Dr Faith Gibson, Lecturer in Childrens Cancer Nursing Research

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Using Focus Groups with Children and Young People

• Dr Faith Gibson, Lecturer in Childrens Cancer
  Nursing Research
• Institute of Child Health and Great Ormond Street
  Hospital
• for Children NHS Trust, London

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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.

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Overview of the Session (90 minutes)

• Activity-ice breaker
• Presentation Theory and practice of focus
  groups
• Activity
• Presentation Running a focus group
• Closing comments

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Ice Breaker
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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

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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

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The story behind their use

• Origins traced back to 1920s
• 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

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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

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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

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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

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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

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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

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Working within an ethical framework

• 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

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

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Post it pyramids
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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

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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

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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

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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

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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

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Using activities

• Ice-breaker
• Age-specific activities, designed for the purpose
• Brainstorming
• Sentence completion
• Visual prompts
• Vignettes
• Fantasy wishes
• And
• Emphasise participation

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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

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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

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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

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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

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Secret Box