Focus Groups: A Practical and Applied Research Approach for Counselors Victoria E. Kress and Marie F. Shoffner Focus groups are becoming a popular research approach that counselors can use as an efficient, practical, and applied method of gathering information to better serve clients. In this article, the authors describe focus groups and their potential usefulness to professional counselors and researchers. Practical implications related to the use of focus groups in counseling practice are discussed, and case examples are provided demonstrating how focus groups can be useful to counselors.
Counselors increasingly need to justify their costs to third party payers, agencies, school and college administrators, and clients (Myrick, 2003; Whiston, 1996). Counselors are being asked to defend their services, increase their efficiency, and demonstrate successful counseling outcomes (Sexton, 2001). Particularly in the current managed care and accountabilityfocused environment, client satisfaction with counselors’ services and client involvement in selecting services are priorities for the counselor–client relationship (Hayes, Barlow, & Nelson-Gray, 1999). Despite the current emphasis on accountability and client satisfaction with services, it is often difficult to establish the efficiency of counseling because its effectiveness and methods often are not precise or measurable (Whiston, 1996). Although one obvious way for counselors to demonstrate accountability is through assessing clients’ perceptions and needs through research endeavors, few counselors and mental health practitioners engage in research (Bauman et al., 2002; Borders, 2002; Hayes et al., 1999; Haynes, Lemsky, & Sexton-Radek, 1987). Clinicians have identified the following reasons for infrequently engaging in research: insufficient time, limited financial resources, lack of assistance, limited individual interest, limited employer support, lack of collaborative research partners, interference of research endeavors with the counseling process, a belief that research does not inform practice, past negative research experiences, and lack of relationship between research and position responsibilities (Haynes et al., 1987). Similarly, Hayes et al. (1999) indicated that the integration of research into practice has not occurred for two reasons: the inadequacies of traditional research methods to address issues that are important to practice and the lack of a clear link between empiricism and professional success in the practice context. In other words, many counselors believe that the research literature is not practical and does not inform their work with clients; furthermore, they believe research does not help counselors assess their clients’ needs and the change process, nor does it assess for counselor effectiveness. These
findings and conclusions, which suggest that practical research methods that directly relate to work with clients and that do not require a great deal of resources, may be most helpful to counselors. One practical research methodology that may be useful in achieving this end is focus group research. With a rise in postmodern thought, qualitative research methodologies such as focus groups have been gaining in popularity (Kitzinger & Barbour, 1999). We believe that focus groups are an effective means of understanding the counseling process and clients’ needs and experiences in counseling. Historically, the study of human behavior has focused on quantitative research in which controlled experiments and statistical analyses are used as a means of uncovering an assumed truth. Loesch and Vacc (1997) stated that in order to align “research methodology with the philosophical underpinnings of the helping professions,” research must “evolve from reliance on traditional, primarily quantitative perspectives to encompass greater recognition and acceptance of newer, primarily qualitative methodologies” (p. vi). This qualitative focus can be considered a reaction to traditional counseling research, which has been based on positivistic, modernist, and linear principles (Schwartz & Breunlin, 1983) and an assumption that reality can be objectively measured apart from the researcher. Qualitative research approaches differ from quantitative research approaches in many ways. For example, whereas quantitative researchers believe that a truth exists, qualitative researchers believe that there is no “truth” or “reality” and that reality is socially constructed; quantitative research is deductive whereas qualitative research is inductive; quantitative researchers’ role is to be objective whereas qualitative researchers are interactive; in quantitative research participants are blind to the experimental hypotheses, but in qualitative research, participants are fully informed and included in the analyses (Heppner, Kivlighan, & Wampold, 1999). At their core, quantitative research approaches, which are based on the ways of knowing commonly referred to as positivism or mod-
Victoria E. Kress, Department of Counseling, Youngstown State University; Marie F. Shoffner, Department of Human Services, University of Virginia. Correspondence concerning this article should be addressed to Victoria E. Kress, Department of Counseling, Youngstown State University, Beeghley Hall, Youngstown, OH 44555 (e-mail: vewhite@ysu.edu).
© 2007 by the American Counseling Association. All rights reserved.
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Kress & Shoffner ernism, assume that there is a solid truth and that through scientific investigations, this truth can be progressively exposed until an objective reality is revealed (Ashworth, 2003). From this modernist perspective, the researcher is an objective third party who is “outside human society, looking in” (Ashworth, 2003, pp. 22–23). In contrast, postmodernist philosophy, as applied to research, posits that there is no truth and that the researcher is not detached from the research process but is actively involved. Thus, whereas the modernist asks, “What are the facts?” the postmodernist asks, “What are the assumptions?” Whereas the modernist asks, “What are the answers?” the postmodernist asks, “What are the questions?” Qualitative research methodologies, with their emphasis on relativity and context, are a good fit with professional counseling regarding emphasis on the individuality of human experience, culture relativity, and developmental change (Myers, Sweeney, & Witmer, 2001). With more attention being given to qualitative research, greater interest has been shown in focus groups. Although there has been an increase in the attention given to focus groups (beginning in the 1970s), focus group research is not a new research methodology. Some authors trace the initial use of focus groups back to the 1920s, when Bogardus and Turstone used them to develop survey instruments (Wilkinson, 2003); most authors indicate that Robert Merton (e.g., Merton & Kendall, 1946) and his colleagues, Kendall and Fiske, initially developed focus groups in the 1940s (Stewart & Shamdasani, 1990). Merton’s research group initially developed focus groups to obtain information from audiences about their perceptions of radio programs (Wilkinson, 2003). Before the 1970s, focus groups were primarily used as a market research tool, and most of the research using this method was in the areas of business and marketing. The practical and efficient nature of focus groups has led to a rapid increase in the popularity of the technique. The focus group method is being used more frequently in applied research (Stewart & Shamdasani, 1990), and it has been expanded to the areas of public health, education, communications, media studies, feminist research, sociology, and psychology (Wilkinson, 2003). Focus groups are one qualitative research methodology that has been effectively used in a variety of counselingrelated settings. For example, focus groups have been used in college and university settings to determine college students’ perceptions of student alcohol use and appropriate university responses (Rapaport, Minelli, Angera, & Thayer, 1999) and to assess the sexual health needs of college women (Walden & Fennell, 1995). In community/agency settings, focus groups have been used as a means of eliciting clients’ preferences for care (Ryan et al., 2001), uncovering the constructions of healing and coping of women who have survived sexual abuse (S. L. Morrow & Smith, 1995), understanding factors that affect adolescents’ decisions to seek health care (Ginsburg, Menapace, & Slap, 1997), and developing and planning a research project related to the treatment of clients with dual
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diagnoses (Loneck & Way, 1997). Focus groups have also been used with children and parents in school settings to evaluate the perceived effectiveness of a school district’s counseling program (Scruggs, 1999) and with teachers in school settings to better understand why and when teachers make student referrals to school counselors (Jackson, 2000). Finally, focus groups have been used with children and in school settings as a means of evaluating sexual abuse prevention programs (Charlesworth & Rodwell, 1997), understanding children’s perceptions of siblings with emotional disabilities (Litzelfelner, 1995), and examining children’s knowledge and beliefs about AIDS (Elliot, Gruer, Farrow, & Henderson, 1996). These examples illustrate that focus groups can be used in various settings and for various functions. Depending on the research design, the groups can be used for needs assessment, for program development and evaluation, and for exploratory research. The purpose of this article is to briefly describe focus groups and their potential usefulness to counselors and researchers, provide specific applications and case examples demonstrating how focus groups can be helpful, and provide practical implications related to the use of focus groups in counseling practice and research.
Focus Groups Focus groups are a qualitative research methodology that can be used to obtain information about the opinions, perceptions, attitudes, beliefs, and insights of a small group of people (Kitzinger & Barbour, 1999). Such groups provide a means of obtaining group participants’ individual and unique understandings of experiences. In particular, focus groups are helpful in evaluation research or in understanding how people regard a specific experience or event (Krueger, 1994). The Structure of Focus Groups Although focus groups vary considerably depending on their purposes, they can be defined broadly as a technique wherein 8 to 12 individuals discuss a particular topic of interest for 1–2 hours under the direction of a group moderator (Stewart & Shamdasani, 1990). The role of the moderator is to promote interaction, probe for details when necessary, and ensure that the discussion remains directed toward the topic of interest. The data produced by focus groups are the identified themes that group members discuss as they interact with each other and the transcripts of the group discussion (Morgan, 1988). Some researchers choose to record and transcribe focus group data to better assess identified themes, whereas others document themes during the group (Stewart & Shamdasani, 1990). Focus group participants are helped to focus on a particular topic, which they then discuss in some depth. The interaction between the participants is as important as the actual content of the conversation. For example, one participant may disagree with another and point out the logic behind her or his point of view. This, in turn, may lead the first participant to have
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Focus Groups: A Practical and Applied Research Approach for Counselors a change of opinion. The other group participants may then offer their views on the topic. Although much of what goes on during a focus group may appear to be discussion, it is, in fact, facilitated and purposeful data collection. In focus groups, moderators ask participants open-ended questions, monitor members’ responses, and use these responses to facilitate the discussion of primary themes. Typically, preestablished, structured questions are developed and used in guiding the discussion. The first one or two questions are used as a means of facilitating members’ comfort level with the group. About two to five essential questions are asked before participants are presented a final general question that closes the focus group. The number of questions depends on the age and developmental stage of group members. An effective moderator is critical for the success of a focus group. Moderators use probing comments, observe nonverbal behaviors, and process and explore participants’ answers as a means of generating themes related to the participants’ responses. Many of the basic individual and group counseling skills that counselors have (e.g., reflections, paraphrasing) can be used to encourage members to dialogue about the questions presented by the moderator. Focus groups are naturalistic. Members use language closer to everyday conversation than the language used in structured interviews and engage in a range of “communicative processes—such as storytelling, joking, arguing, boasting, teasing, persuasion, challenge and disagreement” (Wilkinson, 2003, p. 185). As such, moderators need to be flexible and have the ability to adapt to various situations as they arise. Stewart and Shamdasani (1990) indicated that focus group moderators benefit if they are flexible, able to express thoughts quickly, aware of their own biases, empathic, expressive of their own feelings, genuinely interested in other peoples’ thoughts and feelings, and insightful about people. When discussing an optimal group moderator, Karger (1987) stated, The best facilitator has unobtrusive chameleon-like qualities; gently draws consumers into the process; deftly encourages them to interact with one another for optimum synergy; lets the intercourse flow naturally with a minimum of interventions; listens openly and deeply; uses silence well; plays back consumer statements in a distilling way which brings out more refined thoughts or explanations; and remains completely nonauthoritarian and nonjudgmental. Yet the facilitator will subtly guide the proceedings when necessary and intervene to cope with various kinds of troublesome participants who may impair the productive group process. (p. 54)
The aforementioned behaviors and characteristics involve skills and traits that professional counselors are trained to develop. Indeed, depending on the goals of the focus group and the information being sought, it may be difficult to distinguish between a group counseling facilitator and a focus group moderator. Thus, it is important
for focus group moderators to be clear about their past or potential future relationship with focus group participants and strive to be aware of any potential ethical issues that may arise (e.g., a client’s potential discomfort with having a counselor serve as a focus group moderator). To prevent role confusion, it is suggested that focus group moderators avoid having their clients participate in focus groups that they are facilitating. To avoid confusion related to the function of a focus group, it is recommended that the facilitator emphasize the purpose of the focus group, clarify the members’ and facilitators’ roles in the group, and provide clear examples of member and facilitator behaviors that are appropriate for a focus group. Focus group facilitators increase their effectiveness if they (a) maintain focus on the questions, (b) anticipate situations that shift the focus of the group from a general one to one that is personal, and (c) practice responses to such a shift. The moderator encourages and facilitates an open exchange of information when participants are treated as experts and when they are encouraged to share opinions and ideas. This interaction of participants is the defining feature of a focus group. It is this interaction that provides the rich, detailed data that researchers use to identify themes in participants’ responses. Participants’ ideas stimulate discussion on the topic, and group members ask each other questions and interact in such a way that ideas and perceptions are coconstructed and further developed. According to Morgan (1988), the primary strength of the focus group technique “is the explicit use of group interaction to produce data and insights that would be less accessible without the interaction found in group” (p. 12). This interaction among focus group members is what makes the focus group unique in comparison to asking participants individually about their perceptions or having participants write out their personal reactions. Unlike group counseling, a detailed record of the ongoing discussion in the focus group is further analyzed for content and for themes. After the focus groups have ended, the next step is to determine how to make meaning of the data. Just as the uses of focus groups are variable, so are the ways in which the data can be analyzed (Wilkinson, 2003). The most basic level of analysis is taking notes during the focus group and, afterward, identifying themes based on these notes. At the other end of the continuum is transcribing the focus group session using orthographic transcription, then using computer-assisted programs (e.g., NUD*IST or the Ethnograph) to help in developing themes. A review of edited collections of focus group research (e.g., Barbour & Kitzinger, 1999) can provide examples of the variability in uses of focus groups and data analysis possibilities (Wilkinson, 2003). Advantages of Focus Group Research Because of the emphasis on participants’ perceptions, focus groups have been praised as being more culturally sensitive
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Kress & Shoffner and empowering than more traditional research methods (Chiu & Knight, 1999; Hughes & Dumont, 1993; Race, Hotch, & Packer, 1994). Because human development, empowerment, and cultural sensitivity are valued cornerstones of the counseling profession (Sweeney, 2001), focus group methodology and counseling philosophy have a natural affinity. The counseling values of (a) respect for clients’ perspectives, (b) an invitational stance of encouraging clients, and (c) a search for understanding are consistent with qualitative research philosophies (Paisley & Reeves, 2001) and are especially pronounced in relation to focus group research. Also, the skills needed to facilitate focus groups overlap with and are similar to counselors’ basic individual and group counseling skills. Thus, in many ways, focus groups are a natural fit with counselors’ skills and philosophies and can be more useful and efficient than traditional research methods. Focus groups have many advantages, including flexibility, economy of time, and direct contact between researchers and participants (Krueger, 1994). The most significant advantage of focus groups may be their ability to elicit a synergistic effect that cannot be obtained through individual interviews; through the conversational process, participants react to each other, and unique data or ideas are developed (Stewart & Shamdasani, 1990). The focus group itself can serve as an intervention because it allows group members to explore pertinent issues, and it may allow for members’ attitudes to be expressed in a way that is ultimately helpful to all group participants. Although many qualitative research methodologies are time-intensive (Paisley & Reeves, 2001), focus groups provide a relatively time-efficient means of gathering rich data. This time efficiency is especially important for counselors who are under increasing pressures to meet productivity standards and who have limited time to engage in research.
Focus Group Applications As stated previously, the focus group methodology can be applied in a variety of counseling-related settings. In this section, we present specific examples of research applications of the focus group methodology, with emphasis on ways focus groups can help counselors improve their clinical practice and contribute to counseling research. More specifically, we present a discussion and examples of focus groups serving as a means of (a) conducting needs assessments and assessing clients’ preferences for care, (b) program development and evaluation and outcome assessments, and (c) descriptive research. These focus group functions are highlighted through examples of the authors’ and others’ use of focus groups. Needs Assessment and Client Preferences for Care The use of focus groups, in conjunction with quantitative data collection procedures, has been suggested as a means of
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assessing community mental health needs (Hayward, Peck, & Smith, 1993). For example, K. Morrow, Costello, and Boland (2001) used focus groups to develop an understanding of women who were HIV-positive regarding their experiences and perceptions of services that would best support them. The results of the focus groups supported women’s interest in and perceived need for psychosocial group intervention and provided feedback on how to structure groups. Specifically, the participants requested changes focusing on specific considerations for group facilitators, barriers that could affect interventions, and attention to important group attributes and group guidelines. According to the researchers, the results of their study supported ongoing development of psychosocial support groups for women with HIV disease. When using focus groups to conduct client or community needs assessments, it is recommended that researchers make efforts to ensure that selected participants represent the demographic characteristics of the population of interest. Avoiding leading or closed questioning techniques will provide the most accurate and useful information about the needs of particular client groups. Program Development and Evaluation and Outcome Assessment Focus groups have also been suggested as a means of developing and evaluating programs of mental health related services, including counseling-related outcome assessment (Boechler, Neufeld, & McKim, 2002; Straw & Smith, 1995). For example, the first author (Kress, n.d.) applied a focus group format in a community setting for the purpose of evaluating the effectiveness of a sexual abuse recovery program. A short-term, solution-focused, group counseling program for adolescent survivors of childhood sexual abuse had been developed and implemented for a family and children’s agency. Agency staff members and the first author (i.e., the program developer) were interested in assessing group members’ perceptions of the group. More specifically, we were interested in the effectiveness of the group in increasing members’ sense of empowerment and improving their coping skills. As part of the evaluation process, 1 week after the group was completed, group members were interviewed by two moderators (not including the group facilitator), using a focus group format. Group members were asked the following questions: What did you like about the group? What should be changed about the group? What has been most helpful to you? What has been least helpful to you? and What did you learn about ways to cope and deal with your past abuse experiences. The focus group was found to be more helpful than an individual interview format because group members encouraged other members to talk and remember different group experiences (e.g., one group member shared that she thought one activity had been helpful, and another girl replied, “Oh yeah, I forgot about that one, I . . .”). It was our perception that the focus
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Focus Groups: A Practical and Applied Research Approach for Counselors group was more effective than a written evaluation form would have been for the same aforementioned reasons; this was especially important given that many of the adolescent girls had difficulty reading and writing. After the focus groups were completed and the audio recordings were transcribed, the data were organized so that participants’ responses were grouped by questions. The first author and two other investigators independently reviewed and organized the data into themes related to the questions. After meeting independently and identifying and developing themes, the three investigators met to narrow down the identified themes and to discuss their differences of opinion regarding the themes. After thoroughly processing reactions to the data, consensus between the investigators was achieved in relation to identified themes. The focus group provided rich and helpful information concerning the group members’ perceptions of the group. For example, with regard to what was helpful about the group, members’ responses could be organized by the following themes: increased positive self-feelings, decreased isolation in discussing the abuse, increased sense of interpersonal connection, and an increased future orientation. These themes indicated that group members’ perceptions were consistent with the group program developer’s goals. With regard to what was least helpful about the group, members identified the following themes: needing more and longer sessions, needing more time to share about past abuse experiences, difficulty with abstract group activities (more concrete and structured activities were preferred), and a concern that members did not like being in group with people they knew from other contexts (e.g., school). Group members were able to provide concrete information about what was generally and specifically helpful and not helpful about the group. This information was then available to provide information on how to better develop the program to meet the needs of this population. Boechler et al. (2002) provided another example of focus groups serving as a means of program evaluation and outcome assessment. In attempting to find a tool to measure the dimensions of client satisfaction appropriate for their community mental health center, these researchers used focus groups as part of a multimethod approach in selecting and refining a measure that assessed client satisfaction. These authors suggested that focus groups provide important information on consumer perspectives and should be used in evaluating client satisfaction. Day (1995) described the development of an education and awareness program that was designed to help give African American parents of teenagers the skills and confidence they needed to help their teenage children prevent and cope with drug- and alcohol-related issues. Day used focus groups to assess the effectiveness of the program, and the findings provided implications that Day used in revising the program training materials. Probably the most difficult issue in using focus groups to assess program effectiveness is to facilitate client responses
that are not affected by a desire to provide the expected answer. For example, in a focus group assessing clients’ opinions on the effectiveness of a cognitive–behavioral group intervention to control overeating, some clients may choose to emphasize the best qualities of the intervention in order to please the researcher. This might lead the researcher to conclude, perhaps erroneously, that there were few areas that needed to be changed. Discussing the potential for bias in responses and asking questions that address both the strengths and the weaknesses of an intervention or program are ways to avoid bias in focus group research. Descriptive Research Focus groups can also be used in exploratory and descriptive research. This is especially helpful when investigating constructs that have not previously been effectively operationalized or when examining highly phenomenological constructs. For example, the second author was involved in designing and overseeing focus groups that examined students’ opinions regarding careers in mathematics, science, and technology (Shoffner, Newsome, & Barrio, 2005). The construct being examined, (i.e., outcome expectations) had not been sufficiently operationalized for pre- and early adolescents. Students in Grades 6–9, were divided into groups on the basis of grade and gender. Group members were asked open-ended questions that focused on mathematics, science, and computer interests and on what they might expect if they were to pursue higherlevel courses in any of these subjects. Group members provided rich and informative information about why young people might choose to rule out careers in these areas long before they have actually begun investigating specific career paths. For instance, a common theme in group members’ responses was how to balance the demands of more difficult course work with other areas of interest. This information might help inform school counselors about topics that should be addressed with young people as part of a career development program. In addition, the researchers were able to investigate Bandura’s (1977, 1986) concept of outcome expectations more thoroughly than had previous researchers. The study authors found that identified themes supported the three types of outcome expectations of Bandura but also found two additional types of outcome expectations not previously examined. These research results had implications not only for counseling practice but also for research and theory. The challenges in using focus groups for descriptive or exploratory research include (a) using too limited a sample of group participants and (b) not using other data collection approaches to provide additional supportive evidence on the findings. For example, it might be important and useful to individually interview several of the group members to determine the level of influence of the group dynamic.
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Limitations There are several limitations to the use of focus groups in research. Although many of the potential limitations can be prevented, there are several that are inherent to the nature of groups or to the nature of qualitative research. One limitation in all forms of qualitative research is the interpretation of the content of the discussion. Although efforts can be made to identify researcher and coder biases in order to make this a known part of the research endeavor, it is possible that some of these beliefs may be unknown to the researcher and may influence how meaning is assigned to the discussion. Therefore, it is important, when possible, to use some kind of audit system so that individuals who are unfamiliar with the nature of research can examine the data and decide whether the choices made and the meaning assigned to the data are logical and subsequently supported by the existing data. The use of audiotapes within a group format does not allow researchers to identify individual speakers within the transcriptions. If the researcher can identify the various speakers, they can then analyze ways that participants’ perceptions change on the basis of input of others. If possible, studies should include videotaped discussions to identify the individual speakers to assess the influence of speakers on each others’ perceptions.
Summary and Conclusions Focus groups can provide counselors with valuable information and research data in a relatively efficient manner. The focus group method can be used in almost any counseling environment to answer a variety of questions related to needs assessment; program evaluation; or descriptive, exploratory study. Focus groups can be combined with other qualitative and quantitative methods (e.g., quantitative designs using assessment measures such as a pre- and postsurvey; Kitzinger & Barbour, 1999). We have examined the use of focus groups to assess client needs; conduct program evaluation; and engage in descriptive, exploratory study. These three applications include numerous counseling-related practical uses of focus groups. More specifically, focus groups can be used to determine the client’s perception of the impact of counselor-provided services; the perception of clients from different populations regarding their service needs; how different client populations perceive prevention and developmental programs; how effective prevention and developmental programs are in changing client-perceived perceptions of their behaviors; the preferred interventions of specific client populations; and attitudes, opinions, and beliefs that may interfere with optimal client growth. If counselors are to continue providing quality services to clients, we must know the clients’ perception of their needs as well as their perceptions of the impact of counseling services. Numerous
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restraints make research a difficult endeavor for most counselors. Nonetheless, counselors have a responsibility to continually seek out effective and innovative ways to efficiently meet clients’ needs and to improve services. Focus groups are one practical and effective means of gathering information and conducting research that can contribute to improved counselor practice.
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