Units of meaning.
In general, qualitative analysis begins with organizing data. Large amounts of data need to be stored in smaller and manageable units, which can be retrieved and reviewed easily. To obtain a sense of the whole, analysis starts with reading and rereading the data, looking at themes, emotions and the unexpected, taking into account the overall picture. You immerse yourself in the data. The most widely used procedure is to develop an inductive coding scheme based on actual data [ 11 ]. This is a process of open coding, creating categories and abstraction. In most cases, you do not start with a predefined coding scheme. You describe what is going on in the data. You ask yourself, what is this? What does it stand for? What else is like this? What is this distinct from? Based on this close examination of what emerges from the data you make as many labels as needed. Then, you make a coding sheet, in which you collect the labels and, based on your interpretation, cluster them in preliminary categories. The next step is to order similar or dissimilar categories into broader higher order categories. Each category is named using content-characteristic words. Then, you use abstraction by formulating a general description of the phenomenon under study: subcategories with similar events and information are grouped together as categories and categories are grouped as main categories. During the analysis process, you identify ‘missing analytical information’ and you continue data collection. You reread, recode, re-analyse and re-collect data until your findings provide breadth and depth.
Throughout the qualitative study, you reflect on what you see or do not see in the data. It is common to write ‘analytic memos’ [ 3 ], write-ups or mini-analyses about what you think you are learning during the course of your study, from designing to publishing. They can be a few sentences or pages, whatever is needed to reflect upon: open codes, categories, concepts, and patterns that might be emerging in the data. Memos can contain summaries of major findings and comments and reflections on particular aspects.
In ethnography, analysis begins from the moment that the researcher sets foot in the field. The analysis involves continually looking for patterns in the behaviours and thoughts of the participants in everyday life, in order to obtain an understanding of the culture under study. When comparing one pattern with another and analysing many patterns simultaneously, you may use maps, flow charts, organizational charts and matrices to illustrate the comparisons graphically. The outcome of an ethnographic study is a narrative description of a culture.
In phenomenology, analysis aims to describe and interpret the meaning of an experience, often by identifying essential subordinate and major themes. You search for common themes featuring within an interview and across interviews, sometimes involving the study participants or other experts in the analysis process. The outcome of a phenomenological study is a detailed description of themes that capture the essential meaning of a ‘lived’ experience.
Grounded theory generates a theory that explains how a basic social problem that emerged from the data is processed in a social setting. Grounded theory uses the ‘constant comparison’ method, which involves comparing elements that are present in one data source (e.g., an interview) with elements in another source, to identify commonalities. The steps in the analysis are known as open, axial and selective coding. Throughout the analysis, you document your ideas about the data in methodological and theoretical memos. The outcome of a grounded theory study is a theory.
Descriptive generic qualitative research is defined as research designed to produce a low inference description of a phenomenon [ 12 ]. Although Sandelowski maintains that all research involves interpretation, she has also suggested that qualitative description attempts to minimize inferences made in order to remain ‘closer’ to the original data [ 12 ]. Descriptive generic qualitative research often applies content analysis. Descriptive content analysis studies are not based on a specific qualitative tradition and are varied in their methods of analysis. The analysis of the content aims to identify themes, and patterns within and among these themes. An inductive content analysis [ 11 ] involves breaking down the data into smaller units, coding and naming the units according to the content they present, and grouping the coded material based on shared concepts. They can be represented by clustering in treelike diagrams. A deductive content analysis [ 11 ] uses a theory, theoretical framework or conceptual model to analyse the data by operationalizing them in a coding matrix. An inductive content analysis might use several techniques from grounded theory, such as open and axial coding and constant comparison. However, note that your findings are merely a summary of categories, not a grounded theory.
Analysis software can support you to manage your data, for example by helping to store, annotate and retrieve texts, to locate words, phrases and segments of data, to name and label, to sort and organize, to identify data units, to prepare diagrams and to extract quotes. Still, as a researcher you would do the analytical work by looking at what is in the data, and making decisions about assigning codes, and identifying categories, concepts and patterns. The computer assisted qualitative data analysis (CAQDAS) website provides support to make informed choices between analytical software and courses: http://www.surrey.ac.uk/sociology/research/researchcentres/caqdas/support/choosing . See Box 5 for further reading on qualitative analysis.
Ethnography | • Atkinson P, Coffey A, Delamount S, Lofland J, Lofmand L. Handbook of ethnography. Sage: Thousand Oaks (CA); 2001. • Spradley J. The ethnographic interview. Holt Rinehart & Winston: New York (NY); 1979. • Spradley J. Participant observation. Holt Rinehart & Winston: New York (NY); 1980. |
Phenomenology | • Colaizzi PF. Psychological research as the phenomenologist views it. In: Valle R, King M, editors. Essential phenomenological alternative for psychology. New York (NY): Oxford University Press; 1978. p. 41-78. • Smith J.A, Flowers P, Larkin M. Interpretative phenomenological analysis. Theory, method and research. Sage: London; 2010. |
Grounded theory | • Charmaz K. Constructing grounded theory. 2nd ed. Sage: Thousand Oaks (CA); 2014. • Corbin J, Strauss A. Basics of qualitative research. Techniques and procedures for developing grounded theory. Sage: Los Angeles (CA); 2008. |
Content analysis | • Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative Content Analysis: a focus on trustworthiness. Sage Open 2014: 1–10. DOI: 10.1177/2158244014522633. • Elo S. Kyngäs A. The qualitative content analysis process. J Adv Nurs. 2008; 62: 107–115. • Hsieh HF. Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15: 1277–1288. |
The next and final article in this series, Part 4, will focus on trustworthiness and publishing qualitative research [ 13 ].
The authors thank the following junior researchers who have been participating for the last few years in the so-called ‘Think tank on qualitative research’ project, a collaborative project between Zuyd University of Applied Sciences and Maastricht University, for their pertinent questions: Erica Baarends, Jerome van Dongen, Jolanda Friesen-Storms, Steffy Lenzen, Ankie Hoefnagels, Barbara Piskur, Claudia van Putten-Gamel, Wilma Savelberg, Steffy Stans, and Anita Stevens. The authors are grateful to Isabel van Helmond, Joyce Molenaar and Darcy Ummels for proofreading our manuscripts and providing valuable feedback from the ‘novice perspective’.
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Reading and interpreting ethnography, stimulated recall interviews in ethnography, analysis of native and nonnative ethnographic interviews power relations between the researcher and the researched: an, how they see me vs. how i see them: the ethnographic self and the personal self, negotiating positionality in ethnographic investigations of workplace settings: student, consultant or confidante, the use of ethnographic interviewing to inform questionnaire construction, participant observation, ethnography, and their use in educational evaluation: a review of selected works., virtual ethnography: interactive interviewing online as method, introducing 'ethnography and self-exploration', spradley's ethnographic questioning: an invitation for healing, related papers.
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Apa format for an interview paper, example of in-text citation in an interview paper.
Important Note on Personal Interviews:
That being said, there is a general structure if you want to cite a personal interview as part of your APA works cited list:
Author, A. (Year, Month Date). Interview type.
APA format example:
Marino, B. (2024, October 18). Personal Interview.
An interview paper is a research-based essay based on information gathered in interviews with various people. While other research papers primarily cite published print sources, interview papers draw their evidence from unpublished conversations—in person, by phone or by email. The interviewees are usually individuals with expertise in the topic being discussed or participants in a study or survey. Aside from academic reports or essays, interview papers are prevalent in journalism, as spoken responses to questions form much of the basis of many newspaper or magazine articles. The nature of interview papers allows for the potential to include unique insights in your writing. Two people can interview the same person about the same subject but receive somewhat different sets of information depending on the questions they ask. Personal factors, too, can influence the outcome of an interview, as the interviewee's level of comfort and emotional condition at the time of the conversation may render them or less communicative.
An APA-formatted paper typically consists of four major sections:
When using American Psychological Association (APA) style, your interview should either be cited as personal communication or recorded in detail in your text. The APA interview writing format has specific rules for how to write an interview paper.
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Implementation Science volume 19 , Article number: 66 ( 2024 ) Cite this article
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Communication is considered an inherent element of nearly every implementation strategy. Often it is seen as a means for imparting new information between stakeholders, representing a Transaction orientation to communication. From a Process orientation, communication is more than information-exchange and is acknowledged as being shaped by (and shaping) the individuals involved and their relationships with one another. As the field of Implementation Science (IS) works to strengthen theoretical integration, we encourage an interdisciplinary approach that engages communication theory to develop richer understanding of strategies and determinants of practice.
We interviewed 28 evaluators, 12 implementors, and 12 administrators from 21 Enterprise-Wide Initiatives funded by the Department of Veteran Affairs Office of Rural Health. Semi-structured interviews focused on experiences with implementation and evaluation strategies. We analyzed the interviews using thematic analysis identifying a range of IS constructs. Then we deductively classified those segments based on a Transaction or Process orientation to communication.
We organized findings using the two IS constructs most commonly discussed in interviews: Collaboration and Leadership Buy-in. The majority of segments coded as Collaboration ( n = 34, 74%) and Leadership Buy-in ( n = 31, 70%) discussed communication from a Transaction orientation and referred to communication as synonymous with information exchange, which emphasizes the task over the relationships between the individuals performing the tasks. Conversely, when participants discussed Collaboration and Leadership Buy-in from a Process orientation, they acknowledged both constructs as the result of long-term efforts to develop positive relationships based on trust and respect, and emphasized the time costliness of such strategies. Our findings demonstrate that participants who discussed communication from a Process orientation recognized the nuance and complexity of interpersonal interactions, particularly in the context of IS.
Efficient, reliable information exchange is a critical but often overemphasized element of implementation. Practitioners and researchers must recognize and incorporate the larger role of communication in IS. Two suggestions for engaging a Process orientation to communication are to: (a) use interview probes to learn how communication is enacted, and (b) use process-oriented communication theories to develop interventions and evaluation tools.
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Communication is a vital part of implementation. Yet, predominant discussions about implementation strategies are limited to a Transactional orientation. Conversely, the Process orientation to communication acknowledges the multiple moving elements in an implementation context that influences collaboration and leadership buy-in.
Exemplars of interview segments about communication engaging a Process orientation were identified to demonstrate ways interviewers can probe to gain a deeper understanding of communication as a process.
We provide examples and suggestions for qualitatively examining communication processes to better understand the impact of implementation strategies.
Several theories with a Process orientation are identified for consideration in future research and implementation planning and evaluation.
Most implementation strategies include a communication component, particularly when evidence-based interventions are introduced and promoted throughout an organization. When implementing new programming, it is common to consider communication as simply a means through which information is imparted [ 1 , 2 ]. Implementation Science (IS) researchers have an imperative to understand the role of communication as more than a means for information exchange [ 3 ]. Yet, even as a means for information exchange, Manojlovich and colleagues recognized the lack of attention on communication in implementation research [ 1 ].
Broadly, the study of communication focuses on how messages are used to generate meanings [ 4 ], and provides perspective for moving beyond an emphasis on information exchange, thus moving beyond the task dimension and recognizing the value of the relational dimension. Despite its relatively young development both academically and professionally, the communication discipline offers valuable insight to IS research [ 5 ]. There are two predominant ways to characterize communication: (1) communication as Transaction, and (2) communication as Process. When communication is viewed as a Transaction, it is discussed as a linear one-way flow of information [ 3 ]. The materiality – the element of substantive value – of communication is found in accurate, efficient information transfer, thus putting emphasis on the task dimension and channel (e.g., phone, handout) through which information is exchanged. When practitioners focus their efforts on preparing thoughtful and detailed educational sessions intended to increase program adoption, but do not allow time for interactive questions or develop opportunities for building relationships between key personnel responsible for successful adoption, then we see a reliance on the Transaction orientation to communication. When communication is conceptualized as a Process, we emphasize its constitutive nature wherein our environments – social, organizational, political, etc. – shape and are shaped through communication [ 3 ]. From a Process orientation, the transformative properties of communication emphasize its relational dimension and bring about a materiality from the intangible elements of the process (e.g., tone of voice, relational history, contextual exigency), and concepts such as psychological safety, mutual respect, and trust foreground the mechanics of information exchange. For example, someone may schedule multiple options for the same information session to ensure real-time interactivity for questions and build in opportunities for small group breakouts and post-presentation networking for relationship-building. When understanding of communication shifts to encompass more than information exchange, we begin to recognize the role of communication in building relationships and influencing long term cultural shifts, which is often the goal for implementation scientists [ 3 ]. If the Process orientation is overlooked in favor of a Transaction orientation, we may miss opportunities for identifying evidence-based communication strategies to support implementation.
The majority of subsequent work engaging Manojlovich et al.’s assertions agree on the imperative to engage a Process orientation to communication, but they make no strides in designing approaches for exploring the characteristics of communication surrounding effective implementation strategies (e.g., [ 6 , 7 , 8 ]). As the conversation initiated by Manojlovich and colleagues about the role of communication in implementation science has progressed, recognition of communication has grown, but emphasis continues to focus on formal contexts (e.g., trainings and webinars) [ 1 ]. Further, quantitative measures that assess information accuracy like the one used in Zhao and colleagues’ work overlook the importance of informal communication (e.g., rapport-building before meetings, impromptu connections) and the nuanced influence of the relational dimension that contributes to effective implementation. Bustos et al.’s (2021) analysis acknowledges both the formal and informal strategies through which communication might occur, but the communication they refer to is discussed from a Transaction orientation (i.e., “how information… was communicated to program staff” (p. 10)) [ 9 ].
For this study, we draw on interviews with employees of the Department of Veterans Affairs (VA) who evaluated, implemented, and administered interventions focused on improving the health and well-being of rural Veterans or the clinical staff who serve them. These interviews were exploratory and wide-ranging; for the purposes of this manuscript, we treat the interviews as akin to direct observations of intervention stakeholders discussing their real-world experiences operationalizing implementation strategies. Instead of focusing on what we could learn from the communication described in the interviews, we directed our attention to what lessons could be missing because of the way participants discussed communication. In this manuscript, we provide examples of how Transaction and Process orientations to communication appear in the data when individuals described their experiences, as well as their relationships that supported IS strategies and facilitated intervention goals. We also suggest interview strategies to elicit detail about communication from a Process orientation to support ongoing learning of these informal communication processes. Though these interviews were not focused on communication, we use data from the interviews to argue that noticing communication helps us discover how to do implementation science better. Specifically, a Process orientation emphasizes the space between IS strategies and outcomes, and advances understanding of implementation challenges and solutions.
The VA’s Office of Rural Health (ORH) supports the creation of Enterprise-Wide Initiatives (EWIs) to address issues facing rural Veterans from mental health and primary care access to training and education of VA staff who serve rural Veterans. As a part of the funding cycle, EWI teams must conduct annual evaluations. The Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI) was created through a 2019 partnership between ORH and the VA’s Quality Enhancement Research Initiative to support EWI evaluation and disseminate best practices. The CEEWI team, consisting of implementation science experts and qualitative data analysts, reviews the annual reports and provides feedback to EWI teams on reporting standards.
As part of the initial CEEWI project, EWI evaluators, implementors, and administrators were interviewed about effectiveness of IS strategies they used and why, in part, to assist the CEEWI team in understanding key aspects of EWI implementation and evaluation. The interview guide included questions about the participant’s role on the EWI, the core components of the EWI, implementation strategies and their impact on desired outcomes, outcome measures used for evaluation, and the evaluation process. CEEWI team members and EWI leadership identified the evaluators, implementors, and administrators to recruit for the study. While recruitment sought a purposive sample of roles from each EWI, ultimately the sample was a convenience sample based on availability and willingness to participate during the first nine months of the COVID-19 pandemic. Additional details about recruitment and data collection can be found in an earlier manuscript from this larger project [ 10 ]. We conducted 43 semi-structured interviews, which averaged 51 min (range 20–77 min), from April – December 2020 with evaluators, implementors, and administrators from 21 EWIs. While most interviews were conducted one-on-one, 8 were group interviews ranging from 2 to 4 participants [ 10 ]. This study uses these interviews as an example on how communication is described when discussing implementation strategies.
Audio-recordings were transcribed, reviewed for accuracy, and uploaded into MAXQDA, a qualitative data management software [ 11 ]. Two doctorally trained qualitative analysts (NJ & JVT) leveraged their previous IS knowledge and conducted primary-cycle inductive coding to identify IS constructs and trends in the data [ 12 ]. The analysts initially coded all transcripts together in real-time and resolved discrepancies immediately. During this first round of coding, several IS constructs were identified in participants’ discussion of their implementation strategies, including Staff Buy-in, Tailoring, Rapport, Fidelity, and Mentorship. Collaboration and Leadership Buy-in emerged as the two most discussed IS constructs among participants. For secondary-cycle deductive coding to interpret how communication was conceptualized in discussions of Collaboration and Leadership Buy-in, the lead author, a Health Communication scholar, used an iterative process to develop a codebook to identify the language representing a Process or Transaction orientation for each construct (i.e., Collaboration and Leadership Buy-in) [ 3 , 12 ]. The analysis focused on the how communication was discussed, not about the form of communication that took place.
Collaboration, a term often characterizing various levels of formal and informal partnerships between individuals, departments or organizations, is defined as a mutually beneficial and well-defined relationship between two or more parties to achieve common goals [ 13 ]. An example of discussing Collaboration from a Transaction orientation to communication would be using the term Collaboration to describe monthly meetings where the parties update one another about the status of their tasks and goals. From a Process orientation, Collaboration would be discussed in relational terms, describing the trust and rapport the team members have among one another.
Leadership Buy-in represents the role of support from individuals in leadership positions for a program’s adoption and sustainability, particularly when competing clinical and administrative demands are at play [ 7 ]. An example of discussing Leadership Buy-in using a Transaction orientation to communication would be a description of strategies for adoption that only focused on leadership education. However, someone who engaged a Process orientation to communication might: (1) discuss tailored persuasive strategies for demonstrating value to specific decision-makers, or (2) acknowledge the necessity for long-term relationships with individuals in leadership roles for sustainment.
We conducted 43 interviews with 28 evaluators, 12 implementors, and 12 administrators. We coded a total of 90 segments as Collaboration ( n = 46) and Leadership Buy-in ( n = 44) across all the interviews. Most segments coded as Collaboration ( n = 34, 74%) and Leadership Buy-in ( n = 31, 70%) discussed communication from a Transaction orientation. The following results present examples of the discussion of Collaboration and Leadership Buy-in from the Transaction and Process orientations to communication.
When communication is treated as a transaction, it is discussed as a one-way flow of information traveling from one party to another during a discrete moment in time [ 3 ]. The materiality of communication is reduced to accurate, efficient information transfer, thus putting emphasis on the channel (e.g., Teams meeting, email) through which information is exchanged and the task dimension of the interaction.
Participants sometimes discussed Collaboration in a way that missed its nuance and treated communication as merely a means for transferring information that produced Collaboration. For example, one participant implied that communication, regardless of quality, is inherently good, thus the more there is, the better. They identified “communication across the team level” as an important strategy having the most impact on desired outcomes. “The more communication there is, the more people are able (…) to divide up [responsibilities].” (1A) In this instance, communication is synonymous with information exchange. While we do not have enough information to assess the quality of communication that Participant 1A is referring to, the fact they only discussed the parties involved and quantity of communication is an example of the Transaction orientation to communication.
In another example, a participant explained what they felt did not work as well in their evaluation process. “We have excellent communication with some, but not all members of the [EWI] (…) I’m not sure they’re always on the same page with each other, and then depending on who we’re having a meeting with, we might hear one thing but then that’s not what someone else was going to do (…) that’s one of the pieces that I think is hard for us.” (2A) Again, we see the Transaction orientation, and the barometer for effective communication is accuracy. The participant went on to discuss ways to improve this lack of alignment among team members, suggesting that “even if it’s just being invited to join calls (…) [for us] to answer questions about the [evaluation] data” would improve teamwork. (2A) This passage highlights an important aspect of communication – being present for an interaction and having the opportunity to answer questions enables information exchange.
One participant described the communication that occurred during a monthly videoconference:
The learning collaborative is focused on bringing people [together] to share their experiences and how various facilitators identify ways to shape their program, but also the way that our national team gives feedback about the data (…) One call a month is right after a report (…) they do a data review on the call where they go over the numbers with the entire learning collaborative, everyone in the program, giving them feedback from a national perspective and always reminding people of the milestones of the metrics that they’ve agreed to under the ORH grant. (3A)
Here, we see another example of a participant discussing communication in terms of information exchange.
Participants also discussed Leadership Buy-in from a Transaction orientation. In the following passage, participant 4A described the benefits of the EWI leadership team visiting sites in-person:
They would do a site visit to all the hubs (…) and meet with the local leadership team and that’s where they confirmed if there were any issues that they might have. They would do like a 2–3 day site visit (…) so it helped create that structure where people knew exactly who to report to and how these programs were established and plenty of opportunities to address any concerns or any issues they might have.
There are substantial implications for local Leadership Buy-in through in-person visits, yet the only aspect of communication discussed here is information exchange and clarifying the information flow hierarchy (i.e., who to report to).
Participant 5A described their program’s efforts to obtain Leadership Buy-in:
Simple outreach and education, that was really the only things that we could do, and then as they continued, training kind of showed its usefulness. That had an impact on leadership buy-in.
Here, buy-in is attributed to education, which may account for some or even most of buy-in, but it does not recognize the relational dimension of communication.
For another EWI, leadership turnover at the facility presented a significant barrier to program sustainment, because Leadership Buy-in was perpetually reset, which exacerbated a “conflict between implementation and sustainment strategies” when the decision-maker for sustainment funding was not the same person to “sign off on it originally” (9A). Given the EWI provided seed-funding for specialty staff to implement the program, the expectation was that the facility would eventually incur the expense for sustainment, but the plan for funds was not made explicit at the time of application for the seed-funding. Participant 9A went on to explain how their program responded to the unforeseen challenge obtaining sustainment funding from sites:
Our clinical director worked really hard with the first cohort of sites prior to their funding ending to try to come up with strategies to pitch the program to leadership (…) Most sites had challenges with changing leadership priorities.
In response, the interviewer clarified their sources for funding, then changed topics: “Interviewer: Ok, alright. How about strategies that were intended to optimize the effectiveness outcomes for your EWI?” In this example, the interviewer seems to be approaching the participant’s description of Leadership Buy-in from a Transactional orientation. A Process-oriented approach that asked about the nature and details of pitching the EWI to leadership may have provided more information about implementation strategy.
From the process perspective, no single interaction serves as the cause or proof of effective Collaboration. Rather, the Process orientation recognizes the value of communication lies in the cumulative outcomes of consistent, often routine, interactions.
Collaborations require shared responsibility, mutual authority, accountability, and sharing of resources and rewards for success [ 13 ]. Collaboration in implementation has focused on strategies to enhance partners’ ability to work together to achieve mutual benefits. We identified examples from participants discussing Collaboration with a Process orientation to communication. From these examples we see that Collaboration is seen as a product of long-term efforts to develop positive relationships and establish trust and autonomy to make one’s own decisions. Many participants recognized the uniqueness and value in reaching the point of Collaboration. For example, Participant 10A shared, “The partnerships, it’s like a very special kind of relationship–, where we have to trust them, we rely on each other, but we also need to be able to make independent decisions.” Participant 6A also recognized the importance of relationships, “I would say they’re collegial but they’re not fully collaborative (…) when they’re really more deeply integrated and their role is understood and recognized (…) they are more collaborative members.”
One participant on a different EWI echoed this sentiment that individuals’ intent and motivations for the work should extend beyond the assignment to be considered Collaboration, “It’s not just trying to check off a box (…) there truly is a passion behind it, on all of our parts, and that has been wonderful.” (7B) Recognizing others’ intent for their work allows one to acknowledge how interpersonal communication is influenced by more than information exchange.
In the following exemplars, we can see how interviewers were able to elicit detail about the interactions surrounding the implementation strategies they were discussing.
Exemplar for Probing Collaboration . In Table 1 , we share an exemplar for engaging the Process orientation to communication, which led to greater explication of the role of communication in the implementation process.
Through this example, we see a more nuanced treatment of communication as a process after the interviewer probed twice to understand the participant’s use of “facilitation” as an implementation strategy. We gained description of the collaborative atmosphere within a team and how individuals’ psychological safety is manifested through authentic interactions.
It takes more than information-exchange to garner support (e.g., financial, staff) for facilitation and sustainment. One participant acknowledged the web of influence that contributes to Leadership Buy-in and effective implementation:
We reached out to all the rural sites their leadership… sort of advertising the program, so we would schedule a conference call with a director, chief of staff, emergency room chief, to sort of discuss the program (…) then we would follow up with an actual 1-day on-site visit (…) where we meet with again, leadership, but we also meet with the [staff from several departments] (…) It’s an all-day visit to further introduce our program, to the team on site, as well as learn more about their program, and how [our EWI] might incorporate itself, and what challenges (…) we might face in implementation. (2B)
Here, we see an acknowledgement of reciprocal relationship-building to learn about priorities and needs.
Several participants discussed how time costly it is to gain Leadership Buy-in to ease the burden of change on an organization and staff, particularly for a nationwide program. One participant reflected:
Ten years ago, it was a [regional] project, so the main kind of instruction came from a [regional] level down, you know. The site visit was just a medical director and the nurse manager telling you that, ‘Hey, this is what’s going to happen,’ and it happened. Now (…) it’s like a year-long process to get people familiarized (…) go live went from one day to four days long. (11B)
Despite its value, garnering Leadership Buy-in has its challenges. Sometimes identifying the right individuals who represent the relevant leadership roles is not clear cut.
Once we have identified that our program can go to that site, we ask the local (…) program manager to identify who (…) key local leaders are (…) It’s important to have the managers of those sites involved in this process from the beginning (…) We (…) set up an initial meeting (…) where we review the implementation process plan with everybody on that call, and answer questions about what we and [specialty care] services will provide as part of the training opportunity and clearly delineate what we need the site or the facility to commit to provide (…) we answer questions, alleviate concerns, things like that. (7B)
Participant 7B went on to describe the challenge of identifying the right leadership representative:
The only barrier that we’ve encountered is some challenges in getting the right leadership on the call to review this in real time and answer questions (…) whether it is due to leadership turnover at the site, even from the time that we set up the call to the time that we actually do the call, there have been some change-overs, and that has been a challenge.
Again, we see this participant engaging a strong Process orientation to communication as they emphasize the importance of relationship-building for Leadership Buy-in.
Exemplar for Probing Leadership Buy-in . In the following example, the interviewer engaged the Process orientation to communication with probes that led to greater explication of the role of communication in developing Leadership Buy-in (Table 2 ).
Results illustrate ways administrators, implementors, and evaluators characterized communication related to Collaboration and Leadership Buy-in. From the Transaction orientation, we saw that the term communication was used synonymously for information exchange. The problem of implementation lies beyond efficient and reliable information transfer, and instead centers on cooperative sensemaking and learning within and among teams situated in an organization that is influenced by its social, geographic, and political environments [ 2 , 14 , 15 ]. Communication necessary for effective implementation is based on improvisation and reciprocity and constitute relationships over time [ 2 , 15 ]. Our data indicate these processes are occurring in implementation, but we may not always be paying close enough attention to their occurrence. If most discussions about communication engage a Transaction orientation, then practitioners and evaluators will never have the insight necessary to maximize the impact of their communication efforts.
Participants often discussed Leadership Buy-in more as an outcome of education, and less as a byproduct of improvisational relationship-building, which demonstrates the predominant Transaction orientation to communication privileging rehearsed, often unidirectional, and mostly controlled interactions. Formal information exchange is undoubtedly an important element of effective implementation; the Transaction orientation aligns well with the goals of dissemination and implementation as a field [ 15 ]. However, our data point to the importance of thinking about communication from a Process orientation for improving effectiveness of implementation strategies—and show how members of implementation and evaluation teams too often focus on the transaction elements of communication. Previous work that engages the Transaction orientation and points to the benefits of reliable information exchange has paved the way for more exploratory naturalistic methods for studying IS from a Process orientation to communication [ 3 , 14 , 15 , 16 ]. As noted in our findings, the Transaction orientation overlooks the intricacies of processes that occur among individuals to build trust, cultivate buy-in, and influence team decision-making, all of which are markers of successful implementation.
Given the purpose of IS is to promote the adoption of research and evidence-based practices, it would behoove implementation scientists to tap into the richness of interdisciplinary theorizing and engage a Process orientation to communication [ 17 ]. As thinking about communication has evolved from a Transaction orientation, scholars recognized the symbolic process that humans use to create meaning through informal, improvised interactions over a period of time [ 2 ]. Recent analysis of implementation strategies for behavioral health interventions called for explicit attention to the supportive role communication may play in most, if not all, strategies [ 15 ]. The Process orientation to communication enriches theorizing and elevates scholars’ and practitioners’ understanding of how to leverage implementation strategies to be meaningfully responsive to the relationships among the interested parties [ 18 ]. However, we warn against over-characterizing communication into a ‘nebulous, global process’ [ 2 , 19 ]. For gaining insight on communication processes, we suggest two strategies: 1) interviewers focused on understanding implementation strategies could probe their interviewees to learn more about how communication is enacted; and 2) IS practitioners could utilize process-oriented communication theories in developing interventions and evaluation tools (e.g., interview guides).
The supplementary material accompanying this article includes excerpts from our interview data as examples demonstrating hypothetical ways interviewers can elicit more nuanced understanding of communication processes (see Tables S1 and S2).
Our analysis identified examples of missed opportunities for interviewers to probe about communication from a Process orientation recognizing the relational dimension of communication. Interview probes like those recommended in Tables S1 and S2 could lead to valuable understanding of the processes of communication, allowing exploration of the relational dimension of communication and implementation, and insight to individuals’ attitudes and sensemaking about those experiences. This may contribute to a more nuanced understanding of the importance of communication in implementation strategies beyond a transactional information exchange. We also provided examples highlighting the constitutive role communication plays in relationship-building. Our goal is to help attune IS researchers to the value of the processes of communication as a critical component of many implementation strategies.
Challenges to implementing any new program may be significantly varied and widespread. No single barrier serves as an intervention’s fatal flaw, but rather, implementation is affected by numerous factors shaped through informal interactions [ 17 , 20 ]. A recent study that aimed to identify which implementation strategies should be most closely considered for which determinants of practice reported one of its limitations was the heterogeneity of responses [ 21 ]. This variation in responses among administrators, implementors, and evaluators points to the value of a more nuanced understanding of the unique, context-dependent, and relationally based communication processes undergirding implementation strategies [ 21 ]. Further, in their ethnographic study on hand hygiene programs, Goedken and colleagues poignantly emphasized the importance of understanding how implementation strategies are used and defined in real-world settings for understanding determinants of practice [ 22 ]. By looking below the surface of implementation strategies and focusing on the interactions surrounding those strategies, we may begin to recognize the determinants of practices, the mechanisms for change, more precisely. Discussing communication from a Process orientation allows us to access what is happening below the surface that cannot be observed as an outsider. With greater insight on communication processes occurring throughout implementation, the field of IS would be poised to provide meaningful guidance for combining implementation strategies [ 22 ]. In a similar vein, IS researchers should consider the temporality of IS strategies and how this underscores the role of communication. The role of Leadership Buy-in at all stages of development and implementation on effectiveness cannot be overstated [ 23 ]. Albright suggests shifting away from the predominant focus of research on the active implementation period to explore activities occurring during design and preparation [ 15 ].
Most implementation strategies have a communication component representing the channel for education and promotion (e.g., workshops, webinars, brochures) [ 15 ]. Our proposed interview strategies interrogate communication in a way that recognizes the relational dimensions of interpersonal interactions, providing insight about what truly results in effective implementation. By understanding communication from a Process orientation, we may enrich our understanding of implementation strategies [ 24 ].
Theories that engage a Transaction orientation to communication often ascribe to the traditional knowledge-intention-behavior paradigm that proposes a stable, linear positive relationship between knowledge and behavior change (e.g., Theory of Reasoned Action, a predictive theory suggesting a strong relationship among individuals’ attitudes about a behavior, their intention, and their behavior [ 25 ]) and tends to overlook the nuance of communication processes. However, humans are more complicated and inconsistent than these theories acknowledge. The Process orientation to communication allows for more realistic approaches that privilege the constitutive nature of communication to co-create meaning socially. In a recent scoping review of 158 studies in implementation research on maternity care, effective communication was noted as a key factor for promoting change across the body of work, but the majority of research was atheoretical and ambiguous in operationalization of communication [ 26 ].
Health communication scholars are trained to be sensitive to the cooperative nature of establishing shared meaning, multiple interpretations of behaviors, and the challenges of coordinating interactions when studying implementation strategies. Several theories, including two that pay special attention to how meaning is created socially, Coordinated Management of Meaning (CMM) [ 27 ] and Structuration Theory [ 28 ], could highlight perspectives that recognize communication as a complex process and translate well to practice. CMM is a constructivist theory that provides a practical heuristic for interpreting interpersonal communication events that comprise larger conversations. As such, CMM informs practitioners’ decision-making by illuminating patterns of interactions to find ways of talking that could result in desired outcomes [ 29 ]. Structuration Theory, coined by sociologist Anthony Giddens in the late 1970s, describes the dynamic relationship between individuals and their environment that constrains and enables social practices [ 28 ]. Through its critical lens, Structuration Theory highlights the (lack of) agency individuals perceive for themselves and others, and the rules and resources perpetuated through social interactions. Lastly, Diffusion of Innovations, a framework well-entrenched in IS research and practice, also engages a process paradigm [ 30 , 31 ]. There is ample opportunity and an imperative to employ a Process orientation to better understand communication in implementation science.
This study has multiple limitations. We did not collection demographic data to describe our participants beyond the role they held on their EWI teams. The data represents a convenience sample of administrators, implementors, and evaluators working on EWIs funded at the time of data collection, which resulted in variability in representation across EWIs and staff roles. Further, because of the diversity of foci, designs, and timelines of EWIs, we cannot draw conclusions about effectiveness of strategies discussed in this paper. Lastly, the interviews were not conducted to assess communication explicitly. Despite these limitations, our analysis facilitates concrete suggestions for improving understanding of the role of communication in implementation.
Research analyzing the role of communication from a Process orientation would enrich the field of IS. Similar to Fishman et al.’s work comparing measurement and operationalization of attitude among IS studies and those grounded in psychology, our work emphasizes the importance of interdisciplinary collaboration [ 32 ]. The interviewees and interviewers in our study focused predominantly on a Transaction orientation to communication; more studies are needed that focus on this level of distinction, particularly how to adopt a Process orientation to communication for implementation strategy specification. There is great potential for a body of knowledge about communication processes that has been systematically developed to inform IS strategies supporting a range of aspects crucial to effectiveness including Leadership Buy-in and Collaboration. Future research may do well to conduct direct observation to characterize communication processes related to implementation strategies from a rich Process orientation. Dissemination Science, as one facet of Dissemination and Implementation Science, is firmly rooted in the mechanics of communication and would greatly benefit from engaging the Process orientation. A recent scoping review demonstrated that the field of Dissemination Science lacks insight to communication from the Process orientation; in their review of dissemination determinants, the Transaction orientation persists in focusing on imparting information from one party to the next [ 33 ].
This study described instances of two broadly accepted orientations to communication engaged by implementation scientists. The findings demonstrate opportunities – and strategies – for engaging in the Process orientation of communication to gain greater insight into the role communication plays in implementation outcomes. We hope this work inspires dialogue, new interdisciplinary collaboration, and innovative methods to highlight the utility of engaging the Process orientation to communication to undergird the value of communication theory to implementation science for improving health services. When communication is understood as a process, practitioners will be better able to prepare for the unpredictability and uniqueness of the relational dimensions of communication.
The datasets presented in this article are not readily available in accordance with federal requirements and standards and guidelines for the protection of participants’ privacy and to maintain confidentiality. Requests to access the datasets should be directed to Dr. Heather Reisinger ([email protected]).
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We would like to thank the interview participants who participated in this study for their time and insights. We would also like to acknowledge Office of Rural Health (ORH) program analysts Dr. Kelly Lora Lewis, Karyn Johnstone, Nicole Sanchez, Maura Timm, Anthony Achampong, Richard Huang, and Janice Garland for their assistance, as well as Dr. Sheila Robinson, former Deputy Director of ORH, Dr. Peter Kaboli, Executive Director of ORH, and Dr. Thomas Klobucar, former Executive Director of ORH, for their support. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
VA Office of Rural Health and QUERI Project #: PEC 19–456.
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HSR, EC, JVT, NJ, EB, DJ, and JF are responsible for the concept for this manuscript. NJ drafted the initial manuscript and HSR, JVT, EC, EB, DJ, KSS, and JF contributed substantially in the form of manuscript structure and revisions. HSR developed the proposal for this project and obtained funding, with input from JVT, EB, and JM. HSR, JVT, EB, JM, and MS conducted interviews. KA and BR advised on all aspects of the project including development of the standardized evaluation reporting template and manuscript revisions.
Correspondence to Nicole L. Johnson .
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Johnson, N.L., Van Tiem, J., Balkenende, E. et al. Gaps in communication theory paradigms when conducting implementation science research: qualitative observations from interviews with administrators, implementors, and evaluators of rural health programs. Implementation Sci 19 , 66 (2024). https://doi.org/10.1186/s13012-024-01395-3
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Interviewing is an elemental aspect of ethnographic research. Ethnographic approaches to research emerged first within anthropology and sociology in the first half of the 20th century and have become popular in a range of fields, including health sciences, nursing, education, computer science, and design (Leder Mackley & Pink, 2013; Rosenberg, 2001).
Interviews are an exchange between two or more people where a researcher designs a set of questions to gather information on one or more topics (Blackstone, 2012). Interviews provide ethnographic researchers the opportunity to engage and question, with an eye toward understanding a community or group being studied.
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Importance of Ethnographic Interviewing in Research. Ethnographic interviewing stands as a cornerstone in qualitative research, offering unparalleled insights into human behavior and cultural nuances. This method allows researchers to delve deep into the lived experiences of individuals, uncovering rich narratives that quantitative data often ...
THE ETHNOGRAPHIC INTERVIEW. Ethnography is a form of qualitative research that includes descriptions of people, places, languages, events, and products. The data is collected by means of observation, interviewing, listening, and immersion with the least amount of distortion and bias. The following is an overview of interviewing.
Ethnography Uncovered: A Comprehensive Guide to Understanding People and Cultures. Ethnography is a qualitative research method that focuses on the systematic study of people and cultures. It involves observing subjects in their natural environments to better understand their cultural phenomena, beliefs, social interactions, and behaviors within a specific community or group.
It is estimated that 90 percent of all social science research uses interview data (Briggs, 1992/1986). This review will provide a historical and current overview of the role of ethnographic interviews in language and education research. To successfully examine the role of interviews in language and education research it is imperative to ...
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By far the most popular methods in ethnographic research are participant observation (see here) and unstructured interviewing (see below). Nevertheless, technology shifts mean that ethnographers are continually expanding how they search for data, utilizing new audio-visual and other, still often considered "experimental" methods as these ...
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Use of ethnographic interviewing in a clinical setting increases the clinician's understanding of the clients' viewpoints regarding their needs and preferences. This knowledge can lead to more realistic and meaningful treatment goals. ... Her current research interests include treatment approaches in aphasia and perceptions of accented ...
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Virtual ethnography: Interactive interviewing online as method. It is felt that the authors were able to sustain conversations beyond the scope of many traditional face-to-face interview sessions, noting that the participants enjoyed the process and often found it hard to quit their interactions with us.
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Building trusting relationships with participants. Building and maintaining trust with participants is a key element of ethnographic work, as trust is 'fundamental to the conduct of social action and interaction' (Atkinson Citation 2017, 21).In ethnographic research, trust is often addressed in terms of field relations, and ethnography textbooks advise researchers to perform impression ...
An interview paper is a research-based essay based on information gathered in interviews with various people. While other research papers primarily cite published print sources, interview papers draw their evidence from unpublished conversations—in person, by phone or by email. The interviewees are usually individuals with expertise in the ...
We conducted 43 interviews with 28 evaluators, 12 implementors, and 12 administrators. We coded a total of 90 segments as Collaboration (n = 46) and Leadership Buy-in (n = 44) across all the interviews.Most segments coded as Collaboration (n = 34, 74%) and Leadership Buy-in (n = 31, 70%) discussed communication from a Transaction orientation.