Mariangela Mazzi

A standardized approach to qualitative content analysis of focus group discussions from different countries

OBJECTIVE To describe the methodological procedures of a multi-centre focus group research for obtaining content categories also suitable for categorical statistical analyses. METHODS Inductive content analyses were performed on a subsample of 27 focus groups conducted in three different countries, the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona). The analyses of the subsample of focus group discussions were performed in five steps: (1) independent development of content categories in each of the participating centres, (2) obtaining consensus categories, (3) creation of a manual with coding rules and defining criteria for categories and subcategories, (4) assessment of inter-rater reliability to identify unreliable categories to be revised, and (5) repetition of inter-rater reliability assessment. RESULTS The resulting coding system considers five areas: non verbal communication, process oriented expression, task oriented or problem focused expressions, affective or emotional expressions, and physicians personal characteristics. It contains 12 categories of acceptable inter-rater reliability and 41 subcategories. CONCLUSION The coding procedures show how focus group data, obtained in an international multi-centre study can be analysed in a systematic way combining scientific rigour with the richness of data obtainable from qualitative methodologies. PRACTICE IMPLICATION The applied procedures may be helpful for multi-centre focus group research on other topics.

Does socioeconomic status affect the use of community‐based psychiatric services? A south Verona case register study

Objective:  To assess the effect of socioeconomic status (SES) on psychiatric service use in an Italian area with a well‐developed community‐based psychiatric service.

When coders are reliable: The application of three measures to assess inter-rater reliability/agreement with doctor-patient communication data coded with the VR-CoDES

OBJECTIVE To investigate whether different measures of inter-rater reliability will compute similar estimates with nominal data commonly encountered in communication studies. To make recommendations how reliability should be computed and described for communication coding instruments. METHODS The raw data from an inter-rater study with three coders were analysed with; Cohens κ, sensitivity and specificity measures, Fleisss multirater κj, and an intraclass correlation coefficient (ICC). RESULTS Minor differences were found between Cohens κ and an ICC model across paired data (largest margin=0.01). There were negligible differences between the multirater estimates e.g. κj (0.52) and ICC (0.53). Sensitivity analyses were in general agreement with the multirater estimates. CONCLUSION It is more practical to analyse nominal data with >2 raters with an appropriate model ICC for inter-rater studies, and little difference exists between Cohens κ or an ICC. PRACTICE IMPLICATION Alternatives to Cohens κ are readily available, but researchers need to be aware of the different ICC definitions. An ICC model should be fully described in reports. Investigators are encouraged to supply confidence limits with inter-rater data, and to revisit guidance regarding the relative strengths of agreement of reliability coefficients.

An empirical method to identify patterns in the course of psychotic episodes of people with schizophrenia.

Objective: This paper illustrates the process of constructing, selecting and applying simple measures in order to empirically derive patterns of course of psychotic episodes in schizophrenia.

Reassessing treatment environments after two decades: client and staff perceptions of an Italian community mental health service environment, then and now.

Community-based psychiatric services and programs developed in accordance with the 1978 Italian psychiatric reform have now been in operation for a quarter of a century. The paper presents the results of a study in which three treatment environments of South-Verona, i.e. a general hospital psychiatric ward, a community mental health center (CMHC) and two residential facilities have been investigated using the Ward Atmosphere Scale (WAS) and the Community Oriented Programs Environment Scale (COPES). Staff and patient ratings have been collected in the three environments thus allowing comparisons between respondents and settings. For the ward and the CMHC, whose staff had already been interviewed almost twenty years before, a comparison between studies was also possible. Results seem to show that original policies, attitudes and staff commitment have successfully survived the passage of time with only minor adjustments and that the single-staff module of South-Verona may have effectively contributed in this respect.