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  • 00:00

    [MUSIC PLAYING][Fundamentals of Qualitative Research Methods, Leslie Curry,PhD, MPH, Professor of Public Health,Yale School of Public Health, Professor of Management,Yale School of Management (Secondary) Lecturer,Yale College.Yale Global Health Leadership Initiative]

  • 00:05

    LESLIE CURRY: Welcome back to our serieson qualitative research methods.I'm Leslie Curry from the Yale School of Public Health.And this module is on a major qualitative studydesign, focus groups.Just a brief overview of the modules, the goalis to enhance our capacity to conceptualize, designand conduct qualitative research in the health sciences.[Overview of the modules.Goal, to enhance our capacity to conceptualize, design,and conduct qualitative research in the health sciences]Three are total of six modules in this series.

  • 00:27

    LESLIE CURRY [continued]: [Modules, what is qualitative research?Developing a qualitative research question,major qualitative study design-- interviews, major qualitativestudy design-- focus groups, overview of qualitative dataanalysis, scientific rigor in qualitative research]And this module examines the major qualitative study design,focus groups.[What is a focus group?]So what is a focus group?In this picture, you see a group of individualssitting in a circle in a room, and some conversationhappening.A focus group is a group of peoplewith certain characteristics who generate narrative

  • 00:48

    LESLIE CURRY [continued]: data in a focused discussion.[Group of people with certain characteristicsgenerate narrative data in a focused discussion]The interaction and the group dynamics are really essential.[Interaction and group dynamics are essential,widens range of responses, activates forgotten details,releases inhibitions]The interaction among individualscan do several things.It can widen the range of responses,we're hearing from a range of individualswith a common experience, but of course,different individual perspectives and views.

  • 01:10

    LESLIE CURRY [continued]: The group dynamics can activate forgotten details,hearing someone recount a story of their experiencemight help another remember.This happened to me.And the group exchange can also release inhibitions,can make people feel more comfortable in describingtheir experience with a particular phenomenon.Focus groups can be useful for a number of kinds of topics

  • 01:33

    LESLIE CURRY [continued]: in the health sciences.The first, characterizing social and cultural normsaround a given health area, health behavior,or type of health care delivery.[Qualitative study design focus groups.Leslie Curry, PhD, MPH, Professorof Public Health, Yale School of Public Health, Professorof Management, Yale School of Management, Secondary,Lecturer, Yale College]Focus groups can be useful for sharing and comparing.[Sharing and comparing, Morgan]Really like this phrase by David Morgan,who's the author of The Focus Group Kit,

  • 01:53

    LESLIE CURRY [continued]: and who describes sharing and comparingas the dynamic in the group where each member will offer uptheir perspective.And in that context, in the discussion,comparing their experience with others in the room.This can generate insights that wouldn'tbe possible in a one-on-one exchange.

  • 02:15

    LESLIE CURRY [continued]: Focus groups can reveal how people talk about an issue,[Revealing how people talk about an issue]because people are sitting around a tableand exchanging amongst themselves,the researcher or moderator can listen and learnthe kinds of language people use,their intonation, their views about a given issue.Focus groups can also be useful for exploring

  • 02:35

    LESLIE CURRY [continued]: potentially sensitive topics.[Exploring potentially sensitive topics]We mentioned this in the individual interviewmodule as well.And so it really is dependent on the particular topic,and the responding group that you'll be working withto determine whether or not individual one-on-one interviewformat would be most appropriate,or whether a group format is most appropriategiven your topic.

  • 02:58

    LESLIE CURRY [continued]: [Designing focus group studies]A few minutes on designing focus group studies.What do they look like?[Group size and number]There are some standards for the group sizeand number in focus groups.So the principle, one in terms of group size,is that you want to have 5 to 10 participants per group.Fewer than five, typically, the dynamics are flatter,

  • 03:20

    LESLIE CURRY [continued]: there isn't as much momentum in the group, maybe notas much speak and freedom when you have small group exchange.And more than 10 participants, itis very difficult for the moderatorto keep the discussion moving, flowing well,and for each participant to have enough timeto express substantively their view on a given topic.

  • 03:41

    LESLIE CURRY [continued]: So the range of 5 to 10 is a guideline.And second guideline is the numberof focus groups per strata.We typically recommend having three to five groupsper strata.So just a minute on stratification.If you determine that a given topic may generate

  • 04:02

    LESLIE CURRY [continued]: some tension, or difficulty, if it's addressed,say, with a group of mixed gender,you may decide that it's important to havefocus groups with all women, and a separate set of focus groupswith all men.And if that occurs, you need to be surethat you conduct three groups, a minimum of threegroups of women, and a minimum of three groups of men.

  • 04:25

    LESLIE CURRY [continued]: So a group composition, [Group composition]attention to group composition, really very critical.There are a number of ways we can think about assemblingfocus groups, and they really dependto great length on the nature of the questionthat you're asking.So several considerations.We want to avoid power differentialsin the room among individuals.[Avoid power differentials]

  • 04:45

    LESLIE CURRY [continued]: So for instance, if you were conductinga study about culture change in nursing homes.The pioneering effort to individualizecare in nursing homes, by which residents express their needs,and certified nurse assistants and nurse aidesare free to deviate from schedules in orderto respond to a resident preference

  • 05:06

    LESLIE CURRY [continued]: or need, you would want to be mindful of having a focusgroup with a certified nursing assistants or nurse aidestogether with, for instance, the charge nurse, or the nursinghome administrator.You could imagine that the dynamic in that roomcould really inhibit free exchange.So be mindful of power differentials in the room.[Homogeneity, heterogeneity]

  • 05:27

    LESLIE CURRY [continued]: Thinking about homogeneity and heterogeneity in the group,how alike do you want the group to be,and how different do you want the group to be?We're looking for some diversity so youhave a range of opinions, and yet, youdon't want to also have homogeneity or similarityin the group so that there is enough common groundto share and compare.[Strangers, acquaintances]

  • 05:48

    LESLIE CURRY [continued]: Strangers versus acquaintances is another considerationin the composition of groups.Are you interested in having people who've neverhad an exchange with one another,or is it more appropriate in a given circumstanceto have acquaintances, those who have some familiaritywith each other.[Experts, novices]Experts and novices, are we lookingto talk to experts in a given area, who have

  • 06:08

    LESLIE CURRY [continued]: deep knowledge of a phenomenon?Or are we looking for more naive view?[Stratify by salient characteristics]And then stratifying by these salient characteristics,as I mentioned, it may be gender in a given group, whereyou want to pay attention to those potential dynamicsand create separate strata for those groups.[Data collection, stimulate a ripple effect]Data collection.I like this image because, to me, it sort of tells

  • 06:30

    LESLIE CURRY [continued]: all we need to know about data collection in focus groups.The idea is to just drop a pebble into the pondand to stimulate a ripple effect of conversation,[Discussion guide structure]The discussion guide, there are some guidance,some established techniques for structuring discussion guides.[Number of questions, 8 12 questions, fewer better,5, 10 min questions]

  • 06:51

    LESLIE CURRY [continued]: In general, the number of questions,we're looking for no more than 8 to 12 questions,fewer is better.It's helpful to kind of label the questionsas 5 or 10 minute questions.One that the researcher comes in and thinks,I don't want them to spend too muchmore than five minutes on this.It's a relevant topic that's introducing them, bringing themto the core issue.

  • 07:11

    LESLIE CURRY [continued]: The 10 minute question is where I reallywant them to linger and have deeper discussion.[Sequence, Opening, answer quickly base on facts,Introductory, foster interaction, focus on topic,Transition, link intro to key, put topicin context, Key, 2 5 key questions]The sequence of questions, there are also some guidelines there.The opening questions should be thingsthat could be answered quickly, that are based on facts.You want the individual to use their voice,to not be threatened, to not have a tricky question,to establish them as the expert, so there's one answer

  • 07:33

    LESLIE CURRY [continued]: and they know it.So opening questions are really very useful for settingthe stage in the room.An introductory question is to begin to foster interactionamong the group, and have them beginto focus on the topic at hand.Transition questions, lengthy introduction to the real keyquestions and begin to put the topic in context.

  • 07:53

    LESLIE CURRY [continued]: So you're moving people some further-- the broad, comfort,establishing questions into the core topic at hand.And there should be no more than 2 to 5 key questionsin the guide.[Discussion guide, item writing]So item writing, just some things to keep in mind.Conversational clear, simple language.[Conversational, clear, simple language]

  • 08:14

    LESLIE CURRY [continued]: Sometimes as researchers, we sit in our teamsand we construct these complex, compound sentencesthat are our questions for our discussion guide.And when you speak them out loud,only then you can hear maybe how silly they sound,or potentially off-putting.So read them aloud, practice them, see whether they in factfeel conversational and clear.[Open ended, think back]Open ended questions are critical.

  • 08:37

    LESLIE CURRY [continued]: Again, not leading in any way, having very broad parametersfor the respondents to begin to generate and shapethe direction of the discussion.The think back technique can be really very useful,asking people to think back to the last timewhen you were at the doctor's office.It brings them out of the room, backto a time and place that grounds them in an experiencewhere they feel--

  • 08:58

    LESLIE CURRY [continued]: then they can draw upon details thatare relevant to the discussion.So that can be useful.[Avoid if possible, asking why, sharp, may cause defensiveness,giving examples, may lead participants]Avoid, if possible, asking why.This may seem counter intuitive.This is what we're trying to understand, why don't youdo x or y?We don't want to ask this question so boldlyand directly.It's very sharp in tone, it may cause defensiveness,

  • 09:19

    LESLIE CURRY [continued]: it may make the respondent feel like, theremust be a right answer and I better give that right answer.So in fact, we want to avoid the why question.Instead, we want to invite peopleto comment on how something happens,or to describe their experience in detail.We also want to avoid giving examples.This may lead participants.

  • 09:39

    LESLIE CURRY [continued]: Sometimes, this technique can be useful,to give a very brief example, to sort of get people going,but it also runs the risk of leading participantsdown a particular path.So be cautious on the examples.[Be aware of participants limits, time, attention,language, cultural issues, communication skills]Be aware of the participants' time, limits of all types,the time, limits to attention, limitsto language, various cultural issues

  • 10:02

    LESLIE CURRY [continued]: and various communication skills.We, for instance, have done lots of focus groupswith frail, older adults in the community,and bringing them to common spaces, libraries,and community centers to talk about services that they'rereceiving in their homes, and we needto be very mindful of their physical comfort, their abilityto stay engaged in a conversation, the communication

  • 10:25

    LESLIE CURRY [continued]: skills, from the researcher, to populations who may notbe familiar, necessarily, or accustomed to being in researchenvironments.So these sensitivities are really very, very criticalin conducting focus groups.[Moderator skills]Moderator skills.Moderating focus groups requires a great deal of skill,and really, the only way to attain these skills

  • 10:47

    LESLIE CURRY [continued]: is to practice moderating.But there are some techniques that are reallyvery critical to facilitating constructive and productivediscussions.The first is having a strong interviewing technique.[Strong interviewing technique]This means the ability to ask an open question,and to receive the information, to listen acutelyfor opportunities to dig deeper.

  • 11:09

    LESLIE CURRY [continued]: [Keen observational skills]So having these keen observational skills,watching what's happening in the room,you can imagine in the moment, youknow you have eight people sitting around a table,you're beginning to just drop that pebble,so there's a ripple effect and the conversation starts,you're very tuned to the dynamics in the group.This is one of the unique assets of a focus group model,

  • 11:29

    LESLIE CURRY [continued]: and so keen observational skills, watch,who's speaking first?Who's listening?Who's leaning forward?Who's pulling back?It's really very, very critical.[Ability to control and guide discussion]Need to have an ability to control and guidethe discussion.This requires in-the-moment judgment.Again, think back to the interviewer module

  • 11:50

    LESLIE CURRY [continued]: where we have the image of a path with a railing, kindof going through a marsh, you wantto be able to let the respondent,let the group conversation go, and yet you alsoneed to control it, and guide it without prematurely truncatingconversation.This is very tricky and has to be assessed in the moment.[Ability to suppress own personal views]

  • 12:10

    LESLIE CURRY [continued]: Need an ability to suppress our own personal views.It's perhaps easier than it sounds.We're often researching a topic that is of great interestto us.We probably have personal views, but weneed to be really very neutral in the role of moderator.[Respect for participants, active listening, eye contact,concern for comfort]And lastly, again, respect for the participants.So active listening, leaning forward, paying attention,

  • 12:33

    LESLIE CURRY [continued]: not scribbling notes or looking at the tape recorder,or watching the time go by, watching the clock.Active listening, eye contact with each individual,concern for their comfort in the space.Respect for participants is really alsovery important to establishing a safe space for the datacollection.

  • 12:56

    LESLIE CURRY [continued]: So we're going to listen to an excerpt from a focus group,and listen carefully really to the moderator.Some of the audio, you'll hear multiple members speakingat once, but listen for the moderator's voice,and then we'll review what you've heard.So let's listen.[Illustration with audio, what do you hear?][VIDEO PLAYBACK]- We're not going to go around the circle anymore.We just need to-- just join in whenever

  • 13:17

    LESLIE CURRY [continued]: you have something to say.What, to you all, what makes a good doctor?What does it take to be a good doctor, would you say?[INTERPOSING VOICES]- One that listens, Mary says?OK.- Yeah.- Is that what you said, Irene?OK.- Definitely, yes.- And what else about a doctor makes a good doctor?

  • 13:40

    LESLIE CURRY [continued]: - [INAUDIBLE] In the office.- OK.- [INAUDIBLE] seeing, [INAUDIBLE]..- And how would the doctor do that,or how would he show that?- [INAUDIBLE] like he was talking to you,and being concerned about your problem.- OK.Any other thoughts about what makes a good doctor?

  • 13:60

    LESLIE CURRY [continued]: Maybe, touching you.This is Jenny, you know?Not touching you all over, but you know, like nice touch.- Yeah.- That's very good.- Tender, loving care.- Feels good with that.- Nice personality, yeah.- OK, that's Dorothy.What do you mean by that, nice personality?

  • 14:21

    LESLIE CURRY [continued]: [INAUDIBLE] thing.- Well, I think they get to show that they areinterested in you, you know.- OK.Do you have any ideas how they might show they're interested?[END PLAYBACK]

  • 14:34

    LESLIE CURRY: OK.So what did you hear there?Several things happening at once.[Moderator identifying speakers, ice breaker question,clarifying probes, dynamic exchanges]You hear the moderator interjecting saying, Mary,what do you think?Is that what you think, Emily?So identifying speakers.This is important for really the sort of mechanics of generatinga data set for focus groups.The transcriptionist has to be able to identify a given

  • 14:56

    LESLIE CURRY [continued]: voice with a name, some identificationso that you're able to understand which personis speaking at what time, and you'reable to look at patterns of speechacross members in the group.So being able to tag a specific name,or identification to a voice is reallycritical for transcription.And in the moderating, we often-- we

  • 15:16

    LESLIE CURRY [continued]: instruct people in the group, before you speak pleasesay your name.This isn't a very natural thing for us to do.And so participants often will just begin talking.And so the moderator can sort of quietly interject,Mary said this, and did you hear that?Is that what you said, Emily?You hear in this excerpt an ice breaker question.

  • 15:36

    LESLIE CURRY [continued]: Something very open, easy, you know what does ittake to be a good doctor?And you can hear the respondents feelingconfident in describing, I want one who pays attention to me.One who is close in the interactions,who knows your name.Do you hear the moderator asking clarifying probes?

  • 15:58

    LESLIE CURRY [continued]: What do you mean by that nice personality?Asking for just a little more about whatthe respondent means when she's describing nice personality.And then lastly, you can hear the very dynamic exchangesin the group where individuals are starting,this is very early in the group.And you can hear them already startingto reflect back and forth across each other.

  • 16:21

    LESLIE CURRY [continued]: So just to give you a sense of whatthe dynamic interplay might sound like in a focus group.[Analysis of focus group data]Analysis of focus group data.This is an area where I think we often fall short.There are some assumptions we maycome to the data thinking well, it'sjust a bunch of individual.We'll analyze it like individual interviews,

  • 16:41

    LESLIE CURRY [continued]: which, it loses the richness of the group dynamic.And in fact, doesn't pay attentionto some of the critical aspects of focus group data, which issort of the group interaction.And so analysis of focus group datarequires careful attention to several things.[Group is a unit of analysis, not individuals within it]We have to remember that the group is the unit of analysis,

  • 17:04

    LESLIE CURRY [continued]: not the individuals within it.And so we're looking to extract the summary of emerging ideasand themes at the group level, not individual utteranceswithin the text.So just mindful as we are approaching the data.[View of one member, or theme for group]We want to be looking for whether or nota theme is a view of one member, or whether it

  • 17:25

    LESLIE CURRY [continued]: was a theme for the group.Was it really only one participantwho felt a given way, or expresseda particular experience or perspective,or was this one where there developedsome consensus, or some shared view throughout the groupdiscussion?[Response to question or emerged spontaneously?]We want to know whether a question, whether a responseemerged as a result of a question led by the moderator,

  • 17:47

    LESLIE CURRY [continued]: or whether it was something that spontaneously camefrom the group conversation.[More text does not mean issue is more important]We want to note that more text does notmean the issue is more important, necessarily.There may be some very brief text on somethingthere was great agreement, quickly.And so we don't want to be sort of distractedinto thinking that if there's a lot of conversation

  • 18:09

    LESLIE CURRY [continued]: about something, it means it's reallythe essence of the study.And so looking at the dynamics in the group, really verycritical throughout the group.Is there biasing?Is there groupthink?Is there a single member who dominates the discussion?[Tips for a good focus group]So several tips for a good focus group.[Create rapport among group members first]Creating the rapport among the group members first.

  • 18:31

    LESLIE CURRY [continued]: This is in contrast to individual interviews,where it's really very much about the interviewerand the respondent, and establishingthat space for candor and disclosure right up front.In this instance, the moderator wantsto be very, very light, almost invisible in the room,off to the side, and really focusingon the relationship among the members is the primary goal.

  • 18:55

    LESLIE CURRY [continued]: And creating a relationship among themin the first moments of the group is the primary goal.[Establishing safe space, engage the hesitant]Establishing a safe space, knowinghow to make hesitant people feel comfortable in contributingin that space, to really-- also can be very useful.[Be prepared to redirect]Being prepared to redirect the group,

  • 19:16

    LESLIE CURRY [continued]: so listening very, very carefullyand letting the group sort of take itselfdown a certain path, but not too far.And being ready to interject without squelchingthe dynamics.This is tricky.We want to bring the group around gently backto the topic at hand, and not interject with too much control

  • 19:39

    LESLIE CURRY [continued]: because that can sort of deflate the momentum in a group.So be careful.[Manage dynamics, can constrain and bias]Managing the dynamics in the room.So there are always dynamics in every group that we experience,focus groups is no different.And so there will be people who feelmore confident, who are more vocal,who have stronger opinions.

  • 20:00

    LESLIE CURRY [continued]: There will be others who are more hesitant,and maybe feel more anxious in the group space.And so managing those dynamics, reallyis something the moderator is responsible for from the momentthe group begins through till the end.Because the domineering dynamics can constrain conversation,

  • 20:23

    LESLIE CURRY [continued]: and the sort of repeated interjection of a givenperspective or view can also bias the dialogue.So managing those dynamics is really very important.[Be aware of non verbal information]Lastly, one of the benefits of focus groupsis that we're getting to watch people as well.So being aware of the non-verbal information in the room,and there's lots of it.

  • 20:44

    LESLIE CURRY [continued]: In our focus group work, we have a primary moderatorwho's responsible for sort of dropping that pebbleand then facilitating the conversation as it goes,and we have a second person in the room whois managing all the logistics so that they're unobtrusive,and taking careful note of non-verbal informationin the room.

  • 21:04

    LESLIE CURRY [continued]: Who pulls away from the table?Who seems to be aggressive?Who is nodding in deference all the time to another respondent?And those kinds of nonverbal dataare really very useful in interpretationagain of the group findings, and with the groupas a unit of analysis.

  • 21:25

    LESLIE CURRY [continued]: [Thank you]Thank you for your attention.

Abstract

Leslie Curry, PhD, MPH, Professor of Public Health, Yale College, in this fourth module of the fundamentals of qualitative research series, discusses and shares an example of a focus group, including when to use, designing, the discussion guide, moderator skills, data analysis, and tips.

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Major Qualitative Study Design: Focus Groups

Leslie Curry, PhD, MPH, Professor of Public Health, Yale College, in this fourth module of the fundamentals of qualitative research series, discusses and shares an example of a focus group, including when to use, designing, the discussion guide, moderator skills, data analysis, and tips.

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