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Researchers, however, may be unaware of the antecedents of what they have come to accept as orthodoxies of focus group usage within their field and how these can operate both to provide opportunities and place limitations around the development of the method. This is the topic of the second part of this introductory chapter. When focus groups are unquestioningly adopted, the development of innovative practices may be constrained, whereas an historical appreciation may allow researchers, instead, to draw selectively and constructively on the rich legacy of focus group usage, enabling them to critically assess the assumptions that underpin different approaches to research design, formulating research questions, planning and running focus groups, generating and analyzing data, and presenting and using findings.

In order to better understand the potential of focus groups, the challenges they present and, perhaps, in order to assist in formulating some constructive responses, it is worth briefly tracing the origins of focus group research, which continue to influence current practice.

Originally developed at the Bureau of Applied Social Research at Columbia University to gauge the response to public broadcasts (Merton and Kendall, 1946), focus groups were soon enthusiastically adopted in broadcasting, marketing and public opinion research (Kidd and Parshall, 2000). These usages continue in the established fields of broadcasting, marketing and public opinion polling, but also surface in interesting new guises. Recent examples include the use of focus groups to inform plans for communicating with members of the public following radiological terrorism (with echoes of the public broadcasting origins of the method) (Pearce et al., 2013). Also of note is a recent marketing-type exercise carried out by a member of the Law Faculty at Ohio Northern University who wanted to find out what employers wanted from new graduates (Wawrose, 2013). The discipline of design has frequently employed focus groups, drawing on marketing approaches, and using members of their target audience, in order to establish that their prototypes are fit for purpose.

Many researchers continue to employ focus groups in order to elicit the ‘views’ or ‘attitudes’ of particular constituencies, as testified by the huge number of journal articles with these words in the title – particularly, but not exclusively, in the fields of health and social care research. Here focus groups have frequently been employed in order to elicit the views of specific sectors of the population (often minority ethnic groups) who do not take advantage of services – especially screening programmes – e.g. breast cancer screening among Chinese American immigrant women (Lee-Lin et al., 2013) or oral cancer screening among rural black Americans (Howell et al., 2013). This mirrors the marketing approach to studying market segmentation and the potential for targeting certain client groups. (Some of these usages are re-visited in the next chapter.) Many of these projects involve collaborations between medical or nursing researchers and social scientists (mainly medical sociologists, health psychologists and medical anthropologists).

Some health services research applications have taken usage of focus groups a stage further, aiming to access service users’ – or, frequently, non-users’ – perspectives in order to plan appropriate and effective interventions. Focus groups are especially well suited to informing the development of education programmes (e.g. Song et al., 2014, who used focus groups to design a psycho-education programme for patients with schizophrenia and their carers). Bottorff et al. (2014) used the method to develop tailored messages for Aboriginal youth about the link between tobacco exposure and breast cancer. (Some of the issues arising from such usages are further debated in Chapter 2.)

Another important strand in the development of focus groups was their use in organizational research and development, practised mainly by staff at the Tavistock Institute in London during the 1940s. In common with marketing research, however, problems to be researched were, for the most part, defined by the companies for whom they effectively provided a consultancy, client-based service. This discouraged the emergence of a distinctive organizational focus group approach, since, as Kevern and Webb (2001) point out, the aims of the business sector (including, of course, marketing) are somewhat different to those of academic researchers. Nevertheless, some qualitative researchers may find themselves in a not dissimilar situation to that of research consultants, particularly when they are conducting focus groups under the auspices of a large-scale clinical trial, and multi-disciplinary working gives rise to its own important challenges. The very different lenses through which clinicians/practitioners and social scientists approach focus group research become apparent during the process of data interpretation and analysis (although it is argued in later chapters on analysis that this can, if handled constructively, afford a valuable resource for making sense of data).

Taking an approach very similar to that of the organizations who employed the research consultants at the Tavistock Institute, the nursing and medical professions, in particular, have used focus groups in order to ‘trouble shoot’ with regard to areas of clinical practice that have been deemed problematic. This includes research into clinical decision-making in relation to specific issues – e.g. performing episiotomies (Wu et al., 2013). Focus groups have even been employed in order to plan for the delivery of new medical procedures (Lane et al., 2011) – in this case, the first human intracortical visual prosthesis.

These research activities also extend to cover management issues – e.g. policy implementation in community nursing (Haycock-Stuart and Kean, 2013); or incident reporting in the labour and delivery context (Waters et al., 2012). Following the lead of the design discipline, researchers in information systems have, more recently, developed the use of focus groups to address their own specific questions (Belanger, 2012; O’hEocha et al., 2010), and they have been utilized in order to advance research on web design (Küster and Vila, 2011).

In sharp contrast to the marketing and business models, many researchers (again, predominantly in the health and social care fields) have used focus groups in accordance with their deeply held convictions regarding equity and empowerment, and have sought to ‘give voice’ to marginalized groups or those whose contribution has been muted. This body of work has drawn heavily on the model provided by community development with the ultimate aim of effecting change (whether this involves consciousness-raising, identification and publicizing of barriers or, even engagement with policy makers). This approach generally seeks to employ the sort of ‘dialogical research methods’ advocated by the Brazilian educationalist Freire (1972). Padilla argues that ‘the essential role of the investigators in dialogical research is to facilitate the production of knowledge for and by the subjects’ (Padilla, 1993, p. 158), thus challenging conventional assumptions regarding the power relationship between researcher and researched. Some of the projects in this tradition engage members of the community as co-researchers, and this may involve them in acting as focus group facilitators or co-moderators (e.g. Littlechild et al., 2015) and, even, data analysts (Makosky-Daley et al., 2010). The participatory research model has underpinned many pieces of research with ethnic minority groups, carried out with the aim of developing what Maiter et al. (2013) have described as a ‘shared critical consciousness’. This approach has chimed well with the orientation of feminist researchers, leading some to claim focus groups as an inherently feminist method, although Wilkinson (1999) suggests that this is perhaps slightly overstating the case. However, many such projects have focused on women, including a recent project in Thailand which sought to strengthen women weavers’ self-care (Nilvarangkul et al., 2013). Focus groups have also been employed in order to give voice to many other marginalized groups in a range of contexts – e.g. Khadka et al. (2012) who sought to elicit the perspectives of visually impaired children

Practitioner-researchers have also fused elements of the community development and organizational research model in order to carry out action research with fellow professionals in order to address specific aspects of practice – e.g. Jimbo et al. (2013) who convened focus groups with primary care clinicians and medical office staff in order to identify perceived barriers and facilitators with regard to using a web-based interactive decision aid for colorectal cancer screening. The example provided by Fardy and Jeffs (1994), however, provides the most detailed account to date of the use of focus groups as part of their approach to developing consensus guidelines on managing the menopause in general practice/family medicine.

Although most examples of such usages come from the health and social care fields, one participatory project in Baltimore involved research with fire union leaders and firefighters aimed to inform implementation of an urban firefighting canvassing programme (Frataroli et al., 2012). In the city of Philadelphia, which the authors note, is characterized by a history of experimentation in relation to its criminal justice system, Wood and Beierschmitt (2014) applied a participatory action research approach to address the practice of policing mental and behavioural health incidents.

Again drawing on the community development approach and, here, echoing its concern with addressing power differentials between researcher and participants, focus groups have frequently been employed in action-oriented projects, seeking to work with patients, clients, or community members in order to inform or, even to change, professional practice or policy. Examples include the work of Makosky-Daley et al. (2010) who explored, with American-Indians in Kansas and Missouri, the barriers to breast and colorectal cancer screening and use of the Internet for obtaining health-related information. Another example is afforded by Littlechild et al. (2015) who engaged with older people (including black and minority ethnic community members and people with dementia) in order to evaluate the impact of health services and policy. (These projects are further discussed in the next chapter, in relation to the specific advantages afforded by focus groups.)

Some researchers have also employed focus groups to good effect in communicating with or, even, working collaboratively with policy makers. Examples include the work of Wutich et al. (2010) who elicited the views of water policy makers in Arizona. In the context of research into sustainability and everyday practice of members of the general public, Prades et al. (2013) also sought to engage policy makers through an action research approach.

As suggested by this quick rundown of the various uses to which focus groups have been put, there is no one hard and fast approach. However, where researchers casually employ focus groups without weighing up the respective merits afforded by these very different traditions, they may miss out on possibilities. The advice dispensed via marketing research manuals, for example, although it may be helpful with regard to some aspects of focus group studies in other contexts, may be less appropriate where the method is being employed to achieve different ends.

While marketing researchers and political pollsters seek to ‘multiply up’ (Asbury, 1995) their findings from focus groups to make inferences about the population at large, health and social care or social science endeavours using focus groups are generally carried out on a much smaller scale and rely on sampling techniques (see Chapter 5) that preclude statistical generalization. Although much of the research carried out within the field of health and social care is also concerned with eliciting participants’ perspectives, the focus is less on establishing simply whether audience responses are positive or negative, as on teasing out the reasons behind these views; who holds particular views and why; and, ultimately, how attitudes are formed. Accordingly, health and social care researchers would be well-advised to look beyond the sampling strategies offered by marketing texts (see the discussion in Chapter 5), and to explore, instead, approaches which move beyond the notion of ‘representative’ sampling. Here researchers could learn important lessons from community development applications of focus groups, where recognition is given to the different lenses through which various sectors of a ‘community’, or social situation, may view events, suggesting that the researcher should be mindful of the need to consult with, or even simply to reflect the views of, these different constituencies – regardless of how many people are involved, or how ‘representative’ they are of the wider population.

Puchta and Potter (2002) argue that ‘attitudes’ are, in practice, the result of a series of analytic decisions on the part of those who profess to hold certain views. This references the capacity of focus groups to unpick these processes and to arrive at a deeper understanding of how ‘attitudes’ are articulated, contested, defended, qualified and revised through interaction. This moves away from the notion of measuring views enshrined in much research employing questionnaires, and explores, instead, the many shades of meaning that may be involved, allowing for inconsistencies and contradictions. Those usages of focus groups which capitalize on this feature of group discussions produce more nuanced explanations that can, ultimately, provide more useful – although more complex – insights (see the discussion in Chapters 8 and 9 on analysis). Moreover, community development approaches – and others which pay attention to the content and process of interaction within groups – are much better suited to dealing with such complexities, treating ‘messiness’ as data rather than as ‘noise’ or a source of frustration for the analyst.

Similarly, the organizational model of focus group usage tends to prioritize the concerns of employers – or professionals – rather than those of patients or clients. (This topic is re-visited in Chapter 2.) This raises a different set of questions, relating to why the research is being carried out; who has commissioned it; and whose interests it ultimately serves. Again, such topics are more fully addressed within the community development literature – and important insights can be gained from such discussions, even where the research is not specifically geared towards effecting change.

Returning to the myriad possibilities afforded by different approaches to using focus groups by these different models, each potentially has something to offer the researcher. However, uncritical acceptance of advice dispensed in different contexts can serve to merely exacerbate some of the tensions and challenges involved. There is no right or wrong way to go about doing focus group research; however, there are less- and better-considered ways, depending on the thought that has gone into selecting approaches or elements of different focus group traditions. The researcher is free to adapt, borrow, or combine any approaches that take his or her fancy, but should always be mindful of the fit between these and the research question at hand (Kitzinger and Barbour, 1999). The development of hybrids is entirely acceptable – and may even result in the most innovative use of focus groups and the most insightful data and analysis. As Morgan and Bottorff (2010) advise: researchers need to find what works for them and should ‘select a way of using focus groups that matches the goals of the project’ (p. 579). This, however, is easier said than done and the next two chapters set about equipping the focus group researcher to make a considered choice, having weighed up the advantages and potential disadvantages of focus groups and having decided where his/her own usage fits in relation to philosophical, methodological and disciplinary traditions.