interview protocol for qualitative research example

Imperial College London Imperial College London

Latest news.

US health research agency ARPA-H sets out funding vision during Imperial visit

Seven Imperial scientists elected as Fellows of the Royal Society

GSK backs Imperial’s Fleming Initiative with £45m pledge to fight AMR

• Centre for Higher Education Research and Scholarship
• Research and Innovation
• Education evaluation toolkit
• Tools and resources for evaluation

Interview protocol design

On this page you will find our recommendations for creating an interview protocol for both structured and semi-structured interviews. Your protocol can be viewed as a guide for the interview: what to say at the beginning of the interview to introduce yourself and the topic of the interview, how to collect participant consent, interview questions, and what to say when you end the interview. These tips have been adapted from  Jacob and Furgerson’s (2012) guide to writing interview protocols and conducting interviews for those new to qualitative research. Your protocol may have more questions if you are planning a structured interview. However, it may have fewer and more open-ended questions if you are planning a semi-structured interview, in order to allow more time for participants to elaborate on their responses and for you to ask follow-up questions.

Interview protocol design accordion widget

Use a script to open and close the interview.

This will allow you to share all of the relevant information about your study and critical details about informed consent before you begin the interview. It will also allow a space to close the interview and give the participant an opportunity to share additional thoughts that haven’t yet been discussed in the interview.

Collect informed consent

The most common (and encouraged) means of gaining informed consent is by giving the participant a participant information sheet as well as an informed consent form to read through and then sign before you begin the interview. You can find the template for participant information sheets  and informed consent form on the Imperial College London Education Ethics Review Process (EERP) webpage . Other resources for the EERP process can also be found on this website.

Start with the basics

To help build rapport and a comfortable space for the participant, start out with questions that ask for some basic background information. This could include asking their name, their course year, how they are doing, whether they have any interesting things happening at the moment, their likes and interests etc. (although be careful not to come across as inauthentic). This will help both you and the participant to have an open conversation throughout the interview.

Create open-ended questions

Open-ended questions enable more time and space for the participant to open up and share more detail about their experiences. Using phrases like “Tell me about…” rather than “Did you ever experience X?” will be less likely to elicit only “yes” or “no” answers, which do not provide rich data. If a participant does give a “yes” or “no” answer, but you would like to know more, you can ask, “Can you tell me why?” or “Could you please elaborate on that answer a bit more?” For example, if you are interviewing a student about their sense of belonging at Imperial, you could ask, “Can you tell me about a time when you felt a real sense that you belonged at Imperial College London?”

Ensure your questions are informed by existing research

Before creating your interview questions, conduct a thorough review of the literature about the topic you are investigating through interviews. For example, research on the topic of “students’ sense of belonging” has emphasised the importance of students feeling respected by other members of the university. Therefore, it would be a good idea to include a question about “respect” if you are interested in your students’ sense of belonging at Imperial or within their departments and study areas (e.g. the classroom). See our sense of belonging interview protocol for an idea.

Begin with questions that are easier to answer, then move to more difficult or abstract questions

Be aware that even if you have explained your topic to the participant, you should not assume that they have the same understanding of the topic as you. Resist the temptation to simply ask your research questions to your participants directly, particularly at the beginning of the interview, as these will often be too conceptual and abstract for them to answer easily. Asking abstract questions too early on can alienate your participant. By asking more concrete questions that participants can answer easily, you will build rapport and trust more quickly. Start by asking questions about concrete experiences, preferably ones that are very recent or ongoing. For example, if you are interested in students’ sense of belonging, do not start by asking whether a student “belongs” or how they perceive their “belonging.” Rather, try asking about how they have felt in recent modules to give them the opportunity to raise any positive or negative experiences themselves. Later, you can ask questions which specifically address concepts related to sense of belonging, for example whether they always feel “respected” (to follow on from our earlier example). Then, at the end of the interview, you could ask your participant to reflect more directly and generally on your topic. For example, it may be good to end an interview by asking the participant to summarise the extent to which they feel they ‘belong’ and what the main factors are. Note that this advice is particularly important if dealing with topics that may be difficult to form an opinion on, such as topics which require students to remember things from the distant past, or which deal with controversial topics.  

Use prompts

If you are asking open-ended questions, the intention is that the participant will use that as an opportunity to provide you with rich qualitative detail about their experiences and perceptions. However, participants sometimes need prompts to get them going. Try to anticipate what prompts you could give to help someone answer each of your open-ended questions (Jacob & Furgerson, 2012). For example, if you are investigating sense of belonging and the participant is struggling to respond to the question “What could someone see about you that would show them that you felt like you belonged?”, you might prompt them to think about their clothes or accessories (for example do they wear or carry anything with the Imperial College London logo) or their activities (for example membership in student groups), and what meaning they attach to these. 

Be prepared to revise your protocol during and after the interview

During the interview, you may notice that some additional questions might pop into your mind, or you might need to re-order the questions, depending on the response of the participant and the direction in which the interview is going. This is fine, as it probably means the interview is flowing like a natural conversation. You might even find that this new order of questions should be adopted for future interviews, and you can adjust the protocol accordingly.

Be mindful of how much time the interview will take

When designing the protocol, keep in mind that six to ten well-written questions may make for an interview lasting approximately one hour. Consider who you are interviewing, and remember that you are asking people to share their experiences and their time with you, so be mindful of how long you expect the interview to last.

Pilot test your questions with a colleague

Pilot testing your interview protocol will help you to assess whether your interview questions make sense. Pilot testing gives you the chance to familiarise yourself with the order and flow of the questions out loud, which will help you to feel more comfortable when you begin conducting the interviews for your data collection.

Jacob, S. A., & Furgerson, S. P. (2012). Writing Interview Protocols and Conducting Interviews: Tips for Students New to the Field of Qualitative Research. The Qualitative Report, 17 (2), 1-10.

Welch, C., & Piekkari, R. (2006). Crossing Language Boundaries:. Management International Review, 46 , 417-437. Retrieved from https://link.springer.com/content/pdf/10.1007%2Fs11575-006-0099-1.pdf

Prompts, Not Questions: Four Techniques for Crafting Better Interview Protocols

• Published: 05 June 2021
• Volume 44 , pages 507–528, ( 2021 )

Cite this article

• Tomás R. Jiménez 1 &
• Marlene Orozco 2  

6052 Accesses

22 Citations

14 Altmetric

Explore all metrics

A Correction to this article was published on 05 August 2023

This article has been updated

We offer effective ways to write interview protocol “prompts” that are generative of the most critical types of information researchers wish to learn from interview respondents: salience of events, attributes, and experiences; the structure of what is normal; perceptions of cause and effect; and views about sensitive topics. We offer tips for writing and putting into practice protocol prompts that we have found to be effective at obtaining each of these kinds of information. In doing so, we encourage researchers to think of an interview protocol as a series of prompts, rather than a list of questions, for respondents to talk about certain topics related to the main research question(s). We provide illustrative examples from our own research and that of our students and professional colleagues to show how generally minor tweaks to typical interview prompts result in richer interview data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA) Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Survey Interviewing: Departures from the Script

I Got an Interview, How Do I Prepare for It?

Qualitative Interviewing

Change history, 05 august 2023.

A Correction to this paper has been published: https://doi.org/10.1007/s11133-023-09543-9

Barry, Robert A. 1957. The social desirability variable in personality assessment and research . New York: The Dryden Press.

Google Scholar  

Bates, Timothy, and Alicia Robb. 2006. Small business viability in America’s urban minority communities. Urban Studies 51 (13): 2844–2862.

Article   Google Scholar  

Becker, Howard. 1998. Tricks of the trade: How to think about your research while you’re doing it . Chicago: University of Chicago Press.

Book   Google Scholar  

Carian, Emily K. 2019. Constructing manhood: Men's rights activists and feminist men's shared meanings of gender . PhD Dissertation. Department of Sociology, Stanford University.

Carian, Emily, and Jasmine Hill. 2021. Teaching interviews: Illuminating frameworks of social desirability in the classroom . San Bernardino. Unpublished Manuscript. Department of Sociology, California State University.

Carr, Deborah, Elizabeth Heger Boyle, Benjamin Cornwell, Shelley Correll, Robert Crosnoe, Jeremy Freese, and Mary C. Waters. 2017. The art and science of social research . New York: W.W. Norton and Company, Inc..

Glynn, Carroll J., Andrew F. Hayes, and James Shanahan. 1997. Perceived support for one's opinions and willingness to speak out: A meta-analysis of survey studies on the "spiral of silence". The Public Opinion Quarterly 61 (3): 452–463.

Goffman, Erving. 1959. The presentation of self in everyday life . New York: Anchor Books.

Grazian, David. 2015. American zoo: A sociological safari . Princeton: Princeton University Press.

Hart, Chloe Grace. 2021. Trajectory guarding: Managing unwanted, ambiguously sexual interactions at work. American Sociological Review 86 (2): 256–278.

Holland, Paul W. 1986. Statistics and causal inference. Journal of the American Statistical Association 81 (396): 945–960.

Jiménez, Tomás R. 2010. Replenished ethnicity: Mexican Americans, immigration, and identity . Berkeley: University of California Press.

Jiménez, Tomás R. 2017. The other side of assimilation: How immigrants are changing American life . Oakland: University of California Press.

Jiménez, Tomás R., and Adam L. Horowitz. 2013. When White is just alright: How immigrants redefine achievement and reconfigure the ethnoracial hierarchy. American Sociological Review 78 (5): 849–871.

Jiménez, Tomás R., Deborah J. Schildkraut, Yuen J. Huo, and John F. Dovidio. 2021. States of belonging: Immigration policies, attitudes, and inclusion . New York: Russell Sage Foundation Press.

Lamont, Michele. 2000. The dignity of working men: Morality and the boundaries of race, class, and immigration . Cambridge: Harvard University Press.

Lofland, John, David Snow, Leon Anderson, and Lyn H. Lofland. 2006. Analyzing social settings: A guide to qualitative research and analysis . Fourth edition. Belmont: Wadsworth Publishing.

Lamont, Michèle, and Ann Swidler. 2014. Methodological pluralism and the possibilities and limits of interviewing. Qualitative Sociology 37 (2): 153–171.

Marrow, Helen B. 2011. New destination dreaming: Immigration, race, and legal status in the rural American south . Stanford: Stanford University Press.

McCracken, Grant. 1998. The long interview . Qualitative Research Methods Series. Newbury Park: Sage Publications.

Morgan, Stephen L., and Christopher Winship. 2014. Counterfactuals and causal inference: Methods and principles for social research . 2nd edition. New York: Cambridge University Press.

Nederhof, Anton J. 1985. Methods of coping with social desirability bias: A review. European Journal of Social Psychology 15 (3): 263–280.

Noelle-Neumann, Elisabeth. 1974. The spiral of silence a theory of public opinion. Journal of Communication 24 (2): 43–51.

Orozco, Marlene. 2021. The salience of ethnic identity in entrepreneurship: An ethnic strategies of business action framework. Unpublished Manuscript.

Rivera, Lauren A. 2016. Pedigree: How elite students get elite jobs . Princeton: Princeton University Press.

Roth, Wendy. 2012. Race migrations: Latinos and the cultural transformation of race . Stanford: Stanford University Press.

Roth, Wendy D., and Biorn Ivemark. 2018. Genetic options: The impact of genetic ancestry testing on consumers’ racial and ethnic identities. American Journal of Sociology 124 (1): 150–184.

Seidman, Irving. 2019. Interviewing as qualitative research: A guide for researchers in education and the social sciences . New York: Teachers College Press.

Sobotka, Tagart. 2021. Bad doctors, enablers, and the powerless: The opioid crisis and the construction of blame. PhD Dissertation. Department of Sociology, Stanford University.

Smith, Tom W., Davern, Michael, Freese, Jeremy, and Stephen L. Morgan. 2019. General social surveys, 1972–2018: Cumulative codebook. GSS NORC.  https://gss.norc.org/documents/codebook/gss_codebook.pdf .

Stuart, Forrest. 2016. Down, out, and under arrest: Policing and everyday life in skid row . Chicago: University of Chicago Press.

Vasquez, Jessica M. 2011. Mexican Americans across generations : Immigrant families, racial realities . New York: New York University Press.

Waldinger, Roger David. 1996. Still the promised city?: African-Americans and new immigrants in postindustrial New York . Cambridge: Harvard University Press.

Warikoo, Natasha Kumar. 2011. Balancing acts: Youth culture in the global city . Berkeley: University of California Press.

Waters, Mary C. 1990. Ethnic options: Choosing identities in America . Berkeley: University of California Press.

Weiss, Robert Stuart. 1995. Learning from strangers: The art and method of qualitative interview studies . New York: Free Press.

Widen, Sherri, Marlene Orozco, Eileen Lai Horng, and Susanna Loeb. 2019. Reaching unconnected caregivers: Using a text-message education program to better understand how to support informal caregivers role in child development. Journal of Early Childhood Research 18 (1): 29–43.

Download references

Acknowledgements

We would like to thank our colleagues who supported this work and provided examples from their research: Emily Carian, Molly King, Tagart Sobotka, and Chloe Hart. Special thanks to Forrest Stuart for his input on several drafts. We would also like to thank the participants of the Migration, Ethnicity, Race and Nation workshop at Stanford for their comments on the manuscript.

Author information

Authors and affiliations.

Department of Sociology, Stanford University, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA, 94305-2047, USA

Tomás R. Jiménez

Department of Sociology, Stanford University, 450 Jane Stanford Way, Building 120, Room 030B, Stanford, CA, 94305-2047, USA

Marlene Orozco

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Tomás R. Jiménez .

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Jiménez, T.R., Orozco, M. Prompts, Not Questions: Four Techniques for Crafting Better Interview Protocols. Qual Sociol 44 , 507–528 (2021). https://doi.org/10.1007/s11133-021-09483-2

Download citation

Accepted : 04 May 2021

Published : 05 June 2021

Issue Date : December 2021

DOI : https://doi.org/10.1007/s11133-021-09483-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Ethnography
• Counterfactual
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

The Qualitative Interview in Psychology and the Study of Social Change: Sexual Identity Development, Minority Stress, and Health in the Generations Study

David m. frost.

University College London

Phillip L. Hammack

University of California, Santa Cruz

Bianca D. M. Wilson

University of California, Los Angeles

Stephen T. Russell

University of Texas at Austin

Marguerita Lightfoot

University of California, San Francisco

Ilan H. Meyer

Associated data.

Interviewing is considered a key form of qualitative inquiry in psychology that yields rich data on lived experience and meaning making of life events. Interviews that contain multiple components informed by specific epistemologies have the potential to provide particularly nuanced perspectives on psychological experience. We offer a methodological model for a multi-component interview that draws upon both pragmatic and constructivist epistemologies to examine generational differences in the experience of identity development, stress, and health among contemporary sexual minorities in the United States. Grounded in theories of life course, narrative, and intersectionality, we designed and implemented a multi-component protocol that was administered among a diverse sample of three generations of sexual minority individuals. For each component, we describe the purpose and utility, underlying epistemology, foundational psychological approach, and procedure, and we provide illustrative data from interviewees. We discuss procedures undertaken to ensure methodological integrity in process of data collection, illustrating the implementation of recent guidelines for qualitative inquiry in psychology. We highlight the utility of this qualitative multi-component interview to examine the way in which sexual minorities of distinct generations have made meaning of significant social change over the past half-century.

The interview method has a long and distinguished history in qualitative inquiry across the social sciences ( Platt, 2012 ). Interviewing has become increasingly widespread in psychology ( Brinkmann, 2016 ), as qualitative methods have gained prominence in the discipline ( Gergen, Josselson, & Freeman, 2015 ). More than simply providing an account of attitudes or experience, the interview represents a site of social practice in which meaning is made in the interaction ( Mishler, 1986 ; Potter & Hepburn, 2005 ). An approach that integrates multiple epistemologies acknowledges the co-constructed nature of the interview and capitalizes on the potential of this interaction to produce knowledge grounded in lived experience ( Tappan, 1997 ).

Because of its ability to provide access to meaning making about lived experience in context, the qualitative interview affords the potential to study social change. That is, because the method calls upon individuals to make meaning of life events and experiences, it produces discourse content that can be analysed for its relation to larger cultural discourses and narratives (e.g., Hammack & Toolis, 2014 , 2016 ). The personal narratives produced through qualitative interviewing thus reveal the way in which individuals are in active states of navigating social and cultural change ( Hammack & Toolis, 2014 ).

One area of considerable social change has been the meaning of sexual diversity and the rights accorded individuals who identify as sexual minorities (i.e., lesbian, gay, bisexual, queer, and other individuals who do not identify as heterosexual) in the United States, Western Europe, and some Central and South American countries. These developments (for example, marriage equality for same-sex couples) highlight how social and policy changes create different environments for sexual minorities of different generations. It is clear that the coming of age of a sexual minority person in the US in the 2010s is vastly different from, for example, that of a sexual minority person in the 1960s, when homosexuality was still criminalized and considered a mental disorder (e.g., Hammack, Frost, Meyer, & Pletta, 2018 ; Russell & Fish, 2016 ).

Despite the overall improvements in the social and political climate, inequalities in health based on sexual orientation persist, and sexual minority youth continue to experience high levels of bullying and evidence high rates of suicidality relative to the general population ( Meyer, 2016 ; Russell & Fish, 2016 ). Thus, important questions about the impact of social change on the lived experience of sexual minorities remain unanswered in the research literature. Are recent social changes translating to more positive lived experiences for today’s sexual minority youth relative to older cohorts of sexual minority individuals? Does sexual identity matter less for young people who have more open-minded peers than it did for sexual minorities who came of age in less accepting times? To what extent do sexual minority youth experience prejudice and discrimination in a more progressive climate? Do contemporary sexual minority youth differ from older sexual minorities in the centrality they ascribe to a sexual minority identity (McCormack, 2012; Savin-Williams, 2005 )? How should investigators aiming to study the lived experience of sexual minorities assess and adequately account for these shifting social environments?

This paper presents a qualitative approach to answering questions surrounding the lived experience of sexual minority individuals in the context of rapid social change. We use the term “lived experience” to generally refer to people’s personal and subjective descriptions, perceptions, understandings, and interpretations of their own psychological and social experiences (e.g., Tappan, 1997 ). Specifically, the purpose of this article is to describe a methodological approach for understanding sexual identity development and minority stress in the context of social change as developed for and used within the Generations Study: a multi-site, mixed methods study of sexual identity, minority stress, and health across three generations of sexual minorities in the US. The methodological approach consists mainly of an interview protocol informed by multiple epistemologies and innovative it its integration of component methods typically used in isolation (i.e., lifeline methods, identity mapping methods, life story methods, and comparative temporal reflection). Through this integration, this new methodological approach is able to investigate generational differences in the experience of minority stress processes in tandem with identity development processes for the first time in a single study.

The minority stress framework ( Meyer, 2003 ) describes prejudice and stigma as stressors to which sexual minorities are exposed, which, in turn, have an adverse effect on their health and well-being. The minority stress framework outlines how prejudice and stigma lead to specific stress processes, including expectations of rejection, concealment of a stigmatized identity, internalization of negative beliefs about one’s social identities, and experiences of discrimination (both acute events and chronic everyday mistreatment). Like all stress, minority stress processes create strain on individuals’ ability to adapt to their environment and are therefore associated with decreases in mental health and well-being. Sexual minority individuals utilize a variety of resources located both in the individual (e.g., coping, mastery, meaning-making) and the LGBT community (e.g., connectedness, positive identity development, support from other sexual minority people), which build resilience that can reduce or eliminate the negative impact of minority stress on health (e.g., Bruce, Harper, & Bauermeister, 2015 ; Frost & Meyer, 2012; Meyer, 2015 ).

Because minority stress is a theory about socially embedded stress, historical shifts in the social environment should correspond with significant shifts in the experience of minority stress. Thus, if prejudice and stigma related to sexual minorities were reduced, we would expect a corresponding reduction in the experience of minority stressors. Not only could the level of stress exposure be changed, but also the types and quality of stressors could change with shifting norms and values. For example, internalized homophobia—a minority stressor—is related to the socialization of a sexual minority person in an environment that teaches prejudice and stigma about homosexuality and bisexuality (e.g., Herek, Gillis, & Cogan, 2009 ; Herek & McLemore, 2013 ). Both heterosexual and sexual minority people learn this as they are socialized. People who identify as sexual minorities are at risk of applying negative notions about being a sexual minority to their own sense of self, thus being exposed to internalized homophobia (e.g., Newcomb & Mustanski, 2010 ; Puckett & Levitt, 2015 ). To the extent that socialization in a more positive social environment would reduce homophobic and biphobic prejudice and stigma, then there would be no, or reduced, internalization of such negative attitudes. In this example, because the underlying social environment has changed, internalized homophobia could be eliminated as a stressor.

The Shifting Social Environment of Sexual Minorities

Despite understandable concerns about possible setbacks in LGBT-inclusive public policy in the current presidential administration, the last two decades have nonetheless witnessed significant increases in positive attitudes toward and social inclusion of sexual minorities in the US. For example, sexual minorities can now serve openly in the military and same-sex couples can now get married in all US states. Also, attitudes toward sexual minority individuals and same-sex couples have drastically improved, with most of the US population supporting same-sex marriage for the first time as of 2014 (Pew, 2016). Acceptance of and positive attitudes toward sexual minorities is very strongly related to age, with younger people having more favorable attitudes than older people (cf. Frost, Meyer, & Hammack, 2015 ).

Improving attitudes toward same-sex sexuality and relationships among younger generations have led some researchers to contend that youth and emerging adult sexual minorities come of age in a “post-gay” era (e.g., McCormack, 2012; Savin-Williams, 2005 ). This research suggests that adolescents and emerging adults with same-sex attractions, desires, and behaviors are not as marginalized and stigmatized as older cohorts have been, and thus their sexual minority identity may be a less central component of their overall self, compared with the experience of sexual identity among older cohorts of sexual minorities. This research stands in contrast to other studies, which show that sexual orientation continues to be an important aspect of youth identity and overall sense of self (e.g., Cohler & Hammack, 2007 ; Russell, Clarke, & Clary, 2009 ). Further, in spite of a more positive climate for sexual identity diversity, young sexual minorities continue to experience minority stress (e.g., Baams, Grossman, & Russell, 2015 ) and to engage with cultural discourses of stigma (e.g., Hammack & Cohler, 2011 ; Hatzenbuehler, 2017 ). There is little doubt that today many sexual minority adolescents and emerging adults are socialized in a radically different social environment than any previous generation ( Russell & Fish, 2016 ). Consistently, studies have shown that the current cohort of sexual minority youth are coming out (i.e., disclosing their sexual orientation to important others) at increasingly younger ages ( Floyd & Bakeman, 2006 ; Grov et al., 2006 ; for review, see Russell & Fish, 2016 ).

Despite the overall improvements in attitudes toward same-sex sexuality and relationships, inequalities persist ( Meyer, 2016 ). For example, federal law does not protect sexual minorities against employment discrimination. Also, sexual minorities continue to be victims of very high rates of antigay violence and bullying ( Kahn, 2016 ). Researchers continue to speculate that prejudice and related victimization underlie findings that sexual minority youth (regardless of gender) report higher rates of mental health problems, substance use, sexual risk, and suicidality than their heterosexual peers (e.g., Fish & Pasley, 2015 ; Marshal et al., 2011 ; Mohr & Husain, 2012 ; Russell & Fish, 2016 ). Thus, it is likely that sexual minority youth and emerging adults continue to experience stigma and victimization, navigating both a new, liberating narrative of “normality” regarding same-sex desire and an older narrative of stigma and subordinate status in the course of their development (e.g., Cohler & Hammack, 2007 ; Hammack, Thompson, & Pilecki, 2009 ; White, Moeller, Ivcevic, & Brackett, 2018 ). Further, sexual minority youth of color and gender non-conforming youth may experience changes in the social climate (or lack thereof) in importantly unique ways that are not accurately represented in the existing body of research evidence ( Fine, Torre, Frost, Cabana, & Avory, 2018 ). Research on sexual identity and minority stress and resilience has not adequately assessed the role of the shifting sociohistorical context in the lives and health of sexual minorities and important variability within such experiences. As a result, many claims have been made about the importance of a sexual minority identity and the extent to which the current social climate for sexual minorities has indeed “gotten better” (e.g., Savin-Williams, 2016 ), which warrant further rigorous research to fully investigate ( Frost et al., 2014 ; Hammack, 2018 ).

In addition to historical consideration of the social environment, research on sexual minorities has yet to fully integrate intersectional and life course perspectives. Specifically, a life course perspective ( Elder, 1998 ) allows for an understanding of how differences in the social and policy context, along with cohort-defining events (e.g., the Stonewall riots, the onset of AIDS, the repeal of “Don’t Ask, Don’t Tell”) shape the identities and lived experience of each generation differently. From a developmental perspective, a life course paradigm further concerns the complex interplay between social and historical context and individual development ( Cohler & Galatzer-Levy, 2000 ; Hammack, 2005 ). Thus, specific generations of sexual minorities can be considered distinct based on differential exposure to cohort-defining events and other aspects of the social and political context that shaped the historical periods in which they “came of age” ( Hammack et al., 2018 ). Thus, a life course perspective is essential to any attempt to directly investigate the degree to which the kinds of social and policy changes described above translate to differences in the lived experiences of the current cohort of sexual minority youth relative to previous generations.

Sexual minorities are diverse with regard to many characteristics including race/ethnicity, geographic region or residence, socio-economic status, immigration status, etc., all of which shape their lived experiences. Intersectionality frameworks implore researchers pay attention to unique intersectional circumstances, especially related to sexual orientation, race/ethnicity, and gender ( Cole, 2009 ; Crenshaw, 1996; McCall, 2005 ; Rosenthal, 2016 ; Stirratt et al., 2008 ; Warner, 2008 ; Wilson et al., 2010 ). For example, lesbian and bisexual Black women have unique experiences of identity, stress, and health associated with their sexual orientation, race/ethnicity, and gender that cannot be fully captured by considering race and gender categories separately ( Bowleg, 2008 ). Researchers need to explore how multiple social statuses shape the relationship among cohort, identity, minority stress, and health.

Although our focus was primarily on the development of sexual identity, we operate from a position that recognizes that sexual identity development and the experience of minority stress does not occur in isolation and is theoretically and analytically inseparable from other identities, including but not limited to gender and race/ethnicity. Further, as Bowleg (2008) argues, “…questions about intersectionality should focus on meaningful constructs such as stress, prejudice, discrimination rather than relying on demographic questions alone” (p. 316). Thus, there is a need for qualitative research to develop experience-oriented tools to examine intersectional experiences of what it is like to live minority stress as a person who is, for example, a young queer Latina woman, rather than simply striving to identify differences in the types and frequencies of minority stress across groups defined by age cohort, sexual orientation, race/ethnicity, and gender.

Examination of intersectionality has been previously achieved through the use of tools such as identity mapping, developed by Narvaéz and colleagues (2009) and Sirin and Fine (2007) , which was designed to study the experience of minority stress at the intersection of various forms of oppression and stigmatized identities. Such tools for assessing these elements of intersectional experiences of oppression and minority stress have thus far been anchored in studies of specific temporal and geographic contexts and have yet to incorporate understandings of intersectionality with understandings of where such intersectional experiences occur within the life course. Conversely, qualitative approaches to understanding the development of identity across the life course, such as narrative life story methods (e.g., McAdams, 1995 ) and lifeline drawing techniques (e.g., Grambling & Carr, 2004 ), do not explicitly include the kind of intersectionality focus advocated for by Bowleg and other methodologists operating from critical race, feminist, and queer theoretical and methodological perspectives (e.g., Bowleg, 2008 ; Cho et al., 2013 ; Crenshaw, 1991 ). Thus, in order to understand the complex diversity of lived experiences in sexual identity development and minority stress in the context of social change, a qualitative approach is needed which combines component methods which have thus far been largely isolated in their use in psychological research.

Following a life course approach to sexual identity development, individuals are understood to make meaning of their same-sex desire in the context of specific historical, cultural, and political contexts ( Cohler & Galatzer-Levy, 2000 ; Hammack & Cohler, 2009 ). The words and narratives individuals have to understand and describe their desire are historically contingent ( Hammack, 2005 ). Thus, a qualitative approach to access this meaning making directly is essential to document how sexual minorities engage with cultural narratives that shape their sexual identity development and experiences of minority stressors in the context of rapid social change and at the intersection of multiple social identities and statuses. The field still lacks an understanding of generational differences in the experience of minority stress processes in tandem with identity development processes. Research is needed to address these questions about the role of social change across the lifespan in sexual identity development and experience of minority stress, while taking into consideration intersecting identities and social statuses. Addressing these important but unanswered questions therefore requires an integrative methodological approach that is able to examine the complex interrelations of minority stress, social change, and sexual identity development.

We present one such approach developed by the authors who are co-investigators in a national multi-phase mixed methods research project called the Generations Study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD Grant#: 1R01HD078526). All aspects of the research involving human subjects were approved by the Institutional Review Board (IRB) at [University of California, Los Angeles], with which all other universities’ IRBs involved in the study established a relying agreement. The Generations Study explored generation-cohort similarities and differences in sexual identity, minority stress and resilience, access to health care, and health outcomes. The study focused on three cohorts of sexual minorities in the USA.

The three cohorts were defined by the distinct nature of their social environments during two critical periods of development: adolescence and emerging adulthood. The youngest generation was 18–25 at the beginning of our study in 2015. We refer to them as the cultural inclusion generation, as they experienced an improved social context for sexual diversity in which sodomy laws had been ruled unconstitutional and the cultural discourse had shifted to that of equality, leading to inclusion of sexual minorities in the military and equal access to legal marriage. Members of the institutional advancement generation were 34–41 years old at the time of our study and had experienced childhood and adolescence at the height of the AIDS epidemic, which disproportionately impacted sexual and gender minorities and led to the development of health organizations around the country that went on to aim to serve the broader LGBT communities. This generation was also the first to have greater access to resources through the Internet. LGBT people in general, not just the gay men and transgender women who were disproportionately impacted by the epidemic, gained heightened public scrutiny and increased stigma and prejudice due to fear of HIV/AIDS but also greater political awareness and consolidation of LGBT community institutions (like health centers). Members of the identity formation generation were 52–59 years old at the time of our study and experienced the post-Stonewall environment, when homosexuality was considered a mental disorder and sodomy was illegal in many states but when the first Gay Pride event took place (in 1970) and a larger discourse of pride in sexual minority identity took hold in the LGBT community.

The qualitative approach of the Generations Study sought to address the following specific aims: (a) To describe similarities and differences among sexual minority cohorts in trajectories of the formation, expression, and experience of sexual identity; (b) To describe similarities and differences among sexual minority cohorts in trajectories of exposure to minority stress and resilience (availability of coping and social support resources); and (c) To describe similarities and differences among sexual minority cohorts in trajectories of utilization of health and social services and public health information. Reflected in the combination of these aims, the Generations Study was guided by both scholarly and practical goals. These goals include the advancement of social scientific knowledge about how social changes have shaped the experience of sexual identity development and minority stress, as well as goals to inform interventions and policy change directed at improving the health and well-being of sexual minority individuals, who continued to experience health inequalities relative to their heterosexual peers ( Meyer, 2016 ).

The Qualitative Interview: A Multi-Component Approach

Links between paradigm, epistemology, and method.

The scholarly and pragmatic aims of the Generations Study required an approach to qualitative inquiry which can best be categorized as operating within a paradigm of methodological pluralism and emphasizing paradigmatic complementarity (see Madill & Gough, 2008 , for a discussion of qualitative paradigms within psychology). Specifically, our aim was to examine participants’ accounts of their lived experiences through the combination of multiple methodological components and the accumulation of multiple researchers’ perspectives in the design of the study collection of data aimed toward achieving scholarly and practical purposes ( Madill, Jordan, & Shirley, 2000 ). The epistemological positions underpinning the design of the qualitative approach can be best described as straddling elements of constructivism and pragmatism Namely, the approach stems from constructivism in its emphasis on narrative and lived experience and that it did not assume a knowable truth or an “objective” reality of lived experience to exist, but rather that idiographic and subjective meaning of participants’ experiences could be examined through one-on-one engagement in research interviews (e.g., Ponterotto, 2005). Elements of pragmatism shaping our approach are evident in our implementation of a diversity of methods and the accumulation of multiple researchers’ perspectives for both scholarly and practical purposes ( Madill et al., 2000 ), such as informing social and health policy. As noted in recent guidelines for designing qualitative research, these epistemological positions need not be considered mutually exclusive ( Levitt, Motulsky, Wertz, Morrow, & Ponterotto, 2017 ).

This paradigmatic and epistemological position required a semi-structured interview protocol that was open enough to provide storied accounts of lived experience reflective of narrative meaning making processes, as well as specific content-oriented questions about phenomena central to the aims and research questions of the study (e.g., sex and sexual cultures, community, stress and coping, access to healthcare). Thus, the instrument included general questions about key events and trajectories in participants’ general life stories, as well as specific questions about same-sex desire awareness, sexual experiences and sexual identity development, and minority stress experiences, including stressful life events related to sexuality, experiences with stigma and expectations of discrimination based on sexuality, internalized homophobia, and perceptions of relationships between sexual minority stress and the structural and cultural dimensions of other social statuses (e.g., race/ethnicity, gender, rural residence). Given the focus of the study on identity development and individual-level meaning making of experiences of minority stress, the design of the study involved individual one-on-one interviews (rather than, for example, focus groups). Interviews were conducted by trained interviewers and lasted on average between two and a half to three hours.

Qualitative Interview Protocol

The interview protocol (provided in the online supplemental material ) was organized in eight sections. The course of the interview was designed to progressively narrow in scope from the opening section which was the broadest and most unstructured (i.e., the life story) to the most specific content-focused sections nearing the end of the interview (e.g., health care utilization). The narrowing scope of the interview allowed for the emergence of constructs relevant to the study (e.g., minority stress, coping) to emerge naturally within the participant’s discussion of his/her/their overall lived experience initially, with opportunity to obtain more specific accounts of such experiences later in the interview, as opposed to using the focal constructs of the study to guide the course of the interview from the start.

We present each section of the interview protocol below along with a discussion of the conceptual purpose, epistemological foundations, methodological intent, and exemplar data excerpts to illustrate the section’s utility. Table 1 provides an overview of the interview components and summarizes these linkages. It is important to note that the data exemplars are included for the purpose of illustrating the methodological utility of the approach and the richness of the types of data that emerged from the interview: The data presented are in no way intended to reflect the full range of study findings. The sections are presented in the order in which most interviews progressed. However, interviewers were given the freedom to change the order of the sections when warranted by the natural flow of conversation with participants.

Linkages between epistemology, method, and utility within an integrative qualitative approach.

Note - This table describes the primary elements shaping each section of the interview. However, the entire interview protocol was informed by a blending of life course, narrative, and intersectionality approaches, and thus no section was exclusively informed by a singular approach.

1. Lifeline.

The first section of the interview was designed to obtain a broad sense of participants’ life stories and overall life trajectories. Specific experiences around the focal constructs of the study could be contextualized in later sections. To facilitate this, we used two established qualitative tools to elicit life story narratives: Lifeline drawings and the life story interview.

First, participants were asked to complete a lifeline drawing activity. Lifeline techniques have been used in life course and developmental research to obtain visual depictions of events and transitions that constitute individuals’ understandings of their own life histories (e.g., de Vries, LeBlanc, Frost, Alston-Stepnitz, Stephenson, & Woodyatt, 2016 ; Gramling & Carr, 2004 , Hammack, 2006 ). Informed by both life course and life events traditions (e.g., Elder, 1998 ), lifeline tools reveal important moments of continuity and change within the life course and provide the foundation for discussion of the social and historical circumstances that shape the life course trajectory ( de Vries et al., 2016 ). In the present use, participants were asked to “Please draw a line that represents your life. The line should begin when you were born, go to today and then continue into your future. The line should go up when it was a good time in your life and down when it was a bad time in your life. Take a few minutes to think about your life and draw the line, and when you are finished we can discuss it.” Participants were provided with the visual tool, included in Figure 1 , on which they could draw their lifeline. After participants completed their drawing, interviewers asked participants to briefly describe why they drew the line the way they did (e.g., “Why did you start off the line at a high point?”; “Why did the line change directions here?”).

Example Lifeline Drawing.

The example lifeline provided in Figure 1A comes from a 24-year-old Latino gay man. His line illustrates several ups and downs in life, including early childhood bullying and problems with family, financial trouble and dropping out of college, followed by turning points characterised by weight loss, confidence gain, and re-enrolling in school. His line also notes a generally high (positive) interpretation of the present but flat trajectory headed toward the future, which he characterizes as exciting but also anxiety provoking.

A contrasting example can be seen in Figure 1B , the lifeline of a 21-year-old Latina lesbian woman. Her lifeline also can be characterized by several ups and downs, starting with immigrating to the US from Mexico when she was 5, through parental divorce, depression, and declaring a major in college. In contrast to Figure 1A , this woman’s lifeline ends in a positive upward trajectory anticipating a better future compared to her past and present.

Grounded in epistemological concerns relating to pragmatism, this section of the interview served several purposes. It provided participants with a “settling in” activity that served to build rapport with the interviewer. It provided the interviewer with broad context for how the participants viewed their overall life trajectory and key events and transitions within that trajectory. It provided a visual sketch of participants’ life trajectories that could be referenced in subsequent discussions and used later for formal analysis using narrative analytic methods ( Lieblich, Tuval-Mashiach, & Zilber, 1998 ). Finally, both the lifeline and discussion of its construction provided key data used to frame the following life story segment of the interview.

2. Life story.

Following the creation of the lifeline, the interview employed central elements of the Life Story Interview (LSI), a flexible protocol commonly used in personality and social psychology to explore identity development through a constructed life story narrative (McAdams et al., 2008). Modified versions of the LSI have been used successfully with diverse populations, including sexual minorities ( Frost, 2011 ; Hammack & Cohler, 2011 ). The portion of the LSI employed here inquired about participants’ critical life events, social influences, and values. Specifically, interviewers framed the LSI by telling participants: “Now, I’d like us to focus on a few key events that happened to you in your life. For each event, please describe what was happening, where you were, who you were with, and what you were thinking and feeling at the moment.” Participants were asked to talk about their first memory, a high point in their life, a low point in their life, and a turning point. For example, the Latino male participant ( Figure 1A ) identified the death of his aunt and cousin while he was in university as a low point, and a recent moment when he became financially stable and able to emerge from debt as his high point. In contrast, the Latina female participant ( Figure 1B ) identified her graduating high school as the high point in the life story, while her low point was a moment a few weeks before the interview in which she felt like she was “going into a depression,” having experienced “a crash” of negative emotions after being questioned by members of her family regarding her sexual orientation.

At no point during this broadest section of the interview were participants asked specifically to talk about sexual identity or minority stress, unless they brought up the topics themselves. However, the lifeline and life story, and associated narratives, were used to anchor specific events and discussions of sexual identity and minority stress in participants’ broader life histories when brought up in the following content-specific sections of the interview.

With its roots in narrative and constructivist epistemologies, the LSI provided data that was useful in understanding the meaning of significant events in participants’ life histories via processes of narrative (re)telling. Specifically, this portion of the interview provided access to the spontaneously constructed personal narrative of the interviewee. Narrative psychologists view the personal narrative as a source of coherence, continuity, and meaning making (e.g., Cohler, 1982 ; Hammack & Toolis, 2014 ; McAdams, 1990 , 1997 ). The personal narrative is especially significant for those who experience adversity or discontinuity in the anticipated life course ( Cohler, 1991 ; Hammack & Toolis, 2014 ), which describes the likely experience of sexual minorities who are socialized in a context of heterosexism and presumed heterosexuality ( Herek & McLemore, 2013 ). This portion of the interview allowed us to apply an interpretive, hermeneutic approach grounded in constructivist epistemology to the way in which our participants made meaning of significant life events. We were especially interested in the way in which events related to sexual identity development or the experience of sexual minority status might appear in the personal narrative absent specific prompting for such events. This approach allowed us to examine generational similarities and differences in the centrality of a sexual minority identity to the general life story and thus to address one of our central research questions about social change and the meaning of a sexual minority identity.

3. Identity mapping of social identities and communities.

To shift the discussion from participants’ general life histories to specific aspects of their social identities and community memberships, the interviewer guided participants through an identity mapping activity and discussion. Identity mapping activities have been successfully employed in previous research designed to elicit detailed discussions of multiple personal and social identities and how they relate to one another in the context of a focal lived experience (e.g., Cruwys et al., 2016 ; Narvaéz et al., 2009; Sirin & Fine, 2007 ). Specifically, participants were presented with the visual tool included in Figure 2 . They were asked to use that tool “as a starting point for listing the identities and roles that describe who you are. You can write words or phrases that represent different aspects of yourself. These might include social identities or labels related to gender, race, sexuality, class, occupation, different roles in your life, or any words or phrases that describe you.” As visible in the identity map provided in Figure 2 , a 38-year-old Pakistani man includes several identities pertaining to his sexual orientation (queer), race/ethnicity (Pakistani, South Asian, POC), gender (cis-gender male), as well as identities related to immigration, socioeconomic status, and health. He also notes identities related to his political views (e.g., progressive, activist) and his being a survivor of past abuse.

Example Identity Map.

Given the present study’s interest in intersectionality as it relates to the experience of sexual identity development, gender, and race/ethnicity in particular, the following discussion of participants’ identity maps focused on these core identities and their intersections. If participants did not spontaneously list something for each of these core identities, the interviewer prompted them to consider whether they would like to include them on their maps (e.g., “I noticed you did not include anything about your gender on your map…”). Such prompting was more often needed among those with typically privileged or dominant social identities that are often taken for granted in everyday life (e.g., male gender, White race/ethnicity). To prompt participants to reflect on their experiences of their intersecting core identities, interviewers asked participants a series of questions repeating versions of the following adaptable prompt for the possible intersections: “Tell me about your experience of being [SEXUAL IDENTITY] in the [RACE/ETHNICITY/GENDER] community.” These prompts were designed according to Bowleg’s (2008) recommendation that, in order to best assess intersectionality experiences, researchers should ask about them directly.

This direct discussion of intersectional identity experiences is reflected in the following experience of a 54-year-old Chinese gay man:

I feel sometime a double discrimination in both community… I think I didn’t come out to my family for the longest time, just because I hear these horror story about, especially in the Chinese culture, and probably lot of different culture can relate to it, that family’s very important, and that you don’t wanna disgrace your family. I just felt like they would disown me, and they would be ashame of me…. Then, being a Chinese gay in the gay community, [...] I don’t feel really totally accepted in the [gay community]. … I don’t consider it as my community. I always felt angry at people that said oh, “I’m only attracted to White guys only, or I’m only attracted only Asians.” Then I don’t want that, either, because I want people to like me for how I look.

As this excerpt from one interview reveals, this section of the protocol elicited narratives of intersectionality to capture the diversity of lived experience among sexual minorities typically unrepresented in traditional quantitative research.

In line with constructivist epistemological foundations, additional questions in this section of the interview focused on how participants see themselves in terms of masculinity and femininity in their gender expression, as well as what communities they feel they belong to and what it is like to be a member of such communities. Just as the life story section provided a life course anchor for specific events and experiences discussed later in the interview, the identity map served as a general sketch of identity intersections that interviewers returned to in discussing specific experiences related to sexual identity, race, and gender later in the interview. Thus, this section was designed to fulfil pragmatic epistemological goals not only for giving the participant an opportunity to nominate and describe their identities in their own words, but also providing additional foundational data for orienting the subsequent temporal reflective discussions.

4. Sex and sexual cultures.

Next, the interviewer turned the discussion to more narrowly focus on specific types of lived experience within specific life domains. The first of these more specific discussions focused on participants’ “sex life and relationships.” In this section, participants were asked to discuss their experiences of sex and relationships, including how they felt about sex and relationships, how they went about findings partners, and the things that both excited and worried them about sexuality.

Interviewers guided participants through these discussions using a series of questions designed to elicit comparative temporal reflection. Stemming from constructivist perspectives, these discussions were designed to explore the meanings participants give to their lived experiences and how they viewed their own lived experiences staying the same or changing across various ages and developmental periods. The guided discussions involving comparative temporal reflection were designed to avoid imposing an expectation of change, further allowing participants the freedom to describe and interpret the meaning of their lived experiences as stable or changing throughout the life course.

To illustrate this process of comparative temporal reflection, participants were asked to describe their sex life and relationships during adolescence and puberty and at the present time. Participants were asked to reflect on how aspects of their sex life and relationships have changed or stayed the same between puberty and adolescence to the present. If they described changes over time, interviewers prompted them to discuss why they thought the changes had occurred, the ages the changes had occurred, and specific life events or social factors that may have precipitated changes. Participants were also asked to relate their discussions to the identity map and locate them in relation to other events on their lifelines and in their life stories.

For example, in the following exchange, a 36-year-old Black woman discussed how the ways she looks for sexual and relationship partners have changed as she has gotten older, especially now that she has a child from a previous relationship. She reflected on the role that the Internet now plays—both positive and negative—in her search for sexual and relationship partners, along with her changing needs/desires from a partner.

Interviewer: How about the ways with age, what’s changed in the ways you go looking for sex, in the kinds of things you’re looking for in a relationship?

Interviewee: The kind of things I’m looking for? Nobody wants stability…. Nobody wants somebody with kids. That’s number one. [chuckles] Or, they’re young and they want kids. I’m like, “My eggs are powdered.” [chuckles] …As far as sex, my sex drive has not changed since I was 15… The sex is not an issue…. Just relationship.

Interviewer: How about the way you go about finding it? Where did you find your relationships before? How did you find [previous partner]?

Interviewee: Online…. Internet makes it a lot easier, but also Internet makes it a lot harder, because… It’s all about looks…. Going out in person, looking for relationships … is hard, because I don’t look like a lesbian from what I’ve been told. I’ve had to kind of learn to step up and be the aggressor.

As this excerpt reveals, in this section of the interview we were able to elicit narratives of sex and sexual culture in both the remembered past and the experienced present. This excerpt reveals the ways that changing personal motives for sex and relationships can be both facilitated and frustrated by elements of one’s sexual culture (e.g., online dating, community standards of attraction, gender roles). Interviewees provided rich data on understandings of intimacy and sexual minority communities that revealed the ways in which radical social change—in this case, coupled with technological change—over the past half-century impacted their understandings of identity, community, and sexual practice.

5. Challenges, stress, and coping.

Again involving comparative temporal reflection, the fifth section of the interview contained questions about challenges and stressors in participants’ lives and how they coped with them. The opening questions focused on participants’ “single greatest challenge in life,” how they “handled” that challenge, and how this challenge impacted them “as a person.” Participants were asked to locate the challenge on their lifeline to contextualize it within the broader scope of their life course development. This discussion was not focused on sexual orientation or minority stress. Indeed, we asked about “challenges” to avoid guiding participants to narratives of stress and pathology, allowing the participants’ narratives to take a natural form. This approach allowed us to document the degree to which participants’ most challenging and stressful life experiences came about, were shaped by, or involved minority stress, without explicitly prompting about sexual minority status.

After the general discussion of challenges, questions focused on participants’ experiences of minority stress and coping directly. Participants were asked if they experienced any challenges in their life specifically related to being a sexual minority person (the interviewer used the sexual identity label from each participant’s identity map). For any event that participants recalled, they were asked to narrate what happened, who was involved, how they felt about the experience, and how they coped with the experience. These prompts were used to produce an account of the experience with a clear narrative trajectory and evaluative frame. Participants were also asked to reflect back across their lives and discuss any times they struggled to accept themselves as a sexual minority person and times when they had to negotiate being out and concealing their sexual identities. This section also included an opportunity for participants to reflect on the question, “in your day-to-day experiences, do you feel that society is accepting of you and other LGB people?” and whether or not their perspectives on societal acceptance have changed over time.

The following exchange between an interviewer and a 22-year-old Asian man illustrates the kinds of narratives elicited in this section. The participant described challenges in accepting himself as gay during adolescence and how it has remained a challenge throughout his life:

Interviewee: When I was a kid, I did—I was a Boy Scout. I was on the swim team. I also did martial arts. I had a lot of very stereotypically masculine things. It was sort of okay for a while. Then I began to see small tinges of homophobia from time to time. Every single time, when I would see it, I would make a mental note of, “Prob’ly should not tell you.” Because you’ll have some offensive—they’ll shout out a homophobic slur. …When in other cases, for instance—a few years ago, actually, I was working with a project with a friend. …He said that he would not be comfortable with changing in front of me. I’ve known this guy for about three years. When he said that I was taken aback, because I told myself—I said, “Why am I friends with a bigot? Why is he the—the implicit homophobia? Why am I getting this from him?”

Interviewer: He knew you were gay and made the comment?

Interviewee: He knew I was gay, and then he made the comment. Which is, I would say, is even worse. …It reminds me to be very careful with my identity. Because there have been certain times when I’ve felt that if I were to share that bit of my identity, I would be unsafe. There have been a few times here or there. There are very few straight men that are truly comfortable with me. …There are certain people that stick out to me where just—no, it is not safe. It’s just feeling—being excluded from that community. From the greater community.

In addition to illustrating his struggle to feel fully included in society, this participant’s narrative illustrates experiences of prejudice and the cognitive burden and stress associated with managing concealment, which can be both psychologically damaging and protective (e.g., a cognitive burden of secret keeping, which can sometimes help to avoid prejudice and discrimination) ( Meyer, 2003 ).

This section of the interview ended with a discussion of participants’ use of coping strategies and access to social support available to help them deal with general challenges and challenges related to minority stress. Specifically, they were asked “what types of things helped you deal with challenges and negative experiences you’ve had related to being (sexual identity label)?” As in previous sections, participants were asked to reflect on whether or not their coping strategies and access to support have remained the same or changed over the years. Given the role of community connectedness as a coping resource in the minority stress experience (Frost & Meyer, 2012; Meyer, 2003 ), participants were also asked to reflect on the extent to which they utilized sexual minority community resources (e.g., an LGBT center) or services targeted to sexual minority communities.

6. Interpretations of social and historical change.

Again utilizing comparative temporal reflection methods, the next section of the interview focused on participants’ memories of historical events, cultural moments, and social representations of sexual minority people and issues. Participants were asked: “Can you tell me about your memories during puberty and adolescence about what was happening in society with regard to LGBT issues?” They were then prompted to reflect on how LGBT issues were talked about in the wider society at this time in their lives, from whom and where they heard LGBT issues discussed, and what they felt and thought about such mentions when they occurred. They were then asked to reflect on how LGBT issues are discussed today, and what they feel and think about such discussions.

Illustrating both perceptions of a shift in cultural discussions of LGBT issues, as well as the persistence of stigma in the dominant narratives that are told about the LGBT community, the following younger Black genderqueer person’s narrative illustrates the value of directly interrogating participants’ perceptions of social and historical moments and how they shape lived experiences of sexual identity and minority stress:

Interviewee: I don’t remember—yeah, my hometown wasn’t—so I didn’t have—I didn’t have super great Internet access all the time, as a kid. Or growing up, I didn’t— our computer was really shitty and wasn’t super great. Yeah, local media didn’t report on it. People didn’t talk about it.

Interviewer: How about now? What do you see as major issues today, with regard to LGBT people?

Interviewee: The murder of trans people I guess I’d include in that group, but also just homeless youth that are lesbian, gay, bi, queer youth that are homeless because they couldn’t stay where they lived, out of either because they weren’t accepted or violence happened or assault happened, I think is really intense and a lot more prevalent than a lot of people would realize. Yeah, and it’s not always super safe out there.

As this excerpt reveals, this section of the interview provided the opportunity for participants to offer their own interpretations of the social context of sexual identity development and minority stress at two points in their development—during adolescence (a critical period for identity development; Hammack & Toolis, 2015 ) and today. Notably, this participant reported not hearing much in the news about sexual minority people when growing up, but they remembered having access to a “space” that was accepting. They further noted a recognition of violence against trans people as characterizing the social and historical events shaping the present climate surrounding sexual minority lives. These narrative accounts allow us to examine diversity in how members of different generations have interpreted the massive social and historical changes for sexual minorities over the past half-century. They also allow us to examine generational differences in interpretations of the present social and political context for sexual and gender identity diversity.

7. Healthcare utilization.

Given the focus of the broader study on health and healthcare utilization, the last major section of the interview contained very specific questions about experiences of seeking and receiving care related to mental and physical health. Participants were asked to discuss where they go when they need care, including whether they go to or would prefer to use LGBT-specific healthcare providers. They were asked about their last experience seeking healthcare and specific aspects of that experience. Interviewers also prompted participants to discuss deterrents to seeking healthcare, how open they are about their sexual identities in healthcare contexts, and whether they have ever sought care for reasons related to sexual identity or gender expression.

To illustrate the types of narratives elicited by this section of the interview, the following example from a 39-year-old White woman exemplifies the complexities of navigating minority stress in healthcare contexts:

Healthcare’s harder to navigate in many ways. I feel like I end up making choices around what’s good for my lymphedema. Then secondary is, “Are they queer-friendly?” My GP, not particularly queer-friendly. In fact, on my—I can tell that she’s a little horrified that I’m poly on my diagnosis form for my last annual. One of the things she put was “high-risk bisexual activity” as one of my diagnoses. I don’t know how you get treated for that, [ laughs ] but I was pretty horrified, because I’d been with one man my whole life, right?

Noting how her identification as polyamorous on her medical records resulted in her provider’s assumption that she was engaging in high-risk sexual behaviour, this participant’s narrative provided a critical experiential window into the healthcare experiences of sexual minorities. Given she has a serious health problem, she noted she must privilege her seeking care for this over seeking care that is LGBT-affirming.

This portion of the interview was primarily rooted in pragmatist aims. Following from the behavioral model of health services use ( Martos, Wilson, Gordon, Lightfoot, & Meyer, 2018 ), it was designed to understand and document participants’ preferences for certain types of health care provision and allowed us to obtain data on the healthcare decisions and challenges associated with potential minority stressors in healthcare settings.

8. Reflections and goals.

In order to (a) account for imagined futures within a life course framework and (b) end the interview in a positive discussion (given that the last few sections of the interview were primarily focused on negative experiences), the last section prompted participants to discuss their goals for the future. They were asked to look back at their lifeline and tell the interviewer about their goals for the future regarding work, relationships, and family life. Finally, they were asked to consider their entire lifeline, and reflect on what they thought has been the most positive aspect of being a sexual minority (interviewers used participants’ preferred sexual identity labels).

The following excerpt from a 25-year-old Black woman provides an illustrative response to these final questions of the interview.

Interviewer: Finally, looking back over your life, what would you say has been the most positive aspect of being bisexual?

Interviewee: The struggles. It forces you to be accepting, I think, because I don’t feel like anyone who has this type of sexual orientation is any different from anyone else who is heterosexual. I think that other people would want to treat you like you’re different. I feel like it forces you to be able to express yourself and be able to be open-minded enough to accept that everybody’s not gonna accept your sexuality. You can still help them to understand you as a person, as much as they will allow. If you can be patient enough to help other people see that you’re just another person, and you just want to be respected as just that, then it makes you pretty strong.

As this excerpt reveals, this final section of the interview provided the valuable opportunity for participants to narrate their future life goals and to consider the positive value of a sexual minority identity. It also illustrates the concepts of resilience and stress-related growth, noting struggles associated with being a sexual minority person, but also the strength derived from such experiences.

Methodological Integrity

The Generations Study’s methodological approach strived to achieve methodological integrity throughout the process of data collection. In doing so, we follow the recommendations for promoting methodological integrity offered by Levitt and colleagues (2017 ). Specifically, we highlight how aspects of sampling, interviewing training, and quality assurance were implemented to enhance fidelity to the substantive focus of the study and utility of the methodological approach to achieve the study’s aims and purpose.

Sampling was central to achieving the aims of the study and allowing sufficient representation and diversity of lived experience to reflect the study’s conceptual foundations in minority stress, life course, intersectionality, and social change. For example, many qualitative studies focus on one geographic area and lack the ability to compare across locations, potentially missing important diversity in lived experiences. To address this issue, we recruited participants from culturally distinct geographic regions of the country. Each site had a catchment area of 80 miles, which included urban and non-urban areas. Based on the study’s foundations in intersectionality and life course perspectives, we used quota sampling to ensure roughly equal representation of participants across age cohort, gender, and racial/ethnic groups. Obtaining a diverse sample also contributes to the study’s potential to achieve a high degree of one form of generalizability in qualitative research— transferability ( Polit & Beck, 2010 ). Combined with thick descriptions of the data and study design, ensuring recruitment of participants from several core social status groups relevant to the phenomenon under study increases readers’ understandings of whether and under what conditions various findings may reflect the experiences of people not included in the study directly.

Several procedures were established to achieve consistency in the interviews across the four study sites and to ensure the data collected were sufficiently rich in detail pertaining to content and narrative reflection. First, interviewers from each study site met in person, were trained on the interview protocol, and conducted mock interviews. All investigators in the study listened to the mock interviews for each interviewer and provided feedback until interviewers were deemed ready to begin interviewing. Interview quality and consistency were assured through weekly in-site meetings between interviewers and the lead investigator at each site. In addition, online meetings among all interviewers across the sites took place bi-weekly using video conferencing software. Different reflexive and engagement exercises were conducted. The purpose of this engagement in reflexivity and positionality was to recognize and manage the role of researchers’ perspectives in the data collection process, to maintain consistency in the implementation of the interview protocol, and to continue to hone the skills of the interviewers ( Barry, Britten, Barber, Bradley, & Stevenson, 1999 ).

Discussion and Conclusions

Interview methods are increasingly common in qualitative psychology ( Brinkmann, 2016 ), but few interview studies specify the purpose, epistemological grounding, theoretical foundation, or procedure associated with their protocol. With greater attention to methodological standards in qualitative psychology, there is a need for greater specificity of protocols and practices to ensure integrity and fidelity in the data collection process. Our aim was to provide a model for qualitative inquiry that can address this need.

In presenting the methodological approach utilized in the Generations Study, our goal was to highlight the unique potential for a qualitative approach—employing life course, narrative, and intersectionality perspectives through a combination of component methods previously used in isolation from one another—to provide a rich and nuanced understanding of the complex lived experiences of diverse sexual minority individuals in the context of social change. At the center of this methodological approach is a novel multi-component interview protocol, the first to integrate lifeline methods, life story methods, identity mapping methods, and comparative temporal reflection about personal identity, social change, minority stress, and health. Through this integration, this new methodological approach was able to investigate generational similarities and differences in the experience of minority stress processes in tandem with identity development processes for the first time in a single study. This approach also achieves an understanding of the experience of sexual identity and minority stress at the intersection of multiple social identities and forms of oppression related to sexual orientation, gender, and race/ethnicity, rather than falling into the methodological “trap” of using simplistic additive combinations of demographic characteristics as a proxy for an intersectionality approach ( Bowleg, 2008 ).

To understand how social change has shaped the lives of sexual minority individuals, research needs to directly investigate generational differences in lived experience of sexual identity development and minority stress. The life course (e.g., Elder, 1998 ; Hammack et al., 2018 ) and intersectionality perspectives (e.g., Bowleg, 2008 ; Cole, 2009 ; Crenshaw, 1996) highlight the importance of understanding sexual identity development in relation to sociohistorical context and focus on how variability in lived experience exists within unique intersections of age cohort, gender, race/ethnicity, and geographic location ( McCall, 2005 ; Stirratt et al., 2008 ; Warner, 2008 ; Wilson et al., 2010 ). The qualitative approach we presented reflects these theoretical and methodological foundations, and as a result is positioned to address gaps in existing knowledge about how social change has shaped the lives of sexual minority individuals (e.g., Frost et al, 2015 ; Hammack, 2018 ; Meyer, 2016 ).

The general approach utilized in the content-specific sections of the interview protocol prompted participants to reflect on specific events or experiences in adolescence relative to their present experiences and the changes they see over their lives. This methodological strategy was designed to directly interrogate developmental trajectories and changes throughout the life course, along with the meanings and explanations of such trajectories. Furthermore, because each participant was asked to provide such reflection, regardless of their present age cohort, the resulting dataset as a whole allowed for generational comparisons in experiences (during the same historical period, but different ages), as well as for all individuals when they were in adolescence (same age, different historical period).

The novel structure of the interview protocol, along with the purposive sampling strategy, allows for between-cohort analyses in the study’s aims to answer nomothetic research questions focused on group differences. Additionally, the intra-individual developmental reflections discussed previously allow for change analyses oriented toward answering idiographic questions focusing on individual persons and the nuances of their lived experience. Thus, the qualitative data obtained within the present approach allows for an examination of the broader aims relating to the role of social change in the experience of sexual identity development and minority stress with a direct analytic window into the role that social change plays in these experiences. The data exemplars included in this methodological paper were intended to illustrate the utility of this approach and analytic potentials emerging from its use. However, it is important to reiterate that the data presented in the paper are for illustrative purposes only and do not reflect the breadth of findings of the Generations Study.

In addition to understanding the role that social change has played in the lives and well-being of sexual minority individuals, data produced from the present qualitative approach is intended to be useful within policy making and social change efforts ( Gergen et al., 2015 ). Specifically, the qualitative data in the Generations Study has the potential to illustrate how social policies have potentially both restricted and facilitated development of positive sexual identities and shaped the experiences of minority stress throughout the target generations’ lived experiences. Qualitative data, particularly in the form of narratives, has the potential to illuminate the intersection of lived experience and the social influence of structural factors such as cultural attitudes and social policies (e.g., Frost, 2018 ). Given sexual minorities continue to experience social and health inequalities due to their stigmatized social status ( Meyer, 2016 ), there remains a need for data on how the shifting social climate shapes their identities and lived experiences, in both negative and positive ways.

We recognise that this study is potentially unique in terms of its scope and scale, and not all qualitative researchers interested in similar questions will have access to the same amount of resources for staffing and sampling that Generations had as a result of its federal funding. However, the possibilities produced by the integration of the various component methods (i.e., lifeline drawing, life story interview, identity mapping, narrative reflection) will likely prove useful to researchers who desire the ability to simultaneously understand intersectional identity development and social change by using a single interview protocol. Thus, we intend this integrative aspect of the present methodological approach to be adaptable for future research. Similarly, the processes undertaken to promote methodological integrity in the form of fidelity and utility can serve as useful illustrations of such processes ( Levitt et al., 2017 ) and hopefully prove useful in other team-based qualitative research projects.

The qualitative approach utilized in the Generations Study is not without its limitations. As a result of the scale and collaborative nature of the research, a significant amount of effort was needed to train interviewers and engage a team of researchers across the country in simultaneous data collection efforts, thus posing a challenge to consistency in data collection. As described above, several procedures were implemented to address these concerns and promote methodological integrity, but these may not be possible in smaller scale projects. Further, the scope of the work required a significant amount of burden on the participants and researchers, both in terms of time investment and willingness to engage with emotionally difficult topics in a high degree of depth in the interviews. For these reasons, the degree to which the current approach can be useful in achieving similar aims with a smaller sample remains a question.

Despite these limitations, the success of Generations Study in achieving its aims hinges on its nuanced and multifaceted qualitative approach. Namely, the insights produced from this approach will allow for an understanding of the ways in which social change has shaped the lived experience of three diverse cohorts of sexual minority individuals through the application of life course, narrative, and intersectionality perspectives. This article outlined the qualitative approach utilized to examine the impact of social change with the hope that it can be usefully adapted for other researchers in need of tools to assess the impact of social change on the lived experience of sexual minorities or other populations of people who face the challenge of identity development within rapidly shifting social environments. By combining life course and intersectionality frameworks, along with multiple qualitative methods that allow for a variety of analytical potentials, we hope this integrative qualitative approach will prove valuable in such socially engaged qualitative research efforts.

Supplementary Material

Supplemental materials, contributor information.

David M. Frost, University College London.

Phillip L. Hammack, University of California, Santa Cruz.

Bianca D. M. Wilson, University of California, Los Angeles.

Stephen T. Russell, University of Texas at Austin.

Marguerita Lightfoot, University of California, San Francisco.

Ilan H. Meyer, University of California, Los Angeles.

• Baams L, Grossman AH, & Russell ST (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth . Developmental Psychology , 51 ( 5 ), 688–696. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Barry CA, Britten N, Barber N, Bradley C, & Stevenson F (1999). Using reflexivity to optimize teamwork in qualitative research . Qualitative Health Research , 9 ( 1 ), 26–44. [ PubMed ] [ Google Scholar ]
• Brinkmann S (2016). Methodological breaching experiments: Steps toward theorizing the qualitative interview . Culture & Psychology , 22 ( 4 ), 520–533. [ Google Scholar ]
• Bruce D, Harper GW, & Bauermeister JA (2015). Minority stress, positive identity development, and depressive symptoms: Implications for resilience among sexual minority male youth . Psychology of Sexual Orientation and Gender Diversity , 2 ( 3 ), 287–296. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bowleg L (2008). When Black+ lesbian+ woman≠ Black lesbian woman: The methodological challenges of qualitative and quantitative intersectionality research . Sex Roles , 59 ( 5–6 ), 312–325. [ Google Scholar ]
• Cho S, Crenshaw KW, & McCall L (2013). Toward a field of intersectionality studies: Theory, applications, and praxis . Signs : Journal of Women in Culture and Society , 38 ( 4 ), 785–810. [ Google Scholar ]
• Clarke V, & Peel E (2005). LGBT psychology and feminist psychology: Bridging the divide . Psychology of Women Section Review , 7 ( 2 ), 4–10. [ Google Scholar ]
• Cohler BJ (1982). Personal narrative and life course. In Baltes P & Brim OG (Eds.), Life span development and behavior (Vol. 4 , pp. 205–241). New York: Academic Press. [ Google Scholar ]
• Cohler BJ (1991). The life story and the study of resilience and response to adversity . Journal of Narrative and Life History , 1 , 169–200. [ Google Scholar ]
• Cohler BJ, & Galatzer-Levy RM (2000). The course of gay and lesbian lives: Social and psychoanalytic perspectives . Chicago, IL: University of Chicago Press. [ Google Scholar ]
• Cohler BJ, & Hammack PL (2007). The psychological world of the gay teenager: Social change, narrative, and “normality .” Journal of Youth and Adolescence , 36 , 47–59. [ Google Scholar ]
• Cole ER (2009). Intersectionality and research in psychology . American Psychologist , 64 ( 3 ), 170–180. [ PubMed ] [ Google Scholar ]
• Crenshaw K (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color . Stanford Law Review , 43 ( 6 ), 1241–1299. [ Google Scholar ]
• Cruwys T, Steffens NK, Haslam SA, Haslam C, Jetten J, et al. (2016). Social Identity Mapping: A procedure for visual representation and assessment of subjective multiple group memberships . British Journal of Social Psychology , 55 , 613–642. [ PubMed ] [ Google Scholar ]
• Dedoose Version 7.0.23, web application for managing, analyzing, and presenting qualitative and mixed method research data (2016). Los Angeles, CA: SocioCultural Research Consultants, LLC; ( www.dedoose.com ). [ Google Scholar ]
• de Vries B, LeBlanc AJ, Frost DM, Alston-Stepnitz E, Stephenson R, & Woodyatt CR (in press). The relationship timeline: A method for the study of shared lived experiences in relational contexts . Advances in Life Course Research . DOI: 10.1016/j.alcr.2016.07.002 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Elder GH (1998). The life course as developmental theory . Child Development , 69 , 1–12. [ PubMed ] [ Google Scholar ]
• Fine M, Torre ME, Frost D, Cabana A, & Avory S (2018). Refusing to check the box. In Gallagher K (Ed.), The methodological dilemma revisited: Creative, critical and collaborative approaches to qualitative research for a new era (p. 11–31). New York, NY: Routledge. [ Google Scholar ]
• Fish JN, & Pasley K (2015). Sexual (minority) trajectories, mental health, and alcohol use: A longitudinal study of youth as they transition to adulthood . Journal of Youth and Adolescence , 44 ( 8 ), 1508–1527. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Floyd FJ, & Bakeman R (2006). Coming-out across the life course: Implications of age and historical context . Archives of Sexual Behavior , 35 ( 3 ), 287–296. [ PubMed ] [ Google Scholar ]
• Frost DM (2011). Stigma and intimacy in same-sex relationships: A narrative approach . Journal of Family Psychology , 25 ( 1 ), 1–10. [ PubMed ] [ Google Scholar ]
• Frost DM (2018). Narrative approaches within a social psychology of social justice: The potential utility of narrative evidence. In Hammack PL (Ed.) The Oxford handbook of social psychology and social justice (pp. 83–93). New York, NY: Oxford University Press. [ Google Scholar ]
• Frost DM, McClelland SI, Clark JB, & Boylan EA (2014). Phenomenological research methods in the psychological study of sexuality. In Tolman D & Diamond L (Eds.), APA handbook of sexuality and psychology (pp. 121–141). Washington D.C.: American Psychological Association Press. [ Google Scholar ]
• Frost DM, Meyer IH, & Hammack PL (2015). Health and well-being in emerging adults’ same-sex relationships: Critical questions and directions for research in developmental science . Emerging Adulthood , 3 ( 1 ), 3–13. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Frost DM, & Ouellette SC (2004). Meaningful voices: How psychologists, speaking as psychologists, can inform social policy . Analyses of Social Issues and Public Policy , 4 , 219–226. [ Google Scholar ]
• Frost DM, & Ouellette SC (2011). A search for meaning: Recognizing the potential of narrative research in social policy-making efforts . Sexuality Research & Social Policy , 8 ( 3 ), 151–161. [ Google Scholar ]
• Gergen KJ, Josselson R, & Freeman M (2015). The promises of qualitative inquiry . American Psychologist , 70 ( 1 ), 1–9. [ PubMed ] [ Google Scholar ]
• Gramling LF, & Carr RL (2004). Lifelines: A life history methodology . Nursing Research , 53 ( 3 ), 207–210. [ PubMed ] [ Google Scholar ]
• Grov C, Bimbi DS, Nanín JE, & Parsons JT (2006). Race, ethnicity, gender, and generational factors associated with the coming‐out process among gay, lesbian, and bisexual individuals . Journal of Sex Research , 43 ( 2 ), 115–121. [ PubMed ] [ Google Scholar ]
• Hammack PL (2005). The life course development of human sexual orientation: An integrative paradigm . Human Development , 48 , 267–290. [ Google Scholar ]
• Hammack PL (2006). Identity, conflict, and coexistence: Life stories of Israeli and Palestinian adolescents . Journal of Adolescent Research , 21 ( 4 ), 323–369. [ Google Scholar ]
• Hammack PL (2018). Gay men’s identity development in the twenty-first century: Continuity and change, normalization and resistance . Human Development , 61 , 101–125. doi: 10.1159/000486469 [ CrossRef ] [ Google Scholar ]
• Hammack PL, & Cohler BJ (2009). Narrative engagement and sexual identity: An interdisciplinary approach to the study of sexual lives. In Hammack PL & Cohler BJ (Eds.), The story of sexual identity: Narrative perspectives on the gay and lesbian life course (pp. 3–22). New York, NY: Oxford University Press. [ Google Scholar ]
• Hammack PL, & Cohler BJ (2011). Narrative, identity, and the politics of exclusion: Social change and the gay and lesbian life course . Sexuality Research and Social Policy , 8 , 162–182. [ Google Scholar ]
• Hammack PL, Frost DM, Meyer IH, & Pletta D (2018). Gay men’s health and identity: Social change and the life course . Archives of Sexual Behavior , 47 , 59–74. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hammack PL, Thompson EM, & Pilecki A (2009). Configurations of identity among sexual minority youth: Context, desire, and narrative . Journal of Youth and Adolescence , 38 ( 7 ), 867–883. [ PubMed ] [ Google Scholar ]
• Hammack PL, & Toolis E (2014). Narrative and the social construction of adulthood . New Directions in Child and Adolescent Development , 145 , 43–56. [ PubMed ] [ Google Scholar ]
• Hammack PL, & Toolis E (2015). Identity, politics, and the cultural psychology of adolescence. In Jensen L (Ed.), The Oxford handbook of human development and culture (pp. 396–409). New York, NY: Oxford University Press. [ Google Scholar ]
• Hammack PL, & Toolis EE (2016). Putting the social into personal identity: The master narrative as root metaphor for psychological and developmental science . Human Development , 58 , 350–364. [ Google Scholar ]
• Hatzenbuehler ML (2017). Advancing research on structural stigma and sexual orientation disparities in mental health among youth . Journal of Clinical Child and Adolescent Psychology , 46 ( 3 ), 463–475. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hendricks ML, & Testa RJ (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients . Professional Psychology: Research and Practice , 43 ( 5 ), 460–467. [ Google Scholar ]
• Herek GM, Gillis JR, & Cogan JC (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective . Journal of Counseling Psychology , 56 ( 1 ), 32–43. [ Google Scholar ]
• Herek GM, & McLemore KA (2013). Sexual prejudice . Annual Review of Psychology , 64 , 309–333. [ PubMed ] [ Google Scholar ]
• Hsieh HF, & Shannon SE (2005). Three approaches to qualitative content analysis . Qualitative Health Research , 15 ( 9 ), 1277–1288. [ PubMed ] [ Google Scholar ]
• Kahn L (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12 — United States and selected sites, 2015 . Morbidity and Mortality Weekly Report , 65 ( 9 ), 2–202. [ PubMed ] [ Google Scholar ]
• Levitt HM, Motulsky SL, Wertz FJ, Morrow SL, & Ponterotto JG (2017). Recommendations for designing and reviewing qualitative research in psychology: Promoting methodological integrity . Qualitative Psychology , 4 ( 1 ), 2–22. [ Google Scholar ]
• Lieblich A, Tuval-Mashiach R, & Zilber T (1998). Narrative research: Reading, analysis, and interpretation . Thousand Oaks, CA: Sage. [ Google Scholar ]
• Madill A, & Gough B (2008). Qualitative research and its place in psychological science . Psychological Methods , 13 ( 3 ), 254–271. [ PubMed ] [ Google Scholar ]
• Madill A, Jordan A, & Shirley C (2000). Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructionist epistemologies . British Journal of Psychology , 91 ( 1 ), 1–20. [ PubMed ] [ Google Scholar ]
• Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, … & Brent DA (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review . Journal of Adolescent Health , 49 ( 2 ), 115–123. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Martos AJ, Wilson PA, Gordon AR, Lightfoot M, & Meyer IH (2018). “ Like finding a unicorn”: Healthcare preferences among lesbian, gay, and bisexual people in the United States . Social Science & Medicine , 208 , 126–133. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• McAdams DP (1990). Unity and purpose in human lives: The emergence of identity as a life story. In Rabin AI, Zucker RA, Emmons RA, & Frank S (Eds.), Studying persons and lives (pp. 148–200). New York, NY: Springer. [ Google Scholar ]
• McAdams DP (1995). The life story interview . Evanston, IL: Northwestern University. [ Google Scholar ]
• McAdams DP (1997). The case for unity in the (post)modern self: A modest proposal. In Ashmore RD & Jussim L (Eds.), Self and identity: Fundamental issues (pp. 46–80). New York, NY: Oxford University Press. [ Google Scholar ]
• McAdams DP, & Bowman PJ (2001). Narrating life’s turning points: Redemption and contamination. In McAdams DP, Josselson R, & Lieblich A (Eds.), Turns in the road: Narrative studies of lives in transition (pp. 3–34). Washington, D.C.: American Psychological Association Press. [ Google Scholar ]
• McAdams DP, Reynolds J, Lewis M, Patten A, & Bowman PJ (2001). When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narrative, and their relation to psychosocial adaptation in midlife adults and in students . Personality and Social Psychology Bulletin , 27 , 472–483. [ Google Scholar ]
• McCall L (2005). The complexity of intersectionality . Signs , 30 ( 3 ), 1771–1800. [ Google Scholar ]
• McCormack M (2013). The declining significance of homophobia . Oxford, UK: Oxford University Press. [ Google Scholar ]
• Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence . Psychological Bulletin , 129 ( 5 ), 674–697. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Meyer IH (2015). Resilience in the study of minority stress and health of sexual and gender minorities . Psychology of Sexual Orientation and Gender Diversity , 2 ( 3 ), 209–213. [ Google Scholar ]
• Meyer IH (2016). The elusive promise of LGBT equality . American Journal of Public Health , 106 ( 8 ), 1356–1358. doi: 10.2105/AJPH.2016.303221 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Meyer IH, & Frost DM (2013). Minority stress and the health of sexual minorities. In Patterson CJ & D’Augelli AR (Eds.) Handbook of psychology and sexual orientation (pp. 252–266). New York, NY: Oxford University Press. [ Google Scholar ]
• Meyer IH, Schwartz S, & Frost DM (2008). Social patterning of stress and coping: Does disadvantaged social status confer excess exposure and fewer coping resources? Social Science & Medicine , 67 , 368–379. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mishler EG (1986). The analysis of interview-narratives. In Sarbin TR (Ed.), Narrative psychology: The storied nature of human conduct (pp. 233–255). New York: Praeger. [ Google Scholar ]
• Mohr A, & Husain A (2012). The Youth Risk Behavior Survey and sexual minority youth in Wisconsin, 2007–2011 . Madison, WI: Wisconsin Dept. of Health Services. Accessed June 20, 2016. https://www.dhs.wisconsin.gov/publications/p0/p00827.pdf . [ Google Scholar ]
• Narváez RF, Meyer IH, Kertzner RM, Ouellette SC, & Gordon AR (2009). A qualitative approach to the intersection of sexual, ethnic, and gender identities . Identity , 9 ( 1 ), 63–86. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Newcomb ME, & Mustanski B (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review . Clinical Psychology Review , 30 ( 8 ), 1019–1029. [ PubMed ] [ Google Scholar ]
• Peel E (2001). Mundane heterosexism: Understanding incidents of the everyday . Women’s Studies International Forum , 24 , 541–554. [ Google Scholar ]
• Platt J (2012). The history of the interview. In Gubrium JF, Holstein JA, Marvasti AB, & McKinney KD (Eds.), The SAGE handbook of interview research: The complexity of the craft (2nd ed., pp. 9–26). Thousand Oaks, CA: Sage. [ Google Scholar ]
• Polit DF, & Beck CT (2010). Generalization in quantitative and qualitative research: Myths and strategies . International Journal of Nursing Studies , 47 ( 11 ), 1451–1458. 10.1016/J.IJNURSTU.2010.06.004 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Potter J, & Hepburn A (2005). Qualitative interviews in psychology: Problems and possibilities . Qualitative Research in Psychology , 2 ( 4 ), 281–307. [ Google Scholar ]
• Puckett JA, & Levitt HM (2015). Internalized stigma within sexual and gender minorities: Change strategies and clinical implications . Journal of LGBT Issues in Counseling , 9 ( 4 ), 329–349. [ Google Scholar ]
• Rosenthal L (2016). Incorporating intersectionality into psychology: An opportunity to promote social justice and equity . American Psychologist , 71 ( 6 ), 474–485. [ PubMed ] [ Google Scholar ]
• Russell ST, Clarke TJ, & Clary J (2009). Are teens “post-gay”? Contemporary adolescents’ sexual identity labels . Journal of Youth and Adolescence , 38 ( 7 ), 884–890. [ PubMed ] [ Google Scholar ]
• Russell ST, & Fish JN (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth . Annual Review of Clinical Psychology , 12 , 465–487. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Savin-Williams RC (2005) The new gay teenager . Cambridge, MA: Harvard University Press. [ Google Scholar ]
• Savin-Williams RC (2016). Becoming who I am: Young men on being gay . Cambridge, MA: Harvard University Press. [ Google Scholar ]
• Sirin SR, & Fine M (2007). Hyphenated selves: Muslim American youth negotiating identities on the fault lines of global conflict . Applied Development Science , 11 ( 3 ), 151–163. [ Google Scholar ]
• Stirratt MJ, Meyer IH, Ouellette SC, & Gara MA (2008). Measuring identity multiplicity and intersectionality: Hierarchical classes analysis (HICLAS) of sexual, racial, and gender identities . Self and Identity , 7 ( 1 ), 89–111. [ Google Scholar ]
• Tappan MB (1997). Interpretive psychology: Stories, circles, and understanding lived experience . Journal of Social Issues , 53 ( 4 ), 645–656. [ Google Scholar ]
• Warner LR (2008). A best practices guide to intersectional approaches in psychological research . Sex Roles , 59 ( 5–6 ), 454–463. [ Google Scholar ]
• Watters JK, & Biernacki P (1989). Targeted sampling: options for the study of hidden populations . Social Problems , 36 ( 4 ), 416–430. [ Google Scholar ]
• White AE, Moeller J, Ivcevic Z, & Brackett MA (2018). Gender identity and sexual identity labels used by U.S. high school students: A co-occurrence network analysis . Psychology of Sexual Orientation and Gender Diversity , 5 ( 2 ), 243–252. [ Google Scholar ]
• Wilson BD, Harper GW, Hidalgo MA, Jamil OB, Torres RS, & Isabel Fernandez M (2010). Negotiating dominant masculinity ideology: Strategies used by gay, bisexual and questioning male adolescents. American Journal of Community Psychology , 45 ( 1–2 ), 169–185. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Westrate NM, & McLean KC (2010). The rise and fall of gay: A cultural-historical approach to gay identity development . Memory , 18 ( 2 ), 225–240. [ PubMed ] [ Google Scholar ]

Home > HCAS > HCAS_PUBS > HCAS_JOURNALS > TQR Home > TQR > Vol. 17 > No. 42 (2012)

Writing Interview Protocols and Conducting Interviews: Tips for Students New to the Field of Qualitative Research

Stacy A. Jacob , Slippery Rock University Follow S. Paige Furgerson , Texas Tech University

Students new to doing qualitative research in the ethnographic and oral traditions, often have difficulty creating successful interview protocols. This article offers practical suggestions for students new to qualitative research for both writing interview protocol that elicit useful data and for conducting the interview. This piece was originally developed as a classroom tool and can be used by professors teaching qualitative research in conjunction with academic readings about qualitative interviewing.

Qualitative Interviewing, Interviewing Tips, New Researchers, Students, Professors

Publication Date

Creative commons license.

10.46743/2160-3715/2012.1718

Recommended APA Citation

Jacob, S. A., & Furgerson, S. P. (2012). Writing Interview Protocols and Conducting Interviews: Tips for Students New to the Field of Qualitative Research. The Qualitative Report , 17 (42), 1-10. https://doi.org/10.46743/2160-3715/2012.1718

Since January 20, 2015

Included in

Quantitative, Qualitative, Comparative, and Historical Methodologies Commons , Social Statistics Commons

Submission Location

https://doi.org/10.46743/2160-3715/2012.1718

To view the content in your browser, please download Adobe Reader or, alternately, you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.

• The Qualitative Report
• About This Journal
• Aims & Scope
• Editorial Board
• Open Access

TQR Publications

• The Qualitative Report Conference
• TQR Weekly Newsletter
• Submit Article
• Most Popular Papers
• Receive Email Notices or RSS

Special Issues:

• Volume 25 - Issue 13 - 4th World Conference on Qualitative Research Special Issue
• World Conference on Qualitative Research Special Issue
• Reflecting on the Future of QDA Software
• Volume 22, Number 13: Asian Qualitative Research Association Special Issue - December 2017

Advanced Search

Print ISSN: 1052-0147

E-ISSN: 2160-3715

Follow TQR on:

Submission Locations

• View submissions on map
• View submissions in Google Earth

Home | About | FAQ | My Account | Accessibility Statement

Privacy Copyright

Prompts, Not Questions: Four Techniques for Crafting Better Interview Protocols

We offer effective ways to write interview protocol “prompts” that are generative of the most common types of information researchers wish to learn from interview respondents: the salience of events, attributes, and experiences; the structure of what is normal; perceptions of cause and effect; and views about sensitive topics. We offer tips for writing and putting into practice protocol prompts that we have found to be effective at obtaining each of these kinds of information. In doing so, we encourage researchers to think of an interview protocol as a series of prompts, rather than a list of questions, for respondents to talk about certain topics related to the main research question(s). We provide illustrative examples from our own research to show how generally minor tweaks to typical interview prompts result in richer interview data.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• For authors
• Browse by collection
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 7, Issue 9
• Protocol for a qualitative study exploring perspectives on the INternational CLassification of Diseases (11th revision); Using lived experience to improve mental health Diagnosis in NHS England: INCLUDE study
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Corinna Hackmann 1 ,
• Amanda Green 1 ,
• Caitlin Notley 2 ,
• Amorette Perkins 1 ,
• Geoffrey M Reed 3 ,
• Joseph Ridler 1 ,
• Jon Wilson 1 , 2 ,
• Tom Shakespeare 2
• 1 Department of Research and Development , Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital , Norwich , UK
• 2 Department of Clinical Psychology , Norwich Medical School, University of East Anglia , Norwich , UK
• 3 Department of Psychiatry , Global Mental Health Program, Columbia University Medical Centre , New York , New York , USA
• Correspondence to Dr Corinna Hackmann; Corinna.hackmann{at}nsft.nhs.uk

Introduction Developed in dialogue with WHO, this research aims to incorporate lived experience and views in the refinement of the International Classification of Diseases Mental and Behavioural Disorders 11th Revision (ICD-11). The validity and clinical utility of psychiatric diagnostic systems has been questioned by both service users and clinicians, as not all aspects reflect their lived experience or are user friendly. This is critical as evidence suggests that diagnosis can impact service user experience, identity, service use and outcomes. Feedback and recommendations from service users and clinicians should help minimise the potential for unintended negative consequences and improve the accuracy, validity and clinical utility of the ICD-11.

Methods and analysis The name INCLUDE reflects the value of expertise by experience as all aspects of the proposed study are co-produced. Feedback on the planned criteria for the ICD-11 will be sought through focus groups with service users and clinicians. The data from these groups will be coded and inductively analysed using a thematic analysis approach. Findings from this will be used to form the basis of co-produced recommendations for the ICD-11. Two service user focus groups will be conducted for each of these diagnoses: Personality Disorder, Bipolar I Disorder, Schizophrenia, Depressive Disorder and Generalised Anxiety Disorder. There will be four focus groups with clinicians (psychiatrists, general practitioners and clinical psychologists).

Ethics and dissemination This study has received ethical approval from the Coventry and Warwickshire HRA Research Ethics Committee (16/WM/0479). The output for the project will be recommendations that reflect the views and experiences of experts by experience (service users and clinicians). The findings will be disseminated via conferences and peer-reviewed publications. As the ICD is an international tool, the aim is for the methodology to be internationally disseminated for replication by other groups.

Trial registration number ClinicalTrials.gov: NCT03131505 .

• International Classification of Diseases
• Personality Disorders
• Anxiety Disorders

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-018399

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Strengths and limitations of this study

This study is the first to gather expert by experience views on the proposed criteria to be fed into the revision process of the International Classification of Diseases.

All aspects of the proposed study have been co-produced with experts by experience and agreed with a representative from WHO.

Qualitative focus group data will be thematically analysed to form the basis of co-produced recommendations to be fed back to WHO.

The themes and resulting recommendations will be limited to five diagnostic categories and will only reflect views from the UK.

Introduction

Diagnostic systems have a number of functions both from the perspective of the clinician and service user. 1–3 Diagnosis offers indications for treatment, may guide expectation regarding prognosis and can help people to make sense of their experiences of living with mental health (MH) difficulties. 1 2 In order for a diagnostic system to be useful, it is critical that it reflects the day-to-day experiences of people living with the symptoms. Service users have reported relief derived from diagnostic definitions that resonate with and explain their experiences. 1 4 On the other hand, some feel their diagnosis does not ‘fit’ with or describe their experiences, and thus has limited utility other than being a ‘tick box’ exercise of labelling and categorising. 5–7 To date, it appears that no revision of the major systems for psychiatric diagnosis (International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders) has sought feedback from service users prior to publication.

Diagnostic systems are designed for clinicians; despite this, service users can easily access the diagnostic criteria. Research shows that the labels, language and descriptions used in these systems can impact people’s self-perception, their interpretations of how other people view them and their understanding of the implications of having a diagnosis, including the prognosis and potential for recovery. 5 8 9 These interpretations can have a direct impact on factors such as self-worth and self-stigmatisation, social and occupational functioning, recovery and service use. 5 6 10 For example, service users have reported that terms like ‘disorder’ and ‘enduring’ suggest permanency, impeding their hope for recovery. 5 Similarly, others have reported that the descriptions and terms used in diagnostic systems (eg, language like ‘deviant’, ‘incompetent’, ‘disregard for social obligations’ and ‘limited capacity’) can be stigmatising and unhelpful, leading to feelings of rejection, anger and possible avoidance of services. 5 6 8 Clarity on the perceptions of individuals receiving a diagnosis, in terms of the language, meaning and implications of what is included in the system, may help to minimise possible negative consequences.

Evidence suggests that clinicians also have concerns regarding the validity and clinical utility of the current diagnostic systems. 3 11–13 For instance, health professionals have reported that some diagnostic definitions feel arbitrary, artificial or unreflective of the typical presentations they observe in practice. 11 12 Other evidence suggests that clinicians find the categories difficult to use, particularly for distinguishing between disorders. 9 12 14 Clinicians have also expressed reservations regarding the terminology and associated stigma, particularly for conditions such as Schizophrenia and Personality Disorder. 13 15 These findings are from studies that have been conducted after the criteria have been released. Prospective input from clinicians on the proposed criteria as part of the process of revision may therefore improve the validity and clinical utility of diagnostic systems.

The value of expertise by experience is increasingly recognised by policymakers, 16–18 service providers and researchers. 19 20 Many have argued that processes of diagnosis could be improved by including perspectives of those with lived experience. 10 21 It has been suggested that within the diagnostic categories, "the traditional language is useful for listing and sorting but not for living and experiencing. ‘Naming' a thing is not the same as 'knowing'a thing" (p90) 22 and therefore categories could be improved by viewing service users as ‘authors of knowledge from whom others have something to learn’ (p291). 21 Likewise, it has been argued that diagnostic systems could be improved by addressing problems identified by practising clinicians. 3

Input regarding the proposed content for the ICD-11 from service users and clinicians should be used to support the process of revision and improvement. Feedback and clarity from service users on (1) whether the content of the system is in line with their experience of symptoms and (2) their interpretations of the content and language should facilitate the development of a system that is more accurate and valid, with minimised unintended negative impact.

Aims and objectives

This research project will use a focus group methodology to ask service users and clinicians who use the ICD diagnostic tool (psychiatrists and general practitioners) their views on the proposed content for the ICD-11. Data collected through collaborative discussion in the groups will be inductively analysed, and resulting themes will be triangulated with an advisory group (involving additional service users and clinicians). The output will be recommendations for improvement to ICD-11 content that have been co-produced with a feedback group (of different service users and clinicians).

Research questions

What are the views and perspectives of service users and clinicians on the content of the ICD-11?

How could the system be improved for the benefit of service users and clinicians?

Methods and analysis

Study design.

This is a qualitative study. Data will be collected through focus groups. Focus groups are an appropriate method of data collection to answer the study research questions seeking to explore views and perspectives of service users and clinicians, where our analysis will aim to define key themes and points of consensus or divergence gathered through interaction, 23 24 drawing on participants own perspectives and choice of language. 25 Participants will be given a copy of the proposed diagnostic criteria relevant to their diagnosis to discuss in the group. This will include both the technical version (as it is proposed for the ICD-11) and a lay translation of the criteria. Thematic analysis 26–28 will be used to identify emergent recurring and/or salient themes in the focus group data. The themes will form the basis for co-produced recommendations to support the development of the ICD-11. Data collection for this study commenced in February 2017 and analyses are planned to be completed and fed back to WHO by the end of December 2017.

Co-production

The research team that developed this project includes a service user expert by experience (AG), two academics (TS, CN), two research clinicians (a consultant psychiatrist (JW) and a clinical psychologist (CH)) and two research assistant psychologists (AP, JR). A service user expert by experience research team member will be involved in all aspects of the research, including design, facilitating focus groups, analysis, write-up and dissemination.

In developing the project, team members consulted a local service user governor, service users and the service user involvement leads at the hosting National Health Service organisation. This input helped shape the design (changing and broadening the process of recruitment of service users and supporting the use of focus groups) and the initial selection of the diagnoses that were included.

Co-production with service users, clinicians and researchers will continue throughout the project. Data analysis will be co-produced through involvement of the service user expert by experience on the research team and the advisory and feedback groups.

Diagnoses under investigation

With agreement from WHO, five diagnoses have been selected for exploration: Personality Disorder, Bipolar I Disorder, Schizophrenia, Depressive Disorder and Generalised Anxiety Disorder. These diagnoses include a wide range of symptom phenomena. Personality Disorder, Bipolar I Disorder and Schizophrenia are found to be more stigmatised, rejected and negatively viewed than other diagnoses, meaning they may have a particularly negative impact and be more consistently associated with harm. 29 30 Depressive Disorder and Generalised Anxiety Disorder are highly prevalent, making the largest contribution to the burden of disease in middle-income and high-income countries, including the UK. 31

Lay translation

The lay translations of the criteria have been produced by members of the research team including psychiatrists and other clinicians, and approved by a representative from WHO to ensure they reflect the proposed ICD-11. Documents have been created presenting lay translations alongside the technical version as it is written in the ICD-11, so that participants are easily able to refer to either source. Copies of these are available in English for researchers wishing to replicate this study.

Recruitment

Sampling will be purposive and include a number of pathways to ensure maximum inclusivity. Recruitment of service users will be both via clinicians in a MH trust and self-referral via a number of routes. Promotion of the study will be via clinicians, service user involvement leads in a MH trust and non-governmental organisations (NGOs). Clinicians in the MH trust will be asked to identify potential participants and seek consent to be contacted by the research team. Service user involvement leads will disseminate information about the study to service users and the membership of a MH trust (which includes many previous service users), providing a telephone number and email address to self-refer if interested. NGOs will promote the study using the same materials. The study will be promoted through recruitment posters, service user involvement forums and on social media. Clinicians will be recruited via team leaders, word of mouth and email communications promoting the project.

Once self-referral or consent to contact has been established, a member of the research team will make contact, provide potential participants with a brief overview of the study, and answer any questions. If the individual wishes to be involved in the study, they will be sent a copy of the participant information sheet via post or email. This information sheet outlines the purpose and nature of the study, and the ethical safeguards regarding data protection and privacy. Potential participants will have at least 72 hours to consider whether they would like to be involved in the study. If the individual would like to take part in the study, researchers will arrange to meet them at least 1 week before the focus group to complete the consent process and give them the relevant proposed diagnostic criteria to read and consider.

Sample size

There will be two service user focus groups for each of the five diagnoses. Additionally, there will be four clinician focus groups. The ICD system is primarily used by medical doctors in the UK, although clinical psychologists have been included in this study as they also apply the system in their work. 32 In this study, the diagnostic criteria presented to participants are divided into distinct discussion points. During the focus groups, these discussion points will be addressed one by one and participants will be asked for their feedback through predefined questions and prompts. This includes asking people their views of the proposed features, the language used, the positives and negatives of what is included and how the classification might be improved for the benefit of service users. In light of this, the number of groups was agreed based on research stating that using more standardised interviews decreases variability and thus requires fewer focus groups. 33 In total, there will be 14 groups, containing three to six participants each. This will give a total sample of 42–84 participants (30–60 service users and 12–24 clinicians). The advisory group will comprise three to five additional service users and three clinicians. Lastly, the feedback group will comprise five service users and three clinicians. The focus group size was chosen to allow participants opportunity to discuss their views and experiences in detail, while increasing recruitment feasibility. 34 The sample size should be sufficient in providing data to meet the aims and to cover a range of views. Evidence suggests that the majority of themes are discovered in the first two to three focus groups. 35

Inclusion and exclusion criteria

Adult service users (18 years and older) may be included in the focus groups if they have formally received at least one of the five diagnoses under investigation and have accessed services within the last 5 years (including those currently in receipt of services). People with multiple diagnoses may only take part in one focus group, but will be given the option of which group. Clinicians will have had experience working in MH, including the use of the psychiatric diagnoses under investigation. Individuals may only participate in either one focus group, the advisory group or the feedback group.

Individuals will be excluded if they are under the age of 18 years, lack the capacity to consent, or have an inability to speak fluent English (as fluent English is required to participate in the focus groups). Individuals will also be excluded if their participation is deemed unsafe to themselves or others by their lead clinician or clinicians on the research team.

Data collection

Focus groups are the most applicable method for data collection to meet our research aims, as attitudes, opinions and beliefs are more likely to be revealed in the reflective process facilitated by the social interaction that a focus group entails than by other methods. 23–25 Additionally, focus groups have proved to be a useful way of exploring stigma issues in MH, 36 and service users are often familiar with group settings for discussing MH issues.

The summary of the new diagnostic guidelines and lay translation will enable participants to reflect on both the content and the language of the proposed criteria. During the groups, topic guides will encourage participants to discuss and share views of the relevant diagnostic category. This includes their overarching views, thoughts and feelings; as well as, specific reflections on areas such as the language used, aspects that may be helpful or unhelpful, and suggestions for improvement.

Each focus group will be led by an experienced and trained member of the research team and have an assistant facilitator. Service user focus groups will last 60–90 min, and clinician focus groups will last 2–2.5 hours to account for the discussion of multiple diagnoses.

The focus groups will be audio-recorded and transcribed verbatim. The transcripts will first be read and descriptively openly coded (using the same language as participants where possible) by the lead researcher. Approximately 25% of the transcripts will be independently open coded by another member of the research team, as a validity check. Codes will be compared and discussed until consensus is reached. The five diagnoses will initially be analysed separately to produce themes that are relevant to each diagnosis. Following this, these themes will be compared with identify common themes relevant to all the diagnostic categories. Analysis of data will mainly be descriptive. We will take a critical realist epistemological stance to analysis, recognising that there are multiple individual realities, but taking a pragmatic approach to analysing data at face value, drawing on the perspectives of individuals as they choose to represent themselves through discussion. 37 Thematic analysis will be used to inductively code themes that reoccur or appear important. 26–28 The concept of salience will be referred to here, to guide coding that is conceptually and inherently significant, not just frequently occurring. A qualitative data management software system (NVIVO-11) will be used to facilitate data analysis.

In addition to descriptive data for thematic coding, focus groups generate data that is conversational. Analysis of this requires an inductive approach that focuses on instances in the data where there is marked agreement (consensus), disagreement or divergence. These instances will be identified as ‘critical moments’. The sample size is small and purposive. Consequently, summary quantified coding matrices will not be produced. Instead there will be a focus on the 'critical moments' to direct the analysis and eventual findings, reporting on the issues that are of central importance to the participants.

Following analysis of each focus group, a second stage analysis will be conducted to compare and contrast findings across groups. The analysis will seek out consensus, disagreement and inconsistency within service user and clinician focus groups, and between diagnoses. This second stage analysis will involve discussions within the research team to refine the themes and to develop higher level themes, that is, grouping the open codes into meaningful conceptual categories. This will allow tentative conclusions to be drawn about aspects of the diagnostic criteria which may be particularly pertinent for some groups and less important for others. It will also enable conclusions to be drawn regarding generic language or overall responses to the diagnostic criteria, in comparison to more nuanced reactions to diagnostically specific categories.

The output from the analysis will be higher level themes and categories that form the basis of recommendations for the ICD-11. These themes will be triangulated with the advisory group. The resulting themes will be discussed with the feedback group in order to co-produce the recommendations. These recommendations will be contextualised with a description of the themes and identified areas of agreement and disagreement for feedback to WHO.

Data protection

All confidential data will be kept for 5 years on password-protected computers and/or locked filing cabinets only accessible to members of the research team. During transcription, audio-recordings will be anonymised, with all identifiable information removed prior to using the software analysis tool. All audio-recordings will be destroyed immediately after transcription.

Ethics and dissemination

Ethical considerations.

Written informed consent to participate and be audio-recorded will be obtained from all participants. Data management and storage will be subject to the UK Data Protection Act 1998. Ethical approval for the current study was obtained from the Coventry and Warwickshire Research Ethics Committee (Rec Ref: 16/WM/0479).

Declaration of Helsinki

This study complies with the Declaration of Helsinki, adopted by the 18th World Medical Association (WMA) General Assembly, Helsinki, Finland, June 1964 and last revised by the 64th WMA General Assembly, Fortaleza, Brazil, October (2013).

Output and dissemination

This research has been designed to obtain feedback with recommendations for the ICD-11, and to develop a methodology that can be replicated in other countries that use the ICD system. Additionally, the findings, and learning in terms of the process of co-producing and conducting research with experts by experience, will be disseminated via peer-reviewed publications, conferences, media and lay reports.

Service user involvement in MH is a priority. 19 Studies have found that both clinicians and service users have questioned the accuracy, validity and clinical utility of the ICD and other psychiatric diagnostic tools. 3 8 9 11 12 38 Despite this, to date, service user and clinician feedback has not been obtained prior to revision of the ICD manual. In light of this, is not clear whether the content resonates with the experiences of people giving and receiving the diagnoses, could lack clinical utility, or even, cause harm (eg, in terms of the language used).

Limitations

This study is designed to input feedback from service users and clinicians in the forthcoming revision of the ICD. The usefulness of the data and resulting recommendations is dependent on input, that is, reflective of the views of service users and clinicians that the new system will impact. The current study will include two focus groups for each disorder in an attempt to minimise bias 35 and to account for group-think processes that may occur within individual groups. Taking a critical realist epistemological stance is a pragmatic approach to work with discursive data created through the interactional context of a focus group. It is acknowledged that there are multiple competing realities and perspectives that may differ across time and context, and the analysis findings will be limited to the time and context of this study. Transferability of findings is nonetheless maximised by triangulation to ensure the inclusion of multiple stakeholder perspectives, enabled by the advisory and feedback groups of experts by experience that will co-produce the recommendations reported to WHO. Interpretation of the feedback will take into account potential limitations regarding the generalisability of the findings. The current project is exploring only five of the diagnoses that are included in the ICD-11. The ICD is internationally used, and the current project will reflect the experiences and views of service users and clinicians in the UK only. Future research may include both additional diagnostic categories and encapsulate expertise by experience and relevant clinicians in different countries.

The current study will use feedback from experts by experience to co-produce recommendations for the revised diagnostic system proposed for the ICD-11. This feedback aims to improve the accuracy, validity and clinical utility of the manual, and minimise the potential for unintended negative consequences. This qualitative approach has not been previously employed by any countries that use the ICD system. Our vision is that this process will become a routine feature in future revisions of all diagnostic systems.

Acknowledgments

We would like to thank the library services at Norfolk and Suffolk Foundation Trust for aiding the searching and retrieval of documents. We would like to thank Kevin James (service user governor), Lesley Drew and Sharon Picken (service user involvement leads) for their input during the development of the project. We would also really like to thank Dr Bonnie Teague who generously offered the benefit of her wisdom and proof reading skills.

• Kilbride M ,
• Welford M , et al
• Johnstone L ,
• Bonnington O ,
• Stalker K ,
• Ferguson I ,
• Castillo H ,
• van Rijswijk E ,
• van Hout H ,
• van de Lisdonk E , et al
• Shadbolt N ,
• Starcevic V , et al
• Milton AC ,
• Kelly B , et al
• 16. ↵ Department of Health . Putting People First: Planning together – peer support and self-directed support . London : Department of Health , 2010 .
• 17. ↵ Department of Health . No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages . London : Department of Health , 2011 .
• 18. ↵ Department of Health . Closing the Gap: Priorities for essential change in mental health . London : Social Care, Local Government and Care Partnership Directorate , 2014 .
• Simpson EL ,
• Beresford P
• Malone P , et al
• Wilkinson S
• MacQueen KM ,
• Stevens S ,
• Serfaty M , et al
• Carlyle D , et al
• 31. ↵ World Health Organization . The global burden of disease: 2004 update . Switzerland : World Health Organization , 2008 .
• 32. ↵ The British Psychological Society . Diagnosis – policy and guidance . http://www.bps.org.uk/system/files/documents/diagnosis-policyguidance.pdf ( accessed Jul 2017 ).
• Schulze B ,
• Angermeyer MC
• Denzin NK ,

Contributors CH is the chief investigator for this project and wrote the protocol. TS is supervising the project and helped to develop all aspects of the project. AG is the expert by experience on the research team, and led on developing the co-production, and the public and patient involvement. CN led the development of the methodology. AP had a specific contribution to the literature review. GMR is the WHO consultant for the project. GMR developed the original idea for the project and has had input into the development of the lay criteria. JR provided input to ethical considerations and the lay criteria. JW led on the development of the lay criteria. All authors supported the development and critical review of the protocol.

Competing interests None declared.

Ethics approval Coventry and Warwickshire HRA Research Ethics Committee (16/WM/0479).

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF: