Methods
Prior to the current study, a focus group of seven women were
interviewed in order to test the interview guide. One of the design
consequences of this initial focus group interview was to conduct single
interviews as to minimize influence from the other women. Therefore it
was decided to perform semi-structured individual interviews in the
current study (12,13).
Informants were purposefully sampled with four groups of pregnant women
based on the stage of pregnancy. The women in the first group were
interviewed at a pregnancy consultation at 28 to 37 weeks of gestation
concerning the mode of delivery. The second group comprised women at
term, scheduled for elective caesarean delivery. The third group
consisted of women in post-term pregnancies who were attending a planned
examination prior to induction of labour.
The women were asked about their preferences regarding timing of
prophylactic antibiotic treatment for caesarean delivery and asked to
elaborate on their choices (Appendix S1). In addition, we noted their
age, parity, and body mass index (BMI), but further demographics were
not collected to ensure anonymity of participants.
Sampling strategy and structure of the
interviews
Initially the women were contacted in person at the hospital when they
arrived for a scheduled appointment. The aim of the current interview
study was briefly outlined. If they volunteered to participate, they
were given the informational pamphlet intended for participants in a
possible future randomised trial on prophylactic antibiotics prior to or
after cord clamping at caesarean delivery (Appendix S1). Thereafter they
were given enough time to read the information undisturbed. The women
were interviewed using an interview guide, to ensure a focused interview
and that the same topics were discussed with all women (see Table S1).
However, the interview structure remained flexible, allowing for
follow-up questions to be asked if the women’s answers were unclear or
needed elaboration. It allowed the researcher to explore unanticipated
issues and to consider additional questions for the subsequent
interviews. The women were both thoroughly asked about their preferences
regarding antibiotic treatment and also about their attitudes to
participation in a future RCT. Only the first issue about the
preferences is discussed in this study.
The interviews were conducted from February to June 2020. All interviews
were audio-recorded, and subsequently transcribed verbatim and
anonymized by the first author. The women had no prior information
regarding the local antibiotic prophylaxis procedures, until after the
interview.
Additionally, post hoc interviews were performed where pregnant women in
various stages of pregnancy were asked about their views on the
neutrality and objectivity of the informational pamphlet (see Table S2).
Analyses
The analyses were performed by two authors, including the interviewer,
using a systematic text condensation approach described by Malterud (12)
to make a cross-sectional analysis of the interviews and to ensure a
systematic interpretation aided by NVivo version 12 by QSR International
(15).
First, themes were noted during a read-through of the
interview-transcripts. Second, coding was then conducted by identifying
and sorting meaning units - a text paragraph from the
interview-transcript contributing to illustrate the issue - on which the
main categories were based (Table 2). The main categories were divided
into two or three sub-categories, but these sub-categories were adjusted
if necessary, to ensure nuances of the answers were covered. When the
two authors had agreed on the final sub-categories, they were used for
the third step - condensation. Each sub-category was condensed in a
process described as making false quotations, which is an essential step
for the systematic text condensation approach. Finally, the condensates
were synthesized and recontextualised. Our recapitulations were
validated with the meaning units from the interview to ensure
accordance between the data and our recontextualization and
representative quotations were used as substantiation. The process
remained flexible as the authors discussed the interviews as they
progressed and if new themes emerged the above process was fully or
partially repeated.