Health Science Education
Faculty of Health Sciences
The University of Sydney
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Appendix A: Case studies - focus groups in qualitative research |
The aim of this paper is to provide researchers and students with an overview of literature on focus group interviews. This is by no means a complete "how to" guide but a snapshot of some of the key issues to be considered when using this technique. There are several useful monographs available from which I will be quoting. Topics include the origin of focus groups, definitions, use of focus groups, participants, the interview guide, the moderator, collecting and analysing data. In addition, the Appendix contains a list of case studies where focus group interviews or discussion have been used in allied health research.
Kreuger (1988) suggests that focus group interviews were born in the late 1930's by social scientists who had doubts about the accuracy of traditional information gathering methods. Rice expressed concern in 1931 by stating that "a defect of the interview for the purposes of fact-finding in scientific research, then, is that the questioner takes the lead...data obtained from an interview are likely to embody the preconceived ideas of the interviewer as the attitude of the subject interviewed" (Rice, 1931, p.561 cited in Kreuger, 1988, p.18). This lead to a more non-directive approach to interviewing where the emphasis was shifted from the interviewer to the interviewee. According to Stewart and Shamdasani (1990), the focused group interview had its origins in the evaluation of audience response to radio programs in 1941 by Robert Merton, a prominent social scientists. Merton applied this technique to the analysis of army training and morale films during World War II.
Focus group interviewing today takes on many different forms as researchers modify procedures to suit their own needs. Its' use in market research aims to gather consumer perceptions and opinions on product characteristics and advertising. Focus group interviews enable the producers, manufacturers and sellers to understand the thinking of consumers (Kreuger, 1988, p.20). Merton, however, feels that this application of focus group research is being misused in that plausible interpretations are taken from group interviews and are treated as being reliably valid (Merton, Fiske & Kendall, 1990, p.xxi).
Smith defined group interviewing to be "...limited to those situations where the assembled group is small enough to permit genuine discussion among all its members" (Smith, 1954, p.59 cited in Stewart & Shamdasani, 1990, p.10). Glesne and Peshkin (1992) suggest that interviewing more than one person at a time sometimes proves very useful; some young people need company to be emboldened to talk, and some topics are better discussed by a small group of people who know each other.
Denzin and Lincoln (1994, p.365) state that Merton et al. coined the term "focus group" in 1956 to apply to a situation in which the interviewer asks group members very specific questions about a topic after considerable research has already been completed. Kreuger defines a focus group as a "carefully planned discussion designed to obtain perceptions in a defined area of interest in a permissive, non-threatening environment" (1988, p.18).
Qualitative research concentrates on words and observations to express reality and attempts to describe people in natural situations. The key element here is the involvement of people where their disclosures are encouraged in a nurturing environment. It taps into human tendencies where attitudes and perceptions are developed through interaction with other people. During a group discussion, individuals may shift due to the influence of other comments. Alternately, opinions may be held with certainty. Kreuger suggests that the purpose is to obtain information of a qualitative nature from a predetermined and limited number of people" (1988, p.26).
Interviews are an important part of any action research project as they provide the opportunity for the researcher to investigate further, to solve problems and to gather data which could not have been obtained in other ways (Cunningham, 1993, p.93). The group interview is essentially a qualitative data gathering technique that finds the interviewer/moderator directing the interaction and inquiry in a very structured or unstructured manner, depending on the interview's purpose (Denzin & Lincoln, 1994, p.365). Merton et al. (1990) suggests that the focused interview with a group of people "...will yield a more diversified array of responses and afford a more extended basis both for designing systematic research on the situation in hand..." (p.135).
Focus groups can be used at any point in a research program. Stewart and Shamdasani have summarised the more common uses of focus groups to include:
According to Patton (1990), focus groups interviews are essential in the evaluation process: as part of a needs assessment, during a program, at the end of the program, or months after the completion of a program to gather perceptions on the outcome of that program.
Will depend on the purpose of the study. Stewart and Shamdasani suggest that convenience sampling can be employed, that is, the group must consist of representative members of the larger population (1990, p.53). It is best to over recruit by 20% as some people may not wish to participate or not turn up on the day (Morgan, 1988).
Most focus groups consist of between 6-12 people. Merton et al. suggests that "the size of the group should manifestly be governed by two considerations...it should not be so large as to be unwieldy or to preclude adequate participation by most members nor should it be so small that it fails to provide substantially greater coverage than that of an interview with one individual" (1990, p.137). However, the number of participants will depend on the objectives of the research (Stewart & Shamdasani, 1990). For example, smaller groups (4-6 people) are preferable when the participants have a great deal to share about the topic or have had intense or lengthy experiences with the topic of discussion (Kreuger, 1988, p.94).
Some studies require that several (3-4) groups are convened. According to Morgan, "one important determinant of the number of groups is the number of different subgroups required...if there are several distinct population segments...you may want or need to run separate groups in each" (1988, p.42). Morgan believes that one group is never enough as you may be observing the dynamics of that group and little else.
This guide should be developed in collaboration with all researchers and sets the agenda for the discussion, that is, to provide direction. According to Stewart and Shamdasani (1990), it should grow directly from the research questions that were the impetus for the research. When formulating questions for the interview guide, Stewart and Shamdasani suggest two principles must be considered:
As these two principles appear to be conflicting, the researcher can start with general questions, move to specific questions and then back to a set of more general questions. The funnel approach (from general to specific) is one way of engaging the interest of participants quickly. Very specific questions about the topic towards the beginning may set the discussion on a track that is too focussed and narrow.
Kreuger (1988) suggests that a focused interview will include less than ten questions an often around five or six. Stewart and Shamdasani (1990) propose that most interview guides consist of fewer than a dozen questions.
Unstructured, open-ended questions allow respondents to answer from a variety of dimensions. Questions must be carefully selected and phrased in advance to elicit maximum responses by all participants. "Questions that include words such as how, why, under what conditions, and similar probes suggest to respondents that the researcher is interested in complexity and facilitating discussion" (Stewart & Shamdasani, 1990, p.65). However, Kreuger argues that why questions should be rarely used in a focus group as they force participants to provide quick answers that seem rational or appropriate to the situation (1988, p.62).
Some examples of general
open-ended questions include:
"What did you think about the program?"
"How did you feel about the conference?"
"Where do you get new information?"
"What did you like best about the proposed program?" (Kreuger, 1988.
p.60)
The technique of moderating a focus group is a skill in itself where the moderator may have to wear many hats and assume different roles throughout the course of the discussion. Scott, 1987 cited in Stewart and Shamdasani (1990, p.70) states that "moderators have the difficult task of dealing with dynamics that constantly evolve...must handle the problems by constantly checking behaviour against attitudes, challenging and drawing out respondents with opposite views and looking for the emotional component of the responses".
The moderator must attempt to build rapport in the group. Stewart and Shamdasani (1990) suggest that it is a good idea to have group members introduce themselves and tell a little about themselves. This method can help "break the ice". The recommended pattern for introducing the group discussion includes the welcome, overview of the topic, ground rules and the first question (Kreuger, 1988, p.80).
Interviewer attributes may contribute to successful interviews. According to Kreuger, moderators must be mentally alert and free from distraction, anxieties and pressures; should practice the discipline of listening to others in group situations; should memorise the questioning route and should be able to listen and think at the same time (1988, p.75).
Glesne and Peshkin feel that a good interviewer is anticipatory; alert to establish rapport; naive; analytic; paradoxically bilateral (dominant but also submissive); nonreactive; nondirective and therapeutic; and patiently probing (1992, pp.79-85). Time management is another essential skill of the moderator, in particular, noting when a topic has been exhausted and further discussion will yield little new information.
Tape recorders are invaluable for focus group discussions however they are prone to pick up background noises. The microphones and recorder should be set up prior to the interview and should be visible to participants. The moderator must encourage participants to speak one at a time to avoid garbling the tape (Kreuger, 1988). However, Howe and Lewis (1993) suggest that members of the group will need to identify themselves before they speak.
The moderator can attempt to make notes or an assistant moderator can try to capture exact phrases and statements made by participants. The consideration here is that the note taking should not interfere with the discussion. Notes should be complete and useable in the event the tape recorder stops working. In addition, Morgan (1988) suggests that regardless of the method of data collection, the moderator should make field notes after each session to facilitate data analysis.
The information collected from a focus group discussion is raw data. The researchers' task is to prepare a statement regarding the collected data. The first step is to transcribe the entire interview. This will provide a complete record of the discussion and will facilitate analysis of the data. The next step is to analyse the content of the discussion. The aim of this analysis is to look for trends and patterns that reappear within either a single focus group or among various focus groups. Kreuger (1988, p.109) suggests that content analysis begins with a comparison of the words used in the answer. Also, the researcher must consider the emphasis or intensity of the respondents' comments. Other considerations relate to the consistency of comments and the specificity of responses in follow up probes. According to Stewart and Shamdasani (1990), a rather substantial body of literature exists on content analysis, including books by Krippendorf (1980), Gottschalk (1978), and Ericsson and Simon (1984). More recently, the use of computer software (for example NU*DIST) facilitates the ease of transcription and content analysis.
It can be concluded that focus group interviews can be used in a variety of settings. A review of the literature revealed that for successful data collection, focus group methodology must be employed in a manner to promote validity. The issues outlined about are essential elements for credible qualitative (action) research.
Cunningham, J.B. (1993). Action research and organisational development. London: Praeger.
Denzin, N.K., & Lincoln, Y.S. (1994). Handbook of qualitative research. London: Sage.
Glesne, C., & Peshkin, A. (1992). Becoming qualitative researchers: An introduction. New York: Longman.
Howe, R., & Lewis, R. (1993). A student guide to research in social science. Cambridge: Cambridge University Press.
Kreuger, R.A. (1988). Focus groups: A practical guide for applied research. London: Sage.
Merton, R.K., Fiske, M., & Kendall, P.L. (1990). The focused interview: A manual of problems and procedures. (2nd ed.). London: Collier MacMillan.
Morgan, D.L. (1988). Focus groups as qualitative research. London: Sage.
Patton, M.Q. (1990). Qualitative evaluation and research methods. (2nd ed.). London: Sage.
Stewart, D.W., & Shamdasani, P.N. (1990). Focus groups: Theory and practice. London: Sage.
A CD-ROM search of allied health literature over the last five years revealed a plethora of studies where focus group interviews were used as part or all of the data gathering methodology. It revealed that this technique can be used in a variety of contexts spanning many professional areas.
Anderson, N.L.R. (1994). Resolutions and risk-taking in juvenile detention. Clinical Nursing Research, 3(4), 297-315.
Twenty teenagers participated in this study during interviews and focus group discussions.
Bach, C.A., & McDaniel, R.W. (1993). Quality of life in quadriplegic adults: A focus group study. Rehabilitation Nursing, 18(6), 364-367, 374, 427-428.
A focus group technique was used to determine subjects' opinions about what constitutes an acceptable quality of life. Three focus groups with a total of 14 subjects met to discuss the topic.
Beck, K.H., & Bargman, C.J. (1993). Investigating Hispanic adolescent involvement with alcohol: A focus group interview approach. Health Education Research, 8(2), 151-158.
Focus group interviews were conducted with Hispanic teenagers to explore their patterns of alcohol consumption, influences on drinking and possible intervention strategies.
Borges, R., Mullen, P.D., Meertens, R., Rijken, M., Eussen, G., Plagge, I., Visser, A.P., & Blijham, G.H. (1993). The information seeking behaviour of cancer outpatients: A description of the situation. Patient Education and Counselling, 22(1), 35-46.
The intention to seek information, the realisation of the intention and the reasons for not realising it are measured with several qualitative and quantitative methods: written questionnaires, audio records and focus group interviews.
Brown, G.D. (1993). Accounting for power: Nurse teachers' and students' perceptions of power in their relationship. Nurse Education Today, 13(2), 111-120.
Interviews and focus group discussions were used to examine how nurse teachers and students perceive power to operate within their relationship.
Dellasega, C., & Mastrian, K. (1995). The process and consequences of institutionalising an elder. Western Journal of Nursing Research, 17(2), 123-140.
A qualitative study using in-depth interviews were conducted with 7 individuals who had recently placed an older relative in a long-term care facility.
Deming, M., Doyle, K., & Woods, S. (1993). A comprehensive assessment plan for professional preparation programs in health education at Eastern Illinios University. Journal of School Health, 63(5), 210-213.
Strategies used in a comprehensive assessment plan for the Health Studies Department at Eastern Illinios University include focus group interviews, Departmental Advisory Council review and assessment by internship preceptors.
Ellis, B.H. (1991). Nurses' communicative relationships and the prediction of organisational commitment, burnout and retention in acute care settings. Michigan: Michigan State University.
Focus group interviews with nurses, as well as extant theory and research from organisational communication and nursing, provided the basis for the hypotheses.
Fox, A.L. (1993). Use of focus groups in program planning: The Tridec experience. Beta Release, 17(4), 13-19.
This paper outlines the process used by a diabetes education centre to plan and conduct focus group interviews to evaluate the extent to which clients' needs are being met.
Knight, S.M., Glascoff, M.A., & Rikard, G.L. (1993). A view from behind the wheel: College students as designated drivers. Health Values, 17(4), 21-27.
This qualitative study used focus group interviews to explore designated driving from the perspective of underage college students.
Lindsay, G.M. (1993). Vision becomes a reality: Crafting a paediatric oncology nursing curriculum. Canadian Oncology Nursing Journal, 3(3), 123-124.
Focus group interviews with nurses (in clinical, research and academic roles), parents of children with cancer and other providers were convened.
Nyamanthi, A., & Shuler, P. (1990). Focus group interview: A research technique for informed nursing practice. Journal of Advanced Nursing, 15(11), 1281-1288.
The purpose of this paper is to present a qualitative research technique which used focus group interviews to promote the development of a programme devised to reduce risk behaviours in minority populations.
Packer, T., Race, K.E.H., & Hotch, D.F. (1994). Focus groups: A tool for consumer-based program evaluation in rehabilitation agency settings. Journal of Rehabilitation, 60(3), 30-33.
A series of focus groups were conducted in a vocational training and rehabilitation setting. A total of 70 clients participated in 8 focus groups intended to identify clients' perceptions of the agency's program service strengths and weaknesses.
Stanton, B.F., Aronson, R., Borgatti, S., Galbraith, J., & Feigelman, S. (1993). Urban adolescent high-risk sexual behaviour: Corroboration of focus group discussions through pile-sorting. AIDS Education and Prevention, 5(2), 162-174.
Focus group discussions among 57 urban youths aged 10-14 were employed to explore factors placing urban adolescents at risk for engaging in HIV risk behaviours.
Stevens, P.E. (1994). Lesbians' health-related experiences of care and non-care. Western Journal of Nursing Research, 16(6), 639-359.
This feminist narrative study used in-depth interviews, focus groups and a multistaged narrative analytic approach of a diverse sample of 45 lesbians conveying their health care experiences.
Strong, J., Ashton, R., Chant, D., & Cramond, T. (1994). An investigations of the dimensions of chronic low back pain: The patients' perspective. British Journal of Occupational Therapy, 57(6), 204-208.
Using the technique of focus group discussion, the participants gave their perspective on living with chronic pain. Transcripts from the group were content analysed to give an indication of the relative importance of the emerging themes.
Tessaro, I., Eng, E., & Smith, J. (1994). Breast cancer screening in older African-American women: Qualitative research findings. American Journal of Health Promotion, 8(4), 286-293.
Qualitative research methods elicited social and cultural themes related to breast cancer screening. Focus group discussions were conducted in the natural settings of older African-American women.
Wagenaar, A.C., Finnegan, J.R., Wolfson, M., Anstine, P.S., Williams, C.L., & Perry, C.L. (1993). Where and how adolescents obtain alcoholic beverages. Public Health Reports, 108(4), 459-464.
Patterns of acquisition of alcoholic beverages by underage youth were studied using focus group methods with a sample of mid western youth.
Yates, P., Dewar, A., & Fentiman, B. (1995). Pain: The views of elderly people living in long-term residential care. Journal of Advanced Nursing, 21(4), 667-674.
The aim of this research was to investigate the views of pain and pain management practices held by elderly people living in long-term residential care settings. Ten 60-90 minute focus group interviews, each involving around five elderly people, were convened in four large, long-term care settings in Brisbane.
© M. Lewis 4.12.1995
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Copyright © 1998 Ian Hughes, The University of Sydney
Last updated: 24 August, 1999
