"The Lesser of two Evils" Versus "Medicines not Smarties": Constructing Antipsychotics in Dementia

Dilbagh Gill, MPharm; Saleh Almutairi, PhD, MSc, BSc; Parastou Donyai, PhD, BPharm, BSc


Gerontologist. 2019;59(3):570-579. 

In This Article

Research Design and Methods


Professionals with a role in the care and management of patients with dementia in care homes were recruited using purposive sampling. Recruitment was completed by posting letters to publicly-available addresses (e.g., GP practices) or through known contacts and already-recruited interviewees. A doctoral student (second author) carried out in-depth semi-structured face-to-face interviews using interview schedules (piloted first with three volunteers) that focused first on general descriptions of dementia and disease progression, before considering beliefs about and professional experiences with antipsychotic prescribing and use in dementia. Participants were recruited until no new concepts emerged to inform the study (i.e., sampling saturation). The interviews were audio-recorded.


The sample of 28 participants (17 female) consisted of care-home managers (CHM) (n = 5), general practitioners (GPs) (n = 5), community psychiatric nurses (CPNs) (n= 7), psychiatrists (n = 5), geriatricians (n = 2), pharmacists (n = 2), a memory-clinic nurse, and a social worker.

Data Analysis Using Discourse Analysis

The interviews were transcribed verbatim into password-protected documents, removing sensitive information to keep data anonymized/de-identifiable. The doctoral student ensured data integrity in consultation with the author by checking the transcripts against the audio files. A critical discourse analysis was undertaken jointly by a Masters-level student of pharmacy (first author) and the senior author. The focus was to identify concepts key to critical discourse analysis, namely; interpretative repertoires and subject positions (discourse resources); how these resources were used to build descriptions, accounts and arguments (discourse processes); and how different subject positions were embedded in different interpretative repertoires, including identifying ideological dilemmas (Wetherell et al., 2001). Interpretative repertoires, the common-sense way in which people talk about the world, are composed of the lexicon of common knowledge, the cultural ideas, explanations and "terms and metaphors" people draw on to build explanations, descriptions, accounts and arguments (Potter & Wetherell, 1987). Because of the fluid nature of talk, people can take up subject positions to define themselves and their identity through their discourse (Wetherell et al., 2001). And since these everyday discourses are full of inconsistencies they can result in ideological dilemmas, complex and contradictory use of interpretative repertoires (Billig et al., 1988).

A detailed, line-by-line scrutiny was conducted by reading each interview numerous times and considering the whole data before examining small chunks of text (e.g., parts of sentences) in relation to the research question, interpretative repertoires, subject positions and ideological dilemmas. There was a particular focus on rhetorical choices made by the participants to depict antipsychotics. The analysis was tabulated and rhetorical choices and subject positions grouped according to concepts they conveyed. Then, the next interview was read and re-read and considered for additional or supporting material to add to concepts already generated, and so on. Although each transcript was treated as a separate case, these were brought together to identify patterns within a single interview and across the data set. The focus of analysis was the external world of discourse and its meaning and effects, and of how specific words, descriptions and explanations were brought together and used through the language employed to account for actions and events. The repertoires were identified with relevant quotes selected to portray these. Data validation was demonstrated in data triangulation (collecting data from eight participant sub-groups), description of study procedures, and audit trails.

Compliance With Ethical Standards

The University's Research Ethics Committee (UREC 1217), and the local NHS Research & Development office (letter of access granted June 22, 2012) and Primary Care Research Partnership (reference TV85) reviewed and approved the research. Written consent from each participant was obtained before the interviews.