Use of focus group methodology to develop an asthma self-management program useful for community-based medical practices

Evaluating a Media Strategy to Provide Health Messages to Medically Underserved Populations

For nearly every category of chronic disease, blacks with African American ancestry (AAs) bear a disproportionate disease burden in comparison to their non-Hispanic white (NHW) counterparts. The purpose of this study was to evaluate perceptions of a radio-based health communication strategy, geared towards AA adults and the medically underserved. The radio broadcast, titled "Closing the Gap in Healthcare, Inc. (CGHI)," is delivered by a well-known AA male physician in South Carolina. The mission of CGHI is to decrease health disparities in a four-county area of the South Carolina coastal region, defined as the "Lowcountry," by providing evidence-based health information to a broad community audience via radio broadcast messaging. To evaluate the impact of the CGHI, investigators conducted 12 focus groups (FGs) with community members from the broadcast coverage area to evaluate responses to FG questions based on 11 attributes of effective health communication. Potential FG participants were identified/recruited via a South Carolina-based marketing firm. The FGs conducted in the Sea Islands were culturally and racially homogenous. The investigators developed a FG interview guide. Before each FG started, the informed consent process was administered to each participant. Each two-hour FG was digitally recorded.

Unequal burden of disease, unequal participation in clinical trials: solutions from African American and Latino community members

African Americans and Latinos are underrepresented in clinical trials. The purpose of this study was to elicit solutions to participation barriers from African Americans and Latinos. Fifty-seven adults (32 African Americans, 25 Latinos) ages 50 years and older participated. The Institute of Medicine's Unequal Treatment conceptual framework was used. Six racially/ ethnically homogenous focus groups were conducted at five sites in three counties. Themes within groups and cross-cutting themes were identified. The NVIVO program was used for data classification. The data were reviewed for final coding and consensus. Shared solutions included addressing costs, recruiting in community contexts, conducting community and individualized patient education, and sharing patient safety information. Participants were unanimously in favor of clinical trials navigation recruitment interventions. Solutions specific to African Americans included diversifying research teams, recognizing past research abuses, and increasing community trust. Solutions specific to Latinos included providing low-literacy materials, providing Spanish-speaking clinicians and advocates, and clarifying that immigration status would neither be documented nor prevent participation. Solutions from African Americans and Latinos reflect their cultural backgrounds and historical experiences. The results suggest the importance of developing a tailored, barriers-focused navigation intervention to improve participation among diverse racial and ethnic populations.

Understanding preventive behaviors among mid-Western African-American men: a pilot qualitative study of prostate screening

BACKGROUND: African-American men bear a disproportionate burden for disease compared to other ethnic and racial groups. Due to gender differences in socialization and lifestyle practices, men are more likely to adopt attitudes and beliefs that undermine their health and well-being, including beliefs related to masculinity. The purpose of this study was to explore and understand the contextual factors in the attitudes and beliefs of African-American men's view of health in general, and as related to prostate cancer in particular. METHODS: Qualitative data from 15 African-American men were collected from two focus groups and analyzed for common themes using a qualitative descriptive design. RESULTS: Three themes emerged that focused on the beliefs and attitudes regarding general health and prostate cancer screening: (i) traditional beliefs about masculinity; (ii) psychosocial impact from family medical history; and (iii) sexual mores regarding digital rectal exams. CONCLUSIONS: The socialization of African-American men and masculinity ideologies may be significant factors in the focus group member's decisions to seek preventive health behavior changes. Further research is needed to examine the determinants of African-American men's health seeking behavior, in particular on the influence of masculine beliefs.

Qualitative methods to ensure acceptability of behavioral and social interventions to the target population

OBJECTIVES

This paper introduces qualitative methods for assessing the acceptability of an intervention.

METHODS

Acceptability refers to determining how well an intervention will be received by the target population and the extent to which the new intervention or its might meet the needs of the target population an d organizational setting. In this paper, we focus on two common qualitative methods for conducting acceptability research and their advantages and disadvantages: focus groups and interviews.

RESULTS

We provide examples from our own research and other studies to demonstrate the use of these methods for conducting acceptability research and how one might adapt this approach for oral health research.

DISCUSSION

We present emerging methods for conducting acceptability research, including the use of community-based participatory research, as well as the utility of conducting acceptability research for assessing the appropriateness of measures in intervention research.

Factors influencing perceptions of breast cancer genetic counseling among women in an urban health care system

The study assessed perceptions of breast cancer genetic counseling. Focus groups were conducted with twenty women (ages < = 50 years) in a Midwestern, urban health system identified as at above average risk of developing hereditary breast cancer and referred for breast cancer genetic counseling following mammography. All participants associated the words "breast cancer" with fear. African American women who received breast cancer genetic counseling may have channeled their fear into increased vigilance related to breast health. African American women who did not receive breast cancer genetic counseling were most knowledgeable about it. In contrast, Caucasian women who did not receive it reported uncertainty about the role of genetic counseling and testing in assessing breast cancer risk, mistrust in medical professionals, and lack of trust in the accuracy of genetic tests. The results could be used to help develop interventions to improve informed decision-making regarding breast cancer genetic counseling.

Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans

BACKGROUND

Colorectal cancer is the third most common cancer in Vietnamese Americans. Their colorectal screening rates are lower than the rates of whites.

METHODS

Four focus groups were conducted to identify Vietnamese American sources and credibility of health information, media utilization, and intervention approaches.

RESULTS

Vietnamese Americans trusted doctors and patient testimonials and had access to, and received most of their health information from, Vietnamese- language print and electronic media. Recommended intervention approaches include promoting doctors' recommendation of screening and using Vietnamese-language mass media, print materials, and oral presentations.

CONCLUSIONS

Focus groups are useful in determining communication channels and intervention approaches.

Developing educational interventions for paediatric respiratory diseases: from theory to practice

A cure for many childhood respiratory diseases is not yet possible and treatment usually has to focus on disease control. For families, this frequently involves a series of quite complex tasks. Education helps families develop the necessary knowledge, attitudes, beliefs and skills to manage illness effectively, and is one of the main tasks of the clinical team. Unfortunately, health education interventions often fail to bring about any significant gains in the health or well being of the target population. This article describes how a systematic approach can be applied to the development of health educational interventions to maximise their chance of being effective.

Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook

To become active partners in chronic illness management, patients need relevant information which clearly explains treatment choices. This paper describes a method of producing information to feed into production of a guidebook for people with irritable bowel syndrome (IBS). Users were involved throughout the development process. Five focus groups were held involving 23 people with IBS out of 147 who responded to a newspaper article asking for help with a study of self-care in IBS. Qualitative analysis of transcripts from these meetings formed the basis of guidebook development. Patients described their experiences, coping strategies, experiences of the healthcare system, treatments and social consequences of the condition. Medical literature searches were made to find answers to identified areas of information need. The book includes direct quotes from patients describing their own experiences. Guided and practical ways of support are required for people with IBS who want to self-manage their condition.

Modifying a breast cancer risk factor survey for African American women

PURPOSE/OBJECTIVES

To evaluate a breast cancer risk factor survey for use with African American women.

DESIGN

Two focus groups consisting of women randomly selected from the patient population of Henry Ford Health System in Detroit, MI.

SETTING

A large, vertically integrated, private, nonprofit health system.

SAMPLE

Focus Group I consisted of 11 African American women aged 18-50, with a mean age of 41 years. Focus Group II consisted of nine African American women aged 51 and older, with a mean age of 60.9 years.

METHODS

A qualitative approach was used to gather and interpret the focus group data.

MAIN RESEARCH VARIABLES

Perceptions of a breast cancer risk factor survey and perceptions of breast cancer risk factors.

FINDINGS

The focus group participants suggested ways to improve the survey. Women in the younger age group appeared to lack awareness regarding breast cancer risk factors. Women in the older age group reported not knowing their family health histories.

CONCLUSIONS

Based on comments made by the focus group participants, the survey was modified substantially. Breast cancer risk factors were perceived differently by women in the two age groups.

IMPLICATIONS FOR NURSING

Results of a survey of a large, ethnically diverse sample of women could inform the development of culturally and age-appropriate nursing interventions designed to address breast cancer risk perceptions and enhance the likelihood of adherence to recommended mammography screening guidelines.

Using focus groups to develop a culturally sensitive videotape intervention for HIV-positive women

Research-based interventions for women with the human immunodeficiency virus (HIV) are usually developed without input from the women who receive the intervention. An exploratory study was performed using focus group methodology to develop a culturally sensitive videotape intervention for educating HIV-positive women about pregnancy and antiretroviral use. Women who met the study criteria were HIV-positive and of childbearing age. These women volunteered to participate in the focus groups to provide information on decisions concerning pregnancy and antiretroviral use during pregnancy to decrease perinatal transmission. A total of five focus groups were conducted in 1998. Responses to three questions that were relevant to the video are presented in this article. Information gained from the focus groups was used successfully to develop a videotape currently being used in a multisite intervention study. Focus group methodology is a useful strategy to develop culturally and content relevant educational interventions for research and practice.

Focus groups in dermatology

Focus groups have considerable potential for study of the attitudes and experiences of patients and health care providers within dermatology. This article describes the use of such groups, using specific dermatological examples.

Can raters consistently evaluate the content of focus groups?

Focus groups are increasingly being used to provide insights to researchers and policy makers. These data complement quantitative approaches to understanding the world. Unfortunately, quantitative and qualitative methodologies have often been viewed as antithetical, rather than complementary, strategies. While focus groups can clearly generate rich information that is unobtainable through other quantitative methods, it is important to determine the degree to which different raters can consistently extract information from transcripts. Thus, our goal was to quantify agreement in the interpretation of transcripts from patient and physician focus groups, using decision-making in ischemic heart disease as a model. We used data from focus groups with both patients and physicians that sought to identify factors affecting diagnostic and treatment decisions in ischemic heart disease. Three raters independently reviewed transcribed audiotapes from focus groups of patients with ischemic heart disease, as well as focus groups of physicians who care for these patients. We found that raters could not distinguish between major and minor factors reliably. More troubling, however, is that consistency regarding the apparently straightforward judgment as to the mere presence or absence of a factor was difficult to achieve. In particular, the three raters of each transcript failed to agree on between one third and one half of the factors. This reasonably high level of disagreement occurred despite the raters: (1) having generated the individual factors themselves based upon their reading a random sample of actual transcripts and (2) being trained in the use of rating forms (including standard definitions of themes). These data suggest that if a single rater evaluates focus group transcripts, as is commonly done, judgments may not be reproducible by other raters. Moreover, a single rater may not extract all important information contained in the transcripts.