Table 3.

Steps taken in qualitative analysis to ensure rigor

Familiarization	The first stage entailed familiarization with the data, reading and rereading respondents’ narratives, noting salient ideas and patterns for an overview of all the data and generating of initial codes.
Development of initial codes	Three analysts experienced in qualitative research independently inductively coded 10 transcripts, and then met to review, compare, and define codes establishing inclusion and exclusion criteria for development of initial codes. The coding framework remained open to refinement as the analysis proceeded through constant comparison and inductive thematic analysis.
Systematic application of codes	Application of initial codes systematically to all the data, using constant comparison to move between individual narratives and the entire data set to ensure coherence and consistency in development of categories and themes.
Constant comparison	Through constant comparison of codes both within and across individual narratives, emergent and recurring patterns were merged into categories and themes drawn from the data.
Reviewing of themes	We compared and discussed interpretations to reach consensus, to further refine emerging themes, to assure accuracy between integration of data and interpretations, and to ensure that themes were appropriate.
Refining and linking themes	Ongoing analysis refining themes and links between themes to form the coherent overall story told by the analysis. Themes were inductively derived from the data.
Peer debriefing	To enhance credibility, each step of the analysis was reviewed in periodic meetings of the analytic team, and findings were discussed by the research team to ensure applicability and accuracy between integration of data and interpretation, verifying that assertions were supported by the data.
Use of quotes	Participants’ verbatim quotes are used to substantiate analytic findings, providing evidence of how the data built the interpretation.