Enriching qualitative research by engaging peer interviewers: a case study

Abstract

Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peer-interviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men’s experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.

Keywords

case study gambling housing instability lived experience peer interviewers qualitative

Introduction

When conducting research, certain populations are harder for researchers to access than others. People facing housing instability or homelessness may be difficult to reach as they do not have ready access to a telephone or internet; with no fixed address it will be difficult to initiate contact and engage them in longitudinal research. Some may be unwilling to disclose their contact information if they are involved in illicit drug use or if they are undocumented immigrants (Dowbor et al., 2014). For such reasons initial contact and future follow-up can prove quite difficult for researchers.

Many hard-to-reach populations, by definition, often experience disadvantaged circumstances and disenfranchisement: ‘the homeless and transient, chronically mentally ill, high school dropouts, criminal offenders, prostitutes, juvenile delinquents, gang members, runaways and other street people’ (Lambert and Wiebel, 1990: 1). Some have been exploited by researchers and research practices in the past (Goel and Salganik, 2010; Noy, 2008; Padgett, 2008). Social desirability and fear of breaches of privacy may affect how populations with more marginalized statuses engage with researchers. For example, people who have been involved in illegal behavior or who have been systematically stigmatized through negative public perceptions (for example, people addicted to illegal drugs), may be circumspect in the answers they provide on sensitive topics as a way to protect their privacy (Heckathorn, 1997). This may lead to under-reporting of, or misrepresentation of socially undesirable behaviours and traits; for example, participants may distort their responses to questions to align more closely with social norms (Krumpal, 2013). Language barriers, distrust of government or service providers, lack of transportation, as well as dangerous and isolated physical environments, are acknowledged challenges in conducting research with hard-to-reach groups (Froonjian and Garnett, 2013). In recognition of the social invisibility of some populations, researchers use a variety of techniques to reach out to these communities including, snowball, targeted and time-location sampling methods (Magnani et al., 2005; Matheson et al., 2014). Despite these challenges, gaining in-depth knowledge of the conditions and concerns experienced by these populations is crucial to the development of effective evidence-based interventions. From an ethical perspective, extra care must be exercised to ensure that research does not exploit vulnerable populations. Researchers must strive to develop effective practices for recruiting and engaging with members of historically marginalized groups (Pitts and Smith, 2007).

Insider research, defined as research conducted by members of a community or institution that is being studied, is commonplace in ethnographic work (Brannick and Coghlan, 2007; Taylor, 2011). This type of inquiry requires that we carefully consider issues of confidentiality, consent, role confusion, and objectivity (DeLyser, 2001; Humphrey, 2013). Despite these cautions, such research can have immense value by improving collective understanding of the lived experiences of people facing multiple complex vulnerabilities (Brannick and Coghlan, 2007; Humphrey, 2013; Taylor, 2011). Researchers are often socially located in positions of power and privilege (Denzin, 2003). This creates multiple blind spots for researchers without lived experience, who may be insulated from the realities they are studying. Having the expertise of people with lived experience helps to contextualize, communicate and apply findings. The intersectional nature of the identities of people with lived experience (for example, gender, immigrant status, low income), both for those researched and researchers is important to acknowledge within the context of research. Therefore, incorporating insiders into the research approach may be viewed as challenging, as insiders experience socioeconomic and structural inequities that often exclude them from active participation in traditional research institutions like universities and hospitals. We argue that researchers often miss a valuable opportunity to include people with insider knowledge of the community of interest.

There are many approaches to insider research: investigators with membership in the group being researched (Hodkinson, 2005), contact tracers to recruit members from targeted networks, and indigenous observers who report on patterns and trends in areas of interest (Power, 1994). There is also peer-interviewing which provides a method where peers (defined by their lived experience) of the group being researched are involved in qualitative data collection. Herein we present a case study to illustrate how peer-interviewers were engaged in a community-based qualitative study on problem gambling and housing instability. All names in this case study are pseudonyms to protect the identity of the participants.

Peer-interviewing

In an effort to include people with lived experience in the research process, some researchers have hired people with lived experience to conduct interviews with their peers. The method has been used in research with sex workers (Benoit et al., 2005), people living with HIV/AIDS (Greene et al., 2009), refugees, homeless young people (Couch et al., 2014), lone mothers, children and people with disabilities (Edwards and Alexander, 2011). Proponents of this approach argue that it provides tangible benefits for peer-interviewers – such as skills development and improved self-esteem. Researchers benefit through increased awareness and acceptance of disenfranchised groups, improved quality of research, greater facilitation of access to hard-to-reach populations, and increased comfort of participants in the research process (Elliott et al., 2002; Greene et al., 2009; Kilpatrick et al., 2007; Remple et al., 2007; Kelaher et al., 2010).

Despite these benefits, others argue that a peer-interviewing approach presents practical and ideological challenges, such as a larger investment in time and money to hire, train, and monitor peer-interviewers; lack of funding to provide proper training; and perceived power imbalances between the peer-interviewers and researchers (Delman and Lincoln, 2009; Remple et al., 2007). Delman and Lincoln (2009) warn that researchers and peer-interviewers may have different opinions on research questions and outputs. Greene et al. (2009; 2013) argue that peer-interviewers may experience distress as participants talk about their personal journeys of addictions, mental illness and recovery. Hearing these stories might prove detrimental to the peer-interviewers’ own recoveries.

At the core of the peer-interviewing method is the concept of expertise by experience which reflects the idea that identity produces knowledge (Frankham, 2009; Gallagher and Gallacher, 2008). Proponents of this concept believe that one’s identity creates a particular view of the world which then produces knowledge that is viewed as authentic¹ and more valid because it is grounded in the experiences of those being researched (Nind, 2014). People considered insiders, by virtue of their personal experience, are believed to have information that traditional researchers (outsiders) cannot access.

Some have cautioned about privileging personal experience as a route to knowledge generation. Choosing one or many individuals as representative of a group while assuming that a single viewpoint is shared by the group, may lead to new essentialisms – one person speaking for others – and homogenization of people (Frankham, 2009; Nind, 2014). Another concern is that researchers may unquestionably accept all that insiders represent, since being critical of peer experience and knowledge may be equivalent to denial of their realities (Nind, 2014).

Edwards and Alexander (2011) argue that peers may want to present an overly positive image of their community. They may feel compelled to manage how a community facing stigma is represented to other members of the research team either through whom they choose to recruit or how they interact with participants during interviews. Peer-interviewers may be viewed by their community as ‘similar but different’; similar because they have lived experience, yet different from them in their role as interviewer (Edwards and Alexander, 2011).

While an individual’s lived experience may create a positive rapport between peers and participants, this does not translate into the expertise to conduct research activities like interviewing (Power, 1994). Peer-interviewers may require comparatively more supervision and feedback on their interviewing skills than someone with formal academic training to ensure quality data collection and ethical principles (Benoit et al., 2005). Valuing experiential expertise means researchers may spend additional time training peer-interviewers.

Despite these cautions, there are merits to insider research including the democratization of knowledge production; for example, questions about legitimate and authoritative knowledge can be raised (Nind, 2014). Insider research does not claim to get at one, true knowledge, but can provide a new way to envision experience and provide a more nuanced understanding of complex lives (Nind, 2014). Peer-interviewers have the potential to discover knowledge that may otherwise go unnoticed by researchers without lived experience. Some argue that in these instances, peer-interviewers can improve the quality of data; participants will respond more genuinely to someone they know is familiar with their life circumstances.

There is an inherent power imbalance between researchers and research participants, often marked by differences in socio-economic status. Such imbalances necessitate that researchers employ self-reflexivity in their research practice (Cloke et al., 2000; Doyle, 1999; Shaw, 2003). Self-reflexivity, commonly used in ethnographic research, has its roots in feminist epistemology (Henwood, 2008). To be self-reflexive, researchers need to acknowledge their social positions, biases, motivations for conducting research, and how these influence the research process (Tracy, 2010). Active attention to their own biases and motives and to how they interact with those around them can help researchers to erode preconceptions of a group or phenomenon and conduct research that better represents their subjects’ experiences, thus increasing honesty and authenticity (Finlay, 2002; Tracy, 2010).

Self-reflexivity, arguably, is integral to the research process, but lived experience may provide added depth in understanding and enhances knowledge creation. In essence it provides a way to incorporate experiential knowledge of a topic into the research process. Denzin (2003: 198) states:

The research self is not separable from the lived self. Who we are and what we can be, what we can study, and how we can write about what we study are all tied to how a knowledge system disciplines its members and claims authority over knowledge. Needed are concrete practices through which we can construct ourselves as ethical subjects engaged in ethical research, even if that means challenging the authority of a discipline’s cherished modes of representation.

We adopt the stance that self-reflexivity alone cannot compensate for general lack of insider knowledge and lived experience. Together, self-reflexivity and insider knowledge enrich the experience of research practice and can occur on multiple levels. The academic research team can reflect on the research process (their interaction with the peers and participants) and the design of the research questions (Dowling, 2006), a process of epistemic-reflexivity (Henwood, 2008). Asking peers to provide self-reflections (i.e. journaling and debriefing) on their role and social location in the research process, and their personal disclosure of lived experience to participants, allows peers to develop their own practices of self-reflexivity. Thus, we are not suggesting that peer-interviewing is separate from/better than reflexive practice, rather that the principles of self-reflexivity are deepened when peers are invited to be viable members of the research team. Despite calls for research practices, like Denzin’s (2003), to relocate the sole responsibility for the production and ownership of knowledge beyond knowledge producing systems (academics, funding agencies), there is a lack of research that specifically addresses the strengths and challenges associated with engagement of peer-interviewers in the research process (Kelaher et al., 2010). In 2014, we conducted a qualitative study on problem gambling and housing instability. Peer-interviewers were hired and trained as part of the study design. The objective of this article is to illustrate, through a detailed case study, how to engage and meet challenges that may arise in research that includes peer-interviewers.

Study setting

The Problem Gambling and Housing Instability study was conducted in collaboration with the Good Shepherd Ministries (GSM), a community-based organization in Toronto, Canada that provides a range of programs and services for homeless clients in the inner city. The agency provides drop-in meal programs, overnight shelter beds, case management, and specialized health services. The GSM also provides supportive housing for people living with HIV and AIDS, and for seniors with a history of chronic homelessness. In an antecedent study with the GSM the research team screened their clients to measure the prevalence of problem gambling (Matheson et al., 2014). Participants for the qualitative case study presented in this article, were identified from the prevalence study based on their experiences with gambling. Thirty interviews were conducted from October 2013 to February 2014.

Interviewer recruitment and hiring process

We developed a job posting designed to recruit people who had experienced either mental illness, gambling or substance addictions or homelessness, and who had some professional experience working with people with these health issues. We wanted to recruit interviewers somewhat in our own likeness so that the fundamental power relations of the research were not too disrupted. Our qualitative interview guide was designed to explore the complex relationship between problem gambling and housing instability within the context of concurrent disorders. Therefore, it was important that candidates had lived experience with one of the study’s topics, to ensure they brought a genuine understanding and empathy when asking participants sensitive questions.

We felt that risk to data integrity would be mitigated by targeting our job postings to people graduating from training in the helping professions (such as social work) at local colleges as well as people who had graduated from addictions programs and were working as facilitators within these programs. These individuals would potentially already have some experience interviewing, working in groups, and facilitation and understand the principles of neutrality.²

We contacted social and community service programs at community colleges that routinely reserve program spots for students with lived experience relevant to their programmes of study, and asked them to post the job description at their student employment centres. We also recruited through our community partner, specifically targeting clients who had graduated from the Drug and Alcohol Recovery Enrichment Program (DARE) and were acting as group facilitators. Finally, we distributed the job posting to colleagues who were currently working with people with lived experience or had done so in the past. This recruitment strategy was successful and resulted in eight applicants, of whom three were hired.

Candidate selection

Job interviews included traditional interview questions about career goals, past job experiences and education, and their reasons for applying to the position. We used behavioural interviewing (for example, tell me about a time you were required to use active listening skills) to assess candidates’ abilities to ask probing questions and disclose lived experience, taking care to ensure our questions were sensitive and respectful of their lived experiences. For example, we presented the following scenario:

You are a peer-interviewer working on this project. You ask the participant how gambling has affected their housing stability, and he simply replies, ‘yes it has.’ How do you go about having the participant elaborate more on his experience?

We used behavioural interviewing to understand how candidates had handled specific workplace scenarios in the past and how they might respond to scenarios that might arise in the current position (Simons, 1995), like establishing rapport, de-escalation, maintaining composure and probing for additional information. Such questions assess attributes like knowledge, skills, abilities, and attitudes that are critical for exceptional job performance (Simons, 1995). We were particularly interested in understanding whether candidates would have the ability to create a welcoming and empathetic environment rather than one that would be reactive and critical of participants and their responses.

Peer self-reflection was an integral part of the study design. As part of the interview assessment, we asked candidates to write a journal entry to assess their ability to reflect on and clearly articulate their thoughts, in writing, on their lived experience and recovery. As an example we asked candidates the following:

Please provide an example of a previous accomplishment in your recovery process and provide a sample reflective journal entry about your experience.

Candidates were interviewed by the same three team members, with the same questions and instructions about how to write the journal entry. We operated under the principle of neutrality when asking questions and responding to each candidate’s answers. We spent considerable time ensuring our questions were appropriately formulated to elicit authentic responses as we did not want to create an atmosphere wherein candidates would feel a need to downplay or exaggerate their lived experience to improve their chances to be hired. To this end, we formulated questions in relation to the context of the study (‘Tell us about your experience or knowledge of mental health, addictions, problem gambling and housing instability’). We asked the more challenging questions about their stage of recovery later in the interview when we had established rapport, and we phrased these questions as neutrally as possible (‘Give me an example of an important goal you had to set and tell me about your progress in reaching that goal’). This approach, combined with the written reflections, allowed candidates several opportunities to share their lived experience and recovery journey.

When we contacted candidates’ references we were careful not to reveal that we were hiring people with lived experience. In some cases, referees talked about their knowledge of the candidate’s lived experiences and how this made them a particularly good candidate.

Human resources

We followed standardized hiring practices at the hospital. If the criminal record verification returned a list of prior charges or convictions, we were prepared to work with our Human Resources department to determine if these issues would somehow inhibit the candidate’s ability to perform his or her duties. None of the candidates we interviewed were flagged with criminal records, but knowing what would be of concern a priori was helpful to the team to enable us to prepare for challenges in the hiring process. Our intent was not to set blanket criteria that would mean candidates were screened out solely on the basis of any previous criminal activity, but to ensure the safety of the candidate and the target participants.

As per standard terms of hospital employment, persons hired are expected to be in recovery and to refrain from substance use while working at the hospital and at the community partner agency. Peer-interviewers expressing concerns about relapse could step down from their position immediately if this was their desire. For those wishing to remain in their position, hospital policy required us to refer them to our employee health team for consultation and direction. Human Resources asked us to be cognizant of the potential for paid employment to compromise financial support from Ontario provincial social assistance programs (such as Ontario Disability Support Program and Ontario Works), so we asked candidate peer-interviewers to consider this prior to accepting employment.

Training

General training

We wanted to provide opportunities for peer-interviewers to develop new skills and to gain a sense of empowerment from being acknowledged as experts. Peer-interviewers have important experiential knowledge that can enhance rapport between the interviewer and interviewee and increase engagement. As such, we developed a comprehensive training curriculum covering topics of interviewer neutrality (reactions to responses, asking questions in a non-leading way), the impact of bias on study outcomes, interviewer safety, and standardized interviewing skills (asking questions verbatim). We also provided training in the substantive content of the study (gambling and housing instability), research objectives, study rationale, principles of ethical research, face-to-face interviewing skills, as well as strategies for probing and maintaining participant engagement.

Qualitative interviewing is traditionally built around scientific method, personal skills and adherence to a somewhat mechanical set of rules of interviewing (Kvale and Brinkmann, 2009). We incorporated principles of neutrality in our interviewing pedagogy combined with an approach to interviewing that values and centres empathy and personal experience. Our training cultivated the principles of scientific rigour (such as unbiased interviewing) within the peer-interviewers, while allowing them the opportunity to use empathy in their encounters with participants. Interviewers will develop their own personal style which includes situated personal judgment when posing questions. Traditionally, qualitative interviewing aims for a style of ‘gently nudging without bias’ (Rapley, 2004: 20), encouraging participants to provide open and honest responses. The interviewer displays neutrality in the topic and responses to the questions, balanced with sufficient interest to allow reactive probing and encourage dialogue. When we engage peer-interviewers in a study we understand that they have personal experience which brings with it a strong connection to the topic under study. And, we acknowledge the value that experiential knowledge brings to the project and to peer-participant encounters. The dilemma for peer-interviewers, maybe more so than non-peers, is how to remain neutral in an interview given their heightened sensitivity to the topics under discussion. It is through our curriculum, and importantly through personal and guided reflections, in the form of journaling and debriefing, that we encouraged peer-interviewers to assess, re-assess, and improve their interviewing skills.

Kvale and Brinkmann (2009) suggest that knowledge is socially produced in qualitative interviews and goes beyond a mechanical set of rules of engagement. Insider knowledge of the topic of the interview allows a peer to pose relevant questions to an interviewee’s answers in the moment. According to Kvale and Brinkmann (2009: 82) if we merely view ‘scientific method’ in a mechanical way (following rules, for example) then ‘the production of knowledge through personal interaction is not a legitimate scientific method.’ Yet, good qualitative interviewers have special skills that allow them to engage meaningfully with interviewees. Kvale and Brinkmann (2009) argue that qualitative interviewing is akin to a craft, a skill learned as an apprentice. We concur with their argument that the medium of the interview is language and personal connection/interaction. Peers bring particular skills to the interview that may not be technical but are the very reasons that we wanted them on our team. For example, language is extremely important when we engage people experiencing multiple vulnerabilities, stigma and discrimination. Consulting with our peers on language helped us to create questions that would not be stigmatizing or patronizing for interviewees.

Peers may be better craftspeople or artisans than people without lived experience precisely because they bring a personal and deep knowledge of space and place of the lived experience. When interviewers offer their thoughts and own experiences, they begin to treat the participant as a human being and engage in a ‘cooperative, engaged relationship – centred on mutual self-disclosure – [that] can encourage “deep disclosure”’ (Rapley, 2004: 19). We hoped to meet a balance between neutrality and craft with the peer-interviewers who worked on the project. In adopting this pedagogy, we recognize and accept that peer-interviewers take on a task that even the most experienced interviewers may find challenging – we asked them to be neutral yet personable, while using their discretion to go ‘off script’. Peer-interviewers with relatable lived experience have an opportunity to do more than nudge gently; their experiential knowledge allows them to be more responsive to the interviewee’s answers.

Training took place in a group setting. Practice sessions helped peer-interviewers become familiar and comfortable with the interview materials, and gave then time to practice with interviewing and probing. To ensure validity and reliability, we provided training on establishing and maintaining rigor in qualitative research in relation to the peer-interviewer’s role in the discourse (Baxter and Eyles, 1997). Training extended into the field through an early-interview shadowing practice designed to enhance classroom learning and identify gaps in knowledge. A trainer observed the first interview with each peer, followed by post-interview debriefing and constructive feedback. Ongoing personal debriefing sessions and group meetings allowed the peer-interviewers to discuss skill progression and challenges. In our experience, the training agenda and scheduled debriefing with peer-interviewers was no more time intensive than the training and monitoring required for our previous qualitative projects.

Training also focused on self-awareness and reflexivity because there was potential for a peer to self-disclose their own lived experience during an interview. Peers needed to understand how to constructively channel their own experience into the research process without leading the participant or changing the tone of the interview. Training also helped the peer-interviewers to recognize appropriate moments for disclosure without introducing interviewer bias and when it would be purposeful. Peers may naturally reduce interviewer bias related to emotional reactions to participants’ answers to questions. For example, this peer-interviewer does not react emotionally to Spencer’s comment about suicide.

I was really, really intoxicated, I thought about like, committing suicide .

Peer-interviewer: Thanks for sharing that.

Yeah, I never told anybody that.

The ease of peer-interviewers to address sensitive topics in a more natural way may reduce the tendency to skip or re-word questions that may feel invasive or sensitive; interviewers without such experience might have a more emotional response (Krumpal 2013). Peer-interviewers were instructed only to disclose what they felt comfortable sharing and in situations where they felt disclosure would be helpful to the interview process. To help peer-interviewers decide on how much to disclose, we provided some reflective questions like ‘Why am I choosing to disclose now?’, ‘Do I think this will have a positive impact on the participant’s comfort and ability to talk further?’ The debriefing sessions and journaling allowed peer-interviewers to reflect on their self-disclosure.

Peer-interviewers were instructed not to counsel participants, which was difficult for those who had themselves participated in counseling or had taken counseling training.

Safety training and infield practices

Safety training sessions were conducted by the GSM and the research team. The GSM reviewed on-site safety protocols: people to contact during emergencies, panic button locations in interview rooms, protocol for emergencies if a panic button was not present, and the in-house verbal codes identifying the type of crisis. Their staff also trained peer-interviewers on protocol for meeting study participants onsite to ensure their own safety and that of shelter clients living onsite (for example, escorting study participants into, within and out of the building; visitor sign-in procedures). Furthermore, peer-interviewers were told how to contact on-site counselors if they, or the participant, experienced distress. Counselors were also available for peer-interviewers who might experience distress.

In-house safety training conducted by the research team covered both peer and participants’ safety. Peer-interviewers were required to call a designated member of the research team prior to the start of the interview while in the presence of the participant and then again at the end of the interview after the participant had left. Peer-interviewers learned how to identify and respond to participant distress (suicidal ideation, aggressive impulses) to assess potential for immediate danger to themselves, the participant, or others. Peer interviewers had access to onsite counselors and crisis intervention teams if immediate assistance was needed.

If peer-interviewers felt emotionally or physically unwell on the day of an interview, they were free to cancel the interview and were asked to follow up with their team contact. If a peer felt that their interview competencies were compromised in any way (for example, if a physical or emotional reaction was triggered by something the participant said or the participant’s emotional or behavioural state such as intoxication) s/he was instructed to end the interview and leave the environment. Peer-interviewers were provided with techniques to gracefully end an interview should they feel that their own safety or that of the participant was in jeopardy (such as telling the participant they did not have all the interview materials and could not proceed). Participants were told that they would have an opportunity to participate at a later date with a different interviewer if the research team deemed it safe. Peer-interviewers debriefed with the research team about the challenges of the interaction and had the opportunity for immediate counseling if needed. Peer-interviewers were also trained to withdraw from an interview if they were acquainted with the study participant and to reschedule the participant with another peer-interviewer. This ensured that there was no risk of potentially unsafe or inappropriate situations, and that the informed consent process was not compromised

Recovery safety: individual wellness plans

To ensure his or her ‘recovery safety,’ each peer-interviewer worked with a research staff member to develop a written wellness plan. The purpose was to provide an opportunity to reflect on areas of concern for their recovery well-being and create an action plan if they experienced distress (were in danger of relapse). Each interviewer wrote a four-section wellness plan. In the first section, peer-interviewers listed their known early warning signs (i.e. triggers) of relapse, taking into account the research topics and the interview environment. In section two they constructed a toolkit of coping strategies – mental (meditation), verbal (call to sponsor) and physical (meditation) – they previously used to de-escalate a stressful situation. In section three, peer-interviewers reflected on their situational confidence to stay safe considering what they had developed for sections one and two, in combination with what they had learned in the general and safety training. They also described high-risk situations previously experienced, that they might experience during the course of the study, and potential challenges these high-risk situations might have for their journey of recovery (such as their ability to identify and safely exit high-risk situations). They were also asked to think of situations or encounters they should try to avoid (for example, interviews with intoxicated participants). The last section of the wellness plan challenged the peer-interviewers to review their early warning signs in light of their toolkit of strategies and situational confidence to ensure that they had covered all potential high-risk situations and strategies to mitigate the associated risks.

The wellness plan was designed to be both proactive and reactive to the evolving research process and personal learning of the peer-interviewers. The wellness plan evolved in response to peer-interviewers’ lived experiences in the research process with new early warning signs and new strategies to address challenges to recovery added as the study progressed. Developing a proactive plan to monitor safety, recovery and potential relapse was important so that we could respond quickly if a peer-interviewer experienced a crisis. This was a substantial commitment from the research team, but one deemed integral to the safety of the peer-interviewers.

Participant experience

Peer-interviewers helped develop the language and structure of the interview guide during the preliminary interviews. Through early verification of interview data quality it became apparent that the peer-interviewers enriched the research process by providing an ‘insider perspective’ in the development of the data collection instruments. For example, they were able to create a mutual space wherein participants felt comfortable to share their experiences. While it is difficult to clearly establish that the rapport between the peer-interviewer and participant enriched the data we collected, we have a sense that the connection allowed participants to be open to a deeper and honest conversation as explained by Yuri:

You may not realize it now, but I’m telling you I’m getting a lot out of this. It has a lot to do with you making me feel comfortable in answering these things and giving me the opportunity to think about things going back, you know, 10-15 years. I found it very easy talking to you. I thought that the questions were not terribly intrusive or anything like that. I never felt compelled to distort the truth. I just said basically what I’ve wanted to say for years, and it made it feel better for myself.

The interviewers’ own experiences enabled them to interject with pertinent questions that probed further into the narratives of the participants and to clarify meanings of questions in appropriate language. The peer-interviewers were particularly good at this, asking non-leading questions (‘If I was going to be triggered by something I would visually see an advertisement that would tell me that the Lottery is coming, 50 million dollars, and I would be triggered to do that behaviour. So, that’s what I mean by triggering just to explain it a little bit clearer for you’). Interviewers interacted with study participants using their own experiences (‘yeah, it’s [crack] quite possessive. I understand exactly where you’re coming from. You never seem to shake ‘the demon’ as I used to call it’), and recognized moments when going ‘off the guide’ to create new questions was useful (‘Did you ever think about sober living type places? Have you ever tried those?’). Having lived experience enabled peer-interviewers to notice when participant stories might be inconsistent or relate to a particular pattern of behaviour; something they used to get deeper descriptions of the participant’s experiences. For example, asking about potential relapse experiences when someone mentioned the loss of a loved one.

Some peer-interviewers found that disclosure enhanced participant-peer rapport from the onset of the interview. Peer-interviewers were empathetic to participants yet were able to maintain professional decorum. Participants were responsive to such disclosure which seemed to put them at ease, viewing the peer-interviewer as someone who could relate to their own experiences.

Steve:

I don’t know if you know what crack does…

Peer-interviewer:

Do I know anything about crack? Yeah. As I shared before, I spent 15 years using crack. So, I’ve lost a lot.

Steve:

God bless. So you know what it’s like.

Peer-interviewer:

I can totally relate a lot with your own experiences. I lived in abandoned houses, and I used to sleep in my office when I was in sales, suffered from mental health issues, 11 years drug addiction, 11 years. So I totally understand where you’re coming from because I’m one of you.

Yuri:

Yeah, wow. No offense to you, but it’s comforting, you know?

The peer-interviewers completed journal entries about their experiences as interviewers and with the research process in relation to their personal journey of recovery and professional lives. Their connection with participants, insights about their own experiences, and skills they discovered, were themes in these journal entries.

Peer-interviewer:

I have always been confident entering practically any situation. Interviewing has helped build this confidence by giving me more skills to begin conversations and to keep them going. I learned most participants are eager and willing to share their experiences; some just need a little more encouragement than others. It has been a real pleasure to play the role of interviewer, to gain people’s trust and having them feel comfortable enough to share their stories without holding anything back. Being a peer-interviewer and doing these interviews has had an amazing profound positive effect on my recovery. It’s made me think deeper. It’s made me stronger. I value things I have taken for granted more than I have in the past. I’ve learned to be more caring.

Discussion and conclusion

Through this case study we demonstrate how peer-interviewers can be engaged as vital members of the research process. We also address the argument by Kelaher et al. (2010) to produce more research that specifically deals with the practical concerns associated with employing peer-interviewers. This method expands knowledge systems to include relevant experience. While we acknowledge the merits of self-reflexivity in qualitative research that aims to understand the experiences of marginalized groups, we strongly believe that it is important to find practical ways to enhance the role of personal experience in the social construction of knowledge and demonstrate how this can be done.

The peer-interviewers had intimate knowledge of many of the situations and marginalized identities experienced by study participants. Like Finlay (2002) and Tracy (2010), we argue that the peer-interviewers can improve the richness of qualitative data because they are able to establish deeper rapport with participants which enhances the process of sharing personal stories, if only because the rapport established helped interviewees to be more comfortable to talk openly about painfully difficult situations they had experienced. While it is difficult to clearly establish that the rapport that developed between the peer-interviewer and participant enriched the data we collected, we have a sense that the connection allowed participants to be open to a deeper conversation. Without a study that looks specifically at this question we can only surmise this is the case (a study that engages both qualitative reflexive interviewers and peer-interviewers in the same study to compare interactions with interviewees and explores the richness of the data collected). We feel community partnerships and peer-interviewer engagement are key to a well-rounded research approach – it is inclusive, it brings together various ways of knowing (knowledge of the service provider, the peer-interviewers and academic researchers). It was our intent in this project to be inclusive and to bring together these various forms of knowledge.

Peer-interviewers participated in the research design and data analysis, conducted the interviews, and provided valuable feedback to the research team. In doing so, they infused their lived understandings of problem gambling, housing instability, and addiction. We argue that this does not replace but rather complements traditional reflexive research practice by incorporating real life experience into interactions with participants. The mainstream academic members of our team played the role of attentive, interested, engaged listeners in our interaction with the peer-interviewers and with the stories emerging from the qualitative interviews. We respectively listened to and learned from the peers, absorbing their wisdom and ways of knowing; bringing together our multiple relational experiences and lived actualities which enhanced our reflexive research practice. Working closely with our community partner helped us better understand the situational experiences of our participants, further enhancing our reflexive practice. Building a complement of researchers from various identities (academic, non-academic, gender, ethnicity, lived experience) who are working to reduce health inequities associated with poverty and other forms of marginal status provided a means to engage in reciprocal reflection.

In order to conduct research that includes real life experience, we answered Denzin’s (2003) call to alter the way that researchers view authority over knowledge. By fully incorporating peer-interviewers throughout the research process, we situated knowledge production and possession in a different light. Specifically, that the peer-interviewers’ lived experiences were as valuable as the more traditional ways that knowledge is transferred and produced within academia. We encouraged the peer-interviewers to infuse the research with the richness of their experiences. While there were challenges associated with producing knowledge in a non-standard fashion, we argue that with careful planning and access to appropriate resources, encouraging peer-interviewers to bring their experiences to knowledge production is feasible and data enriching.

Although our use of peer-interviewing methods was positive, we acknowledge some challenges recruiting peer-interviewers. Remple et al. (2007) argue that recruitment of people with lived experience can be time consuming and more costly than traditional employee recruitment. To assist in recruiting candidates, we bypassed the use of a traditional hospital-based (widely distributed) job posting and used a more focused approach, reaching out to colleges and our own contacts to reach potential candidates. As a result, the applicant pool was far smaller than we normally achieve via postings through the Human Resources Department of our research institution, but we would argue much richer. We spent more time planning the recruitment approach including consultation with the hospital’s Human Resource and Ethics Review departments.

The comprehensive safety plan developed for this particular study was built upon existing safety practices that we had designed for previous studies (in-field safety checks, debriefing) recognizing the increased challenges that peer-interviewers may face. Greene et al. (2009; 2013) argue that participating in data collection can trigger negative emotions and threaten the safety and wellbeing of peer-interviewers. Our approach to working with peer-interviewers was proactive. We established detailed protocols through conversations with Human Resources, the Research Ethics Board and the Centre for Excellence in Peer Support with the Self Help Alliance (http://self-help-alliance.ca/services/centre-for-excellence-in-peer-support/). This reflection was quite beneficial, motivating us to prepare a course of action to address challenging situations that peer-interviewers might face (such as needing support after a triggering event); from the beginning of the study the peer-interviewers felt supported knowing that a concrete safety plan was in place.

While we acknowledge that we may face new challenges, our learning through engaging peer-interviewers and our new practice for training and safety protocols gives us confidence to embrace this practice in future studies. Proactive planning allowed us to ensure the safety of the peer-interviewers, collect rich and valid data, and meet projected timelines. Our approach can be used as a model for other researchers working with peer-interviewers. Our success with this project should also build confidence among other researchers, funders and reviewers to engage peer-interviewers as integral members of a research project.

Conclusion

We described our approach to engagement of people with lived experience with some practical guidelines. Our purpose was to show that qualitative researchers can move beyond common practices to include lived experience in the creation and interpretation of knowledge. We argue that the advantages of inclusion far outweigh the challenges. Thoughtful hiring practices, training, and proactive planning – all necessary components of any research project – make it possible to conduct rigorous qualitative research while engaging people with lived experience as peer researchers. Like Elliott et al. (2002), we maintain that such research practice is beneficial to all involved: participants experience an enhanced comfort with the research process; peer-interviewers gain professional competencies and feel included as knowledge experts; team members engage in meaningful ways with colleagues who can bring their personal subject area expertise to the project; and, the data becomes richer as peer-interviewers establish rapport with participants. In involving those with insider knowledge of the sensitivity of topics like addictions, mental illness and homelessness, the research process becomes more inclusive and respectful. Providing a supportive environment for peer-interviewers enables and encourages their recovery and personal and professional growth. In our experience the inclusion of peer-interviewers can enrich the lives of all team members and create a sense of comfort for participants who are given the opportunity to be heard by their peers and as a result feel genuinely understood.

Often, engaging people with lived experience is no different from our traditional approaches to building a research team. For example, hiring and research ethics processes are much the same. We have outlined some particular nuances of the research process that differ – mostly in relation to training to ensure the peer-interviewers have the tools and support to manage their recovery safety and their disclosure of their lived experience to participants. We argue that these are key considerations when considering peer-interviewers as their recovery safety is paramount. We feel strongly that the wellness plan is key, and an obligation of the research team, to support peer-interviewers to preserve their recovery well-being while they listen to the stories of their peers and encounter environments that may be difficult.

Footnotes

Acknowledgements

We are grateful to the men who shared their personal and difficult stories in the interviews. We thank the peer-interviewers who provided personal insights and a comfortable environment for participants to share their stories. The authors appreciate the support of the staff of Good Shepherd Ministries in Toronto, Canada who made it possible to complete this study through their enthusiasm, guidance and space to conduct the interviews. We extend our thanks to Allan Strong from the Centre for Excellence in Peer Support with the Self Help Alliance for advice on the safety resources we developed for the peer-interviewers. We would also like to express thanks Amy Katz for her input on language sensitivity for this article.

Funding

The Centre for Research on Inner City Health (CRICH) is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. The study was funded by the Ontario Problem Gambling Research Centre. At the time of the study Julia Woodhall-Melnik and Sara Guilcher were funded by the Canadian Institutes of Health Research Strategic Training Initiative. The opinions expressed in this article are those of the authors and independent from the funding sources.

Notes

Author biographies

Kimberly Devotta is a research coordinator in the Centre for Research on Inner City Health (CRICH) Survey Research Unit (SRU), St. Michael's Hospital. She has coordinated a mix of quantitative and qualitative studies for the unit, and has written training manuals and methodology reports to shape best practices.

Julia Woodhall-Melnick is a Post-Doctoral Fellow at CRICH in the Actions for Health Equity Interventions program funded by CIHR. Julia’s program of research is centered on measuring and conceptualizing meaningful definitions of place-based stability and exploring interventions for preventing homelessness and assisting unhoused populations.

Cheryl Pedersen is a research manager in the CRICH SRU. Cheryl brings to the SRU over 10 years of research management experience in the health care industry and has a particular interest in the social determinants of health and health equity.

Aklilu Wendaferew is the Assistant Executive Director of the Good Shepherd Ministries where he leads Department Heads and Program Managers to ensure implementation of the Good Shepherd’s mission, goals and strategic direction while overseeing the delivery of a wide range of programs and services. He has extensive experience in providing counseling and piloting counseling programs, having worked as a Clinical Social Worker, Program Supervisor, Family Counsellor and Mental Health Crisis Worker in a range of organizations.

Tatiana P Dowbor is the CRICH SRU Lead. She has a background in public health and her research interests lie within social determinants of health, health equity, immigrant health, research methodology and program evaluation.

Sara JT Guilcher is an Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto and an Adjunct Scientist at CRICH. Sara’s research interests relate to improving health service delivery for vulnerable populations.

Sarah Hamilton-Wright is a Research Coordinator at CRICH. She has a background in geography and a keen interest in qualitative research and innovative research methods. At CRICH, she has contributed to a range of studies that explore and further the understanding of the intersection of issues such as housing instability, complex needs, partner violence and problem gambling behaviour to people’s health and well-being.

Peter Ferentzy is a Scientist with the Centre from Addiction and Mental Health’s Social and Epidemiological Research Department. His dissertation is a historical sociology of the origins and development of the modern concept of addiction with an emphasis on how it has interacted with ideas about mental illness and compulsions in general. Dr. Ferentzy has published extensively on Gamblers Anonymous, as well as on the history of addiction. Ferentzy is author of Dealing With Addiction – Why the 20th Century Was Wrong, and co-author of The History of Problem Gambling: Temperance, substance abuse, medicine, and metaphors.

Stephen W Hwang is a professor of medicine at the University of Toronto and the Director of Centre for Research on Inner City Health, St. Michael's Hospital. His research focuses on improving the health of people who are homeless or vulnerably housed.

Flora I Matheson is a Sociologist and research scientist at the Centre for Research on Inner City Health, St. Michael's Hospital. She is also an adjunct scientist in the Mental Health and Addictions program at the Institute for Clinical Evaluative Sciences, and an Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto. Her research focuses on people facing imprisonment, homelessness, problem gambling, mental illness and substance abuse. She examines these health issues through a combined lens of sex, gender and the social determinants of health.

References

Baxter

Eyles

(1997) Evaluating qualitative research in social geography: establishing ‘rigour’ in interview analysis. Transactions of the Institute of British Geographers 22(4): 505–525

Benoit

Jansson

Millar

Phillips

(2005) Community-academic research on hard-to-reach populations: benefits and challenges. Qualitative Health Research 15(2): 263–282.

Brannick

Coghlan

(2007) In defense of being ‘native’: the case for insider academic research. Organizational Research Methods 10(1): 59–74.

Couch

Durant

Hill

(2014) Uncovering margnialised knowledges: undertaking research with hard to reach young people. International Journal of Multiple Research Approaches 8(1): 15–23.

Cloke

Cooke

Cursons

Milbourne

Widdowfield

(2000) Ethics, reflexivity and research: encounters with homeless people. Ethics, Place and Environment: A Journal of Philosophy and Geography 3(2): 133–154.

Delman

Lincoln

(2009) Service users as paid researchers. In: Wallcraft

Schrank

Amering

(eds) Handbook of service user involvement in mental health research. West Sussex Wiley, 139–151.

DeLyser

(2001) ‘Do you really live here?’ Thoughts on insider research. Geographical Review 91(1): 441–453.

Denzin

(2003) The cinematic society and the reflexive interview. In: Gubrium

Holstein

(eds) Postmodern interviewing. Thousand Oaks, CA: Sage, 141–156.

Dowbor

O’Campo

Firestone

(2014) Surveying hard-to-reach populations. CRICH Survey Research Unit Methodology Bits (2).

10.

Dowling

(2006) Approaches to reflexivity in qualitative research. Nurse Researcher 13(3): 7–21.

11.

Doyle

(1999) Empowering homeless women through academic research. Area 31(3): 239–246.

12.

Edwards

Alexander

(2011) Researching with peer/community researchers – Ambivalences and tensions. In: Williams

Vogt

(eds) The SAGE handbook of innovation in social research methods. London: Sage, 269–293.

13.

Elliott

Watson

Harries

(2002) Harnessing expertise: involving peer interviewers in qualitative research with hard-to-reach populations. Health Expectations 5(2): 172–178.

14.

Finlay

(2002) ‘Outing’ the researcher: the provenance, process, and practice of reflexivity. Qualitative Health Research 12(4): 531–545.

15.

Frankham

(2009) Partnership research: a review of approaches and challenges in conducting research in partnership with service users. Discussion Paper. NCRM. (Unpublished).

16.

Froonjian

Garnett

(2013) Reaching the hard to reach: drawing lessons from research and practice. International Journal of Public Administration 36(12): 831–839.

17.

Gallagher

Gallacher

(2008) Methodological immaturity in childhood research? Thinking through participatory methods. Childhood 15(4): 499–516.

18.

Goel

Salganik

(2010). Assessing respondent-driven sampling. Proceedings of the National Academy of Sciences of the United States of America 107(15): 6743–6747.

19.

Greene

Ahluwalia

Watson

Tucker

Rourke

Koornstra

Sobota

Monette

Byers

(2009) Between skepticism and empowerment: the experiences of peer research assistants in HIV/AIDS, housing and homelessness community-based research. International Journal of Social Research Methodology 12(4): 361–373.

20.

Greene

(2013) Peer research assistantships and the ethics of reciprocity in community-based research. Journal of Empirical Research on Human Research Ethics 8(2): 141–152.

21.

Heckathorn

(1997) Respondent-driven sampling: a new approach to the study of hidden populations. Social Problems 44(2): 174–199.

22.

Henwood

(2008) Qualitative research, reflexivity and living with risk: valuing and practicing epistemic reflexivity and centering marginality. Qualitative Research in Psychology 5(1): 45–55.

23.

Hodkinson

(2005) ‘Insider research’ in the study of youth cultures. Journal of Youth Studies 8(2): 131–149.

24.

Humphrey

(2013) Dilemmas in doing insider research in professional education. Qualitative Social Work 12(5): 572–586.

25.

Kelaher

Warr

Feldman

Tacticos

(2010) Living in ‘Birdsville’: exploring the impact of neighbourhood stigma on health. Health & Place 16(2): 381–388.

26.

Kilpatrick

McCartan

McAlister

McKeown

(2007) ‘If I am brutally honest, research has never appealed to me …’ The problems and successes of a peer research project. Educational Action Research 15(3): 351–369.

27.

Krumpal

(2013) Determinants of social desirability bias in sensitive surveys: a literature review. Quality & Quantity 47: 2025–2047.

28.

Kvale

Brinkmann

(2009) InterViews: Learning the craft of qualitative research. Thousand Oaks, CA: Sage.

29.

Lambert

Wiebel

(1990) The collection and interpretation of data from hidden populations. Washington, DC: United States National Institute on Drug Abuse.

30.

Magnani

Keith

Saidel

Heckathorn

(2005) Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS (suppl 2): S67–S72.

31.

Matheson

Devotta

Wendaferew

Pedersen

(2014) Prevalence of gambling problems among the clients of a Toronto homeless shelter. Journal of Gambling Studies 30(2): 537–546.

32.

Nind

(2014) What is inclusive research? London: Bloomsbury.

33.

Noy

(2008) Sampling knowledge: the hermeneutics of snowball sampling in qualitative research. International Journal of Social Research Methodology 11(4): 327–344.

34.

Padgett

(2008) Qualitative methods in social work research (second edition). Los Angeles, CA: Sage.

35.

Pitts

Smith

(2007) Researching the margins: Strategies for ethical and rigorous research with marginalized communities. Basingstoke: Palgrave Macmillan.

36.

Power

(1994) Some methodological and practical implications of employing drug users as indigenous fieldworkers. In: Boulton

(ed) Challenge and innovation: Methodological advances in social research on HIV/AIDS. Philadelphia, PA: Taylor & Francis, 97–109.

37.

Rapley

(2004) Interviews. In: Seale

Gobo

Gubrium

Silverman

(eds) Qualitative Research Practice. Thousand Oaks, CA: Sage.

38.

Remple

Johnston

Patrick

Tyndall

Jolly

(2007) Conducting HIV/AIDS research with indoor commercial sex workers: reaching a hidden population. Progress in Community Health Partnerships: Research, Education, and Action 1(2): 161–168.

39.

Shaw

(2003) Ethics in qualitative research and evaluation. Journal of Social Work 3(1): 9–29.

40.

Simons

(1995) Interviewing job applicants: how to get beyond first impressions. Cornell Hotel and Restaurant Administration Quarterly 36(6): 21–27

41.

Taylor

(2011) The intimate insider: negotiating the ethics of friendship when doing insider research. Qualitative Research 11(1): 3–22.

42.

Tracy

(2010) Qualitative quality: eight ‘big-tent’ criteria for excellent qualitative research. Qualitative Inquiry 16(10): 837–851.