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Critical Incident Interviews (CII)

The Critical Incident Technique (CIT) is a set of procedures for collecting descriptions of human behaviors and categorizing them to inform practical and research applications[1]. We adapted this technique to collect information about the experiences of adults who have Sickle Cell Disease (SCD) via one-on-one interviews, called Critical Incident Interviews (CIIs) and during the patient focus groups. The CIIs were conducted during the same period of time as the focus groups. We sought to interview both adults with SCD and their providers, with the idea that the provider interviews would supplement information that was provided by patients. As with the focus groups, patients were recruited using flyers describing the study that were distributed to health care sites, and through SCD community agencies.

Recruitment and Data Gathering

Participants who were recruited for the interviews to represent a broad range of experience with SCD including both genders, a span of ages, and SCD genotypes. Interviewees were recruited from urban and rural areas in 22 states. Similarly, a variety of types of health care providers were recruited.

All 15 clinicians and 36 persons with SCD were interviewed individually by telephone. The remaining 84 persons providing critical incidents participated in the in-person focus groups. Individuals with SCD were asked to think about times that SCD had either positive or negative effects on their lives. Clinicians were asked analogous questions about individuals with SCD that they knew.

The CIIs were a highly efficient method of qualitative data collection: the 138 persons interviewed provided 1,213 critical incidents for analysis. We created the incidents by listening to tapes of the interviews, and following a prescribed format for transforming the anecdotes to text. A senior team member reviewed each incident to insure that the standards for an adequate critical incident were met: (1) The incident described a SINGLE behavior, (2) The behavior was CRITICAL to the outcome (positive or negative impact on quality of life due to SCD), (3) Another person could understand what is going on, (4) Non-essential information was eliminated, and (5) unstated inferences did not have to be made. Incidents not meeting these criteria were either sent back to the interviewer for correction or were eliminated. Sixteen incidents (1.3%) were eliminated.

Data Analysis

Qualitative data are analyzed by identifying themes or similarities among the materials provided by multiple interviews. The CITPDF icon uses a process of taxonomy development to identify themes. The CIT also uses independent analysis followed by discussion to consensus to ensure the stability and generality of the themes. Thus, the project team was then divided into two teams of two members each which independently categorized the same 200 incidents by identifying the key behavior responsible for the positive (or negative) outcome and briefly describing this behavior. The two teams met to compare their preliminary set of categories and to derive a single, agreed- upon taxonomy for the incidents. Discussions centered around the areas of difference. Solutions included convincing the other team to change their interpretations, or developing more general categories that incorporated differences or breaking down categories that were too large to accommodate the detail perceived by the other team. Additional sets of approximately 200 incidents were then categorized. The teams developed specific and higher-order categories as needed to accommodate incidents that were deemed by all to be qualitatively different from the rest. Finally, the last group of incidents resulted in the creation of only three single-incident categories within the higher-order structure; that is, no unique general themes emerged indicating saturation. The resulting 140 specific categories of incidents had been grouped into 16 summary categories : emotions; attitudes, beliefs and behaviors; family and social relationships; morbidities and co-morbidities; sexuality and reproduction; medical care; economic issues; employment issues; education; faith/spirituality; altruism; stress (control and predictability); activity limitations; housing issues; community issues; and idiosyncratic responses.

[1] Flanagan, J. (1954). The critical incident technique. Psychological Bulletin, 51(4), 327–358.