Skills and sensitivity required – on conducting interviews with long-term care recipients

Authors: Assma Hajji, Judith Kieninger, Ruth Fulterer, and Birgit Trukeschitz (WU Vienna University of Economics and Business, Research Institute for Economics of Aging)

First interviewer experiences from the Austrian team of the EXCELC project.

 

About the interviews
So far, the team of the Research Institute for Economics of Aging has trained 25 interviewers in four of the Austrian ”Laender” to conduct interviews in Vienna, Upper Austria, Lower Austria and Vorarlberg from May 2016 to February 2017. Their task consists of interviewing recipients of long-term care and their informal carers on different aspects of their lives and home care services using a standardised questionnaire. Data collection was supported by the Austrian Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, by social care organisations and local authorities.

Who are our interviewers?

Most of our interviewers have a background in the social sciences – they come from the fields of sociology, social work, business and economics, health sciences, or even law. Some are still in education and see this as a great opportunity to get some valuable first-hand experience in empirical research.  A few of them are employed in the care sector themselves – for them, doing the interviews offers an opportunity to view this field from a different angle as researchers. Two-thirds of our interviewers are women, the interviewers’ ages range from 20 to 55, with most of them being young adults.

14[1] of them agreed to answer a short survey we sent out asking them about their experiences and impressions. We have collected their statements and used them to put together the following sections on their experiences with conducting interviews with long-term care recipients.

The beginning of the interview – delving into new surroundings

Ringing the doorbell, the interviewers don’t really know what to expect on the other side of the door. All they have is a name and some contact details – and about one or two hours of time to get to know the people living within these walls.

In many cases, the participants are looking forward to being visited – after all, it’s not every day that a researcher from a university comes over to ask questions about your daily life, and the visits provide a nice break from daily routines. People talk about their lives freely, some offer tea and biscuits. Others would like to, but are not able to cater for guests anymore because of physical strain, illness or economic circumstances. Some are visibly uncomfortable because of this – such as Mr. F, who has “only water to offer” for his guests or Ms. L, who apologises for her scrawly handwriting on the informed consent form. Despite all of this, they are happy to face the challenge and contribute to the research project.

For some, however, the willingness to help out is accompanied by fear of the unknown visitors. The interviewers need a great deal of sensitivity and empathy in order to be able to counter-act those feelings, build trust and create a relaxed atmosphere. And in some cases, a familiar person – maybe a son or a daughter – will stay with the participants to make them feel more secure.

Different personalities and environments: a challenge for the interviewers

No two interviews or participants are exactly alike. The interviewers are aware of that and know that with every new interview they are expected to adapt to the situation they find themselves in and to tune into the participant’s needs and react accordingly. “I get to experience so many different settings and have to find ways of adapting to new contexts quickly – I find this really interesting and I feel I can learn a lot from it’” – this was how one of our interviewers put it after having experienced quite a few different interview situations himself.

With each interview they conduct, the interviewers get to know different conversation styles. As a result, they constantly develop new skills and strategies in order to successfully lead their counterparts through the questionnaire. The participants signal their needs both verbally and non-verbally – and for the interviewers, they need to interpret these cues and respond by speaking more clearly, loudly, faster or slower. This is what an interviewer noted after having done interviews with two very different participants – the first one very talkative, the second one not so much: “With Mr. A, I had to speak a lot more loudly and articulate very clearly. I also had to repeat the questions several times. Most importantly, I had to be very patient as it took him a long time to answer the question”. Each conversation partner – whether s/he may be reserved, timid, tired, articulate, talkative or upset – requires a different conversation strategy from the interviewer.

The interview: A balancing act between social expectations and methodological requirements

The first step before the actual interview consists of establishing a connection and feeling of mutual trust between the interviewer and interviewed person. The first few minutes, the short bits of small-talk at the beginning, all of this is essential when it comes to building trust and the basis for open and honest communication. But interviewers also need to make sure that the data collected are as valid as possible: is it, for example, really necessary for the interviewee’s husband to watch over her throughout the entire length of the interview? Is the daughter’s presence critical for her mother to take part in the interview, or is it rather a need for control on her part? The interviewers know that the presence of other people may affect how the person answers the questions. On the other hand, not having someone trusted around may lead to feelings of insecurity or irritation. Once again, it is down to the interviewers’ ability to gauge the situation and find a middle ground, establishing conditions that meet methodological requirements whilst making sure that the participants’ willingness to cooperate is not lost in the process.

Handling emotional ups and downs

The interviewers’ experiences show that their visits provide a welcome break from everyday life for the participants. However, positive and negative emotions often lie close together: excitement about the visit, happiness about the fact that someone is interested in their life stories and hope that their concerns are being heard and addressed are mixed with feelings of sadness when talking about burdensome aspects of life, or hesitation and difficulty in finding the right answers. Even though the efforts are usually rewarded, being an interviewer requires a great deal of maturity and groundedness to cope with these kinds of situations.

“Conducting” the interview: finding the right balance in providing space for personal narratives whilst maintaining methodological standards

One interviewer notes that, in order for the “message to truly get across”, eye contact between the interviewer and participant is essential. The older persons often do not like being forced into a fixed corset of pre-formulated questions and answers. They find ways to escape these constraints, giving elaborate answers dotted with personal anecdotes and life experiences. Whenever this happens, interviewers and interviewees may find themselves in conflict: while the interviewer may be focused on the questionnaire in the hopes of getting through the interview without taking too many detours, the interviewee may very well see this as an opportunity to have a lively and engaged conversation, to tell stories and share experiences.

The interview covers subjects related to the respondents’ daily lives, their care situations and quality of life, all of which are very personal topics. It is therefore not surprising that, for some of the respondents, certain questions spark the need to reflect on their personal situation and talk some more. Successfully “conducting” the interviews therefore not only implies being able to get through the survey question by question or block by block, but also to listen empathically and show interest in the respondents and their elaborations.

After the interview – what remains?

In many cases, the interviewers are left with the positive feeling of having provided participants with a nice little break from everyday life, the opportunity to voice their needs and concerns and be heard and appreciated. “I think giving the interview really made his day”, said one of our interviewers after a visit, or “Ms. M is a charming, humble woman – I believe that the interview has given her quite a bit of confidence”.

But it is not only the participants who can take something away. The participants’ life stories and wealth of experiences turn the visits into valuable moments for the interviewers as well, as one of them put it: “I found this encounter – just like every other one so far – to be truly enriching”

“I have the uttermost respect for the lifetime achievements of these persons, who have now become old and in need of care”

The field phase in Austria is expected to be completed by autumn 2017. We are looking forward to the results of the quantitative analysis of the data collected, which will be available in early summer 2018.

[1] We would like to give a special thanks to: Veronika Böhmer Maria Estella Dürnecker, Stephanie Egg, Stefan Fuchshuber, Lukas Hirsch, Martin Köpplmayr, Judith Litschauer, Franziska Maurhart, Johanna Meditz, Bernhard Prinz, Gerlinde Schröttenhamer, Eva Stiftinger, Andreas Stöger and Philipp Weber.

 

EXCELC team’s presentation on the Health Economics Day 2017 in Finland

By Dr Lien Nguyen, and Ismo Linnosma, Centre for Health and Social Economics, National Insitute for Health and Welfare (THL)

On the Health Economics Day last month in Finland, there were eight selected health economics presentations in the afternoon, one of which was from the Finnish members of the EXCELC team. Ismo Linnosmaa presented some findings from the study of self-assessed quality of life (QoL) among Austrian, English and Finnish people. Data used in the study were collected online last summer and sent to the team by Research Now. The results indicated that after having controlled for individual characteristics, there are no statistically significant differences in self-assessed QoL, though only between the English and Finnish people. Instead, the Austrian people were more likely to report better QoL than the Finns. In addition, the study lends support to the hypothesis of the positive association between QoL and income. People with higher income tend to assess QoL as very good or so good it could not be better. As the reasons behind the findings of differences in QoL between the three countries are not known, the Excelc team plans to investigate the theme further in the near future.

The Health Economics Day (Terveystaloustieteen päivä) is an annual seminar traditionally held in February in Finland that brings together health service experts, policy makers, researchers and people interested in health economics. The usual programme of the day is divided into two parts. In the morning, invited speakers give talks on topics that are both topical and relevant from the perspective of health economics. The afternoon programme is composed of presentations of researchers presenting and discussing the most recent findings from their own research in health economics as well as organized sessions on some important topics in health economics.  

EXCELC Team Meeting and Advisory Group in Vienna 2017

By Dr Laurie Batchelder, Research officer at PSSRU Kent

The EXCELC team met in Vienna last week (8 – 10 February) to catch up and share our ideas and progress to date with the EXCELC policy and scientific advisory group.

On Thursday, the EXCELC team discussed the great progress we’ve made since we last met in September. Juliette Malley, Laurie Batchelder and Eirini Saloniki updated us on progress with the preference study and presented some preliminary results, including basic preference models for Austria, England and Finland for both the ASCOT service user measure and the ASCOT carer measure, as well as mode and temporal comparisons with the ASCOT service user measure. Birgit Trukeschitz, Assma Hajji, Judith Kieninger and Judith Litschauer updated us on progress with the Austrian fieldwork. They also presented some preliminary descriptive results. Ismo Linnosmaa, Lien Nguyen and Hanna Jokimaki similarly updated us on progress with the Finnish fieldwork and presented some preliminary descriptive results. We all discussed the challenges conducting fieldwork and strategies we can use to improve recruitment of carers. Following the meeting, the team got the chance to marvel at the beautiful sites of Vienna and try some traditional Viennese food.

On Friday, the EXCELC team shared their work with the EXCELC advisory group. Birgit Trukeschitz and Juliette Malley kicked off the meeting with an introduction to the EXCELC project and its various workpackages. Ismo Linnosmaa and Birgit Trukeschitz then presented reflections on the process of translating ASCOT into Finnish and German. Laurie Batchelder and Eirini Saloniki also presented preliminary findings from the preference study from the ASCOT service user measure and the ASCOT carer measure. Birgit Trukeschitz and Assma Hajji then presented their progress with the Austrian fieldwork, and Hanna Jokimaki presented progress with the Finnish fieldwork. We discussed the similar challenges both Austria and Finland have faced during the fieldwork stage. We had good discussions following each presentation with lots of ideas about how to present and build on the work we are doing. The meeting closed with tea and coffee, more engaging discussions, and Krapfen!

“It’s hard to imagine situations that you’ve not experienced before properly:” Reflections on what aspects of quality of life people value using the Best-Worst Scaling (BWS) Task

by Dr Laurie Batchelderbatchelder-laurie

Recently our team published a research note on the work we undertook to understand people’s preferences for different quality of life states described by the ASCOT service user and carer measures. The method we used to draw out people’s preferences for quality of life states was a task called Best-Worst Scaling (BWS). During this task, we asked participants to trade-off and choose different care-related quality of life states.

We wanted to make sure that the presentation of the BWS task was clear before it was presented in the mainstage study, so we tested the BWS task in a small group of people in England, Austria and Finland. We asked them to reflect on everything they were thinking and feeling while completing the BWS task. We also interviewed these people after the task in order to better understand their decision-making processes.

This research note sets out our key findings and highlights some problems we encountered when we tested this method, along with how we overcame these problems. These changes have now been piloted, and we have just completed the main fieldwork, collecting people’s preferences for ASCOT quality of life states.

We are currently using the data we have collected about how people understand the BWS experiment to look in more detail at how people make decisions about their preferences. This will help us to better understand the data we collected from the BWS task and to plan future experiments. It will also provide us a better understanding of the BWS task overall. We presented this work at the ILPN conference at LSE in September 2016 (see link to our presentation at ILPN here and also Storify of the ILPN conference here) and further discussed these findings at the NORFACE Workshop: Health Politics, Health Policy, Long-Term Care and Inequalities in October 2016 in Mannheim, Germany.

Next year we will provide a further update – some results from the analysis of the BWS data from England, Austria and Finland.

Read more about this study here!

EXCELC team at ILPN 2016

EXCELC team at ILPN 2016

Here are members of the EXCELC team catching-up following another excellent ILPN conference last week (also see Storify of the conference here).  There were lots of interesting presentations at the ILPN conference and some great ones from the members of the EXCELC team, with Laurie Batchelder presenting some findings from the development phase of the preference study and Ismo Linnosmaa and Birgit Trukeschitz presenting some reflections on the process of translating ASCOT into Finnish and German.  Juliette Malley and Julien Forder also presented on related work and analyses to understand the effectiveness and efficiency of long-term care that we plan to update and expand upon as part of the EXCELC study.

At our meeting we discussed the excellent progress being made in the fieldwork stages of this project.  Birgit Trukeschitz, Assma Hajji updated us on progress with the Austrian fieldwork, and outcome from the pilot. Ismo Linnosmaa , Lien Nguyen and Hanna Jokimaki similarly updated us on progress with the Finnish fieldwork and outcomes from the pilot. Juliette Malley, Laurie Batchelder, Eirini Saloniki and Julien Forder updated on progress with the fieldwork for the preference study across all three countries — Austria, England and Finland — which is now complete. Data has been sent to us by the fieldwork organisations and we are currently checking the data to make sure everything is looking OK. We also discussed our plans for our team meeting in February to be held in Vienna and the first meetings of the policy and scientific advisory groups.

More to come soon!