A short article by Professor Ismo Linnosmaa and Dr Eirini Saloniki has recently been published in the OPTIMI. OPTIMI is a newsletter in health and social economics concentrating on recent research and findings about productivity, effectiveness, costs, finance and incentives in health and social care in Finland. The newsletter disseminates recent research findings to support decision-making at various levels of health and social care. OPTIMI is published four times a year and it is edited at the Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki. To read the article please follow this link.
By Eirini Saloniki, Research Associate at PSSRU & CHSS at the University of Kent.
It was nine years ago when I was given the opportunity to study for a year abroad at the University of Kent with the Erasmus programme. A fantastic and mind-opening experience – in fact, so fantastic that I returned to Kent not only to study for a PhD but now also working at the University. Who would have thought that I will live the Erasmus ‘dream’ again, this time as a staff member? Yes, the Erasmus programme is available for staff too…! I was eager to apply but I had to find a hosting institution first. It took a Skype meeting and “I suppose we talk about 2-4 weeks visit?” before I found myself applying to spend two weeks as a Visiting Researcher at the National Institute for Health and Welfare (THL) in Helsinki. The application process was fast and within a couple of weeks I was informed that I was successful. I put my excitement aside and focused on organising everything for the visit with the weather not being a concern as I was told that it will be over 10 degrees in May!
Nervous (as it was my first time in Helsinki) but at the same time ready to face the challenge, I spent my first day at the Institute trying to get used to the new routine and working environment, including having lunch at as early as 11:30am. Everyone was very welcome and it really felt like I was a member of the Centre for Health and Social Economics (within THL). The days to follow involved many meetings with health and social economists and late stays at the office (I must have lost track of time as it was so bright in the evening). I had the opportunity to discuss the projects we work on at the Centre for Health Services Studies and the Personal Social Services Research Unit with senior economists, and share best practice. I was also able to share my knowledge of how to control for taste and scale heterogeneity in preference elicitation for social care-related quality of life, and present some preliminary results from the work we are doing in Kent as part of the EXCELC project in an internal seminar. The seminar was well-attended with the audience showing real interest in the project. Importantly, I got to know all about the Finnish health and social care system, and its associated difficulties when it comes to data handling and interpretation. This is an important consideration for the cross-national element of the project that I am involved in.
It was a great honour to be asked to co-write (with Professor Ismo Linnosmaa) a short piece about “Measuring effectiveness in social care: the present and future for researchers and policy-makers” which is to be featured in the THL newsletter, distributed across Finland.
Before I even realised, my time in Helsinki was over. This experience was invaluable and once again undoubtedly mind-opening. The interaction with senior economists working under a different research environment and the transfer of knowledge as well as discussions for future collaboration were beyond my expectations.
Would I do it again? ABSOLUTELY. Lots to learn in this visit but above all lots to gain. I wholeheartedly recommend the Erasmus programme to other researchers.
By Dr Laurie Batchelder, Research Officer at PSSRU Kent
Greetings from America! Just a quick update on how things went at ISPOR this week (International Society for Pharmacoeconomics and Outcomes Research – 22nd Annual International Meeting). I gave a talk on our preliminary work on the generation of preferences for the ASCOT-C in the English data, which was well received. I fielded a few questions about how we plan to compare these preferences for the ASCOT-C across countries, so I highlighted our plans for the cross-country analysis using a pooled model. Many people were also interested in when we plan to publish the ASCOT-C work, which is great news! In addition, my presentation had been selected as an ISPOR 22nd Annual International Meeting Research Presentation Award finalist!
I also presented our preliminary work on the comparison between face-to-face versus internet data for eliciting SCRQoL preferences using the ASCOT-S in the English dataset, which was also well-received. Similarly many were very interested in this work and asked questions about the presentation of the Best Worst Scaling task & how this differed between the two modes. There was also a focus on looking at heterogeneity in a very detailed way (which we plan on doing). Again many people were very interested in ASCOT and when we plan to publish this work, which is great news!
In general, I found that there was a lot of discussion talking with others (economists, pharmacists, consultants) after the talk, at the poster, and even in some preference sessions that other methods, such as BWS is the “way forward” and the “next step” with eliciting preferences, given it’s less cognitively burdensome and that it provides more detailed information within a profile compared to TTO, which I think is really promising.
Full poster and presentation references:
COMPARING INTERNET AND FACE-TO-FACE SURVEYS AS METHODS FOR ELICITING PREFERENCES FOR CARE-RELATED QUALITY OF LIFE: EVIDENCE FROM ENGLAND USING THE ASCOT SERVICE USER MEASURE
Saloniki E1, Batchelder L1, Malley J2, Burge P3, Lu H3, Forder J1
1University of Kent, Canterbury, UK, 2London School of Economics and Political Science, London, UK, 3RAND Europe, Cambridge, UK
CARER SOCIAL CARE-RELATED QUALITY OF LIFE OUTCOMES: ESTABLISHING PREFERENCE WEIGHTS FOR THE ADULT SOCIAL CARE OUTCOMES TOOLKIT FOR CARERS Batchelder L1, Saloniki E1, Malley J2, Burge P3, Lu H3, Linnosmaa I4, Trukeschitz B5, Forder J1 1University of Kent, Canterbury, UK, 2London School of Economics and Political Science, London, UK, 3RAND Europe, Cambridge, UK, 4National Institute for Health and Welfare (THL), Helsinki, Finland, 5Wu – Vienna University of Economics and Business, Vienna, Austria
CHESS are hosting a seminar on ‘Preference elicitation for social care-related quality of life: theory and practice’ on May 17 in the NCC buildings in Helsinki.
There will be presentations by members of the EXCELC team, including some early findings from the preference study. The programme for the seminar can be downloaded here.
First interviewer experiences from the Austrian team of the EXCELC project.
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 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.
 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.
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.
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!