Posted by: Adam Pattison Rathbone20 NOV 2015
My PhD aims to understand what it is like to take medicines everyday as prescribed, using interviews and focus groups to collect data from patients. Last year I wrote a blog about completing the first qualitative interview of my PhD at Durham University. Almost 18 months later, I have just completed my first focus group. I had imagined the session would be something similar to a pulmonary or cardiac rehab session — the patients would arrive, I would do a presentation, they would ask me questions that I would not know the answers to and I would spend the week after looking them up. But I could not have been more wrong.
I had already analysed some focus group data for a paper looking at GP and pharmacist collaboration. This data comes in the form of long transcripts, around 100 pages, that document, verbatim, what was said and who said it. Reading and analysing the data came naturally to me. I found ways of coding what participants said and then clustering it together to form themes. This is called thematic analysis and is commonly used to analyse qualitative data. Ideally the researcher reads the transcripts over and over again to become familiar with the data. I became so familiar that, at times, I felt like I had been at the focus group. I thought this experience of analysing focus group data would prepare me for running my own focus groups, but this was not the case.
After initially finding it difficult to recruit patients, I managed to find a day when all interested parties were available to attend. I planned on arriving early to familiarise myself with the room, find the best place to put the audio recorder and arrange some seating — as well as prepare the necessary refreshments. However, due to terrible traffic, I arrived ten minutes late, after most of my participants had already arrived and introduced themselves to each other.
I quickly set up the projector and laptop to prepare the talk, feeling like I was crashing a party. The focus group had two aims: the first was to ‘test’ my findings in real patients, to see if they thought I had described the phenomenon of adherence accurately, and the second was to get some opinions about common compliance devices.
I whistled through my talk — I have ‘the gift of the gab’ so presenting is not a problem for me. But this is where I stumbled. Once the talk was over, the participants started chatting, spontaneously, about their adherence, what they thought of my research and the compliance devices I had shown them. Occasionally they would ask me to put a particular slide back on the screen but, on the whole, I was a spare part.
It felt strange to be a pharmacist surrounded by patients talking about medicines and adherence issues they have had and not leading or joining in the discussion. Occasionally, one of the participants would ask a question, such as: “Well, what is atenolol actually for?” but, before I had time to respond with my perfected description of the drug’s mechanism of action, one of the other participants would respond with, ”I take that too, it is for your blood pressure”. The conversation continued — without me. The conversation, and consequent data, seemed to be focused enough on my research for it to be described as a ‘focus group’ without my intervention or involvement. After about 1.5 hours, the conversation started to slow down until we all agreed the session was over.
As I was driving back to the office, I reflected on the session. Initially I felt that the focus group had not gone well. The fear of what my supervisors, examiners or peer-reviewers might say if they knew of my failure turned knots in my stomach. “How could it have gone well when I have not said or done anything for the last hour or so — I just sat and watched?” I asked myself.
It was at this point that I realised that this is what focus groups are about. They are not like pulmonary or cardiac rehab at all — they are not a clinical service or intervention. I was there to watch, hear the patients’ views and listen to their stories.