semi structured interview case study

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How to Conduct and Analyze Semi-Structured Interviews

A semi-structured interview is one of the most effective tools for systematically gathering qualitative and quantitative data. This is a method which allows you to ask predetermined questions, determined, perhaps, by the theoretical framework or theory of change underpinning the project, or by your research hypothesis. It is also one which keeps questions open-ended, to gain a comprehensive view of surrounding information.

Before the semi-structured interview

Selecting an appropriate sample size, or deciding whether to interview the complete treatment group are all important aspects of research design. To do this, you need to consider the characteristics and size of the entire treatment group, and then determine whether a representative sample would be best selected according to some of the attributes, or within sub-groups, or whether taking a randomized sample is best.

Interviewers should be trained, and understand the challenges with asking open ended questions; how to adhere to the research questions and seek specific information, while also not leading respondents to answer a specific way. Remaining engaged while taking notes, and establishing rapport are also important aspects of a good interview technique.

After the semi-structured interview

Once the interviews have been conducted, knowing what to do with this data is key. There are a range of different analytic methods which could be applied to qualitative data, and choosing the right one will depend on the research you are conducting. By definition, qualitative data is categorical, thus, you should already have some idea of the different categories you are working with, and what “strongly agree” or “strongly disagree” might mean in the context of the theory for a given question. Coding and sorting your data to give it meaning is key to a sound analysis. As you designed the questionnaire, you will already have an idea of the value you place on different responses, and what constitutes an improvement in your ordinal data. You will also want to keep track of some of the classification variables which might hold explanatory power in the differences in outcomes, such as gender or age.

Clean the data

You will likely need to spend some time cleaning the data, particularly the ‘open-ended’ questions where the answers may be long, and differ from person to person. If you have had a range of interviewers, you may want to spend some time just reading through all the data to try and gain a consistent view of the picture being painted by the data before beginning with the analysis. Never underestimate the power of ‘eye-balling’ your data. Give it a good read, and long think before commencing with any number-crunching.

Define clear questions

For your more defined questions, it may be simple to represent the findings. Say, for example, you are trying to ascertain the level of resources, and their use across a group of early childhood development centers, some of your questions will ask directly the number of books, toys or games available. This is quantitative information easily shown. You could graph the number of ECD centers which have between 0 – 5 resources, 5 – 10, or more than 10. If you then want to comment on the quality of these resources, you may have your interviewer observe their quality across ranked categories such as ‘new and in excellent condition’; ‘well-used but still with useful life’; illegible, parts missing, very old’. This might be done in conversation with the interviewee, the ECD center worker to ascertain their understanding of the importance of quality and engaging resources. From this data you can easily determine the overall resource need by determining how many of the centers require resources supplementation, but you may wish to apply a deeper analysis to how these resources are perceived by ECD workers. Then there may be questions on use; the frequency and level of engagement. Where frequency may be easy to map (once again you could categorize frequencies and group centers accordingly), you may want to conduct some type of thematic or narrative analysis on the comments regarding how well the children engage with the resources. There will be layers of information. A thematic analysis will allow you to begin to gather themes across a range of comments. You might find themes around reasons why the young children are not engaging adequately such as feeling hungry or tired, or themes around how the significance of engagement is perceived by the ECD practitioners. There are softwares for conducting rigorous thematic analysis through word identification (narrative analysis), or in a small enough sample, you can identify the frequency of themes yourself.

Methods Map

Sage Publishers have a really useful guide, the ‘ Methods Map’ , for defining and mapping various research methods, which begins to guide you in the most appropriate one for your purpose. The map surrounding qualitative data analysis includes a range of analytic methods. From this resource, you can delve into the broader academic literature to understand how various methods may be implemented. Even when using deductive approaches, such as action research where you are not testing a theory, but rather gathering information to form one; approaches where your questions will be more open-ended, and adhere less to a stricture, you will want to systematically analyze the data from these interviews to develop a strong base of information.

If you have a good idea of the overall implementation and research questions you hope to answer as you design the interview, it will then be much easier to understand what to do with your data.  This is why framing your impact and researching methodologies for reaching this impact is such critical groundwork. Researching what ‘good’ looks like in the space that you’re working will assist you in developing appropriate categories for data collection, which are context relevant, and empirically proven. For example, if an empirical study finds that exercise 3 times a week improved well-being, and that frequency of exercise means certain things about mental wellness, and you’re running a program in community wellness, design your categories accordingly.

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• What is a semi-structured interview?

Last updated

5 February 2023

Reviewed by

Cathy Heath

When designed correctly, user interviews go much deeper than surface-level survey responses. They can provide new information about how people interact with your products and services, and shed light on the underlying reasons behind these habits.

Semi-structured user interviews are widely considered one of the most effective tools for doing this kind of qualitative research , depending on your specific goals. As the name suggests, the semi-structured format allows for a more natural, conversational flow, while still being organized enough to collect plenty of actionable data .

Analyze semi-structured interviews

Bring all your semi-structured interviews into one place to analyze and understand

A semi-structured interview is a qualitative research method used to gain an in-depth understanding of the respondent's feelings and beliefs on specific topics. As the interviewer prepares the questions ahead of time, they can adjust the order, skip any that are redundant, or create new ones. Additionally, the interviewer should be prepared to ask follow-up questions and probe for more detail.

Semi-structured interviews typically last between 30 and 60 minutes and are usually conducted either in person or via a video call. Ideally, the interviewer can observe the participant's verbal and non-verbal cues in real-time, allowing them to adjust their approach accordingly. The interviewer aims for a conversational flow that helps the participant talk openly while still focusing on the primary topics being researched.

Once the interview is over, the researcher analyzes the data in detail to draw meaningful results. This involves sorting the data into categories and looking for patterns and trends. This semi-structured interview approach provides an ideal framework for obtaining open-ended data and insights.

• When to use a semi-structured interview?

Semi-structured interviews are considered the "best of both worlds" as they tap into the strengths of structured and unstructured methods. Researchers can gather reliable data while also getting unexpected insights from in-depth user feedback.

Semi-structured interviews can be useful during any stage of the UX product-development process, including exploratory research to better understand a new market or service. Further down the line, this approach is ideal for refining existing designs and discovering areas for improvement. Semi-structured interviews can even be the first step when planning future research projects using another method of data collection.

• Advantages of semi-structured interviews

Flexibility

This style of interview is meant to be adapted according to the answers and reactions of the respondent, which gives a lot of flexibility. Semi-structured interviews encourage two-way communication, allowing themes and ideas to emerge organically.

Respondent comfort

The semi-structured format feels more natural and casual for participants than a formal interview. This can help to build rapport and more meaningful dialogue.

Semi-structured interviews are excellent for user experience research because they provide rich, qualitative data about how people really experience your products and services.

Open-ended questions allow the respondent to provide nuanced answers, with the potential for more valuable insights than other forms of data collection, like structured interviews , surveys , or questionnaires.

• Disadvantages of semi-structured interviews

Can be unpredictable

Less structure brings less control, especially if the respondent goes off tangent or doesn't provide useful information. If the conversation derails, it can take a lot of effort to bring the focus back to the relevant topics.

Lack of standardization

Every semi-structured interview is unique, including potentially different questions, so the responses collected are very subjective. This can make it difficult to draw meaningful conclusions from the data unless your team invests the time in a comprehensive analysis.

Compared to other research methods, unstructured interviews are not as consistent or "ready to use."

• Best practices when preparing for a semi-structured interview

While semi-structured interviews provide a lot of flexibility, they still require thoughtful planning. Maximizing the potential of this research method will depend on having clear goals that help you narrow the focus of the interviews and keep each session on track.

After taking the time to specify these parameters, create an interview guide to serve as a framework for each conversation. This involves crafting a range of questions that can explore the necessary themes and steer the conversation in the right direction. Everything in your interview guide is optional (that's the beauty of being "semi" structured), but it's still an essential tool to help the conversation flow and collect useful data.

Best practices to consider while designing your interview questions include:

Prioritize open-ended questions

Promote a more interactive, meaningful dialogue by avoiding questions that can be answered with a simple yes or no, otherwise known as close-ended questions.

Stick with "what," "when," "who," "where," "why," and "how" questions, which allow the participant to go beyond the superficial to express their ideas and opinions. This approach also helps avoid jargon and needless complexity in your questions.

Open-ended questions help the interviewer uncover richer, qualitative details, which they can build on to get even more valuable insights.

Plan some follow-up questions

When preparing questions for the interview guide, consider the responses you're likely to get and pair them up with some effective, relevant follow-up questions. Factual questions should be followed by ones that ask an opinion.

Planning potential follow-up questions will help you to get the most out of a semi-structured interview. They allow you to delve deeper into the participant's responses or hone in on the most important themes of your research focus.

Follow-up questions are also invaluable when the interviewer feels stuck and needs a meaningful prompt to continue the conversation.

Avoid leading questions

Leading questions are framed toward a predetermined answer. This makes them likely to result in data that is biased, inaccurate, or otherwise unreliable.

For example, asking "Why do you think our services are a good solution?" or "How satisfied have you been with our services?" will leave the interviewee feeling pressured to agree with some baseline assumptions.

Interviewers must take the time to evaluate their questions and make a conscious effort to remove any potential bias that could get in the way of authentic feedback.

Asking neutral questions is key to encouraging honest responses in a semi-structured interview. For example, "What do you consider to be the advantages of using our services?" or simply "What has been your experience with using our services?"

Neutral questions are effective in capturing a broader range of opinions than closed questions, which is ultimately one of the biggest benefits of using semi-structured interviews for research.

Use the critical incident method

The critical incident method is an approach to interviewing that focuses on the past behavior of respondents, as opposed to hypothetical scenarios. One of the challenges of all interview research methods is that people are not great at accurately recalling past experiences, or answering future-facing, abstract questions.

The critical incident method helps avoid these limitations by asking participants to recall extreme situations or 'critical incidents' which stand out in their memory as either particularly positive or negative. Extreme situations are more vivid so they can be recalled more accurately, potentially providing more meaningful insights into the interviewee’s experience with your products or services.

• Best practices while conducting semi-structured interviews

Encouraging interaction is the key to collecting more specific data than is typically possible during a formal interview. Facilitating an effective semi-structured interview is a balancing act between asking prepared questions and creating the space for organic conversation. Here are some guidelines for striking the right tone.

Beginning the interview

Make participants feel comfortable by introducing yourself and your role at the organization and displaying appropriate body language.

Outline the purpose of the interview to give them an idea of what to expect. For example, explain that you want to learn more about how people use your product or service.

It's also important to thank them for their time in advance and emphasize there are no right or wrong answers.

Practice active listening

Build trust and rapport throughout the interview with active listening techniques, focusing on being present and demonstrating that you're paying attention by responding thoughtfully. Engage with the participant by making eye contact, nodding, and giving verbal cues like "Okay, I see," "I understand," and "M-hm."

Avoid the temptation to rush to fill any silences while they're in the middle of responding, even if it feels awkward. Give them time to finish their train of thought before interrupting with feedback or another prompt. Embracing these silences is essential for active listening because it's a sign of a productive interview with meaningful, candid responses.

Practicing these techniques will ensure the respondent feels heard and respected, which is critical for gathering high-quality information.

Ask clarifying questions in real time

In a semi-structured interview, the researcher should always be on the lookout for opportunities to probe into the participant's thoughts and opinions.

Along with preparing follow-up questions, get in the habit of asking clarifying questions whenever possible. Clarifying questions are especially important for user interviews because people often provide vague responses when discussing how they interact with products and services.

Being asked to go deeper will encourage them to give more detail and show them you’re taking their opinions seriously and are genuinely interested in understanding their experiences.

Some clarifying questions that can be asked in real-time include:

"That's interesting. Could you give me some examples of X?"

"What do you mean when you say "X"?"

"Why is that?"

"It sounds like you're saying [rephrase their response], is that correct?"

Minimize note-taking

In a wide-ranging conversation, it's easy to miss out on potentially valuable insights by not staying focused on the user. This is why semi-structured interviews are generally recorded (audio or video), and it's common to have a second researcher present to take notes.

The person conducting the interview should avoid taking notes because it's a distraction from:

Keeping track of the conversation

Engaging with the user

Asking thought-provoking questions

Watching you take notes can also have the unintended effect of making the participant feel pressured to give shallower, shorter responses—the opposite of what you want.

Concluding the interview

Semi-structured interviews don't come with a set number of questions, so it can be tricky to bring them to an end. Give the participant a sense of closure by asking whether they have anything to add before wrapping up, or if they want to ask you any questions, and then give sincere thanks for providing honest feedback.

Don't stop abruptly once all the relevant topics have been discussed or you're nearing the end of the time that was set aside. Make them feel appreciated!

• Analyzing the data from semi-structured interviews

In some ways, the real work of semi-structured interviews begins after all the conversations are over, and it's time to analyze the data you've collected. This process will focus on sorting and coding each interview to identify patterns, often using a mix of qualitative and quantitative methods.

Some of the strategies for making sense of semi-structured interviews include:

Thematic analysis : focuses on the content of the interviews and identifying common themes

Discourse analysis : looks at how people express feelings about themes such as those involving politics, culture, and power

Qualitative data mapping: a visual way to map out the correlations between different elements of the data

Narrative analysis : uses stories and language to unlock perspectives on an issue

Grounded theory : can be applied when there is no existing theory that could explain a new phenomenon

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Semi-structured Interviews

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• First Online: 01 January 2020
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Open-ended interview ; Qualitative interview ; Systematic exploratory interview ; Thematic interview

The semi-structured interview is an exploratory interview used most often in the social sciences for qualitative research purposes or to gather clinical data. While it generally follows a guide or protocol that is devised prior to the interview and is focused on a core topic to provide a general structure, the semi-structured interview also allows for discovery, with space to follow topical trajectories as the conversation unfolds.

Introduction

Qualitative interviews exist on a continuum, ranging from free-ranging, exploratory discussions to highly structured interviews. On one end is unstructured interviewing, deployed by approaches such as ethnography, grounded theory, and phenomenology. This style of interview involves a changing protocol that evolves based on participants’ responses and will differ from one participant to the next. On the other end of the continuum...

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Magaldi, D., Berler, M. (2020). Semi-structured Interviews. In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3_857

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• Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

• P. Gill 1 &
• J. Baillie 2  

British Dental Journal volume  225 ,  pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

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Interviews in the social sciences

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Development of Qualitative Semi-Structured Interview Guide for Case Study Research

• Nuzhat Naz, Fozia Gulab, Mahnaz Aslam

Interviewing is an effective strategy to acquire data for qualitative research that uses case studies as a research methodology.  It helps to explain, understand, and explore research subjects' opinions, behavior, and experiences to narrow down the area of research that researcher is interested to discover while listening to them being involved through dialogue. Therefore, structured or semi-structured interviews become effective tools of knowing the experiences and perceptions of research subjects relating to central themes of area of investigation. The aim of this research is to share with researchers the systematic process to be followed in developing semi-structured interview guides. Literature review suggests five distinct phases that the researcher needs to be mindful of when developing a qualitative semi-structured interview guide; they must identify if the prerequisites for conducting a semi-structured interview are met, utilize previously acquired knowledge, formulate a preliminary guide, pilot test it, and then present the completed semi-structured interview guide. Salient features of each phase are explained through literary support followed by researcher’s experience of working on each phase to proceed in developing the interview guide.  A well-developed semi- structured interview guide becomes an authentic and valid source of data collection whereas weakly developed semi-structured interview guide distorts the findings of research resulting in unreliable, inaccurate and invalid data collected.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License .

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6 Semi-structured interviewing

• Published: June 2005
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This chapter presents a guide to conducting effective semi-structured interviews. It discusses the nature of semi-structured interviews and why they should be used, as well as preparation, the logistics of conducting the interview, and reflexivity.

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QUALITATIVE METHODS

10 Semi-structured Interview

Clément Pin

A widely used qualitative research technique, the semi-structured interview consists of a verbal interaction solicited by the interviewer from a respondent, based on a grid of questions used in a very flexible manner. The interview aims both to collect information and to give an account of the person’s experience and view of the world, from a comprehensive perspective. It is useful for various types of public policy evaluations, including clarifying the objectives of a policy, analysing its implementation or studying its reception.

Keywords: Qualitative methods, semi-structured interview, induction, empathy, case study, ideal-type, realist evaluation

I. What does this method consist of?

The semi-structured interview is a data collection technique widely used in qualitative research in the social sciences. In very general terms, it is radically different from a questionnaire survey, which aims to produce standardised data on a vast population in order to search for regularities in the variation of opinions or attitudes between groups of individuals by statistical processing. The practice of interviewing, whatever its specific form, is used to produce data that allow us to better understand the singularity of the experience that individuals or groups of individuals have of their relations with others, with institutions, or more broadly of social phenomena. While the qualitative and in-depth study of a singular case may in itself give rise to knowledge with a certain degree of generalisation, this knowledge is usually derived from data processing using several case studies and ideal-types, as well as from cross-checking with data collected by means of the other two classic qualitative techniques, namely observation and the analysis of written sources. Qualitative techniques can also be used in mixed method research.

The practice of interviewing emerged in the nineteenth century in the field of clinical psychology and social enquiry for medical and political purposes respectively. It developed as a research technique in its own right during the 20th century in the United States and then in Europe in a comprehensive sociological approach in the wake of the work of Max Weber. The function of the interview is to gather the words of individuals, the general theoretical postulate being that social phenomena cannot be understood and therefore explained independently of the meaning that individuals give to their actions. On this common basis, several scientific interview practices have been progressively formalised, the main ones being the ethnographic interview, the non-directive interview and the semi-structured interview. However, it is the latter that has become the most widely used technique in policy analysis in recent decades, particularly in France (Pinson, Sala Pala, 2017). In this context, it is often used, if not as an exclusive mode of data collection, at least as a privileged one, on the grounds that it allows for the production of data with intrinsic value (and not only by cross-checking with observations or documentation).

Like other forms of social science interviewing, the semi-structured interview is a verbal interaction solicited by the interviewer from a respondent. However, in the case of the semi-structured interview, the interaction situation is special in that the respondent is initially placed in the role of informant, the holder of valuable (common, non-scientific) knowledge on the topic of interest to the interviewer.

Epistemologically, the semi-structured interview is part of a scientific mode of reasoning in which the fieldwork is not simply meant to verify pre-existing theories developed in the abstract, but rather the basis for developing the research question and hypotheses: the theory is produced by induction from the field data, according to the principle of grounded theory popularised by Anselm Strauss.

What is meant by a ‘semi-structured’ interview? Although the interviewer should prepare an organised grid of questions to guide the interview, the use of this grid is not rigid. The challenge is for the respondent to provide as much information as possible, both objective (on the phenomena, institutions or processes studied) and subjective (on his/her representations, value system, beliefs). It is therefore necessary to interact with the interviewee in such a way that he or she actively assumes the role of informant, in a conversational manner rather than a questionnaire administered “from above”. The quality of a semi-structured interview thus depends to a large extent on the interviewer’s attitude of empathy and attentive listening, which will enable him/her to make the most appropriate use of his/her grid of questions in the situation (Kaufmann, 2016).

The application of these methodological principles will never have the effect of cutting short the debates specific to the field of qualitative research and the different forms of interviewing, whether these debates concern the validity of the data collected (their degree of objectivity/subjectivity, their veracity/factuality, their partiality, etc.), or between scientific paradigms (constructivism/critical realism), so that there is no good use of semi-structured interviewing that is not reflected upon, methodically elaborated, and explained.

II. How is this method useful for policy evaluation?

Semi-structured interviews can be used to address three main types of evaluation questions. First, it can help to make the often complex set of initial objectives of a public policy understandable. Secondly, semi-structured interviews can be used in an evaluation process that aims to trace the processes of policy implementation, to understand how its objectives are concretely translated into the interventions and practices of administrative agents. Finally, although less recognised for this purpose in the French context, the semi-structured interview survey can contribute to producing evaluations by documenting the reception of a policy by its beneficiaries and, more broadly, by the individuals it targets. If these three uses can be combined in the same evaluative research, we will specify their respective contributions in turn.

From the perspective of clarifying the objectives of a policy, the semi-structured interview appears to be one of the rare means of empirically approaching the work of the government and, more precisely, the decision-making processes involved in putting public problems on the agenda and defining policies to deal with them. Because of their highly political nature, governmental spheres remain difficult to access for observation. Written sources, because of their official and consensual character, remain poor in terms of information for capturing debates and controversies between policymakers driven by ideologies, institutional logics and particular interests. The semi-structured interview is therefore used as a technique for retrospectively accessing first-hand information that is indispensable for deciphering the issues that presided over the formation of compromises and trade-offs that are only very implicitly expressed in the official formulation of policy objectives.

In an evaluation approach centred on the study of the means effectively deployed (outputs) in application of a policy, the use of the semi-structured interview appears at first sight to be less central. On the one hand, since the necessary data are by definition of a pronounced administrative and technical nature, they are often available in written form. Moreover, as the agents’ practices are considered more ordinary, they lend themselves more to observation, which can be a useful technique at this stage, in order to grasp the practices of adapting the rule to the diversity of situations and publics concerned (see separate chapter on direct observation ). However, the semi-structured interview can be used as a complement to cross-check the explanatory hypotheses concerning the agents’ practices with the accounts they give of their work situations and the expert representations they develop about the publics they interact with.

The use of semi-structured interviews in the study of the effects (outcomes) of a policy is conceivable if we do not reduce this study to the only (quantitative) measurement of impacts but seek to understand (qualitatively) the process of producing these effects. This type of analysis, formalised in the 1990s by the pioneers of qualitative evaluation such as Michael Patton, emphasises that the same policy can have different meanings depending on the populations concerned, and that this diversity produces significant variation in its effects. The concept of reception (Revillard, 2019) helps to analyse the interactions between the logics of appropriation (cognitive and practical) and the effects (symbolic and material) of a policy. The empirical study of reception involves conducting semi-structured interviews, the particularity of which is to give primacy to the comprehension dimension rather than the information dimension, the examination focusing primarily on the subjectivity of the recipients. Another, less subjectivist, practice of semi-structured interviews is also developed in the realist evaluation. We present it in the next section.

III. An example of the use of this method in the evaluation of educational policies

Theorised by the sociologist Ray Pawson, realist evaluation is now well recognised in international scientific literature and is used by many governmental organisations (see separate chapter on realist evaluation ). Its main characteristic is to replace the ordinary question “does this policy work? (in the sense of does it produce the intended effects?) with a more detailed questioning of “what effects does it produce? for whom? in what contexts? under what conditions? The (critical) realism of this approach lies in the postulate that measuring the impact of a policy is insufficient to grasp its effects, and that these are so different depending on the target audience and the context that it is essential, in order to evaluate it, to understand the variety of processes that it activates. Evaluating a policy is therefore a matter of formulating and empirically examining hypotheses about the way in which contexts, mechanisms and outcomes interact (the ”contexts-mechanisms-outcomes“ analysis scheme – CMO).

The work of formulating and examining hypotheses is based centrally on the conduct of semi-structured interviews designed according to a logic described as a teacher-learner function (Pawson, 1996), halfway between the structured and unstructured interview. The informational dimension of the interview is dominant, with the exchange with the interviewee focusing less on his or her experiences and representations than on a reflection on research hypotheses (theory-driven). This interview practice cannot, however, be described as directive insofar as, depending on the phase of the survey, the interviewer and the respondent will alternately play the roles of teacher and learner. In order to help anticipate and control this role switching, Ana Manzano (2016) distinguishes three phases in interview uses. The first set of interviews performs a theory gleaning function, i.e. it identifies provisional hypotheses from the actors about the effects of contextual circumstances on the functioning of the programme studied. In a second phase, certain theories are discarded and the selected theories are examined in greater detail by means of less standardised interviews in order to question the interviewees in a variety of ways with a view to refining the theory (theory refining). In the third phase of theory consolidation, the evaluator acts as a teacher by presenting his or her contextualised understanding of the programme to the respondent, to which the respondent can react by using examples in a logic of verification or falsification.

A recent example of an evaluation conducted in the field of educational policy illustrates this practice of semi-structured interviews particularly well. In order to evaluate the Colombian policy aimed at reducing regional inequalities in educational success by extending the length of the school day universally (Jordana Unica programme), Juan David Parra (2022) carried out a qualitative study consisting of 31 interviews (11 with officials from central and deconcentrated state services, 20 with school headmasters and educators), 20 focus groups (10 with parents, 10 with students) and 40 hours of non-participatory observations in schools. He also administered a questionnaire to a representative sample of school headmasters (N = 681). This survey enabled him to formulate, refine and then consolidate hypotheses on the implementation, reception and effects of this policy by emphasising the importance of reasoning at three levels: the decentralisation of educational policies, the well-being of children and adolescents, and the motivation of pupils.

IV. What are the criteria for judging the quality of the mobilisation of this method?

A first element conditioning the quality of a study based on semi-structured interviews concerns the number and choice of interviewees. As the representativeness of the sample is not a criterion of validity, the principle is rather to carry out a sufficient number of interviews (generally estimated at between 20 and 30) to gather the testimony of people who, from a formal or informal point of view, occupy different positions and are in different situations with regard to the object studied, so that they may have different points of view, in other words, varied experiences, practices and representations about it.

A second quality criterion is the way the interviews are conducted. The semi-structured interview must alternate between moments intended to collect narratives or stories freely produced by the respondent (generally at least at the beginning of the interview) and moments of greater directivity aimed at collecting information previously targeted by the interviewer. This art of interviewing is prepared beforehand by drawing up an interview guide, which evolves over the course of the research and can be adjusted according to the interviewees. This guide not only includes the formulation of initial instructions and general themes for discussion, but also establishes a series of follow-up questions that make it possible to obtain the information sought. Conducting interviews also depends on the posture the interviewer and respondent adopt in the situation and the follow-up techniques used by the interviewer.

A third set of issues lies in the processing of the data collected by the interviews. This decisive stage aims to analyse the content of the interviews in a cross-referenced and comparative manner so as not only to synthesise and cross-check the information collected, but also to produce an interpretation that is both global and detailed of the object studied, with reference to the theoretical framework and the research hypotheses initially formulated. This phase of the work requires the data collected in each interview to be relatively decontextualised by analysing their content in terms of the categories of analysis relating to the functioning of the action system and/or the processes studied and the experience of the various actors concerned.

V. What are the strengths and limitations of this method compared to others?

The main advantage of semi-structured interviews is that they provide essential data for understanding the processes by which a public policy produces its effects, from the genesis of the multiplicity of its objectives and its content (means devoted, instruments developed), to the actual methods of implementation and the various ways in which it is received. These data relate to the practices and representations of all the actors involved or more widely concerned (a priori) by the same policy. Depending on the research stages and the types of respondents solicited (decision-makers, implementers, beneficiaries, recipients), the use of the semi-structured interview can be modulated to activate its informative or comprehensive dimension first.

Its main limitations are twofold. Firstly, in the context of a strictly qualitative evaluation, it is required that the administration of proof operates by crossing the use of interviews with other data collection techniques, namely observation and the analysis of written sources. Secondly, as a qualitative method, it is clear that the use of the semi-structured interview does not in itself allow for the production of quantitative evaluations, evaluations which are otherwise very useful in providing contextual data for the design of the questioning of a qualitative evaluation.

Finally, it should be noted that in the current context of quantitative impact evaluation development, semi-structured interviews can find their place in the framework of research adopting a mixed methodology (Pin, Barone, 2021). Semi-structured interviews can thus contribute to the design (upstream) and interpretation (downstream) of a randomised experiment. In this case, as in others, the use of the interview will be modulated according to the research stages. The semi-structured interview technique will initially be used in a “qualitative instrumentalized” way to help identify the various contextual conditions of implementation of a programme whose impact we are trying to measure and thus refine its implementation methods. The semi-structured interview can then be used in an ’empowered qualitative’ logic to construct ideal-types that provide a posteriori explanatory elements of a qualitative nature to understand the causal processes that led to the measured impacts.

Some bibliographical references to go further

Kaufmann, Jean-Claude. 2016. L’entretien compréhensif . Armand Colin.

Manzano, Ana. 2016. “The craft of interviewing in realist evaluation”. Evaluation , n°22: 342-360.

Parra, Juan David. 2022. “Decentralisation and school-based management in Colombia: An exploration (using systems thinking) of the Full‐Day Schooling programme”. International Journal of Educational Development , n°91: 102579.

Pawson, Ray. 1996. “Theorizing the interview”.  British Journal of Sociology , n°47: 295-314.

Pin, Clément. and Barone, Carlo. 2021. “L’apport des méthodes mixtes à l’évaluation”. Revue française de science politique , n°71: 391-412.

Pinson, Gilles. and Sala Pala, Valérie. 2007. “Peut-on vraiment se passer de l’entretien en sociologie de l’action publique?”. Revue française de science politique , n°57: 555-597.

Revillard, Anne. 2018. “Saisir les conséquences d’une politique à partir de ses ressortissants: la réception de l’action publique”. Revue française de science politique , n°68: 469-492.

Policy Evaluation: Methods and Approaches Copyright © by Clément Pin is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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• Semistructured interviewing in primary care research: a balance of relationship and rigour
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• http://orcid.org/0000-0002-2660-3358 Melissa DeJonckheere 1 and
• Lisa M Vaughn 2 , 3
• 1 Department of Family Medicine , University of Michigan , Ann Arbor , Michigan , USA
• 2 Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
• 3 Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
• Correspondence to Dr Melissa DeJonckheere; mdejonck{at}med.umich.edu

Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.

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Introduction

Semistructured interviews can be used by family medicine researchers in clinical settings or academic settings even with few resources. In contrast to large-scale epidemiological studies, or even surveys, a family medicine researcher can conduct a highly meaningful project with interviews with as few as 8–12 participants. For example, Chang and her colleagues, all family physicians, conducted semistructured interviews with 10 providers to understand their perspectives on weight gain in pregnant patients. 1 The interviewers asked questions about providers’ overall perceptions on weight gain, their clinical approach to weight gain during pregnancy and challenges when managing weight gain among pregnant patients. Additional examples conducted by or with family physicians or in primary care settings are summarised in table 1 . 1–6

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Examples of research articles using semistructured interviews in primary care research

From our perspective as seasoned qualitative researchers, conducting effective semistructured interviews requires: (1) a relational focus, including active engagement and curiosity, and (2) practice in the skills of interviewing. First, a relational focus emphasises the unique relationship between interviewer and interviewee. To obtain quality data, interviews should not be conducted with a transactional question-answer approach but rather should be unfolding, iterative interactions between the interviewer and interviewee. Second, interview skills can be learnt. Some of us will naturally be more comfortable and skilful at conducting interviews but all aspects of interviews are learnable and through practice and feedback will improve. Throughout this article, we highlight strategies to balance relationship and rigour when conducting semistructured interviews in primary care and the healthcare setting.

Qualitative research interviews are ‘attempts to understand the world from the subjects’ point of view, to unfold the meaning of peoples’ experiences, to uncover their lived world prior to scientific explanations’ (p 1). 7 Qualitative research interviews unfold as an interviewer asks questions of the interviewee in order to gather subjective information about a particular topic or experience. Though the definitions and purposes of qualitative research interviews vary slightly in the literature, there is common emphasis on the experiences of interviewees and the ways in which the interviewee perceives the world (see table 2 for summary of definitions from seminal texts).

Definitions of qualitative interviews

The most common type of interview used in qualitative research and the healthcare context is semistructured interview. 8 Figure 1 highlights the key features of this data collection method, which is guided by a list of topics or questions with follow-up questions, probes and comments. Typically, the sequencing and wording of the questions are modified by the interviewer to best fit the interviewee and interview context. Semistructured interviews can be conducted in multiple ways (ie, face to face, telephone, text/email, individual, group, brief, in-depth), each of which have advantages and disadvantages. We will focus on the most common form of semistructured interviews within qualitative research—individual, face-to-face, in-depth interviews.

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Key characteristics of semistructured interviews.

Purpose of semistructured interviews

The overall purpose of using semistructured interviews for data collection is to gather information from key informants who have personal experiences, attitudes, perceptions and beliefs related to the topic of interest. Researchers can use semistructured interviews to collect new, exploratory data related to a research topic, triangulate other data sources or validate findings through member checking (respondent feedback about research results). 9 If using a mixed methods approach, semistructured interviews can also be used in a qualitative phase to explore new concepts to generate hypotheses or explain results from a quantitative phase that tests hypotheses. Semistructured interviews are an effective method for data collection when the researcher wants: (1) to collect qualitative, open-ended data; (2) to explore participant thoughts, feelings and beliefs about a particular topic; and (3) to delve deeply into personal and sometimes sensitive issues.

Designing and conducting semistructured interviews

In the following section, we provide recommendations for the steps required to carefully design and conduct semistructured interviews with emphasis on applications in family medicine and primary care research (see table 3 ).

Steps to designing and conducting semistructured interviews

Steps for designing and conducting semistructured interviews

Step 1: determining the purpose and scope of the study.

The purpose of the study is the primary objective of your project and may be based on an anecdotal experience, a review of the literature or previous research finding. The purpose is developed in response to an identified gap or problem that needs to be addressed.

Research questions are the driving force of a study because they are associated with every other aspect of the design. They should be succinct and clearly indicate that you are using a qualitative approach. Qualitative research questions typically start with ‘What’, ‘How’ or ‘Why’ and focus on the exploration of a single concept based on participant perspectives. 10

Step 2: identifying participants

After deciding on the purpose of the study and research question(s), the next step is to determine who will provide the best information to answer the research question. Good interviewees are those who are available, willing to be interviewed and have lived experiences and knowledge about the topic of interest. 11 12 Working with gatekeepers or informants to get access to potential participants can be extremely helpful as they are trusted sources that control access to the target sample.

Sampling strategies are influenced by the research question and the purpose of the study. Unlike quantitative studies, statistical representativeness is not the goal of qualitative research. There is no calculation of statistical power and the goal is not a large sample size. Instead, qualitative approaches seek an in-depth and detailed understanding and typically use purposeful sampling. See the study of Hatch for a summary of various types of purposeful sampling that can be used for interview studies. 12

‘How many participants are needed?’ The most common answer is, ‘it depends’—it depends on the purpose of the study, what kind of study is planned and what questions the study is trying to answer. 12–14 One common standard in qualitative sample sizes is reaching thematic saturation, which refers to the point at which no new thematic information is gathered from participants. Malterud and colleagues discuss the concept of information power , or a qualitative equivalent to statistical power, to determine how many interviews should be collected in a study. They suggest that the size of a sample should depend on the aim, homogeneity of the sample, theory, interview quality and analytic strategy. 14

Step 3: considering ethical issues

An ethical attitude should be present from the very beginning of the research project even before you decide who to interview. 15 This ethical attitude should incorporate respect, sensitivity and tact towards participants throughout the research process. Because semistructured interviewing often requires the participant to reveal sensitive and personal information directly to the interviewer, it is important to consider the power imbalance between the researcher and the participant. In healthcare settings, the interviewer or researcher may be a part of the patient’s healthcare team or have contact with the healthcare team. The researchers should ensure the interviewee that their participation and answers will not influence the care they receive or their relationship with their providers. Other issues to consider include: reducing the risk of harm; protecting the interviewee’s information; adequately informing interviewees about the study purpose and format; and reducing the risk of exploitation. 10

Step 4: planning logistical aspects

Careful planning particularly around the technical aspects of interviews can be the difference between a great interview and a not so great interview. During the preparation phase, the researcher will need to plan and make decisions about the best ways to contact potential interviewees, obtain informed consent, arrange interview times and locations convenient for both participant and researcher, and test recording equipment. Although many experienced researchers have found themselves conducting interviews in less than ideal locations, the interview location should avoid (or at least minimise) interruptions and be appropriate for the interview (quiet, private and able to get a clear recording). 16 For some research projects, the participants’ homes may make sense as the best interview location. 16

Initial contacts can be made through telephone or email and followed up with more details so the individual can make an informed decision about whether they wish to be interviewed. Potential participants should know what to expect in terms of length of time, purpose of the study, why they have been selected and who will be there. In addition, participants should be informed that they can refuse to answer questions or can withdraw from the study at any time, including during the interview itself.

Audio recording the interview is recommended so that the interviewer can concentrate on the interview and build rapport rather than being distracted with extensive note taking 16 (see table 4 for audio-recording tips). Participants should be informed that audio recording is used for data collection and that they can refuse to be audio recorded should they prefer.

Suggestions for successful audio recording of interviews

Most researchers will want to have interviews transcribed verbatim from the audio recording. This allows you to refer to the exact words of participants during the analysis. Although it is possible to conduct analyses from the audio recordings themselves or from notes, it is not ideal. However, transcription can be extremely time consuming and, if not done yourself, can be costly.

In the planning phase of research, you will want to consider whether qualitative research software (eg, NVivo, ATLAS.ti, MAXQDA, Dedoose, and so on) will be used to assist with organising, managing and analysis. While these tools are helpful in the management of qualitative data, it is important to consider your research budget, the cost of the software and the learning curve associated with using a new system.

Step 5: developing the interview guide

Semistructured interviews include a short list of ‘guiding’ questions that are supplemented by follow-up and probing questions that are dependent on the interviewee’s responses. 8 17 All questions should be open ended, neutral, clear and avoid leading language. In addition, questions should use familiar language and avoid jargon.

Most interviews will start with an easy, context-setting question before moving to more difficult or in-depth questions. 17 Table 5 gives details of the types of guiding questions including ‘grand tour’ questions, 18 core questions and planned and unplanned follow-up questions.

Questions and prompts in semistructured interviewing

To illustrate, online supplementary appendix A presents a sample interview guide from our study of weight gain during pregnancy among young women. We start with the prompt, ‘Tell me about how your pregnancy has been so far’ to initiate conversation about their thoughts and feelings during pregnancy. The subsequent questions will elicit responses to help answer our research question about young women’s perspectives related to weight gain during pregnancy.

Supplemental material

After developing the guiding questions, it is important to pilot test the interview. Having a good sense of the guide helps you to pace the interview (and not run out of time), use a conversational tone and make necessary adjustments to the questions.

Like all qualitative research, interviewing is iterative in nature—data collection and analysis occur simultaneously, which may result in changes to the guiding questions as the study progresses. Questions that are not effective may be replaced with other questions and additional probes can be added to explore new topics that are introduced by participants in previous interviews. 10

Step 6: establishing trust and rapport

Interviews are a special form of relationship, where the interviewer and interviewee converse about important and often personal topics. The interviewer must build rapport quickly by listening attentively and respectfully to the information shared by the interviewee. 19 As the interview progresses, the interviewer must continue to demonstrate respect, encourage the interviewee to share their perspectives and acknowledge the sensitive nature of the conversation. 20

To establish rapport, it is important to be authentic and open to the interviewee’s point of view. It is possible that the participants you recruit for your study will have preconceived notions about research, which may include mistrust. As a result, it is important to describe why you are conducting the research and how their participation is meaningful. In an interview relationship, the interviewee is the expert and should be treated as such—you are relying on the interviewee to enhance your understanding and add to your research. Small behaviours that can enhance rapport include: dressing professionally but not overly formal; avoiding jargon or slang; and using a normal conversational tone. Because interviewees will be discussing their experience, having some awareness of contextual or cultural factors that may influence their perspectives may be helpful as background knowledge.

Step 7: conducting the interview

Location and set-up.

The interview should have already been scheduled at a convenient time and location for the interviewee. The location should be private, ideally with a closed door, rather than a public place. It is helpful if there is a room where you can speak privately without interruption, and where it is quiet enough to hear and audio record the interview. Within the interview space, Josselson 15 suggests an arrangement with a comfortable distance between the interviewer and interviewee with a low table in between for the recorder and any materials (consent forms, questionnaires, water, and so on).

Beginning the interview

Many interviewers start with chatting to break the ice and attempt to establish commonalities, rapport and trust. Most interviews will need to begin with a brief explanation of the research study, consent/assent procedures, rationale for talking to that particular interviewee and description of the interview format and agenda. 11 It can also be helpful if the interviewer shares a little about who they are and why they are interested in the topic. The recording equipment should have already been tested thoroughly but interviewers may want to double-check that the audio equipment is working and remind participants about the reason for recording.

Interviewer stance

During the interview, the interviewer should adopt a friendly and non-judgemental attitude. You will want to maintain a warm and conversational tone, rather than a rote, question-answer approach. It is important to recognise the potential power differential as a researcher. Conveying a sense of being in the interview together and that you as the interviewer are a person just like the interviewee can help ease any discomfort. 15

Active listening

During a face-to-face interview, there is an opportunity to observe social and non-verbal cues of the interviewee. These cues may come in the form of voice, body language, gestures and intonation, and can supplement the interviewee’s verbal response and can give clues to the interviewer about the process of the interview. 21 Listening is the key to successful interviewing. 22 Listening should be ‘attentive, empathic, nonjudgmental, listening in order to invite, and engender talk’ 15 15 (p 66). Silence, nods, smiles and utterances can also encourage further elaboration from the interviewee.

Continuing the interview

As the interview progresses, the interviewer can repeat the words used by the interviewee, use planned and unplanned follow-up questions that invite further clarification, exploration or elaboration. As DiCicco-Bloom and Crabtree 10 explain: ‘Throughout the interview, the goal of the interviewer is to encourage the interviewee to share as much information as possible, unselfconsciously and in his or her own words’ (p 317). Some interviewees are more forthcoming and will offer many details of their experiences without much probing required. Others will require prompting and follow-up to elicit sufficient detail.

As a result, follow-up questions are equally important to the core questions in a semistructured interview. Prompts encourage people to continue talking and they can elicit more details needed to understand the topic. Examples of verbal probes are repeating the participant’s words, summarising the main idea or expressing interest with verbal agreement. 8 11 See table 6 for probing techniques and example probes we have used in our own interviewing.

Probing techniques for semistructured interviews (modified from Bernard 30 )

Step 8: memoing and reflection

After an interview, it is essential for the interviewer to begin to reflect on both the process and the content of the interview. During the actual interview, it can be difficult to take notes or begin reflecting. Even if you think you will remember a particular moment, you likely will not be able to recall each moment with sufficient detail. Therefore, interviewers should always record memos —notes about what you are learning from the data. 23 24 There are different approaches to recording memos: you can reflect on several specific ideas, or create a running list of thoughts. Memos are also useful for improving the quality of subsequent interviews.

Step 9: analysing the data

The data analysis strategy should also be developed during planning stages because analysis occurs concurrently with data collection. 25 The researcher will take notes, modify the data collection procedures and write reflective memos throughout the data collection process. This begins the process of data analysis.

The data analysis strategy used in your study will depend on your research question and qualitative design—see the study of Creswell for an overview of major qualitative approaches. 26 The general process for analysing and interpreting most interviews involves reviewing the data (in the form of transcripts, audio recordings or detailed notes), applying descriptive codes to the data and condensing and categorising codes to look for patterns. 24 27 These patterns can exist within a single interview or across multiple interviews depending on the research question and design. Qualitative computer software programs can be used to help organise and manage interview data.

Step 10: demonstrating the trustworthiness of the research

Similar to validity and reliability, qualitative research can be assessed on trustworthiness. 9 28 There are several criteria used to establish trustworthiness: credibility (whether the findings accurately and fairly represent the data), transferability (whether the findings can be applied to other settings and contexts), confirmability (whether the findings are biased by the researcher) and dependability (whether the findings are consistent and sustainable over time).

Step 11: presenting findings in a paper or report

When presenting the results of interview analysis, researchers will often report themes or narratives that describe the broad range of experiences evidenced in the data. This involves providing an in-depth description of participant perspectives and being sure to include multiple perspectives. 12 In interview research, the participant words are your data. Presenting findings in a report requires the integration of quotes into a more traditional written format.

Conclusions

Though semistructured interviews are often an effective way to collect open-ended data, there are some disadvantages as well. One common problem with interviewing is that not all interviewees make great participants. 12 29 Some individuals are hard to engage in conversation or may be reluctant to share about sensitive or personal topics. Difficulty interviewing some participants can affect experienced and novice interviewers. Some common problems include not doing a good job of probing or asking for follow-up questions, failure to actively listen, not having a well-developed interview guide with open-ended questions and asking questions in an insensitive way. Outside of pitfalls during the actual interview, other problems with semistructured interviewing may be underestimating the resources required to recruit participants, interview, transcribe and analyse the data.

Despite their limitations, semistructured interviews can be a productive way to collect open-ended data from participants. In our research, we have interviewed children and adolescents about their stress experiences and coping behaviours, young women about their thoughts and behaviours during pregnancy, practitioners about the care they provide to patients and countless other key informants about health-related topics. Because the intent is to understand participant experiences, the possible research topics are endless.

Due to the close relationships family physicians have with their patients, the unique settings in which they work, and in their advocacy, semistructured interviews are an attractive approach for family medicine researchers, even if working in a setting with limited research resources. When seeking to balance both the relational focus of interviewing and the necessary rigour of research, we recommend: prioritising listening over talking; using clear language and avoiding jargon; and deeply engaging in the interview process by actively listening, expressing empathy, demonstrating openness to the participant’s worldview and thanking the participant for helping you to understand their experience.

Further Reading

Edwards R, & Holland J. (2013). What is qualitative interviewing?: A&C Black.

Josselson R. Interviewing for qualitative inquiry: A relational approach. Guilford Press, 2013.

Kvale S. InterViews: An Introduction to Qualitative Research Interviewing. SAGE, London, 1996.

Pope C, & Mays N. (Eds). (2006). Qualitative research in health care.

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Contributors Both authors contributed equally to this work.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; internally peer reviewed.

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Original research article, integrating information from semi-structured interviews into management strategy evaluation: a case study for southeast united states marine fisheries.

• 1 Department of Applied Ecology, Center for Marine Sciences and Technology, North Carolina State University, Morehead City, NC, United States
• 2 National Oceanic and Atmospheric Administration (NOAA) Beaufort Laboratory, Southeast Fisheries Science Center, Beaufort, NC, United States
• 3 Duke University Marine Lab, Nicholas School of the Environment, Beaufort, NC, United States

Management strategy evaluation (MSE) has become a more common tool for engaging stakeholders in fisheries management, and stakeholder participation in MSE is increasingly recognized as a vital component of the process. The participation of stakeholders, specifically fishers, in MSE is of particular importance because they often possess intimate knowledge of the socio-ecological management system that MSE seeks to model. When the resources to conduct a “full” MSE with direct fisher involvement are unavailable, MSEs are sometimes conducted by desk-based analysts with no fisher engagement. We propose an intermediate framework in which information collected from semi-structured interviews is used to inform a “desk-based” MSE. We demonstrate that semi-structured interviews with commercial and recreational fishers can elicit some of the same kinds of information that fishers provide during direct participation in MSE. We conducted 30 semi-structured interviews with commercial and recreational fishers from the Southeast United States participating in either Atlantic cobia ( Rachycentron canadum ) or black sea bass ( Centropristis striata ) fisheries. We collected primarily qualitative and some quantitative information about preferred conceptual objectives and management measures, and how their fishing behavior has changed in response to past management action. Commercial fishers generally preferred conceptual objectives and management measures that align with traditional MSY-based fisheries management, while recreational fishers’ responses were substantially more heterogeneous, indicating a more diverse range of desired objectives and preferred management measures. We synthesized this information to develop a suite of management procedures that employ a range of fishing mortality-based constant-catch harvest control rules and size-based management measures for simulation testing against preferred objectives by sector. We demonstrate that integrating information from semi-structured interviews with MSE in this way offers a cost-effective alternative intermediate approach to fisher participation in MSE when direct participation is not possible.

Introduction

Management strategy evaluation (MSE) is an increasingly common tool for engaging stakeholders in fisheries management ( Deith et al., 2021 ). MSE is a closed-loop simulation framework that seeks to model entire management scenarios. MSE typically includes an operating model (OM) to simulate population and fishery dynamics, an estimation model to determine stock status, i.e., an assessment or some simplification of the process, and an implementation model in which a management procedure is applied. Then the effects are projected forward in time ( Punt et al., 2016 ; Ono et al., 2017 ). The primary goal of MSE is to identify management procedures that will achieve objectives in the long-term and are robust to uncertainty ( Butterworth and Punt, 1999 ; Butterworth, 2007 ).

One of the key advantages of MSE is the ability to directly involve stakeholders in the development of management scenarios ( Bunnefeld et al., 2011 ). Stakeholder participation in MSE is widely recognized as a vital component of the process ( Bunnefeld et al., 2011 ; Feeney et al., 2019 ; Goethel et al., 2019 ; Deith et al., 2021 ). The degree of stakeholder participation is dependent on the timetable for completing the MSE and the format. MSEs can be conducted over multiple years as an iterative process in which stakeholders participate as part of a dedicated MSE group. Over several years, the group identifies conceptual objectives and uncertainties in the management system, works with scientists to operationalize those objectives, selects candidate management procedures for simulating testing, and engages in participatory modeling exercises to identify risks and tradeoffs by evaluating management procedures against objectives and over a range of uncertainties ( Punt et al., 2016 ; Feeney et al., 2019 ; Goethel et al., 2019 ). We refer to these as “full MSEs” with “full” stakeholder participation. Examples include the OysterFutures workgroup who met nine times over two years for a Maryland eastern oyster ( Crassostrea virginica ) MSE ( Goethel et al., 2019 ; Goelz et al., 2020 ), and the Management Strategy Advisory Board of the International Pacific Halibut commission who met twice a year during 2013-2020 to participate in MSE for pacific halibut ( Hippoglossus stenolepis ) ( Branch, 2020 ). Full MSEs can also be conducted under truncated timetables in which stakeholder involvement in the MSE can be facilitated through a series of workshops designed to expedite the process, e.g., the Atlantic herring ( Clupea harengus ) MSE, which was conducted in just one year ( Deroba et al., 2019 ). Stakeholder participation is a central aspect of what makes MSE effective ( Dickey-Collas, 2014 ; Goethel et al., 2019 ). The participation of fishers is of particular importance because they often possess intimate knowledge related to uncertainties in the socio-ecological management system that MSE attempts to model, e.g., fishery operations, social and political dynamics, biology, ecology, and fine-scale spatial and seasonal processes ( Neis et al., 1999 ; Crona, 2006 ; Wilson, 2006 ; Murray et al., 2006 ; Paterson, 2010 ).

However, MSE is a time and resource-intensive process, therefore many MSE tools or simulation frameworks for assessing tradeoffs are developed by analysts without fishers’ involvement. These are colloquially referred to as “desk-based” MSEs. Semi-structured interviews are a common tool for eliciting qualitative and quantitative fishers’ knowledge ( Hind, 2015 ), and information obtained from semi-structured interviews has been used to inform, complement, improve, or directly integrate fishers’ knowledge with stock assessment ( Neis, 1992 ; Carruthers and Neis, 2011 ; Tesfamichael et al., 2014 ; Duplisea, 2017 ). This study began with the idea that there could be a ‘middle ground‘ between full and desk-based MSEs in which semi-structured interviews are conducted during a desk-based MSE with stakeholders, specifically fishers, to address knowledge gaps related to conceptual management objectives, candidate management measures, fishing behavior, and other observations related to the management system when resource limitations preclude direct stakeholder participation.

In this paper, we present a case study in which we applied this intermediate MSE approach to two marine fisheries in the Southeast United States: the Southeast black sea bass ( Centropristis striata ) and Atlantic cobia ( Rachycentron canadum ) fisheries. Although commercial fishing remains the dominant source of global removals, regionally, recreational fishing can rival or exceed commercial removals ( Coleman et al., 2004 ; Arlinghaus et al., 2019 ). In the Southeast United States (SE US), recreational fishing is the dominant source of fishing mortality ( Shertzer et al., 2019 ). We chose these two fisheries for our case study to compare interview results and integration with MSE across fisheries with different degrees of recreational use. The overarching goal of the article is to describe how information obtained from semi-structured interviews conducted with commercial and recreational fishers was used to inform a MSE tool designed to evaluate tradeoffs between potentially competing commercial and recreational fishing objectives. We present results from interviews with commercial fishermen and recreational anglers in each fishery and discuss how information obtained from interviews was used to set up management scenarios for future testing of the MSE tool.

Case study background

Currently, both fisheries’ recreational component is made up of private recreational anglers and the for-hire recreational fleet, i.e., private charter vessels and headboats, and there exists at least one commercial fishery ( SEDAR, 2018 ; SEDAR, 2020 ). The management procedure used to set total allowable catch (TAC) for both black sea bass and cobia fisheries is a constant catch harvest control rule (HCR) based on a fishing mortality ( F ) reference point and is regulated using management tools such as minimum size limits, vessel/trip limits, bag limits and seasonal closures ( SEDAR, 2018 ; SEDAR, 2020 ). Southeast black sea bass fisheries are managed using an 11-inch size limit and vessel limits in the commercial sector, and a 13-inch size limit and combination of bag limits and vessel trip limits for the recreational sector, respectively ( SEDAR, 2018 ). The TAC for black sea bass is allocated nearly equally (50-50) between commercial and recreational sectors, but in recent years, commercial fisheries have not attained their allocation, recreational fishing, primarily from private angling, has become the dominant source of mortality and the magnitude of dead discarded fish from the recreational sectors has greatly increased ( Rudershausen et al., 2014 ; SEDAR, 2018 ). The Southeast Atlantic cobia commercial fishery, an incidental bycatch fishery, is managed using a 36-inch size limit and vessel limits, while the recreational fishery is also managed using a 36-inch size limit and bag limit ( SEDAR, 2020 ). As of the 2019 stock assessment, the commercial fleet is allocated less than 10% of the TAC, and the recreational fleets over 90% ( SEDAR, 2020 ). During the past 10 years however, the recreational fleets have landed more than 95% of the cobia TAC ( SEDAR, 2020 ).

Research design

We conducted interviews with commercial and recreational fishers from the Southeast US to learn what they valued about the fishery they participated in, their desired fishery objectives, preference for future management actions, and how past management actions had affected their fishing behavior. Interviews were conducted using a semi-structured interview instrument (Appendix I), meaning that interviewees could introduce other topics, including suggesting alternative goals and management actions not included in the instrument ( Patton, 1990 ; Murray et al., 2010 ; Carruthers and Neis, 2011 ). The goal of the interviews was to obtain information related to the values driving broad-scale conceptual fishery objectives ( Andrews et al., 2021 ), learn fishers’ preferred management measures, and collect information on fisher behavior that could inform the development of the MSE tool. We designed the interview instrument to include questions salient to the history of management in each fishery and described in the case study background.

We conducted a total of 30 interviews between May and August of 2020 in two phases due to a difference in sampling methods. During the first phase, 14 interviews were conducted during May with five commercial fishers who fished for black sea bass in the commercial pot fishery, one commercial fisher who caught cobia in seasonal commercial bycatch fisheries, six recreational fishers for black sea bass, of whom five identified as private anglers and one as a private charter, two recreational fishers for cobia, of whom one identified as a private angler and the other a private charter and headboat captain ( Table 1 ). We selected initial interview participants based on the number of years of participation in each fishery with preference for those who had fished for 10 or more years, and additional participants were identified using snowball sampling by asking interviewees to recommend other commercial fishermen or recreational anglers ( Murray et al., 2006 ). The second phase occurred during June-August, in which an additional 16 interviews were conducted with 16 recreational fishers, all of whom identified as private anglers: ten who fished for black sea bass and six who fished for cobia ( Table 1 ). Participants during the second phase were selected from the National Oceanic and Atmospheric Administration’s (NOAA) Marine Recreational Information Program (MRIP) database using a combination of stratified random sampling (by state within the Southeast US) and systematic random sampling of license holders who had renewed their license for 10 or more years.

Table 1 Interview participation by sector (recreational or commercial) and species (black sea bass or cobia) by phase (1 or 2).

Our study occurred during the height of the COVID-19 pandemic, therefore all participants were contacted and interviewed via telephone. Once contacted, fishers were read a script that described the purpose of the study and how information collected during interviews would be used (Appendix II). For those who declined to participate, we thanked them for their time and ended the call. For those who chose to participate, we assigned them a code referring to the species they fished for, i.e., “BSB” for black sea bass or “COB” for cobia, the sector they fished in, i.e., “CO” for commercial and “RE” for recreational (includes private and for-hire sectors), and their number in the order of interviews conducted. Detailed notes, including participant quotes, were made during each call. We attempted to call from university-owned computers using Cisco Jabber to call from a North Carolina State University (NCSU) number and record calls. However, calls were flagged as spam on cell phones, therefore all calls were made using personal phones and were not recorded. As such, we made transcriptions whenever possible during calls, and kept detailed notes. Interviews ranged from approximately 20 minutes to 1.5 hours. All participants were anonymously referred to in terms of their target species and sector in our results. All data collection and analyses involving human subjects were conducted in compliance with NCSU’s Human Subjects Independent Review Board.

Integration with MSE

We synthesized the information obtained from the semi-structured interviews to be integrated with an MSE tool. The MSE tool consists of an OM connected with an assessment model, and an implementation/projection model. The OM was conditioned to reflect the estimates of population and fishery dynamics from the most recent black sea bass and cobia stock assessments ( SEDAR, 2018 ; SEDAR, 2020 ), and written in R statistical software ( R Core Team, 2022 ). The assessment model is an integrated statistical catch-at-length model developed by Cao et al. (2017) for the Gulf of Maine Northern Shrimp ( Pandalus borealis ) population in AD Model Builder ( Fournier et al., 2012 ); it is a forward-projecting assessment that applies a growth transition matrix to the fish (or shellfish) population dynamics to model the probability of fish transitioning from one length bin to the next ( Chen et al., 2003 ). The implementation/projection model is an extension of the OM that simulates the population forward in time three years, then a stock assessment is conducted to model the real-world assessment process, then implementation/projection model applies reference points estimated from the assessment to the population to simulate the implementation of management procedures, and the process is repeated. This forms the complete MSE simulation loop that models the entire management scenario. We chose a size-structured framework because most marine stocks in the Southeast US are managed using regulations that are size-based and avoids the need for age-length conversion which introduces additional uncertainty into assessment model estimates ( Quinn and Deriso, 1999 ; Cao et al., 2017 ).

We emphasize that the purpose of this study is not to present the MSE model in full or its results, but rather to demonstrate the ways that semi-structured interviews can be integrated with the framework itself. Integration with the framework described above was accomplished by synthesizing the interview results to determine the conceptual objectives of commercial and recreational fishers in black sea bass and cobia fisheries against which management procedures are evaluated and determine the management procedures for simulation testing. We used interview responses related to changes in fishing behavior to determine what kind of HCR was necessary to capture the functional response of the commercial and recreational fleets to changes in the population dynamics within the implementation/projection model. We determined management procedures for implementation and simulation testing by reconciling the HCR with preferred management measures, i.e., finer-scale tools such as sector allocation and minimum size limits. We also used responses to determine performance metrics: the measurements that are required to determine whether objectives were met by the management procedure ( Plagányi et al., 2014 ; Grüss et al., 2016 ).

Responses to interview questions

Results are organized in the following order: summaries of responses from general recreational fishers (if applicable), followed by summaries specific to recreational black sea bass and cobia fishers, followed by general commercial fishers (if applicable), followed by summaries specific to commercial black sea bass and cobia fishers.

In response to Question 1, which asked what was most important to participants about the fishery, most recreational fishers voiced that sustainability/conservation and the ability to keep fishing seasons open were of utmost importance to them ( Table 2 ). Some recreational fishers discussed their concerns: those who fished for cobia specifically cited a reduction in the availability of legal-sized fish and importance of larger fish to the fishery ( Table 2 ). Recreational black sea bass fishers also identified catching larger fish as being of great importance ( Table 2 ), and identified maintaining clean water, fishery sustainability, availability, and equitable harvest between recreational and commercial sectors as features important to them ( Table 2 ). Commercial both black sea bass and cobia fishers described fishing as a business and necessity for their livelihood. In this sense, they summarized what they valued about the fishery in terms of how it fit into their business portfolio. However, some commercial black sea bass fishers expressed enthusiasm for eating black sea bass, and the sustainability of the fishery ( Table 2 ).

Table 2 Responses to interview Question 1 by sector (recreational or commercial) and species (black sea bass or cobia).

Question 2 asked participants to choose three conceptual objectives from a list of six that we provided: A) “Catching the greatest number of pounds,” B) “Catching the greatest number of fish,” C) “Catching the largest size fish,” D) “Maximizing the length of the season,” E) “Conservation of the resource,” and E) “Increased access or opportunity within the fishery,” and rank each as their first, second and third most-preferred. All participants were encouraged to provide any other objectives they thought were missing and rank them if desired. Responses to Question 2 provided quantitative summaries of objective prioritization for commercial and recreational fisheries by species ( Figure 1 ). We note that not all participants chose to rank objectives, providing qualitative answers instead. Recreational black sea bass fishers ranked “catching the largest fish,” and “maximizing the length of the season” second and most frequently, each with n = 4, and “conservation of the resource” and “increased access or opportunity [within the fishery]” third, each with n = 4; another also suggested reducing recreational black sea bass discards as an objective but did not rank it. The recreational black sea bass fisher who identified as a charter captain explicitly suggested the sustainability and optimization of yield as their top-ranked objective. Recreational cobia fishers ranked “maximizing the length of the season” first with n = 5, and also second with n = 4, and “catching the greatest number of fish” third and most frequently with n = 6; the fisher who identified as a charter and headboat captain suggested “consistency of success” as an equally top-ranked objective to “maximize length of the season,” referring to a combination of having enough days to fish and enough fish available to be caught. Commercial black sea bass fishers consistently ranked “catching the greatest number of pounds’’ first (n = 3), followed by “catching the greatest number of fish” and “increased access or opportunity [within the fishery]” (n = 2), and nearly all options excluding “catching the largest fish” were ranked third by at least one participant (n = 1). One commercial black sea bass fisher suggested that one objective should be reducing mortality from recreational discarding of black sea bass. The commercial cobia fisher ranked “increased access or opportunity [within the fishery]” first, “maximizing the length of the season” second, and “catching the greatest number of pounds” third. At least one recreational black sea bass fisher ranked each objective first, but “catching the greatest number of pounds” received the highest rank (n = 3).

Figure 1 Tallied responses to Interview Question 2 which asks fishers to identify their top three conceptual objectives from a list provided by the interviewer. Conceptual objectives were ranked 1st, 2 nd , or 3rd by commercial fishers (left) and recreational fishers (right) for black sea bass (red) and cobia (blue). Options for ranking were (A) “Catching the greatest number of pounds,” (B) “Catching the greatest number of fish,” (C) “Catching the largest size fish,” (D) “Maximizing the length of the season,” (E) “Conservation of the resource,” and (F) “Increased access or opportunity within the fishery.”.

Question 3 asked participants to choose three management measures from a list of six that we provided: A) “Changing the vessel/trip or bag limits,” B) “Changing the size limits,” C) “Changing the size limits to a slot limit,” D) “Seasonal closures,” E) “In-season adjustments to vessel/trip or bag limits,” and E) “Changing catch limit allocation among sectors,” and rank them as their first, second, and third most-preferred. Interviewers encouraged participants to list any additional management measures they preferred and rank them as desired. Question 3 provided quantitative summaries of management measures preference for commercial and recreational fisheries by species ( Figure 2 ). Recreational black sea bass fishers ranked “change size limits” first and most frequently (n = 6), “change size limit to a slot limit” second (n = 5), and “change vessel/trip/bag limits,” “change size limits,” and “seasonal closures” third, each with n = 3. Recreational cobia fishers generally ranked “change allocation among sectors” first (n = 4), “change vessel/trip/bag limits” second (n = 4), “change vessel/trip/bag limits,” “change size limit to a slot limit,” and “in-season adjustments to limits” third, each with n = 1. Commercial fishers consistently ranked “changing the size limits” first (n = 3), “seasonal closures” second (n = 3), and “changing vessel/trip/bag limits” third (n = 2). The commercial cobia fisher did not choose to rank any of the six measures first, ranked “changing vessel/trip/bag limits” second, and both “changing size limits” and “seasonal closures” third. No additional management measures were proposed.

Figure 2 Tallied responses to Interview Question 3 which asks fishers to identify their top three management measures from a list provided by the interviewer. Management measures were ranked 1st, 2nd, or 3rd by commercial fishers (left) and recreational fishers (right) for black sea bass (red) and cobia (blue). Options for ranking were (A) “Changing the vessel/trip or bag limits,” (B) “Changing the size limits,” (C) “Changing the size limits to a slot limit,” (D) “Seasonal closures,” (E) “In-season adjustments to vessel/trip or bag limits,” and (F) “Changing catch limit allocation among sectors.”.

Question 4 asked participants to describe any changes in their fishing behavior in response to past vessel or trip limits, depending on whether they were a commercial or recreational fisher. Some recreational fishers expressed hesitation when answering this question. They often answered that they followed the regulations, threw small fish back, or did not fish during a closure. Other recreational fishers reported that they fished less, targeted other species, or promoted more catch and release when trip limits were reduced. Some also expressed that this caused them to fish less offshore. A recreational cobia fisher reported that, “I will not run offshore and justify the fishing if I can’t come home with enough fish.” Most recreational fishers however stated that it caused no change to their behavior, that they followed the regulations, and kept fewer fish. Commercial fishers generally cited switching up gear, fishing new areas, or targeting different species when past changes to vessel limits were implemented. Commercial black sea bass and cobia fishers reported having to change some aspect of their business operations when vessel limits were reduced; for example, the commercial cobia fisher described changing the business model to focus on fewer catches of higher quality meat, stating that “you need to be able to make it on less and be smart about how to go about it, “ and one commercial black sea bass fisher shared that they, “had to work to maximize profits. Used to have two guys working on the boat, now we have only one. I’ve cut corners on everything I can. Learned to maximize bait and groceries. Pay less a percent to the crew that I used to. Been taking off things off expenses, taking tackle out of expenses.” Another commercial black sea bass fisher commented on their frustration with past changes to trip limits, “We’ve gone through changes and every year we go through a different change. The problem with trip limits is they’re not very enforceable. Can tell you from the commercial aspect, if commercial boats were required to carry VMS (vessel monitoring system), if they were required to have that, then it would be more enforceable … all they can do is look at your fish box, might catch a red snapper violation, but can only gauge trip limit when catch is offloaded.”

Question 5 asked participants to describe any changes in their fishing behavior in response to past changes to size limits in their respective sector. Recreational fisher responses varied. Some expressed that the greater size limits caused them to fish more to catch their limit, and others stated that they, “just didn’t focus on black sea bass as much. But if I’m catching 9/10 under size, I could be going after something else, I know I can catch.” Some recreational fishers expressed concern about handling more fish and increased discard mortality. One cobia angler stated that they “gotta handle more fish, so there’s more opportunity for injury to fish and angler.” A recreational cobia fisher said that the changes in size limits were confusing, especially near state lines, or that they were disappointed and did not understand the rationale behind differing size limits among sectors. Slot limits, which were suggested as a potential management measure in Question 3, came up in discussions with both commercial and recreational fishers in response to this question. Most commercial fishers were against a slot limit because it would forgo yield. Recreational fishers were generally more receptive to slot limits. Some stated that they thought it would enable them to focus on retaining larger fish (within the legal range), with one angler stating that “if the science supports, I support it”. Others took the opportunity to say, “no slot limits.” Commercial fishers generally reported that they let more fish go, changed gear to accommodate the new size limits, or had no change. One commercial black sea bass fisher had repeatedly expressed that more restrictions would have negative effects for commercial fishermen; they said, “fight them [size limit changes] when they come up and they’re proposed. Fight them and try to stop them. No size limit when I started.”

Question 6 asked participants to describe any changes in their fishing behavior in response to past seasonal closures. Recreational and commercial fishers for both black sea bass and cobia cited fishing less, targeting other species, or not fishing at all. Some recreational fishers stated that they were disappointed when closures occurred but noted that their livelihood was not at stake; others responded by saying they simply followed the regulations. However, one recreational cobia fisher reported that, “If I catch a cobia and it’s out of season, he goes in the box.” One commercial black sea bass fisher described how they switched fisheries entirely in response to closures: “I gill netted instead of black sea bass fishing. Now I can black sea bass fish all year. I luckily can fish here in the wintertime for black sea bass now though since closures have not happened in a while.” Commercial black sea bass fishers also expressed strong opposition to seasonal closures, stating that they wanted to avoid them at all costs.

Synthesis of interview results for integration with MSE

Several responses to Question 1 overlapped with ranked conceptual objectives listed in Question 2, therefore we synthesized responses to Questions 1 and 2 to identify a preliminary set of conceptual objectives and performance metrics for evaluation in the MSEs ( Table 3 ). Additionally, for responses to Questions 2 and 3, we prioritized objectives and management measures by the number of times they were selected (highest n) regardless of rank. For recreational black sea bass fishers, “catching the most pounds’’ was the number-one ranked objective in Question 2, however, “catching the largest fish” and “maximize the length of the season” were the most frequent responses. Given that recreational black sea bass fisher responses to Question 1 included “regularly catch large individuals/fish,” “availability during cooler months,” and “sustainability/legitimate season (keep it open)” ( Table 2 ) suggest that the number-two ranked objectives may be of greater importance. Consequently, we chose all three as recreational fishing objectives for evaluation. For performance metrics, we chose to measure changes in the median of recreational catch, the proportion of legal-sized fish in the estimated population, and the exploitation rate as a proxy for season length ( Bohaboy et al., 2022 ). Reducing discards was an additional objective that both a commercial and recreational fisher cited but did not rank in response to Question 2. Given the recent increase in discard mortality in the most recent assessment for black sea bass ( SEDAR, 2018 ), we included this as an additional conceptual objective for both sectors and chose to measure the magnitude of discards as a performance metric. For commercial black sea bass fishers, “catching the greatest number of pounds” was the most common and number one-ranked conceptual objective in response to Question 2, and responses to Question 1 included “added source of income/family business;” therefore we selected “catching the greatest number of pounds” as the primary commercial fishing objective for the black sea bass MSE. However, commercial catches of black sea bass have consistently been lower than the proportion of the total allowable catch allocated to the sector ( SEDAR, 2018 ), suggesting that attaining the TAC may not be a sufficiently realistic performance metric, therefore we chose to examine changes in the median of commercial catch. For the commercial and recreational cobia fishers, “maximize length of the season” was the number one-ranked objective in Question 2, therefore this was selected as the primary commercial and recreational fishing objective for the cobia MSE. Additionally, we selected “catching the largest fish,” recreational cobia anglers’ number two-ranked objective, as an additional recreational fishing objective. We used the same performance metrics identified for use in the black sea bass MSE. We chose exploitation rates as a performance metric for both commercial and recreational season length, and the proportion of legal-sized fish in the population, respectively. Conservation of the resource was not the number one-ranked objective in responses to Question 2 for any fishery or sector, however, recreational black sea bass fishers consistently ranked it second ( Figure 2 ), and recreational fishers’ responses to Question 1 suggested it was a high priority, e.g., “maintaining healthy stock of larger fish,” “sustainability/keeping it open,” and “sustainability/legitimate season (keep it open)” ( Table 2 ). We interpreted these responses to mean that conservation, in the sense of keeping the fishery open in the long-term, was an important objective regardless of fishery and sector, therefore, we translated this into a conceptual objective designed to avoid fishery closures ( SEDAR, 2018 ; SEDAR, 2020 ): maintain spawning stock biomass above the minimum stock size threshold ( Table 3 ).

Table 3 Conceptual objectives and performance metrics derived from participants’ responses to interview questions.

We synthesized responses from all questions to determine what HCR and management measures should comprise management procedures for implementation and simulation testing. In response to Question 3, “changing the size limit” was the highest ranked management measure among commercial fishermen and recreational anglers for black sea bass in response to Question 2 ( Figure 2 ), and the reduction of discards was cited as a concern by both a commercial fisherman and recreational angler in response to Question 2. Additionally, “equitable harvest” was mentioned in response to Question 1 by recreational anglers for black sea bass ( Table 2 ). Therefore, due to concerns over discards and the inequity in size limits across sectors, we chose to explore an 11-inch minimum size limit in both commercial and recreational fisheries, and a decrease in dead recreational discards by half ( Table 3 ). Recreational cobia fishers ranked “changing allocation among sectors” as their most preferred management measure ( Figure 2 ). We chose not to explore any management measures that would change the allocation further in favor of the recreational sector given the magnitude of the TAC landed by the recreational fleets. In responses to Questions 1 and 4, commercial fishermen for both black sea bass and cobia spoke of the value of the fishery in terms of economic importance and changing their business model or operations to maximize profits in response to management action ( Table 2 ). This information is aligned with the prioritization of yield-based conceptual fishery objectives and is consistent with the aim of traditional maximum sustainable yield (MSY)-based management ( Kell and Fromentin, 2007 ). Therefore, we selected a range of status quo HCRs that are explored in current stock assessments, specifically variations of the F -based reference point that will achieve MSY, e.g., F MSY   and fractions of F MSY , including those with a P* management buffer, for testing in both MSEs. Additionally, because the majority of participants cited no change to fishing behavior in response to changes to vessel/trip and bag limits, changes to minimum size limits, or seasonal closures, we only included the constant catch HCR in the implementation/projection model, as opposed to an HCR that includes a functional response in fishing to stock status ( Berger et al., 2012 ).

We reconciled F -based constant catch HCRs with preferred management measures to develop a list of management procedures for implementation ( Table 4 ). For black sea bass, the management procedures included a constant catch at F MSY with no changes to minimum size limits or allocation by sector, 75 %   F MSY with no changes to minimum size limits or allocation by sector, F MSY with P* = 0.4 with no changes to minimum size limits or allocation by sector, F MSY with P* = 0.38 with no changes to minimum size limits or allocation by sector, F MSY with P* = 0.4 with no changes to minimum size limits, but 50% less catch allocated to discard to simulate improved discard practices ergo higher black sea bass discard survival, and F MSY with P* = 0.4 with 11-inch minimum size limits for both recreational and commercial sectors and no change to allocation by sector ( Table 4 ). F MSY with P* = 0.38 was included in the last two because it was the preferred alternative implemented for managing Southeast black sea bass in 2018 (Chip Collier, SAFMC, personal communication). For cobia, we chose to test the same four black sea bass management procedures without changes to size limits or allocation ( Table 4 ). We chose F MSY , 75 %   F MSY and F MSY with P* = 0.4 because these are all management procedures used for projections in the most recent stock assessments ( SEDAR, 2018 ; SEDAR, 2020 ).

Table 4 Management procedures by species: black sea bass (BSB) and cobia (COB).

Using information obtained from semi-structured interviews with stakeholders, we were able to identify conceptual objectives and preferred management measures, and develop candidate management procedures for implementation and simulation testing; these constitute several elements of the MSE participatory modeling framework outlined by Goethel et al. (2019) , and represent several key features of stakeholder engagement in MSE regardless of timetable ( Punt et al., 2016 ; Deroba et al., 2019 ; Feeney et al., 2019 ). Our study demonstrates that conducting semi-structured interviews with stakeholders, specifically commercial fishermen and recreational anglers, in tandem with MSE tool development is a viable intermediate approach to a full MSE when direct stakeholder participation in MSE is not feasible.

Our study was not without some shortcomings. Without iterative stakeholder participation and feedback, we had to translate information obtained from interview responses into information that could be used in the MSE tool. The compartmentalization and distillation of information obtained from fishers is an ongoing concern in resource management ( Holm, 2003 ) and who is doing the translating, and how the information is put to use by resource managers and scientists matters, therefore we must look critically at the translation process ( Murray et al., 2005 ). Our participants chosen during the first phase was largely based on snowball sampling, however, most participants were recreational fishers who were chosen using a statistical sampling framework during Phase II. Most landings in Southeast marine fisheries come from recreational fishing ( Shertzer et al., 2019 ), therefore we believe our approach was equitable. Another challenge in integrating experiential knowledge with quantitative frameworks is that it requires a process designed to receive it ( Nadasdy, 1999 ; Stephenson et al. 2016 ; Steins et al., 2020 ); the design of our MSE tool and initial testing precluded the exploration of certain management scenarios that could have been developed from interview responses. For example, recreational black sea bass anglers ranked “changing the size limit to a slot limit” as their second most-preferred management procedure in Question 3 ( Figure 2 ), and slot limits were the subject of much discussion in response to Question 5 (see Results). During initial testing of the MSE tool, we modified fishery selectivity in the OMs and implementation/projection model to reflect the implementation of a slot limit but could not obtain convergent model results. Similarly, although “seasonal closures” was the third most-preferred management procedure for both recreational black sea bass and cobia anglers ( Figure 2 ), this conflicted with our goal of conditioning the OMs to reflect the most recent stock assessment estimates for black sea bass and cobia, which used non-seasonal models ( SEDAR, 2018 ; SEDAR, 2020 ). We also acknowledge some sampling bias. In choosing fishers who have participated in the black sea bass and cobia fisheries for 10 or more years, we exclude those who may have exited either fishery due to past management actions. By selecting participants with long histories of fishing however, we may avoid the ‘shifting baseline syndrome’ sometimes associated with newer entrants to the fishery whose experience with fisheries management may be limited ( Murray et al., 2010 ). We also acknowledge a heavy skew toward private anglers in terms of recreational fisher participation in interviews. Charter and headboat operations are an important component of recreational fishing economies in the Southeast US, and the captains, crew and clients are likely to have different motivations and perspectives concerning each fishery. Moreover, for black sea bass, private angling comprises the greatest proportion of landings and fishing mortality ( SEDAR, 2018 ). For cobia, landings data and fishing mortality are aggregated by general commercial and recreational fleets ( SEDAR, 2020 ), but MRIP catch estimates suggest that private angling and charter boats are equally responsible for the majority of fishing mortality in the Southeast US (National Marine Fisheries Service Fisheries Statistics Division, personal communication). Additionally, we focused on fishermen participating in the commercial pot fishery for black sea bass because it is the dominant source of fishing mortality in the commercial sector ( SEDAR, 2018 ). This introduces a bias toward views of the commercial black sea bass pot fishery in commercial black sea bass responses. However, few fishers attended SEDAR, 2018 , and those that did were participants in the commercial pot fishery.

One of the key features of MSE is the ability to identify tradeoffs associated with each management procedure ( Bunnefeld et al., 2011 ; Punt et al., 2016 ). Many of the management procedures chosen for simulation testing based on the interview results were MSY-based, which have often failed to meet recreational objectives ( Miller et al., 2010 ; Ihde et al., 2011 ). Recreational fisheries remain the dominant source of fishing mortality in the Southeast US ( Shertzer et al., 2019 ), therefore, it is vital to engage with fishery stakeholders, specifically those from recreational sectors, to determine where those tradeoffs may occur. New intermediate approaches to engaging stakeholders and utilizing their data in MSE are being pioneered to determine whether management strategies meet recreational objectives ( Bellquist et al., 2022 ). Although labor-intensive, our study represents a cost-effective alternative intermediate framework for stakeholder engagement in MSE. We anticipate that these approaches will become increasingly necessary as recreational fisheries outgrow commercial fisheries ( Arlinghaus et al., 2019 ) and the cost of government implementation of MSE remains high ( Aranda & Motos, 2006 ).

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving human participants were reviewed and approved by North Carolina State University Independent Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author contributions

MD is the first author for this work. JC is the senior author. All other authors shared an equal contribution as second authors. All authors contributed to the article and approved the submitted version.

Acknowledgments

We would like to acknowledge the National Marine Fisheries Service Marine Fisheries Initiative grant program, federal award number NA19NMF4330236, for funding this research. We would like to thank Dr. Cassidy Peterson for her insight, the reviewers of this manuscript for their feedback and suggestions and express our deep appreciation for the time that all interview participants gave to this research.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmars.2022.1063260/full#supplementary-material

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Keywords: marine resource management, fishers’ knowledge, management strategy evaluation, experiential knowledge, ecosystem approach management

Citation: Damiano M, Wager B, Rocco A, Shertzer KW, Murray GD and Cao J (2022) Integrating information from semi-structured interviews into management strategy evaluation: A case study for Southeast United States marine fisheries. Front. Mar. Sci. 9:1063260. doi: 10.3389/fmars.2022.1063260

Received: 06 October 2022; Accepted: 15 November 2022; Published: 07 December 2022.

Reviewed by:

Copyright © 2022 Damiano, Wager, Rocco, Shertzer, Murray and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Matthew Damiano, [email protected]

† These authors have contributed equally to this work

This article is part of the Research Topic

Co-creating Knowledge with Fishers: Challenges and Lessons for Integrating Fishers' Knowledge Contributions into Marine Science in Well-Developed Scientific Advisory Systems

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Qualitative research method-interviewing and observation

Shazia jamshed.

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia

Buckley and Chiang define research methodology as “a strategy or architectural design by which the researcher maps out an approach to problem-finding or problem-solving.”[ 1 ] According to Crotty, research methodology is a comprehensive strategy ‘that silhouettes our choice and use of specific methods relating them to the anticipated outcomes,[ 2 ] but the choice of research methodology is based upon the type and features of the research problem.[ 3 ] According to Johnson et al . mixed method research is “a class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, theories and or language into a single study.[ 4 ] In order to have diverse opinions and views, qualitative findings need to be supplemented with quantitative results.[ 5 ] Therefore, these research methodologies are considered to be complementary to each other rather than incompatible to each other.[ 6 ]

Qualitative research methodology is considered to be suitable when the researcher or the investigator either investigates new field of study or intends to ascertain and theorize prominent issues.[ 6 , 7 ] There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation.[ 7 ]

Interviewing

This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[ 8 ] As no research interview lacks structure[ 9 ] most of the qualitative research interviews are either semi-structured, lightly structured or in-depth.[ 9 ] Unstructured interviews are generally suggested in conducting long-term field work and allow respondents to let them express in their own ways and pace, with minimal hold on respondents’ responses.[ 10 ]

Pioneers of ethnography developed the use of unstructured interviews with local key informants that is., by collecting the data through observation and record field notes as well as to involve themselves with study participants. To be precise, unstructured interview resembles a conversation more than an interview and is always thought to be a “controlled conversation,” which is skewed towards the interests of the interviewer.[ 11 ] Non-directive interviews, form of unstructured interviews are aimed to gather in-depth information and usually do not have pre-planned set of questions.[ 11 ] Another type of the unstructured interview is the focused interview in which the interviewer is well aware of the respondent and in times of deviating away from the main issue the interviewer generally refocuses the respondent towards key subject.[ 11 ] Another type of the unstructured interview is an informal, conversational interview, based on unplanned set of questions that are generated instantaneously during the interview.[ 11 ]

In contrast, semi-structured interviews are those in-depth interviews where the respondents have to answer preset open-ended questions and thus are widely employed by different healthcare professionals in their research. Semi-structured, in-depth interviews are utilized extensively as interviewing format possibly with an individual or sometimes even with a group.[ 6 ] These types of interviews are conducted once only, with an individual or with a group and generally cover the duration of 30 min to more than an hour.[ 12 ] Semi-structured interviews are based on semi-structured interview guide, which is a schematic presentation of questions or topics and need to be explored by the interviewer.[ 12 ] To achieve optimum use of interview time, interview guides serve the useful purpose of exploring many respondents more systematically and comprehensively as well as to keep the interview focused on the desired line of action.[ 12 ] The questions in the interview guide comprise of the core question and many associated questions related to the central question, which in turn, improve further through pilot testing of the interview guide.[ 7 ] In order to have the interview data captured more effectively, recording of the interviews is considered an appropriate choice but sometimes a matter of controversy among the researcher and the respondent. Hand written notes during the interview are relatively unreliable, and the researcher might miss some key points. The recording of the interview makes it easier for the researcher to focus on the interview content and the verbal prompts and thus enables the transcriptionist to generate “verbatim transcript” of the interview.

Similarly, in focus groups, invited groups of people are interviewed in a discussion setting in the presence of the session moderator and generally these discussions last for 90 min.[ 7 ] Like every research technique having its own merits and demerits, group discussions have some intrinsic worth of expressing the opinions openly by the participants. On the contrary in these types of discussion settings, limited issues can be focused, and this may lead to the generation of fewer initiatives and suggestions about research topic.

Observation

Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.[ 11 ]

Research can be visualized and perceived as painstaking methodical efforts to examine, investigate as well as restructure the realities, theories and applications. Research methods reflect the approach to tackling the research problem. Depending upon the need, research method could be either an amalgam of both qualitative and quantitative or qualitative or quantitative independently. By adopting qualitative methodology, a prospective researcher is going to fine-tune the pre-conceived notions as well as extrapolate the thought process, analyzing and estimating the issues from an in-depth perspective. This could be carried out by one-to-one interviews or as issue-directed discussions. Observational methods are, sometimes, supplemental means for corroborating research findings.

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Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

• Jacqueline Maria Dias 1 ,
• Muhammad Arsyad Subu 1 ,
• Nabeel Al-Yateem 1 ,
• Fatma Refaat Ahmed 1 ,
• Syed Azizur Rahman 1 , 2 ,
• Mini Sara Abraham 1 ,
• Sareh Mirza Forootan 1 ,
• Farzaneh Ahmad Sarkhosh 1 &
• Fatemeh Javanbakh 1  

BMC Nursing volume  23 , Article number:  322 ( 2024 ) Cite this article

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Metrics details

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

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Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to all second year nursing students who voluntarily participated in the study.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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Dr Fatma Refaat Ahmed is an editorial board member in BMC Nursing. Other authors do not have any conflict of interest

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Dias, J.M., Subu, M.A., Al-Yateem, N. et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs 23 , 322 (2024). https://doi.org/10.1186/s12912-024-01962-5

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Received : 06 January 2024

Accepted : 22 April 2024

Published : 11 May 2024

DOI : https://doi.org/10.1186/s12912-024-01962-5

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