Using Focus Groups in research: more than just a fashion statement?

1. Using Focus Groups in research: more than just a fashion statement? A/Prof Paul Ward Discipline of Public Health paul.ward@flinders.edu.au

2. Plan of Session • Introductions – expectations, needs/wants • What are focus groups and why/when might you use them? • Epistemological and methodological issues • Critique - advantages and disadvantages • Research Ethics • Practicalities • Thinking about analysis

3. Introductions • What are your knowledges and experiences of focus groups? • Why are you here? (and why now?) • What do you want out of this session?

4. What are focus groups and why/when might we use them?

5. Remember…… • As with all research methods, let your research question determine your methodology and methods (NOT the other way around!!!) • Just because they may be seen to be trendy (Tony Blair seemed to lead the UK on the basis of them) – don’t be fooled into just using them uncritically

6. What are Focus Groups? • Group discussions/ group interviews • Facilitated by researcher (often helped by another person) • Getting people to think about, discuss/debate an issue (or set of issues) – related to your research question • More than just a bunch of individuals responding to your questions • Allows for interaction (new data, conflicting data) • Allows participants to interpret each others’ responses • Not just a series of separate conversations with you!! • The sum should be more than it’s individual parts!!!!

7. Why/when might you use them? • MAIN REASON – when you want to generate discussion/debate about your research question/ area of research • You do not think that individual responses will yield the kinds of data you want • When you think that individuals may not be able to provide adequate responses on your research question • Haven’t thought about the issues • The issue requires discussions • Might be normal/ everyday/ taken for granted issues • When people may not feel ‘safe’ talking in individual interviews • Young people? • Groups that may work on basis of collective discourse

8. Why/when might you use them? • Other reasons are the same as all qualitative methods • Lack of research in area • Wanting to develop theory • Wanting to develop a quantitative stage of study • Etc, etc • REMEMBER – this is not a group counselling session – there is always a possibility of a ‘research relationship’ to stray into a ‘therapeutic relationship’ – but even more so in focus groups

9. Situating focus groups within an epistemological and methodological framework

10. Rationale for talking about epistemology and methodology here…… • Highlight the philosophical bases of ALL research • Explore the point or rationale of focus groups • Situate them within epistemological and methodological framework • There is a tendency for ‘cookbook methods’ • Add 1 RCT, wait for 18 months, then sprinkle with some focus groups…. • Add 4 focus groups and 15 interviews, wait for 1 year…. • However – this divorces ‘methods’ from their philosophical bases • Therefore – quick re-cap on epistemology, methodology and method

11. Epistemology • Concern the questions of what is (or what should be) acceptable forms of knowledge • Central to this is whether the social world (i.e. that involving people and structures) can or should be studied according to the same principles and procedures as the natural sciences • Positivism • objectivity, generalisation, the development of general laws/ truths and testing of theories (deductivism) • Interpretivism - • social reality can only be understood through social constructions such as language, consciousness and shared meanings. • Does not predefine variables, but explores human sense-making in naturalistic settings.

12. In essence….. • Positivism is about explanation (need for statistical generalisation etc) • Interpretivism is about understanding (need for depth and context etc)

13. Methodology • Method and methodology are often used as though they were synonyms - they aren’t • Methodology is not just a posh word for method. • Methodology is the study of methods and refers to the strategy or approach to research. • Very much related to the epistemological position

14. Method • Method is a specific technique (or set of techniques) for data collection • Informed by methodology (which is shaped by epistemology) • Within quantitative methodology – questionnaire survey, experiment etc • Within qualitative methodology – focus groups, individual interviews, observation, documentary analysis

15. Links…… Epistemology Interpretivism Positivism Methodology Qualitative Quantitative Experiment Method Interview Focus group Technique RCT

16. Types of research questions • Describing or answering questions about a particular, localised occurrence or context • Understanding the perspectives of particular groups towards events, beliefs or practices (dentists, GPs, nurses, patients, homeless etc) • Exploring complex research area where little is known (theory generation) • …….. Answering the WHY question…….. • Why do young girls continue to smoke? • Why do young men engage in many high-risk activities? • Why are some health care services inequitable provided? • ………providing CONTEXT and UNDERSTANDING……

17. Some benefits of qualitative research • The potential to illuminate everyday life – to better understand the familiar and strange • Can provide specific, concrete details to guide an understanding of a particular setting • Can provide interpretation of local meanings that activities and practices have for a group engaged in them • To illuminate differences across settings – how different GPs interpret guidelines/ diagnose flu/ prescribe antibiotics etc

18. Characteristics of qualitative research (1) • Natural context – occur in ‘natural’ settings • Places where people interact (GP/dental surgery, classroom, street corner etc) • Study of inanimate objects (how health care/policy is developed or organised) • Non-manipulative – study situations/objects ‘intact’ • Researcher observes, interviews, records, describes settings ‘as they are’ • Researcher as ‘instrument’ – researchers engages in a situation and attempts to make sense of it • Data collected through human observation • Data interpretation through human perceptions • Subjectivity of researcher – insights, experiences, perceptions of researcher are important part of the study

19. Characteristics of qualitative research (2) • Interpretive character – researcher attempts to explain ‘why’ and ‘how’ something is happening - focus is on meaning rather than specific behaviours • Focus on process, rather than outcome – how and why things happen • Depth (rather than breadth) of understanding –hence the smaller number of cases • Inductive analysis – research begins with open-ended questions rather than attempting to test a priori hypotheses. • Context sensitivity – findings are placed in social, historical and spatial context – limiting generalisations

20. Characteristics of qualitative research (3) • Empathic neutrality – complete objectivity is not possible – but pure subjectivity undermines credibility • Attempt to understand (not prove) something • Goal is not to advocate or to advance personal agendas • Personal experience is included as part of relevant data, although non-judgemental stance towards whatever content may emerge from data • Reflexivity – attempting to include the role of the researcher in the whole process (question construction, design, analysis etc) • Flexibility of design – research is open to adaptation as understanding deepens or situations change • Focus on ‘emic’ perspectives – write from the perspectives of the participants (emic) rather from the researcher’s own perspective (etic). • Perspectives of the participants in the study • What are they thinking, why are they thinking it, what are their assumptions, motives, goals values etc.

21. Some limitations • Subjectivity is inherent • In ALL research (not just qualitative) • Reflexivity is championed in qualitative • Labour/ time intensive • Underestimation of the vast amount of time it takes to undertake the data collection, arrange the interviews/ focus groups, transcribe the data, undertake data analysis etc • Misunderstanding of novice researchers • Many researchers think it is a ‘soft option’, but have little understanding of the complexities involved • Quality and trustworthiness of studies are then compromised • Limited generalisability – ‘moderatum generalisability’ • However, this is not the point of qualitative studies, therefore seems an inappropriate standard by which to judge

22. Critique of focus groups

23. Some Advantages • Has many of advantages of many qualitative methods, but in addition……. • Group dynamics – ‘more than the sum of its parts’ • Generating ‘new’ data that wouldn’t have been gained through individual interviews • Participants ‘bouncing off’ each other • In Literature - Time efficient • Not a good methodological justification • Not wholly convincing either (set up time, arranging lots of people for same time, developing appropriate themes, transcribing, analysis etc etc)

24. Some Limitations • Maybe less detailed or in-depth than some interviews • Potential for ‘group speak’ • Some people going with consensus rather than offering an alternative viewpoint • Potential for power dynamics • Different levels of involvement • In Literature, issue of Public vs Private views • May only get ‘public’ views in focus group • Holds onto positivistic notion of a ‘truth’ – which is private • IF there is a private view, hidden from public view, can researchers ever get to it???????

25. Research ethics

26. Research ethics • ALL research needs to consider and respond to the following ethical principles: • Research Merit and Integrity • Respect • Beneficence • Justice • However, when thinking about using focus groups, we have some additional ethical issues to consider

27. Research ethics • Data control – if 1 person wants their data to be removed, how does one do this within the context of a discussion - and make it amenable to analysis? • Confidentiality and anonymity – a variety of things may be talked about within the group, how do you make sure none of that goes outside the group? • Power – there may be distinct power dynamics – how do you make sure each person has an equitable voice?

28. Practicalities of focus groups

29. Practicalities • Setting it up • Deciding on composition and size • Running focus group • Transcribing • Potential pitfalls

30. Setting it up • Adequate physical facilities • Big enough room • ‘friendly’ atmosphere • Child-care facilities? • Disabled access? • Car parking or public transport routes? • Relevant recording equipment • Good quality audio recorder – to pick up a variety of voices at different distances from microphones • Make sure you have pre-tested it and know how it works • Refreshments • Incentives? • Okay – consistent and in-line with what you’re asking them to do

31. Deciding on composition and size • Heterogenous vs homogenous? • Heterogeneous • diversity of perspectives on central research question • Homogeneous • May be good for sensitive issues – Kitzinger’s work on HIV • shared experiences – good for bouncing off each other and a sense of ‘safety’ • May be good for marginalised groups – for whom individuals may feel ‘powerless’ within a heterogeneous group • What’s a good sized group? • Ideal size is 6 to 10 participants • Not enough discussion vs alienation of some people or too rowdy • Over-recruit!!! – invariably get last-minute cancellations

32. Running focus group • Role of facilitator (YOU) - success depends heavily on skills of the facilitator • keeping discussion going • keeping discussion within the research framework • making sure people have a say – fairness and respect • trying to involve ‘quiet’ participants • trying to make ‘ethnographic’ notes on the non-verbals (HARD – so maybe take an observer along too)

33. Transcribing • Takes MUCH longer than transcribing individual interviews • Help the transcriber – ask people to go around room and either say their name or pick a pseudonym • Level of voice is really important – ask people to speak up • Also – ‘civility’ rules – ask people (wherever possible) not to talk over one another – if this happens it’s not transcribe-able – so ask to repeat maybe?

34. Some Potential Pitfalls • Dominance by one person • Going off topic • Writing up – sometimes it’s hard to see that there was more than 1 person in the room at the time!!!! – analysis and writing is on the basis of group discourse, not individual discourse

35. Introduction to Qualitative Analysis ….. Not a workshop on analysis…. But you need to think about it BEFORE collecting data….

36. Transcript provided • Example of part of focus groups transcript • THIS is what you’ll have to analyse • Have a quick look through, then we’ll talk about methods of analysis.

37. Background to qualitative analysis • Inductive – theory development • Looking for patterns in the data – emergent themes • No pre-defined variables to focus on – variables/themes/issues are defined as a result of the analysis • Data collection and analysis occur simultaneously • No single agreed approach to analysis – depends on theoretical orientation, type of data, research question, research setting etc • Involves reading, re-reading, and re-reading piles and piles of notes, transcripts, initial analyses – until it ‘makes sense’

38. Useful quote to keep in mind….. • Plummer (quoted in Chapple & Rogers (1998, p.559)) suggests that: • “… analysis is the truly creative part of the work – it entails brooding and reflecting upon mounds of data for long periods of time until it ‘makes sense’ and ‘feels right’, and key ideas and themes flow from it. It is also the hardest part to describe”. Chapple A & Rogers A. Explicit guidelines for qualitative research: a step in the right direction, a defence of the ‘soft’ option, or a form of sociological imperialism? Family Practice 1998; 15: 556-561.

39. Stages involved in ALL analytical approaches • Organising the data • Developing categories, themes, and patterns from the data • Testing emergent theories/hypotheses against the data • Searching for alternative explanations in the data • Writing the report

40. Some issues to bear in mind • The process is not linear • Iterative – stages build upon each other, and inform each other • Cyclical – interpretation may lead to re-classification • Process does not have the same clear structure • Sometimes unclear which ‘stage’ you are at • May go from ‘description’ to ‘interpretation’ • Unpredictability • The process of analysis • When is analysis finished? • How long will it take?

41. (1) Organising the data • What are data? • Transcripts of focus groups • Field notes • Memos • Reflections or comments by researcher (and recorder) • Develop a data management system • All data are organised, dated and sequenced • Manual or computer? - for large datasets, computers make life easier • WARNING – although they are called “Qualitative analysis software packages” – they are glorified filing cabinets • YOU do the analysis, the software package helps you to organise the data, to sort the data, and to find the data at a later stage.

42. (2) Describing the data • Provide a ‘picture’ of the setting, people and events • Setting – where and when did research take place • People – describe who participated • Events – what happened throughout the research process • Provides a context, within which to situate the analysis of verbal/textual data • Called a ‘thick’ or ‘rich’ description • Also consider issue of reflexivity • Why that setting and those people? • Describe inter-personal relationships? • Describe what it felt like in each encounter

43. (3) Searching and coding the data SEARCHING • Involves reading and re-reading the data – to get a ‘sense of it’ • Reading ALL data (memos, transcripts, reflections) • What seem to be the important issues ‘emerging’ from the data? • As you read – make notes of the sections, themes, issues that initially seem important • Coloured pens • Notes in margins • Underlining • Make notes of particular themes that seem to re-occur • Keep searching until you feel that you have documented the main issues emerging • And have highlighted where these occur in the data

44. (3) Searching and coding the data CODING • Breaking data into smaller units – to make sense of the data • Naming and labelling of phenomena through close examination of the data. • Strauss & Corbin (2004, p.303) state that • “During open coding the data are broken down into discrete parts, closely examined, compared for similarities and differences, and questions are asked about the phenomena as reflected in the data. Through this process, one’s own and others’ assumptions about phenomena are questioned or explored, leading to new discoveries”. • The transcripts are read, and re-read, and each discrete incident, idea, event, concept etc are labelled (coded). • Similar incidents or ideas are given the same label (code), thereby allowing comparison both within and between transcripts

45. (4) Categorising data • Process of coding may have developed hundreds of codes • Although these will be discrete, there will be similarities between some codes • Also, need to have a smaller number of categories to make the analysis manageable, and the findings ‘readable’ • Therefore – collapse codes into meaningful categories • Category is a group or classification of individual codes/ labels/ themes • One method of coding and categorising data is Constant Comparison

46. Constant comparison • Comparing newly identified topics/themes to determine if they represent NEW categories – or should be placed in existing categories • “is this theme similar to or different from existing categories?” • If similar – these are added to the existing categories – which are changed accordingly • If not similar – new categories are created • Continues until ‘data saturation’ • No new categories emerging • All categories have been exhausted • How do we know when we’ve reached saturation?????? • Data saturation • When no new themes/concepts emerge from the data • When we’ve ‘looked’ for negative cases (data that contradicts the emerging category) and discrepant cases (data that adds a different perspective to the category) • Negative/discrepant cases may be sought within the other transcripts, although also may involve recruiting new research participants

47. Constant comparison Some steps in constant comparison • Collect data from several cases • Identify important issues or themes • Identify recurrent themes and use them to create categories • Collect additional data to provide more examples for each category and to elaborate on dimensions of each category • Describe how categories account for documented events • Reformulate some categories and delete others as dictated by data • Identify patterns and relationships between categories • Develop a theory by continuing to collect and compare data and refining categories and relationships

48. (5) Synthesising the data • Involves looking for patterns and links between categories • Need to search for, and determine the links between categories • How do they all fit together? • A process of re-assembling the data • bring back the complexity of the data • links between categories • context that is lost in coding and categorising (sometimes called ‘fracturing’) • Essential for integrating and understanding the holistic nature of the data • Really useful for reporting the data • Provides a framework for reporting • Can report each category, and also how they all fit together

49. Web of qualitative data analysis Organise Describe Synthesise Search Categorise Code

50. Summary • Focus groups can be very good for generating discussion/debate about your research questions • Main Adv – “more than the sum of its parts” – the added value that comes from debate/discussion • Potential pitfalls – power, voice and group speak • Need skillful moderator to minimise these • If thinking about using focus groups – make an informed choice based on your RESEARCH QUESTION, rather than because they seem to be fashionable in research!!!