| 116 These free-flowing discussions contrast with qualitative studies using direct questioning which have reported decreased vocabulary, poor reasoning of verbal information, confused word associations and limited data quality (41-44). All participants also understood the intent and purpose of the photo elicitation techniques i.e., that they were being used to prompt them to reflect on the thoughts and feelings of the couple in the hypothetical scenario. One researcher from the Netherlands noted, ‘No additional explanation was needed on the use of projective techniques. Some participants dove straight into the questions they saw written on the handouts’. Comprehensibility of the photo elicitation techniques was also evident in the participants’ engagement with the ‘experiences’ of Thelma and John. Some empathised with the characters, for example one participant noted that Thelma’s situation was very similar to her own and said “…it is hard not to personalize that…” (Canada, Participant 4) whilst others compared and contrasted their own experiences to the scenario. Interviewer: ‘Okay, will you want to add anything else to what [Thelma] thinks about this situation?’ Participant: ‘Well, I think that because she is with a friend or her husband, she feels that she is safe’ Interviewer: ‘What could [Thelma] feel, a few weeks after this diagnosis?’ Participant: ‘Well, I think she feels bad about it, because nobody wants to hear such a diagnosis. But I can handle everything, I can handle everything…’ Poland, Participant 1 Interviewer: ‘So, I’m wondering whether you can put yourself into Thelma’s shoes and imagine what she might be thinking and feeling’. Participant: ‘Two things are happening; I’m looking at them and [also] thinking what happened to me’. Australia, Participant 8 Manageability To understand how the techniques supported manageability, we examined how easy it was to complete the essential steps in the research process. Word association activities were manageable for most participants and served as ‘icebreakers’, supporting free-flowing conversations, and triggering spontaneous thoughts around the key research concepts of ‘dementia’ and ‘support’.
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