Focus Groups in Action: A Practical Guide

1. Focus Groups in Action:A Practical Guide Sue Duvall Laura Halverson Brooke Ike Mariah Martin Claire Roach Laura Streichert University of Washington HSERV 531 - Community Nutrition

2. Why conduct qualitative research? To understand a population�s perspective and experiences To gather more information in fewer cases It is a relatively inexpensive method to collect data

3. Why Qualitative Research(cont�d) In preparation for quantitative research: learn the vocabulary of the population of interest discover the perspective of the population of interest ascertain possible issues in quantitative data methods As a follow-up to quantitative research: help interpret quantitative data add depth to the quantitative data address problems with the quantitative methods

4. Human Subjects Qualitative research often involves human subjects Federal regulations define a human subject as "a living individual about whom an investigator conducting research obtains (1) data through intervention or interaction with the individual, or (2) identifiable private information." (http://www.rgs.uci.edu/ora/rp/hrpp/definition.htm)

5. Confidentiality and Human Subjects Participants are required to sign an informed consent form (one copy for the subject and one for the investigator to keep). Forms explain the purpose and benefit of the focus group, procedures, risk, stress and discomfort that may occur because of the participation, and contact information if they have any questions after the study Lead investigator signs the form

6. Researcher Confidentiality Form Signed by all the researchers involved in the study Emphasizes confidentiality, privacy, and respect for the subjects and the information that they provide Ensures data gathered is for the study purposes only

7. What is a Focus Group? Focus groups are a small group of a selected population that are asked open-ended questions in a discussion type atmosphere to generate data.

8. Limitations of Focus Groups Risk of biases introduced by moderator Domineering and/or passive participants Does not provide depth of information compared to other methods, such as key informant interviews

9. Role of the Moderator Stays relaxed and sets tone Introduces and guides the discussion Actively and carefully listens Does NOT participate, or share views, or engage in the discussion Does NOT editorialize comments Is non-judgmental and respectful

10. Role of the Moderator(cont�d) Is familiar enough with the questions that she can ask them in a conversational manner Gives thankful welcome and close that acknowledges the participants for giving their time and ideas If possible, moderator should have connection to the group (e.g.: be a mother, WIC participant)

11. Role of the Notetaker Tests and places the audio recording equipment Note: it helps to talk to participants beforehand to gauge quiet speakers Comes prepared with pens & paper Sits in the room during the entire discussion where they can see & hear the participants -- do not sit by the facilitator Sketches participant seating arrangement Note: use identifiers other than names

12. Example of map in a focus group

13. Role of the Notetaker(cont�d) Tries to be aware of correct recording during the focus group session Serves as timekeeper Does not join in conversation - avoids nodding or reaction Identifies themes, follow-up questions, body language, confusion, nonverbal communication (especially when no one is speaking), facial expressions, gestures, signs of agreement, disagreement, frustration, concern, etc.

14. Even More on the Notetaker After the discussion, notetaker checks notes for legibility and gaps Notetaker and moderator should meet soon after the focus group to review experience Take home message on the observer: You should be a �fly on the wall� during the discussion and simply observe If no one knows you are there, you are doing a good job!

15. Role of the Transcriber Reviews tape to capture data Note: It helps to have two people to review and clarify content

16. Getting Started Set up the room according to number of people Introduction points to write on flip chart Helpful Tips for Today: Your comments are confidential. We are taking notes, but not names. Please speak up so we all can hear you. Everyone gets a chance to talk. There are no wrong answers; all comments are important. Please let me know if you have any questions

17. Getting Started(cont�d) Moderator introduces herself, notetaker, and the study Thank people for coming Review the group�s purpose and goals Explain how the meeting will proceed and how members can contribute Set the tone by asking an opening question (e.g. �How many children do you have and what is their favorite food?�)

18. During the Discussion Use scripted questions approved by UW Human Subjects division Be aware of voice recorder function and fidelity, making sure that soft-spoken individuals speak loud enough and minimizing any noise that might interfere with the recording Use �Moderator Probes� Facilitate the discussion so that everyone is included in it

19. During the Discussion (Cont�d) Remind yourself not to share own views on a participant�s remarks (including �That�s a good point�) as this response may bias the response of the other participants Be aware of how you�re sitting. Make sure that you face everyone in the group and do not start to lean towards one part of the group that seems more animated and engaged. Don�t be afraid of silence. Give participants the chance to think about their answers.

20. Moderator Probes Be aware of recording: better to use non-verbal prodding while someone is talking. Be neutral: don�t react for or against anyone�s statement Body language: nodding head, continued eye contact Vocalizations: �uh, huh��; �yes�oh, okay�� Reflecting back: �what I understood you to say was��; �Let me see if I understood you correctly��

21. Moderator Probes(cont�d) Clarification: �I�m not sure I understand� can you tell me more��; �Can you tell me more about why you think it is important� Substitution: �How often do you�� Other examples: �Is there anything else��; �Could you explain that to me� I want to be sure I understand�� Timing: Listen for natural breaks in the conversation or repetition before you move on to the next question.

22. Moderator Body Language

23. Closing When all questions have been asked, ask if anyone has any other comments to make Summarize key points based on focus group discussion Have we missed anything? Audio taping ends

24. Closing (cont�d) Tell the group about next steps that will occur and what they can expect to happen Thank the group for coming Ask participants to complete a short questionnaire including questions about age, ethnicity, number and ages of children, and years they have been in WIC Give reimbursement for participation

25. WIC Pilot Focus Group General Points Try to stay on script approved by UW Human Subjects division Be aware of voice recorder function and fidelity

26. Food Insecurity Questions Participant knowledge of health effects We have heard that some WIC families run out of food and some don�t. How do you think a child�s health is affected by not having enough food? Reasons for food insecurity What do you think are some reasons why some families have trouble having enough food to feed their families? Coping Strategies People do different things when they are running out of money for food to make their food or money go further. If you knew someone (a friend) who was worried about running out of food, what are some things you would you tell her to do?

27. Food Insecurity Questions(cont�d) WIC�s role What do you think WIC should do to help your friend to have enough food? If you were in the situation of running out of food and not having enough money for food for you and your child or children, what could WIC do that would be most helpful? What kind of information do you think WIC should provide? How do you think WIC should provide this information? What difference does being on WIC make to the way a parent can feed their family?

28. Healthy Weight Questions Participant knowledge of health effects People who don�t have money to buy enough food compared to those that do, are more likely to be overweight. What do you think could be the cause of this?

29. Healthy Weight Questions(cont�d) WIC�s Role Has WIC provided you or anyone you know with information about healthy weight? What kind of information do you think WIC should provide about healthy weight? If you had a child who was overweight, would you want WIC to offer help? If so, what would you like WIC to do? If a woman on WIC wanted help with her weight after having a baby, what could WIC offer or provide that would be most helpful to her? Would you like WIC to offer to help? If so, what would you like WIC to do?

30. Closing Question General experiences, observations, ideas about WIC When you think about the WIC Program, what (if anything) do you think is most helpful? What about the WIC Program is least helpful?

31. Managing the Discussion KEY GOALS: Keep everyone involved in the conversation Stay focused on the topic Remain neutral and don�t share opinions or judgments that may influence participants

32. Managing Personalities DOMINANT Participant Elicit comments from others Change the subject Avoid eye contact Turn your body slightly away

33. Managing Personalities PASSIVE Participant Ask directly for thoughts Make eye contact Use the person�s name Smile in her direction

34. Managing Personalities BORED Participant Similar to Passive Participant Give her the chance to speak first Move slightly closer to engage him/her in the conversation

35. Managing Personalities SOFT-SPOKEN Participant Ask her to speak up; remind of ground rules Emphasize that everyone wants to hear what you have to contribute to the discussion as everyone�s opinions are valuable Ask her to repeat what she said Reflect back

36. Handling Inappropriate Questions or Comments Questions About the Study Introduction Confirm confidentiality Deflect until end so you can stay on topic Be sure to keep promise and return to question

37. Handling Inappropriate Questions or Comments Asking for Your Opinion Do not provide. Remain neutral. Purpose of discussion is to hear from them, not you Share at end if someone wants to discuss.

38. Handling Inappropriate Questions or Comments Asking for Information on Topic or Other Do not provide until end of session Refer to someone if you don�t know answer

39. Handling Inappropriate Questions or Comments Insensitive Comments If not direct attack, let it go and move on All views are important to capture Don�t expect �PC� participants

40. Handling Inappropriate Questions or Comments Personal Attacks Acknowledge strong feelings Remind all that opinions are important/ no right or wrong answers Remind all to be respectful and not direct feelings at others

41. Handling Inappropriate Questions or Comments Incorrect or Harmful Advice At end of session provide correct information Don�t single original speaker out

42. Final Tips Enjoy yourself Be interested Stay relaxed Be yourself Thank everyone sincerely

43. Your Turn

44. Resources Sharyne Shiu-Thornton, Ph.D. Focus Group Training Guide, November, 2004 HSERV 531 Project assignment notes, including Focus Group Discussion Guide Krueger, Richard A. Moderating Focus Groups. from Focus Group Kit. Sage Publications.1998. The Community Toolbox. Conducting Focus Groups. Available at: http://ctb.ku.edu/tools/en/section_1018.htm UC Irvine Research and Graduate Studies Human Research Protection Program. UC Irvine. 2003. http://www.rgs.uci.edu/ora/rp/hrpp/definition.htm. Accessed 21 January 2005. Tips for WIC Grocery Tour Discussion Group Facilitators. Handout