Workshop, step 2

Summary of the updated analysis of discussions with health professionals

1. Following the coding procedure of the first transcripts, we added two new themes:

• Underline text in blue for the new theme Authorities and governmental organization
• Underline text in red for the new theme Suggestions for support interventions

2. We decided to incorporate the previous theme Barriers for care and challenges related to identifying the target population in clinical settings (yellow) into the theme Communication and competence in clinical settings (red). The theme will change name so that it is instead Communication, barriers, and competence in clinical settings. Please continue to highlight it in yellow as previously, then we will have an easier time placing it into that, as a subgroup in communication, barriers, and competence in clinical settings later on.

The definitions of the two new themes are as follows:

• Authorities and governmental organization
  Here you place everything that involves statements related to the structure, processes, and competence in authorities and governmental organizations, including Migrationsverket (Migration Agency).
  
  
• Suggestions for support interventions
  Here you place everything that involves statements/answers about relevant support interventions for LGBTQ+ forced migrants. For example, in the end of each discussions we ask participants to suggest relevant interventions that may support the situation, health, and wellbeing of persons within the target population. Those statements are placed in this theme. Please note that the participants need to talk about it as a potential intervention, not just talk in general about important aspects of health services.

Here are the instructions, with updated versions:

Directions for the next step in the analysis of discussions

Thank you for participating in the first step of our analysis of discussions with health professionals. In the workshops we had together, we talked about our individually identified preliminary themes and settled on four preliminary themes that we all felt covered the content of the discussions. These four themes are summarized below.

In the next step in the analysis, we will all individually prepare by reading one transcript and code parts of the text with different colors representing the four themes. The section of text that we highlight in the transcript is called a meaning unit. You should aim to include as much of the context needed to understand it as an extracted part of the document.

A meaning unit can be a sentence, several sentences, or even one (or several) paragraphs. If you feel that a meaning unit that you have identified fits into more than one theme, you can highlight it as being part of all the themes you feel is appropriate. Please highlight the meaning units in the following colors:

• Blue for the theme Descriptions of the experiences within the target population
• Red for Communication, barriers, and competence in clinical setting
  • As a subgroup under this theme: Yellow for Barriers for care and challenges related to identifying the target population in clinical settings
• Green for Social support and support from non-governmental organizations through external resources/processes
• Underline text in blue for the new theme Authorities and governmental organization
• Underline text in red for the new theme Suggestions for support interventions

At the end of this page, you can read a summary of this step according to Malterud, which we are following. Malterud is the author of the analytic process called systematic text condensation.

Please note that we will now herafter refer to our five preliminary themes as code groups.

If you feel that some important aspects of the discussions are not highlighted sufficiently based on our four code groups as detailed above, then please write down you suggestions for more code groups. We will discuss this during our next meeting and if we feel it is necessary we have the option of revising the existing code groups, or alternatively, to add new code groups. Please feel free to be creative in this process.

We will discuss our coding processes in detail when we meet next time in January. Then, we will go through the transcript we have coded and settle on final a coding together.

The dates/times for the meetings planned for this spring is presented online at our website: https://www.rkh.se/workshops

Please write down the future dates and times in you schedule. If you are unable to attend some meetings, please contact Tommy and we will discuss it together to try and find a solution.

Looking forward to collaborating with you all!

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Please note that the last theme is closely related to some other themes. We will re-evaluate later in the analysis if this theme needs to be rephrased or merged with another theme.

Please note that we should strive towards less interpretation when we code. In other words, try to be mindful of keeping the coding close to the descriptions in the discussions, rather than you interpreting what they are saying.

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Here is a summary of how Malterud writes about this step according to systematic text condensation. I have highlighted some important information related to this step and your contibution.

Identifying and sorting meaning units – from themes to codes

We start by systematically reviewing the transcript line by line to identify meaning units. A meaning unit is a text fragment containing some information about the research question. Only parts of the whole text are meaning units. Not every element of a talk will include text of relevance or with contextual information. With the laundry metaphor, socks, underwear, T-shirts, blouses, and sweaters all represent different relevant types of clothing, while table- cloths and rags are not included for further management.

Meaning units, short or long, are not limited to sentences or remarks. You should rather include too much than too little. Then we start coding, which includes identifying, classifying, and sorting meaning units potentially related to the previously negotiated themes. We identify meaning units and mark them with a code – a label that connects related meaning units into a code group (which we previously called preliminary themes).

Be very flexible in the coding procedure. It is ok to change your mind many times. Therefore, do not discard too much text as non- meaning units too early on in the process – rather take too much than too little. We also reflect upon commonalities and differences within and across the coding groups. Creative development of codes, where you gradually change the sorting principles as you become aware of what the meaning units tell you, requires flexibility.

One meaning unit may be coded under several code labels. Yet, if double or triple codes frequently appear, codes are not sufficiently distinctive and should be reconsidered. So far, you should maintain a limited amount of code groups, labelling them as distinctively as possible, without too much overlap.