In the field of neglected tropical diseases (NTD), there is increasing emphasis on addressing the gap between the scientific efficacy of tools and their translation into different local contexts (1). Social science research can unpack the social inquiry necessary to support more sustainable interventions. To contribute to the rising need of social science research in NTDs, the iCHORDS Research Methods Series will outline the definition, methodology, and importance of relevant research methods in the NTD field. In this blog, we will specifically be focusing on Focus Group Discussions (FGDs) and providing a link to our associated infographic.
What is a Focus Group Discussion?
An FGD is a qualitative research method that involves interactive group discussions on a set of issues led by a trained facilitator. FGDs have up to 10 participants and rely on group interactions to stimulate discussion on the relevant research issue (2). The purpose of focus groups is to better understand how a particular group thinks or feels about an issue, idea, product, or service. The aim is not to reach a consensus but to uncover a broad range of perspectives and experiences.
Application within NTD
Social Factors
FGDs can help understand social factors influencing NTD adoption. These include access barriers, incentives for implementers to deliver interventions, local understanding of disease, political factors, and livelihood patterns that leave those most vulnerable behind (3).
Community Response
They also offer insight into community compliance and resistance behaviours towards NTD control programs. Focus group studies have uncovered that local resistance to MDA is due to community perceptions about drug toxicity, lack of confidentiality during screening, and beliefs about the necessity of treatment (4,5). A study by Masong et al. revealed that women refused treatment due to fears of forced sterility, resonating with local anxieties behind the intention of development projects and the lack of trust established in the community (6). Focus groups provide a means to identify knowledge gaps and doubts among groups to support more equitable and sustainable NTD interventions
How do you do it?
Sampling Participants
Focus groups can consist of 6 to 10 participants with similar backgrounds or experiences relative to the research issue. A clear rationale should be provided to guide group discussion sampling technique, including how participants were separated (i.e. by age, gender, occupation, etc.). Participants must also be in a comfortable and non-threatening environment to openly share their views without fear of judgement from others. This means being aware of pre-existing relationships and power dynamics between participants.
Considerations: Relationship between sampling and representativeness, justification for how participants are separated, power imbalances between participants, privacy of the discussion environment
Facilitation
Facilitators must be well trained to ensure even participation, preserve careful wording of questions, maintain a neutral attitude, adapt to the flow of the discussion, and summarize the session to reflect opinions evenly and fairly. Consider having one facilitator and one observer to transcribe interactions. Audio recordings of the interview are recommended but consent must be granted by the participants.
Skills: Probe discussion, control reaction to participants, use subtle group control for dominant or shy talkers, record discussion, keep participants engaged
Analyzing Data
Group interactions such as non-verbal cues, overlapping discussions, and quiet conversations should be included in the verbatim transcripts. Different strategies can be used to organize and analyze interview data. Refer to IDI sheet for more information
Reporting Results
Participants should know how findings will be used. Reporting should use stratifiers, such as m/f, position/role, and age, to ensure participants remain anonymous.
Adapted from: The use of focus group discussion methodology: Insights from two decades of application in conservation
Why use it?
Various social contexts present multifaceted challenges to the efficacy of NTD intervention implementation and scaling-up (7). FGDs can characterize challenges, norms, values and realities from group perspectives, allowing interventions to be designed in a way that meets community needs (6). The flexibility to select participants within a focus group also allows researchers to listen to group perspectives of their choosing – including marginalized and vulnerable populations.
Group interactions from FGDs produce data and insights that are otherwise unachievable from individual interviews. Interactive data generated from discussion participants sharing their views, hearing the views of others, and refining their own views can increase the clarity, depth, and detail of the discussion (2). Although FGDs provide valuable insight, they cannot produce numerical results, thus cannot be used where statistical data is required.
Studies using FGDs within the NTDs space
Should I get screened for sleeping sickness? A qualitative study in Kasai province, DRC
The Role of Personal Opinions and Experiences in Compliance with MDA for LF Elimination in Kenya
References
1. Krentel A, Gyapong M, Ogundahunsi O, Amuyunzu-Nyamongo M, McFarland DA. Ensuring no one is left behind: Urgent action required to address implementation challenges for NTD control and elimination. PLoS Negl Trop Dis [Internet]. 2018 Jun 7;12(6):e0006426–e0006426. Available from: https://pubmed.ncbi.nlm.nih.gov/29879105
2. Hennink MM. Focus group discussions. Oxford University Press; 2013.
3. Bardosh K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty [Internet]. 2014;3(1):35. Available from: https://doi.org/10.1186/2049-9957-3-35
4. Mpanya A, Hendrickx D, Vuna M, Kanyinda A, Lumbala C, Tshilombo V, et al. Should I get screened for sleeping sickness? A qualitative study in Kasai province, Democratic Republic of Congo. PLoS Negl Trop Dis [Internet]. 2012/01/17. 2012 Jan;6(1):e1467–e1467. Available from: https://pubmed.ncbi.nlm.nih.gov/22272367
5. Babu B V, Kar SK. Coverage, compliance and some operational issues of mass drug administration during the programme to eliminate lymphatic filariasis in Orissa, India. Trop Med Int Heal [Internet]. 2004 Jun 1;9(6):702–9. Available from: https://doi.org/10.1111/j.1365-3156.2004.01247.x
6. Christine Masong M, Ozano K, Tagne MS, Tchoffo MN, Ngang S, Thomson R, et al. Achieving equity in UHC interventions: who is left behind by neglected tropical disease programmes in Cameroon? Glob Health Action [Internet]. 2021 Jan 1;14(1):1886457. Available from: https://pubmed.ncbi.nlm.nih.gov/33641612
7. Boyce C, Neale P. Conducting In-Depth Interviews: A Guide for Designing and Conducting In-Depth Interviews for Evaluation Input. 2006.
Blog and Infographic created by: Jacie Liu
