VOL: 103, ISSUE: 4, PAGE NO: 34
Sue Campbell, MPH, BSc, RGN, is an independent health consultant in Uganda
- This article has been double-blind peer-reviewed
- Download a print-friendly PDF file of this article here
When planning research the first step is to formulate the question. This enables the researcher to identify the appropriate research methodology. Focus group discussions (FGDs) gained popularity in the 1950s as a mechanism for assessing opinion on products in the marketplace (Winch et al, 2000). The following steps should be followed if this method is chosen.
Write a brief
Research needs clear guidelines and writing a brief helps to formulate these. The RCN Research Society (2004) stresses three key areas in ethical research with humans: ensuring consent; protecting confidentiality; and balancing potential risks and benefits.
The RCN Research Society (2004) defined informed consent as ‘an ongoing agreement by a person to receive treatment, undergo procedures or participate in research, after risks, benefits and alternatives have been adequately explained’. Recording and transcribing of FGDs needs specific consent.
Participants’ privacy and dignity must be safeguarded and all personal information must remain confidential. Tapes of recorded sessions must be stored securely.
Harm versus benefits
To gain approval from research ethics committees, a study must be reviewed in the light of its short-term effects and long-term goals.
Identify and train facilitators
Skilled and independent facilitation of the focus group is essential. The structure must be both flexible but cover pre-determined areas. This is especially important if there is more than one group.
The facilitator must be able to stimulate and direct while maintaining a neutral position and create a safe and non-judgemental atmosphere. She or he should not be concerned if the group is silent as it may be the first time participants have considered the issue (CPRC, 2003). Ideally, a second facilitator should record the discussions or the session should be taped and transcribed.
The interview guide is an overall direction for the discussion, providing the facilitator with topics and issues that should ideally be covered at some point. It is loosely structured and does not suggest potential responses. A good focus group interview guide consists of 20 questions or fewer (CPRC, 2003), and proceeds logically from one topic to another and from the general to the specific. Pre-testing the guide with ‘mock’ focus groups is essential in order to ensure that the questions are clear and likely to stimulate discussion.
Sampling and recruitment
Local contacts can be used to identify suitable participants but care must be taken to avoid systematic bias and friendship groups. Systematic or random procedures can help prevent this.
Focus groups are generally made up of 6-10 individuals but some researchers have used as many as 15 and others as few as four (Gibbs, 1997). Often the participants have experiences in common but not always. They may be strangers to each other or drawn from an existing group.
If a group is too heterogeneous, the differences between participants can have a considerable impact on their contributions. If a group is too homogenous, diverse opinions and experiences may not be revealed (Gibbs, 1997).
It is also important that practitioners do not participate in FGDs with current or previous service users as this is unfair to both parties. Efforts also need to be made to ensure the groups are as inclusive as possible. This could involve, for example, providing interpreters if appropriate, or using venues with wheelchair access. The nature of a research question may require some FDG members to have used the service.
Once prospective participants have been selected, they should be contacted by the researcher to assure them of confidentiality and confirm that they fit the required criteria. The researcher will also need to clarify participants’ expectations and confirm they are willing to take part (CPRC, 2003).
Incentives to participate will need to be decided and participants informed in advance. Other practicalities include booking a suitable venue and any equipment required, arranging refreshments and organising interpreters or childcare if required. The focus groups should also be timed for the convenience of participants.
Conducting the discussion
Interaction between group members is part of the FGD process and should be encouraged. Everyone should be introduced, and name badges handed out if this will be helpful.
The purpose of the focus group should be explained, along with how long the process will take and what feedback participants will receive. Messages about confidentiality should be reinforced. If appropriate, participants should be given time to talk to each other alone.
Group members should be seated so that they can all see each other and the discussion should begin with the easier topics. However, it is important to ensure that essential topics are covered early in the session (Laws, 2003).
A focus group study may include one meeting with several groups or a few meetings with one group (Gibbs, 1997). Individual sessions usually last 1-2 hours followed by a 15-minute debriefing session in which the facilitator should summarise what has been said and give participants an opportunity to ask questions or provide feedback (Laws, 2003).
The greatest strength of focus groups is the interaction they allow between participants. They should not be analysed as if they were a series of individual interviews, for example by adding up responses to particular questions, as the group process is likely to influence people. Once the discussion has been written up, it can then be given back to the participants for their comments (Billingham et al, 2001).
Reporting the findings
The report should summarise key findings. Research themes need to be set out under headings, and quotes from participants can be included. The report should be reviewed by a colleague before it is disseminated. Involving as many key stakeholders as possible in the FGD will assist in taking the results forward. It is important to remember that highlighting data and recommendations does not guarantee funding. The FGD is just the first step in a process of change.
- The government is committed to reforming the NHS, turning it into a patient-centred service fit for the 21st century. At the heart of this modernisation is the involvement of the public in healthcare decision-making.
- Participation enables community members to share their perceptions of a particular problem and to establish some common ground. It engages a variety of people in identifying and testing out possible solutions. At the same time it can generate a sense of ownership for the service users or research participants and be linked directly to actions at their level (Winch et al, 2000). l Consultation, whereby service users are actively engaged in giving feedback on decisions and in providing information that is not routinely sought, often uses research-type methods. These include quantitative methods such as surveys, and qualitative methods such as focus groups.
Implications for practice
Focus groups are particularly useful when:
- In-depth information is needed on how people think about an issue - their reasoning as to why things are as they are and why they hold the views they do (Kitzinger, 1995);
- An organisation needs guidance as to what people regard as the key issues for them when it is setting a framework for larger-scale research;
- People’s opinions need to be sought as to how particular products or services could be improved (Winch et al, 2000);
- Data is required on social norms and cultural expectations, for example on the issue of sexual health and young people;
- There is a perceived power differential between the participants and the decision-makers (Ridley and Jones, 2002);
- People have similar experiences in relation to the subject under discussion but may lack the confidence to express those opinions.
The main disadvantages of focus groups are:
- They may be ‘typical’ but not necessarily representative, excluding marginalised groups, and it may be hard to reach any generalised conclusions;
- Participants may not be sufficiently ‘informed’ about the issues that are being discussed;
- They are time-consuming and relatively costly to conduct (Ridley and Jones, 2002);
- They have an obviously narrow focus.