Combining Observations and Interviews: Understanding Decision-Making in the Obesity Clinic

Abstract

Although it is well known that there are financial limitations on U.K. National Health Service treatment for severe obesity, little is known about how these constraints affect decision-making in clinic. In this study, we combined two qualitative methods (non-participant observation and in-depth interviews) to examine decision-making in progress. A longitudinal approach was taken to research and patients were followed up for up to 3 years. In total, 22 consultations were observed and 78 in-depth interviews were undertaken. Participants were sampled purposefully, and data were analyzed using a combination of narrative and thematic approaches. We met a number of practical challenges during the research, including how to undertake purposeful sampling while respecting patient confidentiality, how to ensure consultation-recordings were undertaken reliably while the researcher was not on-site, and how to go about synthesizing data from the two different methodologies used. A number of additional challenges arose, including gaining the trust of clinicians who were uncomfortable when discussing the impact of financial limitations on treatment decision-making and how to initiate and maintain long-term relationships with patients, many of whom had had poor experiences of accessing health care in the past.

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