Interviewing one's peers: methodological issues in a study of health professionals

In interview research, the relationship between interviewer and informant is central Citation[1–5]. Very often, this issue is framed in terms of a status or knowledge gap. Hence, the “professional” expertise of the practitioner may be contrasted with the “lay” knowledge of the patient, with corresponding disparity in terms of power Citation[6], Citation[7]; this has important methodological and ethical implications Citation[8], Citation[9]. The interviewer is often of higher social status, with no prior or future relationship with the informant Citation[10]. However, there are also situations in which researcher and informant occupy a similar role or status, possess a similar body of knowledge, and share an ongoing professional relationship. Whilst the methodological implications of such situations have been examined in the context of social Citation[10], Citation[11], educational Citation[12], and healthcare research Citation[13], Citation[14], literature in this area is sparse. However, as clinicians are increasingly using qualitative methods to study and evaluate aspects of primary healthcare Citation[15–22], an understanding of these issues has important implications.

In this article we report insights gained from a study of health professionals’ conceptions of osteoarthritis. Although attitudes and beliefs concerning osteoarthritis were the principal substantive focus of the study, a secondary aim was to explore informants’ experience of being interviewed by a professional peer.

Material and methods

We conducted interviews with 15 practitioners: 9 general practitioners (GPs), 3 consultant rheumatologists, and 3 community physical therapists (PTs). These clinicians had a median of 24 years’ post qualification experience (range 7–37 years), and eight were male. They were chosen to represent a range of clinical experience and practice settings (e.g. for GPs, both single-handed and group practices, and for rheumatologists, both university and non-university hospitals). Participants were approached by letter regarding participation. All of the rheumatologists and PTs approached agreed to participate; we needed to approach 12 GPs to secure the 9 interviewees. The basis of sampling was principally to obtain the views of GPs, but we included smaller numbers of the other two professions to provide some comparative data. The Local Research Ethics Committee approved the study and all participants gave informed consent. One of the authors (LC), who is a GP, carried out the interviews in north-west England over a three-month period.

In a semi-structured format, we asked informants about their understanding of osteoarthritis as a clinical entity, and how this influenced their approach to clinical work – e.g. whether they regarded osteoarthritis as an issue of disease or of normal change, and how they explained osteoarthritis to patients. At the interview's conclusion, we sought informants’ views on what it was like to be interviewed by a professional peer. Specifically, we asked: “What was it like being interviewed by a fellow professional?” Further questions or probes were then used as appropriate.

The interviews lasted between 20 and 60 minutes, and the topic of being interviewed by a peer commonly occupied the last 5–10 minutes. We audiotaped the interviews and analysed the transcripts by hand, using thematic analysis Citation[23]. Although data analysis was primarily inductive, it was also guided by an a priori understanding of issues likely to be raised. Sections of text were gathered under broad categories, which were given provisional descriptions. As analysis proceeded, categories were refined, merged, or split, and their descriptions modified, as appropriate Citation[24]. As well as subsuming data under emerging themes, we also sought data that did not fit these themes (“deviant” cases) Citation[25]. Both researchers coded a subsample of three interviews to check consistency.

Results

Discussion

When interviewing expert professionals, the researcher's identity is influential. Academic researchers without a professional background can approach the interview without preconceptions Citation[26], and can employ a certain naivety to encourage detailed explanations from the informant. Their status as an “outsider” may, however, generate reticence or suspicion. In contrast, a fellow professional can harness prior understanding of the topic and the professional culture Citation[27], and may be able to pursue issues more thoroughly by virtue of not having to seek explanations of basic terminology and concepts. He or she can also enlist feelings of professional cooperation and solidarity to encourage disclosure, and may gain informants’ confidence more readily than a non-practitioner Citation[28]. It may also be possible to explore sensitive issues or tap extreme or deviant views Citation[14], Citation[16], Citation[29]. Chew-Graham et al. Citation[14] report that access is easier when the GP informant knows the interviewer to be a clinician, and they also suggest that such interviews gave richer data. Moreover, Andersson et al. Citation[13] suggest that shared knowledge and interest between the participants may increase the interviewer's credibility. A fellow GP may thus more readily elicit a “private” account Citation[16].

In this study, certain advantages of a professional background did appear to operate. However, on occasions the interviewer's professional identity served to redefine the purpose of the interview. The study sought information on practitioners’ conceptual and explanatory frameworks, yet this was sometimes translated into questions of factual knowledge and professional competence. For some informants, this gave rise to feelings of being under professional scrutiny. Other studies have suggested that the interviewer may be treated by his or her peer informants as an “expert” in the focus of the interview Citation[14], Citation[30]. Chew-Graham et al. Citation[14] also identified the notion of being under scrutiny, and in both their study and our own the interviewer's identity as a GP may have contributed to the feeling that the interview was a factual assessment of clinical knowledge – despite assurances to the contrary in our study. Again, the specific peer relationship seems to be central to this. If the interviewer had been a social scientist, there might have been no concern that such a person would test medical knowledge, since the social scientist would not necessarily have been perceived to know the correct answers. Accordingly, clinicians may respond readily to a non-clinician interviewer when questioned about their practice Citation[26], whilst informants who feel they are being judged will be particularly cautious in conversations with a fellow professional Citation[14].

Questions of professional identity may underlie many of the issues raised by this study. Constructing and maintaining a distinct professional identity is central to professional socialization Citation[31], and this identity is often maintained through communication processes Citation[32], Citation[33]. In an interview with a fellow professional the individual's professional identity is at stake, and steps are therefore taken to protect this identity. Concern with the status of one's professional knowledge, a certain defensiveness regarding one's practice, and a polite and positive attitude to the interview are all potential communicative means of sustaining a professional identity.

There is the possibility when interviewing one's peers of “conceptual blindness”, whereby “the interviewer's own feelings and opinion about the field [may] govern the dialogue and interpretation” Citation[13]. An allied issue is that familiarity of the “insider” with the area of study may dominate the process of data analysis Citation[34] and prevent novel insights Citation[35]. Obtaining sufficient distance from the topic being investigated may be problematic when interviewing fellow GPs Citation[15], Citation[17]. In our study, the interviewer sought to address this issue through a reflexive approach to the study Citation[36]. She utilized her clinical knowledge to frame appropriate questions and interpret the answers, whilst also attempting to remain attentive to ideas and interpretations that lay outside the familiar explanatory framework of medicine.

This study also highlights how interviewing one's peers challenges some traditional assumptions about the informant–interviewer relationship – that they are considered to be anonymous to each other, from different social groups, and unlikely to meet again Citation[10]. A pre-existing or possible future professional relationship between interviewer and interviewee may affect the conduct of the interview and the data that result. The interviewer may therefore have to manage a combination of roles with regard to the informant: researcher and colleague Citation[12].

Apparent equality of status in an interview between peers may conceal more subtle intra-professional hierarchies, which may influence the nature and process of disclosure. Structural differences, such as those of age or gender, will also operate separately from those of professional status. In this study, there were indications that the interviewer was seen by informants, on different occasions and even within a single interview, as professionally both junior and senior, and that the researcher–informant relationship differed across types of professional peers. This is likely to reflect, at least partially, differing perceptions of the relative “expertise” of the interviewer. Whether the informant and interviewer are from the same or different professions may therefore have somewhat different methodological implications, and should be considered when interviewing fellow practitioners.

This study also illustrates the reciprocity of qualitative interviews. The interview account is not simply “collected” from the informant but is “co-authored” by both participants Citation[37]. Rather than being one-way communication from informant to researcher, the interview involves a two-way exchange, in which both parties may ask questions Citation[38]. Moreover, whilst ostensibly the interview has an agreed focus, each party may at times pursue other agendas. The interview is a social situation like any other, and displays what ethnomethodologists refer to as “reflexivity” – informants are concerned as much with achieving certain purposes (e.g. of self-presentation) within that situation as with providing a description of their beliefs or attitudes Citation[39]. Even apparently “private” accounts are “social constructs, created by the self-presentation of the informant and whatever interactional cues are given off by the interviewer about the acceptability or otherwise of the accounts being presented” Citation[40]. What informants say is conditioned by the broader social – and, in this case, professional – context of the interview, and by one party's assumptions regarding the other's role, status, and identity Citation[41].

Certain factors may have restricted the insights emerging from the interviews on this topic. The time available for the interviews with working practitioners was limited, and most of this was devoted to exploring the primary focus of the study. Whilst asking informants directly about their experiences of the interview – rather than relying solely on the interviewer's perceptions – provides a new perspective on this topic, addressing the issue so explicitly may inevitably have encouraged socially desirable responses.

Nonetheless, this study highlights important methodological issues when conducting interviews with fellow practitioners. As an insider, the interviewer can gain potentially rich insights by capitalizing on a shared culture and a common stock of technical knowledge, as well as feelings of collegial trust. Conversely, a need to project a positive professional identity to a colleague may mould the informant's responses, especially when the objectives of the study bear upon professionally sensitive or contentious issues. Involving both a clinician and a non-clinician in the interpretation of the data may offset the drawbacks of either approach. Intrinsically, however, the insider's understanding of a professional culture is neither better nor worse than that of an outsider – the appropriate approach relates to the objectives of the study.

The authors would like to thank the informants for giving their time to take part in the interviews, Carolyn Chew-Graham for advice on the interview process prior to the study, and Christian Mallen and Jackie Waterfield for comments on the manuscript. This project is part of a programme of work funded by the Medical Research Council. LC was also funded by the West Midlands Deanery.