3. Methodology
3.8 Phase Two – the qualitative aspect of the current study
Phase Two constituted a focus group approach undertaken with intervention participants. This aspect of the study was designed to provide a qualitative exploration of the features and experience of the intervention as perceived by participants. Sections 3.8.1– 3.8.2 will now consider means of focus group
90 implementation for Phase Two. Specific details regarding the implementation of Phase Two are provided in section 4.3.
3.8.1 Focus Groups
Focus groups are a form of group interview, often including between five and twelve participants. They facilitate detailed, reciprocal discussion between participants, regarding a topic of interest selected by the researcher (de Ruyter, 1996; 44), enabling the collective perspective of a number of participants regarding a social experience to be captured. It is from this interaction that experiential data emerges (Willig, 2013). The researcher-led nature of these discussions is considered to be both a positive and a negative; whilst they may entail manufactured social interactions within an unnatural setting, they also enable efficient data collection regarding the phenomenon of interest, capturing insights that may otherwise have not been readily available from participants, had other approaches been implemented. Focus groups are typically used for the following purposes (Cohen, Manion and Morrison, 2011):
Generating hypotheses that derive from the insights of group participants; Gathering qualitative data, such as data on attitudes, values and opinions; Generating data quickly and at low cost;
Empowering participants to speak out, in their own words.
A focus group was favoured over semi-structured interviews for several reasons. Firstly, focus groups enable group discussion around the focus topic and it is possible to capture contrasting perspectives from participants within the immediate context of the group discussion. As Willig (2013; 35) states, focus groups: “mobilize participants to respond to and comment on one another’s contributions. In this way, statements are challenged, extended, developed or qualified in ways that generate rich data for the researcher”. Such data may not be readily available via semi-structured interviews. Secondly, focus groups enable efficient gathering of data, whereas data collection via a series of interviews may be labour intensive in
91 comparison. Thirdly, focus groups can take place in less artificial settings than one-to-one interviews and are intended to provide participants with the opportunity to interact in the same way that they would outside of the research context, thereby increasing the ecological validity of the data obtained via group discussions (Willig, 2013).
However, it has been argued that whilst group-based discussion may generate a variety of responses, such discussion may also inhibit the exchange of opinions and may even lead to the loss of minority or opposing points of view (Gordon and Langmaid, 1988). Focus groups also have the potential to be dominated by strong personalities and more vocal members (de Ruyter, 1996; 44). Elements of Nominal Group Technique were therefore employed in the current study to address the limitations of a traditional focus group design and to ensure that all participants had the opportunity to contribute; this technique will now be discussed.
3.8.2 Nominal Group Technique
Nominal group technique (NGT, Delbecq et al., 1975) is considered to be a structured alternative to, or possible component within, traditional focus group designs. This process requires the development of well-articulated research questions (Elliott and Shewchuk, 2002; 71) and includes several key steps (see Figure 3.3).
This format collects participants’ opinions through structured processes, whilst guarding against the possibility of group polarisation experienced within focus group interactions. NGT thereby optimises the breadth and diversity of responses obtained as all participants are able to contribute equally (Elliott and Shewchuck, 2002). The weighting system used provides a valid representation of the range of views held by the group of participants, with all contributions/themes agreed with the participants within the immediate context of the session (Elliott and Shewchuck, 2002; 68).
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Figure 3.3 – An illustration of the Negative Group Technique employed in Phase Two of the current research (from de Ruyter, 1996; 45).
3.8.3 Phase Two Research Questions
The overall focus for Phase Two was as follows:
“An exploration of participants’ perceptions of their anxiety regulation, post CBT-based intervention, and their view of the CBT-based intervention’s contribution to this”.
The need to translate this focus into clearly defined research questions has been emphasised. The following research questions were, therefore, those used in the focus group sessions:
1. The session moderator introduces the topic for discussion and ensures that participants understand the "problem statement".
Participants write their individual reflections on a piece of paper.
2. Participants mention one item each in response to the problem statement. The moderator records these in a location visible to the whole group. The process is repeated until all items are recorded.
3. The complete set of items is reviewed and duplications are eliminated by the moderator.
4. The relative importance of each item is established via a voting process. This typically involves asking participants to select five items which they consider to be the most important and ranking them by assigning points.
5. The results are compiled and aggregated on the basis of the individual scores given. A second round of compilation of scores is possible, should participants wish to change their responses.
93 1. Have you noticed any changes in how often you worry since attending
the programme? (Assessing frequency of worries).
2. You have said whether you worry more often or less often since the programme. Now tell me about the size of your worries: are these bigger or smaller since the programme? (Assessing severity of worries).
3. When you are feeling worried or anxious, what helps you to cope? (Focusing on coping skills).
4. Have you used any different strategies for managing your worries, since you attended the programme? (Assessing the output of the intervention).
5. What strategies, if any, have you found to be the most useful? (Assessing preferred coping mechanisms).
6. What did you like best about the programme? (Assessing programme qualities).
7. What was most useful? (Assessing programme qualities).
8. What needs to change about the programme/what would make the programme better? (Assessing possible programme alterations).
Questions 3-5 were considered as open questions, associated with traditional focus group discussions, whilst questions 6-8 were considered in an NGT format. Questions 1-2 followed a Likert Scale format, as below.
Question 2. I worry: Very much less Somewhat less No change Somewhat more Very much more
Questions 1-2 were intended as introductory items, designed to be answered on an individualised basis by participants, as opposed to forming the basis for group discussion. These items were included following recommendations from de Ruyter (1996) regarding the need to provide NGT participants with a ‘warm-up’ item to familiarise them with the broader topic for discussion.
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3.8.4 Phase Two data analysis procedures
Data analysis of the responses from the focus group incorporated Thematic Analysis for questions 3 to 5, based upon Braun and Clarke’s six stage model of Thematic Analysis (2006) and NGT-based analysis for questions 6 to 8. As outlined in section 3.8.2, NGT analysis provides ranked items and an indication of key themes derived from participants’ responses. A full account of data analysis procedures is provided in chapter four.