Qualitative research for substance abuse prevention: focus groups and key informant interviews partnerships for Success-II Assessment Training

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Qualitative research for substance abuse
prevention focus groups and key informant
interviewspartnerships for Success-IIAssessment
Training

• Liz Lilliott, Ph.D.
• BHRCS-PIRE

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Todays purpose

• Review the basics of qualitative methods
• Provide tips on conducting focus groups and key
  informant interviews
• Describe the protocol for conducting focus groups
  or interviews for the PFS-II assessment
• Practice conducting a focus group.

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Defining Qualitative Research
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• Quantitative

• Qualitative

• Descriptive
• How and Why
• Structured and semi-structured Interviews
• Focus groups
• Observations
• Participant-observation
• Photovoice
• Helps define nature parameters of an issue,
  the context- helps you improve impact
• Story telling

• Countable
• Who, what, when, where how much,
• Multiple choice response surveys
• Rates of events (DWIs, suicides, births to teen
  parents, numbers of people attending)
• Can measure impact best- what funders like
• Bean Counting

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Representativeness- Those you gather data from
should represent the population you study

• Quantitative

• Qualitative

• Typically smaller numbers of participants
• Representation who speaks for whom
• Seek Key participants that represent a category
• Tribal council
• Chief of police
• Seek individuals who represent the range of
  experiences in your target group

• The perfect sample is 100 of your target group.
  (but then its technically not a sample)
• Must attend to demographic representation- age,
  race, geography, gender, student, etc.
• Sampling methods (how you choose your
  participants) are critical in interpretation
• Eg., Randomized vs. Convenience

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Why qualitative research?

• Helps you get to the research questions that ask
  WHY and HOW
• Social/Cultural/Historical aspects of phenomenon
• Why dont more people get arrested in this
  community for providing alcohol to a minor?
• How does the Latino community use and share
  prescription drugs?
• How has the community responded in the past to
  the problems of alcohol?

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Practical reasons for qualitative approaches

• May not have the resources to collect accurate
  quantitative data
• To reach sectors who respond well to direct
  interaction
• To identify issues that do not emerge in
  quantitative approaches, problem solve
• Offers an opportunity for participants to have a
  real voice

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For the PFS - Contributing Factors

• Qualitative research will help you define
  contributing factors as they affect different
  populations in your county.
• How do Columbus youth access alcohol vs. youth
  in Deming?
• How do immigrant parents address UAD?
• How do Navajo elders store and share meds?
• How do different social groups understand how
  drinking laws are enforced?

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Shared assumptions among qualitative researchers

• There is no such thing as The Truth. You can get
  at the multiple truths through qualitative
  research.
• You are not there to help, counsel or advise your
  research subjects. Your research, if done well,
  may ultimately help them.
• Your data are the collective responses of your
  participants their view(s), not necessarily
  yours

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Always assess your own biases and assumptions

• Be critically aware of how you are both similar
  to and different from your subjects, and never
  assume that any similarity (e.g., being the same
  sex or ethnicity) means that you automatically
  know or understand the experience of the
  other.
• We all live in a world that is strongly
  influenced by cultural processes nobody is more
  influenced by culture than anyone else.

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Focus groups and key Informant Interviews

• Nuts and Bolts for PFS-II

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Focus groups are good for

• Gathering information about a group of peoples
  beliefs
• Testing theories/hypotheses (from data gathered
  in other ways or to help you shape the
  development of other data collection)
• Getting feedback on a specific product (e.g., a
  media campaign, a specific prevention program)
• Helping people come to a consensus over a topic,
  sharing ideas, and resolving problems
• In relating their ideas to one another, you test
  the strength of peoples attitudes and beliefs.

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Key Informant interviews are better for

• Going deep into identifying the source and
  resolution of problems
• Gaining specific information about an
  individuals experience, knowledge and beliefs.
• Very sensitive topics - depending on your
  context.
• Focus groups with participants with different
  stakes in a problem can be problematic.

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Practical matters to consider

• Certain populations can be hard to get into a
  room at one time for a focus group
• Do you need childcare?
• Do work requirements make it difficult?
• Are local politics too delicate that privacy may
  be violated or tensions may erupt?
• Might you have language or other accessibility
  issues?
• Is there a neutral space where you can meet?
• It may be better to conduct interviews if these
  are strong barriers

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For interviews.

• Try to conduct it where you will be relatively
  free of interruptions and where the person can
  feel safe and private.
• Will your interviewee represent an agency or that
  individuals personal knowledge and experience?
• Be prepared that in some cases staff may need
  supervisor authorization to talk with you.

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Ground Rules

• Explain the purpose of what youre asking these
  questions
• Ask participants not to share information with
  people outside of this room, especially who
  (very important in small communities)
• Best to offer privacy of information (for
  groups cannot be completely protected). Do assure
  that nothing will be shared publically that can
  identify a participant
• Encourage participants to speak amongst each
  other (not just about answering the moderator)
• Nobody has to answer a question they dont wish
  to
• Try not to speak over one another
• No right or wrong answers the participants are
  the experts, not you
• Also APPLIES TO INTERVIEWS

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Focus Groups/Interviews for PFS-II Assessment

• Each county should collect qualitative data with
  each of these groups for their assessment.
• Conduct at least one focus group with
• Health Care Providers, Doctors, Pharmacists (or
  at least 3 key informant interview(s)
• Law Enforcement (or at least 3 key informant
  interview (s))
• Youth (12-17)
• Young Adults (18-25)
• Community members at large (also in Spanish)

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Things to consider for focus groups

• Think about the demographics of your community
• Should you do more than one group in one category
  in order to capture the diversity of your county?
  
• Are there other groups you should consider to
  improve your approach?
• Community/tribal leaders
• Alcohol retailers
• School staff
• Parents of teens
• People in recovery
• Also, always think of these as an opportunity to
  expand your coalition.

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Focus Groups Practical recommendations

• Use a liaison of that community to help you
  recruit.
• Offer incentives and food/drink
• Peoples contributions and time are valuable
• Think of culturally appropriate incentives
• Cash incentives may be appropriate for some
  (community members) may not be for others (law
  enforcement).
• 5-10 people
• Recruit for 12, as some will often drop. Any
  less than 5, you might consider doing individual
  interviews instead.
• Find a neutral private space to conduct the
  focus group.

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Representation issues to think about

• Recruit in relation to your research question
• If you want to know what women in the community
  say they think and do, make your group is just
  women from the community.
• If you want to know what people think women in
  the community think and do, it can be both men
  and women.
• Try NOT to recruit only those who are on your
  side you want to think through different sides
  of an issue.
• Try to be representative of the group.
• Parents of youth 12-20 should not just be 5
  parents already participating in your prevention
  coalition try to recruit for individuals who may
  not know each other well.

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FG practical recommendations

• Get names and numbers and call to remind
  participants. Then call again.
• Can offer participants a copy of the questions
  so they know what to expect- but people should
  not have to prepare.
• Best to have a neutral individual moderate the
  focus group
• Depending on context, a community member or an
  outsider can be more effective.
• Or recruit a local college or graduate student in
  sociology, anthropology, public health, social
  work to conduct the groups
• Use a note taker, or scribe. If the context
  permits, record the discussion so you can refer
  to it later.

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Remember

• There is no focus in a focus group of more than
  12 people
• Not about polling people for their opinion
  about capturing the general sentiment of a group
• Consider using the consent forms provided and
  adapt as necessary
• Use the demographic form provided and consider if
  you need to gather additional data about
  participants

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Also remember

• Your interviewee is the authority, NOT YOU.
• Its not useful if you talk more than the
  participant does
• Always assume the interview/FG will take longer
  than you plan.
• Qualitative data collection is exhausting must
  analyze, ask good probes, respond appropriately,
  take notes, keep people on track, stay on time,
  and resolve problems (like that gentleman who
  wont let anyone get a word in edgewise)
• Write up your thoughts and notes as soon as
  possible.

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Techniques for conducting qualitative
interviewing/focus groups

• You do not have to ask every question as worded
  reword so your audience understands
• Use probes to help you but be prepared to follow
  an interesting stream of discussion.
• Be neutral try to avoid agreeing with people
  but encourage them to continue to speak.
• Uh-hum Okay instead of yes youre right.
• Thats interesting. Can you tell me more about
  that?
• How did you learn that?
• Can you describe for me a little more what
  thats like?
• Im sorry, Ive never heard that term/concept
  (used in that way). Can you explain it to me?

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Focus group techniques

• Be prepared if participants bring up emotional
  topics (but they should never be required to).
• People in small communities, or who know each
  other well will act more comfortable around each
  other BUT they also tend to use foreshortened
  references to events like what happened when
  the principal found out , you remember when
  or you know how they are/how it is.
• Always ask people to explain/describe/elaborate.
• If you are an outsider, this can be used in your
  favor to ask people to explain issues and events
  in detail.
• If you are an insider, ask them to explain as
  they will have their own perspective of the
  event.

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FG Getting people to talk

• If you find that people are not offering
  different perspectives on an issue, state an
  opposing position Ive heard some people here
  say that(law enforcement are not doing their
  jobs). Have you ever heard that?
• People will often speak about what others think
  if they do not feel comfortable stating what
  they think.
• Encourage discussion by asking others to offer
  their point of view (avoid words like opinion),
  Does anyone have something to say about that?
  Has anyone had a different experience?

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Qualitative research techniques

• With talkers and digressers, try to redirect
  to the next question, or in focus group, ask
  someone else to have a chance to talk.
• Reinforce your neutrality people often find it
  hard to state negative opinions about things,
  especially when they think that you represent a
  certain position on the issue.
• i.e., participants may insist that allowing
  minors to drink is terrible if they also believe
  that you think that. That is also the most
  socially acceptable position.
• Summarize and ask for people to confirm your
  synthesis. If there are differing positions,
  summarize them and ask people to tell you if you
  are on track.

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Taking notes

• Words and phrases, star or underline important
  ones
• If interviewing 11, no need for a scribe (more
  than 1 person can overwhelm the participant).
• FG scribe can type or hand-write as much as
  possible what people say.
• Your own impressions and notes about unspoken
  behaviors that may not be captured on audio
  recording (rolling her eyes).
• Save some time after the event to debrief with
  scribe and write up general notes and
  impressions.

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Coding- choose a strategy according to your
purpose

• Question-level coding summarize all the ways
  that individuals have answered particular
  questions, with a focus on your overall question.
• -throw out extraneous information
• -For write-up, describe the dominant responses,
  with details about alternative explanations or
  points of view
• Theme coding notice what particular themes
  emerge again, keeping your overall question in
  mind.
• How do medical providers prevent drug shopping?
  Emergent theme challenges of rural service
  providers.
• Free coding most time-consuming but allows for
  more discovery about a topic.

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Analysis of qualitative data

• DO
• Look for common themes
• Explore different positions on a topic
• Think about relationships between demographic
  factors and peoples positions (e.g., more women
  seemed to think that UAD was a problem with the
  schools)
• Identify good quotes and use in write- up in
  order to illustrate your point.

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In analysis the point is NOT .

• To determine whether people are right or
  wrong.
• To diagnose, psychoanalyze, or interpret deeper
  sentiments, but to analyze surface patterns.
• To try to pull out hard data peoples
  impressions are whats important.
• To count peoples responses- but it is ok to say,
  a minority took this position.

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Protocol for Final reporting
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Recommended roles (can vary)

• Program staff supervise recruitment and
  logistics.
• Interview/focus group recruiter
• Work with liaison to identify good sites,
  potential participants
• Determines incentive, scheduling, calls and calls
  again.
• Focus group facilitator- one or multiple
  coalition members
• Scribe
• Facilitator with scribe most likely ones to code,
  write up results
• Recording FGs will be helpful to fill in the
  blanks but exact transcriptions are not required.
  
• Results should be reviewed with coalition before
  submission.

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Write-up

• Complete the questions in report form about each
  focus group/interview and each intervening
  variable
• Do not provide names of fg/int participants
• Additional analysis to consider
• Compare groups perspectives as relevant (were
  there important differences between groups
  responses?)
• What was the most important information learned
  for each IV?
• In what areas do you and your community need to
  build capacity?

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Troubleshooting

• Start as early as you can.
• You may not be able to conduct a focus group with
  one of your chosen groups.
• You may find that only 3-4 people show up to your
  focus group, though you have recruited for more.
  Do the group the best you can, and see if you can
  do interviews with those who couldnt show.
• Please call or email Liz with any questions or
  concerns lilliott_at_pire.org or 575-313-7029.

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Materials

• Sample consent forms
• Interview/focus group questions (Spanish for
  community members)
• Recommended introductory script (Spanish
  English)
• Sample demographic sheet
• Final report assessment template

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Try it out!
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Practicing a focus group

• Get into 5 groups, try to get at least one member
  from each county
• Select an interviewer, scribe and the remainder
  role play being participants
• Ask a few questions from one focus group protocol
  
• Participants can try different attitudes so the
  facilitator can practice
• Not wanting to talk
• Talking too much
• Talking over the others
• Reflect together on techniques, prompts, probes,
  language of script

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Thanks!

• Liz Lilliott
• BHRCS-PIRE
• Albuquerque, NM
• lilliott_at_bhrcs.org
• 505-765-2330