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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)