The evolution of interview methodologies to inform the co-design of interventions for an implementation initiative to enhance transitions in care practices in primary care

Background: People living with chronic health conditions are at risk for poor transitions in care (TiC) because of poor discharge coordination and care integration. An ongoing study in Alberta, Canada called A DiseAse-Inclusive Pathway for Transitions in Care (ADAPT) focuses on co-designing interventions to enhance TiC practices in primary care for high-risk people with chronic diseases. The aim of this paper is to provide an overview of the application and evolution of the qualitative interview methods used in the context of the ADAPT study, and highlight key findings and lessons learned from using each method. Methods: Initial steps for co-design included current state assessments of TiC workflow processes for primary care. To create comprehensive maps of existing processes, qualitative interviewing techniques were applied. The first methodological approaches used were the ORID (Objective, Reflective, Interpretive, and Decisional) framework (Phase 1) and cognitive task analysis (CTA) (Phase 2). Challenges were encountered using both approaches (i.e., Phase 1 lacked detail and Phase 2 was resource intensive). Therefore, a novel hybrid approach was developed (Phase 3). Results: Results from Phase 1 were grouped into five key themes: People, Processes, System, Outcomes, and Solutions. Phase 2 resulted in an in-depth understanding of each key primary care activity during the transition out of acute care. The themes identified in Phase 1 were critical in supporting the evolution of the interview guide and approach in Phase 3. The new hybrid approach allowed immediate incorporation of interview data into a visual current state map highlighting processes and team member involvement throughout a patient’s TiC journey. Conclusion: The new hybrid approach led to a balance of providing enough detail in a timely fashion to better prepare the study to move into identifying opportunities for practice change and intervention co-design. Developing hybrid approaches for rapid qualitative analysis that balance rigor and efficiency is important to advance research to facilitate complex implementation initiatives.