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hi welcome back to our series on qualitative research methods I'm Leslie curry from the Yale School of Public Health and this module is on a major qualitative study design focus groups just a brief overview of the modules the
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goal is to enhance our capacity to conceptualize design and conduct qualitative research in the Health Sciences there are total of six modules in this series and this module examines
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the major qualitative study design focus groups so what is a focus group in this picture you see a group of individuals sitting in a circle in a room and some
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conversation happening a focus group is a group of people with certain characteristics who generate narrative data in a focused discussion the interaction and the group dynamics are
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really essential the interaction among individuals can do several things it can widen the range of responses we're hearing from a range of individuals with a common experience but of course different individual perspectives and
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views the group dynamics can activate forgotten details hearing someone recount a story of their experience might help another remember you know this happened to me and the group exchange can also release
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inhibitions can make people feel comfortable in describing their experience with a particular phenomenon focus groups can be useful for a number of kinds of topics and the Health
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Sciences the first characterizing social and cultural norms around a given health area health behavior or type of healthcare delivery focus groups can be
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useful for sharing and comparing really like this phrase by David Morgan who's the author of the focus group kit and who describes sharing and comparing as the dynamic in the group where each
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member will offer up their perspective and in that context in the discussion comparing their experience with with others in the room this can generate insights that wouldn't be
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possible on in a one-on-one exchange focus groups can reveal how people talk about an issue because people are sitting around a table and exchanging amongst themselves the researcher
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moderator can listen and learn the kinds of language people use their intonation their views about a given issue focus groups can also be useful for exploring
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potentially sensitive topics we mentioned this in the individual interview module as well and so it really is dependent on the particular topic and the respondent group that you'll be working with to determine
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whether or not individual one-on-one interview format would be most appropriate or whether a group format is most appropriate given your topic so a few a few minutes on designing focus
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group studies what do they look like well there are some standards for the group size and number in focus groups so the principle one in terms of group size is that you want to have five to ten
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participants per group fewer than five typically the dynamics are flatter there isn't as much momentum in the group maybe not as much speak and freedom when you have small group exchange and more
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than ten participants it is very difficult for the moderator to keep the discussion moving flowing well and for each participant to have enough time to express substantively their view on a
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given topic so the range of five to ten is a guide guideline and the second guideline is the number of focus groups per strata we typically recommend having
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three to five groups per strata so just a minute on stratification if you determine that a given topic may generate some tension or difficulty if
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it's addressed say with a group of mixed gender you may decide that it's important to have focus groups of with all women and a separate set of focus groups with all men and if that occurs you need to be sure that you kind
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three groups a minimum of three groups of women and a minimum of three groups of men so group composition attention to group composition really very critical
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there are a number of ways we can think about assembling focus groups and they really depend in great to great lengths on the nature of the question that you're asking so several considerations we want to avoid power differentials in
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the room among individuals so for instance if you were conducting a study about culture change in nursing homes the pioneering effort to individualize
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care and nursing homes by which residents express their needs and certified nurse assistants and nurse aides are free to deviate from schedules in order to respond to a resident preference or need you would want to be
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mindful of having a focus group with the certified nursing assistants or Nurse Aides together with for instance the charge nurse or the nursing home administrator you could imagine that the dynamic in that room would really could
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really inhibit free exchange so be mindful of power differentials in the room thinking about homogeneity and heterogeneity in the group how alike do you want the group to be and how different do you want the group to be
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we're looking for some diversity so that you have a range of opinions and yet you don't want to want to also have homogeneity or similarity in the group so that there is enough common ground to
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share and compare strangers versus acquaintances is another consideration the composition of groups are you interested in having people who have never had an exchange with one another or is it more appropriate in a given
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circumstance to have acquaintances those who have some familiarity with each other experts and novices are we looking to talk to experts in a given area who have deep knowledge of a phenomenon or
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are we looking for more naive view and then stratifying by these saline characteristics as I mentioned it may be gender in a given group where you want to pay attention to those potential dynamics and create separate strata for
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those groups data collection I like this image because to me it sort of tells all we need to know about data collection and focus groups the idea is to just drop a pebble into the
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pond and to stimulate a ripple effect of conversation the discussion guide there are some there's some guidance some established techniques for structuring
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discussion guides in general the number of questions we're looking for no more than eight to twelve questions fewer is better it's helpful to kind of labeled questions as five or ten-minute
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questions one that the researcher comes in and thinks I don't want them to spend too much more than five minutes on this it's a relevant topic that's introducing them bringing them to the core issue the 10-minute question is where I really want them to linger and have deeper
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discussion the sequence of questions are also some guidelines they're the opening questions should be things that could be answered quickly that are based on facts you want the individual to use their voice to not be threatened not have a
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tricky question to establish them as the expert right so there's one answer and they know it so opening questions are really very useful for setting the stage in the room an introductory question is
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to begin to foster interaction among the group and have them begin to focus on the topic at hand transition questions link the introduction to the real key questions and begin to put the topic in
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context so you're moving people some sort of the broad comfort establishing questions into the core the core topic at hand and there should be no more than two to five key questions in the guide
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so item writing just some things to keep in mind conversational clear simple language sometimes as researchers we sit in our teams and we construct these complex compound sentences that are our
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questions for our discussion guide and when you speak them out loud only then you can hear maybe how how silly they sound or potentially off-putting so read them aloud practice them see whether they in fact feel conversational and
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clear open-ended questions are critical again not leading in any way having very broad parameters for the respondents to begin to generate and shape the direction of the discussion the think back technique can
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be really very useful asking people to think back to the last time when you were at the doctor's office it brings them out of the room back to a time in place it grounds them in an experience where they feel then they can draw upon
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details that are relevant to the discussion so that can be useful avoid if possible asking why this may seem counterintuitive this is what we're trying to understand why don't you do X
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or Y we don't want to ask this question so boldly and directly it's very sharpened tone it may cause defensiveness it may make the respondent feel like there must be a right answer and I better give that right answer so
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in fact we want to avoid the Y question instead we we want to invite people to comment on how something happens or to describe their experience in detail we also want to avoid giving examples this
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may lead participants sometimes this technique can be useful to give a very brief example to sort of get people going but it also runs the risk of leading participants down a particular
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path so be cautious on the examples be aware of the participants time there are limits of all types the time limits to attention limits to language various cultural issues and various
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communication skills we for instance have done lots of focus groups with frail older adults in the community and bringing them to common spaces libraries and community centers to talk about services that they're receiving in their
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homes and we need to be very mindful of their physical comfort their ability to stay engaged in a conversation the communication skills from the researcher to populations who may not be familiar
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necessarily or customed to being in research environments so these sensitivities are really very very critical in conducting focus focus groups moderator skills moderating focus
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groups requires a great deal of skill and really the only way to attain these skills is to practice moderating but there are some techniques that are really very critical to facilitating constructive and productive discussions
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the first is having a strong interviewing technique this means the ability to ask an open question and to receive the information to listen acutely for
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opportunities to dig deeper so having these keen observational skills watching what's happening in the room you can imagine in the moment you know you have eight people sitting around a table you're beginning to just drop that pebble so there's a ripple effect and
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the conversation starts you're very tuned to the dynamics in the group this is one of the unique assets of a focus group model and so keen observational skills watch who's
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speaking first who's listening who's leaning forward who's pulling back it's really very very critical need to have an ability to control and guide the discussion this requires in the moment judgment
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again we've you think back to the interviewer module where we have the image of a path with a railing kind of going through a marsh you want to be able to let the respondent let the group
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conversation go and yet you also need to control it and guide it without prematurely truncating conversation this is very tricky and has to be assessed in the moment need an ability to suppress
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our own personal views this perhaps easier than it sounds we're often you know researching a topic that is of great interest to us we probably have personal views but we need to be really very neutral in the role of moderator
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and lastly again respect for the participants so active listening leaning forward paying attention not scribbling notes or looking at the tape recorder or watching the time go by watching the
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clock you know active listening I contact with each individual concern for their comfort in the space respect for participants is really also very important to establishing a safe space
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for the data collection so we're going to listen to an excerpt from a focus group and listen carefully really to the moderator some of the audio you'll hear
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multiple members speaking at once but listen for the moderators voice then we'll review what you've heard so let's listen we're not going to go run the circle anymore we just need to just join in whenever you have something to
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say um what to you all makes a good doctor what what does it take to be a good doctor would you say one that lets
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you marry says okay that would you think I mean okay and what else about a doctor makes a good doctor in the office okay
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and how would the doctor do that well how would he show that I don't think you pissed or didn't even think about your problem yeah any other thoughts about
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what makes a good doctor maybe watching you Jenny you know not not touching you all over but you know like nice studying and
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that's very good and over here feels good with that oh nice version out kind of Dorothy what do you mean by that nice personality well I'm saying I think
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you guys show that they are interested in you you know okay giving the ideas of how they might show how they're interested okay so what did
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you hear there several things happening at once you hear the moderator interjecting saying Mary what do you think is that what you think Emily so identifying speakers this is important
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for really the sort of mechanics of generating a data set for focus groups the transcriptionist has to be able to identify a given voice with a name some identification so that you're able to
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understand which person is speaking at what time and your Libby to look at patterns of speech across members in the group so being able to tag a specific name or identification to a voice is really critical for transcription and in
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the moderating we often we instruct people in the group before you speak please say your name this isn't a very natural thing for us to do and so participants often will just begin talking and so the moderator can sort of
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quietly interject you know meri said this and did you hear that is that what you said Emily you hear in this in this excerpt an icebreaker question something very open easy you know what does a
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doctor what does what does it take to be a good doctor and you can hear the respondents feeling confident in describing you know I want one who you know pays attention to me one who you know is close in the
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interactions who knows your name do you hear the moderator asking clarifying probes what do you mean by that nice personality asking for just a little more about you you know what the
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respondent means when she's describing nice personality and then lastly you can hear the very dynamic exchanges in the group where individuals are starting this is very early in the group and you can hear them already starting to
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reflect back and forth across each other so just to give you a sense of what the dynamic interplay might sound like in a focus group analysis of focus group data
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this is an area where I think we often fall short there are some assumptions we may come to the data thinking well it's just a bunch of individual will analyze it like individual interviews which
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loses the richness of the group dynamic and in fact doesn't pay attention to some of the critical aspects of focus group data which is sort of the group interaction and so analysis of focus
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group data requires careful attention to several things we have to remember that the group is the unit of analysis not the individuals within it and so we're looking to extract the summary of
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emerging ideas and themes at the group level not individual utterances within the text so just a mindful as we're approaching the data we want to be looking for whether or not a theme is a
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view of one member or whether it was a theme for the group was it really only one participant who felt a given way or expressed a particular experience or perspective or was this one where there developed some consensus or
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some shared view throughout the group discussion we want to know whether question whether a response emerged as a result of a question led by the moderator or whether it was something
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that spontaneously came from the group conversation we want to note that more text does not mean the issue is more important necessarily there may be some very brief text on something there was
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great agreement very quickly and so we don't want to be sort of way distracted into thinking that if there's a lot of conversation about something it means it's really the essence of the study and so looking at the dynamics in the group
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really very critical throughout throughout the group is there biasing is there groupthink is there a single member who dominates the discussion so several tips for a good focus group
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creating rapport among the group members first this is in contrast to individual interviews where it's really very much about the interviewer and the respondent and establishing that space for candor
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and disclosure right up front in this instance the moderator wants to be very very light almost invisible in the room off to the side and really focusing on the relationship among the members is is
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the primary goal in creating a relationship among them in the first moments of the group is the is the primary primary goal establishing a safe space
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knowing how to make hesitant people feel comfortable in contributing in that space really also can be very useful being prepared to redirect the group so
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listening very very carefully and letting the group sort of take itself down a certain path but not too far and being ready to interject without squelching the dynamics this is tricky
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we we want to bring the group around gently back to the topic at hand and not interject with too much control because that can sort of deflate the momentum in
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a group so be careful managing the dynamics in the room so there are always dynamics and every that we experienced focus groups is no different and so there will be people
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who feel more confident who are more vocal who have stronger opinions there will be others who are more hesitant and maybe feel more anxious in the group
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space and so managing those dynamics really is something the moderator is responsible for from the moment the group begins through to the end because the domineering dynamics can constrain
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conversation and the sort of repeated interjection of a given prospective of you can also bias the dialogue so managing those dynamics is really very important lastly one of the benefits of
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focus groups is that we're getting to watch people as well so being aware of the nonverbal information in the room and there's lots of it in our focus group work we have a primary moderator who's responsible for sort of dropping
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that pebble and then facilitating the conversation as it goes and we have a second person in the room who is doing managing all the logistics so that they're unobtrusive and taking careful
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note of nonverbal information in the room who pulls away from the table who seems to be aggressive who is nodding in deference all the time to another respondent and those kinds of nonverbal
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data are really very useful in interpretation again of the group findings and with the group as a unit of analysis thank you for your attention
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