This is the third part of a multi-part series on in-depth interviews for gathering patient insights. While each part is intended to be standalone, you can read previous entries here (Intro to Patient Insights, part 1, part 2). Enjoy!

So by now, you’ve gone through the exercise of identifying the business decisions blocking your team. 

You’ve started at the end goal, what you need to know to make these decisions, and worked with your team to identify the research questions and objectives that, if achieved, will help you clarify the decisions.

As a refresher, here were some of the research questions we examined in previous posts:

• What challenges do T2D patients in our target population face at home, both specific to accessing our product, and in general? 

• What are the potential financial challenges to accessing our DTx in this population?

• How have T2D patients been managing these challenges without pharmacological intervention in the past?

• Assuming that we can address hurdles to financial access for this population through Medicare, what usability and accessibility challenges might they face? 

• What do users with different visual abilities experience when they interact with specific user flows of our DTx?
• What accessibility initiatives, if any, should we prioritize in patients who have vision loss?

There are a number or research questions here, and if you recall our target of 1-6 research questions per project, we may need to pull out just a few. And today we are going to focus on using the semi-structured in-depth interview to write patient interview questions and address some of these questions.

Developing the Discussion Guide

Maybe your first thought is that you can just grab the first research question and start cranking through. Not quite. Research questions are not patient interview questions.

Research questions help you and your team define exactly what it is you’re looking to learn, and help you gain buy-in from your organization on investment in patient insights. Once you have them defined, however, you can’t just turn around and ask patients that one burning question you want the answer to—sorry, it doesn’t work that way (if only it were that easy!). 

Using open-ended questions

Now, in order to turn this into a usable interview guide, focus on generating open-ended questions that connect to these research questions. This is the opposite of the dreaded closed-ended question (Yes/No questions). There’s a time and place for those (like a survey), but qualitative research is made for open-ended responses!

You’re going to have lots of questions—that’s great!—but don’t rush in with everything all at once. Give the participant room to respond, and ask follow-up probing questions if they don’t offer up the type of information you are looking for. 

Think of yourself as a skilled podcast host that only chimes in occasionally to ask a follow-up question and keeps the conversation flowing organically. Here are some examples of questions you may ask the participant, and associated probes, that will help you answer your research question.

Research Question: What challenges do T2D patients in our target population face at home, both specific to accessing our product, and in general? 

• Discussion Guide Question:
  • “I’d like to hear more about what your experiences were leading up to your diagnosis, could you tell me about that time and any symptoms you experienced?” 
    • PROBE: Did anyone help you? 
    • PROBE: What impact does T2D have on your daily life (e.g. work, psychosocial, financial, etc)?“I’d like to hear more about what your experiences were leading up to your diagnosis, could you tell me about that time and any symptoms you experienced?”
  • “What has it been like to manage your T2D?”
    • PROBE: What are the biggest challenges you face managing your T2D?
    • PROBE: How has this changed over time?
  • “There are a lot of devices on the market now for managing T2D. Which of these devices have you used, if any?”
    • PROBE: What have those experiences been like?
    • PROBE: Why did you change devices?
  • “You indicated you have used health apps before, can you tell me a bit about the ones you have used?”
    • PROBE: What did you like/dislike about the app?
    • PROBE: Did your doctor have access to the data from that app?

These types of questions allow the respondent to create a rich picture of what they do, why they do it, and allow you to follow-up. If you’re not very experienced with interviews, these questions can also help you avoid obvious pitfalls and dead ends. Closed questions can put you in a corner. If you ask a few in a row, and end up with “no, no, no”, it can feel like an awkward social encounter that you're looking for any excuse to leave. 

You’re trying to say just enough to get them to start talking. Sometimes you may need to rephrase or provide a bit of context, but certainly not so much that you’re leading them to the answer you want. Which leads us to our next topic...

Discussion Guide Pitfalls

Leading questions

What are leading questions? Leading questions are questions that tend to get a person to answer in a specific way. 

Example: “Would you download an app that could make managing your condition so easy you’d forget you had T2D?” 

• In all likelihood, they’ll say yes to a question framed like this. That may give you a false sense of security that T2D patients are going to love your app. You’re missing out on the opportunity to truly hear what you need to in order to create the best product.

Introducing bias

Also be cognizant of what you share, as you may be biasing the participant in a certain way, which can also muck up your data. 

Example: “Thank you so much for joining the call and agreeing to participate in our research. I’m so excited to get your feedback, the team has worked really hard on it, and we think you’re going to love this solution.”

• Participants are humans, and that means they are navigating interpersonal dynamics. If you talk about how hard you worked and how proud you are of your product, chances are they don’t want to hurt your feelings and may not tell you how they truly feel. Another missed opportunity for quality data. 

Interrogation

No one wants a patient experience interview to turn into an episode of NCIS. Yes, the point is to get your questions answered, but it shouldn’t be done in a rapid-fire question format or in a way where it feels disrespectful to the participant. 

Example: “Why haven’t you asked your doctor for a health app?” [I’m not sure] “Would you ask them in your next appointment?” [Maybe] “Why wouldn’t you ask them?” [Get me out of here!]

• If you aren’t getting the answer you want, you can try to rephrase, but in a situation like this, it may be time to move onto a different question altogether.

Interview Etiquette

Introduction

I know many of us are out of practice with social interactions, so let’s review how to start conversations. Remember to introduce yourself first. When it comes to titles, not only does the participant likely not care, but if you have a senior or leadership title it can introduce biases as well. You can just say “I work in clinical operations” or “I work in product management.” After that is out of the way, a little small talk is fine to warm up the conversation (especially if there are pets in view!).

Wrap up

Conversely, how you close out the interview is equally important. Keep an eye on the clock and know you should start to wrap about 8 minutes before the end (yes, this is the sweet spot we find). That gives you time to ask if they have anything else to share (a nice way to ask this is “is there anything I didn’t ask you that you feel I should have?”). More often than not, they have things to say, even if it’s just reiterating an earlier point, so it can take a couple of minutes. Before you close, thank them for their time and sharing sensitive experiences with you. And don’t forget to let them know any next steps (like how they are getting paid!).

Side note: make sure you're offering patients a fair incentive for their participation. Market rates are $90-$100/hr. Don't skimp - these insights are critical to your business success. Just remember what happens when you don't invest in patient insights.

The guide is just a guide

This is one to highlight. So many clients (and their legal and compliance teams!) get hung up on every word in a discussion guide. But an organic conversation cannot be perfectly scripted, so remember that you are not beholden to the discussion guide. A semi-structured interview is just that—semi-structured. Use the guide to organize your thoughts and reference back to throughout the conversation, but let the participant dictate where the discussion goes. The more you do, the more comfort you will get with this type of improv.

Acknowledge the conversation

When talking to patients and caregivers, remember that you are asking them to recall what might be traumatic events and experiences. It can be tough to relive some of these memories. Acknowledge this at the beginning of the interview that you understand some things can be challenging and they only need to answer what they are comfortable doing. As they express themselves throughout the conversation, be engaged and thank them for sharing along the way.

Consent is cool

We will talk more about consenting participants for projects in later posts, but putting this here as a reminder to ensure that you not only get the participant’s consent for the interview, but also for the recording (if applicable) and any potential use of that data, internally or externally. No one wants to end up with their face as a Facebook ad unknowingly (yes, this happened to Savvy co-founder, Ronnie Sharpe).

Practice

There is an art to interviewing. It takes practice. You’re juggling a lot of things in the moment; being engaging, checking your discussion guide to see if you’ve hit the themes you’re looking for, taking notes, keeping track of time, and most importantly, really listening to the patient! Make sure you take the time to run through your discussion guide with a colleague first, especially to get a sense of timing. You must be respectful of their time and do everything you can to not run over. It always goes by quicker than you expect!

Final thoughts

Before we close out this installment, it’s worth noting that having the opportunity to talk to a patient about their lived experiences is a huge privilege. They are willing to share their personal stories with you in an effort to teach you what it is like to live with their condition. Meet this opportunity with humility, excitement, and proper preparation so you both have a great experience. 

In our final two installments, we’ll cover how to work up your data into insights, and how to ensure that everyone on your team benefits from them.

See you next time!

About Savvy Cooperative

Jahed Momand is VP of Product & Marketing at Savvy Cooperative, and previously led patient-focused research groups at digital health startups such as Conversa Health and ZoomCare.

Savvy Cooperative helps the healthcare industry create patient-centered products and solutions by providing a marketplace for patient insights. Pharma and startups alike can connect directly with patients to participate in clinical, UX, and market research. Savvy’s unique co-op model leverages its members’ networks to quickly recruit diverse patients, and pays patients for sharing their insights! Savvy’s award-winning co-op has been featured in FastCompany, TechCrunch, The Boston Globe, and named one of the 50 Most Daring Entrepreneurs by Entrepreneur Magazine.