(2004; 98 pages)
3.5 Focus group discussions
Focus group discussions (FGDs) can be used to collect information on:
• common health problems and medicines used to treat them
• sources of medicines
• sources of advice
• perceived drug use problems
• reasons why drug use problems occur
• possible solutions.
The results from the FGDs complement the findings from the semi-structured interviews. They can be further used to contrast drug use patterns among different groups of respondents and to compare their views on drug problems.
How to conduct FGDs
Instead of having an interview with one person, a researcher preparing for an FGD invites several people to participate. The selection of group members demands careful planning. When organizing FGDs it is generally advisable to choose ‘homogeneous’ groups in terms of age, sex, socio-economic status, etc. since this facilitates open discussion. In mixed groups considerations of status and hierarchy can affect the discussions. Groups should be relatively small, between six to a maximum of 10 members. Possible groups for a study on drug use include:
• young men
• young women
• women who have small children
• married men
• elderly men
• elderly women
• people of different ethnic backgrounds, if relevant.
It is best to conduct at least two FGDs per category of respondents.
Question lists for FGDs should include a limited number of questions. Preparing five or six good and relevant questions is generally more than enough for about one and a half hours discussion with six to 10 people. If more questions are prepared, the facilitator will have to rush through the discussion. One should not forget that in FGDs - contrary to individual interviews - the reaction of one person leads to contributions from others. To encourage lively discussion it is often good to start with a little ´icebreaker´, for example a game, or a lively way of introducing the participants to each other. The questions should be neutral and open-ended. Often FGDs start with general questions, which everyone responds to, then, in the course of the discussion, more specific issues are raised.
The moderator’s role
The most important requirement for a successful FGD is a skilled moderator. Group discussions, though very efficient as a data-gathering tool, are not easy to conduct. The moderator does not need to have high academic qualifications, but (s)he must understand the aim of the discussion, and must have good communication skills. The moderator’s role is to:
• encourage everyone to participate in the discussion
• stimulate discussion between participants, particularly when new information is given, or a diverging perspective is put forward
• guide the group from one discussion topic to another
• not express his or her own opinion - facilitate do not teach
• not act as an expert, but retain control over the discussion.
The choice of venue for an FGD is important. The place should be viewed as neutral by participants. It is better not to choose the local health centre as a venue, as people may not feel free to express their ideas where health workers are present. Providing small extras such as refreshments can create a friendly, relaxed atmosphere, which encourages discussion. Providing child care may be necessary.
The interviewer should be present in the venue before people arrive, to start talking with the participants and to create an informal atmosphere that encourages a group discussion. The discussion’s aim and structure should be explained to the group members.
In practice, it is hard to control the composition of the group involved in such a discussion. In public settings, people passing by or those who happen to be in the setting may start observing the discussion. They may even start interfering in it. It is important that the moderator has an appropriate response to such unplanned interference. For example, if men stand by watching a session with mothers, the moderator can inform the men that there will be a separate group discussion for them. The moderator can also prevent such interference by selecting a neutral, relatively secluded place. It may also be helpful to inform people who may interfere about the discussion’s purpose before it takes place and to explain why they were not invited to take part.
Recording and reporting
Finally, FGDs are usually recorded on tape. These recordings should be done with care. Always ask the participants for their consent before taping. In addition, one observer/researcher should make notes. It is sometimes unclear from the tape which participant is speaking, and in the notes, the observer can also record non-verbal communication. You can also choose not to use a tape recorder. It is then best to ask two observers to make notes, which they consolidate into a single record of the FGD after the session.
The results of the group discussion can be analysed and interpreted in the same way as the semi-structured interviews described above. FGDs are ideally combined with semi-structured individual interviews. These interviews can be used to gain understanding of ideas and views that were not expressed in the group.
BOX 6. FOCUS GROUP DISCUSSIONS
A community-based study conducted in the Philippines
The following guide for discussion with mothers of small children was used in a community drug use study in the Philippines. The researchers use focus group discussions to elicit the mothers’ ideas about medicines. These ideas are being used in the development of educational materials. To encourage a lively discussion, the moderator starts the discussion with a sorting game. Twelve popular medications (herbal and pharmaceutical) are put on a table and the participants are asked to sort the medications into piles. (The popular medications have been elicited from key informant interviews done prior to the focus group discussions). The recorder notes the comments made during the sorting.
Strengths and weaknesses of focus group discussions
The strengths of FGDs are:
• the method is quick and cheap
• a greater pool of expertise is tapped than in individual interviews; a more diverse picture of drug use will emerge
• the contribution of one person often triggers others to share their views and experiences.
The weaknesses of FGDs are:
• a skilled moderator is required
• the success of a group discussion is a bit unpredictable
• in some cases one or more participants dominate; the views of others are not recorded and so are under-represented
• the depth of information may be limited. It is hard to probe one person’s ideas, as others also have to be given a chance to speak
• analysis of the information gathered is demanding.