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7.1 Entering the community to contact participants
This may be done a day or even a week before the focus group. However, in some circumstances, participants may be contacted as late as the day of the focus group. Your team will already have made plans concerning when to make first contact with the participants, but there are a few points to make about arranging the session with potential participants.
It is a very good idea for the members of the team who will conduct the focus group to visit the participants in their home to invite them to the session. This will indicate that the team considers the participant important enough to make a personal visit and could encourage them to attend. When you visit participants at their home, you can collect some basic demographic data: their age, occupation and marital status, for example. Registration at the time of the focus group takes up valuable time, and people may not want to register and give away personal details in front of other participants.
When you first arrive in a particular location, it is probably appropriate to contact the local leader, or perhaps the health worker, to obtain permission to enter the community. They will most probably help you locate your participants and can be of great use in arranging a site for the session. It is a courtesy to explain your purpose, but try not to give details of the session as this could influence responses.
Consider the daily activities of the participants and be sensitive to the amount of time they would have available to give up for a two hour session. A focus group scheduled late afternoon might interfere with the preparation of an evening meal for example, and you will find that you'll have fewer people willing to participate. By the time participants get to the session, linger for a while talking to friends, then return home, they could easily have lost half a day. Never pressure people into attending. People who are anxious about duties awaiting them at home will not be good participants anyway. You can encourage participation by offering child care at the session. In one study which used focus groups, when women indicated that they would only be free after the evening meal, the researcher arranged to serve them dinner, and so maximised participation and created a warm and friendly atmosphere which encouraged the participants to discuss some sensitive issues relating to their health (Siriporn Chirawatkul, pers.comm.).
7.2 Before the participants arrive
The team should arrive before the appointed time to make sure the place where the focus group discussion is to be held is ready. The checklist you will have prepared should also cover these preparations, so always refer to it before the session.
If you have already arranged the session a day or two ahead, it is worth visiting the participants to remind them if this is at all possible. You may also need to make another courtesy call to the local leader or health worker.
The seating needs to be arranged to encourage a group discussion (in a circle) and the equipment set up and tested once more.
7.3 As the participants arrive
One reason the team will arrive before the appointed time is to let people know that the session will go ahead as planned, and the team is ready to receive them.
The reception time is designed to get to know the participants and to put them at ease. The role of the team is rather like hosting a gathering of friends or neighbours.
Small talk is ideal at this point. It is best to talk about minor issues. You should be aware that issues that will be raised in the focus group should not be discussed before the session begins. Sometimes people will only be prepared to express their views once. Controversial topics should also be avoided! We must maintain the "neutral" appearance at all times so people will be free to express themselves later.
If participants did not register in their homes, then this would be the time to complete that task. In some communities it is a good idea to give participants name tags. It will help the moderator a great deal to be able to remember participants' names, and it creates a friendly, warm atmosphere. It also helps the observer identify responses of certain participants.
The reception time is also a time to observe the participants to see how they communicate with each other. Talkative or dominating people should be seated next to the moderator so that he or she can turn away from the dominator should the situation arise that they are taking over the session. Shy people can be seated opposite the moderator to enable maximum eye contact. The observer should greet participants at the door while the moderator/s are conducting the "small talk".
Should participants ask questions about the topic to be discussed, it is important not to give them too much information. If participants have a detailed idea of what information we require, when the questions are asked they may not respond in a natural way. For this study, the following points can be given as a "routine" response to such questions:
NOTE TO TRAINER
Add in to this section the responses that you all agree to give to specific questions about the session and the topic under discussion.
7.4 Deciding when to start
The ideal number of participants is eight. Should only some of the participants turn up, be prepared to start with as little as four. This is not really as productive, but we must respect the fact that those participants who have come, may have done so at the expense of their normal activities. They must be made to feel important, and we can do this by demonstrating that their views are still worth listening to.
Should less than four participants arrive, then it is not a waste of time to sit casually with them and discuss the same questions. They may be able to give you some new information that can help with the study. Even talking like this can provide you with valuable information.
7.5 What to do if too many people arrive for the focus group
Often in villages, the focus group will be seen as an unusual and entertaining event. It is best for our research purposes if only those invited actually attend. However, should a crowd of people assemble you need to be sensitive to local custom.
Discretion in discouraging extra
people will be left to the team's knowledge of the area and local custom. Be aware of the
need for flexibility in this matter. In one study, extra people were asked to leave, but a
second focus group was arranged the following day so that the moderator could talk to them
also (Siriporn Chirawatkul, pers.comm.).
This part of the session is important as it sets the atmosphere for the whole focus group. It needs to be casual, but people need to be aware that there will be some structure and that we need to follow a semi-planned format. It is important not to appear too casual as people may not take the session too seriously. On the other hand, too much formality may restrict the flow of conversation.
8.2 Points for introducing the session
Welcome the participants and thank them for coming. Introduce the team. If you are working in two languages, then the moderator should welcome the group through a direct translation. This gives the strong impression of their involvement in the session.
Explain team's work. Provide a simple explanation of the project without giving away the exact nature of the research questions.
Explain the different roles of the team.
Explain why the participants were chosen. Include the importance of their contribution to the study and the community.
Make sure people understand that the session will be confidential.
Explain that you will be using a tape recorder (if appropriate) for the session in order to remember later what was said.
Explain how the focus group works and "ground rules":
a group discussion that is built around certain questions;
session lasts for around an hour and a half;
because of the need for translation and tape recording it is essential that only one person talks at a time (if appropriate);
at certain times, the observer may need to check a point with the moderator, so please be patient (or if using two moderators, then there may be communication between them).
Try to keep the conversation "in the group" as other conversations going on between a couple of group members may distract the flow of discussion.
Tell participants you would like to hear from ALL of them about their feelings on the subject. Anything they want to say is important. Remember to give all in the group the chance to speak.
Because there is much information to get through in one hour, explain you may need to move onto the next question before the group has really explored one area.
Vague comments cannot provide the group with adequate information. Ask participants to clarify points when necessary. "I agree" comments will usually be followed by requests for explanation. "It is difficult to..." may need to be explained a bit more, such as why is it difficult.
The group members introduce themselves.
Ask for any questions.
Start the session off with a question that will put the participants at ease. This can be a question that demonstrates that they all have something in common and can be comfortable about speaking freely. Or, it could be simply a very general question that is easy to answer and gets the group relaxed. This question may be rather long, certainly longer than in a survey questionnaire. This is because in general this encourages fuller answers in response. For example: "As I've explained, I am interested in finding out about the health problems of people in this village. I wonder if you could tell me what you think the main health problems are here?"
The research team will have carefully prepared questions for the focus groups. If you are working in a second language, the field staff who may also be the translators may need to provide the research team with some guidance in wording the questions as well as translating them.
The question lines have been created to meet specific needs to obtain the right information as quickly as possible. During the pilot sessions it may become obvious that some of these need to be revised, as the participants are not able to understand what is wanted of them.
The most important thing to remember is that the questions need to be asked in exactly the same way as they have been prepared. If you change the order or think that something is wrong, check with the team first.
9.2 Types of questions used
The questions used in focus groups are what we call open-ended. This means that the question could be answered in a variety of ways. This helps the participants to answer what is important to them rather than in a specific way.
We start the session with very open-ended and general questions, but begin to get more specific as we get onto the topic of interest. This allows us to get the information we are really after.
Focus groups avoid yes/no questions. We phrase a question to encourage a discussion. If you ask "do you.." or "is.." questions, then you may simply get a yes/no answer.
Focus groups rarely use "'why" questions. This is because it suggests a sensible answer, and the participants may tend to answer in whatever way they think is correct, or what they think you want to hear.
"Accidental" questions may become necessary to ask once the focus group has begun. This happens when we have not anticipated the direction of the discussion, and a topic of great interest emerges during the session. If you think of any such extra or "accidental" questions, and are moderating with a controlling moderator, let them know before you explore the topic further. We usually try and ask these questions at the end of the session in the last five to ten minutes, but it may be necessary to ask them at the time they are suggested.
For example, suppose you were conducting a focus group on schistosomiasis haematobium (urinary schistosomiasis) and someone in the group says that haematuria (blood in the urine) is normal (Bello and Idiong 1982; Nash et al. 1982). This would be an occasion for an accidental or unplanned question, as set out in a hypothetical example in Box 8. "M" is the moderator.
NOTE TO TRAINER
It would be worthwhile to spend some time looking at the question guide that you have prepared, or if you are preparing the question guide with the help of the field staff, then it is better to let the staff complete the training sessions first.
Box 8: Accidental questions: Haematuria in young boys
M: We've been discussing various illnesses which you see in older children. You've mentioned malaria, cough, and diarrhoea? Is that all?
A: Yes (all participants agree). Older girls and boys are quite healthy around here. Of course, they have the normal things, like menstruation in girls and blood in urine in the boys, but that's part of growing up.
M: Blood in urine is interesting. Could you tell me a bit more: in what ways is this normal?
A: Like I said, it's just like menstruation, it's the first sign that the boy is becoming a man. All boys have this ...
M: They do?...
Perhaps the area that requires the most practice is the control of the focus group You will not be able to remember all of these techniques at first, but with each new focus group try to practice another skill.
Perhaps the most powerful tool for encouraging participation by the group is to explain adequately at the beginning of the session the purpose of the study (in general terms) and how important their contribution is to the study.
The following list is not necessarily complete. Part of your task is to make suggestions about other techniques that could aid in the flow of discussion.
10.2 Encouraging discussion
Wherever possible maintain a friendly and warm attitude to make the participants feel comfortable. As previously mentioned, being non judge mental and open can help a lot. Also as mentioned before, aim to be somewhat casual, but not too much so in case the participants do not take the session seriously.
Pauses and prompts
Pausing to allow a participant to think more on the topic being discussed is a very useful technique. It can also allow a new speaker to comment. Some participants who are shy may not compete for time to speak, but these people will often talk if there is a break in the discussion.
This technique is very difficult to do if you are nervous about the success of the focus group. It is natural to want to fill in the gaps in conversation. Try practicing this on family and friends to see how it works. With confidence in the technique, you will be able to use it more effectively.
The pause should not last more than five seconds (which can seem like a lifetime if you are anxious!). The pause used with confidence will also stop you rushing onto the next topic too quickly.
You can also use the pause to make eye contact with someone. This can encourage that person to speak. Just try not to embarrass anyone, particularly the shy ones.
Establishing eye contact can also be a means of prompting someone to continue to talk. Raising your eyebrows, nodding, and other gestures (which vary from culture to culture) may also encourage people to continue to talk. Other prompts are verbal - some have meaning ("I see, that's interesting, keep on ..."), others are simply reassuring sounds ("mmm", "uh-huh") to encouraging a speaker to continue his or her line of response.
This technique is so important, that we will need to prepare probes for each question we ask should no one respond. Generally, we try to avoid vague comments, and the probe can encourage a speaker to give more information. For example:
"Could you explain further?"
"Would you give me an example of what you mean?"
"I don't understand..."
The general probe is used often at the beginning of the discussion. This helps the participants know that we want precise answers.
A question can be rephrased if the group members are finding it difficult to answer. Be very careful not to change the meaning of the original question and do not hint at the answer.
"I was referring to access to the clinic. What I meant to ask you was, are there any factors that either prevent you going to the clinic or make it easy for you?"
This technique is supposed to keep the conversation lively. It also reminds the group of the question being asked.
"Mrs X, you told us that you cannot always take your child to the clinic because transport is difficult. Mrs Y (who has not yet said anything), does anything stop you from taking your child to the clinic?"
Sometimes it is helpful to give an example of a particular subject (for example, a possible intervention, or a set of symptoms) in order to test the knowledge and attitudes of the group or to clarify the generalisability of a previous comment. In one study, a research team used clinical vignettes to find out local terminology for different kinds of diarrhoeal disease, and to test the accuracy of those vignettes before incorporating them also into in-depth interviews with mothers and grandmothers (Abdullah Sani et al. 1990).
Suppose, for example, you want to try to determine if treatment differs depending on whether a child has a simple fever, or other symptoms which might indicate malaria. You could ask:
"You've suggested that babies who have fever should be treated by the local healer. But suppose that a baby had a bad fever, and was shivering and very cold, and didn't seem to be getting any better: what would you do then?"
Box 9 gives examples of a number of different styles of questions which you might use within a single focus group.
10.3 Dealing with specific individuals
Not all participants will respond in the ideal way! For this reason we will look at some ways to deal with some of the more common group problems (see also Scrimshaw and Hurtado 1987:15-19; Sittitrai and Brown 1990; Stewart and Shandasani 1990:96-98).
Often in groups there will be "experts". This can mean someone who is considered either by themselves or others to have a lot of knowledge on the topic in discussion.
Although "experts" can offer a lot of useful information, they should not be allowed to take over and they may prevent other group members from speaking. Opening statements should emphasise that all participants have knowledge on the subject, and that you want to hear everyone's opinions.
Sometimes, participants will have a special status in the community that you were not aware of. They might be the wife of an important person, be more affluent than other group members, or have any number of other qualities that prevent or restrict conversation from others. If you identify such a person you should try to limit attention to this fact, although the group members will be aware of it.
These are participants who want to answer all the questions for the group. They often answer questions immediately and prevent others from speaking.
Again, the introductory comments should emphasise the need for all participants' comments, and the initial discussion on this aspect should keep the potential problem alive in people's minds.
Box 9: Moderator question styles
M: I wonder if you could tell me about the different kinds of illnesses your children get? [general question]
M: So there's a special sort of fever when the child gets very cold and is really shivering, and the child could die? [repetition]
M: Suppose the child had a fever, and was very cold, and then complained of a very bad headache? What do you think might be wrong with it? [clinical vignette]
M: Let's suppose you took this child to the local store, and you were given some tablets. You gave those to her, but she didn't get any better. Now what would you do? [hypothetical]
M: You all think that's true then? Mrs Y, what about you? [prompt]
Mrs Y: Well, not really. You see my brother-in-law helps out...
M: That's interesting, how? [probe]
Mrs Y: Well, he would lend me the money so that I could take the baby to the clinic.
M: Can he always do that? [check for generalisability of specific person's experience]
M: What do the rest of you do if you
have no money? Do you borrow from someone, or do you do something else? [check for
generalisability within the group]
Dominant talkers are identified, if possible, during the reception time and are seated next to the moderator. This is done so body language can be used! This means turning slightly away from the dominant talker and looking other group members in the eye.
Should a dominant talker continue, then more drastic measures need to be taken!
Look slightly bored while avoiding eye contact, but be tactful and hind.
Thank the dominant talker for his or her comment, and ask for other comments from the group.
There will always be shy people in a group. Again, try to identify these people in the reception time and seat them opposite the moderator to enable maximum eye contact.
If this does not help, try gently to address them by name. Be very careful with this technique as it could embarrass them and prevent them from speaking again!
People who can't stop talking
These people talk on and on about a topic. They cease to provide good information, and will prevent others from speaking. As you only have about one hour for the discussion on several topics, it is essential that you keep these people under control.
Deal with these people by stopping eye contact after 20 to 30 seconds. The observer and other team members, if present, should do the same. Look bored, look at other participants, but do not look at the participant of concern.
As soon as the participant pauses,
be ready to fire the next question at another participant, or repeat the same question, if
necessary, to other members of the group.
As well as talking, people give many messages through body language. These are very important to understand if the meaning behind what people are saying is to be understood, and observers of focus groups need to take note of these as well as verbal responses to questions.
It is difficult to be expert at this without special training. Try to use common sense, by being aware of this. In the training and debriefing sessions, discuss body language, including common gestures and expressions used in your culture to indicate feeling or emotion.
The observer is the main team member watching body language and tone of voice. Although this will be a major part of his or her role, it is also important for all team members to consider body language during the discussion. The observer will note certain things during the session that he or she will want more information about, so practice observing signs people give that do not involve words and listen to what they are saying at the same time!
11.2 Things to watch for in "non-verbal" messages
The expressions people use whilst talking provide us with a lot of information about how they are feeling about what they are saying. Try writing a list of the types of facial expressions used to give certain impressions, and include the real message they are sending.
This is as important as facial
expressions. The way people are sitting can give you a lot of information about how they
are feeling about the discussion. People use body language differently in different
cultural settings. Try to list down some body postures that convey feelings (such as
boredom, excitement, interest, impatience, anger or resentment, or lack of understanding),
and include facial expressions in this exercise. If listing is difficult, try to
demonstrate the body postures and facial expressions yourselves.
There are many ways of recording focus group discussions, but whatever method you choose for your project, it is the responsibility of the observer to record the session. The interpretation of information relies on the quality of the record of the session, and so it is a very important part of the project.
In many circumstances, you will not have access to tape recorders or video cameras, and must therefore rely on paper and pencil. This is perfectly satisfactory, although it will limit the amount of information you can manage as well as the detail in which you can examine the responses of participants.
If you are only taking notes and have no other method of recording, then the quality of your notes becomes very important. Unless you have skills in shorthand (and most of us do not) then you will find it near impossible to record each response from each participant. One way of getting as much as possible is to try and summarise each participant's response. You should try and include direct quotes where interesting statements are made, or even to shown a common response.
Also be aware that if you are taking notes only, it is your interpretation of the response that you are recording through the summary. Be very careful to keep the summary true to what the participant intended. Do not record a quote that could take on a different meaning if read away from the discussion in which it was said.
If you are taking notes as well as recording the session, then the way you write your notes will change a little. If you have a tape recording that will be used to produce a full written or typed transcript of the whole session, then all you need to do is jot down words that can be used during the debrief to remind you of what was said, and by whom. If the taped recording is used to provide a record that will be used only if necessary, then your notes should be as full as possible.
Immediately after the session if possible, and certainly within 24 hours, you need to write up your notes in detail. This is especially important where your analysis will rely on these notes. Always ensure that you have the session written up before the next focus group. As you can't always remember details from one or two sessions ago, it is very easy to get confused. Check with the moderator: she or he may be able to remember some details you have forgotten, or have a different interpretation of various gestures or statements.
Do not forget to include your observations of the non-verbal messages in your notes. These can be of great assistance later for analysis.
12.3 Tape recording
This is a particularly useful method of recording the session. It can be used as a complete and accurate record when there are questions or confusions about responses or their meaning. It can provide a record of the whole session for anyone who was not present at the session, buy would like a detailed knowledge of the results of the focus groups. It can be very helpful for observers to expand their notes if they are unclear about their own summary.
Perhaps the most effective use of the tape recording is the full written transcript. This is only possible where you have the staff to produce the documents. As it takes one full working day to produce a transcript of a 90 minute focus group, not many offices will be able to use this method. However, it is recommended if it is at all possible as it will improve the quality of your results quite significantly.
The observer should set up and test the tape recording equipment in the field even if it was tested in the home office. It is also recommended to have two tape recorders so that each session has a back up recording should one of the recorders fail. Also, if you start one tape recorder about three minutes before the other, then you will not lose any of the session while turning the tapes around. However, good note taking skills can help you fill in the missing information.
You should always ask permission to record the session. It is probably better to use small microphones, as large ones can be a distraction especially if there are children around. Place the microphones in the centre of the group, and try to ensure that the voices of all participants will be heard. Always take at least two sets of spare batteries, and a spare microphone if possible. You should have extra cassettes too in case the session is very successful and goes on longer than you expected.
12.4 Video recording
This type of recording is rarely
used in research in developing countries. Mostly, researchers and health departments do
not have access to such equipment, but even if they do, video cameras can be very
distracting to the group. This of course depends on how much exposure they have had to
such technologies. If you are using video (and it can be very useful) follow the same
principles as with tape recordings. Just ensure that people are not aware of the camera
too much as this could easily stop a free and natural discussion.
Closing the discussion and having refreshments together can be as important as the discussion itself. This is for two main reasons. People should feel that their contribution has been worthwhile, and that you are really interested in them as people in the community. The participants should leave the meeting feeling satisfied that the time taken from their daily duties was well invested.
13.2 Closing the focus group discussion
The last five to ten minutes of the discussion should be reserved for any extra questions that appeared necessary during the discussion. The observer may want to ask a question or may want to use this time to check that her or his notes are correct.
After the last question has been asked and adequately covered, and there is a pause in the discussion, advise the participants that the discussion is formally closed. Thank them very much for their valuable contribution and invite them to join you for refreshments and informal conversation.
Some participants may want to leave immediately, and should be made to feel comfortable about this. Assure people that they are welcome to join you for refreshments, but they are free to get back to their duties if necessary.
13.3 Refreshment time
This time should be used to answer questions asked by the participants. It is not really possible to predict what types of questions will be asked, but as you progress with the focus groups you can decide how best to answer any common questions concerning the study. Participants will often want to know whether they have provided the "right" information. Always reassure them that they were extremely helpful. This message should be given in a very sincere fashion, even if the session seemed to be of minimal value! It may turn out to be valuable during analysis later, so you can assure people with confidence.
Another purpose of this time is to listen carefully for any further information that is revealed that was not discussed in the session. Sometimes people may feel more comfortable about discussing things in this very informal time. You cannot write anything down during this time, so try hard to remember anything that seems important.
Some participants may want to stay and continue general conversation with their friends. Usually the focus group team can expect to stay with the participants for about half an hour. You will need to use your own judgement about the most appropriate time to leave.
13.4 Leaving the location
If appropriate and possible, it is a
courtesy to find the local leader or health worker before leaving the area to report on
the success of the meeting. He or she may also have questions to ask. This should only be
a brief courtesy call before setting off.
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