Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

Between March 2007 and March 2008, a Masters-prepared nurse (KO) with qualitative research experience and with no previous connection to any of the interviewees, collected data using both focus group interviews (n = 21) and individual interviews (n = 16). Interview participants were assured that their responses would remain confidential and anonymous, and that responses would be linked to 'categories' only, not individual settings. Two focus groups were conducted at each site: one with physicians, and one with RNs and RTs. Individual interviews were conducted with the medical and patient care directors at each site, either in person, or later by telephone. The semistructured [9] interviews, lasting between 50 and 75 minutes, centred on the perceived barriers and facilitators to MDI/spacer use. Separate interview schedules [see Additional file 1] were developed for each level of adoption (early adopters, adopting, yet to adopt). Probing questions were used to help illuminate statements given by participants that were incomplete, vague, or ambiguous [11] . A court reporter, an individual trained in the verbatim recording of the spoken word, was used to record the focus group interviews, and both electronic and print copies of the transcribed interviews were produced [12] . A digital recording device was used to record the individual interviews, which were later transcribed. All interview transcripts were checked for accuracy and completeness using line-by-line comparison between the audio recordings and written transcripts. At each site, interviews were conducted until data saturation occurred, that is, until no new themes emerged from the data [10] .