research paper on interview

Using an interview in a research paper

Consultant contributor: Viviane Ugalde

Using an interview can be an effective primary source for some papers and research projects. Finding an expert in the field or some other person who has knowledge of your topic can allow for you to gather unique information not available elsewhere.

There are four steps to using an interview as a source for your research.

Know where and how to start.
Know how to write a good question.
Know how to conduct an interview.
Know how to incorporate the interview into your document or project.

Step one: Where to start

First, you should determine your goals and ask yourself these questions:

Who are the local experts on topic?
How can I contact these people?
Does anyone know them to help me setup the interviews?
Are their phone numbers in the phone book or can I find them on the Internet?

Once you answer these questions and pick your interviewee, get their basic information such as their name, title, and other general details. If you reach out and your interview does not participate, don’t be discouraged. Keep looking for other interview contacts.

Step two: How to write a good question

When you have confirmed an interview, it is not time to come up with questions.

Learning as much as you can about the person before the interview can help you create questions specific to your interview subject.
Doing research about your interviewee’s past experience in your topic, or any texts that they have written would be great background research.

When you start to think of questions, write down more questions than you think you’ll need, and prioritize them as you go. Any good questions will answer the 5W and H questions. Asking Who, What, When, Where, Why, and How questions that you need answered for your paper, will help you form a question to ask your interviewee.

When writing a good question, try thinking of something that will help your argument.

Is your interviewee an advocate for you position?
Are they in any programs that are related to your research?
How much experience do they have?

From broad questions like these, you can begin to narrow down to more specific and open-ended questions.

Step three: The interview

If at all possible, arrange to conduct the interview at the subject’s workplace. It will make them more comfortable, and you can write about their surroundings.

Begin the interview with some small talk in order to give both of you the chance to get comfortable with one another
Develop rapport that will make the interview easier for both of you.
Ask open-ended questions
Keep the conversation moving
Stay on topic
The more silence in the room, the more honest the answer.
If an interesting subject comes up that is related to your research, ask a follow-up or an additional question about it.
Ask if you can stay in contact with your interview subject in case there are any additional questions you have.

Step four: Incorporating the interview

When picking the material out of your interview, remember that people rarely speak perfectly. There will be many slang words and pauses that you can take out, as long as it does not change the meaning of the material you are using.

As you introduce your interview in the paper, start with a transition such as “according to” or other attributions. You should also be specific to the type of interview you are working with. This way, you will build a stronger ethos in your paper .

The body of your essay should clearly set up the quote or paraphrase you use from the interview responses,. Be careful not to stick a quote from the interview into the body of your essay because it sounds good. When deciding what to quote in your paper, think about what dialogue from the interview would add the most color to your interview. Quotes that illustrate what your interviewer sounded like, or what their personality is are always the best quotes to choose from.

Once you have done that, proofread your essay. Make sure the quotes you used don’t make up the majority of your paper. The interview quotes are supposed to support your argument; you are not supposed to support the interview.

For example, let’s say that you are arguing that free education is better than not. For your argument, you interview a local politician who is on your side of the argument. Rather than using a large quote that explains the stance of both sides, and why the politician chose this side, your quote is there to support the information you’ve already given. Whatever the politician says should prove what you argue, and not give new information.

Step five: Examples of citing your interviews

Smith, Jane. Personal interview. 19 May 2018.

(E. Robbins, personal communication, January 4, 2018).

Smith also claimed that many of her students had difficulties with APA style (personal communication, November 3, 2018).

Reference list

Daly, C. & Leighton W. (2017). Interviewing a Source: Tips. Journalists Resource.

Driscoll, D. (2018 ). Interviewing. Purdue University

Hayden, K. (2012). How to Conduct an Interview to Write a Paper . Bright Hub Education, Bright Hub Inc.

Hose, C. (2017). How to Incorporate Interviews into Essays. Leaf Group Education.

Magnesi, J. (2017). How to Interview Someone for an Article or Research Paper. Career Trend, Leaf group Media.

Chapter 11. Interviewing

Introduction.

Interviewing people is at the heart of qualitative research. It is not merely a way to collect data but an intrinsically rewarding activity—an interaction between two people that holds the potential for greater understanding and interpersonal development. Unlike many of our daily interactions with others that are fairly shallow and mundane, sitting down with a person for an hour or two and really listening to what they have to say is a profound and deep enterprise, one that can provide not only “data” for you, the interviewer, but also self-understanding and a feeling of being heard for the interviewee. I always approach interviewing with a deep appreciation for the opportunity it gives me to understand how other people experience the world. That said, there is not one kind of interview but many, and some of these are shallower than others. This chapter will provide you with an overview of interview techniques but with a special focus on the in-depth semistructured interview guide approach, which is the approach most widely used in social science research.

An interview can be variously defined as “a conversation with a purpose” ( Lune and Berg 2018 ) and an attempt to understand the world from the point of view of the person being interviewed: “to unfold the meaning of peoples’ experiences, to uncover their lived world prior to scientific explanations” ( Kvale 2007 ). It is a form of active listening in which the interviewer steers the conversation to subjects and topics of interest to their research but also manages to leave enough space for those interviewed to say surprising things. Achieving that balance is a tricky thing, which is why most practitioners believe interviewing is both an art and a science. In my experience as a teacher, there are some students who are “natural” interviewers (often they are introverts), but anyone can learn to conduct interviews, and everyone, even those of us who have been doing this for years, can improve their interviewing skills. This might be a good time to highlight the fact that the interview is a product between interviewer and interviewee and that this product is only as good as the rapport established between the two participants. Active listening is the key to establishing this necessary rapport.

Patton ( 2002 ) makes the argument that we use interviews because there are certain things that are not observable. In particular, “we cannot observe feelings, thoughts, and intentions. We cannot observe behaviors that took place at some previous point in time. We cannot observe situations that preclude the presence of an observer. We cannot observe how people have organized the world and the meanings they attach to what goes on in the world. We have to ask people questions about those things” ( 341 ).

Types of Interviews

There are several distinct types of interviews. Imagine a continuum (figure 11.1). On one side are unstructured conversations—the kind you have with your friends. No one is in control of those conversations, and what you talk about is often random—whatever pops into your head. There is no secret, underlying purpose to your talking—if anything, the purpose is to talk to and engage with each other, and the words you use and the things you talk about are a little beside the point. An unstructured interview is a little like this informal conversation, except that one of the parties to the conversation (you, the researcher) does have an underlying purpose, and that is to understand the other person. You are not friends speaking for no purpose, but it might feel just as unstructured to the “interviewee” in this scenario. That is one side of the continuum. On the other side are fully structured and standardized survey-type questions asked face-to-face. Here it is very clear who is asking the questions and who is answering them. This doesn’t feel like a conversation at all! A lot of people new to interviewing have this ( erroneously !) in mind when they think about interviews as data collection. Somewhere in the middle of these two extreme cases is the “ semistructured” interview , in which the researcher uses an “interview guide” to gently move the conversation to certain topics and issues. This is the primary form of interviewing for qualitative social scientists and will be what I refer to as interviewing for the rest of this chapter, unless otherwise specified.

Types of Interviewing Questions: Unstructured conversations, Semi-structured interview, Structured interview, Survey questions

Informal (unstructured conversations). This is the most “open-ended” approach to interviewing. It is particularly useful in conjunction with observational methods (see chapters 13 and 14). There are no predetermined questions. Each interview will be different. Imagine you are researching the Oregon Country Fair, an annual event in Veneta, Oregon, that includes live music, artisan craft booths, face painting, and a lot of people walking through forest paths. It’s unlikely that you will be able to get a person to sit down with you and talk intensely about a set of questions for an hour and a half. But you might be able to sidle up to several people and engage with them about their experiences at the fair. You might have a general interest in what attracts people to these events, so you could start a conversation by asking strangers why they are here or why they come back every year. That’s it. Then you have a conversation that may lead you anywhere. Maybe one person tells a long story about how their parents brought them here when they were a kid. A second person talks about how this is better than Burning Man. A third person shares their favorite traveling band. And yet another enthuses about the public library in the woods. During your conversations, you also talk about a lot of other things—the weather, the utilikilts for sale, the fact that a favorite food booth has disappeared. It’s all good. You may not be able to record these conversations. Instead, you might jot down notes on the spot and then, when you have the time, write down as much as you can remember about the conversations in long fieldnotes. Later, you will have to sit down with these fieldnotes and try to make sense of all the information (see chapters 18 and 19).

Interview guide ( semistructured interview ). This is the primary type employed by social science qualitative researchers. The researcher creates an “interview guide” in advance, which she uses in every interview. In theory, every person interviewed is asked the same questions. In practice, every person interviewed is asked mostly the same topics but not always the same questions, as the whole point of a “guide” is that it guides the direction of the conversation but does not command it. The guide is typically between five and ten questions or question areas, sometimes with suggested follow-ups or prompts . For example, one question might be “What was it like growing up in Eastern Oregon?” with prompts such as “Did you live in a rural area? What kind of high school did you attend?” to help the conversation develop. These interviews generally take place in a quiet place (not a busy walkway during a festival) and are recorded. The recordings are transcribed, and those transcriptions then become the “data” that is analyzed (see chapters 18 and 19). The conventional length of one of these types of interviews is between one hour and two hours, optimally ninety minutes. Less than one hour doesn’t allow for much development of questions and thoughts, and two hours (or more) is a lot of time to ask someone to sit still and answer questions. If you have a lot of ground to cover, and the person is willing, I highly recommend two separate interview sessions, with the second session being slightly shorter than the first (e.g., ninety minutes the first day, sixty minutes the second). There are lots of good reasons for this, but the most compelling one is that this allows you to listen to the first day’s recording and catch anything interesting you might have missed in the moment and so develop follow-up questions that can probe further. This also allows the person being interviewed to have some time to think about the issues raised in the interview and go a little deeper with their answers.

Standardized questionnaire with open responses ( structured interview ). This is the type of interview a lot of people have in mind when they hear “interview”: a researcher comes to your door with a clipboard and proceeds to ask you a series of questions. These questions are all the same whoever answers the door; they are “standardized.” Both the wording and the exact order are important, as people’s responses may vary depending on how and when a question is asked. These are qualitative only in that the questions allow for “open-ended responses”: people can say whatever they want rather than select from a predetermined menu of responses. For example, a survey I collaborated on included this open-ended response question: “How does class affect one’s career success in sociology?” Some of the answers were simply one word long (e.g., “debt”), and others were long statements with stories and personal anecdotes. It is possible to be surprised by the responses. Although it’s a stretch to call this kind of questioning a conversation, it does allow the person answering the question some degree of freedom in how they answer.

Survey questionnaire with closed responses (not an interview!). Standardized survey questions with specific answer options (e.g., closed responses) are not really interviews at all, and they do not generate qualitative data. For example, if we included five options for the question “How does class affect one’s career success in sociology?”—(1) debt, (2) social networks, (3) alienation, (4) family doesn’t understand, (5) type of grad program—we leave no room for surprises at all. Instead, we would most likely look at patterns around these responses, thinking quantitatively rather than qualitatively (e.g., using regression analysis techniques, we might find that working-class sociologists were twice as likely to bring up alienation). It can sometimes be confusing for new students because the very same survey can include both closed-ended and open-ended questions. The key is to think about how these will be analyzed and to what level surprises are possible. If your plan is to turn all responses into a number and make predictions about correlations and relationships, you are no longer conducting qualitative research. This is true even if you are conducting this survey face-to-face with a real live human. Closed-response questions are not conversations of any kind, purposeful or not.

In summary, the semistructured interview guide approach is the predominant form of interviewing for social science qualitative researchers because it allows a high degree of freedom of responses from those interviewed (thus allowing for novel discoveries) while still maintaining some connection to a research question area or topic of interest. The rest of the chapter assumes the employment of this form.

Creating an Interview Guide

Your interview guide is the instrument used to bridge your research question(s) and what the people you are interviewing want to tell you. Unlike a standardized questionnaire, the questions actually asked do not need to be exactly what you have written down in your guide. The guide is meant to create space for those you are interviewing to talk about the phenomenon of interest, but sometimes you are not even sure what that phenomenon is until you start asking questions. A priority in creating an interview guide is to ensure it offers space. One of the worst mistakes is to create questions that are so specific that the person answering them will not stray. Relatedly, questions that sound “academic” will shut down a lot of respondents. A good interview guide invites respondents to talk about what is important to them, not feel like they are performing or being evaluated by you.

Good interview questions should not sound like your “research question” at all. For example, let’s say your research question is “How do patriarchal assumptions influence men’s understanding of climate change and responses to climate change?” It would be worse than unhelpful to ask a respondent, “How do your assumptions about the role of men affect your understanding of climate change?” You need to unpack this into manageable nuggets that pull your respondent into the area of interest without leading him anywhere. You could start by asking him what he thinks about climate change in general. Or, even better, whether he has any concerns about heatwaves or increased tornadoes or polar icecaps melting. Once he starts talking about that, you can ask follow-up questions that bring in issues around gendered roles, perhaps asking if he is married (to a woman) and whether his wife shares his thoughts and, if not, how they negotiate that difference. The fact is, you won’t really know the right questions to ask until he starts talking.

There are several distinct types of questions that can be used in your interview guide, either as main questions or as follow-up probes. If you remember that the point is to leave space for the respondent, you will craft a much more effective interview guide! You will also want to think about the place of time in both the questions themselves (past, present, future orientations) and the sequencing of the questions.

Researcher Note

Suggestion : As you read the next three sections (types of questions, temporality, question sequence), have in mind a particular research question, and try to draft questions and sequence them in a way that opens space for a discussion that helps you answer your research question.

Type of Questions

Experience and behavior questions ask about what a respondent does regularly (their behavior) or has done (their experience). These are relatively easy questions for people to answer because they appear more “factual” and less subjective. This makes them good opening questions. For the study on climate change above, you might ask, “Have you ever experienced an unusual weather event? What happened?” Or “You said you work outside? What is a typical summer workday like for you? How do you protect yourself from the heat?”

Opinion and values questions , in contrast, ask questions that get inside the minds of those you are interviewing. “Do you think climate change is real? Who or what is responsible for it?” are two such questions. Note that you don’t have to literally ask, “What is your opinion of X?” but you can find a way to ask the specific question relevant to the conversation you are having. These questions are a bit trickier to ask because the answers you get may depend in part on how your respondent perceives you and whether they want to please you or not. We’ve talked a fair amount about being reflective. Here is another place where this comes into play. You need to be aware of the effect your presence might have on the answers you are receiving and adjust accordingly. If you are a woman who is perceived as liberal asking a man who identifies as conservative about climate change, there is a lot of subtext that can be going on in the interview. There is no one right way to resolve this, but you must at least be aware of it.

Feeling questions are questions that ask respondents to draw on their emotional responses. It’s pretty common for academic researchers to forget that we have bodies and emotions, but people’s understandings of the world often operate at this affective level, sometimes unconsciously or barely consciously. It is a good idea to include questions that leave space for respondents to remember, imagine, or relive emotional responses to particular phenomena. “What was it like when you heard your cousin’s house burned down in that wildfire?” doesn’t explicitly use any emotion words, but it allows your respondent to remember what was probably a pretty emotional day. And if they respond emotionally neutral, that is pretty interesting data too. Note that asking someone “How do you feel about X” is not always going to evoke an emotional response, as they might simply turn around and respond with “I think that…” It is better to craft a question that actually pushes the respondent into the affective category. This might be a specific follow-up to an experience and behavior question —for example, “You just told me about your daily routine during the summer heat. Do you worry it is going to get worse?” or “Have you ever been afraid it will be too hot to get your work accomplished?”

Knowledge questions ask respondents what they actually know about something factual. We have to be careful when we ask these types of questions so that respondents do not feel like we are evaluating them (which would shut them down), but, for example, it is helpful to know when you are having a conversation about climate change that your respondent does in fact know that unusual weather events have increased and that these have been attributed to climate change! Asking these questions can set the stage for deeper questions and can ensure that the conversation makes the same kind of sense to both participants. For example, a conversation about political polarization can be put back on track once you realize that the respondent doesn’t really have a clear understanding that there are two parties in the US. Instead of asking a series of questions about Republicans and Democrats, you might shift your questions to talk more generally about political disagreements (e.g., “people against abortion”). And sometimes what you do want to know is the level of knowledge about a particular program or event (e.g., “Are you aware you can discharge your student loans through the Public Service Loan Forgiveness program?”).

Sensory questions call on all senses of the respondent to capture deeper responses. These are particularly helpful in sparking memory. “Think back to your childhood in Eastern Oregon. Describe the smells, the sounds…” Or you could use these questions to help a person access the full experience of a setting they customarily inhabit: “When you walk through the doors to your office building, what do you see? Hear? Smell?” As with feeling questions , these questions often supplement experience and behavior questions . They are another way of allowing your respondent to report fully and deeply rather than remain on the surface.

Creative questions employ illustrative examples, suggested scenarios, or simulations to get respondents to think more deeply about an issue, topic, or experience. There are many options here. In The Trouble with Passion , Erin Cech ( 2021 ) provides a scenario in which “Joe” is trying to decide whether to stay at his decent but boring computer job or follow his passion by opening a restaurant. She asks respondents, “What should Joe do?” Their answers illuminate the attraction of “passion” in job selection. In my own work, I have used a news story about an upwardly mobile young man who no longer has time to see his mother and sisters to probe respondents’ feelings about the costs of social mobility. Jessi Streib and Betsy Leondar-Wright have used single-page cartoon “scenes” to elicit evaluations of potential racial discrimination, sexual harassment, and classism. Barbara Sutton ( 2010 ) has employed lists of words (“strong,” “mother,” “victim”) on notecards she fans out and asks her female respondents to select and discuss.

Background/Demographic Questions

You most definitely will want to know more about the person you are interviewing in terms of conventional demographic information, such as age, race, gender identity, occupation, and educational attainment. These are not questions that normally open up inquiry. [1] For this reason, my practice has been to include a separate “demographic questionnaire” sheet that I ask each respondent to fill out at the conclusion of the interview. Only include those aspects that are relevant to your study. For example, if you are not exploring religion or religious affiliation, do not include questions about a person’s religion on the demographic sheet. See the example provided at the end of this chapter.

Temporality

Any type of question can have a past, present, or future orientation. For example, if you are asking a behavior question about workplace routine, you might ask the respondent to talk about past work, present work, and ideal (future) work. Similarly, if you want to understand how people cope with natural disasters, you might ask your respondent how they felt then during the wildfire and now in retrospect and whether and to what extent they have concerns for future wildfire disasters. It’s a relatively simple suggestion—don’t forget to ask about past, present, and future—but it can have a big impact on the quality of the responses you receive.

Question Sequence

Having a list of good questions or good question areas is not enough to make a good interview guide. You will want to pay attention to the order in which you ask your questions. Even though any one respondent can derail this order (perhaps by jumping to answer a question you haven’t yet asked), a good advance plan is always helpful. When thinking about sequence, remember that your goal is to get your respondent to open up to you and to say things that might surprise you. To establish rapport, it is best to start with nonthreatening questions. Asking about the present is often the safest place to begin, followed by the past (they have to know you a little bit to get there), and lastly, the future (talking about hopes and fears requires the most rapport). To allow for surprises, it is best to move from very general questions to more particular questions only later in the interview. This ensures that respondents have the freedom to bring up the topics that are relevant to them rather than feel like they are constrained to answer you narrowly. For example, refrain from asking about particular emotions until these have come up previously—don’t lead with them. Often, your more particular questions will emerge only during the course of the interview, tailored to what is emerging in conversation.

Once you have a set of questions, read through them aloud and imagine you are being asked the same questions. Does the set of questions have a natural flow? Would you be willing to answer the very first question to a total stranger? Does your sequence establish facts and experiences before moving on to opinions and values? Did you include prefatory statements, where necessary; transitions; and other announcements? These can be as simple as “Hey, we talked a lot about your experiences as a barista while in college.… Now I am turning to something completely different: how you managed friendships in college.” That is an abrupt transition, but it has been softened by your acknowledgment of that.

Probes and Flexibility

Once you have the interview guide, you will also want to leave room for probes and follow-up questions. As in the sample probe included here, you can write out the obvious probes and follow-up questions in advance. You might not need them, as your respondent might anticipate them and include full responses to the original question. Or you might need to tailor them to how your respondent answered the question. Some common probes and follow-up questions include asking for more details (When did that happen? Who else was there?), asking for elaboration (Could you say more about that?), asking for clarification (Does that mean what I think it means or something else? I understand what you mean, but someone else reading the transcript might not), and asking for contrast or comparison (How did this experience compare with last year’s event?). “Probing is a skill that comes from knowing what to look for in the interview, listening carefully to what is being said and what is not said, and being sensitive to the feedback needs of the person being interviewed” ( Patton 2002:374 ). It takes work! And energy. I and many other interviewers I know report feeling emotionally and even physically drained after conducting an interview. You are tasked with active listening and rearranging your interview guide as needed on the fly. If you only ask the questions written down in your interview guide with no deviations, you are doing it wrong. [2]

The Final Question

Every interview guide should include a very open-ended final question that allows for the respondent to say whatever it is they have been dying to tell you but you’ve forgotten to ask. About half the time they are tired too and will tell you they have nothing else to say. But incredibly, some of the most honest and complete responses take place here, at the end of a long interview. You have to realize that the person being interviewed is often discovering things about themselves as they talk to you and that this process of discovery can lead to new insights for them. Making space at the end is therefore crucial. Be sure you convey that you actually do want them to tell you more, that the offer of “anything else?” is not read as an empty convention where the polite response is no. Here is where you can pull from that active listening and tailor the final question to the particular person. For example, “I’ve asked you a lot of questions about what it was like to live through that wildfire. I’m wondering if there is anything I’ve forgotten to ask, especially because I haven’t had that experience myself” is a much more inviting final question than “Great. Anything you want to add?” It’s also helpful to convey to the person that you have the time to listen to their full answer, even if the allotted time is at the end. After all, there are no more questions to ask, so the respondent knows exactly how much time is left. Do them the courtesy of listening to them!

Conducting the Interview

Once you have your interview guide, you are on your way to conducting your first interview. I always practice my interview guide with a friend or family member. I do this even when the questions don’t make perfect sense for them, as it still helps me realize which questions make no sense, are poorly worded (too academic), or don’t follow sequentially. I also practice the routine I will use for interviewing, which goes something like this:

Introduce myself and reintroduce the study
Provide consent form and ask them to sign and retain/return copy
Ask if they have any questions about the study before we begin
Ask if I can begin recording
Ask questions (from interview guide)
Turn off the recording device
Ask if they are willing to fill out my demographic questionnaire
Collect questionnaire and, without looking at the answers, place in same folder as signed consent form
Thank them and depart

A note on remote interviewing: Interviews have traditionally been conducted face-to-face in a private or quiet public setting. You don’t want a lot of background noise, as this will make transcriptions difficult. During the recent global pandemic, many interviewers, myself included, learned the benefits of interviewing remotely. Although face-to-face is still preferable for many reasons, Zoom interviewing is not a bad alternative, and it does allow more interviews across great distances. Zoom also includes automatic transcription, which significantly cuts down on the time it normally takes to convert our conversations into “data” to be analyzed. These automatic transcriptions are not perfect, however, and you will still need to listen to the recording and clarify and clean up the transcription. Nor do automatic transcriptions include notations of body language or change of tone, which you may want to include. When interviewing remotely, you will want to collect the consent form before you meet: ask them to read, sign, and return it as an email attachment. I think it is better to ask for the demographic questionnaire after the interview, but because some respondents may never return it then, it is probably best to ask for this at the same time as the consent form, in advance of the interview.

What should you bring to the interview? I would recommend bringing two copies of the consent form (one for you and one for the respondent), a demographic questionnaire, a manila folder in which to place the signed consent form and filled-out demographic questionnaire, a printed copy of your interview guide (I print with three-inch right margins so I can jot down notes on the page next to relevant questions), a pen, a recording device, and water.

After the interview, you will want to secure the signed consent form in a locked filing cabinet (if in print) or a password-protected folder on your computer. Using Excel or a similar program that allows tables/spreadsheets, create an identifying number for your interview that links to the consent form without using the name of your respondent. For example, let’s say that I conduct interviews with US politicians, and the first person I meet with is George W. Bush. I will assign the transcription the number “INT#001” and add it to the signed consent form. [3] The signed consent form goes into a locked filing cabinet, and I never use the name “George W. Bush” again. I take the information from the demographic sheet, open my Excel spreadsheet, and add the relevant information in separate columns for the row INT#001: White, male, Republican. When I interview Bill Clinton as my second interview, I include a second row: INT#002: White, male, Democrat. And so on. The only link to the actual name of the respondent and this information is the fact that the consent form (unavailable to anyone but me) has stamped on it the interview number.

Many students get very nervous before their first interview. Actually, many of us are always nervous before the interview! But do not worry—this is normal, and it does pass. Chances are, you will be pleasantly surprised at how comfortable it begins to feel. These “purposeful conversations” are often a delight for both participants. This is not to say that sometimes things go wrong. I often have my students practice several “bad scenarios” (e.g., a respondent that you cannot get to open up; a respondent who is too talkative and dominates the conversation, steering it away from the topics you are interested in; emotions that completely take over; or shocking disclosures you are ill-prepared to handle), but most of the time, things go quite well. Be prepared for the unexpected, but know that the reason interviews are so popular as a technique of data collection is that they are usually richly rewarding for both participants.

One thing that I stress to my methods students and remind myself about is that interviews are still conversations between people. If there’s something you might feel uncomfortable asking someone about in a “normal” conversation, you will likely also feel a bit of discomfort asking it in an interview. Maybe more importantly, your respondent may feel uncomfortable. Social research—especially about inequality—can be uncomfortable. And it’s easy to slip into an abstract, intellectualized, or removed perspective as an interviewer. This is one reason trying out interview questions is important. Another is that sometimes the question sounds good in your head but doesn’t work as well out loud in practice. I learned this the hard way when a respondent asked me how I would answer the question I had just posed, and I realized that not only did I not really know how I would answer it, but I also wasn’t quite as sure I knew what I was asking as I had thought.

—Elizabeth M. Lee, Associate Professor of Sociology at Saint Joseph’s University, author of Class and Campus Life , and co-author of Geographies of Campus Inequality

How Many Interviews?

Your research design has included a targeted number of interviews and a recruitment plan (see chapter 5). Follow your plan, but remember that “ saturation ” is your goal. You interview as many people as you can until you reach a point at which you are no longer surprised by what they tell you. This means not that no one after your first twenty interviews will have surprising, interesting stories to tell you but rather that the picture you are forming about the phenomenon of interest to you from a research perspective has come into focus, and none of the interviews are substantially refocusing that picture. That is when you should stop collecting interviews. Note that to know when you have reached this, you will need to read your transcripts as you go. More about this in chapters 18 and 19.

Your Final Product: The Ideal Interview Transcript

A good interview transcript will demonstrate a subtly controlled conversation by the skillful interviewer. In general, you want to see replies that are about one paragraph long, not short sentences and not running on for several pages. Although it is sometimes necessary to follow respondents down tangents, it is also often necessary to pull them back to the questions that form the basis of your research study. This is not really a free conversation, although it may feel like that to the person you are interviewing.

Final Tips from an Interview Master

Annette Lareau is arguably one of the masters of the trade. In Listening to People , she provides several guidelines for good interviews and then offers a detailed example of an interview gone wrong and how it could be addressed (please see the “Further Readings” at the end of this chapter). Here is an abbreviated version of her set of guidelines: (1) interview respondents who are experts on the subjects of most interest to you (as a corollary, don’t ask people about things they don’t know); (2) listen carefully and talk as little as possible; (3) keep in mind what you want to know and why you want to know it; (4) be a proactive interviewer (subtly guide the conversation); (5) assure respondents that there aren’t any right or wrong answers; (6) use the respondent’s own words to probe further (this both allows you to accurately identify what you heard and pushes the respondent to explain further); (7) reuse effective probes (don’t reinvent the wheel as you go—if repeating the words back works, do it again and again); (8) focus on learning the subjective meanings that events or experiences have for a respondent; (9) don’t be afraid to ask a question that draws on your own knowledge (unlike trial lawyers who are trained never to ask a question for which they don’t already know the answer, sometimes it’s worth it to ask risky questions based on your hypotheses or just plain hunches); (10) keep thinking while you are listening (so difficult…and important); (11) return to a theme raised by a respondent if you want further information; (12) be mindful of power inequalities (and never ever coerce a respondent to continue the interview if they want out); (13) take control with overly talkative respondents; (14) expect overly succinct responses, and develop strategies for probing further; (15) balance digging deep and moving on; (16) develop a plan to deflect questions (e.g., let them know you are happy to answer any questions at the end of the interview, but you don’t want to take time away from them now); and at the end, (17) check to see whether you have asked all your questions. You don’t always have to ask everyone the same set of questions, but if there is a big area you have forgotten to cover, now is the time to recover ( Lareau 2021:93–103 ).

Sample: Demographic Questionnaire

ASA Taskforce on First-Generation and Working-Class Persons in Sociology – Class Effects on Career Success

Supplementary Demographic Questionnaire

Thank you for your participation in this interview project. We would like to collect a few pieces of key demographic information from you to supplement our analyses. Your answers to these questions will be kept confidential and stored by ID number. All of your responses here are entirely voluntary!

What best captures your race/ethnicity? (please check any/all that apply)

White (Non Hispanic/Latina/o/x)
Black or African American
Hispanic, Latino/a/x of Spanish
Asian or Asian American
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
Other : (Please write in: ________________)

What is your current position?

Grad Student
Full Professor

Please check any and all of the following that apply to you:

I identify as a working-class academic
I was the first in my family to graduate from college
I grew up poor

What best reflects your gender?

Transgender female/Transgender woman
Transgender male/Transgender man
Gender queer/ Gender nonconforming

Anything else you would like us to know about you?

Example: Interview Guide

In this example, follow-up prompts are italicized. Note the sequence of questions. That second question often elicits an entire life history , answering several later questions in advance.

Introduction Script/Question

Thank you for participating in our survey of ASA members who identify as first-generation or working-class. As you may have heard, ASA has sponsored a taskforce on first-generation and working-class persons in sociology and we are interested in hearing from those who so identify. Your participation in this interview will help advance our knowledge in this area.

The first thing we would like to as you is why you have volunteered to be part of this study? What does it mean to you be first-gen or working class? Why were you willing to be interviewed?
How did you decide to become a sociologist?
Can you tell me a little bit about where you grew up? ( prompts: what did your parent(s) do for a living? What kind of high school did you attend?)
Has this identity been salient to your experience? (how? How much?)
How welcoming was your grad program? Your first academic employer?
Why did you decide to pursue sociology at the graduate level?
Did you experience culture shock in college? In graduate school?
Has your FGWC status shaped how you’ve thought about where you went to school? debt? etc?
Were you mentored? How did this work (not work)? How might it?
What did you consider when deciding where to go to grad school? Where to apply for your first position?
What, to you, is a mark of career success? Have you achieved that success? What has helped or hindered your pursuit of success?
Do you think sociology, as a field, cares about prestige?
Let’s talk a little bit about intersectionality. How does being first-gen/working class work alongside other identities that are important to you?
What do your friends and family think about your career? Have you had any difficulty relating to family members or past friends since becoming highly educated?
Do you have any debt from college/grad school? Are you concerned about this? Could you explain more about how you paid for college/grad school? (here, include assistance from family, fellowships, scholarships, etc.)
(You’ve mentioned issues or obstacles you had because of your background.) What could have helped? Or, who or what did? Can you think of fortuitous moments in your career?
Do you have any regrets about the path you took?
Is there anything else you would like to add? Anything that the Taskforce should take note of, that we did not ask you about here?

Qualitative Research 101: Interviewing

5 Common Mistakes To Avoid When Undertaking Interviews

By: David Phair (PhD) and Kerryn Warren (PhD) | March 2022

Undertaking interviews is potentially the most important step in the qualitative research process. If you don’t collect useful, useable data in your interviews, you’ll struggle through the rest of your dissertation or thesis. Having helped numerous students with their research over the years, we’ve noticed some common interviewing mistakes that first-time researchers make. In this post, we’ll discuss five costly interview-related mistakes and outline useful strategies to avoid making these.

Overview: 5 Interviewing Mistakes

Not having a clear interview strategy /plan
Not having good interview techniques /skills
Not securing a suitable location and equipment
Not having a basic risk management plan
Not keeping your “ golden thread ” front of mind

1. Not having a clear interview strategy

The first common mistake that we’ll look at is that of starting the interviewing process without having first come up with a clear interview strategy or plan of action. While it’s natural to be keen to get started engaging with your interviewees, a lack of planning can result in a mess of data and inconsistency between interviews.

There are several design choices to decide on and plan for before you start interviewing anyone. Some of the most important questions you need to ask yourself before conducting interviews include:

What are the guiding research aims and research questions of my study?
Will I use a structured, semi-structured or unstructured interview approach?
How will I record the interviews (audio or video)?
Who will be interviewed and by whom ?
What ethics and data law considerations do I need to adhere to?
How will I analyze my data?

Let’s take a quick look at some of these.

The core objective of the interviewing process is to generate useful data that will help you address your overall research aims. Therefore, your interviews need to be conducted in a way that directly links to your research aims, objectives and research questions (i.e. your “golden thread”). This means that you need to carefully consider the questions you’ll ask to ensure that they align with and feed into your golden thread. If any question doesn’t align with this, you may want to consider scrapping it.

Another important design choice is whether you’ll use an unstructured, semi-structured or structured interview approach . For semi-structured interviews, you will have a list of questions that you plan to ask and these questions will be open-ended in nature. You’ll also allow the discussion to digress from the core question set if something interesting comes up. This means that the type of information generated might differ a fair amount between interviews.

Contrasted to this, a structured approach to interviews is more rigid, where a specific set of closed questions is developed and asked for each interviewee in exactly the same order. Closed questions have a limited set of answers, that are often single-word answers. Therefore, you need to think about what you’re trying to achieve with your research project (i.e. your research aims) and decided on which approach would be best suited in your case.

It is also important to plan ahead with regards to who will be interviewed and how. You need to think about how you will approach the possible interviewees to get their cooperation, who will conduct the interviews, when to conduct the interviews and how to record the interviews. For each of these decisions, it’s also essential to make sure that all ethical considerations and data protection laws are taken into account.

Finally, you should think through how you plan to analyze the data (i.e., your qualitative analysis method) generated by the interviews. Different types of analysis rely on different types of data, so you need to ensure you’re asking the right types of questions and correctly guiding your respondents.

Simply put, you need to have a plan of action regarding the specifics of your interview approach before you start collecting data. If not, you’ll end up drifting in your approach from interview to interview, which will result in inconsistent, unusable data.

Your interview questions need to directly link to your research aims, objectives and research questions - your "golden thread”.

2. Not having good interview technique

While you’re generally not expected to become you to be an expert interviewer for a dissertation or thesis, it is important to practice good interview technique and develop basic interviewing skills .

Let’s go through some basics that will help the process along.

Firstly, before the interview , make sure you know your interview questions well and have a clear idea of what you want from the interview. Naturally, the specificity of your questions will depend on whether you’re taking a structured, semi-structured or unstructured approach, but you still need a consistent starting point . Ideally, you should develop an interview guide beforehand (more on this later) that details your core question and links these to the research aims, objectives and research questions.

Before you undertake any interviews, it’s a good idea to do a few mock interviews with friends or family members. This will help you get comfortable with the interviewer role, prepare for potentially unexpected answers and give you a good idea of how long the interview will take to conduct. In the interviewing process, you’re likely to encounter two kinds of challenging interviewees ; the two-word respondent and the respondent who meanders and babbles. Therefore, you should prepare yourself for both and come up with a plan to respond to each in a way that will allow the interview to continue productively.

To begin the formal interview , provide the person you are interviewing with an overview of your research. This will help to calm their nerves (and yours) and contextualize the interaction. Ultimately, you want the interviewee to feel comfortable and be willing to be open and honest with you, so it’s useful to start in a more casual, relaxed fashion and allow them to ask any questions they may have. From there, you can ease them into the rest of the questions.

As the interview progresses , avoid asking leading questions (i.e., questions that assume something about the interviewee or their response). Make sure that you speak clearly and slowly , using plain language and being ready to paraphrase questions if the person you are interviewing misunderstands. Be particularly careful with interviewing English second language speakers to ensure that you’re both on the same page.

Engage with the interviewee by listening to them carefully and acknowledging that you are listening to them by smiling or nodding. Show them that you’re interested in what they’re saying and thank them for their openness as appropriate. This will also encourage your interviewee to respond openly.

Need a helping hand?

3. Not securing a suitable location and quality equipment

Where you conduct your interviews and the equipment you use to record them both play an important role in how the process unfolds. Therefore, you need to think carefully about each of these variables before you start interviewing.

Poor location: A bad location can result in the quality of your interviews being compromised, interrupted, or cancelled. If you are conducting physical interviews, you’ll need a location that is quiet, safe, and welcoming . It’s very important that your location of choice is not prone to interruptions (the workplace office is generally problematic, for example) and has suitable facilities (such as water, a bathroom, and snacks).

If you are conducting online interviews , you need to consider a few other factors. Importantly, you need to make sure that both you and your respondent have access to a good, stable internet connection and electricity. Always check before the time that both of you know how to use the relevant software and it’s accessible (sometimes meeting platforms are blocked by workplace policies or firewalls). It’s also good to have alternatives in place (such as WhatsApp, Zoom, or Teams) to cater for these types of issues.

Poor equipment: Using poor-quality recording equipment or using equipment incorrectly means that you will have trouble transcribing, coding, and analyzing your interviews. This can be a major issue , as some of your interview data may go completely to waste if not recorded well. So, make sure that you use good-quality recording equipment and that you know how to use it correctly.

To avoid issues, you should always conduct test recordings before every interview to ensure that you can use the relevant equipment properly. It’s also a good idea to spot check each recording afterwards, just to make sure it was recorded as planned. If your equipment uses batteries, be sure to always carry a spare set.

Where you conduct your interviews and the equipment you use to record them play an important role in how the process unfolds.

4. Not having a basic risk management plan

Many possible issues can arise during the interview process. Not planning for these issues can mean that you are left with compromised data that might not be useful to you. Therefore, it’s important to map out some sort of risk management plan ahead of time, considering the potential risks, how you’ll minimize their probability and how you’ll manage them if they materialize.

Common potential issues related to the actual interview include cancellations (people pulling out), delays (such as getting stuck in traffic), language and accent differences (especially in the case of poor internet connections), issues with internet connections and power supply. Other issues can also occur in the interview itself. For example, the interviewee could drift off-topic, or you might encounter an interviewee who does not say much at all.

You can prepare for these potential issues by considering possible worst-case scenarios and preparing a response for each scenario. For instance, it is important to plan a backup date just in case your interviewee cannot make it to the first meeting you scheduled with them. It’s also a good idea to factor in a 30-minute gap between your interviews for the instances where someone might be late, or an interview runs overtime for other reasons. Make sure that you also plan backup questions that could be used to bring a respondent back on topic if they start rambling, or questions to encourage those who are saying too little.

In general, it’s best practice to plan to conduct more interviews than you think you need (this is called oversampling ). Doing so will allow you some room for error if there are interviews that don’t go as planned, or if some interviewees withdraw. If you need 10 interviews, it is a good idea to plan for 15. Likely, a few will cancel , delay, or not produce useful data.

You should consider all the potential risks, how you’ll reduce their probability and how you'll respond if they do indeed materialize.

5. Not keeping your golden thread front of mind

We touched on this a little earlier, but it is a key point that should be central to your entire research process. You don’t want to end up with pages and pages of data after conducting your interviews and realize that it is not useful to your research aims . Your research aims, objectives and research questions – i.e., your golden thread – should influence every design decision and should guide the interview process at all times.

A useful way to avoid this mistake is by developing an interview guide before you begin interviewing your respondents. An interview guide is a document that contains all of your questions with notes on how each of the interview questions is linked to the research question(s) of your study. You can also include your research aims and objectives here for a more comprehensive linkage.

You can easily create an interview guide by drawing up a table with one column containing your core interview questions . Then add another column with your research questions , another with expectations that you may have in light of the relevant literature and another with backup or follow-up questions . As mentioned, you can also bring in your research aims and objectives to help you connect them all together. If you’d like, you can download a copy of our free interview guide here .

Recap: Qualitative Interview Mistakes

In this post, we’ve discussed 5 common costly mistakes that are easy to make in the process of planning and conducting qualitative interviews.

To recap, these include:

If you have any questions about these interviewing mistakes, drop a comment below. Alternatively, if you’re interested in getting 1-on-1 help with your thesis or dissertation , check out our dissertation coaching service or book a free initial consultation with one of our friendly Grad Coaches.

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Methodology

How Do You Incorporate an Interview into a Dissertation? | Tips

Published on November 5, 2014 by Bas Swaen . Revised on December 19, 2022.

You have performed qualitative research for your dissertation by conducting interviews that you now want to include: how do you do that? Chances are that this was never explained to you and you don’t know what is expected. That’s why in this article we describe how interviews can be included in, for instance, the discussion section of your dissertation and how they can be referenced.

Including interviews in your dissertation, referring to interviews, quoting from interviews, mentioning the name of the interviewee.

To present interviews in a dissertation, you first need to transcribe your interviews . You can use transcription software for this. You can then add the written interviews to the appendix. If you have many or long interviews that make the appendix extremely long, the appendix (after consultation with the supervisor) can be submitted as a separate document. What matters is that you can demonstrate that the interviews have actually taken place.

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When you have added the interviews to the appendix, you can then paraphrase to them in your dissertation. Paraphrasing is done as follows:

It became clear from an interview with Y that … (Appendix 1).

Sometimes you are not allowed to add the transcription of an interview to the appendix. In this case it is not possible to refer to this interview. According to the APA Style it is possible to refer to it like this:

APA interview citation MLA interview citation

If you literally copy the words of the interviewee, then you need to quote . Finding interesting quotes is easier if you know how to get usable information out of the person during the interview. That’s why you should conduct the interviews in a professional manner.

Don’t just blindly note the name of the person you’re interviewing, but ask yourself two questions:

Are you allowed to mention the name? This is the first question you should ask yourself before you include the interviewee’s name in a dissertation . Determine, in consultation with the interviewee, whether the name should be anonymized (and get informed consent). Sometimes, in fact, the interviewee doesn’t want that. This may be the case when you have interviewed, for example, an employee and the employee does not want his or her boss to be able to read the answers because this could disturb their working relationship. Another situation where this can occur is, for example, when the interview contains very personal questions.
Does it add anything to mention the name? The second factor to consider is whether it is relevant to mention the name. Does it add anything to your research? When the interviewee is an unknown person you have approached on the street, the name of this person is not very important. But if you have interviewed the CEO of a large organization, then it can be very relevant to mention their name. In this second case, add a short introduction so that the reader of the dissertation knows immediately who this person is.

Thus, you may mention the name if you have permission from the interviewee to do so and if it is relevant to the research. If you don’t have permission to use the name or if you don’t want to mention the name, you can then choose to use a description. For example: “Employee 1”.

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Interview Research

Research Methods Guide: Interview Research

Introduction
Research Design & Method
Survey Research
Data Analysis
Resources & Consultation

Tutorial Videos: Interview Method

Interview as a Method for Qualitative Research

Goals of Interview Research

Preferences
They help you explain, better understand, and explore research subjects' opinions, behavior, experiences, phenomenon, etc.
Interview questions are usually open-ended questions so that in-depth information will be collected.

Mode of Data Collection

There are several types of interviews, including:

Face-to-Face
Online (e.g. Skype, Googlehangout, etc)

FAQ: Conducting Interview Research

What are the important steps involved in interviews?

Think about who you will interview
Think about what kind of information you want to obtain from interviews
Think about why you want to pursue in-depth information around your research topic
Introduce yourself and explain the aim of the interview
Devise your questions so interviewees can help answer your research question
Have a sequence to your questions / topics by grouping them in themes
Make sure you can easily move back and forth between questions / topics
Make sure your questions are clear and easy to understand
Do not ask leading questions
Do you want to bring a second interviewer with you?
Do you want to bring a notetaker?
Do you want to record interviews? If so, do you have time to transcribe interview recordings?
Where will you interview people? Where is the setting with the least distraction?
How long will each interview take?
Do you need to address terms of confidentiality?

Do I have to choose either a survey or interviewing method?

No. In fact, many researchers use a mixed method - interviews can be useful as follow-up to certain respondents to surveys, e.g., to further investigate their responses.

Is training an interviewer important?

Yes, since the interviewer can control the quality of the result, training the interviewer becomes crucial. If more than one interviewers are involved in your study, it is important to have every interviewer understand the interviewing procedure and rehearse the interviewing process before beginning the formal study.

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How To Write An Interiew Paper: Ultimate Guide

While you’re in school and studying different subjects, it can be tricky to understand each assignment’s needs and depths, especially long-form research papers that might count for a large percentage of your total grade. Writing an interview paper can involve a lot of research, require a lot of time and effort to find and schedule interviews with the right people, and write an engaging and easy-to-read piece. So here’s your ultimate blueprint on how to write an interview paper!

What Is An Interview Paper?

How to write an interview paper, the step-by-step guide on writing an interview paper, how to start an interview paper, how to write a conclusion for an interview paper, how to format an interview paper, checklist of essentials for an impressive interview paper, topics for an interview paper.

An interview paper is an intriguing but complex assignment to write about a topic that incorporates interviews and perspectives of different people on the issue. These interviews are usually with people who are stakeholders in a problem or the general public that has been inevitably affected by a country’s policy or about a particular case that caused havoc. In addition, it can also be a descriptive piece elaborating on the personal experience or anecdote of one person.

It’s definitely a learned skill and requires a lot of effort into cultivating precise questions networking to find the best people to interview (they can range from being your family members who were involved in a particular issue or have stark opinions on your topic to policymakers and governors who contributed to either passing or striking a specific act), and finally putting it all together to communicate the varying perspectives effectively without bias.

Here’s an excerpt from an interview paper example :

With the recent upsurge in mental health and psychology, many experts in the field are celebrating the increased awareness but also worry about the dissipation of false information. Especially with social media, information is communicated from one part of the world to another within seconds. It can lead to the misuse of terms and psychological context, leading to severe harm and damage. Dr. Rosen Luis, a professor of abnormal psychology at the University of Georgia, elaborated upon the issue of false information being spread on social media in a personal interview conducted last year. “As social media penetrates the global world at a more rapid rate than anything else in the world, sensitive information like that regarding mental health can easily be misused or leveraged in incorrect circumstances due to the lack of supervision on growing platforms. Social media also creates unrealistic expectations about how a mental illness should look. There’s no one distinct way a disorder manifests in everybody and can lead to different lifestyle changes for different people.” (R. Luis, Phone Interview, Jun 22, 2021)

So you might be thinking about how to write a paper based on an interview and what are the different components of such a paper? Well, a lot goes into an article of this kind, so it’s essential to break it down into separate elements so you can tackle each with great effort and accuracy to cultivate a solid assignment and fetch a top grade!

If you have the freedom to choose your topic for the assignment, it is essential that you pick up a contentious concept that is the center of debate and leads to some civil discourse. An interview paper needs to be backed with air-tight research and credible interviews taken ethically and incorporate direct, in-depth questioning and sources.

Now you may be wondering how to include an interview in a research paper, mainly because interviews often look like scripts instead of concrete research material, so it’s important to note that while your discussions will be long-form and extensive, you’ll have to pick and choose responses from your different interviews to use as quotes or credible backing for your statements within the content of the paper.

If you have no desire to get all those knowledge or experience a long tiring writing process, you can use an opportunity to buy cheap dissertation online .

To make the writing process easier, you should be absolutely sure in what to do in each step. Here is a list of steps you need to take to get a perfect interview paper.

Step 1 – Selecting the ideal topic for your paper : The topic you end up choosing for your interview paper can genuinely make or break your grade. It’s best not to look at generalized ideas or concepts that have been established as facts, as it’s unlikely that such topics will have a large-scale difference of opinion. Searching for a good case could begin with looking for issues that cause healthy discussion, differ within groups of different cultural, political, social, or economic backgrounds, and are essential conversations to have. It’s vital to ensure that the topic doesn’t cause a threat to someone’s rights, identity, or existence.
Step 2 – Ideation and Research : Now that you’ve established your topic and a basic crux of your thesis statement, you can begin ideating the direction you want to take your paper. For instance, you choose capital punishment and its use to decrease long-term crime patterns in Singapore (known to have one of the highest percentages of the executed population via capital punishment), you’ll think about whether you want to talk about its history, grassroots change, crime statistics and also decide who all you’ll want to interview. A big part of writing an interview paper is finding people from diverse backgrounds with conflicting opinions to give your readers a 360-degree view on the issue.
Step 3 – Crafting your interview questions : After having decided your topic and doing in-depth research about the same, it’s time to curate a set of interview questions that are brief, to-the-point, and extract the information you require for your assignment. Crafting good open-ended questions is a learned skill and will improve with the number of interviews you prep for. Ensure that all your questions are about the topic, fact-checked, and easy to understand for the interviewee.
Step 4 – Taking the interviews : Once the interview blueprint is ready, you’ve to schedule and conduct interviews with the people you’re choosing to talk to (it is preferred that you conduct interviews in-person, so it is as personal and direct as possible). Be sure to ask your questions clearly and record the interviewee’s responses using a recording device so you can precisely transcribe the answers afterward. It’s crucial that your interviewee feels comfortable talking to you about the topic, especially if it is something very sensitive and personal. Good interview ethics also involve letting your respondent know they can communicate if they want something they spoke about to be scratched out of the interview.If you’re planning on using published interviews, you can skip the third and fourth steps and pick up essential quotes from the already published interviews. Remember to cite the quotes in the correct format so that you don’t get into any unnecessary plagiarism issues.
Step 5 – Creating an outline : With regards to the obtained interview responses, you’ll create a very detailed skeleton for the interview paper, so you know precisely which idea goes where. This will help you when you finally get down to writing the actual essay, as you’ll be able to keep track of your different ideas, quotes, and sources and establish an engaging flow. You can also spend some time writing transitionary sentences that you’ll use when you move from one paragraph to the next.
Step 6 – Writing the paper : Now that you’re done with all the back-end research, interviewing, and outlining, you’ve to sit down and fill in the gaps to produce a stellar essay. You have all the elements you need to decrease your distractions, be charged up, and just write it out. Contrary to popular belief, writing is actually a learned skill. Even if you don’t believe you’re as good with words as others, learning a few tips and tricks can easily elevate your writing to a notch above. Using precise and appropriate vocabulary, leveraging analogies, metaphors, and other language elements to convey your ideas, and having perfect grammar and syntax are some of the ways you can better your writing.

The basics of any paper are a thesis statement, introduction, body, and conclusion. You would’ve formulated your thesis statement while ideating the direction you wanted to take your paper in, and through the outline, you’ve hopefully followed the one-idea, one paragraph to give rise to a well-constructed body. Here’s some guidance on the two components that determine the first impression and last impression your reader has of the paper:

The introduction of your interview paper is the first thing that the reader looks at, so it’s crucial to hook the reader to keep them engaged to follow through with reading the paper. You can include:

Your thesis statement Intriguing data about your topic A quote from one of your interviewees Citing any information that’s been in the news with regards to your topic

The purpose of a catchy introduction is to connect the idea at hand to the reader’s life and intrigue them enough to learn more about the issue.

For example , if you’re writing on the capital punishment topic, beginning with an alarming statistic to depict the dire need to start a serious conversation about its effectiveness or ineffectiveness could hook the reader very well:

“ Juxtaposing the modern ideals of reformation and change, over 400 individuals have been giving the death penalty in Singapore since 1991″

Like any research paper, a firm conclusion is a must in a well-written interview paper. Since your paper will deal with some contrasting ideas, summarizing all the perspectives while shedding more light on the thesis statement will hook your reader to think about the information and views brought up in your essay long after they finish reading. Though this is one of the many assignments you’ve to write for school, interview papers dealing with conflicting real-life issues also contribute to social change via beginning civil discourse and fact-oriented discussion on important causes.

Step 7 – Citing the sources : It’s vital that after you finish the contents of your essay, you spend time formatting your interview paper in the correct format and cite all of your sources in the needed manner (e.g., MLA, APA, etc.). It’ll help provide credibility to your arguments, show that you delved into air-tight research for your topic, and protect you from any coincidental issues in plagiarism checkers.
Step 8 – Revision : It’s believed that looking at your paper, especially one you’ve spent hours on, with a fresh set of eyes, gives you a better perspective on things to change and helps you spot any missed grammar and style errors. You can finish your draft, take a nap, get back to the assignment and make the changes, read it aloud to make any mistakes more noticeable, or even ask a friend to have a read-through.

It’s essential that you know the interview paper format to be able to present a well-written, researched, and formatted assignment for an excellent grade. So here are some steps on how to write an interview paper in APA format –

If you’re citing a personal interview that you conducted in the course of writing the piece, here’s the format to follow:

Include the name of the interviewee and their qualifications, job description, and experience Mention the purpose of involving them in your research paper Incorporate a couple of quotes from their interview Cite the interview in the correct APA format

For, e.g., – (Interviewee first name initial & last name, interview format, date of interview)

If you’re citing an already published interview of someone in the field, the way you format the quotes in the paper and the bibliography should follow the format of the document in which you found the interview. Say you found an interview of a renowned politician in a social science journal that followed the MLA format; you must follow the same and cite the social science journal as your source.

To have peace of mind that you’ve done everything you needed for the perfect interview paper, here’s a short checklist you can quickly run through before submitting your assignment

Included all interviewees point’s of view Remained neutral while elaborating on others’ opinions even if you have a solid personal perspective on the subject Followed the one-idea, one-paragraph rule and included well-written transitory sentences Utilized precise and high-level vocabulary and sentence structure Proofread the essay to rid it of any grammar or syntax inconsistencies Used the correct format to cite sources within the paper and in the bibliography

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Should marijuana be legalized?
Should the same humanitarian and crime laws apply in times of war?
Should gun rights be ubiquitous?
Is capital punishment leading to grassroots change?
Should society be capitalist, socialist, or an amalgamation of both?
Should cloning be legal?
Is the concept of marriage as idolized as it used to be?
Is choosing to be child-free selfish?
Should the rich pay more tax?
Are our immigration policies outdated in a globalized world?
Should celebrities be more accountable for their actions than the average person?
Are companies doing enough to contribute to climate change effects?
Should holistic therapies be considered certified medical treatments?
Should upbringing be gendered?
Is having kids in a time of such turmoil ethical?
Should prostitution be legalized?
How should racism or homophobia be combated on an individual level?
College degrees and their relevance in the digital age
Going vegan v/s consuming meat: What’s better for the climate?
How important is your religion to you?
Are money and happiness correlated?
How much does early-child development affect one’s mental health into adulthood?
Is stealing ever okay?
Are arranged marriages still as popular?

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Introduction

When you incorporate original interview data into your writing, you are developing new ideas by using quotations and often sources that no one else has accessed. Drawing from interviews can liven up your writing, ground your big concepts within the specific circumstances of particular individuals, and introduce you to insights you might never have considered on your own. Additionally, interviews are an exciting way for you to provide a larger audience for people who might not otherwise have opportunities to share their stories, perceptions, and experiences.

There are lots of good reasons to incorporate original interview data into your writing. But doing so also involves making many, specific writing decisions. On this page we explore some of those decisions by considering: 1) the process by which interview data is gathered; 2) models for interview incorporation; and 3) identification of ways that writing with interview data can be like writing with information from any other source (as well as some of the unique writerly considerations that interviews raise).

Contents Before You Write Different Models of Incorporating Interview Data Summarizing, Paraphrasing, or Quoting Referring to your Interviewees Using Verbatim or Non-Verbatim

Before You Write

Of course, before you can incorporate interview data into your writing, you need to plan and conduct your interviews and begin to analyze your findings.

Interviewing is a common form of research and information gathering in many different fields and across many different genres. In order to develop and actualize a plan for why interviews will help you answer the questions you’re asking, whom you’ll interview, and what you’ll ask these subjects, you’ll want to consult a range of resources. Talk with your instructor, mentor, or advisor about common ways of approaching interviews for this assignment or in this discipline. Additionally, many undergraduate textbooks about research in the social sciences and humanities offer introductions to interviewing. We’ve listed a few great resources to help you learn more.

For comprehensive introductions to research methods used in the writing research that include some information about interviews, consider:

Jackie Grutsch McKinney’s book Strategies for Writing Center Research —especially pages 55-69. While Grutsch McKinney’s is focused on writing center research, her close consideration of the different ways to structure interviews as well as how to plan and conduct them can be applied to all interview contexts. Additionally, her treatment of data analysis in chapter 8 provides a step-by-step guide for coding qualitative data—one of the approaches you might use to make sense of what your interview data means.
Joyce Kinkead’s Researching Writing: An Introduction to Research Methods —especially pages 37-39. This is a potential textbook for that could be used for a class specifically about the formal study of writing. However, its direct and specific information about interviewing is applicable for any social science researcher preparing to use interviews for research.

These resources focus more specifically on qualitative research methods in particular and interviewing in particular:

Robert Bogdan and Sari Knopp Biklen’s Qualitative Research for Education: An Introduction to Theories and Methods —especially pages 103-109. Bogdan and Knopp Biklen’s treatment of interview practices provides a brief overview of how to approach and implement this research methodology.
Irving Seidman’s Interviewing as Qualitative Research: A Guide for Researchers in Education and the Social Sciences —especially pages 78-94. This entire book explores interview practices, logistics, and applications, but chapter six in particular usefully details particular interviewing techniques and provides transcripted examples of some of these strategic techniques in action.

The rest of the information on this page assumes that you have learned to develop and implement your interview plan, that you’ve analyzed the information you’ve gathered, and that you’re now ready to start weaving that information into your writing.

Different Models for Incorporating Interview Data

You can use interview data in many different ways. Most often, you will probably be making an argumentative or analytical point and illustrating and supporting it with evidence from your interviews. For example, in the following passage from the book Booty Capitalism: The Politics of Banking in the Philippines , Paul D. Hutchcroft, a political science professor at Australian National University, begins with an original claim, follows that with a quotation from an interview subject that exemplifies that claim, and then offers additional commentary on that issue. Note how the quotation from the interview both connects the concepts of banking and politics and introduces the prism metaphor that Hutchcroft continues into the next sentence.

The major focus of this [book] is two arenas that offer particular insights into the nature of relations between state and oligarchy in the banking system: bank supervision and selective credit allocation. “Banking,” observes one former bank president, “is a prism through which to understand power politics in the Philippines.” A study of the banking system highlights larger patterns at work within the political economy: how a predatory oligarchy extracts privilege from a patrimonial state, and how developmental policy objectives are continually choked out by a clamor of particularistic demands made by those who currently enjoy proximity to the political machinery. (7)

Generalizing about a Trend or Theme

Using information from an interview to support your claim is the primary purpose for incorporating interview data into your writing, but how you do this may change according to your specific intent. In what follows, we explore different models for weaving interview data into your writing and provide examples of what this looks like.

It is important to consider the politicization of the nationality responses in context. On the whole, the vast majority of republican executives did not try to influence the process, and the nationality question was a non-issue in the predominantly ethnically Russian regions. In my regional interviews I found that in the oblasts and krays, there were almost no reports of difficulty with the nationality question. Officials in those areas reported that respondents who were not ethnically Russian had no difficulty citing a different nationality. This finding corresponded with my observations of the enumeration process in Moscow. There were sporadic cases of respondents in ethnically mixed marriages registering one child as of one parent’s ethnic group and the other child as of the other parent’s ethnic group. However, this is a conceptual issue rather than a problem of politicization. ( 367-8 )

Quoting to Illustrate a Trend or Theme

Sometimes interviewees say things that are so strikingly similar that it is useful to draw attention to these complementary concepts and word choices by putting them together. In the following passage, Jane Calvert, a professor at the University of Edinburgh, and Joan Fujimura, a sociology professor at UW-Madison, use this strategy while writing about scientists’ responses to the new and developing field of systems biology. Note that these authors carefully tie quotations to specific anonymized interviewees through parenthetical citations.

In another US university, the decision to build an interdisciplinary research centre was top-down, initiated by university and funding administrators and initially opposed by most campus laboratory scientists. The building of new interdisciplinary structures is challenging for the existing disciplinary “fiefdoms” (Biologist19) and “silos” (Biologist9 and Biologist12) “where people feel protected and safe” (Biologist19) because they are not required to step outside of their “comfort zones” (Biologist7).

Putting Two Sources in Conversation with Each Other

Sometimes writers can use one interviewee to contribute to or complicate what another interviewee says. The following paragraph from Hutchcroft’s Booty Capitalism shows this practice at work. In addition to bringing two sources together, in this passage Hutchcroft also strategically incorporates paratextual insight gained from the interview process into his analysis. He uses the former governor’s laughter to showcase an attitude that directly contrasts with what the former bank supervisor says.

Even when the Central Bank has acted against those who milked their banks, former bank owners have been known to use personal connections, even up to the Supreme Court, to confound Central Bank discipline. Former Governor Jaime Laya noted that even martial law “didn’t seem to stop the lawsuits against Central Bank personnel.” He actually laughed as he told me how the Central Bank legal office has “never won a case.” But the former head of the bank supervision sector, who has herself been sued, doesn’t find it a laughing matter: “Why only in this country,” she exclaimed, “do the regulators go to the jail, and the bankers go scot-free?” (9)

Providing a Profile/Telling a Story

Sometimes your writing needs to focus on your interview subject as a full and complex individual. In order to analyze an issue, you need to write about this individual’s background, family, and previous experiences. In this situation, you’ll weave together information you gained from your interviews with quotations from this person. This kind of writing is common when you are using interviews to develop ethnographis case studies. In the following example of this technique, Kate Vieira, a professor in the Department of Curriculum and Instruction at UW-Madison, tells the story of Jocélia, an undocumented Brazilian immigrant living in Massachusetts:

Jocélia, a 22 year-old Brazilian woman who grew up in a favela (shanty town) in Brazil, came to the United States to study and to earn money. When her visa expired and the small sum she had borrowed from cousins ran out, she quit her ESL classes and began to work illegally. When I met her in 2008, she had been in the United States for 4 years, had managed to buy a house for her mother in Brazil, and had plans to buy another one for herself and a car. To earn money as an undocumented worker, she held down two jobs: one from 3 p.m. to midnight and another from 5 a.m. to afternoon. One evening, exhausted from having not slept in days, she nodded off as she drove home from work, resulting in a serious accident that led her to a friend’s house in South Mills and to a Catholic retreat. When I came here, I was not a youth who had fun. I only worked, and this made me a little frustrated, you know? Sad, lonely, understand? And nobody could change my mind. I had to work . . . But the Lord showed me something different, that I can’t live only for work . . . So I went there [to the retreat] and I really felt that the Lord touched us. It was a very good experience . . . (444)

Attending to Language

As explored in greater depth in the discussion about verbatim transcription , sometimes you want to analyze or consider the language an individual uses or the implications of certain kinds of words or even pauses. For example, in the following passage, Beth Godbee, a writing and rhetoric professor at Marquette University, meticulously considers the implications of her subjects’ specific words and phrasing. Although this example is taken from Godbee’s analysis of a conversation she recorded between a writer Susan and a writing center tutor Kim as opposed to a direct interview she conducted, the attention she pays to language could just as well be applied to information from an interview.

Kim reinforces Susan’s qualifications: “You’re gonna—you’re the specialist in this area. You know these kids; you see what know the effects are, and maybe where some change could be made” (lines 558-561). Here Kim revises her projection of Susan as a “specialist” in the future tense (“gonna,” as in “you’re going to be”) to a statement of her current position (“you’re,” or “you are now”). By repairing her speech mid-utterance, Kim emphasizes Susan’s current status and qualifications to write, thereby reframing her institutional power to assert her right to speak. (185)

Summarizing, Paraphrasing, or Quoting

As the above examples show, interview data is incorporated into writing through summaries, paraphrases, or quotations. In some ways this makes working with interviews just like working from any other kind of outside. As you choose between summarizing, paraphrasing, or quoting, a guiding question for you to consider is: What is most important about this information?

Is it the overall story it tells or the general perspective it provides? Then summarizing might be the best option.
Is it the particular take on a complex issue? Then paraphrasing that idea in your own words to make it as understandable as possible might be best.
Is it the memorability, specificity, or authenticity of the language the source used? Then probably go with a quote, but be sure to contextualize this quotation by providing necessary background and commentary.

Of course, in working with interview data, you might go with all three incorporation strategies by, for example, summarizing early in a paragraph to provide an overall sense of what this source is saying, paraphrasing a key idea or two, and then including a poignant quotation that exemplifies the argument you are making. For more information about quoting and paraphrasing outside sources in your writing, check out our resources on this issue .

Referring to your Interviewees

In certain writing situations, you are expected to identify the people you interviewed by using their real names. This is often the case in journalistic writing as well as when you have consulted with an expert on an issue. But, even in these writing contexts, you must receive permission from them to associate their words and insights with their names by clearly establishing whether or not they are talking with you “on the record.”

However, when you are conducting interviews for academic research, you are frequently expected to use pseudonyms so that your subjects’ responses are confidential. Protecting your subjects’ privacy should be your primary priority. They are giving you access to personal experiences and trusting you with their individual insights and observations; you must honor that trust by anonymizing their identities so that readers can’t figure out who your subjects were. Developing a research methodology that keeps all of your data confidential is an important part of the IRB (Internal Review Board) process, and in order to receive permission to do research at your institution you’ll need a plan that outlines how you’ll achieve confidentiality. Part of that plan will involve using different names for your subjects. But selecting pseudonyms is a bigger issue than just choosing different names at random.

Ruth Allen and Janine L. Wiles, Social and Community Health scholars at the University of Auckland, have closely considered the many issues surrounding pseudonym selection in connection to their original psychological and health-related research. They advocate that researchers think critically about this process and even bring their subjects into these discussions of identity and confidentiality. You need to be thoughtful about what aspects of your subjects’ true identities you are communicating or obscuring through the pseudonyms you use. The following questions are adapted from ones Allen and Wiles recommend researchers ask themselves when preparing to use pseudonyms for participants:

Does the researcher or the participant choose the pseudonym? How does this issue get talked about with the participants?
Is it important, valuable, or expected to use first name or also include last names and/or titles (i.e., Cara, Mr. Terrance, Dr. Jean Nichols)?
Within the context of this writing, should the names to be associated with a specific gender, ethnicity, and/or culture? Should those nominal identity markers align with the participants’ actual identities?
Do pseudonyms need to be selected for other people, places, activities, and organizations mentioned in the interview? And if so, who makes those choices?

How you answer these questions should be informed by your specific context. For example, in relation to that fourth question, if a participant is talking supportively about a small on-campus organization that you want to bring attention to through your writing, it might make sense to refer to this organization by name even though its size might make it harder to disguise your participant’s identity. However, if your interviewee is speaking critically about a large, multi-national corporation where she works, you might want to develop a pseudonym for that company in order to protect this individual as much as possible.

Using Verbatim or Non-Verbatim

When you are conducting interviews, you are engaging people in very focused conversation. But when we converse, we say “like” a lot and “um” and “ah.” We start sentences and then interrupt ourselves and never return to complete those earlier thoughts. Conversation is never as direct and naturally coherent as writing can be. As a result, when you’re representing other people’s speech, you need to decide if you’ll be employing what is called “verbatim transcription” or “non-verbatim transcription.”

In “verbatim transcriptions,” you write out what people say exactly as they say it. You include all the filler words, false starts, and grammatical inconsistencies. You may even choose to include coughs and laughs. Scholars have traditionally upheld verbatim accounts as being accurate depictions of the interview process, but as Blake Poland pointed out, “much of the emotional context of the interview as well as nonverbal communication are not captured at all well in audiotape records, so that the audiotape itself is not strictly a verbatim record of the interview” (291). “Non-verbatim transcriptions,” (sometimes called “intelligent transcription”) respond to this acknowledged gap between the complexities of real conversation and the limitations of writing by encouraging writers to focus on the primary substance of participants’ quotes. In “non-verbatim transcriptions, you eliminate the unnecessary utterances like “er,” “well,” and “you know” and just include the foundational meaning of the interviewees’ words.” For example:

Verbatim Transcription : Well, you see, I was [pause] the problem, as I saw it, was more of a, a matter of representation, you know? How can I, like, be the one that’s just out there just declaring the way things are when I’ve not even, like, you know, experiencing the whole process for myself? Non-verbatim Transcription : The problem, as I saw it, was more a matter of representation. How can I be the one that’s out there declaring the way things are when I’ve not even experienced the whole process for myself?

The choice to use verbatim or non-verbatim transcription in quoting your participants should be informed by intentional considerations you are making as a writer. There are good reasons to use either forms. As Mahesh Kumar has identified in a blog post for the Transcription Certification Institute, verbatim transcription is useful for showcasing the thought process by which interview participants develop their ideas. False starts and self-corrections track down how someone is thinking about an issue in real time, and some fillers can be useful expressions of personality. Additionally, some linguistics research and conversation analysis methodologies expect highly structured, verbatim transcriptions that even account for pauses and simultaneous dialogue. However, quotations presented through non-verbatim transcriptions are clearer and easier to read and enable you to present your interview subjects as articulate (Poland 292). Whether you go with verbatim or non-verbatim transcription, make sure that you are being consistent with this choice across your article, paper, report, or essay. Also, if it’s common in the genre you are writing to discuss your methodology choices, it may be useful to clarify which transcription form you have chosen to use and why this was an appropriate choice.

Works Cited

Allen, Ruth E.S., and Janine L. Wiles. “A Rose by Any Other Name: Participants Choosing Research Pseudonyms.” Qualitative Research in Psychology , Dec. 2015. Research Gate , doi: 10.1080/14780887.2015.1133746.

Bogdan, Robert C., and Sari Knopp Biklen. Qualitative Research for Education: An Introduction to Theories and Methods . 5 th ed., Pearson, 2007.

Calvert, Jane, and Joan H. Fujimura. “Calculating Life? Duelling Discourses in Interdisciplinary Systems Biology.” Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences , vol. 42, no. 2l, 2011. Science Direct , https://doi.org/10.1016/j.shpsc.2010.11.022 .

Godbee, Beth. “Toward Explaining the Transformative Power of Talk About, Around, and for Writing.” Research in the Teaching of English , vol. 47, no. 2, 2012, pp. 171-97.

Grutsch McKinney, Jackie. Strategies for Writing Center Research . Parlor Press, 2016.

Herrera, Yoshiko M. “The 2002 Russian Census: Institutional Reform at Goskomstar.” Post-Soviet Affairs , vol, 20, no. 4, 2004, pp. 350-86.

Hutchcroft, Paul D. Booty Capitalism: The Politics of Banking in the Philippines , Ateneo de Manila University Press, 1998.

Kinkead, Joyce. Researching Writing: An Introduction to Research Methods . University Press of Colorado, 2015.

Kumar, Mahesh. “Verbatim Vs Non-Verbatim Transcription: Differences, Requirements, & Jobs.” Transcription Certification Institute , 5 December 2017. Accessed online 19 June 2017. https://blog.transcriptioncertificationinstitute.org/verbatim-vs-non-verbatim-transcription-differences-requirements-jobs/.

Poland, Blake D. “Transcription Quality as an Aspect of Rigor in Qualitative Research.” Qualitative Inquiry , no. 1, vol. 3, 1995, pp. 290-310.

Seidman, Irving. Interviewing as Qualitative Research: A Guide for Researchers in Education and the Social Sciences . 3 rd ed., Teachers College Press, 2006.

Vieira, Kate. “Undocumented in a Documentary Society: Textual Borders and Transnational Religious Literacies.” Written Communication , vol 28, no. 4, 2011, pp. 436-61.

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Legal Studies Research Beyond 50%: Providing contextual and coaching information substantially improves adults' ability to detect children's lies

Psychology, Crime & Law (in press); USC Law Legal Studies Paper 24-28

42 Pages Posted: 12 Jul 2024

Alison O'Connor

Brock University

Thomas D. Lyon

University of Southern California Gould School of Law

Georgia Ellery

Angela d. evans.

Institute of Child Study (Brock University)

Date Written: July 11, 2024

The present research examined how contextual/coaching information and interview format influenced adults’ ability to detect children’s lies. Participants viewed a series of child interview videos where children provided either a truthful report or a deceptive report to conceal a co-transgression; participants reported if they thought each child was lying or telling the truth. In Study 1 (N = 400), participants were assigned to one of the following conditions that varied in the type of interview shown and if context about the event in question was provided: full interview + context, recall questions + context, recognition questions + context, or full interview only (no context). Providing context (information about the potential co-transgression and coaching) significantly enhanced overall and lie accuracy, but this served the greatest benefit when provided with the recall interview, and participants held a lie bias. In Study 2 (N = 100), participants watched the full interview with simplified coaching information. Detection accuracy was reduced slightly but remained well above chance and the lie bias was eliminated. Thus, detection performance is improved when participants are given a child’s free-recall interview along with background information on the event and potential coaching, though providing specific coaching details introduces a lie bias.

Keywords: lie-detection, child witness, context, accuracy, coaching, bias, interview, question type

Suggested Citation: Suggested Citation

Alison O'Connor (Contact Author)

Brock university ( email ).

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University of Southern California Gould School of Law ( email )

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Institute of Child Study (Brock University) ( email )

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Published: 15 July 2024

Barriers and facilitators of improved nutritional support for patients newly diagnosed with cancer: a pre-implementation study

Benedicte Beichmann 1 , 3 ,
Christine Henriksen 1 ,
Ingvild Paur 2 , 3 &
Mari Mohn Paulsen 4 , 5

BMC Health Services Research volume 24 , Article number: 815 ( 2024 ) Cite this article

Metrics details

Disease-related malnutrition affects a significant number of patients with cancer and poses a major social problem worldwide. Despite both global and national guidelines to prevent and treat malnutrition, the prevalence is high, ranging from 20 to 70% in all patients with cancer. This study aimed to explore the current practice of nutritional support for patients with cancer at a large university hospital in Norway and to explore potential barriers and facilitators of the intervention in the Green Approach to Improved Nutritional support for patients with cancer (GAIN), prior to implementation in a clinical setting.

The study used individual interviews and a focus group discussion to collect data. Study participants included different healthcare professionals and patients with cancer treated at a nutrition outpatient clinic. The Consolidated Framework for Implementation Research (CFIR) was used to guide the thematic data analysis.

Barriers connected to the current nutritional support were limited resources and undefined roles concerning responsibility for providing nutritional support among healthcare professionals. Facilitators included a desire for change regarding the current nutritional practice. The GAIN intervention was perceived as feasible for patients and healthcare professionals. Potential barriers included limited knowledge of technology, lack of motivation among patients, and a potential added burden experienced by the participating patients.

Conclusions

The identification of the potential barriers and facilitators of the current nutritional support to patients with cancer will be used to plan the implementation of improved nutritional support in a randomized controlled trial for patients with cancer prior to clinical implementation. The current findings may be of value to others trying to implement either or both nutritional support and digital application tools in a clinical healthcare setting.

Trial registration

The study was registered in the National Institutes of Health Clinical trials 08/09/22. The identification code is NCT05544318.

Peer Review reports

One of many burdens patients with cancer may face during their course of disease is disease-related malnutrition [ 1 , 2 ]. Disease-related malnutrition, from here on referred to as malnutrition, occurs when there is an unbalance between the energy need and the intake or uptake of energy, leading to unfavorable alterations in body composition and - functions [ 3 ]. The causes of this unbalanced condition vary; however, several aspects contribute to the risk of becoming malnourished. Cancer diagnosis, cancer stage, the patient’s age, inflammation, and cancer treatment are some of the potential factors [ 1 ]. Independent of the causes, malnutrition increases the risk of morbidities and worsens cancer prognosis, and thus, decreases the risk of overall survival [ 4 , 5 , 6 ].

Globally, malnutrition is estimated to affect 20–70% of all patients with cancer [ 1 ]. The large range is closely related to treatment setting, tumor type, and stage of disease as demonstrated by Mashall et al [ 7 ]. Their findings indicated that 31% of patients with cancer were malnourished in an Australian population. Within this population, individuals with breast cancer exhibited the lowest prevalence of 13%, while patients with upper gastrointestinal cancer had the highest prevalence at 62% [ 7 ].

Further, malnutrition is a major social problem, with significant costs for societies worldwide. In the United Kingdom, expenditure on malnutrition in 2012 amounted to approximately 22.1 billion euros, which represented 15% of the total costs used on health and social care [ 8 ]. Similarly, a recent report found that malnutrition costs the Norwegian society around 2.9 billion euros per year, of which health services costs related to malnutrition (i.e. costs connected to tertiary healthcare, nursing homes, and home care) were estimated to reach 1.2 billion euros in 2022 [ 9 ]. The major driver for these costs is prolonged hospital stays for malnourished patients [ 9 ].

In accordance with the latest guidelines on nutrition for patients with cancer from the European Society for Clinical Nutrition and Metabolism (ESPEN) [ 10 ], all hospitalized or ambulatory patients should be screened for malnutrition. If a risk of malnutrition has been identified, a nutritional assessment should be carried out. Thereafter, an individual plan to ensure sufficient nutrition should be outlined in cooperation with the patient and their caretakers according to Norwegian guidelines [ 11 ].

Despite international and national guidelines to prevent and treat malnutrition, patients at risk of malnutrition continue to be under-recognized, and thus, malnutrition is undertreated. Research from both Scandinavia and the United States shows that screening for malnutrition is not practiced routinely [ 12 , 13 , 14 ]. Simultaneously, studies show that only 41–53% of the identified at-risk patients in Norwegian hospitals receive nutritional treatment [ 15 , 16 ] even though research indicates beneficial effects from intensified nutritional counseling during cancer treatment [ 17 , 18 ]. The lack of systematic screening and treatment of malnutrition might be one of many reasons for the high prevalence of malnutrition across the healthcare system.

Green Approach to Improved Nutritional support (GAIN) is a randomized clinical trial that will test the effects of an improved nutritional support, simultaneously with the clinical cancer treatment, for patients with newly diagnosed colon, rectal, anal, and cervical cancer. The improved nutritional support will involve continuous dialogue with a registered dietitian from the time of diagnosis and throughout the next 6 months of cancer treatment. Nutritional support will be given through both digital systems and physical attendance.

Implementing nutritional interventions into clinical practice can be demanding [ 19 , 20 ]. To increase the potential for successful implementation of the intervention, barriers and facilitators should be investigated at different levels, i.e. level of the patient, the individual healthcare professional and the healthcare team [ 21 , 22 ].

This study aimed to explore the current practice of nutritional support for patients with cancer at a large university hospital in Norway, and further, to explore potential barriers and facilitators of implementing an improved nutritional support for patients newly diagnosed with cancer throughout the clinical cancer pathway to obtain a better understanding of how to implement the clinical trial, GAIN.

Study design and participants

This study reports qualitative findings from individual interviews and a focus group discussion regarding patients´ and healthcare professionals´ views on the current nutritional support for patients with cancer and potential barriers and facilitators of the intervention in the GAIN study. Study participants included nurses, physicians, registered dietitians, and a health secretary, in addition to patients with cancer treated at a nutrition outpatient clinic at a large university hospital in Norway. The participants were purposively selected, as they represented a selection of stakeholders that are involved in the clinical cancer pathway. Healthcare professionals were identified and suggested by their leader on request from the GAIN project, and thereafter asked to participate by e-mail. Patients were asked to participate by their treating dietitian on behalf of the GAIN project. Some of the healthcare professionals from this study will be involved in future investigations in the ongoing clinical GAIN study, whereas the included patients will not.

This study was an important part of the preparations, development and implementation of GAIN, a randomized clinical trial aiming to reduce malnutrition among patients with cancer. The intervention in GAIN includes an improved nutritional support, through early and frequent communication with a registered dietitian during cancer therapy, both digitally and physically. The physical attendances include a baseline visit close to the time of diagnosis and an obligatory visit approximately 6 months from baseline. Twelve months after baseline the participants will receive questionnaires concerning quality of life, physical, psychological and social functions. Frequent dietary assessment through a digital dietary tool, will take place every 25th day from baseline through the next 6 months or as often as the participants are in need for or desire. If the assessment reveals insufficient intake of energy, protein, or fluids compared to the estimated needs, the participant will be offered an additional visit to a registered dietitian. Participants in the control group will attend 2 visits: one at baseline and 6 months after baseline. The control group will receive standard care (i.e., nutritional screening for malnutrition and support if indicated), according to the clinical cancer pathway, and thereby no nutrition support specifically from GAIN. The clinical trial in the GAIN project adheres to the CONSORT guidelines [ 23 ]. The timeline of the GAIN project is illustrated in Fig. 1 .

Timeline and overview of the GAIN project. Abbreviations GAIN: Green Approach to Improved Nutritional support, RCT: Randomized Clinical Trial

MyFood is a digital tool designed to prevent and treat malnutrition [ 24 , 25 ] that will be used in the intervention group in GAIN. This is accomplished through the assessment and evaluation of dietary intake, either reported by the patient, by their treating healthcare professional, or their next-of-kin. MyFood includes both an application that reports the recorded intake, and a website that allows healthcare professionals to evaluate and monitor the reports [ 24 ]. Screenshots of MyFood are illustrated in Fig. 2 . The application is available for use at home, where the patient can compose their homemade meals, or at the hospital with the possibility to choose from the different hospital menus included in MyFood. Allergies, specific diets, and/or symptoms may also be registered [ 24 ].

The MyFood tool from a patient view. From the left [ 1 ] Main menu of functions; [ 2 ] Menu for dinner recording; [ 3 ] Evaluation of recorded intake compared to estimated requirements for fluids, energy, and protein

Interview guides and procedure

Healthcare professionals were either interviewed individually or included in a focus group. Prior to the interviews, the healthcare professionals were asked to fill out a form (supplementary file 1 ) including questions about work experience, occupation, age, and gender. The interview guides were based on the Consolidated Framework for Implementation Research (CFIR) and developed for this study and can be found in the supplementary material (supplementary file 2 – 4 ). In brief, the interview guide for healthcare professionals included questions about the respective hospital department, with a focus on the nutritional support routines including the use of digital tools, i.e., video calls and applications. A question about the perceived impression of satisfaction with nutritional support among patients was also included. After a short demonstration of MyFood, respondents were asked about their perceptions of using the digital dietary tool. At last, they were encouraged to share thoughts about the GAIN intervention, with emphasis on barriers and facilitators.

All patients were interviewed individually. For patients, the interview guide included questions about previous experience with organized nutritional support. Background information regarding diagnosis, age, and gender was received from their treating dietitian. Patients were asked to describe their nutritional treatment so far and share thoughts about the use of digital tools in nutritional support and their opinions regarding digital versus physical consultations. The patients received an individual demonstration of MyFood and were asked to elaborate on the use and design.

The first author (BB) performed the focus group interview, with help from the last author (MMP) taking notes. During the focus group, participants were offered hot drinks (i.e., tea or coffee) and a snack. The interviews took place in a meeting room (focus group) or consultation room (individual interviews). The first author also performed the individual patient interviews, in addition to one individual interview with a healthcare professional. The remaining six of the seven individual interviews with the healthcare professionals were conducted by the last author.

All interviews were recorded with a digital voice recorder (Olympus VN-741PC or WS-852). A Dictaphone application, developed by the University Center for Information Technology at the University of Oslo, was used as a backup. The focus group interview lasted an hour, whereas the individual interviews lasted from 16 to 45 min. The first author transcribed all the recordings verbatim, using the software f4transkript, version 7, 2018 (Marburg).

The consolidated framework for implementation research

The CFIR is a framework to guide systematical assessments of potential barriers and facilitators before implementing strategies for an upcoming intervention [ 26 ]. The framework provides a compilation of 39 constructs, organized within five domains. The five domains are (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of the individuals involved, and (5) process of implementation [ 19 ].

Data analysis

To analyze the transcripts, thematic analysis as described by Braun and Clarke [ 27 ], was used. Initially, each transcript was thoroughly read through. To perform the data analysis, NVivo version 12 (QSR International) was used. Based on CFIR version 2009 [ 19 ], each of the 5 domains, with the 39 belonging constructs were generated into the software program. Thereafter, data were coded into one of the following themes: Intervention characteristics, inner setting, outer setting, or process.

Trustworthiness in the analysis, including credibility, confirmability, dependability, and transferability was emphasized. This involved the inclusion of both healthcare professionals and patients in the interviews, audio taping, and transcribing the material verbatim. It also involved the first (BB), the second (CH), and the last (MMP) authors in the development of the interview guides. The data were analysed systematically, involving both the first (BB) and the last (MMP) authors in the analysis and the interpretation of the results.

The study was performed in accordance with the Helsinki Declaration and was approved by the Norwegian Regional Ethical Committee, reference identification: 267889. The GAIN study is registered in the National Institutes of Health Clinical trials, identifier: NCT05544318, and in the Norwegian Agency for Shared Services in Education and Research (SIKT), reference identification: 219582. All participants signed written consents.

Participant characteristics

Nineteen participants contributed to the data material. This included 12 individual interviews with seven healthcare professionals and five patients, and one focus group with seven personnel (i.e., five registered dietitians, one nurse, and one health secretary) employed at a nutrition outpatient clinic. All participants were either employed or treated at a large university hospital in Norway. The patients that contributed to the interviews all had a cancer diagnosis and received support in accordance with their nutrition-related symptoms or diagnosis. Table 1 describes the characteristics of the participants.

Figure 3 gives an overview of the applied CFIR domains and constructs. In total, 19 of the 39 constructs were identified in the data material and included in this study. No data were sorted into the theme “ Characteristics of individuals” , it is therefore not included in the figure.

An overview of The Consolidated Framework for Implementation Research 2009-version [ 20 ], including four of its five domains. Data were sorted into 19 of the 39 consorts (illustrated in bold text with dark colors), the remaining consorts (light colors and regular text) were not applied

Barriers and facilitators of providing the current nutritional support

To obtain an understanding of the present situation related to nutritional support in the relevant healthcare facilities (inner setting), barriers and facilitators of the current nutritional support within these settings were explored. This showed that most patients were screened for malnutrition by healthcare professionals as recommended by guidelines, however, several other aspects of nutritional support were noted as challenging. The CFIR describes available resources as the resources dedicated to the ongoing project, such as money, training, education, and time [ 19 ]. Healthcare professionals described limited time and work resources as specific barriers to providing nutritional support and care (Inner setting, CFIR construct available resources).

It is probably a question of resources. The constant pressure to get these patients [patients with cancer] through the system and get them treated … I would like to wish for more dietitians , it is not always easy to get hold of them – although they try to be available (physician 1).

A respondent stated that frequent follow-ups were important in order to detect possible side effects from treatment and offer help to relieve nutrition-impact symptoms (e.g. diarrhea, nausea, or reduced appetite). However, a lot of different information was given during the follow-ups, and little time was left to discuss and focus on nutrition (Inner setting, CFIR construct available resources).

We don’t talk much about nutrition [with the patient] … When we have the first conversations about treatment plans , there is so much to say (physician 2).

All healthcare professionals were asked if nutritional-related work and tasks were encouraged by their leaders and management. Most of the respondents claimed that there was little or no management involvement concerning nutrition (Inner setting, CFIR construct leadership engagement).

… No , I don’t think nutrition is talked about that much [from leaders and management] (nurse 1).

However, there were some differences across wards, as one of the respondents mentioned an increased focus from the hospital management over the last years.

The majority of respondents concurred that the responsibility for providing nutritional support to patients was shared between physicians and nurses. Moreover, if necessary, they referred the patient to a registered dietitian. However, there were some discrepancies between the different respondents regarding the social network and communication within the different wards. Some agreed that the nurses had an initial responsibility for nutritional support, as they often carry out nutritional screening, whereas others immediately indicated that the physician had the main responsibility (Inner setting, CFIR construct network, and communication).

… The day-to-day follow-up is very much the nurses [main responsibility for nutrition]. We [nurses] follow the patient , we weigh them , and we make them responsible. But we also pass it [i.e. , clinically relevant information] on to the physicians. And we ask the physicians to refer to a dietitian , or we do the screenings… We are the ones paying attention to the patient (nurse 2). It [nutritional support] is a collaborative project , but it has to be the physicians in a way , who must have the total responsibility… with a close collaboration or delegation to the dietitians (physician 1).

The need for change regarding nutritional support became evident when one of the respondents explained how dietary recording often is challenging and time-consuming in a hospital setting. The challenges could be even more complex if the patient received meals from friends or family, or bought food outside the hospital (Inner setting, CFIR construct tension for change).

Yes , I personally think there are challenges… the spouse brings homemade fish soup , and it’s a bit like - what is it really? [Ingredients in the soup] …. They [the patients] have been to Kiwi [a local grocery store] and bought things - and then we [nurses] have to Google our way to what each food item contains. We spend a lot of time on that. A lot (nurse 1).

Barriers and facilitators of the improved nutritional support

To warrant a successful implementation of the improved nutritional support in the GAIN study, intervention characteristics were explored among the respondents. The digital dietary registration tool MyFood was one of these characteristics. The respondents described the potential advantages of digital assessment tools as ease of use, empowerment of the patient, efficiency, and transparency compared to traditional dietary recording on paper. This applied to both patients and healthcare professionals included in the study – and they perceived digital assessment tools to be relevant regardless of location (e.g. hospitalized or home-based) (Intervention characteristics, CFIR construct relative advantage).

For me , it would have been nice to have an overview of what I eat … water intake , and weight too. I think it’s useful to pay attention. And if someone else can benefit from it [i.e. healthcare professionals] , that’s great (patient 2). … it’s super useful if they [patients] manage to record , and we [registered dietitians] can just extract that information and not have to spend time on dietary recalls , but rather spend time on the results of the registration. Then it’s great (registered dietitian 1).

The design of MyFood received only positive comments. It was perceived as simple, intuitive, and neat (Intervention characteristics, CFIR construct design quality, and packaging).

It [the MyFood app] is nicely organized and user-friendly - and there are not too many choices. It’s manageable and efficient (patient 1).

However, the use of digital communication in general, instead of physical consultations was pointed out as a potential barrier (intervention characteristics, CFIR construct design quality, and packaging).

It works , but it’s not the same as being face-to-face… You lose the personal relationship with the therapist (patient 2).

Concerns were also raised regarding the lack of technological skills and the use of digital tools among older patients (Intervention characteristics, CFIR construct complexity).

The elderly will probably find it demanding. After all , there are a number of [research] studies that already gather information using apps – and they [the elderly] don’t want to participate (nurse 3).

When the healthcare professionals were asked about their belief in the GAIN intervention, most respondents implied that it would be of great value to the patients – especially throughout the cancer treatment (Intervention characteristics, CFIR construct evidence strength and quality).

I think it [nutrition] has a big impact on how they [patients with cancer] get through the treatment. If they don’t eat , they often feel nauseous , experience fatigue , become sedentary , then they get problems with their digestion … it kind of becomes a vicious circle then. So , I think that it [improved nutritional support] has a lot of impact (nurse 3).

It was also mentioned that the improved nutritional support and frequent contact between the treating healthcare professionals and patients at home would lead to better systemic monitoring of the patient compared to present routines.

Despite positive feedback concerning the intervention in GAIN, several of the healthcare respondents expressed concern about the patient burden related to the different elements of the intervention (Outer setting, CFIR construct patient needs and resources).

For patients treated with radiotherapy , I think it might be a bit too much … At the beginning of the treatment there is a lot to consider. I experience that they feel that they lack an overview. They come in for radiotherapy here every day. Then there are blood tests once a week. Then they get chemotherapy at another place once a week , and then there is a doctor’s appointment once a week. And all these appointments are at different places in the hospital (nurse 3).

The reported concern applied to patients receiving frequent oncology treatment, but also encompassed the period between different treatment regimens (such as radiotherapy and chemotherapy), during which patients remain at home. Several potential barriers were reported, e.g., a reduction in the joy of eating due to strict dietary recording, and more stress as a result of several settings where food is brought up (for instance at home from family, oncology nurses, oncologists, dietitians and by the GAIN employees), and an increase in experienced fatigue attributed to their participation in the GAIN study. This concern also applied to the use of MyFood (Outer setting, CFIR construct patient needs and resources).

I think for some patients it [MyFood] will be a fantastic tool and then I think there are some patients who don’t , who will find that it becomes too much , that it [the dietary recording] sort of takes over , that there is too much focus on nutrition. They [the patients] almost can’t bear to eat or can’t bear to eat a banana , because they can’t bear to record it afterward (nurse 5).

Concerning the extra burden on the patient, it was also pointed out that the patients, who might benefit the most from the improved nutritional support, possibly could be the ones with the lowest compliance to the intervention.

To facilitate the implementation of the GAIN intervention, respondents mentioned the need for training and support (Process, CFIR construct Executing).

Technical support [concerning digital software in general] to the users [both healthcare professionals and patients]. I think that is extremely important for them [the patients]. Just to log in and to download an app - it may stop there for some. For a group who are ill , weak , and older this can be challenging (registered dietitian 2).

Three days of dietary recording per month as outlined in the draft protocol of the GAIN study was perceived as feasible by both healthcare professionals and patients (Process, CFIR construct Executing).

An overview of the results sorted into main themes and the affecting factors within these themes are given in Fig. 4 .

An overview of the main themes and belonging factors potentially influencing the implementation of the GAIN intervention. Barriers and facilitators are represented in the figure with – and +, respectively. *Electronic patient record

This pre-implementation study explored healthcare professionals’ and patients’ views on the current nutritional support in the clinical cancer pathway and potential barriers and facilitators of the GAIN intervention including improved nutritional support for patients with cancer. This study found barriers related to the current nutritional support, such as limited resources and undefined roles concerning responsibility for providing nutritional support among healthcare professionals. Facilitators included a desire for change regarding current nutritional practice. The GAIN intervention was perceived as feasible and efficient with the use of a digital dietary tool. Contrary, potential barriers included a possible lack of technological skills among older patients, lack of motivation among patients in general and the potential added burden to the patients by participating in the intervention.

Current practices of nutritional support

Exploring the current practices for providing nutritional support showed that most patients were screened for malnutrition by healthcare professionals assessing their weight and dietary intake. However, limited resources, including time and the number of healthcare professionals, as well as limited leadership engagement, were identified as barriers to delivering nutritional support. These findings are consistent with a Canadian review describing barriers and facilitators to implementing evidence-based guidelines for health outcomes in long-term care by McArthur et al. [ 22 ], who identified time constraints, inadequate staffing, and lack of organizational support as barriers. Similar findings have also previously been identified in Norwegian studies on the implementation of the MyFood tool in different contexts [ 28 , 29 , 30 ].

The healthcare respondents in the present study had different opinions on who was responsible for providing nutritional support but agreed that it was a joint responsibility. This finding highlights the importance of employing consistent and comprehensible language – using unified terms that patients are familiar with rather than advanced medical jargon dependent on occupation – when providing nutritional support to patients. Using a common language may assure that patients receive accurate information irrespective of the healthcare professional communicating the information. This was demonstrated in a systematic review which found that patients with cancer experienced confusion due to conflicting and unrelatable language, when receiving dietary advice from healthcare professionals [ 31 ].

The improved nutritional support in the GAIN intervention

Both barriers and facilitators related to the GAIN intervention were identified. Old age and thereby potential lack of technological knowledge among the patients was seen as a potential barrier. Despite this expressed concern from healthcare professionals, none of the responding patients mentioned this as a barrier for them. Contrarily, it was mentioned that the majority of older adults nowadays are more comfortable with technology than perceived by the general public. These beliefs are supported in a study by Aure et al. [ 32 ] who found that older adults are both able and willing to use self-monitoring tools despite lack of prior experience with technology. Research also suggests that older adults are interested in providing data on diet and lifestyle, especially if it can help them improve their lifestyle [ 33 , 34 ].

During the focus group discussion, the registered dietitians had different opinions on how frequently the patients in the intervention group in the GAIN study should record their dietary intake in MyFood between the study visits. Different suggestions were proposed, but it was agreed that 3 consecutive days, every month for 6 months, should be manageable for the patient and give an acceptable insight into the patient’s nutritional status for the healthcare professionals. The patients agreed that a 3-day dietary recording would be feasible. Although there are uncertainties connected to dietary records such as changing the usual dietary pattern for ease of recording or desirability to report food perceived as healthy, Kwan et al. [ 35 ] found that a 3-day recording was an acceptable approach for assessing the dietary intake in a similar study population recently diagnosed with cancer. The study also showed that error rates for completion and prevalence of missing data were lower if the patients received proper instructions on how to use the dietary registration tool [ 35 ]. This highlights the importance of technical support and training to facilitate the intervention and complies with what was argued by the respondents in the current study.

An important barrier to the implementation of improved nutritional support for patients with cancer was found when exploring the outer setting of the intervention. Several of the healthcare professionals included in this study expressed their concern regarding a potential patient-experienced burden. This burden was specific to the improved nutritional support, in terms of the extra follow-ups and communication with dietitians, in addition to the digital dietary registration at home combined with the cancer treatment. A load of psychosocial consequences, for instance emotions such as disappointment, guilt, and powerlessness were mentioned as possible consequences of the increased nutritional focus through dietary recording and following nutritional support. These emotions were also identified by Alberda et al. [ 36 ], who investigated the patient perspective of nutritional care and support in patients with head and neck or oesophageal cancer. The study found that some patients felt helpless when failing to meet their prescribed calorie goal, especially when their weight declined, and the next treatment intervention was a feeding tube [ 36 ]. Similarly, a qualitative study by Findlay et al. [ 37 ], aimed to understand the perspective of nutritional support among patients with head and neck cancer and their caregivers. They observed that patients felt overwhelmed and overloaded, having a multitude of questions as a consequence of a recent cancer diagnosis early in the cancer treatment pathway [ 37 ]. Furthermore, Findlay et al., found that the patients did not welcome the nutritional support before experiencing nutritional impact symptoms. However, the importance of such advice and treatment was shown to be highly appreciated in hindsight [ 37 ].

As opposed to the lack of control patients have over surgical approach and chemoradiation, eating is somewhat within their control. The desire to obtain information on diet and nutrition among patients with cancer seems to exceed the available scientifically based recommendations, especially if healthcare professionals do not convey this information to the patient [ 38 ]. A German cross-sectional study [ 39 ] found that the most common reason for change of diet or diet modification among patients with cancer were “to actively contribute something to the therapy” and “to support the therapy”. Less than 20% of the patients who changed or planned to change their diet in this study obtained information regarding nutrition from healthcare professionals. More than half of the patients, however, gathered the information on their own using diverse methods (e.g. the internet, friends, and family) [ 39 ].

An Italian Intersociety Working Group for Nutritional Support in Cancer Patients suggests that patients with head and neck, gastrointestinal, or lung cancer, in addition to patients with advanced disease stage or aggressive treatment such as high dose chemotherapy, radical radiotherapy, or combined chemoradiation should immediately be referred to a specialist in nutrition, i.e., registered dietitian, independent of malnutrition risk [ 40 ]. This corresponds to what was practiced in the study by Findlay et al. [ 37 ] and is comparable to the improved nutritional support that will be provided by the GAIN study. While the referral to a registered dietitian introduces an additional consideration for the patient during a troublesome time, receiving practical advice for managing common nutrition impact symptoms associated with their cancer diagnosis, stage or treatment can be beneficial. A literature review by Richards et al. [ 41 ], looked into the timing of nutritional intervention for patients with cancer. Twelve of the 15 included studies provided an early nutrition intervention to the intervention groups. Early nutrition interventions were found to improve health and nutrition outcomes [ 41 ]. Two studies compared the impact of early and late nutrition intervention, and both studies found that early intervention was more favorable than late intervention due to a significant reduction in weight loss, a significant improvement in treatment tolerance, and a significant decrease in unplanned hospitalizations [ 42 , 43 ].

Strengths and limitations

There are several limitations to this study. Amongst them are the limited number of participants from each group of respondents, which may restrict the comprehensiveness of perspectives captured within this population. Nevertheless, the collected data were rich and gave valuable insights into the key barriers and facilitators for nutritional support in cancer patients, and informed the planning of the implementation of the GAIN intervention into clinical practice. Despite the limited number of participants, both patient and healthcare professional perspectives were captured, providing valuable insights.

Another limitation is that none of the patients included in this study were diagnosed with the cancer diagnoses intended to be included in the GAIN study. Since this study found indications of an increased patient-experienced burden among the interviewed healthcare professionals it would be preferable to have an opinion from the patients with the actual diagnoses. However, the included patients received nutritional support simultaneously with cancer treatment, which is similar to the intervention in the GAIN study. Thus, one could expect the patients from these diagnostic groups to be comparable with the intended diagnostic groups in the intervention.

A strength of this study was the inclusion of several groups of healthcare professionals, which contributed to different perspectives on the existing and improved nutritional support.

Another strength was the use of an established framework in implementation science to identify potential barriers and facilitators of the current nutritional support and the upcoming GAIN intervention. While processing the data, an updated version of the CFIR was published [ 26 ]. Although there are several alterations in the structure of the updated version (i.e., relocations of domains and constructs), we do not believe that this would have affected the results in the present study as a comparison between the two versions of the framework is possible and feasible if necessary [ 19 ].

Lastly, emphasizing trustworthiness in the analysis, maintaining the transferability, dependability, and confirmability as described by Nowell et al. [ 44 ], was considered a strength.

This study showed the perspectives of healthcare professionals and patients on the current nutritional support for patients with cancer and explored potential barriers and facilitators for implementing an improved nutritional support through the GAIN study. Barriers to providing nutritional support included limited resources and unclear roles among healthcare professionals. The desire for change in the nutrition practice was identified as a facilitator for improved nutrition support, as was the use of digital dietary tools among all respondents. However, potential barriers included older patients’ possible lack of technological skills, general patient motivation, and the increased patient-experienced burden. The identification of the potential barriers and facilitators will be used to plan the implementation of improved nutritional support for patients with cancer in the GAIN study. Our finding might also be relevant for similar research studies, planning to implement nutritional interventions using digital tools during the cancer treatment course.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

The Consolidated Framework for Implementation Research

Electronic patient record

Green Approach to Improved Nutritional support for patients with cancer

Randomized clinical trial

Norwegian Agency for Shared Services in Education and Research

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Acknowledgements

We thank the participants in the study. We also thank the collaborating healthcare personnel involved in the recruitment of participants.

Open access funding provided by University of Oslo (incl Oslo University Hospital). This study was funded by the Institute of Basic Medical Sciences, University of Oslo.

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Ingvild Paur

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Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway

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All authors contributed to plan and design the GAIN project. BB, CH, and MMP formulated the research questions and designed this study; BB and MMP performed the interviews and the focus group discussion; BB and MMP analyzed the data; IP designed the GAIN-figure; BB and MMP wrote the article. All authors provided critical revision of the manuscript for important intellectual content and approved the final manuscript.

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The study was performed in accordance with the Helsinki Declaration. The research protocol was approved by the Norwegian Agency for Shared Services in Education and Research (SIKT) on December 15, 2022, ref. number 219582. It was also approved by the Norwegian Regional Ethical Committee on November 15, 2022, ref. number 267889. And registered in the National Institutes of Health Clinical trials on September 8, 2022, identifier NCT05544318. Informed oral and written consent were obtained from all the study participates.

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MMP held shares in FoodCapture AS, which commercializes the MyFood system, during the period when the data were collected; however, MMP no longer has any ownership interest in the company.

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Beichmann, B., Henriksen, C., Paur, I. et al. Barriers and facilitators of improved nutritional support for patients newly diagnosed with cancer: a pre-implementation study. BMC Health Serv Res 24 , 815 (2024). https://doi.org/10.1186/s12913-024-11288-2

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Nursing aide turned sniper: Thomas Crooks' mysterious plot to kill Trump

BUTLER, Pa. – Donald Trump and would-be assassin Thomas Crooks started on their violent collision course long before the former president's political rally ended in gunshots and death.

Crooks, 20, was a one-time registered Republican, a nursing home worker with no criminal record, shy in school, and living in a decent middle-class neighborhood in suburban Pennsylvania with his parents. Trump, 78, was eyeing Crooks' state as a key battleground – but not in the way that anyone envisioned on Saturday.

Riding high on polls showing that he's got a strong chance of toppling President Joe Biden, the former president had been campaigning for reelection in swing states, and Pennsylvania is a key prize. Trump won the state in 2016 but lost it four years later.

And on July 3, Trump's campaign announced he would hold a rally at the Butler Farm Show grounds, about 30 miles north of Pittsburgh.

"Pennsylvania has been ravaged by monumental surges in violent crime as a direct result of Biden’s and Democrats’ pro-criminal policies," Trump's campaign said in announcing the event, noting that when he's elected, he'll "re-establish law and order in Pennsylvania!"

The Saturday attack on Trump turned the heated rhetoric of the 2024 presidential campaign freshly violent. Authorities said bullets fired from Crooks' AR-15 style rifle about 150 yards away grazed Trump's ear, killed a rally attendee as he dove to protect his family, and critically wounded two others. Secret Service agents killed Crooks moments later.

Attack planned well in advance

Investigators are still seeking Crooks' motive – despite his Republican leanings, he had donated recently to a progressive voter-turnout campaign in 2021 – but indicated he'd planned the attack well in advance.

The shooting marks the first assassination attempt against a former or current U.S. president since President Ronald Reagan was injured in a March 1981 shooting at a Washington, D.C., hotel.

There are many questions about why Crooks turned into a would-be presidential assassin, firing indiscriminately into hordes of political supporters.

FBI special agent Kevin Rojek said on a call with media that law enforcement located "a suspicious device" when they searched Crooks' vehicle and that it's being analyzed at the FBI crime lab.

"As far as the actions of the shooter immediately prior to the event and any interaction that he may have had with law enforcement, we're still trying to flesh out those details now," Rojek said.

None of Crooks' shocked neighbors or high school classmates described him as violent or that he in any way signaled he was intent on harming Trump. Sunday morning, reporters and curious locals swarmed the leafy streets of the home where Crooks lived with his parents in Bethel Park, about 50 miles from the shooting scene.

Those who knew him described a quiet young man who often walked to work at a nearby nursing home. One classmate said he was bullied and often ate alone in high school.

Sunday morning, neighbor Cathy Caplan, 45, extended her morning walk about a quarter mile to glimpse what was happening outside Crooks’ home.“It came on the morning news and I was like ‘I know that street,’” said Caplan, who works for the local school district. "It feels like something out of a movie.”

Dietary aide turned deadly killer

Authorities say they are examining Crooks' phone, social media and online activity for motivation. They said he carried no identification and his body had to be identified via DNA and biometric confirmation.

Although no possible motive has yet been released, Crooks nevertheless embodies the achingly familiar profile of an American mass shooter: a young white man, isolated from peers and armed with a high-powered rifle. His attack was one of at least 59 shootings in the United States on Saturday, according to the Gun Violence Archive.

According to records and online posts of the ceremony, Crooks graduated from Bethel Park High School, about 42 miles from Butler County, on June 3, 2022. That same day, Trump met briefly with investigators at his Mar-a-Lago club in Florida as they examined whether he improperly took classified documents with him when he left the White House.

A classmate remembered Crooks as a frequent target of bullies. Kids picked on him for wearing camouflage to class and his quiet demeanor, Jason Kohler, 21, said. Crooks usually ate lunch alone, Kohler said.

Crooks worked as a dietary aide at the Bethel Park Skilled Nursing and Rehabilitation, less than a mile from his home. In a statement provided to USA TODAY on Sunday, Marcie Grimm, the facility's administrator, said she was "shocked and saddened to learn of his involvement."

Neighbor Dean Sierka, 52, has known Crooks and his parents for years. The families live a few doors apart on a winding suburban street, and Sierka’s daughter, who attended elementary, middle and high school with Crooks, remembers him as quiet and shy. Sierka said they saw Crooks at least once a week, often when he was walking to the nursing home from his parents' three-bedroom brick house.

"You wouldn’t have expected this," Sierka said. "The parents and the family are all really nice people."

"It's crazy," he added.

Secret Service role: Did they do enough?

Founded in 1865, the Secret Service is supposed to stop this kind of attack, and dozens of agents were present Saturday. As the former president and presumptive Republican presidential nominee, Trump's public appearances are managed by the Secret Service, which works with local law enforcement to develop security plans and crowd-management protocols.

In the days before the event, the agency's experts would have scouted the location, identified security vulnerabilities, and designed a perimeter to keep Trump and rally attendees safe. Congress and the Secret Service are now investigating how Crooks was able to get so close to the former president, and several witnesses reported seeing him in the area with the gun before Trump took the stage.

As the event doors opened at 1 p.m., the temperature was already pushing close to 90, and ticketed attendees oozed through metal detectors run by members of the Secret Service's uniformed division. Similar to airport security screenings, rallygoers emptied their pockets to prove they weren't carrying guns or other weapons.

Media reports indicate the Secret Service had in place, as usual, a counter-sniper team scanning the surrounding area for threats.

In an exclusive interview, former Secret Service Director Julia Pierson told USA TODAY that maintaining such a sniper security perimeter is part of the agency's responsibility for safeguarding protectees like Trump from harm. She said agents typically consider 1,000 yards to be the minimum safe distance for sniper attacks.

The Secret Service has confirmed that it is investigating how Crooks got so close to Trump, who took the stage shortly after 6 p.m. Officials say Crooks' rifle was legally obtained but have not yet released specifics.

Outside the venue at that time, Greg Smith says he tried desperately to get the attention of police. He told the BBC that he and his friends saw a man crawling along a roof overlooking the rally. Other witnesses said they also saw a man atop the American Glass Research building outside the official event security perimeter, well within the range of a 5.56 rifle bullet.

"We noticed the guy bear-crawling up the roof of the building beside us, 50 feet away from us," Smith told the BBC. "He had a rifle, we could clearly see him with a rifle."

Smith told the BBC that the Secret Service eventually saw him and his friends pointing at the man on the roof.

"I'm thinking to myself, why is Trump still speaking, why have they not pulled him off the stage?" Smith said. "Next thing you know, five shots rang out."

From his nearby deck, Trump supporter Pat English watched as the former president took the stage to Lee Greenwood's "God Bless the U.S.A.," and attendees raised their cell phones to record.

English had taken his grandson to see the rally earlier but left when it got too hot. From his deck, they listened as Trump began speaking at 6:05 p.m., backed by a crown of red-hatted MAGA supporters waving "fire Joe Biden" signs.

And then gunfire began.

Boom, boom, boom

"I heard a 'boom, boom, boom' and then screams,” English said Sunday. "I could see people running and the police run in."

Trump was saying the word "happened" as the first pop rang out. He reached up to grab his ear as two more shots echoed, and the crowd behind him – and Trump himself – ducked. Plainclothes Secret Service agents piled atop the president as a fusillade of shots rang out, apparently the Secret Service killing Crooks.

The crowd screamed, and the venue's sound system picked up the agents atop Trump planning to move the former president to safety. One yelled, "shooter's down. Let's move, let's move."

The agents then helped Trump back to his feet as they shielded him on all sides.

The sound system then picked up Trump's voice: "Wait, wait," he said, before turning to the audience and triumphantly raising his fist to yell "fight, fight" as the crowd cheered, blood streaming down his face.

By 6:14 p.m. Trump's motorcade was racing from the scene, and in a later statement, Trump's campaign said he was checked out at a local medical facility.

"I was shot with a bullet that pierced the upper part of my right ear," Trump said in a statement. "I knew immediately that something was wrong in that I heard a whizzing sound, shots, and immediately felt the bullet ripping through the skin. Much bleeding took place, so I realized then what was happening."

Firefighter 'hero' gunned down

Outside of the Butler Township Administration Office Sunday afternoon, Pennsylvania Gov. Josh Shapiro identified the rally attendee killed by Crooks as Corey Comperatore, a firefighter, father of two and longtime Trump supporter.

“Corey died a hero,” Shapiro said. “Corey dove on his family to protect them last night at this rally. Corey was the very best of us. May his memory be a blessing.”

Two other Pennsylvanians are still undergoing treatment for their injuries, Shapiro said.

Pennsylvania State Police identified two wounded attendees David Dutch, 57, of New Kensington, and James Copenhaver, 74, of Moon Township. Both are hospitalized and listed in stable condition. Shapiro said he spoke with the family of one victim and received a message from the other.

Biden spoke briefly with Trump on Saturday night, and the president condemned the assassination attempt as “sick.” He said there’s no place for political violence in the U.S. and called on Americans to unite together to condemn it.

But earlier in the week, Biden told campaign donors in a private phone call it was time to stop talking about his own disastrous presidential debate performance and start targeting Trump instead.

"I have one job and that's to beat Donald Trump," Biden said. "We're done talking about the (June 27) debate. It's time to put Trump in the bullseye."

Republicans across the country have used similar language to attack their opponents over the years, and political scientists say violent rhetoric used worldwide almost invariably leads to physical violence.

On Sunday, someone parked a truck-mounted electronic billboard at the gates to the Butler Farm Show grounds reading "Democrats attempted assassination," along with a picture of Trump clutching an American flag, his face overlaid with a bullseye crosshairs.

Authorities say they have not yet determined a motive for Crooks' attack. But in a statement, Trump declared the shooting an act of evil and thanked God for preventing the unthinkable.

"We will fear not, but instead remain resilient in our faith and defiant in the face of wickedness," Trump said.

And he said he'd be back on the campaign trail for the Republican National Convention in Milwaukee, which starts Monday.

"Based on yesterday’s terrible events, I was going to delay my trip to Wisconsin, and the Republican National Convention, by two days," Trump said on his Truth Social account Sunday, "but have just decided that I cannot allow a 'shooter,' or potential assassin, to force change to scheduling, or anything else."

Contributing: David Jackson, Aysha Bagchi, Christopher Cann, Bryce Buyakie, Emily Le Coz, Josh Meyer, USA TODAY Network

How the assassination attempt unfolded : Graphics, maps, audio analysis show what happened

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Published: 18 July 2024

Insights on the contribution of doctoral research findings from a school in a South African University towards policy formulation

Florence Upenyu Damba ORCID: orcid.org/0000-0002-4668-9574 1 ,
Ntombifikile Gloria Mtshali 1 &
Moses John Chimbari 1 , 2

Humanities and Social Sciences Communications volume 11 , Article number: 930 ( 2024 ) Cite this article

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Health humanities
Social policy

Translation of health research findings into policy contributes to improvement of health systems. Generally, in sub-Saharan Africa policymakers rarely use research evidence and hence policies are often not informed by research evidence. Unless published or in the case of commissioned research, doctoral health research is often not used for health policy formulation. This paper analysed the potential and utilization of doctoral research from the School of Nursing and Public Health by KwaZulu-Natal Health Department of Health. The study adopted a mixed methods approach that combined elements of qualitative and quantitative research aspects. Qualitative data was collected through content analysis of 29 theses produced in the School of Nursing and Public Health, University of KwaZulu-Natal between 2014 and 2021 and interviews held with four Department of Health personnel as policymakers. When researchers could not get information on how research questions were formulated from content analysis, they checked the student questionnaire for answers. Quantitative data was collected from 79 participants through structured questionnaires. Participants included 47 PhD graduates, 11 final year PhD students and 21 PhD supervisors. Data from content analysis and interviews was analyzed thematically while data from questionnaires was analyzed quantitatively. Eleven (52%) PhD supervisors reported that findings from 22 studies were being considered for policy development and adoption while some had resulted in policy guidelines and frameworks that can be used to formulate policies. Factors such as failure to involve the Department of Health during the formulation of research questions, inappropriate packaging of research findings, policymakers not aware of the availability of research findings, lack of commitment to the dissemination of research results by students and poor demand for research evidence by policymakers hindered the translation of PhD research findings into policy. From the 29 theses reviewed, sixteen (28%) of PhD respondents highlighted that they involved the Department of Health to formulate research questions while forty-two (72%) did not. The theses review also revealed limited identifiable information related to policy formulation. The study confirms the use of PhD research findings for policy formulation. Additionally, it highlights the factors that hinder utilization of PhD work by policymakers. Further research to understand the perspectives of policymakers on factors that contribute to utilization of PhD work as well as how the findings have contributed to policy formulation is recommended since there was not sufficient data collected from policymakers due to Covid-19 restrictions.

In 2013, World Health Organization (WHO) reported that for 20 years there had been an unprecedented effort to use evidence in policy and decision making for health systems. Globally, it has been acknowledged that translation of health research into policy and practice is vital for enhancing the performance of health systems, promoting service delivery, and improving health outcomes (Barratt et al. 2017 ; Langlois et al. 2016 ; El-Jardali et al. 2014 ). However, evidence indicates that whilst there are numerous promising research findings, they are underutilized and often take a long time to be translated into health policy (Walugembe et al. 2015 ; El-Jardali et al. 2014 ). Research generated by universities can be used to influence national health policies to improve service delivery and outcomes (Pariyo et al. 2011 ; Nankinga et al. 2011 ). Studies that document the pathway of students’ research generally show that a substantial proportion of this work ends up on the shelves and are often underutilized (Caan and Cole 2012 , Bullen and Reeve 2011 ). Translation of research findings into policy can be facilitated through numerous ways. Researchers should strive to disseminate their research findings through appropriate methods for targeted policymakers. Examples of these include news media, social media, policy briefs, one-on-one meetings, policymakers’ workshops, and seminars. Researchers should also involve policymakers and other stakeholders in the earlier stages of the research particularly during the identification of key research questions (Uzochukwu et al. 2016 ).

The KwaZulu-Natal Provincial Health Research and Ethics Committee (KZN-PHREC) in South Africa sets research priority questions for the province and communicates them to the leaders of all academic institutions and research organizations. The priority research questions are also posted on the KwaZulu-Natal Department of Health (KZN-DOH) website to encourage researchers to address the questions through research projects (KZN-DOH webpage). Despite the growing knowledge of the factors influencing utilization of health research into policy, we are not aware of research that has specifically examined how doctoral research generated from the University of KwaZulu-Natal (UKZN) School of Nursing and Public Health (SNPH) through doctoral studies has contributed to existing policies or influenced formulation of guidelines and policies in South Africa. Understanding what facilitates utilization of doctoral research findings for policy formulation is critical to ensure that research conducted by doctoral students does not go to waste. We therefore conducted this study to establish if the knowledge generated from doctoral studies at UKZN, SNPH has contributed to existing DOH policies or formulation of DOH guidelines and policies and analyze the factors that may hinder or promote knowledge uptake by policymakers.

The study was conducted in KwaZulu-Natal (KZN) province and data was collected at UKZN in the College of Health Sciences (CHS), School of Nursing and Public Health (SNPH). The school has an average enrollment of 44 PhD students per year with a throughput of 32 students per year. The school has an average total of 54 PhD supervisors distributed across nine disciplines namely, Behavioral Medicine, Biostatistics & Bioethics and Medical Law, Family Medicine, Nursing, Public Health Medicine, Rural Health, Telemedicine, Traditional Medicine and Occupational and Environmental Health. The SNPH works closely with the KZN-DOH to provide skilled staff and inform research.

Study design

A case study design applying the mixed methods approach was used in this study. The SNPH in the CHS was treated as the case. The case study design was adopted because it allows the researcher to investigate a topic in its real-life context (Crowe et al. 2011 ). Mixed methods research was conducted to get an in-depth and comprehensive understanding of the research questions and complex phenomena that required the use of both qualitative and quantitative methods (Dawadi et al. 2021 ). The use of mixed methods research enabled researchers to answer the research questions with sufficient depth and breadth allowing them to develop more effective and refined conclusions based on complementarity of the different approaches (Dawadi et al. 2021 ). The mixed method approach also allowed triangulation to enrich and strengthen research results through use of different methods of data collection and analysis (Molina-Azorin 2016 ). A convergent mixed method approach was applied in the study (Tariq and Woodman 2013 ). Qualitative and quantitative data was collected concurrently, and the two data sets were analyzed separately and compared, contrasted, and combined at interpretation stage (Creswell and Clark 2017 ). Equal priority was given to both data sets considering the equal importance of both types of data in answering the posed research questions (Dawadi 2019 ). The three research questions that the study responded to were “How have PhD theses produced in the SNPH, UKZN between 2014 and 2021 contributed to existing policies or influenced policy formulation?”, “What factors contribute to utilization of doctoral research findings in the SNPH, UKZN by policymakers?” and “What factors influence utilization of doctoral research findings by DOH?”. The three research questions had the common goal of establishing if doctoral research findings from the SNPH contributed to existing policies or influenced policy formulation.

Study population and sampling

Non-probability purposive sampling was adopted to select the sample for both the qualitative and quantitative aspects of the study. We used our judgment in selecting individuals or items that possessed the required qualities and were able to provide the required data to respond to the questions of interest (Hibberts et al. 2012 ; Baker et al. 2013 ; Creswell 2014a ). Sampled items for the qualitative aspect included PhD theses and key DOH personnel at provincial level who were members of the research committee involved in granting permission to researchers conducting research in the DOH facilities. Sampled individuals for the quantitative aspect of the study included PhD theses, PhD graduates, PhD final year students, and PhD supervisors. The sample size for the two data sets was calculated using the Cochran formula below:

The targeted population included 81 PhD theses, 81 PhD graduates, 48 PhD final year students and 48 PhD supervisors. Out of the 81 theses that were marked and passed only fifty-one were available according to library records. There were however only thirteen theses available in the library repository as the data base was still being developed. Fourteen graduates whose thesis could not be accessed from the library agreed to share their soft copies. An additional twenty- four hard copies of the theses were obtained from the Postgraduate office. Out of the fifty-one theses that were accessed only twenty-nine met the criteria. We considered the 7-year timeframe we used to be reasonable because quality data was available for that period than earlier times and the study period coincided with the time the College adopted the thesis by publications format for presenting thesis which seems favorable for policy processes. We characterized a thesis as “policy related” if it highlighted the development of a framework, a model, guidelines, policy briefs, and if the study highlighted potential for the findings to be translated to policy. We excluded studies that were conducted outside South Africa. Of the eighty-one PhD graduates that were expected to participate only forty-seven (58%) participated. Eleven out of forty-eight (23%) PhD final year students participated. Due to Covid-19, it was not clear if they were still registered or not, so follow-up was difficult. Twenty-one (44%) out of forty-eight PhD supervisors participated making the overall response rate 45%.

Summary of sample selection

We selected all those who met the study’s criteria for eligibility as summarized. Theses produced between 2014 and 2021 based on studies conducted in South Africa, PhD graduates who graduated between 2014 and 2021, PhD final year students who were in the data collection and analysis, thesis write up, thesis submission and awaiting results, PhD supervisors who have supervised PhDs to graduation, and research committee members of the DOH were included in the study. Theses not based on studies conducted in South Africa, PhDs that graduated before 2014, PhD final year students in the proposal development stage, PhD supervisors who have not supervised PhDs to graduation, and those not in the DOH research committee were excluded.

Data collection methods and process

We adopted a mixed methods approach previously used and demonstrated to produce good results (Munce et al. 2021 ; Dawadi 2019 ; Mckim 2017 ). We used a combination of three data collection tools: content analysis, questionnaire, and interviews. The aim of combining the three tools was to manage two research questions and obtain stronger evidence for conclusions by merging research findings (Creswell 2014b ; Greene et al. 1989 ). The data collection tools are described in detail below:

Thesis content analysis

We conducted content analysis of doctoral theses produced between 2014 and 2021 in the SNPH, UKZN. Content analysis allowed us to analyze the data qualitatively and at the same time quantify it by measuring the frequency of different categories and themes (Grbich 2012 ). Content analysis was also conducted to confirm responses to the questionnaires. Twenty-nine PhD theses were analyzed to determine their implications on policy. A thesis by publication is submitted in the form of a series of already published, accepted or under review journal articles. A traditional thesis is a comprehensive piece of research in a book form.

We used a data extraction form to collect information from hard and soft copies of theses. The extraction form captured information on the discipline, research questions identification process, research findings dissemination methods and framework/model/guidelines/policy brief development and contribution of study to policy. The researchers checked the methods section of the theses under review for clues on how the research question formulation process was conducted and from the way thesis are written, the 29 studies had no indication of how the process was carried out. Since we had used mixed methods, we were able to get the information on how the process was conducted from the student questionnaire. Under each of the categories, we extracted information and presented it in a form of questions as indicated in the supplementary file attached:

Qualitative data was also collected through in-depth interviews conducted with four key DOH personnel at provincial level using a structured interview guide which included open-ended questions that were informed by literature review and the objectives of the study (Vaismoradi et al. 2013 ). The DOH personnel were members of the research committee who were responsible for granting permission to the researchers to conduct research. The researcher who conducted the interviews acquired interviewing skills through workshops and consultations with experienced qualitative researchers. The researcher was trained on interview and transcribing skills. Interviews provided detailed and rich data regarding phenomenon under study (Barrett and Twycross 2018 ) which was confirmed by questionnaire data (Harris and Brown 2010 ). Quotations that best illustrated the factors affecting translation of doctoral research into policy were used.

An interview guide with questions focusing on DOH’s expectations from doctoral students and the barriers, and facilitators of utilization of doctoral research findings by DOH was used to solicit for responses from participants. An interview guide allowed the researcher to control the line of questioning (Creswell 2014b ). Participants were contacted through email and telephone. The interviews lasted 40 minutes. Three of the interviews were done through zoom and one was conducted face to face. All four interviews were recorded with permission from the interviewees. Notes were taken to back up the audio recordings in case there were interruptions and, in the event, that the researcher forgot to switch on the recorder.

Questionnaire

Quantitative data was collected through a questionnaire using KoboCollect software. Participants were contacted through email. Two questionnaires were used for data collection. One questionnaire was administered to 47 PhD graduates and 11 PhD final year students. The other one was administered to 21 PhD supervisors. Completing questionnaires took about 40 min to an hour. PhD and PhD final year students’ questionnaire consisted of 50 questions. The supervisors’ questionnaire comprised of 30 questions. Data was fed on Microsoft Excel and cleaned before analysis.

Analysis of qualitative and quantitative data

We used qualitative content analysis to analyze data obtained through review of theses. Qualitative content analysis enables a purposeful interpretation of the data as well as the context in determining meaning which provides a good description of the material (Schreier 2014 ). Content analysis facilitated the categorization of data into themes, thus allowing the information to be analyzed appropriately. We categorized the content of the theses from raw data without a theory-based categorization matrix (Elo et al. 2014 ).

Recorded interviews were transcribed verbatim in a Microsoft word document by the researcher and a research assistant and imported into NVivo 12 to manage coding of the data. The files from which the data came from were given a unique identifier. Transcripts were read over and over as recommended by Erlingsson and Brysiewicz in order to familiarize with the data and get the sense of the text as a whole (Erlingsson and Brysiewicz 2017 ). The scripts were closely examined to identify common themes such as topics and ideas that came up repeatedly. The text was divided into meaning units keeping the research aim and question clearly in focus. The meaning units were then condensed further while keeping the meaning intact. Codes were developed using open coding. The exercise was repeated until the researchers were satisfied with the outcome. Codes that appeared to deal with the same issue were assigned to categories and themes. Quantitative data were analyzed using IBM- SPSS version 27 and summarized as percentages. Data from interviews was analyzed thematically using NVivo 12 software.

Rigour/quality/validity and reliability

Triangulation of qualitative and quantitative methods was used to enhance validity through the convergence of information from different sources (Molina-Azorin 2016 ; Nancy Carter et al. 2014 ; Zohrabi 2013 ; Creswell and Clark 2017 ; Rolfe 2006 ). In-depth interview was pilot tested on DOH personnel who did not take part in the study to check the validity of the tool. Prior to administering the questionnaires, a pilot study was conducted among PhD graduates, PhD final year students and PhD supervisors before being used as final documents, after which they were refined and some questions were rephrased before distribution to participants to ensure validity of the tool (Creswell and Hirose 2019 ; Thomas 2010 ; Ehrenberg and Sniezek 1989 ). The pilot test was used to improve precision, reliability, validity of data, identify problems/omissions, and assess time spent to complete the survey. The interview guide was also pilot tested to ascertain if participants interpreted the meaning of the questions as intended. The research instruments were reviewed by experts in the field of research and unclear questions were revised based on the reviewers’ comments (Zohrabi 2013 ).

Integration of qualitative and quantitative findings

The two data types were handled and analyzed separately and compared and contrasted for corroboration purposes (Tariq and Woodman 2013 ; O’cathain et al. 2010 ). Integration of the two data sets was done during interpretation of the findings (Chaumba 2013 ). The intention of integration was to develop results and interpretations that expand understanding, are comprehensive and validated and confirmed (Creswell and Clark 2017 ). The researchers listed the findings from each component of the study and considered where the findings agreed (convergence), offered complementary information on the same issue (complementarity), or appeared to contradict each other (discrepancy or dissonance) (Farmer et al. 2006 ).

Ethical considerations

The study was approved by the Biomedical Research Ethics Committee (BREC/00001384/2020) and the Kwa-Zulu-Natal Provincial Department of Health (KZ-202008-030). All research was performed in accordance with the ethical standards of institutional research committee applicable when human participants are involved. Written informed consent was obtained from all participants in the study.

Demographics of participants

Table 1 shows the demographics of the sources of data.

Eleven (52%) PhD supervisors reported that findings from 22 studies were being considered for policy development and adoption while some had resulted in policy guidelines and frameworks that can be used to formulate policies. Table 2 below indicates the studies produced between 2014 and 2021 that are being considered for policy development and adoption.

Emerging themes

Two major themes emerged during interviews with DOH personnel and content analysis of PhD theses:

Involvement of DOH in the formulation of research questions

DOH priority research questions

Meetings with DOH

Dissemination methods used to communicate research findings to DOH including policy briefs, journal articles, National Health Research Database (NHRD), conference presentations, research reports, media, copies of theses, presentation at DOH annual health research days and stakeholder meetings.

Findings from the two data sets (qualitative and quantitative) were integrated and are discussed below:

Theme 1: Involvement of DOH in the formulation of research questions

The findings revealed that DOH is somewhat involved in the formulation of research questions. Sixteen (28%) of the PhD respondents highlighted that they involved DOH while forty-two (72%) did not involve DOH. Interview data indicated that DOH publishes a list of priority research questions on its website and sends it to senior management of research and academic organizations in KwaZulu-Natal including the SNPH with the hope that researchers will engage with it, for example, some of the participants stated that:

“We have a list of priority research questions that we have published on our website, and we have also sent to the senior management of research and academic organisations in KwaZulu-Natal. We developed these priority research questions with our district managers, program managers and facility managers. We hope that researchers who are looking for topics will engage with them, and we hope that we have advertised them well enough for them to know about them”. Respondent 1, DOH

“The department of Health has a research agenda that is published on its communication platforms”. Respondent 4, DOH

According to data sources, in most cases students do not respond to priority research questions. In some instances, they conduct studies that are part of their supervisors’ bigger projects. For example, 2 (10%) supervisors mentioned that their commissioned projects involve PhD students. PhD research work is not commissioned by DOH as confirmed by one of the participants from DOH,

“We do not really commission research because we cannot pay for it. When we need research to be done, we usually do it in partnership with institutions or if possible, we just do it ourselves”. Respondent 2, DOH .

Theme 2: Research findings dissemination

Only twenty-two (38%) students confirmed that they sent their findings to DOH while thirty-six (62%) did not share their research findings with DOH despite the condition in the DOH gatekeeper permission that the report should be submitted to the DOH. This was also supported by the qualitative data indicating that although part of DOH approval letter instructs students to share their research findings with them, only a small fraction of the students send their research results on completion of their studies.

“The expectation is that as part of dissemination of research findings, the researcher should then come back and share their findings with the Department of Health and table their recommendations because when we do research we want to come up with recommendations at the end. Unfortunately, this is not really monitored or done”. Respondent 2, DOH .

However, it was reported that it is difficult for DOH to monitor the feedback of research findings since there are many projects approved every year in KZN. For example, one of the participants said,

“ Part of our letter of approval states that students are required to send their research findings to DOH on completion of their studies. Beyond that we don’t really do anything and it’s quite difficult to monitor because there are hundreds of projects approved every year in KZN so to follow up will take a lot of time. There is need to systematize it so that when the researcher is done, we ask them to send us their findings. We cannot really do it on an individual basis, and we haven’t got a system in place yet to automate it. We have been discussing various options, but we have not really hit on one that we think is going to improve everything”. Respondent 1, DOH .

Analysis of theses showed that research findings were disseminated to DOH and stakeholders through various methods; peer-reviewed journal articles, copies of theses, conference presentations, community/stakeholder meetings and policy briefs. This corroborates with what was highlighted by PhD graduates and final years in their responses for the questionnaire study. Table 3 below shows responses from the questionnaire on the methods that were used by students to disseminate research findings to DOH.

Five (24%) supervisors stated that their students used policy briefs to disseminate their findings to DOH while seventeen (81%) supervisors said that students used peer-reviewed publications. Sixteen (76%) supervisors reported that students used stakeholder feedback meetings, two (10%) supervisors said they used the media and one (5%) supervisor stated that the students used X. According to PhD graduates and final years questionnaire data, conference presentations were used more than the other methods to disseminate research findings to DOH. Dissemination to NHRD and use of media were the least used methods of dissemination with 1 (2%) participant each.

Thirty-one (53%) PhD students stated that they had attended the KZN-DOH annual research day and twenty-three (40%) had presented on such research days. Twenty-seven (47%) attended the research days to listen to other researchers’ presentations. The dissemination of research findings through the KZN-DOH annual research day was corroborated by a DOH respondent:

“The department holds a research day annually and only a few researchers get the opportunity to present their research findings. There is poor attendance of policymakers who have the decision-making powers at the event hence the research findings and recommendations will not be translated into policy. Respondent 3, DOH .

Apart from KZN-DOH annual research day, the students also presented at other national and international conferences. 76% of participants presented their work at least at four local scientific conferences while 72% presented their work at least at five international conferences. Policymakers suggested dissemination strategies that are potentially useful to translate research into policy such as setting aside a specific day for DOH employees to meet and read an article by a student from SNPH, UKZN that has policy implications or for students from SNPH, UKZN to present their research findings to relevant employees in the department who may consider them for policy formulation. One of the participants stated that,

“It can be sessions at work where you can come up with one article a Friday once a month and engage in research that has been done and choose whatever works for you to improve practice or even in policy development. DOH needs to allow students who have done research an opportunity to present their studies to relevant employees in the department who might take the recommendations seriously and use them to improve and inform our own practice and develop informed policies from them”. Respondent 4, DOH

Policy briefs produced or policy contributions by students

Only two students produced policy briefs with one student producing two policy briefs and the other one producing one. This was confirmed by data obtained from the PhD graduates and final year students’ questionnaire. Only two (3%) students responded that they produced policy briefs. Only one (5%) supervisor indicated that their students have produced policy briefs. Respondents from DOH were not aware of any research conducted by students in the SNPH during the period 2014 to 2021 that has been used in programs, either for guidelines or policy formulation.

“I cannot name any recent or specific research that was done in the SNPH between 2014 and 2021 that was used in programs either for guidelines or policy formulation. Research that I remember that was conducted at UKZN and translated into policy very quickly was research conducted during the early years of HIV which was used in creating policy around HIV and infant nutrition”. Respondent 1, DOH

“I do not want to lie to you… none. whatsoever. I have not heard of any research study conducted by a student actively being converted into influencing our policies or guidelines”. Respondent 4, DOH

“I don’t know of any specific research from the school that was used for policy formulation”. Respondent 3, DOH

Regarding feedback on research results to DOH, supervisors expressed varied degrees of compliance. They were asked to state their responses on a 5- point Likert scale: Never, Rarely, Sometimes, Often and Always. Table 4 shows frequency of feedback of research results to DOH by PhD supervisors.

The gap between research and policy and practice is still very wide in low and middle- income countries such as South Africa (Uzochukwu et al. 2016 ). The failure to take-up high- quality research evidence by policymakers is a persistent problem. Academics and policymakers have different incentives (Nutley et al. 2007 ), rules, obligations, values and interests (Newman et al. 2016 ). We analysed the contribution of doctoral theses to the formulation of health policies in KwaZulu-Natal, South Africa. Fifty-two percent (52%) of PhD supervisors who participated in the study reported that 22 studies conducted between 2014 and 2021 in the SNPH, UKZN were being considered for policy development and adoption. Some of the studies resulted in the development of policy guidelines and frameworks that can guide the formulation of policies. According to the information obtained from PhD supervisors’ questionnaire, the studies were successful in reaching policymakers because where supervisors thought there was policy relevancy arising from PhD work, they ensured that they engaged with policymaking entities such as the Department of Health and the Department of Environment, Forestry and Fisheries at provincial and local government level as well as at national level for research findings to be translated into policy. Some studies were also successful in reaching policymakers because supervisors had meetings with policymakers to highlight problem areas and possible solutions. Some supervisors revealed that studies were successful in reaching policymakers because the students embedded their work within their larger projects through a learning collaborative that was established within KZN-DOH which facilitates evidence-based learning. However, none of the 22 studies were included in the 29 theses analyzed by the researchers.

Although we found some evidence of utilization of doctoral research findings for policy formulation, the research was not utilized to its fullest potential by policymakers (Nutley et al. 2007 ). Two major themes of the factors that contribute to utilization of PhD work emerged from the study; involvement of DOH in the formulation of research questions and dissemination methods used to communicate research findings to DOH. The factors were the same across the two data sets (qualitative and quantitative) hence they were merged.

In contrast, DOH personnel reported that they were not aware of any PhD research from the SNPH that has influenced policy formulation. Perhaps, the challenge leading to this disparity is that the provincial officials interviewed may not have been fully aware of research conducted in all the districts and municipalities. Students and supervisors may be disseminating findings to the district and municipalities. It could also be a problem of deficiencies of the reporting systems in cascading information upwards. It is sensible that students report their findings to officials who are closer to their research sites. Furthermore, these findings would be relevant to that municipality or district where research is being conducted. Hence, they disseminate their findings to the closest office. On the other hand, provincial officials are swamped with work and may not be fully aware of research conducted in all the eleven districts.

Results of our study showed that policymakers were not aware of the availability of doctoral research findings due to lack of meaningful discussion of available research findings between researchers and policymakers, their suitability to policy- related problems and identification of other policy related areas requiring research attention (Uzochukwu et al. 2016 ). DOH was also not aware of the availability of research findings because they were not involved in the formulation of research questions for the projects. The results revealed that forty-two (72%) students did not engage with DOH/ policymakers during the formulation of research questions for their projects. It is acknowledged that engagement of stakeholders during formulation of research questions for projects ensures that appropriate research questions are pursued as well as informing policymakers of the availability of research findings (Edwards et al. 2019 , Oliver and Cairney 2019 ). This finding is in line with studies conducted in Ghana and Tanzania (Kok et al. 2017 , Wolffers and Adjei 1999 ). WHO stresses the value of closer collaboration between research organizations and the policymakers they seek to influence, so that evidence creation is better aligned with policy priorities (Organization 2016 ). DOH was also not aware of the evidence from research they did not commission. We established that DOH does not commission research due to lack of funding. Policymakers are likely to translate research that they have commissioned because they would have defined what gap needs to be informed by pending evidence (Mapulanga et al. 2020 ).

The poor demand for research evidence on research projects approved by DOH was also reported as a barrier. This may reflect DOH’s perception of the value of doctoral research evidence or their prioritization of research for decision-making (Ezenwaka et al. 2020 ). Part of DOH approval letter states that students are required to send their research findings to DOH on completion of their studies. However, according to the data obtained from the students’ questionnaire only twenty-two (38%) students sent feedback to DOH when they completed their studies. This was supported by supervisors who reported that students hardly give feedback to institutions that give them permission to carry out their studies. Although DOH do not have an automated system to monitor projects that have been completed out of the hundreds of projects they approve in the province per year, they do not have to rely on students who have completed their studies for feedback. They can use other strategies such as journal clubs to access research results. A participant from DOH suggested that as DOH they can form journal clubs where they can meet once a month and read an article by a student from the SNPH. Another participant suggested that students from SNPH can be asked to come and share their research findings with relevant people in the department. The study also revealed that 76.1% supervisors sent feedback of students’ research findings to DOH.

The methods through which research findings were communicated by the students could have also influenced demand and research uptake by DOH (Uzochukwu et al. 2016 ). It was interesting to note that PhD research findings were disseminated at scientific conferences and in scientific journals more than at policy forums or workshops (Edwards et al. 2019 ; Mcvay et al. 2016 ). 76% of the students reported that they presented their work at least at four local scientific conferences whilst 72% presented their research findings at least at five international conferences. Often, policymakers are not present at these conferences. This finding shows that PhD students prefer to communicate their research results through scientific conferences and peer-reviewed journals more than active engagement with policymakers. These results are consistent with the findings of (Ndlovu et al. 2016 ) that academics prioritize scholarly communication and prefer academic journals and conferences as communication platforms. In the SNPH, this could be attributed to a culture where publishing in peer-reviewed journals is rewarded and carries considerable prestige and power. Institutional priorities such as number of journal articles published, number of conferences attended and number of grants attracted limit researchers commitment to responding to policy issues facing policymakers (Ha et al. 2022 ; Gordon and Bartley 2015 ).

Scientific journals, with their assortment of articles may contain nothing of interest to a policymaker whose needs are very specific (Glied et al. 2018 ). It has also been argued that some policymakers might not have the skills and resources to access research evidence or time to source for evidence from scientific journals (Hyder et al. 2011 ). Most policymakers have responsibilities and priorities that may prevent them from spending a lot of time reading or reviewing the materials provided to them in detail (Brownson et al. 2018 ). Presenting research findings in less complex formats such as policy briefs that use simple language, has been shown to improve health research transfer in policymaking (Newman 2014 ). It was not the case with this study where only three policy briefs were produced. The study revealed that only 3.4% of the students who participated in the survey produced policy briefs. This supports findings of a survey of researchers in the Eastern Mediterranean Region that showed that only 15% produced policy briefs (El-Jardali et al. 2012 ). The low production of policy briefs may be attributed to researchers’ lack of policy briefs writing skills.

DOH acknowledges the strategic role of knowledge translation in attaining national health goals, as evidenced by the creation of KZN-DOH annual research day which is a one-day evidence-to-policy workshop aimed at getting feedback on research that they have approved. The main perceived benefit of the platform is to provide a non-academic space (Fernández-Peña et al. 2008 ) recommended for researchers to disseminate research findings to policymakers who can translate research into policies and adoption of interventions to public health settings (Proctor and Chambers 2017 ; Tinkle et al. 2013 ). The other benefit of the forum is that it is a platform where researchers and policymakers discuss health policy implications of research findings pertaining to policy and practice (Parkhurst 2017 ). This finding is also supported by a study conducted in Nigeria which found that the Nigerian research days that were organized by the Department of Family Health, Federal Ministry of Health of Nigeria had fostered a platform to discuss policies on maternal and child health by allowing dialog among various stakeholders, including researchers and policymakers (Johnson et al. 2020 ). The combined use of policy briefs, policy dialogs and meetings with policymakers have been proposed to enhance knowledge translation as the strategies are deemed to be likely familiar to both researchers and policymakers (Edwards et al. 2019 ).

Whilst the KZN-DOH annual research day is ideal for dissemination of research findings; our study reveals that DOH is not utilizing the platform to its fullest potential. Only 40% of the students presented their research findings at the KZN-DOH annual research day. Only a few students got the opportunity to present their research findings since it is a one-day event. The event may be extended to two or three days or may be conducted on a quarterly basis to allow for more research results to be disseminated to DOH. It was also reported that attendance by policymakers who have the decision-making powers at the event was poor hence the likelihood of the research findings and recommendations being translated is low. Our study also found that although researchers are encouraged to address priority research questions posted on DOH website, projects did not respond to these questions. A previous study highlighted that sharing research priority lists is important in research question identification and rewarding such engagement would incentivize postgraduate students to demonstrate how they engaged policymakers at various levels (Obuku et al. 2021 ). When research does not respond to priority research questions raised, it minimizes the likelihood of research findings being used in policy and practice.

Only thirteen PhD theses produced in the SNPH between 2014 and 2021 were accessed from the institutional repository. The SNPH has an average enrollment of 44 students per year and a throughput of 32 students per year. Given the number of PhD students expected to have graduated during the period under study, the theses in the institutional repository reflected very low levels of content deposit. The finding confirms Harnad’s position that most universities’ institutional repositories are 85% empty with deposit levels sitting at 15% or below (Harnad 2011 ). Some supervisors highlighted that they held meetings with policymakers to highlight problem areas and possible solutions.

Implications for future research and policy

This paper has identified the gaps that exist in the process of translating doctoral research findings into policy. This has opened an opportunity to explore possible solutions to address the gaps. Our findings are unique to the field in that they are postulated by authorities and participants who have an active role in both the development and use of research findings with the department of Health in KwaZulu-Natal. The department on its own is a typical case study that can be portrayed as an example of how such challenges in translating research manifest and how they can be solved. Results of this study contributed to the development of a framework that guides both students and policymakers on the processes necessary for consideration of doctoral research findings in policy formulation.

Strengths and limitations

This is the first study that has attempted to highlight the extent to which doctoral research from the SNPH at UKZN has contributed to existing policies or influenced formulation of guidelines and policies of DOH, South Africa. Data were collected using three different sources (document review, questionnaires, and interviews) which allowed cross-checking of findings. Nonetheless, we encountered some shortcomings, particularly with regards to access to PhD theses produced between 2014 and 2021. The library repository was not up to date and had a limited number of theses produced during the period under study; therefore, the document review did not include all the theses that were produced between 2014 and 2021. The only way to obtain all the theses produced during the period under study was to get them from the graduates themselves. However, some of them were reluctant to share their theses for personal reasons. We could have missed some important information pertaining to our study. Another limitation is that the study was carried out in a single school in one college of UKZN, yet the university has four colleges with 19 different schools. For this reason, our findings may not be generalized for UKZN. Some of the reviewed theses were too recent not allowing enough time for research findings to be utilized for policy. The other limitation was that several PhD supervisors who were approached to participate in the study could not participate due to various reasons such as busy schedules and not having had supervised PhD students to completion. It was a requirement for PhD supervisors to have had supervised students to completion. Due to lockdown restrictions the email was the only means of recruiting participants for the study. However, people have a tendency of not responding to emails even after reminded on several occasions. Since the online questionnaire was the only option for collecting data, the response rate was very low.

This study has identified the gaps that exist in the process of translating doctoral research findings into policy. The findings from this study indicated that some studies were being considered for policy development and adoption while some had resulted in policy guidelines and frameworks that can guide the uptake of PhD work. The study revealed that DOH was not aware of the availability of doctoral research findings which could be attributed to the format in which the research results were disseminated and the fact that students did not involve policymakers in the formulation of research questions for their projects. Research results were communicated through scientific conferences and peer-reviewed journals more than active engagement with policymakers. Findings from this study contributed to the development of a framework that guides both students and policymakers on the processes necessary for consideration of doctoral research findings in policy formulation.

Data availability

The data involved in this study are from in-depth interviews and questionnaire surveys, and because the original data involves personal information, it cannot be fully disclosed due to identifiability issues. De-identifiable datasets generated and analyzed during the study will be made available from the corresponding author on reasonable request.

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Damba, F.U., Mtshali, N.G. & Chimbari, M.J. Insights on the contribution of doctoral research findings from a school in a South African University towards policy formulation. Humanit Soc Sci Commun 11 , 930 (2024). https://doi.org/10.1057/s41599-024-03439-x

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Game Changer: Exploring the Role of Board Games in the Lives of Autistic People

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Published: 05 July 2024

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Liam Cross 1 ,
Francesca Belshaw 2 ,
Andrea Piovesan 2 &
Gray Atherton ORCID: orcid.org/0000-0002-3954-9127 1

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This mixed methods paper reports findings from three studies examining the overlap between autism and hobbyist board gaming. The first was a quantitative survey of over 1600 board gamers, showing that autistic individuals are overrepresented in this hobby compared to the general population and that autistic traits measured by the AQ are significantly elevated amongst board gamers. Study 1 also assessed gamers’ motivations and preferences and reported key differences as well as similarities between autistic and non-autistic gamers. The second was a qualitative study that reported the results of 13 interviews with autistic individuals who are hobbyist board gamers. Using Interpretive Phenomenological Analysis (IPA), four key themes were uncovered, including a preference for systemising, escapism and passions, the social lubrication effect of games and difficulties with deception. In the third, 28 autistic individuals were introduced to board games in groups of 5–10 over an afternoon. Subsequent focus groups were then analysed using IPA. This analysis uncovered themes around how board games are challenging but encouraged growth and how they were an alternative vehicle for forging social relationships. Through this paper, we discuss how and why board games may be a popular hobby amongst the autistic population, and its potential utility for improving autistic wellbeing.

Socialization via Online Gaming: Perspectives of Five Autistic Adolescents and Their Parents

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Introduction

Autism spectrum condition (ASC) is a neurodevelopmental condition affecting an estimated 1% of the population globally (Kogan et al., 2018 ). A recent systematic review by Zeidan et al. ( 2022 ) estimated that the median prevalence of autism worldwide is 100/10,000 (1% prevalence), with a median male-to-female ratio of 4.2 to 1 and co-occurring intellectual disability at around 33%. Great strides have been made to improve awareness and acceptance of autism, including reconceptualising autism as a condition with considerable accompanying strengths (Cope & Remington, 2022 ). Nevertheless, there is still a need to understand the strengths and challenges inherent to the autistic experience to improve the quality of life throughout the lifespan, as research suggests that autistic adults do not experience the same gains as neurotypicals when moving through adulthood (Atherton et al., 2021 ).

Flow Theory, Monotropism and Passions

Around 75–90% of autistic people, compared to an estimated 30% of neurotypicals (Klin et al., 2007 ), report having strong interests in domains where they develop expertise and high levels of engagement (Caldwell-Harris & Jordan, 2014 ). These are traditionally referred to as restricted interests in the DSM V, though here we use the term passions as this is a strengths-based term (Bailey, 2023 ; Barton & Hamilton, 2012 ). Two theories have been used to understand the hyper-focus often seen in autistic people when engaged with their passions. Csikszentmihalyi and Csikszentmihalyi, ( 1990 ) described flow as a psychological state in which one achieves a high level of enjoyment of a task to the point of experiencing optimal happiness where nothing else seems to matter. An increasingly popular model for autism that can describe this atypical focus of attention is the interest model, also known as monotropism (Murray et al., 2005 ). In a monotropic flow state, autistic people can gain predictability, achievement, and optimal happiness by being ‘pulled in’ by their passions (Milton, 2017 ). Some have argued that monotropic attention may be advantageous to autistic people when it is channelled to provide educational and social advantages, such as developing expertise and demonstrating enthusiasm (Wood, 2021 ).

Though autism can be understood as a condition with considerable accompanying strengths, research suggests that there are still struggles autistic people face in everyday life (Graham Holmes et al., 2020 ). To compensate for these, many autistic people become adept at masking or camouflaging, which means hiding one’s autistic traits in order to fit into a neurotypical world (Hull et al., 2017 ). Masking is related to poor mental health outcomes (Bradley et al., 2021 ), including an increased risk for negative self-appraisal (Cage & Troxell-Whitman, 2019 ) and engaging in self-harm (Mournet et al., 2023 ). One method for living authentically is for autistic people to be open about their areas of expertise or interests, which is positively linked to their quality of life (Grove et al., 2018 ). Passions engage and motivate autistic individuals and often reduce stress and anxiety (Attwood, 2003 ). For example, Winter-Messiers ( 2007 ) found that when autistic students were involved in activities related to their passions, they reported higher self-esteem, felt more confident and displayed more enthusiasm and positive emotions. Autistic individuals often report the need to express their desires and interests to allow them to feel comfortable in social situations and their environments (Späth & Jongsma, 2020 ). In this sense, it is vital to encourage the passions of autistic people and create opportunities for these passions to be explored in social spaces.

Autism and Board Games

Board gaming is a pastime that may be particularly well suited to autistic monotropic engagement, as it requires sustained attention and a transfer of established skills to new domains (Gobet et al., 2004 ). As autism is a particularly heterogeneous condition, a characteristic which extends to the diversity of passions in those on the spectrum (Nowell et al., 2021 ), the variety of board game options may be particularly well suited to this population (Brown & MacCallum-Stewart, 2020 ). The wide array of board games on offer means autistic people can find a game that suits their unique interests. For instance, research on the most common passions of autistic people includes animals and transport (Cho et al., 2017 ). These are also common themes of board games (Cross et al., 2023 ), which may mean that autistic people could find game themes that allow them to engage with their areas of expertise, which has been shown to benefit autistic well-being (Harrop et al., 2019 ).

Autistic individuals often struggle to form close relationships and friendships, with research suggesting they are more likely to feel lonely and isolated (Mazurek, 2014 ; Umagami et al., 2022 ). Board games may be a vital hobby to improve these outcomes. Rogerson et al. ( 2016 ), for instance, interviewed eleven board gamers who stressed the importance of board games sociality, highlighting how spending time with like-minded people was a crucial aspect of play.

Though there is very little academic work in this area (Atherton & Cross, 2021 ), there is a great deal of anecdotal evidence that modern board games may be a popular hobby for those on the spectrum. Multiple magazine articles and blog posts discuss the link between the two (Russell, 2023 ), and there are myriad examples of overlap between autism and modern board gaming in popular media (Arndt, 2023 ).

Modern Board Gaming

Modern board gaming is a fast-growing hobby, and its community is evolving rapidly, having achieved unparalleled popularity and commercial success in the last twenty years. In 2016, The Guardian reported on ‘The Rise and Rise of Tabletop Gaming,’ citing related social and design factors underpinning this surge in interest. While board games may have previously been synonymous with childhood, consumer demographics of modern board games are decidedly adult (Woods, 2012 ). They include young professionals, including couples, who prefer to play games with friends rather than go out to pubs or clubs. They often overlap with ‘geek culture,’ or individuals who are also interested in computers, video games, science fiction and comics (Woo, 2012 ). With the general acceptance of games in the broader culture, including those accessible on mobile platforms like smartphones and browsers, gamification within Western culture provides fertile ground for the continued proliferation of board games. Market research predicts a $4 billion growth in the global board games market from 2020, reaching $30 billion by 2026 (Arizton Advisory Intelligence, 2020 ). Millions attend conventions like GenCon, Spiel and the UK Games Expo annually. With the rise of game cafes, the growing acceptance and self-identification of ‘geek’ or ‘nerd culture’ (Kinney, 1993 ; Woo, 2012 ), and the pandemic spurring at-home forms of entertainment (Coward-Gibbs, 2022 ), board gaming is gaining popularity and visibility.

Purpose of the Current Studies

To date, there is a limited amount of research exploring the impact board gaming might have on the social lives of autistic individuals. This work, therefore, aims to address this gap in three ways: (1) By exploring the representation of autistic people in the hobby, (2) By understanding what it is autistic board gamers get out of the hobby, and (3) By introducing autistic people not already involved in the hobby to it, to understand if and how it could be beneficial to them. This paper reports three studies examining the relationship between autism and board games to better understand the potential benefits of board gaming for autistic individuals. Study 1 assessed the prevalence of autistic individuals and those with higher autistic traits in this hobby, as well as gamer preferences and motivations. Study 2 explored the lived experience of 13 autistic gamers through interviews. Study 3 introduced groups of autistic people to board games and then examined their utility through focus groups.

This work set out to investigate the prevalence of autism amongst board game hobbyists and evaluate whether this is indeed a leisure activity that is common in the autistic population (as anecdotal evidence suggests). A large dataset which surveyed hobbyist board gamers (Cross et al., 2023 ) was utilised to establish the prevalence of mental health conditions and other demographics in this population. Preferences for game styles, themes and mechanics, and gamers’ motivations for playing were also explored. These findings offer clinicians and educators interested in utilising board games in their work valuable data about the games that autistic individuals most and least enjoy. This dataset is open access on the open science framework ( https://osf.io/vygd3/?view_only=d1d52d8e0fca4e98be9c5c4dd54e846b ).

This study utilised a survey design administered on Qualtrics. A target sample of 1500 board gamers was solicited, and data collection was left open for two months. Participants were recruited from special interest groups for board gamers on social media, and further invites were sent out to gamers from industry mailing lists. This call was explicitly addressed to those already involved in the hobby. However, as we wanted to assess the rate of autism naturally present amongst this population, the call did not mention autism, and autistic participants were not directly recruited. Each participant was given a digital copy of a board game in return for participation. Respondents were surveyed on their demographics and preferences in the hobby. All measures and response formats are reported briefly below, and a full copy of all questions and answers can be found in the supplementary materials. More details on the design and data can be found at Cross et al. ( 2023 ).

RQ1: Is autism more or less prevalent among board gamers than in the general population?

RQ2: Do the motivations and preferences for board gaming differ between autistic and non-autistic players?

Demographics

Respondents first reported gender, biological sex assigned at birth, age, ethnicity, nationality, educational level and diagnosed mental health conditions. These were answered using drop-down sections using the standard Qualtrics pre-sets. Those who indicated they had a diagnosis of ASC were asked to specify if they received that diagnosis from a medical professional and at what age they were diagnosed. All participants also completed the Autism Quotient (AQ), a commonly used 50-item measure of autistic trait levels (Baron-Cohen et al., 2001 ).

Gamers’ Experiences

Respondents were then asked to report their general experiences with playing board games. This included their level of familiarity with games (newbie/novice, casual, midcore/core or hardcore/expert), the number of hours played on average per month (< 1, 1–4, 5–9, 10–19, 20–29, 30–39, 40 +), and their preferred platform (online, in-person or both equally). Then, participants were asked to rate their enjoyment of several gaming elements such as preferred player count; game length, pieces (i.e., cards, dice, etc.), style (competitive, cooperative, etc.), classification (Euro, Ameri, Hybrid), and type (gateway, party, heavy, etc.), on a slider scale from ‘not at all’ to ‘very much’. Next, respondents were asked to rate their preferences on how much they enjoyed 28 board game mechanics (an industry/hobby-specific term referring to the rules and actions that keep the game moving towards a victory, i.e., dice rolling, worker placement, area control, player elimination, etc.) again from ‘not at all’ to ‘very much.’ Following this, respondents rated their enjoyment of the 14 most popular board gaming themes (as indicated by BoardGameGeek.com, i.e., war, crime, farming) on the same slider scale. Respondents then indicated (via similar sliding scales) how important (not important—very important) several aspects were when choosing a game (i.e., theme, components, mechanics, etc.) and what motivates them to play a game (competition, socialising, escapism, etc.). Respondents then indicated how important gaming was for their social life and how important it was to feel like a part of the board gaming community. All slider scales generated a number from 0 to 100 (which was not visible to participants) and were presented with the anchor point positioned in the middle of the scale, which needed to be moved before the page could progress. Definitions of all relevant terms and example games were provided alongside each question. For a full copy of the measures, please see the supplementary materials.

Participants

A total of 1603 individuals completed the questionnaire, specifically 1242 males and 361 females aged between 18 and 73 years old (mean age = 32.38; SD = 9.21), with ethnicities of White (60.6%), Asian (34.1%), Black (1.4%), Hispanic (1.1%), Middle Eastern (0.6%), and Other (2.2%). across 63 different countries, with a concentration of participants from the US (11.2%), UK (27.4%), France (18.3%) and China (25.5%). Participants showed a high level of education (37.7% reported being university graduates, and 20.7% held a postgraduate degree). Edge Hill University’s ethics committee granted full ethical approval, and all participants gave informed consent.

Results & Discussion

Mental health and neurodevelopmental conditions.

Alpha levels of Mann–Whitney U tests reported below were not corrected for multiple tests as these were exploratory analyses. Maintaining a 0.05 alpha level will provide further insights to explore in future studies. As shown by Table 1 , most participants (72.9%) indicated having no mental health or neurodevelopmental condition. In contrast, just over one-fourth of participants reported having at least one medically diagnosed mental health/neurodevelopmental condition. Of the respondents, 4.7% of the sample reported having autism, with Clopper-Pearson’s exact method suggesting 3.70 and 5.83% as the lower and upper limits for the population proportion with 95% level of confidence. This statistic is much higher than the estimated global prevalence rate of 1%, according to 99 estimates from a systematic review of 71 papers (Zeidan et al., 2022 ). The prevalence of individuals with autism in our sample is also higher compared to studies that looked at adults exclusively and reported a prevalence of 1.1% (95% CI: 0.3–1.9%; Brugha et al., 2011 ). Additionally, research suggests that autism rates are highest in Western countries (for instance, the prevalence in Asia is 0.36%) (Qiu et al., 2020 ). As such, our data suggests that autism rates among board gamers are significantly higher than is typically found in the general adult population worldwide. In a similar vein, given the complexity of many board games and the cognitive skill level required to play them, it is unlikely that individuals with intellectual disability (where comorbidity with autism is an estimated 25% (Idring et al., 2015 ) to 33% (Zeidan et al., 2022 ) would be represented in this online sample.

Our sample showed a typical prevalence of individuals with ADHD. A total of 4.1% (2.98–4.93 Clopper-Pearson’s 95% confidence limits) of participants reported a diagnosis of ADHD, which is in line with reported prevalence in adult general population of 2.5% (95% CI 2.1 – 3.1) to 5.2% reported by others (95% CI 4.6–5.8) (Fayyad et al., 2007 ; Simon et al., 2009 ). As past literature has found significant comorbidity between autism and ADHD in the general population (around 50%; Rong et al., 2021 ), we checked this comorbidity in our sample. Among individuals with a diagnosis of autism, 9.3% of individuals reported also having ADHD. This was higher than the frequency of ADHD in TD individuals (2.7%) and BAP individuals (5.8%). However, 9.3% comorbidity is significantly lower than what has been found in past studies looking at autism in the general population (around 50%; Rong et al., 2021 ), which may suggest that autistic board gamers are a unique group (discussed further in the discussion).

Similarly, participants with dyslexia were 4.2% (3.25–5.28 Clopper-Pearson’s 95% confidence limits), a similar prevalence rate to what is estimated in the general population.

Shaywitz and Shaywitz ( 2005 ) suggested that the prevalence of dyslexia is between 5 and 17% of school-age children in the United States, while, although the prevalence in adulthood is less studied, it is thought to be around 4% (DSM-V, as cited by Soriano-Ferrer & Martínez, 2017 ).

The most common mood disorder was depression, with 13.2% (11.49–14.85 Clopper-Pearson’s 95% confidence limits) of the sample reporting having received a diagnosis. This is in line with the estimates suggested by Lim et al. ( 2018 ) of 12.9%, and higher compared to the 8.1% estimates of depression prevalence among adults (20 + yo) in the USA between 2013 and 2016 (Brody et al., 2018 ). Anxiety was the second most common condition reported by 12.2% of participants (10.60–13.87 Clopper-Pearson’s 95% confidence limits). This was higher than what was reported by previous research that suggested that the current global prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures (Baxter et al., 2013 ). The prevalence of anxiety in our sample was also higher than that recorded in adults exclusively, which has been estimated to be 3.8–10.4% in Euro/Anglo cultures and 2.8% in Asian cultures (Remes et al., 2016 ).

Autism Quotient

Research suggests that many adults may have autism, but due to age and other variables, a formal diagnosis is often missed (Lai & Baron-Cohen, 2015 ). Therefore, we also explored the level of autistic traits self-reported by our sample. We were interested in exploring the relationship between board gaming and individuals with subclinical autistic traits, known as the Broad Autism Phenotype (BAP). The BAP refers to elevated but subclinical levels of autistic traits commonly possessed by close relatives of people with a clinical diagnosis of autism (Losh et al., 2011 ).

Participants’ mean AQ dichotomous score was 21.36 (SD: 7.09; median: 22, range: 1–45). A Wilcoxon signed-rank test indicated that the AQ dichotomous score of our sample was significantly higher than 19.38 ( Z = 848643, p < 0.001), which is the mean AQ dichotomous score of 450,394 people reported by Ruzich et al. ( 2015 ). The number of respondents who scored above the clinical cut-off of 32 was then calculated, indicating individuals who would be highly likely to have or receive a clinical diagnosis of autism (Woodbury-Smith et al., 2005 ). 107 participants (6.7%) had a dichotomous score equal to or higher than this cut-off score. If used as a proxy for the likelihood of an autism diagnosis, this suggests that autism is more than five times higher in this sample than the global prevalence rate of 1%. Next, we assessed the proportion of people who display elevated but not clinical levels of autistic traits, scoring in the Broader Autism Phenotype range of above 26 using the original cutoff scores for the BAP (Baron-Cohen et al., 2001 ). A total of 467 participants (29.1%) were included in the BAP range. The frequency of individuals scoring in the BAP range was far greater than the scores found in students in science fields (15.4%) and non-science fields (8.3%) (Baron-Cohen et al., 2001 ). To compare gamer motivations and preferences we split our sample into two groups: an ASC group (160 participants, 10% of our sample), which included everybody who reported having a diagnosis of autism and those who had a dichotomous score equal to or above the clinical cut-off point of 32 on the AQ, and a TD group (1443 participants), which included the remaining participants. A Kruskal–Wallis test ( X 2 (2) = 926.8, p < 0.001) and pairwise comparisons (all p s < 0.001) confirmed that AQ total scores were significantly higher in people with a diagnosis of autism (mean: 144.2; SD: 8.8; median: 143.0; range: 131–176) compared to BAP individuals (mean: 129.7; SD: 4.7; median: 129; range: 117–144), which, in turn, had higher scores compared to neurotypicals (mean: 110.4; SD: 11.7; median: 112; range: 71–132).

The only neurodevelopmental condition which appeared elevated in our sample compared to the general population estimate was autism with 4.7% of board gamers in our sample reported having a clinical diagnosis of autism compared to the general population estimate of 1% (Zeidan et al., 2022 ). Equally, analyses showed that the average AQ score of this population was higher than the general population, with 6.7% of the sample scoring above the clinical cut-off and 29.1% in the BAP range. Those who reported having a medical diagnosis of autism, combined with those that scored above the clinical cut-off point for the AQ, equalled 10% of the total sample. These findings show that, as hypothesised, the proportion of autistic individuals and individuals with elevated levels of autistic traits are over-represented amongst board gamers compared to the general population.

Gamers’ Experience

A significant Pearson’s Chi-Square (Table 2 ) suggested that participants in the ASC group (those with a clinical diagnosis of autism or those scoring above the clinical cut-off in the AQ) had more board game experience than the non-ASC group. In total, 62.8% of autistic gamers consider themselves midcore or hardcore players, while only 50.0% of the non-ASC group considered themselves as such. A significant Pearson’s Chi Square also indicated that the ASC group (53.1%) preferred to play online over the Non-ASC group (40.4%). There was no significant difference in the number of hours played between the two groups.

Game Preferences

Mann–Whitney U tests (Table 3 ) indicated that the non-ASC group preferred to play with 3 or more players, while this was rated lower for those in the ASC group. Meanwhile, those in the ASC group liked to play alone more than those in the non-ASC group. The ASC group also reported a preference for cooperative games over the various forms of competitive games, a preference not seen in the non-ASC group. Similarly, those in the ASC group reported a greater dislike for lighter social/party games compared to those in the non-ASC group.

Although Mann–Whitney U tests (Table 4 and Fig. 1 ) indicated that those in the ASC group consistently gave lower ratings than those in the non-ASC group, the rating order was similar between the non-ASC and ASC groups, with few notable exceptions. Autistic players ordered engine building, hand management, tile placement, set collection and dungeon crawling mechanics as more preferable than Non-ASC players. Those in the ASC group also showed a reduced preference for certain social elements, including storytelling, trading, social deduction, deduction, and hidden information games.

Median Ratings for Game Mechanics in Order for Each Group

Again, Mann–Whitney U tests (Table 5 and Fig. 2 ) indicated that, out of the 14 themes, those in the ASC group gave lower ratings compared to those in the non-ASC group for the adventure, ancient, real-world, crime, and horror themes. Despite this, the order of preference across themes is similar between the two groups. The only notable exception is the crime theme, which is one of the least favourite themes for the ASC group while occupying a relatively high position for the non-ASC group.

Median Ratings for Game Themes in Order for Each Group

Game Choice and Motivation

Mann–Whitney U tests (Table 6 ) indicated that the ASC group gave lower ratings than the non-ASC group when indicating how important gameplay, mechanics, theme, style and components were in the choice of board games. However, the order of the ratings within each category seemed to be the same between the non-ASC and ASC groups. The only exception is that the non-ASC group were more motivated to play board games because of the emphasis on social interaction rather than strategizing. Meanwhile, this was reversed for the ASC group.

Summary of Findings

Autistic gamers showed a preference for online over in-person gaming. Also, they showed an elevated appreciation for cooperative and solo gameplay while rating party games lower than their non-ASC counterparts. The higher ratings for solo and online gaming and lower ratings for party games could be interpreted as showing that autistic people are more comfortable in their own company than neurotypicals (Baldwin & Costley, 2015 ). However, other findings, such as the penchant for cooperative games, show a social side to autistic players. Autistic gamers also ranked certain kinds of game mechanics more favourably than neurotypicals. These mainly included logical and systematic aspects of games, such as engine building, set collection and hand management, while ranking social elements such as storytelling, deduction and trading less favourably. This seems to mirror autistic preferences for logic, maths, and the sciences (Wei et al., 2013 ).

Similarly, autistic players ranked game themes revolving around transport, trains, history, and animals higher than neurotypicals, with other themes such as horror and crimes ranked lower. This overlaps with popular passions in autism (Cho et al., 2017 ). It also contradicts anecdotal evidence that individuals with autism are more likely to be interested in crime (Im, 2016 ). Similarly, autistic gamers ranked strategizing as a more important motivation for playing than socialising, which was reversed amongst neurotypicals. The results presented here help elucidate autistic individuals’ reasons for board gaming, and the dataset is made open access to aid with this.

Importantly, our results suggest that autistic people are able to find aspects of gameplay that suit their particular needs and interests. While there are differences between autistic and non-autistic board game preferences, board games have enough variety that they can accommodate a variety of preferences. That said, there are still significant areas of overlap in the preferences of autistic and non-autistic gamers, showing that there are ways to play games in mixed groups without sacrificing enjoyment. Furthermore, in line with monotropism, it appears that autistic players are playing board games for longer, and even playing individually. This suggests that board games may represent an overlap between a special interest and a preference for systemising. To further understand the reasons why autistic people may be drawn to board gaming, and the way that board gaming affects their social lives, we interviewed 13 autistic people who were board gaming enthusiasts.

Thirteen autistic board game hobbyists (10 male, 3 female, age range: 24–51) from the US, Europe and the UK were recruited through board gaming social media networks and through contact information left in Study 1. All participants were avid board game players; some were also involved in their design, distribution and retail. All participants had a formal diagnosis of autism (except one who was self-diagnosed). Interviews were conducted online (via video conferencing) or in person, with participants choosing their preferred mode, and each one lasted around one hour. All participants gave full informed consent, were debriefed upon the interview’s conclusion, and paid £10. The study received full ethical approval from Edge Hill University’s ethics review board.

The semi-structured interviews focused on individuals’ experiences surrounding board games, motivations and preferences, and how they felt the hobby intersected with their condition. Example questions included ‘What do you enjoy most about the hobby?’ ‘How does gaming feature in your everyday life?’ ‘Would you say your interest in board games relates to your autistic traits, and if yes, how so?’ All interviews were recorded and then transcribed. Two independent coders then coded these transcriptions using the process outlined by Graneheim and Lundman (2004). Specifically, they each independently reviewed the data and coded each interview into subthemes. After independently coding the transcripts and creating a list of subthemes for each interview, the two coders reconvened. Together they agreed on a list of subthemes that appeared consistently across the interviews based on their independent coding. They then consensually agreed on a set of master themes that they felt best characterised the interviews and subsequent subthemes.

The method of analysis used throughout the coding process was Interpretive Phenomenological Analysis (IPA) (Eatough & Smith, 2017 ), a type of thematic analysis focusing on lived experience and participant voices that is particularly suited to autism research (MacLeod, 2019 ). IPA is beneficial for amplifying the voices of members of marginalised and minority groups, as it attempts to use the participants’ own language to form codes, themes, and subthemes (Tuffour, 2017 ). It is also useful when researchers are interested in moving beyond pre-conceived theory and instead want to understand how individual experiences may open new areas of inquiry (Smith et al., 2009 ). It is important to note the positionality of the researchers in this study. One of the researchers was unfamiliar with autism and board gaming. The other was a seasoned autism researcher and familiar with board games. This difference in backgrounds was preferable as it meant that shared observations about codes and themes were driven by the data rather than familiarity with existing research literature.

RQ1: What does hobbyist board gaming afford autistic players? RQ2: How do they conceptualise the intersection between board gaming and autism?

Results and Discussion

Four key themes arose from the interviews. See Table 7 for the frequency of themes within the interviews and selected quotes from participants that illustrate each theme. One coder applied the final codes. Results highlighted the benefits of board gaming for autistic individuals involving structure, friendships and escaping the outside world.

Theme 1: Systems are Both Comforting and Stimulating

Participants discussed how board games’ intellectual challenge and strategic depth drew them into the hobby from an early age. Learning the rules of a game and figuring out how to use those rules to maximise their strategy was key to their enjoyment. The rules gave games a challenge by constraining players to specific pre-sets (time limits, hand limits, turn limits, dice rolls, and victory goals). In this way, games became like a puzzle to solve. The sense of competition, problem-solving, and accomplishment was important for participants. The ability to play games over and over and thus improve on their previous strategy or take more risks in the game was particularly rewarding.

In addition to finding the structure and repetition of the games engaging, participants also found comfort in how game play was based on a clear system. Knowing the rules meant that nothing unexpected was going to happen and it also meant everyone started the game on the same page. Each player had the same rules to follow, and they didn’t have to worry about anything unexpected happening that they might not understand. Importantly, conversations and discussions were centred on predefined, mutually understood systems. Players felt like they understood the ‘language’ of the game based on their comfort with board game systems, and so it was easy to engage other players in discussions around that game and other games. In this way, being a board game enthusiast with extensive knowledge about board games led to engaging discussions about this shared interest.

Participants reported that the rules and structure involved in playing the board game were both stimulating and comforting. Previous research by Müller et al. ( 2008 ) found that structured social environments were ideal for interactions between autistic people and others. Results of the current study support this, with all participants expressing how the rules and structured setting of board games were well matched with their autistic traits, as it gave a sense of security compared to the usual interactions where the rules are unclear (Mazurek, 2014 ). Board games match well with the systemising theory of autism, which explains the motivation of autistic people to rely on structure and rules to help their decision-making (Baron-Cohen, 2009 ).

Theme 2: Passions and Escapism

Many people discussed how board games had become a passion. In this way, when they played board games with other gamers who were also passionate about the hobby, they could participate in what felt like meaningful conversations. In other contexts, they might feel self-conscious when talking in detail about a special interest. Through board gaming, they found people who understand why they love the things they do. This gave participants a sense of belonging and connectedness.

Inherent to this enjoyment of engaging with a special interest in board gaming, games themselves provided escapism through immersion. Participants reported feeling absorbed in a new world when playing a game, particularly when it was aligned with another passion (i.e., science fiction, fantasy, animals or history). Individuals could find many different themes and mechanics associated with games that suit their differences, preferences, needs and interests. One participant who runs a board gaming club in their community found that through playing games, their autistic attendees felt more comfortable discussing their other passions (like Pokemon, Marvel or Dungeons and Dragons) and often found that other gamers shared these passions.

Immersion not only allowed for engagement in a passion but also gave participants license to not think about real life. Participants could escape themselves by being a character and focusing on the game’s progression. More than anything, games gave them the liberty to do something purely for enjoyment and something that had no lasting ramifications as it’s ‘just a game.’ As one participant explained, ‘It enables me to just switch off my brain.’ Participants expressed that being themselves can be too pressurising but that board games are a distraction from this stress. They help manage extreme emotions by gaining comfort in the knowledge that the purpose at that moment is to have fun and not take things too seriously.

Passions and escapism allowed participants to lose themselves within their areas of interest. The wide selection of board games allowed them to choose games based on specific passions, resulting in enjoyment and satisfaction. Indeed, many common board game themes such as sci-fi, transport, animals, etc. match common passions of autistic people (Klin et al., 2007 ). Engaging in passions was clearly an essential component of the hobby and was helpful for reducing stress and anxiety (Attwood, 2003 ). Furthermore, engaging in active discussion about passions can evidently reduce autistic individuals’ difficulties in communication and social interaction (Winter-Messiers, 2007 ). As well as highlighting the importance of passions for adults, the current study shows the importance of passions being positive, not negative, and something that needs to be encouraged and seen as valuable, not a problem.

Theme 3: Games as a Social Lubricant

An overriding theme in the interviews was the social side of gaming. The hobby created opportunities for making friends and joining the gaming community. One participant said, “It’s probably my primary method of making friends”. Participants overwhelmingly attested that games were a social lubricant, allowing them to interact socially in comforting and authentic ways.

Participants discussed how the structure of board games enhanced their ability to socialise. By being able to focus on a game, interactions were less nebulous. In this way, the game being at the root of the interaction reduced pressure and stress. Games provided common ground in conversation where there was no need to worry about small talk or trying to fit in. They already fit in with the group because of the interests they shared. “ Yeah, it’s just a medium through which to be with other people.” Board gaming provided security to engage in meaningful conversations where the social interactions occurred in parallel with the game, which reduced pressure and led to less masking.

Players also got to know other players meaningfully by seeing how they played together. Some of their closest friendships evolved by seeing how their play styles fit with other players. Getting along in the game also made conversations outside of the game easier. It afforded an avenue to nurture friendships. Planning to play games together again, meeting up at a board gaming event, or playing games online was a way for players to socialise. Because friendships with gamers were based on shared interests, participants felt like their board game friends knew their authentic selves.

Participants also discussed how their board gaming friendship groups were a mix of autistic and non-autistic players. They felt that within these mixed groups, they were appreciated for their autistic traits, for instance, being the first to learn the rules, being the main organiser of meet-ups, or even being the most level-headed. Participants discussed how in their experience, it was prevalent for gamers to have autism or be somewhere on the spectrum, so in this way, it was not stressful to disclose their autism to fellow board gamers. Almost every participant discussed how they had moved away from playing video games precisely because they were getting so much more social enjoyment from board games, a pastime still full of strategy and replayability but one that better facilitated social interaction with real-life players.

This theme discussed how board games may work as a social lubricant. Previous research explains that while autistic individuals struggle with social skills such as communication, they still desire social interaction and friendships just like neurotypicals (Crompton et al., 2020 ). Coupled with research showing that board games positively affect the development of friendships (Parks & Parks, 2023 ) and encourage conversation and reciprocal social behaviours (Rogerson et al., 2018 ), the current study expands on previous research by articulating the broader motivations for gaming. Board games allow autistic individuals to find people with the same interests. They can talk about their passions, which instead of appearing tedious and creating awkward moments, is welcomed within these groups. Thanks to its straightforward rules, the game also becomes a safe place where social reciprocity can flourish.

Theme 4: Social Games and Deception

Deception is a mechanic of some popular board games, often referred to as social deception games, that require players to hide their identities or catch which player among them is bluffing. Popular social deception board games, which follow closely from the original parlour game ‘Mafia,’ include games like Werewolf, Spyfall, Deception: Murder in Hong Kong, Battlestar Galactica and Shadows over Camelot. In these games, a randomly chosen player is dealt a character card which tells them whether they are ‘innocent’ or ‘a traitor,’ and the game’s goal is to ‘win’ as your character by either revealing the traitor or evading detection. Some of these games are relatively short and could be conceived as ‘party games.’ Others are played over several hours and have more complex game mechanics, requiring sustained attention to detect deception or deceive other players. Within the interviews, participants were explicitly asked about their enjoyment of social deception games due to research on autism and theory of mind, which suggests autistic people may struggle with bluffing and detecting deceit (Frith et al., 1994) and honesty, which suggests that autistic people dislike mistruth (Atherton et al., 2019 ).

Interestingly, our participants reported that, on the whole, they quite enjoyed social deception games. Some participants stated that this likely would be a surprise, as they were aware of the stereotype that autistic people would do poorly at such games. Instead, they found that the logical side of figuring out other people’s intentions was fun and something they did well. At the same time, participants reported that they often struggled when they were the traitor, as they felt it was hard to come up with a lie under pressure. That said, some participants reported that after having played social deception games for many years, they had ‘figured out’ strategies for being the traitor after observing others. Other participants felt comfortable admitting that lying under pressure was simply a skill they did not possess even after having played these games quite often. However, because lie production took place in a gamified setting and was ‘just for fun,’ they did not mind that this was a bit hard for them and still enjoyed playing these kinds of games. More than anything, the participants enjoyed how social these games were, so the shared enjoyment of the group overshadowed their unease when playing as the traitor.

Social deception games were a theme which exposed some participants’ complicated relationships with bluffing and deception. Some participants enjoyed playing them, while others did not believe they had the necessary skills or motivation. However, participants did suggest that they enjoyed the social aspects of these types of games even if they found lie production difficult. They also felt that games were a safe space to practice these skills, and they appreciated how the game allowed experimentation with these types of mechanics. This is a particularly interesting theme as there is a plethora of research that suggests not only are autistic people poor deceivers (which participants largely supported) but that autistic people have a strong preference for honesty (Atherton et al., 2019 ). However, this theme suggests that there are aspects of deception that autistic people enjoy and that if practised in the right setting, they are quite competent (many participants discussed observing both verbal and non-verbal cues to spot lies), and games may provide a safe space to practice these skills.

The current study aimed to explore the lived experiences of autistic gamers to better understand why they might engage in the hobby and what benefits they associated with board gaming. Four themes emerged from the interviews, the first involved how the systems inherent to board games were both stimulating and comforting, the second discussed how board games offered escapism and overlap with passions, the third showed how games acted as a social lubricant or alternative vehicle for social communication, and finally the fourth had to do with social deception games and how these were both difficult but enjoyable.

In conclusion, these themes both support and contradict a number of influential theories of autism as understood through the lens of the board gaming hobby. First, interest in board games as explained by autistic boardgamers centres upon the structure that defines the game. This structure is inherently interesting, as it allows strategizing and improvement over time through replayability. Not only is the board gaming structure interesting, but it provides healthy boundaries within the social interactions between players. In contrast to open-ended social interactions like chit-chat at a dinner party, players are able to talk about the game and get to know people through the way they interact around the board. Importantly, these interviews contradict one of the dominant theories of autism, the social motivation theory, which suggests that autistic people are not as interested in social interactions as neurotypical people (Chevallier et al., 2012 ). Participants here discussed how one of the biggest draws to board gaming is the social connection they experience when playing games, including how they prefer them over less socially interactive hobbies like video games. This includes playing games that they find more difficult in order to have social experiences within groups. One can take away from these interviews the possibility that autistic people, while socially motivated, may lack the confidence to engage in unstructured social interactions (or they simply find this style of interaction less rewarding). Activities like board gaming may provide a valuable set of social constraints which allow autistic people to engage in ways that map onto their existing strengths and interests.

Study 2 interviewed autistic people who already play board games. Study 3 built on this by exploring the benefits of introducing board games to autistic individuals who were not previously involved in this hobby. To achieve this, four community centres for autistic individuals around the UK were visited. Attendees were introduced to a range of games over an afternoon play session and then focus groups were conducted to learn more about their experiences.

In this mixed methods study, the researchers visited community groups for autistic adults to play a range of commercially available board games (Dixit, Codenames, Werewolf, Spyfall, Hanabi, Deception Murder in Hong Kong. For a description of what these games entail, please see boardgamegeek.com). Twenty-eight individuals took part, 16 males and 12 females aged between 18 and 60 years old. The majority of these were not regular gamers. All participants had a diagnosis of ASC and were attendees at 1 of 3 different community groups for autistic adults in the UK in Plymouth (n = 10), Maidenhead (n = 8), Huddersfield (n = 5) and a neurodiversity group at a university in Liverpool (n = 5). Four separate game sessions and four separate focus groups were conducted, one at each of the above sites. Each play session lasted for around 2 h, and participants at each site played games with each other and with the two researchers. Following the game sessions, the participants at each site were interviewed about their experiences in a focus group, which lasted approximately 45–60 min. A range of community groups were invited to participate, and all who agreed to participate were included. All individuals had a formal diagnosis of autism from a medical professional.

The semi-structured interviews focused on the game’s experiences, including preferences and challenges, and how similar board games may be used in future group sessions. All participants gave full informed consent and were debriefed upon the conclusion of the interview. The study received full ethical approval from Edge Hill University’s ethical review board.

RQ1: What could hobbyist board gaming afford new autistic players?

RQ2: How do players conceptualise the intersection between board gaming and autism?

Two key themes arose from the interviews. See Table 8 for the frequency of themes within the interviews and selected quotes. These frequencies were based on the agreement between coders on the subthemes found across all interviews, and then each interview was recoded by one of the researchers to gain accurate frequency counts in the interviews for each subtheme and theme. Results highlighted how board gaming could be an alternative vehicle for forging social relationships and how board gaming can be both challenging but also a growing experience.

Theme 1: Board Games as an Alternative Vehicle for Forging Social Relationships

Participants described how playing games acted as a vehicle for creating and maintaining friendships. Games reduced the anxiety that comes with traditional avenues for making friends. Board games, in fact, created the perfect environment for socialisation because it eliminated small talk, which participants found dull and disingenuous. Similarly, the game provided a distraction from the pressure of usual conversations, while at the same time, the game provided the topic for the talk among players. The social interaction between autistic individuals and other players, therefore, occurred naturally, without imposition. This was rewarding for the players because, while playing the game, they got to know others while avoiding awkward situations. Eventually, for some participants, the fluid interaction with others was the only reason why they enjoyed the game.

In summary, participants in these sessions expressed how playing games offered a rewarding and enjoyable alternative form of social interaction, which helped alleviate many of the social pressures they often felt in unstructured social situations. Aside from the social side of board gaming, our participants also expressed a range of other competencies that they felt could benefit from board gaming, even though these also presented significant challenges.

Theme 2: Board Games Can Be Both a Challenge but Also a Growth Experience to Demonstrate and Build Skills

Participants described how games presented various challenges but also offered an avenue for skill development. For example, many of the deceptive/bluffing aspects of some games were problematic for some players, even though they provided a source of excitement and strategy.

Participants indicated that they did not like to lie because their non-verbal actions betrayed them.

Similarly, making up a credible lie was sometimes difficult for them. For these reasons, they felt they did a poor job in games requiring them to trick, bluff or deceive. Although individuals clearly expressed that they found deception challenging, they also noted how the games naturally help refine skills such as perspective-taking, bluffing, and reading other people. For example, participants talked at length about the way they observed other players’ behaviours to try and detect and untangle truthful vs bluffing statements in the games.

Participants also enjoyed the metacognition that these games encouraged, such as thinking about their own thinking strategies, and other players’ choices. For example, a more logical/deductive strategy was often used to detect lies. Players enjoyed challenging themselves socially by building their persuasion and debate skills. However, participants recognised that autistic individuals might find other aspects of the games challenging, particularly in relation to the complexity of the game. Despite these issues, participants discussed how games allowed them to grow their confidence.

Others noted that although they find the process challenging, this challenge allows them to learn to adapt to change.

Autistic individuals, new to board gaming, expressed many of the same sentiments as more seasoned gamers in Study 2. They discussed the way in which board games can act as a social lubricant and the comfort found in the systems and rules inherent in games. They also discussed how they felt they struggled with the social deductive and bluffing aspects of games, yet also described the kinds of rich perspective-taking they engaged in when playing them. Unlike more seasoned players in Study 2, Study 3’s participants did not discuss game themes and passions, although this is not surprising since they were exposed to a significantly smaller range of games. Unlike Study 2’s participants, they also reported struggling more with some of the more complex rules, though this, too, is to be expected since they were less experienced.

General Discussion

We reported on a series of studies highlighting the unique potential that board gaming may have to impact and transform the lives of adults on the spectrum. In study 1, we explored the popularity of the hobby among autistic people. As predicted, across a sample of over 1600 board gamers, we found that autism (and anxiety, conditions that often co-occur) were elevated among board gamers, while other mental health conditions were not. Furthermore, we found that the BAP was also elevated in our sample. Clinical and subclinical cut-off rates for autistic traits presented in our sample occurred at a significantly higher rate than is typically seen in the general population. This study also highlights autistic players’ preferences and motivations within this hobby. In study 2, autistic board gamers indicated that the form of structured socialisation that took place during the game suited autistic ways of being. In study 3, we introduced board games to community groups of autistic adults around the UK, finding that board gaming ‘newbies’ echoed many of the sentiments of more seasoned gamers. Games made socialising easier, and it was fun to problem-solve within a set of rules. Perhaps most importantly, study 3 showed how board games could bring together diverse groups of autistic people who often have different needs and interests. Groups stated how they had come together for the first time rather than interacting within their smaller, well-established friendship circles. Together, our results suggest that board games may occupy an essential place in the social lives of autistic people. It also indicates that this may be a valuable hobby for autistic people, as it may benefit them cognitively and socially in several ways.

Improving mental health outcomes for autistic people is a pressing matter for autism research (Crane et al., 2019 ). Research suggests that as autistic people age, they are less likely to experience gains in quality of life compared to neurotypical people. This disparity is particularly pronounced for autistic people diagnosed later in life, which is a growing proportion of the autistic population (Atherton et al., 2021 ). To increase the quality of life for autistic people, understanding and promoting healthy leisure patterns may be essential (Potvin et al., 2013 ). A plethora of research suggests that friendship and social connection protect mental health (for a review, see King et al., 2016 ), with shared interests as a key factor in establishing relationships (Yang et al., 2011 ). This may be particularly important for autistic people who exhibit passions, which can be a source of bonding with others which can lead to an acceptance of atypical behaviours (Sosnowy et al., 2018 ), and allow for a more immediate connection and purpose within a social group (Chan et al., 2022 ).

Our findings suggest that board games may be particularly beneficial for autistic adults by allowing them to interact socially in a way that is suited to their social style. Research shows that autistic people struggle to socialise in more open-ended or loosely structured settings that require small talk (Pfeiffer et al., 2017 ). In situations where there is no structure to conversation, autistic people can miss social cues leading to social anxiety (Livingston et al., 2019 ), resulting in avoiding social situations where they might face rejection (Hull et al., 2017 ). This mismatch between neurotypical social styles and autistic ways of being may be at the heart of the many studies finding that autistic people experience significantly more loneliness than neurotypicals (Umagami et al., 2022 ). Despite a need for social connection, autistic people may feel that their social skills preclude them from entering social situations where they can cultivate friendships (Stice & Lavner, 2019 ).

Board gaming offers a unique solution to these issues by removing the small talk and moving the attention from other implicit social cues such as body language, which autistic people often find challenging, to the game and its rules. Additionally, players can use a common language about the game (Knight et al., 2019 ), allowing them to discuss their passions with others who share these interests. Finally, the structure of gaming allows for further interactions over time, as indicated by participants who were both seasoned gamers (study 2) and new to gaming (study 3). Because board games can be played at a slower pace than video games or sports, players can converse more freely during the game. Over time, they can have the unstructured interactions that autistic people often find difficult to have immediately or with strangers.

Similarly, board gaming offers autistic people self-efficacy as it depends on cognitive skills particularly adapted to autistic ways of being. Since the earliest conceptualisations of autism, the condition was characterised as one where individuals enjoyed understanding systems and rules (Kanner, 1943 ). After more investigation, researchers found that autistic people (Wheelwright & Baron-Cohen, 2001 ) and their family members (Baron-Cohen, 1998 ) were more likely to be involved in the STEM fields, leading to the influential ‘empathising-systemising’ theory of autism (Baron-Cohen et al., 2001 ). In this theory, autistic people are posited to be ‘hyper-systemisers,’ meaning they are inclined to figure out the rules or structure underlying incoming information (Baron-Cohen, 2006 ). While the assertion that autistic people are not as empathetic as other people (a position taken by the systemising theory) has been the source of much debate (Duffy & Dorner, 2011 ), there is evidence that an autistic strength is the ability to decode the underlying ‘systems’ at play in our world (Greenberg et al., 2018 ). Systemising may also lie at the heart of autistic passions, as discussed, for instance, in interviews with highly successful autistic people (South & Sunderland, 2022 ).

Given autistic people’s penchant for systemising, the focus that board games place on understanding rules and the social aspects of conversing about the underlying structure of games makes this a particularly valuable pastime for autistic adults. Research shows that autistic people do particularly well in occupations where they can work with structures and passions (Bross & Travers, 2017 ). Few studies have focused on the potential for hobbies that build on an understanding and enjoyment of systems and passions. While several studies show that autistic people enjoy video games, research suggests that video games can become problematic for autistic people who, possibly in response to developing a special interest in video games, are more likely to meet the criteria for video game addiction (Coutelle et al., 2022 ). As discussed by participants in Study 2, board games offer similar pleasures to video games, while being more social. While they can be enjoyed by themselves online, all games can be played with others, and some games can only be played with others. The sociality of board games seemed to be particularly important for participants. In this way, board gaming may provide a vital opportunity for social networking for autistic people. This finding is also echoed in research on tabletop role playing games with autistic players (Atherton, Hathaway, et al., in press), where results showed that role playing through a character allowed for a deep bond with fellow players in a way that felt particularly natural and authentic.

Future research may want to understand how board gaming as a hobby can be used to benefit the lives of autistic people; research may also wish to focus on sub-populations with restricted language and the use of language-based games in relevant skill-building. Research comparing mental health outcomes in autistic board gamers and video gamers may be useful, as our research suggests that board games may offer advantages to video games. There is also scope to investigate board gaming interventions for autistic children and adults. Our research indicates that social and cognitive skills are helped through board gameplay, which may be particularly beneficial to autistic people. Investigating the benefits of board gaming in a controlled study would be an essential contribution.

There are several limitations to this study that would benefit from further research. First, this study focused on individuals with the cognitive capacity to play modern board games, which may exclude some individuals on this autism spectrum. That said, given that many commercial board games have now produced child-friendly versions of games, it may be that with the right support individuals with high cognitive needs may still be able to engage in the hobby with support and simpler gaming formats. One recent study has investigated board gaming in an adult autistic population with co-occurring intellectual disabilities (Atherton et al., 2024 ) and found similar benefits in this sample, suggesting that board games may be a useful hobby across the spectrum.

Another limitation of this study is that while approximately 1/3 of the sample was comprised of people with non-white ethnic backgrounds, the majority of participants were White, male, and highly educated compared to the global population. This homogeny is also found among board gaming hobbyists, including board game designers, who are disproportionately white males (see Dias, 2023 , for a review). Given that autism is also disproportionately diagnosed in males over females, and in White over minority children (Shenouda et al., 2023 ), it may be that this sample again speaks to the fact that a specific population may be more likely to both receive an autism diagnosis and be introduced to board gaming. Future research should focus on recruiting more diverse samples and exploring how board games may be beneficial to the wider autistic population, including females and those with minority ethnic identities.

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Cross, L., Belshaw, F., Piovesan, A. et al. Game Changer: Exploring the Role of Board Games in the Lives of Autistic People. J Autism Dev Disord (2024). https://doi.org/10.1007/s10803-024-06408-0

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Using an interview in a research paper

Step one: Where to start

Step two: How to write a good question

Step three: The interview

Step four: Incorporating the interview

Step five: Examples of citing your interviews

Reference list

Chapter 11. Interviewing

Types of Interviews

Creating an Interview Guide

Type of Questions

Background/Demographic Questions

Temporality

Question Sequence

Probes and Flexibility

The Final Question

Conducting the Interview

How Many Interviews?

Your Final Product: The Ideal Interview Transcript

Final Tips from an Interview Master

Sample: Demographic Questionnaire

Example: Interview Guide

Further Readings

Qualitative Research 101: Interviewing

Overview: 5 Interviewing Mistakes

1. Not having a clear interview strategy

2. Not having good interview technique

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5. Not keeping your golden thread front of mind

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Research Methods Guide: Interview Research

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Introduction

Before You Write

Different Models for Incorporating Interview Data

Generalizing about a Trend or Theme

Quoting to Illustrate a Trend or Theme

Putting Two Sources in Conversation with Each Other

Providing a Profile/Telling a Story

Attending to Language

Summarizing, Paraphrasing, or Quoting

Referring to your Interviewees

Using Verbatim or Non-Verbatim

Works Cited

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Analysis Papers

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Job Materials and Application Essays

Proposals and Dissertations

Research Papers

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Legal Studies Research Beyond 50%: Providing contextual and coaching information substantially improves adults' ability to detect children's lies

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