Published in The British Medical Journal - 30th August 2021

We reported the qualitative aspect of this study according to the 32-item Consolidated Criteria for Reporting Qualitative Research checklist (online supplemental file 2).18 Box 1 describes the data collection process including the preinterview questionnaires (used to purposively sample participants; online supplemental files 3 and 4), semistructured interviews (topic guides in online supplemental files 5 and 6) and acceptability questionnaires (online supplemental files 7 and 8). In accordance with IPDAS guidance,9 10 semistructured interviews were used to assess patients’ views on decisional needs and health professionals’ views on patients’ decisional needs, gather feedback on the draft decision aid, and assess useability and acceptability of the decision aid. Participants were provided the draft decision aid prior to the interview but some participants did not review it beforehand. At the end of each interview, participants were given the opportunity to provide any additional feedback or comments. Changes to the decision aid were made throughout the interview process. Modifications were compared with older versions of the decision aid to understand whether changes were useful.

Box 1

Data collection process

Preinterview questionnaires used to purposively sample participants

For health professionals, we gathered data on demographics, profession, years of experience, clinical setting and number of patients with subacromial pain syndrome seen per year (online supplemental file 3). For patients, we gathered data on demographics (eg, age, gender), duration and severity of shoulder pain and previous treatments, previous imaging and previous sick leave for shoulder pain (online supplemental file 4).

Semistructured interviews

Interviews were used to gather feedback on the best way to present different aspects of the decision aid, such as treatment options, numeric estimates of benefits and harms, practical issues and questions to ask a health professional. Participants were then asked to ‘think out loud’ while they read through the decision aid. They were encouraged to say everything that came to mind (eg, concepts that might be challenging to understand, what their eye was drawn to) and give feedback on how the decision aid could be improved. The researcher conducting the interview used additional questions to prompt participants who were unsure of what to say. For example, some participants were prompted to give feedback on the relevance, usefulness, formatting, and language of each section, and the use of images. Interview guides for health professionals and patients are in online supplemental files 5 and 6, respectively.

Acceptability questionnaires

After the first round of interviews (n=12 health professionals; n=7 patients) and several redrafts, we began assessing acceptability with a brief questionnaire at the end of each interview because we felt we were getting close to the final version of the decision aid. A separate questionnaire, adapted from The Ottawa Hospital Research Institute,29 was used for health professionals (online supplemental file 7) and patients (online supplemental file 8).

All interviews were conducted one-on-one via videoconference due to COVID-19. All interviews lasted between 30 and 60 min and were conducted by a researcher with experience in conducting qualitative interviews (CJ). The interviewer was a female PhD candidate and occupational therapist. Two pilot interviews were conducted before recruitment to test the interview guides. During participant interviews, the interviewer took notes to highlight key concepts emerging from the interview and direct further questioning. The interviewer did not have an established relationship with participants prior to the study commencing. Participants were informed of the reason for the study prior to being interviewed. All interviews were audiorecorded (with verbal consent obtained from participants) and transcribed verbatim for analysis. All participants had the opportunity to review the transcript of their interview prior to data analysis if they wished. Health professionals and patients and who completed an interview were compensated for their time with a US$100 and US$50 supermarket gift card, respectively. Health professionals were compensated with more money to account for potentially sacrificing appointment slots to participate in this study.




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