1. 10 Focus Groups: Learning Objectives
describe the history and uses of focus groups
list the elements of an interview guide for focus groups
summarize the advantages and disadvantages of focus group methods in public health
list design issues for focus group activities
enumerate moderator and observer/note taker techniques
participate in or observe a focus group in class

2. Tony's comments on participant observations

3. Group Data Collection Methods

4. Natural Groups Examples people doing laundry by the river
mother’s club
men gathered around tree to play cards
teenagers hanging around outside a 7-11
people in a laundromat
people at a karoke bar
patients in a waiting room at a dentist office

5. Natural Groups:
usually more heterogeneous than you would like, but used a lot because they are there
in modern developed countries, there are fewer opportunities for natural groups, because of the way we have been isolated by technology
Participatory Research Methods, session 9
Intervention-Product Oriented Working Groups(where need to come to a decision), session 10

6. How many have been in focus groups, or run them?
experiences and insights?

7. Focus group: facilitated group discussion on a focused topic
Huge industry in US
Propaganda comprises 1/7th of our economy
Hollywood studies test-market violent films using focus groups aged and even recruit children as young as 9 to evaluate story concepts, commercials, theatrical trailers and rough cuts for R-rated movies (NYT )
Term applied to broad array of group exercises (buttons pushed watching election debates)
Use of “focus groups” for presidential debates in October 96, where had a group watching the debate on a TV screen, with a hand held numeric monitor, in which they were to push buttons indicating support for each candidate as the debate progressed

8. HISTORY
first used to evaluate effectiveness of war time propaganda over 50 years ago
looking at impact of persuasive texts read by singer & patriotic figure Kate Smith, on pledging war bonds
used in marketing research, 40+ years ago, to sell products
how can Brand X toothpaste be made to appeal to college students, pulled people off street who didn’t know each other
began used in health activities in late 1970’s
currently they are sexy and in, Medline papers, many in 1996
many are done inappropriately
more formal than natural groups, rare in a village to assemble people who don’t know each other

9. KEY FEATURE: if a focus group is going well, the participants will interact amongst themselves
Group interaction produces data and insights less likely without the interaction found in a group
Use a moderator and a recorder
quick & dirty tool in qualitative research
have been used a great deal in HIV research, will hear about it from several guest lectures
Moderator or facilitator helps start discussion and keep it going, and usually cannot take notes
Recorder takes notes and as necessary feeds probes or ideas to monitor
In marketing focus groups, recorder has an ear-piece connected to people observing in another room, who suggest direction

10. When to consider using focus groups?
Understanding some issue from specific population’s perspective
Generate hypotheses based on informants’ insights
Survey instrument development
or have reason to believe that previous treatments of that issue have not sufficiently included that essential perspective
generate hypotheses based on informants’ insights
(observe process of idea formation)
Survey instrument development

11. When to consider using focus groups?
Formative research: needs assessment
Educational materials pre-testing
Health promotion techniques
Evaluating research sites, study populations, or programs
Exploration of interpretation of research results
Community participation or mobilization
Orienting oneself to a new field

12. Advantages of focus groups
Does not discriminate between literates & non-literates
Can encourage participation from those who are reluctant to be interviewed on their own
Can encourage contributions from those who feel they have nothing to say, or are characterized as unresponsive

13. Either self-contained data collection technique, or part of a larger research program

14. Choosing between focus group discussions and alternative data collection strategies?

16. Married Thai men talk of brothel experiences, VanLandingam found men could talk in this circumstance

18. When should you consider using another data collection method
When should you consider using another data collection method? Types of topics
Opinions with unknown basis in behavior or little/no personal experience
Abstract or complex ideas
When participants would not actively or easily discuss the topic of interest

19. When should you consider using another data collection method
When should you consider using another data collection method? Types of respondents
Adolescents
Elderly
Severe mental illness

20. Ethical issues use of names/identification Who sees data
Tape recording & data management
video taping is much much more intrusive, less acceptable so don’t do it
is much more difficult to analyze, better to have printed transcripts
Inherent invasion of privacy issues

21. Conduct enough groups
In geographic regions where meaningful difference felt to exist
climate, weather,
local economic conditions,
local lifestyle,
political leanings,
level of literacy
Pre-testing where change order of materials presented
can be etically driven by looking at the literature (on caste groups, say)
can be emically driven by the informant interviews you do

22. Size of groups: 4-12, ideal 6-8

24. Smaller groups expect greater depth of response from each participant
highly sensitive to dynamics between individuals
use a smaller group when
topics are complex, or intense (e.g. child abuse perpetrators or victims)
participants have expertise on the topic, or have authority or power, since they may be irritated if they do not have enough time to say what they feel is important

25. Larger groups expect
respondents may speak longer, with irrelevant information, when they finally get an opportunity to speak
frustration or dissatisfaction among group members, because of inability to get a turn to speak, with resulting lower quality & quantity of output

26. Larger groups expect
low-level participation problems, need more moderator involvement
more tendency for side conversation between respondents
dominant/submissive relationships evolve
more generation of ideas
generally harder to do well

27. Composition (sampling) of groups
Homogeneity to avoid conflict, and refusals to share opinions-- How much is necessary?
foster discussion; so that participants are comfortable with each other.
avoid ‘experts’ who can dominate
often useful to have a screening questionnaire for participants
want them to share a common interest in the topic & feel comfortable together

28. Factors that can lead to problematic heterogeneity
gender,
on some issues, having men and women can be OK, unless there is considerable gender based disagreement
explore with both types of groups
SES/education, SOCIAL CLASS CRITICAL ONE
life stage, Age, new mothers cf older mothers, or mothers with large family
lifestyle,

29. Factors that can lead to problematic heterogeneity
user status,
users of a product or practitioners, or non- practitioners
sometimes can get contrasts if include both, especially if there is no social stigma
level of expertise/experience,
those who have used a product, or practiced a behavior for a long time may be quite different from a novice
e.g. don’t include smokers & non-smokers these days
often may get a rational defense or withdrawal by minority groups
nurses new on the job, and old timers

30. Factors that can lead to problematic heterogeneity
marital status,
use of contraceptives among married and unmarried women
sub-cultures/ethnicity
sometimes some heterogeneity can be useful, e.g. young & old

31. can choose respondents who have previously participated in focus groups
though you may find advice to not do so in print

32. Friends: to include or not?
literature says people in a focus group should not know one another
some people may not meet with others they do not know
in many communities it is impossible to find strangers, everyone knows each other, yet focus groups can be run successfully there
people who know one another may not want to discuss sensitive issues or present a point of view that is not acceptable to others (courtesy bias)
friends may not want to talk about your agenda, but use the venue as a social gathering

33. Setting of the groups privacy acoustics
avoid noisy areas so respondents can hear one another & moderator can hear all respondents, can be problem when hold them in situ so have to find quietest spot
accessible to respondents, culturally conducive for the participants
if people travel a long way, this could affect group results
a brothel, a pasture, a farm field

34. Setting of the groups Any external observers?
if so, have two-way mirror, or set up partitions, or adjacent rooms with open doorways, make this clear to the participants (marketing does this)
Neutral sites, but familiar, don’t bring them into your office
schools or government buildings may induce a desire to respond “correctly”
natural environments, convenient locations conducive to conversations with familiar surroundings, may enhance quality of data

35. Seating Arrangements
avoid designating status, e.g. at head of table, next to moderator
hunkering on the floor may be appropriate in many settings
enable moderator to have good eye contact with all respondents, and for each respondent to be in sight of all other participants (harder with larger groups)
visible name tags (first name or pseudonyms) can help calling on people by name

36. Recruiting participants
common source of failure, too few people show up, 1 or 2 or 3, like a response rate in a survey
use key community leaders, rather than unknown person to approach participants
advertising in local radio station, print media, generally less successful
repeated contacts, a single phone call is not sufficient, let them know they will be contacted later to remind them at the initial contact
mail reminders, make additional phone calls, at least the night before

37. Incentives paying people other incentives
usually focus group more important to the researcher than to the participant
market researchers pay
often social researchers don’t have the funds
other incentives
gives participants a voice on issues that affect them (psychological) (stakeholders)
social or professional interaction among peers
food
sometimes women may find it necessary to bring a friend

38. Over-recruit strategy, especially for marginalized participants
such as prostitutes
sometimes women may find it necessary to bring a friend
if you offer monetary incentives you might over-recruit, and if get too many people, pay the ones who don’t participate

39. Duration of group Attention span, until they get tired
Time of day, people tend to be less bright in afternoon (when this class is held)
Maximum start to finish = 2 hrs (consider break)

40. Focus Group Discussions Field Guide
have document like an ethnographic field guide, sometimes called a topic guide
summary statement of issues & objectives to cover in a focus group
road map and memory aid for moderator
often have initial question to which all participants asked to respond
have document like an ethnographic field guide, sometimes called a topic guide
summary statement of issues & objectives to cover in a focus group
prepared jointly by team
road map and memory aid for moderator
often have initial question to which all participants asked to respond
can be describing some aspect of their experiences they have in common with other group members
suggests all contributions equally valued

41. Focus Group Discussions Field Guide common errors:
mostly questions are of interest to the researcher, and not to the participant
start with what is of interest to the participants, will generate lively discussion
then shift to researcher’s central interests, when group members feel comfortable sharing & comparing their experiences & opinions
have too many questions so try to push group along, rather than explore
common error:
mostly questions are of interest to the researcher, and not to the participant
start with what is of interest to the participants, will generate lively discussion
then shift to researcher’s central interests, when group members feel comfortable sharing & comparing their experiences & opinions
have too many questions so try to push group along, rather than explore
best to outline question areas or issues, include special probes under each of key issues
detail depends on experience of moderator
may need different topic guides for focus groups on same subject, with different composition of respondents
e.g. safer sex behavior among teenagers of different sex or sexual identity

42. Focus Group Discussions Field Guide common errors:
best to outline question areas or issues, include special probes under each of key issues
detail depends on experience of moderator
may need different topic guides for focus groups on same subject, with different composition of respondents
e.g. safer sex behavior among teenagers of different sex or sexual identity
common error:
mostly questions are of interest to the researcher, and not to the participant
start with what is of interest to the participants, will generate lively discussion
then shift to researcher’s central interests, when group members feel comfortable sharing & comparing their experiences & opinions
have too many questions so try to push group along, rather than explore
best to outline question areas or issues, include special probes under each of key issues
detail depends on experience of moderator
may need different topic guides for focus groups on same subject, with different composition of respondents
e.g. safer sex behavior among teenagers of different sex or sexual identity

43. Topics to include
don’t cover too many issues or participants will become bored and fatigued, group will jump around unnaturally
if too many issues, suggests preparatory research hasn’t been sufficiently focused, or need a different method at this stage
eliminate questions that are “nice to know”, but not relevant to research objectives
eliminate questions such as “how many” or “how often” that could be better addressed in a quantitative study

44. Topics move from general to specific
flow of group is more natural
analyst has framework for comments made in group
key issues can emerge naturally
Order topics to avoid putting respondents in irreversible situations or verbal “dead ends”
e.g. if talking about legislating gun control in Montana, and find out one person is a member of the Montana Militia

46. Focus Group Operational and Logistic Issues

47. Introduction, warm-up Thanks for coming, your presence is important
Describe what a focus group is
Describe role of moderator, recorder

48. Purpose
state purpose of group, that interest is in idea, comments, suggestions
no right or wrong answers
all comments welcome
feel free to disagree with one another, we want to have many points of view

49. Procedure explain use of audio/video tape, and confidentiality
sometimes having each person speak their name, or a pseudonym, record that and play it back can break the ice here
tell people they can speak without waiting for moderator to call on them
ask people to speak one at a time
tell people they can interrupt the moderator, who may want to move the discussion along

50. Self Introduction
ask each participant to introduce self, say a little about themselves
can use pseudonyms,

51. Body of discussion beginning Natural progression across topics
moderator could make a statement such as
how did your learning you have panic attacks change your life?
Natural progression across topics
what ways have you notice your body changing since you began taking Panban®?
OK to overlap between topics

52. Body of discussion again avoid why questions Transitions
we have been talking about taking drugs for panic attacks, I’d now like to look at other ways of dealing with this problem
Using the guide during the FGD -- probing; relevant deviations

53. Body of discussion Ranking at the end can sometimes be helpful
giving information
sometimes moderator has to spend a great deal of time giving information, when seen as an expert, provider of info, A REASON TO NOT HAVE AN EXPERT as moderator

54. Closure
“before we end, I’d like to go around the room once more and ask each of you if there is anything else you would like to say about the idea of labial frenulum stimulation as we’ve described it for a way of coping with panic attacks
Questions and answers
Don't forget thank you for time and insights

55. Moderators (QUALITIES AND EXPERIENCE OF THIS PERSON ARE CRITICAL INGREDIENT)
generally moderator is not the Achilles Heel of FGD, it is selection & recruitment
facilitator and moderator are different terms for same thing
note taker could be an alternate moderator, takes notes, feeds ideas/perspectives to moderator

56. Moderator characteristics style
KEY: can the moderator encourage participants to talk about this topic?
can sometimes be a professional, often is a “group facilitator”
sensitive topics may require a moderator whose background can put participants at ease
Moderator probing appropriate & effective
Ability to think through contingencies vs. thinking/interpreting literally

57. Moderator characteristics style
KEY: can the moderator encourage participants to talk about this topic?
Ability to put others at ease; non-threatening
Active listening, not an interviewer
Balance between understanding empathy and disciplined detachment
understand your bias, it may be hard to avoid projecting that
Enthusiasm, be supportive, and not judgmental

58. Moderator characteristics style
KEY: can the moderator encourage participants to talk about this topic?
well versed on subject matter and on specific objectives of research, especially for complex questions
sometimes for highly technical or controversial material, use a pair of moderators

59. Moderator Level of involvement
Low is good for exploration
Low participation -- exploratory research goals; good for content analysis
High is good for focus
High participation -- externally generated agenda (e.g. compare results for a new group or with narrowly defined research question)
Self-managed groups
("remember we're interested in [topic]" emphasize want different perspectives; stimulate low-level participants; encourage people to "tell their story"; emphasize all opinions are important

60. Same or variable moderators for several groups
comparability vs. seniority problems

61. Some techniques for moderators:
Build personal context
Top-of-mind associations
Probing obvious terms ("What does 'it's hard to do that' mean to you?"; "What about it is good?"; "In what way is it easy to use the pill?"; "How can you tell that the medication works?")
Conceptual mapping (how group terms)
"I'm a five-year old" DON’T CONVEY IMPRESSION OF BEING AN EXPERT

62. Some techniques for moderators:
Role playing
Highlight contradictions
Repeating
Mirroring / Rephrase and ask for verification
Silence
"I'm confused"
Third person
Using the guide -- Tracking = returning to guide throughout discussion (useful for transitions)

63. Cost: expensive time intensive, require skilled researchers
may be cheaper than a larger number of informant interviews to get comparable info, but sometimes not so
planning, analysis take considerable cost
administrators often surprised at price-tag

64. Focus Group Discussions Reports and Data Analysis
team approach to analysis, especially if cultural factors are a focus of research
Report preparation meeting immediately after FGD
Define structure of field report

65. Debus HANDBOOK FOR EXCELLENT IN FOCUS GROUP RESEARCH
Very practical material
On reserve in library

66. Class Exercise begin by 2:45,

67. Focus group exercise with 5-6 participants from the class

68. Focus:

69. Other students to take notes,
note techniques used,
evaluate effort
note that we haven’t done the background work to lead up to the focus group

70. FDG
Introduction
Thank you for taking the time to join us today.
I'm SB and I've been commissioned by the Dean's office to see what can be done to help graduate students cope with stress.
________ is here to help me as a recorder
You've been selected for this effort, I understand because you are known to have very successful ways of coping with stress
I'm going to ask you to write your first names on this tent-card so people can call on each other by name, I hope that is OK with you
We want to understand your experiences as a graduate student, the stress you perceive, and ways in which you deal with it.
There are no right or wrong answers to questions asked, we are interested in your opinions and comments, and I expect you may have differing points of view.
Don't feel like you have to respond but if you want to follow up on something someone else has said, agree or disagree, or give an example, please feel free to do that.
Don't feel you have to respond to me all the time. I'm here to ask questions, listen, and make sure everyone has an opportunity to participate
Initial Question
Increasingly studies show that stress causes health problems and recreation is often an important way to cope with stress. The School is interested in student perspectives on recreation and activities to deal with stress and how it might facilitate these.
Can each of you respond to how you deal with the stress of being a graduate student?
Can you give me an example of ways you have used university facilities or people to help you cope?
Probes:
would you explain further?
can you give me an example of what you mean?
please tell me more
say more
uh huh
is there anything else?
please describe what you mean
I don't understand
does anyone else see it differently
has anyone else had a different experience?
are there other points of view?
Later on:
are there any other ideas or thoughts or experiences any of you wish to describe?
do you think we have missed anything in the discussion?
Conclusion
some of the ideas I have heard expressed are:
thank you all for taking part, it has been very valuable

71. NEXT TUESDAY
Other group activities
Nominal groups