AN EXAMPLE OF A DEBRIEFING TEMPLATE

• Comment le groupe a fonctionné ?
• Contexte environnemental
• Tensions éventuelles
• Problèmes éventuelles avec certaines questions/topic
• Points à approfondir au cours des interviews suivantes
• Premier résultats frappants

AN EXAMPLE OF A QUESTIONNAIRE

Questionnaire used in the KCE research project on citizen and patient participation in reimbursement decision-making (to be published in 2013).

PART 1 – Prior experience and purpose

• Has citizen-patient participation with regard to reimbursement decisions already been discussed in one or several groups?
• At what occasion? When was that? Why was this? Which decision / organ was involved? What type of citizen-patient was involved?
• What were the arguments pro and/or con?
• What was the motivation/background for/of these arguments? Which targets were researched?  
• What type of participation was considered? and what type was not considered ? (who, method, decision, …)
• What were or are the conclusions regarding citizen-patient participation?
• Is participation important for the future of our healthcare system or no?
• If no why?
• If yes why? Is it feasible now? What is the high-level goal that could be achieved now and in the future? What are the main obstacles?
• What do you want to attain by including public preferences in health care decision making?

PART 2 – HOW TO INVOLVE

Explanation by interviewer of levels of participation: inform – consult – debate – co-decision – decision

• What level(s) of participation would be most desirable and why?
• What would influence this choice: the subject/type of decision? The moment in the decision-making process?
• For each of these desired levels of intensity, what would be advantages / disadvantages?
• From your knowledge of the different stakeholders, what is feasible now? What is feasible in the Belgian context?
• How should such participation be organised?
• Who could be involved :
• Citizen? Taxpayer? Consumer? Patient? Expert?
• From your experience, what’s the opinion of the stakeholders about the citizen-patient to involve or not to involve ?
• Who would represent the citizen-patient ?
• What would be your ideal scenario to involve the citizen-patient in reimbursement decisions.

PART 3 – EXAMPLES OF PARTICIPATION

• From your experience, can you give examples of participation linked to reimbursement decisions that you know about of have witnessed? If none, is there an example you have been thinking of yourself?
• What was positive or negative about these examples?

[Probe for more than one example. If they are giving foreign examples, we ask them how this could work in Belgium. What would be the same, what would be different.]

Systematic probing questions for all examples the respondent gives:

• what would be better compared to a situation without participation
• what would be negative ?
• how would it work / be organized
• who would be involved (who would represent the citizen-patient)
• what barriers do you see

PART 4 – WRAPPING UP

Based on the choice made, probe again with regard to:

• Type of motivation for participation: democracy, equity, efficiency, …
• Which role do citizen-patient have to take within the decision making process? The user of health services perspective (more particular) or the public policy perspective (more diffuse).

Understand the priorities :

• what would be the most interesting to achieve at mid term? at long term?
• what would be the easiest to get going: the way of lesser resistance?

Closing question when thanking:

• Anything else you would like to say or stress?

AN EXAMPLE OF A TOPIC LIST

The example presented below is fictitious. It could have been used in the KCE research project on refractive eye surgery (in progress), but instead a questionnaire was used.

• Discovery of eye problems
• When?
• How?
• Which solution?
• Reaction?
• Satisfaction with solution. Change to new solution, which one?
• Encounter with eye surgery
• When?
• How?
• Consideration of the eye surgery
• Motivations?
• How far in the process
• Final decision/decision so far
• Planning of the eye surgery
• Experience of the eye surgery and after care
• Emotions – fears
• Practicalities
• Informed consent
• Evaluation of the eye surgery
• Quality of sight
• Pain
• Adverse effects
• Reimbursement of glasses, contact lenses, refractive eye surgery

AN EXAMPLE OF AN INTRODUCTORY TEXT

Bonjour,

Je me présente, je m’appelle [Prénom Nom], je travaille pour [institution] en tant que [décrire sa fonction en essayant de ne pas se positionner comme ‘supérieur’ au(x) répondant(s)], C’est moi qui distribuerai la parole ce soir et modérerai la discussion.

Comme vous le savez, nous réalisons en ce moment un projet relatif au [sujet de l’étude].

Dans ce cadre, nous souhaiterions connaitre les opinion, expériences, sentiments de [description de la population d’étude] quant à [description du sujet de l’étude].

Ce projet est financé/demandé par [bailleur de fonds] avec pour objectif de [objectif de l’étude].

Nous vous avons contacté parce que vous [reprendre les caractéristiques du segment de l’échantillon attendu]. Vous avez été identifié(s) via [source de recrutement].

Notre discussion durera approximativement [fourchette de durée de l’interview/focus group].

Le contenu des discussions et les propos échangées resteront confidentiels. Autrement dit, si certaines phrases seront reprises dans notre rapport final, aucune citation ne reprendra le nom de la personne qui l’a formulée.

(Pour les focus groups) Avant de commencer, je voudrais également vous présenter [Prénom Nom de l’observateur] qui va observer ce groupe afin de voir comment se déroulent les discussions et m’aider éventuellement à distribuer équitablement la parole et garder le temps en vue.

Je vous présente également et [Prénom et Nom du rapporteur] qui prendra note des discussions.

(Pour tous) Je souhaiterais par ailleurs vous demander l’autorisation d’enregistrer l’entretien/les discussions : cela nous permettra de revenir sur vos propos exacts lors de l’analyse de l’ensemble des entretiens, de ne pas déformer vos propos en cas de citation pour illustrer nos résultats et ne pas prendre de notes trop précise pendant l’entretien, ce qui facilitera nos échanges. Si vous/personne n’y voit d’inconvénients, je laisse le dictaphone enregistrer. (celui-ci ayant été enclenché dès le début de l’entretien)

Quelques règles de base : il n’y a pas de bonne ou mauvaise réponse. Les discussions se font dans le respect mutuel de chacun.

(Pour les focus groups) Nous vous remercions de bien vouloir ne pas rapporter ce qui se sera dit ici à l’extérieur du groupe.

Pour ce qui est de la prise de parole, ne parlez pas entre vous, en aparté, mais faites profiter le groupe de vos réflexions. En plus, s’il y a plusieurs conversations en même temps, l’enregistrement en pâtira. Si vous souhaitez prendre la parole, faites-moi un petit signe.

(Pour tous) Vous êtes libre de quitter le groupe/arrêter l’interview à tout moment.

(Pour les focus groups) Avant de passer à la première question, je vous propose de commencer par un tour de table afin de vous présenter en donnant votre prénom et [1 ou 2 caractéristiques en fonction de la question de recherche]. Si vous préférez vous pouvez donner un pseudonyme.

CHECKLIST FOR THE PREPARATION OF FOCUS GROUP INTERVIEWS

OTHER CHECKLISTS AND QUALITY CRITERIA FOR QUALITATIVE RESEARCH

In what follows we will elaborate on two other checklists enabling qualitative researchers to guard the quality of their work.

Henwood and Pidgeon¹⁰⁵ identified seven attributes which characterise good qualitative research. Their schema, which links criteria with methods of achieving sound research, offers a helpful guide for novice researchers. They argue for:

• The importance of fit - The themes or analytical categories offered by the researcher should fit the data. The researcher demonstrates this by writing clear, explicit accounts of how these categories were evolved.
• Integration of theory - The researcher needs to discuss the relationship between units of analysis and the degree to which they can be integrated or generalised (for instance, exploring how themes might be combined moving towards a theory).
• Reflexivity – The role of the researcher needs to be acknowledged and accounted for in the documentation of the research.
• Documentation – The researcher needs to provide an audit trail: a comprehensive account of what was done and why.
• Theoretical sampling and negative case analysis – The researcher needs to continuously develop and modify any emerging theory, exploring cases that do not fit as well as those which might generate new knowledge.
• Sensitivity to negotiated realities – While participant validation may be necessary, the researcher needs to demonstrate awareness of the research context, power differentials and participant reactions to the research. It is particularly important to explain any differences between the researcher’s interpretations and those of the participant(s).
• Transferability - The researcher should suggest how the research may have applicability beyond the particular research context.

Malterud¹⁰⁶ provides the following checklist:

Aim

• Is the research question a relevant issue?
• Is the aim sufficiently focused, and stated clearly?

• Are the researcher's motives, background, perspectives, and preliminary hypotheses presented, and is the effect of these issues sufficiently dealt with

Method and design

• Are qualitative research methods suitable for exploration of the research question?
• Has the best method been chosen with respect to the research question?

Data collection and sampling

• Is the strategy for data collection clearly stated (usually purposive or theoretical, usually not random or representative)?
• Are the reasons for this choice stated?
• Has the best approach been chosen, in view of the research question?
• Are the consequences of the chosen strategy discussed and compared with other options?
• Are the characteristics of the sample presented in enough depth to understand the study site and context?

Theoretical Framework

• Are the perspectives and ideas used for data interpretation presented?
• Is the framework adequate, in view of the aim of the study?
• Does the author account for the role given to the theoretical framework during analysis?

Analysis

• Are the principles and procedures for data organization and analysis fully described, allowing the reader to understand what happened to the raw material to arrive at the results?
• Were the various categories identified from theory or preconceptions in advance, or were they developed from the data?
• Which principles were followed to organize the presentation of findings?
• Are strategies used to validate results presented, such as cross-checks for rivalling explanations, member checks, or triangulation? If such strategies are not described in this section, they should appear as validity discussion later in the report.

Findings

• Are the findings relevant with respect to the aim of the study?
• Do they provide new insight?
• Is the presentation of the findings well organized and best suited to ensure that findings are drawn from systematic analysis of material, rather than from preconceptions?
• Are quotes used adequately to support and enrich the researcher's synopsis of the patterns identified by systematic analysis?

Discussion

• Are questions about internal validity (what the study is actually about), external validity (to what other settings the findings or notions can be applied), and reflexivity (the effects of the researcher on processes, interpretations, findings, and conclusions) addressed?
• Has the design been scrutinized?
• Are the shortcomings accounted for and discussed, without denying the responsibility for choices taken?

• Have the findings been compared with appropriate theoretical and empirical references?
• Are a few clear consequences of the study proposed?

Presentation

• Is the report easy to understand and clearly contextualized?
• Is it possible to distinguish between the voices of the informants and those of the researcher?

References

• Are important and specific sources in the field covered, and have they been appropriately presented and applied in the text?