Using Think-Aloud methodology and protocol analysis in mammographic practice research

Introduction: The Think-Aloud method is a qualitative research technique which provides verbal data, called verbal protocols, directly from participants’ voices. Verbalisations arise from both short- and long-term memory in real time, providing explanation and understanding of decision-making during problem solving and task performance. Think-Aloud and verbal protocols are considered a methodology as the research design and procedures are framed within theory and philosophy, and there are specified collection procedures of the data and analysis in response to the research question. The aim of this paper is to discuss Think-Aloud methodology within a simulated environment necessary during radiographer image quality decision-making. Methods: Both concurrent and retrospective verbalisations, data validity, and a three-stage analysis of verbal protocols are described. To explain Think-Aloud research methods and analysis, and to showcase this methodology, a PhD research study case example of radiographer decision-making for the evaluation of mammographic image quality (MIQ) is included: ‘What clinical reasoning processes and strategies do radiographers undertake during an evaluation of the cranio-caudal view for positioning image quality?’ Results: A synopsis from the MIQ Think-Aloud methodology is presented within decision-making rationality theories and models, a verbal protocol analysis and Think-Aloud mammography decision-making model, and a three stage MIQ decision-making framework. Conclusion: Inclusion of both concurrent and retrospective Think-Aloud verbalisations with a three-stage analysis process ensures verbal protocols provide a robust methodology to study radiographers’ image quality decision-making. Think-Aloud Methodology is transferable to other radiography problem-solving and decision-making research. Implications for practice: Think-Aloud methodology can provide insight and appreciation for the decision-making complexities faced by radiographers, as they would occur in real time.