|Manual for the Use of Focus Groups (Methods for Social Research in Disease) (International Nutrition Foundation for Developing Countries - INFDC, 1993, 97 pages)|
|Part II: Staff training for focus group discussions|
Perhaps the area that requires the most practice is the control of the focus group You will not be able to remember all of these techniques at first, but with each new focus group try to practice another skill.
Perhaps the most powerful tool for encouraging participation by the group is to explain adequately at the beginning of the session the purpose of the study (in general terms) and how important their contribution is to the study.
The following list is not necessarily complete. Part of your task is to make suggestions about other techniques that could aid in the flow of discussion.
10.2 Encouraging discussion
Wherever possible maintain a friendly and warm attitude to make the participants feel comfortable. As previously mentioned, being non judge mental and open can help a lot. Also as mentioned before, aim to be somewhat casual, but not too much so in case the participants do not take the session seriously.
Pauses and prompts
Pausing to allow a participant to think more on the topic being discussed is a very useful technique. It can also allow a new speaker to comment. Some participants who are shy may not compete for time to speak, but these people will often talk if there is a break in the discussion.
This technique is very difficult to do if you are nervous about the success of the focus group. It is natural to want to fill in the gaps in conversation. Try practicing this on family and friends to see how it works. With confidence in the technique, you will be able to use it more effectively.
The pause should not last more than five seconds (which can seem like a lifetime if you are anxious!). The pause used with confidence will also stop you rushing onto the next topic too quickly.
You can also use the pause to make eye contact with someone. This can encourage that person to speak. Just try not to embarrass anyone, particularly the shy ones.
Establishing eye contact can also be a means of prompting someone to continue to talk. Raising your eyebrows, nodding, and other gestures (which vary from culture to culture) may also encourage people to continue to talk. Other prompts are verbal - some have meaning ("I see, that's interesting, keep on ..."), others are simply reassuring sounds ("mmm", "uh-huh") to encouraging a speaker to continue his or her line of response.
This technique is so important, that we will need to prepare probes for each question we ask should no one respond. Generally, we try to avoid vague comments, and the probe can encourage a speaker to give more information. For example:
"Could you explain further?"
"Would you give me an example of what you mean?"
"I don't understand..."
The general probe is used often at the beginning of the discussion. This helps the participants know that we want precise answers.
A question can be rephrased if the group members are finding it difficult to answer. Be very careful not to change the meaning of the original question and do not hint at the answer.
"I was referring to access to the clinic. What I meant to ask you was, are there any factors that either prevent you going to the clinic or make it easy for you?"
This technique is supposed to keep the conversation lively. It also reminds the group of the question being asked.
"Mrs X, you told us that you cannot always take your child to the clinic because transport is difficult. Mrs Y (who has not yet said anything), does anything stop you from taking your child to the clinic?"
Sometimes it is helpful to give an example of a particular subject (for example, a possible intervention, or a set of symptoms) in order to test the knowledge and attitudes of the group or to clarify the generalisability of a previous comment. In one study, a research team used clinical vignettes to find out local terminology for different kinds of diarrhoeal disease, and to test the accuracy of those vignettes before incorporating them also into in-depth interviews with mothers and grandmothers (Abdullah Sani et al. 1990).
Suppose, for example, you want to try to determine if treatment differs depending on whether a child has a simple fever, or other symptoms which might indicate malaria. You could ask:
"You've suggested that babies who have fever should be treated by the local healer. But suppose that a baby had a bad fever, and was shivering and very cold, and didn't seem to be getting any better: what would you do then?"
Box 9 gives examples of a number of different styles of questions which you might use within a single focus group.
10.3 Dealing with specific individuals
Not all participants will respond in the ideal way! For this reason we will look at some ways to deal with some of the more common group problems (see also Scrimshaw and Hurtado 1987:15-19; Sittitrai and Brown 1990; Stewart and Shandasani 1990:96-98).
Often in groups there will be "experts". This can mean someone who is considered either by themselves or others to have a lot of knowledge on the topic in discussion.
Although "experts" can offer a lot of useful information, they should not be allowed to take over and they may prevent other group members from speaking. Opening statements should emphasise that all participants have knowledge on the subject, and that you want to hear everyone's opinions.
Sometimes, participants will have a special status in the community that you were not aware of. They might be the wife of an important person, be more affluent than other group members, or have any number of other qualities that prevent or restrict conversation from others. If you identify such a person you should try to limit attention to this fact, although the group members will be aware of it.
These are participants who want to answer all the questions for the group. They often answer questions immediately and prevent others from speaking.
Again, the introductory comments should emphasise the need for all participants' comments, and the initial discussion on this aspect should keep the potential problem alive in people's minds.
Box 9: Moderator question styles
M: I wonder if you could tell me about the different kinds of illnesses your children get? [general question]
M: So there's a special sort of fever when the child gets very cold and is really shivering, and the child could die? [repetition]
M: Suppose the child had a fever, and was very cold, and then complained of a very bad headache? What do you think might be wrong with it? [clinical vignette]
M: Let's suppose you took this child to the local store, and you were given some tablets. You gave those to her, but she didn't get any better. Now what would you do? [hypothetical]
M: You all think that's true then? Mrs Y, what about you? [prompt]
Mrs Y: Well, not really. You see my brother-in-law helps out...
M: That's interesting, how? [probe]
Mrs Y: Well, he would lend me the money so that I could take the baby to the clinic.
M: Can he always do that? [check for generalisability of specific person's experience]
M: What do the rest of you do if you have no money? Do you borrow
from someone, or do you do something else? [check for generalisability within
Dominant talkers are identified, if possible, during the reception time and are seated next to the moderator. This is done so body language can be used! This means turning slightly away from the dominant talker and looking other group members in the eye.
Should a dominant talker continue, then more drastic measures need to be taken!
· Look slightly bored while avoiding eye contact, but be tactful and hind.
· Thank the dominant talker for his or her comment, and ask for other comments from the group.
There will always be shy people in a group. Again, try to identify these people in the reception time and seat them opposite the moderator to enable maximum eye contact.
If this does not help, try gently to address them by name. Be very careful with this technique as it could embarrass them and prevent them from speaking again!
People who can't stop talking
These people talk on and on about a topic. They cease to provide good information, and will prevent others from speaking. As you only have about one hour for the discussion on several topics, it is essential that you keep these people under control.
Deal with these people by stopping eye contact after 20 to 30 seconds. The observer and other team members, if present, should do the same. Look bored, look at other participants, but do not look at the participant of concern.
As soon as the participant pauses, be ready to fire the next question at another participant, or repeat the same question, if necessary, to other members of the group.