Using Focus Groups with Children and Young People

1. Using Focus Groups with Children and Young People Dr Faith Gibson, Lecturer in Children’s Cancer Nursing Research Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London

2. Learning outcomes… • To be able to describe the advantages and disadvantages of using focus groups. • To be able to describe the steps taken when planning and running a focus group. • To be able to highlight the particular techniques used when working with children and young people in focus groups. • To be able to outline the ethical issues involving children and young people in focus groups. • To summarize approaches to analysis and reporting of focus group data.

3. Overview of the Session (90 minutes) • Activity-ice breaker • Presentation – Theory and practice of focus groups • Activity • Presentation – Running a focus group • Closing comments

4. Ice Breaker

5. Identifying dimensions of the role of the CNS Exploring the role of nurses in day care Identifying competencies of general and specialist nurses Exploring fatigue with teenagers Listening to children and young peoples views of their cancer experience Exploring experiences with young people during the diagnostic period My experience….your experience????

6. A focus group is……. • A carefully planned discussion • Designed to obtain perceptions • On a defined area of interest • In a permissive non-threatening environment • Conducted with approximately 7-10 people • By a skilled interviewer • To share ideas and perceptions • In which group members influence each other by responding to ideas and comments in the discussion

7. The story behind their use…… • Origins traced back to 1920’s • Used then to develop survey instruments • Developed in response to general dissatisfaction with interviews • Became popular and developed strongly as a research technique for market research • Adopted for party political research • Well established as a mainstream method across all fields of social and educational research • In health care seen increase in use in last 10 years

8. Characteristics…. • Involve people: small enough to share insights, large enough to provide diversity • Conducted in a series: to detect patterns and trends across groups • Composed of people who are similar: defined by the study • Used to produce research data: differs from other group interactions • Make use of qualitative data: participants influence each other like in real life as opposed to interviews • Have a focussed discussion: carefully predetermined and sequenced

9. Some common myths…. • Cheap and quick • Require moderators with highly developed professional skills • Must consist of strangers • Not used to discuss sensitive topics • Tend to produce conformity • Are a more natural means of collecting data • Should not be used for decision making • Must be validated by other methods

10. Why focus groups with children/young people • Create a safer peer environment • Replicate the type of small group setting similar to the classroom • May help to re-dress the power imbalance • May be encouraged to give their opinions when they hear others • Memory may be jogged by others contributions • Acknowledges participants as experts • Greater involvement in the research process

11. Where to start……. • Framing your research question • Detailing outcomes of the research • Agreeing sample and setting • Deciding approaches to data collection • Identifying data analysis techniques

12. Early planning process…. • Number of sessions: practical and substantive issues considered • Time and place: knowledge of participants to increase uptake • Style and format: standardise for coverage and analysis • Recording tools: tape, video, group activities, note taking • Analysis: most challenging aspect where less has been written • Pilot: process and questions

13. Working within an ethical framework • Duties • Rights • Benefits/harm • Risk of distress • Risks to children from participating- benefits to children in the future • Respect for privacy and confidentiality, use of quotes • Trust • Understanding • Keeping children safe Refer to checklists, e.g. NCB, RCPCH, MRC

14. Post it pyramids

15. Group composition factors • Age dictates size of group, average 5-8 • Participants in a group should be within two-year age span • Used with children over 6 years • Single-sex/mixed sex • Known/unknown • Homogenous/heterogeneous • Last 45 mins-90 mins • Research question will influence many factors

16. Location/seating • Familiarity balanced against suitability • Noise levels and distractions • Seating arrangements, floor, seated in circle with moderator, with/without table • Eye contact • Choice of seating

17. The Moderator • Make the group feel comfortable and at ease • Set themselves apart from other authority figures • Matching moderator to the group • Allowing participants to influence the agenda • Keep discussions focused on the topic • Ensure all participants have an opportunity to contribute • Remain mindful of non-verbal signs and fatigue/boredom • Be aware of/note group dynamics • Enhance the clarity of participants contributions

18. Introducing the group • Standard statement • Format and nature of the group discussion • Confidentiality, what this means • Ground rules • Recording, tape/video • Role of assistant moderator • The opening topic, sequencing questions • Discussion • Ending the discussion • Summary, concluding for the group and the individual

19. Conducting the discussion.. • Flexibility or structure • Probing • Noting non-verbal language • Creating space for everyone to contribute • Addressing dominant participants • Drawing out reticent participants • Avoiding simultaneous dialogue • Value interactions, recognise cannot follow every point raised • Exploring emerging issues, diversity of view • Challenging social norms and apparent consensus

20. Using activities • Ice-breaker • Age-specific activities, designed for the purpose • Brainstorming • Sentence completion • Visual prompts • Vignettes • Fantasy wishes • And………… • Emphasise participation

21. Mechanical Transcript, tape, notes, observation based Revise decision if necessary Diagram of seating arrangements De-brief immediately after and take notes Organize data Interpretative Review tapes, transcripts, and notes look for emerging themes and develop coding categories Construct overview grid Making group comparisons Reliability and members check Analysing data

22. Threats to quality……. • Clarity of purpose • Appropriate environment • Sufficient resources • Appropriate participants • Recruitment and scheduling of sessions • Skilful moderator • Effective questions • Careful data handling • Systematic and verifiable analysis • Appropriate presentation • Honouring the participant and the method

23. Ensuring quality and reporting back • Detail participants and the context in which views were given • True representation of findings • Face validity • Convergent validity: confirmed by future behaviours, experiences or events? • Feedback, written, user forum, conferences, publication • Influencing practice

24. In summary……. • Preparation and planning ensures success • Not to be taken on as an easy option • Research question influences methods • Group composition, format, etc all need considerable thought • Rigour at all stages is crucial • And…………… • Valuable approach to gathering valid and reliable data directly with children and young people

25. Secret Box