Background
Methods
Qualitative approach | Phenomenology |
Research paradigm | Constructivism |
Setting | Study developed in a research group seeking to develop the use of qualitative research in adolescent psychiatry |
Ethical issues | The relevant French Institutional Committee of the Paris North University Hospital Group approved this study All patients and their parents provided written consent before inclusion |
Sampling strategy | Purposive sampling strategy: selective and deliberate |
Researchers first contacted clinicians at recruitment sites (Argenteuil and Remiremont Hospitals) where recruitment was planned and explained the study design and objectives to them in detail | |
Clinicians identified potential participants—adolescents and parents—whom they considered most likely to provide useful information | |
Clinicians mentioned the study to potential participants and gave them an information sheet about it | |
Researchers met each interested teen and his/her parents | |
To describe the study | |
To collect social and demographic data | |
To obtain their written consent | |
Inclusion/exclusion criteria | Adolescents between 12 and 18 years at the time of the interview |
Adolescents and parents must speak French fluently | |
Adolescents must not have an eating disorder (i.e., anorexia nervosa, bulimia, avoidant/restrictive food intake disorder, or another unspecified eating disorder) or a weight-related disorder such as obesity | |
Adolescents could have food-related symptoms and their effects on the family relationships would be part of our field of exploration | |
Adolescents must not present acute or severe psychiatric disorders—schizophrenia, bipolar disorder, or autistic spectrum disorders—(the focus of this study was not the adolescents’ psychopathology but rather the relevance of photo-elicitation in research in adolescent psychiatry) | |
Families must not have major dysfunctional patterns, such as neglect or abuse | |
Adolescents must be able to talk about their experience of family relationships around food and the family meal | |
Adolescents must have been receiving care for at least 6 months | |
Participants | Adolescents receiving psychiatric care in an outpatient setting and one or both of their parents |
All saw their psychiatrist at least once a month | |
All had chronic mental disorders that had begun during adolescence (depression, anxiety, social phobia, personality disorder). This diagnosis was made by each patient’s referring psychiatrist, according to DSM 5 criteria | |
None had a somatic disease | |
Data saturation | Data saturation according to the principle of theoretical sufficiency: |
When new participants were not adding anything significant to the database | |
When the themes obtained offered a sufficient explanatory framework in view of the data collected | |
Two further individual interviews were conducted with no new themes emerging, to ensure full data saturation | |
Data collection period | From April 2015 to November 2015 |
Data collection methods | Individual in-depth interviews using photo-elicitation: |
At the end of the preliminary interview, the adolescent was given a digital camera. They could refuse and use their own equipment (smartphone) if they preferred | |
Instructions: “You must take a photograph of the table after a family meal. The table should not yet have been cleared. No person should appear in the picture, so everyone at the table must have gotten up. You can take as many pictures as you want, but you will have to choose just one that you will talk about with the researcher at the interview”
| |
We chose to ask for a photo after the family meal to encourage a narrative of the entire meal | |
For ethical reasons, no person could appear in the photographs | |
Individual interviews a week after: | |
Of the adolescent and immediately after of the parent(s) | |
The selected photograph was displayed on a computer screen during both interviews | |
The interviewer began by asking the adolescent for a description of the family meal from which the photograph resulted | |
At any point during the interview, the interviewer and the participant could go back to the photograph | |
Individual in-depth interviews: | |
Unstructured, open-ended approach | |
One introductory prompt: “can you tell us about this family meal?” | |
To get rich and detailed personal data from each participant | |
To enter the interviewees’ psychological and social world | |
To remain open and attentive to any unknown issues that they might introduce | |
All interviews were: | |
Audio-recorded with participants’ permission | |
Transcribed word for word, including nonverbal aspects (pauses, laughter, etc.) | |
Anonymized | |
Interviewers | The same researcher (JS), an adolescent psychiatrist, conducted all the interviews |
Duration of the interviews | From 60 to 90 min |
Data analysis | Thematic analysis: |
To identify, analyze and report themes within data | |
To identify the similarities and the differences in the participants’ narratives | |
To discern recurrent patterns and to integrate new elements that emerged from the analysis | |
In a data-driven analysis with inductive approach = coding the data without any reference to theoretical notions or researcher’s preconceptions | |
Criteria to ensure validity | Analysis conducted independently by the three researchers (JS, EC, LP) |
To verify that the themes identified were an exact reflection of the data | |
Research group monthly meetings: | |
To discuss the results | |
To be supervised by a researcher more distant from the material (ARL) | |
To resolve disagreements on the inclusion or exclusion of a theme (discussion continued until a consensus was reached) |
Activities | Rationale | |
---|---|---|
Stage 1 | Repeatedly read each transcript, as a whole | Obtain a global picture of the interview and become familiar with the interviewee’s verbal style |
Stage 2 | Code the transcript by making notes corresponding to the fundamental units of meanings | Make descriptive notes using the participant’s own words |
Stage 3 | Make conceptual notes through processes of condensation, abstraction, and comparison of the initial notes | Categorize initial notes and reach a higher level of abstraction |
Stage 4 | Identify initial themes Provide text quotes that illustrate the main ideas of each theme | Themes are labels that summarize the essence of a number of related conceptual notes |
Stage 5 | Identify recurrent themes across transcripts and produce a coherent ordered table of the themes, gathered into domains of experience | Move from the particular to the shared across multiple experiences. Recurrent themes reflect a shared understanding of the phenomena among all participants |
Gender | Age | Body mass index (kg/m2) | Psychiatric diagnosis | Adjunctive treatment | Duration of treatment in months | Parental situation | Parents interviewed | |
---|---|---|---|---|---|---|---|---|
F1 | Girl | 18 | 19,6 | Depression | Sertraline 100 mg/day | 22 | Divorced | Mother |
F2 | Girl | 17 | 23 | Anxiety disorder | Individual psychotherapy | 8 | Divorced | Mother |
F3 | Girl | 16 | 21 | Borderline personality disorder | Individual psychotherapy, day hospital | 18 | Divorced | Mother |
F4 | Girl | 14 | 18.4 | Anxiety disorder | Fluoxetine 20 mg/day | 8 | Married | Father |
F5 | Girl | 13 | 21 | General anxiety disorder | Individual psychotherapy | 14 | Married | Parents |
F6 | Girl | 16 | 22.3 | Panic disorder | Individual psychotherapy | 12 | Divorced | Mother |
F7 | Girl | 17 | 21.5 | Borderline personality disorder | Individual psychotherapy | 6 | Married | Parents |
F8 | Girl | 15 | 19.6 | Depression | Individual psychotherapy, fluoxetine 20 mg/day | 11 | Married | Father |
F9 | Girl | 16 | 18.3 | Depression | Individual psychotherapy | 16 | Divorced | Mother |
F10 | Girl | 14 | 20.6 | Panic disorder | Sertraline 100 mg/day | 7 | Divorced | Mother |
M1 | Boy | 13 | 22.7 | Depression | Fluoxetine 20 mg/day, day hospital | 24 | Divorced | Mother |
M2 | Boy | 16 | 19.1 | Borderline personality disorder | Individual psychotherapy | 15 | Divorced | Mother |
M3 | Boy | 17 | 18.7 | Depression | Fluoxetine 40 mg/day, day hospital | 24 | Divorced | Mother |
M4 | Boy | 15 | 21 | Depression | Individual psychotherapy | 16 | Married | Father |
M5 | Boy | 16 | 19.6 | Borderline personality disorder | Individual psychotherapy, day hospital | 15 | Divorced | Mother |
Results
The role of photo-elicitation
Take a picture: participate in this study with pleasure and engagement
F1: “I chose that one because it’s beautiful, because I did it really well.”
M4: “Finally I opted for seeing everything that I usually see, so that we can do the best examination of the picture.”
F8: “I chose this picture because it is exactly what I see from my seat, it’s taken exactly as if it were my eyes.”
M2: “Why were we limited to a single picture? Me, I took lots of them, with a zoom, from above (…) do you want to see them?”
Mother of F1: “We were taken aback the day that she said, ‘don’t clear the table, I have to take a picture.’ I don’t know if her stepfather was more astonished by the story of the photo or by her attitude, how she took it to heart.”
The photographic image: a support for the narrative
F5: “I would never have imagined you could say so much about a photo!”
M5: “Do you see this fruit basket at the center? eh, I made it in school, for Mother’s Day, when I was in kindergarten.”
F2: “Ah that’s my mother’s, they are her yogurts and no one else can touch them!”
Mother of F3 (about Fig. 1 ): “I was wondering why she chose to keep that one; she took others, better … at least, in my opinion.”
Access to family interactions through the object that was photographed
The taking of the picture
M2: “I think my little brother also wanted to take pictures; so I asked for his advice and he was so happy. He had the idea of taking pictures of our two plates to show the difference, but my mother said it would be better to be able to see the whole table.”
M1: “Isn’t my dog’s head in this picture? Ah no! But at the beginning I had kept it but my mother must have deleted it when she was checking.”
F4: “…it was me! They were there, but I am the one who chose and who took the pictures.”
View of the family visible in the still-life photograph
F1: “A meal where we are all together because on Monday my mother has English and I have dance in the evening (…) Tuesday we are all together.”
F4 (Fig. 2 ): “ Breakfast with brother and sister… it’s an important moment for us, when the two of us are really together.”
F3: “I don’t know why I kept this picture. It’s true that the framing is bad, you could say it’s cut (…) But this table doesn’t hold four people. When my father still lived with us, we didn’t eat there anyway, we ate in the living room.”
Exploration of family interactions around meals and food
Parent–child relationship patterns
Express both difference from and resemblance to others by food
M4: “In fact, it works like that, I have to taste everything each time. My mother repeated it incessantly and now it’s like her voice is in my head.”
M1: “I began to invent recipes, just for me. Once I made a mixture of pears and potatoes in the blender.”
Food: expressing love within the parent–child relationship
Mother of F9: “there’s love in it, it’s nothing but love (…) because they know I sacrificed to make it…”
F5: “I don’t really like boiled beef (…) I make myself eat a little, because I know it makes her happy when I do.”
Functioning of the family group
Family cohesion and a relational game
F10: “Sometimes the meal is over but we stay there, we sit, and we talk.”
Father of F7: “That can be two minutes of screaming and two minutes later we are all going to laugh.”
Mother of F6: “There was a phase when she didn’t eat, at least, not in front of me, but there was this strange phenomenon of food that disappeared from the refrigerator.”
M2: “In fact, I have packages of chips hidden in my room (…) my mother yells at me but at the same time she laughs because she did the same thing when she was my age.”
Transmission and family history
Father of F4: “We are epicureans, when we get together for these occasions, and we have to transmit that to the children.”
Mother of F5: “There was also Grandma Alice’s apple charlotte, there’s something special when I cook these recipes.”
M1: “My father never let us have onions or butter. Now for example, we can make onion tarts often.”
F9: “My father is kind of random, my mother very straightforward. My mother is steak, salad, yogurt, and an apple; my father is an omelet and chips and then merguez mixed with anything.”
An individual relation to food
F7: “I think that my parents never made me eat something, so I always said, I don’t like it. But now I try, I verify if I really don’t like it….. and sometimes I like it and sometimes I don’t.
Mother of F6: “In fact, she is totally ‘I can make it but I’d prefer if you do it.”
F4: “First, I watched my mum and then she showed me and after that she let me do it, but stayed behind me. After that, she just watched and now I do it alone.”
F4: “With my friends, we talk a lot about food, we organize ‘crepe parties’ just for us, and it’s great.”
Mother of F3: “Yes, I cook brussels sprouts, I cook them for me; it would bother me to think that I deprive myself of something I like because of my daughters’ tastes… after all, the fridge is big enough.”