ethnically appropriate, information-seeking and recruitment messages for a prostate cancer screening programme for men at high risk. A further example is provided by Bottorff et al. (2014) who designed tailored messages about the link between tobacco exposure and breast cancer for First Nations people and Métis in Canada. Such usages bring to mind the approaches used in marketing research with the aim of producing messages designed for particular target audiences and fall into the orbit of ‘social marketing’. A recent critique of social marketing (Crawshaw, 2012) points out that it consistently fails to take adequate account of the day-to-day lives, priorities and constraints of the individuals and groups being addressed.
The researcher working in this area treads a narrow line between encouragement, persuasion and empowerment, and much depends on the way in which focus groups are carried out, how they are embedded in studies and, importantly, who has commissioned the research and what is done with the findings. Certainly, much of the knowledge underpinning health promotion advice is essentially provisional in nature (with recommendations frequently being withdrawn or even reversed), and health professionals’ firmly held convictions should, perhaps, be subjected to a degree of scrutiny similar to that reserved for exploring the lack of conviction of their patients or clients. (This raises particularly difficult questions for social scientists engaged in health services research with practitioners/clinical colleagues.) Ultimately, it is possibly the extent and nature of consultation with patients in the course of a project that separates the potentially coercive from the potentially empowering in this field of research. Drawing on a model more akin to that espoused by design researchers, Stellefson et al. (2010) produced and proceeded to test and refine prototype materials for chronic obstructive pulmonary disease (COPD) self-management education DVDs for a rural population. While this approach admittedly accepts without question the value of self-management, there is evidence of a genuine attempt to engage with users and to seek to reflect their concerns.
The knowledge of clinicians and other professionals can undoubtedly be enhanced through focus group findings which provide an understanding of the processes involved and which can offer the potential to take account of the findings in future practice. A focus group study of the needs of released prisoners (Luther et al., 2011), for example, focused on identifying the implications for practice in order to limit return to high-risk behaviour in relation to HIV/AIDS.
Moran et al. (2012) provide an interesting example of an approach which successfully combined two orientations – that of focusing on specific practice issues and providing unanticipated insights. They were concerned to establish what patients (with ADHD and autistic spectrum disorders) and carers thought of routine outcome measures used in a Child and Adolescent Mental Health service. Although the emphasis was predominantly on the outcome measures and researchers sought to determine levels of agreement (using kappa coefficients), nevertheless, the discussion identified some broader and potentially useful concerns – interestingly, described as ‘irrelevant’ in terms of the original aims of the research:
One predominant fear was a fear of discharge and subsequent lack of access to support should problems recur in the future. Carers wanted rapid access to advice that they could dip in and out of, and were worried that outcome monitoring would be used to limit access to services. (2012, p. 74)
Similarly, den Oudsten et al. (2011) – in this case, alongside a large quantitative international collaboration – carried out focus groups with people with Parkinson’s disease, their family carers and professionals in order to establish their views on quality of life measures. The researchers reported that this exercise identified important new themes.
However, focus groups have added potential – particularly for the practitioner– researcher – for use in overtly action-research-oriented projects. Crabtree et al. argue that ‘it is possible to use focus groups as a data collection tool and an intervention simultaneously’ (Crabtree et al., 1993, p. 146).
Claims and challenges in focus
The varying terms employed by different writers (or disciplinary representatives) who label their method as involving ‘group interviews’, ‘focus group interviews’ or ‘focus group discussions’ reflect different assumptions as to the purpose of the study and the nature and status of the data that are generated. Some usages emphasize the capacity of focus groups to access ‘views’ and may, at times, implicitly reference the quantitative tradition of data collection, privileging the notion of fixed ‘attitudes’. Others focus, either implicitly or explicitly, on a social constructionist model that emphasizes the potential of focus groups to elicit exchanges between participants as they co-construct perspectives and responses. (This is discussed in more detail in Chapter 2 in relation to ‘epistemological and ontological’ underpinnings of focus group research.) The definition that I continue to apply (first outlined in Chapter 1) is suitably broad to afford space for both applied and more theoretical usages of focus groups: ‘Any group discussion may be called a focus group as long as the researcher is actively encouraging of, and attentive to, the group interaction’ (Kitzinger and Barbour, 1999, p. 20).
Being actively encouraging of group interaction relates, most obviously, to running the focus group discussion and ensuring that participants talk amongst themselves rather than interacting only with the researcher, or ‘moderator’. However, it also relates to the preparation required in developing a topic guide and selecting stimulus materials that will encourage interaction, as well as to decisions made with regard to group composition, in order to ensure that participants will have enough in common with each other to make discussion seem appropriate, yet have sufficiently varying experiences or perspectives in order to allow for some debate or differences of opinion. Likewise, although being attentive to group interaction refers to the process of moderating discussions, with the researcher picking up on differences in views or emphasis of participants and exploring these, it also relates to the importance of paying attention to group interaction: to group dynamics and to the activities engaged in by the group – whether this be forming a consensus, developing an explanatory framework, interpreting health promotion messages, or weighing up competing priorities. Later chapters in this book are concerned with providing advice on all of these aspects of research design, the running of focus groups and analyzing the data generated.
Focus groups, in common with other qualitative methods, excel at providing insights into process rather than outcome. This, however, is sometimes overlooked by researchers who employ focus groups as a method. A common usage is the so-called ‘nominal group technique’, which has proved so popular in health services research. Literally meaning ‘a researcher-convened rather than naturally occurring group’ – a group in name only – the most common variant of ‘nominal groups’ involves employing a ranking exercise in order to encourage participants to determine their priorities. While I would contend that important insights can be gained by paying detailed attention to the discussion generated during the process of debating and weighing up competing priorities, many proponents of this approach concentrate their efforts, instead, on the outcome of such deliberations. A notable exception is provided by Demant and Ravn (2010) who capitalized on the data-generating potential afforded by a ranking exercise to allow young Danish people to articulate, explore, debate and refine their ideas about drugs and risk. (This study is discussed in more detail in Chapter 6 on generating data.)
Although some commentators have bemoaned the tendency of focus groups to produce consensus, others, such as Myers and Macnaghten (1999), have pointed out that, in the event, many groups do not develop a consensus, and that, moreover, it is the interchanges between participants that constitute the most valuable data for the researcher attempting to gain insight into group processes; not the outcome of the discussion.
All comments made during focus groups are highly dependent upon context and are contingent upon
