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Table 4 Overview of a selection of techniques used to stimulate concurrent or retrospective verbal reports in qualitative health research interviews

From: A scoping review of the potential for chart stimulated recall as a clinical research method

  Description Advantages Limitations
Think-aloud technique [36] Participants speak aloud any words in their mind as they complete a task or solving a problem.
Can incorporate direct observation, audio or video recording.
As a real-time approach, may give more valid information than retrospective CSR.
Links the thinking processes of the participant with concurrent perceptions, thus revealing information in working memory.
May be combined with vignettes or simulations.
May be used to study individual differences in performing the same task.
In clinical settings, is time-consuming and intrusive for participants.
Given the limited capacity of memory, can hinder the participant’s cognitive processes, thus altering performance if tasks involve a high-cognitive load.
Needs sufficient instructions and prompts from researcher to ensure sufficient verbalisation takes place, but prompts may then change how people think.
Case vignettes [38] A brief carefully written description (or video/audio/photograph etc.) of a person or situation, designed to simulate key features of a real world scenario, is used to pose questions to a research participant. Inexpensive, practical and safe approach to explore decision-making.
Allows standardisation of cases across participants.
The context or variables in the vignette can be varied across or within participants to address questions of interest.
Concerns that the artificiality of vignettes threatens external validity.
Cannot test the relationship between beliefs in a hypothetical situation and actions in real practice.
Risk of observer biases.
The critical incident technique [39] Focuses on respondents’ accounts of events that have actually happened (incidents). Incidents are deemed to be critical when the purpose of the action and the outcome of the incident are reasonably clear and relevant to the phenomenon under study. Systematic five-step process suited to the exploration of dilemmas.
Encourages the natural tendency of people to tell anecdotes, but increases their value as data by focusing them onto a limited area of interest.
Facilitates exploration of two sides of behaviour: good and bad; effective and ineffective; avoidable and unavoidable etc.
Interview focuses on the specific reasons for actions and behaviours.
Focuses on skewed examples of care rather than routine cases.
Operators may be reluctant to participate if they feel their performance is being scrutinized.
Reliance on memory alone can result in data degradation and other data collection problems.
Video-stimulated recall [40] A method of enhancing participants’ accounts of a consultation using a video-recording of the event to encourage and prompt recall in a post-consultation interview A useful method to explore specific events within the consultation; mundane or routine occurrences; non-spoken events; and “taken for granted practice”.
Visual stimuli may be a stronger stimulus for recall and allows participants to comment on non-verbal behaviours.
Can be used to explore clinician and patient views.
Complex, costly and time-consuming.
May generate a lot of data.
Ethical hurdles of recording patient-encounters.
Inappropriate probing during the interview may lead to reflection and analysis rather than recall of events as they happened.
Audio-stimulated recall [41] A method of enhancing participants’ accounts of the consultation using an audio-recording of the event to encourage and prompt recall in a post-consultation interview Facilitates analysis of conversation and verbal communication techniques.
Less intrusive than video-recordings.
Can be used to explore clinician and patient views.
Audios reproduce only a portion of the original experience. Inappropriate probing during the interview may lead to reflection and analysis of actions rather than recall of un-consciously produced patterns of action.
Time consuming.
Chart- stimulated recall During the interview, a patient’s chart is used as an aide-memoire to the physician’s recall of a case while the interviewer probes the reasons why certain decisions were made Can add to the specificity of interview data, bridge the gap between real and perceived practice, and facilitate a deeper exploration of cognitive reasoning Lack of information on use of chart-stimulated recall by non-clinical researchers, specific ethical issues and the number of charts required to give adequate representation of practice.
Protocol analysis [36] A verbal process which reveals the “step-by-step” progression of a person’s problem-solving ability Can reveal in detail the information that participants are concentrating on while performing their tasks. Can be combined with think-aloud technique. Can be problematic in ill-structured tasks in complex environments.
Has been criticized for being too reductive.
Material probes [42] Objects (e.g. keepsakes, awards, trophies, and collectibles) or places (buildings, wards, open spaces) are used to prompt participants and elicit responses or memories during interviews. Can help to keep the participant focused on a topic and provide a trigger for memories that might otherwise remain buried or actively excluded.
Researcher can suggest materials or let participant choose them; participants can choose items they see as important to the topic, thereby adding to the depth of the discussion.
Allowing participants to choose objects can lead to the researcher losing some control over the interview and what is discussed.
Choice of materials should be aligned with the research aim to ensure coherence across interviews.
Photo elicitation [43] Inserting a photograph into a research interview to expand sensory awareness, increase the reflexive process and allow researchers to glean insights that might not be accessible via verbal-only methods. Photos can be provided by the researcher, the respondent, or both.
Elicit longer and more comprehensive interviews by overcoming the fatigue and repetition of conventional interviews.
Ethical issues regarding consent of photographed individuals.
Participant chosen photos may veer towards the positive rather than negative end of their experiences.
May not lead to a deep commentary if photos do not pose anything extra-ordinary or represent only taken-for-granted aspects work or activities.