Transplant Coordinator Focus Groups
7.11. INTERACTION FORMATS
Transplant professionals
I ensured that I arrived for interviews at least fifteen minutes in advance, in order to find complex locations and to address any unexpected circumstances. There were numerous cases where participants were late for the interview due to other commitments. I either waited for the participant, or rescheduled these meetings, depending on the situation. Several of the participants in my research perform highly demanding clinical and patient-related tasks, which must take priority over research interviews. I was aware of this, and the possibility of waiting, or rescheduling interviews, was built into the data collection timeframe.
I occasionally made notes during the interview, though these were kept brief in favour of portraying an interest in what a participant was saying. This was achieved through active listening, paraphrasing, reflecting, body language and eye contact, hence establishing a rapport between the participant and myself (Guion, Diehl & McDonald, 2001).
After thanking the participant for the interview and leaving the interview location, I recorded my observations about the interview location, the participant and the interview itself. Participants were sent a formal thank you letter by e-mail.
Transplant coordinators
Transplant coordinator focus groups were conducted following the guidelines of Krueger and Casey (2000). This involved clearly delineating my role and that of the research assistant, familiarity with the data collection tool, paying attention to seating and body language and using techniques to facilitate discussion, such as pauses and probes.
In their guide to focus groups, Krueger and Casey (2000) argue that the demographic characteristics of the moderator (in this case myself) and the assistant moderator
(hereafter referred to as the research assistant) may have an impact on the dynamics of a focus group discussion and should be considered with care.
I am female, under the age of thirty years and a fluent English speaker. I also speak second language French and Afrikaans. I decided to moderate the discussions myself because I was familiar with the topic at hand, and had established a relationship of trust with a number of the participants over a period of approximately two years.
Familiarity with my research questions, objectives and topics also ideally positioned me to probe certain points which were deemed highly relevant, whilst still allowing the discussion to flow freely (Krueger & Casey, 2000).
A research assistant was employed to offer support during the first focus group but not during the second. This was because there were a large number of participants in the first group, and a more manageable number in the second. Furthermore,
significant travel was required for the second group, and this was impractical for the research assistant. The research assistant was female, under the age of thirty years and spoke both English and Afrikaans fluently. She was highly qualified, with a financial background and extensive experience in consultancy work. The research assistant was able to appreciate the importance of her role in facilitating audiotaping, transcription, and logistical troubleshooting whilst withholding her personal views and opinions of the topics under discussion. Added to this, the research assistant also possessed excellent social skills, and was able to make participants feel comfortable as they entered the venue and had breakfast before the group commenced. The
research assistant made extensive notes on her perceptions of the group dynamics, and did not participate in the discussion (Krueger & Casey, 2000).
There were specific characteristics of the participants which I considered when making choices about group facilitation. These included the following:
• All participants in the groups were English speaking, some were also proficient in Afrikaans, isiXhosa, isiZulu and Sesotho.
• All participants were over the age of thirty.
• All participants were female.
• All participants were registered nurses.
Given that all participants were English speaking, it was not necessary to enlist the services of an interpreter to conduct the discussion in a language other than English.
Hence, English was chosen as the official language of the groups. The research assistant was available to translate Afrikaans phrases or terms that were used during the first group, however this proved unnecessary. Both I and the research assistant were younger than the participants, and this assisted in establishing an easy
relationship amongst the group as there was no sense of the participants being
subordinate to the research team. All those present were female, and I think this may have led to more open discussion. As the participants were all registered nurses, it would not have been appropriate to have another medical professional present, as this may have also led to power asymmetries amongst the group. Hence, the research assistant did not hold a healthcare qualification.
Where possible the research team set up the venue before participants arrived.
Dictaphones were placed at either end of the table, signaling from the outset the intention to record discussions. Number tents were also positioned on the table to aid in transcription and to take into account the dynamics which I had previously observed in the group. For instance, participants who seemed quieter were seated opposite me in order to facilitate maximum eye contact.
As they entered the venue, I greeted the participants and introduced them to my research assistant. The participants already knew one another. In the first group, participants were invited to have breakfast and many took the opportunity to catch up and chat with the research team. In these interactions, the research team ensured that discussion was kept to general topics and steered away from transplantation as far as possible (Krueger & Casey, 2000). All consent forms were distributed, signed and collected from participants before the groups officially began.
When everyone was seated, I began the discussion. Dictaphones were turned on and these were checked to ensure functionality throughout the discussion. I welcomed participants and thanked them for attending. Ground rules for the group were established, and participants were advised as to the group format. In Group 1, each time a new participant spoke, my research assistant recorded their number and wrote down the beginning of the sentence. I did not make use of notes, as these can
interrupt the flow of the discussion and can make participants feel uncomfortable (Krueger & Casey, 2000).
After the groups, I sent participants a formal thank-you letter via e-mail. These were followed up three weeks later, inviting any comments or questions. None of the participants had any comments or questions.
During the first focus group, the research team noted some dynamics which could possibly have caused tension between certain participants. However discussion was generally convivial. Some were argumentative, and this made for a deep conversation where participants generally addressed each other, and I had to occasionally prompt or steer the dialogue in a different direction. Although participants expressed intense frustrations with certain aspects of their work it was also clear that they were
enthusiastic about transplant and its merits. One participant found discussion of transplant disturbing due to personal experiences. Following the group, the participant was followed up telephonically and offered counselling, which was declined.
During the second focus group I did not observe any unusual dynamics between individual participants, all of whom knew each other well. There was a good deal of laughter during the group, and the participants were not as argumentative as those in Group 1. The participants in the second group expressed similar frustrations to those in the first, though they also seemed more satisfied with the support systems which were in place to facilitate their job performance.
Cadaver donor families
Prior to the interview, I was briefed on the details of each family by the transplant coordinator. I took this opportunity to memorise the names of the potential
participants and the name of the loved one who had been the organ donor. Families were greeted and brought through to the interview room by the transplant
coordinator, where I was introduced to them. They were invited to help themselves to refreshments, and some small talk ensued. When all individuals were seated I
commenced the information and consent process. The study information sheet (Appendix 9) was distributed and participants were given an opportunity to ask questions about my study. Attention was drawn to the fact that the questions were sensitive, and may cause emotional stress. It was emphasised that the interview could be terminated at any time, and that questions which were deemed inappropriate would be skipped. Families were also advised that the transplant psychologist was on hand should they require therapeutic intervention. Consent documents (Appendices 10 and 11) were signed, and the participants also filled in a contact sheet (Appendix 12) for thank-you letters and further correspondence. I then turned on the dictaphone and began the interview.
At the end of the interview, participants were thanked and asked if they would like to see the psychologist. All these requests were declined. In the hours following the interview, I sent a thank-you note to the families via e-mail. This was followed up with another note two weeks later which invited questions and served to thank the familes for their contribution once again. In both cases, the families sent encouraging replies, stating that they valued the opportunity to contribute and the chance to tell their story.
The first interview took place with a family who had donated the organs of their teenage son who died following complications from surgery. The interaction was highly emotional, with participants expressing frustration and disappointment in the donation process. At the end of the interview, I felt it essential to share some of their
views with the transplant coordinator as soon as possible. To this end, I requested that I be permitted to breach confidentiality and disclose part of the interview, in order that remedial action may be taken. The family agreed to this request and follow-up with the coordinator suggests that remedial action was initiated soon after the interview.
The second family had donated the organs of an aunt following complications related to lupus. Motivated by a Christian desire to do good and to prolong the life of another, the possibility of donation had been discussed with the deceased prior to her death.
This interview was not as emotionally charged as the first, and no issues which required immediate action were forthcoming.
Living kidney donors
As with the transplant coordinator discussions, these focus groups were conducted according to the guidelines proposed by Krueger and Casey (2000).
Participants were greeted by the transplant coordinator who introduced me to them and to each other. Name tags were provided. Participants were invited to have refreshments, and conversed with each other freely. It was not possible to sit
participants in a deliberate fashion as I did not have any prior knowledge of individual characteristics.
When everyone was seated, the study information sheet (Appendix 13) was distributed and an opportunity to ask questions about my study was given. It was emphasised that the focus group could be terminated at any time, and that questions which were deemed inappropriate could be skipped. Potential participants were advised that the transplant psychologist was on hand should they require therapeutic intervention. Confidentiality implications of participating in a focus group discussion were explained. Participants were required to sign consent documents (Appendices 11 and 14) and they also filled in a contact sheet (Appendix 12) for thank-you letters and further correspondence. I then turned on the dictaphone and began the discussion, using the same format as was used for the transplant coordinator focus groups.
At the end of the discussion, participants were thanked and asked if they would like to see the psychologist. All requests were declined. A thank-you note was sent to each participant via e-mail, and this was followed up with another note two weeks later which invited questions and thanked donors for their contribution once again.
No notes were taken during the discussion. However, I recorded my impressions immediately afterwards. Participants appeared to get along well, and the discussion was free-flowing. One participant experienced some emotional stress when
recounting her story. The other group members also made gestures of support, such as hand-holding. Participants were offered reimbursement of their travel expenses, and one accepted.