Conducting an Effective Interview In this session we will discuss effective skills for interviewing in order to collect high quality data for our assessment. We will have the opportunity to practice some of these skills during this session, and will also have an opportunity to practice them while using the ClASS tools in the upcoming Breakout Sessions. ASK team members what their experience is in conducting interviews (could be interviewing people for jobs, for research or because they need information that someone else has). Point out that there is a wide range of experience and we can all learn from each other how about to elicit important information from our interviewees during this session. TELL participants to jump in any time to ask questions.

Learning Objectives Define “In-depth Interview” By the end of the session, participants will be able to: Define “In-depth Interview” Describe 3 skills for effective communication List the qualities of a good interviewer Identify and describe effective interviewing techniques Now that we’ve had an overview of the ClASS Framework, process and methods, we will dive a little deeper into perhaps the most important method of all – the in-depth interview. REVIEW objectives of session. Session draws heavily from the following sources: http://edis.ifas.ufl.edu/fy393 ITECH Barbados MOM Curriculum 2009

In-depth Interviews “In-depth interviews are excellent tools to use in planning and evaluating programs because they use an open-ended, discovery- oriented method, which allows the interviewer to deeply explore the respondent’s feelings and perspectives on a subject. This results in rich background information that can shape further questions relevant to the topic. ”

Characteristics of In-depth Interviews Open-ended Questions: Give respondents the freedom to answer questions using their own words. Semi-structured Format: Interview should be conversational, with questions flowing from previous responses when possible.  Seek Understanding and Interpretation: Interviewer should continually seek clarity and understanding throughout the interview. Recording Responses: Written notes include observations of both verbal and non-verbal behaviors as they occur, and immediate personal reflections about the interview. Open-ended Questions. Questions need to be worded so that respondents expound on the topic, not just answer “yes” or “no.” Many open-ended questions begin with “why” or “how,” which gives respondents freedom to answer the questions using their own words. Semi-structured Format. Although it is important to pre-plan the key questions, the interview should also be conversational, with questions flowing from previous responses when possible. For example, if an interviewee remarks that “The elections are approaching,” an appropriate response would be, “How do you feel about the candidates involved?” Seek Understanding and Interpretation. It is important to use active listening skills to reflect upon what the speaker is saying. The interviewer should try to interpret the nuances of what is being said and should seek clarity and understanding throughout the interview. Recording Responses. Written notes should include observations of both verbal and non-verbal behaviors as they occur, and immediate personal reflections about the interview. We will talk more about note-taking in an upcoming session. In sum, in-depth interviews involve not only asking questions, but systematically documenting the responses to probe for deeper meaning and understanding. These characteristics may seem simple, but there are some important skills involved in performing all of them at once. We will learn more about these skills in just a moment. www.classtoolkit.org

Effective Communication People like to share with people who are sincere, approachable, and non-judgmental. These qualities are communicated primarily by facial expressions, followed by tone, and, to a limited extent, by words. People often remember more about how a subject is communicated than the speaker’s knowledge of the subject. Before we talk about interviewing, let’s begin with effective communication. ASK participants “With what kind of person do you tend to enjoy sharing information, stories, ideas? And how do you determine whether someone is that kind of person?” CLICK to reveal bullet points.

Types of Communication Verbal Spoken words Nonverbal The way we sit/stand Facial expressions Silence Eye contact Gestures (smiling, leaning forward, nodding) Nonverbal Verbal We tend to forget about non-verbal communication, but in fact, only 7 to 11% of the communication people receive is verbal, and the rest is nonverbal. Nonverbal communication may not always match a verbal message, and differences in how messages are perceived can lead to confusion. ASK participants to provide an example of when someone says one thing but seems to feel a different way. Some examples are: Crying while saying, “I am fine.” Saying that you are listening when you are not making eye contact with the speaker and are looking all around the room while the speaker is speaking. Saying that you are not bored or tired when you are yawning. People use nonverbal communication signs instead of expressing themselves verbally because they may feel uncomfortable explicitly expressing emotions such as anger, boredom, or confusion. The interviewer needs to be aware both of what the interviewee might be communicating nonverbally to him/her, and what he/she as the interviewer is communicating nonverbally to the interviewee.

Effective Communication Techniques (1) Active listening Attending fully to what the speaker is saying by focusing wholly on what is being said. Requires the listener to give full attention to the speaker until either the message has been received or the speaker has finished speaking.  While communicating effectively may sound easy, it can take a lot of practice to learn. Often, instead of truly listening to what the other person is saying, we’re thinking about what our response will be to what they’re saying, or what we want to say next, or something else entirely. Thus, prior to conducting an in-depth interview, it is a good idea to practice using the skills we will discuss in this session on a friend or colleague. We will have some time to practice during this training, but you might also want to consider practicing with a friend as well. Begin by instructing them to talk about a topic of interest and practice your active listening strategies during the conversation. Afterward, ask for feedback and continue with different topics until using these skills becomes a natural way of interacting.

Active Listening ASK participants: How do you know when someone is actively listening to you? Possible answers include: Making eye contact. Facing the speaker. Concentrating on the speaker and what he/she is saying. Paying attention. Demonstrating real interest in what is being said. Avoiding distractions, like phone calls, other people, or paperwork (note that this is a factor related to the environment in which you are holding a conversation—in this picture, the pair has chosen a meeting place that is free of many distractions). GIVE participants a minute or two to think of a time that they had to talk to someone who was a bad listener. ASK a couple of volunteers to share what made that person a bad listener, and how it made them feel.

Effective Communication Techniques (2) Reflective listening: The process of verbally “reflecting” back what someone has said Helps the interviewer check whether s/he understands the interviewee Helps the interviewee feel understood and respected Reflective listening builds on active listening and involves verbally reflecting back to the speaker the emotions inherent in their message. By paying attention to tone and emotional content, the interviewer can gain a greater understanding of the messages being delivered.

Reflective Listening Confirms that you have understood the interviewee by using statements such as: “So you feel frustrated that there’s not enough time to do a complete physical exam.” “It sounds like you’re concerned about this patient’s ability to adhere to treatment.” “So you’re wondering if this training will address the performance gaps you’ve identified.” Note that these examples include the word “you,” which emphasizes that the interviewer is actively listening and reflecting back what he or she heard the interviewee say. This helps to check for understanding.

Effective Communication Techniques (3) Summarizing: Process of synthesizing and re-stating what the interviewee has said in order to capture key concerns and issues READ slide. ASK participants: What are some ways in which the use of summarizing might assist you in conducting an effective interview? CLICK to see possible answers on the next slide.

Summarizing To confirm that you have understood the interviewee’s story or issue To change topics, close discussion, or clarify something To collect your thoughts To show the interviewee that you have heard and respect his/her point of view Summarizing is a good technique to use when you want to…READ points on slide.

Listening Activity NOTE: This activity should take 10-15 minutes total. USE the instructions below to complete the exercise. After participants have completed the exercise with their partners, bring them back together as a large group. ASK participants to share how it felt to have people actively and reflectively listening and summarizing. ASK participants to share how they will use these techniques in their interviews. DIVIDE participants into pairs. Each pair should choose a first speaker and a listener. ASK the speaker to choose a controversial topic about which to speak (or use one of the examples below), uninterrupted, for 1-2 minutes. The speaker can express his/her opinion, or can just choose a position to support. ASK the listener to practice applying both active and reflective listening. When the speaker has finished speaking, the listener should summarize what the speaker said, taking about 30 seconds. The pairs should then switch roles and repeat the exercise. WRAP-UP the activity by discussing first how the speakers felt during this exercise, and then the listeners. Suggested topics: If no gloves are available, should health care providers (HCWs) still draw blood, manage deliveries, etc., i.e., without gloves? HCWs who test HIV-positive should not be allowed to work in the hospital. Women who are HIV-positive should not have children. HCWs should be allowed to refuse to take care of HIV-positive patients if they wish. Pregnant patients should not have a choice about HIV testing; it should be mandatory. Debrief: After all participants have gotten a chance to speak, discuss in a larger group: Was it more difficult to listen quietly when you disagreed with what your partner said? As a listener, was it difficult to summarize? As a speaker, did the listener summarize correctly?

Qualities of a Good Interviewer Open-minded Flexible and responsive Patient Observant A good listener Friendly On top of being an effective communicator, there are certain qualities that make a good interviewer. Open-minded. Judgment or criticism can be barriers to communication, so it is important to maintain openness during the interview process. Do your best to leave behind any pre-conceived ideas and maintain a neutral attitude. If interviewees perceive that they are being judged or evaluated, then they are less likely to openly share their opinions. Flexible and responsive. Human interactions are complex and people’s responses to questions are often unpredictable, so good interviewers must be able to think on their feet, respond to challenges, and make sure that the core purpose of the assessment is being served. Patient. Allow the respondent to speak freely and open up at a pace that is personally comfortable. It is a true skill to be able to do this while keeping the interview to its scheduled time. This takes practice. Observant. Good interviewers are observant, picking up subtle cues such as facial expressions, body language, and tone of voice. A good listener. A good listener is one who uses the strategies we just discussed to listens actively. Friendly: Again, people like to share with those who are sincere, approachable and friendly. You might be surprised at how demonstrating these characteristics can really improve the quality of your interview. www.classtoolkit.org

Effective Interview Techniques Create a rapport Use open-ended questions Use probes to go deeper into a subject Avoid leading questions Clarify vague or hard-to-understand responses by summarizing or presenting a scenario or example Cultivating the qualities just mentioned will go far in being able to incorporate the interviewing techniques listed here.

Create a Rapport Learn culturally-specific styles and techniques for building rapport Be an engaged listener with a neutral attitude Tune into non-verbal communication cues and adjust your interviewing style depending on the interviewee Make eye contact and smile Ask about family or other appropriate small talk Being friendly and open-minded helps to create a rapport with your interviewee so that they are drawn to share with you. Remember, people like to share with people who are sincere, approachable, and non-judgmental. READ techniques on slide. ASK participants to give examples of how they create rapport and put people at ease. Do they have any suggestions to add? CONCLUDE this topic by reading any points below that participants did not mention. Also good to start with appropriate greeting, introduce yourself. Introduce project and purpose of project; Told why they were selected for interviews, and how the info they provide will help the project. Respondents like to know why/how their ‘story’ will be of some benefit. They should also be told their information will be kept confidential and the steps to be taken to protect their privacy. These few steps, which take less than 5-10 minutes, can make the difference between a rich, detailed and insightful narrative and a skimpy, vague and uninformative exercise. (Source: DRAFT Interview Skills TIG) www.classtoolkit.org

Open-ended Questions Open Leave the answer very open to what the interviewee wants to say Results in a long, narrative answer Often start with: “How” “What” “Describe” “Explain” Closed Ask for specific answers, such as “yes” or “no” Quick, easy to answer, give you facts, answer with short word or phrase Often start with: “Do” “Are” “Will” “How many” “If” or “Would” The reason we use open ended questions is because they usually result in narrative responses that provide more information than closed-ended questions. The interviewee must be given time to reflect and share opinions/feelings. ASK a participant, “Do you like mangoes?” (They will likely answer yes/no) ASK another, “How many mangoes do you eat per week?” (They will likely answer yes/no) ASK another to come up with an open ended question that would probably get at those responses. Possible answers might include: “How do you feel about mangos?” or “Describe the 1st time you ate a mango?”

‘Opening up’ Closed Questions Do you have enough resources for your program? Is it challenging to learn counseling skills through a computer? Would you say your Internet is reliable? Do participants ever drop out of your DL program? Did facilitators have experience before they taught your eLearning course? ASK volunteers to try “opening up” the questions on the slide, one by one. Possible answers are included below. Do you have enough resources for your program? How is the program funded? Tell me about the resources for your program? Can you please explain any resource challenges that your program faces. Is it challenging to learn counseling skills through a computer? How do you feel about learning through a computer? Are there any challenges to learning counseling skills through a computer? Would you say your Internet is reliable? Do you have challenges with your Internet? Describe your Internet connection. Do participants ever drop out of your DL program? Describe any participant drop out? Did facilitators have experience before they taught your eLearning course? What kind, if any, of training did facilitators have before they taught your eLearning course?

Probes Probes are neutral questions, phrases, sounds, and gestures used to encourage participants to elaborate on their answers A highly effective way to encourage further sharing without the interviewer imposing him or herself into the narrative One of the most important tools in in-depth interviewing Probing is also a highly effective way to stimulate respondents to produce more information. Some times probes are built into an interviewing tool, but often it is up to the interviewer to know when to use them and how. ASK participants, what are probes? CLICK to reveal bullet points.

Types of Probes Silent Echo “Uh-huh” Long question “Tell me more” Summarizing There are a number of different ways to probe: Being Silent – One of the most effective but most difficult probes to use is the silent probe. Just as nature abhors a vacuum, so too do interviewers dread silence. Often, they will rush to fill the void with another question instead of giving respondents a chance to think and reflect. Often silence will prompt a respondent to reveal something highly significant or unexpected resulting in a flow of rich and insightful information. These ‘surprises’ are well worth the minor discomfort a few moments of silence may impose. Echo – Another effective probing technique is the ‘echo probe,’ in which the interviewer mirrors the last thing a respondent said. Echoing encourages the respondent to continue with the story. This method is particularly useful when respondents are explaining a process or event. For example, if a program coordinator is being interviewed, the interviewer may ask, “OK, so you create flyers to market the course, post flyers at the local clinics to invite participants to apply for the course, they contact you for information about the course, then what happens?” The beauty of the echo probe is that the interviewer is remaining neutral by allowing the respondent to direct the interview. Uh –huh – Saying “uh huh” or “OK” can encourage the informant to continue talking. Also, fully focusing on the interviewee, nodding and making eye contact. Long question – instead of just getting right to the point with your question, you can intentionally make the question long. This sometimes encourages further sharing, especially for sensitive topics. E.g. “We’re interested in the various things people do these days to keep from getting diseases when they have sex. Some people do different kinds of things, and some people do nothing special. Do you ever use condoms?” A short response by the informant can then open the door for you to ask more about condom use. Tell me more – asking questions such as “What else can you tell me about that?” “So how did that make you feel?” “Oh I understand. And what happened after that?” This is a direct probe. Summarizing is also considered a type of probe.

When to Use Probes Response to your question is unclear/brief Interviewee seems to be waiting for a reaction from you before continuing to speak Interviewee appears to have more information on the subject To get more detail about what the interviewee thinks or feels in relationship to the topic being discussed To further or confirm your understanding or encourage more explanation Don’t use probes in excess. Do not use when responses become repetitive or lack substance, or when the interviewee appears annoyed. Going back to your rapport, it is important to tune into the interviewee’s non-verbal communication and emotional cues to inform the way you conduct the interview. Probing is probably the most important technique in qualitative interviewing and also one of hardest. It is difficult because it: Requires solid understanding of research objectives and tools Requires patience and sensitivity Good time management skills Good interpersonal skills

Examples of Probes “Can you give me an example of that?” “Please tell me more about . . .” “What exactly do you mean by that?” “How typical is that (occurrence, thing)? “What are some of the other ways to do . . .” “Mmm,....really?”, “interesting…”, “I see…” “Why do you think that is?” Here are a few examples of probes.

Leading Questions Leads interviewee along a particular line of thinking Subtly prompts interviewee to answer in a particular way Risks revealing your own value judgments and biases Interviewees often provide a response in accord with the question because they are reluctant to contradict the interviewer ASK participants, “What are leading questions?” CLICK to reveal bullet points.

Examples of Leading Questions How challenging is it to learn how to diagnose patients using a distance learning method? Most students with few technical skills will struggle in this eLearning program, is that right? Was one reason you stopped staffing the telementoring line because the mentors weren’t interested in adding to their responsibilities? Do you think the reason facilitators don’t follow up with participants is because they don’t have access to a computer or internet connection? ASK participants first why these are leading questions. Then… ASK participants to ask the same questions without leading the interviewee. It must be challenging to learn how to diagnose patients using a distance learning method? (assuming that it is hard to learn certain skills through DL) Could say: I’ve heard some people say that it is challenging to diagnose patients using a DL learning method, and others who say it is great because they can practice on a computer before trying on a real patient. What do you think? Most students with few technical skills will struggle in this eLearning program, is that right? (assuming that tech savvy students don’t have problems with the program) How do you think technical skills influence how a student does in a eLearning program? Was one reason you stopped staffing the telementoring line because the mentors weren’t interested in adding to their responsibilities? (Assuming the mentors are too busy or not interested) What were some of the reasons you stopped staffing the telementoring line? Do you think the reason facilitators don’t follow up with participants is because they don’t have access to a computer or internet connection? (assuming f/u is b/c of access to computer and internet) Why do you think the facilitators don’t follow up with the participants? .

Exercise: Observe an In-Depth Interview (1) So far we have talked about effective communication skills (active listening, reflecting and summarizing), qualities of a good interviewer (open-minded, flexible and responsive, patient, observant, good listening, friendly), and effective interviewing techniques (creating a rapport, using open-ended questions, using probes to go deeper into a subject, avoiding leading questions). ASK participants if there are any questions on what we’ve talked about so far before we observe an in-depth interview. NOTE: This exercise should take about minutes. Advance preparation and instructions for this activity can be found in your facilitators guide. REFER participants to Exercise 1 handout: Observe an In-depth interview (30 minutes) ADVANCE to the next slide to reveal discussion questions. www.classtoolkit.org

Exercise: Observe an In-Depth Interview (2) What did the interviewer do well? Discuss how the interviewer phrases questions. What are some ways the interviewer solicited clarification on answers that were unclear? When does the interviewer ask open-ended questions? When does the interviewer follow up interview questions with probing questions? What could the interviewer have done to improve the quality of information he received? www.classtoolkit.org

Interviewing “DOs” Prepare in advance! Understand purpose of the assessment Only ask questions interviewees can reasonably be expected to answer Be thoroughly familiar with informed consent documents and be able to explain them to the interviewee if necessary. Know the questions well in advance and be able to rephrase or produce follow-up questions and probes Know the flow of questions so you can adjust the order to match conversation flow if necessary. Use culturally-specific styles and techniques for building rapport. Remain neutral and remember that your body language and reactions can convey your own biases. To conclude this session we will just go through a couple of key points. Here are some rules of thumb to keep in mind when conducting interviews.

Interviewing “DON’Ts” Don’t let the interviewee have too much control over the interview Don’t lead the interviewee based on preconceived notions Don’t be judgmental toward responses Don’t ask dichotomous questions (when they can be avoided) Never tell a participant they’ve contradicted themselves This slide points out interviewing don’ts. This first one isn’t really about control for control’s sake…it’s just to make sure that the interview is moving in the direction of gathering the information you need. So keep in mind, if the interviewee starts to ask you questions, politely deflect them and say you’re interested in their opinions. Or if the topic strays too far away from the topic of interest, again politely return to the subject at hand. Also, never tell a participant they’ve contradicted themselves - ask for clarification. They are the experts on their experience, so they can explain how the complexity of their answer works for them.

QUESTIONS? www.classtoolkit.org