The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient-clinician interaction in primary care settings.
We reviewed studies in the literature which used video methods in health care research and, we also used our own experience based on the video studies we conducted in primary care settings.
This paper highlighted the benefits of using video techniques such as multi-channel recording and video coding and compared “unmanned” video recording with the traditional observation method in primary care research. We proposed a list, which can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles researchers should anticipate when using video recording methods in future studies.
With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilized as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.
Keywords: Primary care research, Video recording, ObservationsThe health care system is complex and involves a range of people from various backgrounds and perspectives who communicate, interact, and collaborate. Several US Institute of Medicine reports have addressed major problems in healthcare delivery, such as medical errors, poorly designed medical technologies, and poorly designed work environments. 1 To this end, an Institute of Medicine (IOM) report proposed a partnership between health care and industrial and system engineering, including Human Factors Engineering (HFE), to create solutions for these problems. 2 HFE is the study of interactions of humans with the systems, products and environment and takes a system approach to study interactions. 3 Primary care is one of the main components of the health care system and involves the widest scope of health care, including a variety of demographics such as patients of different ages and socioeconomic backgrounds as well as patients with different kinds of chronic and acute health problems. 4 There are several HFE issues specific to the primary care environment that human factors researchers can address with various methods. Some of them are related to information processing, standardization, simplification, work pressure and work load, organizational design, information access, technology acceptance, usability, and the effect of EHR use on doctor-patient interaction. 5 Depending on the context, HFE researchers are tasked with determining which components of the system are likely to influence patient outcome measures (e.g. satisfaction, trust, and adherence to treatment). Therefore, the HFE discipline can play a major role in improving overall primary care health systems, leading to better health outcomes. 4
Observational research is a commonly used method in primary care studies. However, direct observation is not always the best choice for analysing primary care encounters 6 , as it is difficult for researchers to capture all details in a live setting, particularly when components occur simultaneously. 7 Video recording may eliminate some of the challenges that occur in direct observation research in a primary care setting 8,9 , since video recording accurately records clinical events, allows researchers to verify their observations, and allows for the collection of systematic feedback by means of strategic participant review. 10 Video data can also give researchers insight into the consistency between self-assessment and observable behavior. Finally, the video recording of subjects’ ongoing activities in their natural setting 11 can also be a particularly useful way to employ ethnographic studies in a complex primary care environment.
However, using video effectively requires determining appropriate research questions and identifying types of data required beforehand, to inform study design. Video recording research also requires technical knowledge to ensure the appropriate selection of cameras, video quality adjustment, and positioning of cameras. 12,13 Currently, enhanced video technology allows for richer data and facilitates the data collection process with alternatives such as multi-channel streams and remote controlled cameras. 14,15 It is essential to note that the research purpose may affect the type of technology used in the study design.
This paper outlines the steps for using video methods in a primary care setting. This paper also addresses potential benefits of using video observation and video analysis methods, which can be used by human factors and health care researchers in primary care settings.
Primary care researchers began using video recordings to study consultations in the late 1970s. 16 In one early study, a communication analyst videotaped primary care consultations with a single video camera and subsequently analyzed the communication patterns between doctors and patients to improve doctors’ communication skills. 17 The results showed that doctors’ communication styles affected patient satisfaction. Recent studies have used video data to analyze nonverbal communication cues to inform more effective doctor-patient interactions. 18–20 Video data was also utilized to train doctors to improve their interactions with patients. 16 In addition, studies have used video recordings to explore doctor-patient-computer interactions. 21–29 These studies were instrumental in identifying the best spatial organization of an exam room, better design of exam-room computers, impact of computer use on communication and effective use of the computer by the doctor during the clinical visit. Several studies also utilized video elicitation interviews (which are basically interviews done after the recording, asking the doctors or patients to reflect on what they see on the video) to analyze doctor-patient interaction in the visits for teaching purposes. 30,31 Video elicitation allowed researchers to integrate the data from the video recording and participants’ related thoughts, beliefs and emotions obtained from the elicitation interviews. 32 Although traditional observation can provide a range of interesting and insightful information about primary care encounters, the encounter occurs through complex and multiple interactions, which can be explored by video data better. Finally, video data has also been used in health care settings in addition to primary care consultation for various purposes. 33
Video-recording methods require careful planning in order to gather data that effectively answers potential research questions. Table 1 , which is derived from our experience of several studies 26–28 , summarizes the steps to conduct a video observation study in a primary care setting for a given problem.
Steps followed to conduct this video study