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Focus groups.

In this issue, Laursen, Danielson, and Rosenberg (2015) report on a study using focus groups to examine communication needs for spouses of patients on a surgical unit. Focus groups are used for data collection in certain qualitative studies, and their use involves nuances that should be understood. In this column, I will discuss briefly the basic concept and components of focus groups, and review a focus group study.

What Are Focus Groups?

Not all groups that are called focus groups are research focus groups. Focus groups employed in research as a data collection method use the discussion within a group to generate data the researcher might not obtain otherwise. Focus groups can be used in place of individual interviews in qualitative studies when they meet the purpose of the study (Krueger & Casey, 2015). The purpose and advantage of a focus group are to allow researchers to examine how the group interacts and affects participants' perceptions and possible decision making (Duggleby, 2005). The use of the interaction among participants produces insights and data that most likely could not be obtained from individual interviews (Morgan, 1997).

Researchers usually choose focus groups for data collection because they perceive the nature of the phenomenon under study as a social experience. Research questions can focus on specific experiences the group members share, as well as attitudes, perceptions, beliefs, and opinions (Then, Rankin, & Ali, 2015). For example, to understand how nurses work together as a team, focus groups might be used. The effect of collecting data from a group means people will react to each other's comments; they may disagree or they may reinforce what others say. In a study in which I was involved, the team found there were facilitating interactions, such as asking questions of each other, adding to what others say, helping to explain, or playing off each other. Nonfacilitating interactions included talking about another's experience, extended silence, or issues related to hierarchy or professional identity (Mark et al., 2009).

Focus groups should not be used in certain situations, such as when the purpose is to build consensus, seek sensitive information that normally would not be discussed in a group, in emotionally charged situations, and when confidentiality cannot be ensured. Focus groups have been used for describing specific group experiences, developing instruments, identifying problems within a program, and interpreting quantitative results. Many appropriate uses exist in health care, but implementation should be considered carefully (Redmond & Curtis, 2009).

Components of Focus Groups

Focus groups usually consist of 6-10 people, although reasons may exist for 5 or as many as 12. The group structure should allow each person a chance to contribute to the discussion. The rule of thumb is the group should be homogenous. If group members are considerably different or if some people in the group do not feel safe to talk (e.g., the supervisor is in the group), the interaction may suffer or a few people may dominate the group. This will depend on the nature and purpose of the study. A general recommendation is participants should be strangers, but reasons could support the use of acquaintances (Krueger & Casey, 2015).

Experts recommend at least three to five focus groups for each participant category in the study. Having only two groups can be problematic, as one of the groups could be unusual and difficult and the researcher will not be able to identify the unusual group until the third focus group meets. The number of groups also depends on when saturation is reached. Saturation is the point when researchers are not obtaining new information (Krueger & Casey, 2015).

The group is facilitated by a moderator. Due to expense or expertise, researchers will sometimes moderate their own focus groups. However, some experts recommend a trained, independent moderator with researchers serving as observers of the group (Campbell, 2007). This allows researchers to observe and note the interactions and topics discussed. The focus group often starts with a relatively structured set of questions with moderator involvement to ask for clarification, probe for detail, and elicit experiences. As the group progresses, the moderator usually will allow the group to continue the discussion and mostly intervene to keep people on track. Researchers often find it useful to pilot questions to examine how they work in a group setting. To facilitate focus group participation, the location should be comfortable and located conveniently (Then et al., 2014).

The focus group usually is recorded and the data are analyzed as in other qualitative studies. Instead of comparing participants, however, the researcher compares groups. During analysis, researchers identify patterns and themes across groups. In addition, they examine the group effect or how the group behaved. For exam pie, were people facilitative with each other or did a lot of nonfacilitative interactions occur? Did people change their minds when they heard others? Did conversations wander? How each focus group interacts can have a profound effect on the study results and the insights gained (Krueger & Casey, 2015).

What to Review in Studies Using Focus Groups

When evaluating a report of a study that used a focus group, readers should consider certain features related to this type of data collection. The aim of the study should align with the nature of focus groups: a structured conversation addressing a topic that can be viewed as a social issue or a problem that could benefit from the discussion of the participants. The report should indicate how participants were selected, justify the number of people in each focus group, and identify the number and appropriateness of focus groups to the research question. Information about sample should include the number and composition of groups. Were members strangers or acquaintances? What experiences or situations were part of the selection? Was it a homogeneous group or more diverse? Does this sample fit the aim of the study? Was the moderator one of the researchers or a trained facilitator? The independence of the moderator from any organizational hierarchy should be established clearly (Shenton, 2004).

As in most qualitative studies, researchers should report if data saturation occurred and when. When appropriate to the aim of the study, findings should reflect the group experience in the quotations and description. Researchers should note any major difference among the groups in the study. For example, were there groups in which some individuals were relatively silent or others were dominant (Webb & Kevern, 2001)?

In the area of trustworthiness, readers should consider the team who did the study. Did they have enough differences to serve as checks and balances to each other? Readers also should review how researchers described their data collection, handling, and analysis; was it systematic and verifiable? Question guides should have allowed participants to expand on the topic and provide experiences, decisions, and behaviors appropriate to the purpose. In addition, other standard qualitative procedures should be in place to ensure quality data (Shenton, 2004).

Focus groups have been used to study many areas of interest to medical-surgical nursing, such as factors that influence implementation of a screening tool for delirium (Swan, Becker, Brawer, & Sciamanna, 2011) and patients', caregivers', and providers' perceived strategies for diabetes care (Akohoue, Patel, Adkerson, & Rothman, 2015). Informed readers should understand this useful data collection method as well as other qualitative techniques. If further information is needed, the references can provide more details about focus groups.

REFERENCES

Akohoue, S.A., Patel, K., Adkerson, L.L., & Rothman, R.L. (2015). American Journal of Health Behavior, 39(3), 433-440.

Campbell, S. (2007). The process of planning, organizing and conducting focus group discussions. Nursing Times, 103(4), 34-35.

Duggleby, W. (2005). What about focus group interaction data? Qualitative Health Research, 15(6), 832-840.

Krueger, R.A., & Casey, M.A. (2015). Focus groups: A practical guide for applied research. Los Angeles, CA: Safe.

Laursen, J., Danielson, A.K., & Rosenberg, J. (2015). Spouses needs for professional support: The spouses' perspective on communication. MEDSURG Nursing, 24(5), 325-330, 362.

Mark, D.D., Connelly, L.M., Hardy, M.D., Robinson, J., Jones, C.C., & Street, T.A. (2009). Exploring deployment experiences of Army medical department personnel. Military Medicine, 174(6), 631-636.

Morgan, D.L. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA: Sage.

Redmond, R., & Curtis, E. (2009). Focus groups: Principles and processes. Nurse Researcher, 16(3), 57-69.

Shenton, A.K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22, 63-75.

Swan, B.A., Becker, J., Brawer, R., & Sciamanna, C.N. (2011). Factors influencing the implementation of a point-of-care screening tool for delirium. MEDSURG Nursing, 20(6), 318-322.

Then, K.L, Rankin, J.A., & AN, E. (2015). Focus group research: What is it and how can it be used? Canadian Journal of Cardiovascular Nursing, 24(1), 16-22.

Webb, C., & Kevern, J. (2001). Focus groups as a research method: A critique of some aspects of their use in nursing research. Journal of Advanced Nursing, 33(6), 798-805.

Lynne M. Connelly, PhD, RN, is Associate Professor and Director of Nursing, Robert J. Dehaemers Endowed Chair, Benedictine College Atchison, KS. She is Research Editor for MEDSURG Nursing.
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Title Annotation:Research Roundtable
Author:Connelly, Lynne M.
Publication:MedSurg Nursing
Date:Sep 1, 2015
Words:1502
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