Dr Faith Gibson,Dr Faith Gibson, Lecturer in Children’s Cancer Nursing Lecturer in Children’s Cancer Nursing Research Research

Institute of Child Health and Great Ormond Street HospitalInstitute of Child Health and Great Ormond Street Hospitalfor Children NHS Trust, Londonfor Children NHS Trust, London

Using Focus Groups with Using Focus Groups with Children and Young PeopleChildren and Young People Using Focus Groups with Using Focus Groups with

Children and Young PeopleChildren and Young People

Learning outcomes…• To be able to describe the advantages and

disadvantages of using focus groups.• To be able to describe the steps taken when

planning and running a focus group.• To be able to highlight the particular

techniques used when working with children and young people in focus groups.

• To be able to outline the ethical issues involving children and young people in focus groups.

• To summarize approaches to analysis and reporting of focus group data.

Overview of the Session (90 minutes)

• Activity-ice breaker• Presentation – Theory and

practice of focus groups• Activity• Presentation – Running a focus

group • Closing comments

Ice Breaker

My experience….your experience????

• Identifying dimensions of the role of the CNS

• Exploring the role of nurses in day care

• Identifying competencies of general and specialist nurses

• Exploring fatigue with teenagers

• Listening to children and young peoples views of their cancer experience

• Exploring experiences with young people during the diagnostic period

A focus group is…….• A carefully planned discussion• Designed to obtain perceptions• On a defined area of interest• In a permissive non-threatening environment• Conducted with approximately 7-10 people• By a skilled interviewer• To share ideas and perceptions• In which group members influence each

other by responding to ideas and comments in the discussion

The story behind their use……

• Origins traced back to 1920’s• Used then to develop survey instruments• Developed in response to general dissatisfaction

with interviews• Became popular and developed strongly as a

research technique for market research• Adopted for party political research• Well established as a mainstream method across

all fields of social and educational research• In health care seen increase in use in last 10

years

Characteristics….• Involve people: small enough to share insights,

large enough to provide diversity• Conducted in a series: to detect patterns and

trends across groups• Composed of people who are similar: defined by

the study• Used to produce research data: differs from other

group interactions• Make use of qualitative data: participants influence

each other like in real life as opposed to interviews• Have a focussed discussion: carefully

predetermined and sequenced

Some common myths….

• Cheap and quick• Require moderators with highly developed

professional skills• Must consist of strangers• Not used to discuss sensitive topics• Tend to produce conformity• Are a more natural means of collecting data• Should not be used for decision making• Must be validated by other methods

Why focus groups with children/young people

• Create a safer peer environment• Replicate the type of small group setting similar

to the classroom• May help to re-dress the power imbalance• May be encouraged to give their opinions when

they hear others• Memory may be jogged by others contributions• Acknowledges participants as experts• Greater involvement in the research process

Where to start…….• Framing your research question• Detailing outcomes of the

research• Agreeing sample and setting• Deciding approaches to data

collection• Identifying data analysis

techniques

Early planning process….

• Number of sessions: practical and substantive issues considered

• Time and place: knowledge of participants to increase uptake

• Style and format: standardise for coverage and analysis

• Recording tools: tape, video, group activities, note taking

• Analysis: most challenging aspect where less has been written

• Pilot: process and questions

Working within an ethical framework

Refer to checklists, e.g. NCB,RCPCH, MRC

•Duties

•Rights

•Benefits/harm

•Risk of distress

•Risks to children from participating- benefits to children in the future

•Respect for privacy and confidentiality, use of quotes

•Trust

•Understanding

•Keeping children safe

Post it pyramids

Group composition factors

• Age dictates size of group, average 5-8• Participants in a group should be within

two-year age span• Used with children over 6 years• Single-sex/mixed sex• Known/unknown• Homogenous/heterogeneous• Last 45 mins-90 mins• Research question will influence many

factors

Location/seating• Familiarity balanced against

suitability• Noise levels and distractions• Seating arrangements, floor,

seated in circle with moderator, with/without table

• Eye contact• Choice of seating

The Moderator• Make the group feel comfortable and at ease• Set themselves apart from other authority figures• Matching moderator to the group• Allowing participants to influence the agenda• Keep discussions focused on the topic• Ensure all participants have an opportunity to

contribute• Remain mindful of non-verbal signs and

fatigue/boredom• Be aware of/note group dynamics• Enhance the clarity of participants contributions

Introducing the group• Standard statement• Format and nature of the group discussion• Confidentiality, what this means• Ground rules• Recording, tape/video• Role of assistant moderator• The opening topic, sequencing questions• Discussion• Ending the discussion• Summary, concluding for the group and the

individual

Conducting the discussion..

• Flexibility or structure• Probing• Noting non-verbal language• Creating space for everyone to contribute• Addressing dominant participants• Drawing out reticent participants• Avoiding simultaneous dialogue• Value interactions, recognise cannot follow every

point raised• Exploring emerging issues, diversity of view• Challenging social norms and apparent consensus

Using activities• Ice-breaker• Age-specific activities, designed for the

purpose– Brainstorming– Sentence completion– Visual prompts– Vignettes– Fantasy wishes– And…………

• Emphasise participation

Analysing data• Mechanical• Transcript, tape,

notes, observation based

• Revise decision if necessary

• Diagram of seating arrangements

• De-brief immediately after and take notes

• Organize data

• Interpretative• Review tapes,

transcripts, and notes look for emerging themes and develop coding categories

• Construct overview grid

• Making group comparisons

• Reliability and members check

Threats to quality…….• Clarity of purpose• Appropriate environment• Sufficient resources• Appropriate participants• Recruitment and scheduling of sessions• Skilful moderator• Effective questions• Careful data handling• Systematic and verifiable analysis• Appropriate presentation• Honouring the participant and the method

Ensuring quality and reporting back

• Detail participants and the context in which views were given

• True representation of findings• Face validity• Convergent validity: confirmed by future

behaviours, experiences or events?• Feedback, written, user forum,

conferences, publication• Influencing practice

In summary…….• Preparation and planning ensures success• Not to be taken on as an easy option• Research question influences methods• Group composition, format, etc all need

considerable thought• Rigour at all stages is crucial• And……………• Valuable approach to gathering valid and

reliable data directly with children and young people

Secret Box