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Section 1: Introduction
Section 2: Introduction to focus groups
Section 3: Overview of skills training session
Section 4: Roles of the team
Section 5: Personal characteristics of the moderator
Section 6: Preparation for each focus group discussion
Section 7: Entering the community and activities for the reception of participants
Section 8: Beginning the focus group discussion
Section 9: Moderator skills: Asking questions
Section 10: Encouraging and controlling the discussion
Section 11: Moderator and observer skills: Observing non-verbal messages
Section 12: Observer skills: Recording the session
Section 13: Closing the discussion and meeting
Section 14: The debrief
As with any programme, planning is essential to the success of a research programme using focus groups. It is the same with training your staff. Planning is important to make sure the whole thing runs smoothly and everything is included, but for this particular task there is another important reason for careful planning.
As this method may be new to both you, the trainer and the project staff, it can be very easy to give the impression of confusion if you are not well prepared. Confidence of the project team in you, the team's ability to perform the task, and in the end, the method, depends on how organised you are.
How involved your staff will be in planning the project, collecting the information and analysing the results will depend on the decisions you make according to what staff you have available. If the staff are highly involved in all aspects of the project, then they should go through the team leader training sessions before this section. Part II of this manual is mainly directed to field staff who will be moderating and observing the focus groups and is concerned with practical aspects of conducting a focus group, along with the skills required to do so.
This section provides all the main points that need to be covered while training your field staff. It is not intended to be used as a series of lecture notes, but simply as a guide to the trainer about the content of the training course. Different communities respond better with different types of learning styles and it will be up to you to select the most appropriate learning method for your staff.
Try to be as imaginative as you can with the training, and include as much practice of the new skills as possible. Exercises can be made that help the staff practice single skills (such as listening) with each other or family and friends. Make sure that you set up some practice focus group sessions for the staff before you pre-test in the field setting. There are many new skills for them to learn and feel confident about and you should expect that most field staff will feel rather nervous before they have had experience.
Do not send your staff out into the field before they have had time to feel a little more comfortable with the method.
If you are training staff who have had no experience in research, no tertiary education, or have only been involved in clinical aspects of health, then you will need to be rather sensitive to their learning needs. These ideas and approaches to improving programmes may be very new to them and they may feel insecure and unsure of their ability to perform the tasks required. The best way to deal with this very common problem is to keep all training sessions as simple as possible. Never use difficult language, as this is the quickest way to lose the interest of the trainees. Difficult language also makes people feel inferior and less able to carry out the tasks. In addition, regular practice will help to build confidence in their ability. Give staff regular encouragement and always remind them they are not expected to have all the skills perfected immediately.
Sometimes the staff who will be involved in a research project using focus groups will normally have a clinical role in your department, and may need you to spend some extra time with them carefully going through the benefits of doing this type of research. If they are rushed through a training programme for a task they do not believe is of much benefit, they certainly will not try hard to overcome any difficulties they may have. In addition, if health professionals are insecure and feel threatened, they may jeopardise the project by open rejection of the method.
If you have access to anyone with training experience, then either recruit them into the project or consult them for advice on local learning styles.
It is very important to evaluate the training sessions. If there are problems in learning the new skills, you want to discover those before you get into the field setting. It is outside the scope of this manual to discuss evaluation techniques, but even if you have had no experience in evaluation of educational sessions, it is wise to set up checks throughout the training programme. It is not necessary to have great skills in education programmes and their evaluation to be successful with the course. You can use written or spoken tests, practice sessions, or just informal talks with the staff.
Some of the material included below
repeats material discussed in Part I, but it is included here to stress the importance of
these areas in field staff training.
2.1 Why are we using focus group discussions?
What are focus groups?
Focus groups are group discussions in which about eight people are gathered together to discuss a topic of interest. The discussion is guided by a group leader (called a moderator) who asks questions and tries to help the group have a natural and free conversation with each other.
Focus groups are aimed at encouraging participants to talk with each other, rather than answer questions directly to the moderator. The group interaction of focus groups is important because it gives us some understanding of how the people are thinking about the topic.
The questions asked of the group are usually "focused". By this we mean that they focus on one or two main topics, to get a really detailed idea about how the people think about the area of interest. They are also focused because participants of any focus group usually share common characteristics, such as age, sex, educational background, religion, or something directly related to the topic being studied. This encourages the group to speak freely.
Focus groups can find out about people's feelings, attitudes and opinions about a topic of interest. They examine only one or two topics in great detail, in an effort to really understand why people think or behave the way they do.
How can focus groups be used in health programmes?
Focus groups can be used in many different ways in health programmes. They can explore a new area of interest about which little is known, or they can establish what the community thinks about a new project plan and check whether the plan is appropriate for the community. Focus group discussions can solve project problems. For example, if a health education project did not appear to be changing the behaviour of the community, then focus groups can explore the reasons why. Focus groups can also be used when you are evaluating a project. They can give you the community's ideas about how useful the project is. They are also used to address staff problems, by providing understanding about programme problems from the point of view of the staff themselves.
What information will we be collecting?
NOTE TO TRAINER
In this section it is worthwhile to provide a very clear description of the project. You can explain what the problems are that you are trying to solve. You will need to go through in some detail your objectives and the list of information you require. If your objectives have been written in complicated language, then it is advisable either to simplify them, or present them to the staff in a way that will not make them feel that the project is difficult for them to manage. This, of course, will depend on the language skills and educational background of the staff.
How will we use the data from Focus Group Discussions?
NOTE TO TRAINER
Here you will need to be clear about how you will use focus group results. To make this a little clearer, read the example list below of how you might want to use the information:
• to get ideas about what the community sees as important issues to the topic so that good questionnaires can be written for a larger study in the population;
• to discover local words related to the topic;
• to have additional information about the topic to be used with results from other studies;
• to help the team become more familiar with the area and the communities who live there;
• to assist decision makers with future plans to benefit the community.
2.2 Conducting the Focus Group Research Project
Introduction
The following section gives you a very brief outline of the whole process of conducting the project. It starts with the planning of the project and goes through all its aspects, including managing the results of the focus group discussions.
Focus group pre-planning
NOTE TO TRAINER
Your sharing of the detail in this section will depend upon what involvement the staff will have in project planning. You may need to provide as much detail as that in Part I of this manual, or alternatively you may just need to describe the main steps that were performed to plan the project.
Conducting the focus groups
BEFORE THE SESSION:
• pre-arrange the focus groups by visiting the site and talking to the local leaders and participants, and selecting the place where the focus groups will be held;
• check all equipment before leaving for the field;
• arrive at the site early to arrange seating and equipment.
DURING THE SESSION:
• receive participants;
• open the meeting;
• conduct the session;
• close the session.
AFTER THE SESSION:
• immediately debrief in the field;
• extend debrief at home office;
• expand field notes and check accuracy.
Management of the Results
NOTE TO TRAINER
It is necessary to provide an
explanation of how you will manage the information. This simply means describing to the
staff what decisions have been made concerning how you record the sessions, how you will
store the information, and how you intend to analyse the information. Again, the detail
you provide to the staff will depend on their involvement with these aspects of the
project. However, it is important to explain to the staff the entire project, even if they
are only involved in one aspect, such as moderating.
3.1 Introduction
The moderator plays a key role in the focus group discussion. Many of the sessions in the training course apply to the moderator, but other roles are discussed, as well as general issues related to focus groups, that the whole team needs to understand. Although certain sessions are directed to the moderator, and others to the observer or other team members, it is recommended that all team members attend all sessions. For this reason the sessions are not grouped according to which team member is to be involved, but are presented in the same order as they occur during a focus group project.
Although there is much to learn about focus groups, the easiest way to improve skills is to practice, each time trying to include more skills. For the purposes of this training course we will include all of the things you will need to know to be able to conduct a focus group.
It is recommended that you prepare a field guide to take with you into the field. A field guide is a summary of all the main points about focus groups. They can be very useful in refreshing your memory on areas you wish to develop more in each focus group. It also helps you in the beginning when it is not reasonable to expect to be able to remember everything at once.
3.2 Knowledge and skills required of field staff in focus group discussions
The knowledge and skills that you will need to develop will be discussed under different headings:
• Roles of the team (including management of focus groups in a second language).
• General personal characteristics of the moderator.
• Preparation for focus group sessions.
• Activities for reception of participants.
• Communication and co-ordination with the team.
• Beginning the focus group.
• Asking questions.
• Encouraging and controlling the discussion.
• Observing for non-verbal messages.
• Closing the sessions.
• The debrief.
4.1 Introduction
It is important to understand the roles of all members of the team in the field. A clear understanding is essential to the success of focus group sessions. The participants should feel that the team is confident and sure about what it is doing. If you allow confusion to reign over the session, not only will the participants feel uneasy (and perhaps less inclined to take the session seriously), but the quality of the information you collect may be reduced. It is also important to understand the roles and needs of your team members and to be understanding when problems arise.
This session will look at the roles of the team required where the focus group is conducted in the language of the moderator, then will discuss an alternative arrangement where the participants speak a different language from the moderator. A more detailed description of the specific responsibilities of the moderator, the observer and the translator will follow in later sessions.
4.2 Single language focus groups
Moderator
The moderator is the discussion leader. It is a very demanding job, but with practice and a little confidence, it can be performed well. The moderator is in control of the session and is responsible for the direction that the focus group takes. He or she will use all the techniques taught in this course to help the participants feel comfortable and to encourage a lively and natural group discussion.
The moderator will be provided with a question-line (or question guide) that will provide the direction for asking questions to obtain the information of interest to the project. The moderator must be familiar with all the objectives of the study, as this is essential to explore responses that are given during the focus group and may not be expected by the planning team. To demonstrate this, say a participant gave an answer to a question that was not expected by the team. It may prove to be very important to the main objectives, but if the moderator is not familiar with the purpose of the study he or she may brush over the answer and miss the opportunity to explore something relevant.
Observer
The observer has several functions. The main task is to observe the session and to take notes. How many notes you take will depend on how the session is being recorded. If you are relying only on the observer's notes, then you will need to get as close to catching every response as you can. On the other hand if the session is being tape recorded, then less detail of the session is required.
In addition to noting responses, the observer is also looking at any nonverbal sign or body language that the group demonstrates. This can tell you a lot about how the group feels about the topic under discussion as well as give some indication of how many people hold the same idea. Sometimes people may nod their head in agreement or shake their head in disagreement without actually saying anything. Observing these signs can add a lot to the written notes of the responses. A more detailed discussion of body language will follow in Section 11 below.
The observer also acts as a "back-up" moderator. He or she can quietly pass notes to the moderator to point out any major question not asked, any area that could be followed up, or anything they think may help.
The observer is also responsible for any equipment that is being used, such as tape recorders or cameras.
Assistants
If staff permits, it can be useful to have focus group assistants. These team members are used to help the moderator and observer run a smooth focus group. They are particularly useful in keeping down crowds during sessions, minding the children of participants, preparing any refreshments, and generally helping to host the session. They can easily be recruited from the community in which you are working for a particular session. They need not have any training or understanding of the project.
4.3 Conducting focus groups in a second language
If the team member or researcher who wants the final control over the discussion does not speak the language of the participants, then translators are required to assist in the session. It should be noted that direct translations of each response to the moderator by interrupting the discussion is not desirable. For this reason, where translation is required, it is necessary to have a four-member team. For this, it is necessary to have two moderators, an observer and a translator.
Moderator Translator
This role is one where a translator is trained to be the session moderator, but is directed to some degree by a controlling moderator. The moderator translator will conduct the session with the help of the prepared question guide. They will pose the questions and encourage the discussion, but should only ask questions previously discussed by the team, or those that are included on the question guide. If the moderator translator thinks that a response should be explored, they will need to check with the controlling moderator first. They will need to be very familiar with the study objectives, and although they are directed by the controlling moderator, they should have the skills to conduct the session alone. The only difference is that the controlling moderator will have the final say about what direction the discussion will take. In more formal research projects, the team member who is responsible for the project may need to have direct control over the focus group session. In other projects, the team leader or coordinator may want to moderate the sessions themselves, but may be restricted by language.
Controlling Moderator
As described, this member of the team has the final say about what questions are added or dropped from the question guide. They should allow the moderator translator a reasonable amount of freedom in leading the discussion. If the controlling moderator interrupts the discussion too frequently, then it will disrupt the flow of the session. This moderator should simply listen and observe, and interrupt only when a new line of questioning that has not previously been discussed by the team is necessary.
Translator
This member of the team has perhaps the most tiring task of all. The translator is expected to keep both the controlling moderator and the observer (see below) informed of the entire sessions. The translator should aim to provide the other team members with a summary translation of each response by each participant. It is not possible to provide a full and direct translation for such a long period. It is also necessary to translate what the assistant moderator is saying in order to aid in the overall understanding of the session.
Observer
The role of the observer for translator-assisted sessions is essentially the same as that in the single language sessions. They are there to look, listen and take notes. In this case, the observer will be noting responses as they are translated by the translator. These notes will be used in the debrief after the focus group discussion is over. The debrief checks on the direction of the focus group and the quality of the information gained. The notes are also important to the development of future question guides for further focus groups. For these reasons it is extremely important that the translation is as accurate as possible.
The diagram (Box 7) illustrates the seating allocations of the Moderator Translator, Controlling Moderator, Translator and Observer, as well as participants. Note that both the moderator translator and controlling moderator are part of the circle with focus group participants, whilst the translator and observer are positioned behind the moderators to avoid disruption.
4.4 Communication and co-ordination with team members
As you can see from our discussion about the roles of each team member, there are clear responsibilities for all members of the team. It should also be apparent that a high level of communication and co-ordination is required to achieve results. There will always be times when some team members will feel that the session is sliding out of control. Hopefully, you will not all experience the problem at the same time. The main point here is to understand the roles and needs of your team members and to be understanding when problems arise.
The other aspect of communication is translation where you are working in a second language. It is really important that the team knows what is going on at all times. If you are losing track of what is going on, it is better to stop the session than for the translator to try to keep pace and to provide the moderator or observer with an inaccurate translation.
Good communication also involves
honest and helpful feedback of the session during the debrief. You will be expected to
discuss any difficulties you face as soon as they arise, and we hope that you will feel
comfortable in doing so.
5.1 Introduction
Because of the nature of focus groups, and the need for natural discussion by the participants, the atmosphere for the discussion is extremely important. There are many personal characteristics of the moderator that, if developed intentionally, can aid in producing excellent results from focus groups.
The list appears very long, and at first glance may make you feel that it is impossible to be all these things. Do not worry, it is just a matter of being aware of these issues, and as you gain more experience, practice more of them. You are not expected to be able to perform in this way at your first focus group!
5.2 Characteristics
Adequate knowledge
To be able to perform well in a focus group, you will have practice sessions as well as theory lessons. Please try and make yourself as familiar with the materials as possible before the field focus groups begin.
You should also have enough background information about the topic you are working on to help you better understand the responses you get as well as to be able to follow up on critical areas. You will have been provided with a summary of the areas of interest to aid your understanding.
If you have any worries or difficulties, please let the team leader know so that any problems can be rectified. There will also be regular meetings to discuss the focus groups to see if there is anything that can be done to improve them.
Listening skills
Being a good listener is a good skill to develop. For focus groups, it is particularly important. You need to be able to listen to what the participants are telling you so you can summarise comments and repeat them back to the participants to check understanding; in addition it is only possible to gain information from the group if the moderator is not talking too much!
It is the role of the moderator to encourage the group to speak, rather than talk throughout the discussion. However, it is very easy to do this, especially if you are anxious about the success of the discussion. In addition, the moderator will not be taking many notes and therefore close attention to the discussion is necessary. You will need to be able to remember the comments and then relate them somehow to the next question, and to ask follow-up questions on the basis of what people say. Asking good quality follow-up questions is only possible if you are listening carefully to the participants' comments and really trying to think about what they mean.
The skill of good listening requires practice! You can practice this et home by listening to a group conversation and trying to remember the main points.
Leadership skills
The role of the moderator is also that of a leader. Leadership does not mean taking over the group, but directing the discussion. On the other hand, you do not want the group to lead you. If this occurs you will not have time to get the information you need to meet the needs of the research project.
Techniques to keep the conversation on the subject will be discussed later.
Relationship with the participants
In order to encourage discussion, participants in focus groups need to be able to communicate with you comfortably. Even if you are local staff, you will probably not be working in your own villages. It is important to try to understand what the participants are saying and what it really means to them. Being sincere in learning about the community should be felt by the group. Good moderators are very sensitive to the needs of the community in which they work, and should be as familiar as possible with important aspects of the local culture.
Your tone of voice could tell the participants many things without you actually saying anything wrong! Where it is necessary to ask further questions so as to gain more information, this must be done in the most gentle and friendly way possible.
It is also extremely important not to be judgemental about any response you hear. People will not talk freely if they think they are being judged, if they feel that you disagree with them, or if they feel that they are giving the "wrong answers". There are no right or wrong answers in focus groups.
Patience and flexibility
Sometimes focus groups do not go as planned. This can occur by interruptions of many kinds. It helps to try to think of what these interruptions might be, but sometimes (often!) the unexpected happens. Babies need to be fed, more people turn up, the group doesn't work well together. Some groups may not talk much, or, at first not even arrive! If things happen that you cannot control, then you need to accept whatever happens. Always keep your sense of humour.
Observation skills
As well as listening to the participants' responses it will also be necessary to watch for anything that could indicate boredom, anxiety, tiredness, or impatience. If this occurs, be prepared to fix any problems swiftly.
Clothing
It is always a good idea to find out
how the local people would expect you to dress. If you are working in very poor
communities you will not be well accepted in very expensive clothes. This could well
distance you from the local people. On the other hand, some communities would expect a
certain standard of dress, particularly if you represent a district or provincial health
office. Find out from local staff the best thing to wear in the field.
6.1 Mental preparation
As the focus group is an activity that requires intense concentration for a one to two hour period, it is important that the moderator is mentally alert and free from anxieties or worries. For the period of the study that includes focus groups, being well rested will assist in your ability to concentrate.
Another factor influencing the success of the focus group is your ability to conduct a smooth and natural conversation, and it will be necessary for you to memorise the questions that will be asked. You will always have a copy of them in front of you, but they should only be glanced at to remind you what the next question should be or what small prompting questions to use to encourage conversation. We will provide examples of this later.
6.2 Focus group discussion checklist
Any activity that requires many activities, equipment and field visits needs to be well planned. Although the majority of plans have been made, it will always be necessary to make sure that you are leaving for the field with everything necessary to conduct the focus group as successfully as possible.
You should prepare a checklist to go through before you leave for the field for every focus group. Any member of the team can be responsible to check that everything is prepared and available. In your list include all the paper work, necessary equipment and lists of participants. When making your equipment list, think about everything you will possibly need including batteries and spare pieces of equipment should any equipment fail. Take extra batteries and tapes with you. Also ensure that one person is responsible for actually testing all the equipment before departure.
Use the checklist before every focus
group, even when you feel you know all that is required from memory. It is a good habit to
get into and will save you much anxiety especially in the early days of the project.
Checklists also stop everyone thinking that someone else has prepared things!