Focus Group Work Research Articles

G183(P) Learning together study days: cross specialty education to improve children and young people’s health

Aims The UK is lagging behind the majority of Europe in children and young people’s health outcomes. 1 One possible hypothesis for this is the lack of integration between primary, secondary and tertiary care. The World Health Organisation supports effective inter-professional education as it enables effective and collaborative practice. 2 There is published evidence that inter-professional learning can lead to better patient care and safety, reduced mortality rates and better use of specialist health resources. 3–5 Methods Following focus group work and a pilot study day, the authors created three study days: Child and Adolescent Mental Health, Public Health and Adolescent Sexual Health. These are areas where good care crosses traditional medical specialties and health care professions. Royal College curricula were analysed to define learning outcomes. The study days were advertised to paediatric, GP and relevent specialty trainees as well as other children’s and young people’s health professionals. Each day featured a mix of lecture and small group case based learning. Results The three days were attended by 163 trainees (85 paediatric, 52 GP, 26 other). We received pre and post course online feedback from 85 (53%) and 104 (64%) trainees respectively. Across the three days the proportion of delegates who strongly agreed with the statement ‘My learning is enhanced when I learn with health care professionals from different specialties’ increased from 40.7 to 60.2% (Tables 1 and 2). Conclusions This series demonstrates that it is both desirable and feasible to offer cross specialty inter-professional education in Children and Young People’s health and that it not only increases confidence and knowledge in the individual subject areas but also improves the delegates’ own perceptions of learning in the wider cross specialty team. References Wolfe I, Thompson M, Gill P, et al . Health services for children in Western Europe. Lancet 2013; 381 (9873):1224–1234 WHO Framework for Action on Interprofessional Education {$} Collaborative Practice 2010 Simmonds S, Coid J, Joseph P, et al . Community mental health team management in severe mental illness: a systematic review. Br J Psychiatry 2001; 178 :497–502 Naylor CJ, Griffiths RD, Fernandez RS. Does a multidisciplinary total parenteral nutrition team improve outcomes? A systematic review. J Parenter Enteral Nutr . 2004; 28 :251–258 Holland R, Battersby J, Harvey I, et al . Systematic review of multidisciplinary interventions in heart failure. Heart 2005; 91 :899–906

Adolescent Girls' Choices of Schoolyard Activities in Urban Pakistan

Adolescent girls in Pakistan are restricted from outdoor physical activities due to the risks of crime and teasing, and by “cultural norms.” Schoolyards are potentially key recreational places. However, there is little space for recreation at most low-fee private schools, and State-run schools have little incentive to support outdoor activities. Focus group discussions, participant observation, interviews and group work elicited the outdoor space preferences of parents and schoolgirls. The girls display considerable ingenuity for outdoor play in constrained environments, and aspire for more vigorous physical activity and quality recreation. Policy reforms, changes to schools' approaches to the use of outdoor space, and societal efforts are required to make adolescent-girl-friendly spaces more widely available.

Communication in a Human biomonitoring study: Focus group work, public engagement and lessons learnt in 17 European countries

A communication strategy was developed by The Consortium to Perform Human Biomonitoring on a European Scale (COPHES), as part of its objectives to develop a framework and protocols to enable the collection of comparable human biomonitoring data throughout Europe. The framework and protocols were tested in the pilot study DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human biomonitoring on a European Scale). The aims of the communication strategy were to raise awareness of human biomonitoring, encourage participation in the study and to communicate the study results and their public health significance. It identified the audiences and key messages, documented the procedure for dissemination of results and was updated as the project progressed. A communication plan listed the tools and materials such as press releases, flyers, recruitment letters and information leaflets required for each audience with a time frame for releasing them. Public insight research was used to evaluate the recruitment material, and the feedback was used to improve the documents. Dissemination of results was coordinated in a step by step approach by the participating countries within DEMOCOPHES, taking into account specific national messages according to the needs of each country. Participants received individual results, unless they refused to be informed, along with guidance on what the results meant. The aggregate results and policy recommendations were then communicated to the general public and stakeholders, followed by dissemination at European level. Several lessons were learnt that may assist other future human biomonitoring studies. Recruitment took longer than anticipated and so social scientists, to help with community engagement, should be part of the research team from the start. As a European study, involving multiple countries, additional considerations were needed for the numerous organisations, different languages, cultures, policies and priorities. Therefore, communication documents should be seen as templates with essential information clearly indicated and the option for each country to tailor the material to reflect these differences. Future studies should consider setting up multidisciplinary networks of medical professionals and communication experts, and holding training workshops to discuss the interpretation of results and risk communication. Publicity and wide dissemination of the results helped to raise awareness of human biomonitoring to the general public, policy makers and other key stakeholders. Effective and timely communication, at all stages of a study, is essential if the potential of human biomonitoring research to improve public health is to be realised.

Engaging staff to deliver compassionate care and reduce harm.

The delivery of compassionate care leads to safer care but this will only occur with an engaged workforce under effective leadership. In addition, there is a need to understand the behaviours that drive nurses to make particular decisions about care. This article describes the pilot of a simple survey tool (ENGAGE) to ascertain levels of staff engagement to use as an enabler of effective change. It also describes a unique pilot initiative of focus group work, quality improvements and leadership coaching on two hospital wards. This work centred on the patient-nurse relationship and challenged the traditional teaching of preventing harm. Initial results were promising: while many staff did not feel nurtured or guided by their manager or acknowledged by the senior team, they did feel glad to come to work and empowered to improve patient care. Three months after the first ENGAGE survey, a repeat found significantly improved levels of engagement. Alongside this were improvements in avoidable harms and patient experience. Staff were motivated to improve care and admitted they did not really see their patients as individuals with identity and personality. Managers were motivated to improve engagement and take their wards forward.

Kidh Fabric: Product Development for Community Business Reinforcement

This research, Kidh fabric: product development for community business reinforcement was conducted with three main aims: 1) to study Kidh fabric history in northeastern Thailand; 2) to study problems and solutions related to processed fabric products; and 3) to study fabric product pattern design development for community business reinforcement. This qualitative study used a purposive random sampling technique, with samples including people involved with Tai Dam fabric products. Data were collected through structured interview, observation, focus group discussion and work shop.In addition, data reliability and validation tests were conducted with a triangulation method. The results show that Kidh Fabric production processes from three community business groups had the same points in keeping their unique designs and purposes to improve their own business and marketing. There needs to be coordination between community members in the production and design processes, as well as to increase product value by using new knowledge and technology. In conclusion, to develop Kidh fabric products for community reinforcement, all three communities need more support and cooperation from government units, private organization and community leaders. Moreover, these communities businesses need more knowledge and technological support to improve their production process, marketing, personalities in order to transform their community production units into strong and stable business groups.

Early identification of familial hypercholesterolaemia in general practice using patient-specific reminders: focus group with General Practitioners

BackgroundFamilial Hypercholesterolaemia (FHc) is a commoninherited disorder, leading to raised serum cholesterolevident from the first year of life. One in 500 people areaffected by the minor heterozygote form of this condi-tion, of which an estimated 85% are unidentified.National English guidelines,producedbyNICE,high-light the importance of cholesterol screening and FHcidentification in prevention of coronary heart disease[1,2]. However, evidence based approaches to supportguideline implementation are under developed. Theincorporation of computerised patient specific remindersis thought to have clinical utility in the identification ofpatients with genetic conditions but as yet not evaluatedin primary care for FHc.Materials and methodsIn order to develop computer based prompts are accepta-ble to general practitioners a focus group was held forgeneral practitioners from the Inner City Derby area, ofwhich the outcome would inform the design of a futurefeasibility study to assess the use and impact of suchreminders for FHc in clinical practice.ResultsGeneral practitioners were in favour of specific patientreminders for early identification of individuals at risk ofFHc. Emerging themes included brevity, clear and succinctstatements, explicit actions that linked specific screeningtests to specific diseases and the need to tailor differentGP clinical systems.ConclusionsClinicians need to be alert to the prevalence of FHc inclinical practice. Based on results from both the focusgroup and preliminary work, PSR’s were considered to bean overall effective method of early identification of FHcin general practice and therefore considered relevant inpre-trial work to inform substantive research in the earlyidentification of FHc in primary care.

Sources and Resources

This paper presents and discusses the outcome of a mentorship programme for capacity enhancement of Nigerian policy makers for evidence use in policy making. Policy makers were mentored by senior researchers to foster their research capacity for evidence-informed policy making. The mentorship programme involved lectures, focus group discussions, dialogues, and group work. Mentees were taught research techniques and how to use research evidence in the policy-making process. The mentorship programme knowledge assessment test and evaluation outcome indicated a considerable improvement in the mentees’ skill, knowledge and understanding of evidence-informed policy making.

UMA LEITURA DAS REPRESENTAÇÕES SOCIAIS DOS PROFESSORES SOBRE O PODER PROFISSIONAL DOCENTE

Este trabalho pretende apresentar resultados obtidos com a pesquisa científica desenvolvida no Programa de Pós-Graduação em Sociologia, da Universidade Federal de Pernambuco - UFPE, cujo principal objetivo foi o de compreender as representações sociais dos professores dos cursos de licenciatura acerca do poder profissional docente, seus processos de construção e seus produtos. A pesquisa de natureza qualitativa apreendeu, por meio de entrevistas semiestruturadas e trabalhos com grupos focais, as representações sociais que se apresentaram distintas para os sujeitos pesquisados, e que puderam ser organizadas em três categorias: na primeira, os docentes investigados representam socialmente o poder profissional dos professores como uma ilusão, ou seja, algo inexistente. Na segunda categoria esse poder é socialmente representado como um alvo, uma meta em construção. E para o último grupo de professores a representação social do poder profissional docente organiza-se numa categoria denominada de evidência, dito de outra forma, esse poder existe e é constatado a partir das próprias características conceituais de poder profissional contido na literatura específica.

Indigenous perspectives on ecotourism development: a British Columbia case study

PurposeThe purpose of this research is to examine Gitga'at First Nation approaches and objectives concerning the use of local biological and cultural resources through the lens of a locally‐driven proposal to establish an eco‐cultural tourism enterprise.Design/methodology/approachThis project was developed in collaboration with the Gitga'at First Nation and employed a qualitative case study approach. Primary data gathering techniques were active participation, semi‐structured interviews, focus group discussions and work with key informants.FindingsParticipant responses highlight the interconnectivity and importance of social, ecological and cultural integrity in local economic development. Three major principles for resource use were widely expressed: control and management by Gitga'at; equitable distribution of any benefits; and the imperative of environmental and cultural sustainability.Research limitations/implicationsGitga'at band members living within the Gitga'at traditional territory played a central part in this research. Future work could include non‐resident band members. Furthermore, if the Gitga'at decide to move forward with this proposal, further research could examine how the resource use principles discussed here may be applied.Practical implicationsThis research provided a forum to explicitly identify research participants' hopes and concerns surrounding eco‐cultural tourism and the possible outcomes of this potential project.Social implicationsThis research may be beneficial to other communities interested in eco‐cultural tourism development or other development activities dependent on local resources use.Originality/valueAlthough essential to creating economic opportunities that reflect local goals and interests, socio‐cultural dimensions are often overlooked in local economic development. This research explicitly sought to unpack these domains.

The Assessment of Recovery Capital: Properties and psychometrics of a measure of addiction recovery strengths

Sociological work on social capital and its impact on health behaviours have been translated into the addiction field in the form of 'recovery capital' as the construct for assessing individual progress on a recovery journey. Yet there has been little attempt to quantify recovery capital. The aim of the project was to create a scale that assessed addiction recovery capital. Initial focus group work identified and tested candidate items and domains followed by data collection from multiple sources to enable psychometric assessment of a scale measuring recovery capital. The scale shows moderate test-retest reliability at 1 week and acceptable concurrent validity. Principal component analysis determined single factor structure. The Assessment of Recovery Capital (ARC) is a brief and easy to administer measurement of recovery capital that has acceptable psychometric properties and may be a useful complement to deficit-based assessment and outcome monitoring instruments for substance dependent individuals in and out of treatment.

Education about dementia in primary care: Is person-centredness the key?

Primary care is ideally placed to recognise and manage dementia and yet dementia can be overlooked or misattributed by primary care practitioners and is underdiagnosed. This might be explained by a lack of formal training in the diagnosis of dementia combined with a reluctance to diagnose due to its associated stigma. This paper describes focus group work with service users, carers and health professionals, conducted to develop an educational intervention for primary care promoting person-centred responses to people experiencing cognitive decline and dementia. Data was analysed thematically and four themes emerged: Reframing dementia as cognitive decline (Individual level); triggers for the recognition of dementia (Practitioner level); engaging the whole primary care team (Practice level); the relationship between primary and secondary care (Service level). Findings are discussed in the context of their contribution to challenging attitudes to dementia in primary care and the positive aspects of person-centred primary care for dementia.

‘Fields of Play’: the District Six Museum and the history of football in Cape Town1

This article examines the distinctive features of the District Six Museum’s memory work on the history and heritage of apartheid forced removals in Cape Town, and shows how these approaches were applied in the museum to a project through which a new exhibition on the history of football in Cape Town was created. Since its inception in December 1994, the District Six Museum has become one of the most prominent examples of new museums whose methods of work are based on participation, annunciation and inscription, and a model of memory work based upon the idea of knowledge ‘transaction’. The practice of the District Six Museum poses challenges for conventional museum methods both in South Africa and internationally. In 2008, the exhibition ‘Fields of Play’ was produced by the District Six Museum, after three years of collection and focus group work which drew upon these participatory methods. While excitement about the 2010 World Cup – the first to be held on African soil – was reaching fever pitch in South Africa, the District Six Museum created a complex exhibition of the history of football in Cape Town in relation to the spatial patterns of removal and displacement under apartheid. The exhibition showed how football became an arena for holding on to the past, for embracing and displaying the resources of modernity, and for acting out modes of citizenship. This article shows how the District Six Museum’s exhibition went beyond conventional sports exhibitions such as the hall of fame and those created for the purposes of marketing and public relations.

Validation of a quality-of-life scale for women with bladder pain syndrome/interstitial cystitis

To validate a disease-specific scale to measure the impact of symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC), a condition that affects up to 6.5% of U.S. women. Participants were drawn from the RAND Interstitial Cystitis Epidemiology (RICE) Study, a telephone probability survey of 146,231 US households. Women who met RICE BPS/IC symptom criteria (n = 3,397) completed the 6-item RAND Bladder Symptom Impact scale (RICE BSI-6). The RICE BSI-6 was adapted from a scale used to assess the impact of diabetes on life and sexuality and modified based on expert input on face validity and focus group work; items specific to diabetic symptoms were eliminated. Validated scales of symptom severity, mental- and physical-health-related quality of life (QoL), depression, coping, and perceived control were used to assess convergent validity. The RICE BSI-6 (α = 0.92) was significantly related to greater symptom severity, worse general mental- and physical-health-related QoL, more severe depression symptoms, and lower perceived control over life in general and over BPS/IC symptoms (P values < .05). It was also associated with less use of distancing coping (P < .05). The RICE BSI-6 shows excellent internal consistency and strong convergent validity. It can be used to examine the effects of psychosocial and treatment interventions on QoL among women with BPS/IC.

Perceptions of effective leadership in music facilitators working with older people

Abstract Although there is now an accepted need for initiatives that support older people’s well-being, little attention has been paid to what constitutes effective leadership of such activities. This research explored perceptions of effective leaders of musical activities with older people. Three case study sites engaged with the research that drew on the views of participants, music leaders and stakeholders in the field through the use of questionnaires, individual interviews, focus group interviews and group work in a consultative conference. Overall, being a ‘good leader’ was thought to involve being knowledgeable, patient, positive, enthusiastic and having a sense of humour in order to create a relaxing atmosphere. Participants indicated that successful facilitators responded to their needs, motivated them and encouraged them to continue participating in the activities through supportive feedback, good pacing of the sessions and focused attention. The findings are discussed in relation to their implications.

Extending services and enhancing systems: working together to manage increased numbers of referrals

Improving access to palliative care for all patients with life limiting illness has resulted in a significant increase in referrals to specialist palliative care services. Expanding services to keep pace...

Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

PurposeThis article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure.MethodsEQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions.ResultsSelecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states.ConclusionsA 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

Sustainable landscape governance: Lessons from a catchment based study in whole landscape design

This paper investigates the implementation of governance for sustainable landscapes, based on a catchment case study in lowland England. A participatory research process, spanning six and a half years, employed formal and informal in-depth interviews, focus group work and workshop techniques with 71 stakeholders representative of a wide range of interests in the catchment. A scenario design process within a GIS framework was used as a focus for capturing the key issues and visions of the stakeholders. Two contrasting but plausible scenarios for 2020 emerged from this process; one scenario was driven by the sustainable intensification of agricultural production and world trade, the other by the enhanced protection of ecosystem services and multi-objective land use. It was clear from discussions with stakeholders that the mechanisms for delivering an integrated approach to landscape management are not currently in place, although there have been some policy successes that could be built upon. There is also a need for new approaches to land tenure which include tax incentives and improved forms of cooperation and leadership in both policy and contiguous landscape stewardship. The methodology itself was appreciated by the stakeholders who found it useful to think more holistically. In addition, the study demonstrates an approach that individual practitioners and researchers can develop the skills to implement.

The Valued People Project: users' views on learning disability nursing

A well-educated and trained workforce is undoubtedly crucial to the development of quality care for people with learning disabilities. Notwithstanding this, and unsure as to the need to continue to commission educational programmes for one part of this workforce-pre-registration learning disability nursing-South Central Strategic Health Authority commissioned the Valued People Project to undertake a detailed strategic review of educational commissioning, along with a review of the specialist learning disability health workforce more generally. This project has recently been completed, and provides a unique evidence-based expert evaluation of the future strategic direction of education commissioning and leadership for workforce issues in specialist learning disability services, as well as the wider NHS workforce. This is the first in a series of articles that reports on one aspect of the project: the focus group work undertaken with parents and relatives of people with learning disabilities, and people with learning disabilities themselves, as to the need and type of health workforce needed to support them in the future. The article concludes by identifying the key messages of importance from parents and people with learning disabilities concerning the future specialist and wider NHS workforce.

Understanding Community and Family Barriers and Supports to Physical Activity in American Indian Children

Increasing physical activity (PA) in children and adults is necessary to prevent or ameliorate chronic diseases such as obesity, type 2 diabetes and cardiovascular disease. Interventions designed to increase PA at the individual and community level through policy and environmental change are essential. American Indian (AI) communities face a disproportionate burden of chronic disease and are eager to work on multi-level methods for disease prevention. 1 Over the past 10 years our research group has been partnering with multiple AI communities in northern Wisconsin on research to understand barriers and supports to healthy lifestyles and PA. Methods have included the WINGS epidemiological work and parental questionnaires 2 (see this issue), key informant interviews and focus groups 3-4 , PhotoVoice/GIS mapping, accelerometry/direct observation 5 , and environmental assessment. An intervention, Healthy Children, Strong Families, and Supportive Communities, is underway and focuses both on the family environment and aiding individuals in making healthy choices. 6 The intervention also assists communities in making community level changes to support healthy lifestyles. Our journey with these communities to understand the prevalence of obesity and cardiovascular disease and the role of attitude and environment in order to aid intervention design has taught us many valuable lessons. The framework of our work has been community based participatory research 7-8 , and tribal members were involved at all stages of the research whenever possible. In this commentary, discussion of the lessons learned from each of these methods is divided into 3 realms: community views and suggestions, objective measurement, and environmental assessment. Some methods cross more than one realm. These notes from the field may help other communities as they travel a similar journey toward wellness. Community Views and Suggestions During the WINGS study, the parent survey for parents of 3-8 year old children included an open ended question seeking suggestions for changes in the community that might encourage healthier lifestyles. 2 Caregivers provided 90 suggestions of how to promote healthy lifestyles in their community. Fifty-six of those suggestions specifically mentioned physical activity related changes. Common themes noted by caregivers were the desire for more family oriented activities, more activities and sports directed at younger children, parents needing to spend more time with children in activities, and needing more facilities for younger children/families. Our key informant and focus group work showed the importance of understanding parental views of health in order to intervene in increasing PA. Parents had a view of health

Reflecting on the Use of IPA with Focus Groups: Pitfalls and Potentials

Interpretative Phenomenological Analysis (IPA) is a phenomenological, hermeneutic method for analysing semi-structured interview data, supported by a robust theoretical foundation and detailed practical procedures. The use of IPA with focus group data does not yet have the same status, and it should not be assumed that either theory or practice can remain unchanged when applied to focus groups. Two core features of IPA are discussed and problematized in the context of focus group work: the negotiation of part-whole relationships and the management of the interplay between real-time discursive and post-hoc thematic sense-making. With both these issues, practical solutions are offered from our own research on care. Although it is possible to adjust the IPA method for group data, there remain some profound theoretical and epistemological questions about whether the resultant focus on the group-individual dynamic and the discursive construction of experience represents too fundamental a shift from the idiographic and the psychological to be considered “true IPA.” However, working through these issues and attempting to move from either/ors to both/ands are seen as being true to the spirit of phenomenological enquiry.