Logo for Open Educational Resources

Chapter 11. Interviewing

Introduction.

Interviewing people is at the heart of qualitative research. It is not merely a way to collect data but an intrinsically rewarding activity—an interaction between two people that holds the potential for greater understanding and interpersonal development. Unlike many of our daily interactions with others that are fairly shallow and mundane, sitting down with a person for an hour or two and really listening to what they have to say is a profound and deep enterprise, one that can provide not only “data” for you, the interviewer, but also self-understanding and a feeling of being heard for the interviewee. I always approach interviewing with a deep appreciation for the opportunity it gives me to understand how other people experience the world. That said, there is not one kind of interview but many, and some of these are shallower than others. This chapter will provide you with an overview of interview techniques but with a special focus on the in-depth semistructured interview guide approach, which is the approach most widely used in social science research.

An interview can be variously defined as “a conversation with a purpose” ( Lune and Berg 2018 ) and an attempt to understand the world from the point of view of the person being interviewed: “to unfold the meaning of peoples’ experiences, to uncover their lived world prior to scientific explanations” ( Kvale 2007 ). It is a form of active listening in which the interviewer steers the conversation to subjects and topics of interest to their research but also manages to leave enough space for those interviewed to say surprising things. Achieving that balance is a tricky thing, which is why most practitioners believe interviewing is both an art and a science. In my experience as a teacher, there are some students who are “natural” interviewers (often they are introverts), but anyone can learn to conduct interviews, and everyone, even those of us who have been doing this for years, can improve their interviewing skills. This might be a good time to highlight the fact that the interview is a product between interviewer and interviewee and that this product is only as good as the rapport established between the two participants. Active listening is the key to establishing this necessary rapport.

Patton ( 2002 ) makes the argument that we use interviews because there are certain things that are not observable. In particular, “we cannot observe feelings, thoughts, and intentions. We cannot observe behaviors that took place at some previous point in time. We cannot observe situations that preclude the presence of an observer. We cannot observe how people have organized the world and the meanings they attach to what goes on in the world. We have to ask people questions about those things” ( 341 ).

Types of Interviews

There are several distinct types of interviews. Imagine a continuum (figure 11.1). On one side are unstructured conversations—the kind you have with your friends. No one is in control of those conversations, and what you talk about is often random—whatever pops into your head. There is no secret, underlying purpose to your talking—if anything, the purpose is to talk to and engage with each other, and the words you use and the things you talk about are a little beside the point. An unstructured interview is a little like this informal conversation, except that one of the parties to the conversation (you, the researcher) does have an underlying purpose, and that is to understand the other person. You are not friends speaking for no purpose, but it might feel just as unstructured to the “interviewee” in this scenario. That is one side of the continuum. On the other side are fully structured and standardized survey-type questions asked face-to-face. Here it is very clear who is asking the questions and who is answering them. This doesn’t feel like a conversation at all! A lot of people new to interviewing have this ( erroneously !) in mind when they think about interviews as data collection. Somewhere in the middle of these two extreme cases is the “ semistructured” interview , in which the researcher uses an “interview guide” to gently move the conversation to certain topics and issues. This is the primary form of interviewing for qualitative social scientists and will be what I refer to as interviewing for the rest of this chapter, unless otherwise specified.

Types of Interviewing Questions: Unstructured conversations, Semi-structured interview, Structured interview, Survey questions

Informal (unstructured conversations). This is the most “open-ended” approach to interviewing. It is particularly useful in conjunction with observational methods (see chapters 13 and 14). There are no predetermined questions. Each interview will be different. Imagine you are researching the Oregon Country Fair, an annual event in Veneta, Oregon, that includes live music, artisan craft booths, face painting, and a lot of people walking through forest paths. It’s unlikely that you will be able to get a person to sit down with you and talk intensely about a set of questions for an hour and a half. But you might be able to sidle up to several people and engage with them about their experiences at the fair. You might have a general interest in what attracts people to these events, so you could start a conversation by asking strangers why they are here or why they come back every year. That’s it. Then you have a conversation that may lead you anywhere. Maybe one person tells a long story about how their parents brought them here when they were a kid. A second person talks about how this is better than Burning Man. A third person shares their favorite traveling band. And yet another enthuses about the public library in the woods. During your conversations, you also talk about a lot of other things—the weather, the utilikilts for sale, the fact that a favorite food booth has disappeared. It’s all good. You may not be able to record these conversations. Instead, you might jot down notes on the spot and then, when you have the time, write down as much as you can remember about the conversations in long fieldnotes. Later, you will have to sit down with these fieldnotes and try to make sense of all the information (see chapters 18 and 19).

Interview guide ( semistructured interview ). This is the primary type employed by social science qualitative researchers. The researcher creates an “interview guide” in advance, which she uses in every interview. In theory, every person interviewed is asked the same questions. In practice, every person interviewed is asked mostly the same topics but not always the same questions, as the whole point of a “guide” is that it guides the direction of the conversation but does not command it. The guide is typically between five and ten questions or question areas, sometimes with suggested follow-ups or prompts . For example, one question might be “What was it like growing up in Eastern Oregon?” with prompts such as “Did you live in a rural area? What kind of high school did you attend?” to help the conversation develop. These interviews generally take place in a quiet place (not a busy walkway during a festival) and are recorded. The recordings are transcribed, and those transcriptions then become the “data” that is analyzed (see chapters 18 and 19). The conventional length of one of these types of interviews is between one hour and two hours, optimally ninety minutes. Less than one hour doesn’t allow for much development of questions and thoughts, and two hours (or more) is a lot of time to ask someone to sit still and answer questions. If you have a lot of ground to cover, and the person is willing, I highly recommend two separate interview sessions, with the second session being slightly shorter than the first (e.g., ninety minutes the first day, sixty minutes the second). There are lots of good reasons for this, but the most compelling one is that this allows you to listen to the first day’s recording and catch anything interesting you might have missed in the moment and so develop follow-up questions that can probe further. This also allows the person being interviewed to have some time to think about the issues raised in the interview and go a little deeper with their answers.

Standardized questionnaire with open responses ( structured interview ). This is the type of interview a lot of people have in mind when they hear “interview”: a researcher comes to your door with a clipboard and proceeds to ask you a series of questions. These questions are all the same whoever answers the door; they are “standardized.” Both the wording and the exact order are important, as people’s responses may vary depending on how and when a question is asked. These are qualitative only in that the questions allow for “open-ended responses”: people can say whatever they want rather than select from a predetermined menu of responses. For example, a survey I collaborated on included this open-ended response question: “How does class affect one’s career success in sociology?” Some of the answers were simply one word long (e.g., “debt”), and others were long statements with stories and personal anecdotes. It is possible to be surprised by the responses. Although it’s a stretch to call this kind of questioning a conversation, it does allow the person answering the question some degree of freedom in how they answer.

Survey questionnaire with closed responses (not an interview!). Standardized survey questions with specific answer options (e.g., closed responses) are not really interviews at all, and they do not generate qualitative data. For example, if we included five options for the question “How does class affect one’s career success in sociology?”—(1) debt, (2) social networks, (3) alienation, (4) family doesn’t understand, (5) type of grad program—we leave no room for surprises at all. Instead, we would most likely look at patterns around these responses, thinking quantitatively rather than qualitatively (e.g., using regression analysis techniques, we might find that working-class sociologists were twice as likely to bring up alienation). It can sometimes be confusing for new students because the very same survey can include both closed-ended and open-ended questions. The key is to think about how these will be analyzed and to what level surprises are possible. If your plan is to turn all responses into a number and make predictions about correlations and relationships, you are no longer conducting qualitative research. This is true even if you are conducting this survey face-to-face with a real live human. Closed-response questions are not conversations of any kind, purposeful or not.

In summary, the semistructured interview guide approach is the predominant form of interviewing for social science qualitative researchers because it allows a high degree of freedom of responses from those interviewed (thus allowing for novel discoveries) while still maintaining some connection to a research question area or topic of interest. The rest of the chapter assumes the employment of this form.

Creating an Interview Guide

Your interview guide is the instrument used to bridge your research question(s) and what the people you are interviewing want to tell you. Unlike a standardized questionnaire, the questions actually asked do not need to be exactly what you have written down in your guide. The guide is meant to create space for those you are interviewing to talk about the phenomenon of interest, but sometimes you are not even sure what that phenomenon is until you start asking questions. A priority in creating an interview guide is to ensure it offers space. One of the worst mistakes is to create questions that are so specific that the person answering them will not stray. Relatedly, questions that sound “academic” will shut down a lot of respondents. A good interview guide invites respondents to talk about what is important to them, not feel like they are performing or being evaluated by you.

Good interview questions should not sound like your “research question” at all. For example, let’s say your research question is “How do patriarchal assumptions influence men’s understanding of climate change and responses to climate change?” It would be worse than unhelpful to ask a respondent, “How do your assumptions about the role of men affect your understanding of climate change?” You need to unpack this into manageable nuggets that pull your respondent into the area of interest without leading him anywhere. You could start by asking him what he thinks about climate change in general. Or, even better, whether he has any concerns about heatwaves or increased tornadoes or polar icecaps melting. Once he starts talking about that, you can ask follow-up questions that bring in issues around gendered roles, perhaps asking if he is married (to a woman) and whether his wife shares his thoughts and, if not, how they negotiate that difference. The fact is, you won’t really know the right questions to ask until he starts talking.

There are several distinct types of questions that can be used in your interview guide, either as main questions or as follow-up probes. If you remember that the point is to leave space for the respondent, you will craft a much more effective interview guide! You will also want to think about the place of time in both the questions themselves (past, present, future orientations) and the sequencing of the questions.

Researcher Note

Suggestion : As you read the next three sections (types of questions, temporality, question sequence), have in mind a particular research question, and try to draft questions and sequence them in a way that opens space for a discussion that helps you answer your research question.

Type of Questions

Experience and behavior questions ask about what a respondent does regularly (their behavior) or has done (their experience). These are relatively easy questions for people to answer because they appear more “factual” and less subjective. This makes them good opening questions. For the study on climate change above, you might ask, “Have you ever experienced an unusual weather event? What happened?” Or “You said you work outside? What is a typical summer workday like for you? How do you protect yourself from the heat?”

Opinion and values questions , in contrast, ask questions that get inside the minds of those you are interviewing. “Do you think climate change is real? Who or what is responsible for it?” are two such questions. Note that you don’t have to literally ask, “What is your opinion of X?” but you can find a way to ask the specific question relevant to the conversation you are having. These questions are a bit trickier to ask because the answers you get may depend in part on how your respondent perceives you and whether they want to please you or not. We’ve talked a fair amount about being reflective. Here is another place where this comes into play. You need to be aware of the effect your presence might have on the answers you are receiving and adjust accordingly. If you are a woman who is perceived as liberal asking a man who identifies as conservative about climate change, there is a lot of subtext that can be going on in the interview. There is no one right way to resolve this, but you must at least be aware of it.

Feeling questions are questions that ask respondents to draw on their emotional responses. It’s pretty common for academic researchers to forget that we have bodies and emotions, but people’s understandings of the world often operate at this affective level, sometimes unconsciously or barely consciously. It is a good idea to include questions that leave space for respondents to remember, imagine, or relive emotional responses to particular phenomena. “What was it like when you heard your cousin’s house burned down in that wildfire?” doesn’t explicitly use any emotion words, but it allows your respondent to remember what was probably a pretty emotional day. And if they respond emotionally neutral, that is pretty interesting data too. Note that asking someone “How do you feel about X” is not always going to evoke an emotional response, as they might simply turn around and respond with “I think that…” It is better to craft a question that actually pushes the respondent into the affective category. This might be a specific follow-up to an experience and behavior question —for example, “You just told me about your daily routine during the summer heat. Do you worry it is going to get worse?” or “Have you ever been afraid it will be too hot to get your work accomplished?”

Knowledge questions ask respondents what they actually know about something factual. We have to be careful when we ask these types of questions so that respondents do not feel like we are evaluating them (which would shut them down), but, for example, it is helpful to know when you are having a conversation about climate change that your respondent does in fact know that unusual weather events have increased and that these have been attributed to climate change! Asking these questions can set the stage for deeper questions and can ensure that the conversation makes the same kind of sense to both participants. For example, a conversation about political polarization can be put back on track once you realize that the respondent doesn’t really have a clear understanding that there are two parties in the US. Instead of asking a series of questions about Republicans and Democrats, you might shift your questions to talk more generally about political disagreements (e.g., “people against abortion”). And sometimes what you do want to know is the level of knowledge about a particular program or event (e.g., “Are you aware you can discharge your student loans through the Public Service Loan Forgiveness program?”).

Sensory questions call on all senses of the respondent to capture deeper responses. These are particularly helpful in sparking memory. “Think back to your childhood in Eastern Oregon. Describe the smells, the sounds…” Or you could use these questions to help a person access the full experience of a setting they customarily inhabit: “When you walk through the doors to your office building, what do you see? Hear? Smell?” As with feeling questions , these questions often supplement experience and behavior questions . They are another way of allowing your respondent to report fully and deeply rather than remain on the surface.

Creative questions employ illustrative examples, suggested scenarios, or simulations to get respondents to think more deeply about an issue, topic, or experience. There are many options here. In The Trouble with Passion , Erin Cech ( 2021 ) provides a scenario in which “Joe” is trying to decide whether to stay at his decent but boring computer job or follow his passion by opening a restaurant. She asks respondents, “What should Joe do?” Their answers illuminate the attraction of “passion” in job selection. In my own work, I have used a news story about an upwardly mobile young man who no longer has time to see his mother and sisters to probe respondents’ feelings about the costs of social mobility. Jessi Streib and Betsy Leondar-Wright have used single-page cartoon “scenes” to elicit evaluations of potential racial discrimination, sexual harassment, and classism. Barbara Sutton ( 2010 ) has employed lists of words (“strong,” “mother,” “victim”) on notecards she fans out and asks her female respondents to select and discuss.

Background/Demographic Questions

You most definitely will want to know more about the person you are interviewing in terms of conventional demographic information, such as age, race, gender identity, occupation, and educational attainment. These are not questions that normally open up inquiry. [1] For this reason, my practice has been to include a separate “demographic questionnaire” sheet that I ask each respondent to fill out at the conclusion of the interview. Only include those aspects that are relevant to your study. For example, if you are not exploring religion or religious affiliation, do not include questions about a person’s religion on the demographic sheet. See the example provided at the end of this chapter.

Temporality

Any type of question can have a past, present, or future orientation. For example, if you are asking a behavior question about workplace routine, you might ask the respondent to talk about past work, present work, and ideal (future) work. Similarly, if you want to understand how people cope with natural disasters, you might ask your respondent how they felt then during the wildfire and now in retrospect and whether and to what extent they have concerns for future wildfire disasters. It’s a relatively simple suggestion—don’t forget to ask about past, present, and future—but it can have a big impact on the quality of the responses you receive.

Question Sequence

Having a list of good questions or good question areas is not enough to make a good interview guide. You will want to pay attention to the order in which you ask your questions. Even though any one respondent can derail this order (perhaps by jumping to answer a question you haven’t yet asked), a good advance plan is always helpful. When thinking about sequence, remember that your goal is to get your respondent to open up to you and to say things that might surprise you. To establish rapport, it is best to start with nonthreatening questions. Asking about the present is often the safest place to begin, followed by the past (they have to know you a little bit to get there), and lastly, the future (talking about hopes and fears requires the most rapport). To allow for surprises, it is best to move from very general questions to more particular questions only later in the interview. This ensures that respondents have the freedom to bring up the topics that are relevant to them rather than feel like they are constrained to answer you narrowly. For example, refrain from asking about particular emotions until these have come up previously—don’t lead with them. Often, your more particular questions will emerge only during the course of the interview, tailored to what is emerging in conversation.

Once you have a set of questions, read through them aloud and imagine you are being asked the same questions. Does the set of questions have a natural flow? Would you be willing to answer the very first question to a total stranger? Does your sequence establish facts and experiences before moving on to opinions and values? Did you include prefatory statements, where necessary; transitions; and other announcements? These can be as simple as “Hey, we talked a lot about your experiences as a barista while in college.… Now I am turning to something completely different: how you managed friendships in college.” That is an abrupt transition, but it has been softened by your acknowledgment of that.

Probes and Flexibility

Once you have the interview guide, you will also want to leave room for probes and follow-up questions. As in the sample probe included here, you can write out the obvious probes and follow-up questions in advance. You might not need them, as your respondent might anticipate them and include full responses to the original question. Or you might need to tailor them to how your respondent answered the question. Some common probes and follow-up questions include asking for more details (When did that happen? Who else was there?), asking for elaboration (Could you say more about that?), asking for clarification (Does that mean what I think it means or something else? I understand what you mean, but someone else reading the transcript might not), and asking for contrast or comparison (How did this experience compare with last year’s event?). “Probing is a skill that comes from knowing what to look for in the interview, listening carefully to what is being said and what is not said, and being sensitive to the feedback needs of the person being interviewed” ( Patton 2002:374 ). It takes work! And energy. I and many other interviewers I know report feeling emotionally and even physically drained after conducting an interview. You are tasked with active listening and rearranging your interview guide as needed on the fly. If you only ask the questions written down in your interview guide with no deviations, you are doing it wrong. [2]

The Final Question

Every interview guide should include a very open-ended final question that allows for the respondent to say whatever it is they have been dying to tell you but you’ve forgotten to ask. About half the time they are tired too and will tell you they have nothing else to say. But incredibly, some of the most honest and complete responses take place here, at the end of a long interview. You have to realize that the person being interviewed is often discovering things about themselves as they talk to you and that this process of discovery can lead to new insights for them. Making space at the end is therefore crucial. Be sure you convey that you actually do want them to tell you more, that the offer of “anything else?” is not read as an empty convention where the polite response is no. Here is where you can pull from that active listening and tailor the final question to the particular person. For example, “I’ve asked you a lot of questions about what it was like to live through that wildfire. I’m wondering if there is anything I’ve forgotten to ask, especially because I haven’t had that experience myself” is a much more inviting final question than “Great. Anything you want to add?” It’s also helpful to convey to the person that you have the time to listen to their full answer, even if the allotted time is at the end. After all, there are no more questions to ask, so the respondent knows exactly how much time is left. Do them the courtesy of listening to them!

Conducting the Interview

Once you have your interview guide, you are on your way to conducting your first interview. I always practice my interview guide with a friend or family member. I do this even when the questions don’t make perfect sense for them, as it still helps me realize which questions make no sense, are poorly worded (too academic), or don’t follow sequentially. I also practice the routine I will use for interviewing, which goes something like this:

  • Introduce myself and reintroduce the study
  • Provide consent form and ask them to sign and retain/return copy
  • Ask if they have any questions about the study before we begin
  • Ask if I can begin recording
  • Ask questions (from interview guide)
  • Turn off the recording device
  • Ask if they are willing to fill out my demographic questionnaire
  • Collect questionnaire and, without looking at the answers, place in same folder as signed consent form
  • Thank them and depart

A note on remote interviewing: Interviews have traditionally been conducted face-to-face in a private or quiet public setting. You don’t want a lot of background noise, as this will make transcriptions difficult. During the recent global pandemic, many interviewers, myself included, learned the benefits of interviewing remotely. Although face-to-face is still preferable for many reasons, Zoom interviewing is not a bad alternative, and it does allow more interviews across great distances. Zoom also includes automatic transcription, which significantly cuts down on the time it normally takes to convert our conversations into “data” to be analyzed. These automatic transcriptions are not perfect, however, and you will still need to listen to the recording and clarify and clean up the transcription. Nor do automatic transcriptions include notations of body language or change of tone, which you may want to include. When interviewing remotely, you will want to collect the consent form before you meet: ask them to read, sign, and return it as an email attachment. I think it is better to ask for the demographic questionnaire after the interview, but because some respondents may never return it then, it is probably best to ask for this at the same time as the consent form, in advance of the interview.

What should you bring to the interview? I would recommend bringing two copies of the consent form (one for you and one for the respondent), a demographic questionnaire, a manila folder in which to place the signed consent form and filled-out demographic questionnaire, a printed copy of your interview guide (I print with three-inch right margins so I can jot down notes on the page next to relevant questions), a pen, a recording device, and water.

After the interview, you will want to secure the signed consent form in a locked filing cabinet (if in print) or a password-protected folder on your computer. Using Excel or a similar program that allows tables/spreadsheets, create an identifying number for your interview that links to the consent form without using the name of your respondent. For example, let’s say that I conduct interviews with US politicians, and the first person I meet with is George W. Bush. I will assign the transcription the number “INT#001” and add it to the signed consent form. [3] The signed consent form goes into a locked filing cabinet, and I never use the name “George W. Bush” again. I take the information from the demographic sheet, open my Excel spreadsheet, and add the relevant information in separate columns for the row INT#001: White, male, Republican. When I interview Bill Clinton as my second interview, I include a second row: INT#002: White, male, Democrat. And so on. The only link to the actual name of the respondent and this information is the fact that the consent form (unavailable to anyone but me) has stamped on it the interview number.

Many students get very nervous before their first interview. Actually, many of us are always nervous before the interview! But do not worry—this is normal, and it does pass. Chances are, you will be pleasantly surprised at how comfortable it begins to feel. These “purposeful conversations” are often a delight for both participants. This is not to say that sometimes things go wrong. I often have my students practice several “bad scenarios” (e.g., a respondent that you cannot get to open up; a respondent who is too talkative and dominates the conversation, steering it away from the topics you are interested in; emotions that completely take over; or shocking disclosures you are ill-prepared to handle), but most of the time, things go quite well. Be prepared for the unexpected, but know that the reason interviews are so popular as a technique of data collection is that they are usually richly rewarding for both participants.

One thing that I stress to my methods students and remind myself about is that interviews are still conversations between people. If there’s something you might feel uncomfortable asking someone about in a “normal” conversation, you will likely also feel a bit of discomfort asking it in an interview. Maybe more importantly, your respondent may feel uncomfortable. Social research—especially about inequality—can be uncomfortable. And it’s easy to slip into an abstract, intellectualized, or removed perspective as an interviewer. This is one reason trying out interview questions is important. Another is that sometimes the question sounds good in your head but doesn’t work as well out loud in practice. I learned this the hard way when a respondent asked me how I would answer the question I had just posed, and I realized that not only did I not really know how I would answer it, but I also wasn’t quite as sure I knew what I was asking as I had thought.

—Elizabeth M. Lee, Associate Professor of Sociology at Saint Joseph’s University, author of Class and Campus Life , and co-author of Geographies of Campus Inequality

How Many Interviews?

Your research design has included a targeted number of interviews and a recruitment plan (see chapter 5). Follow your plan, but remember that “ saturation ” is your goal. You interview as many people as you can until you reach a point at which you are no longer surprised by what they tell you. This means not that no one after your first twenty interviews will have surprising, interesting stories to tell you but rather that the picture you are forming about the phenomenon of interest to you from a research perspective has come into focus, and none of the interviews are substantially refocusing that picture. That is when you should stop collecting interviews. Note that to know when you have reached this, you will need to read your transcripts as you go. More about this in chapters 18 and 19.

Your Final Product: The Ideal Interview Transcript

A good interview transcript will demonstrate a subtly controlled conversation by the skillful interviewer. In general, you want to see replies that are about one paragraph long, not short sentences and not running on for several pages. Although it is sometimes necessary to follow respondents down tangents, it is also often necessary to pull them back to the questions that form the basis of your research study. This is not really a free conversation, although it may feel like that to the person you are interviewing.

Final Tips from an Interview Master

Annette Lareau is arguably one of the masters of the trade. In Listening to People , she provides several guidelines for good interviews and then offers a detailed example of an interview gone wrong and how it could be addressed (please see the “Further Readings” at the end of this chapter). Here is an abbreviated version of her set of guidelines: (1) interview respondents who are experts on the subjects of most interest to you (as a corollary, don’t ask people about things they don’t know); (2) listen carefully and talk as little as possible; (3) keep in mind what you want to know and why you want to know it; (4) be a proactive interviewer (subtly guide the conversation); (5) assure respondents that there aren’t any right or wrong answers; (6) use the respondent’s own words to probe further (this both allows you to accurately identify what you heard and pushes the respondent to explain further); (7) reuse effective probes (don’t reinvent the wheel as you go—if repeating the words back works, do it again and again); (8) focus on learning the subjective meanings that events or experiences have for a respondent; (9) don’t be afraid to ask a question that draws on your own knowledge (unlike trial lawyers who are trained never to ask a question for which they don’t already know the answer, sometimes it’s worth it to ask risky questions based on your hypotheses or just plain hunches); (10) keep thinking while you are listening (so difficult…and important); (11) return to a theme raised by a respondent if you want further information; (12) be mindful of power inequalities (and never ever coerce a respondent to continue the interview if they want out); (13) take control with overly talkative respondents; (14) expect overly succinct responses, and develop strategies for probing further; (15) balance digging deep and moving on; (16) develop a plan to deflect questions (e.g., let them know you are happy to answer any questions at the end of the interview, but you don’t want to take time away from them now); and at the end, (17) check to see whether you have asked all your questions. You don’t always have to ask everyone the same set of questions, but if there is a big area you have forgotten to cover, now is the time to recover ( Lareau 2021:93–103 ).

Sample: Demographic Questionnaire

ASA Taskforce on First-Generation and Working-Class Persons in Sociology – Class Effects on Career Success

Supplementary Demographic Questionnaire

Thank you for your participation in this interview project. We would like to collect a few pieces of key demographic information from you to supplement our analyses. Your answers to these questions will be kept confidential and stored by ID number. All of your responses here are entirely voluntary!

What best captures your race/ethnicity? (please check any/all that apply)

  • White (Non Hispanic/Latina/o/x)
  • Black or African American
  • Hispanic, Latino/a/x of Spanish
  • Asian or Asian American
  • American Indian or Alaska Native
  • Middle Eastern or North African
  • Native Hawaiian or Pacific Islander
  • Other : (Please write in: ________________)

What is your current position?

  • Grad Student
  • Full Professor

Please check any and all of the following that apply to you:

  • I identify as a working-class academic
  • I was the first in my family to graduate from college
  • I grew up poor

What best reflects your gender?

  • Transgender female/Transgender woman
  • Transgender male/Transgender man
  • Gender queer/ Gender nonconforming

Anything else you would like us to know about you?

Example: Interview Guide

In this example, follow-up prompts are italicized.  Note the sequence of questions.  That second question often elicits an entire life history , answering several later questions in advance.

Introduction Script/Question

Thank you for participating in our survey of ASA members who identify as first-generation or working-class.  As you may have heard, ASA has sponsored a taskforce on first-generation and working-class persons in sociology and we are interested in hearing from those who so identify.  Your participation in this interview will help advance our knowledge in this area.

  • The first thing we would like to as you is why you have volunteered to be part of this study? What does it mean to you be first-gen or working class?  Why were you willing to be interviewed?
  • How did you decide to become a sociologist?
  • Can you tell me a little bit about where you grew up? ( prompts: what did your parent(s) do for a living?  What kind of high school did you attend?)
  • Has this identity been salient to your experience? (how? How much?)
  • How welcoming was your grad program? Your first academic employer?
  • Why did you decide to pursue sociology at the graduate level?
  • Did you experience culture shock in college? In graduate school?
  • Has your FGWC status shaped how you’ve thought about where you went to school? debt? etc?
  • Were you mentored? How did this work (not work)?  How might it?
  • What did you consider when deciding where to go to grad school? Where to apply for your first position?
  • What, to you, is a mark of career success? Have you achieved that success?  What has helped or hindered your pursuit of success?
  • Do you think sociology, as a field, cares about prestige?
  • Let’s talk a little bit about intersectionality. How does being first-gen/working class work alongside other identities that are important to you?
  • What do your friends and family think about your career? Have you had any difficulty relating to family members or past friends since becoming highly educated?
  • Do you have any debt from college/grad school? Are you concerned about this?  Could you explain more about how you paid for college/grad school?  (here, include assistance from family, fellowships, scholarships, etc.)
  • (You’ve mentioned issues or obstacles you had because of your background.) What could have helped?  Or, who or what did? Can you think of fortuitous moments in your career?
  • Do you have any regrets about the path you took?
  • Is there anything else you would like to add? Anything that the Taskforce should take note of, that we did not ask you about here?

Further Readings

Britten, Nicky. 1995. “Qualitative Interviews in Medical Research.” BMJ: British Medical Journal 31(6999):251–253. A good basic overview of interviewing particularly useful for students of public health and medical research generally.

Corbin, Juliet, and Janice M. Morse. 2003. “The Unstructured Interactive Interview: Issues of Reciprocity and Risks When Dealing with Sensitive Topics.” Qualitative Inquiry 9(3):335–354. Weighs the potential benefits and harms of conducting interviews on topics that may cause emotional distress. Argues that the researcher’s skills and code of ethics should ensure that the interviewing process provides more of a benefit to both participant and researcher than a harm to the former.

Gerson, Kathleen, and Sarah Damaske. 2020. The Science and Art of Interviewing . New York: Oxford University Press. A useful guidebook/textbook for both undergraduates and graduate students, written by sociologists.

Kvale, Steiner. 2007. Doing Interviews . London: SAGE. An easy-to-follow guide to conducting and analyzing interviews by psychologists.

Lamont, Michèle, and Ann Swidler. 2014. “Methodological Pluralism and the Possibilities and Limits of Interviewing.” Qualitative Sociology 37(2):153–171. Written as a response to various debates surrounding the relative value of interview-based studies and ethnographic studies defending the particular strengths of interviewing. This is a must-read article for anyone seriously engaging in qualitative research!

Pugh, Allison J. 2013. “What Good Are Interviews for Thinking about Culture? Demystifying Interpretive Analysis.” American Journal of Cultural Sociology 1(1):42–68. Another defense of interviewing written against those who champion ethnographic methods as superior, particularly in the area of studying culture. A classic.

Rapley, Timothy John. 2001. “The ‘Artfulness’ of Open-Ended Interviewing: Some considerations in analyzing interviews.” Qualitative Research 1(3):303–323. Argues for the importance of “local context” of data production (the relationship built between interviewer and interviewee, for example) in properly analyzing interview data.

Weiss, Robert S. 1995. Learning from Strangers: The Art and Method of Qualitative Interview Studies . New York: Simon and Schuster. A classic and well-regarded textbook on interviewing. Because Weiss has extensive experience conducting surveys, he contrasts the qualitative interview with the survey questionnaire well; particularly useful for those trained in the latter.

  • I say “normally” because how people understand their various identities can itself be an expansive topic of inquiry. Here, I am merely talking about collecting otherwise unexamined demographic data, similar to how we ask people to check boxes on surveys. ↵
  • Again, this applies to “semistructured in-depth interviewing.” When conducting standardized questionnaires, you will want to ask each question exactly as written, without deviations! ↵
  • I always include “INT” in the number because I sometimes have other kinds of data with their own numbering: FG#001 would mean the first focus group, for example. I also always include three-digit spaces, as this allows for up to 999 interviews (or, more realistically, allows for me to interview up to one hundred persons without having to reset my numbering system). ↵

A method of data collection in which the researcher asks the participant questions; the answers to these questions are often recorded and transcribed verbatim. There are many different kinds of interviews - see also semistructured interview , structured interview , and unstructured interview .

A document listing key questions and question areas for use during an interview.  It is used most often for semi-structured interviews.  A good interview guide may have no more than ten primary questions for two hours of interviewing, but these ten questions will be supplemented by probes and relevant follow-ups throughout the interview.  Most IRBs require the inclusion of the interview guide in applications for review.  See also interview and  semi-structured interview .

A data-collection method that relies on casual, conversational, and informal interviewing.  Despite its apparent conversational nature, the researcher usually has a set of particular questions or question areas in mind but allows the interview to unfold spontaneously.  This is a common data-collection technique among ethnographers.  Compare to the semi-structured or in-depth interview .

A form of interview that follows a standard guide of questions asked, although the order of the questions may change to match the particular needs of each individual interview subject, and probing “follow-up” questions are often added during the course of the interview.  The semi-structured interview is the primary form of interviewing used by qualitative researchers in the social sciences.  It is sometimes referred to as an “in-depth” interview.  See also interview and  interview guide .

The cluster of data-collection tools and techniques that involve observing interactions between people, the behaviors, and practices of individuals (sometimes in contrast to what they say about how they act and behave), and cultures in context.  Observational methods are the key tools employed by ethnographers and Grounded Theory .

Follow-up questions used in a semi-structured interview  to elicit further elaboration.  Suggested prompts can be included in the interview guide  to be used/deployed depending on how the initial question was answered or if the topic of the prompt does not emerge spontaneously.

A form of interview that follows a strict set of questions, asked in a particular order, for all interview subjects.  The questions are also the kind that elicits short answers, and the data is more “informative” than probing.  This is often used in mixed-methods studies, accompanying a survey instrument.  Because there is no room for nuance or the exploration of meaning in structured interviews, qualitative researchers tend to employ semi-structured interviews instead.  See also interview.

The point at which you can conclude data collection because every person you are interviewing, the interaction you are observing, or content you are analyzing merely confirms what you have already noted.  Achieving saturation is often used as the justification for the final sample size.

An interview variant in which a person’s life story is elicited in a narrative form.  Turning points and key themes are established by the researcher and used as data points for further analysis.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Neurol Res Pract

Logo of neurrp

How to use and assess qualitative research methods

Loraine busetto.

1 Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany

Wolfgang Wick

2 Clinical Cooperation Unit Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany

Christoph Gumbinger

Associated data.

Not applicable.

This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.

The aim of this paper is to provide an overview of qualitative research methods, including hands-on information on how they can be used, reported and assessed. This article is intended for beginning qualitative researchers in the health sciences as well as experienced quantitative researchers who wish to broaden their understanding of qualitative research.

What is qualitative research?

Qualitative research is defined as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” , but excluding “their range, frequency and place in an objectively determined chain of cause and effect” [ 1 ]. This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ].

Why conduct qualitative research?

Because some research questions cannot be answered using (only) quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ]. A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors – but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed.

While qualitative research is common in other fields, it is still relatively underrepresented in health services research. The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs (...) " [ 4 ]. This focus on quantitative research and specifically randomised controlled trials (RCT) is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ]. Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand – "questions before methods" [ 2 , 7 – 9 ]. This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them. Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention – essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ] . Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, (...) are not compromises in learning how to improve; they are superior" [ 8 ].

Research problems that can be approached particularly well using qualitative methods include assessing complex multi-component interventions or systems (of change), addressing questions beyond “what works”, towards “what works for whom when, how and why”, and focussing on intervention improvement rather than accreditation [ 7 , 9 – 12 ]. Using qualitative methods can also help shed light on the “softer” side of medical treatment. For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

How to conduct qualitative research?

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. As Fossey puts it : “sampling, data collection, analysis and interpretation are related to each other in a cyclical (iterative) manner, rather than following one after another in a stepwise approach” [ 15 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.  1 , this can involve several back-and-forth steps between data collection and analysis where new insights and experiences can lead to adaption and expansion of the original plan. Some insights may also necessitate a revision of the research question and/or the research design as a whole. The process ends when saturation is achieved, i.e. when no relevant new information can be found (see also below: sampling and saturation). For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented.

An external file that holds a picture, illustration, etc.
Object name is 42466_2020_59_Fig1_HTML.jpg

Iterative research process

While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research (e.g. constructivism or interpretivism as opposed to positivism). The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ].

Data collection

The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study

Document study (also called document analysis) refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.

Observations

Observations are particularly useful to gain insights into a certain setting and actual behaviour – as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. In non-participant observations, the observer is “on the outside looking in”, i.e. present in but not part of the situation, trying not to influence the setting by their presence. Observations can be planned (e.g. for 3 h during the day or night shift) or ad hoc (e.g. as soon as a stroke patient arrives at the emergency room). During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups. Written notes can be taken during or after the observations, depending on feasibility (which is usually lower during participant observations) and acceptability (e.g. when the observer is perceived to be judging the observed). Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions. Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Semi-structured interviews

Hijmans & Kuyper describe qualitative interviews as “an exchange with an informal character, a conversation with a goal” [ 19 ]. Interviews are used to gain insights into a person’s subjective experiences, opinions and motivations – as opposed to facts or behaviours [ 13 ]. Interviews can be distinguished by the degree to which they are structured (i.e. a questionnaire), open (e.g. free conversation or autobiographical interviews) or semi-structured [ 2 , 13 ]. Semi-structured interviews are characterized by open-ended questions and the use of an interview guide (or topic guide/list) in which the broad areas of interest, sometimes including sub-questions, are defined [ 19 ]. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e.g. document study or observations. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different (blocks of) questions may differ and some questions may be skipped altogether (e.g. if the interviewee is not able or willing to answer the questions or for concerns about the total length of the interview) [ 20 ]. Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher. This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ].

Focus groups

Focus groups are group interviews to explore participants’ expertise and experiences, including explorations of how and why people behave in certain ways [ 1 ]. Focus groups usually consist of 6–8 people and are led by an experienced moderator following a topic guide or “script” [ 21 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ]. Depending on researchers’ and participants’ preferences, the discussions can be audio- or video-taped and transcribed afterwards [ 21 ]. Focus groups are useful for bringing together homogeneous (to a lesser extent heterogeneous) groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ]. Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i.e. “the sharing and comparing” among participants [ 21 ]. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ]. Moreover, attention must be paid to the emergence of “groupthink” as well as possible power dynamics within the group, e.g. when patients are awed or intimidated by health professionals.

Choosing the “right” method

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this – i.e. the “fit” between question and method [ 14 ]. It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results.

Let us assume that our research aim is to examine the (clinical) processes around acute endovascular treatment (EVT), from the patient’s arrival at the emergency room to recanalization, with the aim to identify possible causes for delay and/or other causes for sub-optimal treatment outcome. As a first step, we could conduct a document study of the relevant standard operating procedures (SOPs) for this phase of care – are they up-to-date and in line with current guidelines? Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs. These results can (and should) be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation? It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Are the physicians simply not aware of the SOPs (because their existence is limited to the hospital’s intranet) or do they actively disagree with them or does the infrastructure make it impossible to provide the care as described? Another rationale for adding interviews is that some situations (or all of their possible variations for different patient groups or the day, night or weekend shift) cannot practically or ethically be observed. In this case, it is possible to ask those involved to report on their actions – being aware that this is not the same as the actual observation. A senior physician’s or hospital manager’s description of certain situations might differ from a nurse’s or junior physician’s one, maybe because they intentionally misrepresent facts or maybe because different aspects of the process are visible or important to them. In some cases, it can also be relevant to consider to whom the interviewee is disclosing this information – someone they trust, someone they are otherwise not connected to, or someone they suspect or are aware of being in a potentially “dangerous” power relationship to them. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT. The discussion might reveal discrepancies (between SOPs and actual care or between different physicians) and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves. For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by (senior) physicians only. The resulting combination of data collection methods is shown in Fig.  2 .

An external file that holds a picture, illustration, etc.
Object name is 42466_2020_59_Fig2_HTML.jpg

Possible combination of data collection methods

Attributions for icons: “Book” by Serhii Smirnov, “Interview” by Adrien Coquet, FR, “Magnifying Glass” by anggun, ID, “Business communication” by Vectors Market; all from the Noun Project

The combination of multiple data source as described for this example can be referred to as “triangulation”, in which multiple measurements are carried out from different angles to achieve a more comprehensive understanding of the phenomenon under study [ 22 , 23 ].

Data analysis

To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts (see Fig.  3 ). Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour (e.g. laughing, crying, pausing) and with or without phonetic transcription of dialects and filler words, depending on what is expected or known to be relevant for the analysis. In the next step, the protocols and transcripts are coded , that is, marked (or tagged, labelled) with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. Jansen describes coding as “connecting the raw data with “theoretical” terms” [ 20 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources (e.g. SOPs, emergency room observations, staff and patient interview). In a process of synthesis and abstraction, the codes are then grouped, summarised and/or categorised [ 15 , 20 ]. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ]. The coding process is performed using qualitative data management software, the most common ones being InVivo, MaxQDA and Atlas.ti. It should be noted that these are data management tools which support the analysis performed by the researcher(s) [ 14 ].

An external file that holds a picture, illustration, etc.
Object name is 42466_2020_59_Fig3_HTML.jpg

From data collection to data analysis

Attributions for icons: see Fig. ​ Fig.2, 2 , also “Speech to text” by Trevor Dsouza, “Field Notes” by Mike O’Brien, US, “Voice Record” by ProSymbols, US, “Inspection” by Made, AU, and “Cloud” by Graphic Tigers; all from the Noun Project

How to report qualitative research?

Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i.e. to pre-define and set in stone the research questions and primary or secondary endpoints. Rather, it is a way to describe the research methods in detail, which might not be possible in the results paper given journals’ word limits. Qualitative research papers are usually longer than their quantitative counterparts to allow for deep understanding and so-called “thick description”. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation. The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ]. It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement (e.g. “Five interviewees expressed negative feelings towards XYZ”) [ 21 ].

How to combine qualitative with quantitative research?

Qualitative methods can be combined with other methods in multi- or mixed methods designs, which “[employ] two or more different methods [ …] within the same study or research program rather than confining the research to one single method” [ 24 ]. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of (unexpected) results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 – 26 ]. The resulting designs can be classified according to when, why and how the different quantitative and/or qualitative data strands are combined. The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig.  4 .

An external file that holds a picture, illustration, etc.
Object name is 42466_2020_59_Fig4_HTML.jpg

Three common mixed methods designs

In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results. Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. Amongst other things, this would make it possible to assess whether interview respondents’ subjective impressions of patients receiving good care match modified Rankin Scores at follow-up, or whether observed delays in care provision are exceptions or the rule when compared to door-to-needle times as documented in the registry. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved. In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed. Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different (types of) hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups.

How to assess qualitative research?

A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ]. However, none of these has been elevated to the “gold standard” in the field. In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper.

Assessors should check the authors’ use of and adherence to the relevant reporting checklists (e.g. Standards for Reporting Qualitative Research (SRQR)) to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research (paper). Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ].

Reflexivity

While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research. This includes what is called reflexivity, i.e. sensitivity to the relationship between the researcher and the researched, including how contact was established and maintained, or the background and experience of the researcher(s) involved in data collection and analysis. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ]. It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

Sampling and saturation

The aim of qualitative sampling is for all variants of the objects of observation that are deemed relevant for the study to be present in the sample “ to see the issue and its meanings from as many angles as possible” [ 1 , 16 , 19 , 20 , 27 ] , and to ensure “information-richness [ 15 ]. An iterative sampling approach is advised, in which data collection (e.g. five interviews) is followed by data analysis, followed by more data collection to find variants that are lacking in the current sample. This process continues until no new (relevant) information can be found and further sampling becomes redundant – which is called saturation [ 1 , 15 ] . In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. This is generally referred to as “ purposive sampling” , in which researchers pre-define which types of participants or cases they need to include so as to cover all variations that are expected to be of relevance, based on the literature, previous experience or theory (i.e. theoretical sampling) [ 14 , 20 ]. Other types of purposive sampling include (but are not limited to) maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ]. In the above EVT example, a purposive sample could include all relevant professional groups and/or all relevant stakeholders (patients, relatives) and/or all relevant times of observation (day, night and weekend shift).

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ].

Good qualitative research is iterative in nature, i.e. it goes back and forth between data collection and analysis, revising and improving the approach where necessary. One example of this are pilot interviews, where different aspects of the interview (especially the interview guide, but also, for example, the site of the interview or whether the interview can be audio-recorded) are tested with a small number of respondents, evaluated and revised [ 19 ]. In doing so, the interviewer learns which wording or types of questions work best, or which is the best length of an interview with patients who have trouble concentrating for an extended time. Of course, the same reasoning applies to observations or focus groups which can also be piloted.

Ideally, coding should be performed by at least two researchers, especially at the beginning of the coding process when a common approach must be defined, including the establishment of a useful coding list (or tree), and when a common meaning of individual codes must be established [ 23 ]. An initial sub-set or all transcripts can be coded independently by the coders and then compared and consolidated after regular discussions in the research team. This is to make sure that codes are applied consistently to the research data.

Member checking

Member checking, also called respondent validation , refers to the practice of checking back with study respondents to see if the research is in line with their views [ 14 , 27 ]. This can happen after data collection or analysis or when first results are available [ 23 ]. For example, interviewees can be provided with (summaries of) their transcripts and asked whether they believe this to be a complete representation of their views or whether they would like to clarify or elaborate on their responses [ 17 ]. Respondents’ feedback on these issues then becomes part of the data collection and analysis [ 27 ].

Stakeholder involvement

In those niches where qualitative approaches have been able to evolve and grow, a new trend has seen the inclusion of patients and their representatives not only as study participants (i.e. “members”, see above) but as consultants to and active participants in the broader research process [ 31 – 33 ]. The underlying assumption is that patients and other stakeholders hold unique perspectives and experiences that add value beyond their own single story, making the research more relevant and beneficial to researchers, study participants and (future) patients alike [ 34 , 35 ]. Using the example of patients on or nearing dialysis, a recent scoping review found that 80% of clinical research did not address the top 10 research priorities identified by patients and caregivers [ 32 , 36 ]. In this sense, the involvement of the relevant stakeholders, especially patients and relatives, is increasingly being seen as a quality indicator in and of itself.

How not to assess qualitative research

The above overview does not include certain items that are routine in assessments of quantitative research. What follows is a non-exhaustive, non-representative, experience-based list of the quantitative criteria often applied to the assessment of qualitative research, as well as an explanation of the limited usefulness of these endeavours.

Protocol adherence

Given the openness and flexibility of qualitative research, it should not be assessed by how well it adheres to pre-determined and fixed strategies – in other words: its rigidity. Instead, the assessor should look for signs of adaptation and refinement based on lessons learned from earlier steps in the research process.

Sample size

For the reasons explained above, qualitative research does not require specific sample sizes, nor does it require that the sample size be determined a priori [ 1 , 14 , 27 , 37 – 39 ]. Sample size can only be a useful quality indicator when related to the research purpose, the chosen methodology and the composition of the sample, i.e. who was included and why.

Randomisation

While some authors argue that randomisation can be used in qualitative research, this is not commonly the case, as neither its feasibility nor its necessity or usefulness has been convincingly established for qualitative research [ 13 , 27 ]. Relevant disadvantages include the negative impact of a too large sample size as well as the possibility (or probability) of selecting “ quiet, uncooperative or inarticulate individuals ” [ 17 ]. Qualitative studies do not use control groups, either.

Interrater reliability, variability and other “objectivity checks”

The concept of “interrater reliability” is sometimes used in qualitative research to assess to which extent the coding approach overlaps between the two co-coders. However, it is not clear what this measure tells us about the quality of the analysis [ 23 ]. This means that these scores can be included in qualitative research reports, preferably with some additional information on what the score means for the analysis, but it is not a requirement. Relatedly, it is not relevant for the quality or “objectivity” of qualitative research to separate those who recruited the study participants and collected and analysed the data. Experiences even show that it might be better to have the same person or team perform all of these tasks [ 20 ]. First, when researchers introduce themselves during recruitment this can enhance trust when the interview takes place days or weeks later with the same researcher. Second, when the audio-recording is transcribed for analysis, the researcher conducting the interviews will usually remember the interviewee and the specific interview situation during data analysis. This might be helpful in providing additional context information for interpretation of data, e.g. on whether something might have been meant as a joke [ 18 ].

Not being quantitative research

Being qualitative research instead of quantitative research should not be used as an assessment criterion if it is used irrespectively of the research problem at hand. Similarly, qualitative research should not be required to be combined with quantitative research per se – unless mixed methods research is judged as inherently better than single-method research. In this case, the same criterion should be applied for quantitative studies without a qualitative component.

The main take-away points of this paper are summarised in Table ​ Table1. 1 . We aimed to show that, if conducted well, qualitative research can answer specific research questions that cannot to be adequately answered using (only) quantitative designs. Seeing qualitative and quantitative methods as equal will help us become more aware and critical of the “fit” between the research problem and our chosen methods: I can conduct an RCT to determine the reasons for transportation delays of acute stroke patients – but should I? It also provides us with a greater range of tools to tackle a greater range of research problems more appropriately and successfully, filling in the blind spots on one half of the methodological spectrum to better address the whole complexity of neurological research and practice.

Take-away-points

Acknowledgements

Abbreviations, authors’ contributions.

LB drafted the manuscript; WW and CG revised the manuscript; all authors approved the final versions.

no external funding.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

  • Knowledge Base

Methodology

  • Unstructured Interview | Definition, Guide & Examples

Unstructured Interview | Definition, Guide & Examples

Published on January 27, 2022 by Tegan George . Revised on June 22, 2023.

An unstructured interview is a data collection method that relies on asking participants questions to collect data on a topic. Also known as non-directive interviewing , unstructured interviews do not have a set pattern and questions are not arranged in advance.

In research, unstructured interviews are usually qualitative in nature, and can be very helpful for social science or humanities research focusing on personal experiences.

An unstructured interview can be a particularly useful exploratory research tool. Known for being very informal and flexible, they can yield captivating responses from your participants.

  • Structured interviews : The questions are predetermined in both topic and order.
  • Semi-structured interviews : A few questions are predetermined, but other questions aren’t planned.
  • Focus group interviews : The questions are presented to a group instead of one individual.

Table of contents

What is an unstructured interview, when to use an unstructured interview, advantages of unstructured interviews, disadvantages of unstructured interviews, unstructured interview questions, how to conduct an unstructured interview, how to analyze an unstructured interview, presenting your results, other interesting articles, frequently asked questions about unstructured interviews.

An unstructured interview is the most flexible type of interview, with room for spontaneity. In contrast to a structured interview , the questions and the order in which they are presented are not set. Instead, the interview proceeds based on the participant’s previous answers.

Unstructured interviews are open-ended. This lack of structure can help you gather detailed information on your topic, while still allowing you to observe patterns in the analysis stage.

It can be challenging to know what type of interview best fits your subject matter. Unstructured interviews can be very challenging to conduct, and may not always be the best fit for your research question . Unstructured interviews are best used when:

  • You are an experienced interviewer and have a very strong background in your research topic.
  • Your research question is exploratory in nature. While you may have developed hypotheses, you are open to discovering new or shifting viewpoints.
  • You are seeking descriptive data, and are ready to ask questions that will deepen and contextualize your initial thoughts and hypotheses .
  • Your research depends on forming connections with your participants and making them feel comfortable revealing deeper emotions, thoughts, or lived experiences.

Even more so than in structured or semi-structured interviews, it is critical that you remain organized and develop a system for keeping track of participant responses. Since the questions are not set beforehand, the data collection and analysis becomes more complex.

Differences between different types of interviews

Make sure to choose the type of interview that suits your research best. This table shows the most important differences between the four types.

Unstructured interviews have a few advantages compared to other types of interviews.

Very flexible

Respondents are more at ease, reduced risk of bias, more detail and nuance.

Unstructured interviews also have a few downsides compared to other data collection methods.

Low generalizability and reliability

Risk of leading questions, very time-consuming, risk of low internal validity.

It can be challenging to ask unstructured interview questions that get you the information you seek without biasing your responses. You will have to rely on the flow of the conversation and the cues you pick up from your participants.

Here are a few tips:

  • Since you won’t be designing set questions ahead of time, it’s important to feel sufficiently comfortable with your topic that you can come up with questions spontaneously.
  • Write yourself a guide with notes about your topic and what you’re seeking to investigate or gain from your interviews, so you have notes to refer back to.
  • Try to ask questions that encourage your participant to answer at length. Avoid closed-ended questions that can be answered with a simple “yes” or “no.”
  • Relatedly, focus on “how” questions rather than “why” questions to help put your participants at ease and avoid any feelings of defensiveness or anxiety.
  • Consider beginning the interview with an icebreaker or a “freebie” question, to start on a relaxed and comfortable note before delving into the more sensitive topics.

Here are a few possibilities for how your conversation could proceed:

Conversation A: 

  • Interviewer: Do you go to the gym? How often?
  • Participant: I go to the gym 5 times per week.
  • Interviewer: What feelings does going to the gym bring out in you?
  • Participant: I don’t feel like myself unless I go to the gym.

Since the participant hinted that going to the gym is important for their mental health, proceed with questions in that vein, such as:

  • You say you “don’t feel like yourself.” Can you elaborate?
  • If you have to skip a gym day, how does that make you feel?
  • Is there anything else that makes you feel the way going to the gym does?

Conversation B:

  • Participant: No, I hate the gym.

Since the participant seems to have strong feelings against the gym, you can probe deeper.

  • What makes you feel this way about the gym?
  • What do you like to do instead?
  • Do your feelings about the gym reflect on your feelings about exercise in general?

Once you’ve determined that an unstructured interview is the right fit for your research topic , you can proceed with the following steps.

Step 1: Set your goals and foundations

As you conceptualize your research question, consider starting with some guiding questions, such as:

  • What are you trying to learn or achieve from an unstructured interview specifically?
  • Why is an unstructured interview the best fit for your research, as opposed to a different type of interview or another research method ?
  • What is the guiding force behind your research? What topic will serve as the foundation for your unscripted and follow-up questions?

While you do not need to plan your questions ahead of time for an unstructured interview, this does not mean that no advanced planning is needed. Unstructured interviews actually require extensive planning ahead to ensure that the interview stage will be fruitful.

  • Perhaps you have been studying it for quite some time, or you have previously conducted another type of research on a similar topic.
  • Maybe you are seeking a bit more detail or nuance to confirm or challenge past results, or you are interested in delving deeper into a particular question that arose from past research.

Once you are feeling really solid about your research question, you can start brainstorming categories of questions you may ask. You can start with one broad, overarching question and brainstorm what paths the conversation could take.

Step 2: Assemble your participants

There are a few sampling methods you can use to recruit your interview participants, such as:

  • Voluntary response sampling : For example, posting flyers in the dining hall and seeing who answers.
  • Stratified sampling of a particular age, race, or gender identity that is relevant to your research.
  • Convenience sampling of other students at your university, colleagues or friends.

Step 3: Decide on your setting

You should decide ahead of time whether your interview will be conducted in-person, over the phone, or via video conferencing.

In-person, phone, or video interviews each have their own advantages and disadvantages.

  • In general, live interviews can lead to nervousness or interviewer effects, where the respondent feels pressured to respond in a manner they perceive will please you.
  • Videoconferencing specifically can feel awkward or stilted, which could affect your results. However, your participant may be more comfortable in their own home.
  • Not being face-to-face with respondents, such as in a phone interview, could lead to more honest answers. However, there could be environmental conditions or distractions on the participant side that could affect their responses.
  • Consent to video- or audio-recording
  • Signature of a confidentiality agreement
  • Signature of an agreement to anonymize or pseudonymize data.

Step 4: Conduct your interviews

As you conduct your interviews, pay special attention to any environmental conditions that could bias your responses. This includes noises, temperature, and setting, but also your body language. Be careful to moderate your tone of voice and any responses to avoid interviewer effects.

Remember that one of the biggest challenges with unstructured interviews is to keep your questions neutral and unbiased. Strive for open-ended phrasing, and allow your participants to set the pace, asking follow-up questions that flow naturally from their last answer.

After you’re finished conducting your interviews, you move into the analysis phase. Don’t forget to assign each participant a pseudonym (such as a number or letter) to be sure you stay organized.

First, transcribe your recorded interviews. You can then conduct content or thematic analysis to create your categories, seeking patterns that stand out to you among your responses and testing your hypotheses .

Transcribing interviews

The transcription process can be quite lengthy for unstructured interviews due to their more detailed nature. One decision that can save you quite a bit of time before you get started is whether you will be conducting verbatim transcription or intelligent verbatim transcription.

  • If you consider that laughter, hesitations, or filler words like “umm” affect your analysis and research conclusions, you should conduct verbatim transcription and include them.
  • If not, intelligent verbatim transcription allows you to exclude fillers and fix any grammar issues in your transcription. Intelligent verbatim transcription can save you some time in this step.

Transcribing has the added benefit of being a great opportunity for cleansing your data . While you listen, you can take notes of questions or inconsistencies that come up.

Note that in some cases, your supervisor may ask you to add the finished transcriptions in the appendix of your research paper .

Coding unstructured interviews

After you’re finished transcribing, you can begin your thematic or content analysis . Here, you separate words, patterns, or recurring responses that stand out to you into labels or categories for later analysis. This process is called “coding.”

Due to the open-ended nature of unstructured interviews, you will most likely proceed with thematic analysis, rather than content analysis. In thematic analysis, you draw preliminary conclusions about your participants through identifying common topics, ideas, or patterns in their responses.

  • After you have familiarized yourself sufficiently with your responses, you can separate them into different codes or labels.
  • However, codes can be a bit too specific or niche for robust analysis. You can proceed by grouping similar codes into broader themes.
  • After identifying your themes, be sure to double-check your responses to ensure that the themes you chose appropriately represent your data.

Analyzing unstructured interviews

Once you’re confident with your preliminary thoughts, you can take either an inductive or a deductive approach in your analysis.

  • An inductive approach is more open-ended, allowing your data to then determine your themes.
  • A deductive approach is the opposite, and involves investigating whether your data confirm preconceived themes or ideas.

Thematic analysis is quite subjective, which can lead to issues with the reliability of your results. The unstructured nature of this type of interview leads to greater dependence on your judgment and interpretations. Be extra vigilant about remaining objective here.

After your data analysis, you’re ready to combine your findings into a research paper .

  • Your methodology section describes your data collection process (in this case, describing your unstructured interview process) and explains how you justified and conceptualized your analysis.
  • Your discussion and results sections usually describe each of your coded categories, and give you the opportunity to showcase your argument.
  • You can then conclude with your main takeaways and avenues for further study.
  • Since unstructured interviews are predominantly exploratory in nature, you can add suggestions for future research in the discussion section .

Example of interview methodology for a research paper

Let’s say you are a history student particularly interested in the history of the town around your campus. The town has a long history dating back to the early 1600s, but town census data shows that many long-term residents have been moving away in recent years.

You identify a few potential reasons for this shift:

  • People are moving away because there are better opportunities in the closest big city
  • The university has been aggressively purchasing real estate to build more student housing
  • The university has long been the main source of jobs for the town, and education budget cuts have led to a hiring freeze
  • The cost of living in the area has skyrocketed in recent years, and long-time residents can no longer afford their property taxes

Anecdotally, you hypothesize that the increased cost of living is the predominant factor in driving away long-time residents. However, you cannot rule out the possibility of the other options, specifically the lack of job options coupled with the university’s expansionist aims.

You feel very comfortable with this topic and oral histories in general. Since it is exploratory in nature but has the potential to become sensitive or emotional, you decide to conduct unstructured interviews with long-term residents of your town. Multi-generational residents are of particular interest.

To find the right mix of participants, you post in the Facebook group for town residents, as well as in the town’s NextDoor forum. You also post flyers in local coffee shops and even some mailboxes.

Once you’ve assembled your participants, it’s time to proceed with your interviews. Consider starting out with an icebreaker, such as:

  • What is your favorite thing about this town?
  • Tell me about a memory of the town that you have that’s particularly special.

You can then proceed with the interview, asking follow-up questions relevant to your participants’ responses, probing their family history, ties to the community, or any stories they have to share– whether funny, touching, or sentimental.

Establishing rapport with your participants helps you delve into the reasoning behind the choice to stay or leave, and competing thoughts and feelings they may have as the interview goes on. Remember to try to structure it like a conversation, to put them more at ease with the emotional topics.

  • Has increased cost of living led to you considering leaving the area? → The phrasing implies that you, the interviewer, think this is the case. This could bias your respondents, incentivizing them to answer affirmatively as well.
  • Are there any factors that would lead to you considering leaving the area? → This phrasing ensures the participant is giving their own opinion, and may even yield some surprising responses that enrich your analysis.

After conducting your interviews and transcribing your data, you can then conduct thematic analysis, coding responses into different categories. Since you began your research with several theories for why residents may be leaving that all seemed plausible, you would use the inductive approach.

After identifying the relevant themes from your data, you can draw inferences and conclusions. Your results section usually addresses each theme or pattern you found, describing each in turn, as well as how often you came across them in your analysis.

Perhaps one reason in particular really jumped out from responses, or maybe it was more of a mixed bag. Explain why you think this could be the case, and feel free to include lots of (properly anonymized) examples from the data to better illustrate your points.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

  • Student’s  t -distribution
  • Normal distribution
  • Null and Alternative Hypotheses
  • Chi square tests
  • Confidence interval
  • Quartiles & Quantiles
  • Cluster sampling
  • Stratified sampling
  • Data cleansing
  • Reproducibility vs Replicability
  • Peer review
  • Prospective cohort study

Research bias

  • Implicit bias
  • Cognitive bias
  • Placebo effect
  • Hawthorne effect
  • Hindsight bias
  • Affect heuristic
  • Social desirability bias

An unstructured interview is the most flexible type of interview, but it is not always the best fit for your research topic.

Unstructured interviews are best used when:

  • You are an experienced interviewer and have a very strong background in your research topic, since it is challenging to ask spontaneous, colloquial questions.
  • Your research question is exploratory in nature. While you may have developed hypotheses, you are open to discovering new or shifting viewpoints through the interview process.
  • You are seeking descriptive data, and are ready to ask questions that will deepen and contextualize your initial thoughts and hypotheses.
  • Your research depends on forming connections with your participants and making them feel comfortable revealing deeper emotions, lived experiences, or thoughts.

The four most common types of interviews are:

  • Structured interviews : The questions are predetermined in both topic and order. 
  • Unstructured interviews : None of the questions are predetermined.

There are various approaches to qualitative data analysis , but they all share five steps in common:

  • Prepare and organize your data.
  • Review and explore your data.
  • Develop a data coding system.
  • Assign codes to the data.
  • Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

The interviewer effect is a type of bias that emerges when a characteristic of an interviewer (race, age, gender identity, etc.) influences the responses given by the interviewee.

There is a risk of an interviewer effect in all types of interviews , but it can be mitigated by writing really high-quality interview questions.

Social desirability bias is the tendency for interview participants to give responses that will be viewed favorably by the interviewer or other participants. It occurs in all types of interviews and surveys , but is most common in semi-structured interviews , unstructured interviews , and focus groups .

Social desirability bias can be mitigated by ensuring participants feel at ease and comfortable sharing their views. Make sure to pay attention to your own body language and any physical or verbal cues, such as nodding or widening your eyes.

This type of bias can also occur in observations if the participants know they’re being observed. They might alter their behavior accordingly.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

George, T. (2023, June 22). Unstructured Interview | Definition, Guide & Examples. Scribbr. Retrieved March 12, 2024, from https://www.scribbr.com/methodology/unstructured-interview/

Is this article helpful?

Tegan George

Tegan George

Other students also liked, what is a focus group | step-by-step guide & examples, structured interview | definition, guide & examples, semi-structured interview | definition, guide & examples, what is your plagiarism score.

The Interview Method In Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, Ph.D., is a qualified psychology teacher with over 18 years experience of working in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Interviews involve a conversation with a purpose, but have some distinct features compared to ordinary conversation, such as being scheduled in advance, having an asymmetry in outcome goals between interviewer and interviewee, and often following a question-answer format.

Interviews are different from questionnaires as they involve social interaction. Unlike questionnaire methods, researchers need training in interviewing (which costs money).

Multiracial businesswomen talk brainstorm at team meeting discuss business ideas together. Diverse multiethnic female colleagues or partners engaged in discussion. Interview concept

How Do Interviews Work?

Researchers can ask different types of questions, generating different types of data . For example, closed questions provide people with a fixed set of responses, whereas open questions allow people to express what they think in their own words.

The researcher will often record interviews, and the data will be written up as a transcript (a written account of interview questions and answers) which can be analyzed later.

It should be noted that interviews may not be the best method for researching sensitive topics (e.g., truancy in schools, discrimination, etc.) as people may feel more comfortable completing a questionnaire in private.

There are different types of interviews, with a key distinction being the extent of structure. Semi-structured is most common in psychology research. Unstructured interviews have a free-flowing style, while structured interviews involve preset questions asked in a particular order.

Structured Interview

A structured interview is a quantitative research method where the interviewer a set of prepared closed-ended questions in the form of an interview schedule, which he/she reads out exactly as worded.

Interviews schedules have a standardized format, meaning the same questions are asked to each interviewee in the same order (see Fig. 1).

interview schedule example

   Figure 1. An example of an interview schedule

The interviewer will not deviate from the interview schedule (except to clarify the meaning of the question) or probe beyond the answers received.  Replies are recorded on a questionnaire, and the order and wording of questions, and sometimes the range of alternative answers, is preset by the researcher.

A structured interview is also known as a formal interview (like a job interview).

  • Structured interviews are easy to replicate as a fixed set of closed questions are used, which are easy to quantify – this means it is easy to test for reliability .
  • Structured interviews are fairly quick to conduct which means that many interviews can take place within a short amount of time. This means a large sample can be obtained, resulting in the findings being representative and having the ability to be generalized to a large population.

Limitations

  • Structured interviews are not flexible. This means new questions cannot be asked impromptu (i.e., during the interview), as an interview schedule must be followed.
  • The answers from structured interviews lack detail as only closed questions are asked, which generates quantitative data . This means a researcher won’t know why a person behaves a certain way.

Unstructured Interview

Unstructured interviews do not use any set questions, instead, the interviewer asks open-ended questions based on a specific research topic, and will try to let the interview flow like a natural conversation. The interviewer modifies his or her questions to suit the candidate’s specific experiences.

Unstructured interviews are sometimes referred to as ‘discovery interviews’ and are more like a ‘guided conservation’ than a strictly structured interview. They are sometimes called informal interviews.

Unstructured interviews are most useful in qualitative research to analyze attitudes and values. Though they rarely provide a valid basis for generalization, their main advantage is that they enable the researcher to probe social actors’ subjective points of view.

Interviewer Self-Disclosure

Interviewer self-disclosure involves the interviewer revealing personal information or opinions during the research interview. This may increase rapport but risks changing dynamics away from a focus on facilitating the interviewee’s account.

In unstructured interviews, the informal conversational style may deliberately include elements of interviewer self-disclosure, mirroring ordinary conversation dynamics.

Interviewer self-disclosure risks changing the dynamics away from facilitation of interviewee accounts. It should not be ruled out entirely but requires skillful handling informed by reflection.

  • An informal interviewing style with some interviewer self-disclosure may increase rapport and participant openness. However, it also increases the chance of the participant converging opinions with the interviewer.
  • Complete interviewer neutrality is unlikely. However, excessive informality and self-disclosure risk the interview becoming more of an ordinary conversation and producing consensus accounts.
  • Overly personal disclosures could also be seen as irrelevant and intrusive by participants. They may invite increased intimacy on uncomfortable topics.
  • The safest approach seems to be to avoid interviewer self-disclosures in most cases. Where an informal style is used, disclosures require careful judgment and substantial interviewing experience.
  • If asked for personal opinions during an interview, the interviewer could highlight the defined roles and defer that discussion until after the interview.
  • Unstructured interviews are more flexible as questions can be adapted and changed depending on the respondents’ answers. The interview can deviate from the interview schedule.
  • Unstructured interviews generate qualitative data through the use of open questions. This allows the respondent to talk in some depth, choosing their own words. This helps the researcher develop a real sense of a person’s understanding of a situation.
  • They also have increased validity because it gives the interviewer the opportunity to probe for a deeper understanding, ask for clarification & allow the interviewee to steer the direction of the interview, etc. Interviewers have the chance to clarify any questions of participants during the interview.
  • It can be time-consuming to conduct an unstructured interview and analyze the qualitative data (using methods such as thematic analysis).
  • Employing and training interviewers is expensive and not as cheap as collecting data via questionnaires . For example, certain skills may be needed by the interviewer. These include the ability to establish rapport and knowing when to probe.
  • Interviews inevitably co-construct data through researchers’ agenda-setting and question-framing. Techniques like open questions provide only limited remedies.

Focus Group Interview

Focus group interview is a qualitative approach where a group of respondents are interviewed together, used to gain an in‐depth understanding of social issues.

This type of interview is often referred to as a focus group because the job of the interviewer ( or moderator ) is to bring the group to focus on the issue at hand. Initially, the goal was to reach a consensus among the group, but with the development of techniques for analyzing group qualitative data, there is less emphasis on consensus building.

The method aims to obtain data from a purposely selected group of individuals rather than from a statistically representative sample of a broader population.

The role of the interview moderator is to make sure the group interacts with each other and do not drift off-topic. Ideally, the moderator will be similar to the participants in terms of appearance, have adequate knowledge of the topic being discussed, and exercise mild unobtrusive control over dominant talkers and shy participants.

A researcher must be highly skilled to conduct a focus group interview. For example, the moderator may need certain skills, including the ability to establish rapport and know when to probe.

  • Group interviews generate qualitative narrative data through the use of open questions. This allows the respondents to talk in some depth, choosing their own words. This helps the researcher develop a real sense of a person’s understanding of a situation. Qualitative data also includes observational data, such as body language and facial expressions.
  • Group responses are helpful when you want to elicit perspectives on a collective experience, encourage diversity of thought, reduce researcher bias, and gather a wider range of contextualized views.
  • They also have increased validity because some participants may feel more comfortable being with others as they are used to talking in groups in real life (i.e., it’s more natural).
  • When participants have common experiences, focus groups allow them to build on each other’s comments to provide richer contextual data representing a wider range of views than individual interviews.
  • Focus groups are a type of group interview method used in market research and consumer psychology that are cost – effective for gathering the views of consumers .
  • The researcher must ensure that they keep all the interviewees” details confidential and respect their privacy. This is difficult when using a group interview. For example, the researcher cannot guarantee that the other people in the group will keep information private.
  • Group interviews are less reliable as they use open questions and may deviate from the interview schedule, making them difficult to repeat.
  • It is important to note that there are some potential pitfalls of focus groups, such as conformity, social desirability, and oppositional behavior, that can reduce the usefulness of the data collected.
For example, group interviews may sometimes lack validity as participants may lie to impress the other group members. They may conform to peer pressure and give false answers.

To avoid these pitfalls, the interviewer needs to have a good understanding of how people function in groups as well as how to lead the group in a productive discussion.

Semi-Structured Interview

Semi-structured interviews lie between structured and unstructured interviews. The interviewer prepares a set of same questions to be answered by all interviewees. Additional questions might be asked during the interview to clarify or expand certain issues.

In semi-structured interviews, the interviewer has more freedom to digress and probe beyond the answers. The interview guide contains a list of questions and topics that need to be covered during the conversation, usually in a particular order.

Semi-structured interviews are most useful to address the ‘what’, ‘how’, and ‘why’ research questions. Both qualitative and quantitative analyses can be performed on data collected during semi-structured interviews.

  • Semi-structured interviews allow respondents to answer more on their terms in an informal setting yet provide uniform information making them ideal for qualitative analysis.
  • The flexible nature of semi-structured interviews allows ideas to be introduced and explored during the interview based on the respondents’ answers.
  • Semi-structured interviews can provide reliable and comparable qualitative data. Allows the interviewer to probe answers, where the interviewee is asked to clarify or expand on the answers provided.
  • The data generated remain fundamentally shaped by the interview context itself. Analysis rarely acknowledges this endemic co-construction.
  • They are more time-consuming (to conduct, transcribe, and analyze) than structured interviews.
  • The quality of findings is more dependent on the individual skills of the interviewer than in structured interviews. Skill is required to probe effectively while avoiding biasing responses.

The Interviewer Effect

Face-to-face interviews raise methodological problems. These stem from the fact that interviewers are themselves role players, and their perceived status may influence the replies of the respondents.

Because an interview is a social interaction, the interviewer’s appearance or behavior may influence the respondent’s answers. This is a problem as it can bias the results of the study and make them invalid.

For example, the gender, ethnicity, body language, age, and social status of the interview can all create an interviewer effect. If there is a perceived status disparity between the interviewer and the interviewee, the results of interviews have to be interpreted with care. This is pertinent for sensitive topics such as health.

For example, if a researcher was investigating sexism amongst males, would a female interview be preferable to a male? It is possible that if a female interviewer was used, male participants might lie (i.e., pretend they are not sexist) to impress the interviewer, thus creating an interviewer effect.

Flooding interviews with researcher’s agenda

The interactional nature of interviews means the researcher fundamentally shapes the discourse, rather than just neutrally collecting it. This shapes what is talked about and how participants can respond.
  • The interviewer’s assumptions, interests, and categories don’t just shape the specific interview questions asked. They also shape the framing, task instructions, recruitment, and ongoing responses/prompts.
  • This flooding of the interview interaction with the researcher’s agenda makes it very difficult to separate out what comes from the participant vs. what is aligned with the interviewer’s concerns.
  • So the participant’s talk ends up being fundamentally shaped by the interviewer rather than being a more natural reflection of the participant’s own orientations or practices.
  • This effect is hard to avoid because interviews inherently involve the researcher setting an agenda. But it does mean the talk extracted may say more about the interview process than the reality it is supposed to reflect.

Interview Design

First, you must choose whether to use a structured or non-structured interview.

Characteristics of Interviewers

Next, you must consider who will be the interviewer, and this will depend on what type of person is being interviewed. There are several variables to consider:

  • Gender and age : This can greatly affect respondents’ answers, particularly on personal issues.
  • Personal characteristics : Some people are easier to get on with than others. Also, the interviewer’s accent and appearance (e.g., clothing) can affect the rapport between the interviewer and interviewee.
  • Language : The interviewer’s language should be appropriate to the vocabulary of the group of people being studied. For example, the researcher must change the questions’ language to match the respondents’ social background” age / educational level / social class/ethnicity, etc.
  • Ethnicity : People may have difficulty interviewing people from different ethnic groups.
  • Interviewer expertise should match research sensitivity – inexperienced students should avoid interviewing highly vulnerable groups.

Interview Location

The location of a research interview can influence the way in which the interviewer and interviewee relate and may exaggerate a power dynamic in one direction or another. It is usual to offer interviewees a choice of location as part of facilitating their comfort and encouraging participation.

However, the safety of the interviewer is an overriding consideration and, as mentioned, a minimal requirement should be that a responsible person knows where the interviewer has gone and when they are due back.

Remote Interviews

The COVID-19 pandemic necessitated remote interviewing for research continuity. However online interview platforms provide increased flexibility even under normal conditions.

They enable access to participant groups across geographical distances without travel costs or arrangements. Online interviews can be efficiently scheduled to align with researcher and interviewee availability.

There are practical considerations in setting up remote interviews. Interviewees require access to internet and an online platform such as Zoom, Microsoft Teams or Skype through which to connect.

Certain modifications help build initial rapport in the remote format. Allowing time at the start of the interview for casual conversation while testing audio/video quality helps participants settle in. Minor delays can disrupt turn-taking flow, so alerting participants to speak slightly slower than usual minimizes accidental interruptions.

Keeping remote interviews under an hour avoids fatigue for stare at a screen. Seeking advanced ethical clearance for verbal consent at the interview start saves participant time. Adapting to the remote context shows care for interviewees and aids rich discussion.

However, it remains important to critically reflect on how removing in-person dynamics may shape the co-created data. Perhaps some nuances of trust and disclosure differ over video.

Vulnerable Groups

The interviewer must ensure that they take special care when interviewing vulnerable groups, such as children. For example, children have a limited attention span, so lengthy interviews should be avoided.

Developing an Interview Schedule

An interview schedule is a list of pre-planned, structured questions that have been prepared, to serve as a guide for interviewers, researchers and investigators in collecting information or data about a specific topic or issue.
  • List the key themes or topics that must be covered to address your research questions. This will form the basic content.
  • Organize the content logically, such as chronologically following the interviewee’s experiences. Place more sensitive topics later in the interview.
  • Develop the list of content into actual questions and prompts. Carefully word each question – keep them open-ended, non-leading, and focused on examples.
  • Add prompts to remind you to cover areas of interest.
  • Pilot test the interview schedule to check it generates useful data and revise as needed.
  • Be prepared to refine the schedule throughout data collection as you learn which questions work better.
  • Practice skills like asking follow-up questions to get depth and detail. Stay flexible to depart from the schedule when needed.
  • Keep questions brief and clear. Avoid multi-part questions that risk confusing interviewees.
  • Listen actively during interviews to determine which pre-planned questions can be skipped based on information the participant has already provided.

The key is balancing preparation with the flexibility to adapt questions based on each interview interaction. With practice, you’ll gain skills to conduct productive interviews that obtain rich qualitative data.

The Power of Silence

Strategic use of silence is a key technique to generate interviewee-led data, but it requires judgment about appropriate timing and duration to maintain mutual understanding.
  • Unlike ordinary conversation, the interviewer aims to facilitate the interviewee’s contribution without interrupting. This often means resisting the urge to speak at the end of the interviewee’s turn construction units (TCUs).
  • Leaving a silence after a TCU encourages the interviewee to provide more material without being led by the interviewer. However, this simple technique requires confidence, as silence can feel socially awkward.
  • Allowing longer silences (e.g. 24 seconds) later in interviews can work well, but early on even short silences may disrupt rapport if they cause misalignment between speakers.
  • Silence also allows interviewees time to think before answering. Rushing to re-ask or amend questions can limit responses.
  • Blunt backchannels like “mm hm” also avoid interrupting flow. Interruptions, especially to finish an interviewee’s turn, are problematic as they make the ownership of perspectives unclear.
  • If interviewers incorrectly complete turns, an upside is it can produce extended interviewee narratives correcting the record. However, silence would have been better to let interviewees shape their own accounts.

Recording & Transcription

Design choices.

Design choices around recording and engaging closely with transcripts influence analytic insights, as well as practical feasibility. Weighing up relevant tradeoffs is key.
  • Audio recording is standard, but video better captures contextual details, which is useful for some topics/analysis approaches. Participants may find video invasive for sensitive research.
  • Digital formats enable the sharing of anonymized clips. Additional microphones reduce audio issues.
  • Doing all transcription is time-consuming. Outsourcing can save researcher effort but needs confidentiality assurances. Always carefully check outsourced transcripts.
  • Online platform auto-captioning can facilitate rapid analysis, but accuracy limitations mean full transcripts remain ideal. Software cleans up caption file formatting.
  • Verbatim transcripts best capture nuanced meaning, but the level of detail needed depends on the analysis approach. Referring back to recordings is still advisable during analysis.
  • Transcripts versus recordings highlight different interaction elements. Transcripts make overt disagreements clearer through the wording itself. Recordings better convey tone affiliativeness.

Transcribing Interviews & Focus Groups

Here are the steps for transcribing interviews:
  • Play back audio/video files to develop an overall understanding of the interview
  • Format the transcription document:
  • Add line numbers
  • Separate interviewer questions and interviewee responses
  • Use formatting like bold, italics, etc. to highlight key passages
  • Provide sentence-level clarity in the interviewee’s responses while preserving their authentic voice and word choices
  • Break longer passages into smaller paragraphs to help with coding
  • If translating the interview to another language, use qualified translators and back-translate where possible
  • Select a notation system to indicate pauses, emphasis, laughter, interruptions, etc., and adapt it as needed for your data
  • Insert screenshots, photos, or documents discussed in the interview at the relevant point in the transcript
  • Read through multiple times, revising formatting and notations
  • Double-check the accuracy of transcription against audio/videos
  • De-identify transcript by removing identifying participant details

The goal is to produce a formatted written record of the verbal interview exchange that captures the meaning and highlights important passages ready for the coding process. Careful transcription is the vital first step in analysis.

Coding Transcripts

The goal of transcription and coding is to systematically transform interview responses into a set of codes and themes that capture key concepts, experiences and beliefs expressed by participants. Taking care with transcription and coding procedures enhances the validity of qualitative analysis .
  • Read through the transcript multiple times to become immersed in the details
  • Identify manifest/obvious codes and latent/underlying meaning codes
  • Highlight insightful participant quotes that capture key concepts (in vivo codes)
  • Create a codebook to organize and define codes with examples
  • Use an iterative cycle of inductive (data-driven) coding and deductive (theory-driven) coding
  • Refine codebook with clear definitions and examples as you code more transcripts
  • Collaborate with other coders to establish the reliability of codes

Ethical Issues

Informed consent.

The participant information sheet must give potential interviewees a good idea of what is involved if taking part in the research.

This will include the general topics covered in the interview, where the interview might take place, how long it is expected to last, how it will be recorded, the ways in which participants’ anonymity will be managed, and incentives offered.

It might be considered good practice to consider true informed consent in interview research to require two distinguishable stages:

  • Consent to undertake and record the interview and
  • Consent to use the material in research after the interview has been conducted and the content known, or even after the interviewee has seen a copy of the transcript and has had a chance to remove sections, if desired.

Power and Vulnerability

  • Early feminist views that sensitivity could equalize power differences are likely naive. The interviewer and interviewee inhabit different knowledge spheres and social categories, indicating structural disparities.
  • Power fluctuates within interviews. Researchers rely on participation, yet interviewees control openness and can undermine data collection. Assumptions should be avoided.
  • Interviews on sensitive topics may feel like quasi-counseling. Interviewers must refrain from dual roles, instead supplying support service details to all participants.
  • Interviewees recruited for trauma experiences may reveal more than anticipated. While generating analytic insights, this risks leaving them feeling exposed.
  • Ultimately, power balances resist reconciliation. But reflexively analyzing operations of power serves to qualify rather than nullify situtated qualitative accounts.

Some groups, like those with mental health issues, extreme views, or criminal backgrounds, risk being discredited – treated skeptically by researchers.

This creates tensions with qualitative approaches, often having an empathetic ethos seeking to center subjective perspectives. Analysis should balance openness to offered accounts with critically examining stakes and motivations behind them.

Potter, J., & Hepburn, A. (2005). Qualitative interviews in psychology: Problems and possibilities.  Qualitative research in Psychology ,  2 (4), 281-307.

Houtkoop-Steenstra, H. (2000). Interaction and the standardized survey interview: The living questionnaire . Cambridge University Press

Madill, A. (2011). Interaction in the semi-structured interview: A comparative analysis of the use of and response to indirect complaints. Qualitative Research in Psychology, 8 (4), 333–353.

Maryudi, A., & Fisher, M. (2020). The power in the interview: A practical guide for identifying the critical role of actor interests in environment research. Forest and Society, 4 (1), 142–150

O’Key, V., Hugh-Jones, S., & Madill, A. (2009). Recruiting and engaging with people in deprived locales: Interviewing families about their eating patterns. Social Psychological Review, 11 (20), 30–35.

Puchta, C., & Potter, J. (2004). Focus group practice . Sage.

Schaeffer, N. C. (1991). Conversation with a purpose— Or conversation? Interaction in the standardized interview. In P. P. Biemer, R. M. Groves, L. E. Lyberg, & N. A. Mathiowetz (Eds.), Measurement errors in surveys (pp. 367–391). Wiley.

Silverman, D. (1973). Interview talk: Bringing off a research instrument. Sociology, 7 (1), 31–48.

Print Friendly, PDF & Email

  • Harvard Library
  • Research Guides
  • Faculty of Arts & Sciences Libraries

Library Support for Qualitative Research

  • Interview Research
  • Resources for Methodology
  • Remote Research & Virtual Fieldwork

Resources for Research Interviewing

Nih-funded qualitative research.

  • Oral History
  • Data Management & Repositories
  • Campus Access

Types of Interviews

  • Engaging Participants

Interview Questions

  • Conducting Interviews
  • Transcription
  • Coding and Analysis
  • Managing & Finding Interview Data
  • UX & Market Research Interviews

Textbooks, Guidebooks, and Handbooks  

  • The Ethnographic Interview by James P. Spradley  “Spradley wrote this book for the professional and student who have never done ethnographic fieldwork (p. 231) and for the professional ethnographer who is interested in adapting the author’s procedures (p. iv). Part 1 outlines in 3 chapters Spradley’s version of ethnographic research, and it provides the background for Part 2 which consists of 12 guided steps (chapters) ranging from locating and interviewing an informant to writing an ethnography. Most of the examples come from the author’s own fieldwork among U.S. subcultures . . . Steps 6 and 8 explain lucidly how to construct a domain and a taxonomic analysis” (excerpted from book review by James D. Sexton, 1980).  
  • Fundamentals of Qualitative Research by Johnny Saldana (Series edited by Patricia Leavy)  Provides a soup-to-nuts overview of the qualitative data collection process, including interviewing, participant observation, and other methods.  
  • InterViews by Steinar Kvale  Interviewing is an essential tool in qualitative research and this introduction to interviewing outlines both the theoretical underpinnings and the practical aspects of the process. After examining the role of the interview in the research process, Steinar Kvale considers some of the key philosophical issues relating to interviewing: the interview as conversation, hermeneutics, phenomenology, concerns about ethics as well as validity, and postmodernism. Having established this framework, the author then analyzes the seven stages of the interview process - from designing a study to writing it up.  
  • Practical Evaluation by Michael Quinn Patton  Surveys different interviewing strategies, from, a) informal/conversational, to b) interview guide approach, to c) standardized and open-ended, to d) closed/quantitative. Also discusses strategies for wording questions that are open-ended, clear, sensitive, and neutral, while supporting the speaker. Provides suggestions for probing and maintaining control of the interview process, as well as suggestions for recording and transcription.  
  • The SAGE Handbook of Interview Research by Amir B. Marvasti (Editor); James A. Holstein (Editor); Jaber F. Gubrium (Editor); Karyn D. McKinney (Editor)  The new edition of this landmark volume emphasizes the dynamic, interactional, and reflexive dimensions of the research interview. Contributors highlight the myriad dimensions of complexity that are emerging as researchers increasingly frame the interview as a communicative opportunity as much as a data-gathering format. The book begins with the history and conceptual transformations of the interview, which is followed by chapters that discuss the main components of interview practice. Taken together, the contributions to The SAGE Handbook of Interview Research: The Complexity of the Craft encourage readers simultaneously to learn the frameworks and technologies of interviewing and to reflect on the epistemological foundations of the interview craft.  
  • The SAGE Handbook of Online Research Methods by Nigel G. Fielding, Raymond M. Lee and Grant Blank (Editors) Bringing together the leading names in both qualitative and quantitative online research, this new edition is organised into nine sections: 1. Online Research Methods 2. Designing Online Research 3. Online Data Capture and Data Collection 4. The Online Survey 5. Digital Quantitative Analysis 6. Digital Text Analysis 7. Virtual Ethnography 8. Online Secondary Analysis: Resources and Methods 9. The Future of Online Social Research

ONLINE RESOURCES, COMMUNITIES, AND DATABASES  

  • Interviews as a Method for Qualitative Research (video) This short video summarizes why interviews can serve as useful data in qualitative research.  
  • Companion website to Bloomberg and Volpe's  Completing Your Qualitative Dissertation: A Road Map from Beginning to End,  4th ed Provides helpful templates and appendices featured in the book, as well as links to other useful dissertation resources.
  • International Congress of Qualitative Inquiry Annual conference hosted by the International Center for Qualitative Inquiry at the University of Illinois at Urbana-Champaign, which aims to facilitate the development of qualitative research methods across a wide variety of academic disciplines, among other initiatives.  
  • METHODSPACE ​​​​​​​​An online home of the research methods community, where practicing researchers share how to make research easier.  
  • SAGE researchmethods ​​​​​​​Researchers can explore methods concepts to help them design research projects, understand particular methods or identify a new method, conduct their research, and write up their findings. A "methods map" facilitates finding content on methods.

The decision to conduct interviews, and the type of interviewing to use, should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Structured:

  • Structured Interview. Entry in The SAGE Encyclopedia of Social Science Research Methodsby Floyd J. Fowler Jr., Editors: Michael S. Lewis-Beck; Alan E. Bryman; Tim Futing Liao (Editor)  A concise article noting standards, procedures, and recommendations for developing and testing structured interviews. For an example of structured interview questions, you may view the Current Population Survey, May 2008: Public Participation in the Arts Supplement (ICPSR 29641), Apr 15, 2011 at https://doi.org/10.3886/ICPSR29641.v1 (To see the survey questions, preview the user guide, which can be found under the "Data and Documentation" tab. Then, look for page 177 (attachment 8).

Semi-Structured:

  • Semi-Structured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Lioness Ayres; Editor: Lisa M. Given  The semi-structured interview is a qualitative data collection strategy in which the researcher asks informants a series of predetermined but open-ended questions. The researcher has more control over the topics of the interview than in unstructured interviews, but in contrast to structured interviews or questionnaires that use closed questions, there is no fixed range of responses to each question.

Unstructured:

  • Unstructured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Michael W. Firmin; Editor: Lisa M. Given  Unstructured interviews in qualitative research involve asking relatively open-ended questions of research participants in order to discover their percepts on the topic of interest. Interviews, in general, are a foundational means of collecting data when using qualitative research methods. They are designed to draw from the interviewee constructs embedded in his or her thinking and rationale for decision making. The researcher uses an inductive method in data gathering, regardless of whether the interview method is open, structured, or semi-structured. That is, the researcher does not wish to superimpose his or her own viewpoints onto the person being interviewed. Rather, inductively, the researcher wishes to understand the participant's perceptions, helping him or her to articulate percepts such that they will be understood clearly by the journal reader.

Genres and Uses

Focus groups:.

  • "Focus Groups." Annual Review of Sociology 22 (1996): 129-1524.by David L. Morgan  Discusses the use of focus groups and group interviews as methods for gathering qualitative data used by sociologists and other academic and applied researchers. Focus groups are recommended for giving voice to marginalized groups and revealing the group effect on opinion formation.  
  • Qualitative Research Methods: A Data Collector's Field Guide (See Module 4: "Focus Groups")by Mack, N., et al.  This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

In-Depth (typically One-on-One):

  • A Practical Introduction to in-Depth Interviewingby Alan Morris  Are you new to qualitative research or a bit rusty and in need of some inspiration? Are you doing a research project involving in-depth interviews? Are you nervous about carrying out your interviews? This book will help you complete your qualitative research project by providing a nuts and bolts introduction to interviewing. With coverage of ethics, preparation strategies and advice for handling the unexpected in the field, this handy guide will help you get to grips with the basics of interviewing before embarking on your research. While recognising that your research question and the context of your research will drive your approach to interviewing, this book provides practical advice often skipped in traditional methods textbooks.  
  • Qualitative Research Methods: A Data Collector's Field Guide (See Module 3: "In-Depth Interviews")by Mack, N., et al.  This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

Folklore Research and Oral Histories:

In addition to the following resource, see the  Oral History   page of this guide for helpful resources on Oral History interviewing.

American Folklife Center at the Library of Congress. Folklife and Fieldwork: A Layman’s Introduction to Field Techniques Interviews gathered for purposes of folklore research are similar to standard social science interviews in some ways, but also have a good deal in common with oral history approaches to interviewing. The focus in a folklore research interview is on documenting and trying to understand the interviewee's way of life relative to a culture or subculture you are studying. This guide includes helpful advice and tips for conducting fieldwork in folklore, such as tips for planning, conducting, recording, and archiving interviews.

An interdisciplinary scientific program within the Institute for Quantitative Social Science which encourages and facilitates research and instruction in the theory and practice of survey research. The primary mission of PSR is to provide survey research resources to enhance the quality of teaching and research at Harvard.

  • Internet, Phone, Mail, and Mixed-Mode Surveysby Don A. Dillman; Jolene D. Smyth; Leah Melani Christian  The classic survey design reference, updated for the digital age. The new edition is thoroughly updated and revised, and covers all aspects of survey research. It features expanded coverage of mobile phones, tablets, and the use of do-it-yourself surveys, and Dillman's unique Tailored Design Method is also thoroughly explained. This new edition is complemented by copious examples within the text and accompanying website. It includes: Strategies and tactics for determining the needs of a given survey, how to design it, and how to effectively administer it. How and when to use mail, telephone, and Internet surveys to maximum advantage. Proven techniques to increase response rates. Guidance on how to obtain high-quality feedback from mail, electronic, and other self-administered surveys. Direction on how to construct effective questionnaires, including considerations of layout. The effects of sponsorship on the response rates of surveys. Use of capabilities provided by newly mass-used media: interactivity, presentation of aural and visual stimuli. The Fourth Edition reintroduces the telephone--including coordinating land and mobile.

User Experience (UX) and Marketing:

  • See the  "UX & Market Research Interviews"  tab on this guide, above. May include  Focus Groups,  above.

Screening for Research Site Selection:

  • Research interviews are used not only to furnish research data for theoretical analysis in the social sciences, but also to plan other kinds of studies. For example, interviews may allow researchers to screen appropriate research sites to conduct empirical studies (such as randomized controlled trials) in a variety of fields, from medicine to law. In contrast to interviews conducted in the course of social research, such interviews do not typically serve as the data for final analysis and publication.

ENGAGING PARTICIPANTS

Research ethics  .

  • Human Subjects (IRB) The Committee on the Use of Human Subjects (CUHS) serves as the Institutional Review Board for the University area which includes the Cambridge and Allston campuses at Harvard. Find your IRB  contact person , or learn about  required ethics training.  You may also find the  IRB Lifecycle Guide  helpful. This is the preferred IRB portal for Harvard graduate students and other researchers. IRB forms can be downloaded via the  ESTR Library  (click on the "Templates and Forms" tab, then navigate to pages 2 and 3 to find the documents labelled with “HUA” for the Harvard University Area IRB. Nota bene: You may use these forms only if you submit your study to the Harvard University IRB). The IRB office can be reached through email at [email protected] or by telephone at (617) 496-2847.  
  • Undergraduate Research Training Program (URTP) Portal The URTP at Harvard University is a comprehensive platform to create better prepared undergraduate researchers. The URTP is comprised of research ethics training sessions, a student-focused curriculum, and an online decision form that will assist students in determining whether their project requires IRB review. Students should examine the  URTP's guide for student researchers: Introduction to Human Subjects Research Protection.  
  • Ethics reports From the Association of Internet Researchers (AoIR)  
  • Respect, Beneficence, and Justice: QDR General Guidance for Human Participants If you are hoping to share your qualitative interview data in a repository after it has been collected, you will need to plan accordingly via informed consent, careful de-identification procedures, and data access controls. Consider  consulting with the Qualitative Research Support Group at Harvard Library  and consulting with  Harvard's Dataverse contacts  to help you think through all of the contingencies and processes.  
  • "Conducting a Qualitative Child Interview: Methodological Considerations." Journal of Advanced Nursing 42/5 (2003): 434-441 by Kortesluoma, R., et al.  The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described.  
  • "Crossing Cultural Barriers in Research Interviewing." Qualitative Social Work 63/3 (2007): 353-372 by Sands, R., et al.  This article critically examines a qualitative research interview in which cultural barriers between a white non-Muslim female interviewer and an African American Muslim interviewee, both from the USA, became evident and were overcome within the same interview.  
  • Decolonizing Methodologies: Research and Indigenous Peoples by Linda Tuhiwai Smith  This essential volume explores intersections of imperialism and research - specifically, the ways in which imperialism is embedded in disciplines of knowledge and tradition as 'regimes of truth.' Concepts such as 'discovery' and 'claiming' are discussed and an argument presented that the decolonization of research methods will help to reclaim control over indigenous ways of knowing and being. The text includes case-studies and examples, and sections on new indigenous literature and the role of research in indigenous struggles for social justice.  

This resource, sponsored by University of Oregon Libraries, exemplifies the use of interviewing methodologies in research that foregrounds traditional knowledge. The methodology page summarizes the approach.

  • Ethics: The Need to Tread Carefully. Chapter in A Practical Introduction to in-Depth Interviewing by Alan Morris  Pay special attention to the sections in chapter 2 on "How to prevent and respond to ethical issues arising in the course of the interview," "Ethics in the writing up of your interviews," and "The Ethics of Care."  
  • Handbook on Ethical Issues in Anthropology by Joan Cassell (Editor); Sue-Ellen Jacobs (Editor)  This publication of the American Anthropological Association presents and discusses issues and sources on ethics in anthropology, as well as realistic case studies of ethical dilemmas. It is meant to help social science faculty introduce discussions of ethics in their courses. Some of the topics are relevant to interviews, or at least to studies of which interviews are a part. See chapters 3 and 4 for cases, with solutions and commentary, respectively.  
  • Research Ethics from the Chanie Wenjack School for Indigenous Studies, Trent University  (Open Access) An overview of Indigenous research ethics and protocols from the across the globe.  
  • Resources for Equity in Research Consult these resources for guidance on creating and incorporating equitable materials into public health research studies that entail community engagement.

The SAGE Handbook of Qualitative Research Ethics by Ron Iphofen (Editor); Martin Tolich (Editor)  This handbook is a much-needed and in-depth review of the distinctive set of ethical considerations which accompanies qualitative research. This is particularly crucial given the emergent, dynamic and interactional nature of most qualitative research, which too often allows little time for reflection on the important ethical responsibilities and obligations. Contributions from leading international researchers have been carefully organized into six key thematic sections: Part One: Thick Descriptions Of Qualitative Research Ethics; Part Two: Qualitative Research Ethics By Technique; Part Three: Ethics As Politics; Part Four: Qualitative Research Ethics With Vulnerable Groups; Part Five: Relational Research Ethics; Part Six: Researching Digitally. This Handbook is a one-stop resource on qualitative research ethics across the social sciences that draws on the lessons learned and the successful methods for surmounting problems - the tried and true, and the new.

RESEARCH COMPLIANCE AND PRIVACY LAWS

Research Compliance Program for FAS/SEAS at Harvard : The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

  • Harvard Global Support Services (GSS) is for students, faculty, staff, and researchers who are studying, researching, or working abroad. Their services span safety and security, health, culture, outbound immigration, employment, financial and legal matters, and research center operations. These include travel briefings and registration, emergency response, guidance on international projects, and managing in-country operations.

Generative AI: Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.

Privacy Laws: Be mindful of any potential privacy laws that may apply wherever you conduct your interviews. The General Data Protection Regulation is a high-profile example (see below):

  • General Data Protection Regulation (GDPR) This Regulation lays down rules relating to the protection of natural persons with regard to the processing of personal data and rules relating to the free movement of personal data. It protects fundamental rights and freedoms of natural persons and in particular their right to the protection of personal data. The free movement of personal data within the Union shall be neither restricted nor prohibited for reasons connected with the protection of natural persons with regard to the processing of personal data. For a nice summary of what the GDPR requires, check out the GDPR "crash course" here .

SEEKING CONSENT  

If you would like to see examples of consent forms, ask your local IRB, or take a look at these resources:

  • Model consent forms for oral history, suggested by the Centre for Oral History and Digital Storytelling at Concordia University  
  • For NIH-funded research, see this  resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use.

POPULATION SAMPLING

If you wish to assemble resources to aid in sampling, such as the USPS Delivery Sequence File, telephone books, or directories of organizations and listservs, please contact our  data librarian  or write to  [email protected] .

  • Research Randomizer   A free web-based service that permits instant random sampling and random assignment. It also contains an interactive tutorial perfect for students taking courses in research methods.  
  • Practical Tools for Designing and Weighting Survey Samples by Richard Valliant; Jill A. Dever; Frauke Kreuter  Survey sampling is fundamentally an applied field. The goal in this book is to put an array of tools at the fingertips of practitioners by explaining approaches long used by survey statisticians, illustrating how existing software can be used to solve survey problems, and developing some specialized software where needed. This book serves at least three audiences: (1) Students seeking a more in-depth understanding of applied sampling either through a second semester-long course or by way of a supplementary reference; (2) Survey statisticians searching for practical guidance on how to apply concepts learned in theoretical or applied sampling courses; and (3) Social scientists and other survey practitioners who desire insight into the statistical thinking and steps taken to design, select, and weight random survey samples. Several survey data sets are used to illustrate how to design samples, to make estimates from complex surveys for use in optimizing the sample allocation, and to calculate weights. Realistic survey projects are used to demonstrate the challenges and provide a context for the solutions. The book covers several topics that either are not included or are dealt with in a limited way in other texts. These areas include: sample size computations for multistage designs; power calculations related to surveys; mathematical programming for sample allocation in a multi-criteria optimization setting; nuts and bolts of area probability sampling; multiphase designs; quality control of survey operations; and statistical software for survey sampling and estimation. An associated R package, PracTools, contains a number of specialized functions for sample size and other calculations. The data sets used in the book are also available in PracTools, so that the reader may replicate the examples or perform further analyses.  
  • Sampling: Design and Analysis by Sharon L. Lohr  Provides a modern introduction to the field of sampling. With a multitude of applications from a variety of disciplines, the book concentrates on the statistical aspects of taking and analyzing a sample. Overall, the book gives guidance on how to tell when a sample is valid or not, and how to design and analyze many different forms of sample surveys.  
  • Sampling Techniques by William G. Cochran  Clearly demonstrates a wide range of sampling methods now in use by governments, in business, market and operations research, social science, medicine, public health, agriculture, and accounting. Gives proofs of all the theoretical results used in modern sampling practice. New topics in this edition include the approximate methods developed for the problem of attaching standard errors or confidence limits to nonlinear estimates made from the results of surveys with complex plans.  
  • "Understanding the Process of Qualitative Data Collection" in Chapter 13 (pp. 103–1162) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell  Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.  
  • Survey Methodology by Robert M. Groves; Floyd J. Fowler; Mick P. Couper; James M. Lepkowski; Eleanor Singer; Roger Tourangeau; Floyd J. Fowler  coverage includes sampling frame evaluation, sample design, development of questionnaires, evaluation of questions, alternative modes of data collection, interviewing, nonresponse, post-collection processing of survey data, and practices for maintaining scientific integrity.

The way a qualitative researcher constructs and approaches interview questions should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Constructing Your Questions

Helpful texts:.

  • "Developing Questions" in Chapter 4 (pp. 98–108) of Becoming Qualitative Researchers by Corrine Glesne  Ideal for introducing the novice researcher to the theory and practice of qualitative research, this text opens students to the diverse possibilities within this inquiry approach, while helping them understand how to design and implement specific research methods.  
  • "Learning to Interview in the Social Sciences" Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659 - 660.  
  • Qualitative Research Interviewing: Biographic Narrative and Semi-Structured Methods (See sections on “Lightly and Heavily Structured Depth Interviewing: Theory-Questions and Interviewer-Questions” and “Preparing for any Interviewing Sequence") by Tom Wengraf  Unique in its conceptual coherence and the level of practical detail, this book provides a comprehensive resource for those concerned with the practice of semi-structured interviewing, the most commonly used interview approach in social research, and in particular for in-depth, biographic narrative interviewing. It covers the full range of practices from the identification of topics through to strategies for writing up research findings in diverse ways.  
  • "Scripting a Qualitative Purpose Statement and Research Questions" in Chapter 12 (pp. 93–102) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell  Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.  
  • Some Strategies for Developing Interview Guides for Qualitative Interviews by Sociology Department, Harvard University Includes general advice for conducting qualitative interviews, pros and cons of recording and transcription, guidelines for success, and tips for developing and phrasing effective interview questions.  
  • Tip Sheet on Question Wording by Harvard University Program on Survey Research

Let Theory Guide You:

The quality of your questions depends on how you situate them within a wider body of knowledge. Consider the following advice:

A good literature review has many obvious virtues. It enables the investigator to define problems and assess data. It provides the concepts on which percepts depend. But the literature review has a special importance for the qualitative researcher. This consists of its ability to sharpen his or her capacity for surprise (Lazarsfeld, 1972b). The investigator who is well versed in the literature now has a set of expectations the data can defy. Counterexpectational data are conspicuous, readable, and highly provocative data. They signal the existence of unfulfilled theoretical assumptions, and these are, as Kuhn (1962) has noted, the very origins of intellectual innovation. A thorough review of the literature is, to this extent, a way to manufacture distance. It is a way to let the data of one's research project take issue with the theory of one's field.

McCracken, G. (1988), The Long Interview, Sage: Newbury Park, CA, p. 31

When drafting your interview questions, remember that everything follows from your central research question. Also, on the way to writing your "operationalized" interview questions, it's  helpful to draft broader, intermediate questions, couched in theory. Nota bene:  While it is important to know the literature well before conducting your interview(s), be careful not to present yourself to your research participant(s) as "the expert," which would be presumptuous and could be intimidating. Rather, the purpose of your knowledge is to make you a better, keener listener.

If you'd like to supplement what you learned about relevant theories through your coursework and literature review, try these sources:

  • Annual Reviews   Review articles sum up the latest research in many fields, including social sciences, biomedicine, life sciences, and physical sciences. These are timely collections of critical reviews written by leading scientists.  
  • HOLLIS - search for resources on theories in your field   Modify this example search by entering the name of your field in place of "your discipline," then hit search.  
  • Oxford Bibliographies   Written and reviewed by academic experts, every article in this database is an authoritative guide to the current scholarship in a variety of fields, containing original commentary and annotations.  
  • ProQuest Dissertations & Theses (PQDT)   Indexes dissertations and masters' theses from most North American graduate schools as well as some European universities. Provides full text for most indexed dissertations from 1990-present.  
  • Very Short Introductions   Launched by Oxford University Press in 1995, Very Short Introductions offer concise introductions to a diverse range of subjects from Climate to Consciousness, Game Theory to Ancient Warfare, Privacy to Islamic History, Economics to Literary Theory.

CONDUCTING INTERVIEWS

Equipment and software:  .

  • Lamont Library  loans microphones and podcast starter kits, which will allow you to capture audio (and you may record with software, such as Garage Band). 
  • Cabot Library  loans digital recording devices, as well as USB microphones.

If you prefer to use your own device, you may purchase a small handheld audio recorder, or use your cell phone.

  • Audio Capture Basics (PDF)  - Helpful instructions, courtesy of the Lamont Library Multimedia Lab.
  • Getting Started with Podcasting/Audio:  Guidelines from Harvard Library's Virtual Media Lab for preparing your interviewee for a web-based recording (e.g., podcast, interview)
  • ​ Camtasia Screen Recorder and Video Editor
  • Zoom: Video Conferencing, Web Conferencing
  • Visit the Multimedia Production Resources guide! Consult it to find and learn how to use audiovisual production tools, including: cameras, microphones, studio spaces, and other equipment at Cabot Science Library and Lamont Library.
  • Try the virtual office hours offered by the Lamont Multimedia Lab!

TIPS FOR CONDUCTING INTERVIEWS

Quick handout:  .

  • Research Interviewing Tips (Courtesy of Dr. Suzanne Spreadbury)

Remote Interviews:  

  • For Online or Distant Interviews, See "Remote Research & Virtual Fieldwork" on this guide .  
  • Deborah Lupton's Bibliography: Doing Fieldwork in a Pandemic

Seeking Consent:

Books and articles:  .

  • "App-Based Textual Interviews: Interacting With Younger Generations in a Digitalized Social Reallity."International Journal of Social Research Methodology (12 June 2022). Discusses the use of texting platforms as a means to reach young people. Recommends useful question formulations for this medium.  
  • "Learning to Interview in the Social Sciences." Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659-660.  
  • "Slowing Down and Digging Deep: Teaching Students to Examine Interview Interaction in Depth." LEARNing Landscapes, Spring 2021 14(1) 153-169 by Herron, Brigette A. and Kathryn Roulston. Suggests analysis of videorecorded interviews as a precursor to formulating one's own questions. Includes helpful types of probes.  
  • Using Interviews in a Research Project by Nigel Joseph Mathers; Nicholas J Fox; Amanda Hunn; Trent Focus Group.  A work pack to guide researchers in developing interviews in the healthcare field. Describes interview structures, compares face-to-face and telephone interviews. Outlines the ways in which different types of interview data can be analysed.  
  • “Working through Challenges in Doing Interview Research.” International Journal of Qualitative Methods, (December 2011), 348–66 by Roulston, Kathryn.  The article explores (1) how problematic interactions identified in the analysis of focus group data can lead to modifications in research design, (2) an approach to dealing with reported data in representations of findings, and (3) how data analysis can inform question formulation in successive rounds of data generation. Findings from these types of examinations of interview data generation and analysis are valuable for informing both interview practice as well as research design.

Videos:  

video still image

The way a qualitative researcher transcribes interviews should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

TRANSCRIPTION

Before embarking on a transcription project, it's worthwhile to invest in the time and effort necessary to capture good audio, which will make the transcription process much easier. If you haven't already done so, check out the  audio capture guidelines from Harvard Library's Virtual Media Lab , or  contact a media staff member  for customized recommendations. First and foremost, be mindful of common pitfalls by watching this short video that identifies  the most common errors to avoid!

SOFTWARE:  

  • Otter  provides a new way to capture, store, search and share voice conversations, lectures, presentations, meetings, and interviews. The startup is based in Silicon Valley with a team of experienced Ph.Ds and engineers from Google, Facebook, Yahoo and Nuance (à la Dragon). Free accounts available. This is the software that  Zoom  uses to generate automated transcripts, so if you have access to a Zoom subscription, you have access to Otter transcriptions with it (applicable in several  languages ). As with any automated approach, be prepared to correct any errors after the fact, by hand.  
  • Panopto  is available to Harvard affiliates and generates  ASR (automated speech recognition) captions . You may upload compatible audio files into it. As with any automatically generated transcription, you will need to make manual revisions. ASR captioning is available in several  languages .  
  • GoTranscript  provides cost-effective human-generated transcriptions.  
  • pyTranscriber  is an app for generating automatic transcription and/or subtitles for audio and video files. It uses the Google Cloud Speech-to-Text service, has a friendly graphical user interface, and is purported to work nicely with Chinese.   
  • REV.Com  allows you to record and transcribe any calls on the iPhone, both outgoing and incoming. It may be useful for recording phone interviews. Rev lets you choose whether you want an AI- or human-generated transcription, with a fast turnaround.  
  • Scribie Audio/Video Transcription  provides automated or manual transcriptions for a small fee. As with any transcription service, some revisions will be necessary after the fact, particularly for its automated transcripts.  
  • Sonix  automatically transcribes, translates, and helps to organize audio and video files in over 40 languages. It's fast and affordable, with good accuracy. The free trial includes 30 minutes of free transcription.  
  • TranscriptionWing  uses a human touch process to clean up machine-generated transcripts so that the content will far more accurately reflect your audio recording. 

EQUIPMENT:  

  • Transcription pedals  are in circulation and available to borrow from the Circulation desk at Lamont, or use at Lamont Library's Media Lab on level B. For hand-transcribing your interviews, they work in conjunction with software such as  Express Scribe , which is loaded on Media Lab computers, or you may download for free on your own machine (Mac or PC versions; scroll down the downloads page for the latter). The pedals are plug-and-play USB, allow a wide range of playback speeds, and have 3 programmable buttons, which are typically set to rewind/play/fast-forward. Instructions are included in the bag that covers installation and set-up of the software, and basic use of the pedals.

NEED HELP?  

  • Try the virtual office hours offered by the Lamont Multimedia Lab!    
  • If you're creating podcasts, login to  Canvas  and check out the  Podcasting/Audio guide . 

Helpful Texts:  

  • "Transcription as a Crucial Step of Data Analysis" in Chapter 5 of The SAGE Handbook of Qualitative Data Analysisby Uwe Flick (Editor)  Covers basic terminology for transcription, shares caveats for transcribers, and identifies components of vocal behavior. Provides notation systems for transcription, suggestions for transcribing turn-taking, and discusses new technologies and perspectives. Includes a bibliography for further reading.  
  • "Transcribing the Oral Interview: Part Art, Part Science " on p. 10 of the Centre for Community Knowledge (CCK) newsletter: TIMESTAMPby Mishika Chauhan and Saransh Srivastav

QUALITATIVE DATA ANALYSIS

Software  .

  • Free download available for Harvard Faculty of Arts and Sciences (FAS) affiliates
  • Desktop access at Lamont Library Media Lab, 3rd floor
  • Desktop access at Harvard Kennedy School Library (with HKS ID)
  • Remote desktop access for Harvard affiliates from  IQSS Computer Labs . Email them at  [email protected] and ask for a new lab account and remote desktop access to NVivo.
  • Virtual Desktop Infrastructure (VDI) access available to Harvard T.H. Chan School of Public Health affiliates

CODING AND THEMEING YOUR DATA

Data analysis methods should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these). Some established methods include Content Analysis, Critical Analysis, Discourse Analysis, Gestalt Analysis, Grounded Theory Analysis, Interpretive Analysis, Narrative Analysis, Normative Analysis, Phenomenological Analysis, Rhetorical Analysis, and Semiotic Analysis, among others. The following resources should help you navigate your methodological options and put into practice methods for coding, themeing, interpreting, and presenting your data.

  • Users can browse content by topic, discipline, or format type (reference works, book chapters, definitions, etc.). SRM offers several research tools as well: a methods map, user-created reading lists, a project planner, and advice on choosing statistical tests.  
  • Abductive Coding: Theory Building and Qualitative (Re)Analysis by Vila-Henninger, et al.  The authors recommend an abductive approach to guide qualitative researchers who are oriented towards theory-building. They outline a set of tactics for abductive analysis, including the generation of an abductive codebook, abductive data reduction through code equations, and in-depth abductive qualitative analysis.  
  • Analyzing and Interpreting Qualitative Research: After the Interview by Charles F. Vanover, Paul A. Mihas, and Johnny Saldana (Editors)   Providing insight into the wide range of approaches available to the qualitative researcher and covering all steps in the research process, the authors utilize a consistent chapter structure that provides novice and seasoned researchers with pragmatic, "how-to" strategies. Each chapter author introduces the method, uses one of their own research projects as a case study of the method described, shows how the specific analytic method can be used in other types of studies, and concludes with three questions/activities to prompt class discussion or personal study.   
  • "Analyzing Qualitative Data." Theory Into Practice 39, no. 3 (2000): 146-54 by Margaret D. LeCompte   This article walks readers though rules for unbiased data analysis and provides guidance for getting organized, finding items, creating stable sets of items, creating patterns, assembling structures, and conducting data validity checks.  
  • "Coding is Not a Dirty Word" in Chapter 1 (pp. 1–30) of Enhancing Qualitative and Mixed Methods Research with Technology by Shalin Hai-Jew (Editor)   Current discourses in qualitative research, especially those situated in postmodernism, represent coding and the technology that assists with coding as reductive, lacking complexity, and detached from theory. In this chapter, the author presents a counter-narrative to this dominant discourse in qualitative research. The author argues that coding is not necessarily devoid of theory, nor does the use of software for data management and analysis automatically render scholarship theoretically lightweight or barren. A lack of deep analytical insight is a consequence not of software but of epistemology. Using examples informed by interpretive and critical approaches, the author demonstrates how NVivo can provide an effective tool for data management and analysis. The author also highlights ideas for critical and deconstructive approaches in qualitative inquiry while using NVivo. By troubling the positivist discourse of coding, the author seeks to create dialogic spaces that integrate theory with technology-driven data management and analysis, while maintaining the depth and rigor of qualitative research.   
  • The Coding Manual for Qualitative Researchers by Johnny Saldana   An in-depth guide to the multiple approaches available for coding qualitative data. Clear, practical and authoritative, the book profiles 32 coding methods that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldaña discusses the methods, origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. Essential reading across the social sciences.  
  • Flexible Coding of In-depth Interviews: A Twenty-first-century Approach by Nicole M. Deterding and Mary C. Waters The authors suggest steps in data organization and analysis to better utilize qualitative data analysis technologies and support rigorous, transparent, and flexible analysis of in-depth interview data.  
  • From the Editors: What Grounded Theory is Not by Roy Suddaby Walks readers through common misconceptions that hinder grounded theory studies, reinforcing the two key concepts of the grounded theory approach: (1) constant comparison of data gathered throughout the data collection process and (2) the determination of which kinds of data to sample in succession based on emergent themes (i.e., "theoretical sampling").  
  • “Good enough” methods for life-story analysis, by Wendy Luttrell. In Quinn N. (Ed.), Finding culture in talk (pp. 243–268). Demonstrates for researchers of culture and consciousness who use narrative how to concretely document reflexive processes in terms of where, how and why particular decisions are made at particular stages of the research process.   
  • Presentation slides on coding and themeing your data, derived from Saldana, Spradley, and LeCompte Click to request access.  
  • Qualitative Data Analysis by Matthew B. Miles; A. Michael Huberman   A practical sourcebook for researchers who make use of qualitative data, presenting the current state of the craft in the design, testing, and use of qualitative analysis methods. Strong emphasis is placed on data displays matrices and networks that go beyond ordinary narrative text. Each method of data display and analysis is described and illustrated.  
  • "A Survey of Qualitative Data Analytic Methods" in Chapter 4 (pp. 89–138) of Fundamentals of Qualitative Research by Johnny Saldana   Provides an in-depth introduction to coding as a heuristic, particularly focusing on process coding, in vivo coding, descriptive coding, values coding, dramaturgical coding, and versus coding. Includes advice on writing analytic memos, developing categories, and themeing data.   
  • "Thematic Networks: An Analytic Tool for Qualitative Research." Qualitative Research : QR, 1(3), 385–405 by Jennifer Attride-Stirling Details a technique for conducting thematic analysis of qualitative material, presenting a step-by-step guide of the analytic process, with the aid of an empirical example. The analytic method presented employs established, well-known techniques; the article proposes that thematic analyses can be usefully aided by and presented as thematic networks.  
  • Using Thematic Analysis in Psychology by Virginia Braun and Victoria Clark Walks readers through the process of reflexive thematic analysis, step by step. The method may be adapted in fields outside of psychology as relevant. Pair this with One Size Fits All? What Counts as Quality Practice in Reflexive Thematic Analysis? by Virginia Braun and Victoria Clark

TESTING OR GENERATING THEORIES

The quality of your data analysis depends on how you situate what you learn within a wider body of knowledge. Consider the following advice:

Once you have coalesced around a theory, realize that a theory should  reveal  rather than  color  your discoveries. Allow your data to guide you to what's most suitable. Grounded theory  researchers may develop their own theory where current theories fail to provide insight.  This guide on Theoretical Models  from Alfaisal University Library provides a helpful overview on using theory.

MANAGING & FINDING INTERVIEW DATA

Managing your elicited interview data, general guidance:  .

  • Research Data Management @ Harvard A reference guide with information and resources to help you manage your research data. See also: Harvard Research Data Security Policy , on the Harvard University Research Data Management website.  
  • Data Management For Researchers: Organize, Maintain and Share Your Data for Research Success by Kristin Briney. A comprehensive guide for scientific researchers providing everything they need to know about data management and how to organize, document, use and reuse their data.  
  • Open Science Framework (OSF) An open-source project management tool that makes it easy to collaborate within and beyond Harvard throughout a project's lifecycle. With OSF you can manage, store, and share documents, datasets, and other information with your research team. You can also publish your work to share it with a wider audience. Although data can be stored privately, because this platform is hosted on the Internet and designed with open access in mind, it is not a good choice for highly sensitive data.  
  • Free cloud storage solutions for Harvard affiliates to consider include:  Google Drive ,  DropBox , or  OneDrive ( up to DSL3 )  

Data Confidentiality and Secure Handling:  

  • Data Security Levels at Harvard - Research Data Examples This resource provided by Harvard Data Security helps you determine what level of access is appropriate for your data. Determine whether it should be made available for public use, limited to the Harvard community, or be protected as either "confidential and sensitive," "high risk," or "extremely sensitive." See also:  Harvard Data Classification Table  
  • Harvard's Best Practices for Protecting Privacy and  Harvard Information Security Collaboration Tools Matrix Follow the nuts-and-bolts advice for privacy best practices at Harvard. The latter resource reveals the level of security that can be relied upon for a large number of technological tools and platforms used at Harvard to conduct business, such as email, Slack, Accellion Kiteworks, OneDrive/SharePoint, etc.  
  • “Protecting Participant Privacy While Maintaining Content and Context: Challenges in Qualitative Data De‐identification and Sharing.” Proceedings of the ASIST Annual Meeting 57 (1) (2020): e415-420 by Myers, Long, and Polasek Presents an informed and tested protocol, based on the De-Identification guidelines published by the Qualitative Data Repository (QDR) at Syracuse University. Qualitative researchers may consult it to guide their data de-identification efforts.  
  • QDS Qualitative Data Sharing Toolkit The Qualitative Data Sharing (QDS) project and its toolkit was funded by the NIH National Human Genome Research Institute (R01HG009351). It provides tools and resources to help researchers, especially those in the health sciences, share qualitative research data while protecting privacy and confidentiality. It offers guidance on preparing data for sharing through de-identification and access control. These health sciences research datasets in ICPSR's Qualitative Data Sharing (QDS) Project Series were de-identified using the QuaDS Software and the project’s QDS guidelines.  
  • Table of De-Identification Techniques  
  • Generative AI Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.  
  • Harvard Information Security Quick Reference Guide Storage guidelines, based on the data's security classification level (according to its IRB classification) is displayed on page 2, under "handling."  
  • Email Encryption Harvard Microsoft 365 users can now send encrypted messages and files directly from the Outlook web or desktop apps. Encrypting an email adds an extra layer of security to the message and its attachments (up to 150MB), and means only the intended recipient (and their inbox delegates with full access) can view it. Message encryption in Outlook is approved for sending high risk ( level 4 ) data and below.  

Sharing Qualitative Data:  

  • Repositories for Qualitative Data If you have cleared this intention with your IRB, secured consent from participants, and properly de-identified your data, consider sharing your interviews in one of the data repositories included in the link above. Depending on the nature of your research and the level of risk it may present to participants, sharing your interview data may not be appropriate. If there is any chance that sharing such data will be desirable, you will be much better off if you build this expectation into your plans from the beginning.  
  • Guide for Sharing Qualitative Data at ICPSR The Inter-university Consortium for Political and Social Research (ICPSR) has created this resource for investigators planning to share qualitative data at ICPSR. This guide provides an overview of elements and considerations for archiving qualitative data, identifies steps for investigators to follow during the research life cycle to ensure that others can share and reuse qualitative data, and provides information about exemplars of qualitative data  

International Projects:

  • Research Compliance Program for FAS/SEAS at Harvard The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

Finding Extant Interview Data

Finding journalistic interviews:  .

  • Academic Search Premier This all-purpose database is great for finding articles from magazines and newspapers. In the Advanced Search, it allows you to specify "Document Type":  Interview.  
  • Guide to Newspapers and Newspaper Indexes Use this guide created to Harvard Librarians to identify newspapers collections you'd like to search. To locate interviews, try adding the term  "interview"  to your search, or explore a database's search interface for options to  limit your search to interviews.  Nexis Uni  and  Factiva  are the two main databases for current news.   
  • Listen Notes Search for podcast episodes at this podcast aggregator, and look for podcasts that include interviews. Make sure to vet the podcaster for accuracy and quality! (Listen Notes does not do much vetting.)  
  • NPR  and  ProPublica  are two sites that offer high-quality long-form reporting, including journalistic interviews, for free.

Finding Oral History and Social Research Interviews:  

  • To find oral histories, see the Oral History   page of this guide for helpful resources on Oral History interviewing.  
  • Repositories for Qualitative Data It has not been a customary practice among qualitative researchers in the social sciences to share raw interview data, but some have made this data available in repositories, such as the ones listed on the page linked above. You may find published data from structured interview surveys (e.g., questionnaire-based computer-assisted telephone interview data), as well as some semi-structured and unstructured interviews.  
  • If you are merely interested in studies interpreting data collected using interviews, rather than finding raw interview data, try databases like  PsycInfo ,  Sociological Abstracts , or  Anthropology Plus , among others. 

Finding Interviews in Archival Collections at Harvard Library:

In addition to the databases and search strategies mentioned under the  "Finding Oral History and Social Research Interviews" category above,  you may search for interviews and oral histories (whether in textual or audiovisual formats) held in archival collections at Harvard Library.

  • HOLLIS searches all documented collections at Harvard, whereas HOLLIS for Archival Discovery searches only those with finding aids. Although HOLLIS for Archival Discovery covers less material, you may find it easier to parse your search results, especially when you wish to view results at the item level (within collections). Try these approaches:

Search in  HOLLIS :  

  • To retrieve items available online, do an Advanced Search for  interview* OR "oral histor*" (in Subject), with Resource Type "Archives/Manuscripts," then refine your search by selecting "Online" under "Show Only" on the right of your initial result list.  Revise the search above by adding your topic in the Keywords or Subject field (for example:  African Americans ) and resubmitting the search.  
  •  To enlarge your results set, you may also leave out the "Online" refinement; if you'd like to limit your search to a specific repository, try the technique of searching for  Code: Library + Collection on the "Advanced Search" page .   

Search in  HOLLIS for Archival Discovery :  

  • To retrieve items available online, search for   interview* OR "oral histor*" limited to digital materials . Revise the search above by adding your topic (for example:  artist* ) in the second search box (if you don't see the box, click +).  
  • To preview results by collection, search for  interview* OR "oral histor*" limited to collections . Revise the search above by adding your topic (for example:  artist* ) in the second search box (if you don't see the box, click +). Although this method does not allow you to isolate digitized content, you may find the refinement options on the right side of the screen (refine by repository, subject or names) helpful.  Once your select a given collection, you may search within it  (e.g., for your topic or the term interview).

UX & MARKET RESEARCH INTERVIEWS

Ux at harvard library  .

  • User Experience and Market Research interviews can inform the design of tangible products and services through responsive, outcome-driven insights. The  User Research Center  at Harvard Library specializes in this kind of user-centered design, digital accessibility, and testing. They also offer guidance and  resources  to members of the Harvard Community who are interested in learning more about UX methods. Contact [email protected] or consult the URC website for more information.

Websites  

  • User Interviews: The Beginner’s Guide (Chris Mears)  
  • Interviewing Users (Jakob Nielsen)

Books  

  • Interviewing Users: How to Uncover Compelling Insights by Steve Portigal; Grant McCracken (Foreword by)  Interviewing is a foundational user research tool that people assume they already possess. Everyone can ask questions, right? Unfortunately, that's not the case. Interviewing Users provides invaluable interviewing techniques and tools that enable you to conduct informative interviews with anyone. You'll move from simply gathering data to uncovering powerful insights about people.  
  • Rapid Contextual Design by Jessamyn Wendell; Karen Holtzblatt; Shelley Wood  This handbook introduces Rapid CD, a fast-paced, adaptive form of Contextual Design. Rapid CD is a hands-on guide for anyone who needs practical guidance on how to use the Contextual Design process and adapt it to tactical projects with tight timelines and resources. Rapid Contextual Design provides detailed suggestions on structuring the project and customer interviews, conducting interviews, and running interpretation sessions. The handbook walks you step-by-step through organizing the data so you can see your key issues, along with visioning new solutions, storyboarding to work out the details, and paper prototype interviewing to iterate the design all with as little as a two-person team with only a few weeks to spare *Includes real project examples with actual customer data that illustrate how a CD project actually works.

Videos  

undefined

Instructional Presentations on Interview Skills  

  • Interview/Oral History Research for RSRA 298B: Master's Thesis Reading and Research (Spring 2023) Slideshow covers: Why Interviews?, Getting Context, Engaging Participants, Conducting the Interview, The Interview Guide, Note Taking, Transcription, File management, and Data Analysis.  
  • Interview Skills From an online class on February 13, 2023:  Get set up for interview research. You will leave prepared to choose among the three types of interviewing methods, equipped to develop an interview schedule, aware of data management options and their ethical implications, and knowledgeable of technologies you can use to record and transcribe your interviews. This workshop complements Intro to NVivo, a qualitative data analysis tool useful for coding interview data.

NIH Data Management & Sharing Policy (DMSP) This policy, effective January 25, 2023, applies to all research, funded or conducted in whole or in part by NIH, that results in the generation of  scientific data , including NIH-funded qualitative research. Click here to see some examples of how the DMSP policy has been applied in qualitative research studies featured in the 2021 Qualitative Data Management Plan (DMP) Competition . As a resource for the community, NIH has developed a resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use. It is important to note that the DMS Policy does NOT require that informed consent obtained from research participants must allow for broad sharing and the future use of data (either with or without identifiable private information). See the FAQ for more information.

  • << Previous: Remote Research & Virtual Fieldwork
  • Next: Oral History >>

Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License , which allows anyone to share and adapt our material as long as proper attribution is given. For details and exceptions, see the Harvard Library Copyright Policy ©2021 Presidents and Fellows of Harvard College.

Ethnography Made Easy OER

Edit site title and tagline from dashboard > appearance > customize > site identity.

Ethnography Made Easy OER

Conducting Interviews

Samuel Finesurrey

Introduction

Interviews illuminate powerful and textured depictions of events that help us more fully understand individuals and communities, historical perspectives and the present, struggles and joy. Interviews are an exchange between two or more people where a researcher designs a set of questions to gather information on one or more topics (Blackstone, 2012). Interviews provide ethnographic researchers the opportunity to engage and question, with an eye toward understanding a community or group being studied. An interview can reveal the roots of a cultural tradition or communal mindset by unraveling an assortment of shared and individual experiences, emotions and memories. For example, interviewers may ask their interviewees “what was something that surprised you after joining your union?” or “can you tell us the story of the first time you participated in a strike?” Interviews can reveal details that help unlock the ways your informants see themselves fitting into the world around them, as well as how they communicate in that world.

Varied in type, interviews offer a unique opportunity in ethnographic work to empower your informants to share and preserve their truths, while providing an essential research tool in building ethnographies. Often, with interviews, we are able to recover hidden stories, secrets of the past, or untold journeys that have yet to make it into the history textbooks. It is important to remember while your ethnography is built around your analysis, interviews are co-constructed; that is, they are a form of knowledge produced by both the interviewer and the interviewee.

Types of Interviews

Qualitative interviews are the most common interviews in ethnographic work. A qualitative interview is organized by open-ended questions that seek in-depth explanations of traditions, experiences and perceptions. These are generally semi-structured interviews where the interviewer starts with a list of open-ended questions, but will not strictly follow the agenda they prepared. A semi-structured format is useful for qualitative interviews because it provides room for follow-up questions and illuminate the “why” and “how” of a participant’s experience. Qualitative interviews excavate material that is typically inaccessible through quantitative interviews, structured interviews or surveys, which gather responses through close-ended questions, or collect numerical data from participants. Qualitative interviews enable participants to offer free-formed responses, as opposed to selecting from a short list of choices constructed by you, the ethnographer. They offer the flexibility to propose questions that arise in conversation, seek clarification and allow the space for unique and detailed stories to be told. (Griffiths , 2017; Blackstone, 2012) Qualitative interviews seek narratives, not statistics; not just how many or how often, but “How did that feel?” or “What happened after that?” The benefit of qualitative interviews is that they allow you as the interviewer to access the narrative most important to your interviewee through the process of open-ended responses. Further, as opposed to quantitative interviews, structured interviews or surveys, qualitative interviews give you the ability to break from a set list of questions. (Murchinson, 2010) Qualitative interviews are extremely important as they allow informants to become participants who can “co-construct” the project of understanding their culture.

Often informal interviews , which may feel more like conversations, are appropriate in the context of ethnographic research as people can be wary of being recorded when broaching difficult experiences. Informal interviews are often casual exchanges with informants to gather background information for your project, and often in preparation for a formal interview . Informal interviews are often unstructured, meaning they allow the discussion to freely venture from subject to subject, often without a written list of questions to guide the conversation. In unstructured interviewers the interviewer is following the interviewee as they tell their story. Informal interviews improve formal interviews that take place later as you become more knowledgeable about your respondent’s experience, informed on what they care about, while developing the ability to ask more relevant, fruitful, and directed questions. (Murchinson, 2010) Often held in elevators or hallways, over coffee or in a spontaneous meeting without the aid of a recording device, informal interviews can aid exploratory research, or fill in missing gaps later in the process. It is very important in formal or informal interviews to honor the story you are hearing, to show empathy, to ask questions, but never suggest that you are judging what the respondent is telling you.

Formal qualitative interviews are the most demanding form of interview for both you, as the interviewer, and for the participant(s), but they are also potentially the most rewarding. They offer the opportunity to gather depth, details, and anecdotes for your project, and are better when conducted toward the end of your research, once you know the appropriate questions to ask you informant. These interviews are often recorded, and preserved, depending on the designs of the professor and the comfort of your participants. (Blackstone, 2012) You are asking the participant to share with you their time and memories, often about emotionally exhausting experiences. It is important to remember that an interview is a vulnerable experience. Your informant is sitting down and responding to an organized list of open-ended questions that could bring back painful, intimate and buried memories. Even questions that seem simple, like “tell me about growing up with your family,” can be difficult if someone did not have an easy family life, did not grow up with their family, if a parent was ill, in another country, incarcerated or abusive. “Tell me about your job,” can also cause a strong reaction from your interviewee if the work your informant does is dangerous, if there is discrimination in the workplace, or if they are treated badly by management. While these interviews have the potential to offer you important information, it is key to remember your informant is trusting you with their story. You must handle the interaction with the respect and care it deserves. The intimacy of this exchange requires significant preparation by you, the ethnographer.

Preparing for an Interview

The interview preparation process takes time, thought, and effort. You should create an environment where your interviewee feels comfortable to share their truth, and one that also accommodates your goal of conducting a clear, organized and useful interview. The six key steps in preparation include: identifying your informant, setting a time and place, conducting background research, formulating a list of questions, prepping informed consent forms, and preparing for a recording.

First, you need to find someone to interview. This often takes place in the context of participant-observation through conversations with informants. (Murchinson, 2010) People in and around your ethnographic study can serve as useful participants in your project, or they can nominate others to participate. Your interview will offer interviewees an opportunity to share their truth, something many participants will enjoy. Still, when asking people to participate in your projects, it’s important to show appreciation for their willingness to aid you in this ethnography and to be honest about how the interview may be used and preserved. This is true for both formal and informal interviews.

If you have an informant who has agreed to meet for a formal interview, you need to verify the time, date, and location of the interview. The location can determine the tone of the interview, for instance being interviewed in a law office would likely elicit a dramatically different set of responses than an interview held at their workplace, in a park, or the informant’s home. We want to make sure your interviewee is relaxed, but also that there will not be a lot of background noise that may make the recording hard to hear. You can offer to conduct the interview in English or another language you and the interviewee both speak.  If people want to use words from their original language – even if you are not fluent – tell them they can, and then ask for a translation. You want your informant to be as comfortable as possible with every aspect of this process.

Third, you want to conduct background research about the historical and cultural context of the respondent and their story. Consider asking your informant some preliminary questions through an informal interview , or when setting up the time, to help you prepare for a conversation about their life. You can ask something like, “What should I learn about before I interview you so I can really appreciate your experience?” This process is also helpful as it allows informants to get a sense of what you will be asking and to begin recalling their experiences. After setting up the interview, look online, in books, journals, magazines, newspapers and in archives to become more informed about your participant’s worldview. You want to make sure you can ask about, and explain competing understandings of the context in which the story of your interviewee takes place. If you were studying political attitudes that coal miners hold of President Donald Trump, you would have to also study his presidency, his actions on the environment, healthcare and workers’ rights to understand why they might have concerns, or admire his policies.

Next, formulate a list of questions you will be asking. This is called a guide, schedule or frame . If you are interviewing multiple people for your ethnography, you want to be sure to ask everyone a similar set of questions, and then lots of specific follow-ups that are particular to each informant. This is what makes your interview semi-structured. Everyone gets the same basic questions, but with each respondent the interview travels in a unique direction. When thinking of these questions, keep in mind who your interviewee is and what insights they might, or might not be able to offer. Having a guide prepared for the interview helps give you as the interviewer confidence in your ability to remember the key questions and topics you are hoping to broach with your interviewee. You may be passionate about your topic of study, or nervous at the prospect of questioning your informant. A guide allows you to frame your questions in the best way possible, while serving as a tool to make sure the interview accomplishes what you set out to accomplish. For instance, if you have formed a positive or negative opinion of President Trump from your background research, you would not want to reveal that to your informant. Thus, you would not ask either, “what do you like about President Trump?” or “what don’t you like about President Trump?”  But you might say, “can you give me your impressions of President Trump?” and then follow up with, “are there aspects of his leadership you like, and aspects you don’t like very much?”

It’s extremely important to take time in preparing your guide for the interview, keeping in mind the tone you want to set from the beginning and the order in which you want to present your questions. Practice prepared questions with a friend, family member, or in the mirror so that when you enter the interview you are not nervous or distracted, but are able to focus on being an active listener, paying attention to the subtleties in tone and word-selection of your informant. (Blackstone, 2012)   During the interview, as an active listener , you will be taking notes that will lead to follow-up questions based on the responses of your informant. Never look bored, or like you want to get onto the next question (even if you do!) Try to make eye contact and show through your body language that you are interested in what they are saying. If someone gets sad or teary, agitated or starts to laugh, let them have these emotions without judgment. Feel free to ask them “Do you need a break?” “Are you ok? Sorry if these questions are difficult,” or “Do you feel able to continue, or should we stop?”

For semi-structured, or formal qualitative interviews you should be asking open-ended questions, and avoid questions that will elicit yes or no responses. To create an open-ended question, make sure you are gathering stories or addressing the “how” and “why” of a subject. While it’s important to know the one-word responses to questions like “Where are you from?” this is the sort of information that can be gathered through an informal interview, a survey or a quantitative interview . Formal qualitative interviews offer an opportunity to ask open-ended questions that will go beyond inquiring, “Where are you from?” to ask “Tell me a story about where you are from?” or “Why did you chose to leave where you are from to come to New York City?” Through open-ended questions you can gather significantly more detailed responses.

In some classes you will be required to fill out paper work with your interviewee that affirms their willingness to participate in your ethnography. You should print out and organize the informed consent forms that you will be presenting to your informants. These forms are designed to give the interviewee an opportunity to declare in what context they are comfortable with their oral history being used. You should have the forms prepared beforehand , as they will explain the project to informants and ask their permission to use the contents of the interview. It is helpful to practice how you are going to introduce these consent forms to your interviewees. Depending on your goal, or that of your professor, you may be preserving this interview not only for your ethnography, but also for people to look back on in the future. For this reason, you need to make sure you have the proper paperwork to get permission to either use or archive your interview.

People need to be able to opt out of certain questions if they are uncomfortable; they might want the tape recorder turned off if they are giving you sensitive information they do not want recorded. Perhaps they are anxious about you recording and making public their immigration status, why they quit their job, or a personal trauma they experienced, but they still feel you should know.

Finally, before the interview, if you plan to preserve the recording, you must make sure you have audio equipment and it is working properly. For most interviews, cellphones are perfectly acceptable recording devices. Both Apple and Android phones have applications that generally serve the purposes of this project. Recording the interview is extremely helpful in the ethnographic process and offers possibilities for preserving the historic artifacts created with your informants. If permission is given to record the interview, this allows you to focus on active listening , as opposed to writing down every significant observation made by your participant. While taking notes is still a pivotal part of the interview process, even while that interview is being recorded, simultaneously recording the interview allows you time to formulate new questions and think about the informant’s key points, as opposed to endlessly jotting down whole phrases or ideas.

Conducting an Interview

Ideally you will record the interview to come back to and build upon for your ethnography. After turning on the recording device, and testing to be sure that it is recording, begin the formal interview by stating your name, the date, the name of your interviewee and the location of the interview. Then on the tape you will ask your interviewee for permission to record the interview, either exclusively to use for class work, or to have their interview preserved and archived. If you are not recording the interview, informed consent forms are still helpful as they help your interviewee understand how the information they give you will be used. Explain what you are doing, why you selected this informant, how special you think their story will be. You can tell them that there are no right or wrong answers.

The first few minutes are important for setting the tone of the interview. You want to make sure your informant is comfortable so they are as open and honest as possible. You generally should not start the interview with difficult questions that will make your interviewee uneasy. You would not start with a question like, “Tell me about the time you felt most hopeless when working at the factory.” Instead, start light, ask something like, “Tell me something about yourself that I would not know by looking at you?” “How did you become interested in working at that factory?” or “How did you imagine your career path when you were a child?” The first few questions are extremely important. If you make your interviewee uncomfortable at the beginning of the interview you will get less in-depth and candid responses than if you work your way up to the more difficult questions. (Murchinson, 2010) Starting slow can be a great way to get into a rhythm for both you and your informant.

You should attempt to remain respectful of your informant’s narrative, even if it provokes anger, doubt or suspicion in you. You must be careful not to ask questions that give away your opinions on an issue you are asking about. Do not say, for instance, “This seems like a really nice place to work” or “You seem really frustrated with your boss.”  Something more like, “How do you feel about working here?”  or “If someone you cared about wanted a job here, what would you tell them?” Oftentimes interviewees will look for cues on how you feel about their answer to a particular question. If you show that you either approve or disapprove of their response, it will likely change the way the interviewee responds to future questions.

Further, you must be aware that interviewees may knowingly or unwittingly evade a question, exaggerate a story, provide incomplete information, or lie. This does not mean you should shy away from asking challenging or difficult questions. However, it is important to remember people generally want to present themselves in the best light possible. If you think someone may be misleading you, you can ask something like, “You mentioned you were the best athlete in your school, do you think all the other students would agree?” You may get more detail, you may not, or you may be interviewing the best athlete in the school!

What you hear from your interviewee is subjective, but it is this person’s truth; or at least what they want you to know. Often the interviewee will present an ideal, as opposed to real versions of themselves and their culture. Like any primary source, what your informant says during the interview offers you important insights into their worldview. Still, you must always be aware of your interviewee’s lens. Their narrative is shaped by their experiences and the historical moment in which they live. Always ask yourself how might the informant be attempting to shape your opinion with their explanation of events, traditions, daily routines, and personal experiences. Whether their perspective supports or challenges your conclusions, you must recognize the possibilities, as well as the limitations of this interview. (Murchinson, 2010) Your interviewee cannot give you objective truth, therefore, your projects should not uncritically use anything that the interviewee said. Any assertions or insights that the interview provides should be backed up by other sources of information. We must utilize interviews as only one significant part of an ethnographic study. (Esterberg, 2002)

You, as the interviewer must guide, but not direct the interview. You need to allow the informants to tell their stories, but make sure the interview does not stray too far from your topic so it remains useful to your ethnography. People might wander off topic, let them go for a bit, but always, delicately, get back to your questions. Something like, “That’s interesting. Can we go back to talk more about how your political views were formed?” If you do not understand a response, it is okay to ask your interviewee to explain what they mean. You can say, “Sorry I did not get that,” or “Can you explain that a bit more, I am not sure I understand.”

As an interviewer, you should also make sure that you do not finish the sentences of interviewees. Try to be comfortable in silence after asking a question. This is one of the most difficult, but important parts of the interviewing process. By doing this you are giving interviewee time to think and craft a response in their mind. This is essential to seeing the world as your interviewee is explaining it. If you are asking about a delicate topic, sometimes you can offer a wide-range of possible responses so that respondents feel free to say something not so positive.  For instance, “can you tell me about your growing up–some people have wonderful stories about family, some have difficult stories, some have both. How would you describe the family situation in which you grew up?” or “I wanted to ask you about your job. Some people are really focused on what they like about their work, others complain about aspects and lots of people seem to feel mixed.  How would you describe your work situation?”

Throughout the interview, take notes on insights you find interesting or important, words or phrases you find to be compelling, or questions you want to follow up on. This exercise both helps you formulate follow-up questions and will remind you later of your preliminary thoughts. Some interviewers take two-column notes; writing notes on a page with a line down the middle. On the left they jot down notes of what was said verbatim and on the right they write follow-up questions, ideas for future research, or comments for when they revise their notes at a later date.

While it’s extremely important to have prepared a range of topics and questions, especially in formal interviews, you must also be an active listener, adjusting your questions and creating new follow-up questions based on the responses of your informant. If you find yourself too focused on your next question, you might miss something crucial in your informants’ response. What you missed could have altered your line of questioning, or help you realize you are making assumptions that do not apply to your interviewee. (Murchinson, 2010) Being an active listener is not an easy task, but it is essential to being a good interviewer.

Be careful around particularly sensitive topics such as immigration status, illicit activities, gender, sexuality, religious race or class identity, abuse, money, and politics. If we engage in this line of questioning we must make sure the interviewee is prepared for these types of questions, that they fit into subject of the interview, and that the informant knows they do not have to answer any questions they are not comfortable answering. It is completely acceptable to say, “I have some questions that may be delicate.  If you would rather not answer, just tell me, that’s fine.”

After finishing your list of questions, it is advisable to ask the interviewee, “Is there anything I should have asked, but didn’t?” or something like, “I am going to interview many people like yourself. What questions would you be interested in asking others like you?”  These types of questions can give us additional insight into the most critical topics according to the interviewee. Sometimes the answers to these types of questions are quite revealing and will often lead to a new set of questions. You should be prepared for this type of question to extend the interview.

Before you leave, make sure your informant has signed all of the necessary informed consent forms. Then ask if your informant has any pictures, journal entries, newspaper clippings, or other primary documents that they would be willing to lend you for your ethnography. This will help verify and expand upon the information they shared with you during the interview process, but this new data may also lead to a follow up interview. Offer to send your interviewee a copy of the recording, or the resulting ethnography. Finally, follow-up the interview with a note of thanks.

Evaluating Information from Interview

Immediately after you part ways with your informant you should jot down any thoughts, questions, or ideas you took from the interview. By taking these notes, you can place what you just felt and heard in conversation with the larger ethnographic project. In the next day or two, listen to the recording. It is extremely helpful to take detailed notes on significant ideas and quotes to use for your ethnography while the interview is fresh in your mind.

In many cases transcribing the interview is the best way to start the evaluation process. A transcription is a typed-up version of the interview that either you, or someone else creates while listening to the recording. The best transcriptions document every word spoken during the recording including comments like [laughing] or [um….], words in other languages, or not in standard English. This makes it easier for you to code the interview, to mark patterns, commonalities and differences between events described by an individual, or in comparison to other narratives collected. It is best practice to transcribe the interview word-for-word for both use in your ethnography and to make it accessible for a wider audience. Further, if you have the time, it is best to transcribe the interview yourself. You will remember important details by listening again while transcribing yourself, details that a professional transcriber might miss because they did not experience the interview. (Blackstone, 2012) If your interviewee has an accent or speaks in a language other than English, you will likely transcribe fewer errors than a professional transcriber. The text will serve as an important source for your ethnography, as well as a potential historical artifact for future researchers. Often, interviewees want a copy of their interview for themselves, their children, or their grandchildren.

Preserving the Interview

By conducting an interview you become a producer of knowledge, influencing the ways a community, culture or individual is understood. Thus, the interview process is a tremendous opportunity, but it is also a great responsibility for interviewers, as you have been entrusted with someone else’s story. If you are archiving your interviews for future researchers, you have produced a primary source that documents the story of the person, community, or culture you were studying.  The interview also reveals the types of questions people were interested in during the time you lived. Often the consent forms you have collected will allow you or your professor to archive this recorded interview in some sort of collection. When appropriate, you should discuss with your professor ways to make sure this testimony can be used by future researchers and can be of use to the person, family, and community who contributed the interview. And of course, be very careful never to archive information that you have not received permission to archive or information that would make a respondent vulnerable.

Interviews are crucial methods for documenting the history of the present. They allow us to gather stories about how people live in the world today so that we better understand the range of experiences of the present moment and so that people in the future have a record of everyday, non-elite experiences in the 21 st century.

Chapter Summary

  • The chapter outlined distinct kinds of interviews.
  • This chapter covered the best practices in prepping for interviews.
  • It detailed how best to conduct an interview.
  • It explained the process of evaluating interviews.
  • This chapter explored how best to archive your interviews as a way to preserve them and educate future generations.

Chapter Questions:

  • Why are interviews useful in ethnographic work?
  • What are the different types of interviews and when is each useful toward building a strong ethnography?
  • What are the six steps to preparing for an interview?
  • What sort of background is useful before the interview?
  • Why is it important to think about your informant’s point of view?
  • How would you explain the difference between real and ideal culture?
  • How does a guide, schedule or frame help make you an active listener ? How does a recording the interview help make you an active listener ? How does being an active listener improve the interview process?
  • Why are informed consent forms important?
  • How should you start an interview?
  • Why is it important to frame questions in a neutral way?
  • What types of notes are useful when you are recording an interview?
  • Write a paragraph detailing the how a subject that requires sensitivity might come up within the context of your interview and how might you address this subject with your interviewee.
  • Come up with five open-ended questions to ask an interviewee, on topics related to your class?
  • Qualitative Interviews
  • Informal Interviews
  • Formal Interviews.
  • Interview Guide/Schedule/Frame
  • Semi-Structured Interviews
  • Unstructured Interviews
  • Active Listener
  • Open-Ended Questions
  • Ideal Culture
  • Real Culture
  • Informed Consent Forms
  • Transcribing

Esterberg, K. G. (2002). Qualitative Methods in Social Research . Boston, MA: McGraw-Hill.

Fine, M. (2018). Just Research in Contentious Times .  New York, NY: Teachers College Press.

Griffiths, Heather, Nathan Keirns, Eric Strayer, Susan Cody-Rydzewski, Gail Scaramuzzo, Sally Vyain, Tommy Sadler, Jeff D. Bry, and Faye Jones (2017). Introduction to Sociology 2e . Suwanee, GA: 12 th Media Services.

Murchison, Julian M (2010). Ethnography Essentials: Designing, Conducting and Presenting Your Research . San Francisco, CA: John Wiley and Sons.

Paris, Django (2011). Language across Difference: Ethnicity, Communication, and Youth Identities in Changing Urban Schools . Cambridge, UK: Cambridge University Press.

Amy Blackstone (2012), Principles of Sociological Inquiry: Qualitative and Quantitative Methods. Saylor.org.

Attribution-NonCommercial-ShareAlike 4.0 International

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.

informal interview in qualitative research

Need help with the Commons?

Email us at [email protected] so we can respond to your questions and requests. Please email from your CUNY email address if possible. Or visit our help site for more information:

CUNY Academic Commons logo

  • Terms of Service
  • Accessibility
  • Creative Commons (CC) license unless otherwise noted

Twitter logo

Informal and formal mental health: preliminary qualitative findings

Affiliation.

  • 1 Counselling Program, School of Education, University of Northern British Columbia, Prince George, British Columbia, Canada. [email protected]
  • PMID: 23977648
  • PMCID: PMC3751326
  • DOI: 10.3402/ijch.v72i0.21203

Background: Northern-based research on mental health support, no matter the specific profession, helps to inform instruction of new practitioners and practitioners already working in rural or isolated conditions. Understanding the complexities of northern mental health support not only benefits clients and practitioners living in the North, but also helps prepare psychologists and counsellors preparing to work in other countries with large rural and isolated populations. The qualitative phase is part of a multi-year research study on informal and formal mental health support in northern Canada involving the use of qualitative and quantitative data collection and analysis methods.

Objective: The main objective of the qualitative phase interviews was to document in-depth the situation of formal and informal helpers in providing mental health support in isolated northern communities in northern British Columbia, northern Alberta, Yukon and Northwest Territories (NWT). The intent of in-depth interviews was to collect descriptive information on the unique working conditions of northern helping practitioners for the development of a survey and subsequent community action plans for helping practitioner support.

Design: Twenty participants in northern BC, Yukon and NWT participated in narrative interviews. Consensual qualitative research (CQR) was used in the analysis completed by 7 researchers. The principal researcher and research associate then worked through all 7 analyses, defining common categories and themes, and using selections from each researcher in order to ensure that everyone's analysis was represented in the final consensual summary.

Results: The preliminary results include 7 main categories consisting of various themes. Defining elements of northern practice included the need for generalist knowledge and cultural sensitivity. The task of working with and negotiating membership in community was identified as essential for northern mental health support. The need for revised codes of ethics relevant to the reality of northern work was a major category, as was insight on how to best sustain northern practice.

Conclusion: Many of the practitioners who participated in this study have found ways to overcome the biggest challenges of northern practice, yet the limitations of small populations and lack of resources in small communities to adequately address mental health support were identified as existing. Empowering communities by building community capacity to educate, supervise and support formal and informal mental health workers may be the best approach to overcoming the lack of external resources.

Keywords: formal and informal practitioners; mental health; northern; qualitative research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Arctic Regions
  • Cultural Competency
  • Indians, North American / psychology
  • Interviews as Topic
  • Mental Health Services / ethics
  • Mental Health Services / organization & administration*
  • Middle Aged
  • Patient Care
  • Qualitative Research

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Peer-reviewed

Research Article

The role of informal support systems during illness: A qualitative study of solo self-employed workers in Ontario, Canada

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Sociology, Jagannath University, Dhaka, Bangladesh

ORCID logo

Roles Funding acquisition, Supervision, Validation, Writing – review & editing

Affiliation School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada

  • Tauhid Hossain Khan, 
  • Ellen MacEachen

PLOS

  • Published: March 13, 2024
  • https://doi.org/10.1371/journal.pone.0297770
  • Peer Review
  • Reader Comments

Table 1

Today’s labor market has changed over time, shifting from mostly full-time, secure, and standard employment relationships to mostly entrepreneurial and precarious working arrangements. In this context, self-employment (SE), a prominent type of precarious work, has been growing rapidly due to globalization, automation, technological advances, and the rise of the ’gig’ economy, among other factors. Employment precarity profoundly impacts workers’ health and well-being by undermining the comprehensiveness of social security systems, including occupational health and safety systems. This study examined how self-employed (SE’d) workers sought out support from informal support systems following illness, injury, and income reduction or loss. Based on in-depth interviews with 24 solo SE’d people in Ontario, Canada, narrative analysis was conducted of participants’ experiences with available informal supports following illness or injury. We identified three main ways that SE’d workers managed to sustain their businesses during periods of need: (i) by relying on savings; (ii) accessing loans and financial support through social networks, and (iii) receiving emotional and practical support. We conclude that SE’d workers managed to survive despite social security system coverage gaps by drawing on informal support systems.

Citation: Khan TH, MacEachen E (2024) The role of informal support systems during illness: A qualitative study of solo self-employed workers in Ontario, Canada. PLoS ONE 19(3): e0297770. https://doi.org/10.1371/journal.pone.0297770

Editor: Daphne Nicolitsas, University of Crete, GREECE

Received: May 26, 2023; Accepted: January 11, 2024; Published: March 13, 2024

Copyright: © 2024 Khan, MacEachen. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: There are ethical restrictions which prevent the public sharing of minimal data for this study. Data are available upon request from the Research Ethics Board at University of Waterloo via phone (1-519-888-4567 ext. 36005) or email ( [email protected] ) for researchers who meet the criteria for access to confidential data.

Funding: This research was funded by the SSHRC (Social Sciences and Humanities Research Council)CIHR (Canadian Institutes of Health Research) Productive Workforce Partnership Grant (# 895-2018-4009 and #159064). EM: received the grants websites: https://cihr-irsc.gc.ca/e/193.html https://www.sshrc-crsh.gc.ca/home-accueil-eng.aspx The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Today’s labor market is constantly changing; self-employment (SE) has grown as a key non-standard, precarious, and contingent work arrangement internationally [ 1 – 4 ]. SE is part of a "paradigm shift" from managerial/manufacturing capitalism to entrepreneurial capitalism in the present digital era, appearing in different forms than it did 50 years ago [ 5 , 6 ]. The proportion of the precarious work, including SE, has been growing rapidly in recent decades due to globalization, automation, and the information revolution [ 1 , 3 , 7 , 8 ]. It has been estimated that non-standard employment accounts for more than 60% of workers worldwide [ 9 , 10 ]. For instance, in Canada in 2019, 2.9 million people, or more than twice as many as in 1976, identified as self-employed (SE) [ 11 ]. In fact, SE’d workers represent 15% of employment in Canada [ 11 ]. Similarly, 10% of the Australian workforce was SE’d in 2016 [ 12 ], and in 2017 SE’d workers comprised 15% of the workforce in Europe [ 4 ]. Because of the growing ’gig’ economy and the breakdown of traditional employment institutions that provided secure, lifetime positions with predictable promotion and stable income, this SE trend is intensifying [ 3 , 13 – 15 ]. Against this backdrop, scholars have noted that the existing social security systems for workers need to adapt to the new labor market [ 3 ].

SE’d workers have been portrayed as a special group of homogenous people in the research literature [ 8 ], implying that they possess good health, enjoy the freedom of being their own boss and flexible working hours [ 4 , 16 ], do not rely on the states (e.g., social security protection), and enjoy greater job satisfaction, quality of life, and opportunity to gain work-life balance than employees [ 2 , 4 , 16 , 17 ]. They have a reputation for taking on a substantial amount of personal risk in order to build their enterprises and also create job opportunities for others [ 4 , 8 , 13 , 18 ]. However, mounting international evidence stresses that the changing nature of work is having profound adverse effects on workers’ safety, health, and wellbeing [ 4 , 7 , 10 , 18 – 21 ]. The entrepreneurial depictions, mentioned above, do not reflect the recent reality of the SE, where a significant number of SE’d workers in a given society are compelled to undertake this type of work due to unemployment and scarcity of alternatives [ 4 , 18 , 22 – 27 ]. For example, SE’d workers in some sectors are at higher risk for physical and mental health hazards such as musculoskeletal disorders, joint pain, sleep disorders, and digestive complaints, compared to salaried workers [ 18 , 28 , 29 ]. These risks stem from the nature of SE work, for example, some SE’d people encounter a higher level of job demands and workloads (e.g., farmers), self-exploitation (drudgery), isolation due to working alone, reputational threat, customer and contractor betrayal, absence of social protections (e.g., lack of health insurance), and elevated anxiety about financial matters due to volatile income [ 18 ]. In addition, scholars have claimed that the dominant narrative that SE’d are healthier than salaried workers [ 4 , 10 , 18 , 21 , 29 – 31 ] can be explained by the ‘selection effect’ [ 18 ]. The diversity of SE’d workers is described by the Law Commission of Ontario (2012), which noted that: “the experiences and vulnerabilities of this group range from billionaire entrepreneurs to taxi drivers working 90 hours a week simply to pay their bills and includes many people who are gaining income from self-employment activity alongside their main job” (LCO, 2012: 75). Therefore, SE does not always mean self-sufficiency. Instead, some SE’d workers are considered precarious workers at risk of poverty and social exclusion because they have low job and income security, poor working conditions, and limited social safety net coverage [ 3 , 4 , 10 , 21 , 32 ]. In all, SE appears to be a “a double-edged sword” [ 18 ].

Across jurisdictions, SE’d workers are largely excluded from many social security protections, including the workers’ compensation coverage, employment insurance, and state pension plans [ 3 , 7 , 10 , 21 , 33 ]. The ILO’s study of G20 countries found a social protection coverage gap for SE’d workers in many countries [ 34 ]. In some countries (e.g., Estonia, Latvia, Portugal, and Slovick Republic), 40–50% of precarious workers were less likely to receive any form of income support when they were out of work due to injury, sickness or any form of impairment [ 10 , 14 , 21 ]. In this context, Australia (NSW) and Canada (Ontario) are similar, providing limited and partial support for the SE’d workers; with Australian SE’d workers having more schemes to opt into than Canadian workers [ 21 , 33 , 35 ]. However, some welfare states play pivotal roles in terms of protecting SE’d workers [ 10 , 21 ]. For example, Finland provides a broad support system to workers regardless of employment status, in which SE’d workers are covered with earnings-related pension schemes (old-age pension, disability pension, survivors’ pension) and have access to a universal basic social security system (parental and sickness benefits, housing and unemployment benefits) [ 21 , 36 ]. In all, the absence of a social safety net can perpetuate the distress of SE’d workers; mounting evidence illustrates a strong relationship between precarious employment and poorer health outcome [ 4 , 10 , 21 , 37 ] and numerous social costs [ 18 , 21 , 28 ].

Statuary social supports for SE’d workers world-wide are partial and scanty [ 10 , 21 ]. The aim of this study was to examine how, in the absence of such supports, SE’d workers fared when they were injured or ill and unable to work. The focus of this paper is on how SE’d workers turned to informal support systems following illness, injury, and income reduction. By informal support systems, we refer to the SE’d person’s system of primary relationships with individuals such as family members, friends/social networks, and relatives or neighbors [ 38 ], including instrumental, emotional, and informational supports [ 16 ]. Hilbrecht (2016) described instrumental supports as including practical assistance concerning concrete skills, actions, or resources, for example, financial support from family members. Emotional supports include providing empathy, reassurance, and understanding; for example, providing counseling and showing empathy towards SE’d workers during economic volatility. Finally, informational supports offer information or suggestions, such as reliable guidelines and information about government-provided support/benefits [ 16 ].

Methodology

Study design.

A qualitative methodological approach was utilized for this study due to our interest in how SE’d workers’ fared when experiencing ill-health and inability to work. In line with this approach, an interpretative paradigm, which focuses on the understanding of phenomena through meanings people bring to them, was used to reflect upon the narratives provided by participant [ 39 ]. This approach helped to unpack the underlying meanings embedded in SE’d workers’ stories, including everyday practices and experiences situated in a larger cultural context. The study was approved by the Research Ethics Board of the University of Waterloo, Canada.

Participants, sampling, and recruitment

Participants were selected for this study based on the following inclusion criteria: solo SE’d workers (i.e., no employees), aged 18 years or older, experience of illness or injury while SE’d (work-related or not), main income is from self-employment, and fluent in English (due to researcher language limitations) ( Table 1 ).

thumbnail

  • PPT PowerPoint slide
  • PNG larger image
  • TIFF original image

https://doi.org/10.1371/journal.pone.0297770.t001

Various social media platforms were used to recruit participants from Ontario, Canada, including, Linkedin, Facebook, Kijiji, Twitter, and Tumblr. From among eligible participants, we selected participants purposively for information-rich and heterogeneous cases (Patton, 2001). The 24 participants included in the study were between 21 and 62 years of age, with varied education (college diplomas, university degrees, etc.) and income levels ($25k/year—$200k/year). Similar proportions of men and women were included in the study. The workers were interviewed by the lead author using audio/video conferencing with Zoom and WhatsApp. The interviews were conducted between January and July 2021 and lasted 1.10 hours on average.

Data collection

As this study involved soliciting solo SE’d workers’ personal experiences including culturally sensitive information (e.g., income, sickness, personal family lives), a semi-structured, in-depth interview approach was selected to give time and space to each person to explain their situation. Interview questions were informed by literature and discussion with the research team. We used a combination of questions and probes (follow-up questions) to achieve breadth of coverage across the following key topics: (a) work-related experiences; (b) illness, injury or income reduction/loss; (c) government and informal social benefit systems they used; (d) health and wellbeing in the context of work. Interviews were audio-recorded and transcribed verbatim by professional transcriptionists. Oral informed consent was received before interviews started, documented through the transcriptions, stored in a safe location, and approved by the ethics review committee. Along with reflexive journal, detailed field notes were taken after each interview to describe encounters, including the immediate impressions and context, and analytic insights.

Data analysis: Thematic narrative analytical approach

Following Reissman’s (2008) Narrative Thematic Analytical Approach (NTAA), this study aimed to gain insight into the experiences and practices of SE’d workers as told stories (narratives) pertinent to their life experiences [ 40 , 41 ]. NTAA is well fitted for the context of this study because, unlike other types of narrative analysis, it focuses on “what content a narrative communicates [what is told or spoken], rather than precisely how a narrative is structured to make points” [ 42 ] [p.81]. The analysis was composed of several phases: reviewing the transcripts multiple times, developing a codebook, establishing themes and subthemes, and identifying core narrative elements associated with each theme. A combination of both deductive and inductive coding was used during the data analysis process, resulting in a codebook of 10 codes. The codes were informed by the existing literature, and issues identified during interviews. Using Nvivo, the data sets were re-arranged in terms of the codebook. These codes helped us reflect on the overall patterns of the data, including identifying common themes. Our analysis resulted in the development of three major themes, as discussed below.

The findings describe participants’ stories about the navigation of the informal support systems, following their illness, injury, and income reduction and/or loss. This section begins by describing how participants managed by drawing on their own savings, and also how low-wage SE’d workers, such as gig workers, were unable to create a savings pool. The next section describes stories about alternate forms of financial support that SE’d workers relied on when they were ill or injured, such as loans from family. Finally, we describe emotional and practical support as the third main type of informal support that sustained SE’d workers in times of need.

Relying on savings

SE’d workers in this study placed an emphasis on the need to have personal savings in order to get through income fluctuations. As noted by one participant: “I used my savings to back up everything” (Habibur). The participants voiced the idea that SE’d workers are the architect of their own fortune and wellbeing. As SE’d workers were not required to contribute to salary replacement insurance or benefits, they believed that neither the government nor private organizations were obliged to protect them. As one SE’d worker reflected: “There is no help as a self-employed person, I cannot claim anything until I become absolutely disabled” (Remi). The SE’d participants took for granted that they had to save money for future for things like medications, vacations, and pandemic. Participants described relying on savings during periods of illness, as per the following instance: “Well, at that time there was no support systems by the government […] My support system is my own saving money … So basically, when I was sick, I was solely on my own money that I could survive” (Remi). Similarly, a beautician (Farina), noted that SE’d people are obliged to save money given that they have little access to formal supports. When prompted to reflect on their access to social security system supports, SE’d workers in this study felt that, because they pay taxes to the government, it was unfair for them not to have access to income replacement protections following illness or injury or, in the circumstances of the income reduction or loss. In this regard, one SE’d worker noted, “I think everyone has the right to have housing and food and you do not worry about those things” (Jane).

A challenge with relying on savings is that low-income SE’d workers, such as gig workers who constitute a growing portion of the SE’d population, are unlikely to be able to set aside savings and thus may have no funds to support themselves during an illness or injury. For example, as Canadian healthcare coverage does not cover the cost of medication, low-wage SE’d participants in this study struggled with the financial challenge of accessing medication and non-core health care:

I have to pay for my meditation from my own pocket. I have to pay for my IV therapy, a small fee, because part of it is covered under OHIP [Ontario’s free public health insurance]. I have to pay for the transportation to my appointments, my regular doctors’ appointments. …. My neurologist. …. I haven’t had to see them for a while with COVID. …. Blood work is covered …, except what I need a special test every now and then. And it’s $60. Like an hour’s massages [is] $80 to a $120. I don’t have money for that. So, I bought a massage pad to try to help ease those symptoms…. I also look for opportunities like … college students for like, massage therapy, osteopath, those kinds of things where they need people to practice on and they’ll do it for free. So, I look for things like that …where I can get at least treatment … at no cost to myself. Because I just don’t have any extra money. (Mary)

In some cases, SE’d workers managed their lack of funds by not buying required medications: “I … don’t take medication either for it. So, because we can’t afford it […] Well, health care is free in Ontario, but medications I can’t afford them”. Describing scarce income, a SE participant similarly said, “I would rather spend this much money on groceries rather than on medicine. However, medicine is important” (Ander). Drawing on savings was easier for the higher-income SE’d in this study. For example, a SE’d financial advisor was able to rely on her savings when ill and additionally had been paying into private critical illness insurance:

I have no choice. I have to use my own savings […] Yes, yes, I have saved so much that I can do that. I have enough money to support myself for like two or three years. […] I have insurance, for … like, critical illness. If I become critically ill, I have disability insurance, I have savings and that’s it. So, I just survived. So yeah, my earning […] and my passive income … and there is no help from the Government. I’m self-employed so, everything I pay for myself, my own disability or critical illness. […] Only the plan that I purchase my-self through insurance company for critical illness like cancer, heart attack, stroke, other illnesses and then my disability, if I become disable […] I wouldn’t trust the Government. No, no, no, I wouldn’t trust the Government … I’m paid into EI many years, jobs before I’m paid into one time I had to claim, and they ask for back, I don’t trust the Government. (Remi)

Loans and financial support through social networks

Credit card loans were another way that SE’d workers managed financially when their income was low. For some, this meant a cycle of loans and interest, and more payments, as per this SE’d participant: “My savings was very poor … [I had] not enough to support my unworked period of time. So, I had to charge my credit card a lot. And after work I have to pay those” (Mamun). All of the SE’d workers in our study described social networks (e.g., siblings, parents, family members, marriage partners, former spouses) as essential support systems during times of need due to illness or injury. These networks provided varied types of support, including financial, reciprocal (e.g., babysitting for a neighbor), mental, and emotional support.

Most of the SE’d workers borrowed money from either family members or friends to stay afloat during difficult times, such as when they become ill. For instance, when a gig worker, who was also an international student, had to stop working for three months due to an injury, he was without an income and was financially supported by his parents. It was incredibly demanding to bear living and medication costs for long in tandem with international tuition fees, as these students usually fund their own living expenses by working, with tuition paid by their family:

“At that time, I got some money from my parents, like they are in Bangladesh right now. So, they help me to go through it for two months. So yeah, I need a few supports so they offer me something, but I felt pressure to start my work, and returned to work, even though I was not ok … I mean I was sort of forced to return, I was afraid to ask [my parents for] more money for the next month” (Sumon).

Most participants discussed both family and friends helping, in combination. For instance, a SE’d electrician described how his family was why he did not worry about support during times of need: “Yes. I had a very good… family […] and friends that I’ve known for all my life. So, I’m not worried [about support if needed during my illness or income loss]” (Paul). In another case, a SE’d cleaner whose earnings were at subsistence level relied financially on both her husband and her mother when she could not work and earn money following illness or other reasons: “If I do need financial assistance [initially she usually asks her husband]. If it was over three months, I would have to rely on my mom” (Sarika). As well, a SE’d rotary public commissioner described approaching her family members for financial support and then sometimes approaching friends: “My parents are big support system right now for me. So, if I desperately need money, my dad gives me a loan. Usually sometimes he can do it, sometimes he can’t […] Before my friends, my extended family, my brother, my sister”.

Financial support was also described as reciprocal. For instance, a SE’d tailor noted that when she was short of income, she asked friends to help pay her rent, and she did the same for them: “Sometimes we had to face money shortage during my illness or failing to deliver order on time, then I borrow money for house rent from friends, as I have few friends here” (Mila). Likewise, a SE’d licensed home-based childcare provider (Tasmina) described being supported by her husband when her income was low, and also supporting her husband financially when needed.

Some SE’d workers also described members of their community as providing financial support when they had to leave work or had reduced working hours due to being ill with the Covid-19 virus. This support came in the form of donations of money, food or loans with zero interest and flexible time for repayment. For example, one gig worker and international student received donations from his ethnic community when he was ill and unable to work: “…there are many other brothers who used to help me in my impoverished times. Even, when I have issues with my tuition fees, I get help from them” (Habibur). He further added: “[…] who used to give me a lot of financial help through the time I have problem. Or my sickness or even though I have problem with my tuition fees. I always just … call him on say something I have a problem. Whether I have to say just send me the money and I will just pay him. And it doesn’t take any …. He is helping not only me but other international students”.

Emotional and practical support

Emotional, mental, and motivational support also helped SE’d workers in this study during their times of need and were provided by friends and family. For instance, a SE’d property manager expressed gratitude for the emotional supports to her friends: “Uh just emotional, no one’s giving me money. But emotional support or informational support. You know, they’ll tell me, recommend what I should do”. Similarly, a SE’d fashion designer emphasized her friends’ mental and emotional support:

“I have incredible friends. I have a lot of really great emotional support and I used to play Roller Derby before I got sick. There’s a lot of fun and I made lifelong friends there. My best friend is incredible. She lives in Vancouver, but we talk every day […] I have great friends … they’re amazing and they will come and visit me, they will call me”. (Mary)

Other SE’d workers in this study (Tasmina, Patrick, Sarika, Habibur, Bob) described how their friends supported and helped them mentally and emotionally by providing food, lending a hand to help with work, and taking care of children. In this context, one SE’d participant who ran a DJ business (Bob), described a situation when he was committed to perform as a DJ in a wedding program, but could not make it due to a sudden illness. He described how his friends performed on his behalf, thereby saving his professional reputation. Although he paid his friends for this support, they nonetheless helped him at a difficult time:

If I get injured, say my back or something like that, I’m still able to do the job but I might need help carrying the heavy equipment. In that case, I have a few friends … For bigger jobs where I need same extra vehicle, or I have a lot of setups … in those cases I just call one of those people that I can trust that knows the job and they come out and help me. They will do all the heavy lifting … and I pay them as well. So… that comes out of my pocket. They are not employees or anything like that but I also feel like, you know, some friends will just help you out. … So I always make sure do that and they are always ready to help me again, sort of the thing right?

Roommates were also described as helping the SE’d workers following their injury or illness: “[My roommates] help me to cook, they help me to get go to the doctor, buy some medications, that’s all. They help me to buy stuff like I need to buy some goods, they will buy for me.” (Sumon)

The SE’d workers also described their family as an important mental health support system (in addition to the financial support provided). For instance, one SE’d worker was supported by both their mother and husband:

Oh, I don’t currently get financial support from anybody. But … I do in terms of emotional support. …My mom and my partner, all are very supportive, they have all seen me struggle with my health issues over the years. So yeah, I do have a great support system that makes a big difference. (Sarika)

In another example, in another case when a SE’d worker was ill and without income, her husband stepped in to provide childcare that she could no longer afford to pay for: “Ah, my ex-husband has been really great. When I got sick, the kids were a little younger and he took over as primary parent … they went to live with him full time” (Mary). Likewise, spouses were described as supporting their SE’d partners mentally and physically following an illness or injury. For instance, following an injury, a SE’d IT consultant’s wife took a leave from her work to help him. As he explained: “When I got injured that time my wife had to take also leave for some days […] and that’s why her work was also impacted” (Mamun). Similarly, the wife of a SE’d data analyst (Jimmy) managed his client’s email and dealt with the issues that were not too technical when he was ill.

Other close relatives also helped the SE’d workers when they were ill or injured and unable to work. For example, a SE’d home childcare provider how her in-laws helped her during her illness by providing food and care for her children:

As my family doesn’t live over here [in Canada], and my in-laws live with me, [when I get sick] so they can cook. If I cannot cook for my sickness time … they help me—like if I need support to take care of my children because if I’m sick. (Tasmina)

To sum up, participants in our study described getting through illness, injury, job loss or income reduction by relying on savings to support themselves and their families. They also relied on their family, friends, and other social networks for loans, and relied on emotional, mental, and pragmatic supports.

While employees in regular employment relationships are protected by statuary and employer support systems, most SE’d workers, including those we studied in Ontario, were not fully covered in this context. The limited social security support for SE’d workers is well addressed in a mounting international literature [ 3 , 7 , 21 , 33 , 43 – 45 ]. However, very little research has addressed how SE’d workers’ survive during times of injury or illness by drawing on informal support systems, with the exception of Hilbrecht [ 16 ]. It is historically evident that informal support systems, such as social network, family relationship, kinships, and friendships play a pivotal role in times of distress [ 46 , 47 ]. Against the backdrop of historical role of such relationships and social security system coverage gaps, we discerned how this relationship supported SE’d workers, following their illness, income reduction/job loss. In this context, previous researchers have examined the nexus between family and work-life balance and conflict among SE’d workers [ 48 , 49 ], the effectiveness of informational (e.g. advice) and instrumental (e.g., financial aid) social supports for SE’d people [ 50 – 52 ], whether more support (informational and instrumental) leads to better outcomes for SE’d workers [ 52 ], gender relations of SE’d workers in respect to work-family conflict [ 53 ], and how family and community as a resource of supports play out for SE’d men and women differently [ 54 ]. These studies mainly focused on how work-family relations are positively or negatively affected by their SE’d work or vice versa. In short, previous research has shed light on SE’d workers’ experiences with receiving emotional and instrumental supports, and also focused on a work-family context [ 16 ].

We found that SE’d workers in our study used informal support systems to fill gaps in social security protection. This support took the shape of personal savings, loans from family and personal networks, and emotional and practical support from family and friends. Altogether, these supports can be categorized into cultural and social capital [ 55 ], which are widely described as influential impetus of social development, career growth, and success in self-employment [ 47 , 52 , 56 – 58 ]. Moreover, these informal support systems maintain people’s happiness and wellness (“good life”), which is historically addressed in classical scholarship [ 59 – 61 ]. Although we were unable to find any previous studies showing the nexus between family/social networks and the social security of SE’d people, studies have documented that entrepreneurial behavior and success are significantly influenced by their family and kinships [ 62 ]. These kinship support systems provide benefits through learning (e.g., sharing failure or success experiences) and complementarities, risk-sharing, and lower transaction costs [ 62 ]. Our previous findings based on this data set suggested that that some SE’d workers did not trust social security systems to support them in times of need [ 10 , 33 ]. In turn, this may foster relatively more reliance and trust by the SE’d on informal support systems, such as family and social networks.

In our study, family members of SE’d were their key source for a wide range of informal support. Kim, Longest and Aldrich [ 52 ] argues that these relationships are instrumental to launch SE’d businesses and for them to thrive and survive. Our findings, however, differ with Hilbrecht [ 16 ], who found that SE’d workers had conflicted feelings about financial support from spouses. In our study, SE’d workers welcomed the emotional, mental, financial, and practical supports provided by family and social networks. Welfare theorists and social scientists have been castigated for ignoring the role of family in people’s welfare [ 46 ]. Akram and Maitrot (2022) stressed that the family is the pillar of all welfare systems; however, their analyses were built upon the lower middle-income countries and cannot be expected to apply to advanced economies that emphasize individualism [ 46 ]. However, our study suggests that, for SE’d workers in high income countries, families maintain an important welfare role.

SE’d workers in this study described non-family networks as also important sources of support to them when injured or ill. These supports included providing food during illness, lending a hand at work, taking care of children, and also financial support. This help was sometimes reciprocal and sometimes paid. In our study, this community support was interestingly connected to race and cultural background. The SE’d workers from South Asian countries (e.g., Bangladesh, India) received substantial financial and emotional support from their community. For instance, as a disaster-prone country, Bangladesh is known for systems of informal support (e.g., kinship, community) in managing and resilience from natural (e.g. flood) and man-made (e.g. road accident) disasters [ 63 , 64 ]. Similarly, South Asian countries traditionally provide informal care to the elderly [ 46 ]. Although Canada is a high income and predominantly individualistic country, the large population of immigrant families from non-individualistic cultures may provide particular support for self-employment.

Finally, SE’d workers in this study relied heavily on their savings, which is consistent with previous studies showing that neoliberal mindsets of people encourage them to opt into SE and accept lesser reliance on government social security systems [ 10 , 33 , 65 – 69 ]. Neoliberal ideas encourage people to be self-dependent based on savings instead of relying on the states’ contributions. This becomes particularly problematic when gig workers, often young people, become trapped in this unprotected form of work (e.g., gig workers) [ 3 ]. In this study and others, the so-called ‘sustainability’ of savings among SE’d workers was debunked, given the low and inconsistent income among some workers, including gig workers [ 16 , 67 , 70 ]. Indeed, several low-earning solo SE’d workers in our study vehemently expressed that their savings were insufficient to support the costs of prescription medicine and uninsured dental and other therapies. Hence, some were forced to depend on loans or credit cards to stay afloat, which, in turn, pushed them into the ‘vicious cycle’ of debt.

In all, while SE’d workers have never been a homogenous sector, there are now a greater portion of SE’d at the low-income end, such as in gig work. Such SE’d workers generally have no savings for rainy days, as their income is too low to allow for it. So, entrepreneurialism might be a difficult concept to apply to this new, growing low-end SE’d group. In the absence of social security coverage, this group is particularly reliant on informally developed support systems and have little access into supports for a decent life that are enjoyed by employees.

To date, there has been little understanding of how solo SE’d workers experience and navigate income reduction or loss during periods of ill-health or injury. What support systems do SE’d workers seek and avail? Although scholars have engaged with the existing statuary or formal support systems for SE’d workers, little is known about their informal support systems. This study finds that, in the absence of adequate social security protections, SE’d workers relied substantially on informal support systems. While we cannot provide any single solution to better protect SE’d workers, our findings suggest that low-income workers could benefit from social security supports irrespective of employment status. Overall, SE’d workers, as a changing sector, requires consideration of equitable, inclusive, and sustainable social protection systems that ensure protection to meet people’s needs over the life cycle.

Acknowledgments

The authors thank to the participants of the study who shared their stories.

  • View Article
  • Google Scholar
  • PubMed/NCBI
  • 7. Quinlan M: The effects of non-standard forms of employment on worker health and safety: ILO Geneva, Switzerland; 2015.
  • 11. Labour Statistics at a glance, Self-employed Canadians: Who and Why? [ https://www150.statcan.gc.ca/n1/pub/71-222-x/71-222-x2019002-eng.htm ].
  • 12. (ASFA) TAoSFoAL: Super and the self-employed. In.; 2016.
  • 14. OECD Employment Outlook 2019: The Future of Work [ https://doi.org/10.1787/9ee00155-en ].
  • 15. The Effects of Self and Temporary Employment on Mental Health: The Role of the Gig Economy in the UK. [20. https://ssrn.com/abstract=3395144 ].
  • 34. ILO: Ensuring better social protection for self-employed workers. In. Saudia Arabia: International Labour Organization (ILO) Organisation for Economic Co-operation and Development (OECD); 2020.
  • 35. Khan TH, MacEachen, Ellen, Dunstan, Debra: Self-employment and Social Supports in Canada and Australia: A Comparative Policy Analysis. In: Canadian Association for Work & Labour Studies Conference : 2021 ; Alberta, Canada: Canadian Association for Work & Labour Studies 2021.
  • 39. Creswell JW, Poth CN: Qualitative inquiry and research design: Choosing among five approaches: Sage publications; 2016.
  • 42. Riessman CK: Narrative methods for the human sciences: Sage; 2008.
  • 55. Bourdieu P: Outline of a Theory of Practice: Cambridge university press; 1977.
  • 60. Greco S, Holmes M, McKenzie J: Friendship and happiness from a sociological perspective. In: Friendship and happiness . edn.: Springer; 2015: 19–35.
  • 69. Kalleberg AL, Vallas SP: Probing precarious work: Theory, research, and politics. In: Precarious work . edn.: Emerald Publishing Limited; 2017: 1–30.
  • Open access
  • Published: 11 March 2024

“It’s a stressful, trying time for the caretaker”: an interpretive description qualitative study of postoperative transitions in care for older adults with frailty from the perspectives of informal caregivers

  • Emily Hladkowicz 1 , 2 , 4 ,
  • Mohammad Auais 1 ,
  • Gurlavine Kidd 3 ,
  • Daniel I McIsaac 2 , 4 , 5 &
  • Jordan Miller 1  

BMC Geriatrics volume  24 , Article number:  246 ( 2024 ) Cite this article

13 Accesses

Metrics details

Older adults with frailty have surgery at a high rate. Informal caregivers often support the postoperative transition in care. Despite the growing need for family and caregiver support for this population, little is known about the experience of providing informal care to older adults with frailty during the postoperative transition in care. The purpose of this study was to explore what is important during a postoperative transition in care for older adults with frailty from the perspective of informal caregivers.

This was a qualitative study using an interpretive description methodology. Seven informal caregivers to older adults [aged  ≥  65 years with frailty (Clinical Frailty Scale score  ≥  4) who had an inpatient elective surgery] participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using reflexive thematic analysis.

Four themes were constructed: (1) being informed about what to expect after surgery; (2) accessible communication with care providers; (3) homecare resources are needed for the patient; and (4) a support network for the caregivers. Theme 4 included two sub-themes: (a) respite and emotional support and (b) occupational support.

Conclusions

Transitions in care present challenges for informal caregivers of older adults with frailty, who play an important role in successful transitions. Future postoperative transitional care programs should consider making targeted information, accessible communication, and support networks available for caregivers as part of facilitating successful transitions in care.

Peer Review reports

Introduction

The majority of care received by older adults is from informal caregivers [ 1 , 2 ]. While the definition of an informal caregiver ranges from an adult child or a co-residing spouse providing care as needed, to someone who provides ongoing support with Activities of Daily Living (ADLs), the defining feature is that an informal caregiver provides some type of unpaid support [ 3 ].Typically, informal caregivers have a social relationship with the person they are providing care for, and could include a spouse, child, other relative, neighbour or friend [ 4 ].

Having support from an informal caregiver following a hospital stay is associated with a decrease in healthcare utilization, including shorter hospital length of stay, reduced homecare services and a lower likelihood of transitioning into long-term care [ 4 ]. The transition out of hospital is a challenging time that can lead to poor quality of care for older adults [ 5 ]. Transitional care is defined as, “a set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location” [ 6 ]. Older adults having surgery often require the support of informal caregivers during the postoperative transition in care [ 7 ], so ensuring quality transitional care is crucial for older patients and their caregivers [ 6 ]. Importantly, older adults who live at home with family are more likely to be discharged home after surgery than older adults who live alone [ 7 ].

Older surgical patients strongly prioritize going home after surgery [ 8 ], however, research shows that older adults develop the same loss of independence after surgery regardless of living with family or alone [ 7 ]. This results in challenges and negative impacts on well-being for informal caregivers due to their vital roles in supporting the older adult who has transitioned home. Evidence indicates that caregiver strain is increased after surgery compared to pre-surgery, peaking at discharge and in the 2 weeks after surgery [ 9 ]. The prevalence of caregiver strain is likely to increase, as patient-related factors associated with increased caregiver strain (e.g., older age, physical or cognitive impairment, comorbidities) are increasingly common among surgical patients [ 9 ]. Frailty, a state of vulnerability to adverse health outcomes related to accumulation of multidimensional deficits, is highly prevalent among older surgical patients ( ∼  40%), and is associated with a two-fold increase in patient-reported disability after surgery [ 10 , 11 ]. Therefore, understanding the experiences and priorities of individuals providing informal postoperative care to older adults with frailty is important to support the integral role that such caregivers play in the postoperative transition in care, and in planning postoperative transitional care interventions, healthcare planning, and health system policies. Accordingly, the purpose of this study was to explore what is important to informal caregivers during a postoperative transition in care for older adults with frailty.

Materials & methods

Study design.

This was a qualitative study conducted in the interpretive description tradition [ 12 ]. The purpose of interpretive description is to create knowledge that can be applied in a clinical, real-world setting [ 12 ]. Interpretive description is an applicable methodology to address the current research question as new knowledge is required to support informal caregivers during postoperative transitions in care. Semi-structured interviews were conducted to explore what is important to informal caregivers as they help support a postoperative transition in care for older adults with frailty. Interpretive description emphasizes that knowledge does not stay the same as it evolves and changes over time [ 12 ]. As such, this research is positioned within a constructivist paradigm, where multiple realities and perspectives exist, eliminating the possibility of one, single truth [ 13 ]. Informal caregivers were recruited in dyads with older adults with frailty who had inpatient elective surgery. The results of the patient interviews have been previously published [ 14 ].

Reflexivity statement

EH is a female Doctoral student in Aging & Health and a Clinical Research Associate in a perioperative medicine research program. EH has completed a frailty fellowship through the Canadian Frailty Network and was an informal, essential caregiver to her grandfather in long-term care. MA is an Assistant Professor in the School of Rehabilitation Therapy and is a registered physical therapist with expertise in geriatric rehabilitation. GK is a patient partner with lived experience as an older adult who has had inpatient elective surgery and is a retired Social Worker. DIM is an anesthesiologist and scientist who conducts clinical trials to improve patient and system-level outcomes of older people having surgery. JM is an Assistant Professor in the School of Rehabilitation and conducts quantitative and qualitative research in the areas of health services, pain management and primary care.

Setting and participants

Ethics approval was obtained from The Ottawa Health Sciences Network– Research Ethics Board (Protocol# 20200322-01 H) and Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (Protocol# REH-773-20).

This study was conducted at The Ottawa Hospital (TOH), including the Civic and General campuses. TOH is a 900-bed tertiary care Health Sciences Network that is the regional referral center for trauma, vascular, neuro, thoracic and complex oncology surgery, and serves a catchment population of 1.2 million people. Both campuses are located in Ottawa, Canada.

Participants were recruited by emailing or mailing a recruitment poster (Supplemental Material 1 ) to older adults who were transitioning home after surgery. The email/mail requested that the recruitment poster be provided to their informal caregiver. If the informal caregiver was interested in participating, they contacted the lead researcher (EH), who explained the goals of the research and obtained informed verbal consent over the telephone. The participants were not known to the researchers. There is variability in the definition of an informal caregiver across research studies [ 3 ]. For this study, an informal caregiver was defined as someone known to the patient who provided some form of unpaid support and care. The patient and the informal caregiver mutually agreed that they were an informal caregiver during the postoperative transition in care. Caregiver participants were recruited within the year following the patient’s surgery. The patients were older adults ( ≥  65 years) with a Clinical Frailty Scale score of ≥  4 [ 15 ], and had an inpatient elective surgery.

Data collection

Demographic information was collected using a telephone-based questionnaire. Telephone interviews were conducted using a semi-structured interview guide (Supplemental Material 2 ). The interview guide was informed by a continuum of care framework [ 16 ] that highlights the transition points for a hospitalization (admission to hospital, hospital stay and discharge planning, transition out of hospital) to help participants identify what was most important in supporting the postoperative transition in care. The interview guide was reviewed and revised by a patient partner (GK). All telephone interviews were conducted by EH. To mitigate the potential limitations of telephone interviews, the interviewer (EH), consistently checked-in with participants throughout the interview to ask how they were feeling about the discussion, if they had anything they would like to add or expand on, and were asked to clarify what they meant when they used certain language. During the consent discussion and throughout the interview, participants were reminded that they could pause or stop the interview at any time. Caregiver interviews ranged in time from 19 to 51 min. One interview (19 min) was stopped prematurely as the participant described feeling stressed thinking about the first few days at home after surgery and did not want to continue the interview at another time. Recruitment and data collection ended once information power [ 17 ] was achieved. This was evaluated by appraising the study aim, sample specificity, quality of the dialogue and analytic technique [ 17 ], while considering the recommended sample size (between 6 and 16 participants) when doing thematic analysis [ 18 ]. The authors (EH, JM) assessed these components and recruitment ended once the authors felt that there was quality and comprehensive data to support the objective of the research. EH took field notes during and after interviews, and participated in reflexive journalling, to document the meaning assigned to certain phrases, and to highlight emotions that came up for participants and the interviewer.

Interviews were audio-recorded, transcribed, reviewed for accuracy and then analyzed using reflexive thematic analysis [ 19 ] in an interpretive description tradition [ 12 ] to identify clinically relevant themes. A combination of coding on hardcopy transcripts and using Excel software was used for organizing data within codes, themes and subthemes. Rigor was maintained during analysis through an audit trail, documenting analytic field notes and engaging with the research team to encourage reflexivity [ 20 ].

Analysis followed the steps of reflexive thematic analysis: [ 19 ] (1) dataset familiarization; (2) data coding; (3) initial theme generation; (4) theme development and review; (5) theme refining, defining and naming; and (6) writing up. One study investigator (EH) independently coded the transcripts. Once codes were identified, a coding tree was developed (Supplemental Material 3 ). Two investigators (EH, JM) met to critically reflect upon the codes and initial themes, not to reach consensus but to develop a more reflexive and refined analysis [ 19 ]. The study was conducted and reported in alignment with the Consolidated Criteria for Reporting Qualitative Research checklist (COREQ) [ 21 ].

Participants and characteristics

Eight participants consented to participate, and one withdrew from the study and therefore did not complete the interview. Demographic data for the 7 participants who completed the interview are presented in Table  1 . While 2 of 7 informal caregivers did not live with the patient prior to surgery, they both moved in with the patient for a short time after surgery. There were 2 informal caregivers for the same patient (one was a spouse, and one was an adult child). Four patients had surgery before the COVID-19 pandemic was declared, two had surgery after the COVID-19 pandemic was declared, and one patient asked to withdraw from the study so no information on this patient is available. Surgery dates ranged between December 2019– March 2022. All of the interviews with the caregivers occurred within 3–9 months of surgery, and all occurred during the COVID-19 pandemic.

Four themes were constructed upon exploring what is important during a postoperative transition in care from the perspective of informal caregivers (1) being informed about what to expect after surgery; (2) accessible communication with care providers; (3) homecare resources are needed for the patient; and (4) a support network for the caregivers. Theme 4 included two sub-themes: (a) respite and emotional support and (b) occupational support. See Fig.  1 .

figure 1

Themes and sub-themes. A visual of the 4 themes, including the theme that has 2 sub-themes

Theme 1: Being informed about what to expect after surgery

Participants wanted to be informed about what the recovery trajectory might look like for the patient. They wanted to know how to monitor and manage postoperative symptoms and when to seek medical attention. One participant shared:

At least to know what the expectations are and to know that she’s progressing, more or less on a schedule that’s expected for someone her age, so that I know whether or not I need to be, contacting someone to say, you know, this is not looking right to me… because I don’t have a medical background. I don’t know what I don’t know so it would be good to know what to look for. C-005.

Another participant expressed wanting to know how to monitor for infections after surgery:

I think telling the caretakers what signs to look for, for infection and things that could go wrong, you know? So you know what to push the panic button for and what to expect and all that would be helpful. Even looking at the incision, did it look inflamed? I know my husband asked me a couple of times does it look, ah, it’s really sore here, does it look puffy and all red and all that? And it’s hard to tell because to you it looks terrible anyway, you know? Because it was a big, a big invasive, surgery. So, to me it always looked red and puffy and you know? C-004.

Theme 2: Accessible communication with care providers

Participants felt that they did not have access to a healthcare provider after surgery. One participant said how it would be essential to speak to a care provider who knows what the patient has been through and who can help answer questions:

I just find that there is no follow-up. No help from, um, you know after you’re out that hospital door it just seems that’s it… just to know that you can phone somebody. Not necessarily that you had to go into emergency. But you could just phone somebody. You know and ask a question. Somebody directly who answers, who knows what he’s been through. C-003.

Another participant said how they were unsure of who to contact and wanted a single point of contact to mitigate the feeling of experiencing so many moving pieces:

Well who do I speak to now? Well no, you have to call the nurse’s station. And then okay, nobody’s answering that phone. She hasn’t called me back. It’s been day one, I’ll try again. Ah, you know, day two… now I’ll try someone else. So there’s just so many pieces to the puzzle and it’s not always very clear who you’re supposed to talk to. I think that having someone assigned, not necessarily a doctor, but having someone be a single point of contact. You know, who I can call that would guide me… So having a single point of contact, someone assigned that we could feel that we didn’t have to chase for answers would be really helpful. C-005.

Theme 3: Homecare resources are needed for patients

Participants expressed a need for more community and homecare resources to help support the patients during their transition home after surgery. This included a need for nursing homecare and community resources to monitor how the patient is doing at home.

The need for support in the home was apparent when one participant said:

Well just, you know, looking after him, you know, his meals and his, you know, his bed and you’re looking after his bed and, and helping him get up when - if he needed help and that. It’s just never easy. He’s 6 foot 4. I’m 5 foot 2. C-003.

Another participant described how there are not enough resources in the community to provide personal support services, which they expressed is particularly important when the informal caregiver is also an older adult and may not be in the best health:

Um, you know in terms of personal support workers. There’s so many people who come out of hospital, um, where they would qualify for a certain amount of personal support services, whether it be in their situation it’s daily or twice a day or, um, maybe in a situation every other day and, and there are a lot of times when that it is just not happening because here’s not enough resources in the community. It’s fine where there’s family supports that can fill in family, friend neighbour, but there’s a lot of times where people don’t have children and they’re in their 80s and the caregiver, primary caregiver in the home would not rate their health as excellent but maybe moderate. C-002.

Another participant said that she could not find any community resources to support her mother after surgery who lived in a different town:

I did do a bit of searching on the internet and friends did as well, to try and find out what kind of resources, if any, in a smaller community, might be available to her, but we didn’t find anything… it would have been very helpful for both of us in the sense that she really, in some ways, was anxious to get home, which I could understand. She wanted to be, amongst her own stuff… We all do. She wanted to not feel like a burden. But there’s nobody there for you. What happens if you fall? So you know, in some senses I may have kept her longer than she wanted to stay because I didn’t feel that she would have the support that she needed when she went home. C-005.

Theme 4: A support network for the caregivers

Participants highlighted the value and need for a support network for themselves during the postoperative transition in care. While the support network might have looked different for adult child caregivers versus spouse caregivers, the premise was that informal caregivers require a network to provide the support they need in their context. This included respite and emotional support as well as occupational support.

Respite and emotional support (sub-theme A)

One participant described the emotional toll of caregiving and the desire for respite:

Um, it’s a stressful, trying time for the caretaker. I think if you’re not emotionally involved like a PSW or a nurse that comes to the house, it’s totally different because you can go home. But when it’s the family member, it’s different. You know? It’s, um, 24/7 it’s you’re emotionally involved, right? So it’s not a job where you get paid for eight hours and then forget about it, you know? The respite would be nice so a person can go out for a couple of hours and do whatever they wanted, you know? C-004.

Another participant explained how it would have been helpful to have someone to talk to who understood what they were going through:

If we’d have had that one point of contact, you know that person might have also presented a reminder to say ‘no matter how much you want to do this. This is going to be stressful on you too. You need to understand that and cut yourself some slack. Um, and make sure that you carve out a bit of time for yourself’… Ah, so that you don’t feel overwhelmed, guilty… because I think understanding that what you’re going through is normal, helps release some of the pressure… So that you go, okay, you know what? I don’t have to be perfect. And what I’m going through was quite normal. Everybody goes through it. Just breathe. C-005.

Occupational support (sub-theme B)

One participant shared the challenges of working while being an informal caregiver:

And then of course, I’m having to drop everything that, you know, in my workday because I’m still working… I’m going to my boss, “Okay, like I’m offline for the next hour or two because I need to find out what’s going on with my mother.”… not that I’m all that concerned about it, but some people could be. It’s lost wages… and then of course, you’re in a mental mindset that, you know, well I’m not going back to work today because I deal with logic that’s complex and my brain just isn’t in a good headspace… So, it affects me on a number of levels. C-005.

Another participant explained how valuable their support system was regarding work:

It was definitely trying at times, but again, I have a great support system. So if I wasn’t able to take work off for whatever reason, then my husband was able to or my mother-in-law… I could only imagine the people that don’t have that support system. It would be 10 times worse for them… [my Mom] lost her license… Because she lost that independence. So she has no choice but to rely on all these other people. C-006.

This qualitative interpretive description study sought to explore and describe what was important to informal caregivers during a postoperative transition in care for older adults with frailty. Four themes were constructed, including (1) being informed about what to expect after surgery, (2) accessible communication with care providers, (3) homecare resources are needed for patients and (4) a support network is needed for caregivers. The fourth theme included 2 sub-themes: (a) respite and emotional support and (b) occupational support. The findings from this study of informal caregivers should be considered by future informal caregivers, clinicians, researchers and policy-makers when preparing for the role of a caregiver, as well as in developing and evaluating postoperative transitional care interventions and policies.

Caregiver participants wanted to be informed about what to expect after surgery, especially the postoperative recovery trajectory for their loved one. Some evidence is available to inform communications with caregivers that could address this need. For example, research suggests that 1 in 5 older adults with frailty who are having surgery experience worsening patient-reported disability in the early months after surgery, but that 9 in 10 improve by the one-year mark after surgery [ 22 ]. However, further research is still required to inform other dimensions of patient-centered recovery trajectories, including the longitudinal experience of informal caregivers. For example, participants in the current study wanted to know if their loved one was progressing in alignment with expected, positive recovery given patient age and type of surgery. Providing informal caregivers with anticipated timelines for achieving postoperative recovery milestones could help them to feel more confident in monitoring the recovery and progress of their loved one, and with knowing when to contact a healthcare provider with concerns. One qualitative study uncovered that for caregivers, having a disease trajectory would enhance their capacity to provide care by managing their expectations, informing what care interventions to pursue and might ultimately improve their own well-being as a caregiver [ 23 ]. As the health of a loved one declines, the magnitude of informal caregiving required increases [ 24 ]. Therefore, information about recovery would support logistical and financial planning for the postoperative phase (i.e., time off work, homecare, convalescence). Participants in the current study expressed uncertainty for how to support their loved one when they were feeling slowed up, were experiencing pain, or were struggling emotionally. Importantly, healthcare providers play an essential role in preparing informal caregivers for their role [ 25 ]. The preoperative period should incorporate communication of recovery trajectories, education and support for informal caregivers.

Participants also wanted to be informed about potential risks and how to monitor symptoms at home. Aligned with these findings, a prior scoping review highlighted that personalized risk communication before surgery has the potential to support the shared-decision making process and to allow for individualized care planning after surgery [ 26 ]. However, there is a need for evidence informing how similar information can be communicated with informal caregivers. Explicitly supporting caregivers in monitoring postoperative symptoms could also empower informal caregivers to monitor and triage symptoms accordingly, especially if a connection to clinical centers can be maintained. This could also support accessible communication with healthcare providers after surgery, another need identified by participants. This is in line with previous research that has highlighted the challenges that informal caregivers face with not knowing who to contact and difficulties with trying to navigate the healthcare system [ 23 ] Caregivers have expressed a desire for leveraging technology to support access to information and support with providing care [ 23 ]. One such example is remote automated monitoring (RAM), a virtual technique where biophysical variables and patient-reported symptoms can be captured using technology and observed by clinicians [ 27 ]. One qualitative study found that in the context of patients with kidney disease, patients and caregivers believed that RAM increased their knowledge of the disease, fostered clinician accountability and enhanced access to treatment and efficient care; however, patients and caregivers voiced concern that RAM should not replace human connection and face-to-face contact with clinicians when needed [ 28 ]. Research is needed to examine RAM in the context of postoperative transitions in care for older adults with frailty, including from the perspective of patients and informal caregivers. It is important to consider cost and the preferences and needs of informal caregivers, their comfort level, and their access to the internet and technology [ 29 ].

Participants voiced a need for more homecare support and services for patients recovering at home after surgery. While there was a need for more health homecare (nursing care), participants most often described requiring more supportive care (bathing, dressing, etc.,), particularly from informal caregivers who were older spouses. This is in line with the unmet care needs in the landscape of homecare in Canada, where there are more unmet needs for support services (bathing, meal preparation, housekeeping, transportation) than health homecare services (nursing care, physiotherapy, nutritional counselling) [ 30 , 31 ]. An adult child caregiver also conveyed that no community or homecare services were available for their parent who lived in a small town. Older adults who live in small or rural towns have been found to receive less homecare than older adults living in urban areas [ 32 ]. More accessible and publicly-available homecare has been identified as a priority by patients and caregivers [ 33 ] yet funding restrictions and strict eligibility criteria continue to hinder the availability and access to homecare for older adults [ 31 ]. Future homecare priority settings should engage informal caregivers who provide care and support to older adults with frailty.

Further, participants relied on a support network during the postoperative transition in care. Participants turned to their support network for respite and emotional support. Participants described wanting to have respite from caregiving. However, respite care has been described as “inflexible” and isn’t available to many informal caregivers, due to strict eligibility criteria [ 34 ]. Further, there can be hesitation for informal caregivers to accept respite care. This can be for a variety of reasons including caregiver and patient preferences that the informal caregiver is the individual who knows the patient best and should be the one providing support [ 35 ]. It is important to expand access to respite care and to investigate ways to provide respite to informal caregivers in a way that provides comfort to both the informal caregiver and patient. Additionally, participants in the current study shared that they wanted someone to talk to who understood their experience. A systematic review of training for informal caregivers of older adults suggests that support interventions (i.e., telephone-based psychotherapy, case management, interdisciplinary support, e-learning platform) have the potential to decrease stress and improve quality of life among caregivers [ 36 ]. However, among the 24 included articles in the review, none of the articles included informal caregivers to older adults having surgery [ 36 ]. It would be valuable to engage informal caregivers in the design and development of future support interventions for informal caregivers in the context of perioperative medicine.

Participants also relied on their support network for occupational support. This is in line with a systematic literature review of the preferences of informal caregivers which emphasized the need for respite and work-life balance, and the value of sharing the responsibility of care to match these needs [ 37 ]. For working caregivers, professional support is one of the most challenging aspects to achieve while providing informal care [ 37 ]. This is important to consider as 1 in 4 Canadians of working age are informal caregivers and are at risk of job insecurity as a result [ 34 , 38 , 39 ]. Approximately 1 in 20 employed informal caregivers either leave the workforce by retiring, quitting or being terminated as a result of the challenges with balancing work and caregiving [ 34 , 38 ]. While informal caregivers receive 2 weeks of paid leave from work to provide caregiving support in the Netherlands [ 9 ], this is not common practice in other parts of Europe or North America, but perhaps should be considered by policy-makers. Alternatively, flexibility in working hours could support the occupational needs of informal caregivers [ 40 ]. As the Canadian Compassionate Care Benefit (CCB) is only available to informal caregivers who are caring for someone who is at end-of-life [ 41 ], there remains a need to provide support to employed informal caregivers to other patient populations, including older adults recovering from major surgery. The Canadian Centre for Caregiving Excellence has stated that existing financial support for informal caregivers is insufficient and inaccessible, and that there is an urgent need to address the financial burden and out-of-pocket costs that informal caregivers endure [ 34 ]. Each year, informal caregivers provide the same amount of care as 2.8 million full-time paid care providers [ 34 ]. Despite being described as one of the main support structures in society [ 34 ], and experiencing many costs associated with caregiving, informal caregivers face the very real threat of unemployment and financial stress amidst trying to provide care to their loved one. Due to the lengthy wait-lists for long-term care [ 42 ] and unavailability of homecare [ 30 ], informal caregivers are essential. It certainly brings into question, if not informal caregivers, then who? Solutions to support informal caregivers, especially employed informal caregivers, is urgently required [ 34 ].

Transitions in care present challenges for informal caregivers of older adults with frailty, who play an important role in successful transitions. This study highlighted what is important to informal caregivers during a postoperative transition in care that should be considered by relevant groups to facilitate successful transitions in care after surgery. More research is required to provide informal caregivers with information regarding recovery trajectories for older adults with frailty having surgery and should be communicated clearly before surgery to informal caregivers to help with planning. Informal caregivers should be provided with the knowledge and resources for monitoring postoperative symptoms and should be provided with clear contact information and access to a healthcare provider to address any questions or concerns regarding the recovery process. More publicly-funded and accessible homecare services are required, most notably home support services. Informal caregivers require respite and emotional support, and future research is required to understand ways in which this can be provided in a way that matches the needs and preferences of the informal caregiver and patient. Finally, there is a need to provide occupational support, including paid time-off, to help support informal caregivers who are also working.

Strengths & limitations

The strengths and limitations of this study should be considered. This study focused on the experiences of informal caregivers to a population that is often under-represented in research (older adults living with frailty). However, many surgical patients without frailty and their caregivers may have similar views on what is important to them during a postoperative transition in care. While this study included a varied sample of informal caregivers, a purposive sampling was not possible due to the limitations of the recruitment strategy, whereby caregivers contacted the researcher if they were interested in participating. Further, this research was conducted during the COVID-19 pandemic, when the strain on the healthcare system, patients and caregivers was exacerbated. However, the participants in the study did not commonly describe pandemic-related challenges with their experiences. While participants described being confident in remembering their experience during the postoperative transition in care, some of the caregiver interviews took place several months following surgery and their experience, which may have affected their recall. As this study solely focused on the postoperative transition in care following elective surgery, there is a need for future research to explore this in the context of emergency surgeries. Further, participants were recruited from within the same city, which may limit the transferability of our findings. Future work should consider the experiences of those living in other areas.

Informal caregivers play a significant role during postoperative transitions in care for older adults with frailty. Clinicians, researchers, homecare service agencies and policy-makers should consider the results of this study, which highlight the aspects of transitions in care that are important to informal caregivers, when conducting new research and developing policies to support transitions home after surgery for older adults with frailty.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files]. Any additional data are available from the corresponding author on reasonable request.

Abbreviations

Activities of Daily Living

Canadian Compassionate Care Benefit

The Ottawa Hospital

Remote Automated Monitoring

Lilleheie I, Debesay J, Bye A, Bergland A. Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge. BMC Geriatr. 2020;20(1):97. https://doi.org/10.1186/s12877-020-1488-1 .

Article   PubMed   PubMed Central   Google Scholar  

van Broese MI, De Boer A. Providing informal care in a changing society. Eur J Ageing. 2016;13(3):271–9. https://doi.org/10.1007/s10433-016-0370-7 .

Article   Google Scholar  

Roth DL, Fredman L, Haley WE. Informal Caregiving and its impact on Health: a Reappraisal from Population-Based studies. Gerontologist. 2015;55(2):309–19. https://doi.org/10.1093/geront/gnu177 .

Van Houtven CH, Norton EC. Informal care and health care use of older adults. J Health Econ. 2004;23(6):1159–80. https://doi.org/10.1016/j.jhealeco.2004.04.008 .

Article   PubMed   Google Scholar  

Storm M, Siemsen IMD, Laugaland K, Dyrstad DN, Aase K. Quality in transitional care of the elderly: key challenges and relevant improvement measures. Int J Integr Care. 2014;14:e013.

Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs: position statement of the American Geriatrics Society Health Care Systems Committee. J Am Geriatr Soc. 2003;51(4):556–7.

Sokas CM, Hu FY, Dalton MK, et al. Understanding the role of informal caregivers in postoperative care transitions for older patients. J Am Geriatr Soc. 2022;70(1):208–17. https://doi.org/10.1111/jgs.17507 .

Abdellatif S, Hladkowicz E, Lalu MM, Boet S, Gagne S, McIsaac DI. Patient prioritization of routine and patient-reported postoperative outcome measures: a prospective, nested cross-sectional study. Can J Anesth Can Anesth. 2022;69(6):693–703.

Janssen TL, Lodder P, de Vries J, et al. Caregiver strain on informal caregivers when providing care for older patients undergoing major abdominal surgery: a longitudinal prospective cohort study. BMC Geriatr. 2020;20(1):178. https://doi.org/10.1186/s12877-020-01579-8 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. https://doi.org/10.1186/s12877-016-0329-8 .

McIsaac DI, Taljaard M, Bryson GL, et al. Frailty as a predictor of death or new disability after surgery: a prospective cohort study. Ann Surg. 2020;271(2). https://doi.org/10.1097/SLA.0000000000002967 .

Thorne S, Kirkham SR, MacDonald-Emes J. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge. Res Nurs Health. 1997;20(2):169–77.

Article   CAS   PubMed   Google Scholar  

Lincoln YS, Guba EG. The Constructivist Credo. Left Coast; 2013.

Hladkowicz E, Auais M, Kidd G, McIsaac DI, Miller J. I can’t imagine having to do it on your own: a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty. BMC Geriatr. 2023;23(1):848. https://doi.org/10.1186/s12877-023-04576-9 .

Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. https://doi.org/10.1503/cmaj.050051 .

Health Quality Ontario. Evidence Informed Improvement Package. Published online 2013. https://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-transitions-en.pdf .

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60. https://doi.org/10.1177/1049732315617444 .

Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021;13(2):201–16. https://doi.org/10.1080/2159676X.2019.1704846 .

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

Tracy S. Qualitative quality: eight Big-Tent Criteria for excellent qualitative research. Qual Inq. 2010;16:837–51. https://doi.org/10.1177/1077800410383121 .

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042 .

McIsaac DI, Taljaard M, Bryson GL, et al. Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study. Br J Anaesth. 2020;125(5):704–11. https://doi.org/10.1016/j.bja.2020.07.003 .

Leslie M, Gray RP, Eales J, Fast J, Magnaye A, Khayatzadeh-Mahani A. The care capacity goals of family carers and the role of technology in achieving them. BMC Geriatr. 2020;20(1):52. https://doi.org/10.1186/s12877-020-1455-x .

Coe NB, Skira MM, Larson EB. A Comprehensive measure of the costs of caring for a parent: differences according to functional status. J Am Geriatr Soc. 2018;66(10):2003–8. https://doi.org/10.1111/jgs.15552 .

Weinberg DB, Lusenhop RW, Gittell JH, Kautz CM. Coordination between formal providers and informal caregivers. Health Care Manage Rev. 2007;32(2):140–9. https://doi.org/10.1097/01.HMR.0000267790.24933.4c .

Harris EP, MacDonald DB, Boland L, Boet S, Lalu MM, McIsaac DI. Personalized perioperative medicine: a scoping review of personalized assessment and communication of risk before surgery. Can J Anesth Can Anesth. 2019;66(9):1026–37. https://doi.org/10.1007/s12630-019-01432-6 .

Yang H, Dervin G, Madden S, et al. Postoperative home monitoring after joint replacement: Retrospective Outcome Study comparing cases with matched historical controls. JMIR Perioper Med. 2018;1(2):e10169. https://doi.org/10.2196/10169 .

Walker RC, Tong A, Howard K, Darby N, Palmer SC. Patients’ and caregivers’ expectations and experiences of remote monitoring for peritoneal dialysis: a qualitative interview study. Perit Dial Int. 2020;40(6):540–7. https://doi.org/10.1177/0896860820927528 .

Chi NC, Demiris G. The roles of Telehealth Tools in supporting Family caregivers: current evidence, opportunities, and limitations. J Gerontol Nurs. 2017;43(2):3–5. https://doi.org/10.3928/00989134-20170111-04 .

Gilmour H. Unmet Home Care needs in Canada . Stat Can; 2018:3–11. https://www.researchgate.net/profile/Heather-Gilmour-2/publication/329100455_Unmet_home_care_needs_in_Canada/links/5c3798a4458515a4c71b7d37/Unmet-home-care-needs-in-Canada.pdf .

Bacsu J, Abeykoon H, McIntosh T, Jeffery B, Novik N. No Place Like Home: a systematic review of Home Care for older adults in Canada. Can J Aging. 2018;37(4):400–19. https://doi.org/10.1017/S0714980818000375 .

Mitchell LA, Strain LA, Blandford AA. Indicators of Home Care Use in Urban and Rural settings. Can J Aging Rev Can Vieil. 2007;26(3):275–80. https://doi.org/10.3138/cja.26.3.275 .

Kiran T, Wells D, Okrainec K, et al. Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping. BMJ Qual Saf. 2020;29(5):390–400. https://doi.org/10.1136/bmjqs-2019-009993 .

Canadian Centre for Caregiving Excellence. Giving Care: An Approach to a Better Caregiving Landscape in Canada.; 2022. https://canadiancaregiving.org/wp-content/uploads/2022/11/CCCE_Giving-Care.pdf .

van Exel J, de Graaf G, Brouwer W. Give me a break! Informal caregiver attitudes towards respite care. Health Policy. 2008;88(1):73–87. https://doi.org/10.1016/j.healthpol.2008.03.001 .

Aksoydan E, Aytar A, Blazeviciene A, et al. Is training for informal caregivers and their older persons helpful? A systematic review. Arch Gerontol Geriatr. 2019;83:66–74. https://doi.org/10.1016/j.archger.2019.02.006 .

Plöthner M, Schmidt K, de Jong L, Zeidler J, Damm K. Needs and preferences of informal caregivers regarding outpatient care for the elderly: a systematic literature review. BMC Geriatr. 2019;19(1):82. https://doi.org/10.1186/s12877-019-1068-4 .

Research on Aging, Policies and Practice, University of Alberta. How does caregiving impact paid work for employed women and men? Published online 2023. Accessed April 4., 2023. https://rapp.ualberta.ca/wp-content/uploads/sites/49/2023/01/Snapshot-2-How-does-caregiving-impact-paid-work-for-women-and-men-FINAL.pdf .

Research on Aging, Policies and Practice, University of Alberta. Who are employed caregivers in Canada? Published online 2022. Accessed April 4., 2023. https://rapp.ualberta.ca/wp-content/uploads/sites/49/2022/11/2022-Nov-29-Who-are-employed-caregivers-in-Canada-FINAL.pdf .

Stanfors M, Jacobs JC, Neilson J. Caregiving time costs and trade-offs: gender differences in Sweden, the UK, and Canada. SSM - Popul Health. 2019;9:100501. https://doi.org/10.1016/j.ssmph.2019.100501 .

Tompkins B. Compassionate communities in Canada: it is everyone’s responsibility. Ann Palliat Med. 2018;7(S2):118–S129. https://doi.org/10.21037/apm.2018.03.16 .

Article   MathSciNet   Google Scholar  

Roblin B, Deber R, Baumann A. Addressing the Capital Requirement: perspectives on the need for more long-term-care beds in Ontario. Can Public Policy. 2022;48(S2):51–63. https://doi.org/10.3138/cpp.2022-029 .

Download references

Acknowledgements

The authors would like to thank each of the participants who agreed to take part in this study.

This study was funded by the University of Ottawa Department of Anesthesiology and Pain Medicine. E. Hladkowicz was supported by a Canadian Frailty Network Fellowship, an Ontario Graduate Scholarship and a Queen Elizabeth II Graduate Scholarship in Science and Technology while completing this work. DIM received salary support from The Ottawa Hospital Anesthesia Alternate Funds Association and a Clinical Research Chair from the Faculty of Medicine, University of Ottawa.

Author information

Authors and affiliations.

School of Rehabilitation Therapy, Queen’s University, Kingston, Canada

Emily Hladkowicz, Mohammad Auais & Jordan Miller

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

Emily Hladkowicz & Daniel I McIsaac

Patient Partner, The Ottawa Hospital Research Institute, Ottawa, Canada

Gurlavine Kidd

Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus Room B311, 1053 Carling Ave, Mail Stop 249, K1Y 4E9, Ottawa, ON, Canada

School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada

Daniel I McIsaac

You can also search for this author in PubMed   Google Scholar

Contributions

EH, DIM and JM drafted the manuscript or substantially revised it. EH, MA, GK, DIM and JM contributed to the conception and design of the work. EH, MA, GK, DIM, and JM contributed to the acquisition, analysis and interpretation of the data. EH, MA, GK, DIM and JM have approved the submitted version (and any substantially modified version that involved their contribution to the study) and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. All authors have critically reviewed and approved the manuscript.

Corresponding author

Correspondence to Emily Hladkowicz .

Ethics declarations

Ethics approval and consent to participate.

Ethics approval was obtained from The Ottawa Health Sciences Network– Research Ethics Board (Protocol# 20200322-01 H) and Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (Protocol# REH-773-20). Each participant provided informed consent prior to participating in the study. All methods were carried out in accordance with the Declaration of Helsinki, the International Conference on Harmonisation– Good Clinical Practice (ICH-GCP) and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary material 2, supplementary material 3, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Hladkowicz, E., Auais, M., Kidd, G. et al. “It’s a stressful, trying time for the caretaker”: an interpretive description qualitative study of postoperative transitions in care for older adults with frailty from the perspectives of informal caregivers. BMC Geriatr 24 , 246 (2024). https://doi.org/10.1186/s12877-024-04826-4

Download citation

Received : 19 April 2023

Accepted : 19 February 2024

Published : 11 March 2024

DOI : https://doi.org/10.1186/s12877-024-04826-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Transitions in care
  • Informal caregivers
  • Qualitative methods

BMC Geriatrics

ISSN: 1471-2318

informal interview in qualitative research

  • Open access
  • Published: 08 March 2024

Digital clinical empathy in a live chat: multiple findings from a formative qualitative study and usability tests

  • Hanna Luetke Lanfer 1 ,
  • Doreen Reifegerste 1 ,
  • Winja Weber 2 ,
  • Paula Memenga 3 ,
  • Eva Baumann 3 ,
  • Julia Geulen 2 ,
  • Stefanie Klein 2 ,
  • Anne Müller 4 ,
  • Andrea Hahne 4 &
  • Susanne Weg-Remers 2  

BMC Health Services Research volume  24 , Article number:  314 ( 2024 ) Cite this article

125 Accesses

Metrics details

Clinical empathy is considered a crucial element in patient-centered care. The advent of digital technology in healthcare has introduced new dynamics to empathy which needs to be explored in the context of the technology, particularly within the context of written live chats. Given the growing prevalence of written live chats, this study aimed to explore and evaluate techniques of digital clinical empathy within a familial cancer-focused live chat, focusing on how health professionals can (a) understand, (b) communicate, and (c) act upon users’ perspectives and emotional states.

The study utilized a qualitative approach in two research phases. It examined the expected and implemented techniques and effectiveness of digital clinical empathy in a live chat service, involving semi-structured interviews with health professionals ( n  = 9), focus group discussions with potential users ( n  = 42), and two rounds of usability tests between health professionals ( n  = 9) and users ( n  = 18). Data were examined using qualitative content analysis.

Expected techniques of digital clinical empathy, as articulated by both users and health professionals, involve reciprocal engagement, timely responses, genuine authenticity, and a balance between professionalism and informality, all while going beyond immediate queries to facilitate informed decision-making. Usability tests confirm these complexities and introduce new challenges, such as balancing timely, authentic responses with effective, personalized information management and carefully framed referrals.

Conclusions

The study reveals that the digital realm adds layers of complexity to the practice of clinical empathy. It underscores the importance of ongoing adaptation and suggests that future developments could benefit from a hybrid model that integrates the strengths of both AI and human health professionals to meet evolving user needs and maintain high-quality, empathetic healthcare interactions.

Peer Review reports

Empathy is pivotal in human interactions as it fosters understanding and connection between individuals and is considered a prerequisite for prosocial behavior [ 1 ]. From an overarching perspective, scholars agree that empathy is complex and refers to several psychological states or a process rather than being a single, uniform concept [ 2 , 3 ]. It is considered a multidimensional process that involves affective, cognitive, and behavioral aspects. While terminology differs, scholars have defined empathy as a threefold process: (a) understanding another person’s perspectives and emotional states, (b) communicating and (c) acting upon this understanding [ 2 , 3 , 4 ]. Traditionally, empathy has been characterized by face-to-face interactions in real-time, rich in non-verbal cues, body language, tone of voice, and immediate responses [ 5 ]. This also applies to clinical empathy, the empathy of health professionals for patients, which plays a vital role in patient-centered care. It is particularly crucial during distressing diagnoses or stressful medical experiences, as it is linked to increased self-efficacy and treatment adherence, as well as reduced emotional distress and fear among patients [ 6 , 7 ].

With the advent of the digital era, which has reshaped and introduced new forms of healthcare, the conveyance of this clinical empathy – the understanding of emotional states, communicating, and acting upon this – has been challenged. The growing presence of AI-operated tools and robotics, trained to mimic empathetic responses, illustrates this shift. In addition, new forms of digital communication, such as live chats (operated by humans or AI) in health-related settings, introduce unique dynamics to empathetic exchanges. This is because digital platforms change the way we interact, removing or altering traditional cues like tone of voice or facial expression. Therefore, understanding how clinical empathy can be effectively conveyed in digital, real-time textual mediums is pivotal. However, so far, research on digital clinical empathy for text-based, real-time communication tools such as live chats is limited, especially with regard to a differentiation of the three processes of empathy from the perspectives of both users and health professionals. As live chats become increasingly prevalent, the aim of this study was to explore how health professionals can effectively understand emotional states, communicate an understanding of them, and act upon this understanding, using written language in live chat services.

  • Clinical empathy

Clinical empathy is characterized by a clear division of roles: the professional healthcare worker who empathizes and the patient who receives empathy [ 6 ]. Moreover, it has been defined as “a predominantly cognitive (rather than an affective or emotional) attribute (brain mechanism) that involves an understanding (rather than feeling) of the patient’s pain and suffering, combined with a capacity to communicate this understanding (behavioral component)” [ 8 ]. Thus, while empathy in non-professional, informal realms may involve experiencing the emotions of another person (or imagining them), clinical empathy focuses more on understanding and acknowledging these emotional states, communicating this understanding back to the patient and, acting upon this. Studies and reviews on clinical empathy list a series of techniques or elements to foster clinical empathy in relation to each of the processes of empathy [ 3 , 9 , 10 , 11 , 12 ]. Hence, rather than a personality trait, clinical empathy is perceived as a skill that can be learned and improved, and its promotion forms an integral part of medical education and training [ 11 , 13 ]. This is particularly relevant in situations where there is a scary diagnosis such as cancer and / or a particularly stressful phase of disease, which is often accompanied by considerable psychological stress [ 14 ].

In the area of recognizing and understanding emotional states, techniques include active listening, a method wherein health professionals strive not only to hear but comprehend the patient’s emotions and experiences; and perceiving, interpreting, and responding to both verbal and non-verbal emotional cues from the patient [ 3 , 11 ]. The literature describes how to communicate understanding of emotional states, validation and recognition of responses, and authenticity in interactions [ 9 , 10 , 11 ]. Acting upon this understanding is context-dependent and can involve laypeople-oriented communication, especially when describing medical terms, or providing additional support or resources, e.g., psychological support [ 9 , 15 ]. Clinical empathy also involves a balance between emotional engagement and detachment, which allows healthcare professionals to be compassionate, supportive, and understanding, while still being able to make rational medical decisions and avoiding emotional fatigue or burnout [ 3 , 15 ].

Digital clinical empathy

Shifting the focus from traditional modes of empathy, the digital realm requires a new arena of empathy research. Digital empathy, a prospering concept in the literature, encapsulates the understanding of emotional states and communicating and acting upon this understanding through digital media and technologies [ 16 ]. Digital empathy goes beyond face-to-face interactions, shedding light on how empathy requires to be recalibrated when technology comes into play. In this, technologies can either mediate empathy conveyance in human-to-human interactions, such as between two individuals over a video chat or written chat, or facilitate human-machine interaction, like when an AI chatbot is designed to decode and respond to human emotions. As new modes of digital technologies have reshaped communication between healthcare professionals and patients, it is necessary to explore empathy in these digital contexts – hence to investigate digital clinical empathy in its many facets [ 17 ]. A conceptual framework from Gronding et al [ 18 ] illustrates how communication mediums act as filters each of the processes of empathy is influenced by the medium’s richness, immediacy of feedback, transmission quality, and content. Even before the COVID-19 pandemic, telepsychiatry had already begun reshaping communication between healthcare professionals and patients and proven to be effective [ 19 ], necessitating an exploration of empathy in digital contexts. Studies prior to the pandemic, such as one from 2015 [ 20 ] highlighted that patients often felt a strong empathic connection during telemedicine consultations, potentially due to the more direct eye contact characteristic of these interactions compared to typical in-person consultations. The pandemic further accentuated this need to investigate digital clinical empathy. Research during this period showed that patients perceived therapists as equally or more empathetic in online sessions than in traditional settings. This suggests that healthcare providers adapted or developed new skills suited to digital media, like interpreting limited visual cues and maintaining ‘camera-eye’ contact [ 21 , 22 , 23 ] [ 21 , 23 ]. Therefore, while emerging evidence suggests a nuanced adaptation of empathetic techniques in online psychotherapy, particularly via video conferencing, our understanding remains even more limited for other digital communication channels, e.g., text-based tools like live chats.

Empathy in written live chats

Emerging digital healthcare interactions have taken the form of real-time live chats, an increasingly common feature in digital services, particularly for customer interactions in business contexts [ 24 , 25 ]. Live chats are popular for their immediacy, personalization, availability during off-hours, and user control over the conversation pace [ 26 , 27 , 28 ]. These live chats can be powered by humans, or AI-operated tools and robotics or collaboratively operated by AI and supervised by human agents. In many business settings, AI chatbots are gradually taking over customer service roles, sometimes even supplanting human agents [ 25 ]. Given their accessibility and popularity, particularly among younger demographics, variously operated models of live chats have also been employed in various health-related arenas, such as mental health services [ 29 ], cancer advice [ 30 , 31 , 32 , 33 ], and for health promotion [ 34 ]. While AI chatbots have demonstrated reliable guidance for users in areas such as business or finance transactions, they have shown limitations in providing medical advice [ 35 , 36 , 37 ]. There have been instances where AI chatbots have given misleading advice or failed to articulate the rationale or source behind their otherwise medically correct recommendations [ 36 , 38 , 39 ]. This highlights the intricate complexities involved in healthcare advice, requiring nuanced understanding and human judgment, elements AI currently lacks.

Beyond the provision of correct, evidence-based information through live chats, it is equally critical to consider how information is conveyed, aligning with the emotional needs of users. This consideration foregrounds the relevance of digital clinical empathy in the realm of live chat interactions. In this, increasing interactions between humans and technology have led to the emergence of Emotion AI or affective computing [ 40 , 41 ]. Emotion AI has shown increasing proficiency in decoding and recognizing human emotional states based on the analysis of facial expressions, tone of voice, or writing styles in recent years [ 36 ]. With the advancements of Emotion AI, distinguishing AI chatbots with humanlike features from human agents becomes increasingly difficult for users, especially when the interactions are brief, as an experiment with more than 1.5 million users showed [ 42 ]. In this experiment, users were randomly assigned to chat with either a human or AI counterpart for two minutes, followed by the user’s guess about the nature or their encounter [ 42 ]. Despite continuous advancements in decoding emotional states, AI is fundamentally incapable of experiencing emotions and constrained to mimic empathy. This imitation can, at times, lack the depth and authenticity of genuine empathetic responses. Moreover, the responses are often bound by a narrow frame of topics, and there is a risk of the user’s emotional state being misunderstood or not conveyed effectively [ 36 , 41 , 43 , 44 ]. Such limitations in AI’s empathetic abilities have been found to hinder the acceptability of chatbots, especially in sensitive, emotionally-charged contexts [ 24 , 45 , 46 ]. Thus, while AI has immense potential in handling less complex, straightforward queries and analyzing emotional cues, its limitations are accentuated when faced with more complex medical questions. In the current state of technology, this provides a compelling argument for the necessity of human health professionals in providing medical information, particularly in the context of complex healthcare questions.

On the flip side, human health professionals face their own set of challenges in grasping and responding to patients’ perspectives and emotional states when using text-based digital tools [ 29 , 47 , 48 ]. Studies using text-based, written tools echoed challenges in both understanding perspectives and emotional states as well as communicating and acting upon this via chats [ 29 , 47 , 48 ]. This may be as written interactions are devoid of tonal and visual cues that play a role in understanding and communicating empathy in face-to-face interactions. Furthermore, these interactions are essentially disembodied, putting an onus on the written word to convey empathy effectively [ 5 ].

While healthcare providers are trained to justify their knowledge, apply ethical standards, and adopt clinical empathy in face-to-face encounters, there is a dearth of research focusing on digital clinical empathy for health professionals, particularly within the context of written live chats. As live chats become increasingly prevalent, understanding how to convey and adapt empathy to help-seeking users within it is critical. It is hence essential to explore how healthcare providers can effectively understand emotional states, communicate an understanding of them, and act upon this understanding, using written language in live chat services.

Familial cancer, which can have genetic and/or lifestyle-related causes, affects not only the patients but also their relatives and is associated with great anxiety and information needs [ 49 ], making it a good model topic to explore digital clinical empathy.

Therefore, our aim was to investigate the methods of digital clinical empathy in a human-to-human, written live chat, with a specific focus on understanding what users expect and desire from such interactions. Hence, we formulated the following research questions (RQs):

RQ1: What are expected techniques of digital clinical empathy in a human-to-human live chat from the perspective of potential users and responding health professionals with regards to: a. understanding users’ perspectives and emotional states, b. communicating this understanding, c. and acting upon this understanding?

Utilizing these findings for training purposes, we applied and evaluated techniques of digital clinical empathy in actual chat encounters:

RQ2: What are implemented techniques of digital clinical empathy in a human-to-human live chat from the perspective of potential users and responding health professionals with regards to: a. understanding users’ perspectives and emotional states, b. communicating this understanding, c. and acting upon this understanding?

Study design

This study is part of a larger collaborative project between two universities, a Cancer Information Service (CIS) – a government-funded institution that provides free, evidence-based information on cancer-related topics to the public–, and a patient organization for familial cancer, the BRCA-Network. This project accompanies the formative and process evaluation of a live chat service focused on the topic of familial cancer at the CIS [ 32 , 33 ], comparable to a chat service implemented at the American Cancer Information Service [ 30 ]. The live chat is operated by health professionals and provide personalized, evidence-based information to users with questions relating to familial cancer, prevention and early detection. The CIS hosts the live chat service; the universities are primarily responsible for conducting qualitative and quantitative formative and summative evaluations of the service; and the patient organization contributes by providing advice and patient perspectives.

Given that cancer brings with it many uncertainties for the person involved, empathy has proven to be key to cancer-related communication [ 6 ] and thus, has been a focal point during the planning period of the live chat service. The current study focuses on investigating the expected techniques of digital clinical empathy for the chat and evaluating to which extent these were implemented in chat encounters, drawing on both perspectives: the users and the responding health professionals. It started with (1) focus group discussions with potential live chat users and interviews with CIS physicians (i.e., the health professionals) in October/November 2021, relating to RQ1. Questions centered around evaluating the appropriateness, effectiveness, and challenges of a live chat for cancer-related questions, with a focus on the role of empathy in digital written communication from the perspectives of potential users and health professionals (see further details in the supplementary file 1 ). Results from the focus group and interview study were shared with the CIS and used for training purposes with the chat team and development of the chat application. Before launching the chat for the public, we conducted (2) two rounds of usability tests in January and April 2023, addressing RQ2. In the usability tests for the live chat service, potential users and CIS health professionals interacted with the chat system as it would be experienced by end-users, i.e., simulating user inquiries and responses. Users joined the chat encounter while on video conference, sharing their screen and ‘thinking aloud’. The ‘think aloud’ methodology [ 50 , 51 ] is commonly used for usability tests, where potential users verbalize their thoughts while using the new product or service. In our study, it was used to capture immediate user reactions of their experience using the chat. As empathy, especially in a digital context, can be nuanced and is grounded in the users’ perspectives, thinking aloud, which is conducted in real-time, enhances the authenticity of user responses compared to retrospective accounts [ 51 , 52 ].

The usability tests were followed by interviews with the users and reflections with the responding CIS team members, focusing on the expression and perception of empathy in the live chat, exploring how empathetic communication is achieved and received in a written format, and evaluating the overall effectiveness of communication in addressing users’ concerns in a digital healthcare setting (see supplementary file 1 for question guides).

Participants and procedures

Phase 1: interviews and focus groups.

To gain insights into expectations and practice of digital clinical empathy for cancer-related inquiries, we recruited n  = 7 CIS physicians, experienced in engaging with the public through different existing services (e.g., telephone and email service, social media, research management) for semi-structured interviews.

For the focus groups, social media and other digital posts shared by the CIS and cancer support groups were used to recruit n  = 42 younger, digitally-oriented people, i.e. participants who had extensive experience using various digital written communication channels and who could be potential users. This demographic emphasis is strategic, considering that younger generations, who are typically more engaged with digital communication platforms and at risk of familial cancer due to genetic mutations, have been underrepresented in existing CIS services like telephone and email, which predominantly attract an older demographic (aged 50 and above) (see [ 33 ] for further details about recruitment strategies). Of those, n  = 11 focus group participants had no prior experience with cancer, and n  = 31 participants carried a genetic disposition associated with increased cancer risk and/or had experienced a cancer diagnosis. Focus group participants were divided into seven groups with five to seven participants, separating those with and without cancer/mutation experience.

Following the procurement of informed consent, both interviews and focus group discussions were conducted with the online conference tool Zoom (Zoom Video Communications, Inc). Sessions were guided by semi-structured interview and discussion guidelines in line with RQ1 and spanned durations between 21 and 55 min for interviews and 52 and 95 min for focus groups. Interviewees were not provided with monetary compensation. Participants in the focus groups were compensated 25 € for their involvement. All interviews and focus group discussions were facilitated by the lead author, who possesses extensive expertise in collecting qualitative data and was supported by student assistants. Data were gathered in German and quotations used within this paper have been translated accordingly. Interviews and focus groups were audio-recorded, transcribed, and fully anonymized.

Phase 2: usability tests

Two rounds of usability tests with ‘think aloud’ methodology were held in January and April 2023. Participants in the usability tests consisted of n  = 9 health professionals who operated as CIS chat respondents (eight physicians, one lawyer with a specialization in medical social legislation) and participated in both rounds; and two different sets of users ( n  = 18), who participated in the think aloud usability tests. One CIS chat respondent had participated in the interviews of the first phase of data collection. Users of the first round of usability tests had participated in the focus group discussions, the second set were newly recruited participants with no prior experience with our project who responded to social media posts by the CIS and different cancer support groups.

For the usability tests, the CIS health professionals operated the chat through the CIS’ website integrated chat platform embedded within their website. The first author and a research assistant conducted video conferences via Zoom with the users, who shared their screens throughout the chat encounter. Users were encouraged to ‘think aloud,’ articulating their thoughts and reactions verbally by talking during the written chat. If participants remained silent, the first author engaged them with prompts, such as asking them to describe their current thoughts. The users’ comments were documented in detail in a structured protocol by a trained research assistant. This protocol was pre-categorized into sections like positive/negative feedback relating to technical features, communication etc. Additional data, including chat topics, duration, and the number of questions asked, were recorded post-chat using the chat transcripts. Following the chat, each user was interviewed about their chat experience with a focus on empathy in communication. The interviews were audio-recorded and an anonymized, detailed transcript of the interview with selected quotes was prepared in conjunction with the think aloud protocol. Following both rounds of usability tests, CIS health professionals in their role as chat respondents were asked for a written reflection on their chat experiences, guided by a set of main and sub-questions (i.e., strategies of identifying the emotional state, mood of the users, and responding to those). Eight of the nine CIS health professionals handed in their reflections on a digital sheet. The participant characteristics for each of the samples are summarized in Tables  1 and 2 .

Data analysis

Each of the data sets for the two phases of data collection was subjected to an initial independent analysis, utilizing qualitative content analysis [ 53 ]. An introductory coding frame was constructed in accordance with the focal themes for each phase (deductive procedure) and new subcategories were formed, derived directly from the data (inductive procedure). For instance, under the deductive code ‘understanding/expressing need’ from the perspective of a potential user, we identified inductive codes such as ‘not knowing how to start/express feelings’ and ‘different means to express emotions in chat’. Additionally, the same pre-selected code, when viewed from the health professional’s perspective, revealed emerging codes like the ability to read ‘nuances’, the importance of ‘not interpreting’ prematurely, and the need to ‘figure out emotional state throughout chat’.

Following this step, axial coding was performed, rooted in Grounded Theory [ 54 ], whereby subcategories underwent a review process and were linked, collated, and refined to ensure their mutual exclusivity. A thorough re-examination of all transcripts, coded portions, and the final coding frames was undertaken before the different perspectives for each phase were joined and compared. Distinguishing between the processes of ‘b. communicating understanding’ and ‘c. acting upon understanding’ deserved particular attention in this text-based environment, where actions are also a form of communication. In our analytical approach, ‘communicating this understanding’ encompasses codes that highlight communicative acts to acknowledge or validate expressed emotional states or perspectives. On the other hand, ‘acting upon this understanding’ is defined by coding communicative acts that go beyond mere acknowledgment—these acts could involve the provision of additional resources, initiating a referral, or taking steps to address emotional needs directly. Thus, the difference lies in the intent and impact: the former focuses on expressing comprehension and validation, while the latter takes concrete steps based on that understanding.

The data from phase 1 (focus groups and interviews) were amalgamated in response to RQ1, while the data from phase 2 (usability tests) were used to address RQ2. The coding frames of both phases were compared. The first author and two student assistants performed the coding of the data. To ensure the validity and reliability of our coding scheme, a rigorous process was followed. The first author began coding with five transcripts from each dataset, developing the initial categories. Subsequently, student assistants, one for each phase, were trained to use this coding frame. To assess intercoder reliability, two transcripts from each dataset were coded independently by both the first author and the student assistants. Discrepancies in coding were discussed and resolved, leading to further refinement of the coding frame. The first author reviewed all coded transcripts by the research assistants. The MAXQDA software (VERBI GmbH) was utilized to facilitate computer-assisted data analysis.

Ethics approval and consent to participate

The research project was granted ethical clearance by the ethical board of Bielefeld University. Prospective participants from all samples received an information sheet, detailing their role, rights, type of data collection, data protection, and a consent form. Informed consent was obtained from all research participants.

The results section is divided into two sections in line with RQ1 and RQ2. Each of these two main sections has three subsections in line with the three-fold processes of empathy, contrasting the perspectives of (potential) users and health professionals (see participant data in methods section). Each identified theme is marked in italic and accompanied by illustrative quotes. A summary is provided at the end of each subsection and the results conclude with a summarized table that encapsulates the key findings and interpretations across all phases, offering a cohesive and comprehensive overview of our results.

To distinguish participants from the different samples, the following terminology will be applied (Table  3 ): ‘Participants’ includes perspectives from both samples during one phase of data collection. CIS health professionals from the first phase are referred to as ‘CIS interviewee’. As all CIS interviewees are women, their gender is not stated. Focus group participants (i.e., the potential users) are referred to as FGP followed by their gender (F for female and M for male) and age, e.g., ‘FGP M21’. Usability test users (UTU; i.e., the users) are distinguished by rounds 1 and 2 (R1 and R2) as well as their gender and age (e.g., UTU R1 M21). The CIS chat respondents are referred to as ‘CIS respondent’, again without gender as all are females.

Expected techniques to foster digital clinical empathy (RQ1)

Understanding users’ perspectives and emotional states.

In the exploration of digital clinical empathy within the context of human-to-human live chat interactions, the first process of empathy to consider is the understanding of the user’s perspective and emotional state.

Participants from both samples (FGP and CIS interviewees) believed that understanding and recognizing the (emotional) needs of the user was key to enacting empathy, yet prone to interpretation errors in a chat. Several FGPs described it as a challenge to express needs when faced with a diagnosis of cancer (or its probability):

“If you have received a diagnosis, you may not know how to express it. So that means that the person who has to answer in the chat would have to be able to give a good, reflected answer based on relatively unspecific statements.” FGP F21. “Writing has no tone and nuance. When it comes to the advice seekers, it’s just incredibly difficult in a chat to express the emotions one has when dealing with cancer. And for the advisors, it will be difficult to see this and to calm people down or to discern if the advice seeker just wants objective information. Finding that out is very difficult if you only have text.” FGP F39.

There were also some views that emotional states could be deciphered in chat encounters due to variations in expressions as one FGP, who worked in customer chat service, explained:

“From my own experience, I can say that the people who turn a live chat write as differently as they are. Some use emojis, others comment statements with “haha” and others have fears and concerns and you will also read this from the way they write. We all know from WhatsApp and other messengers within our private networks that people have very distinct ways to write. The chat team needs to look at everyone who comes into the live chat individually and respond as you would do in an oral conversation.” FGP F31.

Similarly, some FGPs viewed mutual engagement and explicitness of their needs as an element to foster understanding of their emotional state:

“If I want to be understood, it also comes with a responsibility from my side. Like in the real world, I mean non-digital encounters, I can’t expect my counterpart to understand me right away. I need to open up about my feelings and even more so if we are just texting. However, not everyone is capable to do so or knows how to express themselves. So I still view it as a delicate matter to find the right tone in a live chat on cancer.” FGP M30.

Views from the perspective of CIS interviewees were also mixed wherein half of the participants described presumed challenges in recognizing how the user felt. Others described understanding user needs as a process of mutual engagement throughout the chat:

“You might not know right from the start who and in which kind of state is chatting with you, but I believe by being open and friendly, you give users the opportunity to open up and you’ll know how to engage with them over the course of your encounter.” CIS Interviewee.

In summary, understanding a user’s perspective and emotional state proves multifaceted and mutual, encompassing both user’s expression of needs and respondent’s interpretation. The diverse perspectives within the FGP and interview samples underscore the dynamic nature of the interplay of this empathetic process. While difficulties in expressing needs in an emotionally charged situation such as a cancer diagnosis was described as a challenge, different writing styles and recognizing needs in the process of interacting were described as strategies to gain an understanding of the user’s needs.

Communicating this understanding

Following the recognition of the user’s needs, communicating this understanding back to the recipient is the second facet of empathy.

Participants in the study detailed the various elements involved in conveying this understanding within the context of a live chat setting. From the user’s perspective, the majority of FGP participants highlighted the value of a timely response , indicating that a swift reply is considered an essential part of making them aware their need had been received.

“When chatting, you just don’t have eye contact and you don’t see or feel that now really someone is waiting. Especially when it comes to feelings or the like, then you may not feel so left alone if you get a quick response.” FGP M30. “I have that expectation that I get a prompt feedback. What promptly means – I can’t say right now, but at least an in-between message that they [chat respondents] have received my message, that it has been seen and that they care about it.” FGP F35.

Moreover, many FGPs emphasized the importance of genuine engagement , which includes a personal address by their chosen name in the chat and avoiding formulaic or empty phrases. There was also agreement that respondents should refrain from attempting to take their perspectives:

“If they would write something along the lines ‘I am sorry for you and your family’ that would rather trigger me. As a cancer patient, you get enough compassion from your immediate social network. Here [in the chat] pity comes across strangely and seems like a phrase even if it is perhaps well-intentioned.” FGP F32. “People sometimes say that they can imagine how difficult my situation is. But honestly, hardly anyone can. That’s why I would avoid any such wording.” FGP F34.

From the perspective of FGPs, there were contrasting views on how the user’s worries should be handled . Some FGPs expressed a desire for respondents to avoid language that could potentially exacerbate fears, while a few felt “seen” and taken seriously in having their worries acknowledged.

“Let’s imagine I enter the chat because I suspect my cancer has come back and I am very worried. If the person in the chat would now acknowledge that it was right to be worried, my thoughts would start spinning and I would most likely hear all they write with that voice in my head. So, I would much prefer a more positive connotation in the communication and that they are there to help me.” FGP M28. “Having cancer means going through a lot. And sometimes it’s just nice if somebody sees and acknowledges this.” FGP F32.

FGPs also highlighted the need for authenticity in these interactions. This concept involved the respondent being forthright about their limitations, such as not having all the answers or not being fully acquainted with the user’s personal experience as the following quote shows:

“I want to know if my question can’t be answered. I think that makes a live chat very credible and also very authentic when I notice that the person sitting behind it is really someone who is not all-knowing.” FGP F31.

Being authentic and acknowledging limitations was also viewed as important by CIS interviewees, however, this could also evoke frustrations and not be understood as empathy as one participant, working in the CIS telephone service, explained:

“We can only listen and give advice, but we don’t perform examinations, and this limits us in what we recommend. But this is what people often want: a specific answer, a personalized recommendation. We have to get this across, but it is difficult and requires sensitivity.” CIS interviewee.

Some FGPs underscored the importance of adaptive communication , describing a preference for respondents to adopt a more formal or informal communication style along with the user’s communication style:

“I would dislike a very formal approach, it broadens the distance in this chat even more.… Matching my style, this is what I would appreciate.” FGP M27. “I am talking to doctors and whether that’s in a chat or in real life, I don’t address them by their first name. Equally, I also expect them to address me formally.” FGP F35.

In contrast, all CIS interviewees viewed a more formal, neutral communication style as the better option to avoid miscommunication:

“If we take the extreme of informal – emojis. Do I hurt them when I want to cheer them up and send them a smiley face or a sun or something nice? It’s possible that it comes across all wrong, when their world is falling apart. So I would be very cautious with anything too informal.” CIS interviewee.

From the respondent’s viewpoint, CIS interviewees also detailed the importance of in-depth questioning , seeing it as a method to gain a complete understanding of the user’s (emotional) needs. They also pointed out the need to contextualize this practice:

“To give the user what they need, often a lot of questions and clarifications are needed. Sometimes, it is not clear to the users why we need all that information. To avoid feelings of ‘being interrogated’, it is helpful to elaborate on why these questions are necessary.” CIS interviewee.

In summary, the process of communicating an understanding of a user’s perspective and emotional state, as a facet of digital clinical empathy, revealed a complex interplay between the users’ and the respondents’ perspectives. Both the FGP and the CIS interviewees shared views about key elements like timely response, genuine engagement and authenticity. Divergent views, however, were observed on issues such as handling the user’s worries, with a contrasting need for both avoiding fear-evoking language and acknowledging existing fears. Similarly, while users preferred a more informal or adaptive communication style, respondents favored maintaining a neutral and professional tone.

Acting upon this understanding

Recognizing a user’s needs and communicating that understanding is followed by acting upon that understanding. In a live chat environment, the intended actions proposed by both users and respondents are diverse and multi-faceted.

For FGP participants, representing potential users, several elements were described as key to manifest empathy in a digital setting. An expectation revolved around time commitment . Most FGPs emphasized the importance of the responding physicians dedicating sufficient time to provide individual, personalized responses, ensuring that their needs (both emotional and beyond) are thoroughly addressed.

“Showing empathy in a traditional sense is a balancing act in this chat because of all the emotional nuances that are missing on both sides. To me, dedicating time to my inquiry and being outspoken about it – ‘You can ask me any question. Or what do you need right now?’ – is also a form of empathy to me.” FGP F38.

The importance of dedicating time was equally shared by the CIS interviewees and viewed as a technique to enact empathy:

“In all our services, we aim to convey that we have time and that we take the time to respond individually to the users. In the telephone service, we sometimes offer to call people back if they want to compose themselves first.… We would try a similar approach in the chat.” CIS interviewee.

An additional element of empathy mentioned by multiple FGP participants was the provision of understandable information , often mentioned in conjunction with the previous element of time commitment. Many FGP participants expressed the need for clarification of complicated medical terminologies or study results, providing a level of understanding often missed during consultations with their primary physicians.

“I’ve had that situation several times when I sat at home with my doctor’s letter after a visit to the hospital. And I either thought I had asked all the questions or I was just too overwhelmed to ask any more. And then you sit at home and stumble over words. And you ask yourself ‘How bad is it?’ and the worst thing you can do now is to start googling. If you had access to that chat or any other service with verified information and people who give you context and explanations – maybe I would not go bananas.” FGP M41.

In parallel, CIS interviewees also discussed the provision of individual, evidence-based information as a critical feature of their service. In this, several interviewees agreed it was important to frame factual information empathetically , find the “right tone” when conveying information so as to be perceived as empathetic:

“The information should not just be factually correct, but also humane and interpersonal, well understandable. And, as I said, I have the experience that people in fear filter every piece of information differently than someone else does. Information goes through a grid where everything bad is amplified and all fears are magnified. And it is important that you manage to convey information in the way you want to or you have the reverse effect.” CIS interviewee. “You have to wrap your information so that your evidence becomes empathetic, personal and meets the user at the level where they are.” CIS interviewee.

Some focus group participants described boundary recognition by the respondents as another element of enacting empathy. This aspect covered the acceptance of a participant’s preferred level of anonymity and respect for the withholding of certain information.

“The nice thing about the tool is that it is semi-anonymous. It is a limitation, but also an advantage of the chat, because I’ve noticed that men, in particular, are often ashamed. They don’t want to talk about everything and disclose all their intimate details. If the chat respects that people take time to open up… it can become a safe space to address sensitive topics.” FGP M40.

This anonymity was viewed as a challenge by CIS interviewees who required a certain level of information in order to provide personalized advice, as several interviewees described:

“I think the chat might appeal to people who want to maintain a certain level of anonymity and I do understand that. What some people don’t understand is that the quality of the information we can provide varies with the amount of details we have.… As the respondent, I have to be clear why I need further information to make the user understand.” CIS interviewee.

Moreover, the CIS interviewees proposed empowering users to take further steps in their cancer journey and enabling informed decisions as acts of empathy the CIS aimed to enact to all their users, notwithstanding the communication channel they chose. An advisor working in the telephone service described this as follows:

“I have had telephone sessions with patients who were not well informed and only saw one option for themselves. This can go in both directions: those who overreact and want to be overtreated and others who don’t or don’t want to see the seriousness of their situation. And of course I am not their oncologist and I reach the limits of my knowledge which I have to admit. But I can do my best to support these patients in getting a second opinion or to think once more about their choices.” CIS interviewee.

Lastly, CIS interviewees articulated their intent to ‘go the extra mile’ and go beyond merely answering the users’ questions and thereby expressing empathy. This included potential referrals to support groups, hospitals, or other services within the CIS.

“We have the capacity to go the extra mile and offer users specific information beyond what they ask. If someone comes with questions about hereditary cancer, I can give them the addresses of specialized hospitals in their area, but also contact details of a support group or information about social services. I think it’s good to have a ‘customer first’ concept embedded in the service.” CIS interviewee.

In summary, acting upon a recognized need in a live chat requires several techniques, per the perspectives of both potential users and CIS interviewees. These include dedicating adequate time to individual inquiries, explaining complex medical content in an understandable manner, and acknowledging and respecting users’ boundaries. For CIS interviewees, extending help beyond the immediate scope of questions, facilitating informed decision-making, and careful phrasing of information were seen as vital techniques of empathy.

Implemented techniques fostering digital clinical empathy (RQ2)

During the second phase of data collection, understanding emotional states presented distinct nuances for both users and health professionals involved in the usability test.

Most users exhibited a heightened awareness of the artificial setup of the usability test. They entered the chat without the emotional baggage they might have brought into a real consultation, recognizing that the situation was a constructed setup:

“I entered the chat with a neutral feeling and I am also exiting it that way. I knew this was a test and didn’t come, let’s say, feeling desperate.” UTU R1 F34.

Health professionals also noted this observation, while also reporting heterogeneous understandings of users’ emotional states. For the most part, they felt confident about their grasp of the users’ emotions and needs, drawing from explicit indicators like emoticons and expressions of gratitude.

“I had the impression that I got the users’ needs. In the end, it’s like in a personal conversation: You need to engage with the user individually.” CIS respondent.

However, some health professionals expressed concerns and questioned whether their interpretations were accurate, given the lack of non-verbal cues that would ordinarily help interpretation in other settings.

“Compared to the telephone service, it turned out to be more demanding - due to the omission of other cues. Listening allows us to sense the caller’s emotions very well when the voice wavers, heavy breathing occurs or unusual pauses occur. In general, identifying what the user needed, also emotionally, remained unclear for longer or sometimes changed very abruptly in the course of the conversation, which may also be due to the ‘test situation’.” CIS respondent.

Simultaneously, some health professionals experienced dual attention stress , needing to focus on both the factual aspects of the users’ inquiries and their emotional needs. This dual attention demanded a heightened degree of focus and comprehension, augmenting the challenge of empathetically understanding users in the live chat setting.

In summary, the second phase showed some of the complexities of comprehending emotional states in a live chat setting. While the perceived artificiality of the chat test environment limited the full exploration of emotional needs of the users, health professionals had mixed impressions about getting the users’ needs right. They also experienced a dual challenge of addressing both factual inquiries and emotional needs.

Several aspects stand out regarding the communication of understanding emotional needs during the second phase of data collection.

During the first phase, key elements such as genuine engagement, and authenticity emerged as shared views among both focus group and CIS interviewee participants. The second phase reinforced these findings, particularly with many users expressing appreciation for timely responses from the health professionals:

“I was quite impressed with the pace of the chat. The physician always responded swiftly, even if it was only to ensure she had understood me correctly.… I feel this was quite empathetic.” UTU R2 F42.

Responding timely to a user’s message was described as an employed technique by the CIS respondents and served different purposes (e.g., rephrasing the query, letting the user know they were searching for information). Another reoccurring theme was in-depth questioning as a technique to find out the user’s need and communicate this understanding back. Health professionals reiterated the use of questions to explore the user’s condition or concerns thoroughly. This involved seeking the user’s permission to delve into their medical or personal history. Occasionally, CIS respondents would also explain their rationale behind this questioning, as participants from both samples mentioned. Users overall valued this technique, demonstrating the health professional’s interest in their situation.

“I had the impression that I was in good hands with the person answering my questions; I noticed this from the doctor’s counter-questions. They were personal and directed at me.” UTU R1 F36.

Some observed, however, that it could make the chat feel protracted and difficult to scroll through the chat conversation.

“I got lost at some point and tried to scroll back to the initial question. While I can understand why they have to ask many questions, you have to bear in mind the technology and in this case, a small chat window, and navigating in between questions became complicated.” UTU R1 M30.

Authenticity , a pivotal element from the first phase, was further dissected in the second phase in terms of writing styles . The emergence of typos stood out in several post-usability interviews with users. While some users found typos “humanizing”, signaling the presence of a real person on the other side of the chat, most perceived them as less professional or potentially challenging for specific user groups, such as dyslexics or non-native speakers.

“I noticed the typos. At the beginning, I found them likable, but at some point, it became too much for me. Even though it didn’t affect my reading comprehension, I noticed that I perceived the person as less professional.” UTU R1 F34. “As a non-native speaker, I had put some pressure on myself to spell everything correctly so that the health professional would understand me. Then I saw they also made mistakes. My German is very good and I didn’t have any issues understanding, but for someone else, there might be. I would prefer they check the message for typos before sending it.” UTU R2 F32.

Health professionals, on the counterpart, were aware of this and described this as trade-offs between the necessity of responding quickly and laypeople-oriented versus the potential for introducing errors:

“Correcting typos is time-consuming and slows down the writing process. A spell checker would be helpful here, but as far as I know, there is a problem with data protection. So for the time being, it remains a matter of weighing up what is more important: a perfect answer or a natural conversation that can have spelling mistakes.” CIS respondent. “I increasingly tried to formulate the responses myself and copy less from our data bank. In my experience, this makes the communication faster and more empathetic, but it also carries a higher risk of accidental misinformation or typos.” CIS respondent.

This is in line with the previously identified divergence in preferences for communication styles which surfaced again in phase two. In contrast to expected adaptive communication by focus group participants, users and health professionals of phase two universally acknowledged a neutral, formal communication style during the usability tests. These had a varying reception among the users of whom some valued professionalism and others expressed a preference for a more personalized and less distanced interaction.

“I felt self-conscious at the start as I was addressed so formally and I saw the doctor title [of the respondent]. I wrote and rewrote my question several times, trying to formulate an eloquent question.” UTU R1 M29. “The writing style was very pleasant for me. Since the topic is emotionally charged, it is pleasant to write with someone in a factual manner.” UTU R1 F37.

In summary, while users appreciated the technique of timely responses and tolerated in-depth inquiries, they held mixed views on the formal language and typographical errors in the chat. On the other hand, health professionals described how they tried to balance swift, accurate responses with maintaining a fast, authentic and approachable writing style that translated complex medical language from databanks into simpler, user-friendly expressions, a technique that was positively received by users.

This section explores the third process of empathy in the usability test – acting upon an understood need of the user. During the second phase of data collection, several themes emerged that were in alignment with the first phase’s expectations.

Time commitment was universally appreciated by the users who felt that the health professionals took the time necessary for each consultation, reinforcing the importance of dedicating adequate time to individual inquiries.

“She asked, ‘Do you have any further questions or would you like to end the chat?’ and then I could have said, ‘No, I have another question’. So she left it up to me to decide and I liked that very much.” UTU R1 F49.

From the health professionals’ perspectives, this technique aimed to create a user-centric communication where users could decide the duration and pace of the chat. Nonetheless, some health professionals questioned how much time they could dedicate per user once the chat was launched:

“Inasmuch as we want to dedicate as much time to every user as they need, we also have to view it from a practical perspective. Once the chat is launched, there might be queues. How much time can and should we take for every chat?” CIS respondent.

Emphasized from phase one and slightly nuanced during the usability tests, providing valuable information in the chat was described a relevant enactment of empathy. This encompassed sharing relevant, recent studies and guiding users through the next steps of their care journey. Nonetheless, constraints with the chat format were acknowledged by some users who expressed dissatisfaction when their questions were either addressed superficially or deemed too intricate for the chat’s capabilities. While these users acknowledged the inherent limitations of a chat service, their experience was marked by a degree of frustration when their expectations were unmet:

“Well, you should bear in mind that this is a chat and not suitable to ask complex questions. I wished I had received a more specific answer to my question. Maybe I could have known this before.… I feel a bit weary.” UTU R1 M21.

CIS respondents were also aware that some questions or issues might not be adequately answered in a chat. The offer of referrals to services inside and outside the CIS was viewed positively overall by users, though some found referrals to other CIS services unnecessary, if, for instance, their question had been sufficiently answered or they had chosen the chat for a particular reason.

“The suggestion of talking to the telephone service came out of the blue for me because I felt the question had already been answered. So that made me wonder if there was more to know.” UTU R1 F34. “I would turn to the chat mainly to stay anonymous and when I go to the website, I can see that I can also make a call and if I choose the chat, they [respondents] should make it clear why they suggest a phone call to me.” UTU R2 F33.

For some of the health professionals, the challenge was not only identifying the need for referrals but also packaging referrals in a way that would not make users feel dismissed.

“How and when to suggest referrals so as to not make users feel we ‘are brushing them off’ was a topic that we discussed in our team. In my usability tests, I suggested one referral and I think I found a good way to present it.” CIS respondent.

Finally, many users highly appreciated the reassurance from health professionals that they could return to the chat anytime. This encouragement for future engagement aligns closely with the first phase’s emphasis on fostering an environment that empowers users and goes beyond what is asked, uttered by both users and health professionals:

“Dr [X] invited me to ask any further questions now or at some point in the future and I really appreciated this. It’s a small thing to say but it gives me a positive feeling.” UTU R1 F35.

In summary, the third process of empathy, acting upon an understood need, incorporated a variety of techniques consistent with expectations from phase one in the usability test. Users and health professionals alike emphasized the importance of time commitment in chat encounters, creating an environment where users could control the duration and pace of the encounter. Information management was critical, with users appreciating the relevance and understandability of the provided information, despite some instances of perceived superficiality or complexity. The theme of referrals emerged as a nuanced area, with users generally viewing them positively but questioning their necessity in certain contexts. For health professionals, the challenge lay in framing these referrals in a non-dismissive manner. Encouraging future engagement was unanimously well-received, reinforcing the initial emphasis on creating an inviting environment for ongoing assistance.

In line with the three-fold process of empathy, both phases and their themes are summarized in Table  4 .

Study summary

This qualitative, multi-method study analyzed which techniques of digital clinical empathy, a crucial element in patient-centered care, are expected and evaluated in the digital communication format ‘live chat’ on familial cancer in healthcare. While clinical empathy in face-to-face interactions employs techniques such as active listening, and a balance between emotional engagement and detachment [ 3 , 11 ], the digital era has introduced new dynamics to empathy which need to be explored in the context of the technology [ 21 , 22 ]. Given the growing prevalence of written live chats and the need to understand how healthcare providers can effectively convey empathy in this medium, this study addressed digital clinical empathy. Focusing on the three-fold processes of empathy – understanding emotional states, communicating, and acting upon this understanding – we investigated the expectations, implementation, and evaluations of techniques to foster empathy in a cancer live chat service at a Cancer Information Service (CIS). Our data combined the perspectives of potential users and health professionals during two phases: in focus group discussions and interviews before and in usability tests, followed by written reflections after the live chat encounter.

Principal findings

During the first phase of data collection (focus groups with potential users and interviews with CIS health professionals), hence focusing on the required features of digital clinical empathy, the complex nature of empathy in digital environments became evident. As highlighted by both the potential users and health professionals, understanding emotional states was viewed as a reciprocal process that demands engagement from both parties. This is different from the process of clinical empathy in non-digital settings where understanding emotional states relies heavily on active listening of the health professional [ 3 ]. Moreover, unique to the live chat setting, the respondents have to rely on written cues and interactive engagement to infer emotional states, as they lack access to the visual and tonal cues typically available in face-to-face interactions.

In terms of communicating this understanding, the importance of timely responses, authenticity, and genuine engagement was reiterated across both samples, reflecting similar principles of clinical empathy in traditional settings [ 9 , 10 ]. However, the study found diverging views on the nature of communication. The CIS health professionals, reflecting the professional orientation of clinical empathy, favored maintaining a neutral and professional tone. Meanwhile, the users preferred a more adaptive, and at times informal, communication style while not using empty phrases. This finding underlines the need to recalibrate the ways in which empathy is communicated in live chat settings, balancing professionalism with the informality often associated with digital communication [ 55 ].

Regarding acting upon an understood emotional state and need, both samples agreed on the importance of dedicating adequate time, making complex medical information understandable, and respecting users’ boundaries. These elements reflect practices associated with clinical empathy, such as clear communication and a patient-centered approach [ 8 , 15 ]. Unique to the live chat environment, CIS health professionals emphasized the need to go beyond immediate inquiries and facilitate informed decision-making. This suggests that in the context of live chats, ‘acting’ might encompass not only addressing the immediate concerns of the user but also proactively offering relevant information and further support.

During the second phase of data collection (usability tests with interviews and written reflections), users and health professionals reflected on their experiences of empathetic communication in the usability test setting. This served as a reality check against the required features and expectations from the first phase. The second phase expanded and challenged some findings from phase one. While understanding users’ emotional states was confirmed as complex, the artificiality of the usability test and the intertwined nature of factual and emotional needs amplified this complexity. This underscored the need for a nuanced approach tailored to digital communication, especially when dealing with sensitive health topics such as familial cancer [ 31 , 56 ].

The usability tests also offered additional insights on communicating a recognized need as health professionals described balancing swift, authentic responses while maintaining an approachable writing style. Users’ reactions to language formality and typographical errors were mixed. This highlights a tension between the desire for immediate interaction, inherent in the chat format, and the need to maintain accurate and reliable information exchange [ 57 ].

Acting on an understood need involved unique challenges and opportunities in the digital written context. Health professionals’ time commitment was highly valued by users, yet the live chat format also allowed users a new level of control over the pace and duration of the consultation. Providing valuable information in a chat-suitable format, however, surfaced as a unique challenge with users indicating some responses as too superficial or complex for the chat format.

Referrals, a commonly used strategy in traditional settings, presented new nuances in the digital context. While generally well received, some users questioned their necessity in specific chat contexts, while health professionals highlighted the need for careful framing to avoid users feeling dismissed.

Implications for theory, methods and practice

In terms of theoretical implications, this study shows the necessity of adapting traditional understandings of empathy, largely derived from face-to-face interactions, to suit digital platforms such as live chats [ 16 ]. Here, our study highlights the value of distinguishing between the three processes of empathy [ 2 , 3 ] and describes different techniques for each of them. This nuanced perspective can provide a more comprehensive understanding of empathy in both digital and non-digital healthcare settings. However, the study also points to the complexities in delineating these processes, as they often occur concurrently and interactively, suggesting that empathy may function more as a dynamic, interwoven process rather than isolated stages [ 58 ].

As live chats are increasingly operated by AI bots and robotics, our results underscore the intricate skills required for truly empathetic digital interactions. While current AI has progressed in identifying emotional states and partially in reflecting that understanding back to the user, the multifaceted task of empathetic responses – or acting upon this understanding – remains a challenge in AI development [ 40 , 44 , 45 ]. This challenge, however, presents a direction for future research and may open an avenue for a hybrid, cooperative model that harnesses the strengths of both humans and AI. This way, AI’s precision and speed in recognizing emotional states, especially in difficult areas as solely text-based interactions, can be integrated with the nuanced understanding and empathetic response of human health professionals.

Our study’s methodological approach, integrating the perspectives of both (potential) users and (responding) health professionals before and after the live chat’s development, offers valuable insights. This methodological approach underscores the importance of integrating user and professional perspectives right from the design phase, rather than retrospectively adjusting strategies and techniques. Moreover, the subsequent testing and evaluation phase further strengthens the research and implementation process, allowing for adjustments based on feedback and reflections. This emphasizes the importance of continuous testing and adaptation in the face of evolving user needs and technological advancements [ 59 ].

From a practical perspective, healthcare providers navigating digital spaces must find a way to uphold professional standards while exhibiting authenticity and conveying empathy [ 21 , 60 , 61 ]. This requires an understanding of different techniques, adapted to the specific digital medium [ 5 ]. Acknowledging this, our study results offer recommendations for healthcare professionals, summarized in Table  5 . These recommendations, derived from our findings, could enrich professional training, enhancing digital patient interaction skills.

Finally, the challenge of balancing authenticity and accuracy in a live chat setting points towards the need for additional support and quality control measures in digital healthcare, e.g., complemented by AI or other automated tools. Ensuring the accuracy of information disseminated in such platforms is key to being a reliable, user-friendly channel of health information.

Limitations and future research

Our study contributes to the understanding of digital clinical empathy, yet several limitations must be acknowledged. Firstly, our sampling strategy might have introduced self-selection bias, as participants responded to our recruitment efforts, primarily via cancer-related social media channels. Therefore, our sample might not be representative of the potential users (e.g., users with a suspected diagnosis of cancer or in the early stages of their cancer journey), limiting the generalizability of our findings. Moreover, although our sample included individuals with migrant backgrounds, discussions around empathy in the focus groups did not prominently feature issues specific to minority groups. However, language-related challenges observed during usability tests highlight the need for future research to delve deeper into the intersection of empathy and the experiences of minority groups, particularly in digital healthcare settings. Secondly, the usability test was staged and did not involve real emotionally charged queries. Participants were aware it was a test, which has influenced their reported experiences. Thirdly, the CIS provides multiple channels of communication, such as telephone and email. Our study focused only on the live chat feature, and the experience of empathy could differ when these features are used in combination. Future studies could benefit from exploring the synergistic effect of these channels and the unique characteristics of each medium, employing Grondin’s [ 18 ] conceptual framework. Fourthly, our study aimed to separate and analyze each of the three processes of empathy separately. Despite our efforts to individually analyze each, understanding, communicating, and acting upon users’ emotional states often interweave and should also be viewed holistically. Lastly, our study is qualitative in nature. While this provides rich, detailed data, it lacks the breadth of quantitative studies. A user survey is needed to confirm and quantify the patterns identified in this research. Moreover, examining the content of the chat interactions in future research could provide valuable insights into how specific language and word choices relate to the strategies employed to convey empathy in digital communication.

Our study reveals that empathy remains a complex and nuanced concept, even more so in the digital realm. The absence of non-verbal cues and the reliance on written communication in live chats can hinder the accurate recognition, communication and enactment of empathy. Our study also underscores the spectrum of digital clinical empathy techniques and the diverse preferences among participants. Their emphasis on taking time to provide valuable information (i.e., laypeople-oriented while also fitting the digital communication channel) and being authentic in communicating with the user as a form of empathy is notable.

In conclusion, our study demonstrates that while the digital age has reshaped healthcare encounters, the fundamental need for empathy in health-related areas remains unchanged. The challenge lies in adapting traditional forms of empathetic communication to digital mediums. It is crucial for health professionals to be aware of the potential difficulties of each medium and to continuously strive to understand and address patients’ needs, especially in a text-based environment. As digital healthcare continues to evolve with AI technologies that are trained to imitate empathetic communication, so too must our understanding and practice of empathy within this realm.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

Cancer Information Service

Focus group participant

Research question

Usability test user

Leiberg S, Anders S. The multiple facets of empathy: a survey of theory and evidence. Prog Brain Res. 2006;156:419–40. https://doi.org/10.1016/S0079-6123(06)56023-6 .

Article   PubMed   Google Scholar  

Batson CD. These Things Called Empathy: Eight Related but Distinct Phenomena. In: Decety J, Ickes W, editors. The Social Neuroscience of Empathy: The MIT Press; 2009. p. 3–16. https://doi.org/10.7551/mitpress/9780262012973.003.0002 .

Ekman E, Krasner M. Empathy in medicine: Neuroscience, education and challenges. Med Teach. 2017;39:164–73. https://doi.org/10.1080/0142159X.2016.1248925 .

Maibom HL. Empathy. Abingdon, Oxon, York N. NY: Routledge, 2020.| Series: New problems of philosophy: Routledge; 2020.

Osler L. Taking empathy online. Inquiry. 2021;1–28. https://doi.org/10.1080/0020174x.2021.1899045 .

Sanders JJ, Dubey M, Hall JA, Catzen HZ, Blanch-Hartigan D, Schwartz R. What is empathy? Oncology patient perspectives on empathic clinician behaviors. Cancer. 2021;127:4258–65. https://doi.org/10.1002/CNCR.33834 .

van Vliet LM, Back AL. The different faces of empathy in cancer care: from a desired virtue to an evidence-based communication process. Cancer. 2021;127:4137–9. https://doi.org/10.1002/cncr.33833 .

Hojat M, Maio V, Pohl CA, Gonnella JS. Clinical empathy: definition, measurement, correlates, group differences, erosion, enhancement, and healthcare outcomes. Discov Health Syst. 2023. https://doi.org/10.1007/s44250-023-00020-2 .

Article   Google Scholar  

Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63:e76–84. https://doi.org/10.3399/bjgp13X660814 .

Durkin J, Usher K, Jackson D. Embodying compassion: a systematic review of the views of nurses and patients. J Clin Nurs. 2019;28:1380–92. https://doi.org/10.1111/jocn.14722 .

Fragkos KC, Crampton PES. The effectiveness of Teaching Clinical Empathy to Medical students: a systematic review and Meta-analysis of Randomized controlled trials. Acad Med. 2020;95:947–57. https://doi.org/10.1097/ACM.0000000000003058 .

Wündrich M, Schwartz C, Feige B, Lemper D, Nissen C, Voderholzer U. Empathy training in medical students - a randomized controlled trial. Med Teach. 2017;39:1096–8. https://doi.org/10.1080/0142159X.2017.1355451 .

Arli SK, Bakan AB. An investigation of the relationship between intercultural sensitivity and compassion in nurses. Int J Intercultural Relations. 2018;63:38–42. https://doi.org/10.1016/j.ijintrel.2017.12.001 .

Mehnert-Theuerkauf A, Hufeld JM, Esser P, Goerling U, Hermann M, Zimmermann T, et al. Prevalence of mental disorders, psychosocial distress, and perceived need for psychosocial support in cancer patients and their relatives stratified by biopsychosocial factors: rationale, study design, and methods of a prospective multi-center observational cohort study (LUPE study). Front Psychol. 2023;14:1125545. https://doi.org/10.3389/fpsyg.2023.1125545 .

Article   PubMed   PubMed Central   Google Scholar  

Schwan D. Should physicians be empathetic? Rethinking clinical empathy. Theor Med Bioeth. 2018;39:347–60. https://doi.org/10.1007/s11017-018-9463-y .

Powell PA, Roberts J. Situational determinants of cognitive, affective, and compassionate empathy in naturalistic digital interactions. Comput Hum Behav. 2017;68:137–48. https://doi.org/10.1016/j.chb.2016.11.024 .

Walther JB. Computer-mediated communication. Communication Res. 1996;23:3–43. https://doi.org/10.1177/009365096023001001 .

Article   ADS   Google Scholar  

Grondin F, Lomanowska AM, Jackson PL. Empathy in computer-mediated interactions: a conceptual framework for research and clinical practice. Clin Psychol Sci Pract. 2019;26:17. https://doi.org/10.1111/cpsp.12298 .

Salmoiraghi A, Hussain S. A systematic review of the Use of Telepsychiatry in Acute Settings. J Psychiatr Pract. 2015;21:389–93. https://doi.org/10.1097/PRA.0000000000000103 .

Yellowlees P, Richard Chan S, Burke Parish M. The hybrid doctor-patient relationship in the age of technology - telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry. 2015;27:476–89. https://doi.org/10.3109/09540261.2015.1082987 .

Sperandeo R, Cioffi V, Mosca LL, Longobardi T, Moretto E, Alfano YM, et al. Exploring the question: does Empathy work in the same way in online and In-Person therapeutic settings? Front Psychol. 2021;12:671790. https://doi.org/10.3389/fpsyg.2021.671790 .

Farber BA, Ort D. Clients’ Perceptions of Changes in Their Therapists’ Positive Regard in Transitioning from In-Person Therapy to Teletherapy. Psychother Res. 2022;1–10. https://doi.org/10.1080/10503307.2022.2146544 .

Weinberg H. Obstacles, challenges, and benefits of Online Group Psychotherapy. Am J Psychother. 2021;74:83–8. https://doi.org/10.1176/appi.psychotherapy.20200034 .

Pelau C, Dabija D-C, Ene I. What makes an AI device human-like? The role of interaction quality, empathy and perceived psychological anthropomorphic characteristics in the acceptance of artificial intelligence in the service industry. Comput Hum Behav. 2021;122:106855. https://doi.org/10.1016/j.chb.2021.106855 .

Roy R, Naidoo V. Enhancing chatbot effectiveness: the role of anthropomorphic conversational styles and time orientation. J Bus Res. 2021;126:23–34. https://doi.org/10.1016/j.jbusres.2020.12.051 .

Adam M, Wessel M, Benlian A. AI-based chatbots in customer service and their effects on user compliance. Electron Markets. 2021;31:427–45. https://doi.org/10.1007/s12525-020-00414-7 .

Kim WB, Hur HJ. What makes people feel Empathy for AI chatbots? Assessing the role of competence and warmth. Int J Human–Computer Interact. 2023;1–14. https://doi.org/10.1080/10447318.2023.2219961 .

McLean G, Osei-Frimpong K. Chat now… examining the variables influencing the use of online live chat. Technol Forecast Soc Chang. 2019;146:55–67. https://doi.org/10.1016/j.techfore.2019.05.017 .

van Dolen W, Weinberg CB. An empirical investigation of factors affecting Perceived Quality and Well-Being of Children using an online child Helpline. Int J Environ Res Public Health. 2019. https://doi.org/10.3390/ijerph16122193 .

National Cancer Institute. NCI’s Cancer Information Service. 2023. https://www.cancer.gov/contact . Accessed 23 Jul 2023.

Reifegerste D, Rosset M, Czerwinski F, et al. Understanding the pathway of cancer information seeking: cancer information services as a supplement to information from other sources. J Canc Educ. 2023;38:175–84. https://doi.org/10.1007/s13187-021-02095-y

Memenga P, Baumann E, Luetke Lanfer H, Reifegerste D, Geulen J, Weber W, et al. Intentions of patients with cancer and their relatives to use a live chat on familial cancer risk: results from a cross-sectional web-based survey. J Med Internet Res. 2023;25:e45198. https://doi.org/10.2196/45198

Luetke Lanfer H, Reifegerste D, Berg A, Memenga P, Baumann E, Weber W, et al. Understanding trust determinants in a live chat service on familial cancer: qualitative triangulation study with focus groups and interviews in Germany. J Med Internet Res. 2023;25:e44707. https://doi.org/10.2196/44707

Brody C, Star A, Tran J. Chat-based hotlines for health promotion: a systematic review. Mhealth. 2020;6:36. https://doi.org/10.21037/mhealth-2019-di-13 .

Asada M. Development of artificial empathy. Neurosci Res. 2015;90:41–50. https://doi.org/10.1016/j.neures.2014.12.002 .

Gilbert S, Harvey H, Melvin T, Vollebregt E, Wicks P. Large language model AI chatbots require approval as medical devices. Nat Med. 2023. https://doi.org/10.1038/s41591-023-02412-6 .

Hernandez J, Lovejoy J, McDuff D, Suh J, O’Brien T, Sethumadhavan A, Guidelines for Assessing and Minimizing Risks of Emotion Recognition Applications. In:, Interaction I et al. (ACII); 28/09/2021–01/10/2021; Nara, Japan: IEEE; 2021. p. 1–8. https://doi.org/10.1109/ACII52823.2021.9597452 .

Deiana G, Dettori M, Arghittu A, Azara A, Gabutti G, Castiglia P. Artificial Intelligence and Public Health: evaluating ChatGPT responses to vaccination myths and misconceptions. Vaccines (Basel). 2023. https://doi.org/10.3390/vaccines11071217 .

Ghassemi M, Oakden-Rayner L, Beam AL. The false hope of current approaches to explainable artificial intelligence in health care. Lancet Digit Health. 2021;3:e745–50. https://doi.org/10.1016/S2589-7500(21)00208-9 .

Article   CAS   PubMed   Google Scholar  

Gkinko L, Elbanna A. Hope, tolerance and empathy: employees’ emotions when using an AI-enabled chatbot in a digitalised workplace. ITP. 2022;35:1714–43. https://doi.org/10.1108/ITP-04-2021-0328 .

Miner AS, Milstein A, Hancock JT. Talking to machines about Personal Mental Health problems. JAMA. 2017;318:1217–8. https://doi.org/10.1001/jama.2017.14151 .

Jannai D, Meron A, Lenz B, Levine Y, Shoham Y. Human or Not? A Gamified Approach to the Turing Test: arXiv; 2023.

Ho A, Hancock J, Miner AS. Psychological, relational, and Emotional effects of Self-Disclosure after Conversations with a Chatbot. J Commun. 2018;68:712–33. https://doi.org/10.1093/joc/jqy026 .

Jiang Q, Zhang Y, Pian W. Chatbot as an emergency exist: mediated empathy for resilience via human-AI interaction during the COVID-19 pandemic. Inf Process Manag. 2022;59:103074. https://doi.org/10.1016/j.ipm.2022.103074 .

Loveys K, Prina M, Axford C, Domènec ÒR, Weng W, Broadbent E, et al. Artificial intelligence for older people receiving long-term care: a systematic review of acceptability and effectiveness studies. Lancet Healthy Longev. 2022;3:e286–97. https://doi.org/10.1016/S2666-7568(22)00034-4 .

Nadarzynski T, Miles O, Cowie A, Ridge D. Acceptability of artificial intelligence (AI)-led chatbot services in healthcare: a mixed-methods study. Digit Health. 2019;5:2055207619871808. https://doi.org/10.1177/2055207619871808 .

Moylan CA, Carlson ML, Campbell R, Fedewa T. It’s hard to Show Empathy in a text: developing a web-based Sexual Assault Hotline in a College setting. J Interpers Violence. 2022;37:NP16037–59. https://doi.org/10.1177/08862605211025036 .

Navarro P, Sheffield J, Edirippulige S, Bambling M. Exploring Mental Health professionals’ perspectives of text-based online counseling effectiveness with Young people: mixed methods pilot study. JMIR Ment Health. 2020;7:e15564. https://doi.org/10.2196/15564 .

Black L, McClellan KA, Avard D, Knoppers BM. Intrafamilial disclosure of risk for hereditary breast and ovarian cancer: points to consider. J Community Genet. 2013;4:203–14. https://doi.org/10.1007/s12687-012-0132-y .

Konrad K. Lautes Denken. In: Mey G, Mruck K, editors. Handbuch qualitative Forschung in Der Psychologie. Wiesbaden: VS Verlag für Sozialwissenschaften; 2010. pp. 476–90. https://doi.org/10.1007/978-3-531-92052-8_34 .

Chapter   Google Scholar  

Doi T. Usability Textual Data Analysis: a formulaic coding think-aloud protocol method for usability evaluation. Appl Sci. 2021;11:7047. https://doi.org/10.3390/app11157047 .

Article   CAS   Google Scholar  

Richardson S, Mishuris R, O’Connell A, Feldstein D, Hess R, Smith P, et al. Think aloud and Near live usability testing of two complex clinical decision support tools. Int J Med Inf. 2017;106:1–8. https://doi.org/10.1016/j.ijmedinf.2017.06.003 .

Mayring P, Fenzl T. Qualitative inhaltsanalyse. In: Baur N, Blasius J, editors. Handbuch Methoden Der Empirischen Sozialforschung. Wiesbaden: Springer Fachmedien Wiesbaden; 2019. pp. 633–48. https://doi.org/10.1007/978-3-658-21308-4_42 .

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing. United States if America: Sage Publications, Inc; 2015.

Google Scholar  

Decock S, de Clerck B, Lybaert C, Plevoets K. Testing the various guises of Conversational Human Voice: the impact of formality and personalization on customer outcomes in online complaint management. J Internet Commer. 2021;20:1–24. https://doi.org/10.1080/15332861.2020.1848060 .

Lea S, Martins A, Morgan S, Cargill J, Taylor RM, Fern LA. Online information and support needs of young people with cancer: a participatory action research study. Adolesc Health Med Ther. 2018;9:121–35. https://doi.org/10.2147/AHMT.S173115 .

Radford ML. Encountering virtual users: a qualitative investigation of interpersonal communication in chat reference. J Am Soc Inf Sci. 2006;57:1046–59. https://doi.org/10.1002/asi.20374 .

Coll M-P, Viding E, Rütgen M, Silani G, Lamm C, Catmur C, Bird G. Are we really measuring empathy? Proposal for a new measurement framework. Neurosci Biobehav Rev. 2017;83:132–9. https://doi.org/10.1016/j.neubiorev.2017.10.009 .

Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inf. 2019;126:95–104. https://doi.org/10.1016/j.ijmedinf.2019.03.018 .

Gray DM, Joseph JJ, Olayiwola JN. Strategies for Digital Care of vulnerable patients in a COVID-19 world-keeping in Touch. JAMA Health Forum. 2020;1:e200734. https://doi.org/10.1001/jamahealthforum.2020.0734 .

Newcomb AB, Duval M, Bachman SL, Mohess D, Dort J, Kapadia MR. Building Rapport and Earning the Surgical Patient’s Trust in the Era of Social Distancing: Teaching Patient-Centered Communication During Video Conference Encounters to Medical Students. J Surg Educ. 2021;78:336–41. https://doi.org/10.1016/j.jsurg.2020.06.018 .

Download references

Acknowledgements

We thank all study participants for their participation.

Open Access funding enabled and organized by Projekt DEAL. This study was funded by Helmholtz-Gemeinschaft Deutscher Forschungszentren e. V.

Open Access funding enabled and organized by Projekt DEAL.

Author information

Authors and affiliations.

School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany

Hanna Luetke Lanfer & Doreen Reifegerste

German Cancer Research Center (DKFZ), Division Cancer Information Service, Heidelberg, Germany

Winja Weber, Julia Geulen, Stefanie Klein & Susanne Weg-Remers

Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hanover, Germany

Paula Memenga & Eva Baumann

BRCA-Network, Cologne, Germany

Anne Müller & Andrea Hahne

You can also search for this author in PubMed   Google Scholar

Contributions

HLL conceived of the study design, carried out the data collection and analysis and drafted the article. DR, WW and PM contributed to the conception and design of the study design, advised on drafts of the paper and approved the final manuscript. EB, JG, SK, AM, AH and SWR advised on drafts of the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hanna Luetke Lanfer .

Ethics declarations

The research project was granted ethical clearance by the ethical board of Bielefeld University. Prospective participants from all samples received an information sheet, detailing their role, rights, type of data collection, data protection, and a consent form. Informed consent was obtained from all research participants. Invitations to attend any of the study components were extended to participants solely upon receipt of their signed consent forms. All our procedures have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent for publication

Written consent for publication was obtained from all study participants.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Luetke Lanfer, H., Reifegerste, D., Weber, W. et al. Digital clinical empathy in a live chat: multiple findings from a formative qualitative study and usability tests. BMC Health Serv Res 24 , 314 (2024). https://doi.org/10.1186/s12913-024-10785-8

Download citation

Received : 27 September 2023

Accepted : 26 February 2024

Published : 08 March 2024

DOI : https://doi.org/10.1186/s12913-024-10785-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Empathy research
  • Qualitative content analysis
  • Usability tests

BMC Health Services Research

ISSN: 1472-6963

informal interview in qualitative research

ORIGINAL RESEARCH article

How do the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home a qualitative interview study with multiple stakeholders provisionally accepted.

  • 1 SHARE, Faculty of Health Sciences, University of Stavanger, Norway

The final, formatted version of the article will be published soon.

Often, homecare services are task-focused rather than person-based and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders.Four stakeholder groups (n=57) from a Norwegian municipality participated in an interview study (2019-2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem.All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem.In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services.

Keywords: service ecosystem, Senior Citizens, stakeholder involvement, Patient-Centered Care, Home Care Services, Health Services Research, qualitative research, Idealized Design Approach

Received: 14 Sep 2023; Accepted: 11 Mar 2024.

Copyright: © 2024 Kattouw, Aase and Viksveen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mr. Christophe Eward Kattouw, SHARE, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway

People also looked at

IMAGES

  1. Qualitative research: 3 types of interview to choose from

    informal interview in qualitative research

  2. General Guidelines for Conducting Research Interviews

    informal interview in qualitative research

  3. Types of Interviews in Research and Methods

    informal interview in qualitative research

  4. (PDF) Using Informal Conversations in Qualitative Research

    informal interview in qualitative research

  5. PPT

    informal interview in qualitative research

  6. PPT

    informal interview in qualitative research

VIDEO

  1. Informal Interview

  2. Pretesting and Revising Interview Guides by Huibrie Pieters

  3. Top 30 Objective Qualitative Research Question Answers

  4. Creation of Empathy Map from Interview/Qualitative Research Data

  5. Formal or Informal?

  6. Research interview- Qualitative & Quantitative (group 8

COMMENTS

  1. Using Informal Conversations in Qualitative Research

    Many qualitative researchers choosing to interview people will be familiar with the tale of what happens as you end an interview by thanking the interviewee and, just after you have turned off your digital recorder (or other recording device), the person begins speaking again, telling you things that were perhaps not covered in the interview schedule, or opening up in a more relaxed way and ...

  2. RWJF

    The researcher engages in fieldwork - observation and informal interviewing - to develop an understanding of the setting and to build rapport. Informal interviewing may also be used to uncover new topics of interest that may have been overlooked by previous research. Recording Informal Interviews. Since informal interviews occur 'on the fly ...

  3. (PDF) Using Informal Conversations in Qualitative Research

    Abstract. The aim of this paper is to promote a greater use of informal conversations in qualitative research. Although not a new innovation, we posit that they are a neglected innovation and a ...

  4. Using Informal Conversations in Qualitative Research

    Informal, or unstructured, conversations formed the basis of many early classic ethnographies from. slums (Wirth, 1927), homeless people (Anderson, 1923), life histories (Thomas & Znaniecki, 1918), institutions like the family (Mowrer, 1932) and recreational pursuits and urban life styles (Cressey, 1932).

  5. PDF Conducting an Interview in Qualitative Research

    Preparing for the interview Qualitative interviews need to be natural, like informal conversations. Keeping them natural allows participants to freely talk about their perceptions and experiences. As such, researchers need to follow some guidelines. Firstly, in most qualitative interviews not only the speech of the interviewees, but also many

  6. Using Informal Conversations in Qualitative Research

    The aim of this paper is to promote a greater use of informal conversations in qualitative research. Although not a new innovation, we posit that they are a neglected innovation and a method that should become more widely employed. We argue that these conversations create a greater ease of communication and often produce more naturalistic data.

  7. Online 'chatting' interviews: An acceptable method for qualitative data

    Qualitative research methods allow researchers to understand the experiences of patients, nurses, and other healthcare professionals. ... glyphs, symbols, and sentences, but "chat" is an uncountable informal conversation (Wikidiff, n.d.). As verbs, "text" is sending a ... and email interviews in qualitative research. European Journal of ...

  8. PDF The Role of Informal Conversations in Generating Data, and the Ethical

    2.2 The role of informal conversations in qualitative research. Talking to people is a constituent element of qualitative research and, for example, informal conversations formed the basis of many early "classic" ethnographies from anthropologists such as Frank Hamilton CUSHING, Margaret MEAD and Bronislaw MALINOWSKI.

  9. Qualitative research method-interviewing and observation

    Interviewing. This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[] As no research interview lacks structure[] most of the qualitative research interviews are either semi-structured, lightly ...

  10. Chapter 11. Interviewing

    An unstructured interview is a little like this informal conversation, except that one of the parties to the conversation (you, the researcher) ... Britten, Nicky. 1995. "Qualitative Interviews in Medical Research." BMJ: British Medical Journal 31(6999):251-253. A good basic overview of interviewing particularly useful for students of ...

  11. How to use and assess qualitative research methods

    Abstract. This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions ...

  12. Twelve tips for conducting qualitative research interviews

    Introduction. In medical education research, the qualitative research interview is a viable and highly utilized data-collection tool (DiCicco-Bloom and Crabtree Citation 2006; Jamshed Citation 2014).There are a range of interview formats, conducted with both individuals and groups, where semi-structured interviews are becoming increasingly prevalent in medical education research.

  13. Types of Interviews in Research

    There are several types of interviews, often differentiated by their level of structure. Structured interviews have predetermined questions asked in a predetermined order. Unstructured interviews are more free-flowing. Semi-structured interviews fall in between. Interviews are commonly used in market research, social science, and ethnographic ...

  14. Unstructured Interview

    In research, unstructured interviews are usually qualitative in nature, and can be very helpful for social science or humanities research focusing on personal experiences. An unstructured interview can be a particularly useful exploratory research tool. Known for being very informal and flexible, they can yield captivating responses from your ...

  15. Interview Method In Psychology Research

    Unstructured interviews are sometimes referred to as 'discovery interviews' and are more like a 'guided conservation' than a strictly structured interview. They are sometimes called informal interviews. Unstructured interviews are most useful in qualitative research to analyze attitudes and values. Though they rarely provide a valid ...

  16. PDF Interviewing in Qualitative Research

    Qualitative interview is a broad term uniting semi-structured and unstructured interviews. Quali-tative interviewing is less structured and more likely to evolve as a natural conversation; it is of-ten conducted in the form of respondents narrating their personal experiences or life histories. Qualitative interviews can be part of ethnography ...

  17. Interview Research

    Semi-Structured: Semi-Structured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Lioness Ayres; Editor: Lisa M. Given The semi-structured interview is a qualitative data collection strategy in which the researcher asks informants a series of predetermined but open-ended questions.The researcher has more control over the topics of the interview than in unstructured ...

  18. Interviews

    Often informal interviews, which may feel more like conversations, are appropriate in the context of ethnographic research as people can be wary of being recorded when broaching difficult experiences. ... Qualitative Methods in Social Research. Boston, MA: McGraw-Hill. Fine, M. (2018).

  19. Informal and formal mental health: preliminary qualitative findings

    The qualitative phase is part of a multi-year research study on informal and formal mental health support in northern Canada involving the use of qualitative and quantitative data collection and analysis methods. ... The main objective of the qualitative phase interviews was to document in-depth the situation of formal and informal helpers in ...

  20. What are interviews for? A qualitative study of employment interview

    The use of an exploratory qualitative research approach limits the inferences that can be drawn from current study. ... (7858). Finally, several participants suggested that applicants would likely be more comfortable in an informal interview context. One noted, however, that this might undermine attempts to maintain the confidentiality of the ...

  21. The role of informal support systems during illness: A qualitative

    Interview questions were informed by literature and discussion with the research team. We used a combination of questions and probes (follow-up questions) to achieve breadth of coverage across the following key topics: (a) work-related experiences; (b) illness, injury or income reduction/loss; (c) government and informal social benefit systems ...

  22. Getting more out of interviews. Understanding interviewees' accounts in

    Qualitative interviews - ranging from unstructured to open-ended and to ... The interview society and the irresistible rise of the (poorly analyzed) interview. Qualitative Research 17(2): 144-158. Crossref. ISI. Google Scholar. Weber M (1978[1922]). Economy and Society: An Outline of Interpretive Sociology. Los Angeles: University of ...

  23. "It's a stressful, trying time for the caretaker": an interpretive

    Study design. This was a qualitative study conducted in the interpretive description tradition [].The purpose of interpretive description is to create knowledge that can be applied in a clinical, real-world setting [].Interpretive description is an applicable methodology to address the current research question as new knowledge is required to support informal caregivers during postoperative ...

  24. Digital clinical empathy in a live chat: multiple findings from a

    The study utilized a qualitative approach in two research phases. It examined the expected and implemented techniques and effectiveness of digital clinical empathy in a live chat service, involving semi-structured interviews with health professionals ( n = 9), focus group discussions with potential users ( n = 42), and two rounds of usability ...

  25. Social Sciences

    The research tool was the personal interview (Green and Thorogood 2018) conducted according to a semi-structured protocol (Strauss and Corbin 1998) that was based on a literature review that discusses Arab society and issues relevant to the study's objectives (Strauss and Corbin 1998). In addition to the interviews, we also collected digital ...

  26. ORIGINAL RESEARCH article

    A qualitative interview study with multiple stakeholders Provisionally Accepted. Christophe Eward Kattouw 1* Karina Aase 1 Petter Viksveen 1. 1 SHARE, ... stakeholder involvement, Patient-Centered Care, Home Care Services, Health Services Research, qualitative research, Idealized Design Approach Received: 14 Sep 2023; Accepted: 11 Mar 2024.