What do you do when your carefully planned interview topic guide goes off the rails?
I’d thought interviewing would be easy. After all, I’d carefully constructed my topic guide questions, and thought they were at once sensitive to the cultural expectations of the Roma community members I was interviewing, while also cutting to the heart of the barriers and inequalities that Roma were reported to face in accessing health services. I asked questions like:
Do you feel that health care providers make and effort to understand your culture? and
If you could change one thing about health services in the UK, what would it be?
Yet for some reason, these questions didn’t seem to be stimulating interviewees to talk. They would give answers, sure, but these tended towards one-word response - maybe even a sentence at a push. It seemed I wasn't getting at the topics that made people tick, and so I started experimenting with broader questions, trying to elicit some story, any story about interviewees' health experiences. And suddenly my interviews got longer and interviewees became more impassioned as they narrated past events that were rife with a sense of personal injustice. It seemed that I had fallen into narrative interviewing without even trying.
Methodological concerns and practical applications
To narrative purists, this retrospective adoption of the methodology would be a travesty; stories should be gathered intentionally. Yet if I've learned anything from running a research project - especially a research project that takes place in the ever-chaotic environment of people's real lives - it's that you have to always be looking for what works and what doesn't, and adjusting your strategy when things aren't quite going to plan. I may not have planned to collect individual stories through my interviews, yet this was unquestionably the most valuable choice I made over the course of my research.
Once I abandoned the idea that I needed to ask a prescribed set of questions in every interview, interviewees were able to explore the topic that were important to them. I heard harrowing accounts of surgical error and cancer diagnosis, and one of a woman who gave birth to a stillborn baby alone in her bathroom. Had I stuck to my initial topic guide, I may never have been privy to these stories.
Later, I analysed these narratives in light of the details participants chose to include, the way that they described the sequence of events and the wider life context in which the stories took place. I asked myself why they had chosen to tell these particular stories at these points in time and, moreover, why they had chosen to tell these stories to me. What emerged was a complex picture of participants' sense of powerlessness within health service institutional frameworks, offset by their personal moves towards self-empowerment.
Subverting social inequalities through story
As long as I engaged in my initial semi-structured interview strategy, I was determining the direction of the conversation and, in a sense, telling interviewees what I thought should be important to them. Yet as I was researching a community that I do not belong to, this approach was fraught with assumptions. I entered into my early interviews consumed by ideas of inequalities in access to services, my interview questions inadvertently steered the conversation towards the topic of disadvantage in health systems. By giving interviewees the chance to tell the stories that they deemed important, however, many of the power imbalances implicit in the traditional researcher-participant relationship fell away, and I allowed interviewees to challenges my perceptions of the ways in which Roma engage with health services.
While Roma do face certain challenges in the realm of health service accessibility, participants' narratives revealed a much more nuanced view of their lives than the common representations of disadvantage and marginalisation would suggest. With the space to tell their personal stories, participants expressed the give-and-take between health-related anxieties and efforts to secure the highest quality of care. They voiced their experiences of feeling coerced by health professionals and finding that their personal treatment preferences were not taken seriously. And in expressing this sense of indignation, they created a picture of injustice, in which they were not the victims of the system, but rather active players in advocating for improved quality of care.