1. Focus Groups for the Health Workforce Retention Study

2. By the end of this day’s session, you will be able to:  Describe what qualitative research is and when to use it  Understand the goals of the Health Workforce Retention Study focus groups  Identify roles and responsibilities of each team member participating in the focus groups  Understand how to facilitate a focus group for the Health Workforce Retention Project

3. Qualitative vs. Quantitative Research Why are we doing both qualitative and quantitative research as part of this study?  Complements the quantitative data  Provides us with more in-depth information  Allows us to discuss topics that we didn’t know were important  Provides a “human” element to the research through stories and examples

4. Focus Groups Facilitated discussion which depends on group interaction to get more detailed information on a topic. Gathers people with similar experience to discuss a topic of interest to the researcher. Uses open-ended questions to hear to collect information about people’s feelings, values, and ideas. The purpose is not to come to a consensus; participants can agree and disagree.

5. Health Workforce Retention Study Focus Groups Goals: To gather in-depth information about the specific factors influencing job satisfaction for health workers. To gather information on how policies might be changed to encourage health workers to stay in their positions.

6. Structure of Focus Groups No more than 15 participants Ideally no less than 6 participants No managers Organized by peer group Need comfortable space - participants should face each other Food and drink provided Always set ground rules

7. Roles and Responsibilities

8. Facilitator Discussion leader; control the session and keep the group on topic Responsible for the directing the discussion using the “discussion script.” Judge whether unexpected responses will contribute to objectives of the study Manage group dynamics Act as a good listener and encourage discussion and participation

9. Note-Taker Take notes Record comments Record non-verbal messages Responsible for tape recorder “Back-up” moderator

10. Observer Skills Note-taking  Summarize each person’s response  Include direct quotes of interesting comments.  Keep summary true to what participants intended.  Fill in missing details immediately after the session.

11. Observer Skills, cont. Tape recording  Check to see that voices can be heard.  Tell participants the session will be tape recorded.  Place the microphone in the center of the group.  Replace tape when first one is full. Observation skills  Tone of voice  Body language  Facial expressions  Posture

12. Stages of the Focus Group Introductions (approximately 10 minutes) Rapport Building Stage (approximately 10 minutes) In-Depth Discussion (approximately 45 minutes) Closure (approximately 5 minutes)

13. Be Prepared! Mentally alert Memorize questions Check tape recorder Check that voices can be heard on tape Bring spare batteries and tapes Make sure you have name tags, pens, paper, sign-in sheets Get food and drink for the group

14. Setting Up Arrive before participants. Note-taker should set up outside the room at the doorway to sign people in and give consent forms. Welcome participants as if hosting friends. Talk about something other than the Health Workforce Retention Study. Avoid controversial subjects. Give participants name tags or name tents. Observe participants.

15. Debriefing Immediately write down your thoughts and what you remember from the discussion Meet with the other team member who participated in the focus group to discuss all aspects of the session.  Logistics  Check responses, review themes  Team skills and performance  Was the required information obtained? Put consent forms and notes from focus group in data box.

16. Let’s Practice We need 5 volunteers to participate in a practice focus group. Please refer to your focus group protocol on page 18 of the manual.

17. Encouraging and Controlling Discussion

18. Encouraging discussion Atmosphere Maintain a friendly and warm attitude. Do not judge what participants say. Aim to be somewhat casual, but not too much.

19. Encouraging discussion Pauses and prompts Pauses to allow participants to think or a new speaker to comment. A pause can last up to 5 seconds. Establishing eye contact can encourage someone to speak. Nodding and other gestures can also encourage people.

20. Encouraging discussion Probes. If a participant makes a vague comment, ask him/her for more information: “Could you explain that further?” “Would you give me an example of what you mean?” “I don’t understand.”

21. Encouraging discussion If you are not getting an answer, first repeat the question. If you are still not getting an answer, rephrase the question. Use Reminder questions. e.g. “Dr. Y said that salary is an important factor for making job decisions. Dr. Y, how important is salary in your job decisions?” Call on people individually if necessary.

22. Dealing with Specific Individuals Dominant talkers Should not be allowed to “take over” the focus group Remind group that all participants have knowledge and you want to hear from everyone. Seat next to moderator Moderator turn slightly away from dominant talker and avoid eye contact. Thank dominant talker for comments and ask for comments from others in the group.

23. Dealing with Specific Individuals Shy participants Seat them across from moderator Moderator makes eye contact to encourage participant to speak. Gently address him/her by name to ask for a comment.

24. Dealing with Specific Individuals People who don’t stop talking. Stop eye contact after 20 or 30 seconds. When participant pauses, quickly repeat question or ask a new question of another participant.