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This work was supported by the National Diabetes and Digestive and Kidney Diseases Grant # 1-R34-
DK076663-01A1
Dr. Stephen J. Sills, Ph.D., Department of Sociology, University of North Carolina of Greensboro, 320
Graham Building, Greensboro, NC 27402-6170 USA, sjsills@uncg.edu, Tel: +1.336.792.1191
Nicole R. Pinelli, Pharm.D., Department of Pharmacy Practice, Wayne State University 259 Mack
Avenue, Detroit, MI, 48201. NickiPinelli@wayne.edu
Linda A. Jaber, Pharm.D. Department of Pharmacy Practice, Wayne State University 259 Mack Avenue,
Detroit, MI, 48201. ljaber@wayne.edu
Stephen J. Sills, Ph.D., is an Assistant Professor of Sociology at the University of North Carolina
Greensboro, Greensboro, North Carolina, USA.
Nicole R. Pinelli, Pharm.D., M.S., is an Assistant Professor of Pharmacy Practice at Wayne State
University, Detroit, Michigan, USA.
Linda A. Jaber, Pharm.D. is a Professor of Pharmacy Practice at Wayne State University, Detroit,
Michigan, USA.
Sex and Self-Disclosure 2
Abstract
Demographic and cultural shifts in the United States have resulted in the need to re-evaluate some
common social-scientific methodologies and tailor them to the cultural needs of immigrant populations.
Focus groups have been used to identify the barriers to translation, to frame appropriate health messages,
and to design culturally relevant strategies for outreach and diabetes prevention. In our study, exploring
diabetes prevention in Arab Americans, methodological concerns arose regarding the impact of sex
segregation and gender norms on mixed-sex focus groups. A research design was adopted in which
participants were assigned to one of three conditions: a male only group, a female only group, and a
mixed group. Transcripts from these groups were compared using measures of verbosity and turn-taking.
In addition, post-focus group surveys were administered to explore issues of self-disclosure. By all
measures, men were found to speak more than women. Analysis of post-focus group survey data showed
that Arab American women withheld their comments and felt more comfortable in same-sex groups.
Introduction
According to the Census Bureau, America’s population is now over 300 million (U.S. Census
Bureau 2009). Much of the recent population growth may be attributed to the influx of immigrants which
has both diversified the population and changed its cultural landscape (Pew Hispanic 2006). These
demographic and cultural changes have resulted in the need for new methodological approaches in health
research that emphasize the importance of culture in shaping health outcomes as well as a re-evaluation of
some of the commonly used data collection techniques (Orlandi et al. 1992; Pumariega 1996; Salend and
Taylor 2002; Hazel 2004; Conner 2004). A ‘one-size fits all’ approach to data collection is not
appropriate in this culturally pluralistic society. Culturally sensitive and methodologically appropriate
techniques should be developed and standard methodologies refined to take into account the cultural
This paper examines concerns that arose in conducting qualitative health research regarding
diabetes prevention among Arab Americans. In designing culturally specific health interventions,
qualitative approaches are often useful for identifying key components and major barriers to
implementation. Yet, the very qualitative method used in the study, namely focus groups, may present
challenges due to sex segregation and gender norms within the traditionally male-dominated Arab
American community. As we know, the social context of a guided discussion makes a difference in the
quality and quantity of data that emerges. According to Peek and Fothergill (2009) Arab American
women may withhold information in the context of mixed-sex focus groups. Thus, a series of pilot tests
were conducted to determine the degree of silencing, or lack of self-disclosure, that may occur as a result
The focus group, or group interview, is a common methodology that has been used as a means of
data collection in the social sciences for at least a century. Focus groups gained popularity in the 1930s
and 40s with Robert K. Merton who used them as a tool for gauging reactions to wartime propaganda
Sex and Self-Disclosure 4
materials (Morgan, 1988; Hollander 2004). Since then, the methodology has been employed in a wide
variety of research settings that call for a deep understanding of a groups’ perspective on a particular
issue. It is through the synergistic, collaborative, and interactive atmosphere of the focus group that
participants are influenced to express many ideas that may have been more difficult to express
There are many advantages to using focus groups in health-related research as they provide an
effective method for assessing needs, identifying barriers, framing appropriate health messages, and
designing relevant strategies for outreach (Garfield, Malozowski, Chin, Narayan,Glasgow, Green, Hiss,
and Krumholz 2003). Vincent, Clark, Zimmer, and Sanchez (2006) note that focus groups are an
“efficient method of obtaining information about an underserved population’s experience” (96). Focus
groups produce more in-depth information than quantitative research methods. However, the value of
focus group research is largely dependent on how well the focus groups are designed and executed and
Investigators have used focus groups to explore diabetes care and behavior change issues among
various cultural groups. Past research has demonstrated the effectiveness of the focus group technique in
identifying important health beliefs and nutrition practices of urban Caribbean Latinos and Native
Americans with diabetes (Quatromoni, Milbauer, Posner, Carballeira, Brunt, Chipkin 1994; Hosey 1993).
They have also been used to identify diabetes care issues for urban African Americans (Anderson,
Satterfield, German, and Anderson, 1996) and Latinos with diabetes (Anderson, Goddard, Garcia,
Guzman, and Vazquez 1998). They are especially useful in studying the cultural, psychosocial, and
contextual influences on self-care practices relevant to diabetes prevention (Anderson 2001). Focus
groups can help identify culturally specific health beliefs and which health beliefs are amenable to
change.
Focus groups have often been used when conducting research in ethnic or immigrant
2003; Rice, Weglicki, Templin, Hammad, Jamil, & Kulwicki 2003). Health-related focus group studies in
Sex and Self-Disclosure 5
the Arab American community have included investigations of tobacco use among adolescents (Rice et al
2003), elders' views about health and social support (Ajrouch 2005), cultural considerations for mental
health counseling (Nassar-McMillan and Hakim-Larson 2003), ways in which to enhance health services
(Kulwicki, Miller, and Schim 2000), and on the importance of culturally and linguistically appropriate
Arab Americans, both foreign born and native born, are a steadily growing population in the
United States. Between 1990 and 2000 this population grew by 38% (de la Cruz and Brittingham 2003)
and, while temporary visitors from the Middle East have dropped in recent years, the number of
individuals permanently immigrating from Arabic-speaking countries has remained constant post 2001
(Kayyali 2006). This is not a new phenomenon. Arab immigrants have been settling in the United States
since the late nineteenth century. According to the United States Census Bureau estimates for 2008, there
were about 1.6 million individuals who claim Arab ancestry in the US (U.S. Census Bureau, 2008).
However, it is recognized that this figure is inaccurate and well below the actual total. According to the
Arab American Institute the true figure of those who have Arab ancestry is at least 3.5 million (Arab
Michigan is home of the largest Arab population in the United States and the second highest
concentration of Arab settlement outside of the Middle East. The Arab American community represents
the third largest minority population in Michigan. About 400,000 Arab Americans live in the Detroit
Metropolitan Area (Arab American Institute 2009b). A previous cross-sectional, population-based study
of Arab Americans of Dearborn, Michigan found that the community is largely homogenous with striking
uniformity in cultural identity based on commonality of the spoken Arabic language, the Muslim faith,
and adherence to traditional values and practices. Most (95%) were immigrants with a mean length of
stay in the US of only 11 years. The majority were Lebanese (65%) followed by Yemenis and Iraqis. A
large proportion came from rural areas of the Middle East. Approximately 69% of men and 49% of
Sex and Self-Disclosure 6
women had completed a high school education. About 80% of men were employed compared to 19% of
women. Acculturation, measured by multiple factors including age at immigration, language proficiency
and preference, friends’ ancestry, and socioeconomic status, was low in men and women (Jaber, Brown,
Hammad, Nowak, Zhu, Ghafoor, and Herman 2003; Jaber, Brown, Hammad, Zhu, and Herman 2003).
Focus groups, though commonly used in health research and quite useful in developing culturally
appropriate interventions, may also present “methodological challenges” (Peek and Fothergill 2009). The
focus group is a social interaction in which customs and normative behaviors of a society may be
reenacted, limiting voice of some within the group. Smithson (2000), notes that some individuals tend to
dominate the discourse in the focus group setting resulting in the silencing of others. Hollander (2004) in
fact says that focus groups are less a methodology and more the site of social process that is being
observed by the facilitator. Hollander (2004) advises researchers to consider the social context of the
Who has status or power in the situation? Who speaks first in the discussion? What kinds of
thoughts, feelings, or experiences might be expected in the context, and what kinds might not be
expected? Are these expectations the same for all participants? What are the consequences (both
immediate and long term) for individual participants of disclosing sensitive information? What
The achieved and ascribed statuses of focus group participants may determine the amount of
power and voice one has in the interaction (Peek and Fothergill 2009). The sex of the speaker (or their
gender identity) may play a significant role, in particular when discussing gendered issues. As Morgan
notes, "group interaction requires mutual self-disclosure, it is undeniable that some topics will be
gender or other attributes) as a solution to power imbalances or in the case of sensitive topics (Goldman
and McDonald 1987; Morgan 1996). Yet, as Bristol points out, “evidence in support of the gender
assumption is nonexistent” (1999:479). Hollander also notes that segmentation does not necessarily lead
to more disclosure though it may make some participants feel more comfortable (Hollander 2004). In the
case of research with Arab Americans though, many researchers have chosen to segment their groups.
While most researchers do not explain their rationale for gender segmentation, Peek and Fothergill (2009)
Some of the groups said it would be easier to meet as a mixed male-female group, while others
requested that the interview be conducted with an all-female or all-male group. One student told
Peek over the telephone that she did not think the Muslim women would be comfortable talking
about some of the issues they had faced in front of their male counterparts. Thus, Peek segmented
the groups according to sex in part at the request of the students, but she tried to conduct all-
female or all-male groups if possible because it became apparent that the students in the sex-
segregated groups seemed more comfortable and talked more openly about sensitive topics. (39-
40)
This report comes from a larger project entitled the Feasibility of Diabetes Prevention in Arab
Americans Project. Focus groups were a central component in the research design and were used to
identify barriers to participation in the diabetes prevention program and to demonstrate the feasibility of
lifestyle intervention modeled after the Diabetes Prevention Program (DPP) (Knowler, Barrett-Connor,
Fowler, Hamman, Lachin, Walker, and Nathan, 2002). This program was being implemented in the
Dearborn, MI area. All participants provided written informed consent. The survey and consent
procedures were approved by the Institutional Review Board at Wayne State University.
Sex and Self-Disclosure 8
Before the start of the project, a series of tests were conducted to determine the degree of
“silencing,” or lack of self-disclosure, that may occur in mixed-sex, focus group sessions. Based on our
understanding of gendered roles and behaviors in the Arab American community, we contemplated that in
some instances women may feel less likely to disclose health© information, health beliefs, or provide
candied feedback when men would be present. We also examined if participants felt strong preferences
for delivery of the intervention and educational components of the project in single-sex or mixed-sex
settings. Thus, we devised a test in which focus groups were conducted with participants in three
conditions: a male-only group, female-only group, and a mixed-sexed group. The content of the pilot
script dealt primarily with diabetes awareness, perceptions of risk, diabetes health beliefs, and perceived
barriers to health care. Transcripts from these groups were compared using discourse analysis. In
addition, post-focus group surveys were administered to explore issues of self-disclosure. This strategy
has been a common technique for comparing individual level data to that produced in the group. For
example, Corfman (as cited in Bristol 1999) employed pre-and post surveys to “gather information on
A total of three pilot focus groups were conducted. The groups ranged from eight to twelve
participants and from 90 minutes to 115 minutes in duration. The test compared the volume of linguistic
output and the number of turns taken by each sex in male-only, female-only, and mixed-sex focus groups.
Participants met in the clinic conference room at the Arab Community Center fro Economic and Social
Services (ACCESS), a well-established and well respected health and social service agency that serves
additional staff members were present acting as note-takers and operating the recording equipments.
Participants were randomly assigned to a male-only, female-only, or mixed group. A short survey
was conducted after the group session to collect additional demographic information and to assess issues
with silencing and disclosure, comfort, and willingness to participate in future focus groups. Focus groups
were digitally recorded, transcribed, and then translated into English. Qualitative analysis was performed
using MAXqda2 software. The analysis included the generation of thematic codes and subcodes grounded
Sex and Self-Disclosure 9
in the participant’s discourse. Content analysis was also performed using MAXDictio. All text was coded
as being generated by males or females. Character, word, line, and paragraph counts were made as well as
the number of turns per individual. Averages were computed per person per minute. Survey responses
were coded and entered into a spreadsheet. Simple descriptive and bivariate analysis was conducted with
Characteristics of Participants
Twenty-nine participants (11 men and 18 women) participated in the three conditions. There were
fairly representative of the broader Arab American community. Based on the exit survey, a third (10 of
the 29) were from Lebanon, followed by four each from Yemen, Palestine and Syria, two each from
Egypt and Jordan, and a single person from Iran, Iraq, and the USA. Participants have lived in the USA
for “only a few months” to more than 37 years: “I came this country in 1970, [a] long time ago.” While
one was born in the USA, eight came within the last five years, nine around ten year ago, and five had
The focus groups were conducted in Arabic and the participants indicated that they primarily
speak Arabic in the home, though some indicated that their children spoke primarily English. At least one
participant showed difficulty in comprehension of Arabic. Most indicated having families in the USA (19
of 29 mentioned family in the warm-up). The majority of the women indicated that they were
homemakers (12 of 18). Of those who indicated that they work working outside of the home, nine were in
professional occupations (teachers, engineers, etc.), two were in business, and one was in a service
occupation.
Health-Related Findings
symptoms of the disease, and some of the causes. Focus group participants understood that diabetes was
related to the pancreas and that it results in difficulty regulating blood glucose levels. Yet, there were
Sex and Self-Disclosure 10
those who indicated that they still knew little about diabetes. Participants were knowledgeable of the
symptoms of diabetes, though many were confused of its causes. Answers touched on many of the factors
associated with increased risk of diabetes including genetics/family history, stress, high blood pressure,
diet, drinking alcohol, lack of exercise, obesity, and age. However, some participants also stated that
diabetes was linked to suddenly being startled or shocked, blood-pressure or cholesterol medications,
eating before bedtime, use of sugar substitutes, and sudden anger or sadness. For example, one participant
noted that, “if one of my sons has an accident, this will be like ‘volcano eruption’ and I might develop the
disease at once.” These myths and misperceptions will be further explored in our future research as they
present important implications to the design of health education programs such as the DPP.
Participants felt that diabetes was a common ailment in the Arab world that had recently become
more prevalent with changes in diet. The perception of personal risk for developing diabetes was high.
The general consensus was that the rate was above 50 percent among Arabs with most respondents
estimating in the 60 to 70 percent range. Of the 29 participants, two-thirds (19 of 29) indicated that they
Participants were well-versed in ways in which to prevent diabetes, yet indicated that willpower,
time, and other factors limited their attempts to diet and exercise. They listed regular walking and
exercise, healthy diet (including reduction of fried foods, portion control, reduction in sweets and
carbohydrates, and fewer “junk foods”), regular checkups, reduction in stressors, and increasing personal
knowledge or awareness. Many participants noted that while they understood that prevention was
possible and necessary, the issue became laziness, time, and/or lack of will power.
The major barrier to health care was lack of health insurance and the high cost of seeing a
physician: “many do not have medical insurance and so cannot see doctors regularly… they pay to see a
doctor.” This lack of insurance causes many to delay care until it is absolutely necessary. A male
participant noted that this problem is especially acute among recent arrivals who are searching for
employment: “When people come from the old country they do not find a job right away or find a job
without health insurance; most companies are now cutting back anyway. All things that relate to health
Sex and Self-Disclosure 11
insurance such as the financial factor, the person does not find job.” Other barriers discussed included a
fear or dislike of doctors or medicine; a lack of awareness; negligence, laziness, or stubbornness, and
transportation issues. Language issues, while acknowledge to be a concern, were not seen as a true barrier
to care. About half of the participants expressed a preference for co-ethnic caregivers. It was seen that
most routine medical care was the domain of the wife/mother, yet there was sentiment for shared
responsibility between men and women, especially in making decisions about serious health issues.
About a quarter of the participants expressed a clear preference for same-sex intervention and
education groups. A little more than half of the men in the male-only group (5 of 8), and two of the
women in the women-only group seemed to prefer a separation of the sexes for informational sessions. As
one women noted; “possibly we can express ourselves more freely in women session.” Most of the
remaining 29 participants seemed to agree that mixed-sex groups were acceptable. A male participant in
the mixed group notes, “You should define the community you will deliver the speech to. As an example
in the ICD, we have mixed gender lectures where men and women are seated separately, but in the same
place, where they listen to the same lecture at the same time. However, there are separate lectures for
women only on Wednesdays at 1:00 PM that deals with topics important to women, so it depends on the
Part of the Lifestyles Intervention Program includes consultation and courses on healthy food
preparations. There was a general consensus that cooking was the “women’s realm” and that many men
“would not be interested” in attending a course on healthy food preparation. One female participant
commented, “It is a part of the Arabic culture that men are not interested in cooking.” However, another
female participant also observed, “When men attend these sessions, they will communicate with us better,
listen and accept the meals we cook... I think you should invite women and their husbands.” Yet, this also
presented a problem for childcare. One father said, “In my case [only] one of us could attend because of
the children.”
Sex and Self-Disclosure 12
There was an agreement among participants regarding same-sex versus mixed-sex exercise
classes. Most felt that separate classes should be offered. The only exception was in walking groups.
While there was debate over who walked faster, men or women, there was agreement that this activity
was not gendered and that mixed groups were fine: “Walking in groups around the neighborhood is
encouraging and supportive. It can be done in group with family, or friends, certainly.” On the other hand,
anything that involved “physical activities that require bending or movements,” were considered to be
The primary goal of the series of pilot focus groups was to determine the degree of silencing that
may occur in mixed-sex Arab focus groups as a result of perceived male dominance. The pilot focus
group design was meant to create a test with male-only and female-only control groups and a mixed-sex
experimental group. However, several complications affected the research design. First, the groups were
not of equal size (one group of 12, one of 8, and one of 9 members), thus the measure (amount of text in
turns, lines, or words) was averaged by the number of group members. Second, the focus groups were not
of the same duration (the women-only group lasting for 1 hour and 45 minutes, the men-only for 1 hour
and 30 minutes, and the mixed group for 1 hour and 40 minutes). The mixed group was also imbalanced,
with only three males and six females. Finally, at one point about three-quarters of the way into the
discussion in the experimental mixed group, the facilitator may have biased the outcome by interjecting
Facilitator- (talking to men) You thought that women are reluctant to speak when men are
present… well in this session, women are talking more than you
front of men.
Sex and Self-Disclosure 13
None-the-less, two separate approaches to discourse analysis were performed to compare males
and females and the amount of text produced by each: one looking at turn taking, the other at the amount
of text or utterances produced (verbosity). By all measures, men were found to speak more than women in
all conditions.
Turn-Taking
On average men took 30 turns in the male-only group compared to 23 turns for women in the
female-only group. Men in the mixed group took 41 turns, while women took only 20 (See Table 2).
Thus, in the mixed group, where men were the minority, they spoke more than twice as often as women.
Individual analysis shows that several participants dominated the conversations in their respective focus
groups; particularly Man7 in the men-only group; and Man 3 in the mixed group. Women’s turn taking
was more equitably distributed, though some women clearly took fewer turns than others (see for
example Woman 10 and 12 in the female-only group, and Woman 6 in mixed-sex group.
Verbosity
Utterances could be measured by the number of words, characters, paragraphs, or lines produced
by a speaker. This quantifies the amount of language an individual contributed to the transcription. A rate
can also be computed based on the average number of words generated per individual per minute (See
Table 3). Using this approach we see that men in both the men-only as well as the mixed group produced
more utterances. In particular, men in the Mixed group contributed twice as much text to the transcripts
given that were half as many of them. Women’s utterances were, however, consistent in both the mixed
A Test of Self-Disclosure
It is difficult for a focus group moderator to really tell if someone is holding back information.
Often, if the moderator focuses in on one person alone, the dynamic atmosphere of a focus group will be
lost. We determined that a brief post-focus group survey would be most helpful in determining if there
was information that was not disclosed during the focus group. Analysis of the post-test survey shows that
women were more likely to agree with the statement “I had things to say which I kept to myself” than
men (47.0 percent of women compared with 37.5 percent of men). Women were more likely to agree with
the statements “I could have said more than I did” (55.6 percent of women compared with 50.0 percent of
men), “I felt awkward sharing in front of the group” (27.8 percent of women compared with 10.0 percent
of men) and “I feel more comfortable in same-sex groups” (64.7 percent of women compared with 45.5
percent of men). Yet males were more likely to agree with the statement that “I felt others dominated the
Within the mixed group, all three men disagreed with the statement “I had things to say which I
kept to myself,” while three of the six women agreed. Similarly, all of the men disagreed with the
statement “I felt awkward sharing in front of the group” while the same three women agreed. Four of the
six women agreed that “there were uncomfortable moments during the focus group,” while none of the
men agreed. Finally, all three men in the mixed group were neutral on the issue of feeling more
comfortable in same-sex groups; however, three of the six women strongly agreed that they would be
Conclusions
Though we conducted only a single “test” of the control variable (sex composition of groups), the
triangulation of measures (turn taking, verbosity, and survey results) all indicated that Arab
American men were found to take more turns and to speak with more verbosity than Arab
American women. Speech in groups with men (male only and mixed sex), tended to be
Sex and Self-Disclosure 15
dominated by a few speakers, while the female group was more equitable in the turn-taking and
amount of discourse per participant. Women were more reluctant to share in general, yet the male
domination of the mixed-sex group made the discussion even more awkward for the women and
limited their responses. Thus, the reluctance to self-disclose in mixed-sex groups may result in
loss of important information as women were more likely to talk less, more likely to feel
awkward, and more likely to keep information to themselves. Moreover, they indicate preference
These finding have direct implications for future studies with Arab American populations using
focus group methods as well as for interventions that include male and female participants. It was clear
from the focus group participants that separate or segmented focus group sessions would work best so as
not to alienate a significant proportion of the Arab American community. The findings provide empirical
evidence for the current practices of many qualitative researchers in the Arab American community who
References
Ajrouch, K. J. (2005). Arab American immigrant elders’ views about social support. Ageing & Society,
25(5): 655-673.
Anderson, L. A., Satterfield D., German R., & Anderson, R. M . (1996). Using quantitative and
qualitative methods to pretest the publication Take Charge of Your Diabetes: A Guide for Care.
Anderson, R. M., Goddard C.E., Garcia R., Guzman J. R., & Vazquez F. (1998). Using focus groups to
identify diabetes care and education issues for Latinos with diabetes. Diabetes Education.
24(5):618-25.
Anderson, R. M. (2001) Qualitative research in diabetes: The role of stories in the culture of silence. The
http://www.aaiusa.org/Arab Americans/22/demographics
Arab American Institute (2009b). Arab American Population Highlights. Retrieved from
http://aai.3cdn.net/9298c231f3a79e30c6_g7m6bx9hs.pdf
Bristol, T. (1999). Enhancing focus group productivity: new research and insights. Advances in
multicultural validity in two HIV prevention programs for Latinos. New Directions for
de la Cruz, G. Patricia and Angela Brittingham. (2003). The Arab Population: 2000 Census 2000 Brief.
23.pdf
Garfield S. A. , Malozowski S. , Chin M. H., Narayan K. M. V., Glasgow R. E., Green L. W., Hiss R. G.,
Krumholz H. M., (2003). The diabetes mellitus interagency coordinating committee (dmicc)
Sills Page 17
translation conference working group. Considerations for diabetes translational research in real-
Goldman, A. E., & Mcdonald, S. S. (1987). The Group Depth Interview: Principles and Practice.
Ethnography,.33(5), 602-637.
Hosey G: Talking circles: a community assessment method. Diabetes Educator. 32(1): 89-97.
1993;19(4):351.
Jaber L. A., Brown M. B., Hammad A., Nowak S. N., Zhu Q., Ghafoor A., Herman W. H. (2003).
Jaber L. A., Brown M. B., Hammad A., Q., Herman W. H. (2003). Lack of acculturation is a risk factor
Kayyali, Randa. 2006. The Arab Americans. Westport, Connecticut: Greenwood Press.
Knowler, W. C., Barrett-Connor, E,. Fowler, S. E., Hamman, R.F., Lachin, J. M., Walker, E. A., &
Nathan, D. M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or
Kulwicki, A. D., Miller, J., Schim, S.M. (2000). "Collaborative Partnership for Culture Care: Enhancing
Health Services for the Arab Community Journal of Transcultural Nursing," 11(1): 31-39.
Morgan, D. L. (1988). Focus groups as qualitative research. Newbury Park, CA: Sage.
Orlandi, M. A. ed. (1992). Cultural Competence for Evaluators: A Guide for Alcohol and Other Drug
Competence Series. National Clearinghouse for Alcohol and Drug Information, Rockville, MD.
Sills Page 18
Peek, L. & A. Fothergill (2009). Using focus groups: lessons from studying daycare centers, 9/11, and
Pew Hispanic Center. (2006). From 200 Million to 300 Million: The Numbers behind Population Growth.
http://pewhispanic.org/files/factsheets/25.pdf
Pumariega, A. J. (1996). Culturally competent outcome evaluation in systems of care for children's
Quatromoni, P.A., Milbauer, M., Posner, B.M., Carballeira, N.P., Brunt M., & Chipkin, S.R. (1994). Use
of focus groups to explore nutrition practices and health beliefs of urban Caribbean Latinos with
Rice, V. H., Weglicki, L. S., Templin, T., Hammad, A., & Jamil, H. (2006) Predictors of Arab American
Salend, S. J., & Taylor, L. S. (2002). Cultural Perspectives: Missing Pieces in the Functional Assessment
Shah, S.M., Ayash, C, Pharaon, N.A., and Gany FM. (2007)"Arab American Immigrants in New York:
Health Care and Cancer Knowledge, Attitudes, and Beliefs". Journal of Immigrant & Minority
Health. 10(5):429-36
Smithson, J. (2000). Using and Analyzing Focus Groups: Limitations and Possibilities. International
U.S. Census Bureau. (2008). Table B04003 Total Ancestry Categories Tallied For People with One or
http://www.census.gov/population/www/popclockus.html.
Vincent, D.; Clark L. ; Marquez-Zimmer L.; & Sanchez J. (2006). Using focus groups to develop a
culturally competent diabetes self-management program for Mexican Americans. The Diabetes
Willgerodt, M. A. (2003). Using Focus Groups to Develop Culturally Relevant Instruments. Western
Table 1
Groups by Condition
Frequency Percent
Female-Only 12 41.4
Male-Only 8 27.6
Mixed
Men 3 10.3
Women 6 20.7
Total 29 100.0
Sills Page 21
Table 2
Table 3
Condition N Time (mins) Words Chara Para Lines Words per Words per Words per
min. person person per min
Men 8 90 6869 31902 320 712 76 859 10
Women 12 115 8952 41620 351 767 78 746 6
Mixed
Men 3 100 3992 18269 92 290 40 1331 13
Women 6 100 3478 15428 128 271 35 580 6
Sills Page 23
Table 4
Percent Agree or
Strongly Agree
Question F M
I had things to say which I kept to myself 47.0 37.5
I could have said more than I did 55.6 50.0
I felt awkward sharing in front of the group 27.8 10.0
I felt others dominated the discussion 31.3 36.4
I feel more comfortable in same-sex groups 64.7 45.5