Improving the use of focus group discussions in low income settings

Abstract

Background The quality of data obtained through Focus Group Discussions (FGDs) is highly dependent on appropriate design and facilitation. In low-income settings steep power gradients between researcher and participants, as well as conversational norms, could reduce the ability of participants to voice personal opinions. Activity-oriented exercises have been suggested as a way overcoming these challenges, however little evidence exists - to date - on their use in low-income settings. We selected six exercises for use in Ethiopia and Nigeria and report our experiences. Methods The six exercises (picture sorting, associative pictures, picture ranking, decision trees, predictive story-telling and provocative statements) were used in 32 maternal and new-born care themed FGDs conducted in Amhara and Southern Nations Nationalities and People’s Regions (Ethiopia) and Gombe State (Nigeria). Six facilitators and two supervisors who used these exercises were interviewed about their experiences. FGD verbatim transcripts and interview notes were analysed to explore methodological effectiveness and respondents’ experience. All data were coded in NVIVO using a deductive coding frame. Results Facilitators and participants described the methods as ‘fun’ and ‘enjoyable’. The exercises yielded more in-depth and complete information than ‘normal’ FGDs, but facilitator’s probing skills and overall FGD group dynamics proved crucial in this success. Explaining and conducting the exercises increased FGD length. Data richness, participant reaction and understanding, and ease of facilitation varied by study site, exercise, and participant group. Overall, the exercises worked better in Nigeria than in Ethiopia. The provocative statement exercise was most difficult for participants to understand, the decision-tree most difficult to facilitate and the picture exercises most enjoyable. The story telling exercise took relatively little time, was well understood, yielded rich data and reduced social desirability bias. Discussion The majority of the exercises proved successful tools in yielding richer and less biased information from FGDs and were experienced as fun and engaging. Tailoring of the exercises, as well as thorough training and selection of the facilitators, were pivotal in this success. The difference in the two countries shows that adequate piloting and adaptation is crucial, and that some exercises may not be adaptable to all settings.

Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

“…This study has several limitations. Despite interviews focusing on patients that required unplanned transfer to the ICU, social desirability bias may have prevented people from fully expounding on the negative elements of these events ( 20 ). This confounding element was mitigated by having voluntary participation in the study and interviewers external to clinical care teams and hierarchy structures.…”

Cattle, Cultivation, and Culture: Mixed Methods Reveal Evolving Pathways to Maasai Positive Youth Development

“…After being introduced to the study and agreeing to participate, they engaged in two participatory activities: a blackboard relay race and card construction activity, each combined with discussion. The activities were designed to combat problems with typical focus groups that involve youth, cross-cultural differences, and steep power differentials (Jakobsen, 2012; Johnson et al, 2019; Scheelbeek et al, 2020). Two teams participated in a challenges relay race in which they had three minutes to run to a chalkboard and write challenges facing youth.…”

“…Thus, we were afforded a unique opportunity to gather data from girls in an unencumbered setting. To encourage authentic and active engagement, reduce social desirability, and deposition the researchers, we utilized a game structure involving a relay race to establish their ideas of challenges facing youth which was followed by solutions-oriented card construction and team discussions in which girls were paired up to write down what youth need to be successful in light of such challenges (Jakobsen, 2012; Johnson et al, 2019; Scheelbeek et al, 2020). We expected themes of economics, education, and the environment to surface, as these are contextual factors impacting marginalized, indigenous peoples that are noted in the UN’s Sustainable Development Goals (United Nations, 2021).…”

A qualitative exploration of the experiences of peer leaders in an intervention to improve diabetes medication adherence in African Americans

“…There are several limitations to our study. Focus groups have the advantage of eliciting the views, feelings, and perceptions of a group (31,32). However, participants who share different views may not be comfortable sharing them in a focus group.…”