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What Is a Focus Group? | Step-by-Step Guide & Examples

What is a Focus Group | Step-by-Step Guide & Examples

Published on December 10, 2021 by Tegan George . Revised on June 22, 2023.

A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest.

What is a focus group, step 1: choose your topic of interest, step 2: define your research scope and hypotheses, step 3: determine your focus group questions, step 4: select a moderator or co-moderator, step 5: recruit your participants, step 6: set up your focus group, step 7: host your focus group, step 8: analyze your data and report your results, advantages and disadvantages of focus groups, other interesting articles, frequently asked questions about focus groups.

Focus groups are a type of qualitative research . Observations of the group’s dynamic, their answers to focus group questions, and even their body language can guide future research on consumer decisions, products and services, or controversial topics.

Focus groups are often used in marketing, library science, social science, and user research disciplines. They can provide more nuanced and natural feedback than individual interviews and are easier to organize than experiments or large-scale surveys .

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Focus groups are primarily considered a confirmatory research technique . In other words, their discussion-heavy setting is most useful for confirming or refuting preexisting beliefs. For this reason, they are great for conducting explanatory research , where you explore why something occurs when limited information is available.

A focus group may be a good choice for you if:

You’re interested in real-time, unfiltered responses on a given topic or in the dynamics of a discussion between participants
Your questions are rooted in feelings or perceptions , and cannot easily be answered with “yes” or “no”
You’re confident that a relatively small number of responses will answer your question
You’re seeking directional information that will help you uncover new questions or future research ideas
Structured interviews : The questions are predetermined in both topic and order.
Semi-structured interviews : A few questions are predetermined, but other questions aren’t planned.
Unstructured interviews : None of the questions are predetermined.

Differences between types of interviews

Make sure to choose the type of interview that suits your research best. This table shows the most important differences between the four types.

Topics favorable to focus groups

As a rule of thumb, research topics related to thoughts, beliefs, and feelings work well in focus groups. If you are seeking direction, explanation, or in-depth dialogue, a focus group could be a good fit.

However, if your questions are dichotomous or if you need to reach a large audience quickly, a survey may be a better option. If your question hinges upon behavior but you are worried about influencing responses, consider an observational study .

If you want to determine whether the student body would regularly consume vegan food, a survey would be a great way to gauge student preferences.

However, food is much more than just consumption and nourishment and can have emotional, cultural, and other implications on individuals.

If you’re interested in something less concrete, such as students’ perceptions of vegan food or the interplay between their choices at the dining hall and their feelings of homesickness or loneliness, perhaps a focus group would be best.

Once you have determined that a focus group is the right choice for your topic, you can start thinking about what you expect the group discussion to yield.

Perhaps literature already exists on your subject or a sufficiently similar topic that you can use as a starting point. If the topic isn’t well studied, use your instincts to determine what you think is most worthy of study.

Setting your scope will help you formulate intriguing hypotheses , set clear questions, and recruit the right participants.

Are you interested in a particular sector of the population, such as vegans or non-vegans?
Are you interested in including vegetarians in your analysis?
Perhaps not all students eat at the dining hall. Will your study exclude those who don’t?
Are you only interested in students who have strong opinions on the subject?

A benefit of focus groups is that your hypotheses can be open-ended. You can be open to a wide variety of opinions, which can lead to unexpected conclusions.

The questions that you ask your focus group are crucially important to your analysis. Take your time formulating them, paying special attention to phrasing. Be careful to avoid leading questions , which can affect your responses.

Overall, your focus group questions should be:

Open-ended and flexible
Impossible to answer with “yes” or “no” (questions that start with “why” or “how” are often best)
Unambiguous, getting straight to the point while still stimulating discussion
Unbiased and neutral

If you are discussing a controversial topic, be careful that your questions do not cause social desirability bias . Here, your respondents may lie about their true beliefs to mask any socially unacceptable or unpopular opinions. This and other demand characteristics can hurt your analysis and lead to several types of reseach bias in your results, particularly if your participants react in a different way once knowing they’re being observed. These include self-selection bias , the Hawthorne effect , the Pygmalion effect , and recall bias .

Engagement questions make your participants feel comfortable and at ease: “What is your favorite food at the dining hall?”
Exploration questions drill down to the focus of your analysis: “What pros and cons of offering vegan options do you see?”
Exit questions pick up on anything you may have previously missed in your discussion: “Is there anything you’d like to mention about vegan options in the dining hall that we haven’t discussed?”

It is important to have more than one moderator in the room. If you would like to take the lead asking questions, select a co-moderator who can coordinate the technology, take notes, and observe the behavior of the participants.

If your hypotheses have behavioral aspects, consider asking someone else to be lead moderator so that you are free to take a more observational role.

Depending on your topic, there are a few types of moderator roles that you can choose from.

The most common is the dual-moderator , introduced above.
Another common option is the dueling-moderator style . Here, you and your co-moderator take opposing sides on an issue to allow participants to see different perspectives and respond accordingly.

Depending on your research topic, there are a few sampling methods you can choose from to help you recruit and select participants.

Voluntary response sampling , such as posting a flyer on campus and finding participants based on responses
Convenience sampling of those who are most readily accessible to you, such as fellow students at your university
Stratified sampling of a particular age, race, ethnicity, gender identity, or other characteristic of interest to you
Judgment sampling of a specific set of participants that you already know you want to include

Beware of sampling bias and selection bias , which can occur when some members of the population are more likely to be included than others.

Number of participants

In most cases, one focus group will not be sufficient to answer your research question. It is likely that you will need to schedule three to four groups. A good rule of thumb is to stop when you’ve reached a saturation point (i.e., when you aren’t receiving new responses to your questions).

Most focus groups have 6–10 participants. It’s a good idea to over-recruit just in case someone doesn’t show up. As a rule of thumb, you shouldn’t have fewer than 6 or more than 12 participants, in order to get the most reliable results.

Lastly, it’s preferable for your participants not to know you or each other, as this can bias your results.

A focus group is not just a group of people coming together to discuss their opinions. While well-run focus groups have an enjoyable and relaxed atmosphere, they are backed up by rigorous methods to provide robust observations.

Confirm a time and date

Be sure to confirm a time and date with your participants well in advance. Focus groups usually meet for 45–90 minutes, but some can last longer. However, beware of the possibility of wandering attention spans. If you really think your session needs to last longer than 90 minutes, schedule a few breaks.

Confirm whether it will take place in person or online

You will also need to decide whether the group will meet in person or online. If you are hosting it in person, be sure to pick an appropriate location.

An uncomfortable or awkward location may affect the mood or level of participation of your group members.
Online sessions are convenient, as participants can join from home, but they can also lessen the connection between participants.

As a general rule, make sure you are in a noise-free environment that minimizes distractions and interruptions to your participants.

Consent and ethical considerations

It’s important to take into account ethical considerations and informed consent when conducting your research. Informed consent means that participants possess all the information they need to decide whether they want to participate in the research before it starts. This includes information about benefits, risks, funding, and institutional approval.

Participants should also sign a release form that states that they are comfortable with being audio- or video-recorded. While verbal consent may be sufficient, it is best to ask participants to sign a form.

A disadvantage of focus groups is that they are too small to provide true anonymity to participants. Make sure that your participants know this prior to participating.

There are a few things you can do to commit to keeping information private. You can secure confidentiality by removing all identifying information from your report or offer to pseudonymize the data later. Data pseudonymization entails replacing any identifying information about participants with pseudonymous or false identifiers.

Preparation prior to participation

If there is something you would like participants to read, study, or prepare beforehand, be sure to let them know well in advance. It’s also a good idea to call them the day before to ensure they will still be participating.

Consider conducting a tech check prior to the arrival of your participants, and note any environmental or external factors that could affect the mood of the group that day. Be sure that you are organized and ready, as a stressful atmosphere can be distracting and counterproductive.

Starting the focus group

Welcome individuals to the focus group by introducing the topic, yourself, and your co-moderator, and go over any ground rules or suggestions for a successful discussion. It’s important to make your participants feel at ease and forthcoming with their responses.

Consider starting out with an icebreaker, which will allow participants to relax and settle into the space a bit. Your icebreaker can be related to your study topic or not; it’s just an exercise to get participants talking.

Leading the discussion

Once you start asking your questions, try to keep response times equal between participants. Take note of the most and least talkative members of the group, as well as any participants with particularly strong or dominant personalities.

You can ask less talkative members questions directly to encourage them to participate or ask participants questions by name to even the playing field. Feel free to ask participants to elaborate on their answers or to give an example.

As a moderator, strive to remain neutral . Refrain from reacting to responses, and be aware of your body language (e.g., nodding, raising eyebrows) and the possibility for observer bias . Active listening skills, such as parroting back answers or asking for clarification, are good methods to encourage participation and signal that you’re listening.

Many focus groups offer a monetary incentive for participants. Depending on your research budget, this is a nice way to show appreciation for their time and commitment. To keep everyone feeling fresh, consider offering snacks or drinks as well.

After concluding your focus group, you and your co-moderator should debrief, recording initial impressions of the discussion as well as any highlights, issues, or immediate conclusions you’ve drawn.

The next step is to transcribe and clean your data . Assign each participant a number or pseudonym for organizational purposes. Transcribe the recordings and conduct content analysis to look for themes or categories of responses. The categories you choose can then form the basis for reporting your results.

Just like other research methods, focus groups come with advantages and disadvantages.

They are fairly straightforward to organize and results have strong face validity .
They are usually inexpensive, even if you compensate participant.
A focus group is much less time-consuming than a survey or experiment , and you get immediate results.
Focus group results are often more comprehensible and intuitive than raw data.

Disadvantages

It can be difficult to assemble a truly representative sample. Focus groups are generally not considered externally valid due to their small sample sizes.
Due to the small sample size, you cannot ensure the anonymity of respondents, which may influence their desire to speak freely.
Depth of analysis can be a concern, as it can be challenging to get honest opinions on controversial topics.
There is a lot of room for error in the data analysis and high potential for observer dependency in drawing conclusions. You have to be careful not to cherry-pick responses to fit a prior conclusion.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Student’s t -distribution
Normal distribution
Null and Alternative Hypotheses
Chi square tests
Confidence interval
Quartiles & Quantiles
Cluster sampling
Stratified sampling
Data cleansing
Reproducibility vs Replicability
Peer review
Prospective cohort study

Research bias

Implicit bias
Cognitive bias
Placebo effect
Hawthorne effect
Hindsight bias
Affect heuristic
Social desirability bias

As a rule of thumb, questions related to thoughts, beliefs, and feelings work well in focus groups. Take your time formulating strong questions, paying special attention to phrasing. Be careful to avoid leading questions , which can bias your responses.

There are various approaches to qualitative data analysis , but they all share five steps in common:

Prepare and organize your data.
Review and explore your data.
Develop a data coding system.
Assign codes to the data.
Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

Every dataset requires different techniques to clean dirty data , but you need to address these issues in a systematic way. You focus on finding and resolving data points that don’t agree or fit with the rest of your dataset.

These data might be missing values, outliers, duplicate values, incorrectly formatted, or irrelevant. You’ll start with screening and diagnosing your data. Then, you’ll often standardize and accept or remove data to make your dataset consistent and valid.

The four most common types of interviews are:

Structured interviews : The questions are predetermined in both topic and order.
Focus group interviews : The questions are presented to a group instead of one individual.

It’s impossible to completely avoid observer bias in studies where data collection is done or recorded manually, but you can take steps to reduce this type of bias in your research .

Scope of research is determined at the beginning of your research process , prior to the data collection stage. Sometimes called “scope of study,” your scope delineates what will and will not be covered in your project. It helps you focus your work and your time, ensuring that you’ll be able to achieve your goals and outcomes.

Defining a scope can be very useful in any research project, from a research proposal to a thesis or dissertation . A scope is needed for all types of research: quantitative , qualitative , and mixed methods .

To define your scope of research, consider the following:

Budget constraints or any specifics of grant funding
Your proposed timeline and duration
Specifics about your population of study, your proposed sample size , and the research methodology you’ll pursue
Any inclusion and exclusion criteria
Any anticipated control , extraneous , or confounding variables that could bias your research if not accounted for properly.

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Chapter 12. Focus Groups

Introduction.

Focus groups are a particular and special form of interviewing in which the interview asks focused questions of a group of persons, optimally between five and eight. This group can be close friends, family members, or complete strangers. They can have a lot in common or nothing in common. Unlike one-on-one interviews, which can probe deeply, focus group questions are narrowly tailored (“focused”) to a particular topic and issue and, with notable exceptions, operate at the shallow end of inquiry. For example, market researchers use focus groups to find out why groups of people choose one brand of product over another. Because focus groups are often used for commercial purposes, they sometimes have a bit of a stigma among researchers. This is unfortunate, as the focus group is a helpful addition to the qualitative researcher’s toolkit. Focus groups explicitly use group interaction to assist in the data collection. They are particularly useful as supplements to one-on-one interviews or in data triangulation. They are sometimes used to initiate areas of inquiry for later data collection methods. This chapter describes the main forms of focus groups, lays out some key differences among those forms, and provides guidance on how to manage focus group interviews.

Focus Groups: What Are They and When to Use Them

As interviews, focus groups can be helpfully distinguished from one-on-one interviews. The purpose of conducting a focus group is not to expand the number of people one interviews: the focus group is a different entity entirely. The focus is on the group and its interactions and evaluations rather than on the individuals in that group. If you want to know how individuals understand their lives and their individual experiences, it is best to ask them individually. If you want to find out how a group forms a collective opinion about something (whether a product or an event or an experience), then conducting a focus group is preferable. The power of focus groups resides in their being both focused and oriented to the group . They are best used when you are interested in the shared meanings of a group or how people discuss a topic publicly or when you want to observe the social formation of evaluations. The interaction of the group members is an asset in this method of data collection. If your questions would not benefit from group interaction, this is a good indicator that you should probably use individual interviews (chapter 11). Avoid using focus groups when you are interested in personal information or strive to uncover deeply buried beliefs or personal narratives. In general, you want to avoid using focus groups when the subject matter is polarizing, as people are less likely to be honest in a group setting. There are a few exceptions, such as when you are conducting focus groups with people who are not strangers and/or you are attempting to probe deeply into group beliefs and evaluations. But caution is warranted in these cases. [1]

As with interviewing in general, there are many forms of focus groups. Focus groups are widely used by nonresearchers, so it is important to distinguish these uses from the research focus group. Businesses routinely employ marketing focus groups to test out products or campaigns. Jury consultants employ “mock” jury focus groups, testing out legal case strategies in advance of actual trials. Organizations of various kinds use focus group interviews for program evaluation (e.g., to gauge the effectiveness of a diversity training workshop). The research focus group has many similarities with all these uses but is specifically tailored to a research (rather than applied) interest. The line between application and research use can be blurry, however. To take the case of evaluating the effectiveness of a diversity training workshop, the same interviewer may be conducting focus group interviews both to provide specific actionable feedback for the workshop leaders (this is the application aspect) and to learn more about how people respond to diversity training (an interesting research question with theoretically generalizable results).

When forming a focus group, there are two different strategies for inclusion. Diversity focus groups include people with diverse perspectives and experiences. This helps the researcher identify commonalities across this diversity and/or note interactions across differences. What kind of diversity to capture depends on the research question, but care should be taken to ensure that those participating are not set up for attack from other participants. This is why many warn against diversity focus groups, especially around politically sensitive topics. The other strategy is to build a convergence focus group , which includes people with similar perspectives and experiences. These are particularly helpful for identifying shared patterns and group consensus. The important thing is to closely consider who will be invited to participate and what the composition of the group will be in advance. Some review of sampling techniques (see chapter 5) may be helpful here.

Moderating a focus group can be a challenge (more on this below). For this reason, confining your group to no more than eight participants is recommended. You probably want at least four persons to capture group interaction. Fewer than four participants can also make it more difficult for participants to remain (relatively) anonymous—there is less of a group in which to hide. There are exceptions to these recommendations. You might want to conduct a focus group with a naturally occurring group, as in the case of a family of three, a social club of ten, or a program of fifteen. When the persons know one another, the problems of too few for anonymity don’t apply, and although ten to fifteen can be unwieldy to manage, there are strategies to make this possible. If you really are interested in this group’s dynamic (not just a set of random strangers’ dynamic), then you will want to include all its members or as many as are willing and able to participate.

There are many benefits to conducting focus groups, the first of which is their interactivity. Participants can make comparisons, can elaborate on what has been voiced by another, and can even check one another, leading to real-time reevaluations. This last benefit is one reason they are sometimes employed specifically for consciousness raising or building group cohesion. This form of data collection has an activist application when done carefully and appropriately. It can be fun, especially for the participants. Additionally, what does not come up in a focus group, especially when expected by the researcher, can be very illuminating.

Many of these benefits do incur costs, however. The multiplicity of voices in a good focus group interview can be overwhelming both to moderate and later to transcribe. Because of the focused nature, deep probing is not possible (or desirable). You might only get superficial thinking or what people are willing to put out there publicly. If that is what you are interested in, good. If you want deeper insight, you probably will not get that here. Relatedly, extreme views are often suppressed, and marginal viewpoints are unspoken or, if spoken, derided. You will get the majority group consensus and very little of minority viewpoints. Because people will be engaged with one another, there is the possibility of cut-off sentences, making it even more likely to hear broad brush themes and not detailed specifics. There really is very little opportunity for specific follow-up questions to individuals. Reading over a transcript, you may be frustrated by avenues of inquiry that were foreclosed early.

Some people expect that conducting focus groups is an efficient form of data collection. After all, you get to hear from eight people instead of just one in the same amount of time! But this is a serious misunderstanding. What you hear in a focus group is one single group interview or discussion. It is not the same thing at all as conducting eight single one-hour interviews. Each focus group counts as “one.” Most likely, you will need to conduct several focus groups, and you can design these as comparisons to one another. For example, the American Sociological Association (ASA) Task Force on First-Generation and Working-Class Persons in Sociology began its study of the impact of class in sociology by conducting five separate focus groups with different groups of sociologists: graduate students, faculty (in general), community college faculty, faculty of color, and a racially diverse group of students and faculty. Even though the total number of participants was close to forty, the “number” of cases was five. It is highly recommended that when employing focus groups, you plan on composing more than one and at least three. This allows you to take note of and potentially discount findings from a group with idiosyncratic dynamics, such as where a particularly dominant personality silences all other voices. In other words, putting all your eggs into a single focus group basket is not a good idea.

How to Conduct a Focus Group Interview/Discussion

Advance preparations.

Once you have selected your focus groups and set a date and time, there are a few things you will want to plan out before meeting.

As with interviews, you begin by creating an interview (or discussion) guide. Where a good one-on-one interview guide should include ten to twelve main topics with possible prompts and follow-ups (see the example provided in chapter 11), the focus group guide should be more narrowly tailored to a single focus or topic area. For example, a focus might be “How students coped with online learning during the pandemic,” and a series of possible questions would be drafted that would help prod participants to think about and discuss this topic. These questions or discussion prompts can be creative and may include stimulus materials (watching a video or hearing a story) or posing hypotheticals. For example, Cech ( 2021 ) has a great hypothetical, asking what a fictional character should do: keep his boring job in computers or follow his passion and open a restaurant. You can ask a focus group this question and see what results—how the group comes to define a “good job,” what questions they ask about the hypothetical (How boring is his job really? Does he hate getting up in the morning, or is it more of an everyday tedium? What kind of financial support will he have if he quits? Does he even know how to run a restaurant?), and how they reach a consensus or create clear patterns of disagreement are all interesting findings that can be generated through this technique.

As with the above example (“What should Joe do?”), it is best to keep the questions you ask simple and easily understood by everyone. Thinking about the sequence of the questions/prompts is important, just as it is in conducting any interviews.

Avoid embarrassing questions. Always leave an out for the “I have a friend who X” response rather than pushing people to divulge personal information. Asking “How do you think students coped?” is better than “How did you cope?” Chances are, some participants will begin talking about themselves without you directly asking them to do so, but allowing impersonal responses here is good. The group itself will determine how deep and how personal it wants to go. This is not the time or place to push anyone out of their comfort zone!

Of course, people have different levels of comfort talking publicly about certain topics. You will have provided detailed information to your focus group participants beforehand and secured consent. But even so, the conversation may take a turn that makes someone uncomfortable. Be on the lookout for this, and remind everyone of their ability to opt out—to stay silent or to leave if necessary. Rather than call attention to anyone in this way, you also want to let everyone know they are free to walk around—to get up and get coffee (more on this below) or use the restroom or just step out of the room to take a call. Of course, you don’t really want anyone to do any of these things, and chances are everyone will stay seated during the hour, but you should leave this “out” for those who need it.

Have copies of consent forms and any supplemental questionnaire (e.g., demographic information) you are using prepared in advance. Ask a friend or colleague to assist you on the day of the focus group. They can be responsible for making sure the recording equipment is functioning and may even take some notes on body language while you are moderating the discussion. Order food (coffee or snacks) for the group. This is important! Having refreshments will be appreciated by your participants and really damps down the anxiety level. Bring name tags and pens. Find a quiet welcoming space to convene. Often this is a classroom where you move chairs into a circle, but public libraries often have meeting rooms that are ideal places for community members to meet. Be sure that the space allows for food.

Researcher Note

When I was designing my research plan for studying activist groups, I consulted one of the best qualitative researchers I knew, my late friend Raphael Ezekiel, author of The Racist Mind . He looked at my plan to hand people demographic surveys at the end of the meetings I planned to observe and said, “This methodology is missing one crucial thing.” “What?” I asked breathlessly, anticipating some technical insider tip. “Chocolate!” he answered. “They’ll be tired, ready to leave when you ask them to fill something out. Offer an incentive, and they will stick around.” It worked! As the meetings began to wind down, I would whip some bags of chocolate candies out of my bag. Everyone would stare, and I’d say they were my thank-you gift to anyone who filled out my survey. Once I learned to include some sugar-free candies for diabetics, my typical response rate was 100 percent. (And it gave me an additional class-culture data point by noticing who chose which brand; sure enough, Lindt balls went faster at majority professional-middle-class groups, and Hershey’s minibars went faster at majority working-class groups.)

—Betsy Leondar-Wright, author of Missing Class , coauthor of The Color of Wealth , associate professor of sociology at Lasell University, and coordinator of staffing at the Mission Project for Class Action

During the Focus Group

As people arrive, greet them warmly, and make sure you get a signed consent form (if not in advance). If you are using name tags, ask them to fill one out and wear it. Let them get food and find a seat and do a little chatting, as they might wish. Once seated, many focus group moderators begin with a relevant icebreaker. This could be simple introductions that have some meaning or connection to the focus. In the case of the ASA task force focus groups discussed above, we asked people to introduce themselves and where they were working/studying (“Hi, I’m Allison, and I am a professor at Oregon State University”). You will also want to introduce yourself and the study in simple terms. They’ve already read the consent form, but you would be surprised at how many people ignore the details there or don’t remember them. Briefly talking about the study and then letting people ask any follow-up questions lays a good foundation for a successful discussion, as it reminds everyone what the point of the event is.

Focus groups should convene for between forty-five and ninety minutes. Of course, you must tell the participants the time you have chosen in advance, and you must promptly end at the time allotted. Do not make anyone nervous by extending the time. Let them know at the outset that you will adhere to this timeline. This should reduce the nervous checking of phones and watches and wall clocks as the end time draws near.

Set ground rules and expectations for the group discussion. My preference is to begin with a general question and let whoever wants to answer it do so, but other moderators expect each person to answer most questions. Explain how much cross-talk you will permit (or encourage). Again, my preference is to allow the group to pick up the ball and run with it, so I will sometimes keep my head purposefully down so that they engage with one another rather than me, but I have seen other moderators take a much more engaged position. Just be clear at the outset about what your expectations are. You may or may not want to explain how the group should deal with those who would dominate the conversation. Sometimes, simply stating at the outset that all voices should be heard is enough to create a more egalitarian discourse. Other times, you will have to actively step in to manage (moderate) the exchange to allow more voices to be heard. Finally, let people know they are free to get up to get more coffee or leave the room as they need (if you are OK with this). You may ask people to refrain from using their phones during the duration of the discussion. That is up to you too.

Either before or after the introductions (your call), begin recording the discussion with their collective permission and knowledge . If you have brought a friend or colleague to assist you (as you should), have them attend to the recording. Explain the role of your colleague to the group (e.g., they will monitor the recording and will take short notes throughout to help you when you read the transcript later; they will be a silent observer).

Once the focus group gets going, it may be difficult to keep up. You will need to make a lot of quick decisions during the discussion about whether to intervene or let it go unguided. Only you really care about the research question or topic, so only you will really know when the discussion is truly off topic. However you handle this, keep your “participation” to a minimum. According to Lune and Berg ( 2018:95 ), the moderator’s voice should show up in the transcript no more than 10 percent of the time. By the way, you should also ask your research assistant to take special note of the “intensity” of the conversation, as this may be lost in a transcript. If there are people looking overly excited or tapping their feet with impatience or nodding their heads in unison, you want some record of this for future analysis.

I’m not sure why this stuck with me, but I thought it would be interesting to share. When I was reviewing my plan for conducting focus groups with one of my committee members, he suggested that I give the participants their gift cards first. The incentive for participating in the study was a gift card of their choice, and typical processes dictate that participants must complete the study in order to receive their gift card. However, my committee member (who is Native himself) suggested I give it at the beginning. As a qualitative researcher, you build trust with the people you engage with. You are asking them to share their stories with you, their intimate moments, their vulnerabilities, their time. Not to mention that Native people are familiar with being academia’s subjects of interest with little to no benefit to be returned to them. To show my appreciation, one of the things I could do was to give their gifts at the beginning, regardless of whether or not they completed participating.

—Susanna Y. Park, PhD, mixed-methods researcher in public health and author of “How Native Women Seek Support as Survivors of Intimate Partner Violence: A Mixed-Methods Study”

After the Focus Group

Your “data” will be either fieldnotes taken during the focus group or, more desirably, transcripts of the recorded exchange. If you do not have permission to record the focus group discussion, make sure you take very clear notes during the exchange and then spend a few hours afterward filling them in as much as possible, creating a rich memo to yourself about what you saw and heard and experienced, including any notes about body language and interactions. Ideally, however, you will have recorded the discussion. It is still a good idea to spend some time immediately after the conclusion of the discussion to write a memo to yourself with all the things that may not make it into the written record (e.g., body language and interactions). This is also a good time to journal about or create a memo with your initial researcher reactions to what you saw, noting anything of particular interest that you want to come back to later on (e.g., “It was interesting that no one thought Joe should quit his job, but in the other focus group, half of the group did. I wonder if this has something to do with the fact that all the participants were first-generation college students. I should pay attention to class background here.”).

Please thank each of your participants in a follow-up email or text. Let them know you appreciated their time and invite follow-up questions or comments.

One of the difficult things about focus group transcripts is keeping speakers distinct. Eventually, you are going to be using pseudonyms for any publication, but for now, you probably want to know who said what. You can assign speaker numbers (“Speaker 1,” “Speaker 2”) and connect those identifications with particular demographic information in a separate document. Remember to clearly separate actual identifications (as with consent forms) to prevent breaches of anonymity. If you cannot identify a speaker when transcribing, you can write, “Unidentified Speaker.” Once you have your transcript(s) and memos and fieldnotes, you can begin analyzing the data (chapters 18 and 19).

Advanced: Focus Groups on Sensitive Topics

Throughout this chapter, I have recommended against raising sensitive topics in focus group discussions. As an introvert myself, I find the idea of discussing personal topics in a group disturbing, and I tend to avoid conducting these kinds of focus groups. And yet I have actually participated in focus groups that do discuss personal information and consequently have been of great value to me as a participant (and researcher) because of this. There are even some researchers who believe this is the best use of focus groups ( de Oliveira 2011 ). For example, Jordan et al. ( 2007 ) argue that focus groups should be considered most useful for illuminating locally sanctioned ways of talking about sensitive issues. So although I do not recommend the beginning qualitative researcher dive into deep waters before they can swim, this section will provide some guidelines for conducting focus groups on sensitive topics. To my mind, these are a minimum set of guidelines to follow when dealing with sensitive topics.

First, be transparent about the place of sensitive topics in your focus group. If the whole point of your focus group is to discuss something sensitive, such as how women gain support after traumatic sexual assault events, make this abundantly clear in your consent form and recruiting materials. It is never appropriate to blindside participants with sensitive or threatening topics .

Second, create a confidentiality form (figure 12.2) for each participant to sign. These forms carry no legal weight, but they do create an expectation of confidentiality for group members.

In order to respect the privacy of all participants in [insert name of study here], all parties are asked to read and sign the statement below. If you have any reason not to sign, please discuss this with [insert your name], the researcher of this study, I, ________________________, agree to maintain the confidentiality of the information discussed by all participants and researchers during the focus group discussion.

Signature: _____________________________ Date: _____________________

Researcher’s Signature:___________________ Date:______________________

Figure 12.2 Confidentiality Agreement of Focus Group Participants

Third, provide abundant space for opting out of the discussion. Participants are, of course, always permitted to refrain from answering a question or to ask for the recording to be stopped. It is important that focus group members know they have these rights during the group discussion as well. And if you see a person who is looking uncomfortable or like they want to hide, you need to step in affirmatively and remind everyone of these rights.

Finally, if things go “off the rails,” permit yourself the ability to end the focus group. Debrief with each member as necessary.

Focus Groups – Steps, Examples and Guide

Table of Contents

Focus Group

Definition:

A focus group is a qualitative research method used to gather in-depth insights and opinions from a group of individuals about a particular product, service, concept, or idea.

The focus group typically consists of 6-10 participants who are selected based on shared characteristics such as demographics, interests, or experiences. The discussion is moderated by a trained facilitator who asks open-ended questions to encourage participants to share their thoughts, feelings, and attitudes towards the topic.

Focus groups are an effective way to gather detailed information about consumer behavior, attitudes, and perceptions, and can provide valuable insights to inform decision-making in a range of fields including marketing, product development, and public policy.

Types of Focus Group

The following are some types or methods of Focus Groups:

Traditional Focus Group

This is the most common type of focus group, where a small group of people is brought together to discuss a particular topic. The discussion is typically led by a skilled facilitator who asks open-ended questions to encourage participants to share their thoughts and opinions.

Mini Focus Group

A mini-focus group involves a smaller group of participants, typically 3 to 5 people. This type of focus group is useful when the topic being discussed is particularly sensitive or when the participants are difficult to recruit.

Dual Moderator Focus Group

In a dual-moderator focus group, two facilitators are used to manage the discussion. This can help to ensure that the discussion stays on track and that all participants have an opportunity to share their opinions.

Teleconference or Online Focus Group

Teleconferences or online focus groups are conducted using video conferencing technology or online discussion forums. This allows participants to join the discussion from anywhere in the world, making it easier to recruit participants and reducing the cost of conducting the focus group.

Client-led Focus Group

In a client-led focus group, the client who is commissioning the research takes an active role in the discussion. This type of focus group is useful when the client has specific questions they want to ask or when they want to gain a deeper understanding of their customers.

The following Table can explain Focus Group types more clearly

How To Conduct a Focus Group

To conduct a focus group, follow these general steps:

Define the Research Question

Identify the key research question or objective that you want to explore through the focus group. Develop a discussion guide that outlines the topics and questions you want to cover during the session.

Recruit Participants

Identify the target audience for the focus group and recruit participants who meet the eligibility criteria. You can use various recruitment methods such as social media, online panels, or referrals from existing customers.

Select a Venue

Choose a location that is convenient for the participants and has the necessary facilities such as audio-visual equipment, seating, and refreshments.

Conduct the Session

During the focus group session, introduce the topic, and review the objectives of the research. Encourage participants to share their thoughts and opinions by asking open-ended questions and probing deeper into their responses. Ensure that the discussion remains on topic and that all participants have an opportunity to contribute.

Record the Session

Use audio or video recording equipment to capture the discussion. Note-taking is also essential to ensure that you capture all key points and insights.

Analyze the data

Once the focus group is complete, transcribe and analyze the data. Look for common themes, patterns, and insights that emerge from the discussion. Use this information to generate insights and recommendations that can be applied to the research question.

When to use Focus Group Method

The focus group method is typically used in the following situations:

Exploratory Research

When a researcher wants to explore a new or complex topic in-depth, focus groups can be used to generate ideas, opinions, and insights.

Product Development

Focus groups are often used to gather feedback from consumers about new products or product features to help identify potential areas for improvement.

Marketing Research

Focus groups can be used to test marketing concepts, messaging, or advertising campaigns to determine their effectiveness and appeal to different target audiences.

Customer Feedback

Focus groups can be used to gather feedback from customers about their experiences with a particular product or service, helping companies improve customer satisfaction and loyalty.

Public Policy Research

Focus groups can be used to gather public opinions and attitudes on social or political issues, helping policymakers make more informed decisions.

Examples of Focus Group

Here are some real-time examples of focus groups:

A tech company wants to improve the user experience of their mobile app. They conduct a focus group with a diverse group of users to gather feedback on the app’s design, functionality, and features. The focus group consists of 8 participants who are selected based on their age, gender, ethnicity, and level of experience with the app. During the session, a trained facilitator asks open-ended questions to encourage participants to share their thoughts and opinions on the app. The facilitator also observes the participants’ behavior and reactions to the app’s features. After the focus group, the data is analyzed to identify common themes and issues raised by the participants. The insights gathered from the focus group are used to inform improvements to the app’s design and functionality, with the goal of creating a more user-friendly and engaging experience for all users.
A car manufacturer wants to develop a new electric vehicle that appeals to a younger demographic. They conduct a focus group with millennials to gather their opinions on the design, features, and pricing of the vehicle.
A political campaign team wants to develop effective messaging for their candidate’s campaign. They conduct a focus group with voters to gather their opinions on key issues and identify the most persuasive arguments and messages.
A restaurant chain wants to develop a new menu that appeals to health-conscious customers. They conduct a focus group with fitness enthusiasts to gather their opinions on the types of food and drinks that they would like to see on the menu.
A healthcare organization wants to develop a new wellness program for their employees. They conduct a focus group with employees to gather their opinions on the types of programs, incentives, and support that would be most effective in promoting healthy behaviors.
A clothing retailer wants to develop a new line of sustainable and eco-friendly clothing. They conduct a focus group with environmentally conscious consumers to gather their opinions on the design, materials, and pricing of the clothing.

Purpose of Focus Group

The key objectives of a focus group include:

Generating New Ideas and insights

Focus groups are used to explore new or complex topics in-depth, generating new ideas and insights that may not have been previously considered.

Understanding Consumer Behavior

Focus groups can be used to gather information on consumer behavior, attitudes, and perceptions to inform marketing and product development strategies.

Testing Concepts and Ideas

Focus groups can be used to test marketing concepts, messaging, or product prototypes to determine their effectiveness and appeal to different target audiences.

Gathering Customer Feedback

Informing decision-making.

Focus groups can provide valuable insights to inform decision-making in a range of fields including marketing, product development, and public policy.

Advantages of Focus Group

The advantages of using focus groups are:

In-depth insights: Focus groups provide in-depth insights into the attitudes, opinions, and behaviors of a target audience on a specific topic, allowing researchers to gain a deeper understanding of the issues being explored.
Group dynamics: The group dynamics of focus groups can provide additional insights, as participants may build on each other’s ideas, share experiences, and debate different perspectives.
Efficient data collection: Focus groups are an efficient way to collect data from multiple individuals at the same time, making them a cost-effective method of research.
Flexibility : Focus groups can be adapted to suit a range of research objectives, from exploratory research to concept testing and customer feedback.
Real-time feedback: Focus groups provide real-time feedback on new products or concepts, allowing researchers to make immediate adjustments and improvements based on participant feedback.
Participant engagement: Focus groups can be a more engaging and interactive research method than surveys or other quantitative methods, as participants have the opportunity to express their opinions and interact with other participants.

Limitations of Focus Groups

While focus groups can provide valuable insights, there are also some limitations to using them.

Small sample size: Focus groups typically involve a small number of participants, which may not be representative of the broader population being studied.
Group dynamics : While group dynamics can be an advantage of focus groups, they can also be a limitation, as dominant personalities may sway the discussion or participants may not feel comfortable expressing their true opinions.
Limited generalizability : Because focus groups involve a small sample size, the results may not be generalizable to the broader population.
Limited depth of responses: Because focus groups are time-limited, participants may not have the opportunity to fully explore or elaborate on their opinions or experiences.
Potential for bias: The facilitator of a focus group may inadvertently influence the discussion or the selection of participants may not be representative, leading to potential bias in the results.
Difficulty in analysis : The qualitative data collected in focus groups can be difficult to analyze, as it is often subjective and requires a skilled researcher to interpret and identify themes.

Characteristics of Focus Group

Small group size: Focus groups typically involve a small number of participants, ranging from 6 to 12 people. This allows for a more in-depth and focused discussion.
Targeted participants: Participants in focus groups are selected based on specific criteria, such as age, gender, or experience with a particular product or service.
Facilitated discussion: A skilled facilitator leads the discussion, asking open-ended questions and encouraging participants to share their thoughts and experiences.
I nteractive and conversational: Focus groups are interactive and conversational, with participants building on each other’s ideas and responding to one another’s opinions.
Qualitative data: The data collected in focus groups is qualitative, providing detailed insights into participants’ attitudes, opinions, and behaviors.
Non-threatening environment: Participants are encouraged to share their thoughts and experiences in a non-threatening and supportive environment.
Limited time frame: Focus groups are typically time-limited, lasting between 1 and 2 hours, to ensure that the discussion stays focused and productive.

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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Qualitative Research:...

Qualitative Research: Introducing focus groups

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Peer review
Jenny Kitzinger , research fellow a
a Glasgow University Media Group, Department of Sociology, University of Glasgow, Glasgow G12 8LF

This paper introduces focus group methodology, gives advice on group composition, running the groups, and analysing the results. Focus groups have advantages for researchers in the field of health and medicine: they do not discriminate against people who cannot read or write and they can encourage participation from people reluctant to be interviewed on their own or who feel they have nothing to say.

This is the fifth in a series of seven articles describing non-quantitative techniques and showing their value in health research

**FIGURE OMITTED**

Rationale and uses of focus groups

Focus groups are a form of group interview that capitalises on communication between research participants in order to generate data. Although group interviews are often used simply as a quick and convenient way to collect data from several people simultaneously, focus groups explicitly use group interaction as part of the method. This means that instead of the researcher asking each person to respond to a question in turn, people are encouraged to talk to one another: asking questions, exchanging anecdotes and commenting on each other's experiences and points of view. 1 The method is particularly useful for exploring people's knowledge and experiences and can be used to examine not only what people think but how they think and why they think that way.

Focus groups were originally used within communication studies to explore the effects of films and television programmes, 2 and are a popular method for assessing health education messages and examining public understandings of illness and of health behaviours. 3 4 5 6 7 They are widely used to examine people's experiences of disease and of health services. 8 9 and are an effective technique for exploring the attitudes and needs of staff. 10 11

The idea behind the focus group method is that group processes can help people to explore and clarify their views in ways that would be less easily accessible in a one to one interview. Group discussion is particularly appropriate when the interviewer has a series of open ended questions and wishes to encourage research participants to explore the issues of importance to them, in their own vocabulary, generating their own questions and pursuing their own priorities. When group dynamics work well the participants work alongside the researcher, taking the research in new and often unexpected directions.

Group work also helps researchers tap into the many different forms of communication that people use in day to day interaction, including jokes, anecdotes, teasing, and arguing. Gaining access to such variety of communication is useful because people's knowledge and attitudes are not entirely encapsulated in reasoned responses to direct questions. Everyday forms of communication may tell us as much, if not more, about what people know or experience. In this sense focus groups reach the parts that other methods cannot reach, revealing dimensions of understanding that often remain untapped by more conventional data collection techniques.

Some potential sampling advantages with focus groups

Do not discriminate against people who cannot read or write

Can encourage participation from those who are reluctant to be interviewed on their own (such as those intimidated by the formality and isolation of a one to one interview)

Can encourage contributions from people who feel they have nothing to say or who are deemed “unresponsive patients” (but engage in the discussion generated by other group members)

Tapping into such interpersonal communication is also important because this can highlight (sub)cultural values or group norms. Through analysing the operation of humour, consensus, and dissent and examining different types of narrative used within the group, the researcher can identify shared and common knowledge. 12 This makes focus groups a data collection technique particularly sensitive to cultural variables—which is why it is so often used in cross cultural research and work with ethnic minorities. It also makes them useful in studies examining why different sections of the population make differential use of health services. 13 14 For similar reasons focus groups are useful for studying dominant cultural values (for example, exposing dominant narratives about sexuality 15 ) and for examining work place cultures—the ways in which, for example, staff cope with working with terminally ill patients or deal with the stresses of an accident and emergency department.

The downside of such group dynamics is that the articulation of group norms may silence individual voices of dissent. The presence of other research participants also compromises the confidentiality of the research session. For example, in group discussion with old people in long term residential care I found that some residents tried to prevent others from criticising staff—becoming agitated and repeatedly interrupting with cries of “you can't complain”; “the staff couldn't possibly be nicer.” On the one hand, such interactions highlighted certain aspects of these people's experiences. In this case, it showed some resident's fear of being “punished” by staff for, in the words of one woman, “being cheeky.” On the other hand, such group dynamics raise ethical issues (especially when the work is with “captive” populations) and may limit the usefulness of the data for certain purposes (Scottish Health Feedback, unpublished report).

However, it should not be assumed that groups are, by definition, inhibiting relative to the supposed privacy of an interview situation or that focus groups are inappropriate when researching sensitive topics. Quite the opposite may be true. Group work can actively facilitate the discussion of taboo topics because the less inhibited members of the group break the ice for shyer participants. Participants can also provide mutual support in expressing feelings that are common to their group but which they consider to deviate from mainstream culture (or the assumed culture of the researcher). This is particularly important when researching stigmatised or taboo experiences (for example, bereavement or sexual violence).

Focus group methods are also popular with those conducting action research and those concerned to “empower” research participants because the participants can become an active part of the process of analysis. Indeed, group participants may actually develop particular perspectives as a consequence of talking with other people who have similar experiences. For example, group dynamics can allow for a shift from personal, self blaming psychological explanations (“I'm stupid not to have understood what the doctor was telling me”; “I should have been stronger—I should have asked the right questions”) to the exploration of structural solutions (“If we've all felt confused about what we've been told maybe having a leaflet would help, or what about being able to take away a tape recording of the consultation?”).

Some researchers have also noted that group discussions can generate more critical comments than interviews. 16 For example, Geis et al, in their study of the lovers of people with AIDS, found that there were more angry comments about the medical community in the group discussions than in the individual interviews: “perhaps the synergism of the group ‘kept the anger going’ and allowed each participant to reinforce another's vented feelings of frustration and rage. 17 A method that facilitates the expression of criticism and the exploration of different types of solutions is invaluable if the aim of research is to improve services. Such a method is especially appropriate when working with particular disempowered patient populations who are often reluctant to give negative feedback or may feel that any problems result from their own inadequacies. 19

Conducting a focus group study

Sampling and group composition.

Focus group studies can consist of anything between half a dozen to over fifty groups, depending on the aims of the project and the resources available. Most studies involve just a few groups, and some combine this method with other data collection techniques. Focus group discussion of a questionnaire is ideal for testing the phrasing of questions and is also useful in explaining or exploring survey results. 19 20

Although it may be possible to work with a representative sample of a small population, most focus group studies use a theoretical sampling model (explained earlier in this series 21 ) whereby participants are selected to reflect a range of the total study population or to test particular hypotheses. Imaginative sampling is crucial. Most people now recognise class or ethnicity as important variables, and it is also worth considering other variables. For example, when exploring women's experiences of maternity care or cervical smears it may be advisable to include groups of lesbians or women who were sexually abused as children. 22

Most researchers recommend aiming for homogeneity within each group in order to capitalise on people's shared experiences. However, it can also be advantageous to bring together a diverse group (for example, from a range of professions) to maximise exploration of different perspectives within a group setting. However, it is important to be aware of how hierarchy within the group may affect the data (a nursing auxiliary, for example, is likely to be inhibited by the presence of a consultant from the same hospital).

The groups can be “naturally occurring” (for example, people who work together) or may be drawn together specifically for the research. Using preexisting groups allows observation of fragments of interactions that approximate to naturally occurring data (such as might have been collected by participant observation). An additional advantage is that friends and colleagues can relate each other's comments to incidents in their shared daily lives. They may challenge each other on contradictions between what they profess to believe and how they actually behave (for example, “how about that time you didn't use a glove while taking blood from a patient?”).

It would be naive to assume that group data are by definition “natural” in the sense that such interactions would have occurred without the group being convened for this purpose. Rather than assuming that sessions inevitably reflect everyday interactions (although sometimes they will), the group should be used to encourage people to engage with one another, formulate their ideas, and draw out the cognitive structures which previously have not been articulated.

Finally, it is important to consider the appropriateness of group work for different study populations and to think about how to overcome potential difficulties. Group work can facilitate collecting information from people who cannot read or write. The “safety in numbers factor” may also encourage the participation of those who are wary of an interviewer or who are anxious about talking. 23 However, group work can compound difficulties in communication if each person has a different disability. In the study assessing residential care for the elderly, I conducted a focus group that included one person who had impaired hearing, another with senile dementia, and a third with partial paralysis affecting her speech. This severely restricted interaction between research participants and confirmed some of the staff's predictions about the limitations of group work with this population. However, such problems could be resolved by thinking more carefully about the composition of the group, and sometimes group participants could help to translate for each other. It should also be noted that some of the old people who might have been unable to sustain a one to one interview were able to take part in the group, contributing intermittently. Even some residents who staff had suggested should be excluded from the research because they were “unresponsive” eventually responded to the lively conversations generated by their coresidents and were able to contribute their point of view. Communication difficulties should not rule out group work, but must be considered as a factor.

RUNNING THE GROUPS

Sessions should be relaxed: a comfortable setting, refreshments, and sitting round in a circle will help to establish the right atmosphere. The ideal group size is between four and eight people. Sessions may last one to two hours (or extend into a whole afternoon or a series of meetings). The facilitator should explain that the aim of focus groups is to encourage people to talk to each other rather than to address themselves to the researcher. The researcher may take a back seat at first, allowing for a type of “structured eavesdropping.” 24 Later on in the session, however, the researcher can adopt a more interventionist style: urging debate to continue beyond the stage it might otherwise have ended and encouraging the group to discuss the inconsistencies both between participants and within their own thinking. Disagreements within groups can be used to encourage participants to elucidate their point of view and to clarify why they think as they do. Differences between individual one off interviews have to be analysed by the researchers through armchair theorising; differences between members of focus groups should be explored in situ with the help of the research participants.

The facilitator may also use a range of group exercises. A common exercise consists of presenting the group with a series of statements on large cards. The group members are asked collectively to sort these cards into different piles depending on, for example, their degree of agreement or disagreement with that point of view or the importance they assign to that particular aspect of service. For example, I have used such cards to explore public understandings of HIV transmission (placing statements about “types” of people into different risk categories), old people's experiences of residential care (assigning degrees of importance to different statements about the quality of their care), and midwive's views of their professional responsibilities (placing a series of statements about midwive's roles along an agree-disagree continuum). Such exercises encourage participants to concentrate on one another (rather than on the group facilitator) and force them to explain their different perspectives. The final layout of the cards is less important than the discussion that it generates. 25 Researchers may also use such exercises as a way of checking out their own assessment of what has emerged from the group. In this case it is best to take along a series of blank cards and fill them out only towards the end of the session, using statements generated during the course of the discussion. Finally, it may be beneficial to present research participants with a brief questionnaire, or the opportunity to speak to the researcher privately, giving each one the opportunity to record private comments after the group session has been completed.

Ideally the group discussions should be tape recorded and transcribed. If this is not possible then it is vital to take careful notes and researchers may find it useful to involve the group in recording key issues on a flip chart.

ANALYSIS AND WRITING UP

Analysing focus groups is basically the same as analysing any other qualitative self report data. 21 26 At the very least, the researcher draws together and compares discussions of similar themes and examines how these relate to the variables within the sample population. In general, it is not appropriate to give percentages in reports of focus group data, and it is important to try to distinguish between individual opinions expressed in spite of the group from the actual group consensus. As in all qualitative analysis, deviant case analysis is important—that is, attention must be given to minority opinions and examples that do not fit with the researcher's overall theory.

The only distinct feature of working with focus group data is the need to indicate the impact of the group dynamic and analyse the sessions in ways that take full advantage of the interaction between research participants. In coding the script of a group discussion, it is worth using special categories for certain types of narrative, such as jokes and anecdotes, and types of interaction, such as “questions,” “deferring to the opinion of others,” “censorship,” or “changes of mind.” A focus group research report that is true to its data should also usually include at least some illustrations of the talk between participants, rather than simply presenting isolated quotations taken out of context.

Tapping into interpersonal communication can highlight cultural values or group norms

This paper has presented the factors to consider when designing or evaluating a focus group study. In particular, it has drawn attention to the overt exploitation and exploration of interactions in focus group discussion. Interaction between participants can be used to achieve seven main aims:

To highlight the respondent's attitudes, priorities, language, and framework of understanding;

To encourage research participants to generate and explore their own questions and develop their own analysis of common experiences;

To encourage a variety of communication from participants—tapping into a wide range and form of understanding;

To help to identify group norms and cultural values;

To provide insight into the operation of group social processes in the articulation of knowledge (for example, through the examination of what information is censured or muted within the group);

To encourage open conversation about embarrassing subjects and to permit the expression of criticism;

Generally to facilitate the expression of ideas and experiences that might be left underdeveloped in an interview and to illuminate the research participant's perspectives through the debate within the group.

Group data are neither more nor less authentic than data collected by other methods, but focus groups can be the most appropriate method for researching particular types of question. Direct observation may be more appropriate for studies of social roles and formal organisations 27 but focus groups are particularly suited to the study of attitudes and experiences. Interviews may be more appropriate for tapping into individual biographies, 27 but focus groups are more suitable for examining how knowledge, and more importantly, ideas, develop and operate within a given cultural context. Questionnaires are more appropriate for obtaining quantitative information and explaining how many people hold a certain (pre-defined) opinion; focus groups are better for exploring exactly how those opinions are constructed. Thus while surveys repeatedly identify gaps between health knowledge and health behaviour, only qualitative methods, such as focus groups, can actually fill these gaps and explain why these occur.

Focus groups are not an easy option. The data they generate can be as cumbersome as they are complex. Yet the method is basically straightforward and need not be intimidating for either the researcher or the researched. Perhaps the very best way of working out whether or not focus groups might be appropriate in any particular study is to try them out in practice.

What Is a Focus Group?

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

A focus group is a qualitative research method that involves facilitating a small group discussion with participants who share common characteristics or experiences that are relevant to the research topic. The goal is to gain insights through group conversation and observation of dynamics.

a focus group of people sat on chairs in a circle. one person is making notes on a clipboard.

In a focus group:

A moderator asks questions and leads a group of typically 6 to 12 pre-screened participants through a discussion focused on a particular topic.
Group members are encouraged to talk with one another, exchange anecdotes, comment on each others’ experiences and points of view, and build on each others’ responses.
The goal is to create a candid, natural conversation that provides insights into the participants’ perceptions, attitudes, beliefs, and opinions on the topic.
Focus groups capitalize on group dynamics to elicit multiple perspectives in a social environment as participants are influenced by and influence others through open discussion.
The interactive responses allow researchers to quickly gather more contextual, nuanced qualitative data compared to surveys or one-on-one interviews.

Focus groups allow researchers to gather perspectives from multiple people at once in an interactive group setting. This group dynamic surfaces richer responses as participants build on each other’s comments, discuss issues in-depth, and voice agreements or disagreements.

It is important that participants feel comfortable expressing diverse viewpoints rather than being pressured into a consensus.

Focus groups emerged as an alternative to questionnaires in the 1930s over concerns that surveys fostered passive responses or failed to capture people’s authentic perspectives.

During World War II, focus groups were used to evaluate military morale-boosting radio programs. By the 1950s focus groups became widely adopted in marketing research to test consumer preferences.

A key benefit K. Merton highlighted in 1956 was grouping participants with shared knowledge of a topic. This common grounding enables people to provide context to their experiences and allows contrasts between viewpoints to emerge across the group.

As a result, focus groups can elicit a wider range of perspectives than one-on-one interviews.

Step 1 : Clarify the Focus Group’s Purpose and Orientation

Clarify the purpose and orientation of the focus group (Tracy, 2013). Carefully consider whether a focus group or individual interviews will provide the type of qualitative data needed to address your research questions.

Determine if the interactive, fast-paced group discussion format is aligned with gathering perspectives vs. in-depth attitudes on a topic.

Consider incorporating special techniques like extended focus groups with pre-surveys, touchstones using creative imagery/metaphors to focus the topic, or bracketing through ongoing conceptual inspection.

For example

A touchstone in a focus group refers to using a shared experience, activity, metaphor, or other creative technique to provide a common reference point and orientation for grounding the discussion.

The purpose of Mulvale et al. (2021) was to understand the hospital experiences of youth after suicide attempts.

The researchers created a touchstone to focus the discussion specifically around the hospital visit. This provided a shared orientation for the vulnerable participants to open up about their emotional journeys.

In the example from Mulvale et al. (2021), the researchers designated the hospital visit following suicide attempts as the touchstone. This means:

The visit served as a defining shared experience all youth participants could draw upon to guide the focus group discussion, since they unfortunately had this in common.
Framing questions around recounting and making meaning out of the hospitalization focused the conversation to elicit rich details about interactions, emotions, challenges, supports needed, and more in relation to this watershed event.
The hospital visit as a touchstone likely resonated profoundly across youth given the intensity and vulnerability surrounding their suicide attempts. This deepened their willingness to open up and established group rapport.

So in this case, the touchstone concentrated the dialogue around a common catalyst experience enabling youth to build understanding, voice difficulties, and potentially find healing through sharing their journey with empathetic peers who had endured the same trauma.

Step 2 : Select a Homogeneous Grouping Characteristic

Select a homogeneous grouping characteristic (Krueger & Casey, 2009) to recruit participants with a commonality, like shared roles, experiences, or demographics, to enable meaningful discussion.

A sample size of between 6 to 10 participants allows for adequate mingling (MacIntosh 1993).

More members may diminish the ability to capture all viewpoints. Fewer risks limited diversity of thought.

Balance recruitment across income, gender, age, and cultural factors to increase heterogeneity in perspectives. Consider screening criteria to qualify relevant participants.

Choosing focus group participants requires balancing homogeneity and diversity – too much variation across gender, class, profession, etc., can inhibit sharing, while over-similarity limits perspectives. Groups should feel mutual comfort and relevance of experience to enable open contributions while still representing a mix of viewpoints on the topic (Morgan 1988).

Mulvale et al. (2021) determined grouping by gender rather than age or ethnicity was more impactful for suicide attempt experiences.

They fostered difficult discussions by bringing together male and female youth separately based on the sensitive nature of topics like societal expectations around distress.

Step 3 : Designate a Moderator

Designate a skilled, neutral moderator (Crowe, 2003; Morgan, 1997) to steer productive dialogue given their expertise in guiding group interactions. Consider cultural insider moderators positioned to foster participant sharing by understanding community norms.

Define moderator responsibilities like directing discussion flow, monitoring air time across members, and capturing observational notes on behaviors/dynamics.

Choose whether the moderator also analyzes data or only facilitates the group.

Mulvale et al. (2021) designated a moderator experienced working with marginalized youth to encourage sharing by establishing an empathetic, non-judgmental environment through trust-building and active listening guidance.

Step 4 : Develop a Focus Group Guide

Develop an extensive focus group guide (Krueger & Casey, 2009). Include an introduction to set a relaxed tone, explain the study rationale, review confidentiality protection procedures, and facilitate a participant introduction activity.

Also include guidelines reiterating respect, listening, and sharing principles both verbally and in writing.

Group confidentiality agreement

The group context introduces distinct ethical demands around informed consent, participant expectations, confidentiality, and data treatment. Establishing guidelines at the outset helps address relevant issues.

Create a group confidentiality agreement (Berg, 2004) specifying that all comments made during the session must remain private, anonymous in data analysis, and not discussed outside the group without permission.

Have it signed, demonstrating a communal commitment to sustaining a safe, secure environment for honest sharing.

Berg (2004) recommends a formal signed agreement prohibiting participants from publicly talking about anything said in the focus group without permission. This reassures members their personal disclosures are safeguarded.

Develop questions starting general then funneling down to 10-12 key questions on critical topics. Integrate think/pair/share activities between question sets to encourage inclusion. Close with a conclusion to summarize key ideas voiced without endorsing consensus.

Krueger and Casey (2009) recommend structuring focus group questions in five stages:

Opening Questions:

Start with easy, non-threatening questions to make participants comfortable, often related to their background and experience with the topic.
Get everyone talking and open up initial dialogue.
Example: “Let’s go around and have each person share how long you’ve lived in this city.”

Introductory Questions:

Transition to the key focus group objectives and main topics of interest.
Remain quite general to provide baseline understanding before drilling down.
Example: “Thinking broadly, how would you describe the arts and cultural offerings in your community?”

Transition Questions:

Serve as a logical link between introductory and key questions.
Funnel participants toward critical topics guided by research aims.
Example: “Specifically related to concerts and theatre performances, what venues in town have you attended events at over the past year?”

Key Questions:

Drive at the heart of study goals, and issues under investigation.
Ask 5-10 questions that foster organic, interactive discussion between participants.
Example: “What enhances or detracts from the concert-going experience at these various venues?”

Ending Questions:

Provide an opportunity for final thoughts or anything missed.
Assess the degree of consensus on key topics.
Example: “If you could improve just one thing about the concert and theatre options here, what would you prioritize?”

It is vital to extensively pilot test draft questions to hone the wording, flow, timing, tone and tackle any gaps to adequately cover research objectives through dynamic group discussion.

Step 5 : Prepare the focus group room

Prepare the focus group room (Krueger & Casey, 2009) attending to details like circular seating for eye contact, centralized recording equipment with backup power, name cards, and refreshments to create a welcoming, affirming environment critical for participants to feel valued, comfortable engaging in genuine dialogue as a collective.

Arrange seating comfortably in a circle to facilitate discussion flow and eye contact among members. Decide if space for breakout conversations or activities like role-playing is needed.

Refreshments

Coordinate snacks or light refreshments to be available when focus group members arrive, especially for longer sessions. This contributes to a welcoming atmosphere.
Even if no snacks are provided, consider making bottled water available throughout the session.
Set out colorful pens and blank name tags for focus group members to write their preferred name or pseudonym when they arrive.
Attaching name tags to clothing facilitates interaction and expedites learning names.
If short on preparation time, prepare printed name tags in advance based on RSVPs, but blank name tags enable anonymity if preferred.

Krueger & Casey (2009) suggest welcoming focus group members with comfortable, inclusive seating arrangements in a circle to enable eye contact. Providing snacks and music sets a relaxed tone.

Step 6 : Conduct the focus group

Conduct the focus group utilizing moderation skills like conveying empathy, observing verbal and non-verbal cues, gently redirecting and probing overlooked members, and affirming the usefulness of knowledge sharing.

Use facilitation principles (Krueger & Casey, 2009; Tracy 2013) like ensuring psychological safety, mutual respect, equitable airtime, and eliciting an array of perspectives to expand group knowledge. Gain member buy-in through collaborative review.

Record discussions through detailed note-taking, audio/video recording, and seating charts tracking engaged participation.

The role of moderator

The moderator is critical in facilitating open, interactive discussion in the group. Their main responsibilities are:

Providing clear explanations of the purpose and helping participants feel comfortable
Promoting debate by asking open-ended questions
Drawing out differences of opinion and a range of perspectives by challenging participants
Probing for more details when needed or moving the conversation forward
Keeping the discussion focused and on track
Ensuring all participants get a chance to speak
Remaining neutral and non-judgmental, without sharing personal opinions

Moderators need strong interpersonal abilities to build participant trust and comfort sharing. The degree of control and input from the moderator depends on the research goals and personal style.

With multiple moderators, roles, and responsibilities should be clear and consistent across groups. Careful preparation is key for effective moderation.

Mulvale et al. (2021) fostered psychological safety for youth to share intense emotions about suicide attempts without judgment. The moderator ensured equitable speaking opportunities within a compassionate climate.

Krueger & Casey (2009) advise moderators to handle displays of distress empathetically by offering a break and emotional support through active listening instead of ignoring reactions. This upholds ethical principles.

Advantages and disadvantages of focus groups

Focus groups efficiently provide interactive qualitative data that can yield useful insights into emerging themes. However, findings may be skewed by group behaviors and still require larger sample validation through added research methods. Careful planning is vital.

Efficient way to gather a range of perspectives in participants’ own words in a short time
Group dynamic encourages more complex responses as members build on others’ comments
Can observe meaningful group interactions, consensus, or disagreements
Flexibility for moderators to probe unanticipated insights during discussion
Often feels more comfortable sharing as part of a group rather than one-on-one
Helps participants recall and reflect by listening to others tell their stories

Disadvantages

Small sample size makes findings difficult to generalize
Groupthink: influential members may discourage dissenting views from being shared
Social desirability bias: reluctance from participants to oppose perceived majority opinions
Requires highly skilled moderators to foster inclusive participation and contain domineering members
Confidentiality harder to ensure than with individual interviews
Transcriptions may have overlapping talk that is difficult to capture accurately
Group dynamics adds layers of complexity for analysis beyond just the content of responses

Goss, J. D., & Leinbach, T. R. (1996). Focus groups as alternative research practice: experience with transmigrants in Indonesia. Area , 115-123.

Kitzinger, J. (1994). The methodology of focus groups: the importance of interaction between research participants . Sociology of health & illness , 16 (1), 103-121.

Kitzinger J. (1995). Introducing focus groups. British Medical Journal, 311 , 299-302.

Morgan D.L. (1988). Focus groups as qualitative research . London: Sage.

Mulvale, G., Green, J., Miatello, A., Cassidy, A. E., & Martens, T. (2021). Finding harmony within dissonance: engaging patients, family/caregivers and service providers in research to fundamentally restructure relationships through integrative dynamics . Health Expectations , 24 , 147-160.

Powell, R. A., Single, H. M., & Lloyd, K. R. (1996). Focus groups in mental health research: enhancing the validity of user and provider questionnaires . International Journal of Social Psychiatry , 42 (3), 193-206.

Puchta, C., & Potter, J. (2004). Focus group practice . Sage.

Redmond, R. A., & Curtis, E. A. (2009). Focus groups: principles and process. Nurse researcher , 16 (3).

Smith, J. A., Scammon, D. L., & Beck, S. L. (1995). Using patient focus groups for new patient services. The Joint Commission Journal on Quality Improvement , 21 (1), 22-31.

Smithson, J. (2008). Focus groups. The Sage handbook of social research methods , 357-370.

White, G. E., & Thomson, A. N. (1995). Anonymized focus groups as a research tool for health professionals. Qualitative Health Research , 5 (2), 256-261.

Download PDF slides of the presentation ‘ Conducting Focus Groups – A Brief Overview ‘

Research Design Review

A discussion of qualitative & quantitative research design, strengths of the focus group method: an overview.

The following is a modified excerpt from Applied Qualitative Research Design: A Total Quality Framework Approach (Roller & Lavrakas, 2015, pp. 111-112).

A dynamic group discussion will often stimulate spontaneous ideas and personal disclosures that might otherwise go unstated in an IDI.
A relaxed, interactive, as well as a supportive (e.g., homogeneous) group environment can be conducive to discussing sensitive topics (e.g., a discussion of the immigration process among recent Chinese immigrants to the United States).
As participants exchange opinions, they consider their own views in relation to others’—which may encourage participants to refine their thoughts. In this way the group interaction gives the researcher insight into how people think about the topic(s) being studied and on what basis opinions may change. For example, in a focus group with college students who are considering various study-abroad programs, some participants might change their criteria for selecting one program over another after hearing other participants’ considerations. This discussion would help the researcher identify the important aspects of study-abroad programs that may impact students’ decision making.

Participant interaction, or the social aspect of focus group discussions, can be a particularly important advantage when conducting research with vulnerable and underserved population segments . For instance, women’s studies researchers such as Wilkinson (1999) believe that focus groups offer feminist psychologists an important research approach over other psychological research methods because they (a) come “closer to everyday social processes” (p. 227) and are less “artificial” than other methods; (b) are highly interactive, which “produces insights that would not be available outside the group context” (p. 229); and (c) reduce the moderator’s “exploitation” of the research by shifting control of the discussion to the participants. Other researchers have found the social nature of focus group discussions to be conducive to investigating societal constraints and health needs among Emirati women (Bailey, 2012; Winslow, Honein, & Elzubeir, 2002).

There are two other important strengths of the group discussion method: (1) it allows for the presence of observers , especially in the face-to-face (in-person and sometimes video) mode; and (2) it increases the likelihood that a wide range of attitudes, knowledge, and experiences will be captured in one group session. Whereas most qualitative research methods can conceivably accommodate observers, observers tend to take on a particularly engaged and active role in group interviewing. Face-to-face focus groups are traditionally conducted at a facility equipped with a one-way mirror (and online video group platforms also offer a client backroom), behind which members of the research team can view and hear the discussions. (Note: Group participants are informed of the presence of observers prior to the discussion.) Viewers often include people affiliated with the research sponsor who have a vested interest in learning firsthand about the attitudes and behavior of members of the target population. In addition to gaining clarity on participants’ wants and needs, observers can be helpful in redirecting the discussion on the spot, if necessary, when participants make unanticipated comments that introduce a new way of thinking about the research topic. In these situations, it is important to be able to change course in the research or otherwise pursue new lines of questioning as unanticipated insights emerge from the discussions.

The range of opinions and behavior that can be represented in any one focus group is another important strength of the method because such a range is a factor in finding the “surprising insights” mentioned above. Even the most homogeneous group of participants will relate different experiences and thoughts, thereby giving the researcher an awareness and appreciation of the extent of divergent views on a particular issue. Unlike the IDI method that requires many separate interviews to uncover the spectrum of perspectives related to the subject matter, group discussions offer a time- and often cost-efficient method for revealing differing viewpoints.

Bailey, D. C. (2012). Women and Wasta: The use of focus groups for understanding social capital and Middle Eastern women. Retrieved from The Qualitative Report website: http://www.nova.edu/ssss/QR/QR17/bailey.pdf

Wilkinson, S. (1999). Focus groups: A feminist method. Psychology of Women Quarterly , 23 (2), 221–244.

Winslow, W. W., Honein, G., & Elzubeir, M. A. (2002). Seeking Emirati women’s voices: The use of focus groups with an Arab population. Qualitative Health Research , 12 (4), 566–575. https://doi.org/10.1177/104973202129119991

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What Is a Focus Group? | Step-by-Step Guide & Examples

What Is a Focus Group? | Step-by-Step Guide & Examples

Published on 4 May 2022 by Tegan George . Revised on 6 February 2023.

What is a focus group, step 1: choose your topic of interest, step 2: define your research scope and hypotheses, step 3: determine your focus group questions, step 4: select a moderator or co-moderator, step 5: recruit your participants, step 6: set up your focus group, step 7: host your focus group, step 8: analyse your data and report your results, advantages and disadvantages of focus groups, frequently asked questions about focus groups.

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A focus group may be a good choice for you if:

You’re interested in real-time, unfiltered responses on a given topic or in the dynamics of a discussion between participants
Your questions are rooted in feelings or perceptions , and cannot easily be answered with ‘yes’ or ‘no’
You’re confident that a relatively small number of responses will answer your question
You’re seeking directional information that will help you uncover new questions or future research ideas
Structured interviews : The questions are predetermined in both topic and order.
Semi-structured interviews : A few questions are predetermined, but other questions aren’t planned.
Unstructured interviews : None of the questions are predetermined.

Differences between types of interviews

Make sure to choose the type of interview that suits your research best. This table shows the most important differences between the four types.

Topics favorable to focus groups

However, if your questions are dichotomous or if you need to reach a large audience quickly, a survey may be a better option. If your question hinges upon behaviour but you are worried about influencing responses, consider an observational study .

If you want to determine whether the student body would regularly consume vegan food, a survey would be a great way to gauge student preferences.

However, food is much more than just consumption and nourishment and can have emotional, cultural, and other implications on individuals.

If you’re interested in something less concrete, such as students’ perceptions of vegan food or the interplay between their choices at the dining hall and their feelings of homesickness or loneliness, perhaps a focus group would be best.

Once you have determined that a focus group is the right choice for your topic, you can start thinking about what you expect the group discussion to yield.

Setting your scope will help you formulate intriguing hypotheses , set clear questions, and recruit the right participants.

Are you interested in a particular sector of the population, such as vegans or non-vegans?
Are you interested in including vegetarians in your analysis?
Perhaps not all students eat at the dining hall. Will your study exclude those who don’t?
Are you only interested in students who have strong opinions on the subject?

A benefit of focus groups is that your hypotheses can be open-ended. You can be open to a wide variety of opinions, which can lead to unexpected conclusions.

Overall, your focus group questions should be:

Open-ended and flexible
Impossible to answer with ‘yes’ or ‘no’ (questions that start with ‘why’ or ‘how’ are often best)
Unambiguous, getting straight to the point while still stimulating discussion
Unbiased and neutral

Engagement questions make your participants feel comfortable and at ease: ‘What is your favourite food at the dining hall?’
Exploration questions drill down to the focus of your analysis: ‘What pros and cons of offering vegan options do you see?’
Exit questions pick up on anything you may have previously missed in your discussion: ‘Is there anything you’d like to mention about vegan options in the dining hall that we haven’t discussed?’

If your hypotheses have behavioural aspects, consider asking someone else to be lead moderator so that you are free to take a more observational role.

Depending on your topic, there are a few types of moderator roles that you can choose from.

The most common is the dual-moderator , introduced above.
Another common option is the dueling-moderator style . Here, you and your co-moderator take opposing sides on an issue to allow participants to see different perspectives and respond accordingly.

Depending on your research topic, there are a few sampling methods you can choose from to help you recruit and select participants.

Voluntary response sampling , such as posting a flyer on campus and finding participants based on responses
Convenience sampling of those who are most readily accessible to you, such as fellow students at your university
Stratified sampling of a particular age, race, ethnicity, gender identity, or other characteristic of interest to you
Judgement sampling of a specific set of participants that you already know you want to include

Beware of sampling bias , which can occur when some members of the population are more likely to be included than others.

Number of participants

Lastly, it’s preferable for your participants not to know you or each other, as this can bias your results.

Confirm a time and date

Confirm whether it will take place in person or online

You will also need to decide whether the group will meet in person or online. If you are hosting it in person, be sure to pick an appropriate location.

An uncomfortable or awkward location may affect the mood or level of participation of your group members.
Online sessions are convenient, as participants can join from home, but they can also lessen the connection between participants.

As a general rule, make sure you are in a noise-free environment that minimises distractions and interruptions to your participants.

Consent and ethical considerations

A disadvantage of focus groups is that they are too small to provide true anonymity to participants. Make sure that your participants know this prior to participating.

There are a few things you can do to commit to keeping information private. You can secure confidentiality by removing all identifying information from your report or offer to pseudonymise the data later. Data pseudonymisation entails replacing any identifying information about participants with pseudonymous or false identifiers.

Preparation prior to participation

Consider conducting a tech check prior to the arrival of your participants, and note any environmental or external factors that could affect the mood of the group that day. Be sure that you are organised and ready, as a stressful atmosphere can be distracting and counterproductive.

Starting the focus group

Leading the discussion

As a moderator, strive to remain neutral. Refrain from reacting to responses, and be aware of your body language (e.g., nodding, raising eyebrows). Active listening skills, such as parroting back answers or asking for clarification, are good methods to encourage participation and signal that you’re listening.

The next step is to transcribe and clean your data . Assign each participant a number or pseudonym for organisational purposes. Transcribe the recordings and conduct content analysis to look for themes or categories of responses. The categories you choose can then form the basis for reporting your results.

Just like other research methods, focus groups come with advantages and disadvantages.

They are fairly straightforward to organise and results have strong face validity .
They are usually inexpensive, even if you compensate participant.
A focus group is much less time-consuming than a survey or experiment , and you get immediate results.
Focus group results are often more comprehensible and intuitive than raw data.

Disadvantages

It can be difficult to assemble a truly representative sample. Focus groups are generally not considered externally valid due to their small sample sizes.
Due to the small sample size, you cannot ensure the anonymity of respondents, which may influence their desire to speak freely.
Depth of analysis can be a concern, as it can be challenging to get honest opinions on controversial topics.
There is a lot of room for error in the data analysis and high potential for observer dependency in drawing conclusions. You have to be careful not to cherry-pick responses to fit a prior conclusion.

As a rule of thumb, questions related to thoughts, beliefs, and feelings work well in focus groups . Take your time formulating strong questions, paying special attention to phrasing. Be careful to avoid leading questions , which can bias your responses.

The four most common types of interviews are:

Focus group interviews : The questions are presented to a group instead of one individual.

Social desirability bias is the tendency for interview participants to give responses that will be viewed favourably by the interviewer or other participants. It occurs in all types of interviews and surveys , but is most common in semi-structured interviews , unstructured interviews , and focus groups .

Social desirability bias can be mitigated by ensuring participants feel at ease and comfortable sharing their views. Make sure to pay attention to your own body language and any physical or verbal cues, such as nodding or widening your eyes.

This type of bias in research can also occur in observations if the participants know they’re being observed. They might alter their behaviour accordingly.

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Glob Qual Nurs Res
v.3; Jan-Dec 2016

Methodological Aspects of Focus Groups in Health Research

Anja p. tausch.

1 GESIS–Leibniz Institute for the Social Sciences, Mannheim, Germany

Natalja Menold

Although focus groups are commonly used in health research to explore the perspectives of patients or health care professionals, few studies consider methodological aspects in this specific context. For this reason, we interviewed nine researchers who had conducted focus groups in the context of a project devoted to the development of an electronic personal health record. We performed qualitative content analysis on the interview data relating to recruitment, communication between the focus group participants, and appraisal of the focus group method. The interview data revealed aspects of the focus group method that are particularly relevant for health research and that should be considered in that context. They include, for example, the preferability of face-to-face recruitment, the necessity to allow participants in patient groups sufficient time to introduce themselves, and the use of methods such as participant-generated cards and prioritization.

Focus groups have been widely used in health research in recent years to explore the perspectives of patients and other groups in the health care system (e.g., Carr et al., 2003 ; Côté-Arsenault & Morrison-Beedy, 2005 ; Kitzinger, 2006 ). They are often included in mixed-methods studies to gain more information on how to construct questionnaires or interpret results ( Creswell & Plano Clark, 2007 ; Kroll, Neri, & Miller, 2005 ).

The fact that the group process helps people to identify and clarify their views is considered to be an important advantage of focus groups compared with individual interviews ( Kitzinger, 1995 ). The group functions as a promoter of synergy and spontaneity by encouraging the participants to comment, explain, disagree, and share their views. Thus, experiences are shared and opinions voiced that might not surface during individual interviews ( Carey, 1994 ; Stewart, Shamdasani, & Rook, 2007 ). Although focus groups allow participants to respond in their own words and to choose discussion topics themselves, they are not completely unstructured. Questions relating to the research topic are designed by the researchers and are used to guide the discussion ( Stewart et al., 2007 ). The degree of structure of the focus group depends on the openness of the research question(s). Hence, although it takes more time and effort to organize focus groups, and they cause greater logistical problems than individual interviews do, they might generate more ideas about, and yield deeper insights into, the problem under investigation ( Coenen, Stamm, Stucki, & Cieza, 2012 ; Kingry, Tiedje, & Friedman, 1990 ; Morgan, 2009 ).

Historically, focus groups were used mainly for market research before the method was adopted for application in qualitative research in the social sciences ( Morgan, 1996 ). The use of focus groups in health care research is even more recent. For this reason, methodological recommendations on using focus groups in the health care context are quite rare, and researchers rely mainly on general advice from the social sciences (e.g., Krueger, 1988 ; Morgan, 1993 ; Morgan & Krueger, 1998 ; Stewart et al., 2007 ). Even though focus groups have been used in a great variety of health research fields, such as patients’ treatments and perceptions in the context of specific illnesses (rheumatoid arthritis: for example, Feldthusen, Björk, Forsblad-d’Elia, & Mannerkorpi, 2013 ; cancer: for example, Gerber, Hamann, Rasco, Woodruff, & Lee, 2012 ; diabetes: for example, Nafees, Lloyd, Kennedy-Martin, & Hynd, 2006 ; heart failure: for example, Rasmusson et al., 2014 ), community health research (e.g., Daley et al., 2010 ; Rhodes, Hergenrather, Wilkin, Alegría-Ortega, & Montaño, 2006 ), or invention of new diagnostic or therapeutic methods (e.g., Vincent, Clark, Marquez Zimmer, & Sanchez, 2006 ), the method and its particular use in health research is rarely reflected. Methodological articles about the focus group method in health care journals mainly summarize general advice from the social sciences (e.g., Kingry et al., 1990 ; Kitzinger, 1995 , 2006 ), while field-specific aspects of the target groups (patients, doctors, other medical staff) and the research questions (not only sociological but often also medical or technical) are seldom addressed. Reports on participant recruitment and methods of conducting the focus groups are primarily episodic in nature (e.g., Coenen et al., 2012 ; Côté-Arsenault & Morrison-Beedy, 2005 ) and often focus on very specific aspects of the method (communication: for example, Lehoux, Poland, & Daudelin, 2006 ; activating methods: for example, Colucci, 2007 ) or aim at a comparison between face-to-face focus groups and other methods (individual interviews: for example, Coenen et al., 2012 ; telephone groups: for example, Frazier et al., 2010 ; Internet groups: for example, Nicholas et al., 2010 ). Thus, systematic reviews of factors influencing the results of focus groups as well as advantages, disadvantages, and pitfalls are missing. One consequence is that researchers might find it difficult to recruit enough participants or might be surprised by the communication styles of the target groups. Furthermore, in the tradition of classical clinical research, the group discussions might result in a question-and-answer situation or “resemble individual interviews done in group settings” ( Colucci, 2007 , p. 1,424), thereby missing out on the opportunity to use the group setting to activate all participants and to encourage a deeper elaboration of their ideas. Colucci, for example, proposed the use of exercises (e.g., activity-oriented questions) to focus the attention of the group on the core topic and to facilitate subsequent analyses.

Recommendations from the social sciences on using the focus group method can be subsumed under the following headings: subjects (target groups, composition of groups, recruitment), communication in the groups (discussion guide, moderator, moderating techniques), and analysis of focus groups (e.g., Morgan, 1993 ; Morgan & Krueger, 1998 ; Stewart et al., 2007 ). Specific requirements for health research can be identified in all three thematic fields: Recruitment might be facilitated by using registers of quality circles to recruit physicians or pharmacists, or by recruiting patients in outpatients departments. It might be hampered by heavy burdens on target groups—be they time burdens (e.g., clinical schedules, time-consuming therapy) or health constraints (e.g., physical fitness). With regard to communication in focus groups, finding suitable locations, identifying optimal group sizes, planning a good time line, as well as selecting suitable moderators (e.g., persons who are capable of translating medical terms into everyday language) might pose a challenge. The analysis of focus groups in health care research might also require special procedures because the focus group method is used to answer not only sociological research questions (e.g., related to the reconstruction of the perspectives of target groups) but also more specific research questions, such as user requirements with regard to written information or technical innovations.

The aim of our study was to gather more systematic methodological information for conducting focus groups in the context of health research in general and in the more specific context of the implementation of a technical innovation. To this end, we conducted interviews with focus group moderators about their experiences when planning and moderating focus groups. The groups in question were part of a research program aimed at developing and evaluating an electronic personal health record. We chose this program for several reasons: First, because it consisted of several subprojects devoted to different research topics related to the development of a personal electronic health record, it offered a variety of research content (cf. next section). Second, the focus groups were conducted to answer research questions of varying breadth, which can be regarded as typical of research in health care. Third, the focus groups comprised a variety of target groups—not only patients but also different types of health care professionals (general practitioners, independent specialists with different areas of specialization, hospital doctors, pharmacists, medical assistants, nursing staff).

In this article, we report the findings of these interviews in relation to the following questions: (a) What challenges associated with the characteristics of the target groups of health research (patients, physicians, other health care professionals) might be considered during the recruitment process? How should the specific research question relating to a technical innovation be taken into account during the recruitment process? (b) Should specific aspects of the communication styles of target groups be taken into account when planning and moderating focus groups in health care? Can additional challenges be identified in relation to the technical research question? and (c) How was the method appraised by the interviewees in their own research context?

Research Program and Description of Focus Groups

The “Information Technology for Patient-Centered Health Care” (INFOPAT) research program ( www.infopat.eu ) addresses the fact that, because patients with chronic conditions (e.g., colorectal cancer, type 2 diabetes) have complex health care needs, many personal health data are collected in different health care settings. The aim of the program is to develop and evaluate an electronic personal health record aimed at improving regional health care for chronically ill people and strengthening patients’ participation in their health care process. Subprojects are devoted, for example, to developing the personal electronic health record (Project Cluster 1), a medication platform (Project Cluster 2), and a case management system for chronically ill patients (Project Cluster 3). In the first, qualitative, phase, the researchers explored patients’ and health care professionals’ experiences with cross-sectoral health care and patient self-management, and their expectations regarding the advantages and disadvantages of a personal electronic health record. The information gathered in this phase of the program served as a basis for constructing a personal electronic health record prototype. This prototype was implemented as an intervention in a second, quantitative, phase dedicated to investigating the impact of such a record on a range of health care variables (e.g., self-management, health status, patient–doctor relationship, compliance). The University Hospital Heidelberg Ethics Committee approved the studies of the INFOPAT research program. All participants gave their written informed consent, and the participants’ anonymity and confidentiality were ensured throughout the studies according to the ethical standards of German Sociological Association. 1

Twenty-one focus groups were conducted during the qualitative phase of the program. Three groups consisted of colorectal cancer patients, four comprised type 2 diabetes patients, four were made up of physicians, three comprised physicians and pharmacists, four consisted of physicians and other health care professionals, and three consisted of other health care professionals (for more detailed information, see Tausch & Menold, 2015 ). Participants were recruited from urban and rural districts of the Rhine-Neckar region in Germany. Patients were approached in clinics, by their local general practitioners, or in self-help groups. Health care professionals were recruited in clinics, cooperating medical practices, and professional networks.

The focus groups took place at several locations at the National Center of Tumor Diseases (NCT) in Heidelberg, Germany, and the University of Heidelberg. The groups consisted of between four and seven participants and lasted between 1.5 and 2 hours. All focus groups were conducted by two researchers—a moderator and a co-moderator; a third researcher took notes. Semistructured discussion guides were used, and the groups were video- and audio recorded (cf., for example, Baudendistel et al., 2015 ; Kamradt et al., 2015 ). The researchers performed content analysis on the transcripts; the schema of categories was oriented toward the research questions. The focus groups addressed research questions of varying breadth, including, for example, individual health care experiences (comparatively broad), the expected impact of the record on the patient–doctor relationship (medium breadth), and technical requirements for such a personal health record (comparatively narrow). The variety of the research questions was important for our study because it proved to be of relevance for the interviewees’ appraisal of the usefulness of the focus group method.

Interviews With the Focus Group Moderators

We conducted qualitative interviews with nine of the 10 focus group moderators in the INFOPAT program (one moderator moved to a different department shortly after the completion of data collection and was not available for interview). The interviewees were aged between 30 and 54 years ( M age = 36 years; SD = 8.3 years). Their professions were health scientist, pharmacist, general practitioner, or medical ethicist. Their professional experience ranged from one to 23 years ( M = 7.1 years, SD = 7.7 years), and they had little or no previous experience of organizing and conducting focus groups. The moderators were interviewed in groups of one to three persons according to their project assignment (cf. Table 1 ).

Overview of Interviews and Interviewees.

The interviews lasted approximately 1 hour, and the interview questions were guided by the chronological order in which a focus group is organized and conducted (recruitment, preparation, moderation, methods) and by the utilization and usefulness of the results. We tape recorded the interviews, transcribed them verbatim, and performed qualitative content analysis on the transcripts ( Elo & Kyngäs, 2008 ; Mayring, 2015 ) with the help of the program MAXQDA 10.0.

The final system of categories 2 ( Tausch & Menold, 2015 ) consisted of two types of codes: All relevant text passages were coded with respect to the content of the statement. In addition, a second type of code was required if the statement related to a specific group of participants (e.g., patients, hospital doctors, men, women).

On the basis of the research questions, the contents of interview statements were classified into the three superordinate thematic categories: recruitment, communication in the focus groups, and appraisal of the focus group method. Consequently, the reporting of the results is structured according to three main topics.

Recruitment

Statements relating to the recruitment of the participants were sorted into the main categories “factors promoting participation”, “factors preventing participation”, and “general appraisal of the recruitment process”. Figure 1 shows the subcategories that were identified under these main categories. Because many of the statements referred only to patients or only to health care professionals (physicians, other health care professionals), the subcodes shown in Figure 1 are sorted by these two types of participants.

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Factors relating to the recruitment process.

Factors relevant for all target groups

As the following interviewee statement shows, addressing potential participants face-to-face (rather than in writing) proved crucial for the success of recruitment in all target groups:

Well, a really good tip when recruiting patients is . . . to address the people yourself. Not to get someone else to do it who . . . has nothing to do with [the project], because ultimately you really do have to explain a lot of things, also directly to the patient. And then it’s always good if the person [who does the recruiting] is actually involved in the project. 3

In the case of the clinicians, being addressed by a superior was even more effective for their willingness to participate: “And then top down. If the nursing director asks me, then it’s not so easy to say no.”

Furthermore, a positive response was more often achieved if the groups were scheduled at convenient times for the addressees, and they only had to choose between several alternatives. Patients welcomed times contiguous with their therapies: “And many [of the patients] said: ‘Yes, maybe we can do it after my chemotherapy, on that day when I’m in the clinic anyway?’” Whereas medical assistants were given the opportunity to take part in the groups during working hours, general practitioners preferred evening appointments on less busy weekdays (e.g., Wednesdays and Fridays):

Well, what I found quite good was to suggest a day and a time. And we concentrated on the fact that practices are often closed on Wednesday afternoons. So that’s a relatively convenient day. And then evenings for the pharmacists from seven-thirty onwards.

Interest in the topic of the discussion, or at least in research in general, was an important variable for participation. Together with lack of time, it turned out to be the main reason why sampling plans could not be realized. Among patients, men were much more interested in discussing a technical innovation such as an electronic personal health record, while women—besides their lesser interest—often declined because of family responsibilities: “Well, I’d say a higher proportion of women said: ‘I have a lot to do at home, housework and with the children, therefore I can’t do it.’”

Family physicians, physicians from cooperating medical practices, and hospital doctors showed more interest in discussing an electronic personal health record than did medical specialists in private practice, who often saw no personal gain in such an innovation. For example, one interviewee stated,

Family physicians generally have a greater willingness [to engage with] this [health] record topic. They see . . . also a personal benefit for themselves. . . . or they simply think it might be of relevance to them or they are interested in the topic for other reasons. Some of them even approached us themselves and said, “Oh, that interests me and I’d like to take part.”

In addition, because of heavy workload, private practitioners were difficult to reach (e.g., by telephone). This also lowered the participation of this target group on the focus groups.

Factors relevant only for patients

Two other variables that influenced patients’ willingness to participate were mentioned in the interviews. First, because this target group consisted of cancer patients and diabetes patients with multimorbidity, poor physical fitness also prevented several addressees from participating in the groups. The inability to climb stairs, or the general inability to leave the house, made it impossible for them to reach the location where the groups took place: “[They] immediately replied: ‘Well, no, . . . that’s really too much for me,’ and unfortunately they could not, therefore, be included in the groups.” Furthermore, unstable physical fitness often led to high drop-out rates. The moderators of the focus groups therefore proposed that up to twice as many participants as required should be recruited: “And depending on the severity of the illness, you have to expect a drop-out rate of up to fifty percent. So, if you want to have four people, you should invite eight.”

Second, moderators reported that patients’ liking for, or dislike of, talking and discussing influenced their tendency to join the groups. Participating patients were generally described as talkative. For example: “And with patients, all in all, I had the feeling that those who agreed [to participate] were all people who liked talking, because those who did not like talking refused out of hand.” Patients who refused to participate often argued that they felt uncomfortable speaking in front of a group: “And the men, when they declined they often said: ‘No, group discussion is not for me! I don’t like talking in front of a group.’”

The researchers eventually succeeded in recruiting sufficient participants. However, they were not able to realize the sampling plans according to a certain proportion of male and female patients or types of physicians. “Well, we finally managed to fill up our groups, but only as many [participants] as necessary.” Comparing the different target groups, recruiting patients was described as easier than recruiting physicians: “And that was much easier insofar as you just had to go to the clinic and each day there were five or six patients whom you could address.” However, only 10% of the patients who were addressed agreed to participate. In the health care professional group, the recruitment rates ranged between 0% and 30%, depending on the subgroup. This can be demonstrated by the following interviewee utterance:

And in the private practitioner sector it was rather . . . . Well, we tried to recruit specialists in private practice, in other words internists, gastroenterologists, and oncologists. The success [rate proved to be] extremely poor. . . . Well, on the whole, the willingness to take part, the interest, is not there. Or, well they don’t give the reasons, but they say they don’t want to take part. So that was difficult and, yes, it didn’t go too well.

Communication in the Focus Groups

With regard to the communication in the focus groups, the moderators identified factors that influenced communication in a positive or negative way. In addition, we discussed a number of factors with them that are often described in the social science literature as problematic when conducting focus groups. However, the interviewees considered that some of these factors had not influenced communication in the focus groups conducted within the framework of the INFOPAT program. In our system of categories, we also coded whether the factors in question were related to (a) the setting or (b) the moderation of the focus groups (cf. Figure 2 ).

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Influences on and characteristics of the focus group discussion.

Factors relating to the setting

As Figure 2 shows, communication was reported to be positively influenced by small group size, location, provision of food and beverages, and conducting the focus group without a break. In contrast to general recommendations on focus groups in the context of sociological research, the moderators in the INFOPAT program considered a smaller group size of between four and six participants to be ideal. With regard to location, the interviewees reported that, depending on the target group, different places were perceived as positive. Patients preferred locations inside the clinic because they were easy to reach and caused no additional effort. Furthermore, because these locations were familiar to them, they facilitated an atmosphere of security and ease, which was seen as an important prerequisite for an open and honest discussion. This is clear from the following quotation:

Well, the patient focus groups were all located at the clinic. We chose this location on purpose to make it easier for them, because they come to the clinic anyway for their therapy. And they know the place and they feel comfortable and in good hands.

By contrast, the clinician groups benefited from being located outside the clinic. In contrast to other common addressees of focus groups, these professionals were not only accustomed to participating in groups outside their familiar surroundings but also this location helped them to distance themselves from their professional duties and to engage more deeply in the discussion, as shown by the following quotation:

Yes, one was located at the O-Center. We chose this location on purpose so that the clinicians had to leave the hospital. It’s not too far, only a few yards away. But we wanted them to leave the clinic, and not to run back to the ward when they were called. And, well, I liked this location.

Food and beverages were welcome in all the groups and also helped to create a positive and trusting atmosphere. And finally, the interviewees found that it was better to omit the break, thereby avoiding the interruption of the ongoing discussion. This is reasonable considering the comparatively short duration of the focus group session (between 1.5 and 2 hours). Statements relating to a break might have been different in the case of longer focus group durations.

The interviewees reported that the size and temperature of the room and time pressure on the participants or the moderator had a negative impact on communication. Some of the focus groups in the project took place in midsummer and had to be held in rooms without blinds or air conditioning. The moderators of these groups had to work hard to maintain the participants’ (and their own) attention and concentration. Time pressure on the participants (e.g., the clinicians) led to an unwillingness to engage in active discussion and created a question-and-answer situation, as shown by the following statement:

And in one group of physicians . . . we never reached the point where they joined in fully. During the whole discussion they never completely arrived. And they had already cut the time short in advance. They were under so much time pressure that they were not able to discuss in an open manner.

Moderators reported that they, too, had experienced time pressure—namely, in situations where they did not have enough time to prepare the room and the recording devices. This had caused them to be nervous and stressed at the beginning of the discussion, which had negatively affected the mood of the participants, thereby rendering an honest and open discussion particularly difficult.

Factors relating to the moderation

Many of the positive factors reported by the interviewees have already been described for focus groups in general—for example, using open questions, directly addressing quiet participants, and handling the discussion guide in a flexible way. Furthermore, by showing interest in every statement, and by generating a feeling of security in every participant, moderators fostered a fruitful discussion:

I believe that another important point is that you are calm yourself. That you give the people the feeling “you can feel safe with me, you don’t have to worry that I will make fun of you . . . or that I won’t take you seriously.”

Interviewees also considered that building a bridge between the technical innovation under discussion (a web-based electronic personal health record) and everyday life (e.g., online banking) was an important factor in getting all participants to contribute to the discussion. As one interviewee noted,

We tried to anchor it in their everyday lives. And . . . the example that always worked was when we said: “Think of it as if it were a kind of online banking.” Everyone understands what online banking is. It’s about important data on the internet; they’re safe there somehow. I have my password. And people understood that. Well, it’s important to anchor it in their reality . . . because otherwise the topic is simply far too abstract.

In this context, the fact that the groups were moderated by the researchers themselves proved very helpful because they were able to answer all questions relating to the research topic. As the following quote shows, this was an important prerequisite for opinion formation on the part of participants:

Well, I think that a really important quality criterion . . . is that you have completely penetrated [the topic]. If you only know the process from the outside . . . and you then conduct the focus group about it. . . . Somewhere, at some stage, [one discussion] narrowly missed the point. . . . You simply have to be totally immersed in the topic, well, I believe that [someone who is totally immersed in the topic] is the ideal person for the job. And in our case the thinking was, okay, so I’m a doctor, but on balance it’s more important that both [moderators] are absolutely well informed because it’s a complex topic.

The more specific the research question was, the more useful the moderating strategy of inviting one participant after the other to express their opinion appeared to be. By using this strategy, the moderators ensured that every participant contributed to the discussion.

A point that was strongly emphasized by the interviewees was the duration of the round of introductions at the beginning of the focus group session. In the patient groups, introductions took much more time than the researchers had expected. Patients had a high need to express themselves and to tell the others about their illness and their experiences with the health system. Although this left less time to work through the topics in the discussion guide, the researchers came to realize that there were several good reasons not to limit these contributions: First, the introductions round proved important for helping the participants to “arrive” at the focus group, for creating a basis of trust, and for building up a sense of community among the participants. Second, the interviewees reported that, because many topics in the discussion guide (e.g., participants’ experiences with coordinating visits to different medical specialists) had already been brought up in the round of introductions, they did not have to be discussed further at a later stage:

And that is the crux of this general exchange of experiences at the beginning. Sure, it costs you a lot of time, but I almost think that if you don’t give them that time, you won’t get what you want from them, in the sense that you say: “I want to hear your frank opinion or attitude.” You don’t want them to simply answer you because they think that’s what you want to hear. You have to create an atmosphere in which they really forget where they are. I’m relatively convinced that you wouldn’t achieve that without such [a round of introductions].

The moderators’ experience in the physician groups was different. These groups benefited from having a rather short round of introductions. Giving participants too much time to introduce themselves meant that they presented their expertise rather than reporting their experiences. In contrast to the patient groups, this did not substantially contribute to the discussion of the research topics.

Depending on the context, status differences between the moderators and the participants, or among the participants, were appraised differently by interviewees. In one group comprising physicians and medical assistants, the moderators observed that status differences had a negative influence on communication. Very young female medical assistants, in particular, did not feel free to express their opinions in the presence of their superiors. By contrast, presumed differences in status between family doctors, hospital doctors, and medical specialists in private practice did not have any negative impact on communication. Nor did different forms of address (some participants in these groups were addressed by their first name and some by their last name, depending on the relationship between the moderator and the participants). Status differences between moderators (if medical doctors) and participants (patients) had an impact on communication when patients regarded doctors as an important source of information (e.g., about the meaning of their blood values) or as representatives of the health care system to whom complaints about the system should be addressed. The latter case was the subject of the following interview statement by a moderator who is a physician by profession:

And a lot [was said about] the kind of experiences they had had here at the NCT. And of course, when the patients have been treated here for many years—or even for not so many [years], but they have had many experiences—they sometimes reported at length. And I had the feeling that this had a bit of a feedback function, quite generally, for the NCT. Also the somehow frustrating experiences they had had, or a lot of things that had not gone that well in conversational exchanges [with the staff]. There was a relatively large amount of feedback that didn’t have a lot to do with the topic because I was, of course, involved as a senior physician and I am not an external researcher, but rather someone who is also seen as being jointly responsible, or at least as someone who can channel criticism.

Finally, because most of the moderators were not medical professionals, they did not experience the translation of medical or technical terms into everyday language as problematic. Rather, they automatically used terms that were also familiar to the participants.

Characteristics of the discussion

The factors described above resulted in focus group discussions that might be interpreted as characteristic of health research. The patient focus groups were characterized by a strong need to talk and a high need for information. In the health care professional focus groups, researchers experienced a greater variety of communication styles. Because of a lack of time, or because they falsely expected a question-and-answer situation, some groups demonstrated a low degree of willingness to engage in discussion:

Although, I believe that was partly due . . . well there was one [woman] who was very demanding; she wanted to know straight away: “Yes, what’s the issue here? What do I have to say to you?” Well, the three who came from the one practice, I think they really had the feeling that we would ask them questions and they would bravely answer them and then they could go home again. So, for them this principle that they were supposed to engage in a discussion, for them that was somehow a bit, I don’t know . . . disconcerting. . . . They really thought: “Okay, well we want to know now what this is all about. And they’ll ask us the questions and then we’ll say yes, no, don’t know, maybe. And then we’ll go home again.” Well, at least that was my impression.

Other groups, especially those consisting of different types of health care professionals (e.g., physicians with different areas of specialization, or physicians and pharmacists), were characterized by lively discussion and a great variety of opinions.

Appraisal of the Focus Group Method

We classified moderators’ statements relating to the appraisal of the focus group method into four main categories: “advantages of the method”, “disadvantages of the method”, “recommendations for other researchers in related research areas”, and “statements on how they used the results” (cf. Figure 3 ).

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Appraisal of the focus group method.

The researchers reported that the focus group method yielded a rich blend of perspectives and opinions, brought forth, in particular, by the interaction between the participants:

But for this question and the topic, and for our lack of knowledge, that was . . . a lot of new information . . . and very many good ideas and critical remarks that you naturally read in the literature from time to time. But, let’s say, because of the complexity of the participants’ reactions and the weight they attached to things, it’s different than reading in a literature review that [this or that] could be taken into account.

The results of the focus groups further enriched the researchers’ work by relating it to everyday life: “Well, what was nice was that the topic was related to the participants’ lives. That people said: ‘Now the topic is important for me.’” Furthermore, the method yielded information about which aspects were most important and how the variety of opinions should be prioritized. This was achieved, in particular, by using participant-generated cards:

And with regard to prioritization, we incorporated it using participant-generated cards. We said: “Look: If you could develop this record now, what would be the three most important things that must absolutely be taken into consideration, from your point of view, no matter what they relate to.” And they wrote them down on the cards. And after that they were asked to carry out their own prioritization—that is, what was most important to them personally. One person wrote “data protection” first, while another [wrote] “sharing with my wife.” . . . That was good. . . . That helped a lot because it was simply clear once again what things were important to them.

In cases where concrete questions had to be answered or decisions had to be made, the interviewees also welcomed the opportunity to use structuring methods such as presentations, flip-charts, and participant-generated cards to obtain the relevant information:

. . . Well, the aim was that at the end we [would] have a set of requirements for the engineering [people]. And the engineering [people] don’t so much want to know about experiences and desires and barriers, but rather they want to know should the button be green or red and can you click on it. And that’s why I thought at the beginning it will be difficult with a focus group and an open discussion. Now, if you say that one can also interpret a focus group the way we did, partly with very specific questions and these participant-generated cards, then I think it is indeed possible to answer such questions as well.

Disadvantages

The main disadvantages of the focus group method were seen in the considerable organizational effort and expenditure of time involved. A question raised by some of the interviewees was whether comparable results could have been achieved using less time-consuming and organizationally demanding methods.

It’s true to say that you lose time. Well, you could implement [the innovation] straight away and see whether it’s better. Maybe, in this case you’re wrong and you just think it’s better or in any case not worse than before. You basically lose a year on this whole focus groups thing.

Moreover, in some cases, the discussion went in an unwanted direction and the moderators never fully succeeded in bringing the group back to the intended topics.

Furthermore, like many other medical research projects, INFOPAT included quite specific research questions. In this connection, the moderators emphasized that open focus group discussions would not have succeeded in answering those questions. Only by using methods such as participant-generated cards and prioritization was it possible to answer at least some of them. Nonetheless, some interviewees did not consider the focus group method to be really suitable for this type of research questions:

Of course we also have our engineers as counterparts who . . . need very specific requirements at some point. The question is whether such a focus group . . . . [It] can’t answer that in detail in this first stage. It’s simply not practicable.

Recommendations

As described under the “Communication in the Focus Groups” section above, the round of introductions in the patient groups lasted much longer than planned, thereby shortening the time available for other topics in the discussion guide. As a result, the moderators decided to choose a different thematic focus in each group so that every topic was discussed more deeply in at least one group.

What we usually did was to consider what hadn’t been addressed that much in the previous focus group. That [topic] was given more room in the next focus group because the guide, well it was quite a lot. You could have easily gone on discussing for another hour or two.

Using the results

On the whole, the researchers were satisfied with the number of groups that were conducted and the results that they yielded. They did not agree that more groups would have led to better, or different, results—with one possible exception, namely, in the case of specific target groups (e.g., migrants). Only one group had been composed of patients with a migrant background, and, as one interviewee stated, “I just thought, the patients with a migrant background . . . now that was [only] one group, it by no means covers the whole range.”

In cases where the results of the focus groups were perceived as not being concrete enough to proceed to the next research step (e.g., formulating a specification sheet for the construction of the electronic personal health record), the researchers planned to bring experts together in a roundtable format to make decisions on the basis of the priorities, agreements, and disagreements that had emerged from the focus groups. Following the construction of a prototype, they intended to conduct further focus groups to validate or adapt the usability of the electronic personal health record system.

Our analysis of interviews with focus group moderators yielded considerable insights into methodological aspects of conducting focus groups in health research. Our first research question related to characteristics of the target groups that should be considered during the recruitment process. We identified face-to-face contact as an important factor promoting focus group participation. The interviewees considered this type of contact to be better suited to answering target persons’ questions and explaining the method and aims of the focus groups. Moreover, they felt that addressees might find it more difficult to decline a face-to-face invitation than a written one. With regard to health care professionals, an invitation issued by a hierarchically higher person was most effective, even though ethical aspects should be considered in this case, and voluntary participation should nevertheless be ensured. Otherwise, the order to participate might prevent an atmosphere of open communication and might lead to a lower quantity or to more negative statements.

Furthermore, whereas physicians are usually accustomed to discussing topics with others, an important characteristic that influenced willingness to participate on the part of members of other target groups (other health care professionals, patients) was a liking for, or a dislike of, talking. Researchers might take account of this fact by explaining the method in more detail, by developing arguments to overcome fears, or, as suggested, for example, by Colucci (2007) , by convincing the addressees with other activities implemented in the focus groups. Other relevant personal characteristics—be they related to the research topic (e.g., technical interest in the case of an electronic innovation) or to the specific target group (e.g., physical fitness on the part of patients or lack of time on the part of health care professionals)—should be anticipated when planning recruitment. These characteristics might be taken into account by preparing arguments, providing incentives, giving thought to favorable dates and times, and choosing easily accessible locations. An interesting finding was that, depending on the target group, different locations were considered to have a positive influence on the discussion. Whereas locations inside the clinic were preferred in the case of the patient focus groups because of familiarity and easy accessibility, hospital doctors were more engaged in the discussion when the focus group site was located at least some yards away from their workplace.

Finally, the experience of our researchers that up to 50% of the patients had to cancel at short notice because of health problems does not appear to be uncommon in this research context. That overrecruitment is an effective strategy—particularly in health care research—has been reported by other authors (e.g., Coenen et al., 2012 ).

With our second research question, we focused on aspects of communication in the focus groups. The interviews revealed several factors specific to research topics and addressees of health care studies that influenced the discussions. Consequently, in addition to considering general recommendations regarding the organization and moderation of focus groups (e.g., choosing adequate rooms with a pleasant atmosphere, serving food and beverages, using open questions, showing interest in all contributions, and directly addressing quiet participants), these health care specific aspects should be taken into account. Relevant factors that should be addressed when moderating focus groups in this context are (a) the strong need to talk and the high need for information in the patient groups, (b) status differences between the participants or between the moderators and the participants, (c) the size of the focus group, and (d) the specificity of the topic of discussion. The interview data revealed that these factors influenced the discussions and thus the results achieved with the groups. In addition, the following four possibilities of addressing these factors were identified:

First, the moderators had to devote more time to the round of introductions in the patient groups, which served as a warm-up, created an atmosphere of fellowship and openness, and accommodated this target group’s strong need to talk. Second, with respect to status differences between the moderator and the participants, no definite recommendations can be derived from the interviews. The interviewees found that it was less favorable when the moderator was perceived not only in that role but also in other roles (e.g., physician), because this might hamper a goal-oriented discussion. However, they considered deep insight into the research topic on the part of the moderators to be beneficial, at least for certain research topics. Thus, one should carefully weigh up whether it is more advantageous or more disadvantageous when the group moderator is a physician. Interviewees considered status differences between participants to be disadvantageous only in one case, where—because of organizational constraints—medical assistants and their superiors joined the same focus group, which gave rise to some reticence on the part of the young assistants. Similar problems have been reported by other authors, for example, Côté-Arsenault and Morrison-Beedy (2005 ; see also Hollander, 2004 ). However, interviewees did not experience as problematic status differences between physicians with different areas of specialization.

Third, with respect to group size, interviewees found comparatively small focus groups appropriate to give all participants enough time to tell their stories. In contrast to social science research, where groups of between eight and 20 participants are recommended, our interviewees considered groups of between four and six persons to be optimal. This is in line with Côté-Arsenault and Morrison-Beedy (2005) , who recommended small groups for health research, especially when sensitive topics are discussed. Our interview data revealed that this recommendation might also be useful for other health research topics.

Fourth, with regard to the topic of the discussion, interviewees found it helpful to structure different phases of the discussion in different ways, depending on the specificity of the research questions. In contrast to social science research, certain types of research questions in health research require comparatively specific answers. Some of the focus groups in our study were aimed at collecting participants’ expectations regarding an electronic personal health record or—even more specifically—at developing a product specifications document. Conducting focus groups during the development of a technical innovation is a method that is being increasingly used in health care research. Hence, the experiences of the interviewees with regard to these aspects of their research might be relevant for many other research programs. For this type of research questions, it proved useful to include more structured parts in the discussion, for example, having certain questions answered by each participant in turn, or using methods such as participant-generated cards and prioritization. This made it easier to obtain the opinion of each participant and to cover as many concerns and expectations as possible. This finding is in line with recommendations by Colucci (2007) , who proposed the use of activity-oriented questions for health research topics as an enrichment of data collection and a means of making it easier to talk about sensitive and complex topics.

All the moderators found that their discussion guides contained too many questions and too many topics. This might have been due, at least partly, to a desire to determine all relevant aspects in advance—a tendency that might be typical of health research. However, Morgan (1995) also addressed this phenomenon in relation to social research in general: “A common error in focus group question guidelines is too much emphasis on what is of interest to the researcher and not enough emphasis on what is of interest to the participants” (p. 520).

With our third research question, we addressed the appraisal of the focus group method in the interviewees’ research context. Our results show that one should think carefully before using focus groups in the field of health research. The impression that they are quick and easy to conduct might be a misconception, especially in this research context. In fact, the appraisal of the method by the moderators revealed both advantages and disadvantages. The main advantages were the rich blend of perspectives and opinions obtained and the opportunity to have them prioritized by the target groups. For their research topics, the interviewees saw a further important advantage in the fact that they were able to relate their scientific research to everyday life, a point that might be of general importance for a number of research questions in health research, especially those that refer to new medical diagnostics or technical innovations.

The interviewees considered that the main disadvantages of focus groups were the substantial organizational effort and expenditure of time they required. They raised the question whether comparable results could have been achieved using less costly methods. Fortunately, we conducted our interviews with researchers from a research program aimed at answering research questions of different degrees of specificity. As a result, the moderators were able to compare the usefulness of focus groups for different types of research questions. Their statements revealed that they were satisfied with the results relating to more open research questions such as experiences with cross-sectoral health care. For more specific research questions, the interviewees valued the possibility of organizing the discussions in a more structured way and using methods that activated all participants (e.g., participant-generated cards, prioritizations). Nonetheless, they considered meetings of experts to be a necessary intermediate step, for example, on the way to a product specifications document. We recommend that, depending on the specificity of the results that are projected, consideration should be given to including such intermediate steps in the planning stage.

Limitations of the Study

Our analysis of the interviews with the focus group moderators revealed a number of methodological problems that typically occur when focus groups are used in a health research context and yielded recommendations on using such groups in this context. However, some limitations of the present study should also be discussed: First, we conducted our research with focus group moderators, all of whom worked in the same research program. Even though the INFOPAT program consists of several subprojects, they all deal to a greater or lesser extent with the advantages and disadvantages of an electronic support system (electronic personal health record). Furthermore, the moderators were mainly health scientists and had little or no experience with conducting focus groups. This might also have been specific for the research program in which our study was conducted. In other health care programs, focus groups might be moderated mainly by physicists or lay persons (e.g., in participatory health research). Consequently, had we also conducted interviews with focus group moderators from other research areas or included moderators with other professions or more focus group experience, this might have led to different results. However, our research project is rather typical for applied qualitative research in medical science when developing new technologies. Here, focus groups are used by the researchers to find out the potential requirements for the new technology. The researchers are often experts in a specific scientific topic and have no or only limited experience in conducting qualitative research in terms of focus groups. Therefore, our findings are of a particular importance for the researchers with little experiences in conducting focus groups, which can apply to every research, conducted first time. In addition, the little experience of our focus group moderators was a special advantage and strength of the study. More experienced moderators would have prevented some of the problems our moderators—as other unexperienced moderators—faced. As a result, the moderators would not have named these potential problems in the interviews and given no advice for preventing them.

Second, the study was conducted in Germany and thus represents problems and challenges of the German health care system. In other countries, physicians might have different work-shifts or there might be different possibilities in the health care system to reach the target groups. Therefore, more research on the methodology of focus groups in the context of the development of new technologies in health care in other countries and cultures with a consideration of additional relevant groups is needed.

Third, in our interviews, we focused mainly on the organization and conducting of focus groups. For two reasons, we did not address the aspect of data analysis: First, we conducted the interviews shortly after the focus groups had been completed, at a time when data analysis was still in progress. Second, analysis of qualitative data can be carried out in many different ways, depending on research questions and preferences of researchers, and some of the recommended methods are very complex. Had we discussed them in detail, it would have been too time-consuming in the interviews.

Concluding Remarks

Our results revealed a number of methodological challenges that might be typical of conducting focus groups in health research. We hope that our findings will be of use to researchers in similar research fields. Furthermore, we encourage other researchers who are interested in health research topics to gather more information about methodological aspects specific to this research field. Our results were achieved in the context of the development of a technical innovation. It might be interesting to endeavor to replicate them in other health care research projects dealing with technical innovations. Moreover, we would encourage researchers of other topics in health research to interview focus group moderators about their experiences in their specific research context. We hope that our results will serve as a useful basis for comparing results in different areas of health research.

Acknowledgments

We thank the focus group moderators in the INFOPAT program for their great willingness to share their experiences and for their openness during the interviews.

Author Biographies

Anja P. Tausch , PhD, is senior researcher at GESIS–Leibniz Institute for the Social Sciences, Mannheim, Germany.

Natalja Menold , PhD, is senior researcher and head of the Survey Instruments Unit at GESIS–Leibniz Institute for the Social Sciences, Mannheim, Germany.

1. http://www.soziologie.de/en/gsa/ethik-kommission/code-of-ethics.html , retrieved on 05/10/2015.

2. The language of the research project, focus groups, and interviews was German. The scheme was developed in German on the basis of the German text material from the transcribed interviews. The scheme and the citations were translated for the purpose of international publication by an experienced, qualified, and fully bilingual translator, whose mother tongue is English and who also has an MA in sociology from a German university. A German version of the full categorial system can be found in Tausch and Menold (2015) .

3. All citations included in this publication were translated from German.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the German Federal Ministry of Education and Research (BMBF; FKZ 01KQ1003D).

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Varieties of Qualitative Research Methods pp 191–196 Cite as

Focus Groups

Janet Mola Okoko 4
First Online: 02 January 2023

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Focus group, as a methodology in the social sciences, has been traced to the study done by Paul Lazarsfeld and Robert Merton in the early 1940’s on the effects of media on people’s attitude towards World War II (Liamputtong in Focus group methodology: Principles and practice. Sage Publications, 2011) (Merton and Kendall in Am J of Socio 51(6):541–5571946). Before that, Emory Bogardus described group interviews in a study that was aimed at developing a social distance scale (Wark and Galliher in Am Sociologist, 38(4), 383–395, 2007). The element of having group discussions and group-based research became more popular in market research before other social science researchers started paying attention to it. The term focus groups was mainly used to define the social images of commercial products and judge the reactions to, opinions about, and attitudes toward a product, but is now a generic method that can be applicable to multiple fields of behaviour and human experience (Merton, 1987 ). It is now used to study concepts, programs, services, and institutions (Gil and Granado in Eval Rev 19(1):84–10 1995).

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Additional Readings

Barbour, R. (2018). Doing focus groups (2nd ed.) Sage Publications.

Belzile, J., & Oberg, G. (2012). Where to begin? Grappling with how to use participant interaction in focus group design. Qualitative Research, 12 (4), 459–472.

Jakobsen, H. (2012). Focus groups and methodological rigour outside the minority world: Making the method work to its strengths in Tanzania. Qualitative Research, 12 (2), 111–130.

Krueger, R.A. (1998). Moderating focus groups . Sage Publications.

Onwuegbuzie, A. J., Dickinson, W. B., Leech, N. L., & Zoran, A. G. (2009). A Qualitative framework for collecting and analyzing data in focus group research. International Journal of Qualitative Methods , 1–21. https://doi.org/10.1177/160940690900800301

Sim, J., & Waterfield, J. (2019). Focus group methodology: Some ethical challenges. Quality and Quantity, 53 , 3003–3022. https://doi.org/10.1007/s11135-019-00914-5

Online Resources

1. How to focus groups work (4 min): https://www.youtube.com/watch?v=3TwgVQIZPsw

2. Conducting a focus group (5 ½ minutes): https://www.youtube.com/watch?v=Auf9pkuCc8k

3. Preparing for a focus group (5 min): https://www.youtube.com/watch?v=VSwTvkTsOvI

4. How to run a successful focus group (12 min): https://www.youtube.com/watch?v=gjQtu6yeC1E

5. The focus group method (8 min): https://www.youtube.com/watch?v=LU92Zryjf-0

6. Moderating focus groups (30 min): https://www.youtube.com/watch?v=xjHZsEcSqwo

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Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

P. Gill 1 &
J. Baillie 2

British Dental Journal volume 225 , pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

You have full access to this article via your institution.

Interviews in the social sciences

Eleanor Knott, Aliya Hamid Rao, … Chana Teeger

Professionalism in dentistry: deconstructing common terminology

Andrew Trathen, Sasha Scambler & Jennifer E. Gallagher

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research

Hiba Bawadi, Sara Elshami, … Banan Mukhalalati

Introduction

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Issue Date : 12 October 2018

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Focus Groups

Focus groups are group discussions conducted with the participation of 7 to 12 people to capture their experiences and views regarding specific issues closely related to research question(s). Focus groups data collection method is most suitable for types of studies where multiple perspectives needed to be obtained regarding the same problem.

Focus groups are led by a moderator who is responsible to ensure that group discussions remain focused on the research area . Advantages of focus groups include the possibility of obtaining primary data through non-verbal channels, as well as, verbal channels and approaching the research area from various perspectives.

As is it is the case with any other research method, focus gropes have some disadvantages as well. Group discussions may be heavily influenced by one or two dominant individuals in the group. Also, some members of focus group may be discouraged from participating in discussions due to lack of confidence or not articulate communication skills. Moreover, the nature of primary data obtained through focus groups are greatly influenced by environmental factors such as design of the room, room temperature, time of the day, etc.

It is important to understand that data collection and data analysis using focus groups is much more difficult compared to questionnaires and interviews. You have to make sure that you fully understand these difficulties before making a final choice of primary data collection method. However, this is not to say that you should not use focus group to collect primary data for your dissertation.

My e-book, The Ultimate Guide to Writing a Dissertation in Business Studies: a step by step assistance offers practical assistance to complete a dissertation with minimum or no stress. The e-book covers all stages of writing a dissertation starting from the selection of the research area to submitting the completed version of the work before the deadline. John Dudovskiy

Focus group research: what is it and how can it be used?

PMID: 24660275

The focus group research method has been used in a variety of settings over the years. The method of using group interviews was described as long ago as 1926. Focus groups have been used by large corporations to gather the public's opinions regarding their products. In the past 20 years the focus group method has been increasingly used in health care research in a variety of settings. Researchers use the focus group method in order to obtain in-depth knowledge concerning attitudes, perceptions, beliefs and opinions of individuals regarding a specific health issue. The purpose of this article is to provide a review of the focus group research method. The authors discuss the process, analysis, advantages and disadvantages of this qualitative method.

Focus Groups*
Health Services Research / methods*
Research Design

Open access
Published: 12 April 2024

Participatory methods used in the evaluation of medical devices: a comparison of focus groups, interviews, and a survey

Kas Woudstra 1 , 2 ,
Marcia Tummers 1 ,
Catharina J. M. Klijn 3 ,
Lotte Sondag 3 ,
Floris Schreuder 3 ,
Rob Reuzel 1 &
Maroeska Rovers 2

BMC Health Services Research volume 24 , Article number: 462 ( 2024 ) Cite this article

Metrics details

Stakeholder engagement in evaluation of medical devices is crucial for aligning devices with stakeholders’ views, needs, and values. Methods for these engagements have however not been compared to analyse their relative merits for medical device evaluation. Therefore, we systematically compared these three methods in terms of themes, interaction, and time-investment.

We compared focus groups, interviews, and an online survey in a case-study on minimally invasive endoscopy-guided surgery for patients with intracerebral haemorrhage. The focus groups and interviews featured two rounds, one explorative focussing on individual perspectives, and one interactive focussing on the exchange of perspectives between participants. The comparison between methods was made in terms of number and content of themes, how participants interact, and hours invested by all researchers.

The focus groups generated 34 themes, the interviews 58, and the survey 42. Various improvements for the assessment of the surgical procedure were only discussed in the interviews. In focus groups, participants were inclined to emphasise agreement and support, whereas the interviews consisted of questions and answers. The total time investment for researchers of focus groups was 95 h, of interviews 315 h, and survey 81 h.

Conclusions

Within the context of medical device evaluation, interviews appeared to be the most appropriate method for understanding stakeholder views since they provide a scope and depth of information that is not generated by other methods. Focus groups were useful to rapidly bring views together. Surveys enabled a quick exploration. Researchers should account for these methodological differences and select the method that is suitable for their research aim.

Peer Review reports

Medical devices form an intricate part of the healthcare system. Novel medical devices like robots, nano-technologies, and e-health platforms carry the promise of improving healthcare systems [ 1 ]. As medical devices become more pervasive and complex, it is essential to develop and apply these technologies so that they solve the most pressing medical problems in global healthcare systems. Multiple guidelines and regulations exist that stimulate a practice of medical device research and development that is aimed at solving critical health problems [ 2 , 3 , 4 ]. In these documents, one of the recommendations is to actively involve a diverse selection of stakeholders in the research and development process of medical devices. This should lead to better informed decisions during evaluation: aligning devices with the views, needs, and values of stakeholders like medical professionals or patients. This, in turn, can optimise the use of resources spent on research, development, implementation, or use [ 5 ].

There are several methods for stakeholder involvement but these have not been compared against the background of their suitability for medical device evaluation purposes. Studying methods within this context is important, because there are some typical requirements in medical device evaluation. Methods should yield relevant information for research or development choices, preferably foster agreement among stakeholders regarding the future development and implementation of the medical device, and be feasible in terms of resources. By relevant information we mean: any information that helps to understand what features a device should have or how research into a device should be conducted to meet the needs and values of stakeholders. This could involve effectiveness, functionalities, ease of use, affordability, or possible spill overs. By analysing stakeholder needs and practices and making consequent design changes, medical devices can become more valuable [ 6 , 7 ]. Fostering agreement is important to ensure that a device is sufficiently endorsed to make implementation successful. This requires interaction between stakeholders to find common ground [ 8 ]. In entrepreneurial settings where resources are limited and the life-cycle of medical devices is relatively short, development trajectories generally cannot be too long and costly [ 9 ]. Participatory methods can—on the other hand – give insights into development, evaluation, and implementation issues that can occur, and therefore possibly save costs. Due to these unique conditions, it is important to specifically analyse participatory methods in the context of medical device evaluation or development. Some general comparisons of interviews, focus groups, and surveys exist terms of effect on outcomes exist, but these comparisons are not directly applicable to medical devices, nor are they compared all three together [ 10 , 11 , 12 ].

Interviews and focus groups are the most often-used methods in participatory research of medical devices and therefore we compare these in this study [ 13 ]. Surveys are chosen because they are also used in qualitative research and because they methodologically differ on various aspects from interviews and focus groups [ 13 ]. Qualitative surveys offer open text boxes and therefore researchers cannot ask follow-up questions, and there is no direct interaction between researchers and participants. Therefore, we aimed to investigate how focus groups, interviews, and a survey compare in terms of the number of relevant themes they provide, interaction between stakeholders, and time-investment, when conducted in the context of the evaluation of a medical device.

Comparison in one clinical case

We simultaneously employed and compared three participatory methods: focus groups, interviews, and a survey, in an empirical case-study on minimally-invasive endoscopy-guided surgery for patients with intracerebral haemorrhage (ICH). ICH is the deadliest stroke subtype, with a 30-day case fatality of 40%, and of the patients surviving many live with severe disability [ 14 ]. To improve outcome of patients with ICH, an innovative endoscopic device has been developed that has the potential of removing the haemorrhage by minimally-invasive surgery. A systematic review and meta-analysis of randomised trials investigating surgical treatment of ICH showed that minimally-invasive surgery was associated with a reduction in mortality and an increase in good functional outcome, particularly when performed early after symptom onset [ 15 ]. The Dutch Intracerebral haemorrhage Surgery Trial (DIST) pilot study (NCT03608423) has recently demonstrated in 40 patients with ICH that minimally-invasive endoscopy-guided surgery within 8 h of symptom onset using the novel endoscopy-guided approach was feasible, safe, and technically effective for hematoma removal (Sondag, personal communication). At the time of our research, members of our team (CK, LS, FS) were preparing a phase 3 randomised clinical trial to evaluate effectiveness on functional outcome using early minimally-invasive endoscopy-guided surgery in patients with ICH (NCT05460793). Against this background we employed focus groups, interviews, and a survey to elicit [ 1 ] views of stakeholders on the new endoscopic device and (2) the quality of the (received) hospital care for ICH-patients.

Selection procedure participants

We selected participants who are involved in hospital care for ICH and involved in the use of the new endoscopic device. Three stakeholder groups were identified: patients and relatives, healthcare professionals (HCPs), and policy experts. The number of participants that were determined for each method was guided by the concept of information power, which helps to establish how many participants are needed to acquire a reliable dataset [ 16 ]. Patients, relatives, and HCPs were approached by KW, LS and FS. LS and FS had a physician–patient relationship with the invited patients and relatives, or knew patients and relatives because they had participated in a previous studies related to ICH. HCPs were approached via the network of the neurologists involved in this research (CK, LS, FS), which spans over various ICH care institutions across the Netherlands. Policy experts were approached through networks of CK and MR. In the initial invitations, participants were assigned at random to one of the three methods. Participants that were invited for one method were not allowed to participate in other methods, so there were no cross-overs between methods. Subsequently, all potential participants were contacted via e-mail or by phone. After expressing their willingness to participate, they received an information letter and an informed consent form. In these documents, the aim, conditions, practical details, advantages, and disadvantages of participation were explained. All participants were given two weeks to consider participation, and the conditions of participation were again discussed or presented before each interview, focus group, or survey started. All participants gave written or verbal consent on audio tapes. The local certified ethics committee approved the research protocol.

Data collection method 1: focus groups

We organised five 45-min focus groups, all planned on one evening. The first three focus groups were homogeneous: one for patients, one for HCPs, and one for policy experts. These three focus groups were conducted simultaneously. In these sessions, patients and relatives, HCPs, and policy experts convened in their own groups to discuss their views on the intervention with the new endoscopic device and the quality of hospital care. The participants were first placed in homogeneous groups to familiarize and become comfortable with people with a comparable perspective and make participants at ease. They were also placed in these groups to mirror the first round of interviews that was not primarily aimed at interaction but at constructing the different views of participants. The last two focus groups were also planned simultaneously, fifteen minutes after the first three focus groups. In these focus groups the patients and relatives, HCPs, and policy experts who participated in the first round of focus groups were mixed into two heterogeneous groups to discuss findings from the earlier homogeneous focus groups and to discuss how the different perspectives could be brought together. A number of four to twelve participants per focus groups is advised in literature, so we aimed to include six persons in the homogeneous focus groups, and nine persons in the ensuing heterogenous focus groups [ 17 ]. A minimum number of participants for qualitative research has been proposed of 12, so we aimed to include a higher number than that and tried to include a number that was comparable to the interviews [ 18 ]. Each focus group was led by one moderator, who probed for more in-depth answers if needed, and ensured that every participant was able to participate. All moderators were experienced in moderating group discussions and not in any way involved in ICH-care. Two moderators who participated in the first round moderated the second round. We used semi-structured focus groups protocols (see Appendix 1 ). All focus groups were audio-recorded and transcribed verbally. The audio tapes and transcripts were stored in accordance with European data safety requirements [ 19 ]. Due to the COVID-19 pandemic, the focus groups were organised online via a video call platform. The literature on online or ‘synchronous’ focus groups and interviews indicates that there can be some methodological specificalities to online data collection. It might improve the representation of certain groups, e.g. geographically dispersed people and people with disabilities, and it might be easier to generate richer data on sensitive topics. However, visual ques are harder to read [ 20 , 21 , 22 ]. Altogether, online focus groups might therefore be a useful way of data collection, especially for patients with ICH that encounter many mobility issues and social obstacles.

Data collection method 2: interviews

For the interviews, we used fourth-generation evaluation methodology with some minor modifications [ 23 , 24 , 25 ]. All participants were interviewed twice: in the first round they were asked to share their views on the new endoscopic device and the quality of hospital care, and in the second round they were invited to respond to rival claims of other participants. We aimed to include a number that was comparable to the focus groups and above the minimum number of 12 participants that has been proposed [ 18 ]. All interviews were conducted by KW (3 years of interviewing experience). For both interview rounds, a semi-structured interview protocol was used (see Appendix 2 ). All opinions were processed and presented to other participants anonymously. Due to the COVID-19 pandemic, all interviews were taken via a video call platform, or by phone. As described above, online or synchronous data collection has distinctive features and might be a valuable method of data collection. All interviews were audio recorded and transcribed. The audio tapes and transcripts were stored in accordance with European data safety requirements [ 19 ].

Data collection method 3: qualitative survey

The survey started with information about the study, then asked questions about characteristics of the person filling out the survey, including age, gender, education level, profession, and subsequently questions about improvements in the hospital treatment for ICH and the minimally invasive intervention with the new device. Patients and HCPs were asked to list unmet needs of patients and relevant outcome measures. The questions were closed, answer categories limited, but always followed by an opportunity to provide additional information in an open text field. We invited 78 participants, above the number of participants that proposed as a minimum in qualitative research (which is 12) and above the number of participants that is proposed for qualitative surveys (which is 25 to 50) [ 18 , 26 ]. The survey was conducted via Castor, a digital survey platform. The data were stored in accordance with European data safety requirements [ 19 ].

Units of comparison

The three methods were compared on three outcomes: the number of themes, interaction, and the time-investment of the methods, which are described below.

Number and type of themes

The analysis of the number and type of themes was supported by Atlas.ti software (V.9) and performed by one author (KW) to increase consistency. Following the six steps of thematic analysis by Braun and Clarke [ 27 ], the analysis started with reading and coding the transcripts and survey answers. In later phases these codes were arranged and grouped into themes. This process was discussed with MT and RR to check the credibility of the codes and the themes to ensure consistency and minimise a possible bias. We compared the number of themes provided by each method, and determined what themes were constructed in only one of the methods. Counting themes may not be a conventional approach in qualitative research. However, we aim to provide insight into the breadth and thus comprehensiveness of information collected. Because the coding method was consistent along the three methods, we believe counting themes is an adequate unit of comparison.

Interaction

To assess interaction, we performed three analyses to determine: (i) what themes were addressed by multiple stakeholder groups, (ii) which participants interact with each other, and (iii) how participants interact. All these analyses were performed after the data were collected, and supported by Atlas.ti software (V.9). For the first analysis, we calculated the percentage of the themes that was addressed by two or three stakeholder groups in each data-collection method. For example, if both HCPs and policy experts addressed theme X, this theme was marked as ‘shared’, and consequently the percentage of shared themes of the total amount of themes could be calculated. For this comparison, all methods were taken into account, even though participants did not directly interact in surveys. For the other two analyses, we examined how participants interact. To this aim, we adapted coding schemes by Morgan & Hoffman [ 28 ] and Keyton [ 29 ], which can be applied on verbatim transcripts to code how people react. Our main aims for this analysis were to identify how extensive topics were addressed, and to identify whether stakeholders could reach forms of agreement while interacting. The codes as described by Morgan & Hoffman [ 28 ] were most applicable for these aims so we have used their code book, whereas Keyton [ 29 ] more concisely describes how different turns in an interaction can be coded, so we have adapted her coding process. The main change in the coding book that we made, is that we distinguished who interact from the ways how people interact, which was not clearly incorporated in Morgan & Hofmann’s code book (see Appendix 3 ). We coded who the speaker is and to whom this speaker addresses the message, which will be referred to as turn . When a moderator asked a question to participants, or vice versa, this is coded as a ‘moderator-participant’ turn, and when participants ask and answer questions to each other, these are coded as ‘turn between participants’. When a moderator presented views of other participants, and when participants reacted, these were separately coded as a ‘turn between moderator and participant where moderator presents view of others’. Besides turns we also coded how participants interact in the conversation, using the codes ‘question’, ‘answer’, ‘expansion: sharing new aspect of previous topic’, and ‘agreement’, which will be referred to as acts . Acts are mutually exclusive, but multiple acts could be assigned to one turn in a conversation and vice versa, for example when a participant gives an answer to a moderator and directly poses a question the moderator. KW performed the coding process. These analyses were discussed in-depth with MT and RR, to ensure consistency and minimise a possible bias.

Time-investment

We have operationalised time-investment as the absolute number of hours that all the involved researchers and moderators spent on preparing and performing data-collection and analysing the data. We chose not to analyse the investment from the perspective of the participants, because in this paper aims to compare participatory methods from the perspective of the person or organisation conducting them. Time-investment was based on the researchers’ (KW) agenda, supplemented by sources in the literature, to establish the average time that is needed to transcribe a one-hour audio-tape [ 30 , 31 ]. Because the focus groups and interviews were conducted online, travelling time for researchers and moderators was not taken into account. The calculation of time-investment is set out in detail in Appendix 4 .

Researcher characteristics and reflexivity

The research team partially consists of researchers developing qualitative evaluation methods (KW, MT, MR, RR), and partially of neurologists (CK, FS, LS). There was a doctor-patient relationship between FS and some of the participants. RR is an expert on interactive interviews.

Participants

We invited 24 persons for the focus groups of whom 18 participated, 23 for the interviews of whom 17 participated, and 79 for the survey of whom 43 participated (see Table 1 ). In the focus groups, we had equal numbers of patients or relatives, HCPs, and policy makers: 6 participants in each group. The 17 participants in the interviews were patients ( n = 7 and n = 3 in round 1 and 2), HCPs ( n = 8 and n = 6 in round 1 and 2), and policy makers ( n = 2 in both rounds). In the survey, we included 21 patients, 18 HCPs, and 4 policy makers. See Appendix 5 for an overview of the types and number of enrolled participants per data-collection methods that is completed with the total number of invited participants. The majority of interviews lasted an hour, but the duration varied from 30 to 90 min. All focus groups lasted 45 min.

The number of themes varied between the different methods (see Fig. 1 ). In the explorative round 31 themes were constructed. In the interactive round 19 themes were constructed and 16 of these were also discussed in the first round, so 34 themes were constructed in all focus groups. The first interview round generated 58 themes, the second 40, and all themes in the second round of interviews had already been discussed in the first round. The survey generated 42 unique themes. An overview of all the themes generated can be found in Appendix 6 .

Number of themes constructed in three data collection methods

All methods generated themes about research improvements for the innovation and care experiences in the hospital but there were some unique themes that specifically came up in one of the methods and not in the others. In the focus groups, four themes were constructed that were not generated in the other methods, two of which related to communication between HCPs and patients and relatives. In the interviews 19 themes were generated, that addressed various aspects of the assessment of the new treatment, such as the characteristics of the study population that ideally should undergo the new treatment in a subsequent research phase, and the informed consent procedure of that research phase. In the survey, 9 unique themes were present, ranging from ‘trust in HCPs’ to ‘outcome measure: feasibility’.

Percentage of themes that is addressed by multiple groups of stakeholders

Figure 2 shows that some themes were addressed by multiple stakeholder groups, whereas other themes were mentioned by one stakeholder group only. In the first explorative round of the focus groups, 16 percent of the themes was addressed by two or three stakeholder groups. In the second interactive round the percentage of themes addressed by multiple groups was 35 percent. In the first round of interviews the percentage of themes addressed by multiple groups was 25 percent in the first round and 58 percent in the second round. In the survey, 21 percent of the themes was addressed by multiple stakeholder groups, and these shared themes are all based on the numeric answers. None of the open-text box answers led to themes that were addressed by multiple stakeholders.

Percentage of themes addressed by multiple stakeholder groups in three data collection methods in round 1 (exploration) and round 2 (reaction)

Which participants interact with each other: turns

Figure 3 depicts which participants interacted with each other. In the first round of the focus group the moderators and participants primarily interacted, whereas in the second interactive round, participants more often interacted directly with each other. In the first interview round, 98% of the turns consisted of direct interaction between participants and the moderator and 2% of the turns consisted of interactions about other participants’ perspectives. In interview round 2, 20% of the turns consisted of direct interaction, and 80% percent of the turns entailed other participants’ opinions. The total number of turns in focus groups round one is 89, in round two 115. The total number of turns in interview round one is 1472 and in round two 894.

Which participants interact with each other: presented as percentage of total number of interactions

How participants interact: acts

Figure 4 presents how participants and moderators interacted in each of the rounds in the focus groups and interviews. In the first round of the focus groups, 93% of the acts consisted of questions, follow-up questions, answers, and expansions on topics, whereas concrete expressions of agreement (18 percent) and support (8 percent) were more prevalent in the second round. In interview round one, 99% of the acts consisted of questions, follow-up questions, answers, and expansions upon previous answers. In round two this was 98%.

Form of interaction as percentage of total number of interactions

Figure 5 provides insight in the time-investment of each of the methods, operationalised as the number of hours that needs to be worked by all researchers. The preparation, data-collection, and analysis of the focus groups took 26, 15, and 54 h within in an overall time span of seven months. Of these 54 h of analysis, 19 consisted of transcribing interviews. The recruitment of participants for the interviews and setting a date took a preparation time that spanned over 5 months. The interviews took 26 h, 45 and 244 h for preparation, data-collection and analysis in a time span of 5 months and 10 months for the first and second round. Of these 244 h of analysis, 140 were dedicated to transcribing. The survey took 57 h to prepare and was completed over the course of nine months, as all questions had to be carefully integrated, checked, and piloted using a digital survey platform.

Accumulative number of hours worked by researchers

Summary main findings

This comparison of focus groups, interviews and a survey in an empirical case study on minimally-invasive endoscopy-guided surgery in patients with ICH showed considerable differences in themes, interaction, and time-investment. In the focus groups relatively few themes were discussed, in the survey slightly more themes occurred, and in the interviews the largest number of themes was constructed. Many improvements for the assessment of the minimally invasive procedure were only discussed in the interviews, such as in- and exclusion criteria for the randomised clinical trial. We assume this is due to the extended time that can be dedicated to data collection, so that more detailed topics can be discussed in-depth. In other respects, there were no clear patterns of topics that occurred in specific methods. In terms of interaction, the focus groups where characterised by relatively much agreement and support. In the interviews agreement and support were seldomly expressed: nearly only questions and answers occurred. In terms of time-investment, the survey required the lowest total time investment: a total of 81 h, followed by focus groups with 96 h, and interviews required the highest time investment with a total of 315 h. There were no significant differences in time investment between the two rounds, neither for the focus groups nor for the interviews. The time allocated for preparation, data collection, and analysis was proportional to the number of interviews and focus groups conducted in each round.

Taking these results together, we can conclude that interviews generated the most useful data within the clinical case because they generated the highest number of relevant themes. They did however require a high-time investment. Focus groups appeared to be a technique that can better be employed to generate agreement and support instead of generating many relevant themes. Surveys do not generate the most comprehensive overview of themes, but can be useful if researchers want to map themes in a quick way without asking follow-up questions. It is important to be aware that we analysed these differences in the context of medical device evaluation, where the aim of participatory methods is to inform the research or development process, rather than merely describing stakeholder views.

Comparison literature

Our results are in agreement with other studies that show that focus groups generate fewer themes compared to interviews, and that focus groups are relatively time efficient [ 32 , 33 , 34 ]. Other studies, however, report that focus groups and interviews generate a comparable large number of themes, whereas our results clearly show that interviews generate more themes [ 10 , 35 , 36 , 37 ]. The discrepancy might be explained by the large number of focus groups that were held and the number of participants that participated in these latter studies. Namey et al. [ 35 ] for example assigned 310 participants to 40 focus groups and 40 participants to interviews. Because these authors include such high numbers in focus groups, they also state that focus groups require a lower time-investment. Based on our findings and the findings in the literature, we can assume that with equal inclusion numbers, focus groups take less time at the expense of generating less data.

Strengths and limitations

The major strength of our study is that we compared three participatory methods in one single empirical case study on the development and evaluation of a medical device. With rigorous control of many contextual and methodological factors we can conclude that the differences in the three outcomes of this study are mainly caused by the characteristics of the data collection methods. Another strength is that we have embedded the comparison in an actual participatory assessment of an innovative minimally-invasive surgical treatment, increasing the ecological validity of the results. Patients and their relatives were involved, they interacted with different physicians and policy makers, and the findings were used in later assessments of the new procedure. Therefore, the results of this study are representative for interactions between these groups. The insights have also informed subsequent quantitative studies on the surgical treatment. Albeit our study is focussed on medical device evaluation, it also has consequences for comparisons of qualitative methods in a broader perspective, because we have adopted conventional focus group, interview and survey methodologies. Our results can therefore be compared with those from related studies outside the domain of medical device evaluation. Finally, we performed an analysis of interaction. The analysis of interaction is rarely done, probably because it is laborious. However, this analysis is crucial because interaction between participants and between participants and moderator(s) is one of the primary aims of focus groups and interviews. By showing who interacts with whom and how, we offer insights in the processes of these methods, which can be of use in the selection of one of these methods by others.

Some limitations should also be addressed. First, there are still some variations in the three research designs that could have influenced the outcomes. Different moderators and stakeholders were involved in each method, and their specific characteristics could have affected the results. Using different moderators and participants was a considerate choice, however, since the use of the same moderator or participants in all methods would have influenced the outcomes, as they would have taken their experiences from one activity to the other. Second, a substantial proportion of themes was found in only two or one of the methods, which indicates that none of the methods generated a complete set of data. This implies that the concept of information power might not have been the most suitable technique to determine the number of participants. Saturation might be a better point to close the data collection phase, especially when a diverse range of participants is included, such as in this study. Third, in the survey a relatively low number of participants were enrolled. The data may therefore not be representative of surveys with higher inclusion numbers. Yet, the survey in this study was constructed for qualitative research aims and not intended to produce quantitatively significant results. Fourth, the data of all three methods were collected digitally, because the data-collection was performed during the COVID-19 pandemic. Therefore, the results may not be directly applicable to face-to-face interactions. As work is increasingly being digitalised and organised remotely, it is likely that in the future qualitative data more often are being collected by means of video consulting applications.

Implications

Our results help researchers and innovators to choose a method that is most suitable for their research aim, both in- and outside the domain of medical device evaluation. First we will place the methodological findings in the clinical context in which we worked. Next, we will discuss contextual factors that are relevant for medical device evaluation in general.

As described in the methods section, three methods were compared against the background of the design of a phase 3 randomised clinical trial to evaluate early minimally-invasive endoscopy-guided surgery in patients with ICH (NCT05460793). The clinical results of our research were used to inform different aspects of this randomised clinical trial, such as the selection of relevant outcome variables and the process of acquiring informed consent in this acute intervention trial. The results were also used to see how hospital care for ICH could be improved in general. All methods generated relevant insights in the context of this study, but interviews generated the most comprehensive body of relevant results for the trial and were thus most useful in the specific clinical context.

As described, there are some implications that are relevant for all types of researchers or innovators that want to employ participatory methods. Elucidating needs of stakeholders might especially be relevant in early development stages since they can be translated in the further development and evaluation of a device. It is thus relevant to have a comprehensive, in-depth assessment of these needs and interviews appear to be most appropriate for that aim. If in later stages more specific development issues need to be resolved, stakeholders could be brought together in a small focus group to make a joint decision. Since financial investments are required for participatory evaluations, the question arises whether the benefits live up to these investments. In the literature, stakeholder involvement is generally considered to be beneficial, but an important caveat is that low budgets and small-scale involvements can lead to flawed stakeholder representation and reproducing existing power differences [ 38 ]. We strongly recommend to invest in participatory development and evaluation as this is likely to be highly beneficial, because the perspectives of stakeholders are embedded in the innovation process.

Furthermore, we posit the existence of overarching methodological implications pertinent to participatory research at large, and delineate some considerations. The body of results generated by focus groups was not as comprehensive as in the interviews. This is possibly due to the social dynamic that is at play between participants and the limited time that each individual speaker is talking, which makes expansive questioning by a moderator on all relevant topics hard to realize. This implies that for comprehensively answering a research question, focus groups are not the most suitable method. Nevertheless, topics can be discussed and resolved relatively quickly in a focus group if the participants are more or less on the same page, which implies that focus groups can be a useful decision-making technique. Interviews can best be used for in-depth analyses of different perspectives, to generate much data, and therefore comprehensively answer a research question. Researchers or innovators may shorten the time-investment of interviews by speeding up the analysis, for example by not transcribing full interviews but writing summaries directly after an interview. Surveys might be suitable if researchers or innovators want to carry out a fast exploration of themes, and do not require interaction or an in-depth explication of topics. Qualitative surveys lack the option for inductive questioning, so they are not suitable if researchers want to apply an open research design. Methods presented in this paper could also be combined, or integrated in a stepwise manner in a research of development process. A researcher might first use a survey to explore multiple stakeholders’ wishes, and subsequently arrange a round of interactive focus groups when fast and definite decision needs to be made. An evaluation trajectory of medical devices is hard to plan in advance and unforeseen issues might arise, and these issues might demand specific participatory methods.

Focus groups, interviews, and surveys have clear methodological differences and provide different results within the context of medical device evaluation. Focus groups can best be used to bring views together, but do not enable a comprehensive analysis. Interviews enable an in-depth analysis of stakeholder views and can best be used to comprehensively answer an explorative research question, but are time-intensive. Surveys can be used for a rapid exploration of perspectives. Researchers should account for these methodological differences and select the method that serves their research aim.

Availability of data and materials

No data are available. All relevant data are presented in this study.

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Acknowledgements

We wish to express our gratitude to Leon Bijlmakers and Anke Oerlemans for their valuable help in guiding the focus groups.

This work was sponsored by a Vici fund by the Nederlandse organisatie voor gezondheidsonderzoek en zorginnovatie (ZonMw) (grant number 91818617). CK and LS are supported by the Netherlands Cardiovascular Research Initiative, which is supported by the Dutch Heart Foundation, CVON2015-01: CONTRAST and the support of the Brain Foundation Netherlands (HA2015.01.06). CK is supported by ZonMw (ASPASIA grant, 015008048). FS is supported by the Dutch Heart Foundation (senior clinical scientist grant, T2019T060).

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Kas Woudstra, Marcia Tummers & Rob Reuzel

Department of Operating Rooms, Radboudumc, Nijmegen, Netherlands

Kas Woudstra & Maroeska Rovers

Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboudumc, Nijmegen, Netherlands

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Contributions

KW, RR, MR, MT contributed to the conception and design. KW, CK, LS, RR and MT contributed to the acquisition, analysis and interpretation of data. KW, RR, MR, MT, CK, LS and FS have been drafting the manuscript. MR has obtained funding.

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Correspondence to Kas Woudstra .

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Our study was approved by the local certified ethics committee METC Oost-Nederland (WMO) file number: 2021–6055. All methods included in this study are performed in accordance with the declaration of Helsinki. All participants gave written or verbal informed consent on a recorded audio file prior to enrolment in the study.

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Woudstra, K., Tummers, M., Klijn, C.J.M. et al. Participatory methods used in the evaluation of medical devices: a comparison of focus groups, interviews, and a survey. BMC Health Serv Res 24 , 462 (2024). https://doi.org/10.1186/s12913-024-10887-3

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http://orcid.org/0000-0003-4555-5395 Beatriz Rosendo-Silva 1 , 2 , 3 ,
Filipe Prazeres 2 , 4 , 5 ,
Luiz Miguel Santiago 6 , 7 ,
http://orcid.org/0000-0002-2826-5815 Inês Rosendo 2 , 8
1 Faculty of Medicine , University of Coimbra , Coimbra , Portugal
2 CINTESIS - Center for Health Technology and Services Research; Faculty of Medicine, University of Porto , Porto , Portugal
3 USF Figueira Sul , Coimbra , Portugal
4 Faculty of Health Sciences , University of Beira Interior , Covilha , Portugal
5 CINTESIS@RISE, MEDCIDS , Faculty of Medicine of the University of Porto , Porto , Portugal
6 Centre for Health Studies and Research of the University of Coimbra (CEISUC) , University of Coimbra , Coimbra , Portugal
7 FGM University Clinic , Faculty of Medicine, University of Coimbra , Coimbra , Portugal
8 Family Medicine, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
Correspondence to Dr Beatriz Rosendo-Silva; beatrizrosendosilva{at}gmail.com

Introduction Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.

Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.

Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.

This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence.

Methods and analyses We will conduct qualitative research through synchronous online focus groups of 6–10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.

The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.

Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively.

Ethics and dissemination The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.

Hypertension
QUALITATIVE RESEARCH
Primary Health Care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-076416

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Strengths and limitations of this study

This study will identify strategies for improving adherence to antihypertensive medication in primary care settings, involving both healthcare professionals and patients using focus groups in Portugal.

The online focus group will allow a more inclusive sample of participants and a wider range of views through group interaction which otherwise would be hard to reach and less cost-efficient.

Regarding the focus groups being online, body language may be lost and a lack of understanding by patients can be more difficult to access.

When using online focus groups, technology capacity might also be a barrier to some participants, which will be addressed and minimised by involving family or caregiver help.

The themes and resulting potential strategies to improve non-adherence will only reflect views from Portugal and will lack the opinion of local and national health officials, who are responsible for healthcare management and cardiologists.

Introduction

Hypertension is the leading modifiable risk factor for cardiovascular disease and is a significant contributor to morbidity and mortality globally. 1 Despite the high prevalence of hypertension, there is a disparity concerning both its prevalence and control. 2–4 One relevant factor contributing to inadequate blood pressure control is non-adherence to antihypertensive medication, 5 6 which is estimated at 45% globally. 7

Additionally, the hypertensive population typically consists of elderly individuals, 8 with low socioeconomic status, a low education level 9 and multimorbidity. 10 This scenario worsens as multimorbidity contributes to the increase in medical expenses among the elderly. 11

Non-adherence can be used as a strategy to deal with such expenses but subsequently increases patients’ risks. 11

Increasing adherence to therapeutic recommendations is thought to be a promissory health measure 12 and several strategies to improve medication adherence have been tested in randomised controlled trials. 13–20 On the other hand, regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy. 21

Understanding the perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies have been conducted to comprehend the perspectives, attitudes and beliefs of patients 22 and healthcare professionals 23 concerning medication adherence. None of them focused on adherence to pharmacological therapy for hypertension specifically in Portugal.

When addressing interventions for medication adherence, clinicians and researchers should attend to the characteristics of their unique population, healthcare system, healthcare providers, social policy and community. 24 These factors may differ from other countries/cultures. Hence, it is expected that barriers and strategies to address them are also location - specific. 25

All this evidence emphasises the need for healthcare providers and policymakers in each location to identify and address the barriers to antihypertensive medications through the development of tailored tactics. 25

The primary objective of this study will be to investigate the perspectives of patients diagnosed with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal regarding the most effective strategies to enhance medication adherence.

Another objective of this study is to gain an understanding of the factors contributing to non-adherence to hypertensive medication in Portugal.

Methods and analysis

This will be a qualitative study. We will organise three synchronous online focus groups 26 comprising patients and another three similar focus groups with healthcare professionals. The duration of each session is expected to be of 1 hour.

The participants’ numbers for each focus group will range from 6 to 10 individuals. 27–29 The precise number of focus groups required will be determined based on the achievement of theoretical saturation. 28 30 31

The facilitator of the focus groups will be a female medical doctor and researcher (BR-S) who has experience in conducting interviews.

The videoconferencing application Zoom will be used to enable the involvement of participants residing in diverse regions of Portugal. The researchers involved in this study did not have prior acquaintance with the participants recruited.

Participants will sign informed consent to participate in the study, to the use of their data and opinions in the focus groups, as well as to their audio-recording, and will be informed that they can withdraw from the study at any time.

The focus group meetings with healthcare professionals will be scheduled in December 2023. We will start the analyses of the data retrieved in January 2024.

In relation to the focus group with patients, the recruitment phase will begin in December 2023. The first focus groups will be pilot studies, and necessary changes will be made to improve the scripts and the following gatherings.

In the development of this protocol, the principles of qualitative research design by focus groups were considered, through criteria and standards of quality and transparency already defined: COnsolidated criteria for REporting Qualitative research 32 and Standards for Reporting Qualitative Research. 33

Setting and participants

The focus groups will be composed of maximal variation sampling (purposive sample), in which diverse individuals who are expected to hold different perspectives are chosen, based on predefined inclusion criteria ( table 1 ), and invited to participate. 34

View inline

Inclusion criteria

The focus groups with patients with hypertension will include adult patients with hypertension taking at least one antihypertensive drug from the primary care setting and the nomination of potential patients will include criteria 28 listed in table 1 .

Clinicians will exclude patients who are unable to participate due to cognitive impairment and participants without an email account or whose caregivers or family members do not have an email account.

The promotion of patient focus groups will be through profession-specific mailing lists of family physicians. Among the family doctors willing to collaborate, 15 will be accepted.

Family physicians accepted will be asked to identify and nominate potential participants among their patients with hypertension, regarding their will to participate, and address the need and possibility for assistance from any family member or caregiver to handle the technological requirements of the meeting. Clinicians will address potential participants in the most convenient way (during consultations or via email or telephone) and seek consent from their patients to be contacted (via email or telephone) by the research team.

After obtaining consent to contact, a research team member will contact the participants and give them a concise overview of the study, while addressing any questions they may have. If the person remains interested in participating in the study, a consent form will be sent via email. Each family physician will recruit a maximum of two participants.

The additional three focus groups will gather family physicians, nurses and community pharmacists, and their inclusion criteria are presented in table 1 .

Healthcare professionals will be invited to participate through profession-specific mailing lists, and those who reply showing interest in participating will receive more details about the study and, if selected to participate, will receive a copy of the participant consent form via email.

During the process of selecting participants for the focus groups, it will be given priority to participants’ availability for each meeting date and time.

After generating a pool of potential participants, randomisation of potential participants will be made to minimise selection bias using a random number generator.

The consent form sheet will explain the purpose and ethical safeguards of the study. Researchers will gather signed consent forms from participants who maintain their will to participate before the meetings via email.

Additionally, prior to the focus group meeting, the research team will approach participants to thank them for their availability, to ensure that participants understand the purpose of the research and to check the technological conditions to participate in the focus group.

Data collection

Data collection will be carried out during the focus groups which will be recorded via Zoom.

Each group of participants will be of the same category (patients or healthcare professionals) to maintain homogeneity, 28 minimising the dynamics of power in the meetings.

The moderator (BR-S) will explain the purpose of the study and after an initial icebreaker activity will introduce the questions, promote the discussion and strive to maintain neutrality while ensuring an interactive atmosphere and contributions from every participant.

The scripts to be used were developed after a thorough review of the existing literature and were revised by two researchers with expertise in focus group moderation. Furthermore, each script underwent a linguistic validation process through cognitive interviews, which involved 10 persons from each target population of the focus groups: 10 patients with hypertension and 10 healthcare professionals from a Primary Healthcare Unit before conducting focus groups. These validations introduced small differences in each script to make them more understandable to the target population.

Each script consists of 10 open-ended questions and the primary subjects approached in the scripts will concentrate on the following areas: the definition of hypertension and adherence to hypertensive medication; the reasons or circumstances leading to patient non-adherence to medication; forgetfulness regarding medication; the factors impeding adherence to prescribed medication; the facilitating factors and strategies aimed at helping patients in adhering to medication; and the significant side effects experienced by patients and methods to reduce or prevent them. Additionally, the role of the family in hypertensive management and the involvement of primary healthcare, pharmacies and technology in promoting adherence to pharmacological therapy will be explored.

Participants will be encouraged to engage in group discussions and share their views and experiences regarding the topics of interest.

At the end of the focus group session, the moderator will undertake a summary, and a research assistant and all participants will be encouraged to express their opinions regarding the summary content.

Attendance in the meetings will be limited to participants and the research team, which will include the moderator (BR-S) and the assistant moderator (IR). Researchers will make field notes during or after the sessions whenever they think it is appropriate. Meetings will be transcribed verbatim with all identifiable information removed from the transcription and replaced by a code number prior to data analyses, and subsequently, the recordings of the sessions will be destroyed, to ensure anonymisation.

Supplementary demographic data regarding participants will be gathered via an online anonymous form distributed after the focus groups. This form will encompass various fields designed to capture the following information: age, sex, place of residence, type of geographical location, household composition, educational level, occupation, number of pills taken daily (only for patients) and prior involvement in focus groups, as well as an open section for participants to provide additional comments or suggestions.

Data analyses

The transcribed data will undergo qualitative analyses using the MAXQDA V.12 software program during the period from July 2023 to September 2023.

Two researchers will assess the data through comparative analyses and subsequent consensus.

The information will be categorised and subjected to content analyses to construct a coding tree and identify the primary themes, predominantly aligning with the script questions. In the beginning, category definition and abstraction level will be defined, but both deductive and inductive category development approaches will be employed. A third researcher will review the analyses. The results will be presented narratively, accompanied by illustrative quotations from the data. 28 29 35

Patient and public involvement statement

Data protection.

The research team will keep all confidential data for 5 years, storing it exclusively on password-protected computers that are only accessible to team members. Before conducting data analyses, the audio recordings will undergo anonymisation, ensuring the removal of any identifiable information.

Ethics and dissemination

Written informed consent to participate and be audio-recorded will be obtained from all participants.

The Ethics Committee of the University of Coimbra has approved this study with the number CE-026/2021, which adheres to the Declaration of Helsinki.

This study has been designed to obtain insights and feedback about reasons for non-adherence, and strategies to improve adherence to medication in patients with hypertension to conduct subsequent research to develop and test strategies to address adherence to medication in patients with hypertension. Additionally, these findings will be disseminated via peer-reviewed publications and national and international conferences.

Ethics statements

Patient consent for publication.

Not applicable.

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Contributors All authors were involved in designing the study (FP, LMS, IR and BR-S). BR-S was responsible for the writing of the manuscript. All authors (FP, LMS, IR and BR-S) read and approved the final manuscript draft.

Funding This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). This support consisted of paying the fee for open-access publication.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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Open access
Published: 09 April 2024

Active involvement in scientific research of persons living with dementia and long-term care users: a systematic review of existing methods with a specific focus on good practices, facilitators and barriers of involvement

Janneke M. Groothuijse 1 , 2 ,
Lisa S. van Tol 1 , 2 ,
C. C. M. (Toos) Hoeksel-van Leeuwen 1 , 2 ,
Johannes J. M. van Delden 3 ,
Monique A. A. Caljouw 1 , 2 &
Wilco P. Achterberg 1 , 2

BMC Geriatrics volume 24 , Article number: 324 ( 2024 ) Cite this article

119 Accesses

Metrics details

Active involvement of persons living with dementia (PLWD) and long-term care (LTC) users in research is essential but less developed compared to other patient groups. However, their involvement in research is not only important but also feasible. This study aims to provide an overview of methods, facilitators, and barriers for involving PLWD and LTC users in scientific research.

A systematic literature search across 12 databases in December 2020 identified studies involving PLWD, LTC users, or their carers beyond research subjects and describing methods or models for involvement. Qualitative descriptions of involvement methods underwent a risk of bias assessment using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist 2018. A data collection sheet in Microsoft Excel and thematic analysis were used to synthesize the results.

The eighteen included studies delineated five core involvement methods spanning all research phases: advisory groups, formal and informal research team meetings, action groups, workshops, and co-conducting interviews. Additionally, two co-research models with PLWD and carers were found, while only two studies detailed LTC user involvement methods. Four distinct involvement roles were identified: consulting and advisory roles, co-analysts, co-researchers, and partners. The review also addressed barriers, facilitators, and good practices in the preparation, execution, and translation phases of research, emphasizing the importance of diversity, bias reduction, and resource allocation. Trust-building, clear roles, ongoing training, and inclusive support were highlighted.

Conclusions

Planning enough time for active involvement is important to ensure that researchers have time to build a trusting relationship and meet personal needs and preferences of PLWD, LTC users and carers. Researchers are advised not to presume the meaning of burden and to avoid a deficit perspective. A flexible or emergent design could aid involved persons’ ownership of the research process.

Trial registration

Prospero 2021: CRD42021253736.

Peer Review reports

In research characterized by active involvement, the target group plays a pivotal role in shaping research decisions and outcomes, directly impacting them. Involving patients in health research offers significant benefits [ 1 , 2 ]: it enhances participant recruitment [ 2 ], refines research questions [ 2 ], aligns study results with the target population [ 1 , 2 ], and promotes effective implementation of findings [ 1 ]. Active involvement of patients has also benefits for themselves, namely an enhanced understanding of research, building relationships, personal development, improved health and wellbeing, and enjoyment and satisfaction [ 3 , 4 ]. It gives them a sense of purpose and satisfaction through their tangible impact.

However, for long-term care (LTC) users and persons living with dementia (PLWD) active involvement in research is less developed than for other patient groups [ 5 , 6 ]. PLWD and LTC users share similar care needs, encompassing assistance with activities of daily living (ADLs), medication management, medical condition monitoring, and emotional support. Furthermore, a substantial portion of LTC users comprises individuals living with dementia [ 7 ]. Additionally, statistical data from the United States reveals that one in four older individuals is likely to reside in long-term care (LTC) facilities [ 8 ], and approximately forty to eighty percent of LTC residents in the United States, Japan, Australia, and England experience dementia or severe memory problems [ 7 , 9 ].

Due to these considerations, we have chosen to combine the target audiences of PLWD and LTC users in our systematic review. However, it's important to note that while there are potential advantages to combining these target groups, there may also be challenges. PLWD and LTC users may have varying needs, preferences, and experiences, including differences in care requirements driven by individual factors like the stage of dementia, coexisting conditions, and personal preferences. Therefore, it's imperative to conduct comprehensive research and involve these communities to ensure that involvement approaches are not only inclusive but also tailored to meet their specific requirements.

Given our ageing population and the intricate health challenges faced by PLWD and LTC users, including their vulnerability and shorter life expectancy in old age, it's crucial to establish effective research involvement methods. These individuals have unique needs and preferences that require attention. They possess a voice, and as researchers, it is our responsibility to not only listen to them but also actively involve them in the research process. Consequently, it is essential to identify means through which the voices of PLWD and LTC users can be effectively heard and ensure that their input is incorporated into research.

Fortunately, publication of studies on involvement of PLWD and LTC users in scientific research is slowly increasing [ 5 , 9 , 10 , 11 ]. A few reviews have described how PLWD and LTC users were involved [ 5 , 9 , 10 ]. However, with the increasing attention for involvement, the understanding of when involvement is meaningful grows and stricter requirements can be imposed to increase the quality of active involvement [ 12 , 13 ]. To our knowledge there is no up to date overview of involvement methods used with either or both PLWD and LTC users. Such an overview of involvement methods for PWLD and LTC users would provide a valuable, comprehensive resource encompassing various stages of the research cycle and different aspects of involvement. It would equip researchers with the necessary guidance to navigate the complexities of involving PLWD and LTC users in their research projects.

Recognizing the need to enhance the involvement of PLWD and LTC users in scientific research, this systematic review aims to construct a comprehensive overview of the multiple methodologies employed in previous studies, along with an examination of the facilitators and barriers of involvement. Our overarching goal is to promote inclusive and effective involvement practices within the research community. To achieve this objective, this review will address the following questions: (1) What kind of methods are used and how are these methods implemented to facilitate involvement of PLWD and LTC users in scientific research? (2) What are the facilitators and barriers encountered in previous research projects involving PLWD and LTC users?

Protocol and registration

The search and analysis methods were specified in advance in a protocol. The protocol is registered and published in the PROSPERO database with registration number CRD42021253736. The search and analysis methods are also described below more briefly.

Information sources, search strategy, and eligibility criteria

In preparation of the systematic literature search, key articles and reviews about involvement of PLWD and LTC users in research were screened to identify search terms. In addition, Thesaurus and MeSH terms were used to broaden the search. The search was conducted on December 10, 2020, across multiple databases: PubMed, Medline, Embase, Emcare, Web of Science, Cochrane Library, PsycINFO, Academic Search Premier, JSTOR, Social Services Abstracts, Sociological Abstracts, Psychology and Behavioral Sciences Collection. The search terms were entered in "phrases". The search strategy included synonymous and related terms for dementia, LTC user, involvement, research, method, and long-term care. The full search strategy is provided in supplement 1 .

After conducting the search, records underwent initial screening based on titles and abstracts. Selected reports were retrieved for full-text assessment, and studies were evaluated for eligibility based on several criteria. However, no restriction was made regarding publication date. First, to be included studies had to be written in English, German, French, or Dutch. Second, we only included original research studies. Third, studies were excluded when the target group or their representatives were not involved in research, but only participated as research subjects. Fourth, studies were excluded when not describing involvement in research. Therefore, studies concerning involvement in care, policy, or self-help groups were excluded. Fifth, the focus of this systematic review is on methods. Therefore, studies with a main focus on the results, evaluation, ethical issues, and impact of involvement in research were excluded. Additionally, we have not set specific inclusion or exclusion criteria based on study design since our primary focus is on involvement methodologies, regardless of the chosen research design. Sixth, the included studies had to concern the involvement in research of PLWD or adult LTC users, whether living in the community or in institutional settings, as well as informal caregivers or other representatives of these groups who may represent PLWD and LTC users facing limitations. Studies that involved LTC users that were children or ‘young adults’, or their representatives, were excluded. Studies were also excluded if they involved mental healthcare users if it remained unclear if the care that they received entailed more than only treatment from mental healthcare providers, but for example also assistance with ADL.

Terminology

For readability purposes, we use the abbreviation PLWD to refer to persons diagnosed with dementia, and we use the abbreviation LTC users to refer to persons receiving long-term care, at home or as residents living in nursing homes or other residential facilities. We use the term carers to refer to informal caregivers and other representatives of either PLWD or LTC users. As clear and consistent definitions regarding participatory research remains elusive [ 14 , 15 ], we formulated a broad working definition of involvement in research so as not to exclude any approach to participatory research. We defined involvement in research as “research carried out ‘with’ or ‘by’ the target group” [ 16 ], where the target group or their representatives take part in the governance or conduct of research and have some degree of ownership of the research [ 12 ]. It concerns involvement in research in which lived experienced experts work alongside research teams. We use the terms participation and participants, to refer to people being part of the research as study subjects.

Selection process, data-collection process, and data items

Titles and abstracts were independently screened by the first and second author (JG and LT). Only the studies that both reviewers agreed and met the inclusion criteria were included in the full-text screening process. Any uncertainty about whether the studies truly described a model or approach for involvement, was resolved by a quick screening of the full-text paper. The full-text screening process was then conducted according to the same procedure by JG and LT. Any disagreement was resolved by discussion until consensus was reached. If no agreement could be reached, a third researcher (MC) was consulted. References of the included studies were screened for any missing papers.

The following information was collected on a data collection sheet in Microsoft Excel: year and country of publication, topic, research aim, study design, living situation of involved persons (at home or institutionalized), description of involved persons, study participants (study subjects), theories and methods used, type/role(s) of involvement, research phase(s), recruitment, consent approach, study setting, structure of participatory activities, training, resources, facilitators, barriers, ethics, benefits, impact, and definition of involvement used.

JG independently extracted data from all included studies, the involved co-researcher (THL) independently extracted data from two studies, the second author (LT) from five. Differences in the analysis were discussed with the co-researcher (THL) and second author (LT) until consensus was reached. As only minor differences emerged, limited to the facilitator and barrier categories, data from the remaining studies was extracted by JG.

Risk of bias assessment

Every research article identified through the systematic review exclusively comprised qualitative descriptions of the involvement method(s) employed. Consequently, all articles underwent evaluation using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist 2018 [ 17 ], as opposed to the checklists intended for quantitative or mixed methods research. All included studies were independently assessed on quality by two reviewers (JG,LT) and any disagreement was resolved by discussion until consensus was reached. The CASP Qualitative Checklist consists of ten questions. The checklist does not provide suggestions on scoring, the first author designed a scoring system: zero points if no description was provided (‘no’), one point if a minimal description was provided (‘can’t tell’) and two points when the question was answered sufficiently (‘yes’). The second question of the checklist, “is a qualitative methodology appropriate”, was not applicable to the aims (i.e., to describe involvement) of the included studies and was therefore excluded. The tenth question was translated into a ‘yes’, ‘can’t tell’, or ‘no’ score to fit the scoring system. A maximum of eighteen points could be assigned.

Synthesis methods

Tables were used to summarize the findings and to acquire an overview of (1) the kinds of methods used to enable involvement of PLWD, LTC users, or carers in scientific research, and (2) the facilitators and barriers for involving this target group in scientific research. As to the first research aim, the headings of the first two tables are based on the Guidance for Reporting Involvement of Patients and the Public, long form version 2 (GRIPP2-LF) [ 18 ]. Because our systematic review focusses on methods, only the topics belonging to sections two, three, and four were included. Following Shippee et al., three main research phases were distinguished: preparation, execution, and translation [ 19 ]. Furthermore, the following fields were added to the GRIPP2-LF: First author, year of publication, country of study, setting of involvement, frequency of meetings, and a summary description of activities.

Concerning the second research aim, the extracted facilitators, barriers, and good practices were imported per study in ATLAS.ti for qualitative data analysis. Following the method for thematic synthesis of qualitative studies in systematic reviews [ 20 ], all imported barriers, facilitators and good practices were inductively coded staying 'close' to the results of the original studies, which resulted in 50 initial codes. After multiple rounds of pile sorting [ 21 ], based on similarities and differences and discussions in the research team, this long code list was grouped into a total of 27 categories, which were thereafter subsequently organized into 14 descriptive themes within the three research phases (preparation, execution, translation).

Study selection and characteristics

The Prisma Flow Diagram was used to summarize the study selection process [ 22 ]. In the full text screening, 72 of the 93 remaining studies were excluded because they were not original research articles (n = 5), not about involvement (n = 8), not about involvement in a research project (n = 1), they did not describe a model or method for involvement (n = 34), or they were not about PLWD or LTC users (n = 24). The search resulted in 18 publications eligible for analysis (Fig. 1 ).

Preferred Reporting items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram

Table 1 presents the general study characteristics. Two studies explicitly aimed to develop a model for involvement or good practice, and both focus on co-research either with PLWD [ 23 ] or their carers [ 13 ]. The other sixteen provide a description of the involvement of PLWD [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] or LTC users in their research projects [ 35 , 36 , 37 , 38 , 39 ].

Quality assessment

Table 1 presents the CASP-score per study [ 17 ]. Five scored 16 to 18 points [ 13 , 28 , 29 , 32 , 35 ], indicating high quality with robust methods, clear aims, and strong data analysis. Eleven scored 12 to 15 [ 23 , 24 , 26 , 30 , 32 , 33 , 34 , 36 , 37 , 38 , 39 ], showing generally strong methodologies but with some limitations. Two scored 9 or lower [ 25 , 27 ], signifying significant methodological and analytical shortcomings. Notably, these low-scoring studies were short articles lacking clear recommendations for involvement in research.

Design and implementation of involvement

Phases and methods of involvement.

Table 2 describes the involvement methods used for and the implementation of involvement in research. The included studies jointly presented methods for involvement in the three main research phases [ 19 ]. Regarding the preparation phase, which involves the preparatory work for the study, only three studies provided detailed descriptions of the methods employed [ 26 , 30 , 32 ]. The execution phase, encompassing the actual conduct of the research, was most frequently discussed [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Five studies addressed the translation phase [ 13 , 25 , 31 , 36 , 37 ], where the focus shifts to translating research findings into actionable outcomes.

The eighteen studies introduced a variety of involvement methods, categorizable into five groups: 1) advisory groups, 2) research team meetings (both formal and informal), 3) action groups, 4) workshops, and 5) co-research in interviews. In five studies, individuals including PLWD, LTCF residents, carers, and health professionals participated in advisory/reference groups [ 25 , 26 , 27 , 32 ], working groups [ 27 ], and panels [ 28 ]. These groups offered valuable feedback on research aspects, spanning protocols, design, questionnaires, and implementation of research. Meetings occurred at varying frequencies - monthly, quarterly, or biannually.

Two studies exemplify diverse research collaboration settings. One involving older individuals within an academic research team of five [ 37 ], and another featuring a doctoral student and a co-researcher conducting informal monthly discussions at a local coffee shop [ 31 ]. Brown et al. sought to minimize power differentials and enhance inclusivity [ 37 ], while Mann and Hung focused on benefiting people with dementia and challenging negative discourse on dementia [ 31 ].

An additional five studies employed methods involving frequent meetings, including action [ 35 , 39 ], inquiry [ 23 ], and discussion groups [ 29 , 36 ] In these groups, involved persons with lived experience contributed to developing a shared vision and community improvements, such as enhancing the mealtime experience in care facilities [ 35 ].

Seven studies involved individuals through workshops, often conducted over one or two sessions. These workshops contributed to generating recommendations [ 37 ], informing future e-health designs [ 29 , 30 ], and ensuring diverse perspectives and lived experiences were included in data analysis [ 13 , 24 , 32 , 33 ]. In three studies, representatives worked as co-researchers in interviews, drawing on personal experiences to enhance the interview process, making it more dementia-appropriate and enriching data collection [ 13 , 32 , 34 ]. Finally, one study involved representatives in the recruitment and conduct of interviews [ 38 ].

People involved

The number of persons involved varied from a single co-researcher [ 31 ] to 34 panel individuals providing feedback on their experiences in a clinical trial [ 28 ]. Thirteen studies focussed on PLWD: eleven involved PLWD themselves [ 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 ], one exclusively focused on caregivers [ 13 ], and another one involved people without or with mild cognitive impairment, who participated in a study examining the risks of developing Alzheimer's disease [ 28 ]. Although not all articles provided descriptions of the dementia stage, available information indicated that individuals involved typically fell within the early to mid-stages of dementia [ 29 , 30 , 32 , 33 , 34 ]. Next to PLWD and carers, two studies additionally involved organizational or advocacy representatives [ 25 , 27 ]. The other five studies concerned older adults living in a LTC facility. Two of them involved older residents themselves [ 35 , 39 ], the other three carers, older community/client representatives or health care practitioners [ 36 , 37 , 38 ].

Roles and level of involvement

Four general roles could be identified. First, consultation and advisory roles were held by PLWD and carers [ 25 , 26 , 27 , 28 , 29 , 30 , 32 ], where involved persons share knowledge and experiences to make suggestions [ 32 ], but the research team retained formal decision-making power [ 25 ]. Second, PLWD were involved as co-analysts in data analysis [ 24 , 32 , 33 ]. Co-analysts influence data analysis, but the decision-making power remained with academic researchers [ 24 ]. Third, in six studies the co-researcher role was part of the research design in which involved persons and researchers steer and conduct research together [ 13 , 23 , 31 , 32 , 34 , 36 ]. Finally, two studies partnered with LTC residents [ 35 , 39 ], with residents at the core of the group, and positioned as experts by experience [ 39 ]. Residents had the decision-making authority regarding how to improve life in LTC facilities [ 35 ].

Models for involvement in research

Only two studies designed a model for co-research with PLWD [ 23 ] or their carers [ 13 ] across all research phases. These models underscored the importance of iterative training for co-researchers [ 13 , 23 ] and academic researchers [ 23 ]. Furthermore, these studies advocate involving co-researchers early on in the research process [ 13 ] and in steering committees [ 23 ]. Co-researchers can be involved in designing research materials [ 23 ], conducting interviews [ 13 , 23 ], analysing data [ 13 ], and co-disseminating findings [ 13 , 23 ]. Additionally, one study stressed involving PLWD in identifying (future) research priorities [ 23 ].

Barriers, facilitators, and good practices in research phases

Preparation phase.

Table 3 describes the barriers, facilitators, and good practices per main research phase. Lack of diversity in ethnicity and stages of dementia in the recruitment of involved persons is mentioned as a recurring barrier [ 26 , 28 , 32 , 33 ]. The exclusion of people with cognitive impairments is partly due to gatekeepers’ and recruiters’ bias towards cognitively healthy people [ 28 , 32 ]. It is stressed that researchers should refrain from making assumptions about the abilities of PLWD and ask the person what he/she is willing to do [ 31 ]. It is considered good practice to involve people regardless of cognitive abilities [ 23 ], based on skills, various personal characteristics [ 13 ] and, if possible, relevant prior experience [ 38 ].

Many studies stress the importance of building a mutual trusting relationship between involved persons and academic researchers [ 13 , 23 , 31 , 33 , 34 , 37 ]. A good relationship is believed to break down social barriers [ 37 ], foster freedom of expression [ 33 ], and thereby avoiding tokenistic involvement [ 13 ]. In addition, spending time with these persons is important to become familiar with an individual’s strengths and limitations [ 31 ].

Opting for naturally evolving involvement roles was mentioned as a barrier, as this may result in conflicting expectations and irrelevant tasks [ 37 ]. A clear role description and clarification of tasks is key to balancing potentially different expectations of the involved persons and researchers [ 26 , 28 , 29 , 32 , 38 ]. When designing a role for involvement in research, good practices dictate taking into account personal skills, preferences, development goals, and motivation for involvement [ 13 , 32 ]. This role should ideally be designed in collaboration with involved persons [ 13 , 32 ].

The perception of providing training to involved persons is ambivalent. Studies cited that training should not aim to transform them into “pseudo-scientist” [ 32 , 37 ] and that it raises the costs for involvement [ 28 ]. However, multiple scholars emphasize the importance of providing iterative training to facilitate meaningful involvement and development opportunities [ 13 , 23 , 28 , 31 , 32 , 33 , 36 , 37 ]. Training can empower involved persons to engage in the research process equally and with confidence, with the skills to fulfil their role [ 13 , 33 , 38 ]. However, the implementation of training may present a potential conflict with the fundamental principle of valuing experiential knowledge [ 37 ] and should avoid the objective of transforming co-researchers into 'expert' researchers [ 32 ]. Academic researchers should also be offered training on how to facilitate meaningful involvement [ 13 , 23 , 28 , 31 ].

Limited time and resources were mentioned as barriers to involvement that can delay the research process [ 13 , 33 , 36 , 39 ], restrict the involvement [ 28 ] and hinder the implementation of developed ideas [ 39 ]. Financial compensation for involvement is encouraged [ 25 , 26 , 27 , 32 ], as it acknowledges the contribution of involved persons [ 13 ]. Thus, meaningful involvement in research requires adequate funding and infrastructure to support the involvement activities [ 13 , 28 , 33 , 37 ].

Execution phase

The use of academic jargon and rapid paced discussions [ 13 , 37 ], power differentials, and the dominant discourse in biomedical research on what is considered “good science” can limit the impact of involvement [ 13 , 24 , 32 , 36 , 37 ]. Facilitating researchers should reflect on power differentials [ 35 ] and how decision-making power is shared [ 31 ]. Other facilitating factors are making a glossary of terms used and planning separate meetings for “technical topics” [ 37 ]. In addition, an emergent research design [ 35 ] or a design with flexible elements [ 28 ] can increase ownership in the research project and provide space for involvement to inform the research agenda [ 28 , 35 ]. This requires academic researchers to value experiential knowledge and to have an open mind towards the evolving research process [ 13 , 23 , 31 ].

Furthermore, managing the involvement process and ensuring equity in the collaboration [ 13 , 32 , 33 ], facilitating researchers must encourage involved persons to voice their perspectives. This means that they sometimes need to be convinced that they are experts of lived experience [ 32 , 33 , 36 , 37 , 39 ]. To enable involvement of PLWD, the use of visual and creative tools to prompt memories can be considered [ 24 , 30 , 33 , 34 ], as well as flexibility in relation to time frames and planning regular breaks to avoid too fast a pace for people who may tire easily [ 24 , 25 , 29 , 30 ].

Involvement can be experienced as stressful [ 13 , 32 , 38 ] and caring responsibilities may interfere [ 26 ]. Tailored [ 29 ] physical and emotional support should therefore be offered [ 13 , 23 , 38 ] without making assumptions about the meaning of burden [ 30 , 31 ]. Moreover, being the only PLWD involved in an advisory group was experienced as intimidating [ 25 ] and, ideally, a larger team of PLWD is involved to mitigate responsibilities [ 37 ]. PLWD having a focal point of contact [ 28 , 37 ] and involving nurses or other staff with experience working with PLWD and their carers [ 29 , 30 ] are mentioned as being beneficial. Some stress the importance of involving carers when engaging with PLWD in research [ 25 , 29 , 30 ].

To avoid an overload of information that is shared with the involved persons, tailoring information-sharing formats to individual preferences and abilities is essential to make communication effective [ 27 , 37 ].

Translation

Two studies indicated a need for more robust evaluation measures to assess the effect of involvement [ 28 , 33 ]. Reflection and evaluation of the involvement serves to improve the collaboration and to foster introspective learning [ 13 , 23 , 26 , 31 ]. The included studies evaluated involvement through the use of reflective diaries [ 13 ] or a template [ 38 ] with open-ended questions [ 33 ].

Two studies postulate that findings should benefit and be accessible to PLWD [ 23 , 31 ]. The use of creative tools not only enables involvement of PLWD, but can also increase accessibility of research findings and expand the present representation of PLWD [ 23 ].

The 18 included studies presented multiple methods for involvement in all three research phases. We found five types of involvement: advisory groups, (formal and informal) research team meetings, action groups, workshops, and co-conducting interviews. Only two studies described methods for involvement of LTC users in research. Involved persons were most often involved in consulting and advisory roles, but also as co-analysts, co-researchers, and partners. Involved persons’ roles can evolve and change over time. Especially as involved persons grow into their role, and gain confidence and knowledge of the specific research project, a more active role with shared responsibilities can become part of the research project. In addition, multiple involvement roles can be used throughout the research depending on the research phase.

Compared to the five types of involvement that we identified, other literature reviews about involvement methods for LTC users and PLWD in research also described advisory groups [ 10 ] and workshops [ 5 , 11 ], and methods that were similar to research team meetings (drop-in sessions and meetings [ 11 ]). Methods for action research (action groups) and co-conducting research (interviews) were not included by these other review studies. In addition to our findings, these other reviews also described as involvement methods interviews and focus groups [ 5 , 10 ] surveys [ 10 ], reader consultation [ 11 ]. Those types of methods were excluded from our study, because our definition of involvement is more strict; collecting opinions is not involvement per se, but sometimes only study participation. Moreover, compared to these previous reviews we set a high standard for transparency about the participation methods and the level of detail at which they are described.

Engaging the target group in research, particularly when collaborating with PLWD, LTC users, and carers, involves navigating unforeseen challenges [ 40 ]. This requires academic researchers to carefully balance academic research goals and expectations, and the expectations, personal circumstances and development goals related to the involved person. The aim is to maximize involvement while being attentive to the individual’s needs and avoiding a deficit perspective. Effective communication should be established, promoting respect, equality, and regular feedback between all stakeholders, including individuals living with dementia and LTCF staff. Building a mutual trusting relationship between involved persons and academic researchers through social interaction and clear communication is key to overcome barriers and ensure meaningful involvement. Inclusivity and empowerment, along with fostering an environment where diverse voices are heard, are crucial for the success of involvement in research. Our results are in line with a recent study concerning the experiences of frail older persons with involvement in research, confirming the importance of avoiding stereotypic views of ageing and frailty, building a trusting relationship, and being sensitive to older persons’ preferences and needs [ 41 ].

Furthermore, our results show that training academic researchers and involved persons is essential to develop the skills to facilitate involvement and to fulfil their role with confidence, respectively. Whilst the need for training is acknowledged by others [ 41 , 42 ], there are legitimate objections to the idea of training involved persons, as the professionalization underpinning the concept of training is at odds with voicing a lay perspective [ 43 , 44 ]. Furthermore, it is argued that experiential knowledge is compromised when training is structured according to the dominant professional epistemology of objectivity [ 45 ]. Therefore, training of involved persons should not focus on what researchers think they ought to know, but on what they want to learn [ 41 ].

Academic culture was frequently mentioned as a barrier to meaningful involvement. This result resonates with the wider debate related to involvement in health research which is concerned about active or “authentic involvement” being replaced with the appropriation of the patient voice as an add-on to conventional research designs [ 12 , 46 ]. It is argued that such tokenistic involvement limits the involved persons’ ability to shape research outcomes [ 46 ]. To reduce tokenism requires a culture shift [ 13 ]. We believe that due to the strict definition of involvement and high transparency standard used in this review, tokenistic approaches were excluded. This may set an example for how to stimulate making this culture shift.

Furthermore, the importance of practical aspects such as funding and, by extension, the availability of time should not be underestimated. Adequate funding is necessary for compensation of involvement, but also to ensure that researchers have ample time to plan involvement activities and provide personalized support for PLWD, LTC residents and their carers. Funding bodies increasingly require involvement of the public to be part of research proposals. Yet, support in terms of financial compensation and time for the implementation of involvement in research is rarely part of funding grants [ 42 ]. In addition, whereas an emergent design could aid the impact of involvement, funders often require a pre-set research proposal in which individual components are already fixed [ 5 , 47 ]. This indicates that not only do academic researchers and culture need to change, academic systems also need to be modified in order to facilitate and nurture meaningful involvement [ 47 ].

Strengths and limitations

A key strength of this review is the inclusion of over ten scientific databases, with a reach beyond the conventional biomedical science databases often consulted in systematic reviews. Besides, we believe that we have overcome the inconsistent use of terminology of involvement in research by including also other terms used, such as participation and engagement, in our search strategy. However, there was also inconsistency in length of publications and precision of the explanation of the process of involvement. E.g., involvement in the execution phase was often elaborated on, contributions to the research proposal and co-authoring research findings were only stated and not described. This presented challenges for data extraction and analysis, as it was not always possible to identify how the target group was involved. Involvement in these research phases is therefore not fully represented in this review.

The included studies in this review, the majority of which are of high quality, provide methods for involvement of PLWD and LTC users in research and they do not explicitly attend to the effectiveness or impact of the method for involvement used. Therefore, a limitation of this review is that it cannot make any statements regarding the effectiveness of the involvement methods included. Moreover, our target population was broad, although PLWD and LTC users are largely overlapping in their care needs and share important features, this may have led to heterogeneous results. In future research, it would be interesting to interpret potential differences between involvement of PLWD, LTC users, and their carers. However, as we expected, the amount of literature included in our analyses was too limited to do so. Furthermore, whereas the broad target group is a limitation it is also a strength of our review. Limiting our search to specifically persons living in LTC facilities would have provided limited methods for involvement of persons living with dementia. Our broad target groups enabled us to learn from research projects in which people living with early staged dementia are directly involved from which we can draw lessons on the involvement of people with more advanced stages of dementia and persons living with cognitive problems who live within LTC facilities.

Since January 2021 quite some research has been published about the importance of involvement in research. Although we had quickly screened for new methods, we realise that we may have missed some involvement methods in the past years. There will be a need for a search update in the future.

Implications for future research

Our review shows that a flexible and emergent design may help to increase involved persons' influence on and ownership in the research process. However, not all research objectives may be suitable for the implementation of an emergent design. Future research should therefore examine how aspects of a flexible emergent design can be integrated in, e.g., clinical research without compromising the validity of research outcomes.

Alzheimer Europe has called for the direct involvement of persons living with dementia in research [ 48 ]. In addition, Swarbrick et al. (this review) advise to involve persons regardless of their cognitive abilities [ 23 ]. These statements question the involvement of proxies, such as carers, professional caregivers and others involved in the care of PLWD. While PLWD and persons with other cognitive problems constitute a significant group within residential and nursing homes [ 7 ], none of the studies included in this review have provided methods to directly involve persons with more advanced stages of dementia. This raises the question if research methods should be adapted to allow those with more advanced stages of dementia to be involved themselves or if, concerning the progressive nature of the disease, it is more appropriate to involve proxies. And secondly who should these proxies be? Those that care for and live with persons with an advanced stage of dementia, or for example a person living with an early stage of dementia to represent the voices of persons with more advanced stages of dementia [ 31 ]?

Future research should adopt our example for stricter requirements for involvement and transparency about the involvement methods used. This will reduce tokenistic involvement and further promote the culture shift towards meaningful involvement. In addition, future research should assess the impact of the involvement methods that are described in this review. One of the first instruments that that may be used to do so in varying healthcare settings is the Public and Patient Engagement Evaluation Tool (PPEET) [ 49 ]. Moreover, scholars in this review stress, and we agree with this, that future research is needed on the involvement of persons with more advanced stages of dementia to ensure their voices are not excluded from research [ 33 , 34 ].

This review provides an overview of the existing methods used to actively involve PLWD, LTC users, and carers in scientific research. Our findings show that their involvement is feasible throughout all research phases. We have identified five different methods for involvement, four different roles, and two models for co-research. Our results suggest that planning enough time for involving PLWD, LTC users, and carers in research, is important to ensure that researchers have time to build a trusting relationship and meet their personal needs and preferences. In addition, researchers are advised not to presume the meaning of burden and to avoid a deficit perspective. A flexible or emergent design could aid involved persons’ ownership in the research process.

Availability of data and materials

The full search strategy is provided in supplement 1 . The data extraction form can be provided by the corresponding author on reasonable request.

Abbreviations

Critical Appraisal Skills Programme

Guidance for Reporting Involvement of Patients and the Public, long form version 2

Long-term care

Persons living with dementia

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Acknowledgements

We thank Jan W. Schoones, information specialist Directorate of Research Policy (formerly: Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands), for helping with the search.

This systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Department of Public Health and Primary Care, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, the Netherlands

Janneke M. Groothuijse, Lisa S. van Tol, C. C. M. (Toos) Hoeksel-van Leeuwen, Monique A. A. Caljouw & Wilco P. Achterberg

University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands

Department of Medical Humanities, University Medical Center, Utrecht, The Netherlands

Johannes J. M. van Delden

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Concept: HD, LT, MC, WA; design of study protocol: JG, LT, MC; data collection and extraction: JG, LT, MC, THL; data analysis and interpretation: all authors; writing, editing and final approval of the manuscript: all authors.

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Groothuijse, J.M., van Tol, L.S., Leeuwen, C.C.M.(.Hv. et al. Active involvement in scientific research of persons living with dementia and long-term care users: a systematic review of existing methods with a specific focus on good practices, facilitators and barriers of involvement. BMC Geriatr 24 , 324 (2024). https://doi.org/10.1186/s12877-024-04877-7

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What is a Focus Group
Step 1: Choose your topic of interest. Step 2: Define your research scope and hypotheses. Step 3: Determine your focus group questions. Step 4: Select a moderator or co-moderator. Step 5: Recruit your participants. Step 6: Set up your focus group. Step 7: Host your focus group.
Chapter 12. Focus Groups
Doing Focus Groups. 2nd ed. Thousand Oaks, CA: SAGE. Written by a medical sociologist based in the UK, this is a good how-to guide for conducting focus groups. Gibson, Faith. 2007. "Conducting Focus Groups with Children and Young People: Strategies for Success." Journal of Research in Nursing 12(5):473-483. As the title suggests, this ...
UCSF Guides: Qualitative Research Guide: Focus Groups
Publication Date: 2018. Focus Groups by Richard A. Krueger; Mary Anne Casey. ISBN: 9781483365244. Publication Date: 2014-08-14. Print book available through Interlibrary Loan. Focus groups as qualitative research by David L. Morgan. ISBN: 0761903429. Focus Groups in Social Research by Michael Bloor; Jane Frankland; Michelle Thomas; Kate Stewart.
Focus Groups
A focus group is a qualitative research method used to gather in-depth insights and opinions from a group of individuals about a particular product, service, concept, or idea. The focus group typically consists of 6-10 participants who are selected based on shared characteristics such as demographics, interests, or experiences. The discussion ...
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Quantitative and Mixed Methods Perspectives on Focus Group Research. When focus groups are used within mixed or quantitative research, they tend to be employed as part of instrument development (Nagel & Williams, Citation n.d.).These focus groups are positioned as an adjunct to the quantitative data collection, and appear to be centered on task-focused aims (Department of Health and Human ...
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Focus groups are a form of group interview that capitalises on communication between research participants in order to generate data. Although group interviews are often used simply as a quick and convenient way to collect data from several people simultaneously, focus groups explicitly use group interaction as part of the method.
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A focus group is a qualitative research method that involves facilitating a small group discussion with participants who share common characteristics or experiences that are relevant to the research topic. The goal is to gain insights through group conversation and observation of dynamics. In a focus group: A moderator asks questions and leads a group of typically 6 to 12 pre-screened ...
A Qualitative Framework for Collecting and Analyzing Data in Focus
Traditionally, focus group research is "a way of collecting qualitative data, which—essentially—involves engaging a small number of people in an informal group discussion (or discussions), 'focused' around a particular topic or set of issues" (Wilkinson, 2004, p. 177).Social science researchers in general and qualitative researchers in particular often rely on focus groups to ...
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Among the range of methods for doing research inclusively, the focus group method merits attention. Once the realm of market research, focus groups have gained popularity in social research (Morgan et al. 2008).The focus group method has also enjoyed considerable diversification, meaning that reference to more recent literature on the method will lead the reader to a range of focus group forms ...
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Other researchers have found the social nature of focus group discussions to be conducive to investigating societal constraints and health needs among Emirati women (Bailey, 2012; Winslow, Honein, & Elzubeir, 2002). There are two other important strengths of the group discussion method: (1) it allows for the presence of observers, especially in ...
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Focus group research is a valuable method for gaining insights into participants' perspectives, attitudes, and experiences. It can help researchers and organizations make informed decisions, develop effective strategies, and gain a deeper understanding of complex topics.
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Focus group discussion can be utilised within a suite of techniques in a multi-method research design, as a principal research method in its own right, or as a form of participatory action research to empower participants and promote social change (Wilkinson, 1998, 1999). Our review showed that a range of topics ranging from community ...
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In this chapter you will learn about: An introduction to the focus group method. The nature of focus group research. Why the focus group is used in the health and social sciences. Some criticisms about the focus group method. History and development of focus group methodology. Focus groups employed in market research and social research.
PDF Focus Groups as Qualitative Research
Focus Groups as Qualitative Research. PLANNING AND RESEARCH DESIGN FOR FOCUS GROUPS. Contributors: David L. Morgan Print Pub. Date: 1997 Online Pub. Date: Print ISBN: 9780761903437 Online ISBN: 9781412984287 DOI: 10.4135/9781412984287 Print pages: 32-46 This PDF has been generated from SAGE Research Methods. Please note that the pagination of ...
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Future research could focus on the methods used to monitor participants and the possibility of opening up the online focus groups to a much wider audience. In-person focus groups must take place in a single physical location where the participants gather and can be directly monitored by the researchers.
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A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest. Table of contents.
Methodological Aspects of Focus Groups in Health Research
Focus groups have been widely used in health research in recent years to explore the perspectives of patients and other groups in the health care system (e.g., Carr et al., 2003; Côté-Arsenault & Morrison-Beedy, 2005; Kitzinger, 2006 ). They are often included in mixed-methods studies to gain more information on how to construct ...
Focus Groups
Researchers should, first, state the purpose of the focus group in a research design; then, identify the primary unit of analysis exploited; and finally, list the questions used to collect data in the focus group (Cyr, 2015).Nyumba et al. recognised the process as including the design, data collection, data analysis, and reporting.Nyumba et al. and Liamputtong (), among other authors ...
Interviews and focus groups in qualitative research: an update for the
A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28,29 While not aligned to a particular qualitative methodology (for example, grounded theory or ...
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Focus groups are a common qualitative data collection method and are considered an important qualitative health research technique (Morgan, 1997), owing to their efficient and economical nature (Krueger & Casey, 2000).Focus groups are defined as "group discussions exploring a set of specific issues that are focused because the process involves some collective activity" (Kitzinger, 1994, p ...
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Focus groups are group discussions conducted with the participation of 7 to 12 people to capture their experiences and views regarding specific issues closely related to research question (s). Focus groups data collection method is most suitable for types of studies where multiple perspectives needed to be obtained regarding the same problem ...
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A focus group is a qualitative research method used in market research and social sciences, where a small group of people, typically 6 to 10 individuals, participate in a guided discussion about a particular topic. Learn more about focus group with examples, questions and best practices.
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Focus groups have been used by large corporations to gather the public's opinions regarding their products. In the past 20 years the focus group method has been increasingly used in health care research in a variety of settings. Researchers use the focus group method in order to obtain in-depth knowledge concerning attitudes, perceptions ...
Participatory methods used in the evaluation of medical devices: a
This implies that for comprehensively answering a research question, focus groups are not the most suitable method. Nevertheless, topics can be discussed and resolved relatively quickly in a focus group if the participants are more or less on the same page, which implies that focus groups can be a useful decision-making technique.
Using Focus Groups for Knowledge Sharing: Tracking Emerging Pandemic
This management effort provided an opportunity for an innovative practice-based research study. Here, we outline a novel methodological approach (weekly, iterative focus groups, with two-way communication between USFS staff and leadership), which culminated in a model for focus group coordination during extended crises.
Adherence to pharmacological therapy in patients with hypertension
Methods and analyses We will conduct qualitative research through synchronous online focus groups of 6-10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation.
Active involvement in scientific research of persons living with
Methods for action research (action groups) and co-conducting research (interviews) were not included by these other review studies. In addition to our findings, these other reviews also described as involvement methods interviews and focus groups [5, 10] surveys , reader consultation . Those types of methods were excluded from our study ...

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What is a Focus Group | Step-by-Step Guide & Examples

Table of contents

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Differences between types of interviews

Topics favorable to focus groups

Number of participants

Confirm a time and date

Confirm whether it will take place in person or online

Consent and ethical considerations

Preparation prior to participation

Starting the focus group

Leading the discussion

Disadvantages

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Chapter 12. Focus Groups

Focus Groups: What Are They and When to Use Them

How to Conduct a Focus Group Interview/Discussion

During the Focus Group

After the Focus Group

Advanced: Focus Groups on Sensitive Topics

Further Readings

Focus Groups – Steps, Examples and Guide

Focus Group

Types of Focus Group

Traditional Focus Group

Mini Focus Group

Dual Moderator Focus Group

Teleconference or Online Focus Group

Client-led Focus Group

How To Conduct a Focus Group

Define the Research Question

Recruit Participants

Select a Venue

Conduct the Session

Record the Session

Analyze the data

When to use Focus Group Method

Exploratory Research

Product Development

Marketing Research

Customer Feedback

Public Policy Research

Examples of Focus Group

Purpose of Focus Group

Generating New Ideas and insights

Understanding Consumer Behavior

Testing Concepts and Ideas

Gathering Customer Feedback

Advantages of Focus Group

Limitations of Focus Groups

Characteristics of Focus Group

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Muhammad Hassan

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Qualitative Research: Introducing focus groups

Rationale and uses of focus groups

Some potential sampling advantages with focus groups

Conducting a focus group study

RUNNING THE GROUPS

ANALYSIS AND WRITING UP

What Is a Focus Group?

In a focus group:

Step 1 : Clarify the Focus Group’s Purpose and Orientation

For example

Step 2 : Select a Homogeneous Grouping Characteristic

Step 3 : Designate a Moderator

Step 4 : Develop a Focus Group Guide

Group confidentiality agreement

Opening Questions:

Introductory Questions: