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Table 1 Study design

From: Photo-elicitation with adolescents in qualitative research: an example of its use in exploring family interactions in adolescent psychiatry

Qualitative approach

Phenomenology

Research paradigm

Constructivism

Setting

Study developed in a research group seeking to develop the use of qualitative research in adolescent psychiatry

Ethical issues

The relevant French Institutional Committee of the Paris North University Hospital Group approved this study

All patients and their parents provided written consent before inclusion

Sampling strategy

Purposive sampling strategy: selective and deliberate

     Researchers first contacted clinicians at recruitment sites (Argenteuil and Remiremont Hospitals) where recruitment was planned and explained the study design and objectives to them in detail

     Clinicians identified potential participants—adolescents and parents—whom they considered most likely to provide useful information

     Clinicians mentioned the study to potential participants and gave them an information sheet about it

     Researchers met each interested teen and his/her parents

      To describe the study

      To collect social and demographic data

      To obtain their written consent

Inclusion/exclusion criteria

     Adolescents between 12 and 18 years at the time of the interview

     Adolescents and parents must speak French fluently

     Adolescents must not have an eating disorder (i.e., anorexia nervosa, bulimia, avoidant/restrictive food intake disorder, or another unspecified eating disorder) or a weight-related disorder such as obesity

       Adolescents could have food-related symptoms and their effects on the family relationships would be part of our field of exploration

     Adolescents must not present acute or severe psychiatric disorders—schizophrenia, bipolar disorder, or autistic spectrum disorders—(the focus of this study was not the adolescents’ psychopathology but rather the relevance of photo-elicitation in research in adolescent psychiatry)

     Families must not have major dysfunctional patterns, such as neglect or abuse

     Adolescents must be able to talk about their experience of family relationships around food and the family meal

     Adolescents must have been receiving care for at least 6 months

Participants

Adolescents receiving psychiatric care in an outpatient setting and one or both of their parents

     All saw their psychiatrist at least once a month

     All had chronic mental disorders that had begun during adolescence (depression, anxiety, social phobia, personality disorder). This diagnosis was made by each patient’s referring psychiatrist, according to DSM 5 criteria

     None had a somatic disease

Data saturation

Data saturation according to the principle of theoretical sufficiency:

     When new participants were not adding anything significant to the database

     When the themes obtained offered a sufficient explanatory framework in view of the data collected

     Two further individual interviews were conducted with no new themes emerging, to ensure full data saturation

Data collection period

From April 2015 to November 2015

Data collection methods

Individual in-depth interviews using photo-elicitation:

 

     At the end of the preliminary interview, the adolescent was given a digital camera. They could refuse and use their own equipment (smartphone) if they preferred

      Instructions: “You must take a photograph of the table after a family meal. The table should not yet have been cleared. No person should appear in the picture, so everyone at the table must have gotten up. You can take as many pictures as you want, but you will have to choose just one that you will talk about with the researcher at the interview”

     We chose to ask for a photo after the family meal to encourage a narrative of the entire meal

     For ethical reasons, no person could appear in the photographs

     Individual interviews a week after:

      Of the adolescent and immediately after of the parent(s)

      The selected photograph was displayed on a computer screen during both interviews

      The interviewer began by asking the adolescent for a description of the family meal from which the photograph resulted

      At any point during the interview, the interviewer and the participant could go back to the photograph

Individual in-depth interviews:

     Unstructured, open-ended approach

     One introductory prompt: “can you tell us about this family meal?”

     To get rich and detailed personal data from each participant

     To enter the interviewees’ psychological and social world

     To remain open and attentive to any unknown issues that they might introduce

All interviews were:

     Audio-recorded with participants’ permission

     Transcribed word for word, including nonverbal aspects (pauses, laughter, etc.)

     Anonymized

Interviewers

The same researcher (JS), an adolescent psychiatrist, conducted all the interviews

Duration of the interviews

From 60 to 90 min

Data analysis

Thematic analysis:

     To identify, analyze and report themes within data

     To identify the similarities and the differences in the participants’ narratives

     To discern recurrent patterns and to integrate new elements that emerged from the analysis

     In a data-driven analysis with inductive approach = coding the data without any reference to theoretical notions or researcher’s preconceptions

Criteria to ensure validity

Analysis conducted independently by the three researchers (JS, EC, LP)

     To verify that the themes identified were an exact reflection of the data

Research group monthly meetings:

     To discuss the results

     To be supervised by a researcher more distant from the material (ARL)

     To resolve disagreements on the inclusion or exclusion of a theme (discussion continued until a consensus was reached)