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International Journal of Nursing Studies 44 (2007) 1064–1070
The telephone interview is an effective method of data
collection in clinical nursing research: A discussion paper
Kimberly Musselwhite, Laura Cuff, Lisa McGregor, Kathryn M. King
Faculty of Nursing and Department of Community Health Sciences, University of Calgary, 2500 University Drive, NW,
Calgary, AB, Canada T2N 1N4
Received 31 January 2006; received in revised form 24 March 2006; accepted 20 May 2006
There are varying points of view regarding the advisability and utility of using the telephone to conduct research
interviews. When undertaking the Women’s Recovery from Sternotomy Study, we found the telephone was an effective
mechanism for data collection. Our aim is to identify the advantages and challenges of using the telephone as a mechanism
for data collection in clinical nursing research. The potential benefits associated with using telephone interviews as a
mechanism of data collection include (a) using economic and human resources efficiently, (b) minimizing disadvantages
associated with in-person interviewing, (c) developing positive relationships between researchers and participants, and (d)
improving quality of data collection. The potential challenges to telephone interviewing include (a) maintaining participant
involvement, (b) maintaining clear communication, (c) communicating with participants who offer extraneous information,
(d) encountering participants with health concerns, and (e) communicating with a third party. Telephone interviewing can be
an effective method of data collection when interviewers understand the potential benefits as well as challenges. We offer
solutions to the identified challenges and make pragmatic recommendations to enhance researcher success based on the
current literature and our research practice. Supportive training for interviewers, effective communication between
interviewers and with research participants, and standardized telephone follow-up procedures are needed to ensure successful
telephone data collection. We have found our ‘Manual of Operations’ to be an effective tool that assists research assistants to
meet the requirements for successful telephone interviewing.
r 2006 Published by Elsevier Ltd.
Keywords: Telephone interviewing; Clinical nursing research; Data collection
What is already known about this topic?
interviews by telephone can be an
effective method of data collection in nursing
There are a number of potential benefits as well as
challenges to telephone interviewing.
What this paper adds
A literature review that demonstrates challenges can
be managed to optimize success in telephone interviewing for clinical research.
Practical suggestions on managing the challenges of
telephone interviewing to achieve a successful interview (with valid data).
1. Introduction
Corresponding author. Tel.: +1 403 210 3953;
fax: +1 403 210 3818.
E-mail address: [email protected] (K.M. King).
0020-7489/$ - see front matter r 2006 Published by Elsevier Ltd.
Using the telephone as a mechanism for data
collection in health research has increased in recent
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
years (Carr and Worth, 2001; Evans et al., 2004;
deLeeuw and Hox, 2004). Historically, the majority of
research examining the effectiveness of telephone interviewing has been focused on its use in market survey and
census (i.e., epidemiologic) research. Indeed, market and
epidemiologic survey research has been widely undertaken in North America and Europe (deLeeuw and Hox,
2004; Carr and Worth, 2001; Nathan, 2001). Though the
telephone interview can be useful to collect quantitative
and qualitative data (Burnard, 1994; Coderre et al.,
2004; Sturges and Hanrahan, 2004), less critical analysis
and research have been done examining its use in clinical
nursing research (Carr and Worth, 2001; Worth and
Tierney, 1993). There are particular issues associated
with collecting data for clinical nursing research over the
telephone. These include ongoing consent, interviewing
people at a vulnerable time (i.e., when ill or needing
special care), attending to clinical emergencies, and
managing confidentiality.
Through the Women’s Recovery from Sternotomy
(WREST) Study, we have recent experience conducting
telephone interviews with 480 women who underwent
cardiac surgery. The WREST Study was a multi-centre
clinical trial designed to test the effect of women’s use of
a special undergarment over a 12-week period poststernotomy (King et al., 2005). Informed consent was
obtained and each participant inducted into the study
pre-operatively. Data were collected in person while the
participants remained hospitalized. Following discharge,
WREST Study participants were then interviewed by
telephone several times throughout their post-operative
recovery. These interviews were conducted at regular
intervals from the participant’s first day home from
hospital to 12 weeks following surgery. More recently,
the study has been extended to include a 1-year followup telephone interview. On average, each participant
engaged in eight interviews with a telephone research
assistant (TRA). This experience of conducting telephone interviews with women recovering from cardiac
surgery ultimately led to the development of a telephone
interview manual to assist TRAs to adhere to a standard
of practice for the WREST Study and subsequent
telephone-based studies.
In this article we will identify the advantages and
challenges of using telephone interviews in clinical
nursing research, offer our pragmatic solutions to these
challenges, and make recommendations from both our
practice in clinical trials research and from other authors
experienced in this method of data collection.
2. Benefits of conducting telephone interviews for data
Telephone interviewing may be advantageous for
both researchers and study participants. Here we share
the benefits identified by other authors as well as those
found by the WREST Trial TRAs.
2.1. Using economic and human resources efficiently
Cost-effectiveness is the most frequently identified
benefit of telephone interviewing (Bauman, 1993;
Burnard, 1994; Corey and Freeman, 1990; Marcus and
Crane, 1986; OSU Bureau for Social Research, 2004;
Siemiatycki, 1979; Tausig and Freeman, 1988; Wilson
and Edwards, 2002; Wilson et al., 1998). Using the
telephone as a conduit to study participants is less
expensive than requiring the participant or the research
associate travel for an in-person meeting. Marcus and
Crane claimed that relative to in-person surveys, using
the telephone could reduce data collection costs by
50–75%. Use of the telephone allows interviewers to
cover a greater geographic area (Burnard, 1994; Wilson
and Edwards, 2002) in a timely fashion, rendering a
more efficient data collection process (Bauman, 1993;
Burnard, 1994; OSU Bureau for Social Research, 2004).
Moreover, when the participant is asked to travel to an
interview location, expensive clinic space is often
required. When the telephone is used, the costs of travel
and potential lost time are forgone and convenience is
greatly enhanced. This was particularly so when undertaking our multi-centre clinical trial (King et al., 2005).
Interviews conducted by telephone may also be
completed at a faster pace than those undertaken inperson (Wilson and Edwards, 2002; Worth and Tierney,
1993). The use of telephone interviews for the WREST
Study allowed several centrally located and well-trained
TRAs to speak with women from 10 centres across
Canada, across four different time zones, at times which
were convenient for them. We occasionally found that
participants were not feeling well enough to participate
in scheduled interviews, especially early in their recovery
period. An advantage of telephone data collection is that
a second call could readily be arranged. Alternatively,
when participants were feeling better, they could use our
toll-free number to return our call. Using this strategy
and others identified here led to favourable response
rates (489%) during the WREST Study.
2.2. Minimizing disadvantages associated with in-person
The absence of face-to-face contact during a telephone interview can be advantageous to the research
process. As necessary in our clinical trial, TRAs were
expected to meticulously record participant responses on
the data collection forms. Similar to Smith’s (2005)
observations, we found that the WREST Study TRAs
could take interview notes discreetly, without making
the participants feel uncomfortable. Using the telephone
for data collection interviews may also reduce some
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
forms of response bias (i.e., through facial expressions or
social desirability), as the interviewer and participant are
potentially less affected by each other’s presence
(Marcus and Crane, 1986). This, in turn, may increase
the level of comfort for both parties and result in a more
relaxed interview (Bauman, 1993; Smith, 2005; Tausig
and Freeman, 1988). Also, the anonymity associated
with telephone contact may enable participants to be
more forthcoming with their responses (Sturges and
Hanrahan, 2004).
Researcher safety has also been cited as an advantage
of using telephone interviews to collect data (Corey and
Freeman, 1990; Evans et al., 2004; Marcus and Crane,
1986). Rather than having research assistants travel to
locales where safety cannot be guaranteed, telephone
contact may offer additional security. Nonetheless, over
the course of a telephone-based survey conducted by
Wilson et al. (1998) regarding continence care, several of
the male study participants became ‘‘over familiar’’ (p.
319) with the female interviewers. To assure the safety of
the WREST Study TRAs, interviews were conducted
from a central research office from which calls were
blocked from any caller-identification systems. A tollfree number was provided to participants in cases when
they were unavailable at the time of the call. Also, TRAs
were asked to reveal only their first names to participants and others who may answer the telephone.
2.3. Developing positive relationships between researchers
and participants
Appropriate and beneficial relationships can be built
over the telephone with study participants. Interviews
are more successful (i.e., valid and authentic responses
are gleaned to interview questions) when a relationship
is established (Carr and Worth, 2001; deLeeuw and
Hox, 2004; Evans et al., 2004; Sturges and Hanrahan,
2004). Though WREST Study participants had developed a rapport with the on-site data collector, the initial
telephone contact was particularly important. The first
phone call was the time at which participants formed an
important first impression of the follow-up (i.e., postdischarge) portion of the WREST Study that could
ultimately affect their ongoing participation. Many
women in the study stated they enjoyed the regular
contact with TRAs and appreciated the opportunity to
share elements of their surgical recovery. Other authors
have described how study participants can benefit from
being able to talk about their experiences and concerns
over the telephone (Worth and Tierney, 1993; Tausig
and Freeman, 1988).
2.4. Improving quality of data collection
Conducting telephone interviews from a central
location can improve the quality of data collected, as
it allows communication between multiple interviewers
and enables greater supervision of TRAs by the
investigators (Marcus and Crane, 1986; Wilson and
Edwards, 2002). TRAs receive ongoing training and
support, which has been cited as essential for perceived
job success (Marcus and Crane, 1986; Wassink et al.,
2004). Moreover, inter-rater reliability can be more
readily determined, as is essential in any clinical trial.
Finally, while undertaking telephone interviews to
collect data is more time consuming than using mailed
questionnaires, telephone interviews may reach a wider
spectrum of the population as the respondents are not
required to read or write (OSU Bureau for Social
Research, 2004). As early as 1979, Siemiatycki concluded that the quality of the information obtained in
telephone and in in-person interviews was comparable
and the extra expense of home visits was not justified.
Response rates for telephone interviews have been
described as ‘moderate to high’ (OSU Bureau for Social
Research, 2004) relative to other methods.
3. Challenges to conducting telephone interviews for data
Upon our review of the relevant literature and our
extensive experience, we became aware that there are
potential challenges to telephone interviewing. Here we
identify the challenges and our recommendations for
3.1. Maintaining participant involvement
As early as 1986, Marcus and Crane observed that
telephone interviews may elicit a lower rate of cooperation as do in-person interviews. Some authors have
noted that a rise in the number of unsolicited (or ‘cold’)
calls received in today’s homes (Carr and Worth, 2001;
Evans et al., 2004) may dissuade potential participants
from agreeing to a telephone interview. Survey methodologists have studied introductions made over the
telephone. They concluded that a ‘not selling anything’
introduction can be very useful in soliciting cooperation
from those receiving an unsolicited phone call (deLeeuw
and Hox, 2004). We contend that telephone interviews
elicit similar and possibly higher response rates when
well-established procedures that focus on consistent
courtesy and respect for study participants are in place.
In our experience with the WREST Study, no ‘cold
calls’ were made; study participants were recruited inperson by trained research assistants who advised
participants of the interview schedule. Smith (2005)
claimed the two primary reasons for non-response to
telephone interviews were that the participant had
forgotten or that unforeseen events prevented them
from being able to keep the appointment. We found that
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
non-response to calls was usually the result of one of
three situations: (a) participant activities conflicting with
scheduled interviews, (b) participant confusion over
study procedures, and (c) participants feeling too ill to
engage in the call.
An important acknowledgement in the WREST Study
was that the participants could have limited recall of the
study procedures that were initially presented to them
during the hospitalization period. In any study, particularly in which participants are recruited during a
stressful time, participants may be unclear about the
duration of their participation and the number of data
collection points. For example, some women in the
WREST Study control group thought that they were
removed from the study because they did not receive the
experimental treatment. It was also crucial to emphasize
to these participants that without control group input,
sound experimental research would not be possible. As a
matter of maintaining participant involvement and
ethical procedures, TRAs reminded the participants of
the study aims, the work of participating in the study
(i.e., number of calls, amount of time, and nature of
questions), and that study participation was voluntary,
before beginning each interview.
One successful strategy used in the WREST Study was
to inform participants of all calling dates and allow them
time to write the dates down for reference. We also
ensured that the participant and/or family had the
telephone number (toll-free) of the central research
office should they have questions or concerns about the
study or wish to reschedule their ‘meeting’ with one of
the TRAs. Early in the telephone WREST Study data
collection process, the TRA also determined if the
participant had a preferred calling time. For example,
calls that were scheduled soon after hospital discharge
often needed to be scheduled around rest periods or
visits from homecare nurses. Thus, the participants’
preferred calling times often changed as the surgery
recovery period progressed. All information regarding
preferred calling times or calling date changes was
conveyed to other TRAs. In any nationwide study, TRA
knowledge of time zones and participant location is
A number of factors contribute to participant
unavailability. In the WREST Study, these included
rehospitalization, change of residence, return to employment, travel, as well as death. At the time of recruitment,
we asked all study participants to identify an alternate
contact person. Having this information helped us to
ensure that participants and valuable data collection
opportunities were not lost or that families of participants who died were not contacted needlessly. It is
preferable that the alternate person is not someone
currently residing in the home of the participant (i.e.,
spouse). If the participant has returned to hospital, e.g.,
the spouse is less likely to be available to provide this
information. The WREST Study TRAs also learned to
balance the need to contact study participants with the
participants’ right to confidentiality. When making
contact with another family member or the alternate
contact person, it is important to leave only the most
relevant information with the individual taking the
message (this also applied to leaving messages on
voicemail) and to not enter into a dialogue about the
participant or her study participation.
3.2. Maintaining clear communication
Participants can be indecisive about providing responses to interview questions, particularly when engaging in telephone interviews. Clear and careful
articulation during the telephone call can reduce much
frustration and miscommunication. Older people and
those who are ill are particularly vulnerable to not
understanding when the interviewer speaks quickly,
unclearly, or seems impatient. In our experience, careful
TRA training regarding telephone communication was
imperative. Slowly and clearly articulating and repeating
the interview question, and allowing adequate time for
participants to consider the question and respond were
very helpful strategies for successful data collection.
Participants with hearing difficulties or for whom
English was not their first language could have difficulty
understanding some interview questions. TRA’s speech
rate and tone were modified to the listener’s capacity to
allow for maximum comprehension and make study
participation as easy as possible.
Unlike in-person interviews, multiple methods of
communication cannot be used during telephone communication. Changes in body language and other visual
cues that may indicate confusion, irritability, and so on,
are lost when undertaking telephone interviews (Carr
and Worth, 2001; Thomas and Purdon, 1994; OSU
Bureau of Social Research, 2004). Wilson and Edwards
(2002) recommended that researchers avoid the use of
complicated (i.e., multiple fixed-response questions)
questions when undertaking telephone interviews. Wilson et al. (1998) also endeavoured to reduce interview
confusion by requesting that participants bring a pen
and paper to the telephone to write down potential
responses (i.e., zero means none and 10 means worst
possible). McCormick et al. (1993) included prompts
within the questionnaires to remind interviewers to
review the categories periodically throughout the interview. We found all of these strategies helpful.
There may be situations where participants’ uncertainty appears to be a more global problem (i.e., they
present as confused and are unable to provide any
answers without prompting). In this instance, there may
be a physiological (e.g., pain) or psychological (e.g.,
stress) basis. If the participant does not appear to be in
distress or immediate danger (see below), an interviewer
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
may simply need to terminate the interview and
reschedule for a more appropriate time.
3.3. Communicating with participants who offer
extraneous information
Tausig and Freeman (1988) suggested that participants’ sensitivity to responding to intimate questions
can be minimized once a supportive relationship has
been built between the interviewer and the study
participant. As indicated earlier, relationship building
with participants was an integral part of conducting
successful interviews in the WREST Study. However, as
other authors have noted, the existence of a supportive
relationship may sometimes lead to another difficulty:
the amount of extraneous material offered by the
participant (Worth and Tierney, 1993).
Some study participants are easily engaged and may
have difficulty restricting their responses to the interview
questions; thus, limiting timely completion of the
interview. Howard et al. (1988) found that it was
sometimes difficult to complete the interview in the
desired time frame with participants who liked to discuss
their feelings and problems. The researchers attempted
to resolve this problem by asking the study participants
to refrain from discussing other personal matters until
the end of the interview. In such a situation, we found
the best approach was to politely and consistently
redirect the participant to the interview question.
3.4. Encountering participants with health concerns
When calling participants for health research, the
nature of the study questions may elicit participants’
inquiry about specific health issues. In some circumstances, WREST Study TRAs were asked to advise
participants about their health conditions and concerns.
The focus of the participants’ questions was usually on
general normal post-surgery recovery. WREST Study
participants, e.g., often asked if other people also suffer
from discomforts following sternotomy. The policy, as
written in our ‘Manual of Operations’ was that TRAs
were not to provide medical advice to study participants.
However, when participants were seeking reassurance
that their symptom was not unique, the TRA could
make a general statement such as ‘difficulty sleeping is
not uncommon in people who have had heart surgery’.
In some cases, participants had a serious medical
concern that warranted an appointment with their
healthcare provider. Much more infrequently, TRAs
could encounter a participant who presented in a
condition that required emergency care. TRAs in health
research should be aware of symptoms of serious and
urgent medical concerns that are relevant to the participants with whom they will speak. An algorithm of care
was created for the WREST Study TRAs to enable them
to determine if the participants’ presenting symptoms were
of a non-urgent or urgent nature. In one arm of the
algorithm, the participant was referred to her healthcare
provider. In more urgent situations, the participant was
strongly encouraged to contact a relative or friend
immediately for help or call emergency services. If the
participant was unable to make the call, the TRA could do
so with the participant’s permission. Thereafter, TRAs
made contact with the participant or named alternate
contact, to assure that care had been obtained.
To assist in documentation and follow-up of these
situations, the WREST Study research team created a
Recommendation for Urgent Care Form. The form
enhanced communication between TRAs. It also acted
as a quality assurance measure to ensure consistent and
appropriate care of study participants.
3.5. Communicating with a third party
Family members can be vigilant in protecting a study
participant from perceived intrusion and attempt to
block contact. During the WREST Study, we occasionally encountered this difficulty. Sometimes, the vigilant
family member was unaware of the participant’s
involvement in the study or was concerned that the
participant would find the interviews tiring. When this
occurred, it was important to maintain the participant’s
privacy, reminding the family member that the participant
had been informed of, and consented to, receiving calls
from our office. The toll-free number was then left for the
participant to return our call, or we arranged to call again
at a more appropriate time. In cases when a family
member persisted in rejecting our contact with the
participant, we would politely but firmly indicate that as
informed consent was obtained from the participant, the
decision to terminate study participation must, when at all
possible, be her decision. We would conclude the
conversation indicating the date of the next scheduled
interview. With careful and respectful perseverance, access
to the participant was often achieved. This situation
however, brought to light the importance of having family
members present at the time of consent or made aware of
a participant’s consenting to study participation.
In summary, challenges arise when conducting telephone interviews. We have offered recommendations for
researchers and interviewers to enhance the success of
using telephone interviews as a data collection method.
We have identified additional suggestions for successful
telephone interviews in Table 1.
4. Communication in research and the manual of
Communication between TRAs is essential for effective data collection. Over the course of the WREST
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
Table 1
Additional recommendations for conducting telephone interviews
Listen to another interviewer using study questionnaires, then practise the interview process to effectively prepare for the telephone
Arrange the research space in advance to ensure ease of accessibility to research tools and relevant notes, as well as privacy during
the interview (Smith, 2005).
Whenever possible, try to conduct interviews when participants can access a landline for cost, privacy, and safety reasons (Kuusela
and Simpanen, n.d.).
Ensure that it is a convenient time for both the interviewer and the participant before initiating the interview (Burnard, 1994; Smith,
2005; Wilson and Edwards, 2002). Do not start an interview without being sure there is enough time for completion. A participant
should not feel pressurized to quickly provide answers for the convenience of the interviewer.
Confirm that you are speaking with the correct person before commencing the interview—one family member in our study went so
far as to impersonate the participant.
Set the participant at ease by reviewing the aims of the interview (Burnard, 1994; Smith, 2005), reassuring the participants of their
anonymity (Wilson and Edwards, 2002), then begin the interview with more readily answered generic questions (Burnard, 1994).
Humour can be an effective tool when used appropriately.
If taking notes during the interview, inform the participant so they may be prepared for pauses during the conversation (Smith,
Always thank the participant for their time and assistance (Wilson and Edwards, 2002).
Write any additional notes immediately following the interview (Smith, 2005).
Each page of written records should contain a participant identifier. Paper can stack up quickly and there is potential for pieces to
be misplaced.
Study, five TRAs undertook interviews with women
following sternotomy. Thus, communication about how
the participants wished to be addressed, their preferred
calling times, as well as any potential concerns or
challenges were imperative. We have created a ‘Call
Report Form’ to accompany each participant’s file on
which important notes were written for the next
interviewer. We also implemented the use of a communication book for general information to be shared
amongst the team. These standardized mechanisms for
communication were invaluable to us.
Finally, comprehensive training or operational manuals are essential to the success of telephone interviews
and can enhance the interviewers’ feelings of support
(McCormick et al., 1993) and preparedness (Wassink
et al. 2004). Our ‘Manual of Operations’ was one of the
most important tools created in our research office. As a
result of our experiences during more than 2 years of
telephone interviewing for the WREST Study (and
others), this manual has been revised on a regular basis.
This manual was produced to assist new interviewers to
effectively collect data over the telephone. It contains
information about and expectations for telephone
etiquette, dealing with challenging situations, conducting a telephone interview with a participant, and
guidance for completing the various forms associated
with each of the studies managed from our office. The
manual has a general focus on telephone interviewing
and includes appendices pertaining to specific elements
from each study managed through our office. It has been
an effective tool in training our research assistants who
engage in telephone interviews, offers a foundation for
establishing consistency in interviews (including intraand inter-rater reliability), and serves as the basis for
ongoing feedback and evaluation of research assistants
associated with our office.
5. Conclusion
Telephone interviewing is an effective method of data
collection for clinical nursing research (quantitative and
qualitative) when interviewers are properly prepared.
Market survey and epidemiologic research has been
widely undertaken by telephone. However, undertaking
clinical nursing research by telephone mandates that
particular issues be addressed (i.e., ongoing consent,
interviewing people when ill or needing special care,
attending to clinical emergencies, and managing confidentiality).
In this article, we have described potential benefits
and challenges as well as proposed solutions associated
with undertaking telephone interviews. We have also
provided examples and recommendations from the
literature and from our own experience to assist
researchers considering using the telephone interview
as a mechanism of data collection for their own clinical
studies. In sum, using a combination of effective
communication and standardized procedures is essential
to the success of data collection by telephone. Specifically, when undertaking multi-centre trial research, we
found the telephone interview was an efficient, reliable,
and valid form of data collection. Moreover, when
K. Musselwhite et al. / International Journal of Nursing Studies 44 (2007) 1064–1070
participants have a good research experience, they may
be more open to participating in future studies.
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