thematic analysis of focus groups with consumers and

Thematic Analysis of Focus

Groups With Consumers and

Carers of Mental Illness

© 2019 SAGE Publications, Ltd. All Rights Reserved.

This PDF has been generated from SAGE Research Methods Datasets.

Thematic Analysis of Focus

Groups With Consumers and

Carers of Mental Illness

Student Guide

Introduction

There are many types of qualitative research methodologies, such as interviews,

case studies and autoethnographies (Creswell & Poth, 2018). The type selected

for this dataset is focus groups, and the exemplar draws from one focus group

transcript. The purpose here is to describe the approach that was taken to theming

the transcript, as well as the writing up of findings as a narrative. By taking

stock of the factors that influenced the approach, other researchers such as

PhD students can develop awareness, knowledge, skills, and ownership of the

processes involved in qualitative data analysis.

The dataset exemplar has been drawn from a national study conducted in

2010–2011 on the needs and experiences of consumers and carers of mental

illness. It was funded by beyondblue, a not-for-profit organization in Australia

aimed at increasing awareness of, and reducing the stigma around, mental illness.

Briefly, the study conducted eight focus groups in urban and regional sites across

four of Australia’s eight states and territories to ensure the sample was nationally

representative. The total sample size was 61. Focus groups were comprised of

6–8 people and were in-depth, varying from 2 to 2.5 hours. Participants were

reimbursed AUD$100 as a sign of appreciation for sharing their time and

vulnerable experiences.

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2019 SAGE Publications, Ltd. All Rights Reserved.

SAGE Research Methods Datasets Part

2

of 16 Thematic Analysis of Focus Groups With Consumers and Carers of Mental

Illness

Focus Groups

Focus groups are one common way of collecting data in qualitative research

(Babbie, 2016). They (like all qualitative methods) are chosen because the needs

and experiences of participants are valued more than a ‘tick in the box’; such

quantitative surveys and questionnaires reduce richness by measuring needs

and experiences on a linear scale. Thus, there is fundamental value for the

participant’s voice, and it is collected within a philosophical paradigm that values

the non-quantifiable whole. Researchers who choose qualitative methods typically

endorse emic or ‘insider’ perspectives (Denzin & Lincoln, 2017), and thus holistic

person-centeredness. This helps put power in the participants’ hands and, in

doing so, helps the researcher be responsible for and ethical with their own power

(e.g., someone with access to postgraduate education and prestigious institutional

symbols such as their university and funding bodies).

In addition to epistemological factors, there may also be a practical element to the

choice of a focus group: having many people share their needs and experiences

together saves time, compared to gathering data in one-on-one interviews. Given

that an Honours program only goes for one year, for example, being able to collect

data quickly does matter. If there is more luxury, for example, in a three-year

PhD, then this factor may not play as large a role when deciding on the most

appropriate qualitative research methodology (interviews or focus groups), given

the research questions being investigated. Indeed, the research questions have a

huge bearing on the data collection method. If a topic is simply too sensitive, then

focus groups are not appropriate; their practicality does not justify or outweigh

the need to create a safe space for participants to share their thoughts, feelings,

and experiences. Both focus groups and interviews allow researchers to identify

similarities and differences across participants, but which is eventually decided

upon depends on what is best for the participant, whose voice is so greatly valued.

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If focus groups are selected, then having a group size no greater than eight is

ideal (Babbie, 2016). This is because people vary in the extent to which they feel

comfortable to share their thoughts, feelings, and experiences with people who

are likely to be strangers to them. In turn, it can risk some participants dominating

the discussion and others being marginalized. A smaller group size of six to eight

makes it easier to manage such group dynamics, while still gathering a diverse

range of individualized and nuanced voices.

Data Exemplar: Focus Groups With Consumers and Carers of Mental

Illness

To provide a bit more information about the project: beyondblue is Australia’s

leading non-government organization in mental health awareness. They

commissioned the Social Policy Research Centre (SPRC) at the University of New

South Wales (UNSW) in September 2010 to conduct focus group research with

consumers and carers. beyondblue defines consumers as people with personal

experience of depression, anxiety and related substance use disorders, and

carers as family members and friends who care for consumers. The study aimed

to explore four key themes in relation to mental health issues (identified by

beyondblue when they commissioned the research) – community awareness,

stigma, social and economic impacts, and treatment needs – as the basis for

developing national practice and policy recommendations. The study lasted for six

months and involved several tasks.

The first task was to obtain ethics approval from UNSW’s Human Research

Ethics Committee (HREC). A literature and beyondblue document review was

then conducted to help establish current knowledge in the field about the four key

themes. Findings of the review informed the design of three semi-structured focus

group schedules (with non-leading questions and prompts). Each schedule was

for the three types of focus groups that were going to be conducted – ‘consumers

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only’, ‘carers only’, and ‘mixed groups of consumers and/or carers’. beyondblue

then recruited participants through their e-based national consumer and carer

reference group, ‘blueVoices’. Potential participants living in the local area of the

eight study sites were first screened and then excluded if they had additional

presentations of psychotic disorders (e.g., schizophrenia, schizoaffective disorder,

etc.). These criteria were used to increase sample homogeneity and therefore

representativeness. Eight focus groups were then conducted in Melbourne (urban

Victoria), Bendigo (regional Victoria), Hobart (urban Tasmania), Burnie (regional

Tasmania), Sydney (urban New South Wales), Tamworth (regional New South

Wales), Adelaide (urban South Australia), and Mount Gambier (regional South

Australia). Permission to record the focus groups was sought prior to conducting

them (at the same time as obtaining informed written consent). After all the focus

groups had been conducted, the voice files were sent to a private company for

transcription. The transcripts were then deidentified and thematically analysed,

and the findings were written up in a final report to beyondblue in 2011 (Sawrikar,

Muir, & Craig, 2011) and in peer-reviewed journal article in 2017 (Sawrikar & Muir,

2017).

In total, 61 participants took part, which is large for qualitative research. Of these,

32 (52.5%) were ‘consumers only’, 24 (39.3%) were ‘carers only’, and five (8.2%)

were ‘consumers and carers’. The age range was 17–78 years, with an average of

43.1 years (n = 60 complete data), and 23 (37.8%) participants were male. More

details about the participants can be found in the original report (Sawrikar et al.,

2011).

Thematic Analysis

In this paper, thematic analysis is treated as a two-step process. It first involves

identifying broad or key themes that are emerging from the data (‘coding’), and

then offering deeper meanings about them (‘narrative’). However, it is common

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for qualitative researchers to distinguish between ‘content analysis’ and ‘thematic

analysis’ and, therefore, separate these two steps as independent rather than

sequential. This can cause confusion in terminology!

According to Vaismoradi, Turunen, and Bondas (2013), content analysis is defined

as a “systematic coding and categorising approach for exploring large amounts

of textual information unobtrusively to determine trends and patterns of words

used, their frequency, their relationships, and the structures and discourses of

communication” (p. 400). It is distinguished from thematic analysis, which they

define as “an independent method for identifying, analysing and reporting patterns

(themes) within data” (Vaismoradi, Turunen, & Bondas, 2013, p. 400).

Although these related terms are used interchangeably, there is a basic distinction

between description and analysis being made. Below is a further discussion

about the importance of both when making sense of qualitative data. Thereafter,

explanation about the approach taken to thematically analysing Extract 1 is

provided.

Coding

Only two small extracts of one focus group transcript have been provided here.

This is because the original transcript of this focus group is 66 pages in length.

When you have conducted eight focus groups, there is a lot of data to churn

through. As a researcher, it is critical that all issues raised across those 500

odd pages is documented in some way. It is ethical – honouring the sharing of

your participants, but it is also rigorous – ensuring that themes have been fully

scoped for. NVivo is software that can help researchers manage all their data,

but is not necessary to use because it does not do the thinking for them; it is an

organizational tool, not an analytical one.

It is also ideal if there are several coders working through the transcripts to

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identify all key and sub-themes. However, this comes down to resourcing. If

there are funds available for a team of researchers, then usually one transcript

is chosen for analysis first. All coders work on it independently to help establish

the degree of overlap among them (also known as ‘inter-rater reliability’). It is then

discussed together to help finalize the approach the team will take: identifying,

cross-referencing, and validating the ‘coding framework’. The remaining

transcripts are then equally divided by the number of researchers in the team.

Such an approach helps ensure both consistency and efficiency during this stage

of data analysis.

Importantly, the initial coding framework that is designed is not fixed. It is iteratively

modified and adapted as each transcript is analysed and discussed – adding,

deleting, and re-prioritizing themes as required. This is critical for ensuring that

analysis is fluid and responsive to the data. Indeed, the literature review which

then informs the questions asked on the focus group schedules already indicates

to a researcher key and possible sub-themes, but the dynamic process of

speaking with people uncovers and creates new knowledge which also needs to

be captured. Thinking about the experiences that people share also develops,

matures, ripens, and sophisticates over time. Thus, qualitative data analysis

is a back-and-forth process: researchers start with some idea about the key

issues, but those ideas also grow and expand; re-writing how they may have first

understood some phenomena.

Narrative

In the process of thematic analysis, the first step of coding may also be referred

to as ‘content analysis’. Essentially, it is aiming to exhaust all the data that have

arisen from the focus groups, but is only descriptive at this stage. Good writing

does not simply describe what has been found. It analyses it, giving it deep

meaning that reflects the researchers’ privileged position of having had access

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to so many people’s thoughts, feelings, and experiences. Thus, fully coding a

transcript is not all there is to be done as a researcher analysing qualitative data.

Once the descriptive step of identifying all key and sub-themes has occurred,

another important factor comes into play: page limits play a critical role in helping

researchers decide how to present all that data. In an Honours or PhD

dissertation, an appendix can help carry the load, but in a journal article, the skill

of a writer to be both comprehensive and succinct is truly tested. The work also

needs to be interesting. For example, identifying every quote that sounds similar

across participants is too repetitive for a marker or reader. Instead, it is better to

provide an exemplar quote that best demonstrates the point one is trying to make

and then provide some text in a paragraph that describes and summarizes all the

data relevant to that theme.

Those paragraphs also need to be joined together by the writer’s voice, so that

an analytical ‘story’ is unfolding as it is read. This narrative logically links the key

and sub-themes, and makes clear and explicit to the reader why they are each

important and how they are each related. It is critical that a scholarly writer says

exactly what they mean and mean exactly what they say. Ambiguity in study logic,

design, execution, and analysis compromises the very purpose of research – to

find well-considered evidence for a well-considered argument – and writing is the

means by which all of this is shown. A PhD marker or reviewer of a journal article

will be looking for ambiguity that compromises methodological rigour, and it is

the writer’s job to address it as much as possible. Ideally, the analytical narrative

that the researcher is creating is progressing the field; the findings should be

discussed in a way that leads to new knowledge, not just state what is already

known. The researcher is a powerful agent, and the deeper they think about their

findings, the richer their contributions to the field will be.

Approach for Extract 1

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Extract 1 is from the introductory discussion of the ‘mixed carers and/or

consumers’ focus group in Bendigo (and should be read in full now, so that the

remainder of this section makes sense). Its key purpose was to help establish

rapport within the group quickly, so that participants felt comfortable talking and

sharing with people they did not necessarily know. However, several themes

were identified even at this early stage (e.g., work as a form of carer respite,

family attitudes towards medication, and resilience among consumers). Before a

qualitative researcher discusses these themes, they need to provide contextual

descriptive information about who took part in their study.

Descriptive Sample Data

Some of the first things a researcher would need to note are the number of male,

female, and total participants in the focus group(s). There may also be other

characteristics that are relevant and require reporting. For example, in this study,

a short demographics survey was completed by participants at the end of the

focus group, collecting data on variables such as age, country of birth, and use of

mental health services (each of these were described in the commissioned report

for beyondblue).

Each characteristic of the sample would need some discussion, so that it was

not just descriptive. For example, if there was no sample representativeness

in gender, why? In this study, 38% of the sample were male, so discussion

about their lower participation was required. The report attributed it to gendered

sociocultural expectations about males not being free to discuss their feelings and

having to be strong (and there were data in the focus groups to support this). It

may also be helpful to provide cross-tabulations in the write-up of a qualitative

study, such as the number of male and female participants per focus group. Such

decisions – on how much or how little summary data to present – need to be

made, and should be guided by whether they add to/aid in contextualizing the

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findings.

Mental Health Issues

One important and obvious sample characteristic relevant to this study and

therefore warranting summary is the number and range of mental health issues

that participants are living with. A frequency table would be useful for this purpose

(and accordingly was provided in the commissioned report to beyondblue).

Textual information that goes beyond description would also be helpful. For

example, upon reading Extract 1, it appears that carers of people with postnatal

depression were relatively common in this focus group, and this may be worth

noting if the researcher believes that the caring experience is influenced by the

type of mental illness the consumer has. Thus, they may explore and reflect on the

similarities and differences between carers of people with postnatal depression,

bipolar disorder, depression, anxiety, and any other mental health issues reported

in the sample. Such a reflection would be part of their narrative, when they move

from the broad code/theme of ‘the caring experience being related to the type of

mental illness they live with’ to the deeper meanings of exactly in what ways and

why.

Family Characteristics

Demographic characteristics not collected in a short survey after the focus group

may also emerge as themes during the discussion. For example, length of caring,

number of consumers in the household, and family structures were raised by

participants in this group: reported length of caring varied from two to 30 years,

there may be one or several consumers within a household (and whether they are

child, partner, or parent consumers is also important to identify), and some were

in a single-parent household.

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Importantly, participants may mention such family characteristics but not

necessarily go on to explicitly state how they affect their caring experience. By

drawing on all data from all focus groups, qualitative researchers can deeply

explore whether and how these family characteristics influence the caring

experience, and thus offer reasonable and cogent theories about their possible

relationship. When they do this, however, it is critical that this is made clear –

calling for caution to be exercised and future research to be conducted with more

rigorous methodologies, because the speculative relationships being offered are

not wholly based on the evidence collected in the study.

Respite

Once the researcher has fully described their sample in relation to all relevant

variables, they can then move onto thematic analysis. Work being a form of

respite from caring was raised as one theme in this early discussion. It was also

discussed in more depth later when the specific issue of social and economic

impacts of mental illness within families was explored. Thus, all verbatim quotes

across all transcripts that relate to work as a form of respite would need to be

pulled together, so that they can be summarized succinctly and comprehensively.

For example, how many people mentioned this or agreed with this by nodding?

Whose quote best demonstrates the point, even though several people have

said it? Did anyone report work not being a form of respite and why? In your

reasonable and logical opinion, do people’s thoughts, feelings, and experiences

relate to anything about their demographic profile (e.g. age, sex, cultural

background, family structure, urban/regional residence, etc.)?

Work was not the only form of respite identified by carers. For example, across

all eight focus groups, respite was evidenced through self-care, sharing caring

with others when possible, using humour as a coping strategy, having faith or

hope, and taking up government-funded respite services (these data have not

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been provided here). Thus, the key theme would be identified as respite and

the various examples of it could be classified as sub-themes. Each sub-theme

requires analytical discussion, perhaps by drawing on previous literature to help

compare and contrast study findings to what has already been reported. This

way, the Results section is not just a descriptive list of findings. Importantly, what

one researcher sees as a theme, another may see as a sub-theme; conceptually

seeing it as belonging under a broader ‘umbrella’. As long as a logical justification

is provided, such differences are acceptable (and indeed in keeping with

qualitative inquiry, are valued).

Other Themes

From reading all of Extract 1, it can be seen that several themes were raised by

participants, such as experiences with medication, caring stress, and resilience

among consumers (e.g., founding and facilitating support groups). A similar

process to what has already been described above – pooling all data that relates

to each theme, analysing it deeply including variation among participants, and

writing it up succinctly – would need to occur for all key and sub-themes across all

transcripts until they had been identified and exhausted.

Ethical Writing

There is a final point in need of mention from Extract 1. The burden of caring can

be so great that one participant did say, “You only get 10 years for murder”. That

the group laughed in response to this statement is further evidence of the burden

of caring; it is empathically shared by other carers. However, such a statement

may be confronting for people who are not carers, including consumers.

Nevertheless, and in line with qualitative methodologies that value person-

centredness, it is critical that the researcher reports this sentiment in a way that

does not judge it, but instead honours it as a feeling that was shared due to the

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safe space created by the researcher. Research is conducted in the pursuit of

truth, and focus groups are one way of collecting evidence of that truth. Thus, this

sentiment is truth for the carer, and it is critical that this truth be written up ethically

by the researcher in a narrative that pulls together the privilege of hearing many

truths.

Take-Home Messages

To help summarize the key points of this paper about focus groups and thematic

analysis of focus group transcripts, the following ‘take-home messages’ are

offered:

• Practicing thematic analysis improves awareness, knowledge, skills, and

ownership of the processes involved in qualitative data analysis; it

develops, matures, ripens, and sophisticates over time.

• Both focus groups and interviews allow a qualitative researcher to identify

similarities and differences among participants. However, which method is

used depends on the research questions of the study and what is best

for the participant(s) (some questions are better explored in a one-on-one

setting and/or are psychologically safer).

• Focus groups with six to eight people is an ideal sample size; it allows

diverse experiences to be captured while managing potential dominant

participants.

• Qualitative researchers sometimes use terminology differently to one

another, which can cause confusion. It is therefore important for them to

define and explain their choices.

• Good writing up of qualitative research values both description and

analysis; neither is compromised.

• All emergent themes and sub-themes are exhausted to ensure that data

analysis is both rigorous and ethical.

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• NVivo is software used to help manage qualitative data; it is not relied upon

for analytic purposes.

• Pending resources, checking the inter-relater reliability of one’s coding

framework boosts its rigour. The coding framework is also finalized only

after all transcripts have been themed, to allow the data analysis process to

remain fluid and responsive to the entire dataset.

• Qualitative researchers should aim to write their findings up theoretically,

logically, succinctly, comprehensively, clearly, unambiguously, interestingly,

empathically, ethically, and usefully.

• Qualitative researchers must quickly establish that the focus group is a safe

place for all participants to share their thoughts, feelings, and experiences.

Setting up initial ‘house rules’ about the importance of respect and

confidentiality can aid in this endeavour.

• A write-up of qualitative research first requires descriptive information about

the sample in relation to all relevant variables, before moving onto thematic

analysis. Summary data should not be redundant; it should be provided if it

is seen to help contextualize the themes and sub-themes to be discussed

later. Where appropriate, sample characteristics should be analysed for

whether the sample is representative.

• Qualitative researchers are expected to deeply explore and offer underlying

meanings and relationships. As such, they are subjective and speculative

by nature. Cogent theories informed by previous literature where possible

should be offered, but caution should also be called for.

• A concept map may help qualitative researchers visually explain how and

why they differentiate a key theme from a sub-theme.

• A qualitative researcher is aware of their power and uses it ethically;

honouring other people’s truths and helping effect change for vulnerable

and/or marginalized people where possible.

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Reflective Questions

Extract 2 is from the discussion on the first broad theme of community awareness

of mental illness. It overlaps with the discussion on the second broad theme of

stigma surrounding mental illness. It is for this reason that focus group schedules

are typically semi-structured. If a discussion has naturally touched on a question

one intends to ask later, it could be skipped. Keeping in mind that it is challenging

to reflect on qualitative data that is not meaningful to the qualitative researcher,

read Extract 2 and consider the following reflective questions to help identify your

own approach to analysing the dataset.

1. What do you identify as the key themes?

2. What do you identify as the sub-themes within each key theme?

3. Are you satisfied that you have exhausted all key and sub-themes, and

why?

4. Are there any summary tables you might create from the qualitative

data?

5. How would you write up one of the key themes you have identified in a

paragraph that is both descriptive and analytical and progresses the

field in a way that is interesting, comprehensive, and succinct for a

reader?

Further Reading

Babbie, E. (2016). The practice of social research (14th ed.). Boston, MA:

Cengage Learning.

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and the research design:

Choosing among five approaches (4th ed.). Thousand Oaks, CA: SAGE.

Denzin, N. K., & Lincoln, Y. S. (2017). The SAGE handbook of qualitative

research (5th ed.). Thousand Oaks, CA: SAGE.

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Sawrikar, P., & Muir, K. (2017). Toward a family-oriented treatment approach for

consumers and carers of mental illness. International Journal of Mental Health,

47(2), 15–183. doi:http://dx.doi.org/10.1080/00207411.2017.1367448

Sawrikar, P., Muir, K., & Craig, L. (2011). Focus group research for beyondblue

with consumers and carers. (Final Report prepared for beyondblue).

Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and

thematic analysis: Implications for conducting a qualitative descriptive study.

Nursing and Health Sciences, 15(3), 398–405. doi:http://dx.doi.org/10.1111/

nhs.12048

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http://dx.doi.org/10.1080/00207411.2017.1367448

http://dx.doi.org/10.1111/nhs.12048

http://dx.doi.org/10.1111/nhs.12048

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