The use of video observation in general practice research focuses interactions between technology, personnel, or patients and the practitioner (Spelten, Martin, Gitsels, Pereboom, Hutton & van Dulmen 2015). Communication research using video observation assists researchers to understand dynamics, communication techniques, skill development, and engage in reflective practice (Asan & Montague 2014; Macdonald, Stubbe, Tester, Vernall, Dowell, Dew, Kenealy, Sheridan, Docherty, Gray & Raphael 2013; Noordman, van der Weijden & van Dulmen 2014; van Dillen, Noordman, van Dulmen & Hiddink 2014a, 2014b, 2015; Verbiest, Chavannes, Passchier, Noordman, Scharloo, Kaptein, Assendelft & Crone 2014). Learning from experiences undertaking video-based research in this context, can enhance researchers' preparation and use of technology for this research.
Methods:
Video observation was used as part of a mixed methods study analysing lifestyle risk communication between nurses and patients during chronic disease consultations in general practices. The study was conducted in southern New South Wales, Australia in 2017. Video recordings were analysed using validated observational tools - the Behaviour Change Counselling Index (BECCI) and Nonverbal Accommodation Analysis System (NAAS) as well as content analysis (D'Agostino & Bylund 2011; Lane, Huws-Thomas, Hood, Rollnick, Edwards & Robling 2005). Video recorded general practice nurse (GPN)-patient consultations were recorded as a complete observer, using two Go Pro cameras with SD cards and a GPN operated remote control. Video recordings were stored and managed on a designated password protected laptop.
Results:
What worked?
Data quality, researcher preparation and allowance of time for recruitment and discussion proved valuable for the study’s success. Video observation is known to be a comprehensive data source (Caldwell & Atwal 2005). To achieve this, high quality video hardware and software selections are readily available and need not be costly. Modern video recorders were also found to be unobtrusive.
Adequate preparation through piloting the study components allowed understanding of contextual constraints and management of participant concerns regarding video data collection. Piloting assisted the researcher to determine issues such as setting variability, hardware attachment and portability, battery requirements and participant feedback regarding consent, data storage and management. In this way, preparation allowed the acceptability and feasibility of the technique to be determined (Spelten et al. 2015).
Practitioners are more concerned than their patients regarding participation in video data collection (Henry & Fetters 2012). Allocation of time to explain the research’s purpose and projected outcomes in relation to use of video assisted recruitment. Due to the hierarchical nature of general practice (Wood, Hocking & Temple-Smith 2016), time was required to allow dissemination of the study information throughout the practice and access to the study participants. Additionally, allowance of time is necessary for participant orientation to data collection and the researcher to conduct data analysis.
What didn’t work?
Barriers to conducting video observation research in general practice exist through video acceptability and recruitment. Despite efforts at the preparatory phase of the study, some practice managers, general practitioners and GPNs were still concerned about the intrusiveness of the technique and privacy issues, such as who would have access to the video recordings.
There are complexities in accessing general practice nurses for participation in research. (Halcomb, Salamonson, Davidson, Kaur & Young 2014). While both convenience and purposive sampling was undertaken, difficulties in accessing GPNs added time to the recruitment phase. Practice managers and general practitioners acted as gatekeepers to the practice, and had to be supportive of the project before GPNs and patients could be recruited.
The dynamic nature of consultation spaces also affected recruitment, a known influence of GPN roles (Pearce, Hall, Phillips, Dwan, Yates & Sibbald 2012). In order to meet the study’s aims and observational tool needs, when choosing camera hardware, consideration was given to what behaviours were to be observed and the likely movement patterns of participants during targeted consultations. The layout of some consultation spaces included a treatment room with the capacity for frequent interruptions, thoroughfare or poor sound-proofing between treatment areas. Data collection in these settings had the potential to affect sound and video quality and confidentiality of those not involved in the study.
Other considerations
Issues relating to analysis and bias need to be considered when using video as a research method. Biases such as observer, reactivity and selection bias need to be controlled. Strategies to control bias included the use of subsequent and multiple recordings of the GPNs as well as intra and interrater reliability when using the observational tools. However, selection bias was a concern where some GPNs were reportedly selective about which patients they approached for video recording.
Video observation can generate large amounts of data (Hostgaard & Bertelsen 2012). This data takes time to analyse, particularly if multiple cameras are used. However, the amount of data may be moderated by strict adherence to the research aims and observational tools used (Asan & Montague 2014). The visual nature of the data also necessitates consideration for confidentiality of participants during storage as well as analysis, where privacy is required.
Conclusion:
From our experience, video observation in Australian general practice requires context driven consideration during study preparation and the handling of data. Context plays a key role in hardware and software selections, as do challenges in recruitment. Researchers thinking of using video data collection methods need to consider these issues to ensure data quality and technique acceptability.
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