Introduction
In healthcare settings, clinical interviewing is regarded as the unit of connection between the helper (usually a healthcare practitioner) and the person seeking help (usually the client/patient) (
Sommers-Flanagan et al., 2009) and is therefore utilized by all healthcare professionals to diagnose client problems and to make care decisions. The ability to conduct good clinical interviews is a core competency for healthcare professionals and considered an essential prerequisite for working in any care profession (
Rosqvist et al., 2007). There is a growing call to empower clinical practitioners (referred to as clinicians in the rest of the article) to engage in research in many healthcare disciplines (
Badu, 2023;
Chief Allied Heath Professions Officer’s Team, 2017;
Chulay, 2006;
Moon et al., 2023). However, despite their expertise in clinical interviewing, stepping into a qualitative researcher role without previous research experience could be quite challenging for clinical professionals (
Brim & Schoonover, 2009;
McClelland et al., 2023).
There are major differences between clinical interviewing and research interviewing in terms of goals, purpose, techniques, and levels of reflexivity and co-creation (
Hunt et al., 2011;
McNair et al., 2008;
Robertson & Hale, 2011). The goal of a clinical interview is to find out information in order to benefit the patient (interviewee) while the traditional qualitative research interview traditionally aims to gain information for the researcher (the interviewer) (
Hoddinott & Pill, 1997). Consistent with these goals, the clinician interviewer, particularly in a specialist health setting (such as acute hospital or rehabilitation), assumes the role of “health expert,” structures the questions narrowly based on the clinician’s practice model or the client’s diagnosis, and redefines the participant’s responses to fit this model. Clinicians making diagnostic conclusions and care decisions based on the information gathered from clinical interviews are often trained to use a standard interview format, follow a fixed order of questions, and use decision-making algorithms to minimize clinician bias and legal liability (
Rosqvist et al., 2007). External constraints such as time, caseload pressures, disciplinary boundaries, and a hospital environment all influence the clinical interviewer and can make a clinical interview quite brief and structured (
McNair et al., 2008).
In contrast, a qualitative research interview requires more flexibility, comfort with the unknown, and a willingness to put aside one’s own way of viewing the world (
Robertson & Hale, 2011). Research participants are purposely recruited based on their knowledge of the research topic and are assumed to have greater knowledge relative to the interviewer (
Roulston, 2018). The research interviewer needs to view the participant as the expert in their own experiences and use in-depth questioning, silence, and perhaps other techniques (such as encouraging storytelling) to bring out the rich participant perspective (
Britten et al., 1995;
Hunt et al., 2011). In most qualitative interviews, the interviewer is not bound by a fixed interview schedule but rather modifies the wordings and sequence of the interview guide in response to participant stories and follows through with planned and un-planned probes (
DeJonckheere & Vaughn, 2019;
McNair et al., 2008). Participants in qualitative research volunteer to tell their stories, whereas in clinical practice, clients may be mandated, ambivalent, or feeling anxious about their health—leading to resistance and less openness with the interviewer (
Sommers-Flanagan et al., 2009).
Some interviewing practices that are helpful in clinical interviews may be detrimental in research interviews. Paraphrasing, a practice to check whether the interviewer interpreted the interviewee’s statements correctly, and factual probing may be very useful in the clinical interviews but not very constructive in research interviews where open responses and in-depth probing are required to elicit rich descriptions (
McNair et al., 2008). Redirecting participants to the main agenda when they digress from the topic is effective in clinical interviews to save time, but exploring such tangents is important in qualitative research interviewing as they are often issues of central importance to participants (
Hoddinott & Pill, 1997). Analyzing the transcripts of a focus group and interviews conducted by a clinician new to qualitative research,
Marshall and Edgley (2015) pointed out that the interviewer failed to probe important issues raised by participants. Being used to the clinician lens, they switched between the researcher and clinician roles by explaining the clinical perspective in the interview instead of probing participants’ assumptions. Firsthand experiences of clinicians new to qualitative research highlight the struggles in “unlearning” deep-rooted practices developed from clinical experiences such as making assumptions and asking leading questions that could be unhelpful during qualitative research (
Fisher, 2011;
Wilson, 2008). Clinician researchers also struggled with temptations to renounce the authenticity of participant description of experiences that they believed not to be rational from a clinical perspective (
Moon et al., 2023).
Even if a researcher is an experienced interviewer in clinical settings, preparation before doing the first research interview is highly recommended (
Marshall & Edgley, 2015;
McConnell-Henry et al., 2009;
Robertson & Hale, 2011;
Wohlfart, 2020). Lack of preparation could lead to inadequate depth in asking questions and probing (
Banner, 2010). Clinicians doing research interviews need to be prepared to relinquish some control over the interviewing process and the interview schedule and become comfortable with following the research participants’ train of thought (
McNair et al., 2008). Some of the traits developed by clinicians in the clinical interviewing context such as the use of interpretive comments, speculative probes, premature summarizing statements and paraphrases, and higher control over interview content (
McNair et al., 2008) need to be relearned while doing research interviews. The process of “unlearning” competencies that clinicians feel secure in requires self-reflection, self-criticism, conscious effort, and an openness to learning.
Many methods have been suggested in the literature to develop interviewing skill, including practice (
Donalek, 2005), reflexivity (
McNair et al., 2008;
Uhrenfeldt et al., 2007), and peer feedback (
Durkin et al., 2020). Although not feasible for all clinicians, research supervision in formal training programs such as a PhD degree has been instrumental in training clinicians transitioning to a research role (
Fisher, 2011;
Wilson, 2008). Seeking support from an experienced researcher and learning from the experiences of clinical practitioners embarking on qualitative research are suggested as fundamental when transitioning to this new role (
Marshall & Edgley, 2015).
In this article, we, a team of four experienced clinical occupational therapists (lead author and co-authors AJ, DE, and BB) with no previous experience in qualitative research interviewing, share our experiences while learning to become qualitative research interviewers before undertaking our first qualitative research project. As first-time qualitative researchers, we trained ourselves on multiple fronts including different qualitative methodologies, consenting, preparation of a topic guide, qualitative interviewing, understanding rigor in qualitative research, and qualitative data analysis. This is a firsthand reflective account on our felt need to become competent in qualitative interviewing, the subsequent preparation process, and our appraisals on the differences between clinical and qualitative research interviewing. We take a constructivist approach to our epistemology—recognizing that our understanding of and emerging skills in qualitative interviewing were socially constructed in our discussions, reflections, and practice (
Yilmaz, 2013). Our reflections are context-dependent and subjective and seek to describe the process of developing awareness and skills in qualitative interviewing rather than providing an objective guide to training. Although this paper represents the reflections of only one research team of clinicians preparing to do qualitative interviews, the experiences shared may stimulate reflection and encourage preparation for other novice qualitative researchers in healthcare settings.
Description of the Context and the Authors
The motivation to prepare for this role transition (clinical interviewer to qualitative research interviewer) was a qualitative research proposal put forward by the lead author (BD) and two co-authors (HB and SA). We were responsible for organizing continuing professional development (CPD) activities for occupational therapists at our healthcare site, a large medical corporation. The corporation has many occupational therapists (more than 200) working in highly specialized settings, such as hand therapy, seating and positioning, and dementia care. However, some of the CPD activities focus on generalist occupational therapy topics (such as occupational therapy practice models). As CPD organizers, we were particularly interested to know how these generalist workshops were received by specialized occupational therapists in terms of relevance, usefulness, and impact in their day-to-day roles. Therefore, the study aimed to explore the experiences of occupational therapists working in specialized settings who attend CPD activities on generalist occupational therapy topics (not directly related to their specialty area). This study is continuing, and the results will be published in due course. Ethical approval for the study was provided by the Institutional Review Board of Hamad Medical Corporation, Qatar (MRC-01-22-426).
Since the research setting is a healthcare site with no access to experienced qualitative researchers, four of us (lead author and co-authors AJ, BB, and DE) expressed interest in learning to do qualitative research. We had extensive clinical experience and (for some) quantitative research experience, but the area of qualitative research was new. Details of previous clinical and research experiences of the research team are shown in
Table 1.
The Reflective Process
We decided to write a reflective account of this process, and the lead author compiled (i) reflective statements made by the team from the minutes of the team meetings, (ii) written statements made by the team members on the difference between clinical and research interviews during the preparation stage, (iii) email communications between team members regarding the research, and (iv) chats from a “WhatsApp” group created for the purposes of the research which included only the team members. We gave full written consent for these reflections to be represented here. In addition, each team member reflected on the influence of the work-role transitions theory in our transition to the qualitative interviewing role, the five-stage preparation process, and how our experience of clinical interviewing changed following our research experiences. All reflective statements are described in this paper without any attempt to interpret them. We co-authored this reflection article with our qualitative interviewing mentor (JF).
Initially, we reflected on our preparedness for qualitative research interviewing. Despite having wide experience in clinical interviewing, we felt inadequate at interviewing for qualitative research. Through group discussion, we became aware of the differences in our positionality, approach, and techniques while doing research interviews when compared to clinical interviews. We realized that some of the clinical interviewing habits mentioned in the literature, such as an expert and instructional approach to interviewing and focused, fact-based probing, follow-ups, and interpretations, that are ingrained within us as experienced clinical interviewers might come in the way of eliciting rich descriptions that is required from a qualitative research interview (
McNair et al., 2008). Therefore, we envisaged research interviewing as a noticeably new role and collectively felt that we needed to switch our “clinical interviewer” hat while doing research interviews. As we prepared for this role transition, we chose the work-role transitions theory (
Nicholson, 1984) to structure our preparations to fit into the new role.
Work-Role Transitions Theory
Nicholson (1984) proposed the work-role transitions theory to explain the process of adaptation that people experience when they go through a career/role transition. It also describes how some modes of adaptation may be more constructive than others and suggests ways to adapt more meaningfully to workplace change. The outcome of any transitions in work roles, according to this theory, is a process of “adjustment” which could involve personal development or role development (
Nicholson, 1984). “Personal development entails adapting oneself to fit the role, while role development entails adapting the role to fit oneself” (p. 159). Based on this,
Nicholson (1984) described four modes of adjustment: replication (low personal development, low role development); absorption (high personal development, low role development); determination (low personal development, high role development); and exploration (high personal development, high role development). Replication involves replicating previous job styles without changing many personal or job characteristics. Absorption refers to adjusting one’s personal characteristics to match the new job roles while determination involves making adjustments to the job roles to match personal characteristics. In the exploration mode of adjustment, changes are made in both personal and role characteristics simultaneously.
Job characteristics will influence the mode of adjustment for the worker. The “discretion” (or autonomy the worker has to change tasks) and the “novelty” (the degree to which the role permits the use of prior knowledge, skills, and habits) of the job are key (
Nicholson, 1984). While low discretion provides little opportunity for modifying one’s role, high discretion provides abundant opportunity. Likewise, low job novelty provides little pressure for change in one’s personal characteristics while high novelty provides great pressure to change one’s personal characteristics to fit the role.
The work-role transitions theory made us more aware of the different adjustment outcomes that could possibly ensue during our role transition. Reflecting on challenges faced by other novice clinicians in the literature (
Marshall & Edgley, 2015;
Moon et al., 2023), all of us desired not to become “replicators”—replicating the clinical interviewing style in the research role. We recognized the “novelty” of this situation and had both the motivation and the “discretion” in our job circumstances to develop our research interviewing skills through personal development and training (
Nicholson, 1984). We adopted an “absorption” mode of adjustment (high personal development and low role development) (
Nicholson, 1984). Other authors have reflected on how they brought their clinical expertise/role into their qualitative interviewing [an “exploration” mode of adjustment (high personal development and high role development)] (
Geddis-Regan et al., 2022;
Hiller & Vears, 2016). However, we felt more confident to adopt the “absorption” mode of adjustment for two reasons. As novices, we did not feel confident experimenting with shaping the research interviews based on our clinical expertise as we did not have the theoretical understanding of how this could affect data production and interpretation. Secondly, as the research topic was non-clinical, it felt more separate to our clinical work. Our customary responses to clients in a clinical context were not as relevant or as likely to occur. Therefore, we felt confident learning about the research interviewing role and adjusting our personal characteristics to fit that role. Overall, the work-role transitions theory enabled us to take a more self-reflective approach to adjusting to our new role and to structure our preparation process.
A Five-Stage Preparation Process
We conceived a five-stage preparation process to develop our research interviewing skills. Firstly, we read texts on qualitative methodology (
Morse & Richards, 2002), qualitative interviewing (
Banner, 2010;
McGrath et al., 2019), and articles discussing the differences between qualitative research interviewing and clinical interviewing (
Hoddinott & Pill, 1997;
Hunt et al., 2011;
McNair et al., 2008). Secondly, we rated our self-preparedness on 12 key qualitative interviewing tasks. These skills were taken from the article by
McGrath et al. (2019) and included (1) preparing for a qualitative interview, (2) building rapport with the respondent, (3) consent process, (4) communication strategies for interviewing, (5) in-depth probing: prompts, questions, and silence, (6) level of control: cultural and power dimensions, (7) recording the interview process, (8) writing a reflective statement, (9) fine-tuning interview guide for clarifications, (10) handling unexpected emotions and distress, (11) transcribing the interviews, and (12) checking the interview data. We each marked our level of self-preparedness on the 12 tasks on a 4-point rating scale (highly confident, fairly confident, unsure, and not confident). Validity or reliability of the scale was not examined, but it served as a useful self-reflective tool about our competence in research interviewing and to identify further learning needs. This tool is attached in
Appendix 1.
Thirdly, we wrote reflective statements on the perceived differences between clinical interviewing and research interviewing in order to increase perceptions of novelty of the research interviewing role and discussed our views with each other. Fourthly, a training module was then created and implemented in collaboration with a mentor. This individual (co-author JF) was an academic occupational therapist who has used, supervised, and published qualitative research and was experienced in guiding novice researchers. The training module consisted of a 3-hour workshop and discussion on key topics of qualitative interviewing (see
Appendix 2). After this initial training, the team members engaged in practice interviews with colleagues using the topic guide developed for the research. This was followed by another 1-hour question and answer session with the mentor to clarify doubts and discuss the difficulties and experiences faced during the practice interviews.
Finally, each team member conducted one pilot interview with a potential participant, reflected on the experience, and learned from peer feedback. The pictorial representation of the five-stage preparation process is shown in
Figure 1.
Reflections on the Five-Stage Preparation Process
Self-Directed Learning
The self-regulated readings helped us to understand the competencies required for qualitative interviewing. Through reading, we also realized that there was more “novelty” in this role of qualitative research interviewers than we had previously believed. For example, we recalled how often we use leading questions to get specific answers during clinical interviews which is unacceptable in research interviews. Without deep reflection and practice, we could run the risk of what
Lavis et al. (2023) called “falling back on the familiar”—reverting to our usual responses in an interviewing situation.
Self-Assessment
As expected, we felt more confident with building rapport or handling unexpected emotions that is practiced routinely in clinical practice but less prepared for more research-oriented activities like preparation for qualitative interviewing, writing a reflective statement, letting go of control, in-depth probing, fine-tuning the interview guide, and transcribing interviews. While reflective practice is well-established and encouraged among occupational therapists, we rarely reflect critically on epistemological issues, such as how our interactions with interview participants are socially constructed (rather than objective) or our own positionality as interviewers (
Hunt et al., 2011). Used to clinical guidelines and standardized interview tools, the prospect of designing an interview tool and allowing it to be responsive and change over time was challenging.
Increase Novelty
Through self-directed reading and self-assessment, we felt somewhat unprepared to transition to the new role. A number of authors have explored this dilemma, particularly the risk of assuming that our clinical interviewing skills would transition seamlessly (
Hunt et al., 2011;
Lavis et al., 2023). We wanted to become more reflexive (
McNair et al., 2008) and unlearn some of the clinical interviewing traits so that we could carry out rich, co-constructed research interviews. We wrote down reflective statements about the differences between clinical and qualitative research interviewing to reinforce where we could improve.
Training
Some of the key things we learned from the training included understanding qualitative research, differences between clinical and research interviewing, interviewing strategies, open-ended and neutral questioning, probing, modifying the topic guide based on participant responses, and dealing with unresponsive participants. We reflected on our internalized assumptions and interviewing practices and had the opportunity to problem-solve ways to overcome them. Few of us felt that having more lecture time could have been more helpful.
The practice interviews were an eye-opener that welcomed us to the new world of research interviews as one member remarked, “It felt like as if I am doing an interview for the first time.” When we did the practice interviews, we tended to read from the topic guide, but as we practiced, it became more automatic. Likewise, we tended to ask all the questions on the prompt sheet even if the participant had answered them—just for the sake of asking. We later realized our mistake from participant feedback and became adept at modifying our questions from the topic guide. Moreover, the questions that came up during the practice interviews from participants helped us to anticipate and prepare better to clarify ourselves. It helped us to rehearse new ways of doing interviews, and peer feedback helped us to identify and correct our mistakes. We practiced relinquishing control of the interviews, following the participant’s lead and probing for more descriptions, and resisting our urge to confront participants’ perspectives when it went against our assumptions during the practice interviews. We watched each other during practice interviews and gave feedback when one of us made premature summarizing or interpretive statements, asked leading questions, or redirected participants. Piloting and receiving feedback from both interviewees and observers is a key step identified by
Hunt et al. (2011) in their advice to clinician researchers.
The opportunity to ask questions of a mentor enabled us to clarify doubts regarding interviewing techniques, and our meetings gave space to honestly express our anxieties about whether we were doing it right. The reassurances provided by an experienced mentor helped us greatly in gaining confidence.
Buys et al. (2022) emphasize the importance of having a safe space like this to debrief, gain support, and reflect on the “anxiety-provoking” process of research interviewing—particularly when the mentor is not directly involved in the study.
Practice
The pilot interviews with a potential participant with the actual interview guide in an authentic setting exposed us to the research conditions, which was very beneficial. The fact that all of us were new to qualitative research eased the peer feedback process and made us feel comfortable to receive and give feedback.
Reflections on the Differences Between Clinical and Qualitative Research Interviewing Experiences
We reflected on the differences once before doing the actual research interviews and for the second time after doing the research interviews. Our reflections are summarized in
Table 2.
Several challenges arose in our post-interview reflections. While doing the interviews, we felt that when a participant did not understand the question, we had to take time to think and reframe the question. While it was easier to overcome this problem with those participants who were very fluent and conversational, we felt naïve with those who were not forthcoming because we were more conscious about not asking leading questions. We were conscious that even prompts like “I agree” would be value-laden and “leading” in this context (
Hunt et al., 2011).
Redirecting to the topic was another difficulty faced by us during the interviews. When some participants digressed vastly from the topic, we were confused as to whether to redirect or not and to what extent we should let the participant go on a tangent. As we had prepared ourselves not to interrupt and follow the participants’ lead, we did not interrupt during our interviews but felt this led to some interviews being overly long. While this caused us discomfort, discursiveness has been advised as an interview strategy in qualitative research as a means to get valuable insights about the participants, and hence researchers are advised not to redirect participants even if it consumes time (
Robertson & Hale, 2011).
Although we did not know the research participants at a personal level and did not work in the same units, some power inequality existed such as junior/senior colleagues working in the same institution, CPD organizer/attendee, and researcher/participant. This could have resulted in some reticence in participants. We reflected that this was quite a hierarchical qualitative study (with the study/questions being designed by the researchers with no input from stakeholders) (
Karnieli-Miller et al., 2009) and that participants knew the researchers were responsible for organizing CPD events. We discussed these potential power dynamics in our post-training sessions and practiced our open communication skills. We also reflected as a group how the research intent, researcher’s positionality, participants’ rights and ethical procedures will have affected the interviews and the data collected (
Karnieli-Miller et al., 2009;
McEvoy, 2001).
Final Thoughts and Recommendations
This article describes the preparation process carried out by a group of clinical occupational therapists while preparing for their first qualitative research interview and their reflections during/after their transition to a new role. Several reflection articles are found in the literature on the transition from clinical interviewing to research interviewing, but these are related to the author’s experience as they completed their PhD (
Fisher, 2011;
Hunt et al., 2011;
McNair et al., 2008;
Wilson, 2008). Hence, they mainly describe the common pitfalls made by clinician researchers during the research interview process and advice for overcoming them but not on the preparations for qualitative interviewing. This reflection article, however, describes the preparations we made within our clinical role. The preparations were based on reflective articles describing the transition from clinicians to researchers (
Fisher, 2011;
Hunt et al., 2011;
McNair et al., 2008;
Wilson, 2008), articles offering general recommendations for such transitions (
Banner, 2010;
Hoddinott & Pill, 1997;
Marshall & Edgley, 2015;
McGrath et al., 2019;
Robertson & Hale, 2011), and general guidance articles on developing qualitative interviewing skills (
DeJonckheere & Vaughn, 2019;
Donalek, 2005). As illustrated in the reflections, we found this preparation process helpful and it could provide useful inspiration to other experienced clinicians turned novice qualitative interviewers or researchers recruiting clinicians as researchers.
A novelty in this article is the use of the work-role transitions theory in guiding the preparation process which proved to be effective in preparing the mindset of the research team in their adjustment to the new qualitative research interviewer role. Acceptance of such a role change has been reported to facilitate a good relationship with research participants (
Robertson & Hale, 2011). We set out to “switch hats” during our preparation to become competent research interviewers, and in our case, perhaps this was made easier as the research topic itself was not clinical. Our clinical and research “roles” felt quite separate. However, other authors argue that (particularly where interviewing health service users) role conflict, power dynamics, and even professional ethics can occur for clinician researchers. A number of reflective accounts have described these potential conflicts eloquently (
Hiller & Vears, 2016;
Jack, 2008;
Richards & Emslie, 2000). Interviewees may misunderstand the purpose of a research interview carried out in a healthcare setting or behave and respond differently depending on whether a researcher uses their clinical title (such as Doctor) or an academic one. We reflect that these conflicts may arise for us in future qualitative research and require us to undertake an “exploration” mode of adjustment (
Nicholson, 1984). Interviewing people on health-related topics will mean bringing our clinical instincts into our research role, while still recognizing the difference between a clinical and research interview. In such scenarios, the way forward would be to wear both hats (clinician and interviewer) at the same time in order to elicit rich descriptions from participants while acknowledging and reporting how the researcher’s positionality was influenced by the dual role.
Jack (2008) provides important guidelines for clinicians to guide reflection on this potential role conflict.
Clinicians are increasingly called to engage in research, and qualitative interviewing is being advocated as a powerful tool for clinician researchers (
DeJonckheere & Vaughn, 2019). With their considerable experience in clinical interviewing, it is easy for clinicians to take for granted the preparation required to transition into research interviewers. Some of the difficulties we encountered and reflected in the literature are difficulties with probing, relinquishing control, overcoming personal assumptions, researcher–participant power relations, lack of confidence, and a sense of humility (
Fisher, 2011;
McNair et al., 2008). This article might guide investigators intending to recruit clinicians as research interviewers and those clinicians wanting to engage in qualitative research interviewing in the important preparation process for the transition. Based on our experience, we recommend the following preparation tips for those clinicians beginning their first qualitative research interview:
• Engage in self-reading of qualitative interviewing methods and differences between qualitative research interviewing and clinical interviewing.
• Collaborate with a qualitative research expert for mentorship.
• Utilize a theory such as work-role transitions theory to guide thinking toward the transition.
• Do practice interviews with people from different backgrounds with the topic guide until you feel confident. A minimum of two practice interviews is recommended.
• Engage in self-reflection and peer feedback throughout the process.