Data collection

Investigators from the chiropractic research center (SAS, RDV) conducted all interviews and focus group sessions during an intensive, week-long, site visit to CMSH designed for this purpose. Most interview sessions were conducted by a single interviewer (SAS). Individual interviews were completed with patients, family members, community stakeholders, administrators, and members of the medical staff. Professional staff and assistive personnel from the therapy department and registered nurses and licensed assistants from the nursing department completed role-specific focus groups. Interviews were completed in June 2015, with the DC interviewed at a later time following hire.

Investigators used a semi-structured interview guide with questions tailored to participant role. During the introductory portion of the interviews, the interviewers identified ourselves as a registered nurse (SAS) or doctor of chiropractic (RDV) who worked at the chiropractic research center so our professional backgrounds were apparent to participants. Participants were asked to speak freely about the topic of chiropractic care so that the research team could understand better how chiropractic might fit within the larger work of this healthcare organization. Participants were encouraged to voice both positive experiences or negative concerns about chiropractic and, when such personal reflections were accounted (especially in focus groups), the interviewers prompted the other participants to recount similar or differing experiences. Overall, participants seemed to have few difficulties in sharing their stories about chiropractic. Many people described how either they themselves or a family member had received chiropractic manipulations in the past, often attributing specific clinical outcomes to that chiropractic care. Further, several longer-term staff offered similar accounts of a past experience with a local chiropractor, which helped the researchers understand why some clinicians expressed caution about the new program.

During the interview sessions, several questions generated extended discussion about patient and provider expectations for the chiropractic program, including: 1) How do you think a chiropractor might help your/your patients’ current condition; 2) How will the inclusion of chiropractic services affect the delivery of patient care at this facility; and 3) If successful, what impact will the chiropractic program have on patient care? Interviews were audiorecorded digitally for transcription by a professional service (Way With Words, New York, NY, USA).