Qualitative research for substance abuse prevention: focus groups and key informant interviews

Qualitative research for substance abuse prevention: focus groups and key informant interviews Liz Lilliott, Ph.D. BHRCS-PIRE

Why qualitative research? • Helps you get to the research questions that ask “WHY” and “HOW” • Who, what, when, where as well • Social/Cultural/Historical aspects of phenomenon • Why do youth in our community drink? • Why don’t more drunk drivers get arrested and convicted? • How does the Latino community understand drunk driving laws? • How has the community responded in the past to the problem of drunk driving?

Choosing Qualitative or Quantitative- depends upon…. • Your question • What will the data serve for? (exploring the nature of a problem? advocating to what kind of audience? measuring outcomes?) • Your resources (can you afford to survey a representative sample? Do you have the time and the training to collect qualitative data yourself?) • The community (one method may gather more accurate data than others) Using both is ideal but sometimes that’s not possible

Shared assumptions among qualitative researchers • There is no such thing as The Truth. You can get at the multiple versions of it through qualitative research. • You are not there to help, counsel or advise your research subjects. Your research, if done well, may ultimately help them. • It is important to always assess your own biases and assumptions…

Some tenants of cultural relativism • Be critically aware of how you are both similar to and different from your subjects, and never assume that any similarity (e.g., being the same sex) means that you automatically “know” or “understand” the experience of the other. • We all live in a world that is strongly influenced by cultural processes: nobody is more influenced by culture than anyone else.

You answer the research question, not your subjects • If you want to know why people drink and drive, do not ask your subjects, “Why do people here drink and drive?” You are likely to get very individualized responses (“because they’re immoral”, “because they don’t care”, etc.) • Avoid this line of questioning unless this is your purpose: to understand the different ways that people interpret or BELIEVE that DWI is a problem (moral problem, addiction, it’s ‘cultural’, etc.)

Some qualitative methods • Interviews (formal or informal; semi-structured or open-ended. Participants are targeted according to your purpose • Focus groups 5-12 people to discuss a topic • Written questionnaires (describe - fill in blank) • Observations- includes participant observation • Photovoice • Document review/analysis (e.g., meeting minutes, report documents, newspaper articles)

Focus groups are good for… • Gathering information about a group of people’s beliefs • Testing theories/hypotheses (from data gathered in other ways or to help you shape the development of other data collection) • Getting feedback on a specific ‘product’ (eg, a media campaign, a specific prevention program) • Helping people come to a consensus over a topic, sharing ideas, and resolving problems • In relating their ideas to one another, you test the strength of people’s attitudes and beliefs.

Key Informant interviews are better for • Going deep into identifying the source and resolution of problems • Gaining specific information about an individual’s experience, knowledge and beliefs. • Very sensitive topics - depending on your context. • If you are trying to identify the source or nature of a problem, be careful of conducting focus group that combines those from the commonly stigmatized group with those of the dominant group. • In a focus group, don’t ask those with “problems” to speak in same context with others who have a stake in not having that problem. (e.g., problem drug users and preventionists)

Practical matters to consider… • Certain populations can be hard to get into a room at one time for a focus group • Do you need childcare? • Do work requirements make it difficult? • Are local politics too delicate that anonymity may be violated or tensions can erupt? • Might you have language or other accessibility issues? • Is there a neutral space where you can meet? • It may be better to conduct interviews if these are strong barriers

Developing interview and focus group questions • Identify your research question first (eg, Why are DWI laws not enforced in this community?). • Plan on1-2 hours (any longer you lose people and your concentration) • Focus groups: 8-10 questions, can include probes • Semi-structured interview questions are 10-15 • Ask questions in a way that will incite story-telling ( tell me about…explain how…describe what it’s like…)

Interview and focus group questions • Make questions as neutral as possible, avoid leading questions. • “What happens to people who get arrested for drunk driving here?” DON’T ask: “Why do so many people get off of drunk driving charges here?” • Especially for focus groups or more sensitive topics, start by asking what people in their community think, do, not what individual participants think, do. • Personal opinions or experiences can be probes

For interviews…. • Try to conduct it where you will be relatively free of interruptions and where the person can feel safe and private. • Will your interviewee represent an agency or that individual’s personal knowledge and experience • Some staff may need supervisor authorization (consent forms are handy).

Focus Group Ground Rules • *Explain the purpose • Ask participants not to share information with people outside of this room (very important in small communities) • *Best of offer complete anonymity but if not possible, explain who will have access to their identities. Assure that nothing will shared publically that can identify participant. • Encourage participants to speak amongst each other (not just about answering the moderator). • * Nobody has to answer a question they don’t wish to • Try not to speak over one another • *No right or wrong answer: these are the experts, not you. * Also APPLIES TO INTERVIEWS

Example scripts • ..\..\Desktop\adolescent drug protocol 10.25.05.doc • ..\..\Desktop\Attachment X TCA Consumer Focus Group Script.doc • ..\..\Desktop\focus group protocol 12.10.06.doc

FG: Practical recommendations • Offer incentives and food/drink • People’s contributions and time are valuable • 5-10 people. - Recruit for 12, as some will often drop. Any less than 5, you might consider doing individual interviews instead. • Recruit for your group in relation to your question: • If you want to know what women in the community say they think and do, make your group just women from the community. • If you want to know what people think women in the community think and do, it can be both men and women. • Go through a community liaison to recruit the most representative sample possible (‘high school students’ should not just be 5 white Memorial high school freshman girls who are participating in your prevention program)

FG practical recommendations • Get names and numbers and call to remind participants. Then call again. • Find a neutral & private space to conduct focus group. • Can offer participants a copy of the questions so they know what to expect- but people should not have to prepare. • Best to have a neutral individual moderate the focus group • Depending on context, a community member or an outsider can be more effective. • Consider using your local evaluator or recruiting a local college or graduate student in sociology, anthropology, public health to conduct the groups for you – may not have your prevention bias. • Use a note taker if possible. If the context permits, record the discussion so you can refer to it later. • You do not have to ask every question as worded – use probes to help you but be prepared to follow an interesting stream of discussion.

Remember: • There is no focus in a “focus group” of more than 12 people. • Not about polling people for their opinion – about capturing the general sentiment of a group. • Do you need to have an informed consent document? (ie, are you doing this with children or other vulnerable populations?) • Do you need to gather additional data about participants (age, race/ethnicity, gender, residence, profession)?

Techniques for conducting qualitative interviewing/focus groups • Be neutral & try to avoid agreeing with people but encourage them to continue to speak. • “Uh-hum” “Ok” instead of “yes” “you’re right.” • “That’s interesting. Can you tell me more about that?” • “How did you learn that?” • “Can you describe for me a little more what that’s like? “ • “I’m sorry, I’ve never heard that term/concept (used in that way). Can you explain it to me?” • Be prepared for when participants discuss emotional topics (but they should never be required to).

Focus group techniques • People in small communities, or who know each other well will act more comfortable around each other BUT they also tend to use foreshortened references to events – “like what happened when the principal found out…” , “you remember when…” or “you know how they are” • Always ask people to explain/describe/elaborate. • If you are an outsider, this can be used in your favor to ask people to explain issues and events in detail. • If you are an insider, ask them to explain as they will have their own perspective of the event.

FG: Getting people to talk… • People generally like to agree with one another so if you find that people are not offering different perspectives on an issue, state the more polemical position: “Some people here think that…..(law enforcement are not doing their jobs).” Have you ever heard that? • People will often speak about what ‘others’ think if they do not feel comfortable stating what they think. • Encourage discussion by asking others to offer their point of view (avoid words like opinion), ‘Does anyone have something to say about that?’ ‘Has anyone had a different experience?’

Qualitative research techniques • With “talkers” and “digressers”, try to redirect to the next question, or in focus group, ask someone else to talk. (“I want to make sure that everyone has a chance to talk”.) • Reinforce your neutrality: People often find it hard to state negative opinions about things, especially when they think that you are representing those people or have a certain position on that. • More advanced technique: Summarize and ask for people to confirm your synthesis. If there are differing positions, summarize them and ask people to tell you if you are ‘on track’.

Welcome people’s questions of you…but • About your personal opinion or experience – this can be discussed at the end of the interview, as the point of this moment is to hear what THEY have to say. You don’t want to bias their opinion. • Informational questions can lead to more interesting discussion: “Tell me more about this agency that you represent? Why haven’t I ever heard of them?” can lead to some interesting discussion about the need for greater media awareness of prevention.

Using consent forms • May not be required, but is a handy document that makes you and the participant feel safe, on equal footing and offers legitimacy to your effort. • If working through a university must confirm if an institutional review board should be notified. • If working with youth, must take special efforts for informed consent (schools may have special rules you must follow about informing parents). Federal regulations for Human subjects protection http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm

Consent forms • Identify yourself, your agency, the reasons for the interview/focus group, the risks to the individual, the benefits, incentives, and who they can go to for concerns and questions. Describe the measures that will be taken to protect someone’s identity. • Give participants your business card and a copy of the consent form for their own use. • Put it in simple language and read highlights to participant. • Explain that this document protects the participant, as it documents what you can do with the information they provide and what their rights are as a participant.

Taking notes • Words and phrases, star or underline important ones • FG scribe can type or hand write as much as possible what people say. • Your own impressions and notes about unspoken behaviors that may not be captured on tape (participant is always looking outside). • Good to spend some time after the event to write up general notes and impressions.

Remember: • Your interlocutor is the authority, NOT YOU. • It’s not really an interview if you talk more than the participant does • Always plan for the interview to take longer than it does. • Qualitative data collection is exhausting – must analyze, ask good probes, respond appropriately, take notes, keep people on track, stay on time, and resolve problems like that sweet old lady who won’t shut up-- all at once). • 2 focus groups or 3 interviews in a day is a good day’s work.

Coding- choose a strategy according to your purpose • Question-level coding: summarize all the ways that individuals have answered particular questions, with a focus on your overall question. -you can throw out extraneous information • Theme coding: notice what particular themes emerge – again, keeping your overall question in mind. • How have SPF SIG built capacity to implement? Emergent theme: challenges of rural vs. urban prevention programs. • Free coding: most time-consuming but allows for more ‘discovery’ about a topic. • Can be done with special software for big projects (like NVivo), but MS Word and different color highlighters also work for general coding.

Analysis of qualitative data DO… • Look for common themes • Explore different positions on a topic • Think about relationships between demographic factors and people’s positions (e.g., more women seemed to think that UAD was a problem with the schools…) • Identify good quotes and use in write- up in order to illustrate your point.

The point is NOT …. • To determine whether people are ‘right’ or ‘wrong’. • To diagnose, psychoanalyze, or interpret deeper sentiments, but to analyze surface patterns. • To count people’s responses- but it is ok to say, “a minority took this position.”

Thanks! Liz Lilliott, Ph.D. Associate Research Scientist BHRCS-PIRE Albuquerque, NM lilliott@bhrcs.org 505-765-2330

Qualitative research for substance abuse prevention: focus groups and key informant interviews