Data collection: Phase one focus group

The aims of the phase one focus group were:

• Gain an appreciation of the CTR role.

• Gain an understanding of the role in terms of its creation and purpose.

• Gain an understanding of the issues attached to the role such as challenges, concerns and experiences.

4.8.1 Phase One - Focus groups – theoretical overview Introduction: What are focus groups?

There are many definitions pertaining to focus groups, for example Merton and Kendall’s (1946) noteworthy article on focus groups development recognized them as a way of exploring participant’s specific experiences or opinions about a topic under investigation. Powell et al., (1996) acknowledge focus groups as individuals assembled to discuss their personal experience on the chosen subject of research. Weerakkodys (2002) definition concerns assessing the participant’s oral expressions of opinions on a specific discussion. A later definition by Webb and Doman (2008) define this method as a form of interviews consisting of a small number of people brought together by the researcher to discuss a particular topic. It is the researcher, who usually takes on the role as the moderator that “focuses” the group discussion. Overall it is noted that all definitions are in agreement on the role of focus groups, highlighting the gathering of individuals to gain information about their views and also experiences.

Earlier works by Kitzinger (1995) explained that focus groups capitalise on the communication of the research participants to acquire the required data. Likewise group interactions are also another key factor, which focus groups capture as part of the method. This permits participants to talk to each other, to ask questions, share their experiences and point of views. Gibbs (1997) recognised the unique characteristic of focus groups, in the interaction between participants in producing the insight and data. This is reinforced by Redmond and Curtis (2009) who acknowledged the essence of focus groups is to understand the social dynamic and interaction between the participants through the assortment of verbal and observational data. Focus groups should not be confused with group interviewing, hence it is important to differentiate between the two. Group interviewing is self- explanatory as it involves interviewing a number of people at the same time, the emphasis being the questions and responses between the researcher and participants. Webb and Doman (2008) point out that a group interview is to obtain the individual views of each participant in a cost effective manner, whilst the focus group involves discussion amongst the participants, facilitated by a moderator.

4.8.2 Rationale and uses of focus groups

The main purpose of using focus groups is their ability to discover participants’ attitudes, draw out their feelings, beliefs, experience, reactions and motivations. Kitzinger (1995) acknowledged that this is useful, not only can the participant’s knowledge and experiences be explored; it can also be valuable when examining what people think, how they think and why they think that way. Likewise they offer participants the opportunity to hear and respond to a variety of viewpoints; this in turn is useful as it can promote discussions, whereby one participant’s opinions may generate a chain of other views and responses (Beyea and Nicholl, 2000). The group interaction is crucial to any organised focus group, as it allows participants to respond to and build upon the responses of other members in the group, therefore, allowing researchers to immerse themselves in other people’s lives (Redmond and Curtis, 2009). Krueger and Casey (2014) see focus groups as fundamental for any researcher, as it allows them to help understand, explain and interpret the rich detail from the participant’s perception and feedback.

Focus groups may be used in a range of different situations, Stewart et al., (2014) draw attention to seven distinct common uses for focus groups, as outlined below:

• Collecting general background information on a topic of interest • Generating research hypotheses

• For purpose of stimulating new ideas and concepts • For identifying potential problems

• Generating impressions of service, programmes or products

• For learning how participants talk about the topic of interest which can assist in the design and construction of other research tools

• For assisting with interpretation

Within a healthcare setting, Kitzinger (1995) identified that focus groups have a place when examining peoples experience of disease and of health services and effective for exploring the attitudes and needs of healthcare staff. In addition, Pope et al., (2002) comment that focus groups are especially helpful in assessing user views of services and healthcare provisions whilst, also revealing useful information on quality

of care; they are also valuable for finding out about shared experiences and have been successfully used with users and staff. Webb and Doman (2008) explain that within a healthcare setting, focus groups have been favourable particularly when exploring a range of issues from clinical practice, to educational, managerial or professional perspectives. Similarly, they can also be used to ascertain views of patients, carers and general public / lay people.

4.8.3 Benefits of focus groups

There are a number of benefits to the use of focus groups in research. Focus groups are designed to elicit a range of experiences, attitudes and ideas by interviewing people in a short time. Kitzinger (1995) acknowledged that if the group works cohesively, trust begins to develop and as a result the group may explore findings to a particular issue. Gibbs (1997) highlights that the benefits of focus groups should not be underestimated, as they are able to afford the opportunity to be involved in the decision making process, provide collaborative working and can be empowering for some of the participants. Whilst Webb and Doman (2008) acknowledge focus groups have the possibility of providing a greater breadth of coverage of topics with additional benefits of developing a sense of camaraderie amongst the group. In addition, any issues offered by the participants may have not been anticipated by the researcher which can effectively add a different stance to the research topic (Crossman, 2016).

From a practical perspective, Woodring et al., (2006) comment that focus groups are remarkably versatile, flexible and that their ability to provide exploration is fitting for qualitative research. In relation to this research, a particular benefit is it can be used to develop potential questionnaires or in this case interview questions. This will ensure that the questions are appropriate, pitched at the right level, unbiased and relevant; also ensuring that the language and experiences are represented of the participants and not just those of the researcher (Webb and Doman, 2008). Fleming and Parker (2015) further address several advantages such as they are fast and easy, can be promptly organised, inexpensive, generate ideas in a short time in length and the data retrieved can be easily and swiftly analysed.

4.8.4 Limitations of focus groups

Although focus groups have many benefits, a number of limitations do exist. Notably a phenomenon known as the groupthink syndrome. The groupthink syndrome is effectively when group members have the inclination to restrain their disagreement in favour of maintaining consensus within the group. It was Irving Janis that introduced the theory of groupthink in his landmark study Victims of Groupthink in 1972. His theory concluded that groups often experienced groupthink and as a result groups that displayed groupthink symptoms were more likely to produce poor decision outcomes. Hassan (2013) adds that to preserve harmony or conformity in a group often results in incorrect decisions; group members also curtail any conflict to reach a consensus.

Similarly, another phenomenon known as the spiral of silence theory a phrase coined by Noelle – Neumann (1974) has often been reported when using focus groups. The occurrence of the spiral of silence theory stems from the idea that individuals are less inclined to speak out, due to fear of isolation, if they feel their opinions differ from the majority opinion (Lee & Chun, 2016). Weerakkody (2002) acknowledges that where participants feel afraid to express any views maybe due to their terror of losing face, being embarrassed or shown up in front of others in the group. The facilitator has a crucial role in ensuring parity of views throughout the group is heard.

Participants may also provide opinions and feedback which they propose as socially desirable, a term which acknowledges that they would rather be in agreement with the group than actually say what they truly feel or think, essentially putting them in a positive light with the researcher. Gibbs (1997) acknowledged that researchers should not assume that participants in a focus group are expressing their own individual view; therefore it becomes difficult to recognise an individual message.

Conversely there may be some participants who may get over confident and too sure of themselves during the discussions or articulate overstated views and opinions. Wimmer and Dominick (2014) define this as the group leader effect, which essentially emphasises the issue of a so-called group leader who is more vocal and dominates the focus group. The main concern from a researcher’s perspective is

they may monopolise the discussions taking place and potentially persuade or hinder the opinions expressed by other participants in the group. The outcome of such an incident can be negative, not only can it create anger amongst the group it could overall impact on the discussion taking place and may pollute the data collected by the researcher. One method to remedy such a situation can be through a skilled facilitator who can defuse such individuals and their negativity on the group, by encouraging opportunities for other members to provide their views and feedback or discreetly keeping an eye on the difficult individual (Stewart et al., 2014). Characteristics of certain participants in the group may also have a bearing on the success of a focus group; characteristics such as personalities, culture, status, skills and even life experiences. Participant with low status in the group may become more engrossed in being accepted by a more powerful higher status participant than actually concentrate on the topic in hand. (Fern 2001, Hanafin 2016).

On a more practical level, organising a focus group can sometimes be difficult to bring together, there may be issues regarding assembling a typical or true sample for the particular research because of the small sample (Crossman, 2016). Likewise focus groups may inhibit certain groups of people for example those who are not confident, shy and those with communication problems and possibly even special needs. Krueger and Casey (2014) report any discussions taking place during a focus group may also discourage some people from participating, as the sensitivity of the topics discussed may create trust issues with other participants.