8

Building on the skills you learned about best practice in qualitative interviewing, let’s move to a discussion of focus groups. Focus groups draw on qualitative data collection and analysis techniques in the exploration of experiences, opinions, values and beliefs within a group (Kitzinger 1995). Methodologically, focus groups are an approach to conducting group interviews that “generates data through the opinions expressed by participants individually and collectively” (Halcomb, Gholizadeh, DiGiacomo, Phillips and Davidson, 2007, 1000).

I have observed many social workers to throw around the term “focus group” without an understanding of the care and attention it takes to execute these in a rigorous and acceptable manner. For example, a recent student said to me “oh yeah, focus groups, I’ve done that. I put a couple of my clients in a room and had a conversation with them about our program.” In reality, to run a rigorous and well-designed focus group, a series of best practices must be followed.

When a social worker seeks feedback about clients’ experiences with a particular program, they should start by thinking about sampling, or who should be in their focus group. This entails thinking about stakeholders.

If we go back to our child welfare social worker who is working with parents towards family reunification, we might identify single, dual and multiple parent families as stakeholders. Ideally, 3-4 focus groups should be run for each stakeholder type, with 5-10 people in each group. At times, you will not have that many people, in which case, you do the best you can with what you have! It is also important to over-invite focus group participants as many people end up not attending.

After deciding on the ideal focus group participants, you need to develop a focus group protocol. A protocol is essentially a script that you will follow as the focus group session unfolds. Let’s review the essential elements of a focus group protocol. These include a brief introduction to the area of inquiry for the evaluation, a review of the focus group structure and confidentiality, the eight or so focus group questions, and the wrap-up.

A few words on the flow of focus group questions is warranted. The first question should be introductory, akin to an icebreaker that is related to the evaluation topic. Next, one or two transition questions can be posed that begin to help participants focus in on the central topic. At this point, two to three key questions can be posed. These questions are at the heart of what the evaluation seeks to learn about. Moving towards completion, an ending question asks for information to sum up views on the evaluation topic. Last, it is a good idea to pose a general final question such as “is there anything else that anyone feels we should have talked about but didn’t?”

Now that we’ve learned about the ideal design of focus group questions, let’s see what a whole focus group protocol looks like, below. Note that prior to implementing a focus group protocol with a group, a disclosure document would be provided to participants in the evaluation context for results to be used for internal evaluation. An informed consent document would be provided to participants in situations in which results would be shared external to the organization, such as in a publication, report or presentation. This would be reviewed prior to the start of the protocol. See section on these documents in Chapter 4 for examples.

Supporting youth with developmental disabilities in an outpatient mental health clinic

PROTOCOL AND SCRIPT

Introduction (5 minutes)

Introduce Facilitators and Project

“Thank you for agreeing to participate in this focus group discussion today. My name is ____________. Our team members include (introductions of all researchers present). The focus of today’s session is to find out your views on a population we are interested in learning how to best support youth with developmental disabilities here in the clinic. We are very pleased that you have taken the time to share your views with us.”

Introduction to the Research Project

“Although much is known about how clinical practice approaches may need to address the developmental needs of youth, little is known about practice approaches with youth with developmental disabilities – distinct from youth with intellectual disabilities. The goal of this project is to gather data about clinical social workers’ experiences with youth with developmental disabilities, with the ultimate goal of using this information to promote the development and use of best practices with this population in therapeutic settings.”

Review Focus Group Structure and Confidentiality (5 minutes)

Answers: “The most important thing we want you to remember is that there are no right or wrong answers. We want to know what you think.”

Confidentiality: “We are tape recording the session in order to ensure accuracy in writing up our report. However, your responses will not be linked with your name in any way. Your responses will not be communicated with anyone except in the most general ways in a larger report. Nothing will be reported in a way that will make it possible to identify the person who said it. Data will only be used to improve social work practice within this agency and will not be reported externally.

Taping: Help us to capture this discussion on the tape: “Because we are taping, we may remind you occasionally to speak up and to talk one at a time so that we can hear you clearly when we review the session tapes”

Defining Developmental Disabilities (5 minutes)

Definition of developmental disability is presented. Developmental disability is different from intellectual disability (formerly mental retardation).

• We conceptualize this population as generally “flying under the radar” and being in-between systems of care

• Often, this population is just above the cutoff for Department of Developmental Services (DDS) eligibility

Focus Group Questions (40 minutes)

Please tell us your name & what comes to mind when you think about youth with developmental disabilities.

How do you identify youth with developmental disabilities in your practice?

Follow-up: What presenting problems do they come in with?

Follow-up: Who is referring this population to the clinic?

Follow-up: How often do you see youth from this population?

Do you use standard screening or assessment tools with this population?

Follow-up: How have you modified existing tools for use with this population?

Which therapeutic approaches do you use in clinical work with this population?

Follow-up: Did you develop or modify this approach from the standard model?

Follow-up: How do you know if this work is effective?

What are your biggest challenges in doing clinical work with this population?

Follow-up: What do you need in order to feel good about supporting this population?

Follow-up: What do you need from your supervisor to best support this population?

What advice do you have for doing clinical work with this population?

Is there anything else that we should have talked about with respect to this population?

Wrap-Up (5 minutes)

Reiterate confidentiality of information shared by group members.

How do you feel about participating in this focus group?

Thank participants for attending.

Provide contact information for researchers in written form

Now that you have seen a focus group protocol, let’s talk about the mechanics of running your sessions. To run your focus group, you want to have two experienced evaluators in the room. One will function as the group’s discussion facilitator and the other, a non-participant in the discussion, will be a notetaker.

The facilitator is ideally someone who is known and respected by stakeholders and is ideally someone with characteristics similar to the stakeholders. The notetaker will manage the video or audio recording of the event but will also write down key points that arise during the group discussion.

Another logistical requirement for focus groups includes scheduling the timing of the session to reflect cultural values or community needs. Timing may relate to time of day, the need to take a short break for prayers, or fitting in to a short time window for busy people, for example. In my experience, successful focus groups last between 45 minutes and one hour.

Once the focus group session commences, the facilitator should also be sure to ask that people use first names only. While the facilitator can request data privacy from focus group participants, this cannot be guaranteed.

After collecting data in a focus group, the facilitator and the notetaker and any other members of the evaluation team should analyze both the notes and the audio or visual recording. During this data analysis phase, the focus should be on interpreting the themes that emerge from interactions between participants.

The best practices identified for qualitative data analysis should be used here as well. Using a grid such as the one in Figure 8.1 can help with summarizing results across focus groups (Halcomb, Gholizadeh, DiGiacomo, Phillips and Davidson, 2007; Miles & Huberman, 1994).

	Question 1	Question 2	Question 3	Question 4
Group 1
Group 2
Group 3
Group 4

Figure 8.1 Analysis tool for focus group data

In summary, in evaluation, focus groups are used to gather qualitative data on the collective experience of an intervention. Through listening to the group’s synthesis and validation of ideas, evaluators gain in depth insight into how a given intervention was experienced. Although focus groups present a challenge for confidentiality, having access to a larger number of clients is often cost-effective and ideal. In order to analyze focus group data, evaluators need to follow best practices for qualitative data analysis.

Discussion questions for chapter 8

• Thinking about your current setting, would a focus group be ideal for practice evaluation? Why or why not?
• Thinking of your current client population, what cultural factors might you need to consider in running focus groups as part of your practice evaluation?
• In what instance would you choose focus groups over qualitative interviews or quantitative surveys?

References for chapter 8

Halcomb, E., Gholizadeh, L., DiGiacomo, M., Phillips, J., & Davidson, P. (2007, June). Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. Journal of Clinical Nursing, 16(6), 1000-1011.

Miles, M. & Huberman, A. (1994) Qualitative Data Analysis. Sage Publications Inc., CA.