Setting
The study took place in the province of Nova Scotia. The larger study was designed to generate data about all facets of lesbian and bisexual participants’ experiences of seeking health care. A qualitative component provided information about participants’ interactions with health care workers and about individuals’ personal experiences of barriers to care. The proposal for study, the informed consent form, and all accompanying recruitment advertisements were approved by a university-level ethics committee.
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Sample
We publicized the study widely throughout the province at community organizations, at women’s clinics, on radio, at appropriate cultural events, and at selected family physician practices. Given the constraints of studying an invisible population, snowball sampling (ie, word of mouth) was used to recruit participants. Building trust with participants was foremost. When participants were initially contacted, the informed consent procedure was detailed and explicit.

Ninety-eight women were interviewed in two waves. First we interviewed urban women, and second we purposely spread out to rural areas to capture the diversity of lesbian and bisexual women. More than a third of the participants were added to make sure that rural areas were included. Although qualitative approaches typically employ small sample sizes, this study was also designed to obtain simple descriptive quantitative data.

Interviews
Semistructured interviews were used for face-to-face, audiotaped interviewing. Some of the core questions were derived from articles on lesbian health. The interview guide was reviewed by key informants for validity and then revised through pilot testing. General areas were demographic information, sexual orientation, general health care patterns, preferences for health care providers, disclosure issues, health care information, access issues, and important health care services. The general trend in the categories of questions was to ask an open-ended one (”Can you tell me about your experiences as a lesbian or bisexual woman seeking health care?”) followed by suggested prompts (”experiences with family physicians? specialists? emergency room personnel?”) or any other individualized prompts deemed appropriate by the interviewer.

Average length of interviews was 1.4 hours (range 45 minutes to 3 hours). All interviews were audiotaped; participants received a copy of the tape if they wished. flomax canada

Interviewing team
The interviewing team was composed of one lesbian, one bisexual woman, and two heterosexual women. All interviewers had Master’s degrees and were chosen specifically for sensitivity and skills in interviewing. Participants were interviewed singly by their choice of interviewer. I met periodically with the interviewers to review progress, monitor taping, and discuss emerging themes and special problems. The team and I kept extensive field notes, which served several functions: a detailed accounting of the research process, direction for further discussion, organizing strategies for incoming data, and the basis for thematic codes.

Analysis
Tapes were transcribed verbatim to create a hard text, which I reviewed for accuracy. Several levels of analyses were conducted: content, thematic, and discourse. The discussion in this paper is confined to thematic analysis. The analytic team reduced the interview material to several overarching themes. Working together, a research assistant and I started by locating all instances of talk about family physicians, further breaking the talk into several preliminary themes, or “start codes,” with examples. The codes were discussed and developed, and the transcripts were reviewed until saturation was reached for each final theme. omnicef antibiotic

This process is iterative, with researchers moving back and forth between text and analysis, creating the possibility of developing codes at any point. The procedure is aided by reviewing all field notes and by memos in a separate researcher’s journal outlining the progression of thinking about the content of the emerging themes. Quotes from each final code were then extracted from every transcript and collected in a separate quote file.
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Participants were involved twice: through individual contact and by being invited to a closed group meeting to discuss the findings. Once the interviews were completed, participants received reports of the findings by mail and received a health care kit we designed with information about health and community services. The findings are supported with quotes for each theme.