Liz Lilliott, Ph.D. BHRCS-PIRE

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

Today’s purpose • Review the basics of qualitative methods • Provide tips on conducting focus groups and key informant interviews • Describe the protocol for conducting focus groups or interviews for the PFS-II assessment • Practice conducting a focus group.

Defining Qualitative Research

Quantitative Qualitative Countable Who, what, when, where how much, Multiple choice response surveys Rates of events (DWIs, suicides, births to teen parents, numbers of people attending) Can measure impact best- what funders like “ Bean Counting” Descriptive How and Why Structured and semi-structured Interviews Focus groups Observations Participant-observation Photovoice Helps define nature & parameters of an issue, “ the context”- helps you improve impact “ Story telling”

Representativeness- Those you gather data from should represent the population you study Quantitative Qualitative • Typically smaller numbers of participants • “Representation” – who speaks for whom • Seek Key participants that represent a category • Tribal council • Chief of police • Seek individuals who represent the range of experiences in your target group • The perfect sample is 100% of your target group. (but then it’s technically not a sample) • Must attend to demographic representation- age, race, geography, gender, student, etc. • Sampling methods (how you choose your participants) are critical in interpretation • Eg., Randomized vs. Convenience

Why qualitative research? • Helps you get to the research questions that ask “WHY” and “HOW” • Social/Cultural/Historical aspects of phenomenon • Why don’t more people get arrested in this community for providing alcohol to a minor? • How does the Latino community use and share prescription drugs? • How has the community responded in the past to the problems of alcohol?

Practical reasons for qualitative approaches • May not have the resources to collect accurate quantitative data • To reach sectors who respond well to direct interaction • To identify issues that do not emerge in quantitative approaches, problem solve • Offers an opportunity for participants to have a real voice

For the PFS - Contributing Factors Qualitative research will help you define contributing factors as they affect different populations in your county. • How do Columbus youth access alcohol vs. youth in Deming? • How do immigrant parents address UAD? • How do Navajo elders store and share meds? • How do different social groups understand how drinking laws are enforced?

Shared assumptions among qualitative researchers • There is no such thing as The Truth. You can get at the multiple “truths” through qualitative research. • You are not there to help, counsel or advise your research subjects. Your research, if done well, may ultimately help them. • Your data are the collective responses of your participants – their view(s), not necessarily yours

Always assess your own biases and assumptions… • 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 or ethnicity) 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.

Focus groups and key Informant Interviews Nuts and Bolts for PFS-II

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’ (e.g., 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. • Focus groups with participants with different stakes in a problem can be problematic.

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 privacy may be violated or tensions may 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

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? • Be prepared that in some cases staff may need supervisor authorization to talk with you.

Ground Rules • *Explain the purpose of what you’re asking these questions • Ask participants not to share information with people outside of this room, especially who (very important in small communities) • *Best to offer privacy of information (for groups cannot be completely protected). Do assure that nothing will be shared publically that can identify a 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 answers: the participants are the experts, not you * Also APPLIES TO INTERVIEWS

Focus Groups/Interviews for PFS-II Assessment • Each county should collect qualitative data with each of these groups for their assessment. • Conduct at least one focus group with… • Health Care Providers, Doctors, Pharmacists (or at least 3 key informant interview(s) • Law Enforcement (or at least 3 key informant interview (s)) • Youth (12-17) • Young Adults (18-25) • Community members at large (also in Spanish)

Things to consider for focus groups • Think about the demographics of your community • Should you do more than one group in one category in order to capture the diversity of your county? • Are there other groups you should consider to improve your approach? • Community/tribal leaders • Alcohol retailers • School staff • Parents of teens • People in recovery • Also, always think of these as an opportunity to expand your coalition.

Focus Groups: Practical recommendations • Use a liaison of that community to help you recruit. • Offer incentives and food/drink • People’s contributions and time are valuable • Think of culturally appropriate incentives • Cash incentives may be appropriate for some (community members) may not be for others (law enforcement). • 5-10 people • Recruit for 12, as some will often drop. Any less than 5, you might consider doing individual interviews instead. • Find a neutral & private space to conduct the focus group.

Representation issues to think about • Recruit in relation to your research question: • If you want to know what women in the community say they think and do, make your group is 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. • Try NOT to recruit only those who are “on your side” – you want to think through different sides of an issue. • Try to be representative of the group. • ‘Parents of youth 12-20’ should not just be 5 parents already participating in your prevention coalition; try to recruit for individuals who may not know each other well.

FG practical recommendations • Get names and numbers and call to remind participants. Then call again. • 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. • Or recruit a local college or graduate student in sociology, anthropology, public health, social work to conduct the groups • Use a note taker, or “scribe”. If the context permits, record the discussion so you can refer to it later.

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 • Consider using the consent forms provided and adapt as necessary • Use the demographic form provided and consider if you need to gather additional data about participants

Also remember: • Your interviewee is the authority, NOT YOU. • It’s not useful if you talk more than the participant does • Always assume the interview/FG will take longer than you plan. • 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 gentleman who won’t let anyone get a word in edgewise…) • Write up your thoughts and notes as soon as possible.

Techniques for conducting qualitative interviewing/focus groups • You do not have to ask every question as worded – reword so your audience understands • Use probes to help you but be prepared to follow an interesting stream of discussion. • Be neutral & try to avoid agreeing with people but encourage them to continue to speak. • “Uh-hum” “Okay” 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?”

Focus group techniques • Be prepared if participants bring up emotional topics (but they should never be required to). • 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/how it is…”. • 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… • If you find that people are not offering different perspectives on an issue, state an opposing position: “I’ve heard some people here say 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 “have a chance to talk.” • Reinforce your neutrality: people often find it hard to state negative opinions about things, especially when they think that you represent a certain position on the issue. • i.e., participants may insist that allowing minors to drink is terrible if they also believe that you think that. That is also the most socially acceptable position. • 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’.

Taking notes • Words and phrases, star or underline important ones • If interviewing 1:1, no need for a scribe (more than 1 person can overwhelm the participant). • 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 audio recording (‘rolling her eyes’). • Save some time after the event to debrief with scribe and write up general notes and impressions.

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. -throw out extraneous information -For write-up, describe the dominant responses, with details about alternative explanations or points of view • Theme coding: notice what particular themes emerge – again, keeping your overall question in mind. • How do medical providers prevent drug shopping? Emergent theme: challenges of rural service providers. • Free coding: most time-consuming but allows for more ‘discovery’ about a topic.

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.

In analysis 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 try to pull out hard data; people’s impressions are what’s important. • To count people’s responses- but it is ok to say, “a minority took this position.”

Protocol for Final reporting

Recommended roles (can vary) • Program staff supervise recruitment and logistics. • Interview/focus group recruiter • Work with liaison to identify good sites, potential participants • Determines incentive, scheduling, calls and calls again. • Focus group facilitator- one or multiple coalition members • Scribe • Facilitator with scribe most likely ones to code, write up results • Recording FGs will be helpful to fill in the blanks but exact transcriptions are not required. • Results should be reviewed with coalition before submission.

Write-up • Complete the questions in report form about each focus group/interview and each intervening variable • Do not provide names of fg/int participants • Additional analysis to consider: • Compare groups’ perspectives as relevant (were there important differences between groups’ responses?) • What was the most important information learned for each IV? • In what areas do you and your community need to build capacity?

Troubleshooting • Start as early as you can. • You may not be able to conduct a focus group with one of your chosen groups. • You may find that only 3-4 people show up to your focus group, though you have recruited for more. Do the group the best you can, and see if you can do interviews with those who couldn’t show. • Please call or email Liz with any questions or concerns: lilliott@pire.org or 575-313-7029.

Materials • Sample consent forms • Interview/focus group questions (Spanish for community members) • Recommended introductory script (Spanish & English) • Sample demographic sheet • Final report – assessment template

Try it out!

Practicing a focus group • Get into 5 groups, try to get at least one member from each county • Select an interviewer, scribe and the remainder role play being participants • Ask a few questions from one focus group protocol • Participants can try different attitudes so the facilitator can practice • Not wanting to talk • Talking too much • Talking over the others • Reflect together on techniques, prompts, probes, language of script

Thanks! Liz Lilliott BHRCS-PIRE Albuquerque, NM lilliott@bhrcs.org 505-765-2330

Liz Lilliott, Ph.D. BHRCS-PIRE