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Methodology Matters-V
"Methodology Matters" is the title of a series of intermittently appearing articles on methodology. Other
articles on such topics as Confidena Intervals are planned. Suggestions from readers of additional topics they
would like to ste covered here arc welcome. Please send all such suggestions to the Editor-in-Chief.

Focus Groups

RICHARD A. POWELL and HELEN issues, rather than to enumerate their preva-
M. SINGLE lence. Qualitative methods permit development
of concepts that enable researchers to compre-
Department of Mental Health. University of Excter, hend social phenomena in "naturalistic" rather
Wonford House Hospital, Exeter, UK than experimental settings and accord impor-
tance to the meanings, views and experiences of
respondents. While quantitative methods result

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'Ihts paper introdnces foam group methodology in reliable, empirical data upon which precon-
and d h u s m its relevance to those resePrchIng ceived hypotheses are evaluated, qualitative
M t h care provision. As a qualitative data methods generate detailed, valid data that
conection technJque, tbe finm groap hPs advm permit formulation of new hypotheses and
tnge over other qualitative methods, s u d ~ as the inform further study or practice.
indepth i n k d e w d the nomind group kdd- This paper introduces focus group method-
qrre. lids paper Mphliphts t k s e advantages after ology and discusses its relevance to those
providing guidelines on groap composition, tke researching health care provision. In order to
management of group *on and tke process highlight the special features and strengths of
of annlyging resalts. Copyright 0 1996 Etsevler this methodology, the paper also discusses the
Scieace Ltd. differences and advantages of focus groups and
compares these with two alternative qualitative
Key words Focus group, group discussions, research methods: the indepth interview and the
qualitative research methods. nominal group technique.

WHAT IS A FOCUS GROUP?


Health services research has traditionally
relied upon the use of quantitative methods. A focus group is a group of individuals
Producing results that are amenable to statistical selected and assembled by researchers to discuss
analysis and generalizable to wider populations, and comment on, from personal experience, the
such methods indicate the extent to which health topic that is the subject of the research. As a
services are efficient and effective. For some research technique, the focus group employs
purposes, however, qualitative methods prove guided, interactional discussion as a means of
more appropriate; e.g. when the need is to generating "the rich details of complex experi-
identify or to understand new or complex ences and the reasoning behind [an individual's]

Comsporrdemr should bt addrtascd to: Mr Richard A. PoweIl, Department of Mental Health, University of ktcr,
Wonford House Hospital, Drydcn Road. Exctcr EX2 SAF, UK. Tel. 0139243640; Fax 0 1 3 9 2 - 4 i ) W ; E-mail:
R.A.Powen@exetcr.aC.uk.
500 R.A. Powell and H. M.Single

actions, beliefs, perceptions and attitudes" [I]. asmiations require clarification, elaboration or
This information can be used to identify poten- "salvaging".
tial areas of enquiry or to clarify subject matter
In this respect, a focus group can be employed
that, by its nature, eludes other research instru-
either prior to, concurrently with, or after a
ments. The "focus" underpinning the discus-
quantitative study, or separately to explore
sions is anything that engages the focus group in
complex phenomena not amenable to quantita-
a collective activity, "such as viewing a film,
tive research.
examining a single health education message or
simply debating a particular set of questions"
[21. ORGANISING A FOCUS GROUP
The focus group dates back to the 1920s,when
Group membership and recruitment
it was used as a market research technique.
Today, the focus group has evolved into a data A focus group is composed of individuals with
collection technique that is employed commonly shared key characteristics pertinent to the study
in a range of settings throughout the social and comprises between six and 10 participants
sciences. Examples include investigating experi- who are strangers to each other. In this way, not
ences of childbirth, developing consensus guide- only are participants not inhibited by or defer-
lines for general practice in medicine, evaluating ential to intra-group differences (such as occupa-
a school sexuality education programme and tional seniority among health care
determining the decision-making process behind professionals), but the anonymity engenders an
the search for health care. atmosphere that encourages honest airing of
what could be critical personal views and

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negative experiences.
WHEN TO USE A FOCUS GROUP It is important to ensure that focus groups
embrace the full range of possible observations.
In health services research, the primary goal of
This can be achieved using theoretical sampling.
a focus group is to elicit information to answer
Under this approach, the researchers draw upon
research questions. A focus group may also
their own and existing knowledge of the subject
improve morale and generate feelings of self-
under investigation to identify those salient
worth among its participants, as well as dernon-
characteristics (such as ethnic group or length
strate that an organization (such as a health
of health service contact) likely to infIuence
authority) is listening to users of its services. The
variability in focus group responses. Member-
potential therapeutic benefits and public rela-
ship of the focus group is then stratified
tions successes to be derived from a focus group
according to these characteristics (e.g. if ethni-
are, however, secondary outcomes of the pro-
city and health services usage were of interest, a
cess. researcher might conduct focus groups among
A focus group is especially useful when:
Afro-Caribbean, Asian, Hispanic and Cauca-
existing knowledge of a subject is inadequate sian health service users).
and elaboration of pertinent issues or the In general terms, efforts to recruit participants
generation of new hypotheses is necessary for focus groups must avoid systematic biases in
before a relevant and valid questionnaire can be the selection process. For example, participants
constructed or an existing one enhanced [3]; should not be chosen from individuals suggested
a the subject under investigation is complex and by fellow group members on the grounds that
concurrent use of additional data collection they are "the best" or "most suitable" for
methods is required to ensure validity; the task. Given that .focus groups are used to
a the subject under investigation is complex and identify important issues and illuminate complex
comprises a number of variables. A focus group psychosocial phenomena, they should be com-
enables the researcher to concentrate time and prised of participants from a diverse range
resources on the study's most pertinent of backgrounds, views and experiences (e.g.
variables; ordinary users of mental health services as well
a the results of a quantitative survey are as their more articulate and "suitable" user
ambiguous or misleading and statistical advocates).
!
Focus groups 501

Anticipating subject loss, a researcher gener- note-taker, who can document important
ally over-recruits participants by approximately aspects of the group's interaction, such as
25%. It is desirable to "reward" participants expressive body-language of participants, that
with a small incentive -ideally a non-monetary in the absence of a filmed record of the session
one - if only as a gesture of gratitude for the would go unrecorded. The moderator works to a
time committed to the group and as an means of non-prescriptive, semi-structured interview
minimizing subject attrition. schedule and usually will supplement the pre-
pared questions with sub-questions that enable
researchers to clarify a topic or explore partici-
Number, duration and scheduling of sessions
pants' answers in greater detail. The five or six
The desirable number of focus group sessions questions selected for the discussion guide must
depends upon the nature and complexity of the be open-ended, phrased clearly and simply and
subject under investigation and the use for which must draw upon concrete examples to illustrate a
the data generated by the focus group arc to be topic. Where appropriate, the questions should
employed. From one to 10 sessions are generally be sequenced from less to more sensitive ques-
suBcient for most studies, since at some juncture tions. The moderator should also be receptive to
the group's discussion will simply replicate relevant issues raised by participants that have
existing data, making further sessions unneces- not been anticipated in the discussion guide, and
sary. A focus group session lasts approximately should encourage equal participation of all those
90-120minutes (the length of the session is in the group, ensuring that discussion proceeds
usually determined by the complexity of the accordingly.
subject under investigation or the number of Moderators also must be sensitive to, and be

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participants in the group). Scheduling the time prepared to initiate, appropriate measures to
for the focus group sessions requires a receptive- address ethical dilemmas posed by participants'
ness to participants' other commitments. When overdisclosure, especially on sensitive questions
planning a session, it is advisable to provide (e.g. patients' sexually abusive encounters with
group members with 10-14 days' advance medical professionals) [4]. The major concern is
notice; this enables participants to plan their the preservation of confidentiality among group
schedules to include this additional obligation. members. Researchers should endeavour to
ensure that sensitive information will not be
disclosed by other participants. Measures, such
Meeting setting as asking members before discussion begins to
The researchers will seek out a meeting place sign a written declaration that they will not
for the focus group that is considered neutral; it disclose what they hear, may help counter this
should have no special significance to the problem. It is often advisable for a moderator to
participants and no bearing on the subject linger after the conclusion of a group discussion.
under study. For example, in a study of health This provides an opportunity for individual
care services, this would be a non-health service- participants who may wish to elaborate upon
related setting, or other neutral location a m p or raise points they felt inhibited about discuss-
table to those taking part. This again allows for ing in the group.
frank, unhampered and, if necessary, critical
discussion and expression of negative views. HOLDING THE FOCUS GROUP
Researchers should provide participants with
Moderator role
an opportunity to meet before the formal
Facilitation of open, uninhibited dialogue is discussion begins. One way to do this is to set
central to the role of the moderator. The aside time for informal conversation at the
moderator should therefore be a relaxed, non- beginning of the meeting and provide light
judgemental individual and a good listener, who refreshments for participants. This enables the
ideally shares some of the participants' charac- moderator and note-taker to introduce them-
teristics, such as their age, sex or language. The selves to participants and, more importantly, for
moderator occasionally is accompanied by a the participants to interact informally. The value
502 R A. Powell and H. M. Single

of this "ice-breaking" interaction cannot be In general, the means of analysis employed to


underestimated, as it relaxes participants and process focus group data wrestles with raw,
fosters an atmosphere conducive to frank dis- transcribed information. The process of analysis
cussion. is largely two-stage.
In the formal session, participants should be
seated in a circle, to maximix face-to-face
Stage I
contact. Lively interaction between participants
is the goal of every focus group and the Code and classify the raw data by reviewing
facilitator should play a minimal part in proceed- the transcribed discussions for potential con-
ings to avoid becoming a central focus of group ceptual categories, using the guideline questions
attention. It is recommended that the audio or as initial categories. These coded data are then
video equipment used to record the discussions regrouped or indexed along the lines of the
should be as unobtrusive as possible, in order not nature of the responses provided and the
to inhibit participants' interaction. intensity with which they are expressed, to
Researchers must also be aware of the poten- facilitate further analysis. This process has been
tially self-censoring and conforming inhence considerably simplified by the development of
exerted by the so-called "group effect". Partici- computer software packages, including Ethno-
pants may "jump on the group bandwagon", graph [I and Q.S.R.NUD.IST 181.
adjusting their contributions according to their
individual needs, as well as their perceived
Stage 2
location in the social expectations of the group
Analyse the original data in conjunction with

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the transformed conceptual data. This is the
most problematic phase of focus group data
INFORMED CONSENT analysis, entailing a great deal of creative
Researchers should make clear to participants interpretation. Constant comparisons are car-
that note-taking or recording facilities will be ried out with the data to detect divergent views
employed during the group discussion and among the participants and to contrast observa-
obtain each member's agreement to this proce- tions that relate to variables within the sample
dure. Focus group participants need to receive population. This analytical process is inductive,
assurance from the research team that all involving the conceptualization of themes from
information gathered, the tapes recording the empirical data.
group discussions and the resulting data, are
subject to the same rigorous safeguards and
COMPARISON WITH OTHER
formal assurances of confidentiality and anon-
QUALITATIW METHODS
ymity employed by other research techniques. A
document should be prepared by the researchers The focus group is one of a number of
for each participant, guaranteeing present and qualitative methods available to health services
future anonymity and confidentiality of infor- researchers (others include observational techni-
mation received and acknowledging the use of ques and case studies) [9]. This section discusses
note-taking, or audio or video recording equip the advantages and disadvantages of the focus
ment at the sessions. Two copies of the docu- group compared with the in-depth interview and
ment should be signed by a senior member of the the nominal group technique (Fig. 1).
research team and by the participant, with each
party retaining one copy of the document.
In-depth interview
The indepth interview is a one-to-one
ANALYSING RESULTS research technique in which a respondent
This is a timeconsuming and di6cult stage of answers a researcher's questions. In contrast to
the focus group study. The process of analysing the schedule-structured interview, the indepth
results is the least agreed upon and the least interview pursues a respondent's subjective
developed part of focus group methodology [q. interpretation of a subject following a loosely
Io-dtpth interview Nominal group Focus group
techniqw

I Number of
rnciwlts

individual consensus opinion


VidWences

no parhal yes

N/A Kud med/higtr

low w low

I Depth ofexperiences deep w o w aed

I Range of arperiences wide

I Level of rnmkrator low low

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involvement

FIGURE 1. A comparison of the focus group with the indepth intemcw and the nominal group technique.

structured or unstructured interview guide. being addressed, without conversing with the
Respondents are given considerable liberty in other participants. When requested, participants
their responses and in discussing areas not raised declare their responses and these comments are
by the researcher. As is the case with the semi- recorded on a flipchart by the group facilitator.
structured focus group, the indepth interview After review and discussion of the contents of
enables researchers to gather detailed attitudinal each recorded comment, the group ranks the list
and experiential information from respondents, of comments from the most important to the
and this information is elicited by supplementing least important or acceptable. This initial rank-
the broad, open-ended, exploratory questions ing is recorded, then discussed and this is
with pertinent, gently probing subquestions. followed by a second private ranking of the
listed items. These data comprise the research-
er's core set of information [I I].
Nominal group technique
The nominal group technique, or expert panel,
as it is sometimes called, is an impersonal,
qualitative group method in which "exchange By comparison with the indepth interview,
and interaction between group members is more focus group discussion may be comparatively
controlled than in focus groups" [lo]. The superficial, generating only "surface" informa-
nominal group is similar in size to a focus tion on individual respondents. It is argued -
group, and is used to determine the extent to though this is disputed by others given the use of
which experts agree about a given issue. In this focus groups to investigate attitudes to and
methodology, a facilitator presents the question experiences of intimate sexual health issues -
or problem on which the group's views are that the collective nature of the focus group is
required. The participants list on paper their less appropriate as an investigative tool for the
feelings and experiences connected with the issue disclosure of personal, sensitive information.
R. A. Powell and H. M. Single

Similarly, doubts exist about the extent to which practical guide with an empharis on the topic of
both the moderator and the "group effect" agemg. Research Report No. 90-3, Population
influena individual participation in a focus Studies Centre, University of Michigan,
group discussion. Michigan, 1990.
A comparative advantage of the focus group,
Kreuger R A, Focus groups: a practical guide
however, is its ability to enable researchers to
for applied resemch. Sage Publications Inc.,
identify quickly the full range of perspectives
London, 1988.
held by the respondents. Moreover, the interac-
tional, synergistic nature of the focus group Morgan D L, Focus groups as qualitative
allows participants to clarify or expand upon resemch. Sage Publications Inc., London, 1988.
their contributions to the discussion in the light
Morgan D L (Ed.), Successful focus groups:
of points raised by other participants, thus
advancing the state of the art. Sage Publications
expanding on contributions that might be left
Inc., California, 1993.
underdeveloped in an in-depth interview.
Unlike the focus group, which draws upon Acknorrledgementg The authors u p = their grati-
spontaneous rather than carefully considered tude to Dr Keith Lloyd, Ms Elspcth Mathie and Dr
responses, the nominal group technique is a Andrew Thompson for comments on an earlier draft
directed method. Like the focus group, though of this work. Any remaining errors arc the responsi-
bity of the authors.
not to the same extent, participants' contribu-
tions may be influenced by the "group effect".
However, the focus group is flexible enough to REFERENCES
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