Practical Advice for Planning and Conducting Focus Groups

Focus groups, originally called focused interviews, have been used as a data collection method since World War II and are commonly used in social science research. Krueger (1994) describes a focus group as "a carefully planned discussion designed to obtain perceptions on a defined area of interest in a permissive, nonthreatening environment" (p. 6). Guided by a skilled interviewer, participants share their ideas and perceptions, influencing each other by responding to ideas and comments in the discussion. Nurse researchers have many of the necessary skills and topics of interest appropriate for focus groups, yet this methodology is often underutilized. Multiple resources are available that provide indepth information on conducting focus groups (Krueger, 1994; Morgan, 1993; Morgan & Krueger, 1997; Stewart & Shamdasani, 1990) and analyzing the resulting qualitative data (Krueger, 1997a; Miles & Huberman, 1994). The purpose of this article is to provide researchers with suggestions for adapting focus group guidelines to facilitate data collection and ensure optimal use of resources. Insights gained from focus groups conducted by the authors with women at risk for HIV and women with a history of pregnancy after perinatal loss will be presented as examples

Maintaining Your Focus in Focus Groups: Avoiding Common Mistakes

Focus groups are used frequently in nursing research as a method for collecting qualitative data. However, due to inadequate planning or execution, the results can be of poor quality or even worthless. A well-defined purpose, carefully planned environment, and well trained personnel are discussed as the cornerstones to focus group success. This article sets the stage with a description of a well conducted focus group, then provides examples and a critique of less-than-effective groups. Focus groups can be powerful and effective when their use is appropriate to the study purpose, the environment is non-judgmental and welcoming, and the personnel are skilled

Restrained Expectations in Late Pregnancy Following Loss

Objective- To describe women’s late pregnancy after loss experiences (from 25 weeks gestation to birth), document the timing and frequency of their common discomforts and events, and explore changes in these experiences over time. Design- A longitudinal, qualitative study of pregnancy calendar entries and field notes. Setting- Prenatal care providers and community canvassing in Central New York and the Internet. Participants- Pregnant women (N= 69) with a history of perinatal loss. Main Outcome Measures- Women’s pregnancy calendar entries and field notes. Results- Thematic data analysis yielded two main themes and several subthemes: (a) Precarious Pregnancy Security with subthemes of Informed Awareness and Varying Emotions and (b) Prudent Baby Preparations with subthemes of Physical, Social, and Emotional Preparation. Conclusion- Women reported an increased sense of security about the pregnancy and baby over time but this security was easily shaken. For women with a history of later or multiple loss, anxiety may remain high or increase as the due date approaches. Fetal movement is the most common barometer of fetal well-being during this part of pregnancy. With a better understanding of pregnancy after loss, clinicians can have a positive impact on women’s prenatal experiences

Perinatal loss: Response from author

I appreciate this opportunity to have a dialogue about perinatal loss, subsequent pregnancies, and the state of our science in these areas. The writer thoughtfully questions several important points inherent in my study (reported in September/October 2003 JOGNN)

‘‘My Baby Is a Person’’: Parents’ Experiences with Life-Threatening Fetal Diagnosis

Diagnosis of a lethal fetal diagnosis (LFD) early in pregnancy is devastating for parents. Those who choose to continue with the pregnancy report intense emotional reactions and inconsistent, often insensitive treatment by health care providers. This qualitative descriptive study sought to clarify the experiences and needs of families in order to design responsive perinatal palliative care services, and to establish the feasibility and acceptability of conducting intensive interviews of pregnant women and their partners during their pregnancy with a LFD. We interviewed 2 women and 3 couples during pregnancy or just after birth, using open ended questions. Audiotaped responses were analyzed by two investigators. Two dimensions and six themes emerged. In the dimension of Personal Pregnancy Experience, ‘‘Grieving Multiple Losses’’ elucidates that parents grieve the loss of their normal pregnancy, healthy baby and future parenting. ‘‘Arrested Parenting’’ describes their sudden interruption in the normal process of becoming a parent. The theme ‘‘My Baby is a Person’’ reflects parents’ unanimous desire to honor and legitimize the humanity of their unborn baby. In the dimension of Interactions of Others, three themes were found. ‘‘Fragmented Health Care’’ describes parent’s disjointed and distant encounters with multiple providers. ‘‘Disconnected Family and Friends’’ describes the lack of understanding of what the families were experiencing. ‘‘Utterly Alone,’’ which crosses both dimensions, expresses how the parents’ sense of social isolation adds to their personal sense of loss and loneliness. Recommendations are made for palliative care’s role in respecting and validating the experience of parents living through a doomed pregnancy

Support Groups Helping Women Through Pregnancies after Loss

Pregnancies following perinatal loss are full of fears and anxieties. Standards of care or interventions are not generally available, however support groups exist across the country. This study explored several pregnancy-after-loss support groups. Data were collected through participant observation of meetings, individual interviews, questionnaires, and artifacts. Five paradoxes were identified reflecting conflicts between common cultural expectations and the women’s own perspectives about pregnancy: birth/death, pregnancy equals/does not equal baby, head/heart, public/private, and hope/fear. According to participants, the groups helped members recognize their commonalities, remember their earlier babies who died, develop caring relationships, and learn new coping skills. Key outcomes included “making it through” their pregnancies, finding ways to reconcile the cultural paradoxes, and relating better with their current, live babies

The Influence of Perinatal Loss on Anxiety in Multigravidas

Objective- To compare multigravid women with and without a history of perinatal loss on state anxiety, pregnancy anxiety, and optimism. Design- Comparative descriptive; cross-sectional. Setting- Private obstetric offices in a small northeastern city in the United States. Participants- The sample included 160 women who were between 17 and 28 weeks gestation: 96 multigravidas with no history of loss and 74 women with a history of one or two losses. Main Outcome Measures- State anxiety, pregnancy anxiety, optimism, and perinatal loss history. Results- No group differences were found on demographic variables, state anxiety, or optimism. However, pregnancy anxiety was higher in women with a history of perinatal loss. Pregnancy anxiety was also correlated with desire to see care provider more often and number of phone calls between visits, and was not correlated with the number of living children. Conclusion- Women experiencing pregnancy subsequent to perinatal loss have greater pregnancy anxiety: That is, they are more concerned about their pregnancies and their babies than women without a history of perinatal loss. State anxiety and optimism do not differentiate these two groups. This heightened anxiety should be acknowledged and more frequent contact with the care provider should be offered

Watching & Worrying: Early Pregnancy after Loss Experiences

Purpose- To describe women's early pregnancy after loss experiences (up to 25 weeks gestation), to document the timing and frequency of their common discomforts and events, and to explore changes in these over time. Study Design: Longitudinal, qualitative descriptive, and triangulated (data, methods, analyses). Methods- Qualitative data were collected from 82 women pregnant after a past perinatal loss, who were followed through their 25th week gestation. Field notes were taken on all women; 75 women recorded events of their pregnancy through text and stickers on an investigator-supplied calendar. Thematic analysis was done from field notes and hand-written calendar entries; content analysis was conducted on sticker-entered events and symptoms. Results- Themes identified in the data were Growing Confident, Fluctuating Worry, Interpreting Signs, Managing Pregnancy, and Having Dreams. The first four themes comprise the see-saw nature of these pregnancies. Managing Pregnancy includes the subthemes of Being Hypervigilant, Seeking Reassurance, and Relying on Internal Beliefs. The theme of Having Dreams was a serendipitous finding, in the sense that women reported their dreams without prompting, but the data did not reach saturation. Future research in this area is suggested. Calendar stickers indicate that fatigue and headaches are the most commonly reported discomforts. Fetal movement, felt by all the women by 25 weeks gestation, was very reassuring. Clinical Implications- Nurses should understand that women who have experienced a previous pregnancy loss have omnipresent worry and anxiety during a subsequent pregnancy, and seek reassurance that their pregnancy and baby are okay. Therefore, the frequent calls and visits to healthcare providers from these women represent their most common and comforting way of coping with their worry

Understanding Sexual Abstinence in Urban Adolescent Girls

Objectives- To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population. Design- Four focus groups. Participants and Setting- Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006. Data Analysis- Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes. Results- Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I’m worth it), impact of mothers (Mama says … think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there’s a catch). Conclusions- Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls

Planning for a New Baby: A Creative Approach to Learning

Teaching about pregnancy in a childbearing (ie, maternity or obstetrical) nursing course can be challenging because experiences with pregnant families are not easy to find. Educators are aware that active learning is more effective than passive learning,1 but when hands-on learning opportunities are not readily available, role playing or simulations are useful. While redesigning an undergraduate childbearing family course, the author sought to include a learning experience that would help nursing students understand the complex psychological and physical transition to parenthood that new parents face