Article Figures & Data
Tables
Author, Year Topic Participants Comments on Study Methodology Henry et al,4 2011 Preventive services in primary care Physicians and patients Secondary analysis of video elicitation interviews Gao et al,27 2009 Cross-cultural discussions of colorectal cancer screening Patientsa Used experienced translators and bilingual interviewers O’Brien et al,29 2008 Decisions about breast cancer treatment Patients Included interactions with both medical and surgical oncologists Saba et al,30 2006 Shared decision making in primary care Physicians and patients Compared analysis of video recordings with analysis of video elicitation interviews Frankel et al,26 2005 Instances of effective or significant communication during interactions Physicians and patients Edited audio-recorded interview comments directly onto video recordings before analysis; used both dyad and physician as units of analysis Fossum et al,31–33 2004 Perceptions of communication and quality of care in orthopedic clinics Physicians and patients Examined associations among interaction sequence, content, and patients’ expressions of satisfaction during interviews Coleman et al,34–36 1999 Discussions about smoking in primary care Physicians Investigator recorded several interactions with each physician and chose 1 per physician for elicitation interviews. Participants watched videos immediately before rather than during the interview Epstein et al,37 1998 HIV risk assessment in primary care Physicians and patients Participants watched videos and made both spontaneous and HIV- related comments. Video elicitation interviews were followed by standard interviews focused on barriers to discussions of HIV risk Cromarty,38 1996 Patients’ thoughts during primary care interactions Patients Interviewed a subset of participants from a larger sample of recorded interactions; interviewed patients in their homes Cegala et al,39,40 1996 Perceptions of communication competence in primary care Physicians and patients Used coded interviews for quantitative analysis; all interactions were recorded in the same room using a wall-mounted camera Arborelius,28,41–45 1990 Comparison of physician and patient perspectives; dilemmas in primary care Physicians and patients Conducted 2 video elicitation interviews: 1 for spontaneous comments, and 1 focused on content related to specific research questions Treichler et al,46 1987 Power dynamics in physician- patient interactions Physician and patient Detailed, microanalysis of a single interaction; compares a physician’s and student’s interaction with the same patient Frankel et al,25 1982 Comparison of physician and patient perspectives Physicians and patients Edited audio-recorded interview comments directly onto video recordings before analysis -
HIV=human immunodeficiency virus.
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Note: Multiple articles analyzing the same set of video elicitation interviews are listed together in a single row.
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↵a Study reports that physicians were interviewed, but only data from patient interviews were reported.
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Step Example From Authors’ Study Conceptualizing a video elicitation study 1. Choose a research question for which the added value of video elicitation interviews justifies the time and resources required How do physicians’ and patients’ prioritize discussions of preventive services in primary care? 2. Decide on the scope of data collection Interviewed participants about the entire interaction; asked participants to make unsolicited comments and respond to questions about preventive services delivery Participants and sampling 3. Determine the unit of analysis and sampling frame Interviewed both physicians and patients; used convenience and snowball sampling; recruited physicians before patients; recruited patients (2 per physician) from waiting rooms; paid patients 4. Establish sufficient trust to record physicians Recruited physicians from investigator’s local department and community; presented study aims to clinic staff using an academic detailing approach; offered individualized feedback sessions to physicians and clinics Data collection and management 5. Choose an appropriate video camera Used a professional-grade, portable video camera with a fixed lens; used an adapted medical equipment stand (tripods would not fit in examination rooms) 6. Establish a protocol for recording interactions Used checklists for equipment setup; frequently reviewed recordings to evaluate quality; obtained backup audio recordings; research assistant set up equipment on site and was not in room during the interaction; physicians covered lens during physical examination 7. Minimize the elapsed time between video recording and elicitation interviews Interviewed patients immediately after the interaction in available clinic space; used a laptop computer to play videos; interviewed physicians 1 to 2 weeks later as their schedules allowed 8. Determine the elicitation interview structure Conducted semistructured interviews; investigated both spontaneous comments and discussions about preventive services; interviewers and participants were encouraged to pause recordings and comment; variation among interactions made structured interviews difficult 9. Train interviewers Investigator trained interviewers 10. Determine a protocol for storing video recordings Converted digital cassettes to computer files and stored them on secure servers; archived video recordings for future use 11. Choose a transcription protocol for interviews Used a standard protocol designed for studying medical discourse47 Data analysis 12. Review interview and data quality regularly Discussed data and findings in regular debriefing meetings using transcripts; investigators participated in some interviews 13. Decide how to integrate data from video recordings and elicitation interviews Tried integrating transcripts from video recordings and interviews into a single document (which added considerable time and little additional insight); did not record exact times that participants’ paused videos 14. Choose a method for analyzing elicitation interview data Developed a theory-driven coding system for assessing statements likely to represent tacit clues Mitigating limitations of video elicitation interviews 15. Consider what kinds of interview data (recall, reliving, and/or reflection) are needed Did not address 16. Consider how social pressures related to interview setting may influence interview data Noted that patients often emphasized features they liked about their physicians; were alert to participant responses during interviews that reflected social desirability Type of Research Question Examples From Published Video Elicitation Studies Complex cognitive or decision-making processes How often do physicians and patients identify nonverbal behaviors or gestalt assessments that influence their judgments?4
How do patients’ cultural norms and expectations influence discussions about colorectal cancer screening?27
What factors influence physicians’ decisions to discuss smoking cessation with patients?36Misunderstanding or disagreement during interactions How often do physicians and patients identify the same moments of an interaction as “unusual” or “interesting”?26
How do physicians’ and patients’ perspectives on communication competence differ?39
How do physicians and patients’ thoughts and feelings about information exchange and relational communication differ?40
What kinds of dilemmas do general practitioners experience during physician-patient interactions?45Sensitive, emotional, or stigmatized topics What factors are associated with effective discussions of HIV risk during primary care interactions?37
What power dynamics exist between physicians, patients, and medical students?46Defining effective communication and management for complex problems What processes and stages of treatment decision making are perceived by women with early stage breast cancer29
How do communication behaviors associated with shared decision making relate to patients’ and physicians’ subjective experience of partnership?30
How do orthopedic surgeons manage interactions, and how do these management strategies relate to patient satisfaction?32Influences on participants’ impressions and behaviors after interactions How do comments from physicians with high patient satisfaction scores compare with comments from physicians with low patient satisfaction scores?26
How do patients define “good” vs “bad” physicians?44Participants’ reactions to or assessments of their own actions How do orthopedic surgeons experience interactions with patients?31
How do patients experience interactions with orthopedic surgeons?33
What thoughts do patients have during primary care interactions?38
How do general practitioners experience and understand physician-patient interactions?43-
HIV=human immunodeficiency virus.
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Question Goal Sample Question Thoughts, beliefs, and emotions What were you doing/trying to do at this point in the visit?
What were you noticing/hearing at this point?
Were there any other thoughts going through your mind?
Can you tell me what you felt at this point?
Can you recall more details about your feelings?
What makes this moment in particular stand out to you?
How did you want the other person to perceive you?
Why did you make that statement/ask that question?Impressions of others What did you think the physician/patient was thinking about you at this point?
What were your impressions of the physician’s/patient’s actions at this point?
Why do you think the physician/patient made that statement at this moment?Impressions of self What do you notice about your actions at this point?
What about your behavior at this point surprises you?Decision making processes What let you know that was the right decision to make at this point?
What information did you use in making this decision?
What other courses of action were you considering or were available to you?
What made you decide this was the right decision at this point in time?
How much time pressure did you feel in making this decision?
If the patient had said X instead of Y, how would that have influenced your decisions and/or assessment?-
Adapted, with permission, from Kagan14 and Crandall et al.20
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Additional Files
Supplemental Appendix and Figure
Supplemental Appendix. Physician interview guide used during video elicitation interviews; Supplemental Figure. Camera and camera stand used in the authors' video elicitation interview study
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 2 pages
- Supplemental data: Figure - PDF file, 1 page
The Article in Brief
Video Elicitation Interviews: A Qualitative Research Method for Investigating Physician-Patient Interactions
Stephen G. Henry , and colleagues
Background Face-to-face interactions between doctors and patients are central to primary care and an important focus of primary care research. Video elicitation interviews are a technique for evaluating these interactions. This article describes the concept and method of video elicitation interviews and provides practical guidance for its use.
What This Study Found During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation allows researchers to integrate data about the content of physician-patient interactions, gained from video recordings, with data about participants' associated thoughts, beliefs, and emotions, gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions.
Implications
- While video elicitation interviews are logistically demanding and require considerable time and resources, the detailed data they produce make the effort worthwhile for many important research questions in primary care.
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