Table 2.

Ensuring research integrity and rigor^*.

Issue addressed	Action taken
Informed consent	Interviewer (KW) reviewed informed consent form and Health Insurance Portability and Accountability Act (HIPAA) authorizations with potential study participants immediately prior to each interview
Separation of research and clinical care	Interviewer (KW) assured participants that: no interview data would be shared with their clinical care team nothing said in the interview would affect the patient’s clinical care Interviewer did not participate in any of study participants’ clinical care Instead of professional clinical attire, the interviewer wore street clothes and an identification badge during the interview
Transferability/ External validity	All interviews were audiotaped and transcribed verbatim. Each transcription was reviewed for accuracy against the corresponding recording by an investigator.
Protecting patient privacy	Proper names were replaced with pseudonyms
Reliability	Both investigators analyzed transcriptions independently and assigned initial codes
Credibility	Investigators met regularly to review the analytic codes and resolve discrepancies through discussion
Derivation of themes	Constant comparison was used to examine data within the same interview and across interviews
Confirmability	Audit trail included field notes and memos: Interviewer recorded field notes before and after each interview15 Interviewer recorded Initial memos after each interview reflecting on analytic thoughts, comparisons, connections, hunches, and speculations of the interviewer5 Analytical memo was written after initial coding for each interview Ad-hoc memos were written whenever a significant theme was identified
Objectivity	Field notes and memos emphasized self-reflexivity (the process in which the researcher critically examines how their own values, attitudes, and biases may influence their experience, conduct and interpretation of the interview)

^*The presentation of results meets the standards of the COREQ Checklist for Reporting Qualitative Studies.¹⁶