Evaluating the audio-diary method in qualitative research

Purpose Audio-diary methods are under-utilised in contemporary qualitative research. In this paper we discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach We provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. We pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings The diaries produced were heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms Originality/value This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashio

Why aren't you stopping now?!’ Exploring accounts of white women breastfeeding beyond six months in the East of England

Breastfeeding infants for a period of two years is endorsed by international health agencies such as the World Health Organisation. However, discourses of breastfeeding in a British context are complex and contradictory, juxtaposing representations of breastfeeding as healthy and a moral obligation for mothers with views of the act as unseemly and an expectation that nursing women practice ‘socially sensitive lactation’ especially in public spaces. Sustained breastfeeding rates in the UK are poor and most British women discontinue breastfeeding well before six months. Mothers who elect to feed their infants at the breast for longer than these normative periods appear to experience suspicion and disapproval, especially in a public context and breastfeeding women are only legally protected in feeding their infants in public for up to six months. Although breastfeeding research is flourishing, research on this particular population of mothers remains relatively limited. Therefore, in this study, we explore in-depth experiential accounts of eight women, resident in a town in the East of England, who breastfed their infants beyond six months. Using interpretative phenomenological analysis four themes are presented. Really horrible looks': stigma from families and the community’, ‘Feeling quite exposed’: managing extended breastfeeding etiquette’, ‘Weird freaky paedophiles’: representations of extended breastfeeding women in the media’ and ‘You really need that’: the importance of support for longer-term breastfeeding women’. Applications to extended breastfeeding promotion and advocacy are discussed

Using audio-diaries to capture lived experience in health psychology: technological, methodological and epistemological issues

Although diary methods have a long tradition of use within psychology and appear to have considerable potential in researching health-related processes and experiences, the use of unstructured diary methods to generate detailed phenomenological accounts within contemporary health psychology has thus far been limited. In this poster presentation, we describe a recently completed British study in which a sample of first-time mothers used voice-recording technology to make daily diary entries about their infant feeding experiences. We present a consideration of the benefits and challenges of this approach to data collection. In particular, we focus on ethical and epistemological issues, drawing on the accounts of both participants and members of the research team. We also explore the most suitable ways of analysing data derived from diaries and consider the practical advantages and limitations of using audio-diaries. Finally, some of the implications for developing the use of audio-diaries in health psychologists' research and practice are considered

“It's always on the safe list”: Investigating experiential accounts of picky eating adults

Previous research into severely restricted eating for reasons which are not cultural, medical, due to a lack of food or due to concerns about body image has focused predominantly on “picky/fussy eating” in children. Despite evidence that picky eating does continue into adulthood and recognition in the new diagnostic category Avoidant Restrictive Food Intake Disorder (ARFID) that problematically avoidant and restrictive patterns of eating affect people across the lifespan, relatively little is known about the challenges and consequences faced by older adolescents and adults. This research employs qualitative methods to explore the experience of living as an adult with picky eating behaviours. Semi-structured interviews were undertaken with thirteen adults who identify as picky eaters and eat a highly limited diet, as determined by a checklist food questionnaire. Data were analysed using interpretative phenomenological analysis (IPA). Two themes are presented in this paper: “Constructions of food” and “Motivators for and barriers to change”. These themes show the importance of how individuals perceive food, their diet and themselves, and implications for clinical practice and future research in light of these findings are considered

Becoming a breastfeeding mother: An interactionist perspective

Understanding the establishment of breastfeeding by focussing on the mother-child dyad offers only a limited perspective. Instead, breastfeeding can be understood as becoming established or breaking down within broader networks of relationships (e.g. Dykes, 2006; Tiedje et al., 2002). Quantitative research has suggested that support from various others (lay and professional) can be an important factor in sustaining breastfeeding (Sikorski et al., 2003). However, those around the mother may orientate to breastfeeding in various ways. For example, fathers play a key role in decisions about infant feeding and in supporting breastfeeding, and yet need to define and adjust to their new parenting role and changed relationship with their partner in a way that accommodates breastfeeding (Bar-Yam & Darby, 1997). From the perspective of the mother, breastfeeding can be an important aspect of the transition to motherhood. However, becoming a mother is not an individual project but one that involves redefining roles and relationships with others (Mercer, 2004; Nelson, 2003), and negotiating mothering practices such as breastfeeding in the context of others’ expectations and cultural prescriptions for motherhood (McBride-Henry, 2010). The present research aims to extend understanding of how breastfeeding mothers experience their relations with others and how these are implicated in their experiences of breastfeeding and their developing relationship with their infant. The data discussed here have been taken from a longitudinal qualitative study of 22 new mothers in the UK who expressed an intention to breastfeed and were interviewed during the first week following birth and one month later. At each time point they were also asked to keep an audio-diary of their experiences of feeding their baby for one week. The analysis discussed here draws on symbolic interactionism and other theoretical perspectives which emphasise the relational nature of the self and assume that relations with others are part of, rather than external to, lived experience and mediate more distal cultural influences. The themes explored include the women’s sense of duty to balance what they saw as the needs of their baby, their own needs and the needs, demands and sensibilities of others, and the ways in which they negotiated these. We also discuss the way in which, as the participants were developing their new identities as breastfeeding mothers, others with expertise in breastfeeding or perceived to have knowledge regarding related norms and expectations took on a particular significance in the women’s lives. As such, these "experts" were experienced by the participants as in a powerful position to provide either validation or invalidation of them as breastfeeding mothers. We discuss (i) the implications of our analysis for facilitating supportive interactions between health professionals and breastfeeding mothers and their immediate networks and (ii) the implications for breastfeeding promotion of viewing ongoing engagement with the practices of infant feeding as mutually negotiated and enabled, rather than as the choice of individual women

The lived experience of parenting a child with sensory sensitivity and picky eating

open access article‘Picky eating’ is a common behaviour seen in childhood in both clinical and non-clinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre-selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste-smell, audio-visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi-structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day-to-day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child’s eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children

Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis

UNLABELLED: Prisoners have a high prevalence of hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity of care. We assessed the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons compared to status quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8-24 weeks) or interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks, 95% sustained virological response, £3300/week). Costs (British pounds, £) and health utilities (quality-adjusted life years) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assumed 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/ex-PWID treated within 2 months of diagnosis in prison. PWID and ex-PWID or non-PWID are in prison an average 4 and 8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/quality-adjusted life years gained compared to current testing/treatment and is 45% likely to be cost-effective under a £20,000 willingness-to-pay threshold. Switching to 8-week to 12-week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/quality-adjusted life years gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or with 8 weeks' duration. CONCLUSIONS: Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status quo voluntary risk-based testing under a £20,000 willingness to pay with current treatments but likely to be cost-effective if short-course IFN-free DAAs are used and could be highly cost-effective if PWID treatment rates were increased. (Hepatology 2016;63:1796-1808)