or,

420
00:42:13,460 --> 00:42:24,590
you know, Alan Complexo, the rest of it that Tim and then I actually most Colusa interviews can't be contained in that in that neat sentence.

421
00:42:24,590 --> 00:42:29,160
So they are they are messy. And you might think you're going to get one piece of information.

422
00:42:29,160 --> 00:42:33,440
You come up with a distinctly different set of information. Yeah.

423
00:42:33,440 --> 00:42:35,000
Oh, that's such an interesting point.

424
00:42:35,000 --> 00:42:42,560
And it's one of the things I think that outsiders criticise qualitative research for or maybe novice interviewers worry about,

425
00:42:42,560 --> 00:42:45,350
which is that people will go off on tangents.

426
00:42:45,350 --> 00:42:52,010
And I worry sometimes that people think tangents or people think that things that are tangents aren't actually

427
00:42:52,010 --> 00:42:58,910
tangents and that they'll miss the sort of really rich quality data if they try and steer people away from that.

428
00:42:58,910 --> 00:43:09,960
What are your thoughts on that? I think that's it's an illusion to suggest that there are tangents and that there isn't complexity in the first place.

429
00:43:09,960 --> 00:43:17,450
So any methodology you take to a complex is a public health problem, is going to produce anomalies,

430
00:43:17,450 --> 00:43:26,210
complex patterns and so on, and have a problem with data saying, for example, take the recent example about vaccine uptake.

431
00:43:26,210 --> 00:43:26,570
Now,

432
00:43:26,570 --> 00:43:37,910
trying to understand why vaccine uptake is different in people with different ethnicity is a really complicated question and exactly how you frame it.

433
00:43:37,910 --> 00:43:46,220
So framing it as vaccine uptake rather than the vaccine availability is obviously going to be different.

434
00:43:46,220 --> 00:43:58,430
It's going to take how you define ethnicity in a CPRS UK population where migrants come from over 160 different population countries.

435
00:43:58,430 --> 00:44:09,740
It's going to say, you know, how you talk about and experiences and attitudes and so on and some of the practical difficulties about it.

436
00:44:09,740 --> 00:44:14,870
Going right back to what I said about the beginning, understand the everything through the lens of culture.

437
00:44:14,870 --> 00:44:18,830
It might be about buses, you know, those sorts of things.

438
00:44:18,830 --> 00:44:27,140
So reality is complicated by the practical and, you know, and much more sort of theoretical approaches to a problem.

439
00:44:27,140 --> 00:44:36,020
So I think that any approach that gets annoyed by the complexity is actually just trying to sort of force the boxes up.

440
00:44:36,020 --> 00:44:45,320
But then I think qualitative researchers have the responsibility to distil to some extent the information that they're getting.

441
00:44:45,320 --> 00:44:53,510
So, you know, thematic analyse what they don't just leave it as sort of descriptive, messy reality to really address the.

442
00:44:53,510 --> 00:45:02,390
What question and the so what question, I think varies wildly between, say, what in terms of how do we get this to publishable article,

443
00:45:02,390 --> 00:45:08,480
you know, what are the interesting things that will be interesting both to that particular journal, in that particular format, etc.?

444
00:45:08,480 --> 00:45:14,060
Or if you're looking in a public health environment, that might be a very interesting piece of information.

445
00:45:14,060 --> 00:45:21,050
What's in our gift to change about it? If there's nothing in life to change about it, then why are we doing this research?

446
00:45:21,050 --> 00:45:30,290
And that that is the more interesting question to me. Not really go off on a tangent, but if you do go off on a tangent, can we do anything about it?

447
00:45:30,290 --> 00:45:32,720
Yeah. Oh, that's a fair point.

448
00:45:32,720 --> 00:45:42,920
And and you also raise the knotty issue of analysis and causative analysis, which I want to quickly talk about as well, Laura.

449
00:45:42,920 --> 00:45:48,170
And qualitative research produces a huge amount of data,

450
00:45:48,170 --> 00:45:55,790
and it can be overwhelming count when you start with the sheer amount of words you have to deal with and understand.

451
00:45:55,790 --> 00:46:04,580
Never mind trying to make sense of or produce into a palatable framework that know a journal will accept or that

452
00:46:04,580 --> 00:46:11,270
other health researchers or clinicians will accept as an appropriate way of looking at this particular problem.

453
00:46:11,270 --> 00:46:23,680
And have you any thoughts on approaching analysis for novices or how how can we make this easier for students when they tackle it for the first time?

454
00:46:23,680 --> 00:46:31,000
I think be aware this isn't in a negative sense at all, but be aware of the limitations of everything,

455
00:46:31,000 --> 00:46:35,890
I think the fact that you get lots and lots of words and interview data,

456
00:46:35,890 --> 00:46:41,890
but be very aware of where that has come from in the first place, that this is a partial you know,

457
00:46:41,890 --> 00:46:47,830
it's a really a tiny amount of the words anybody ever says about their experiences that Spain's liberty may be focussed on.

458
00:46:47,830 --> 00:46:51,070
Very interesting, but it's a limited version.

459
00:46:51,070 --> 00:46:59,800
And then so I think I do sometimes get the impression that you have this sort of secret data that you therefore have to disentangle and so on.

460
00:46:59,800 --> 00:47:06,040
Gissing, you have a story of something. Let's try and make some sense through that.

461
00:47:06,040 --> 00:47:11,320
And then I think particularly if he, in some interviews are very focussed.

462
00:47:11,320 --> 00:47:17,830
For example, if you go along, say, some of these care pathway and want to ask you about their discharge or something like that,

463
00:47:17,830 --> 00:47:21,220
then I think it makes sense to jump it up into small chunks.

464
00:47:21,220 --> 00:47:26,980
If you if you're doing a very sort of focussed and predictable and sort of set of research interviews,

465
00:47:26,980 --> 00:47:33,490
I think if you do narrative interviews which are messy and go to places that you didn't intend and so on,

466
00:47:33,490 --> 00:47:41,380
I think I always find it useful to use very, very broad categories so that you keep the integrity of the narrative.

467
00:47:41,380 --> 00:47:47,590
But you can see where it fits in terms of somebody's story and that you don't make too much work for yourself,

468
00:47:47,590 --> 00:47:55,480
because I can remember sort of setting off and sort of, you know, 10 KADES And then I think it was 120 some cases at once.

469
00:47:55,480 --> 00:48:00,940
It's because I was so interested in keeping sort of the integrity of, you know, framing that code,

470
00:48:00,940 --> 00:48:07,690
representing exactly what the participant had said and not merging into somebody else's category and so on.

471
00:48:07,690 --> 00:48:12,610
But I think that I not only created a huge amount of work for myself,

472
00:48:12,610 --> 00:48:21,340
but also I missed the point sometimes because I missed this a the sequential part of the interview.

473
00:48:21,340 --> 00:48:31,720
So I divided up too much. So, for example, I was asking about narrative and nicotine replacement therapy and they gave me an example of it helped.

474
00:48:31,720 --> 00:48:35,860
And then they thought for a minute and said what actually helped was et cetera, et cetera.

475
00:48:35,860 --> 00:48:42,220
But I had coded nicotine replacement therapy and left the next bit, which wasn't actually about it.

476
00:48:42,220 --> 00:48:45,760
But but that obviously reflected on the bit that they just said.

477
00:48:45,760 --> 00:48:54,430
So if I cut up my data too much, I'd have missed that sequence, that the proposal, which is essentially a narrative form.

478
00:48:54,430 --> 00:48:58,390
This happened because of this. Because of this. This followed this. This followed this.

479
00:48:58,390 --> 00:49:08,080
And that's sometimes what you miss out. I think if you go into too much detail, into thematic analysis, it's a very good point.

480
00:49:08,080 --> 00:49:15,130
And, you know, I think that for me, the lesson that I've learnt is just about getting started because,

481
00:49:15,130 --> 00:49:18,910
you know, it's it's a campaign really overwhelming,

482
00:49:18,910 --> 00:49:26,320
and especially when you've got multiple interviews echoing in your head and just sitting down and getting started with it is very, very helpful.

483
00:49:26,320 --> 00:49:34,570
And I think I might, in my experience, mirror some of your experiences in that when I was doing phenomenological research,

484
00:49:34,570 --> 00:49:38,230
a lot of it is individually focussed. Well, it's all individually focussed.

485
00:49:38,230 --> 00:49:45,760
So the complexity there and the messiness was trying to get at the kind of richness of each individual

486
00:49:45,760 --> 00:49:52,210
experience while still being able to make sort of sort of some claims about the group itself.

487
00:49:52,210 --> 00:49:54,820
So all of these people together, what is this like for them?

488
00:49:54,820 --> 00:50:01,930
And then thinking about this on an individual level and on a case by case basis, which is really, really tricky to, you know,

489
00:50:01,930 --> 00:50:09,940
because you're trying to retain that sense of individuality, which is often what we do in most types of qualitative research anyway.

490
00:50:09,940 --> 00:50:19,060
But I think that it's one of the things that I think people find hardest when they start is to kind of retain the sense of individuality,

491
00:50:19,060 --> 00:50:23,410
but also think about the the group level stuff.

492
00:50:23,410 --> 00:50:33,070
But I think, you know what what's apparent in this conversation, Laura, is that qualitative research is messy, isn't it?

493
00:50:33,070 --> 00:50:41,020
I'm very curious. Yeah, no, I'm just going to say the other thing that's I think is important for qualitative researchers

494
00:50:41,020 --> 00:50:48,190
is to be able to sit with uncertainty and to know that at the end of your research,

495
00:50:48,190 --> 00:50:59,140
you're producing an answer or a set of answers, but you're not necessarily producing the answer because there is no the answer in existence.

496
00:50:59,140 --> 00:51:09,310
And I think that's that's exactly true. And I think and you receive a partial version of the world, but you would do this to any research methodology.

497
00:51:09,310 --> 00:51:16,040
So, you know, estimates about infection rates in the country aren't accurate surveyors.

498
00:51:16,040 --> 00:51:21,640
You know, nobody has given these tests. Everybody in the country at the same point.

499
00:51:21,640 --> 00:51:23,260
You know, we're all describing a.

500
00:51:23,260 --> 00:51:31,930
Partial version of reality, but the methodology, the SS and I think the importance in qualitative research is to be able to look up.

501
00:51:31,930 --> 00:51:38,820
So the the story I think I'll probably end on is thinking about your interviews as sort of sarcasms.

502
00:51:38,820 --> 00:51:44,910
But I made the mistake of my record recorder not working one time when I interviewed somebody.

503
00:51:44,910 --> 00:51:50,460
And this is absolute disaster and I apologise profusely to the participants and so on.

504
00:51:50,460 --> 00:51:53,910
And they extremely kindly said, would you like to come and do it again?

505
00:51:53,910 --> 00:52:01,560
At which point I sat and they gave me an entirely different version of events to the version of events I'd receive the first time round.

506
00:52:01,560 --> 00:52:07,470
And none of these contradicted each other. They were just in narrative form, but in a different way,

507
00:52:07,470 --> 00:52:13,140
so that the second interview was a much more sort of negative version of events than that presented in the first one.

508
00:52:13,140 --> 00:52:18,030
And I've never known whether or not feeling so well that day.

509
00:52:18,030 --> 00:52:21,930
Was it because they knew me a bit better? You know, why was that?

510
00:52:21,930 --> 00:52:28,830
But had I just had the first interview, the first experience, I would have gone off and analysed it and put it into it and Vevo and then my,

511
00:52:28,830 --> 00:52:35,010
you know, and come up with an entirely different version than I would have done had I had this second interview.

512
00:52:35,010 --> 00:52:36,750
And that's the same for ethnography.

513
00:52:36,750 --> 00:52:42,340
I think you can learn things right at the end of your ethnographic research, which turns everything on its head a little bit.

514
00:52:42,340 --> 00:52:51,060
So I think whatever you're doing, whatever methodology you choose, has its messiness, has its incompleteness.

515
00:52:51,060 --> 00:52:57,750
And I think we often reflect on that as qualitative research as well. I think that's that's one thing that's really quite universal.

516
00:52:57,750 --> 00:53:00,120
Yeah, you're absolutely right.

517
00:53:00,120 --> 00:53:12,900
And I think I would end this conversation by saying that messiness is beautiful and it's wonderful to work in this type of messiness and to feel

518
00:53:12,900 --> 00:53:22,620
comfortable with it and to know that what you're doing is exploring complexity and not trying to sanitise things or narrow it down too much.

519
00:53:22,620 --> 00:53:31,110
I don't know if you'd agree with that. I think most especially and I think even if you if, for example,

520
00:53:31,110 --> 00:53:37,050
I'm doing a series of interviews with my father at the moment about his life history and I'm learning all sorts of things.

521
00:53:37,050 --> 00:53:47,070
And this is somebody you know, I am participant observation for 40 years now with my father, but I'm learning lots and lots of things about him.

522
00:53:47,070 --> 00:53:53,280
So I think there are many, many sides to people and phenomena that we think we know quite well.

523
00:53:53,280 --> 00:54:02,160
So it's a deliberate line of enquiry that therefore I'm learning about some of the hugely more than I would have done otherwise had I not.

524
00:54:02,160 --> 00:54:04,470
And then the series of interviews.

525
00:54:04,470 --> 00:54:16,020
So I think and again, it's a deliberate form of enquiry which can and more messiness, you know, as you say, a beautiful messiness.

526
00:54:16,020 --> 00:54:24,840
But it's a very helpful methodology for doing that. Yeah, that sounds fascinating what you're doing with your dad, and I wish you the best with it.

527
00:54:24,840 --> 00:54:31,470
And you and I have known each other for quite a long time. We've had many, many conversations about this very issue, about the messy realities.

528
00:54:31,470 --> 00:54:36,090
Of course, he did research, but I think I've learnt a lot today from talking to you.

529
00:54:36,090 --> 00:54:39,360
So thank you very much for your contribution. Thank you.

530
00:54:39,360 --> 00:54:41,798
Likewise. It's been a pleasure.