507301
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HPQ20810.1177/1359105313507301Journal of Health PsychologyGerakopoulou et al.
Article
Clustering of excess health concerns for electromagnetic fields among health personnel: A quantitative and qualitative approach
Journal of Health Psychology 2015, Vol. 20(8) 1060–1072 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105313507301 hpq.sagepub.com
Patricia Gerakopoulou1, Ioannis L Matsoukis1, Nick Giagkou1, Nick Dessypris1, Dimitrios C Cassimos2, ENIGMA Group1 and Eleni Th Petridou1
Abstract Clustering patterns, among health-care personnel, of excessive concerns pertaining to perceived electromagnetic field–related health impacts, as contrasted to those from other environmental factors, were explored. Knowledge/excessive concerns of 722 health-care personnel were assessed using a 22-item structured questionnaire along with a double-phase qualitative study comprising semistructured interviews and focus groups. Over 75 percent of the participants had high perceived knowledge, whereas accuracy was limited to 20 minutes/day). Finally, in addition to age, gender, current professional status, and place of residence, there was another set of 10 questions aiming to assess excessive health concerns on account of the following: (1) duration of an active mobile phone proximate to the body (yes: excessive concerns when the duration of active mobile phone was 3 hours/day); (2) health
impacts due to mobile phone use (yes: excessively or very concerned on the impacts, no: some or no concern); (3) the increasing number of mobile antennas used to improve the signal (yes: excessively or very concerned, no: some or no concern); (4) proximity of mobile phone base stations (yes: excessively or very concerned, no: some or no concerns); (5) mobile phone use by youngsters (yes: excessively or very concerned, no: some or no concerns); (6) perceived financial conflict of interest in EMF health research (yes: excessively or very concern, no: some or no concerns); (7) intensive monitoring of EMF health literature (yes: excessively or very intensive, no: some or no monitoring); (8) need for smoking cessation, especially in case of severe health problems (yes: absolutely or certainly necessary, no: possibly necessary or no need); (9) hygiene habits in the home/working environment and hand washing (yes: excessively considered if hygiene habits are strictly followed and hand washing >10 times/day needed, no: followed overall and hand washing 100,000 as baseline) and two composite scores pertaining to knowledge and behavior. The knowledge composite score is identical to the estimated “correct knowledge” above, ranging from 0 (lack of CK in any of the five related questions) to 5 (maximum knowledge). The behavior composite score comprised the three related questions described above and ranged from 0 (concerned behavior) to 3 (very relaxed behavior). Specifically, nonuse of mobile phone, minimal time of phone calls, and maximum use of mobile phone accessories all score “0” in the behavior composite index. The SAS statistical package was used in all analyses.
Qualitative research A qualitative approach aims at exploring “research questions” about peoples’ experiences and perceptions in order to come up with the essence of meanings and to understand how particular phenomena are generated in particular contexts. In this study, the quantitative methodology was used to explore whether there is a clustering of excessive health concerns among health personnel, whereas the qualitative design aimed to explore the perceptions, cognitions, and attitudes of pediatricians, in particular on the health impact of mobile phone use by eliciting in-depth understanding of the clustering results of the quantitative research. The sample was drawn from a homogeneous population sharing similar demographic, socioeconomic, and educational profiles. The rationale, similar to that employed when a social anthropologist conducts ethnographic research, was focused in one particular community identified by their professional role, notably Greek pediatricians. A sample of some 40 participants is considered adequate to produce a sufficiently penetrating analysis (Smith, 2010). Participants were selected for semistructured comprehensive interviews based on two sampling strategies: maximum variation and typical case (Greek pediatricians). Maximum variation was used for sex (male–female) and place of work (academic hospital, public hospital, private hospital/practice). The number of participants was determined by the saturation criterion or when additional interviews add no additional information. The IPA method was chosen in order to explore in depth how Greek pediatricians’ attitudes and social representations (Farr and Moscovici, 1984) regarding health impacts of environmental exposures, including EMF technology and mobile phone use, are constructed with focus on meanings, perceptions, knowledge, and social influences. Combining empathic with questioning hermeneutics (Smith, 2010; Willing, 2008) holding a debt to symbolic interactionism (Denzin, 1995) and having cognition
Downloaded from hpq.sagepub.com at TULANE UNIV on November 16, 2015
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Journal of Health Psychology 20(8)
as a central analytic concern (Fiske and Taylor, 2010), the method introduces a theoretical commitment to the person as a cognitive, linguistic, affective, and physical being assuming a chain of connection between people’s talk and their thinking and emotional state. It employs in-depth qualitative analysis and suggests a report of results related to interpretive phenomenology (Benner, 1994). The qualitative approach comprised two data collection methods and was conducted by a single interviewer. The first consisted of 18 semistructured individual interviews conducted with female and male pediatricians aged 35–45 years, lasting ~60 minutes, each conducted in four cities across the country, in which ~60 percent of the Greek population reside. Specifically, 15 were conducted with pediatricians practicing in the capital city of Athens, one with a pediatrician practicing in Salonika, one in Larissa, Greece mainland, and a last one on the island of Corfu. In the second approach, 22 experienced and active-in-the-field pediatricians were recruited to participate in three focus groups, lasting ~90 minutes per session, grouped according to their work environment: public, private, and academic hospitals. Semistructured interviews were used as a flexible data collection instrument in both instances. The investigator had prepared a set of questions on an interview schedule, but the interview was guided by the schedule rather than be directed by the investigator (Breakwell, 2006). The interview schedule was designed to explore individually (1) pediatricians’ attitudes, knowledge, and perceptions on the subject of EMF in general; (2) pediatricians’ perceptions, cognitions, and social representations including supposing stereotypes on the exclusive subject of mobile phone use; (3) the level and type of exposure to information on the subject; (4) emotional responses; and (5) everyday behavioral concerns. The aim was to enter, to the extent possible, the psychological and social world of the respondents, the latter perceived as the experiential experts on the subject and therefore allowing maximum opportunity to discuss their
own ideas. The moderator explained to the pediatricians why they had been selected to participate in the qualitative research, informed them that there were no “right” or “wrong” answers, and asked them to express their views freely, ensuring confidentiality. The interviewer made an initial probe by asking the participant to speak about the first three words that come automatically to mind in reference to EMF exposure and mobile phone use. The discussion revolved around the themes raised by participants, but the interviewer were instructed to gently divert the discussion, when necessary, to the topics included in the interview guide carefully structured in advance after literature review and three pilot interviews. All individual and focus group interviews were audiotaped with the participant’s consent and independently transcribed by the principal investigator. The level of transcription was generally at the semantic level: all words spoken including false starts, significant pauses, laughs, and other features worth recording. Thereafter, data were subjected to thematic content analysis. The aim was to understand the content and complexity of meanings rather than measure their frequency beginning by examining in detail at the transcript of one interview before moving on to examine the others, case by case. This followed the idiographic approach to analysis, beginning with particular examples and only slowly working up to more general categorization or claims (Smith, 1995). Consonant with the iterative process of the method, as the analysis continued, earlier transcripts were reviewed in the light of new superordinate themes, and instances from those earlier transcripts were included in the ongoing analysis. Data analysis guided by an interpretative phenomenological approach was based on the detection of meaningful speech fragments and their development into conceptual categories. Common categories were identified and compared to develop more general overarching themes. Subsequently, general hypotheses were formed and further investigated. The process was inductive in the sense that we moved from
Downloaded from hpq.sagepub.com at TULANE UNIV on November 16, 2015
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Gerakopoulou et al.
Table 1. Logistic regression–derived odds ratios (ORs) and 95% confidence intervals (CIs) for excessive health concerns by demographic and psychosocial variables. Variable
Category/increment
Age 10 years more Sex Male Female Country of residence Cyprus Greece Alternative to country introduced variable Population density at Urban areas (>100,000 place of residence population) Other areas (≤100,000 population) Knowledge score One level more knowledgeable Behavior score One level more relaxed
the synthesis of small conceptual units to the construction of more general categories of meaning and experience that reflected the individuals’ worlds. Qualitative analysis is not based on frequencies, but instead on identifying common themes in the data. Two qualitative researchers analyzed participants’ open-ended responses first regarding the “excessive concern” attitude or the “relaxed attitude” on EMF health risks and mobile phone use. Using a subsample, we developed categories, themes, and superordinate themes explaining the specific cognitions, representations, behaviors, and concerns related to EMF exposure, mobile phone use, and other social, medical, and media agents in a procedure akin to thematic content analysis. After generating these categories, two judges independently categorized responses into a list of themes and superordinate themes and the intercoder agreement was computed (by calculating the agreement percentage between coders), which was found to be acceptable. When there was disagreement between coders, the opinion of a third coder was used. The thematic content analysis allowed the emergence of and connections between themes that clustered together. As an adjunct to the process of clustering, directories of the participant’s phrases that support related themes were
OR
95% CIs
p-value
1.83 Baseline 0.86 Baseline 2.11
1.54–2.18
13
HPQ20810.1177/1359105313507301Journal of Health PsychologyGerakopoulou et al.
Article
Clustering of excess health concerns for electromagnetic fields among health personnel: A quantitative and qualitative approach
Journal of Health Psychology 2015, Vol. 20(8) 1060–1072 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105313507301 hpq.sagepub.com
Patricia Gerakopoulou1, Ioannis L Matsoukis1, Nick Giagkou1, Nick Dessypris1, Dimitrios C Cassimos2, ENIGMA Group1 and Eleni Th Petridou1
Abstract Clustering patterns, among health-care personnel, of excessive concerns pertaining to perceived electromagnetic field–related health impacts, as contrasted to those from other environmental factors, were explored. Knowledge/excessive concerns of 722 health-care personnel were assessed using a 22-item structured questionnaire along with a double-phase qualitative study comprising semistructured interviews and focus groups. Over 75 percent of the participants had high perceived knowledge, whereas accuracy was limited to 20 minutes/day). Finally, in addition to age, gender, current professional status, and place of residence, there was another set of 10 questions aiming to assess excessive health concerns on account of the following: (1) duration of an active mobile phone proximate to the body (yes: excessive concerns when the duration of active mobile phone was 3 hours/day); (2) health
impacts due to mobile phone use (yes: excessively or very concerned on the impacts, no: some or no concern); (3) the increasing number of mobile antennas used to improve the signal (yes: excessively or very concerned, no: some or no concern); (4) proximity of mobile phone base stations (yes: excessively or very concerned, no: some or no concerns); (5) mobile phone use by youngsters (yes: excessively or very concerned, no: some or no concerns); (6) perceived financial conflict of interest in EMF health research (yes: excessively or very concern, no: some or no concerns); (7) intensive monitoring of EMF health literature (yes: excessively or very intensive, no: some or no monitoring); (8) need for smoking cessation, especially in case of severe health problems (yes: absolutely or certainly necessary, no: possibly necessary or no need); (9) hygiene habits in the home/working environment and hand washing (yes: excessively considered if hygiene habits are strictly followed and hand washing >10 times/day needed, no: followed overall and hand washing 100,000 as baseline) and two composite scores pertaining to knowledge and behavior. The knowledge composite score is identical to the estimated “correct knowledge” above, ranging from 0 (lack of CK in any of the five related questions) to 5 (maximum knowledge). The behavior composite score comprised the three related questions described above and ranged from 0 (concerned behavior) to 3 (very relaxed behavior). Specifically, nonuse of mobile phone, minimal time of phone calls, and maximum use of mobile phone accessories all score “0” in the behavior composite index. The SAS statistical package was used in all analyses.
Qualitative research A qualitative approach aims at exploring “research questions” about peoples’ experiences and perceptions in order to come up with the essence of meanings and to understand how particular phenomena are generated in particular contexts. In this study, the quantitative methodology was used to explore whether there is a clustering of excessive health concerns among health personnel, whereas the qualitative design aimed to explore the perceptions, cognitions, and attitudes of pediatricians, in particular on the health impact of mobile phone use by eliciting in-depth understanding of the clustering results of the quantitative research. The sample was drawn from a homogeneous population sharing similar demographic, socioeconomic, and educational profiles. The rationale, similar to that employed when a social anthropologist conducts ethnographic research, was focused in one particular community identified by their professional role, notably Greek pediatricians. A sample of some 40 participants is considered adequate to produce a sufficiently penetrating analysis (Smith, 2010). Participants were selected for semistructured comprehensive interviews based on two sampling strategies: maximum variation and typical case (Greek pediatricians). Maximum variation was used for sex (male–female) and place of work (academic hospital, public hospital, private hospital/practice). The number of participants was determined by the saturation criterion or when additional interviews add no additional information. The IPA method was chosen in order to explore in depth how Greek pediatricians’ attitudes and social representations (Farr and Moscovici, 1984) regarding health impacts of environmental exposures, including EMF technology and mobile phone use, are constructed with focus on meanings, perceptions, knowledge, and social influences. Combining empathic with questioning hermeneutics (Smith, 2010; Willing, 2008) holding a debt to symbolic interactionism (Denzin, 1995) and having cognition
Downloaded from hpq.sagepub.com at TULANE UNIV on November 16, 2015
1064
Journal of Health Psychology 20(8)
as a central analytic concern (Fiske and Taylor, 2010), the method introduces a theoretical commitment to the person as a cognitive, linguistic, affective, and physical being assuming a chain of connection between people’s talk and their thinking and emotional state. It employs in-depth qualitative analysis and suggests a report of results related to interpretive phenomenology (Benner, 1994). The qualitative approach comprised two data collection methods and was conducted by a single interviewer. The first consisted of 18 semistructured individual interviews conducted with female and male pediatricians aged 35–45 years, lasting ~60 minutes, each conducted in four cities across the country, in which ~60 percent of the Greek population reside. Specifically, 15 were conducted with pediatricians practicing in the capital city of Athens, one with a pediatrician practicing in Salonika, one in Larissa, Greece mainland, and a last one on the island of Corfu. In the second approach, 22 experienced and active-in-the-field pediatricians were recruited to participate in three focus groups, lasting ~90 minutes per session, grouped according to their work environment: public, private, and academic hospitals. Semistructured interviews were used as a flexible data collection instrument in both instances. The investigator had prepared a set of questions on an interview schedule, but the interview was guided by the schedule rather than be directed by the investigator (Breakwell, 2006). The interview schedule was designed to explore individually (1) pediatricians’ attitudes, knowledge, and perceptions on the subject of EMF in general; (2) pediatricians’ perceptions, cognitions, and social representations including supposing stereotypes on the exclusive subject of mobile phone use; (3) the level and type of exposure to information on the subject; (4) emotional responses; and (5) everyday behavioral concerns. The aim was to enter, to the extent possible, the psychological and social world of the respondents, the latter perceived as the experiential experts on the subject and therefore allowing maximum opportunity to discuss their
own ideas. The moderator explained to the pediatricians why they had been selected to participate in the qualitative research, informed them that there were no “right” or “wrong” answers, and asked them to express their views freely, ensuring confidentiality. The interviewer made an initial probe by asking the participant to speak about the first three words that come automatically to mind in reference to EMF exposure and mobile phone use. The discussion revolved around the themes raised by participants, but the interviewer were instructed to gently divert the discussion, when necessary, to the topics included in the interview guide carefully structured in advance after literature review and three pilot interviews. All individual and focus group interviews were audiotaped with the participant’s consent and independently transcribed by the principal investigator. The level of transcription was generally at the semantic level: all words spoken including false starts, significant pauses, laughs, and other features worth recording. Thereafter, data were subjected to thematic content analysis. The aim was to understand the content and complexity of meanings rather than measure their frequency beginning by examining in detail at the transcript of one interview before moving on to examine the others, case by case. This followed the idiographic approach to analysis, beginning with particular examples and only slowly working up to more general categorization or claims (Smith, 1995). Consonant with the iterative process of the method, as the analysis continued, earlier transcripts were reviewed in the light of new superordinate themes, and instances from those earlier transcripts were included in the ongoing analysis. Data analysis guided by an interpretative phenomenological approach was based on the detection of meaningful speech fragments and their development into conceptual categories. Common categories were identified and compared to develop more general overarching themes. Subsequently, general hypotheses were formed and further investigated. The process was inductive in the sense that we moved from
Downloaded from hpq.sagepub.com at TULANE UNIV on November 16, 2015
1065
Gerakopoulou et al.
Table 1. Logistic regression–derived odds ratios (ORs) and 95% confidence intervals (CIs) for excessive health concerns by demographic and psychosocial variables. Variable
Category/increment
Age 10 years more Sex Male Female Country of residence Cyprus Greece Alternative to country introduced variable Population density at Urban areas (>100,000 place of residence population) Other areas (≤100,000 population) Knowledge score One level more knowledgeable Behavior score One level more relaxed
the synthesis of small conceptual units to the construction of more general categories of meaning and experience that reflected the individuals’ worlds. Qualitative analysis is not based on frequencies, but instead on identifying common themes in the data. Two qualitative researchers analyzed participants’ open-ended responses first regarding the “excessive concern” attitude or the “relaxed attitude” on EMF health risks and mobile phone use. Using a subsample, we developed categories, themes, and superordinate themes explaining the specific cognitions, representations, behaviors, and concerns related to EMF exposure, mobile phone use, and other social, medical, and media agents in a procedure akin to thematic content analysis. After generating these categories, two judges independently categorized responses into a list of themes and superordinate themes and the intercoder agreement was computed (by calculating the agreement percentage between coders), which was found to be acceptable. When there was disagreement between coders, the opinion of a third coder was used. The thematic content analysis allowed the emergence of and connections between themes that clustered together. As an adjunct to the process of clustering, directories of the participant’s phrases that support related themes were
OR
95% CIs
p-value
1.83 Baseline 0.86 Baseline 2.11
1.54–2.18
