Focus group discussion

A focus group consists of a number of people, usually six to ten, who are roughly of equal status and have identifiable common interests, characteristics and a shared knowledge. Unlike a one-way flow of information in individual interviews focus groups generate data from interactions of group discussions. Listening as people share and compare their different points of view about what they think and why they think the way they do provides a wealth of information (American Statistical Association, 1997). Under the guidance of a moderator, the participants discuss specific questions or areas of expertise. FGDs resemble lively and informal discussions among friends who share opinions and feelings about a topic for a

predetermined time. FGDs are organised and directed towards understanding people’s feelings and views towards a particular subject, product or service (Krueger & Casey, 2000). Focus group discussions can also take the form of a workshop, where there is a structured agenda with specific group activities accompanied by plenary sessions (Finch & Lewis, 2003). Focus groups have gained in importance in health research and are a great asset in exploring people’s own views and understanding of health and illness (Pope & Mays, 1995). FGDs have the capacity to bring out the multiplicity of views, areas of consensus and voices of dissent in relation to a socio-cultural environment (Kitzinger, 1995).

In this study, FGDs were conducted with children and with adult community members. Focus groups were held separately for males and females to avoid gender dynamics. Other subgroups were younger and older children, younger and older adults, residents and IDP population, orphans, married girls, and members of the ‘White Army’. Group compositions should be as homogenous as possible as the unit of analysis is the group (Delgado, 2006:150). The aim was to understand participants’ perception of children’s health needs; health risk and protective factors in their environment and to elicit participants’ views about potential and existing challenges and opportunities for children to address important health issues at various levels. FGDs with adult community members also included activities such as historical timeline diagrams, mapping and ranking of health risks for children.

Age groups in children were defined using the classification of the Pan American Health Organisation (PAHO), shown in Figure 4.4. Although this classification has been used in different settings, it should be noted that it has not been validated for South Sudan. The younger and older boys and girls were each divided into two groups at the pre-adolescence and early adolescence cut-off points. Both age groups were equally represented among the boys and the girls.

The cut-off point for the two groups of younger and older adults was 35 years. This was derived from interviews and the general perception of adults that old age would start around that age. Both cut-offs were used as a rough guideline and no one who finally reported to be a little younger or older was sent away. While children knew their age, this was not always the case in adults.

Table 4.4: The stages of adolescence PAHO classification.

Age 8 9 10 11 12 13 14 15 16 17 18

Girls Pre-adolescence Early

Adolescence

Middle Adolescence

Late

Adolescence

Boys Pre-adolescence Early

Adolescence Middle Adolescence Late Adoles cence

The number of FGDs conducted largely depends on whether complementary methods are being used (observation, unstructured and semi-structured interviews) and the knowledge required from a particular group (Ervin, 2000). If detailed knowledge is required about a particular subject with a particular subpopulation, then two or three focus groups are seen as appropriate. If the study is of a wider scope, one FGD in each important subgroup may suffice. A general rule that applies is to continue focus groups until no new information is gained (Ervin, 2000).

The FGD’s were conducted with three trained research assistants: one moderator, one note taker and one observer. The moderator guided the discussion and followed up the discussion with appropriate probes for depth and clarification. The note taker and the observer were responsible for noting down verbal and non- verbal responses and ensuring an on-going digital recording. All FGDs were conducted in Nuer language so that the flow of the conversation was not interrupted through translations into English. FGDs with children lasted no longer than 60 minutes. FGDs with adults lasted no longer than 90 minutes. The strengths and weaknesses of FGD’s are presented in Table 4.5.

Table 4.5: Strengths and weaknesses of FGDs

Strengths Weaknesses

Useful in establishing ‘face validity’ (verifying whether the researcher and the participants are talking about the same thing) and internal triangulation or corroboration (verifying common perceptions) (Ervin, 2000).

Unsuitable for precise, probability oriented social science because it is next to impossible to select a random sample of participants. A roughly proportionate sample of people who represent the community is the best option and only possible if a researcher has become familiar with the community (Ervin, 2000)

Possibility to sample the degree of consensus and uncover different opinions by hearing a number of people (Ervin, 2000).

The shy, the non-vocal or hostile members of a community may not be adequately represented in focus groups (Patton, 2002).

A good way of establishing the context for research and setting the stage for developing interpretations that remain true to the way members of the community think (Krueger & Casey, 2000; Ervin, 2000).

Reliability demands the same results from the same methods used every time with different researchers. But each focus group has a different dynamic and takes on a shape of its own. To some extent it has to be recognised that each moderator can influence the tone and direction of the group discussion (Ervin, 2000).

Provides opportunities for checking out the meaning of concepts that are important for the research in order to develop further lines of questioning (Ervin, 2000).

Group facilitation skills are demanding and need social skills. Screening for moderators and training can be extensive, time consuming and costly (Patton, 2002).

Data are generated through interaction between participants. Responses are spontaneous and less influenced by the researcher who is more of a listener (Finch & Lewis, 2003).

Focus groups can raise expectations among participants especially in applied research (Ervin, 2000).

The flexible nature of an FGD allows the moderator to rephrase questions that are misunderstood (Ervin, 2000).

Focus groups can occasionally raise ‘more heat than light’. Conflict and bitterness can arise over sensitive issues that are normally avoided. People may be condemned for revealing ‘secrets’ to outsiders (Ervin, 2000).

People have a face to face opportunity to correct one another which cannot be done in individual interviews (Ervin, 2000).

Confidentiality may not be totally assured as there is little control over what participants discuss outside the research environment (Ervin, 2000).