Doing Focus Groups. Rosaline Barbour
understand the potential of focus groups, the challenges they present and, perhaps, in order to assist in formulating some constructive responses, it is worth briefly tracing the origins of focus group research, which continue to influence current practice.
Originally developed at the Bureau of Applied Social Research at Columbia University to gauge the response to public broadcasts (Merton and Kendall, 1946), focus groups were soon enthusiastically adopted in broadcasting, marketing and public opinion research (Kidd and Parshall, 2000). These usages continue in the established fields of broadcasting, marketing and public opinion polling, but also surface in interesting new guises. Recent examples include the use of focus groups to inform plans for communicating with members of the public following radiological terrorism (with echoes of the public broadcasting origins of the method) (Pearce et al., 2013). Also of note is a recent marketing-type exercise carried out by a member of the Law Faculty at Ohio Northern University who wanted to find out what employers wanted from new graduates (Wawrose, 2013). The discipline of design has frequently employed focus groups, drawing on marketing approaches, and using members of their target audience, in order to establish that their prototypes are fit for purpose.
Many researchers continue to employ focus groups in order to elicit the ‘views’ or ‘attitudes’ of particular constituencies, as testified by the huge number of journal articles with these words in the title – particularly, but not exclusively, in the fields of health and social care research. Here focus groups have frequently been employed in order to elicit the views of specific sectors of the population (often minority ethnic groups) who do not take advantage of services – especially screening programmes – e.g. breast cancer screening among Chinese American immigrant women (Lee-Lin et al., 2013) or oral cancer screening among rural black Americans (Howell et al., 2013). This mirrors the marketing approach to studying market segmentation and the potential for targeting certain client groups. (Some of these usages are re-visited in the next chapter.) Many of these projects involve collaborations between medical or nursing researchers and social scientists (mainly medical sociologists, health psychologists and medical anthropologists).
Some health services research applications have taken usage of focus groups a stage further, aiming to access service users’ – or, frequently, non-users’ – perspectives in order to plan appropriate and effective interventions. Focus groups are especially well suited to informing the development of education programmes (e.g. Song et al., 2014, who used focus groups to design a psycho-education programme for patients with schizophrenia and their carers). Bottorff et al. (2014) used the method to develop tailored messages for Aboriginal youth about the link between tobacco exposure and breast cancer. (Some of the issues arising from such usages are further debated in Chapter 2.)
Another important strand in the development of focus groups was their use in organizational research and development, practised mainly by staff at the Tavistock Institute in London during the 1940s. In common with marketing research, however, problems to be researched were, for the most part, defined by the companies for whom they effectively provided a consultancy, client-based service. This discouraged the emergence of a distinctive organizational focus group approach, since, as Kevern and Webb (2001) point out, the aims of the business sector (including, of course, marketing) are somewhat different to those of academic researchers. Nevertheless, some qualitative researchers may find themselves in a not dissimilar situation to that of research consultants, particularly when they are conducting focus groups under the auspices of a large-scale clinical trial, and multi-disciplinary working gives rise to its own important challenges. The very different lenses through which clinicians/practitioners and social scientists approach focus group research become apparent during the process of data interpretation and analysis (although it is argued in later chapters on analysis that this can, if handled constructively, afford a valuable resource for making sense of data).
Taking an approach very similar to that of the organizations who employed the research consultants at the Tavistock Institute, the nursing and medical professions, in particular, have used focus groups in order to ‘trouble shoot’ with regard to areas of clinical practice that have been deemed problematic. This includes research into clinical decision-making in relation to specific issues – e.g. performing episiotomies (Wu et al., 2013). Focus groups have even been employed in order to plan for the delivery of new medical procedures (Lane et al., 2011) – in this case, the first human intracortical visual prosthesis.
These research activities also extend to cover management issues – e.g. policy implementation in community nursing (Haycock-Stuart and Kean, 2013); or incident reporting in the labour and delivery context (Waters et al., 2012). Following the lead of the design discipline, researchers in information systems have, more recently, developed the use of focus groups to address their own specific questions (Belanger, 2012; O’hEocha et al., 2010), and they have been utilized in order to advance research on web design (Küster and Vila, 2011).
In sharp contrast to the marketing and business models, many researchers (again, predominantly in the health and social care fields) have used focus groups in accordance with their deeply held convictions regarding equity and empowerment, and have sought to ‘give voice’ to marginalized groups or those whose contribution has been muted. This body of work has drawn heavily on the model provided by community development with the ultimate aim of effecting change (whether this involves consciousness-raising, identification and publicizing of barriers or, even engagement with policy makers). This approach generally seeks to employ the sort of ‘dialogical research methods’ advocated by the Brazilian educationalist Freire (1972). Padilla argues that ‘the essential role of the investigators in dialogical research is to facilitate the production of knowledge for and by the subjects’ (Padilla, 1993, p. 158), thus challenging conventional assumptions regarding the power relationship between researcher and researched. Some of the projects in this tradition engage members of the community as co-researchers, and this may involve them in acting as focus group facilitators or co-moderators (e.g. Littlechild et al., 2015) and, even, data analysts (Makosky-Daley et al., 2010). The participatory research model has underpinned many pieces of research with ethnic minority groups, carried out with the aim of developing what Maiter et al. (2013) have described as a ‘shared critical consciousness’. This approach has chimed well with the orientation of feminist researchers, leading some to claim focus groups as an inherently feminist method, although Wilkinson (1999) suggests that this is perhaps slightly overstating the case. However, many such projects have focused on women, including a recent project in Thailand which sought to strengthen women weavers’ self-care (Nilvarangkul et al., 2013). Focus groups have also been employed in order to give voice to many other marginalized groups in a range of contexts – e.g. Khadka et al. (2012) who sought to elicit the perspectives of visually impaired children
Practitioner-researchers have also fused elements of the community development and organizational research model in order to carry out action research with fellow professionals in order to address specific aspects of practice – e.g. Jimbo et al. (2013) who convened focus groups with primary care clinicians and medical office staff in order to identify perceived barriers and facilitators with regard to using a web-based interactive decision aid for colorectal cancer screening. The example provided by Fardy and Jeffs (1994), however, provides the most detailed account to date of the use of focus groups as part of their approach to developing consensus guidelines on managing the menopause in general practice/family medicine.
Although most examples of such usages come from the health and social care fields, one participatory project in Baltimore involved research with fire union leaders and firefighters aimed to inform implementation of an urban firefighting canvassing programme (Frataroli et al., 2012). In the city of Philadelphia, which the authors note, is characterized by a history of experimentation in relation to its criminal justice system, Wood and Beierschmitt (2014) applied a participatory action research approach to address the practice of policing mental and behavioural health incidents.
Again drawing on the community development approach and, here, echoing its concern with addressing power differentials between researcher and participants, focus groups have frequently been employed in action-oriented projects, seeking to work with patients, clients,