The ethics of transcribing qualitative interviews

Transcription is fundamental to (most) qualitative research. The transcript is (usually) the actual thing you analyse as data, rather than the audio recording of an interview or focus group. And yet it’s curious how little attention it gets. I run a qual methods course and I barely mention it. I’ve done a quick online search and I can’t find much in the methodological journals; ditto the textbooks I have on my shelf.

Nor does it get much attention from procedural ethics. This is pretty odd given the audio recording is arguably the most identifiable research material we generate – it is the one piece of research material with all the details in it, the names, the places, the details you’ve promised the ethics committee you’ll change in order to protect the participant. And it is in the participant’s voice. I’ve never been asked and have not seen any advice that I should address who’ll be transcribing, whether they signed a confidentiality agreement, how they will securely store the material, or if they will destroy the audio recording and the transcription.*

New PhD students get told to do their own transcribing. It’s good experience blah blah; it’ll get you closer to the data. To be fair, it can be a great way to get novice interviewers to really engage with their technique – there’s nothing like *hearing yourself* talking too much, repeatedly interrupting or umming, ahhing and stumbling your way through a tortured question. But give a qual researcher some discretionary cash and I’ll bet they spend it on transcription. It is the most boring and onerous of research tasks. I’ve seen PhD candidates do paid work just so they have cash for transcription. I’ve seen projects flounder because the researcher is totally over transcribing. I’m sure there are researchers who’ve left the last one or two or three interviews un-transcribed in order to get on with things.

And why not pay someone to do it? There’s is no guarantee transcribing your own material will produce a more accurate transcript – paying a professional means getting someone with superior skills. You may get there in the end but it will take several extra hours of your precious time. Chasing up a couple of unclear words marked up by the transcriber will still be quicker than doing the job yourself. You can even anticipate some of this by providing a list of jargon, abbreviations, medical terminology or common phrases used by the participants. Have you got the message that I think transcribing is dull, onerous work, and exceedingly time consuming so best left to the experts?

But, those experts are expensive. I’ve recently been quoted a basic rate of AUD$2-3 per audio minute. The price goes up for more than two speakers, speaker identification, bad sound quality, sometimes for English as second language and fine-grained transcribing (eg for conversation analysis), and a shorter turnaround. That’s AUD$150 for an hour long interview with 1 native English speaker, great sound quality and a week turn around. 10 interviews AUD$1500, 20 interviews AUD$3000, throw in a real (i.e. diverse) sample and well, costs spiral. I was once involved in a grant application that budgeted AUD$50,000 for transcription costs. That’s coming close to a full time research assistant. I  will hold my hand up to making decisions that should be methodological – how many interviews do I need, interviews or focus groups, how long do the interviews need to be – based on reducing the budget. There are projects I’d like to do but don’t because I haven’t got the cash for transcription. I’m sure I’m not alone here. Transcription is an entry level barrier to qual research.

Let’s review – transcription is vital to qualitative research, it’s a methodological and ethical blind spot, an onerous task, and it’s expensive. Hang on – it’s not expensive anymore! A North American company rev.com will transcribe for US$1 per min of audio (AUD$1.3), with a 12 hour turn around and 99% accuracy. And, they don’t charge extra for anything: multiple speakers – free, speaker id- free, superfast turnaround –free, and apparently no sales tax. To make this concrete, that AUD$50,000 budgeted for transcription – rev.com would have charged us AUD$13,000.

My research is generally funded by the public purse. I should reduce costs where I can (right?) and rev.com offers one hell of a saving. I can spend that cash on something else (like research translation) or not ask the public purse to give me so much money in the first place. I don’t know how big the research transcription market is but should all publicly funded research be using rev.com?

I do have a slight misgiving about Australian public funds leaving the economy.

I also wonder about the transcribers. rev.com promote the fact that the transcription is done by people, not robots or computers. Their transcribers are unlikely faster than those employed by my local company. A good transcriber is looking at 3-4 hour’s work for an hour of audio – or longer if it is multiple speakers, crappy recording quality, lots of jargon, etc (i.e. real research data). My local transcriber charges me AUD$150 for their 3-4 hours of work; rev.com will charge me half this. I don’t know what my local company pays their freelancers (Google tells me typists earn AUD$28-35 per hour), but a rev.com transcriber gets US$0.4-0.65 per audio minute, that’s at best US$39/AUD$50 for their 3-4 hours of work. Really, I have no idea the margins for my local company or rev.com but it might be half the pay for exactly the same task undertaken by pretty much similarly qualified people.

My uneasiness is about paying so little with an expectation of a high quality product; a product that is fundamental to our work as qualitative researchers. Maybe if you won’t do it yourself or can’t afford to pay minimum wage, then you simply can’t afford to do qualitative research?

Be interested to hear what my qualitative research colleagues think. You using rev.com?

 

*I found one archived document from Newcastle University (2007, amended 2015) that stated “Transcription should usually be undertaken by the researchers. (ii) If it is to be undertaken by other than the researchers (eg, a transcription service or research assistant) participants must be informed as this potentially compromises data security and participants’ privacy.” I have never heard of a research project informing a participant their data may be comprised because a transcription service is being used.

Thinking about SWASH as a community-engaged research project: the report

SWASH is a repeated cross-sectional survey of the health and wellbeing of community-engaged lesbian, bisexual, queer (LBQ) and other non-heterosexual identifying women in Sydney. It provides a snapshot, and allows us to track changes, demographics including sexuality and gender; community engagement; sexual practice, sexual partners, relationships; cervical cancer/breast cancer/STI/HIV screening, HPV vaccine uptake; smoking, alcohol and other drugs use, help seeking for AOD use; mental health, psychological service access; general health, GP satisfaction; experience of DV and anti-LGBT violence & abuse. SWASH first ran in 1996 and has run every two years since, generating data from 600-1200 respondents at each iteration. It is the longest running periodic survey of LBQ women’s health in the world.

SWASH is also a community-engaged project, run by a collaboration of researchers (Julie Mooney-Somers at Sydney Health Ethics, University of Sydney) and Rachel Deacon at (Langton Centre, South Eastern Sydney Local Health District and Central Clinical School, University of Sydney), and ACON Health (Australia’s largest community health organisation specialisaing in LGBTQ health). Let’s go back to the beginning with an extract from the very first SWASH report (circa 1998):

Nonetheless, sex with a man remains the main risk for HIV transmission to women. During 1997, 66 women were newly diagnosed with HIV infection in Australia, 58 of them through heterosexual contact and 7 through injecting drug use (Australian HIV Surveillance Report April 1998). However, it is important to remember that for a case of ‘heterosexual’ transmission of HIV to occur, neither party need be heterosexual.

There is a tendency among some clinicians, the popular media and members of the general public to assume that lesbians are by definition ‘women who do not have sex with men’, and thus to disregard any possibility of their exposure to HIV or other sexually transmitted infections. Such an assumption equates epidemiological or behavioural categories with social identities and disregards the fact that women who identify as lesbians have often had sex with men in the past and may continue to do so intermittently or even frequently, just as some gay-identified men may have sex with women. Further, because of the social circles in which they move, lesbian-identified women and other women associated with gay/lesbian/queer community who do have sex with men are more likely to have sex with homosexually active men than are women randomly selected from the community at large. If they inject drugs in the company of gay or homosexually active male friends, they are more likely to come into contact with HIV, especially if they share injecting equipment.

Both the Gay and Lesbian Injecting Drug Use Project (GLIDUP) and the Women Partners of Gay/Bisexual Men Project at the AIDS Council of NSW [now ACON] are accessed by women who are connected to Sydney’s gay and lesbian communities. Some of these women have reported having sexual contact with and/or injecting drugs with gay or bisexual men. Women also access GLIDUP’s needle exchange services at major gay and lesbian parties. Late in 1995 the Sydney Men and Sexual Health (SMASH) project released a report on men in the gay community and their sex with women (Prestage et al. 1995). This preliminary report raised issues about women in contact with the gay community which needed to be addressed more directly. These circumstances prompted project officers with GLIDUP and the Women Partners of Gay/Bisexual Men project to initiate research into the contact these women have with community-attached gay and bisexual men. The result was this survey, carried out for the first time in 1996 and again in 1998. It is based on convenience sampling and was initiated in order to estimate risks to women in contact with Sydney’s gay and lesbian community, with the primary aim of finding whether further work was necessary, either in research or targeted prevention campaigns.

SWASH came about because the community was concerned about a lack of visibility of the health issues for LBQ women and the consequences of this invisibility. Front-line community-based health workers and advocates, supported by researchers, initiated a research project to generate evidence for action. Over it’s 22 year history, SWASH has always using this model: community-based health workers and university researchers bringing their different skills, capacities, connections to a research collaboration that is characterised by a shared commitment to producing high quality relevant data to inform action. The individual (and institutional) skills, capacities, and commitments have ebbed and flowed over the time but the collaboration persisted and ever two years a survey was run. Rachel Deacon and I became ‘the university researchers’ in late 2009, taking over from Juliet Richters (and Garrett Prestage).

Being part of the SWASH collaboration for nearly a decade means I take for granted what makes SWASH special as an example of a community-engaged research project. This is the first in a series of blogs about how SWASH works (from my perspective). It would have made sense to start with the review of the survey and planning data collection, but you’ll just have to make do with me jumping into the middle: producing the SWASH report.

Some context: We collected paper survey data at events and venues in Sydney during the Sydney Mardi Gras season in February 2018, followed by an online survey. We used a professional company to data enter the surveys this year (in the past we used a casual research assistant, community volunteers or students), and it really sped things up. Their data quality processes were great so we got a very tidy data set (I highly recommend Paper House). Seven months after data collection, we have a draft report. We’ve hit this point in the cycle much earlier than usual – in large part due to the smooth data entry processes. Despite this being the 5th report Rachel and I have done, it always takes many more hours then I expect/remember to produce the report (note to self for 2020!).

Tomorrow we present the highlights of this year’s draft report to relevant front-line and policy staff at ACON through a formal feedback session. We will also have informal conversations and a few staff will undertake a detailed read. We want to know if what we have found resonates with their recent experiences with the community – for example, have they noticed a change in the drugs people are talking about using or more talk about mental health concerns. We will test out our interpretations of trends in repeated questions or findings for new questions. We will talk about how new or persistent issues connect with ACON’s policy and program work. These conversations make ACON staff aware of the findings so they can feed them in to existing or use to build new programs or advocacy. We’ve already provided early access to sexual practice data for a staff member reviewing an ACON program. We will provide feedback on where LBQ women seek support for their own alcohol and other drug use to add to an evaluation they are already undertaking of their own services. ACON asked us to include a question on mammography for the first time, as they are currently undertaking a program of breast cancer awareness.

We also talk about political and ethical issues around how we report SWASH findings – how to be careful of language so we don’t (further) stigmatise community or behaviour or inadvertently exclude people. This year we’ve changed the way we capture gender identity, using ACON’s suggested gender indicators. We will talk to staff about how to best describe who responded to the survey; this is part of continuing work on the survey itself to meet community expectations around capturing the diversity of ways people describe their experiences, practices or identities, and in some cases, their partners’ identities. When we first asked about weight and height, ACON staff expressed concern about fat stigma and normative ideas around body shape. They presented specific and well informed critiques about how BMI is mis/used and in particular how it does not recognise differences in height and weight proportions which may be related to cultural heritage. We worked together to craft language that reflected these concerns.

After nearly a decade of working together we have a report that reflects the collaboration members’ needs, values and preferences. The language and interpretations are thoughtful and grounded in community perspectives, as well as precise and technical. The final report looks professional – the ACON Design Studio transforms our WORD document into a highly polished output. The report is not a purely technical report – it has the methods and tables but too much commentary and discussion of other literature. At 50 pages it is far too long to be a community report – we have a table for every survey question, and barely any infographics.

SWASH launch photo
SWASH 2016 Report launched at LBQ Women’s Health Conference July 2017

We send hard copies of the final report to mainstream health providers, state and federal government politicians and policymakers, and community partners. We get copies deposited in the National Library of Australia, State Library of New South Wales, NSW Parliamentary Library, and University of Sydney library [because I get an ISBN]. I bring copies to any LGBT health event I attend across the country, ideally getting a copy to every conference attendee (see photo), or leaving copies at an ACON stall or under my conference poster at a mainstream conference.  My university would prefer me to put all this effort into a peer reviewed journal article, but I think the report makes a substantial practical difference to addressing the invisibility of health issues facing LBQ women and providing evidence for action.

The SWASH report is just the start as it triggers a range of community engagement activities, that’ll be the subject of my next blog.

Click here to access the published reports – and the peer reviewed journal articles 🙂

 

Sex and the Country Women’s Association… Community-oriented research translation for LBQ women.

IMG_8859The CWA – Country Women’s Association are the largest women’s organisation in Australia and work to improve the conditions of women and children in the country. They’ve been around since the 1920s. They are an Australian institution no doubt, famous for their cookbooks and cake competitions. IMG_8854Their motto is all God, throne, country… For me, “the CWA” conjures up no-nonsense, white, entirely heterosexual ladies (excuse me my stereotyping). So you can imagine my surprise when I discovered my talk about lesbian, bisexual and queer women’s safer sex was to be at the Lismore CWA Tea Rooms.

Mostly, when I talk about community-engaged/community-based research it’s all about front loading: getting community involved in research development, in data collection and only occasionally in data analysis. But this community event was about research translation – telling an affected community what we have found out, giving back the knowledge we gained through them about LBQ women and sexual health. SWASH, our twenty year health survey, has generated a lot of data on sexual practice, relationships, risk practices, and screening, but it’s been a long time since we’ve shared it.

This was not a stuffy or even a shiny university research forum. The night began with some young local women singing – there was no cash, so they got paid in donated but new sex toys! There was a giant pot of tea, biscuits, and plenty of vegan and gluten-free hot food. image_542202361553653Home made signs and rainbow bunting abounded, with raunchy images from LBQ women’s safer sex campaigns stuck to the walls of the tea room. There was a table of information about local sexual health services and another table full of free viraclean for sex toys, condoms, lube, and gloves from the always awesome ILOVECLAUDE. My research finding were imperfectly projected on a bed-sheet. The lucky door prizes were sex toys and most people won something!

There was a lot of laughing, some whispered confessions and a lot of generosity in the room. One older woman told me about the first time she’d seen a dental dam, and her complete confusion about how exactly it would help. Another told me about the first time she’d received instruction about safer sex for sex with a woman many years ago: a bucket of warm soapy water beside the bed to wash your hands between orifices/bodies. Women talked about where to find a safe GP, where to get safer sex supplies, and how you might start a conversation with a lover about preventing STI transmission. There was a lot of frank conversation about what we do, what we know, and what we aren’t sure about. What women didn’t know or didn’t feel sure about resonated very strongly with Ruby Grant’s recent research with queer young women in Tasmania, Jen Power’s earlier work with lesbian and bisexual women in Victoria, and some of my own work with younger LBQ women in Sydney (more citations at the end of this blog). .

We had a sexual health doctor in attendance (Dr Kate Bolam from Choices Clinic) and women posted anonymous questions throughout the night for her to answer. Several questions came in response to my presentation. I doubt anyone would have asked about the risks involved in oral sex and menstrual blood except I told them three quarters of LBQ women said in the last 6 months they had performed oral sex during menstruation without a barrier (Juliet Richters published this SWASH analysis ). image_542429492779593If they’d read this in a research report, I wonder what they would have done with the uncertainty this produced for them? How would they have gotten answers to questions about their own practice – should they avoid oral sex, try to get dental dams (your best bet is ILOVECLAUDE), or use a tampon (apparently provides little protection). There is a serious dearth of good quality and relevant sexual health information for LBQ women (see citations at the end of this blog). The event gave them the means to take the research findings and apply them to their lives and their practices.

I can take little credit for the event. ACON asked me to participate. The amazing staff at ACON Northern Rivers are deeply connected community people and so could judge the level, the tone, and how to make it work for local women rather than for an out of town academic (no one in the room was likely to cite my work in peer review, there was no local dignitary to shake my hand for the local paper’s photographer, no formal evaluation. I left feeling pretty convinced that community-oriented research translation needs community partners taking the lead.

At the end of the night I realised just how appropriate it was that we held our event in a CWA Tea Room. Both the CWA and SWASH are about a group of people getting together and mustering scare resources in service of their community. Through the community, for the community, and by the community.
What do we know about LBQ women and safer sex in Australia? (let me know if you get stuck at a paywall)

Cox, Peta, McNair, Ruth (2009) Risk reduction as an accepted framework for safer-sex promotion among women who have sex with women. Sexual Health, 6:15-18.

Grant, Ruby, Nash, Meredith (2017) Navigating unintelligibility: Queer Australian young women’s negotiations of safe sex and risk. Journal of Health Psychology, 23(2): 306-319

McNair, Ruth (2005) Risks and prevention of sexually transmissible infections among women who have sex with women. Sexual Health, 2: 209-217.

McNair, Ruth, Power, Jennifer, Carr, Susan (2009) Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations. Australian and New Zealand Journal of Public Health, 33: 87–93.

Mooney-Somers, J, Deacon, RM, Klinner, C, Richters, J, Parkhill, N (2017) Women in contact with the gay and lesbian community in Sydney: Report of the Sydney Women and Sexual Health (SWASH) Survey 2006, 2008, 2010, 2012, 2014, 2016. Sydney: ACON & Sydney Health Ethics, University of Sydney.

Power, Jennifer, McNair, Ruth, Carr, Susan (2009) Absent sexual scripts: lesbian and bisexual women’s knowledge, attitudes and action regarding safer sex and sexual health information. Culture, Health & Sexuality, 11(1):67-81

Richters, Juliet, Prestage, Garrett, Schneider, Karen, Clayton, Stevie (2010) Do women use dental dams? Safer sex practices of lesbians and other women who have sex with women. Sexual Health, 7: 165–169.

Working with peer/community researchers in qualitative research

Anna Olsen and I have a book chapter in the new SAGE Handbook of Qualitative Research Ethics. We draw on our experiences as university researchers using participatory research (PR) to work with community researchers in the field of sexual health to explore the specific ethical issues faced by PR with community/peer researchers. We highlight two key issues: blurred roles of ‘insiders’ and ‘outsiders’ and challenges to rigour. We use several case studies taken from our work around sexual health (with details significantly changed to ensure the anonymity of the communities and projects involved) or developed for research training, in order to begin to address some of the wonders and hazards of ethical practice in PR. A quick peruse of the Handbook contents list and I can see several chapters that’ll be going on the reading list for my qualitative health research students and HDR candidates. If you want a copy of the chapter, let me know.

 

Why I always get an ISBN for my research reports

Mooney-Somers, J, Erick, W, Brockman, D, Scott, R. & Maher, L (2008). Indigenous Resiliency Project Participatory Action Research Component: A report on the Research Training and Development Workshop, Townsville, February 2008. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW. ISBN: 978 0 7334 2647 6.

See that bit at the end, that’s my first ISBN. I can’t recall where I got the notion from, and I wonder now at my presumptuousness. I don’t think it was standard practice in my research centre to get ISBNs for research reports. But I had just come out of a horrid job that I’d stayed put in to get publications (it didn’t really work). I was in a new job and determined to get as much on my CV as I could. The first output was a report on a training workshop. I was thoroughly engrossed in the methodology we were using (participatory action research) and genuinely interested in how it worked in practice. So writing about our process was something I was into, but it was also a publication. The ISBN though, that was kind of surprising.

I’m now the proud owner of 7 ISBNs.

For those who don’t know, an ISBN stands for International Standard Book Number. It is a unique code assigned to your ‘book’. It is super easy to get one if you know how and a complete mystery if you don’t (typical university*). You don’t need one; I suspect most reports published by academics don’t have one. Let me tell you why you should use them.

An ISBN “makes your book more discoverable” says the Australian provider of ISBNs, Thorpe-Bowker. Unsurprisingly a unique code means no confusion about which title is your book if it also has its own code attached. Well. I’m not entirely convinced this is a big deal for academics (honestly, Google your intended title to make sure it is unique-ish).

The much more compelling reason?

An ISBN means your book exists, it gets listed in registries. In the case of the report above, I got a call out of the blue from a library network asking if they could buy (buy!) several copies. Seriously, how did they even know it existed? It had an ISBN.

And then there’s this…

Copyright Acknowledgement

And this

doc20150115200039_Page_1

You see an ISBN means your work is published and that makes it subject to legal deposit rules (a quick look at Wikipedia suggests this is an international standard).

Legal Deposit is a requirement under the Copyright Act 1968 for publishers and self publishing authors to deposit a copy of works published in Australia with the National Library and when applicable, the deposit libraries in your home state. Legal Deposit ensures that Australian publications are preserved for use now and in the future. National Library of Australia (for more read this http://www.nsla.org.au/legal-deposit-australasia)

In NSW a publisher (e.g. your university if they secure the ISBN) is required to send copies of published material to The National Library of Australia, The State Library of New South Wales and The NSW Parliamentary Library. And because the publisher of my work is The University of Sydney, I have to send a copy to them as well.

That’s an very easy way to get my work into the Parliamentary library.

A major struggle in one of my research area’s (lesbian, bisexual and queer women’s health) is the persistent charge that there is no evidence base. The charge is wrong; there is considerable evidence of disparities in health outcomes out there, but it is a hard perception to shake. So getting our biennial reports of the longest running (in the world) survey of lesbian, bisexual and queer women’s health on to the shelves of policy makers… That’s a win. You never who might stumble across them.**

*Your institution’s library should be able to help or look for the “Legal Deposit Officer”.

*I know, I know, policy-makers Goggle everything. I put them all online too – the University archive, this blog, and often twitter announcements. I’m all about covering the bases.

Putting my argument up front would have made my presentation better

I attended a workshop by Nick Hopwood on presenting qualitative research. It was full of tips and strategies – check out the storify – and useful frameworks; Hammersley’s framework for critical review of ethnography (reminding me again that I need to read Hammerlsey) and Kamler and Thompson’s framework for writing abstracts from their ‘Helping doctoral students write’ book (which I promptly ordered).

‘No’ by JDAC available at https://www.flickr.com/photos/jdac/15747357176 under a Creative Commons Attribution 2.0. Full terms at http://creativecommons.org/licenses/by/2.0.
‘No’ by JDAC available at https://www.flickr.com/photos/jdac/15747357176 under a Creative Commons Attribution 2.0. Full terms at http://creativecommons.org/licenses/by/2.0.

I’m a keen reader of Nick’s blog and have used his tips for conference presentations. For my last conference however, I failed to implement one: ‘turn it upside down’; that is, state my argument at the beginning rather than pull it all together at the end. This was because I love a good mystery novel and my co-presenter wasn’t keen.

At the workshop, Nick asked us to review a recent presentation in light of what we’d just learnt. I used this last conference presentation. And funnily enough, I could see how much better it would have been if I had turned it upside down. Here’s why.

The logic for turning the presentation upside down is that it helps you achieve your key motivation for presenting at all – give the audience a clear sense of your key take-home message. If someone pulls the plug on you 10 minutes in (maybe because the previous presenter rambled on), at least they know your argument. And Nick insists the audience is less likely to fall asleep. Luckily, I got the whole 12 minutes allotted at my conference presentation, and as far as I could tell, everyone stayed awake.

After the workshop three compelling reasons to ‘turn it upside down’ occurred to me.

First, if I’d made my big statement upfront then the audience might have been more engaged, curious as to how I’m going to convince them (i.e. the mechanism for ‘the audience is less likely to fall asleep’).

Second, it would have meant the rest of the content would be more likely to be relevant to that argument and not just self-justifying waffle about methods or demonstrations of how clever and well-read I am (no of course I didn’t do that).

The best reason I could think of? Making my argument up front would have given the audience time to digest it. Usually – and indeed in my case – the key argument is in the last slide or two. That gives them about a minute to catch it and process it before the chair calls for questions. This might be the reason for the measly post-presentation discussion at so many conferences. If I’d put it up front, they would have had a whole 10 or 11 minutes to think about my argument, in context, in relation to my data, and more importantly for engagement, in relation to their experience and knowledge of the phenomena. So I’m convinced by Nick’s advice.

But there is a problem. Putting your argument up front means you have to have one. I’m not being flippant here. How many qual presentations have you been to where the main game seemed to be to describe what participants said? You get to the end and think, well gee people really thought some stuff / felt some stuff / needed some stuff. But it can be a bit meh, you’re not sure what it all means, why it matters. I find this kind of qual research depressing; I am sure I have been guilty of it.

Making an argument is scary (people might disagree with you!). Arguments involve taking a stand, saying, this is how we should think about this phenomena. They require I work to persuade you, generally through presenting evidence, like my data analysis. If you think of it, data interpretation in basically an argument. I am claiming that mine is the best (or at least, most productive) way to understand what this participant means. Moving from description to interpretation can be a difficult things students to accomplish. It requires they develop confidence in their ability to interpret (not easy at all). Some tips I give my students:

Lyn Richards uses a great metaphor in her book ‘How to handle qualitative data’ for understanding the difference between data description and interpretation:

‘Somebody’s dead, they were shot and there’s a gun on the ground’ is the beginning of the detective’s questions. We hardly expect the enquiry to end with the facts of a dead body and discarded gun.

In her book ‘How to write a journal article in 12 weeks‘, Wendy Laura Belcher draws on a similar metaphor when talking about making arguments in papers:

Present evidence that supports your case, cross-examine evidence that doesn’t support your case, ignore evidence that is irrelevant to your case, and make sure the jury always knows whom you are accusing of what and why.

So, write the lawyer’s brief not the detective’s report. Can you imagine a prosecuting barrister standing up on front of the judge and jury and not telling them who they think did it? Or, to return to my topic, holding the punchline for the end? I would speculate that if you give the argument up front the audience starts doing some of the work for you – they know where you’re going so they are looking for the links. Hey’ that’s four reasons to put your argument first.

Last piece of advice from Wendy Laura Belcher to relieve you of some argument making anxiety:

Arguments don’t need to be unassailable or bullet proof, just interesting.

Sexual risk and health care seeking behaviour in young Aboriginal and Torres Strait Islander people in north Queensland

The Indigenous Resiliency Project was part of the International Collaborative Indigenous Health Research Partnership (ID: 361621), a trilateral partnership between the National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, and the Health Research Council of New Zealand. There were parallel projects in Canada and New Zealand; together we aimed to examine the role of resilience in protecting Indigenous populations against sexually transmitted and blood-borne infections.

In the qualitative arm we conducted community-based participatory projects with two communities. Check out the findings below:

In 2010 we used the qualitative work as the basis for community surveys. Again, researchers worked closely with community, in this case the Townsville Aboriginal and Torres Strait Islander Health Service. The cross-sectional survey covered location of usual residence, recent and past sexual activity, alcohol and other drug use, history of selected health outcomes and health service utilisation. We trained five young local Aboriginal and Torres Strait Islander people in research ethics and survey methodology. These peer researchers collected surveys from Aboriginal and/or Torres Strait Islander people aged 16 to 24 years at the Townsville Show, sporting events, shopping centres, a health service open day and a NAIDOC parade and community event.

Check out what we found: Scott, R, Foster, R, Oliver, L, Olsen, A, Mooney-Somers, J, Mathers, B, Micallef, J, Kaldor, J and Maher, L (accepted 22/10/2014). Sexual risk and health care seeking behaviour in young Aboriginal and Torres Strait Islander people in north Queensland. Sexual Health

Note: this is a pre-copyedited, author-produced PDF of the accepted article; I’ll post the link to the definitive publisher-authenticated version as soon as it is released.

Tobacco-control project targeting lesbians, bisexual and queer women

The Cancer Institute NSW (the cancer control agency for NSW) awarded an Evidence to Practice grant to ACON (NSW’s leading health-promotion organisation specialising in HIV and LGBTI health). I’m delighted to be the research partner on the grant.

The grant is titled “Tobacco-control project targeting lesbians, bisexual and queer (LBQ) women” and will run until mid-2016. The grant was awarded on evidence from the research I’ve been doing with ACON (and colleague Rachel Deacon) in the SWASH project that shows lesbian and bisexual women in Sydney are smoking at twice the rate of their heterosexual peers, and that rates have changed little despite significant mainstream public health interventions.

This grant is a real win. It is a testament to ACON’s commitment to this area, their strategic plan for 2013-2018 outlined a range of commitments to addressing smoking in LGBTI communities, including:

“seek funding to use our considerable social marketing expertise to identify and address the current high rates of smoking in our communities.”

It is also a testament to the Cancer Institute’s responsiveness to an area that has long been neglected in Australia (compared to the US, for example). And I’ve really pleased that the SWASH survey was key to providing an evidence base for a lack of movement in smoking rates among lesbian and bisexual women in Sydney.

The project will use ACON’s expertise in community-based social marketing to develop a smoking intervention to be delivered online and through community spaces and events. Will update here as the project progresses….

The last outing for the Growing Up with Cancer project

In July, my Growing Up with Cancer (GUWC) project colleague Peter and I attend the 8th International Conference on Teenage and Young Adult Cancer Medicine. It was held at the Royal Society of Medicine in London and what a glorious venue for this project’s last outing!

The conference organisers staged a full exhibition of the Growing Up with Cancer self-portraits (experience all the artworks here) and featured the project in the conference programme.

GUWC self-portraits on show at the International Conference on Cancer in Teenagers and Young Adults
GUWC self-portraits on show at the International Conference on Cancer in Teenagers and Young Adults
GUWC self-portraits on show at the International Conference on Cancer in Teenagers and Young Adults
GUWC self-portraits on show at the International Conference on Cancer in Teenagers and Young Adults

We also presented three conference posters on the research process and the project findings. (If you’d like to quote or use these posters – please acknowledge them correctly)

What healthy young people think about youth cancer – Mooney-Somers, J & Lewis, P. “Little Annabel Harvey and her fight with cancer”: healthy young people’s representations of youth cancer. 8th International conference on teenage and young adult cancer medicine, London July 2104

Using creative methods in research with young people – Mooney-Somers, J & Smith, K. Beyond the Illustration of Research Data: Using professionally facilitated image making techniques to enable participants to describe, enhance and extend data originally captured using traditional text-based methods of research. 8th International conference on teenage and young adult cancer medicine, London July 2104 

Telling friends and partners that you had cancer – Lewis, P & Mooney-Somers, J. Becoming a survivor – young people disclosing cancer to new acquaintances and romantic partners. 8th International conference on teenage and young adult cancer medicine, London July 2104

 

Thinking about chlamydia management at Australian family planning clinics

Very pleased to be able to share the Chlamydia testing and management – FINAL REPORT. This is the outcome of a project that assessed chlamydia testing, contact management and re-testing practices of clinicians at Australian family planning clinics. The project was funded by a National Health and Medical Research Council (NHMRC) Program Grant, and run by The Kirby Institute, UNSW. But the project could not have happened without the support of the management and senior staff of Family Planning organisations. We used a mixed methods approach – a survey of 168 clinicians (run by Joanne Micallef) and 11 focus groups with 70 clinicians (run by me).

Family planning organisations in Australia are state-based non-government organisations and clinics offering a variety of sexual and reproductive health services. There are 29 family planning clinics located across all Australian states and territories. These clinics have high case loads of young, sexually active women (primarily) and men at risk of chlamydia infection.

We’ve presented some findings at the Sexual Health conference in Darwin last year and we’re working on manuscripts. But here are the headlines:

TESTING

  • Screening for chlamydia was perceived by clinicians as routine and a priority.
  • Chlamydia screening facilitators:
    • high community awareness of chlamydia;
    • communicating to clients that chlamydia testing is normal;
    • good relationship between FPC/clinicians and client;
    • providing easy access to screening; and
    • the ability to offer screening without a physical examination.
  • Evaluating the success of chlamydia screening:
    • clinicians felt confident that chlamydia screening was going well at both the individual and FPC level;
    • clients widely accept the offer to be screened for chlamydia;
    • informal review of clinic notes by clinicians reassured them that screening was occurring; and
    • formal reviews through audits challenged the clinicians’ perception of chlamydia screening rates.
  • Challenges of chlamydia screening:
    • clients being considered low or no risk;
    • refusal by clients and dealing with decliners;
    • clinicians worrying that clients may be offended by screening offer so not offering.
  • Clinicians raised concerns about over-testing for chlamydia.

MANAGEMENT

  • Three quarters of clinicians suggested contact tracing the sexual partner(s) of clients in the 6 months prior to the chlamydia diagnosis.
  • Family planning clinicians were proactive in managing contacts of their clients:
    • almost all clinicians would encourage clients to tell partner(s)
    • three quarters would assist clients by providing a brochure containing information on chlamydia.
  • The Let Them Know website has become an important partner notification tool for family planning clinicians.
  • The Let Them Know website is a part of routine practice for many clinicians.
  • Use of the website varied between jurisdictions.
  • For clinicians not using the website, there is a desire to have access to this resource.
  • Contact managementfacilitators:
    • preparing clients for a positive test result;
    • low level of stigma associated with chlamydia; and
    • easy access to chlamydia screening for partners of clients.
  • Evaluating the success of contact management:
    • it is difficult to determine if clients notified their partner(s) and if partner(s) are tested and treated; and
    • there are few indicators for determining the success of contact management.
  • Challenges of contact management:
    • uncertainty around what is expected from clinicians; and
    • clinicians’ doubt around the importance of contact management for chlamydia.
  • The majority of clinicians acknowledged the benefits of patient delivered partner therapy although only 35% of clinicians ever used it. Most clinicians had concerns about using PDPT and its legal status was a major impediment to the uptake of the strategy.

RETESTING

  • Only 22% of clinicians recommend annual testing to all clients.
  • The majority (88%) of clinicians recommend clients return for retesting three months after a diagnosis of chlamydia.
  • The most common strategies for chlamydia retesting included recommending retesting at the time of initial treatment, explaining the importance of retesting after treatment and explaining the risk of repeat infection.
  • Most retesting was opportunistic; that is, a clinician noticed a recent positive chlamydia test recorded in a file and suggested a retest.
  • Evaluating the success of retesting:
    • it is difficult to determine the number of clients who return for retesting; and
    • clinicians were confident that new reminder systems were successful in getting clients to return for retesting.
  • Challenges to retesting:
    • clients often don’t return for retesting;
    • clinicians rely on opportunistic screening as retesting when clients return to the clinic;
    • uncertainty around the value of retesting for chlamydia; and
    • clinicians’ view that proactive retesting reminders undermine client responsibility.
  • ‘Proactive’ client reminder systems had mixed support from clinicians