Use of focus groups to identify health promotion strategies for the early detection of diabetic retinopathy

Background: People with diabetes do not regularly utilise eye services for the early prevention of vision loss due to diabetic eye disease. A community-based screening program has been initiated in Victoria to address this issue. To encourage people to take preventive eye health care measures, the most effective health promotion strategies were identified. Methods: Thirty-three health professionals were invited to attend focus groups. A sample of 35 people with diabetes was approached by their GPs or diabetes educators because of their motivation to participate in diabetes activities. Each group consisted of 10 members. Discussion points included the type of education messages available to people with diabetes; use of eye services among the participants with diabetes; and strategies required promoting the screening service.
Results: Five focus groups were conducted. The discussions highlighted that a great deal could be achieved by using local community networks to promote the benefits of early detection of diabetic retinopathy and local screening program. The group members recommended that particular attention be directed to general practitioners and their distribution of materials to patients. Key issues for planning and implementing the program were highlighted. The groups urged development of strategies to encourage people with diabetes in rural Victoria to participate in a program for the early detection of diabetic retinopathy.     

Use of focus groups in evaluating nutrition education materials

Focus groups were used to study public reaction to the nutrition education material, Dietary Guidelines for Americans, US Department of Agriculture bulletin HG232. Respondents were asked to comment specifically on the content and format of bulletin HG232 and to compare it with several other commonly used nutrition education print materials. The focus group discussions were recorded on videotape and the information was analyzed by two independent reviews of the tapes. The focus groups produced good information on perceived usability of a variety of nutrition education print materials and made specific suggestions for improving HG232. Although there are limitations to using focus groups as a data collection technique (data are not quantitative, making data analysis difficult; responses are influenced by group dynamics; and some suggestions made by the group are not appropriate), the richness and innovativeness of the data collected make focus groups a worthwhile evaluation method for nutritionists.     

Gender focus of target groups for alcohol health promotion strategies in New Zealand

This paper examines issues of gender equity in relation to choice of target groups for alcohol health promotion strategies. Previous research had established a segment of male drinkers, labelled' Young Heavy-drinking men', who were an appropriate target group for alcohol health promotion activities, such as mass-media advertising. The current study used multivariate cluster analysis to identify a segment of female drinkers who might also have been considered an appropriate target group. The analysis was based on the responses of 754 New Zealand women aged 14-65 years. The identified segment, labelled 'Young Heavy-drinking Women', accounted for 12% of the female drinkers, 30% of female consumption and 54% of the problems resulting from women's own drinking. In determining whether limited resources should focus on the male or female target group, a number of issues were considered. The men's segment contained more drinker, and accounted for considerably more of the total alcohol consumption and the alcohol-related problems. They also accounted for a greater proportion of those who were interested in drinking less, and who might therefore be supported by media campaigns encouraging moderate drinking. There were some data from the survey to suggest that considerably more women were experiencing harmful effects from men's drinking, than men were from women's drinking; thus there would be some benefit to women from a focus on male drinking. It was concluded that this benefit to women, on top of the other evidence supporting a male target group, would make it difficult, on the basis of the available data, to argue for a change away from the male target group.     

The role of focus groups in health education for cervical cancer among minority women

Focus groups were used in the development of community-based public health education designed to reduce mortality from cervical cancer among black women in Forsyth County, North Carolina. The educational goals of this National Cancer Institute (NCI) funded project were to increase the proportion of black women, age 18 and older, who obtain Pap smears on a regular basis and return for followup care when necessary. A series of four focus groups were conducted to help develop the conceptual basis for designing educational messages and materials. The groups were led by a black, female professional focus group moderator, and explored a variety of health-related topics ranging from general, ordinary concerns of daily living to knowledge and attitudes about cancer screening. The group discussions suggested that health is regarded as very important to the target population, particularly when related to family functioning. Regarding the Pap smear, most women knew about the test, but had little awareness of its role in the early detection of cervical cancer. Fear and fatalism were clearly the dominant, top-of-mind reactions to cancer, and there was little differentiation among sites or types of cancer. Despite the overall pessimism, the groups agreed that early diagnosis and treatment provide the best hope for good outcomes with cancer.     

Learning to care: a focus for values in health and environmental education

Health and environmental education seek to address the livingconditions and lifestyle choices that lead to health and environmentalproblems by motivating and teaching students how to participatein the reconstruction of themselves and society in accordancewith ecological values and the democratic values of social andeconomic justice. While an ethic of care unites health and environmentaleducation in this endeavour, liberal and conservative educationalpractices in the area of values education are dominated by discoursesof values relativity and neutrality. This paper seeks to providea case for teachers adopting a committed stance in teachingyoung people an ethic of care so that they may participate inthe personal and social changes needed to advance the transitiontowards a healthy and sustainable world. In particular, it drawsupon insights from the literature of environmental values education,which is characterized by intense debates between those of liberaland committed persuasions, to explore the ethical and pedagogicalissues involved in teaching for an ethic of care in both healthand environmental education.     

Use of focus groups to assess the educational needs of the primary care physician for the management of asthma

OBJECTIVES: To determine the educational needs of primary care physicians, in the management of patients with asthma. DESIGN: Focus group discussions with physicians, pharmacists, respiratory therapists and patients. SETTING: Metropolitan Edmonton, Alberta, Canada. PARTICIPANTS: Out of an original mail request to 100 potential recruits, 52 people attended the focus group sessions. These included physicians, pharmacists, respiratory therapists, adult patients and paediatric patients accompanied by their parents. MAIN OUTCOME MEASURE: Consensus of the specific group being interviewed using facilitator-mediated responses, to identify problems in the care of asthma patients and appropriate educational methods to improve the situation. RESULTS: Both diagnostic and treatment concerns were identified by the primary care physicians and others in the study. Confusion with infection was the most common diagnostic problem. Major treatment problems involved confusion about aspects of management strategy and a lack of communication between physicians, patients and other members of the health care team. Poor patient compliance and patients changing doctors frequently were also of major concern. There were inconsistencies in the treatment of asthma between physicians. While most physicians felt that they were up-to-date in management, Asthma Control Guidelines were seldom followed. CONCLUSIONS: There is an urgent need for continuing medical education, not only in management but also in communication with patients and with other members of the health care team. The data permit the development of an ongoing educational programme which is practical and designed to deal with the issues identified in this survey.     

Use of focus groups to explore consumers' preferences for content and graphic design of nutrition publications

The purpose of this research was to determine consumers' preferences for the content and design of nutrition print materials through the use of focus group interviews. Thirty-seven non-pregnant, non-nursing female consumers 20 to 50 years of age attended one of six focus group interviews. Existing nutrition print materials were used to stimulate discussion on content and graphic design features of the materials. Content features discussed included glossaries, quizzes, diet evaluation checklists, diet monitoring forms, and "factual" vs. "how to " information. Graphic design features discussed included color, format, size, organization, and general appearance. Participants were asked to discuss the personal impressions and practical considerations that formed the basis of their opinions regarding each feature and to elaborate on how the existing materials might be improved to meet their particular needs. Features that drew the most positive reactions were bright food colors, organizational cues, clear information and explanations, features that help personalize the issue being addressed, and "how to" information.     

Use of electronic health records can improve the health care industry's environmental footprint

Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7?million beneficiaries, eliminated 1,000 tons of paper records and 68?tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250?tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health.     

The role of high risk groups in environmental health research

High risk groups in environmental epidemiology are characterized by particularly high exposure levels with respect pollutant agents occurring in the various environmental matrices. An investigation of these groups may offer elements of interest also for the general population, which is exposed to lower levels of the agents at study, besides providing the evidence needed in order to implement appropriate remedial action. The discussion of four case-studies concerning populations resident in the neighbourhood of waste dump sites, power lines, incinerators and in areas with presence of fluoro-edenitic fibres, throws light on the rationale of studies on high risk groups. Special emphasis in placed on validity aspects, connections between epidemiologic studies and remediation interventions and ethical issues.     

Use of focus groups to identify concerns about dialysis. Choice Study.

BACKGROUND: Patients with end-stage renal disease (ESRD) may have quality-of-life (QOL) concerns that are not fully appreciated by their providers. The authors conducted focus groups with dialysis patients and dialysis professionals to determine whether this qualitative method would reveal differences between patients' and providers' views about: 1) domains of QOL that are affected by ESRD and dialysis; and 2) aspects of dialysis that affect QOL. METHODS: Separate focus group discussions were held with: 8 adult hemodialysis patients (mean age 50 years; 3 women; mean duration of dialysis 8.5 years), 5 adult peritoneal dialysis patients (mean age 54 years; 3 women; mean duration of dialysis 4.6 years), 8 nephrologists (mean of 12 years of dialysis practice), and 9 other health professionals involved in dialysis care (3 nurses, 2 dietitians, 2 social workers, and 2 technicians; mean of 10 years experience in dialysis care). Discussions were audiotaped, transcribed verbatim, and reviewed independently by three investigators to identify and categorize distinct thoughts. RESULTS: 1,271 distinct thoughts were identified and grouped into 20 related categories, which included ten QOL domains and ten aspects of dialysis that affect QOL. Compared with the professionals, the patients identified one additional relevant QOL domain (10 vs 9), and one additional aspect of dialysis that affects QOL (10 vs 9), and expressed more thoughts per domain (p < 0.05), although the contents of their comments were frequently similar. Among QOL domains, the numbers of related thoughts identified by patients and professionals, respectively, were: freedom/control (60, 89); social relationships (36, 11); anxiety (37, 4); role function (24, 10); energy (12, 10); body image (16, 4); sex (11, 21); mental attitude (21, 0); sleep (15, 1), and cognitive function (13, 7). Among aspects of dialysis that affect QOL, the numbers of thoughts identified by patients and professionals were: general dialysis issues (159, 105); relationships with staff (62, 110); patient education (63, 68); diet (44, 40); scheduling (57, 3); vascular or peritoneal access issues (31, 17), adaptation to dialysis (16, 14); dialysis dose (18, 8); symptoms (25, 0), and self-care (5, 24). CONCLUSIONS: Although health professionals have a good understanding of patient concerns about the effects of ESRD and dialysis, the focus group discussions revealed a breadth and depth of QOL concerns that they may not fully appreciate.     

Making sense of focus groups

CONTEXT: This paper provides an overview of the contribution of medical education research which has employed focus group methodology to evaluate both undergraduate education and continuing professional development. PRACTICALITIES AND PROBLEMS: It also examines current debates about the ethics and practicalities involved in conducting focus group research. It gives guidance as to how to go about designing and planning focus group studies, highlighting common misconceptions and pitfalls, emphasising that most problems stem from researchers ignoring the central assumptions which underpin the qualitative research endeavour. PRESENTING AND DEVELOPING FOCUS GROUP RESEARCH: Particular attention is paid to analysis and presentation of focus group work and the uses to which such information is put. Finally, it speculates about the future of focus group research in general and research in medical education in particular.     

焦点小组访谈法在评价艾滋病宣传教育材料中的应用

目的了解中央下发的艾滋病宣传教育材料在不同目标人群宣传教育工作中的使用情况。方法在重庆、黑龙江两省（市）组织基层工作人员、社区居民、在校大学生、娱乐场所从事商业性行为的女性工作者、农民工5类目标人群，运用焦点小组访谈方法了解艾滋病宣传教育材料的使用情况，了解需求、听取建议。结果中央下发的艾滋病宣传教育材料在基层工作中的使用取得了较好效果，普遍得到5类目标人群的接受和认可。群众对艾滋病都有基本的认识，但不同人群对宣传材料选择的喜好不同。基层工作人员认为实物型宣传材料在基层工作中广受欢迎，建议国家开发针对同性恋和性工作者群体的影视材料；社区居民喜欢有名人的海报和图文并茂的画册；大学生喜欢知识丰富的读本、挂图，以及明星演唱会形式的影视材料；性工作者喜欢综合介绍预防性病、妇科、避孕和艾滋病防治知识的小画册；农民工喜欢图文并茂、以图为主、文字浅显易懂的小画册。结论今后的艾滋病宣传教育材料应在满足不同目标人群需求的基础上开发和改进，以符合基层艾滋病防治工作的实际。     

Use of focus groups to understand African-Americans' dietary practices: Implications for modifying a food frequency questionnaire

ObjectiveTo generate information about dietary practices, food preferences and food preparation methods from African-Americans in Macon County, Alabama, as a precursor to an intervention designed to modify an existing dietary health questionnaire (DHQ).MethodAfrican-American males (30) and females (31) ages 20 to 75 years participated in eight focus groups in Macon County Alabama between June and July, 2007.ResultsThe core topics identified were dietary practices; food preferences; food preparation methods; fast food practices; and seasonal/specialty foods. The younger focus group participants reported consuming mostly fast foods such as hamburgers for lunch. Fruits, vegetables, salads, fish, chicken and sandwiches were the most common lunch foods for the older males and females. Across the groups, rice, cornbread and potatoes were reportedly the most commonly consumed starchy foods at dinner. Frying and baking were the most common cooking methods. Fewer participants reported removing the skin when cooking chicken versus those who did not remove. Traditional foods including fried green tomatoes and cracklings were selected for addition to the modified DHQ, while those not commonly consumed, were deleted.ConclusionsParticipants described high-fat traditional food preferences, common frying and addition of salted meats to vegetables, which informed the modification of a DHQ.     

Mental health case management as a locus for HIV prevention: Results from case-manager focus groups

HIV infection among people with severe mental illness (SMI) is a growing concern, and interventions have been designed to address HIV prevention among these individuals. However, little is known about the preparedness of mental health providers to support these interventions. This study concentrated on mental health case management as a locus for HIV-prevention services. Focus groups of case managers were conducted to learn participants' motivation to adopt HIV-prevention services and barriers/facilitators to such adoption. Participants reported they would be motivated to offer HIV prevention if services were to be presented in the context of existing client relationships and case-management tasks. Barriers and facilitators were discussed at client, provider, and community levels, and recommendations for training were offered. Findings have implications for diffusion of HIV-prevention services in case management, and the line of questioning in focus groups provides a basis for learning about other behavioral health service contexts as loci for disease prevention.During the time of research, Dr Encandela was Assistant Professor at the University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa.Wynne S. Korr, PhD, was Professor at University of Pittsburgh School of Social Work, Pittsburgh, Pa, during the time of research. Dr Korr is now Dean and Professor at the University of Illinois School of Social Work, Urbana, Ill.Kathleen Hulton, MPH, was Graduate Student Assistant at University of Pittsburgh, Pittsburgh, Pa, during the time of research. Ms Hulton is now with the University of Massachusetts at Amherst, Northampton, Mass.     

Use of health information systems in the Russian federation in the assessment of environmental health effects

The Russian Federation has made an intensive effort to compile and use information on the environment and human health. In 1996-1997, we evaluated the information that was collected and analyzed on the local (raion), regional (oblast), and federal levels with reference to its usefulness in the assessment of environmental health effects. The Russian Federation maintains standardized nationwide institutions that routinely collect health data in polyclinics and hospitals and then report to the national offices. The allocations of the workforce and the broad range of surveyed health outcomes are extensive, but a lack of systematic control of information quality limits the ability to take full advantage of these efforts. On the other hand, the hierarchical system of data collection has advantages over more decentralized or commercial health systems. A major weakness in the current reporting is the aggregation and transformation of data. Although this may not disturb the generation of health statistics, it seriously limits the use of regional and federal level data in the assessment of health effects of environmental exposures. In spite of limitations, some revised approaches to the analysis of existing data may be both feasible and fruitful. Combining information from routine data and newly collected data is likely to be the most effective way to assess the relationship between environmental exposures and diseases. Although there is a strong and justifiable desire to rapidly translate information of environmental health effects into policy alternatives, at present, it seems more useful to emphasize data quality, completeness, and plans for the use of data.