Doing Focus Groups. Rosaline Barbour
order to take a measured look at the opportunities and potential pitfalls involved in employing focus groups it is useful to re-visit past and ongoing debates relating to the capacity of focus groups and the challenges that their usage presents for the researcher – whether novice or, indeed, more experienced. This is the subject of the first section of this chapter.
Regardless of the specific approach taken, there are particular properties of focus groups that make them especially attractive to researchers seeking to widen engagement, both in terms of the participants that they can access, and the topics that they can address. This chapter highlights those assets of focus groups that render them an effective tool for researchers from particular disciplines, or professions. It also considers aspects of focus groups that make them amenable to addressing certain sorts of questions.
The main attributes of focus groups are then presented, including their potential for accessing the ‘hard-to-reach’ and the vulnerable; their suitability for addressing ‘difficult’ or ‘sensitive’ topics; and their capacity to capture responses to rapidly evolving situations. Examples are provided of some such applications across a range of research fields.
Next this chapter highlights some potential problems that can arise, including the limits of descriptive research and some of the issues raised by social marketing approaches (which frequently capitalize on the potential afforded by focus groups – most commonly to extend the reach of health promotion messages to include the ‘hard-to-reach’ or recalcitrant). This raises some difficult questions and the benefits of the insights provided by the community development model are once again emphasized to suggest how this issue might be more adequately addressed. While focus groups may allow for a rapid response in terms of researcher involvement as events unfold there are also dangers associated with the opportunistic use of focus groups (particularly when employed by researchers with little previous experience of this method). The – often overlooked – role of the researcher’s predispositions and interests in determining the way in which focus groups are used is also touched upon here. Some of the difficulties experienced by researchers are a result of misconceptions (including, as we have already, seen unreasonable expectations), which can lead to inappropriate usages of focus groups (such as eliciting ‘narratives’, measuring ‘attitudes’, or providing an easy, ‘quick and dirty’, route to data). With regard to the latter approach, the problems arising from a lack of attention to research design are emphasized.
Assets of focus groups
Accessing the ‘hard-to-reach’
Largely because of their perceived informality, focus groups have earned a reputation in terms of their capacity to engage with those who may otherwise slip through the net of surveys, or studies that rely on recruiting those who are in contact with services. They have regularly been the method of choice for researchers attempting to access groups viewed as ‘hard to reach’, such as members of ethnic minority groups (Chiu and Knight, 1999), migrants (Ruppenthal et al., 2005), or street-living youth (Ferguson and Islam, 2008). Some groups, of course, may be marginalized in respect of several of their attributes, such as the drug-using gay men living in an environment characterized by high rates of HIV infections studied by Kurtz (2005) or children with visual impairments (Khadka et al., 2012). Focus groups can encourage greater candour (Krueger, 1994) and give participants permission to talk about issues not usually raised, especially if groups have been convened to reflect some common attribute or experience that sets them apart from others, thus providing ‘security in numbers’ (Kitzinger and Barbour, 1999). More recently, online focus groups have been employed in order to extend the reach of research to include constituencies such as young adults with potentially stigmatizing skin conditions (Fox et al., 2007), children and adolescents born with only one arm (de Jong et al., 2012), and gay and bisexual adolescents (Ybarra et al., 2014). (Online focus groups are discussed in more detail in Chapter 4 on research design.) Focus groups – whether face-to-face or online – may allow the researcher to engage with respondents who are otherwise reluctant to elaborate on their perspectives and experiences.
Engaging with the ‘vulnerable’
This includes potential participants who are rendered especially vulnerable, as a result of particular experiences or attributes, many of whom might also be considered hard-to-reach using more conventional methods, such as surveys or interviews. Focus group researchers have had considerable success in engaging with, for example, people with learning difficulties (Kaehne and O’Connell, 2010); children with cerebral palsy, spina bifida or cystic fibrosis (Nicholas et al., 2010); individuals who have attempted suicide (Ghio et al., 2011); or those with severe mental illness (Whitley and Campbell, 2014). (Some of the issues involved in dealing sensitively and responsibly with participants who fall into these categories are considered in more detail in Chapter 7.) Broadening research engagement to include groups likely to have been marginalized, or even simply largely ignored, due to the acknowledged challenges of recruitment and sampling, is sometimes viewed as being inherently empowering, since it can act to ‘give voice’ to their experiences. Bringing such individuals together – albeit for research purposes – 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