This study uses the transcripts from a study which used in-person and video calls with people who have refractory irritable bowel syndrome (IBS) , to identify their opinions of hypnotherapy as a treatment option for their condition. IBS is a functional disorder of the gut and digestion characterised by abdominal pain, constipation and diarrhoea . It frequently leads to a number of behaviour changes, including socially inhibiting responses such as avoiding work situations, social situations and staying away over night for fear of a flare up of symptoms,  it is considered refractory if it has not responded to treatment after 12 month and an ongoing profile of symptoms has developed . People with IBS may consider their illness to be an embarrassing topic  and as such a sense of safety and privacy with the interviewer and in the location of interview may be important. Hypnotherapy, the use of suggestion, imagery and metaphors in the hypnotic state to create change, has a demonstrable effectiveness in the treatment of refractory IBS  which is recognised by its inclusion within the UK’s National Institute of Health and Care Excellence (NICE) guidelines . The source interview study received ethical approval under the University of Birmingham’s ethics procedures (reference ENR_15–1473).
Methods of source study
A convenience sample  of UK resident adults who self-identified as having a formal diagnosis of IBS which had not responded to pharmacological treatments after 12 months and who had developed a continuing symptom profile  and who had never received hypnotherapy for their condition were recruited. Recruitment was via a poster campaign and by contacting IBS self-help groups and Facebook groups. No incentivisation was offered to potential interviewees but compensation for travel costs incurred in attending interviews was available. Both verbal and written consent for the interview were taken, in the case of video interviews verbal consent was obtained prior to the interview and confirmed in writing by post.
Interviews were conducted either in-person or face-to-face via video call. The decision to use mixed interview modes in this piece of research was taken whilst the study was ongoing and was in response to a sudden recruitment influx from internet advertising (Facebook). It was judged important to capitalise upon this influx rapidly due to the possibility of loss of interest by potential interviewees as the result of the time lag.
The transcription started from the point on the interview when the first question was asked by the interviewer. It concluded when the interviewer turned off the recording device, which was done when the answer to the last question was given and the interviewer judged that the interviewee had finished on the topic. Preamble and postamble were unrecorded. The interviewees perceptions of the interview process were not actively sought. Short pauses in speech were not recorded in the transcript, however if a pause was deemed to be unusually long or to denote a higher than average amount of thought an ellipse was inserted. Laughter and audible sighing were recorded with a single word within the transcript but no notes on body language were included.
A two-stage process of coding was undertaken. This process started with open coding . Open coding involves a close read of the transcript to identify all statements, which are assigned a code. During open coding, codes are generated to fit the statements identified. For example, the statement “it’s got to the point that I know that whenever I’m eating out I know that I‘m going to swell” might generate the code ‘triggers for IBS’, and any subsequent statements regarding ‘triggers for IBS’ would then be assigned to this code. In this way 127 codes were generated. The second stage of the process was to reduce the codes by excluding any not relevant to the topics of interest, for example codes such as ‘non-IBS Life story’, and then amalgamating similar codes into a single code, so ‘massage’, ‘acupuncture’ and ‘meditation’ may all be combined under ‘complementary and alternative medicine (CAM)’. This left 79 codes. These transcripts were then coded again this time using the 79 codes only.
The same topic guide was used for both video call and in-person interviews. The same interviewer (MK) conducted and transcribed all the interviews. The idea to conduct the analysis of the two interview modes did not occur until after the coding had been undertaken. The full protocol of the study is available  as is the full source study .
Methods of the study
Six quantitative measures were used to assess the relative effect upon interviews of the mode of interview, these were: duration of interview in minutes, word count, speech rate, number of codes, number of statements and dominance. These were used to provide quantifiable data over a spread of measures. Two of these measures, duration [23, 25] and dominance,  have been used previously to assess the difference between interview modes. The addition of word count provides a balance to any potential biasing effect to the duration caused by the mode of interview, which if present would be highlighted by speech rate, a measure derived from word count and duration. There is no established practice of assessing the comparative depth and breadth of different qualitative methods, to be able to do this would help to identify some possible subtle impacts created by the different interview modes. To this end both the number of statements and the number of codes are used to act as proxy measures of depth and breadth respectively. An examination of the distribution of the word count data showed a skewed distribution and as such data is presented using the median. Excel 365 was used for calculations of totals and averages. Because of the small sample size no attempt to establish statistical significance was made.
Duration [23, 25] is a measure of the length of the transcribed portion of the interview in minutes, rounded to the nearest full minute. This provides a direct measure to compare the length of in-person and video calling interviews.
Word count is the total number of words said by both the interviewer and the participant. Word count provides a measure of how much is said in the interview, which may be different from the overall duration of the interview as some people will speak faster and slower or may take longer pauses .
Speech rate is a secondary measure calculated by dividing word count by duration to get the average number of words spoken per minute by both interviewer and participant. It is intended to identify whether the use of video calls effect the speed at which people express themselves.
Number of codes
A code is the designation applied to any number of comments in a transcript during the analysis phase which are under the same broad topic. There is a tradition of using the number of codes as a quantitative measure within content analysis  but this has not previously been used to compare modes of interview. The number of codes used on a transcript shows how much variety of discussion is present in that transcript, as such codes can be argued to be a measure of the material’s breadth of content, the more codes are present the greater breadth of material. Two levels of coding exist, the initial open coding and the second level of coding which is derived by reducing the initial open codes through removal of topics irrelevant to the aims of the study and by amalgamating similar codes, from here on this second stage of coding will be referred to as the amalgamated codes. The amalgamated codes are applied to the transcripts and will only record material which relates to those codes, meaning that everything recorded should be relevant to the area of interest to the study. This results in a set of codes which represent the range of discussion within the specific area of interest.
Number of statements
This is the number of statements relating to a code, it is a measure intended to give an idea of the depth and variety captured within the interviews. By using the number of statements as an indicator of how many different ideas or how much additional information was provided on a single code in this by the participants. In practice this means the code ‘ideal therapist’ may encompass multiple statements such as “they’d be able to provide evidence of qualifications” or “someone fairly sort of clean cut”.
As the transcriptions were analysed statements were highlighted and either assigned to an existing code or a code was generated for them. This was done within the Nvivo software package so the number of statements was recorded as analysis was conducted. This figure is distinct from the codes as a single code may have multiple statements in support of it e.g. 40 different codes to summarise the topics of 175 separate statements.
Broadly this metric can be said to represent the number of distinct comments made on a single topic. However, it is imperfect, there will be some instances where multiple comments on a point have been captured within a single statement as they are delivered within the same brief statement and conversely the same point having been made by the same participant multiple times at some remove from each other and thus have been recorded as multiple statements. The use of a single researcher for coding of the transcripts (MK) who was at the time of coding unaware of the statements ultimate use for this purpose will have meant a continuity of style across both in-person and video call interviews which is likely to standardise the error rate.
As statements are being used as a proxy for breadth and variety within the findings it is assumed that there will be only a correlation with the trend, rather than an absolute reflection of it, i.e. higher numbers of statements are likely to suggest more depth and variety but not give a precise indication of how substantial that is, as such small differences in cannot be taken to be meaningful, only large ones. This measure has yet to be validated over multiple studies or in the context of other potential metric or assessments of depth.
Dominance is a measure of the percentage of the interview that the interviewer is leading , this is a subjective measure but quantifiable none the less. Kvale observed that qualitative interviews are not inherently equitable and that the very dynamic of a researcher posing questions for a participant to answer was indicative of a domination . Transcripts of the interviews were analysed to identify verbal dominance within the interviews. Irvine’s definition of ‘floor holding’ was used to identify when the researcher was dominant, meaning that they were steering the exchange in some way or providing a summary, evaluation or assessment of the participant’s speech . The transcript was examined and all sentences by the interviewer which contained an element judged to fit the ‘floor holding’ criteria were copied to a separate file. Any small utterings, for example an ‘ok’ or a ‘go on’ which may have prompted the participant to continue but did not alter the direction of talk have been discounted. The number of words used whilst dominant by the interviewer has then been calculated as a percentage of the total words within the interview, giving a percentage of interviewer’s dominance within the exchange .