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We are all researchers who have conducted diverse qualitative studies in Kenya but not all of us have had an opportunity to interview adolescents. In planning for a second Kenyan case study for REACH- a multi-country study aiming to understand ethical dilemmas and appropriate responses in studies involving vulnerable populations – we needed some advice on how to conduct interviews with adolescents exposed to HIV (HIV positive themselves, or having HIV positive parents). Here are some of the ideas on interviewing adolescents that we shared in a 2-hour brainstorming session. We’d love you to comment on and add to these ideas:
Doing some careful preliminary work: Before starting the work, researchers may grapple with thoughts like will adolescents agree to take part; how should I design my tools and feasibly implement the study; which information is feasible to solicit and in which manner? These realities underscore the need for a preliminary phase where researchers familiarize themselves with the priorities and concerns interviewees may have. To plan our study, we decided we will contact an existing teens’ HIV support network based at a health facility. We felt this group would have valuable insights on all stages of our research, and might even be willing to contribute to developing and piloting tools. We also felt we needed advice from local stakeholders with experience on HIV and adolescent health (for example program managers, community health workers, and facility staff), including on how to respond to any health and social service issues raised in interviews.
Methods and incorporating non-traditional data collection tools: We discussed that to support adolescents’ interest and contributions, we should incorporate non-traditional data collection methods. Visual Voices approaches – which can involve systematic creative writing, drawing, painting, and more recently photovoice techniques - were highlighted as more developmentally appropriate than standard interviews. We also realised that in selecting the technique it is important to carefully consider the fit with the method and the research topic, and any associated ethical dilemmas such as the need to protect participant confidentiality during and post interviews. FGDs may generate more discussion through participants feeling more confident with support of ‘mates’, but participants may also feel more constrained and FGDs are inappropriate for difficult personal stories and sensitive topics. Whatever the approach and methods, it was clear that the skills and sensitivities of the interviewer are absolutely key: we decided that it was not necessarily that the interviewer should be of a particular age or gender, or personality, but that they should be authentic and honest in who they are, while overall demonstrating throughout that they are not there to judge, and will not share individual information.
Setting the scene for the interviews: Good planning is essential for all interviews. We discussed the importance of carefully choosing where the interviews will be, to ensure that participants are comfortable, and asking in advance whether the adolescent would like others present (like a friend, parent or guardian). Often permission needs to be sought first from parents, as an ethics committee requirement or out of courtesy and to build trust. This might be the opportunity to explain the study to parents and adolescents together, and plan an appropriate setting and approach where parents don’t feel alienated or undermined, and do not expect you as a researcher to ‘report back’ what comes from their child. Adolescents on the other hand need to be reassured that their views will be valued, that it’s not going to be an exam and there is no scoring or sharing what is said, and that it’s not a lesson but a way of us learning about young people THROUGH them.
Doing the interviews: We noted the importance of having shorter interviews than might be planned with adults, and allowing space to talk about topics that the adolescents themselves are interested in, without getting too derailed. In being respectful and non-judgmental, we highlighted the importance of being aware that non-verbal cues can give away shock even in the face of very careful wording, and that we should expect to find some of what we hear a bit shocking! And depending on who the interviewer is and what they are comfortable with, we discussed their being able to use local slang or language that adolescents use, and ensuring that the sitting positions are as non-hierarchical as possible (minimizing special treatment for the interviewer), while being socially comfortable. We discussed strategies to handle potential questions – ranging from seeking our views on topics, our own HIV status, and advice – including which questions might be best left until the end of interviews, and which ones might be best avoiding, at least in group discussions.
Overall, our discussion highlighted that we need to follow the good practice that would be expected for any qualitative interviewing, but that the above ideas include some extra ideas or emphases to ensure that the discussions are as rich and comfortable as possible for everybody involved.