Methods Matter Podcast – Focus Groups

Dr Donncha Mullin:

Hello. And welcome to the methods matter podcast from Dementia Researcher and the National Center for Research Methods, the show that pokes its nose into the dark corners of research methods. If like me, you’re always on the lookout for a new perspective or a new approach to your research, then this show is for you. In this series, we will be looking at five different research methods with a research method’s guru, and a dementia researcher that has put the method into practice. I am Donncha Mullin, I’m a clinical research fellow at University of Edinburgh, and I’m delighted to be hosting the second season of this great podcast. So now we’re going to shine a light into those dark corners and focus on focus groups, helping me today, we have two awesome guests. In expert corner, we are once again joined by Dr Kahryn Hughes and in research ranch, we have post-grad researcher, Nadine Mirza. Hello, and thanks for joining us.

Dr Kahryn Hughes:

Hi.

Nadine Mirza:

Hi everyone.

Dr Donncha Mullin:

Great to have you along. Kahryn is an associate professor at University of Leeds, director of the Timescapes Archive, editor and chief of the BSA Sociological Research Online and senior fellow of the National Center for Research Methods. Kahryn is internationally recognized for innovation in qualitative longitudinal methods and an international leader in new qualitative methods. She has led research on the ethical production of digital repositories and archives for work relating to understanding the longitudinal dynamics of poverty, health, and addiction. Nadine is a research psychologist at University of Manchester, as well as being an aspiring clinical and occupational psychologist. She is currently working towards her PhD in mental health, and her research focuses on cognitive testing within ethnic minorities and improving British South Asians access to dementia services and receiving an accurate diagnosis. So let’s begin. Now, I haven’t had much experience with focus groups, but I expected a good way to start is perhaps with one of those random awkward icebreaker questions. So I went online and found my favorite. Are you both ready to answer? Nadine, I’ll ask you first. As a child, what did you want to be when you grew up and why?

Nadine Mirza:

I’m just thinking, what didn’t I wanted to be? I wanted to be a DJ, I wanted to open a bed and breakfast, it was always changing. But a consistent one I wanted to be was a writer, I wanted to be a writer since I was five. I don’t particularly know why, and I know why I didn’t go down a career because my dad just looked at me at five years old and said, “You’re not going to make any money as a writer.” But actually it worked out well because I get to do so much writing in what I do now, so it panned out well.

Dr Donncha Mullin:

Awesome, awesome. You circumvented your dad’s negative, snuck it in there, I like it. I also like the idea of a DJ, Airbnb slot and I think there’s definitely room for you to do that as well, Nadine, keep the Manchester vibe alive.

Nadine Mirza:

Oh, very much so.

Dr Donncha Mullin:

And Kahryn, what about you?

Dr Kahryn Hughes:

Well, it was more of a superpower actually, I just wanted to be able to fly, I just love that idea. But like Nadine, I just absolutely loved writing and having that very creative, immersive experience in writing. And I think that’s why we’re drawn to the careers that we are drawn to often because it allows us to do those sorts of things at great length, actually writing as an academic.

Dr Donncha Mullin:

I love how it clarifies your thoughts a little when you start to put it down on paper, I love that feeling. Well, what do I know about focus groups? So we begin each podcast with me giving a summary of what I understand of the method we’re discussing, which of course today is focus groups.

Dr Donncha Mullin:

So when I think of focus groups, I’m imagining some kind of advertising agency grabbing 10 people off the street to ask them what they think of the new packaging for cereal or what they think of a new ice cream flavor. I know that will be the wrong answer, so I cheated and turned to the Oxford bibliographies, which told me that and prepare yourself for quite a long explanation. Focus groups are a research method using multi-person interviews to generate qualitative data from participants interaction. The purpose is to induce conversation between participants to answer questions relevant to the study goals. In contrast to one-on-one interviews that are also widely used in qualitative research. The source of the data is in the interaction between participants, including similarities and differences between their experiences, opinions, and perceptions. This helps researchers understand not just what the participants think about a topic, but also why they think that way. Kahryn having put to bed my understanding and their other stuffy formal description, can you give us a better description of the technique and introduce us to the method?

Dr Kahryn Hughes:

Well, I think that you got most of it there, but I’ll add just a bit more. So where you observe the interactions of the participants as your objective study, that might be for example, where you get professionals to problem solve, giving social workers a vignette of a situation like a case and asking them to say how they would deal with it. So you’re able to see how they work as a group and capture the key narratives that they use in working through particular sets of problems and decisions, you’re able then also to observe how social workers might interact and that might be a useful method for interrogating hierarchies or power dynamics in professional groups.

Dr Kahryn Hughes:

But there’s a couple of more ways in which you might use focus groups. So you might use it as part of a longer research process. So you might use focus groups to really quickly bring together a breadth of experiences in a particular area as part of an exploratory research design, that phase then produces a lot of research questions you can follow up. But you might use it at the other end of a research process and interrogate the research findings or insights so far from research where you’ve used other sorts of methods, such as one-to-one interviews. So that could also be called a member checking seminar, but it operates on very similar principles to a focus group, it’s to refine your insights and you’re often testing the principle.

Dr Kahryn Hughes:

But then you might use it and I think a lot of people use it this way, particularly students, I think it’s very effective all very often in health research, which is this one off stage of data gathering because you need to generate some insights quite rapidly from quite a large number of people. And probably from multiple viewpoints. So it’s feasible to convene a number of different focus groups such as with patients, with their families and then with practitioners, and to understand those various viewpoints, as well as getting a spread of viewpoints from within each group. And there’s lots of techniques you can use in a focus group as well. So I’ve mentioned vignettes, but you can use and just the broadest possible range of visual or audio prompts. And given that we now routinely work in these blended environments, so you can use film or other materials to support or capture discussion. So film might be used if you are really, really focused say on body language or those interactional dynamics, you might want to fill in order to capture those specifically.

Dr Donncha Mullin:

Wow, I love that idea. I wonder, is it technically difficult to capture the body movements of a larger group of people or would you need to keep that to a smaller group in order to have the right footage to actually see what people are doing?

Dr Kahryn Hughes:

And also you have to, I mean, as part of that, it’s not only the capture of all of those movements, but it’s the analysis because if what you are doing is looking at those micro dynamics, those micro interactions, and you’ve got like 20, 30 people, you’re having to explore how those might be changed depending on the size of the group. But then also having a look at all of that data, it’s questionable about how much actual analysis that you can do, so that might be for a very, very large study. But when it’s a focus group in the way that we are probably going to be talking about it today, it’s preferable to keep the groups quite small. If you were filming that you would have say a couple of cameras, there’s obviously an intensified ethical considerations around how you would use those data because they’re obviously very identifying.

Dr Donncha Mullin:

So I always wanted to ask you which of these methods that we talk about are hard to use or easy to use, but I guess it’s always nuanced and you described a situation there that might get quite technical and quite difficult to use, but also you said that focus groups in general are used by a lot of student researchers. So overall, would you class it as something as a technique that is a hard method to use?

Dr Kahryn Hughes:

I don’t think so. And I know that we’re going to talk about some challenges a little bit later on, but just at this point, I don’t think it’s a hard method to use actually. The challenge is keeping up with the conversation, recording the conversation and having a means of making sure that you can attribute something that’s said or done in a focus group to a particular person, so that you might want to, if you wanting to do those sorts of analyses, these sorts of people said this. So that’s why it’s quite good to have focus groups, so if it’s about not mixing patients, families, and healthcare professionals, keeping those separate that you can talk about what patients were talking about. So recording that, and also eliciting responses in a focus group. But if you keep it small, I personally between no larger than 14, preferably between eight and 12, that would be my sort of recommendation, about 12-ish is quite good.

Dr Donncha Mullin:

Okay, brilliant. That’s some really good stuff, thanks for that wonderful introduction and overview. Now Nadine, I wonder, could you tell us about your research, what you have discovered and how you have used focus groups?

Nadine Mirza:

So as mentioned before, my research is about just helping British South Asians get a more accurate dementia diagnosis. And that includes lots of things such as making sure the tests that are used to diagnose them are designed for their culture and language, interviewing and doing focus groups with staff and service users and carers of those service users to find out what problems are existing when trying to get into memory clinics and what solutions we can come up with. And then I also have used focus groups around adapting different tests for diagnosing dementia. So getting feedback on the content of the tests and how they’re perceiving tests and all that kind of stuff. So I’ve used focus groups at lots of different stages, for test development, to get feedback about services and in PPI work as well.

Dr Donncha Mullin:

Okay, brilliant, that’s a really nice variety idea around it. Just to clarify, when you mentioned adapting the tests for diagnosing dementia, is that adapting it, translating it, or culturally adapting it or what kind of-

Nadine Mirza:

It’s actually a blend of both. So typically what would happen is I get a test and because I know Urdu, which is a very popular South Asian language, I do a translation myself. But then I would go take it to my target population. And for example, through a focus group, I would show them my new version of the test. And not only are they going to criticize whether I maybe use the right words and the language is actually a true translation, they would also look at cultural aspects. So things that are independent of language, such as images or concepts, things like that.

Dr Donncha Mullin:

Awesome, awesome. That’s brilliant. And I can see why you’d use a focus group for that method. I haven’t thought of that, and I’ve had that issue in the past with work I was doing and a focus group could have been a great solution. Did you find that you could carry on with this work during the pandemic, could you use these focus groups during the pandemic?

Nadine Mirza:

It was definitely tougher during the pandemic and I think it’s because the intersectional nature of our population. So it’s not just during the pandemic, it’s older people, it’s South Asians, so called hard to reach population. And then it’s people with dementia and their carers, people who don’t have a lot of time, people who struggle to operate on technology. So I would say the pandemic for a while there couldn’t do anything. It was a very slow, gradual, finding ways. And I had to kind of be adaptive in that sense. So for example, I didn’t always do my focus groups on Zoom because that could be really distressing for some of my participants to see multiple people on screens and a bit of confusion about who’s actually there, who’s not there.

Nadine Mirza:

But one thing I figured out was a lot of my participants were Pakistani, they’ve got so much family back home in Pakistan. And they’re really used to doing WhatsApp conversations, that’s very normal for them. So I was able to do a focus group just on WhatsApp. And that felt very natural and normal to them, to have their phone there and they can hear these voices, but it’s something very common, so it’s just about learning that even though Zoom has taken over the world, there are other forms of technology people might be more comfortable with.

Dr Donncha Mullin:

Amazing. Awesome, I like that, I love that adaptation as you go along. And that’s how you could keep going with focus groups, I love that. Well done. And you’ve mentioned a few things about what were the targets of your research. So whether that’s to get the perspective of patients, or carers, or whether it’s to explore their journey through memory clinics to get a diagnosis, what kind of things can your research tell us so far?

Nadine Mirza:

So far it can tell you that the most obvious answers are under our noses. So for example, when it came to the tests, a lot of people do think that, oh, you just need to translate them and you’re fine, but this is actually a really fun example I had for my focus groups. In one of the tests, there’s an image of a kangaroo and a person who’s just supposed to tell you, oh, it’s a kangaroo. And in my groups, I had about two separate groups, each had about 10 people. And I could say about 14 people didn’t know what it was. And initially, I think because we were in a focus group, a few of them were embarrassed and they didn’t speak up. Then one lady was like, “I don’t know what that is. Is that a giraffe?” And then everyone started saying it and I love that, it was like really reassuring to them to hear it from others like them, I don’t know what that is. And I was asking them, “Can you tell me why?” And they gave me such good nuanced answers like, “We didn’t grow up in this country. We didn’t grow up in Australia with kangaroos or Native, we never saw them in our childhood.”

Nadine Mirza:

And I suddenly realized that we assume knowledge and we underestimate understanding. This is an example of a lot of the flaws I found in the test, we’re just assuming these concepts that are very general in the Western world is going to apply to people from other areas. Something as simple as a kangaroo, which you think every child would know, but not everybody does. So there was a lot of that other things that kind of learned were, for example, the solutions we think are working in the memory services like leaflets and booklets that are translated and even culturally adapted, they’re not that useful. A lot of the people I spoke to said that, “I’ll get a leaflet and it’s in Urdu, or loop and there’s someone like me on the leaflet, but I’m going to just toss that in the bin because when this is happening to me or someone I love, I don’t want to sit there and read things. I want a doctor or a nurse or someone to sit with me one on one, and actually take the time to talk to me.

Dr Donncha Mullin:

I’m sensing some postdoc work potentially along those avenue.

Nadine Mirza:

Potentially.

Dr Donncha Mullin:

Not to put words in your mouth, that does sound like quite a big project to then look at addressing that. But is that something you’re looking at in your PhD or not necessarily?

Nadine Mirza:

Definitely, definitely something I’m looking at my PhD, okay, for example, they’re not liking the leaflets. What do they actually want from staff members? And then going back to staff and asking them, do you think you could even accommodate these things? For example, one of the solutions were that we understand doctors and all might not know our language, but even if they were able to say hello to us in our language, something like [foreign language 00:18:16], it puts them in such a comfortable place. And I think having those conversations in focus groups, everyone suddenly reinforces what you’re saying, like, oh, yes, we would’ve loved that, we would’ve loved that. And they all feel better and they all start talking more because it’s almost like a safe space for them.

Dr Donncha Mullin:

So it’s sounding to me like a focus group, it’s richer than having a survey, say 14 people replied to a survey and all said the same thing. It’s different than if it’s in a focus group and each person is reinforcing it and it can be a deeper level of saying that thing and you can get more from it, is that your experience?

Nadine Mirza:

Absolutely. I think surveys are great, especially if you want me to fix data and probably like numbers and stuff, but focus groups have always given me richer data. I do understand when you might want to do an interview instead of focus group, maybe if you really want to go into personal and more vulnerable things. And in your South Asian communities, well, there’s this stigma issue. So if I was going to discuss more stigmatizing things, I probably wouldn’t do a focus group. But because a lot of this stuff, it was about service experience, but on another technical level, it was richer because people were all corroborating what the other person was saying. Things that they wouldn’t even think to mention came up to them because someone else mentioned something similar.

Dr Donncha Mullin:

Brilliant. I am really excited about the possibility of using focus groups going forward. Now we have had a good description of what the method is, and we’ve had loads of great examples of how it has been used. Let’s get into the detail of focus groups and provide some top tips for anyone who’s new to using this method. In this section, I’m going to ask some quick straightforward questions to both guests on how to put the method into practice. Kahryn, the first ones are for you. Are you ready?

Dr Kahryn Hughes:

Yeah.

Dr Donncha Mullin:

Kahryn, how should someone prepare for doing focus groups?

Dr Kahryn Hughes:

Well, it’s the same old question and I think this is something that Nadine’s research has is not only in terms of how you’ve gone about it, Nadine, but also what’s come up as a consequence, is how relevant is the method to those people and how best to run focus groups with different sorts of groups of people. So there are some real pragmatic challenges or decisions to be made around, well, where are we going to do this? How big does the room need to be? How are people going to get there? Those sorts of things. And also, who out of all of these people, would I most like to speak to and why? So you’re making exactly the same sorts of pragmatic sampling decisions that you would be making in any other sort of research.

Dr Kahryn Hughes:

So it’s both pragmatic and obviously theoretically driven, these people are more likely to be able to answer my questions than those. I think there’s some other questions which is around if you are doing focus groups on questions of conflict, what you don’t want to do is to bring people who are antagonistic or hostile to each other, into the same room. So for example, if you’re doing something on environmentalism and you have different groups with highly different interests, in the question, in the debates and views of each other, you don’t want them in the same room at the same time. So I think that’s something that’s enormously interesting about focus group methodology that isn’t relevant say to survey or RCTs or interviews or any of those other sorts of methodologies.

Dr Kahryn Hughes:

You need similarly to have decided what you want to discuss. And because it’s a group of people, the questions have to be applicable to a large group, and I love your examples, Nadine, about how actually your questions may not have any, investigating what is the kangaroo, that’s what one sort of thing. But your questions may not actually have relevance for the people that you’re engaging with. So I think it’s very important to interrogate all of those aspects of researching with people as you would normally in other forms of research, so working with stakeholders and gatekeepers, those sorts of people who can inform upon people that you want to conduct research with.

Dr Kahryn Hughes:

And then the finally you need to prepare all of the equipment. So you’re going to have a whiteboard, a flip chart, you’re going to film it, you’re going to record it, how are you going to capture what it is that people are going to say? So there are those sorts of things. So focus groups might cost more money for example than interviews because you need extra equipment and you may need room hire and those sorts of things. So it’s a great, great method, but there’s some more or different practical considerations you need to take into account.

Dr Donncha Mullin:

Brilliant. Well, thanks for clarifying those differences. And you sort of touched a little bit on, my next question was around how do you structure the discussion and you did mention about, and specifically having questions that are applicable to the whole group, that’s a really good starting point. And how else might you guide the discussion or facilitate it?

Dr Kahryn Hughes:

So again, it’s do you want a really forensic discussion on some small details, some highly detailed forensic conversations, or do you want a very general overview of what it is that you are talking about? As I mentioned earlier, you might want to be quite, like using vignettes in decision making, that’s such a great strategy, having something that people can speak to and work through, and tell you how they make sense of it relative to how other people might make sense of exactly the same situational case is really helpful because a challenge in focus group methodology is avoiding consensus because when we come together in groups people, as Nadine said, they don’t want to be the odd one out, they don’t want to say something, they don’t want to sound stupid. So often people are say, hmm, yeah, oh yeah, that’s such a good point. Yes, I do agree. And that’s a challenge because that’s not what you want to hear, you want to get breadth of opinion. So having something where everyone has the same access or you support an explanation, you have some sort of explanation, you have something perhaps a visual prompt that everyone can look at. And then talk to from their own perspective, helps you avoid that instant rush to consensus and fib sticking out.

Dr Donncha Mullin:

And it might be a certain naive question. And I actually would love to see a focus group. I feel like that’s what reality TV is at the moment, focus groups of people with polarized opinions, but you did say to try and avoid that, but equally you’re trying to avoid consensus. So is there a sweet spot that you find where there are people who have differing opinions enough, but that they don’t end up at loggerheads.

Dr Kahryn Hughes:

That’s one of your jobs then a focus group is, like sort of dampening down tensions if they arise. They’re unlikely to, though you’re much more likely to get people collaborating in a focus group than being antagonistic. So many years ago, oh, we’re going back a couple of decades here. I ran a focus group with people who were receiving complimentary therapy during their experience of HIV/AIDS. And one of the groups that I ran, they were all gay men and deliberately so, the group was set up in that way. And at one point in the focus group, the tape recorder went off because someone was getting visibly distressed. And the focus group actually turned into a huge supportive group session of people who were coming together because they had shared that experience, shared those anxieties and fears, in some cases, shared similar life histories, that really biographical connections between those people and they were enormously supportive and comforting of each other.

Dr Kahryn Hughes:

So it changed from being focus group to being something completely different. And that raises a host of ethical issues actually, focus groups are highly ethically charged as well. Sounds simple, get everyone in a room, get them to chat, but it is very ethically challenged. And it was at that point, the tape recorder went off because it wasn’t a focus group anymore. So not a naive question at all, it’s absolutely at the heart of focus group methodology, managing the formation of new relationships around a topic that people will quite commonly feel very passionate about, it’s important to them that’s why they’re there.

Dr Donncha Mullin:

And I imagine you need to account for that in any consent form or participant information sheet. And when you’re recruiting, probably do it to factor in that this will be a group discussion and you don’t know where it’s going to go, so it could have different impacts, it’s hard to know exactly what impact it’ll have.

Dr Kahryn Hughes:

Well, you don’t know that. And also then there’s the additional ethical challenge of disclosure. So if you are doing something that’s community based, again, for example, around environmentalism, and people are tipping up and talking about things. They might disclose views or attitudes that are sort of not in tune or in keeping with perhaps others of their neighborhood. And what you don’t want afterwards or they might disclose something personal about their lives and you don’t want those people in that focus group to then go away and start talking about what that person said to the general neighborhood. So managing people’s understandings of confidentiality in focus groups where people cannot really be anonymous to each other, because that’s completely opposite to the intentions of a focus group methodology. That’s another enhanced ethical consideration really.

Dr Donncha Mullin:

Right, right. So that’s some really good tips on structuring the discussion. And we can throw in more if we think of more as we go along. And how do you tend to quantify the outcomes of focus groups?

Dr Kahryn Hughes:

Well, focus groups aren’t necessarily convened to produce those sorts of quantified data. So for example, Nadine, her research demonstrates this, it’s a wonderful methodology for this more interpretive work, where you are eliciting people’s understandings and observing how they may theorize around a particular topic, what are the explanations they’re producing and why are they producing those sorts of explanation? How are they connecting those explanations to other parts of their lives, other ideas. So quantifying that often runs against the intentions of the methodology itself.

Dr Kahryn Hughes:

However, on the other hand, it is quite feasible to run a number of focus groups on a test the principle basis. If you’re asking quite simple questions and getting a sense of what people’s views on this, are they happy with it? Are they going to go with it? For example, if it’s about a hospital based service, for example, and it’s a clinic that everyone goes to and there are ethics around that, but I mean, you might want to ask groups of people around, well, how’s this working for you? What are the barriers to accessing? What are the great bits about it that you really love? Then a focus group is really, really good in terms of getting high numbers of responses with quite detailed explanation. So that’s a sort of a sweet spot in that regard.

Dr Donncha Mullin:

And say for that last approach, because the first approach I can see, it’s more for interpretive, it’s difficult to do any kind of thematic analysis of the transcript if that’s what you’re doing. But is there an element of, if you have been doing it, was it test the principle, I haven’t heard that phrase so much.

Dr Kahryn Hughes:

Yeah.

Dr Donncha Mullin:

Would you then go through a transcript and look for things like saturation of topics that we talked about in previous quality analysis approaches?

Dr Kahryn Hughes:

No, because the challenge with focus groups is consensus, so as I said before. The idea of saturation is that there’s no new knowledge being produced, people are just saying the same thing again and again, that’s often a problem with the question, but also that’s a challenge with focus group methodology, because again, people will seek consensus. It’s really useful, I can’t remember, Nadine, can you help me on this one? Who did forming, norming, storming, and performing? Have you come across that before? It’s in like organizational psychology and research, it’s around how groups form and I can’t remember who did it.

Nadine Mirza:

You’ve said it. It’s [inaudible 00:32:35] something.

Dr Kahryn Hughes:

Oh, brilliant. Thank you so much. Bruce Treitman. That’s making me sound much more well read. But that’s one of the things, is that what you observe in a focus group of a group dynamics, it’s not just one on one, because you’ve got a number of people. And you yourself as a moderator are trying to facilitate the bringing together of people in a way that they’re going to talk about things. However, I think that you can still do thematic analysis. You can look at when I asked this question, what was the association that most people made here? Was it because it was relevant to their family relationships? Was it relevant because it was financially important? Was it relevant in terms of religion, community, whatever, children, or whatever that might be, that there’s still the potential to do those sorts of systematic analysis? What did people mainly do? What was that over the overarching themes that these data can be used to support in terms of my own analysis?

Dr Donncha Mullin:

Okay, okay. I’m in a more specific question for people who are thinking of doing this, but maybe don’t like the idea of typing transcripts and running it that way, is software now at a stage where it can automatically produce a typed manuscript of what was discussed in the focus group?

Dr Kahryn Hughes:

Probably you could to a limited extent because people talk over each other and they interrupt each other, as we’ve just done. So it can pick it up, but you would then still have to carefully sift through any sort of computer-generated transcript in order to, so a great thing to do in a focus group I found is to have a flip chart where you write responses down so that people can see the direction of travel in the discussions. But then also you’ve got like a big pile of paper that can help you work through your transcript and know at what stage people were beginning to talk about this, that, and the other. So you’ve got a physical map of the conversation at the end of a focus group, they go quick and they’re busy.

Dr Donncha Mullin:

Okay, brilliant. And you’ve said they’re busy, what would you do if in a group there’s one person who keeps talking, who has an opinion on everything and is maybe dominating the discussion?

Dr Kahryn Hughes:

I feel seen Donncha. So it’s like in teaching or any other way where you always have that person, people get really enthusiastic and completely immersed and it’s lovely, actually, that’s lovely. Unless of course it’s a bit like a town meeting where someone really has to pontificate. But the way that you do it is very simple and you say that’s so valuable, thank you very much, but I’d like to hear from some other people, if that’s okay. And you only have to say that, and that is a form, it’s quite tricky because it’s it verges on and I think social shaming, you are telling somebody, I don’t want you to talk anymore. So focus groups, you’re skidding around quite a lot in the conversations, they’re not always straightforward. But sometimes you might want to use those sorts of strategies to say thank you so much, it would be great to hear from other people at this point.

Dr Donncha Mullin:

Okay. A good life skill there, thank you. I talked to Nadine a little bit about running a focus groups during the pandemic and doing them online. So I guess this question is more for you. I know that you ended up doing it with a WhatsApp group, which was fantastic. Did you do any on Zoom at all or was it all done on WhatsApp group?

Nadine Mirza:

No. I was able to do one with carers on Zoom, so that was a bit easier, they were quite familiar with the technology. I was working with people around 30s, 40s, so they were quite comfortable on Zoom. And I do say, there are pros and cons to Zoom versus WhatsApp. With WhatsApp, obviously I wasn’t always able to see everyone’s faces and that adds a whole element. So Zoom with carers, it was actually quite all right. We had the chat feature open. So I always kept trying to reassure people, if you’re not comfortable saying things aloud to everyone, please feel free to just pop it in the chat, you could even privately chat message me if you want, which is interesting that you definitely couldn’t do in person. You have someone in a group that they can private message you their thoughts without other people seeing it, so that was an asset of Zoom.

Dr Donncha Mullin:

Mm-hmm, I can see that, that’s three different layers, isn’t it? That you can only get one when you’re in the room and it’s the person who’s comfortable speaking in a group, that’s the private person one on one, and then the chat person, I love that. And I guess we’ve all seen that in any meetings we’ve been at where sometimes the chat is alive, but nobody wants to raise their hand and talk. I think that’ll be missed if we go back to, or it’ll be interesting to see, actually, if people will bring that to in real life because they have gotten used to contributing through text and we’ll just be happier to talk. We’ll see. What skills, Nadine, should someone work on developing if you wanted to run focus groups?

Nadine Mirza:

I would say they’re other abstract skills. It’s not anything where like, oh, you should go read this chapter or something, I think one of the most important skills is listening techniques. So I used to work for an anonymous phone line for helping people with advice and stuff. And I ended up using so many of those techniques for my focus groups. So just for example, active listening, which is just being silent. And I know you have to do those for interviews anyway, but I think far more so for focus groups because you have to keep reminding yourself, I’m just a mediator, I have to let them talk, which can be so awkward when no one is talking for 15 seconds, 30 seconds and it feels like an eternity. And there have been times where I felt like, oh my God, I should just interrupt now, then someone speaks and it’s like, thank God I stayed silent because it’s always going to be something very important.

Nadine Mirza:

And then like mention knowing how to do minimal encouragement correctly, the mm-hmm, uh-huh. There’s a balance between staying silent, but having those little minimal phrases. Paraphrasing what everyone has said, so maybe after everyone’s said their points, making sure that you are taking it in and then say, so I see that we’ve discussed this, this, this and this, this, this. So I think that is very important. Frame of reference is very important, which we use an interviews, which is use the terms that the group is using while you’re talking to them. One example is, so I had one group and they were talking about dementia and they were referring to themselves as we’re people who live with dementia. So I stopped saying service users, and I said, “As people living with dementia.” In contrast, another group was referring to themselves as we’re people who suffer with dementia. And they were actually very much against the living with term because they wanted their suffering acknowledge. So for that group, I was very mindful that, okay, I’m going to say people who are suffering with dementia. So that’s just putting the conversation according to their frame, according to their references.

Dr Donncha Mullin:

Brilliant, I love that. And again, really good life lessons for listening to anyone talk, this could be a form of personality improvement, everyone has to go and run a focus group and get graded on it. Speaking of personalities, rather than the personality of the person doing the focus group, are there certain kinds of personalities that people recommend you look out for when you’re trying to assemble a focus group, a sample?

Nadine Mirza:

I would assume, on a practical level you want gregarious people, outspoken people, you want those extroverts who are going to talk. But actually I try not to think of the ideal participant because if you think about it, that’s a huge form of bias, isn’t it? People who are staying quiet and are less likely to talk and all, because those traits within them could be shaping a whole experience that I’ve just excluded because of the non talkers. Because for example, if someone is not very outspoken, it’s not just going to impact their focus group experience, it would impact how they’re experiencing a service, are they advocating for themselves? How was their diagnostic experience like, what is it like caring for someone? So I personally, I can’t choose who ends up coming to me, but I personally would not favor a certain personality.

Dr Donncha Mullin:

Okay, I love your examples, I think it’s really important. And it always makes me think of these surveys that are done on Twitter, where someone might get 20,000 responses, but they’re all Twitter users, which is some really odd section of outspoken people, often quite angry.

Nadine Mirza:

Exactly, exactly.

Dr Donncha Mullin:

Maybe not so angry in academia, but be more outgoing people in academia and then they think, well, this is a really good sample, well, it’s probably a little bit biased, but that’s a valid point for focus groups. What other methods alongside focus groups have you been using so far in your PhD or even before this that-

Nadine Mirza:

So I’ve definitely used surveys, and questionnaires, and I’ve used semi-structured interviews as well.

Dr Donncha Mullin:

Okay, okay. And the difference between semi-structured interviews and focus groups, is it the number of participants or?

Nadine Mirza:

Yeah, so my semi-structured interviews have been more one-on-one and then it’s mostly just the distinction itself between my roles in an interview versus the focus group. So in the interview, it really much is a back and forth conversation between myself and that person. And even though I should not be talking as much as the person, I’m still talking more than I would in a focus group. In an interview, it’s a conversation between two people. In the focus group, I am simply mediating the conversation that other people are having, almost like they’re interviewing each other and I’m just making sure everyone’s behaving.

Dr Donncha Mullin:

Okay, okay. And now we’ve already talked about consensus in groups, so feel no pressure to agree, but do you agree when, when Kahryn mentioned that the maximum number should be around 14 and a good number would be, was it eight to 12 or so is nice number? Would you-

Nadine Mirza:

I do agree. So I’ve done groups with just for example, three, four people. I think that also depends on who you’re working with. So my biggest groups have been 10 people. That was fine, and that was when we were doing the conversations around the cognitive test. And it was a very step-by-step process, we were going through different questions of the test, so it was very linear, okay, now we’re doing this question, this question, not too much personal stuff coming out. So it was easy to do with 10 people, but for example, when I was doing my WhatsApp with people with dementia, 10, would’ve been too much, we had just three to four people in those groups and that was a more manageable number. So I think you need to match the number to the technique that you’re using.

Dr Donncha Mullin:

Okay, valuable advice. And last quick fire question. Do you find that you should have a break and maybe provide refreshments midway through or do you tend to just do it all in one big go while there’s flow in the conversation?

Nadine Mirza:

So my focus groups have never gone more than an hour. And what I’ve always done was, I guess, again, because of the population I was working at, working with South Asians, there’s no concept of waiting to have tea. So during the focus groups, we had food laid out on the table, everyone had their cups of tea and I think that added to the more casual atmosphere, they were talking to me and they’re sipping their tea and they resume talking to me. And I think that was better, everyone felt more relaxed. I did make a point of course to ask, “We’re already halfway through, does anyone want to take a break, take a rest.” And they all kind of like, “No, no, let’s just keep having our tea, let’s have our samosa and kebab, and let’s just keep going.” And food is a big motivator, I’ve now learned that it is actually rude to do a focus group without food there.

Dr Donncha Mullin:

Brilliant. Well, thank you so much folks for your really insightful and succinct answers to all of those questions. Next up, I’m going to recap on what I’ve learned so far. Well, this has been wonderful so far and I can see it’s obviously much more involved than I expected and clearly because of the popularity of focus groups as a technique. The term focus group has come to mean different things to different people. But I said, I’d recap on what I’ve learned so far. And for me, one of the main things was that focus groups are ideal for a number of different stages of research and data collection. So whether that’s the start of a project possibly when you’re interrogating or exploring an idea, a focus group can be a really good way of guiding you, which avenues to explore in your research. But equally at the other end, once you’ve collected a lot of data, using something called member checking seminars, focus groups can be a great way of interrogating these research findings.

Dr Donncha Mullin:

And I imagine focus groups can be adapted and used for every part in between those steps. Another point I’d learned about is that focus groups can be a great way to get a lot of viewpoints all at once in quite a contained amount of time, we talked about an hour being the sort of max and that makes sense. And also the maximum number of people being sort of not much north of 14, but that might need to be a lot less depending on the topic that you’re discussing, the sensitivity of the topic or the difficulty. And maybe even the medium, so we mentioned how smaller numbers, if it’s a WhatsApp chat group rather than in person, I can see the sense in that.

Dr Donncha Mullin:

My next two learning points are quite closely related. And 0.3 was preparing the room, preparing the sample that attend, preparing the questions that you might use and how to guide your discussion is really important to making this successful technique and maybe using things like vignettes if you wanted to add some structure to a decision-making process and to guide people through it will help the flow of the conversation. And also preparing yourself, so skills that would be useful to have a think about before doing a focus group are many things like active listening, whether that’s paraphrasing back or are using the participants’ term of reference or using the kind of words they use to describe the topics and to use minimal encouragement and to leave time for silence and for people to process their thoughts, are all really key skills for running a successful focus group. So in this final part of the show, we’re going to discuss common pitfalls, challenges and how to avoid them. Nadine, tell us what challenges did you come across in delivering your research and what might you do differently? What have you learned along the way?

Nadine Mirza:

So I thought about this and there are three distinct ones that I can think of. One is, you mentioned earlier as well, there’s a lot of logistics around the focus group, getting the room, finding a time and a place that everyone can kind of agree on. And the population I was working with quite difficult to recruit from as well. And this also introduced another element of bias, but I think I had to balance my pros and cons here. So for example, with the groups that I did around the tests, so I needed 20 people total, I looked at existing groups. So for example, I went to my local Pakistani community center and they already had this group that meets weekly of people who have loved ones who have dementia and they just come and they sit together and they just, so I went to the center and I was like, “How would you feel about me doing a focus group with these existing groups during one of the sessions where they already meet?”

Nadine Mirza:

And in that way the room was already sorted, already got all these people available at this time. And another benefit I got from this was because all these people were familiar with each other, they were friends, which meant no one felt awkward talking around anybody, I didn’t have that introvert, extrovert problem. Everyone was very free with their opinions because these are people they meet every week and have shared their deepest secrets with. So that ended up working in my favor. Another thing was I think you should be very mindful about the comfort level of your groups in terms of things like culture, for example. So with my groups, I never had a mixed men and women group.

Nadine Mirza:

I had my separate women’s group and separate men’s group because there were just certain things they would not be comfortable speaking about in front of the other gender. And it made a huge difference, the things that women would say, the things that men would say, their individual experiences. And because I’m a woman, I was fine in the woman’s group. When I went to the men’s group, I made sure that my supervisor accompanied me, because he’s a South Asian man and they felt far more open speaking. And then another thing I really did with them was I had a representative from the center join the focus groups because a lot of people were initially a bit reluctant, they were a bit confused, are you going to take our data and share it with people?

Nadine Mirza:

And it doesn’t matter how many consent forms and information sheet you throw at people, certain groups are a bit scared. Having the representative who they see like every day, they’re like, no, don’t worry, you can trust her, answer her questions, it’s just a group session. It made all the difference in how much people were willing to share. And then a third technical thing, which I’m so glad I started doing, after my first focus group, I was going to transcribe it myself and I was listening back to the recording. And as mentioned, people do talk over each other. So I was getting confused like, oh my God, who said this, who said this? From then on, we started doing this thing myself and my fellow PhD students, one of us would accompany the other and be transcribing live, sitting there typing things as the conversation is going. So when later on when you’re listening to the recording, you don’t have to do the full sentences, but you can see, oh, this person, okay, it’s not this, this, this, this, it made transcribing so much easier.

Dr Donncha Mullin:

Excellent top tip. Well, thank you for that. Kahryn, what are the common pitfalls? Now you’ve already mentioned avoiding consensus and avoiding having two polar opposite opinions in the room. Have you other pitfalls that you’d like to warn us about and how to go about avoiding them?

Dr Kahryn Hughes:

In addition to the ones that we said, one thing that we haven’t talked about is if you’re dealing with professional groups, there might well be a managerial hierarchy at play. So in addition to all of the other moderation challenges that might be something that you do need to bear in mind. And also when we were talking about how many in a group, if you’ve got 14 people in a group, an hour isn’t enough because that would give each person two minutes to talk or something ridiculous, it’s barely anything, two to four minutes. But the other thing is that although you might be, this is coming right back to your introduction, Donncha, where you were talking about looking at people’s interactions. It’s really important to recognize that because people are forming a distinctive group that’s particular to that particular focus group setting, you need to take that into account rather than uncritically treating the focus group as somehow a naturalistic setting.

Dr Kahryn Hughes:

In addition to people who might dominate you, may also, and Nadine has mentioned this, people who become muted in a conversation for whatever reasons, and they may need to assert themselves to speak and they just don’t want to. In terms of a more of how we might understand this character of the data that we’re collecting, if you are dealing with questions of performativity, i.e. how people are shaping, what it is that they say for the purposes of that particular setting. That this is, it’s quite an artificial setting in some respects. I love your example, Nadine, that actually working with groups who were already established is a wonderful way to go, I think that’s absolutely fantastic.

Dr Kahryn Hughes:

But bringing complete strangers into a room, they’re on their best behavior, they don’t want to sound stupid, all of these things. So actually what you are going to get from them is going to be far more towards that performative. And unless you can do as Nadine does and work with existing groups of people who know each other. And that access to people’s very highly personal experiences is going to be far more limited in that very public setting. Nevertheless, I do want to end up on quite positive note because I do think that focus groups are really great ways of observing how people are theorizing about their experience, the sense making that they’re doing, why they’re saying the things that they’re saying, because they’re doing it in dialogue. And we often as humans theorize their dialogue, we try and work it out together and make sense of it together and work it through. So I think focus group is fantastic to have a look at those sorts of processes.

Dr Donncha Mullin:

Excellent, excellent. So in this final segment, I’m going to give our expert Kahryn one minute to tell our listeners what they should go away and read to further their knowledge on this method.

Dr Kahryn Hughes:

It’s an oldie, but it’s still great. It’s Jenny Kitzinger’s “The Methodology of Focus Groups”, and that is the importance of interaction between the search participants. Rosaline Barbour, she’s written the classic, “Doing Focus Groups”. And there’s a webinar by Rosaline Barbour on YouTube really where she talks about them. There’s a series of SAGE handbooks or longer texts on focus groups. One of which is called “Focus Group Methodology: Principles and Practice”. And, and that was edited by Pranee Liamputtong. But if you really want to be overwhelmed with resources, go to the NCRM website, there’s hundreds of videos and just oodles of materials on conducting focus groups in a wide range of settings with different views and for different purposes, it’ll take you forever to get to the end of those.

Dr Donncha Mullin:

Well, I better get cracking on it then. Folks, thank you so much, I’m afraid that’s all we have time for today. So let me say a huge thank you to our wonderful guests, the astounding Dr. Kahryn Hughes, and the brilliant Nadine Mirza.

Dr Kahryn Hughes:

Thank you.

Nadine Mirza:

Thank you.

Dr Donncha Mullin:

Thank you both. Join us next time folks, as we explore another research method that matters.

END