ReferenceFamily Medicine 2007; 39: 266–273
Authors and institutionNancy Pandhi, Department of Family Medicine; Barbara Bowers, School of Nursing, University of Wisconsin; Fang-pei Chen, School of Social Work, Columbia University
SettingFamily medicine residency in Madison, Wisconsin, US
AimsTo examine how patients perceive a continuity of care doctor–patient relationship in a family medicine setting, from its development through its consequences
Research designThe grounded theory method was used ‘to guide the sampling, data collection, and analysis processes’. In-person interviews
Sampling40 eligible patients (had had an appointment 3 months prior to the study's commencement, were 18 years or older, lived in the 10 zip code areas most populated by clinic patients, and were not patients of the first author) were randomly selected and invited to take part by letter. ‘Individuals not opting out were telephoned and invited to participate in the study if their characteristics added variation to the existing sample. This subsequent participant selection was based on theoretical sampling decisions driven partly by the ongoing analysis and partly by the patient characteristics identified as important for continuity in prior research.’ Patients received US$25. Characteristics of the 14 participants: age range 25–62 years; six male; health status varied from excellent-poor; time with physician varied from 4 months to 19 years
Data collectionEarly interviews were ‘open ended, eliciting participants' perceptions of care’. Interviews were audiotaped and transcribed ‘in entirety’. The authors say that by adopting a grounded-theory approach, they minimised the imposition of preconceptions: each interview was analysed before the next interviews, and questions were used in subsequent interviews that evolved throughout the analysis
Reflexivity‘… researchers were from nursing, social work, and family medicine backgrounds, thereby allowing for multidisciplinary perspectives and reflexivity through the discussion of assumptions or biases potentially affecting analysis’
Ethical issues‘The study protocol was approved by the University of Wisconsin Institutional Review Board, and all subjects gave informed consent’
Data analysis‘… open, axial and selective coding schemes.’ ‘Each interview was analysed prior to conducting subsequent interviews. The subsequent interviews consisted of questions that evolved throughout the analysis. Interview questions verified the conceptual categories, generated new conceptual categories, filled in details about categories, or linked categories together. As the conceptual categories developed, early questions were replaced by other questions’