Grass roots organizations, community-based mental health centers, and other organizations, as well as counselors in private practice, are often required to make important decisions about their programs and services, such as whether to improve a service, expand a program, or modify the direction of an initiative. Frequently, these decisions are made while operating in a context of limited information and intense timeframes. Important, relevant, and timely information can enhance the quality of programmatic decision-making; the question becomes, how should this data be collected?

This article describes processes and procedures associated with conducting focus groups and analyzing group results, and will be useful to those interested in learning about the viability of this approach for decision-making and other purposes. Although focus groups are commonly used by community-based organizations, private practitioners may also benefit from focus groups, albeit in a somewhat different way. Suggestions for private practitioners are embedded in the article, as well.

What is a focus group?
Focus groups are special-purpose groups that provide forums for structured discussion of a topic or topics, and are usually designed to elicit the opinions, attitudes, and beliefs of participants about an issue, product, event, or entity (Krueger, 1998). Focus groups are designed to examine the motivations of participants and learn how much they agree about the topic under discussion (Morgan, 1993).

As a type of qualitative data collection method, focus groups manifest both the advantages and disadvantages associated with qualitative data analysis, identified in detail by Taleff (1999). On the plus side, qualitative methods allow for complexity in the data collection process. Focusing on “why?” and “how?” questions, they allow clients to reach and express their own conclusions and individual attitudes and beliefs. They emphasize interpretation and meaning of collected subjective data (often stemming from the use of open-ended responses) rather than the statistical description of data (Morgan, 1988). On the downside, focus groups, like other qualitative methods, do not allow the researcher to control the research process very well, often yield results that can be difficult to interpret and summarize, and are not easily analyzed using established statistical approaches (Simply Better! Continuous Improvement).

Despite these few methodological constraints, focus groups provide a convenient, relatively speedy, and intensive information-collecting method that can inform agency decision-makers about various programmatic issues. Qualitative information can be collected from numerous participant or target groups, including stakeholders (e.g., current and prospective clients, community activists, funders) about many important programmatic issues. Addiction professionals may be interested in topics such as:

• identifying and ranking goals and objectives.
• examining community awareness and outreach.
• evaluating stakeholder satisfaction with existing goals, programs, services, and providers.
• identifying problem areas in service delivery or unavailable services, as well as earmarking successful programs and services.
• assessing the effectiveness of outreach materials geared to the addictions community.
• identifying community needs for new programs, services, and providers.
• evaluating agency governance, organizational climate, and employee satisfaction.
• evaluating future agency goals and objectives.

Private practitioners can use focus groups to learn more about potential client bases, client satisfaction, and ways to deliver services more effectively. Online and telephone focus groups (see page 65) allow anonymity to participants (Solomon, 1998); accordingly, they offer private practitioners a venue for collecting non-clinical information, such as attitudes, beliefs, and opinions, in a way that allows participants to offer their opinions without being observed by others.

The goal of focus groups — through the use of open-ended interviewing to explore and understand opinions and behaviors — is to maximize the divergence of opinions, rather than to bring participants to agreement about the topics of the discussion (Hawe, 1990). Focus groups provide in-depth insights and understanding of motivations, attitudes, and perceptions; can help generate new concepts, ideas, and questions; can help isolate key variables to use in quantitative research and surveys; and are relatively inexpensive, fast, and adaptable.

When not to use focus groups
Sometimes focus groups should not be used. One way they are often misused is when they are conducted because the decision-maker (hereafter referred to as the client) has no other idea about how to collect information (Morgan, 1988). This “shotgun” approach is commonly done, but usually yields ambiguous results. Furthermore, a group discussion is not always an appropriate vehicle to collect information. Sometimes statistical data is needed, or the topic is, for some reason, inappropriate for participants, and focus groups should not be used (Morgan, 1993). Common misconceptions about focus groups include the belief that they are cheap and quick, that they discourage discussion of sensitive topics, that professional facilitators must always serve as moderators, and that only strangers can participate (Morgan, 1993). Many of these misconceptions help explain why focus groups are sometimes underused or used incorrectly. Addiction professionals need to remember that focus groups are NOT clinical groups. They are designed to elicit qualitative information, and are not for diagnostic or therapeutic purposes.

Focus group goals and objectives
The first step in a focus group study is to identify major topics or issues to be addressed by the focus group. These topics can be specified as research (or project) objectives. Everyone involved in the project (including client, researcher, and moderator) should know these objectives. Begin by writing out why the research project is being done and what it is that you want to learn from the project. This is an important step, because the study objectives provide the basis for the protocol — the focal point of discussion among participants.

The focus group protocol — or, the “moderator’s guide”
A focus group protocol usually consists of between 5 and 10 major questions that address the research objectives and goals. Experience indicates that many protocols try to cover too much terrain in a typically two-hour session — this is an unproductive approach that can cause serious problems during the group discussion. Effective protocols remain brief and highly-focused. If protocol questions are poorly developed, valuable information and insights likely will be lost, and project objectives will not be achieved.

Good protocols include sub-questions (designed to restate the initial question, refine the question, or specify some condition) and probes (used to elicit additional information from participants) (Krueger, 1998). Creative protocols emphasize specific tasks for participants, including brainstorming techniques, card-sort activities, and frequent votes on materials presented to them. Table 1 contains a detailed sample protocol that asks participants about their reactions to an agency’s program brochures, a process known as “message-testing.”

Table 1. Sample Focus Group Protocol: Evaluating Effectiveness of Agency Brochures

An icebreaker is recommended at the beginning of the protocol to help stimulate discussion. A typical icebreaker might ask agency employees, “If you were to describe what clients are like here are the Center, which would you choose: an angry lion, a whining hyena, a charging elephant, or something else?” Though the choices may seem silly to some, once one participant offers a reply, the discussion is off and running.

General rules for developing protocols include (Bers, 1987; Hawe, 1990):

• Begin with a general, simple question to “warm up” the group.
• Organize questions into a logical progression, from broad to specific.
• Introduce progressively narrow questions related to the general question.
• Develop flexible probes based on the need to clarify participant comments.
• End with a “summing up” question that aggregates major ideas stemming from the discussion, so participants can generate concluding thoughts.

Recruiting participants
Project goals affect participant recruitment. Because focus groups allow a wide range of issues to be addressed, it is useful to recruit participants who can speak to the breadth and depth of the discussion topic. Therefore, you might only want to do a focus group with a single type of participant (e.g., current clients, former clients, employees, people who have never heard of your services). On the other hand, it is sometimes more appropriate to combine people from different constituent groups (e.g., clients of different ethnicities, community activists, and uninvolved members of the community). However, this can make later analysis more difficult, when effort must be expended to disentangle what various target groups said.

First, identify which constituencies you want to tap and which constituencies or target markets, if any, should be combined within one group. This decision is usually based on project goals and feasibility issues (e.g., cost, access to participants). The next step is prioritizing target markets. It is often desirable (although not always feasible) to conduct several focus groups for each target group. This will also determine how many focus groups you will conduct by constituency and overall — it is usually wise to conduct more than one focus group in case the group is anomalous in some way. One rule of thumb: stop holding focus groups when you stop hearing new insights from participants.

Recruiting is an art of its own and, depending on your study goals, may entail using people you know personally, placing newspaper advertisements, flyers on cars or community boards, “snowball sampling,” in which people who know others like themselves refer their friends to the recruiter, or several of many other recruiting options. Regardless of the number of groups, it is strongly recommended that, for all your groups, you recruit at least two to four people beyond the number of participants actually needed. Over-recruiting is essential to project success, because many a researcher has had the unpleasant experience of learning “what would happen if they held a focus group and nobody came?” Allow a good deal of time for participant recruitment; often, recruiting specifications are compromised due to lack of time.

How many participants? Generally, focus groups should include between 7 and 10 participants (seldom hold a group with fewer than 5 or more than 12 participants). Sometimes it’s not possible to get even 5 participants to show up (for example, you may only have 3 clients available to participate in the group). In this case, consider doing individual interviews or a more standardized group interview instead of a focus group. By contrast, once a group becomes large (usually over 10 participants), it can become cumbersome and, inevitably, some participants will elect not to offer comments and gradually “fade into the background.”

Therefore, it is better to split the group into two or more focus groups or send home some of the prospective participants with their compensation and the moderator’s appreciation.
“Continuing groups” (comprising individuals who participate in a series of focus groups over an extensive time period) offer a less-commonly used vehicle to examine the intensive experience of a small group. To accomplish this, a focus group of up to 12 participants could be created from a group of agency clients or former clients, who could be tracked for the entire period they use agency services. Such an approach requires tremendous effort and has a number of potential problems, including attrition and the evolving of group mores and interaction patterns that can inhibit participation between members over time. However, such a group affords an agency an intense examination of a sample of clients and their unique experiences and can provide valuable information. Similarly, private practitioners can conduct continuing groups with clients to obtain information on their levels of satisfaction with therapy or the functioning of the practice over the long term.

The ringleader, or moderator
The moderator, who directs the focus group in addressing the topics to be discussed, is integral to the success of the discussion. He or she delineates specific goals for the group, structures the course of discussion, and narrows down participant comments.
Who should moderate a focus group? Some researchers believe that moderators should be as similar to participants as possible, because participants may be more honest when they perceive the moderator as like-minded or similar in demographic or other attributes (Morgan, 1988; Kreuger, 1998). Others believe that isn’t necessary, as long as the moderator possesses effective moderating skills. Another issue is whether to use an “internal moderator,” particularly for an agency focus group. Internal moderators have a feel for the issues, agency, and client history, and are frequently aware of “internal” politics, but face many barriers when moderating. They must remain objective and be comfortable confronting or cutting-off participants, if necessary, whom they frequently know from another, usually professional, context.

The real issue for addiction professionals is whether to select a professional moderator versus an amateur or novice moderator. This decision is frequently made because of fiscal considerations, but it should be viewed as more than a mere financial decision. While professional moderators can charge as much as 25 percent more than less experienced moderators, the trade-off in information resulting from the group may make the money worth investing (Simply Better! Continuous Improvement). A novice might not gather juicy information needed to achieve the project objectives.

What skills do effective moderators use? Effective moderators are facilitators who encourage and promote discussion among participants, rather than shutting down participants’ comments. Good moderators communicate clearly, know the topic well enough to probe effectively, and are also able to:

• draw people out in group discussion.
• rephrase participants’ statements and ask appropriate follow-up questions.
• redirect participants when off-topic.
• concentrate intently and listen closely for important statements.
• create a friendly, non-threatening, responsive, positive climate open to diverse opinions.
• remember what has been discussed, current topic of discussion, and remaining topics, and process this information simultaneously to ask appropriate probes.
• use group dynamics to understand what participants are trying to say.
• use eye contact effectively to encourage participants.
• pace himself or herself carefully to ensure that all protocol questions are addressed, if possible.

Sample probes to elicit additional information from participants include: Can you give me an example of what you mean? Is there anything else? Please describe what you mean. How are they the same? How are they different?

An effective focus group is designed to have participants offer a divergence of opinions, not a single one, or one where everyone creates consensus. Therefore, the moderator strives to generate a higher volume of comments from respondents, as well as greater breadth of coverage of the protocol topics.

Difficult participant styles. Sometimes, participants’ personal style can affect focus group dynamics, and can seriously impair, if not irreparably damage, the process. Krueger (1994) has aptly described these personal styles, which include the expert, who feels as though he or she has a great deal to offer about the topic, and inhibits other participants. Inclined to take over the discussion, the dominant talker sometimes interrupts others and often holds the floor for unreasonable lengths of time. The rambler often feels compelled to speak endlessly, often without any seeming purpose. The shy participant is often unwilling or afraid to speak and often will watch the others, but will not take the initiative to comment.

Moderators are obligated to keep these “personal styles” in check. They can use probes, eye contact, body language, and other devices to inhibit the effects of these participants, so their impact is minimized, or the focus group may yield limited results.

Focus group logistics
Guidelines for group discussion. After introducing himself or herself, the moderator begins by providing participants with guidelines for how the focus group will be conducted. Thus, group members are informed about expectations of them as focus group members, and rules will be followed to ensure the group is successful (McNamara, 1999; Morgan, et al., 1998). Useful guidelines typically include:

• Thank participants for their attendance and inform them how long the focus group will last (usually 90-120 minutes).
• Describe the purpose(s) of the focus group.
• Describe moderator and co-moderator/note-taker (if present) tasks, roles, and responsibilities.
• Describe expectations of participants and then invite them to candidly express their thoughts, opinions, and suggestions.
• Inform them that their confidentiality is guaranteed (but only if you are absolutely sure this is true).
• Inform them if you are audio- or videotaping the session and secure their permission to do so (it is sometimes hard to persuade participants that their participation is confidential when they know the session is being taped).
• Reinforce the importance of diversity of opinions and ensure participants that all opinions are valued. Invite them to share both positive and negative reactions and emphasize that there are no right or wrong answers.
• Rules for participation include:
  • Remind participants to feel free to speak and respond to other participant comments, but to please refrain from side-conversations.
  • Emphasize that they should speak one at a time, not interrupt others.
  • Let them know that, if necessary, the moderator will call on participants who have not participated.
  • Inform them about restroom facilities and refreshments, if applicable.
  • Ask if participants have any questions.

Making participants comfortable. The following procedures help promote the group’s effectiveness, ensure a pleasant experience, and encourage sharing of thoughts and opinions:

• Obtain a comfortable, preferably neutral room with a table in the center.
• Seat participants around the table, facing each other, if possible.
• Serve refreshments (always have a mix of diet and non-diet, hot and cold beverages).
• Have all participants write their first name on a “name tent,” a folded-over cardboard, so the moderator and participants can see and use their name.
• Welcome all participants — use “small talk” to relax them.
• Begin with an overview of the topic/issue to be discussed.
• Begin with first question.

Online and telephone focus groups
A more recent development in conducting focus groups has been to conduct them online or over the telephone instead of the traditional in-person approach. These approaches afford certain advantages over the traditional approach, one being that these types of groups tend to be less expensive to conduct. An online focus group can be conducted using e-mail, Web sites, or Usenet newsgroups. A disadvantage of online discussions is that they are difficult (or impossible) to keep confidential, unless they take place on an intranet, behind a firewall (Nielsen, 1997). Another disadvantage stems from possible bias, due to the fact that even today, Internet users are still more likely to be computer-literate, better educated, and more affluent than non-users — particularly a problem for agencies or private practitioners who are seeking to reach hard-to-reach, possibly economically-challenged, clients.

On the other hand, private practitioners can use these alternative approaches as a more discrete alternative with clients, since they have no direct face-to-face contact during the discussion. Online focus groups afford a useful vehicle to collect anonymous information about client satisfaction with services provided by the practitioner (Frey & Horvick, 2003).

Telephone focus groups, sometimes called tele-focus groups, also offer a convenient alternative to in-person groups. They are often used for projects operating under a tight budget, or when there are logistical or budgetary constraints. As with online groups, telephone groups offer some measure of anonymity, which can make participants feel more secure, especially when offering sensitive information or negative feedback. Like online groups, they are relatively inexpensive and have fewer logistics that must be addressed (Frey & Horvick, 2003).

Extracting useful findings

Group debriefing exercise. A first step in evaluating focus group results is to examine how the group behaved by doing a “debriefing analysis.” The moderator and the observers can do this jointly, honestly evaluating how the group performed by asking themselves:

• Did someone dominate the conversation and prevent the discussion from proceeding?
• Was it a ‘dead’ group — one with little or no action?
• Did the moderator misunderstand something that was said and send the group down the wrong path?
• Did participants appear to be offering their honest opinions or were they inhibited in some way?
• Were important topics addressed or were some skipped?
• What was the context of the group process and how did it relate to what transpired?

The results provide a greater understanding of what was learned from the group discussions. The report interprets what happened at the sessions and how the sessions related to the overall project goals and objectives.

Transcriptions. Often produced to be incorporated into detailed reports of focus group results, transcriptions of taped sessions can lead to bias in reporting focus group results. The primary goal in evaluating transcripts is the pursuit of explanations. It is recommended that readers of the transcriptions first seek idiosyncratic information that was not duplicated in several groups, and second, identify points of agreement and disagreement among participants. Participants may express some strong negative and positive opinions, which could contradict your own — so it is important not to have “selective hearing” or “selective recall” of what was said. The goal is to remain unbiased, recording everything that can be retrieved from the tapes and/or written notes.

Analyzing results. When summarizing your findings, remember: the purpose of the focus group sessions is the priority focus of your interpretation, even when a lot of distracting information is present (a common event in focus groups). It is suggested that you minimize any personal bias as much as possible. Krueger’s (1988) very useful three-part model of how to analyze focus group data defines the first level of analysis as the collection of raw data, which generally includes direct quotations from participants (e.g., “I wish this agency cared more about my needs as a professional, rather than viewing all employees as cattle”). A secondary level of analysis consists of developing descriptive statements that summarize participant comments (e.g., “Several participants agreed that the agency should do more to provide services to ethnically diverse clients”). A tertiary level of analysis is interpretation, which consists of statements that attempt to provide insight into the meaning of the data (e.g., “Overall, community activists appear to believe that the agency has not planned adequately for its extensive catchment area”).

The following are guidelines summarizing focus group data (Simply Better! Continuous Improvement; Morgan, 1997):

• Remember the report’s purpose.
• Identify major themes and emotional “hot points” (e.g., enthusiasm, frustration).
• Identify points of agreement and disagreement articulated by the focus group participants.
• Identify sub-themes running through the discussion.
• Identify mood of discussion (e.g., hostility, optimism).
• Identify consistency between participant statements.
• Identify new avenues of questioning that may have emerged.
• Consider the context of the focus group and its environment.
• Consider the internal consistency of the statements.
• Examine the specificity of responses.

An extensive report documenting focus group results can run 20-25 pages or more, and is sometimes called for, particularly when several focus groups have been conducted. Many reports of this type include extensive references to direct quotes made by participants to exemplify points of interest. An alternative to the this approach is to generate a topline report, commonly used in reporting focus groups results in traditional market research. Usually 5 to 7 pages in length, topline reports document the major group highlights and findings, as well as the prevailing sentiments expressed by group members. Any divergent opinions are duly noted. Topline reports can usually be produced quickly. However, caution must be exercised in generating a topline report, because at times, the only perceptions shared by the author are those that were most memorably articulated by participants; thus, valuable information may be inadvertently lost.

Regardless of the type of report, it is always useful to hold an oral debriefing session with those who requested the focus group take place and hold a stake in the results. This allows them to ask questions about specific points or areas of confusion, and provides a useful conclusion to the focus group project. Oral debriefings often generate useful programmatic recommendations.

Start improving programs now
Agency administrators and other addiction professionals will benefit from recognizing the gains that can be made from drawing on this underused research method. Powerful advances can be made from the use of focus groups, particularly in the arena of explaining phenomena, not just describing it. As such, focus groups remain a powerful tool in the arsenal of addiction professionals seeking to understand and improve programmatic interventions both for prevention and treatment purposes.

Sylvia Kay Fisher is a program specialist with the U.S. Department of Labor; previoulsy, she was a research psychologist at the Bureau of Labor Statistics. She has conducted more than 150 focus groups in many venues and for varied purposes, and has worked as a program evaluator and a therapist with diverse populations.

References
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Frey, C., & Horvick, J. (2003, May 20). Comparison of traditional and telephone focus groups. A paper presented as part of a session entitled “Focus Groups” at the International Field Directors and Technologies annual conference in Nashville, TN.
Gibbs, A. (1997). Focus groups. Social Research Update, 19. Retrieved September 8, 2003, from http://www.soc.surrey.ac.uk/sru/SRU19.html
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Market Navigation, Inc. (2000). How to get more out of your focus group. Retrieved September 8, 2003, from http://www.mnav.com/getmore.htm
McNamara, C. (1999) Basics of conducting focus groups. Retrieved on September 1, 2003, from http://www.mapnp.org/library/evaluatn/focusgrp.htm
Morgan, D.L. (1988). Focus groups as qualitative research. Sage University Paper Series on Qualitative Research Methods No. 16. Beverly Hills, CA: Sage Publications.
Morgan, D.L. (Ed.) (1993). Successful focus groups. Advancing the state of the art. Newbury Park, CA: Sage Publications.
Morgan D.L. (1997, 2nd Edition). Focus groups as qualitative research. London: Sage Publications.
Morgan, D.L., Krueger, R.A., & King, J.A. (1998). The focus group kit. Volumes 1-6. Thousand Oaks, CA: Sage Publications.
Nielsen, J. (1997). The use and misuse of focus groups. Retrieved September 8, 2003, from http://www.useit.
com/papers/focusgroups.html
Simply Better! Continuous Improvement. Customers in focus: A guide to conducting and planning focus groups. U.S. Department of Labor. Retrieved September 8, 2003, from http://www.workforceexcellence.net/pdf/focus.pdf
Solomon, M.B. (1998). Is “Internet focus group” an oxymoron? Quirk’s Marketing Research Review. Retrieved September 8, 2003, from http://www.quirks.com/
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Taleff, M. (1999). What’s so hard about research? Counselor Magazine, 17(6): 13-14.

This article is published in Counselor,The Magazine for Addiction Professionals, December 2003, v.4, n.6, pp. 58-68.

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