– can, nevertheless, have the added benefit of providing support and some researchers have even found that focus groups can act as the catalyst for participants to set up ongoing support groups (as happened following a focus group study of fathers of children with cancer – Jones and Neil-Urban, 2003).
Broaching difficult or ‘sensitive’ topics
Focus groups – and, in particular the permission afforded by the group setting and ‘safety in numbers’ – have also frequently been employed by researchers in order to talk with participants about potentially delicate topics, such as end-of-life care for the terminally ill (Seymour et al., 2002); involvement of families in organ donation (Regan, 2003); children’s experiences of cyber-bullying (Mishna et al., 2009); or perspectives of parents of seriously ill children with respect to advance directives (Boss et al., 2015). In such instances multiple advantages of focus groups have sometimes been drawn upon, such as in the work of Alkhawari et al. (2005), who researched the views of UK Muslim Indo-Asians with regard to transplantation, and who cite the dual capacity of focus groups to reach a specific sector of the population and to broach a sensitive topic. Some such focus group projects have provided insights that are potentially valuable for service providers and an example is provided by de Vries et al. (2014), who looked at how breast cancer survivors cope with fear of recurrence. These nuanced findings can, for example, alert professionals to oversights with regard to how services have been provided in the past.
Some commentators have argued that focus groups are not suitable for eliciting experiences with regard to sensitive topics, and have asserted that one-to-one interviews are more appropriate. However, this assumption is questionable. As Farquhar and Das (1999) point out, the sensitivity of a topic is not fixed – rather it is socially constructed with one person’s or group’s ‘no-go area’ being perfectly acceptable for another. In weighing up options, the researcher is well-advised to consider the wider context in which the focus group discussions are being held. De Oliveira (2011) who carried out focus groups about perceptions of sexual risks with adolescent girls in Southern Brazil explains:
Focus group research about views on sexual risks can also be considered as ‘sensitive’ because to talk about ‘risk-taking’ may involve the disclosure of perceived moral failures. The negativity of risk-taking is originated in the contemporary emphasis on the moral accountability for personal welfare. (2011, online)
This observation about the sociocultural nature of ‘risk’ led de Oliveira to convene groups with girls who shared a similar sociocultural context.
Despite the scepticism of some researchers, focus groups have been used by many researchers to address topics considered ‘sensitive’ in a wide range of ‘difficult’ situations with groups viewed as potentially vulnerable. Focus groups have proved to be a mainstay of research into sexual behaviour (Frith, 2000), often utilizing pre-acquainted groups, as did de Oliveira. Other studies which have focused on sexual behaviour include Flynn et al. (2011) who looked at sexual functioning and cancer; and Klaeson et al. (2011) who talked with women about the impact of breast cancer on their sexuality. Rather than simply documenting attitudes or experiences such work has often provided detailed and nuanced accounts, such as did the study by Davis et al. (2014) into heterosexual men’s condom use and their explanations of their strategies of resistance. In contrast to one-to-one interviews, which excel at eliciting personal narratives, focus groups allow researchers to look at more subtle, but potentially highly relevant understandings and behaviours.
Limitations of focus groups
With regard to the limitations of focus groups for eliciting narratives, the issue is not so much that people will be reluctant to share their experiences in a group setting, as that having several participants competing to tell their individual and detailed stories is likely to produce ‘noise’; that is, data that it is hard to order and attribute to individual speakers. The nature of focus group discussions means that stories are unlikely to unfold sequentially, as they can do in a one-to-one interview, and hence the picture presented will be confusing and attempts to analyze data will be frustrated. Ong (2003) reports on a study of experiences of back pain, where the initial focus group allowed participants to tell their individual stories, with later groups focusing more explicitly on the research questions, suggesting that a series of focus groups may be more appropriate, where the intention is to build up a detailed picture of individuals’ experiences.
Accessing ‘attitudes’
Nor, as we have already seen, are focus groups an appropriate method if you want to measure attitudes. Puchta and Potter (2002) argue that attitudes are the end result of a series of analytic decisions, which suggests that we should be wary of thinking that there is any such thing as an ‘attitude’. They remind us that attitudes are ‘performed’ rather than being ‘pre-formed’ (Puchta and Potter, 2004, p. 27). The implications for the process of analysis and use to which focus group findings can be put are further discussed in Chapter 11.
While marketing researchers tend to focus on using focus group data to make inferences regarding the attitudinal stances or preferences of the wider consumer body, within social science research this is generally not the preferred end product. Nor are results generally required as speedily as with marketing research and there is a venerable survey tradition within the social sciences that serves this requirement much better. If you want to make statistical generalizations from your data, then focus groups are not the method of choice. ‘Focus group samples are usually both unrepresentative and dangerously small’ (Morgan and Krueger, 1993, p. 14).
This reservation also potentially applies to some of the usages made of focus groups by health services researchers – particularly those working alongside clinicians. Some difficult questions are raised by the use, for example, of focus groups in order to access patients viewed as ‘recalcitrant’ or reluctant to take up services, screening programmes, or health promotion advice. Research in this genre is very similar to that carried out under the auspices of organizational research and, in common with this approach, tends to view the research question through a predominantly ‘professional’ lens.
Researchers’ or participants’ concerns?
While the appearance of terms such as ‘non-adherence’ or ‘non-compliance’ can signal research carried out with this partial or partisan professional view, focus group research, again, spans a continuum. Even where the original concern is that of ‘non-adherence’, focus groups can provide valuable explanations, in terms, for example, of identifying competing priorities for patients. Bloor et al. (2001) argue that focus groups are particularly well suited to studying decision-making processes, for example, and the ways in which people weigh up competing priorities or the ways in which they qualify their views to take situational and circumstantial factors into account. Some research uses focus groups in this way in order to elucidate the decision-making processes involved – e.g. non-adherence to osteoporosis medications (Iversen et al., 2011); or adolescents’ use of inhaled asthma controller medication (Wamboldt et al., 2011).
Focus groups have also been used to provide a greater understanding of apparently illogical health-related behaviours, such as neglecting to take folic acid (Barbour et al., 2012) while pregnant. Such studies are characterized by a focus on the importance of lay understandings and take, as their starting point, the notion that apparently illogical beliefs and practices, once viewed from the perspectives of the people involved, are likely to display a coherent and possibly highly sophisticated logic. This, however, only becomes apparent when focus group participants are given scope to justify and expand on their views in a non-judgemental environment.
Some clinician-researchers have built on the findings from focus group studies in order to develop enhanced or more appropriate messages or treatment packages
