Research methods unit III Scholarly Activity

Primary Health Care Research and Development 2004; 5 : 1– 4 Networking Using teleconferencing to enable general practitioner participation in focus groups Helen Tolhurst School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Australia and Sarah Dean Faculty of Medicine, University of Sydney, Australia Focus groups are used increasingly in general practice research, especially where a qualitative method is required to answer exploratory questions. Recently teleconfer- encing has been used to conduct focus groups in research on rural general prac- titioners, where distance makes face-to-face focus groups difŽ cult and where anon- ymity of participants is important. This paper discusses advantages and disadvantages of using teleconferencing as a means of undertaking focus groups and provides examples of research where this has been used. We conclude that focus groups, conducted using teleconferencing, are an appropriate method in research on general practitioners, and can be particularly useful, when conducting research in rural and remote areas, and when anonymity of participants is desirable. Key words : focus group; general practice; research; rural; teleconference Introduction Focus groups have become a common method in general practice research (Cho et al ., 1995; Schattner et al ., 1993). Research has shown gen- eral practitioners often mention time constraints as a barrier to their participation in research studies (Gray et al ., 2001; Jowett et al ., 2000). As the par- ticipation in face-to-face focus groups is a time consuming activity for participants it would be expected that minimizing the time commitment expected of participants would assist in over- coming this barrier. This is particularly the case when the research is being conducted in rural and remote areas where attendance at face-to-face focus groups involves travel to distant locations. A Norwegian study showed that female general prac- titioners (GPs) regarded their family commitments as a barrier to participation in research (Forde and Evenson, 1991). Teleconference focus groups are Address for correspondence: Dr Helen Tolhurst, Rural Research Fellow, Discipline of General Practice (Newbolds), School of Medical Practice and Population Health, Faculty of Health, Uni- versity of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Email: helen.tolhurst@newca stle.edu.au Ó Arnold 2004 10.1191/ 1463423604pc190xx a method which can provide GPs with the opport- unity to participate without the need to travel to a particular location and which could potentially facilitate female GPs’ participation in some research while also meeting their family commit- ments. Recently the focus group method has been adapted to use teleconferencing for health care research (Appleby et al ., 1999; Tolhurst et al ., 1997; Tolhurst et al ., 1999; Tudiver et al ., 2001; White et al ., 1994; White and Thomson, 1995). We discuss the use of teleconference focus groups for research on GPs. Teleconference focus groups as research methodology Teleconferencing is a system that joins three or more participants in different locations through a telephone system (Kuramoto and Dean, 1993). Telephone groups have been used for group support (Macintosh, 1981; Wildsoet et al ., 1996), education (Macintosh 1981; Wildsoet et al ., 1996), group interviews, organizational tasks, contacts before and after face-to-face meetings (Schopler 2 Helen Tolhurst and Sarah Dean et al ., 1998), and in market research (Garigliano, 1998). Teleconference focus groups are similar to face-to-face focus groups, but there are speciŽ c advantages and disadvantages of using them. Parti- cipants are recruited in the same way as they would be for face-to-face focus groups either by letter or telephone, and the focus groups are conducted in much the same way in terms of using an interview schedule if they are semistructured, and of having a facilitator to conduct the focus group. Many issues pertaining to audioconferencing are equally applicable to videoconferencing. Guidelines for the use of focus groups as a health research method The guidelines for the use of teleconference focus groups, are similar to those for face-to-face focus groups, in relation to size, structure, length of time, homogeneity and conŽ dentiality. Guidelines for the design of focus groups for general practice research, which can be applied to teleconference focus groups include: · Structured with a deŽ ned set of focus group questions (Morgan, 1992). · Less than one and a half hours long because of problems with fatigue, loss of interest, poor validity (Cho et al ., 1995). · The group should be homogenous in terms of at least one research factor (Cho et al ., 1995) with homogenous composition for more effec- tive communication, and heterogeneous compo- sition for generating richer, more varied data. Examples of research factors for which focus groups may be homogeneous are gender, age group, and geographical area. · Participants must give informed consent and be aware before the session begins that a video- tape or audiotape recording will be made. In- dividual contribution s must remain conŽ dential and anonymous (Schattner et al ., 1993). · Members should be asked to ensure the privacy of other’ s communications as in face-to-face focus groups but may need to be particularly aware of this if on the telephone in the home (Appleby et al ., 1999). · Group structure and size are two important factors (Morgan, 1992). The usual size of focus groups is six to 10 participant s (Cho et al ., Primary Health Care Research and Development 2004; 5 : 1– 4 1995; Schattner et al ., 1993). Sm all groups, which generate more intense and detailed discussions are recommend ed for research which delves deeply into detailed experience s and feelings of individuals. Larger groups, which produce a brief, steady ow of infor- mation, are recommended for research, which requires generation of a number of ideas. (Morgan, 1992). Advantages of teleconferencing for focus groups Cost effective in terms of time and travel: · Teleconferencing enables practitioners to par- ticipate in research focus groups when time and Ž nancial costs make this difŽ cult. The time commitment and inconvenience of travel have been identiŽ ed as barriers to participation of GPs in focus groups (Schattner et al ., 1993) Incon- venience can be minimized by teleconferencing. Examples of research where teleconferencing was used to facilitate the recruitment of GPs, located in rural and remote areas, are studies conducted by Tudiver et al . in Canada (2001) and Tolhurst et al . in Australia (1997, 1999). In our studies of female rural GPs (Tolhurst et al ., 1997) and violence against rural GPs (Tolhurst et al ., 1999), GPs from remote areas of Australia, over 1000 kms apart, were able to participate, without the cost and time commit- ment that would have been required for a face- to-face focus group. Increased level of anonymity when discussing sensitive issues: · Conducting groups by teleconfer ence has anonymity and facilitat es discussion of sensi- tive issues (Schopler et al ., 1998; White and Thomson, 1995), an example being a study con- ducted by White et al . in New Zealand on sexual relationships between doctors and patients (White et al ., 1994). This study used tele- conferencing to provide anonymity to the participants. The researchers explained, ‘ focus groups are usually less suitable for exploring highly sensitive or personally threatening issues, personal interviews or anonymous mailings being preferred’ (White et al ., 1994: 391). The Using teleconferencing to enable general practitioner participation in focus groups 3 focus group adaptation in this study used the strengths of the focus group method and maintained anonymity. The participants in this study were able to freely disclose personal experiences, beliefs, and values within the group without the threat of being identiŽ ed. Overcoming con icting responsibili ties of participan ts: · Teleconferencing overcomes problems with participants’ con icting responsibilities, such as family responsibilities. For example, in our study of female rural GPs the use of teleconfer- encing enabled participants, with child care responsibilities, to remain at home, while partici- pating in the focus group (Tolhurst, 1997). Limitations of the use of teleconferencing for focus groups Lack of nonverbal cues: · A constraint in using teleconferencing is the lack of nonverbal cues (White and Thomson, 1995), which may be important in the direction, which the discussion takes, and in the level of group participation. For example, during a tele- conference the facilitator is unable to observe nonverbal signs of participants’ agreement or dissatisfaction in relation to other participants’ contribution, or distress when sensitive issues are being discussed. The need for the appropriate technology: · Most potential participants have access to a telephone and most telephone service providers can provide teleconferencing facilities. However technological support is critical to the imple- mentation and maintenance of group activity (Schopler et al ., 1998). Possible bias in sampling: · It is possible that GPs who do not have experience in the use of teleconferencing might be uncomfortable with this method and less likely to participate in teleconference focus groups although no research has been under- taken exploring this issue. Primary Health Care Research and Development 2004; 5 : 1– 4 Discussion These examples show that teleconferencing for focus groups is a useful method for research on general practitioners. The guidelines outlined above for face-to-face focus groups can easily be adhered to when conducting groups by tele- conference. Teleconferencing can be cost effective in general practice research. Its use has the poten- tial to encourage the participation of GPs who otherwise may not participate because of geo- graphical location or commitments at home, by minimizing the time commitment of the GPs, and providing a high degree of anonymity to parti- cipants, when discussing sensitive issues. The use of teleconferencing in general practice research demonstrates how new technology in- corporated with older research methodologies creates new research methods. References Appleby, N.J., Dunt, D., Southern, D.M. and Young, D. 1999: General practice integration in Australia. 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