Method six: Focus groups with practice nurses

Focus group interviews with practice nurses formed the sixth and final method in

the study, and were used to explore current practice, and the potential structure,

process and content of an ‘ideal’ pre-travel consultation. They provided a useful

form of triangulation to test the validity of findings from other methods, and to

provide a rationale and shape of a prototype for the new model of consultation.

Focus groups have been defined as “…an interaction between one or more

researchers and more than one respondent for the purpose of collecting research data” (Parahoo, 1997:296).

This method was chosen to gather data because it offered the following

advantages:

• Focus groups are a recognised method in health care research, particularly for

exploring health promoting beliefs and activities (Parahoo, 1997);

• There is an opportunity to use group dynamics and interactions to generate

more ideas and perspectives than might be achieved through individual

interviews (May, 1997; Sim and Wright, 2000);

• They are a forum to test the validity of findings from other methods; a useful

form of triangulation (Adami and Kiger, 2005);

• An assessment can be made of the degree to which health professionals

support, oppose or contribute to a proposed new model of pre-travel health

consultation (Sim and Wright, 2000);

• Focus groups can be a cost-effective way to gather data (Parahoo, 1997).

Sampling and recruitment

A minimum of 20 and maximum of 30 participants were sought for method six.

Five focus groups of between two and six practice nurses were achieved, with a

total of 23 participants. This represented non-probability, purposive sampling,

because the aim was not to represent the whole practice nurse population evenly

and equally, and participants were selected according to criteria – the nurses had

to engage in travel health care and work in general practices that had not

participated in the audit of structures and AV recordings of consultations.

Potential participants were identified through general practice addresses available

in the public domain. PCT and practice details, including whether travel health

services were provided, were available via the Internet. Only those practices within

PCTs who had given ethical permission, and who had not provided participants for

sheets (Appendix 2) were sent to 35 nurses in 20 general practices. A response

rate of 66 per cent was achieved: six declined, one did not attend, five could not

make any of the dates offered, and 23 participants completed the focus group

interviews.

Despite a non-probability sample, the 23 practice nurses worked in a variety of

general practices, from one single-handed GP practice to those with partnerships

of eight, ranging from rural branch surgeries, suburban premises, to inner city

practices. They had a range of experience within practice nursing of between six

months and over 20 years, and none were newly qualified. Although information

about age was not specifically collected or required for this study, the participants

appeared congruent with statistics that 46 per cent of practice nurses are over the

age of 45 (RCN, 2009b). A pre-paid envelope was provided for replies, and the

nurses accepting participation were then contacted to arrange the date and venue

most convenient for them.

Tools and piloting

The process of developing a discussion schedule was similar to that of the

interview schedule used for travellers – the topics to be discussed were distilled

from the literature on consultations and travel health, and from the findings and

themes from previous methods in this study. They are detailed below under Data

collection and analysis, and a discussion tool about consultation styles is found in

Appendix 10. The role of the researcher was different from other methods, and in

the literature is variously called a moderator or a facilitator rather than an

interviewer, reflecting the different processes to be managed in focus group

The discussion schedule was piloted with a group of four nurses who were not

included in the final study. This permitted familiarisation with the recording

equipment, playback and transcription process, and to check on timing. The pilot

transcript was used to assess the researcher’s techniques as discussion facilitator

and appropriateness of the discussion topics. Techniques used with groups, e.g.

ensuring every participant’s views are heard, or the use of probe questions, were

already familiar to the researcher, but the pilot provided an opportunity to check

and reflect on these, and to ask for objective feedback from group members. No

major changes were required.

Data collection and analysis

The five focus groups were held in September 2008. An Olympus DS50 digital

voice recorder with multi-directional microphone was selected because of its silent

and discreet operation, and software compatibility with Windows programmes for

playback and transcription. The process was to welcome and introduce

participants, establish ground rules and rapport, facilitate the discussion using a

semi-structured schedule, and to close proceedings. The full schedule is shown in

Appendix 9.

The recordings were stored according to data protection requirements, and

transcripts created to organise data for analysis. Silverman’s (2001) adapted

transcription technique, as used for AV consultation recordings and interviews with

travellers, was employed (Appendix 3). Consideration was given to coding using

qualitative data analysis software, and introductory training was undertaken on an

NVivo programme. This offered potential advantages such as auditing the

analytical process, and to a degree, checks on reliability and validity. The

analysis was started ‘by hand’. This proved to be advantageous because thorough

familiarity with the data was gained, enabling interrogation of a small sample in

greater depth and accuracy than was achieved through an NVivo pilot.

The content was first analysed by each of the eight topics to make explicit the full

range of responses to each topic. Data were then searched and categorised by

themes identified in previous methods. These were analysed for congruence with,

or dissonance from those themes. Finally, the contents were searched for any

new concepts or themes not found in previous methods. Analysis was undertaken

using the researcher’s interpretation of text to allocate it to coding categories and

themes. Computerised colour coding and cutting and pasting of text facilitated this

stage. Secondly, computer keyword search functions were used to check all text

had been found and appropriately categorised within a topic, code or theme. The

findings are presented in Chapter 5, Phase Two: What do practice nurses say and

do?