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By Y. Connor. Dominican University of California.

Reflecting on this interview order 480mg bactrim with visa, following listening to and transcribing it generic bactrim 480mg with visa, I decided to only conduct one-to-one interviews thereon buy cheap bactrim 480 mg on line. According to Maxwell (2005), qualitative researchers undertaking semi-structured interviews should pilot test their interview schedules with people as close to their planned interviewees as possible, to determine whether the questions work as intended and what revisions may need to be made. Consistently, potential interview questions were tested on inpatients and outpatients during hospital visits and day centre visits respectively, in order to familiarize myself with the population I would be interviewing, the service and interview settings, as well as the language used by consumers. My experiences during these visits were documented in field notes and were crucial in developing the interview schedule. Questions were framed in terms easily understandable by interviewees and were re-worded according to contextual factors. I was mindful of the value of asking interviewees ‘real’ questions, that I was genuinely interested in the responses to, rather than contrived questions designed to elicit particular kinds of data whilst developing my interview schedule. This reflected an attempt to create a more equal and collaborative dynamic, in which interviewees were able to bring their own knowledge to bear on the questions in ways that I had not necessarily anticipated (Maxwell, 2005). Some examples of questions that were included in the schedule are: What influences you to take/not take your antipsychotic medication? Following the collection of demographic information, an opening question that overviewed the topic and set the stage for the interview, was typically posed (although worded differently each time, the question was usually something along the lines of: Can you please tell me about your experiences with taking antipsychotic medication? Sometimes referred to as the “grand tour” question, this question was designed to elicit narratives detailing interviewees’ conceptions of the identified domain (Hesse-Biber & Leavy, 2004). There was no fixed ordering or wording of questions (except in the demographic information section). Questions tended to graduate from general to more particular in focus, largely dependent on interviewees’ responses. Due to the semi- structured nature of interviews, I, the interviewer, had the freedom to probe or prompt discussion of interesting issues that arose in vivo. Questions aimed to be open-ended and not leading in nature, however inevitably this was not always accomplished and my influence on the interview itself and potentially on the responses attained is undeniable. My training in Clinical Psychology equipped me with counselling skills which proved useful such as reflection or paraphrasing interviewees’ responses to ensure that my interpretation matched what the interviewee was intending to communicate (enhancing respondent validation), as well as rapport-building skills such as advanced empathy and unconditional positive regard. I collected field notes during and following interviews regarding my observations and impressions of participants and their responses. Interesting findings were noted, including tangential topics raised by 80 interviewees. These field notes influenced topics followed up on in subsequent interviews and helped to inform the analysis. As a quality check, after the pilot interview, I transcribed the recording immediately and distributed the transcription to my supervisory panel. I also listened to the interview several times to review my interview technique and the interview schedule. Whilst the interview was deemed satisfactory overall and data from it has been included in that anaylsis, several changes were subsequently made in my approach to interviews. As previously mentioned, interviews from thereon were one-to-one as opposed to involving two consumers at once. Moreover, the demographic information section of the interview was also recorded, as field notes indicated that crucial information was gathered at this stage but had not been recorded. I noticed that during the pilot interview I remained very close to my interview schedule and, thus, did not follow up on interesting information raised by interviewees, potentially limiting my findings. I also noticed that I did not probe interviewees enough and was quick to respond to interviewees perhaps as a result of feeling uncomfortable with silences. Although these flaws in my technique were inevitably not entirely resolved following the pilot interview, my awareness of them undoubtedly lead to an improvement in my technique, which actually continued to improve with experience and as I gained knowledge from interviewees. Interviews were then saved onto a computer and transcribed verbatim into a word processing document. More detailed transcriptions 81 were not required given research questions and the analytic approach. Albeit time- consuming, transcribing the interviews immersed me in the data and provided me with the opportunity to review and reflect on my interview technique. Transcribing was also a way for me to commence analysis, as I became aware of codes and categories within and across interviews and was, thus, able to follow up on these in subsequent interviews. I aimed to transcribe interviews as soon as possible following their occurrence and before further interviews were conducted. Whilst I still took notes during and post interviews and reflected on interviews after their completion, listening to them again when possible, I was aware that not having tangible transcripts of interviews meant that I could not begin formal coding, which requires line-by-line analysis. I, thus, decided to stop data collection after the completion of seven interviews in order to become up-to-date with transcribing, to review my technique and to begin formal coding. This process was in line with one of the core principles of grounded theory, which recommends that the researcher constantly shift between data collection and data analysis in order to strengthen theory generation (Glaser & Strauss, 1967). Yet to reach theoretical saturation, I then continued interviewing, equipped with a greater understanding of the consumer perspective and more areas identified in which to follow up. Having some coding categories in mind after analyzing early interviews, when I began interviewing again I was able to follow up on these and expand on them. I conducted the following interviews in a relatively short period of time, remaining as up-to-date with transcribing as possible, re-listening to 82 interviews when I was unable to transcribe them prior to the conduct of more interviews and continuing to write field notes and memos. Field notes and memos were written at various stages also to capture observations. Constant comparison took place throughout the coding process and is described below. Open coding involves identifying, naming, categorizing and describing phenomena found in text (Glaser & Strauss, 1967).

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When queried about their experiences with antipsychotic medication cheap bactrim 960 mg free shipping, the 162 majority of interviewees alluded to their experiences of side effects at some stage buy 960 mg bactrim visa. Consistent with the literature buy bactrim 480mg lowest price, the types and severity of side effects reported by participants varied between types of medications and between different interviewees, as did their tolerability (Barnes et al. Studies have additionally found that side effects of antipsychotic medications are inversely associated with quality of life (Resnick et al. This was also reflected in interviewees’ talk which frequently highlighted the impact of side effects on their every day functioning, lives and appearances to the outside world, as highlighted in previous qualitative research (i. Although the variation of side effects raised by interviewees is not captured in the extracts that will follow, those presented all link adherence decisions and negative evaluations of medication to the experience of side effects. The below extract represents a strong anti-adherence account whereby Diana talks about “fighting” against taking her medication on the grounds that she experienced intolerable side effects that she likened to additional illness “symptoms”: Diana, 11/02/2009 D: They [medication] made it [illness] really bad. They made their own side effects and also um made-, when I first went to hospital I thought I’d take it and eventually it’s gonna go away and they said, it won’t go away straight away. So that’s alright, I took it and this stuff is really horrible stuff to take, it’s not like, (inaudible) or anything like that, it’s just, it gives you another effect on what mental illness is already doing because the medication wasn’t making me think very well, you know what I mean? I think more suicide, I think more, not going the 163 right way, I couldn’t-, could only make stuff for myself a little bit but I couldn’t contact my kids, I found it really hard to deal with the children, to cook for them, to do the washing and everything like that and then I get, where are you? It also, in 2003, because I went off the medication for about three months, I can understand my mental illness, do you know what I mean? Because I tried to read a bit about it, I tried to read everything about it, but I couldn’t understand it. When off my medication I could understand what it was, the symptoms I was getting and what I was feeling but it was still a lot-, I was-, it was a lot freer, I was much more fast at thinking and um, maybe then I was too fast, but then I was fighting going back on tablets, because it would make me wanna hurt my children again. Diana recalls that she agreed to take her medication in the past as she believed that it would effectively treat/cure her illness (“I thought I’d take it and eventually it’s gonna go away”). She then indicates that her expectations were inconsistent with her actual experiences of taking medication. Diana emphasises how taking medication exacerbated her condition and created secondary “symptoms”, as opposed to alleviating pre- existing symptoms (“it gives you another effect on what mental illness is already doing”). She elaborates to describe the specific side effects that she experienced when taking medication, including cognitive deficits (“medication wasn’t making me think very well”), suicidal ideation (“I think more suicide”) and harmful thoughts (“make me wanna hurt my children”). Diana constructs these cognitive and thought-related side effects as impeding 164 her ability to comprehend information about her illness, to function and to parent her children (“I found it really hard to deal with the children, to cook for them, to do the washing and everything like that”). Following her emphasis of the impact side effects exerted on her life and family, Diana evaluates medication as “horrible stuff to take” and directly attributes side effects to her non-adherence, which she presents as the “easier” option. She contrasts her negative adherence experiences to non-adherence experiences, by linking the latter to an absence of cognitive deficits which enabled her to process information about her illness, thus, enhancing her understanding of her illness (“When off my medication I could understand what it was”). She additionally links her positive experiences of non-adherence to resistance to taking medication (“then I was fighting going back on tablets”). In the following extracts, consumers also talk about how experiencing various side effects influenced their evaluations of medication and adherence choices. Below, consumers directly link past non-adherence to sedation and sexual dysfunction respectively: Steve, 04/02/2009 L: So what made you stop, if you can think back to those times? S: Well, um, I’ll give you the example of the clozapine, that used to knock you out, like half an hour after you take it you’d be zonked out for a good 10 hours. Olanzapine wasn’t working for me but risperidone had sexual, something sexual, yeah. Above, Steve recalls past experiences of sedating side effects when taking clozapine (“you’d be zonked out for a good 10 hours”) and attributes this to his non-adherence by directly representing sedation as “the reason why I stopped taking that”. When asked about his experiences of past non- adherence, Matthew recalls experiencing “something sexual” when taking risperidone which was also directly linked to non-adherence (“That’s why I stopped taking it”). Following a leading question, Matthew denies that he stopped taking risperidone due to ineffectiveness in treating his symptoms. He, thus, could be seen to imply that the sexual side effect impacted more on his evaluation of risperidone than did its primary mechanism: to treat his illness. Whilst the following extracts also highlight the association between side effects and non-adherence, greater emphasis is placed on how side effects detract from the lives of consumers, or hinder them from pursuing “normal” lives, thus, influencing non-adherence. For example, below, Katherine directly links non-adherence to the negative impact of medication on consumers’ lives: Katherine, 05/02/2009 K: Yeah, they really do make you sedated. Above, Katherine explicitly generalises that the impact of sedating side effects on young consumers’ lives influences non-adherence. She could also be seen to empathise with “the kids” by stating that she “can understand why” they discontinue their medication. Her specification that the negative impact of sedation, in particular, influences adherence amongst “kids”, may suggest a perception that consumers adapt to, or become more apt at managing sedating side effects with time/maturity. In the next extract, Oliver associates current non-adherence to feeling more motivated in an employment setting: Oliver, 21/08/08 O: Oh, I haven’t really taken my medication for like three days now, and it’s like I get, really work. I get excited at work I get enthusiastic about it, but then I start taking my medication, my girl makes me take my medication, and then I find that I get uh, I dunno, it’s weird, I start chucking sickies an’ all that I can’t be bothered doing anything, I don’t do the housework. I don’t 167 even sometimes I don’t even shower; my hygiene just goes down the drain, as well. Oliver’s account could reflect the practice of self-medicating, in the sense that he tailors his medication intake to his circumstances. Oliver admits to being non-adherent for “three days” at the time of the interview. He states that since discontinuing medication, he becomes “excited” and “enthusiastic about” his work and contrasts this experience to when he takes his medication and his attendance at work becomes inconsistent (“start chucking sickies”) and he “can’t be bothered doing anything” more generally, including “housework” and maintaining his personal hygiene. Oliver questions whether the dosage he is prescribed causes side effects (“Maybe it’s like, I’m on too much or something. Whilst extracts relating to the negative impact of side effects have thus far primarily focused on how the individual consumer is affected, in the next extract, Diana describes the negative impact that medication has had on her family: Diana, 11/02/2009 D: Yeah. Their attitude was like my mother in law, you just take it, it doesn’t matter what you’re like.

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