Stigma Study

Topic guide for interviews with people enrolled in the SPNS program DRAFT 1/25/2016
This topic guide outlines the key domains to be explored during interviews with people enrolled in the med-HEART multi-site evaluation. Everyone who
consented to participate and had a baseline interview entered in REDCap is eligible to be enrolled in this qualitative aspect of the project. The purpose of the
qualitative study is to complement and further explore the findings of the quantitative module on stigma. Key areas of exploration are listed, with an
accompanying rationale. Given the explanatory nature of these interviews, which aim to pursue participants narrative accounts on stigma, this document will
act to guide, but not direct, discussion. The questions and prompts offer examples of ways in which we will elicit information during interviews. In line with
inductive qualitative research, the topic guide will be adapted throughout the data collection and analysis process, as key themes emerge for explanation of the
quantitative findings.
Interviews will explore experiences related to accessing medical care, housing, substance use and mental health treatment for homeless people living with HIV
through two main questioning strategies: (1) everyday experiences/accounts related to stigma, and (2) specific events and how routine or exceptional these
are related to health care and housing providers. For clarity, these are not differentiated in the topic guide but will be employed throughout interviews, asking
participants to give specific examples and to reflect on how their experiences differ by setting. 3) How stigma affects the clients/patients actions and/or
behaviors related to accessing HIV and other care, staying in care and adherence to treatment regimens.
Domain

Key areas of
exploration

Rationale

Example questions

Prompts/probes

Opening
discussion

Introduction

Establishing rapport;
making participant feel at
ease; leading into
subsequent discussion of
daily life/homelessness/
medical care/HIV/mental
illness/substance use.

How are you? Hows your day been today?

Thank you for agreeing to talk with

me today about your experiences
with health care and other providers
related to getting your needs met.
Our talk should take about one hour
and at the end you will receive a gift
card. If you have questions/concerns
or feel uncomfortable you can stop
me at any point. If you do not want
to answer any question you do not
have too. Any questions? None of
this information will be shared with
your providers and your answers will
not affect the services you receive
here or elsewhere.

Daily life

Concerns/ demands

Housing situation

Gaining a sense of
participants everyday life
with housing struggles;
competing challenges,
demands, and concerns;
how s/he views his situation

Is today a typical day? Whats a typical day

like?

Ask the person to describe the day

and give examples.

Stigma Study

HIV Care

Topic guide for interviews with people enrolled in the SPNS program

Access/frequency of
visits to medical
and other service
providers
Experience

Do they have a routine HIV

provider; what is their
experience with them?

DRAFT 1/25/2016

Tell me about getting HIV medical

care?

What do you like about the visits?

What dont you like?

What are some things that make getting

HIV medical care easy or hard?

Ask follow-up questions

What have your experiences been with

getting and using HIV-medical care
services?

Tell me about a good experience with

getting HIV medical care? How did
that experience make you feel?

How has that good experience affected

your going to medical care? Taking
your medications?

Tell me about a bad experience with

getting HIV care? How did that
experience make you feel?

How has that bad experience affected

your going to medical care? Taking
your medications? Keeping
appointments?

In general, how do you feel your HIV

medical team treats you? How do you
feel the other staff treats you? Can you
give me an example of how they have

e.g., Can you tell me more? Tell me

what you mean by that. Tell me more
about that experience.

Stigma Study

Topic guide for interviews with people enrolled in the SPNS program

DRAFT 1/25/2016

treated you?

Non-HIV
health care
providers

Access to care
(types of providers
seen, when were
they seen?)
Differences
between providers
seen

Finding out about getting

medical care from non-HIV
providers; who the client
sees for other medical care;
experience with accessing
medical care

How do you feel about interacting with

your HIV medical provider? What do
you like? Dislike?

Other than your HIV medical provider

do you have another health care
provider you see regularly? Tell me
where they are located and what
services you receive from them.

What kind of provider are they? Do you

see a clinician? dentist? for women:
gynecologist? Any other medical
providers?

What is your experience like when you

go to their office? How are you treated?

Tell me about any good experiences

with these health care providers. How
did those experiences make you feel?

How did the good experiences affect

your going to these medical providers?
Taking your medications? Keeping
appointments?

Tell me about any bad experiences with

going to these medical providers? How
did the good experiences make you

Probe: If they dislike ask if it makes

them want to avoid going to see the
provider?

Provide guidance regarding types of

providers. For example, primary
care provider, cardiologist, dentist,
gynecologist

Stigma Study

Non-regular
medical
providers
(e.g.
Emergency
department,
pre-hospital
care
providers,
in-patient
hospital
staff)

Topic guide for interviews with people enrolled in the SPNS program
feel?

Access to care
related to nonregular medical
care providers (e.g.
ED staff, EMTs, inpatient hospital
staff)
Differences in
experiences with
different providers

Finding out about getting

medical care from non-HIV
or non-regular care
providers; who the client
sees for other medical care;
experiences with accessing
medical care

How did the bad experiences affect

your going to these medical providers?
Taking your medications? Keeping
appointments?

How do you feel these health carel

providers treat you? How do you feel
the other staff of these providers treats
you? Can you give me some examples?

How do you feel about interacting with

these health care providers providers?
What do you like? Dislike?

Other than the providers mentioned

before have you received any other
medical care? For example, have you
been to the emergency department or
hospital or been transported by an
ambulance?

What services did you receive and who

provided them?

What have your experiences been with

getting and using medical care services
at these places?

Tell me about good experience with

getting care there? How did that
experience make you feel?

How has or will that good experience

affect your going to get care from them
again?

DRAFT 1/25/2016

Provide guidance regarding types of

providers. For example, ambulance
drivers, emergency department staff,
hospital staff

Stigma Study

Behavioral
Health Care
Providers

Topic guide for interviews with people enrolled in the SPNS program

Access to care
(types of providers
seen, when were
they seen?)
Differences
between providers
seen.

Getting specific information

on experience with
behavioural health care
providers.

Tell me about a bad experience with

getting care there? How did that
experience make you feel?

How has or will that bad experience

affect your going to get care from there
again?

How do you feel about interacting with

these medical care services? What do
you like? Dislike?

Other than medical providers do you

see a counsellor for substance use or
mental health?

What services do you receive and by

whom? (dont need to name provider by
name)

What have your experiences been with

getting and using [care from this
provider]?

Tell me about a good experience with

getting care from this provider? How
did that experience make you feel?

How has that good experience affected

your going to receive care from them?
Taking your medications? Keeping
appointments?

Tell me about a bad experience with

DRAFT 1/25/2016

Provide guidance regarding types of

providers. For example, a
psychiatrist, psychologist, substance
abuse counsellor, social worker

Stigma Study

Relationship
with health
care
providers

Topic guide for interviews with people enrolled in the SPNS program
getting care from your behavioral
health care provider? How did that
experience make feel?

Relationship and
interactions with
health care
providers

Treatment
(support, respect
trust)
Stigma,
discrimination

Relationship with various

health care providers; how
much they feel supported,
stigmatized, and in control;
and how these relationships
differ according to
individual characteristics
(health, access to care, drug
use, mental illness).

How has that bad experience affected

your going to your care provider?
Taking your medications? Keeping
appointments?

How do you feel the behavioral health

care provider treated you? How do you
feel the other staff treat you? Can you
give me an example of how they have
treated you?

How do you feel about interacting with

the behavioral health providers ? What
do you like? Dislike?

One of the things Id like to ask you about is

what your relationship is like with your
provider, day-to-day. (INSERT TYPES OF
PROVIDERS MENTIONED)
What is your health care provider like? How do
you get along with them?
Whats a typical interaction with the health
care provider like for you? Can you give an
example?
How would describe a good provider? How
would you describe a bad one?
What about other staff at the clinic/office?
How would you describe a good staff

DRAFT 1/25/2016

Lack of autonomy; environment/

conditions
PROMPT for each provider
Respect, trust, support,
stigma/discrimination, judgement,
negotiation/ control

Practical/emotional

Stigma Study

Topic guide for interviews with people enrolled in the SPNS program
member? A bad one?

DRAFT 1/25/2016

How do you feel about interacting with staff?

What do you like? Dislike?
If you need any help regarding your health or
other concerns, who do you usually ask? How
do you ask about it?
How about other people you know, do they get
on with their health-care providers the same
way as you do? If not why do you think thats
so?

Relationship
with housing
providers

Relationship and
interactions with
housing providers;
case managers

Hierarchy/power
Treatment
(support, respect,
stigma,
discrimination)

Finding out about

interactions with housing
case managers or other
housing providers; how they
feel supported and treated,
how control is exerted, and
how these relationships
differ according to
individual characteristics
(health, access to care, drug
use).

And what about your day-to-day relationship

with people who are helping you with housing?
(who has helped you and how have they helped
you?)

Treatment by shelter staff; treatment

by other housing providers;
transitional housing staff

Have you ever felt disrespected by a housing

provider or staff? Can you give me an example
of a bad situation you have had with a housing
provider?

Respect, trust, support;

stigma/discrimination; judgement;
hierarchy; negotiation;
power/control

How do you feel about interacting with housing

staff? What do you like? Dislike?

Practical/emotional

How does your experience with current

housing staff compare to past experiences?

Differences in treatment based on

mental illness or substance use
disorders

How have your experiences with housing

providers impacted you in terms of trying to
get permanent housing or temporary shelter.

Stigma Study

Closing
discussion

Topic guide for interviews with people enrolled in the SPNS program

Experience of
participating in
study
Other issues not
asked about
Desire to know
about findings

Asking participants to
reflect on their participation
in the study and talking
about their experiences, to
raise any issues not asked
about, and to find out if
they would like to be kept
informed about our findings

Were coming to the end of the interview now.

Thank you very much for your time and for
sharing your thoughts and experiences with
me.
When you feel that you have not been treated
well by any provider, how have you addressed
it and continue to get the services that you
need? Has anyone helped you with this? Who?
How do you see the next few months going?
After that?
How do you see your future? How would
you like it to be?
How do you feel about having participated
in this interview and talking to me about
your experiences? Was it what you
expected?
Is there anything else youd like to say, or
that you think is important? That I havent
asked you about?
Would you like to hear about what we find?

DRAFT 1/25/2016

Probe: Ask for examples as to how

they have addressed situation