2 METHODS
We used the same methodological approach for this study as in a recently
published study,9 because both studies arose from one
research project based on the same methodological approach.
We used semi-structured individual interviews and focus groups to
collect qualitative data from participants in Lincolnshire in the East
Midlands region of England. The School of Health and Social Care Ethics
Committee at the University of Lincoln granted ethics approval for the
study.
We recruited a convenience sample of service users (adults without
active cancer) and primary care practitioners (GPs and nurses) who
agreed to participate in the study. Cancer patients were not recruited
because they were not likely to use the tool for a cancer which was
already known, and we felt it was not worth the stress, even if some
cancer patients had some information to offer.
The interview schedule seeking barriers and facilitators to use of the
tool was informed by an implementation theoretical framework, the
Consolidated Framework for Implementation Research
[CFIR],10 which seeks to understand human and
other factors involved in the deployment of innovations such as cancer
risk assessment tools for symptomatic individuals. The data analysis and
interpretation were also informed by relevant constructs within the
CFIR10: relative advantage (for the facilitators);
patient needs and resources, compatibility, knowledge and beliefs of
individuals involved, and reflecting and monitoring the implementation
process (for the barriers). This theoretical framework was selected
because some of its constructs (those relating to barriers), helped to
explain how the different barriers may make the implementation of the
tool difficult, while other constructs of the framework (those relating
to facilitators) also helped to explain how the different facilitators
identified by participants may aid the implementation of the tool in
patient consultations.
Some service users were recruited using flyers in local public places
(e.g. the public library, advertisements on notice boards) while others
were recruited through members of the patient and public involvement
group who helped to identify and invite potential participants. Service
users were offered individual interviews because these were considered
more feasible for them than focus groups. Service users who were willing
to participate in the interviews contacted the researcher (JNA) for more
information and an appointment for individual face-to-face interviews.
These interviews were subsequently conducted in the preferred place of
interviewees – in their own homes or at the university.
Following invitation letters to practitioners through their general
practices, interested practitioners contacted the researcher for more
information and an appointment to meet the researcher (JNA) for either
individual interviews or focus groups. Some practitioners were unable to
find time to be interviewed individually, and were focus groups instead,
enriching the data through participant interactions. Other willing
practitioners were interviewed individually.
Before asking for the views of participants on the barriers and
facilitators to the implementation of the tool in general practice
consultations, a vignette of the QCancer tool was shown, explained, and
demonstrated to participants where there was Internet access.
Prior to commencing the individual interviews and focus groups,
participants gave a written consent by signing a consent form, and they
were assured of their freedom to discontinue with at any point. All
participants gave permission for audio-recording of the interviews and
focus groups, and notes were taken to complement the audio recorded
data.
After transcribing the data verbatim, the Framework
approach11 was used to analyse which was facilitated
by NVivo version 10. A priori codes, which informed the interview guide,
formed an initial coding framework, and further inductive codes were
identified as analysis of the interview data progressed. Two
investigators (JA, ANS) read the transcripts thoroughly and derived an
initial coding framework which was discussed and agreed by the research
team. Through further interpretation and discussion, the initial themes
were developed iteratively into a smaller number of overarching themes.
There was no need for further collection of data from bother service
user and practitioner participants as the data analysis achieved
saturation, which meant that no new codes or themes were
generated.12 The service user and practitioner data
were analysed separately and then compared for similarities and
differences.