International Journal of Social Research Methodology
ISSN: 1364-5579 (Print) 1464-5300 (Online) Journal homepage: http://www.tandfonline.com/loi/tsrm20
Interview schedule development for a Sequential explanatory mixed method design: complementary-alternative medicine (CAM) study among Indonesian psychologists Andrian Liem To cite this article: Andrian Liem (2018): Interview schedule development for a Sequential explanatory mixed method design: complementary-alternative medicine (CAM) study among Indonesian psychologists, International Journal of Social Research Methodology, DOI: 10.1080/13645579.2018.1434864 To link to this article: https://doi.org/10.1080/13645579.2018.1434864
Published online: 06 Feb 2018.
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International Journal of Social Research Methodology, 2018 https://doi.org/10.1080/13645579.2018.1434864
Interview schedule development for a Sequential explanatory mixed method design: complementary-alternative medicine (CAM) study among Indonesian psychologists Andrian Liem School of Psychology, The University of Queensland, Brisbane, Australia
ABSTRACT
Sequential explanatory mixed method design is the most frequently applied in both health and social sciences literature. It is denoted by ‘QUAN → qual’ which represents the quantitative study occurs first and has greater weight in addressing the study’s aims, and the qualitative study follows to explain quantitative results. Despite the extensive use of sequential explanatory design, there are limited references to this design. Therefore, this methodological paper attempts to fill the gap by providing an illustration in developing a sequential explanatory interview schedule based on complementary-alternative medicine (CAM) study among clinical psychologists in Indonesia. The most important step to develop sequential explanatory interview schedule was the construction of aspects and questions that were immensely grounded on the most notable quantitative results. In this study, eight aspects of interview schedule were constructed after analyses of the nationwide survey. The interview schedule then piloted among participants with fairly similar characteristics to the participants in the main interviews. This process enhanced the quality of questions through feedback from participants and improved the interviewer’s skills through familiarization with questions. It is expected that this reflection report could be adopted as a practical guideline in developing interview schedule for sequential explanatory mixed method design, particularly in the field of psychology.
ARTICLE HISTORY
Received 22 June 2017 Accepted 26 January 2018 KEYWORDS
Sequential explanatory; interview schedule; mixed method; clinical health psychology; complementaryalternative medicine; Indonesia
Introduction The use of Complementary-alternative medicine (CAM) in both developed and developing countries has been rising over the past decades, not only among lay people but also health professionals (Bishop & Holmes, 2013; Mishra, Neupane, & Kallestrup, 2015; World Health Organization [WHO], 2013). However, research about CAM has been dominated by medical science scholars who examine CAM effectiveness through randomized control trials (RCT) (Bishop & Holmes, 2013). For example, acupuncture to improve working memory and mood among patients with depression in the Netherlands (Bosch et al., 2015); and energy therapy in managing patients’ depressive and anxiety symptoms in Hong Kong and Mainland China (Wang et al., 2013). On the other hand, social science scholars
CONTACT Andrian Liem
[email protected]
© 2018 Informa UK Limited, trading as Taylor & Francis Group
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have also investigated the users of CAM and their motivations for use (Fries, 2009). For example, cross-sectional surveys among racial groups in the USA (Hsiao et al., 2006) and within Malaysian diabetic patients (Hasan, Loon, Ahmadi, Ahmed, & Bukhari, 2011). In both medical and social science groups, quantitative research designs have been used in the majority of studies. However, quantitative-based studies cannot explain what is happening beyond the numbers (Scott & Sutton, 2009). Therefore, qualitative designs are increasingly being used to explore participants’ stories and experiences. For example, interviews were conducted with senior citizens in London who visit CAM services regularly (Cartwright, 2007) and with Malaysian patients who use CAM as part of their cancer treatment (Farooqui et al., 2012). Qualitative research has also been used to explore participants’ perspective related to CAM. For example, in an exploration of the meaning of CAM within psychology community in Indonesia it found that CAM has diverse meanings that might be influenced by participants’ knowledge of CAM and cultural background (Liem & Rahmawati, 2017). However, most of the utilization of quantitative and qualitative designs are still dichotomous which are purely quantitative or qualitative only (Castro, Kellison, Boyd, & Kopak, 2010; Fries, 2009). Each quantitative and qualitative design has its limitation. Moreover, interpretation of data from one design only might be misleading, for example, a structured questionnaire about teachers’ emotions regarding teaching practices may only show negative or positive emotion without adequately explain the event that triggered the emotions (Scott & Sutton, 2009). Combining the two approaches into a mixed method design can minimize the limitations and provide a more holistic interpretation of the phenomena under the mixed method study (Baheiraei, Bakouei, Mohammadi, & Hosseini, 2014; Bishop & Holmes, 2013; McKim, 2017). There are three mixed method designs (Creswell & Clark, 2011). The most basic one is triangulation/convergent parallel design, denoted by ‘QUAN + QUAL’ (or ‘QUAL + QUAN’), in which quantitative and qualitative data are collected at the same time and treated equally but then analyzed separately. Both data are compared and may confirm or disconfirm each other. The second design is sequential mixed method in which primary data will be collected and analyzed then followed by the secondary data collection and analysis. Two sub-designs of sequential mixed method are explanatory sequential (‘QUAN → qual’) and exploratory-sequential (‘QUAL → quan’) which have different purposes of use: the first phase with capitalized letters has greater weight in addressing the study’s aims. The last design is advanced mixed method with sub-designs are embedded, transformative, and multiphase mixed methods. The detail of this design can be found in mixed method study design literature, for example, Creswell and Clark (2011) and Saks and Allsop (2007). Interests in the use of mixed method design have been growing in the U.S.A. since in the 1980s through support from government research funding (Brannen, 2005). Initially, mixed method designs were primarily used in social sciences but then also be utilized in health sciences (Cameron, 2009; Castro et al., 2010). Despite the prominence of mixed method designs that provides more comprehensive knowledge, the number of research articles published in journals which use a mixed method design is still limited. In 2012, for example, only 4% of 80 papers in the top 10 CAM journals reported using a mix method design, and only 6% in psychology journals (Bishop & Holmes, 2013). Also, mixed method design is less frequently discussed in psychology textbooks due to preference toward quantitative and experimental designs in psychology research (Hanson, Creswell, Clark, Petska, & Creswell, 2005; Povee & Roberts, 2015). Within the mixed method studies published in journals, the sequential explanatory design is the most frequently applied in both health and social sciences research (Ivankova, Creswell, & Stick, 2006; Shannon-Baker, 2016). For example, assessment of health status of reproductive age women (Baheiraei et al., 2014) and African-American girls’ attitudes toward science investigation (Buck, Cook, Quigley, Eastwood, & Lucas, 2009). The reason for favoring sequential explanatory design is that quantitative design in the first stage will portray the objective statistical findings from the group in general. Afterwards, a qualitative approach can be used to discover subjective nuances from participants as individuals and explain the phenomenon behind the numbers that cannot be described merely by the quantitative data (Baheiraei et al., 2014; Fries, 2009). However, the sequential explanatory design also
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has a disadvantage: it is more time-consuming when compared to concurrent designs that are usually preferred in medical research (Bishop & Holmes, 2013; Ivankova et al., 2006). In order to minimalize the disadvantage of sequential-explanatory, pilot studies for testing the research instruments are sometimes conducted with minimum effort or insufficiently reported, especially for a pilot interview (Majid, Othman, & Yusof, 2017). For example, fewer scholars reported their process when developing interview schedules when compared to their report of questionnaire development for quantitative phases (Bishop & Holmes, 2013; Nassar-McMillan, Wyer, Oliver-Hoyo, & Ryder-Burge, 2010). But in fact, the development of interview schedule is an essential part of qualitative phase because it provides valuable feedback before the main interviews are conducted (Krauss et al., 2009; Luck & Rose, 2007). Although the number is limited, there are some reports of interview schedule development but predominantly clinical studies, such as assessment of mental illness recovery (Wolstencroft, Oades, Caputi, & Andresen, 2010) and evaluation of students with schizophrenia (Chattopadhyay, Kumar, Thirthalli, Mehta, & Thanapal, 2017). In addition, interview schedule for sequential explanatory design is different from other mixed method designs because the questions depend on and are developed based on the quantitative findings. Thus, this paper aims to fill the gap in the current methodological literature on developing interview schedules for sequential explanatory mixed method design; and argues that pilot interviews improve the interview schedule as reported in previous studies (Luck & Rose, 2007; Majid et al., 2017). Instead of an interview protocol, an interview schedule was developed in this study because the interviewer has more flexibility when using it as a guideline, rather than using an interview protocol which is more rigid (Bantjes & Van Ommen, 2008; Dikko, 2016). Study about CAM among clinical psychologists (CP) in Indonesia was used to illustrate the process. CAM study among Indonesian clinical psychologists (CP) The Indonesian Health Ministry defines CAM as (translated version): Non-conventional treatment aimed to improve public health status including promotive, preventive, curative, and rehabilitative ways that are obtained through a structured education with quality, safety, and high effectiveness that is based on biomedical science and which has not been accepted in conventional medicine. (Kementerian Kesehatan RI, 2007)
Eleven CAM methods (acupressure, acupuncture, aromatherapy, dietary-supplements, energy therapy, herbal therapy, massage therapy, meditation, music therapy, spirituality-religious therapy, and yoga) were selected in this study. For each of these methods there are references that support their use to treat psychological problems (i.e. Barnett, Shale, Elkins, & Fisher, 2014). However, none is included in the Standard for Clinical Psychology Services in Indonesia (Indonesian Clinical Psychology Association/ IPK HIMPSI, 2008). Although the integration of CAM with conventional medicine health services began in the early 2000s in Indonesia (Kementerian Kesehatan RI, 2007), to the author’s best knowledge there is no study about CAM among CP as a part of health professionals. Therefore, a sequential explanatory mixed method design was used to explore knowledge of, attitudes toward, experiences of, and educational needs regarding CAM among CP in Indonesia because their clients may ask information or recommendation about CAM. Four primary research questions addressed in this study were: (a) what is the level of perceived CAM knowledge and attitudes towards CAM of clinical psychologists in Indonesia?; (b) what CAM experiences do Indonesian clinical psychologists have?; (c) to what extent does the level of perceived CAM knowledge and attitudes towards CAM affect CAM experiences and educational needs about CAM among Indonesian clinical psychologists?; and (d) what are the perspectives of psychologists in public health center regarding the possibility for CAM integration in clinical practice and psychology education? As a methodological article, the quantitative phase is presented concisely below as the foundation for developing the interview schedule and tested in pilot interviews.
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Summary of quantitative study (phase 1) An online survey was completed by 274 Indonesia CP, predominantly female (86.49%) with the mean age of 35.41 years (SD = 7.87). Details of data collection and analysis for the quantitative phase is reported elsewhere [Liem, 2018] and summary of the quantitative results is displayed on Table 1. In general, participants reported a lack of knowledge of CAM, particularly regarding CAM integration. Spirituality-religious therapy was the most well-known CAM method compared with the other ten methods. Overall, attitudes towards CAM among the participants were positive, especially the attitude towards integration of CAM. More than two-thirds of participants reported that they used CAM for personal purpose (87.23%) and had recommended CAM (83.94%). More than half of the participants reported having ever made a referral to a CAM practitioner (52.19%) and having ever given CAM to their clients (65.69%). Dietary-supplement therapy, spirituality-religious therapy, and meditation were the most reported by participants as having been used for personal and professional purposes. Generally, participants reported a high educational need for CAM, especially regarding the potential risks of CAM. Table 2 shows the correlation between variables. Significant positive correlations were found between age, knowledge, attitudes, experiences, and educational needs of CAM. There was a significant positive correlation between knowledge of CAM and attitudes towards CAM. Knowledge of CAM and attitudes towards CAM were significantly and positively correlated with personal and professional use of CAM. Multiple regressions found that four experiences of CAM were significantly predicted by age, knowledge of, and attitude towards CAM. However, age did not significantly and uniquely contribute to the prediction of CAM for personal use and in professional practice. Attitudes did not significantly and uniquely contribute to the prediction of CAM referral. Educational needs of CAM could not significantly be predicted by age, CAM knowledge, or attitudes towards CAM.
Table 1. Summary of quantitative results. Scale (Sub-scale) Knowledge of CAMA CAM basic information CAM integration in CP practices The risks of CAM use Attitudes towards CAMB Attitudes towards knowledge of CAM Attitudes towards integration of CAM Attitudes concerning the risks associated with CAM# Experiences of CAMC CAM personal purpose CAM recommendation CAM referral The use of CAM in CP’ practice Educational needs of CAMD CAM basic information CAM integration in CP practices The risks of CAM use
n (%) NA NA NA NA NA NA NA NA 239 (87.23) 230 (83.94) 143 (52.19) 180 (65.69) NA NA NA NA
M (SD) 2.78 (.90) 3.30 (1.16) 2.01 (.92) 3.02 (1.04) 4.70 (.77) 4.78 (1.11) 4.95 (1.05) 4.46 (.71) 4.82 (3.02) 3.82 (2.85) 1.76 (2.44) 1.99 (2.35) 5.86 (.84) 5.77 (.94) 5.86 (.87) 5.94 (.86)
Med 2.67 3.00 2.00 3.00 4.70 4.67 5.00 4.50 5.00 3.00 1.00 1.00 6.00 6.00 6.00 6.00
Statistical test Z = −13.10*** X2(2) = 323.55*** Z = 9.76*** X2(2) = 323.55*** NA X2(3) = 399.70***
Z = 13.48*** X2(2) = 21.47***
Notes: A1 = ‘no knowledge at all’ to 7 = ‘know very well’. B 1 = ‘strongly disagree’ to 7 = ‘strongly agree’. C The number represents how many CAM method used by participant (ranged from 0 to 11). D 1 = ‘strongly not needed’ to 7 = ‘strongly needed’, Z = Wilcoxon’s SR test. X2=Friedman’s test. NA = not available. # Reversed scored items so that lower values represent higher risks, suspicion, danger, or confusion. *p
