Running focus groups, (or face-to-face depth interviews), can be hugely rewarding when they ‘go well’. ‘Going well’ means that discussions are rich, informative and insightful. Conversation flows. The group ‘forms, norms, storms and performs’ in harmony (or acceptable disharmony), and when it adjourns at the end, the moderator can feel pleased that they have answers for the client that address and go beyond the brief.
Such discussions are helped when participants are carefully selected to form, or represent the target group. Those carrying out the recruitment take their work seriously. They will only approach those who are expected to perform well / ‘give good value’. So, participants arrive on time, they’re prepared to provide input, they’re willing conspirators. The environment they attend is a comfortable one, maybe purpose built. The provided drinks and snacks refresh, and time passes quickly. The topic guide is at the moderator’s side as an aide memoire to be ‘dipped into’ as necessary – otherwise conversation just flows.
But what happens outside this bubble, when the target participants are affected by a mental health diagnosis such as anxiety, bipolar, obsessive compulsive disorder or schizophrenia?
In that case, little of the above scenario applies. The hoped-for reward and satisfaction are still available for the moderator, but may be more elusive.
Moderator and client expectations need to be rethought: the parameters of the above no longer apply. ‘Small group behaviour’ in such a setting, as identified by Tuckman, may well result in a divergence from the norm. As I experienced in recent focus groups with participants diagnosed with mental health issues, participants rarely stay still, nor remain present throughout. They’re quite willing conspirators (they’ve been trained in advance as to what to expect and have provided consent), but they’re often wary and anxious. The environment may be one in which they feel safe and comfortable, but there may be a game of pool taking place six feet away, and there may be an art and craft activity taking place in the corner. It’s chaotic, disruptive, with only occasional periods of relative calm and quiet. The moderator may be able to take this in their stride, but can he/she really focus on the research objectives, watch body language, and hear what could be mumbled voices? And what about the participants? Can they properly hear, understand and follow the moderator’s lead? What if they haven’t slept for a few nights on the trot, or what if today is the day their ‘fog’ envelops them and stays put for several days?
This is only scratching the surface. Mental health diagnoses come in many shapes and sizes – possibly debilitating one day, but a font of creativity the next. For those affected, having a mental health diagnosis is not conducive to being able to provide richness and insight on a particular day at a particular time. They cannot just ‘turn it on’ when asked.
So why bother?
It is now well known thanks to media coverage that a significant proportion of the UK’s population is likely to be directly affected by a mental health diagnosis each year. MIND, the mental health charity, give a figure of one in four (That’s at least two people in our office … which two?!).
It’s prevalent and pervasive, and, as such, cannot be ignored. Greater awareness and education is required so that there’s a better understanding of what having a mental health diagnosis actually means, but then we need to ensure we openly acknowledge it rather than hide it away or try to avoid it. As a participant in a focus group said recently;
“If you’re in a wheel chair you’re given a ramp and rails. You don’t get anything if you have a mental health problem. You’re invisible”
Impact on the practice of qualitative research
We need to open our arms out to those with disabilities of any kind and make adjustments to our ‘normal’ working methods so that they’re not discriminated. Each project needs consideration in its own right, but I’ve learned that useful pointers could be as follows:
- Provision of clear guidelines (e.g. when group will end, provision of breaks)
- Extended group length
- Known place / environment
- Familiar faces (eg support workers)
- Two (or even three) moderators
- Donation for hosting a group
- Clarity of expression / speech
- Limited / no reading materials
- Provision of breaks
- Low expectations (expect no-shows, erratic timing)
- Accepting / non judgemental
Finally, if nothing else, the majority of those with a mental health diagnosis who take part in qualitative research groups are extremely grateful for having been given the opportunity to have their voice heard.
“I feel I’ve been listened to” (a group participant)
Given this, although it may be a struggle, the reward for the effort is felt by researcher, client and participant: it IS worth it, and it should become more and more ‘normal’ in research programmes.
 Bruce W Tuckman (1965), ‘Developmental Sequence in Small Groups’, Psychological Bulletin 63.