Focus groups help tailor programs

Best used to explore issues thoroughly

To improve the care process in the Newborn Intensive Care Unit at the University of Utah Hospitals and Clinics in Salt Lake City, staff organized focus group interviews with mothers who had infants in the Newborn ICU for more than 14 days within the prior 12 months. From the interviews, staff gained valuable information that helped them meet the mothers’ needs.

For example, they learned that the mothers received little rest for a couple of weeks after the baby was discharged, and the sleep deprivation affected coping skills — something they needed to address on an ongoing basis. Also, they learned that mothers wanted to be involved with their baby’s care in the Newborn ICU but needed to be taught how to participate.

Although staff had previously conducted discharge surveys and phone interviews, they had never received any feedback on how to improve the care process in the Newborn ICU until they used focus groups.

"Focus groups are a form of qualitative research you want to use when you need in-depth understanding of an issue or service. Because people in the groups relate to each other, you get better and more valuable information than if you interviewed that person one-on-one," says Jackie A. Smith, PhD, patient education coordinator at University of Utah Hospital and Clinics in Salt Lake City.

At M.D. Anderson Cancer Center in Houston, focus groups often are used to determine if programs or services need to be altered to fit the needs of a particular culture. For example, the hospital used focus groups to learn which relaxation techniques worked best for Hispanic and Anglo-Saxon breast cancer patients as part of a research project to improve pain management. The focus groups showed the researchers that two different therapeutic approaches were needed, depending on the ethnic background of the patient.

The cost of focus groups can be prohibitive, costing between $1,000 and $5,000. Therefore, patient education managers must be prepared to devote the needed time to the project to make sure it is a success. They will need to define goals and objectives, develop questions, determine demographics of group participants, recruit members, and analyze the information gathered, says Louise Villejo, MPH, CHES, director of patient education at M.D. Anderson. (For details on recruiting focus group participants, see story, p. 96.)

For valuable information, follow rules

Focus groups can be used to tailor a program to a specific population, design quality improvement projects, improve patient satisfaction, develop a patient education program, and evaluate an existing program as well as print materials or a video script. The research technique can provide valuable information but only if done correctly.

"There are certain rules that go along with conducting focus groups, and if you don’t follow the rules, you risk problems," Smith says. General rules include:

• Don’t inform participants of the specific topic before discussion.

• Select participants who don’t know each other so they won’t inhibit individual responses.

• To ensure spontaneity, recruit focus group novices.

• Select an experienced moderator with knowledge of group dynamics and the ability to promote group interaction.

• Keep group size manageable so everyone can participate. Try to limit participants to eight to 12 people per group.

The questions used to solicit information from participants should be written by the planning committee and the moderator and be designed to meet the goals and objectives of the focus group. There should never be more than five or six questions, since the object is to gather in-depth information.

"If you are going to ask 15 questions, you might as well send out a survey," says Smith.

A good moderator will use the questions to begin conversation and then probe for in-depth answers as the discussion begins. Also, a trained moderator will keep the group on track and know how to handle difficult people.

"The moderator doesn’t need to be a professional, but they do need to have some training in group facilitation. They need to understand group dynamics and be comfortable working with groups so they will build trust," says Villejo.

Social workers and health educators often have the background to facilitate, she says.

Smith recommends a professional moderator who is not directly involved with the project. She suggests patient education managers contact marketing or communication departments at universities or advertising agencies to find trained facilitators.

To make sure that all the information shared by group participants is recorded, it’s best to use a tape recorder and have people take notes.

"When we conducted the focus groups for the pain management research, we had three people taking notes and recording the conversation. There were some parts of the tape that didn’t pick up everything, but we were able to put all the notes together and listen to the tape to get complete information," says Villejo.