Table 1.

Steps to RAP informed clinical ethnography

Stage 1 Participant observer(s) (PO) conduct(s) informal interviews with and/or site visits to participating pragmatic trial organizations PO talks with a spectrum of study participants and visits staff meetings, observes clinical procedures, and/or conducts informal and semi-structured interviews with participants PO writes field jottings of observations and informal interviews, maintains logs of data collection activities and schedules, and digitally records semi-structured interviews for transcription PO presents field notes, logs, interview transcriptions, and any supporting material collected during the site visits to the Mixed Methods Consultant (MMC) MMC reviews the presented data and queries the PO to gain more insight into the data and its context. Suggestions for additional data collection may be provided by the MMC based on assessment of quality and lack of evidence of theoretical saturation

Stage 2 Depending on the pragmatic trial context (e.g., trial resources devoted to mixed methods analyses) qualitative data is subjected to immer-sion/crystalization, and/or focused thematic content analysis, and template analysis PO provides a preliminary interpretation of the meaning and significance of the data, which is organized as set of a priori and emergent themes and description of their interrelationships MMC then provides a preliminary interpretation of the meaning and significance of the data organized in the same fashion and attempts to triangulate findings from multiple data sources (observations, interviews, documents) PO and MMC then identify points of convergence and divergence in the two interpretations A discussion between PO and MMC then ensues until consensus is reached regarding the meaning and significance of the data Depending on pragmatic trial context (e.g., trial resources devoted to mixed methods analyses), if consensus is not achieved, PO conducts follow-up interviews and/or returns to the field sites to collect additional data that could be used to resolve interpretation divergence Depending on pragmatic trial context (e.g., trial resources devoted to mixed methods analyses), if consensus is achieved, MMC makes recommendation for identification of disconfirming cases. PO returns to field sites to collect information that could be used to construct such cases Depending on pragmatic trial context (e.g., trial resources devoted to mixed methods analyses), interpretation of study findings is presented to study participants to confirm validity and comprehensiveness

Stage 3 Analysis of qualitative data collected using RAPICE is then integrated with quantitative data to provide comprehensive understanding of implementation process and outcomes The understandings gained from methods integration is then applied to improve implementation outcomes (formative evaluation) or to address the key study questions related to implementation (summative evaluation)