Focus Group Discussions

Focus group discussion is a data collection method by conducting interviews with a group (Patton, 2002). It is a group systematically selected composed of people of different expertise, experience and interest in a particular area of study (Courtois and Turtle, 2008). The participants may not be familiar with each other, as they are selected based on their relevant experience and knowledge of the research objectives (Krueger, 1988). Focus groups involve group discussions around a single theme in order to create candid conversation about the issue (Morgan, 1997; Kreuger, 1988 cited in Bloomberg and Volpe, 2008). Focus group discussions are conducted at the policy implementation level of analysis with street-level bureaucrats (Lipsky, 1997).

In this research, the focus group discussions involved registered nurses only as they were better placed to speak their minds and to respond to the ideas of others on brain drain issues in the Malawi public health sector. Researchers believe that within such an atmosphere ‘a more complete and revealing understanding of the issues is obtained’ (Bloomberg and Volpe, 2008:84).

Focus group discussions are relatively easy to assemble, inexpensive and less time consuming. They also provide ease in data collection because they are pre-grouped according to homogeneity (Ulin et al., 2004). Focus group discussions allow huge amount of data to be collected in a short period of time (Morgan, 1997). Participants were able to bring up issues they felt were important to them and challenged each other’s views unlike in semi-structured interviews. As such, the researcher was able to get a more realistic account of what the nurses thought about determinants of brain drain in the Malawi health sector.

Devine (2002:199) highlights that focus group discussions are pivotal because they have a rare characteristic of allowing participants to ‘interact in a discussion on a particular topic, agree with other interviewees in some respects, disagree in others, and raise new issues and concerns’. This attribute was instrumental in bringing out pertinent issues under study.

According to Bryman and Bell (2011), the dynamics of group discussions could lead individuals to define business problems in new and innovative ways and to stimulate creative ideas for their solution. Miller and Glassner (1997) opine that sharing participants’ membership group may engender a sense of trust in the researcher as participants are able to understand the researcher’s questions and this may lead to answers that are more accurate. Focus group

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discussions may be conducted with the same individual participants who took part in interviews, or with other members of the same population, or with people with expertise in the research subject who would be able to comment on what has, or has not, emerged (Ritchie and Lewis, 2003).

A digital voice recorder was also used just like in the semi-structured interviews to record the interviews. Notes were written on a note pad and the participants’ decision to participate in the discussion was voluntary. Each focus group session took an average of two and a half hours at the interviewees’ organisation premises. Transcription began within two days to ensure timely familiarisation with the data. Again, for ethical reasons, the data provided were treated in the strictest confidence, and that the researcher did not make individuals identifiable attributes.

3.7.1.2.1 Recruitment of Respondents for Focus Group Discussions

The respondents for focus group discussions were recruited using convenience non- probability sampling technique (Ghauri and Gronhaug, 2002; Pole and Lampard, 2002). The registered nurses who were available at the time the researcher visited the sites and willing to take part in the discussions were involved. This was the case because focus group discussions were carried out in a hospital environment where respondents were busy due to the nature of their work. It was difficult to make prearranged contacts. However, within this sample technique, the researcher made deliberate attempts to have representation from both male and female nurses.

In this study, three focus groups of interviewees helped to generate addition information to have an insight understanding of determinants of brain drain in the Malawi health sector. This research, the three focus group discussions one from each region of Malawi involved four registered nurses at Mzuzu Central hospital (North), six nurses at Kamuzu Central hospital (Central) and five nurses at Queen Elizabeth Central hospital (South). Initially, it was planned to have five registered nurses in each group but the focus group at Mzuzu Central hospital had four nurses only not five because of shortage of nurses in the wards. The focus group at Queen Elizabeth Central hospital had five nurses as initially planned while at Kamuzu Central hospital had six participants because one extra nurse asked before we started to join the group discussions. The group allowed her to take part in the discussions. Note should be taken that the variations of participants did not affect the group discussions.

In this research, the focus group discussions involved a combination of nurses who were interviewed and not interviewed due to their availability at the time the researcher visited the health facilities. The participants had equal opportunity to participate in the discussions.

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However, key informants were not included in the focus group to ensure nurses’ free participation without fear.

3.7.1.2.2 Limitations of the Focus Groups

The focus group technique has limitations. According to Punch (2005), they pertain to problems associated with group culture and dynamics, and in achieving balance in-group interaction. As such, the concern is how to deal with such dominance of individuals who influence in focus group discussions. This is the case as while some participants may dominate the discussions, others may not give their views but passively follow the group trend (Ghauri and Gronhaug, 2002; Pole and Lampard, 2002). According to Taylor and Bogdan (1998), most people cannot be expected to say the same things in a group that they might say to an interviewer in private. Group discussions run the risk of not fully capturing all participants’ viewpoints (Hancock and Algozzine, 2006).

As stated by Krueger (1988), focus group interview should be carefully planned to gain views on a defined area of interest in a permissive non-threatening environment and conducted by a skilled interviewer. This discussion is comfortable and often enjoyable for participants as they share ideas and perceptions. Group members influence each other by responding to ideas and comments in the discussion (ibid). In this study, the researcher was able to direct the group discussions without losing crucial information.