ANALYSIS OF FOCUS GROUP DATA

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1 ANALYSIS OF FOCUS GROUP DATA Focus Groups generate a large amount of data which needs to be organized and processed so that the main ideas are elicited. The first step is transcribing the FGs in a way which allows for detailed analysis; the second step is making sense of the data; and the third step is writing the report/paper. Though most of us have already transcribed the focus groups, we are including some points for review. TRANSCRIPTION 1. Anonymity in the transcription: It is important to delete any identifying information during transcription. That would mean that we would need to develop pseudonyms/numbers that hide the real identity of the speakers and of their institutions/city. You can develop a table that gives a key to which pseudonyms that identify which people, institutions and cities. This key needs to be in only one copy, locked in the main office. The original tapes/ digital recordings also need to be in only one copy, locked in the office, and not exchanged by . The transcripts can be exchanged only after all identifying information is removed. If speakers mention other identifying information while speaking (names of hospitals, their own position, other names of people, etc. which could also identify the speaker) it is up to ourjudgment to see if they can stay or they need to be removed (ex: xxxx hospital). 2. Technical aspects: o It is best if the transcription is done by one of the facilitators who was present at the FG. o Transcribe verbatim every word, said by participant and moderator. o It is helpful if the words of the moderator clearly stand out: for example they can be in a different font or italicized. o Also, make sure that each speaker is identified uniquely throughout the transcript. That can be done through numbers or pseudonyms, but it is important to be able to trace the comments of each participant separately. 1

2 o If places of the recording are unclear rewind to try to understand the talk. If it is still unclear, mark (unclear) or (overlapping), when both people talk together. o Mark places of non-verbal interactions (laughter), (crying), (pause), etc. o Small pauses can be marked by. o It is up to eveeryone to decide how much to include of hmmm, uhhh, etc. For more detailed discourse and conversational analyses these are necessary, but for our purposes probably not. o Use additional transcription symbols that work best for you if you need them. o Add line numbers automatically through the WORD Program. o If you will be doing analysis on paper transcripts format the file with a large margin (usually on the right), where to will mark codes and themes. ANALYSIS 1. Purpose and Research Questions: o In this phase of the project we are interested in understanding what kind of stressors health professionals are faced with from their perspective/ what are the factors that influence the quality of medical care from the health professionals perspective / what are the factors that influence the quality of medical care from the patients perspective in each country. o In addition to describing these points, in the analysis we are also interested in: How do HP and patients make links between stress and quality of care, how do the FGs elicit aspects of organizational culture; what similarities and contrasts do we see between different perspectives (HP at different levels, HP and patients, between countries). We can also identify local/ cultural meanings, discourses that construct organizational realities and cultures, and come into play in what we are observing. We can also have some indication of what would be elements of appropriate interventions. 2. Coding and Themes Our main method of analysis is Thematic Analysis (Braun & Clarke, 2006). Teams can choose to use other types of qualitative data analysis also, for example: (Starks & Trinidad, 2007). o Read the transcript several times as a whole. Then start coding text segments according to content of what people are saying. Initially the codes we come up with will be close to the text and more descriptive. Code is a word or a short phrase that suggests a 2

3 meaning relevant for the research objectives; the process of coding is an interpretive technique that both organizes the data and provides a means to introduce the interpretations of it. o As we continue working, we will see that some of the codes are grouping together and forming higher-order themes. These themes will become more categorical, and/or more abstract & theoretical. This is the process of moving from more descriptive analysis to more interpretative. Mark the higher-order themes in a different way to distinguish them from codes (ex: capital letters). Krueger & Casey (2009) suggest that a helpful way of thinking about this process is to consider a continuum of analysis ranging from: 1. raw data; 2. descriptive statements; and 3. interpretation. o Look for relationships between themes and for patterns. This further moves the process to interpretation of what it all means -- > and can lead to development of theory (usually mid-level grounded theory ). o Constantly make memos about findings and ideas about what these relationships could mean. o Some themes will be identified as important because they come up extensively in many FGs (there is no need to state how many times they came up or % of people). Other themes will be identified as important even if they come up rarely, but they are specific, or address an important/exceptional issue as determined by the team, etc. So patterns are not the only thing we can write about - critical incidents might be important to explicate, even if they are single cases (Krueger & Casey, 2009) & attachment Table 6.1. o Identify the constants that emerged regarding each topic area. Illuminate/interpret these constants based upon other findings that emerged in the groups. o Identify the differences and divergences in each topic area. Illuminate these positions based on surrounding group findings (ex. optimistic vs. pessimistic attitudes toward health policy.) o This is an overlapping and iterative process. Summary of analysis: o familiarization with the content (through reading several times each transcription); o identifying a thematic framework (relevant words, sentences, paragraphs, write memos); o indexing/coding (sifting the data, highlighting and sorting out quotes and making comparisons both within and between cases.); 3

4 o categorizing and theme development: lifting the quotes from their original context and rearranging them under the newly-developed category. o mapping and interpretation: make sense of the individual quotes, the relationship between the quotes, and the links between the data as a whole. 3. Specifics for Focus group analysis. Most of thematic analysis is relevant for both interviews and FGs. There are some specifics to pay attention to in FGs: o The analysis can also include the interaction between group moderator and speakers (i.e. how are particular responses related to how the moderator asked the question?). This is important in our case, since the interview guides were quite specific and structured (in the probes that we developed) to facilitate an international study. However, this might have introduced concepts which the speakers might not have introduced spontaneously, or directed the conversation, and this can become clarified through the analysis of responses to particular questions, as well as the impressions from the FGs as a whole. o The analysis can also include the information about the group dynamic (available from the transcript and FG field notes). For example: being late, leaving early, body language, conflicts and arguments during the group, etc. Particularly interaction between participants, how the issues develop as they talk to each other, are there contradictions, agreements, what does the conversation between them bring out? o The analysis can include discussion of local cultural meanings, social situation, national healthcare situation/policy and their relevance to what we are finding in meanings of stress and quality of care. o The analysis can include following the comments of one/each speaker throughout the FG. o It is likely that there will be different codes and themes for the QoC and Burnout Focus groups, but there might also be overlap. o Interpretation of organizational culture a lot can be interpreted about the organizational culture from what people say, how they interact and what assumptions they hold (that might be below/above the surface of the text). 4

5 4. Approaches to analysis o Qualitative Software: Programs such as Atlas.ti, NVivo and MaxQDA allow us to organize the transcripts, field notes, memos, etc. in one place. They also allow for easy coding and linking codes with quotes, development of code categories/themes and identifying patterns. o Paper transcripts: If software is not available, analysis on paper transcripts can be conducted using different colors, sometimes people use a left and a right margin, etc. Some researchers make a photocopy of all transcripts and use the second copy to cut up important segments of the text, and then organize these segments according to themes, and to visually see the development of patterns. It is important to develop a coding scheme to remember from which FG each segment comes from (for example each FG can be photocopied on different color papers). In this method it is important to number each line of the transcripts to follow their order (Krueger & Casey, 2009). 5. Additional Considerations o To makes sense of all the data, consider that it is the purpose and the research questions, which guide what exactly we are looking for when analyzing. Otherwise the data will be overwhelming. o The analysis needs to be systematic & verifiable, in the sense that interpretations and conclusions need to be clearly grounded in the data. o As Braun and Clarke point out, the themes are not the same as the topics introduced by the interview questions (Braun & Clarke, 2006). 6. Sharing with the larger ORCAB group. o It is not expected that we will find common themes, or that we will be coding using the same coding manual. However, we might get ideas from each other and go back and look at the data with new eyes after that. Let s share our list of themes (and sub-themes) among all ORCAB teams. Plan to send your themes by March 31 st,

6 7. Writing o For writing a full report, we can describe all the major themes that we interpreted from the data. For writing a paper for publication, we would need to choose several themes on which to concentrate, or one particular aspect which to explore. For the EHPS Symposium for example, some teams chose to focus on contrasts between doctors and patients, or between health professionals at different levels. Some more theoretical developments can also be addressed based on the FG analysis. In each paper we would describe the themes in detail and include supporting quotes from the transcripts to support interpretations. References: Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research; Fourth Edition. Thousand Oaks, CA: Sage Publications. Starks, H., & Trinidad, S. B. (2007). Choose your method: A Comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17,

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