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Focus Groups – Steps, Examples and Guide

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Focus Group

Definition:

A focus group is a qualitative research method used to gather in-depth insights and opinions from a group of individuals about a particular product, service, concept, or idea.

The focus group typically consists of 6-10 participants who are selected based on shared characteristics such as demographics, interests, or experiences. The discussion is moderated by a trained facilitator who asks open-ended questions to encourage participants to share their thoughts, feelings, and attitudes towards the topic.

Focus groups are an effective way to gather detailed information about consumer behavior, attitudes, and perceptions, and can provide valuable insights to inform decision-making in a range of fields including marketing, product development, and public policy.

Types of Focus Group

The following are some types or methods of Focus Groups:

Traditional Focus Group

This is the most common type of focus group, where a small group of people is brought together to discuss a particular topic. The discussion is typically led by a skilled facilitator who asks open-ended questions to encourage participants to share their thoughts and opinions.

Mini Focus Group

A mini-focus group involves a smaller group of participants, typically 3 to 5 people. This type of focus group is useful when the topic being discussed is particularly sensitive or when the participants are difficult to recruit.

Dual Moderator Focus Group

In a dual-moderator focus group, two facilitators are used to manage the discussion. This can help to ensure that the discussion stays on track and that all participants have an opportunity to share their opinions.

Teleconference or Online Focus Group

Teleconferences or online focus groups are conducted using video conferencing technology or online discussion forums. This allows participants to join the discussion from anywhere in the world, making it easier to recruit participants and reducing the cost of conducting the focus group.

Client-led Focus Group

In a client-led focus group, the client who is commissioning the research takes an active role in the discussion. This type of focus group is useful when the client has specific questions they want to ask or when they want to gain a deeper understanding of their customers.

The following Table can explain Focus Group types more clearly

How To Conduct a Focus Group

To conduct a focus group, follow these general steps:

Define the Research Question

Identify the key research question or objective that you want to explore through the focus group. Develop a discussion guide that outlines the topics and questions you want to cover during the session.

Recruit Participants

Identify the target audience for the focus group and recruit participants who meet the eligibility criteria. You can use various recruitment methods such as social media, online panels, or referrals from existing customers.

Select a Venue

Choose a location that is convenient for the participants and has the necessary facilities such as audio-visual equipment, seating, and refreshments.

Conduct the Session

During the focus group session, introduce the topic, and review the objectives of the research. Encourage participants to share their thoughts and opinions by asking open-ended questions and probing deeper into their responses. Ensure that the discussion remains on topic and that all participants have an opportunity to contribute.

Record the Session

Use audio or video recording equipment to capture the discussion. Note-taking is also essential to ensure that you capture all key points and insights.

Analyze the data

Once the focus group is complete, transcribe and analyze the data. Look for common themes, patterns, and insights that emerge from the discussion. Use this information to generate insights and recommendations that can be applied to the research question.

When to use Focus Group Method

The focus group method is typically used in the following situations:

Exploratory Research

When a researcher wants to explore a new or complex topic in-depth, focus groups can be used to generate ideas, opinions, and insights.

Product Development

Focus groups are often used to gather feedback from consumers about new products or product features to help identify potential areas for improvement.

Marketing Research

Focus groups can be used to test marketing concepts, messaging, or advertising campaigns to determine their effectiveness and appeal to different target audiences.

Customer Feedback

Focus groups can be used to gather feedback from customers about their experiences with a particular product or service, helping companies improve customer satisfaction and loyalty.

Public Policy Research

Focus groups can be used to gather public opinions and attitudes on social or political issues, helping policymakers make more informed decisions.

Examples of Focus Group

Here are some real-time examples of focus groups:

A tech company wants to improve the user experience of their mobile app. They conduct a focus group with a diverse group of users to gather feedback on the app’s design, functionality, and features. The focus group consists of 8 participants who are selected based on their age, gender, ethnicity, and level of experience with the app. During the session, a trained facilitator asks open-ended questions to encourage participants to share their thoughts and opinions on the app. The facilitator also observes the participants’ behavior and reactions to the app’s features. After the focus group, the data is analyzed to identify common themes and issues raised by the participants. The insights gathered from the focus group are used to inform improvements to the app’s design and functionality, with the goal of creating a more user-friendly and engaging experience for all users.
A car manufacturer wants to develop a new electric vehicle that appeals to a younger demographic. They conduct a focus group with millennials to gather their opinions on the design, features, and pricing of the vehicle.
A political campaign team wants to develop effective messaging for their candidate’s campaign. They conduct a focus group with voters to gather their opinions on key issues and identify the most persuasive arguments and messages.
A restaurant chain wants to develop a new menu that appeals to health-conscious customers. They conduct a focus group with fitness enthusiasts to gather their opinions on the types of food and drinks that they would like to see on the menu.
A healthcare organization wants to develop a new wellness program for their employees. They conduct a focus group with employees to gather their opinions on the types of programs, incentives, and support that would be most effective in promoting healthy behaviors.
A clothing retailer wants to develop a new line of sustainable and eco-friendly clothing. They conduct a focus group with environmentally conscious consumers to gather their opinions on the design, materials, and pricing of the clothing.

Purpose of Focus Group

The key objectives of a focus group include:

Generating New Ideas and insights

Focus groups are used to explore new or complex topics in-depth, generating new ideas and insights that may not have been previously considered.

Understanding Consumer Behavior

Focus groups can be used to gather information on consumer behavior, attitudes, and perceptions to inform marketing and product development strategies.

Testing Concepts and Ideas

Focus groups can be used to test marketing concepts, messaging, or product prototypes to determine their effectiveness and appeal to different target audiences.

Gathering Customer Feedback

Informing decision-making.

Focus groups can provide valuable insights to inform decision-making in a range of fields including marketing, product development, and public policy.

Advantages of Focus Group

The advantages of using focus groups are:

In-depth insights: Focus groups provide in-depth insights into the attitudes, opinions, and behaviors of a target audience on a specific topic, allowing researchers to gain a deeper understanding of the issues being explored.
Group dynamics: The group dynamics of focus groups can provide additional insights, as participants may build on each other’s ideas, share experiences, and debate different perspectives.
Efficient data collection: Focus groups are an efficient way to collect data from multiple individuals at the same time, making them a cost-effective method of research.
Flexibility : Focus groups can be adapted to suit a range of research objectives, from exploratory research to concept testing and customer feedback.
Real-time feedback: Focus groups provide real-time feedback on new products or concepts, allowing researchers to make immediate adjustments and improvements based on participant feedback.
Participant engagement: Focus groups can be a more engaging and interactive research method than surveys or other quantitative methods, as participants have the opportunity to express their opinions and interact with other participants.

Limitations of Focus Groups

While focus groups can provide valuable insights, there are also some limitations to using them.

Small sample size: Focus groups typically involve a small number of participants, which may not be representative of the broader population being studied.
Group dynamics : While group dynamics can be an advantage of focus groups, they can also be a limitation, as dominant personalities may sway the discussion or participants may not feel comfortable expressing their true opinions.
Limited generalizability : Because focus groups involve a small sample size, the results may not be generalizable to the broader population.
Limited depth of responses: Because focus groups are time-limited, participants may not have the opportunity to fully explore or elaborate on their opinions or experiences.
Potential for bias: The facilitator of a focus group may inadvertently influence the discussion or the selection of participants may not be representative, leading to potential bias in the results.
Difficulty in analysis : The qualitative data collected in focus groups can be difficult to analyze, as it is often subjective and requires a skilled researcher to interpret and identify themes.

Characteristics of Focus Group

Small group size: Focus groups typically involve a small number of participants, ranging from 6 to 12 people. This allows for a more in-depth and focused discussion.
Targeted participants: Participants in focus groups are selected based on specific criteria, such as age, gender, or experience with a particular product or service.
Facilitated discussion: A skilled facilitator leads the discussion, asking open-ended questions and encouraging participants to share their thoughts and experiences.
I nteractive and conversational: Focus groups are interactive and conversational, with participants building on each other’s ideas and responding to one another’s opinions.
Qualitative data: The data collected in focus groups is qualitative, providing detailed insights into participants’ attitudes, opinions, and behaviors.
Non-threatening environment: Participants are encouraged to share their thoughts and experiences in a non-threatening and supportive environment.
Limited time frame: Focus groups are typically time-limited, lasting between 1 and 2 hours, to ensure that the discussion stays focused and productive.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Chapter 12. Focus Groups

Introduction.

Focus groups are a particular and special form of interviewing in which the interview asks focused questions of a group of persons, optimally between five and eight. This group can be close friends, family members, or complete strangers. They can have a lot in common or nothing in common. Unlike one-on-one interviews, which can probe deeply, focus group questions are narrowly tailored (“focused”) to a particular topic and issue and, with notable exceptions, operate at the shallow end of inquiry. For example, market researchers use focus groups to find out why groups of people choose one brand of product over another. Because focus groups are often used for commercial purposes, they sometimes have a bit of a stigma among researchers. This is unfortunate, as the focus group is a helpful addition to the qualitative researcher’s toolkit. Focus groups explicitly use group interaction to assist in the data collection. They are particularly useful as supplements to one-on-one interviews or in data triangulation. They are sometimes used to initiate areas of inquiry for later data collection methods. This chapter describes the main forms of focus groups, lays out some key differences among those forms, and provides guidance on how to manage focus group interviews.

Focus Groups: What Are They and When to Use Them

As interviews, focus groups can be helpfully distinguished from one-on-one interviews. The purpose of conducting a focus group is not to expand the number of people one interviews: the focus group is a different entity entirely. The focus is on the group and its interactions and evaluations rather than on the individuals in that group. If you want to know how individuals understand their lives and their individual experiences, it is best to ask them individually. If you want to find out how a group forms a collective opinion about something (whether a product or an event or an experience), then conducting a focus group is preferable. The power of focus groups resides in their being both focused and oriented to the group . They are best used when you are interested in the shared meanings of a group or how people discuss a topic publicly or when you want to observe the social formation of evaluations. The interaction of the group members is an asset in this method of data collection. If your questions would not benefit from group interaction, this is a good indicator that you should probably use individual interviews (chapter 11). Avoid using focus groups when you are interested in personal information or strive to uncover deeply buried beliefs or personal narratives. In general, you want to avoid using focus groups when the subject matter is polarizing, as people are less likely to be honest in a group setting. There are a few exceptions, such as when you are conducting focus groups with people who are not strangers and/or you are attempting to probe deeply into group beliefs and evaluations. But caution is warranted in these cases. [1]

As with interviewing in general, there are many forms of focus groups. Focus groups are widely used by nonresearchers, so it is important to distinguish these uses from the research focus group. Businesses routinely employ marketing focus groups to test out products or campaigns. Jury consultants employ “mock” jury focus groups, testing out legal case strategies in advance of actual trials. Organizations of various kinds use focus group interviews for program evaluation (e.g., to gauge the effectiveness of a diversity training workshop). The research focus group has many similarities with all these uses but is specifically tailored to a research (rather than applied) interest. The line between application and research use can be blurry, however. To take the case of evaluating the effectiveness of a diversity training workshop, the same interviewer may be conducting focus group interviews both to provide specific actionable feedback for the workshop leaders (this is the application aspect) and to learn more about how people respond to diversity training (an interesting research question with theoretically generalizable results).

When forming a focus group, there are two different strategies for inclusion. Diversity focus groups include people with diverse perspectives and experiences. This helps the researcher identify commonalities across this diversity and/or note interactions across differences. What kind of diversity to capture depends on the research question, but care should be taken to ensure that those participating are not set up for attack from other participants. This is why many warn against diversity focus groups, especially around politically sensitive topics. The other strategy is to build a convergence focus group , which includes people with similar perspectives and experiences. These are particularly helpful for identifying shared patterns and group consensus. The important thing is to closely consider who will be invited to participate and what the composition of the group will be in advance. Some review of sampling techniques (see chapter 5) may be helpful here.

Moderating a focus group can be a challenge (more on this below). For this reason, confining your group to no more than eight participants is recommended. You probably want at least four persons to capture group interaction. Fewer than four participants can also make it more difficult for participants to remain (relatively) anonymous—there is less of a group in which to hide. There are exceptions to these recommendations. You might want to conduct a focus group with a naturally occurring group, as in the case of a family of three, a social club of ten, or a program of fifteen. When the persons know one another, the problems of too few for anonymity don’t apply, and although ten to fifteen can be unwieldy to manage, there are strategies to make this possible. If you really are interested in this group’s dynamic (not just a set of random strangers’ dynamic), then you will want to include all its members or as many as are willing and able to participate.

There are many benefits to conducting focus groups, the first of which is their interactivity. Participants can make comparisons, can elaborate on what has been voiced by another, and can even check one another, leading to real-time reevaluations. This last benefit is one reason they are sometimes employed specifically for consciousness raising or building group cohesion. This form of data collection has an activist application when done carefully and appropriately. It can be fun, especially for the participants. Additionally, what does not come up in a focus group, especially when expected by the researcher, can be very illuminating.

Many of these benefits do incur costs, however. The multiplicity of voices in a good focus group interview can be overwhelming both to moderate and later to transcribe. Because of the focused nature, deep probing is not possible (or desirable). You might only get superficial thinking or what people are willing to put out there publicly. If that is what you are interested in, good. If you want deeper insight, you probably will not get that here. Relatedly, extreme views are often suppressed, and marginal viewpoints are unspoken or, if spoken, derided. You will get the majority group consensus and very little of minority viewpoints. Because people will be engaged with one another, there is the possibility of cut-off sentences, making it even more likely to hear broad brush themes and not detailed specifics. There really is very little opportunity for specific follow-up questions to individuals. Reading over a transcript, you may be frustrated by avenues of inquiry that were foreclosed early.

Some people expect that conducting focus groups is an efficient form of data collection. After all, you get to hear from eight people instead of just one in the same amount of time! But this is a serious misunderstanding. What you hear in a focus group is one single group interview or discussion. It is not the same thing at all as conducting eight single one-hour interviews. Each focus group counts as “one.” Most likely, you will need to conduct several focus groups, and you can design these as comparisons to one another. For example, the American Sociological Association (ASA) Task Force on First-Generation and Working-Class Persons in Sociology began its study of the impact of class in sociology by conducting five separate focus groups with different groups of sociologists: graduate students, faculty (in general), community college faculty, faculty of color, and a racially diverse group of students and faculty. Even though the total number of participants was close to forty, the “number” of cases was five. It is highly recommended that when employing focus groups, you plan on composing more than one and at least three. This allows you to take note of and potentially discount findings from a group with idiosyncratic dynamics, such as where a particularly dominant personality silences all other voices. In other words, putting all your eggs into a single focus group basket is not a good idea.

How to Conduct a Focus Group Interview/Discussion

Advance preparations.

Once you have selected your focus groups and set a date and time, there are a few things you will want to plan out before meeting.

As with interviews, you begin by creating an interview (or discussion) guide. Where a good one-on-one interview guide should include ten to twelve main topics with possible prompts and follow-ups (see the example provided in chapter 11), the focus group guide should be more narrowly tailored to a single focus or topic area. For example, a focus might be “How students coped with online learning during the pandemic,” and a series of possible questions would be drafted that would help prod participants to think about and discuss this topic. These questions or discussion prompts can be creative and may include stimulus materials (watching a video or hearing a story) or posing hypotheticals. For example, Cech ( 2021 ) has a great hypothetical, asking what a fictional character should do: keep his boring job in computers or follow his passion and open a restaurant. You can ask a focus group this question and see what results—how the group comes to define a “good job,” what questions they ask about the hypothetical (How boring is his job really? Does he hate getting up in the morning, or is it more of an everyday tedium? What kind of financial support will he have if he quits? Does he even know how to run a restaurant?), and how they reach a consensus or create clear patterns of disagreement are all interesting findings that can be generated through this technique.

As with the above example (“What should Joe do?”), it is best to keep the questions you ask simple and easily understood by everyone. Thinking about the sequence of the questions/prompts is important, just as it is in conducting any interviews.

Avoid embarrassing questions. Always leave an out for the “I have a friend who X” response rather than pushing people to divulge personal information. Asking “How do you think students coped?” is better than “How did you cope?” Chances are, some participants will begin talking about themselves without you directly asking them to do so, but allowing impersonal responses here is good. The group itself will determine how deep and how personal it wants to go. This is not the time or place to push anyone out of their comfort zone!

Of course, people have different levels of comfort talking publicly about certain topics. You will have provided detailed information to your focus group participants beforehand and secured consent. But even so, the conversation may take a turn that makes someone uncomfortable. Be on the lookout for this, and remind everyone of their ability to opt out—to stay silent or to leave if necessary. Rather than call attention to anyone in this way, you also want to let everyone know they are free to walk around—to get up and get coffee (more on this below) or use the restroom or just step out of the room to take a call. Of course, you don’t really want anyone to do any of these things, and chances are everyone will stay seated during the hour, but you should leave this “out” for those who need it.

Have copies of consent forms and any supplemental questionnaire (e.g., demographic information) you are using prepared in advance. Ask a friend or colleague to assist you on the day of the focus group. They can be responsible for making sure the recording equipment is functioning and may even take some notes on body language while you are moderating the discussion. Order food (coffee or snacks) for the group. This is important! Having refreshments will be appreciated by your participants and really damps down the anxiety level. Bring name tags and pens. Find a quiet welcoming space to convene. Often this is a classroom where you move chairs into a circle, but public libraries often have meeting rooms that are ideal places for community members to meet. Be sure that the space allows for food.

Researcher Note

When I was designing my research plan for studying activist groups, I consulted one of the best qualitative researchers I knew, my late friend Raphael Ezekiel, author of The Racist Mind . He looked at my plan to hand people demographic surveys at the end of the meetings I planned to observe and said, “This methodology is missing one crucial thing.” “What?” I asked breathlessly, anticipating some technical insider tip. “Chocolate!” he answered. “They’ll be tired, ready to leave when you ask them to fill something out. Offer an incentive, and they will stick around.” It worked! As the meetings began to wind down, I would whip some bags of chocolate candies out of my bag. Everyone would stare, and I’d say they were my thank-you gift to anyone who filled out my survey. Once I learned to include some sugar-free candies for diabetics, my typical response rate was 100 percent. (And it gave me an additional class-culture data point by noticing who chose which brand; sure enough, Lindt balls went faster at majority professional-middle-class groups, and Hershey’s minibars went faster at majority working-class groups.)

—Betsy Leondar-Wright, author of Missing Class , coauthor of The Color of Wealth , associate professor of sociology at Lasell University, and coordinator of staffing at the Mission Project for Class Action

During the Focus Group

As people arrive, greet them warmly, and make sure you get a signed consent form (if not in advance). If you are using name tags, ask them to fill one out and wear it. Let them get food and find a seat and do a little chatting, as they might wish. Once seated, many focus group moderators begin with a relevant icebreaker. This could be simple introductions that have some meaning or connection to the focus. In the case of the ASA task force focus groups discussed above, we asked people to introduce themselves and where they were working/studying (“Hi, I’m Allison, and I am a professor at Oregon State University”). You will also want to introduce yourself and the study in simple terms. They’ve already read the consent form, but you would be surprised at how many people ignore the details there or don’t remember them. Briefly talking about the study and then letting people ask any follow-up questions lays a good foundation for a successful discussion, as it reminds everyone what the point of the event is.

Focus groups should convene for between forty-five and ninety minutes. Of course, you must tell the participants the time you have chosen in advance, and you must promptly end at the time allotted. Do not make anyone nervous by extending the time. Let them know at the outset that you will adhere to this timeline. This should reduce the nervous checking of phones and watches and wall clocks as the end time draws near.

Set ground rules and expectations for the group discussion. My preference is to begin with a general question and let whoever wants to answer it do so, but other moderators expect each person to answer most questions. Explain how much cross-talk you will permit (or encourage). Again, my preference is to allow the group to pick up the ball and run with it, so I will sometimes keep my head purposefully down so that they engage with one another rather than me, but I have seen other moderators take a much more engaged position. Just be clear at the outset about what your expectations are. You may or may not want to explain how the group should deal with those who would dominate the conversation. Sometimes, simply stating at the outset that all voices should be heard is enough to create a more egalitarian discourse. Other times, you will have to actively step in to manage (moderate) the exchange to allow more voices to be heard. Finally, let people know they are free to get up to get more coffee or leave the room as they need (if you are OK with this). You may ask people to refrain from using their phones during the duration of the discussion. That is up to you too.

Either before or after the introductions (your call), begin recording the discussion with their collective permission and knowledge . If you have brought a friend or colleague to assist you (as you should), have them attend to the recording. Explain the role of your colleague to the group (e.g., they will monitor the recording and will take short notes throughout to help you when you read the transcript later; they will be a silent observer).

Once the focus group gets going, it may be difficult to keep up. You will need to make a lot of quick decisions during the discussion about whether to intervene or let it go unguided. Only you really care about the research question or topic, so only you will really know when the discussion is truly off topic. However you handle this, keep your “participation” to a minimum. According to Lune and Berg ( 2018:95 ), the moderator’s voice should show up in the transcript no more than 10 percent of the time. By the way, you should also ask your research assistant to take special note of the “intensity” of the conversation, as this may be lost in a transcript. If there are people looking overly excited or tapping their feet with impatience or nodding their heads in unison, you want some record of this for future analysis.

I’m not sure why this stuck with me, but I thought it would be interesting to share. When I was reviewing my plan for conducting focus groups with one of my committee members, he suggested that I give the participants their gift cards first. The incentive for participating in the study was a gift card of their choice, and typical processes dictate that participants must complete the study in order to receive their gift card. However, my committee member (who is Native himself) suggested I give it at the beginning. As a qualitative researcher, you build trust with the people you engage with. You are asking them to share their stories with you, their intimate moments, their vulnerabilities, their time. Not to mention that Native people are familiar with being academia’s subjects of interest with little to no benefit to be returned to them. To show my appreciation, one of the things I could do was to give their gifts at the beginning, regardless of whether or not they completed participating.

—Susanna Y. Park, PhD, mixed-methods researcher in public health and author of “How Native Women Seek Support as Survivors of Intimate Partner Violence: A Mixed-Methods Study”

After the Focus Group

Your “data” will be either fieldnotes taken during the focus group or, more desirably, transcripts of the recorded exchange. If you do not have permission to record the focus group discussion, make sure you take very clear notes during the exchange and then spend a few hours afterward filling them in as much as possible, creating a rich memo to yourself about what you saw and heard and experienced, including any notes about body language and interactions. Ideally, however, you will have recorded the discussion. It is still a good idea to spend some time immediately after the conclusion of the discussion to write a memo to yourself with all the things that may not make it into the written record (e.g., body language and interactions). This is also a good time to journal about or create a memo with your initial researcher reactions to what you saw, noting anything of particular interest that you want to come back to later on (e.g., “It was interesting that no one thought Joe should quit his job, but in the other focus group, half of the group did. I wonder if this has something to do with the fact that all the participants were first-generation college students. I should pay attention to class background here.”).

Please thank each of your participants in a follow-up email or text. Let them know you appreciated their time and invite follow-up questions or comments.

One of the difficult things about focus group transcripts is keeping speakers distinct. Eventually, you are going to be using pseudonyms for any publication, but for now, you probably want to know who said what. You can assign speaker numbers (“Speaker 1,” “Speaker 2”) and connect those identifications with particular demographic information in a separate document. Remember to clearly separate actual identifications (as with consent forms) to prevent breaches of anonymity. If you cannot identify a speaker when transcribing, you can write, “Unidentified Speaker.” Once you have your transcript(s) and memos and fieldnotes, you can begin analyzing the data (chapters 18 and 19).

Advanced: Focus Groups on Sensitive Topics

Throughout this chapter, I have recommended against raising sensitive topics in focus group discussions. As an introvert myself, I find the idea of discussing personal topics in a group disturbing, and I tend to avoid conducting these kinds of focus groups. And yet I have actually participated in focus groups that do discuss personal information and consequently have been of great value to me as a participant (and researcher) because of this. There are even some researchers who believe this is the best use of focus groups ( de Oliveira 2011 ). For example, Jordan et al. ( 2007 ) argue that focus groups should be considered most useful for illuminating locally sanctioned ways of talking about sensitive issues. So although I do not recommend the beginning qualitative researcher dive into deep waters before they can swim, this section will provide some guidelines for conducting focus groups on sensitive topics. To my mind, these are a minimum set of guidelines to follow when dealing with sensitive topics.

First, be transparent about the place of sensitive topics in your focus group. If the whole point of your focus group is to discuss something sensitive, such as how women gain support after traumatic sexual assault events, make this abundantly clear in your consent form and recruiting materials. It is never appropriate to blindside participants with sensitive or threatening topics .

Second, create a confidentiality form (figure 12.2) for each participant to sign. These forms carry no legal weight, but they do create an expectation of confidentiality for group members.

In order to respect the privacy of all participants in [insert name of study here], all parties are asked to read and sign the statement below. If you have any reason not to sign, please discuss this with [insert your name], the researcher of this study, I, ________________________, agree to maintain the confidentiality of the information discussed by all participants and researchers during the focus group discussion.

Signature: _____________________________ Date: _____________________

Researcher’s Signature:___________________ Date:______________________

Figure 12.2 Confidentiality Agreement of Focus Group Participants

Third, provide abundant space for opting out of the discussion. Participants are, of course, always permitted to refrain from answering a question or to ask for the recording to be stopped. It is important that focus group members know they have these rights during the group discussion as well. And if you see a person who is looking uncomfortable or like they want to hide, you need to step in affirmatively and remind everyone of these rights.

Finally, if things go “off the rails,” permit yourself the ability to end the focus group. Debrief with each member as necessary.

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Written by : Will Webster

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What is a focus group?

Focus groups are a type of qualitative research that bring together a small group of people representing a target audience. In a conversation usually guided by a moderator, this group will discuss a specific topic, products, services or concepts in a controlled environment.

The purpose of focus groups is to have a relaxed, open-ended conversation to gain insights that may not be possible from a survey or individual interview. They’re a very valuable tool in the research toolkit.

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focus group collaborating and sharing thoughts

Focus group roles

In any focus group there are typically three main roles being played.

When should a focus group be used?

Focus groups are a very popular type of research method that’s used in virtually every sector, from tech to academia, and marketing to political science.

Focus groups are a great choice if you want to go deep into a particular topic. If surveys are a brilliant tool for understanding what someone feels about something, focus groups help us to explore why – which is why the two work great in tandem. Focus groups give us an opportunity to capture the human element – the emotions and non-verbal cues that numbers often miss – and help us to explore underlying motivations.

Here are some of the most common focus group use cases.

New product or concept testing

If you’ve got a new product or concept in the works, a focus group can provide valuable feedback before you launch it into the market. You can get a sense of how people might react to it, what they like or dislike, and any improvements they might suggest.

In fact, focus groups are often used by brands to improve on and even co-create products in real time, with concepts discussed and iterated over the course of the session.

Understanding customers better

Focus groups are a great market research tool to help you better understand why customers think and behave the way they do. If, for example, a product isn’t selling as expected, a focus group with your customers can shine light on their barriers to purchase.

Beyond current customers, businesses can also use focus groups to better understand new prospects and bring their target customer segments to life.

Marketing and advertising

Before you invest a lot of money into a marketing or advertising campaign, you could use a focus group to test your messaging and visuals. Once any tweaks are made, you should be left with a campaign that will better resonate with your target audience.

Exploratory research

Focus groups are great when you don’t know what you don’t know. If you’re entering a new market or targeting a new customer segment, they can help you explore and understand the landscape.

When quantitative data isn’t enough

Sometimes, numbers and stats don’t tell the whole story. If you have quantitative data but want to delve deeper into the ‘why’ and ‘how’, focus groups are a great way to do that.

Focus groups can provide rich, qualitative insights that quantitative research methods might miss. But it’s important to remember that they aren’t right for every situation.

If you need to make definitive conclusions about a large population, a quantitative survey will be a better option. The same applies if you’re focusing on sensitive topics that people may not feel comfortable discussing in a group setting, such as financial or health matters.

At the end of the day, the best research method for your use case really depends on your specific goals, who you’re collecting insights from and the nature of the information you’re seeking.

Types of focus groups

Focus groups can take different forms depending on the objectives of the study, the participants, and the nature of the topic being discussed. Ranging from the common to the seldom used, here are the different types of focus group methods.

One-way focus groups

The classic focus group format: a moderator leads a discussion among a group of participants about a particular topic.

Two-way focus groups

Here one group watches another , observing the discussion, interactions and conclusions. This format is used to provide additional insights and a deeper understanding of the topic.

Dual-moderator focus groups

A focus group with two moderators. One ensures the session runs along smoothly; the other makes sure all topics are covered. The aim of this format is to create a more comprehensive discussion.

Dueling-moderator focus groups

Like dual moderator focus groups in that there are two moderators, but here the moderators take opposing viewpoints on the topic. The purpose of this format is to help the participants consider and discuss a wider range of points.

Respondent-moderator focus groups

Where one respondent – or several – plays the role of moderator. This format counters the unintentional bias that can come from a single moderator, and encourages variety in the discussion,

Mini focus groups, dyads and triads

Exactly as they sound, mini focus groups involve fewer participants than usual. These smaller groups – typically made up of 4 to 5 participants – are well suited to complex topics.

There are also focus groups involving two participants and a moderator – known as dyads – and groups with three participants and a moderator, which are known as triads.

Remote focus groups

An online focus group. This format is a great way to give your research a wider geographical reach and access a greater pool of people.

How to run a focus group: Step-by-step guide

The focus groups that generate the best insights are often those that are planned best. Here’s our guide for every step of the process.

1. Research and define your goal

The first step is to identify what you want to learn from the focus group. Are you testing a new product or exploring consumer behavior? Maybe you’re seeking feedback on a marketing campaign or getting to know a new target market?

2. Choose a moderator

If planning is the key ingredient for a great focus group, a good moderator is a close second.

The moderator is the most important person in the room, and needs to be someone who can facilitate discussions, manage a group of strangers, and keep the conversation on track and be able to elicit the feedback desired..

3. Choose a location

The most important consideration here is how you create a comfortable, non-judgmental environment where participants feel safe to share their thoughts and opinions.

And you also need to answer the big question: in-person or online? In-person sessions typically enable better conversation and group chemistry, while online focus groups give you access to a much bigger, broader pool of potential participants.

4. Recruit the right participants

Next, work out who you need to participate in the focus group to reach your goal. Whatever your target audience is, you want the respondents to meet the baseline criteria – noting that the ideal size for a focus group is typically between 6 and 8 participants, and that none of your participants should know each other.

Once you’ve worked out who you want there, you need to recruit them. This is often done via ads, invitations to your CMS database or a third party. Incentives, like cash or gift cards, are typically used to encourage participation.

5. Create a discussion guide

In tandem with step four, it’s time for the moderator to develop a document that will guide the discussion. Based on your research goal or goals, this guide should include a list of focus group questions or topics you want to cover during the session, and strike a good balance between structured and flexible – so you can gather the data you need while not discouraging spontaneous conversation.

6. Conduct the focus group

The big day has arrived. With everything in place, all you need to do is make sure that every participant is given an opportunity to speak.

Don’t forget to record the focus group (with the participants’ consent) and make efforts to capture non-verbal cues from participants.

7. Debrief and iterate

Debrief after each session to understand your key findings, and if necessary, edit the discussion guide for future focus groups based on your learnings and observations so far.

8. Analyse and report on the findings

Now’s time to transcribe your recordings and analyse them for key themes and insights. The aim here is to interpret your findings in the context of your initial goal.

It’s best practice to present your key focus group results and findings in a report, alongside recommendations based on them.

How many people should be in a focus group?

The ideal size of a focus group is generally said to fall between 6 and 8 participants .Why is this the sweet spot? Because it’s small enough to ensure that everyone has a chance to speak and share their views, but large enough to provide a variety of perspectives.

That said, the goal of your research and the topic(s) you’re focusing on can change things. For instance, if the topic is particularly complex or sensitive, a smaller group may be better.

If you have a larger pool of potential focus group attendees, best practice would be to split them up and conduct multiple focus groups, instead of one focus group with too many people.

Focus groups vs in-depth interviews

Focus groups and in-depth interviews are two of the most popular forms of qualitative research . They do, however, differ in what they can bring to your research – which is why they’re often used in tandem to answer a single research question.

The benefits of focus groups over in-depth interviews

Focus groups are designed to encourage interaction between a collection of people, often revealing insights that may not surface in a one-on-one conversation. They give researchers an opportunity to observe group dynamics and how individuals influence each other and can be influenced themselves.

A big advantage of focus groups is their efficiency – in one session you can gather a broad range of insights from multiple individuals.

The benefits of in-depth interviews over focus groups

In-depth interviews are one-on-one discussions between a researcher and participant.

Whereas focus groups are by definition a group discussion, in-depth interviews provide a more personal and detailed exploration of an individual’s perspectives and experiences. Because of this, interviews are great for sensitive or personal topics, and the interviewee won’t be as influenced by others when giving their honest opinions – which is a risk with focus groups.

Another benefit of in-depth interviews is that the researcher/interviewer has greater control over the conversation, which gives you a greater chance of covering all topics thoroughly.

Advantages and disadvantages of focus groups

Like any research method, focus groups come with a variety of pros and cons that are typically associated with any type of qualitative research.

Advantages of focus groups

They give you qualitative insights . Exploring the ‘why’ behind people’s behaviors, views and decisions
They enable interactive discussions . Often leading to deeper insights as participants explore topics and ideas
They give immediate findings . Observing real-time reactions means you can quickly implement them on a concept, product or campaign
You can capture non-verbal data . Non-verbal cues and body language often give a further layer of insight into participants’ attitudes and feelings
You have real-time flexibility . The moderator can steer the conversation to explore new points and topics if they arise

Disadvantages of focus groups

Your sample size is small . And less likely to represent how the total population feels
You’re at risk of conforming beliefs . Meaning that participants may change what they’re saying to match the majority opinion or the loudest voice
They require a skilled moderator . Your findings could be a lot less valuable without one
Data analysis can be time consuming . If you’re hosting multiple groups, transcribing and deciphering data can be labour-intensive and complex
They can be expensive (especially if done in person) . You may need to pay for participant travel, accommodation and incentives, venue rent and even moderator fees

Related resources

Market intelligence 10 min read, marketing insights 11 min read.

Analysis & Reporting

Thematic Analysis 11 min read

Ethnographic research 11 min read, post event survey questions 10 min read, data saturation in qualitative research 8 min read, how to determine sample size 12 min read, request demo.

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What Is a Focus Group?

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

A focus group is a qualitative research method that involves facilitating a small group discussion with participants who share common characteristics or experiences that are relevant to the research topic. The goal is to gain insights through group conversation and observation of dynamics.

a focus group of people sat on chairs in a circle. one person is making notes on a clipboard.

In a focus group:

A moderator asks questions and leads a group of typically 6 to 12 pre-screened participants through a discussion focused on a particular topic.
Group members are encouraged to talk with one another, exchange anecdotes, comment on each others’ experiences and points of view, and build on each others’ responses.
The goal is to create a candid, natural conversation that provides insights into the participants’ perceptions, attitudes, beliefs, and opinions on the topic.
Focus groups capitalize on group dynamics to elicit multiple perspectives in a social environment as participants are influenced by and influence others through open discussion.
The interactive responses allow researchers to quickly gather more contextual, nuanced qualitative data compared to surveys or one-on-one interviews.

Focus groups allow researchers to gather perspectives from multiple people at once in an interactive group setting. This group dynamic surfaces richer responses as participants build on each other’s comments, discuss issues in-depth, and voice agreements or disagreements.

It is important that participants feel comfortable expressing diverse viewpoints rather than being pressured into a consensus.

Focus groups emerged as an alternative to questionnaires in the 1930s over concerns that surveys fostered passive responses or failed to capture people’s authentic perspectives.

During World War II, focus groups were used to evaluate military morale-boosting radio programs. By the 1950s focus groups became widely adopted in marketing research to test consumer preferences.

A key benefit K. Merton highlighted in 1956 was grouping participants with shared knowledge of a topic. This common grounding enables people to provide context to their experiences and allows contrasts between viewpoints to emerge across the group.

As a result, focus groups can elicit a wider range of perspectives than one-on-one interviews.

Step 1 : Clarify the Focus Group’s Purpose and Orientation

Clarify the purpose and orientation of the focus group (Tracy, 2013). Carefully consider whether a focus group or individual interviews will provide the type of qualitative data needed to address your research questions.

Determine if the interactive, fast-paced group discussion format is aligned with gathering perspectives vs. in-depth attitudes on a topic.

Consider incorporating special techniques like extended focus groups with pre-surveys, touchstones using creative imagery/metaphors to focus the topic, or bracketing through ongoing conceptual inspection.

For example

A touchstone in a focus group refers to using a shared experience, activity, metaphor, or other creative technique to provide a common reference point and orientation for grounding the discussion.

The purpose of Mulvale et al. (2021) was to understand the hospital experiences of youth after suicide attempts.

The researchers created a touchstone to focus the discussion specifically around the hospital visit. This provided a shared orientation for the vulnerable participants to open up about their emotional journeys.

In the example from Mulvale et al. (2021), the researchers designated the hospital visit following suicide attempts as the touchstone. This means:

The visit served as a defining shared experience all youth participants could draw upon to guide the focus group discussion, since they unfortunately had this in common.
Framing questions around recounting and making meaning out of the hospitalization focused the conversation to elicit rich details about interactions, emotions, challenges, supports needed, and more in relation to this watershed event.
The hospital visit as a touchstone likely resonated profoundly across youth given the intensity and vulnerability surrounding their suicide attempts. This deepened their willingness to open up and established group rapport.

So in this case, the touchstone concentrated the dialogue around a common catalyst experience enabling youth to build understanding, voice difficulties, and potentially find healing through sharing their journey with empathetic peers who had endured the same trauma.

Step 2 : Select a Homogeneous Grouping Characteristic

Select a homogeneous grouping characteristic (Krueger & Casey, 2009) to recruit participants with a commonality, like shared roles, experiences, or demographics, to enable meaningful discussion.

A sample size of between 6 to 10 participants allows for adequate mingling (MacIntosh 1993).

More members may diminish the ability to capture all viewpoints. Fewer risks limited diversity of thought.

Balance recruitment across income, gender, age, and cultural factors to increase heterogeneity in perspectives. Consider screening criteria to qualify relevant participants.

Choosing focus group participants requires balancing homogeneity and diversity – too much variation across gender, class, profession, etc., can inhibit sharing, while over-similarity limits perspectives. Groups should feel mutual comfort and relevance of experience to enable open contributions while still representing a mix of viewpoints on the topic (Morgan 1988).

Mulvale et al. (2021) determined grouping by gender rather than age or ethnicity was more impactful for suicide attempt experiences.

They fostered difficult discussions by bringing together male and female youth separately based on the sensitive nature of topics like societal expectations around distress.

Step 3 : Designate a Moderator

Designate a skilled, neutral moderator (Crowe, 2003; Morgan, 1997) to steer productive dialogue given their expertise in guiding group interactions. Consider cultural insider moderators positioned to foster participant sharing by understanding community norms.

Define moderator responsibilities like directing discussion flow, monitoring air time across members, and capturing observational notes on behaviors/dynamics.

Choose whether the moderator also analyzes data or only facilitates the group.

Mulvale et al. (2021) designated a moderator experienced working with marginalized youth to encourage sharing by establishing an empathetic, non-judgmental environment through trust-building and active listening guidance.

Step 4 : Develop a Focus Group Guide

Develop an extensive focus group guide (Krueger & Casey, 2009). Include an introduction to set a relaxed tone, explain the study rationale, review confidentiality protection procedures, and facilitate a participant introduction activity.

Also include guidelines reiterating respect, listening, and sharing principles both verbally and in writing.

Group confidentiality agreement

The group context introduces distinct ethical demands around informed consent, participant expectations, confidentiality, and data treatment. Establishing guidelines at the outset helps address relevant issues.

Create a group confidentiality agreement (Berg, 2004) specifying that all comments made during the session must remain private, anonymous in data analysis, and not discussed outside the group without permission.

Have it signed, demonstrating a communal commitment to sustaining a safe, secure environment for honest sharing.

Berg (2004) recommends a formal signed agreement prohibiting participants from publicly talking about anything said in the focus group without permission. This reassures members their personal disclosures are safeguarded.

Develop questions starting general then funneling down to 10-12 key questions on critical topics. Integrate think/pair/share activities between question sets to encourage inclusion. Close with a conclusion to summarize key ideas voiced without endorsing consensus.

Krueger and Casey (2009) recommend structuring focus group questions in five stages:

Opening Questions:

Start with easy, non-threatening questions to make participants comfortable, often related to their background and experience with the topic.
Get everyone talking and open up initial dialogue.
Example: “Let’s go around and have each person share how long you’ve lived in this city.”

Introductory Questions:

Transition to the key focus group objectives and main topics of interest.
Remain quite general to provide baseline understanding before drilling down.
Example: “Thinking broadly, how would you describe the arts and cultural offerings in your community?”

Transition Questions:

Serve as a logical link between introductory and key questions.
Funnel participants toward critical topics guided by research aims.
Example: “Specifically related to concerts and theatre performances, what venues in town have you attended events at over the past year?”

Key Questions:

Drive at the heart of study goals, and issues under investigation.
Ask 5-10 questions that foster organic, interactive discussion between participants.
Example: “What enhances or detracts from the concert-going experience at these various venues?”

Ending Questions:

Provide an opportunity for final thoughts or anything missed.
Assess the degree of consensus on key topics.
Example: “If you could improve just one thing about the concert and theatre options here, what would you prioritize?”

It is vital to extensively pilot test draft questions to hone the wording, flow, timing, tone and tackle any gaps to adequately cover research objectives through dynamic group discussion.

Step 5 : Prepare the focus group room

Prepare the focus group room (Krueger & Casey, 2009) attending to details like circular seating for eye contact, centralized recording equipment with backup power, name cards, and refreshments to create a welcoming, affirming environment critical for participants to feel valued, comfortable engaging in genuine dialogue as a collective.

Arrange seating comfortably in a circle to facilitate discussion flow and eye contact among members. Decide if space for breakout conversations or activities like role-playing is needed.

Refreshments

Coordinate snacks or light refreshments to be available when focus group members arrive, especially for longer sessions. This contributes to a welcoming atmosphere.
Even if no snacks are provided, consider making bottled water available throughout the session.
Set out colorful pens and blank name tags for focus group members to write their preferred name or pseudonym when they arrive.
Attaching name tags to clothing facilitates interaction and expedites learning names.
If short on preparation time, prepare printed name tags in advance based on RSVPs, but blank name tags enable anonymity if preferred.

Krueger & Casey (2009) suggest welcoming focus group members with comfortable, inclusive seating arrangements in a circle to enable eye contact. Providing snacks and music sets a relaxed tone.

Step 6 : Conduct the focus group

Conduct the focus group utilizing moderation skills like conveying empathy, observing verbal and non-verbal cues, gently redirecting and probing overlooked members, and affirming the usefulness of knowledge sharing.

Use facilitation principles (Krueger & Casey, 2009; Tracy 2013) like ensuring psychological safety, mutual respect, equitable airtime, and eliciting an array of perspectives to expand group knowledge. Gain member buy-in through collaborative review.

Record discussions through detailed note-taking, audio/video recording, and seating charts tracking engaged participation.

The role of moderator

The moderator is critical in facilitating open, interactive discussion in the group. Their main responsibilities are:

Providing clear explanations of the purpose and helping participants feel comfortable
Promoting debate by asking open-ended questions
Drawing out differences of opinion and a range of perspectives by challenging participants
Probing for more details when needed or moving the conversation forward
Keeping the discussion focused and on track
Ensuring all participants get a chance to speak
Remaining neutral and non-judgmental, without sharing personal opinions

Moderators need strong interpersonal abilities to build participant trust and comfort sharing. The degree of control and input from the moderator depends on the research goals and personal style.

With multiple moderators, roles, and responsibilities should be clear and consistent across groups. Careful preparation is key for effective moderation.

Mulvale et al. (2021) fostered psychological safety for youth to share intense emotions about suicide attempts without judgment. The moderator ensured equitable speaking opportunities within a compassionate climate.

Krueger & Casey (2009) advise moderators to handle displays of distress empathetically by offering a break and emotional support through active listening instead of ignoring reactions. This upholds ethical principles.

Advantages and disadvantages of focus groups

Focus groups efficiently provide interactive qualitative data that can yield useful insights into emerging themes. However, findings may be skewed by group behaviors and still require larger sample validation through added research methods. Careful planning is vital.

Efficient way to gather a range of perspectives in participants’ own words in a short time
Group dynamic encourages more complex responses as members build on others’ comments
Can observe meaningful group interactions, consensus, or disagreements
Flexibility for moderators to probe unanticipated insights during discussion
Often feels more comfortable sharing as part of a group rather than one-on-one
Helps participants recall and reflect by listening to others tell their stories

Disadvantages

Small sample size makes findings difficult to generalize
Groupthink: influential members may discourage dissenting views from being shared
Social desirability bias: reluctance from participants to oppose perceived majority opinions
Requires highly skilled moderators to foster inclusive participation and contain domineering members
Confidentiality harder to ensure than with individual interviews
Transcriptions may have overlapping talk that is difficult to capture accurately
Group dynamics adds layers of complexity for analysis beyond just the content of responses

Goss, J. D., & Leinbach, T. R. (1996). Focus groups as alternative research practice: experience with transmigrants in Indonesia. Area , 115-123.

Kitzinger, J. (1994). The methodology of focus groups: the importance of interaction between research participants . Sociology of health & illness , 16 (1), 103-121.

Kitzinger J. (1995). Introducing focus groups. British Medical Journal, 311 , 299-302.

Morgan D.L. (1988). Focus groups as qualitative research . London: Sage.

Mulvale, G., Green, J., Miatello, A., Cassidy, A. E., & Martens, T. (2021). Finding harmony within dissonance: engaging patients, family/caregivers and service providers in research to fundamentally restructure relationships through integrative dynamics . Health Expectations , 24 , 147-160.

Powell, R. A., Single, H. M., & Lloyd, K. R. (1996). Focus groups in mental health research: enhancing the validity of user and provider questionnaires . International Journal of Social Psychiatry , 42 (3), 193-206.

Puchta, C., & Potter, J. (2004). Focus group practice . Sage.

Redmond, R. A., & Curtis, E. A. (2009). Focus groups: principles and process. Nurse researcher , 16 (3).

Smith, J. A., Scammon, D. L., & Beck, S. L. (1995). Using patient focus groups for new patient services. The Joint Commission Journal on Quality Improvement , 21 (1), 22-31.

Smithson, J. (2008). Focus groups. The Sage handbook of social research methods , 357-370.

White, G. E., & Thomson, A. N. (1995). Anonymized focus groups as a research tool for health professionals. Qualitative Health Research , 5 (2), 256-261.

Download PDF slides of the presentation ‘ Conducting Focus Groups – A Brief Overview ‘

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World Leaders in Research-Based User Experience

Focus Groups 101

July 31, 2022 2022-07-31

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It is no secret that the field of user experience often favors objective, observational research methods over subjective, attitudinal methods. After all, when something is observed, with proof that it has actually happened, it can be hard to argue against it. However, it takes more than observational research to truly empathize and understand the full complexity of a person’s experience, which includes emotional experiences, mindsets, values, and belief systems. Since there is no other way to gather this data (at the writing of this article, mind reading with neural implants is not possible) researchers must use attitudinal methods to solicit the thoughts and opinions of target customers. A focus group is one of these methods.

Definition: A focus group is a qualitative, attitudinal research method in which a facilitator conducts a meeting or workshop (typically about 1–2 hours long) with a group of 6–9 people to discuss issues and concerns about their experiences with a product or service. The term “focus” relates to the role of the facilitator, who maintains the group’s focus on certain topics during discussions.

Traditionally, focus groups have been a market-research method, used to get a sense of some aspect of a product, service, or concept. In these settings, the focus would typically be on certain words, graphics, videos, or other noninteractive media. All participants are presented with the media as a group and then prompted to provide their thoughts to the facilitator and the rest of the group.

Generally speaking, focus groups can provide useful information about your customers’ overall opinions and their impressions of a product or service.

Focus groups are notoriously problematic and often improperly used. Here are some of their limitations:

They do not provide detailed insights on usability. People will comment on what is shown or remembered and offer opinions, so, by their nature, focus groups cannot provide any objective information on behavior when using a product or service. Thus, they cannot provide detailed usability insights, which would be best found with a usability test or field study . Even if there are some usability insights uncovered when presenting a design, products are almost never used by a whole committee; they’re used individually.
People don’t always know what they will do or what will MOST benefit them in the future. In many focus groups, participants are asked whether they would use a particular product. But users do not always do what they say they will do. So, while it’s helpful to listen to customers’ concerns, preferences, or requests for features or product offerings — especially to uncover unmet user needs — the requests themselves are not always going to be the best solutions to address customers’ needs in a systematic and prioritized way.
Negativity bias often results in people more readily recalling what was bad about an experience (particularly if it was not a great one), which can skew the discussion negatively for everyone else.
The peak-end rule can cause people to overly focus on the most memorable and most recent moments, at the expense of other possibly more-meaningful ones.
Priming can cause participants to overemphasize an aspect of their experience, because it so happened that someone else mentioned it and made them remember it.
Group dynamics may impact how much (or how little) people share. Strong personalities in the group may affect what and how much is shared. Depending on the focus group’s format, it may disproportionately represent the opinions of those who are more talkative or quick to answer. Groupthink is also more likely to occur in these settings if only verbal contributions are given attention. To paraphrase my colleague Sarah Gibbons : a poorly run focus group can be a great way to pay 9 people for the opinions of three.

Given these limitations, focus groups should NOT be utilized in the following contexts:

Evaluating a design’s usability
Evaluating workflows
Creating a list of design requirements
Determining a UI’s impact on emotions
Quantifying satisfaction or other sentiments

Despite these shortcomings, there are some good reasons to consider a focus group:

Participants with similar goals or perspectives can build on each other’s responses or recall experiences in greater detail. Sometimes during interviews, a participant might have trouble recalling all the details of an experience. However, hearing another participant mention something related may trigger the recollection of an important detail, which would otherwise get skimmed over in an interview.
They can help teams clarify users’ mental models and language (vocabulary) around the problem space during discovery phases , before conducting further research. While you should generally run a pilot study for most research studies anyway, a focus group can help researchers rework a research plan or facilitator guide with language that could be more user-centered.
They are a time-efficient method for the researcher. Rather than dedicate 9–12 hours interviewing 6–9 individual participants, a researcher can dedicate 1–2 hours to gather the perspectives of 6–9 people at the same time. It can be a quick way to learn from many people and perspectives (and certainly a 100% improvement to conducting no research at all). These can be especially time-efficient if the researcher is facilitating the focus group online rather than in person.
When run properly, they can yield rich qualitative insights due to a format similar to semistructured interviews . Unlike questionnaires — which can sometimes limit the level of detail covered — focus groups give facilitators the flexibility to explore topics in which the participants are interested. This format is especially useful if the team is still in early stages of product development and trying to discover new information about the problem space.

Given these benefits, focus groups are BEST utilized in the following contexts:

Early discovery research to gauge customer familiarity or interest in a concept and initial impressions
Understanding users’ mental models and expectations
Cocreation workshops with sponsored customers

It’s fair to say that focus groups are often unfairly maligned, considering the many benefits they can yield with relatively less time commitment compared to other methods. The key to reaping these benefits and mitigating limitations is to use a combination of other research methods (like other behavioral or attitudinal methods), and having a strong research plan.

Here are the key things to consider when planning your focus group:

1. Recruit participants that are representative of your target audience(s).

Who do you want to learn about? What specific segment of users are you interested in? Even if your user is “everybody,” use personas , archetypes , or jobs-to-be-done to identify key recruiting criteria . Recruiting is a tricky balance of finding similar user motivations and goals (not demographics) while inviting a mix of backgrounds to reduce bias from other sources — such as having an overly westernized sample when studying a global offering.

2. Note potential sources of bias from the focus group’s structure.

Note who is not included, and why, for consideration during analysis and when strategizing future research. Is it a different segment that’s intentionally excluded? Lack of response? Lack of interest/trust? Bias is difficult to totally eliminate, but awareness of sources of bias can help during analysis and might inform future research. For example:

With online focus groups, there may be potential participants who are excluded from participating (be it due to a poor internet connection, lack of a desktop device, or low literacy in certain digital tools). Thus, they may not be able join a video chat or, if they do join, they may be less likely to participate when using an unfamiliar online-meeting tool or whiteboard platform for the first time.
With in-person focus groups, it’s fair to assume that the study will only involve participants from the immediate commutable vicinity (i.e., within the city or state), especially if travel is not funded by the study or if insufficient notice is provided for those commuting from further distances.
Is your focus group accessible? This is relevant for both in-person and online focus groups. Can disabled participants get into the facility and participate readily? Can nonverbal participants contribute?

3. Treat your focus group like a workshop . Make participants comfortable with participating, verbally or nonverbally.

As you plan your agenda for the focus group, remember that most of your participants likely do not know each other and will be asked to speak honestly, potentially revealing information that may make them feel vulnerable or unlike others. Some people may do it, others may not. Consider having the following in your focus group:

It gives a structured way for participants to build rapport with the facilitator and with each other.
It builds participants’ confidence, in themselves and in the format (particularly if you’re using online-meeting tools or digital whiteboards). Note: Do not “break the ice” with highly personal or sensitive topics, which will likely cause participants to withdraw instead. (In fact, those types of answers are probably not going to come easily in a focus-group format, even with the most “warmed up” group. These types of questions are better suited to 1:1 interviews).
Both written and verbal participation opportunities As with any other UX workshop , offer multiple methods of engagement (verbal and nonverbal) to encourage maximum participation and contribution. This ensures that less vocal or nonnative speakers feel comfortable contributing. You can also use the diverge–converge technique to maximize participation while decreasing bias potential. Note: If covering sensitive topics, offer an anonymous way to contribute (or, again, consider a different, more-private method altogether).

4. Have a (written) plan and guide.

Construct your prompts in advance to avoid leading or biasing participants. As with semistructured interviews, focus-group questions should use the funnel technique : be open-ended and broad at the beginning and progressively build detail and specificity with concepts as the conversation progresses. On a related note: remember to frame followup questions both positively and negatively to avoid leading participants, particularly when the conversation may naturally skew in one of these directions.

Focus groups don’t accurately predict future behavior. However, they can help gauge attitudes and guide future exploration, thus avoiding wasted research time. Still, they should be considered a starting point to further research, rather than a validation step. The good news? If your focus-group participants are willing, not only will you have their input to guide your further research, you may also have a group of customers willing and able to test what you create to further guide your design.

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Qualitative Research:...

Qualitative Research: Introducing focus groups

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Peer review
Jenny Kitzinger , research fellow a
a Glasgow University Media Group, Department of Sociology, University of Glasgow, Glasgow G12 8LF

This paper introduces focus group methodology, gives advice on group composition, running the groups, and analysing the results. Focus groups have advantages for researchers in the field of health and medicine: they do not discriminate against people who cannot read or write and they can encourage participation from people reluctant to be interviewed on their own or who feel they have nothing to say.

This is the fifth in a series of seven articles describing non-quantitative techniques and showing their value in health research

**FIGURE OMITTED**

Rationale and uses of focus groups

Focus groups are a form of group interview that capitalises on communication between research participants in order to generate data. Although group interviews are often used simply as a quick and convenient way to collect data from several people simultaneously, focus groups explicitly use group interaction as part of the method. This means that instead of the researcher asking each person to respond to a question in turn, people are encouraged to talk to one another: asking questions, exchanging anecdotes and commenting on each other's experiences and points of view. 1 The method is particularly useful for exploring people's knowledge and experiences and can be used to examine not only what people think but how they think and why they think that way.

Focus groups were originally used within communication studies to explore the effects of films and television programmes, 2 and are a popular method for assessing health education messages and examining public understandings of illness and of health behaviours. 3 4 5 6 7 They are widely used to examine people's experiences of disease and of health services. 8 9 and are an effective technique for exploring the attitudes and needs of staff. 10 11

The idea behind the focus group method is that group processes can help people to explore and clarify their views in ways that would be less easily accessible in a one to one interview. Group discussion is particularly appropriate when the interviewer has a series of open ended questions and wishes to encourage research participants to explore the issues of importance to them, in their own vocabulary, generating their own questions and pursuing their own priorities. When group dynamics work well the participants work alongside the researcher, taking the research in new and often unexpected directions.

Group work also helps researchers tap into the many different forms of communication that people use in day to day interaction, including jokes, anecdotes, teasing, and arguing. Gaining access to such variety of communication is useful because people's knowledge and attitudes are not entirely encapsulated in reasoned responses to direct questions. Everyday forms of communication may tell us as much, if not more, about what people know or experience. In this sense focus groups reach the parts that other methods cannot reach, revealing dimensions of understanding that often remain untapped by more conventional data collection techniques.

Some potential sampling advantages with focus groups

Do not discriminate against people who cannot read or write

Can encourage participation from those who are reluctant to be interviewed on their own (such as those intimidated by the formality and isolation of a one to one interview)

Can encourage contributions from people who feel they have nothing to say or who are deemed “unresponsive patients” (but engage in the discussion generated by other group members)

Tapping into such interpersonal communication is also important because this can highlight (sub)cultural values or group norms. Through analysing the operation of humour, consensus, and dissent and examining different types of narrative used within the group, the researcher can identify shared and common knowledge. 12 This makes focus groups a data collection technique particularly sensitive to cultural variables—which is why it is so often used in cross cultural research and work with ethnic minorities. It also makes them useful in studies examining why different sections of the population make differential use of health services. 13 14 For similar reasons focus groups are useful for studying dominant cultural values (for example, exposing dominant narratives about sexuality 15 ) and for examining work place cultures—the ways in which, for example, staff cope with working with terminally ill patients or deal with the stresses of an accident and emergency department.

The downside of such group dynamics is that the articulation of group norms may silence individual voices of dissent. The presence of other research participants also compromises the confidentiality of the research session. For example, in group discussion with old people in long term residential care I found that some residents tried to prevent others from criticising staff—becoming agitated and repeatedly interrupting with cries of “you can't complain”; “the staff couldn't possibly be nicer.” On the one hand, such interactions highlighted certain aspects of these people's experiences. In this case, it showed some resident's fear of being “punished” by staff for, in the words of one woman, “being cheeky.” On the other hand, such group dynamics raise ethical issues (especially when the work is with “captive” populations) and may limit the usefulness of the data for certain purposes (Scottish Health Feedback, unpublished report).

However, it should not be assumed that groups are, by definition, inhibiting relative to the supposed privacy of an interview situation or that focus groups are inappropriate when researching sensitive topics. Quite the opposite may be true. Group work can actively facilitate the discussion of taboo topics because the less inhibited members of the group break the ice for shyer participants. Participants can also provide mutual support in expressing feelings that are common to their group but which they consider to deviate from mainstream culture (or the assumed culture of the researcher). This is particularly important when researching stigmatised or taboo experiences (for example, bereavement or sexual violence).

Focus group methods are also popular with those conducting action research and those concerned to “empower” research participants because the participants can become an active part of the process of analysis. Indeed, group participants may actually develop particular perspectives as a consequence of talking with other people who have similar experiences. For example, group dynamics can allow for a shift from personal, self blaming psychological explanations (“I'm stupid not to have understood what the doctor was telling me”; “I should have been stronger—I should have asked the right questions”) to the exploration of structural solutions (“If we've all felt confused about what we've been told maybe having a leaflet would help, or what about being able to take away a tape recording of the consultation?”).

Some researchers have also noted that group discussions can generate more critical comments than interviews. 16 For example, Geis et al, in their study of the lovers of people with AIDS, found that there were more angry comments about the medical community in the group discussions than in the individual interviews: “perhaps the synergism of the group ‘kept the anger going’ and allowed each participant to reinforce another's vented feelings of frustration and rage. 17 A method that facilitates the expression of criticism and the exploration of different types of solutions is invaluable if the aim of research is to improve services. Such a method is especially appropriate when working with particular disempowered patient populations who are often reluctant to give negative feedback or may feel that any problems result from their own inadequacies. 19

Conducting a focus group study

Sampling and group composition.

Focus group studies can consist of anything between half a dozen to over fifty groups, depending on the aims of the project and the resources available. Most studies involve just a few groups, and some combine this method with other data collection techniques. Focus group discussion of a questionnaire is ideal for testing the phrasing of questions and is also useful in explaining or exploring survey results. 19 20

Although it may be possible to work with a representative sample of a small population, most focus group studies use a theoretical sampling model (explained earlier in this series 21 ) whereby participants are selected to reflect a range of the total study population or to test particular hypotheses. Imaginative sampling is crucial. Most people now recognise class or ethnicity as important variables, and it is also worth considering other variables. For example, when exploring women's experiences of maternity care or cervical smears it may be advisable to include groups of lesbians or women who were sexually abused as children. 22

Most researchers recommend aiming for homogeneity within each group in order to capitalise on people's shared experiences. However, it can also be advantageous to bring together a diverse group (for example, from a range of professions) to maximise exploration of different perspectives within a group setting. However, it is important to be aware of how hierarchy within the group may affect the data (a nursing auxiliary, for example, is likely to be inhibited by the presence of a consultant from the same hospital).

The groups can be “naturally occurring” (for example, people who work together) or may be drawn together specifically for the research. Using preexisting groups allows observation of fragments of interactions that approximate to naturally occurring data (such as might have been collected by participant observation). An additional advantage is that friends and colleagues can relate each other's comments to incidents in their shared daily lives. They may challenge each other on contradictions between what they profess to believe and how they actually behave (for example, “how about that time you didn't use a glove while taking blood from a patient?”).

It would be naive to assume that group data are by definition “natural” in the sense that such interactions would have occurred without the group being convened for this purpose. Rather than assuming that sessions inevitably reflect everyday interactions (although sometimes they will), the group should be used to encourage people to engage with one another, formulate their ideas, and draw out the cognitive structures which previously have not been articulated.

Finally, it is important to consider the appropriateness of group work for different study populations and to think about how to overcome potential difficulties. Group work can facilitate collecting information from people who cannot read or write. The “safety in numbers factor” may also encourage the participation of those who are wary of an interviewer or who are anxious about talking. 23 However, group work can compound difficulties in communication if each person has a different disability. In the study assessing residential care for the elderly, I conducted a focus group that included one person who had impaired hearing, another with senile dementia, and a third with partial paralysis affecting her speech. This severely restricted interaction between research participants and confirmed some of the staff's predictions about the limitations of group work with this population. However, such problems could be resolved by thinking more carefully about the composition of the group, and sometimes group participants could help to translate for each other. It should also be noted that some of the old people who might have been unable to sustain a one to one interview were able to take part in the group, contributing intermittently. Even some residents who staff had suggested should be excluded from the research because they were “unresponsive” eventually responded to the lively conversations generated by their coresidents and were able to contribute their point of view. Communication difficulties should not rule out group work, but must be considered as a factor.

RUNNING THE GROUPS

Sessions should be relaxed: a comfortable setting, refreshments, and sitting round in a circle will help to establish the right atmosphere. The ideal group size is between four and eight people. Sessions may last one to two hours (or extend into a whole afternoon or a series of meetings). The facilitator should explain that the aim of focus groups is to encourage people to talk to each other rather than to address themselves to the researcher. The researcher may take a back seat at first, allowing for a type of “structured eavesdropping.” 24 Later on in the session, however, the researcher can adopt a more interventionist style: urging debate to continue beyond the stage it might otherwise have ended and encouraging the group to discuss the inconsistencies both between participants and within their own thinking. Disagreements within groups can be used to encourage participants to elucidate their point of view and to clarify why they think as they do. Differences between individual one off interviews have to be analysed by the researchers through armchair theorising; differences between members of focus groups should be explored in situ with the help of the research participants.

The facilitator may also use a range of group exercises. A common exercise consists of presenting the group with a series of statements on large cards. The group members are asked collectively to sort these cards into different piles depending on, for example, their degree of agreement or disagreement with that point of view or the importance they assign to that particular aspect of service. For example, I have used such cards to explore public understandings of HIV transmission (placing statements about “types” of people into different risk categories), old people's experiences of residential care (assigning degrees of importance to different statements about the quality of their care), and midwive's views of their professional responsibilities (placing a series of statements about midwive's roles along an agree-disagree continuum). Such exercises encourage participants to concentrate on one another (rather than on the group facilitator) and force them to explain their different perspectives. The final layout of the cards is less important than the discussion that it generates. 25 Researchers may also use such exercises as a way of checking out their own assessment of what has emerged from the group. In this case it is best to take along a series of blank cards and fill them out only towards the end of the session, using statements generated during the course of the discussion. Finally, it may be beneficial to present research participants with a brief questionnaire, or the opportunity to speak to the researcher privately, giving each one the opportunity to record private comments after the group session has been completed.

Ideally the group discussions should be tape recorded and transcribed. If this is not possible then it is vital to take careful notes and researchers may find it useful to involve the group in recording key issues on a flip chart.

ANALYSIS AND WRITING UP

Analysing focus groups is basically the same as analysing any other qualitative self report data. 21 26 At the very least, the researcher draws together and compares discussions of similar themes and examines how these relate to the variables within the sample population. In general, it is not appropriate to give percentages in reports of focus group data, and it is important to try to distinguish between individual opinions expressed in spite of the group from the actual group consensus. As in all qualitative analysis, deviant case analysis is important—that is, attention must be given to minority opinions and examples that do not fit with the researcher's overall theory.

The only distinct feature of working with focus group data is the need to indicate the impact of the group dynamic and analyse the sessions in ways that take full advantage of the interaction between research participants. In coding the script of a group discussion, it is worth using special categories for certain types of narrative, such as jokes and anecdotes, and types of interaction, such as “questions,” “deferring to the opinion of others,” “censorship,” or “changes of mind.” A focus group research report that is true to its data should also usually include at least some illustrations of the talk between participants, rather than simply presenting isolated quotations taken out of context.

Tapping into interpersonal communication can highlight cultural values or group norms

This paper has presented the factors to consider when designing or evaluating a focus group study. In particular, it has drawn attention to the overt exploitation and exploration of interactions in focus group discussion. Interaction between participants can be used to achieve seven main aims:

To highlight the respondent's attitudes, priorities, language, and framework of understanding;

To encourage research participants to generate and explore their own questions and develop their own analysis of common experiences;

To encourage a variety of communication from participants—tapping into a wide range and form of understanding;

To help to identify group norms and cultural values;

To provide insight into the operation of group social processes in the articulation of knowledge (for example, through the examination of what information is censured or muted within the group);

To encourage open conversation about embarrassing subjects and to permit the expression of criticism;

Generally to facilitate the expression of ideas and experiences that might be left underdeveloped in an interview and to illuminate the research participant's perspectives through the debate within the group.

Group data are neither more nor less authentic than data collected by other methods, but focus groups can be the most appropriate method for researching particular types of question. Direct observation may be more appropriate for studies of social roles and formal organisations 27 but focus groups are particularly suited to the study of attitudes and experiences. Interviews may be more appropriate for tapping into individual biographies, 27 but focus groups are more suitable for examining how knowledge, and more importantly, ideas, develop and operate within a given cultural context. Questionnaires are more appropriate for obtaining quantitative information and explaining how many people hold a certain (pre-defined) opinion; focus groups are better for exploring exactly how those opinions are constructed. Thus while surveys repeatedly identify gaps between health knowledge and health behaviour, only qualitative methods, such as focus groups, can actually fill these gaps and explain why these occur.

Focus groups are not an easy option. The data they generate can be as cumbersome as they are complex. Yet the method is basically straightforward and need not be intimidating for either the researcher or the researched. Perhaps the very best way of working out whether or not focus groups might be appropriate in any particular study is to try them out in practice.

Interviews and focus groups in qualitative research: an update for the digital age

P. Gill 1 &
J. Baillie 2

British Dental Journal volume 225 , pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

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Introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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What are focus groups?

Last updated

19 January 2023

Reviewed by

Jean Kaluza

Focus groups are a valuable tool for businesses and organizations to gather feedback and insights from a targeted group. The goal of a focus group is to gain a deeper understanding of the participants' attitudes, beliefs, and opinions on your chosen topic.

Using focus groups, businesses and organizations can gain valuable insights to inform decision-making and strategy development.

Analyze focus group sessions

Dovetail streamlines focus group research to help you understand the responses and find patterns faster

What is a focus group?

A focus group is a small, carefully selected group that participates in a moderated discussion or session on a specific topic or issue. The group typically has five to 10 people. Researchers choose participants based on specific criteria, such as demographics, interests, or experiences.

The goal of a focus group is to gather insights and feedback on a particular topic or issue. A trained facilitator typically moderates and guides the discussion, encouraging the participants to share their thoughts and opinions.

The information and insights from a focus group can be valuable for businesses and organizations in making decisions and developing strategies.

Benefits of focus groups

Gathering valuable insights and feedback from a targeted group on a specific topic or issue

Gaining a deeper understanding of the attitudes, beliefs, and opinions of the participants

Providing a platform for participants to share their thoughts and ideas in a group setting

Identifying common themes and trends among participants

Allowing the exploration of new ideas and potential solutions to problems

Providing a cost-effective way to gather information and make decisions

Facilitating open and honest communication among participants

Offering an opportunity for businesses to engage with their customers and stakeholders

Are focus groups worth it?

Whether or not focus groups are worth it depends on the business’s specific goals and objectives. We've seen the benefits that focus groups can provide, but a company will only realize those if they carefully select and conduct a focus group .

A focus group is not necessarily representative of the broader population. A focus group's opinions and insights may not apply to the general public, customers, or stakeholders. That’s why a researcher must carefully pick a representative sample of the target audience.

Additionally, focus groups tend to lean toward the more outspoken participant’s opinions. Participants who are more soft-spoken or conflict-averse may have their points of view lost in translation.

The actual customer sentiment could be lost if the business makes assumptions about the topic or draws conclusions from only part of the group's opinions. This may lead to incorrect, costly decisions.

In essence, focus groups are a very powerful tool, but businesses must use them correctly to reap the benefits.

The main pillars of a focus group

The main pillars of a focus group are the participants, the moderator, and the discussion guide.

Participants

These are the people the business selects to participate in the focus group. The business bases its selection on specific criteria, such as demographics, interests, or experiences of the product or services.

The participants typically represent a diverse range of perspectives related to the topic or issue of discussion.

This person facilitates the discussion. The moderator guides the conversation, encourages participation, and keeps the discussion on track.

The moderator is usually trained and experienced in conducting focus groups. Having skills in managing group dynamics and facilitating open and honest communication is vital.

Discussion guide

The moderator typically uses this tool to structure the focus group discussion. The discussion guide typically includes questions, topics, instructions, or prompts for the moderator to use during the conversation. The researcher should carefully design the discussion guide to ensure the focus group discussion stays on track and is productive and effective.

The types of focus groups

Different needs require unique approaches. As such, several focus group types have evolved over the years, providing more specialized results to match the desired information. These include:

Traditional focus groups

These are the most common type of focus group, where a small group of individuals comes together to participate in a moderated discussion on a specific topic or issue. The group typically has 8–10 people.

Online focus groups

These are similar to traditional focus groups, but the discussion takes place online rather than in person. Online focus groups can use various platforms, such as video conferencing software or online discussion forums.

Mini groups

These are small focus groups of only 4–6 people. Mini groups are ideal for sensitive or personal topics. Businesses can also use mini groups when they need a more in-depth understanding of the participants’ experiences and opinions.

Dual-moderator focus groups

These are focus groups where two moderators facilitate the discussion. This can be useful when the topic or issue is complex or when it is vital to gain perspectives from multiple angles.

Expert focus groups

These are focus groups where the participants are experts or specialists in a particular field. This type of focus group can be useful when a business needs insights and feedback from people with specialized knowledge or expertise.

How to conduct a focus group

Conducting a focus group involves several steps. The specifics will depend on the type of focus group. In general, all focus groups have the following five steps:

1. Identifying the goals and objectives

Before conducting a focus group, it is important to clearly define the goals and objectives of the discussion. This will ensure the focus group is productive and enable the moderator to design an effective discussion guide.

2. Selecting the participants

This typically involves defining the criteria for participation and recruiting people who meet those criteria. Selecting a representative group of participants is crucial to ensure the discussion represents a range of perspectives and experiences.

3. Developing the discussion guide

The discussion guide should include questions or topics, instructions, and prompts for the moderator to use during the discussion. Careful guide design ensures the conversation is productive and extracts all participants' true feelings and thoughts.

4. Conducting the focus group

During the discussion, the moderator should facilitate the conversation, encouraging participation and keeping the dialog on track. It’s important to create an open and comfortable environment where participants feel free to share their thoughts and opinions.

5. Analyzing and reporting the results

After the focus group, the researcher should analyze and report the results to the business. This typically involves transcribing the discussion and identifying common themes and trends among the participants.

Example focus group questions

The specific questions you ask will depend on what you want to know, and it's essential to cover all bases of the topic. Here is an example discussion outline:

What are your initial opinions on the subject?

How does the topic impact you personally?

Can you share an experience or example that relates to the topic?

How do you feel about the current state of the subject?

What are the most critical factors for you regarding the subject?

What are your concerns or challenges related to the topic?

What are your ideas or suggestions for improving the topic?

How should the topic evolve in the future?

Do you have any final thoughts or comments?

What do focus groups pay?

The amount that focus groups pay varies depending on several factors, such as the length of the focus group, the location, and the complexity of the discussion topic. In general, focus group participants can expect payment in line with their time and effort.

Are focus groups qualitative or quantitative?

Focus groups are a qualitative research method, so the information and insights don’t use numerical data. Instead, the focus group discussion explores the participants’ attitudes, beliefs, and opinions on a specific topic or issue.

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Focus Groups

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Janet Mola Okoko 4

Part of the book series: Springer Texts in Education ((SPTE))

Focus group, as a methodology in the social sciences, has been traced to the study done by Paul Lazarsfeld and Robert Merton in the early 1940’s on the effects of media on people’s attitude towards World War II (Liamputtong in Focus group methodology: Principles and practice. Sage Publications, 2011) (Merton and Kendall in Am J of Socio 51(6):541–5571946). Before that, Emory Bogardus described group interviews in a study that was aimed at developing a social distance scale (Wark and Galliher in Am Sociologist, 38(4), 383–395, 2007). The element of having group discussions and group-based research became more popular in market research before other social science researchers started paying attention to it. The term focus groups was mainly used to define the social images of commercial products and judge the reactions to, opinions about, and attitudes toward a product, but is now a generic method that can be applicable to multiple fields of behaviour and human experience (Merton, 1987 ). It is now used to study concepts, programs, services, and institutions (Gil and Granado in Eval Rev 19(1):84–10 1995).

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Breen, R. L. (2006). A practical guide to focus-group research, Journal of Geography in Higher Education , 30 (3), 463–475. https://doi.org/10.1080/03098260600927575

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Hopkins, P. E. (2007). Thinking critically and creatively about focus groups. Area, 39 (4), 528–535. https://doi.org/10.1111/j.1475-4762.2007.00766.x

Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research (4th ed.). Sage Publications.

Liamputtong, P. (2011). Focus group methodology: Principles and practice . Sage Publications. https://doi.org/ https://doi.org/10.4135/9781473957657

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Merton, R. K. (1987). The focussed interview and focus groups: Continuities and discontinuities. The Public Opinion Quarterly, 51 (4), 550–566. http://www.jstor.org/stable/2749327

Morgan, D. L. (1998). The focus group guidebook . Sage Publications.

Nyumba, T., Wilson, K., Derrick, C., & Mukherjee, N. (2018). The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods of Ecology and Evolution, 9 (9), 20–23. https://doi.org/10.1111/2041-210X.12860

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Tadajewski, M. (2016). Focus groups: History, epistemology and non-individualistic consumer research. Consumption Markets & Culture, 19 (4), 319–345. https://doi.org/10.1080/10253866.2015.1104038

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Additional Readings

Barbour, R. (2018). Doing focus groups (2nd ed.) Sage Publications.

Belzile, J., & Oberg, G. (2012). Where to begin? Grappling with how to use participant interaction in focus group design. Qualitative Research, 12 (4), 459–472.

Jakobsen, H. (2012). Focus groups and methodological rigour outside the minority world: Making the method work to its strengths in Tanzania. Qualitative Research, 12 (2), 111–130.

Krueger, R.A. (1998). Moderating focus groups . Sage Publications.

Onwuegbuzie, A. J., Dickinson, W. B., Leech, N. L., & Zoran, A. G. (2009). A Qualitative framework for collecting and analyzing data in focus group research. International Journal of Qualitative Methods , 1–21. https://doi.org/10.1177/160940690900800301

Sim, J., & Waterfield, J. (2019). Focus group methodology: Some ethical challenges. Quality and Quantity, 53 , 3003–3022. https://doi.org/10.1007/s11135-019-00914-5

Online Resources

1. How to focus groups work (4 min): https://www.youtube.com/watch?v=3TwgVQIZPsw

2. Conducting a focus group (5 ½ minutes): https://www.youtube.com/watch?v=Auf9pkuCc8k

3. Preparing for a focus group (5 min): https://www.youtube.com/watch?v=VSwTvkTsOvI

4. How to run a successful focus group (12 min): https://www.youtube.com/watch?v=gjQtu6yeC1E

5. The focus group method (8 min): https://www.youtube.com/watch?v=LU92Zryjf-0

6. Moderating focus groups (30 min): https://www.youtube.com/watch?v=xjHZsEcSqwo

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What Is a Focus Group? | Step-by-Step Guide & Examples

What Is a Focus Group? | Step-by-Step Guide & Examples

Published on 4 May 2022 by Tegan George . Revised on 6 February 2023.

What is a focus group, step 1: choose your topic of interest, step 2: define your research scope and hypotheses, step 3: determine your focus group questions, step 4: select a moderator or co-moderator, step 5: recruit your participants, step 6: set up your focus group, step 7: host your focus group, step 8: analyse your data and report your results, advantages and disadvantages of focus groups, frequently asked questions about focus groups.

Focus groups are a type of qualitative research . Observations of the group’s dynamic, their answers to focus group questions, and even their body language can guide future research on consumer decisions, products and services, or controversial topics.

Focus groups are often used in marketing, library science, social science, and user research disciplines. They can provide more nuanced and natural feedback than individual interviews and are easier to organise than experiments or large-scale surveys .

Prevent plagiarism, run a free check.

Focus groups are primarily considered a confirmatory research technique . In other words, their discussion-heavy setting is most useful for confirming or refuting preexisting beliefs. For this reason, they are great for conducting explanatory research , where you explore why something occurs when limited information is available.

A focus group may be a good choice for you if:

You’re interested in real-time, unfiltered responses on a given topic or in the dynamics of a discussion between participants
Your questions are rooted in feelings or perceptions , and cannot easily be answered with ‘yes’ or ‘no’
You’re confident that a relatively small number of responses will answer your question
You’re seeking directional information that will help you uncover new questions or future research ideas
Structured interviews : The questions are predetermined in both topic and order.
Semi-structured interviews : A few questions are predetermined, but other questions aren’t planned.
Unstructured interviews : None of the questions are predetermined.

Differences between types of interviews

Make sure to choose the type of interview that suits your research best. This table shows the most important differences between the four types.

Topics favorable to focus groups

As a rule of thumb, research topics related to thoughts, beliefs, and feelings work well in focus groups. If you are seeking direction, explanation, or in-depth dialogue, a focus group could be a good fit.

However, if your questions are dichotomous or if you need to reach a large audience quickly, a survey may be a better option. If your question hinges upon behaviour but you are worried about influencing responses, consider an observational study .

If you want to determine whether the student body would regularly consume vegan food, a survey would be a great way to gauge student preferences.

However, food is much more than just consumption and nourishment and can have emotional, cultural, and other implications on individuals.

If you’re interested in something less concrete, such as students’ perceptions of vegan food or the interplay between their choices at the dining hall and their feelings of homesickness or loneliness, perhaps a focus group would be best.

Once you have determined that a focus group is the right choice for your topic, you can start thinking about what you expect the group discussion to yield.

Perhaps literature already exists on your subject or a sufficiently similar topic that you can use as a starting point. If the topic isn’t well studied, use your instincts to determine what you think is most worthy of study.

Setting your scope will help you formulate intriguing hypotheses , set clear questions, and recruit the right participants.

Are you interested in a particular sector of the population, such as vegans or non-vegans?
Are you interested in including vegetarians in your analysis?
Perhaps not all students eat at the dining hall. Will your study exclude those who don’t?
Are you only interested in students who have strong opinions on the subject?

A benefit of focus groups is that your hypotheses can be open-ended. You can be open to a wide variety of opinions, which can lead to unexpected conclusions.

The questions that you ask your focus group are crucially important to your analysis. Take your time formulating them, paying special attention to phrasing. Be careful to avoid leading questions , which can affect your responses.

Overall, your focus group questions should be:

Open-ended and flexible
Impossible to answer with ‘yes’ or ‘no’ (questions that start with ‘why’ or ‘how’ are often best)
Unambiguous, getting straight to the point while still stimulating discussion
Unbiased and neutral

If you are discussing a controversial topic, be careful that your questions do not cause social desirability bias . Here, your respondents may lie about their true beliefs to mask any socially unacceptable or unpopular opinions. This and other demand characteristics can hurt your analysis and bias your results.

Engagement questions make your participants feel comfortable and at ease: ‘What is your favourite food at the dining hall?’
Exploration questions drill down to the focus of your analysis: ‘What pros and cons of offering vegan options do you see?’
Exit questions pick up on anything you may have previously missed in your discussion: ‘Is there anything you’d like to mention about vegan options in the dining hall that we haven’t discussed?’

It is important to have more than one moderator in the room. If you would like to take the lead asking questions, select a co-moderator who can coordinate the technology, take notes, and observe the behaviour of the participants.

If your hypotheses have behavioural aspects, consider asking someone else to be lead moderator so that you are free to take a more observational role.

Depending on your topic, there are a few types of moderator roles that you can choose from.

The most common is the dual-moderator , introduced above.
Another common option is the dueling-moderator style . Here, you and your co-moderator take opposing sides on an issue to allow participants to see different perspectives and respond accordingly.

Depending on your research topic, there are a few sampling methods you can choose from to help you recruit and select participants.

Voluntary response sampling , such as posting a flyer on campus and finding participants based on responses
Convenience sampling of those who are most readily accessible to you, such as fellow students at your university
Stratified sampling of a particular age, race, ethnicity, gender identity, or other characteristic of interest to you
Judgement sampling of a specific set of participants that you already know you want to include

Beware of sampling bias , which can occur when some members of the population are more likely to be included than others.

Number of participants

In most cases, one focus group will not be sufficient to answer your research question. It is likely that you will need to schedule three to four groups. A good rule of thumb is to stop when you’ve reached a saturation point (i.e., when you aren’t receiving new responses to your questions).

Most focus groups have 6–10 participants. It’s a good idea to over-recruit just in case someone doesn’t show up. As a rule of thumb, you shouldn’t have fewer than 6 or more than 12 participants, in order to get the most reliable results.

Lastly, it’s preferable for your participants not to know you or each other, as this can bias your results.

A focus group is not just a group of people coming together to discuss their opinions. While well-run focus groups have an enjoyable and relaxed atmosphere, they are backed up by rigorous methods to provide robust observations.

Confirm a time and date

Be sure to confirm a time and date with your participants well in advance. Focus groups usually meet for 45–90 minutes, but some can last longer. However, beware of the possibility of wandering attention spans. If you really think your session needs to last longer than 90 minutes, schedule a few breaks.

Confirm whether it will take place in person or online

You will also need to decide whether the group will meet in person or online. If you are hosting it in person, be sure to pick an appropriate location.

An uncomfortable or awkward location may affect the mood or level of participation of your group members.
Online sessions are convenient, as participants can join from home, but they can also lessen the connection between participants.

As a general rule, make sure you are in a noise-free environment that minimises distractions and interruptions to your participants.

Consent and ethical considerations

It’s important to take into account ethical considerations and informed consent when conducting your research. Informed consent means that participants possess all the information they need to decide whether they want to participate in the research before it starts. This includes information about benefits, risks, funding, and institutional approval.

Participants should also sign a release form that states that they are comfortable with being audio- or video-recorded. While verbal consent may be sufficient, it is best to ask participants to sign a form.

A disadvantage of focus groups is that they are too small to provide true anonymity to participants. Make sure that your participants know this prior to participating.

There are a few things you can do to commit to keeping information private. You can secure confidentiality by removing all identifying information from your report or offer to pseudonymise the data later. Data pseudonymisation entails replacing any identifying information about participants with pseudonymous or false identifiers.

Preparation prior to participation

If there is something you would like participants to read, study, or prepare beforehand, be sure to let them know well in advance. It’s also a good idea to call them the day before to ensure they will still be participating.

Consider conducting a tech check prior to the arrival of your participants, and note any environmental or external factors that could affect the mood of the group that day. Be sure that you are organised and ready, as a stressful atmosphere can be distracting and counterproductive.

Starting the focus group

Welcome individuals to the focus group by introducing the topic, yourself, and your co-moderator, and go over any ground rules or suggestions for a successful discussion. It’s important to make your participants feel at ease and forthcoming with their responses.

Consider starting out with an icebreaker, which will allow participants to relax and settle into the space a bit. Your icebreaker can be related to your study topic or not; it’s just an exercise to get participants talking.

Leading the discussion

Once you start asking your questions, try to keep response times equal between participants. Take note of the most and least talkative members of the group, as well as any participants with particularly strong or dominant personalities.

You can ask less talkative members questions directly to encourage them to participate or ask participants questions by name to even the playing field. Feel free to ask participants to elaborate on their answers or to give an example.

As a moderator, strive to remain neutral. Refrain from reacting to responses, and be aware of your body language (e.g., nodding, raising eyebrows). Active listening skills, such as parroting back answers or asking for clarification, are good methods to encourage participation and signal that you’re listening.

Many focus groups offer a monetary incentive for participants. Depending on your research budget, this is a nice way to show appreciation for their time and commitment. To keep everyone feeling fresh, consider offering snacks or drinks as well.

After concluding your focus group, you and your co-moderator should debrief, recording initial impressions of the discussion as well as any highlights, issues, or immediate conclusions you’ve drawn.

The next step is to transcribe and clean your data . Assign each participant a number or pseudonym for organisational purposes. Transcribe the recordings and conduct content analysis to look for themes or categories of responses. The categories you choose can then form the basis for reporting your results.

Just like other research methods, focus groups come with advantages and disadvantages.

They are fairly straightforward to organise and results have strong face validity .
They are usually inexpensive, even if you compensate participant.
A focus group is much less time-consuming than a survey or experiment , and you get immediate results.
Focus group results are often more comprehensible and intuitive than raw data.

Disadvantages

It can be difficult to assemble a truly representative sample. Focus groups are generally not considered externally valid due to their small sample sizes.
Due to the small sample size, you cannot ensure the anonymity of respondents, which may influence their desire to speak freely.
Depth of analysis can be a concern, as it can be challenging to get honest opinions on controversial topics.
There is a lot of room for error in the data analysis and high potential for observer dependency in drawing conclusions. You have to be careful not to cherry-pick responses to fit a prior conclusion.

A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest. It is one of four types of interviews .

As a rule of thumb, questions related to thoughts, beliefs, and feelings work well in focus groups . Take your time formulating strong questions, paying special attention to phrasing. Be careful to avoid leading questions , which can bias your responses.

The four most common types of interviews are:

Focus group interviews : The questions are presented to a group instead of one individual.

Social desirability bias is the tendency for interview participants to give responses that will be viewed favourably by the interviewer or other participants. It occurs in all types of interviews and surveys , but is most common in semi-structured interviews , unstructured interviews , and focus groups .

Social desirability bias can be mitigated by ensuring participants feel at ease and comfortable sharing their views. Make sure to pay attention to your own body language and any physical or verbal cues, such as nodding or widening your eyes.

This type of bias in research can also occur in observations if the participants know they’re being observed. They might alter their behaviour accordingly.

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Qualitative study design: Focus groups

Qualitative study design
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Focus Groups

Focus groups bring individuals from the study population together in a specific setting in order to discuss an issue as a group. The discussion generates research data.

Focus groups typically have these features:

Four to ten participants meeting for up to two hours
A facilitator or facilitators to guide discussion using open-ended questions
An emphasis on the group talking among itself rather than to the facilitator
Discussion is recorded and then transcribed for analysis by researchers

Researchers conduct several individual focus group meetings to produce a series. The number of focus groups in the series depends on the study’s aim, methods and resources.

Focus groups use a group setting to generate data different to that obtained in a one-to-one interview. The group context may allow for better examination of beliefs, attitudes, values, perspectives, knowledge and ideas.

Focus groups can be useful in action research methodology and other study designs which seek to empower research participants. Focus groups are also useful in multimethod studies utilising different forms of data collection.

Quick way to collect data from several people
Produces data unique to group setting (e.g. teasing, arguing and non-verbal behaviour) due to the interaction between participants. This is a unique feature of focus groups.
Unlike written questionnaires, focus groups don’t rely on participant literacy to generate data
Can encourage participation from marginalised groups
Can facilitate discussion of stigmatised or counter-cultural topics due to feeling of mutual support among focus group participants
Can generate more critical comments than individual interviews. This is valuable for research aimed at improving products or services.
Can be used to validate findings from quantitative research methods by providing a deeper understanding that statistics cannot.

Limitations

Individual perspectives that dissent from the focus group’s majority may remain hidden due to overriding behavioural or cultural norms, or a desire to be seen as conforming.
Confidentiality of individual responses is compromised due to the existence of the group
Only applicable when the population of interest has shared social and cultural experience or share common areas of concern.
Group discussion does not provide enough depth for researchers to understand experiences, especially in comparison to in-depth interviews.
Data is representative of the range of views in a population, not the prevalence of such views.
The facilitator has a strong effect on the focus groups behaviour and can therefore influence the extent to which issues or views are explored.
Data analysis is usually very time consuming due to the quantity produced.

Example questions

What are the experiences, needs and wishes of mothers who received midwifery care at tertiary hospitals in Victoria, Australia?
How useful is the patient perspective for the creation of an information information booklet for patients with liver cancer?
What factors influence nursing students' development of end-of-life communication skills?

Example studies

Harrison, M., Ryan, T., Gardiner, C., & Jones, A. (2017). Psychological and emotional needs, assessment, and support post-stroke: a multi-perspective qualitative study . Top Stroke Rehabil, 24 (2), 119-125. doi: 10.1080/10749357.2016.1196908

Shilubane, H. N., Ruiter, R. A., Bos, A. E., Reddy, P. S., & van den Borne, B. (2014). High school students' knowledge and experience with a peer who committed or attempted suicide: a focus group study . BMC Public Health, 14 , 1081. doi: 10.1186/1471-2458-14-1081

Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., & Allen, R. E. (2012). The meaning of "aging in place" to older people . Gerontologist , 52(3), 357-366. doi: 10.1093/geront/gnr098

Kitzinger, J. (1995). Qualitative research: introducing focus groups . BMJ, 311 (7000), 299. doi: 10.1136/bmj.311.7000.299

Rice, P. L., & Ezzy, D. (1999). Qualitative research methods: a health focus . South Melbourne, Australia: Oxford University Press.

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Last Updated: Apr 8, 2024 11:12 AM
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Guide to Thematic Analysis

Abductive Thematic Analysis
Collaborative Thematic Analysis
Deductive Thematic Analysis
How to Do Thematic Analysis
Inductive Thematic Analysis
Reflexive Thematic Analysis
Advantages of Thematic Analysis
Thematic Analysis for Case Studies
Thematic Coding
Disadvantages of Thematic Analysis
Thematic Analysis in Educational Research
Thematic Analysis Examples
Introduction

Collecting data from focus groups

How do you analyze focus group data using thematic analysis, challenges and limitations.

Thematic Analysis vs. Grounded Theory
What is Thematic Analysis?
Increasing Rigor in Thematic Analysis
Thematic Analysis for Interviews
Thematic Analysis Literature Review
Thematic Analysis in Mixed Methods Approach
Thematic Analysis in Observations
Peer Review in Thematic Analysis
How to Present Thematic Analysis Results
Thematic Analysis in Psychology
Thematic Analysis of Secondary Data
Thematic Analysis in Social Work
Thematic Analysis Software
Thematic Analysis in Surveys
Thematic Analysis in UX Research
Thematic vs. Content Analysis
Thematic Analysis vs. Discourse Analysis
Thematic Analysis vs. Framework Analysis
Thematic Analysis vs. Narrative Analysis
Thematic Analysis vs. Phenomenology

Thematic analysis is a powerful tool in qualitative research , particularly when applied to interview or focus group data. This method enables researchers to identify, analyze, and report patterns (themes) within data, providing insightful interpretations of various perspectives shared among group participants. When thematic analysis is employed in focus group research, it helps illuminate shared experiences, viewpoints, and the underlying dynamics that might not be as apparent in other research settings. This introduction to thematic analysis for focus groups aims to guide researchers through the practical steps and considerations essential for extracting meaningful insights from group discussions. By focusing on the specific application within focus groups, this article will provide knowledge to researchers who want to use thematic analysis to identify patterns and themes in their research.

Collecting qualitative data from focus groups is a critical step in qualitative research that requires careful attention to detail and methodical execution. To ensure the data's usefulness for thematic analysis, researchers must adeptly navigate through the stages of preparation, execution, and post-session processing. Each phase plays a vital role in securing high-quality data that is both rich and relevant for thematic exploration.

Preparing for the session

Effective data collection includes defining the focus group's objectives, selecting a diverse and representative sample of participants, and crafting clear, open-ended questions that encourage in-depth discussion. The preparation stage also involves logistical considerations, such as choosing a comfortable and neutral location and ensuring all necessary recording equipment is tested and functional.

Conducting the session

The execution phase centers on facilitating the focus group discussion in a way that encourages active and balanced participation from all attendees. The facilitator must manage the session with skill, fostering an inclusive atmosphere and guiding the conversation to maintain relevance to the research questions. It's crucial to record the session accurately, using audio or video equipment, to capture the full spectrum of interactions, expressions, and nuances in communication.

Processing the data

After the focus group session, processing data sources involves transcribing the recordings , a task that requires attention to detail to ensure accuracy and completeness. Researchers should also anonymize focus group transcripts to maintain participant confidentiality . These transcribed texts then become the primary source material for the subsequent thematic analysis, laying the foundation for a thorough and insightful examination of the collected data.

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Qualitative data analysis on focus groups using thematic analysis involves a systematic and rigorous approach to uncovering and understanding patterns, themes, and insights within the rich narratives shared by participants. This method enables researchers to delve beyond surface-level information, identifying deeper meanings and connections that can inform and enrich research findings.

Coding and categorizing data

The first step in analyzing focus group data is to start coding and categorizing the entire data set. This involves reading through all the data meticulously and assigning initial codes to significant or relevant segments of text. A code is a short but descriptive label that represents the essence of a response or discussion point, making it easier to organize and examine the data. Researchers should approach this process iteratively, refining and consolidating codes into broader categories as patterns begin to emerge. This categorization lays the groundwork for the next phase of analysis, facilitating a structured and comprehensive examination of the data.

Identifying patterns and themes

Once the data are coded and categorized, researchers can begin identifying potential themes and sub-themes. This involves examining the categorized data for recurring concepts, relationships, and structures that reveal the underlying context and significance of the participants' discussions. Themes are not just common topics but also convey something important about the data in relation to the research question. They should be distinct yet interconnected, providing a coherent narrative that captures the complexities and nuances of the focus group data. This stage often requires multiple rounds of review and refinement to ensure that the identified themes accurately and comprehensively represent the dataset.

Interpreting and presenting findings

The final step of thematic analysis is interpreting and presenting the findings. Interpretation involves examining the themes in relation to the research question , the broader literature, and the specific context of the study, providing a nuanced understanding of the data's significance. Researchers should consider how the themes interrelate, what they reveal about the research topic, and how they contribute to a deeper understanding of the subject matter.

Presenting the findings effectively is crucial for communicating the research insights to a wider audience. This typically involves describing the thematic analysis process, detailing how themes were derived, and illustrating each theme with relevant quotes or examples from the focus group data. The presentation should provide a clear, coherent narrative that conveys the richness and depth of the participants' experiences and perspectives, offering valuable contributions to the field of study.

While thematic analysis of focus group data can yield profound insights, researchers must navigate various challenges and limitations inherent in this methodology. Recognizing and addressing these issues is crucial to enhance the quality of the research findings.

Data richness vs. manageability : Focus groups generate a wealth of data, which can be both an asset and a challenge. The sheer volume and complexity of the data require careful management and can be time-consuming to analyze comprehensively.
Group dynamics : The interaction among focus group participants can influence the data collected. Dominant personalities may skew the discussion, while quieter members might provide less input, potentially affecting the balance and depth of insights gathered.
Moderator influence : The facilitator's skills and preconceptions can impact the discussion flow and data quality. An effective moderator must be neutral, encouraging balanced participation without leading the conversation or influencing the content.
Participant diversity : While diversity within a focus group can enrich discussions, it can also introduce variations in understanding and engagement levels, which may affect the consistency and comparability of data across groups.
Interpretation subjectivity : Thematic analysis involves a degree of interpretation, which necessitates recognizing the role of the researcher's subjectivity. Ensuring transparency in the coding and analysis process by making notes during data collection and seeking peer verification can help convey the credibility and rigor of the findings.
Contextual understanding : It is crucial to consider the data within the context of the focus group setting. Researchers must be mindful of the specific conditions and dynamics that may influence participant responses and perceptions.

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Methodology: 2023 focus groups of Asian Americans

Table of contents.

About the focus groups
Participant recruitment procedures
Moderator and interpreter qualification
Data analysis
Sample design
Data collection
Weighting and variance estimation
Analysis of Asians living in poverty
Acknowledgments

Pew Research Center created and designed this focus groups plan to understand the experiences and perspectives of Asians living with economic hardship in the United States. The analysis presented in this data essay provides insight into these topics and is not an exhaustive representation of public opinion on these topics or of specific demographic groups.

This research was conducted by PSB Insights for Pew Research Center and was reviewed by an IRB (internal review board) for human subject research.

Pew Research Center conducted 18 in-person focus groups with 144 adult participants from across the United States from Feb. 7 to Feb. 23, 2023. Recruited participants are from 11 Asian origin groups. Each person was offered an incentive amount of $225 to participate. Focus groups were 1.5 hours in length. Guides for immigrant Asian focus groups were translated into 11 non-English languages. ( Read the moderator guide for more.)

The topics for discussion and approximate allotted time during the focus groups were as follows:

Table showing 2023 Asian Americans focus group study discussion guide outline

Study design and group criteria

For each focus group, 10 participants were recruited and eight were ultimately selected to participate. The research team overrecruited participants to account for “no-shows,” as well as participants who may experience other issues preventing participation.

Table showing 2023 Asian American focus group study composition

The study included focus groups from 11 distinct Asian origin groups. These are among the most likely Asian origin groups to live in poverty in the U.S. in 2019. These included participants from three (Chinese, Korean and Vietnamese) of the six largest U.S. Asian origin groups . The study also included participants from eight less populous origin groups (Bangladeshi, Bhutanese, Burmese, Cambodian, Hmong, Laotian, Nepalese and Pakistani). These ethnic origin groups were selected to include voices of those from smaller populations.

Focus groups were further stratified by nativity for selected origin groups. Researchers classified participants into either “U.S. born” or “immigrant” focus groups based on self-reported birthplace and immigration information provided in the screener survey.

Recruitment of focus group participants was conducted via local Asian community member networks, organized by language and ethnicity. Recruitment was conducted in person following guidance on COVID-19 restrictions (i.e., personal visits, community meetings, etc.), via social media (e.g., Facebook, Line, WeChat, WhatsApp) or by phone or email.

All potential participants were screened for eligibility based on a questionnaire designed by Pew Research Center, which included criteria such as ethnic origin affiliation, country of birth, length of time in the U.S. (for immigrants), household income and other demographic profile questions. Once eligible participants were identified, they confirmed if they were available for the focus group and signed an informed consent form.

All participants had to meet the following five criteria to be eligible to participate:

Live within or near the states corresponding to where the research was conducted (California, Minnesota/Wisconsin, New York/New Jersey).
Belong to the ethnic origin group of the respective focus group audience and fluently speak the language the group was conducted in.
Be between the ages of 25 and 59.
Have a household income that qualified them as low income for the purposes of this study – defined as earning a maximum household income of 140%-250% of the federal poverty line. Thresholds varied by recruitment city to account for differences in the cost of living.
Meet “soft quotas” set for the demographic characteristics of gender, education and location of birth to ensure a diverse mix of participants within each focus group. (Soft quotas are flexible recruitment targets that can be adjusted based on realities of recruitment and sample target.)

In order to qualify for the U.S.-born groups, participants had to have been either:

Born in the U.S., or
Born outside the U.S., but arrived in the country before the age of 7.

To qualify for the immigrant group, participants had to have been either:

Born outside the U.S. and arrived in the country after the age of 15, or
Born outside the U.S., arrived in the U.S. between the ages of 7 to 15, and were determined to be connected to the culture of their home country to a degree similar to people born outside the country and immigrated to the U.S. after age 15. This determination was based on a series of questions decided upon by the research team. These questions asked about whether they consume media in English or their native language; how often they participate in holidays and practices associated with their origin country; how well they remember growing up in their origin country; and how many of their friends are Asian but of a different ethnicity than theirs. Respondents were invited to participate in the immigrant focus group only if their answers to at least three of the four questions were considered similar to those who immigrated after age 15 (i.e., they consume media in their native language more often or equally as often as in English; participate in their origin country’s holidays and practices very or somewhat often; remember growing up in the origin country very or somewhat well; and at least some of their friends are Asian but of a different ethnicity).

All focus groups were conducted in person. The table below details locations, which Asian origin groups were recruited, and low-income thresholds applied.

Table showing 2023 Asian American focus group study locations and low-income thresholds

Eligible participants were identified by PSB and then reviewed and approved by the Pew Research Center team for participation. For each focus group, researchers selected eight preferred participants from the 10 recruited participants, ensuring diversity across dimensions for which there were no hard quotas, including gender, educational qualifications and partisan identification. If one of the eight preferred participants did not show up to the focus group or experienced other difficulties to the extent that they could not participate, they were replaced by one of the two overrecruited participants. When replacing participants, the research team strove to keep the groups as diverse as possible with a special emphasis on maintaining gender parity.

PSB Insights partnered with GC Global to help facilitate focus group moderation and interpretation. Recruitment for focus group moderators emphasized the importance of having native language speakers as well as matching moderators’ ethnicity to each origin group. This would help build rapport and facilitate an open conversation with participants. All moderators were briefed on the discussion guide and research objectives prior to the focus groups by PSB Insights. For less experienced moderators, an additional moderator training session was provided.

The research team also hired interpreters to provide on-site simultaneous translations when immigrant focus groups were conducted.

Focus group conversations were video recorded. All conversations were transcribed, translated if conducted in a non-English language and checked for transcription errors. To analyze the focus group transcripts, Center researchers used ATLAS.ti, a qualitative data analysis and research software.

All 18 focus group transcripts were coded using the following structure for individual participants within each focus group:

Origin group
Employment status
Immigration generation
Years in the U.S. (for immigrant participants)

The transcripts were also coded by topic, including but not limited to:

Current economic situation
Communities and resources
The American dream
Immigration experiences (for immigrant focus groups)
Experiences growing up (for U.S.-born focus groups)

Within each topic, we used a list of detailed codes to identify the theme of each response. For example, the research team used the following codes to label responses related to discussions on attitudes toward reaching the American dream:

(code label: “American dream: easy to achieve”)
(code label: “American dream: hard to achieve”)

Several quality control checks were conducted. After coding all transcript documents, researchers viewed organized quotes with demographic codes alongside them. A different researcher then evaluated the codes and made suggestions for changes. Any discrepancies were resolved between the primary coding researcher and the reevaluating researcher. When they could not reach an agreement, the lead researcher would reconcile the coding and set standardized coding practices for similar quotes.

The finalized quotations were exported by research topics into a spreadsheet where each row represented one quote. The research team identified the themes within each detailed topic code and rearranged and extracted quotations into different themes for publication.

While we highlight the sentiments expressed by individual participants in the data essay, they are chosen to highlight the themes discussed by the group more broadly. They are not necessarily representative of the majority opinion in any group.

Quotations in the data essay have been lightly edited for grammar, spelling and clarity.

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Systematic Review
Open access
Published: 26 April 2024

Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research

Sahar Hammoud ORCID: orcid.org/0000-0003-4682-9001 1 ,
Laith Alsabek 1 , 2 ,
Lisa Rogers 1 &
Eilish McAuliffe 1

BMC Health Services Research volume 24 , Article number: 532 ( 2024 ) Cite this article

224 Accesses

Metrics details

In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist.

Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist.

A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% ( n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall.

Conclusions

Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively.

Trial registration

The review protocol is registered with PROSPERO (CRD42023450715).

Peer Review reports

Patient safety (PS) is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum” [ 1 ]. It is estimated that one in 10 patients are harmed in healthcare settings due to unsafe care, resulting in over three million deaths annually [ 2 ]. More than 50% of adverse events are preventable, and half of these events are related to medications [ 3 , 4 ]. There are various types of adverse events that patients can experience such as medication errors, patient falls, healthcare-associated infections, diagnostic errors, pressure ulcers, unsafe surgical procedures, patient misidentification, and others [ 1 ].

Over the last few decades, the approach of PS management has shifted toward actively involving patients and their families in managing PS. This innovative approach has surpassed the traditional model where healthcare providers were the sole managers of PS [ 5 ]. Recent research has shown that patients have a vital role in promoting their safety and decreasing the occurrence of adverse events [ 6 ]. Hence, there is a growing recognition of patient and family involvement as a promising method to enhance PS [ 7 ]. This approach includes involving patients in PS policy development, research, and shared decision making [ 1 ].

In the last decade, research involving patients and the public has significantly increased. In the United Kingdom (U.K), the National Institute for Health Research (NIHR) has played a critical role in providing strategic and infrastructure support to integrate Public and Patient Involvement (PPI) throughout publicly funded research [ 8 ]. This has established a context where PPI is recognised as an essential element in research [ 9 ]. In Ireland, the national government agency responsible for the management and delivery of all public health and social services; the National Health Service Executive (HSE) emphasise the importance of PPI in research and provide guidance for researchers on how to involve patients and public in all parts of the research cycle and knowledge translation process [ 10 ]. Similar initiatives are also developing among other European countries, North America, and Australia. However, despite this significant expansion of PPI research, the reporting of PPI in research articles continues to be sub-optimal, inconsistent, and lacks essential information on the context, process, and impact of PPI [ 9 ]. To address this problem, the Guidance for Reporting Involvement of Patients and the Public (GRIPP) was developed in 2011 following the EQUATOR methodology to enhance the quality, consistency, and transparency of PPI reporting. Additionally, to provide guidance for researchers, patients, and the public to advance the quality of the international PPI evidence-base [ 11 ]. The first GRIPP checklist was a significant start in producing higher-quality PPI reporting; however, it was developed following a systematic review, and did not include any input from the international PPI research community. Given the importance of reaching consensus in generating current reporting guidelines, a second version of the GRIPP checklist (GRIPP2) was developed to tackle this problem by involving the international PPI community in its development [ 9 ]. There are two versions of the GRIPP2 checklist, a long form (GRIPP2-LF) for studies with PPI as the primary focus, and a short form (GRIPP2-SF) for studies with PPI as secondary or tertiary focus.

Since the publication of the GRIPP2 checklist, several systematic reviews have been conducted to assess the quality of PPI reporting on various topics. For instance, Bergin et al. in their review to investigate the nature and impact of PPI in cancer research, reported a sub-optimal quality of PPI reporting using the GRIPP2-SF, mainly due to failure to address PPI challenges [ 12 ]. Similarly, Owyang et al. in their systematic review to assess the prevalence, extent, and quality of PPI in orthopaedic practice, described a poor PPI reporting following the GRIPP2-SF checklist criteria [ 13 ]. While a few systematic reviews have been conducted to assess theories, strategies, types of interventions, and barriers and enablers of PPI in PS [ 5 , 14 , 15 , 16 ], no previous review has assessed the quality of PPI reporting in PS research. Thus, our systematic review aims to address this knowledge gap. The objective of this review is to identify the frequency PPI reporting in PS research using the GRIPP2 checklist from 2018 (the year after GRIPP2 was published) and the quality of reporting following the GRIPP2-SF. The GRIPP2 checklist was chosen as the benchmark as it is the first international, evidence-based, community consensus informed guideline for the reporting of PPI in research and more specifically in health and social care research [ 9 ]. Additionally, it is the most recent report-focused framework and the most recommended by several leading journals [ 17 ].

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to plan and report this review [ 18 ]. The review protocol was published on PROSPERO the International Database of Prospectively Registered Systematic Reviews in August 2023 (CRD42023450715).

Search strategy

For this review, we used the PICo framework to define the key elements in our research. These included articles on patients and public (P-Population) involvement (I- phenomenon of Interest) in PS (C-context). Details are presented in Table 1 . Four databases were searched including Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL to identify papers on PPI in PS research. A systematic search strategy was initially developed using MEDLINE. MeSH terms and keywords relevant to specific categories (e.g., patient safety) were combined using the “OR” Boolean term (i.e. patient safety OR adverse event OR medical error OR surgical error) and categories were then combined using the “AND” Boolean term. (i.e. “patient and public involvement” AND “patient safety”). The search strategy was adapted for the other three databases. Full search strategies are provided in Supplementary file 1 . The search was conducted on July 27th, 2023, and was limited to papers published from 2018. As the GRIPP2 tool was published in 2017, this limit ensured the retrieval of relevant studies. An alert system was set on the four databases to receive all new published studies until December 2023, prior to the final analysis. The search was conducted without restrictions on study type, research design, and language. To reduce selection bias, hand searching was carried out on the reference lists of all the eligible articles in the later stages of the review. This was done by the first author. The search strategy was developed by the first author and confirmed by the research team and a Librarian. The database search was conducted by the first author.

Inclusion and exclusion criteria

Studies on PPI in PS research with a focus on health/healthcare were included in this review. We defined PPI as active involvement which is in line with the NIHR INVOLVE definition as “research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them” [ 19 ]. This includes any PPI including, being a co-applicant on a research project or grant application, identifying research priorities, being a member of an advisory or steering group, participating in developing research materials or giving feedback on them, conducting interviews with study participants, participating in recruitment, data collection, data analysis, drafting manuscripts and/or dissemination of results. Accordingly, we excluded studies where patients or the public were only involved as research participants.

We defined patients and public to include patients, relatives, carers, caregivers and community, which is also in line with the NIHR PPI involvement in National Health Service [ 19 ].

Patient safety included topics on medication safety, adverse events, communication, safety culture, diagnostic errors, and others. A full list of the used terms for PPI and PS is provided in Supplementary file 1 . Regarding the research type and design, we included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals and in English were included.

Any article that did not meet the inclusion criteria was excluded. Studies not reporting outcomes were excluded. Furthermore, review papers, conference abstracts, letters to editor, commentary, viewpoints, and short communications were excluded. Finally, papers published prior to 2018 were excluded.

Study selection

The selection of eligible studies was done by the first and the second authors independently, starting with title and abstracts screening to eliminate papers that failed to meet our inclusion criteria. Then, full text screening was conducted to decide on the final included papers in this review. Covidence, an online data management system supported the review process, ensuring reviewers were blinded to each other’s decisions. Disagreements between reviewers were discussed first, in cases where the disagreement was not resolved, the fourth author was consulted.

Data extraction and analysis

A data extraction sheet was developed using excel then piloted, discussed with the research team and modified as appropriate. The following data were extracted: citation and year of publication, objective of the study, country, PS topic, design, setting, PPI participants, PPI stages (identifying research priorities, being a member of an advisory or steering group, etc.…), frequency of PPI reporting as per the GRIPP2 checklist, and the availability of a plain language summary. Additionally, data against the five items of GRIPP2-SF (aim of PPI in the study, methods used for PPI, outcomes of PPI including the results and the extent to which PPI influenced the study overall, and reflections on PPI) were extracted. To avoid multiple publication bias and missing outcomes, data extraction was done by the first and the second authors independently and then compared. Disagreements between reviewers were first discussed, and then resolved by the third and fourth authors if needed.

Quality assessment

The quality of PPI reporting was assessed using GRIPP2-SF developed by Staniszewska et al. [ 9 ] as it is developed to improve the quality, consistency, and reporting of PPI in social and healthcare research. Additionally the GRIPP2-SF is suitable for all studies regardless of whether PPI is the primary, secondary, or tertiary focus, whereas the GRIPP2-LF is not suitable for studies where PPI serves as a secondary or tertiary focus. The checklist includes five items (mentioned above) that authors should include in their studies. It is important to mention that Staniszewska et al. noted that “while GRIPP2-SF aims to guide consistent reporting, it is not possible to be prescriptive about the exact content of each item, as the current evidence-base is not advanced enough to make this possible” ([ 9 ] p5). For that reason, we had to develop criteria for scoring the five reporting items. We used three scoring as Yes, No, and partial for each of the five items of the GRIPP2-SF. Yes, was given when authors presented PPI information on the item clearly in the paper. No, when no information was provided, and partial when the information partially met the item requirement. For example, as per GRIPP2-SF authors should provide a clear description of the methods used for PPI in the study. In the example given by Staniszewska et al., information on patient/public partners and how many of them were provided, as well as the stages of the study they were involved in (i.e. refining the focus of the research questions, developing the search strategy, interpreting results). Thus, in our evaluation of the included studies, we gave a yes if information on PPI participants (i.e. patient partners, community partners, or family members etc..) and how many of them were involved was provided, and information on the stages or actions of their involvement in the study was provided. However, we gave a “partial” if information was not fully provided (i.e. information on patient/public partners and how many were involved in the study without describing in what stages or actions they were involved, and vice versa), and a “No” if no information was presented at all.

The quality of PPI reporting was done by the first and the second authors independently and then compared. Disagreements between reviewers were first discussed, and then resolved by the third and fourth author when needed.

Assessing the quality or risk of bias of the included studies was omitted, as the focus in this review was on appraising the quality of PPI reporting rather than assessing the quality of each research article.

Data synthesis

After data extraction, a table summarising the included studies was developed. Studies were compared according to the main outcomes of the review; frequency of PPI reporting following the GRIPP2 checklist and the quality of reporting as per GRIPP2-SF five items, and the availability of a plain language summary.

Search results and study selection

The database searches yielded a total of 8491 studies. First, 2496 were removed as duplicates. Then, after title and abstract screening, 5785 articles were excluded leaving 210 articles eligible for the full text review. After a careful examination, 68 of these studies were included in this review. A further 38 studies were identified from the alert system that was set on the four databases and 32 studies from the reference check of the included studies. Of these 70 articles, 56 were further excluded and 14 were added to the previous 68 included studies. Thus, 82 studies met the inclusion criteria and were included in this review. A summary of the database search results and the study selection process are presented in Fig. 1 .

PRISMA flow diagram of the study selection process. The PRISMA flow diagram details the review search results and selection process

Overview of included studies

Details of the study characteristics including first author and year of publication, objective, country, study design, setting, PS topic, PPI participants and involvement stages are presented in Supplementary file 2 . The majority of the studies were conducted in the U.K ( n = 24) and the United States of America ( n = 18), with the remaining 39 conducted in other high income countries, the exception being one study in Haiti. A range of study designs were identified, the most common being qualitative ( n = 31), mixed methods ( n = 13), interventional ( n = 5), and quality improvement projects ( n = 4). Most PS topics concerned medication safety ( n = 17), PS in general (e.g., developing a PS survey or PS management application) ( n = 14), fall prevention ( n = 13), communication ( n = 11), and adverse events ( n = 10), with the remaining PS topics listed in Supplementary file 2 .

Patient representatives, advocates, and patient advisory groups ( n = 33) and patients, service users, and health consumers ( n = 32) were the main groups involved. The remaining, included community members/ organisations. Concerning PPI stages, the main involvement across the studies was in commenting on or developing research materials ( n = 74) including, patient leaflets, interventional tools, mobile applications, and survey instruments. Following this stage, involvement in data analysis, drafting manuscripts, and disseminating results ( n = 30), and being a member of a project advisory or steering group ( n = 18) were the most common PPI evident in included studies. Whereas the least involvement was in identifying research priorities ( n = 5), and being a co-applicant on a research project or grant application ( n = 6).

Regarding plain language summary, only one out of the 82 studies (1.22%) provided a plain language summary in their paper [ 20 ].

Frequency and quality of PPI reporting

The frequency of PPI reporting following the GRIPP2 checklist was 6.1%, where only five of the 82 included studies reported PPI in their papers following the GRIPP2 checklist. The quality of PPI reporting in those studies is presented in Table 2 . Of these five studies, one study (20%) did not report the aim of PPI in the study and one (20%) did not comment on the extent to which PPI influenced the study overall.

The quality of PPI reporting of the remaining 77 studies is presented in Table 3 . The aim of PPI in the study was reported in 62.3% of articles ( n = 48), while 3.9% ( n = 3) partially reported this. A clear description of the methods used for PPI in the study was reported in 79.2% of papers ( n = 61) and partially in 20.8% ( n = 16). Concerning the outcomes, 81.8% of papers ( n = 63) reported the results of PPI in the study, while 10.4% ( n = 8) partially did. Of the 77 studies, 68.8% ( n = 53) reported the extent to which PPI influenced the study overall and 3.9% ( n = 3) partially reported this. Finally, 57.1% ( n = 44) of papers critically reflected on the things that went well and those that did not and 2.6% ( n = 2) partially reflected on this.

Summary of main findings

This systematic review assessed the frequency of reporting PPI in PS research using the GRIPP2 checklist and quality of reporting using the GRIPP2-SF. In total, 82 studies were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials such as educational and interventional tools, survey instruments, and applications while the least was in identifying research priorities and being a co-applicant on a research project or grant application. Thus, significant effort is still needed to involve patients and the public in the earlier stages of the research process given the fundamental impact of PS on their lives.

Overall completeness and applicability of evidence

A low frequency of reporting PPI in PS research following the GRIPP2 guidelines was revealed in this review, where only five of the 82 studies included mentioned that PPI was reported as per the GRIPP2 checklist. This is despite it being the most recent report-focused framework and the most recommended by several leading journals [ 17 ]. This was not surprising as similar results were reported in recent reviews in other healthcare topics. For instance, Musbahi et al. in their systematic review on PPI reporting in bariatric research reported that none of the 90 papers identified in their review mentioned or utilised the GRIPP2 checklist [ 102 ]. Similarly, a study on PPI in orthodontic research found that none of the 363 included articles reported PPI against the GRIPP2 checklist [ 103 ].

In relation to the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting within the 77 studies that did not use GRIPP2 as a guide/checklist to report their PPI. Similarly, Bergin et al. in their systematic review to investigate the nature and impact of PPI in cancer research concluded that substandard reporting was evident [ 12 ]. In our review, this was mainly due to failure to meet three criteria. First, the lowest percentage of reporting (57.1%, n = 44) was related to critical reflection on PPI in the study (i.e., what went well and what did not). In total, 31 studies (42.9%) did not provide any information on this, and two studies were scored as partial. The first study mentioned that only involving one patient was a limitation [ 27 ] and the other stated that including three patients in the design of the tool was a strength [ 83 ]. Both studies did not critically comment or reflect on these points so that future researchers are able to avoid such problems and enhance PPI opportunities. For instance, providing the reasons/challenges behind the exclusive inclusion of a single patient and explaining how this limits the study findings and conclusion would help future researchers to address these challenges. Likewise, commenting on why incorporating three patients in the design of the study tool could be seen as a strength would have been beneficial. This could be, fostering diverse perspectives and generating novel ideas for developing the tool. Similar to our findings, Bergin et al. in their systematic review reported that 40% of the studies failed to meet this criterion [ 12 ].

Second, only 48 out of 77 articles (62.3%) reported the aim of PPI in their study, which is unlike the results of Bergin et al. where most of the studies (93.1%) in their review met this criterion [ 12 ]. Of the 29 studies which did not meet this criterion in our review, few mentioned in their objective developing a consensus-based instrument [ 41 ], reaching a consensus on the patient-reported outcomes [ 32 ], obtaining international consensus on a set of core outcome measures [ 98 ], and facilitating a multi-stakeholder dialogue [ 71 ] yet, without indicating anything in relation to patients, patient representatives, community members, or any other PPI participants. Thus, the lack of reporting the aim of PPI was clearly evident in this review. Reporting the aim of PPI in the study is crucial for promoting transparency, methodological rigor, reproducibility, and impact assessment of the PPI.

Third, 68.8% ( n = 53) of the studies reported the extent to which PPI influenced the study overall including positive and negative effects if any. This was again similar to the findings of Bergin et al., where 38% of the studies did not meet this criterion mainly due to a failure to address PPI challenges in their respective studies [ 12 ]. Additionally, Owyang et al. in their review on the extent, and quality of PPI in orthopaedic practice, also described a poor reporting of PPI impact on research [ 13 ]. As per the GRIPP2 guidelines, both positive and negative effects of PPI on the study should be reported when applicable. Providing such information is essential as it enhances future research on PPI in terms of both practice and reporting.

Reporting a clear description of the methods used for PPI in the study was acceptable, with 79.2% of the papers meeting this criterion. Most studies provided information in the methods section of their papers on the PPI participants, their number, stages of their involvement and how they were involved. Providing clear information on the methods used for PPI is vital to give the reader a clear understanding of the steps taken to involve patients, and for other researchers to replicate these methods in future research. Additionally, reporting the results of PPI in the study was also acceptable with 81.8% of the papers reporting the outcomes of PPI in the results section. Reporting the results of PPI is important for enhancing methodological transparency, providing a more accurate interpretation for the study findings, contributing to the overall accountability and credibility of the research, and informing decision making.

Out of the 82 studies included in this review, only one study provided a plain language summary. We understand that PS research or health and medical research in general is difficult for patients and the public to understand given their diverse health literacy and educational backgrounds. However, if we expect patients and the public to be involved in research then, it is crucial to translate this research that has a huge impact on their lives into an easily accessible format. Failing to translate the benefits that such research may have on patient and public lives may result in them underestimating the value of this research and losing interest in being involved in the planning or implementation of future research [ 103 ]. Thus, providing a plain language summary for research is one way to tackle this problem. To our knowledge, only a few health and social care journals (i.e. Cochrane and BMC Research Involvement and Engagement) necessitate a plain language summary as a submission requirement. Having this as a requirement for submission is crucial in bringing the importance of this issue to researchers’ attention.

Research from recent years suggests that poor PPI reporting in articles relates to a lack of submission requirements for PPI reporting in journals and difficulties with word limits for submitted manuscripts [ 13 ]. Price et al. assessed the frequency of PPI reporting in published papers before and after the introduction of PPI reporting obligations by the British Medical Journal (BMJ) [ 104 ]. The authors identified an increase in PPI reporting in papers published by BMJ from 0.5% to 11% between the periods of 2013–2014 and 2015–2016. The study findings demonstrate the impact of journal guidelines in shaping higher quality research outputs [ 13 ]. In our review, we found a low frequency of PPI reporting in PS research using the GRIPP2 checklist, alongside sub-optimal quality of reporting following GRIPP2-SF. This could potentially be attributed to the absence of submission requirements for PPI reporting in journals following the GRIPP2 checklist, as well as challenges posed by word limits.

Strengths and limitations

This systematic review presents an overview on the frequency of PPI reporting in PS research using the GRIPP2 checklist, as well as an evaluation of the quality of reporting following the GRIPP2-SF. As the first review to focus on PS research, it provides useful knowledge on the status of PPI reporting in this field, and the extent to which researchers are adopting and adhering to PPI reporting guidelines. Despite these strengths, our review has some limitations that should be mentioned. First, only English language papers were included in this review due to being the main language of the researchers. Thus, there is a possibility that relevant articles on PPI in PS research may have been omitted. Another limitation is related to our search which was limited to papers published starting 2018 as the GRIPP2 guidelines were published in 2017. Thus it is probable that the protocols of some of these studies were developed earlier than the publication of the GRIPP2 checklist, meaning that PPI reporting following GRIPP2 was not common practice and thus not adopted by these studies. This might limit the conclusions we can draw from this review. Finally, the use of GRIPP2 to assess the quality of PPI reporting might be a limitation as usability testing has not yet been conducted to understand how the checklist works in practice with various types of research designs. However, the GRIPP2 is the first international, evidence-based, community consensus informed guideline for the reporting of PPI in health and social care research. Reflections and comments from researchers using the GRIPP2 will help improve its use in future studies.

Implications for research and practice

Lack of PPI reporting not only affects the quality of research but also implies that others cannot learn from previous research experience. Additionally, without consistent and transparent reporting it is difficult to evaluate the impact of various PPI in research [ 9 ]: “if it is not reported it cannot be assessed” ([ 105 ] p19). Enhanced PPI reporting will result in a wider range and richer high-quality evidence-based PPI research, leading to a better understanding of PPI use and effectiveness [ 103 ]. GRIPP2 reporting guidelines were developed to provide guidance for researchers, patients, and the public to enhance the quality of PPI reporting and improve the quality of the international PPI evidence-base. The guidance can be used prospectively to plan PPI or retrospectively to guide the structure or PPI reporting in research [ 9 ]. To enhance PPI reporting, we recommend the following;

Publishers and journals

First, we encourage publishers and journals to require researchers to report PPI following the GRIPP2 checklist. Utilising the short or the long version should depend on the primary focus of the study (i.e., if PPI is within the primary focus of the research then the GRIPP2-LF is recommended). Second, we recommend that journals and editorial members advise reviewers to evaluate PPI reporting within research articles following the GRIPP2 tool and make suggestions accordingly. Finally, we encourage journals to add a plain language summary as a submission requirement to increase research dissemination and improve the accessibility of research for patients and the public.

Researchers

Though there is greater evidence of PPI in research, it is still primarily the researchers that are setting the research agenda and deciding on the research questions to be addressed. Thus, significant effort is still needed to involve patients and the public in the earlier stages of the research process given the fundamental impact of PS on their lives. To enhance future PPI reporting, perhaps adding a criterion following the GRIPP2 tool to existing EQUATOR checklists for reporting research papers such as STROBE, PRISMA, CONSORT, may support higher quality research. Additionally, currently, there is no detailed explanation paper for the GRIPP2 where each criterion is explained in detail with examples. Addressing this gap would be of great benefit to guide the structure of PPI reporting and to explore the applicability of each criterion in relation to different stages of PPI in research. For instance, having a detailed explanation for each criterion across different research studies having various PPI stages would be of high value to improve future PPI reporting given the growing interest in PPI research in recent years and the relatively small PPI evidence base in health and medical research.

Funding bodies can also enhance PPI reporting by adding a requirement for researchers to report PPI following the GRIPP2 checklist. In Ireland, the National HSE has already initiated this by requiring all PPI in HSE research in Ireland to be reported following the GRIPP2 guidelines [ 10 ].

This study represents the first systematic review on the frequency and quality of PPI reporting in PS research using the GRIPP2 checklist. Most PS topics were related to medication safety, general PS, and fall prevention. The main involvement across the studies was in commenting on or developing research materials. Thus, efforts are still needed to involve patients and the public across all aspects of the research process, especially earlier stages of the research cycle. The frequency of PPI reporting following the GRIPP2 guidelines was low, and the quality of reporting following the GRIPP2-SF criteria was sub-optimal. The lowest percentages of reporting were on critically reflecting on PPI in the study so future research can learn from this experience and work to improve it, reporting the aim of the PPI in the study, and reporting the extent to which PPI influenced the study overall including positive and negative effects. Researchers, funders, publishers, journals, editorial members and reviewers have a responsibility to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be supported to help future researchers plan and report PPI more effectively, which may ultimately improve the quality and relevance of research.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its Supplementary information files.

Abbreviations

Patient safety

United Kingdom

National Institute for Health Research

Public and Patient Involvement

Health Service Executive

Guidance for Reporting Involvement of Patients and the Public

Second version of the GRIPP checklist

Long form of GRIPP2

Short form of GRIPP2

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

The International Database of Prospectively Registered Systematic Reviews

British Medical Journal

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This research is funded as part of the Collective Leadership and Safety Cultures (Co-Lead) research programme which is funded by the Irish Health Research Board, grant reference number RL-2015–1588 and the Health Service Executive. The funders had no role in the study conceptualisation, design, data collection, analysis, decision to publish, or preparation of the manuscript.

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S.H and E.M.A designed the study. S.H developed the search strategies with feedback from L.A, L.R, and E.M.A. S.H conducted all searches. S.H and L.A screened the studies, extracted the data, and assessed the quality of PPI reporting. S.H analysed the data with feedback from E.M.A. S.H drafted the manuscript. All authors revised and approved the submitted manuscript. All authors agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Hammoud, S., Alsabek, L., Rogers, L. et al. Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research. BMC Health Serv Res 24 , 532 (2024). https://doi.org/10.1186/s12913-024-11021-z

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Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

James Shaw 1 , 13 ,
Joseph Ali 2 , 3 ,
Caesar A. Atuire 4 , 5 ,
Phaik Yeong Cheah 6 ,
Armando Guio Español 7 ,
Judy Wawira Gichoya 8 ,
Adrienne Hunt 9 ,
Daudi Jjingo 10 ,
Katherine Littler 9 ,
Daniela Paolotti 11 &
Effy Vayena 12

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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

Conclusions

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

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Introduction

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table 1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table 2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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JS led the writing, contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. CA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. PYC contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AE contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JWG contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AH contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DJ contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. KL contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DP contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. EV contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper.

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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Purdue graduate student Natalie Seidl tests a subject’s hearing in a sound-attenuating booth. Purdue’s audiology graduate program was ranked No. 8 in the 2024-25 U.S. News & World Report Best Graduate Schools national rankings. (Photo provided by Purdue Department of Speech, Language, and Hearing Sciences)

The new facility at 16 Tech Innovation District will address hearing health needs, with a focus on underserved groups

INDIANAPOLIS — Leveraging Purdue’s internationally recognized expertise in audiology and auditory neuroscience and AI-driven data analytics, Purdue University announced plans for the new Accessible Precision Audiology Research Center (APARC) in Indianapolis on Wednesday (May 1). The community-facing center will address the urgent need for accessible precision audiology, especially among underserved populations in Indiana. It will be housed in the 16 Tech Innovation District, the city’s destination for innovation and entrepreneurship, and be adjacent to Purdue University in Indianapolis, the urban extension campus that launches July 1.

By establishing the APARC in Indianapolis at 16 Tech, Purdue aims to reach diverse populations in Indiana with information about the many health and economic burdens associated with untreated hearing loss, along with providing research-grade standardized hearing assessments for community members. An open-source data hub of standardized hearing measures for researchers using AI-enabled analysis tools will create more testing and treatment capabilities.

“Purdue’s new Accessible Precision Audiology Research Center in Indianapolis will leverage our leadership in both AI and the speech, language and hearing sciences,” said Karen Plaut, executive vice president for research. “Using AI to better analyze measures of hearing loss, the goal of this research center is to develop better testing methods and improve the hearing and overall well-being for people living in central Indiana and beyond.”

ADDITIONAL INFORMATION

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The faculty team leading APARC illustrates the interdisciplinary approaches that are required to meet today’s grand challenges. The team is led by Michael Heinz, associate head for research in the Department of Speech, Language, and Hearing Sciences (SLHS), along with fellow SLHS faculty Jennifer Simpson, Maureen Shader and Josh Alexander, as well as Ananth Garma in the Department of Computer Science and Edward Bartlett in the Department of Biological Sciences. The center is supported by Purdue’s Office of Research and the Office of the Provost and leverages several significant grants from the National Institutes of Health.

“I am especially proud that funding for APARC came about following a research proposal by faculty members during Purdue’s life and health sciences summit in 2023,” Plaut said.

Untreated hearing loss is associated with increased cognitive decline, dementia, social isolation, falls and mental health disorders. Additional comorbidities of hearing loss include cardiovascular disease and diabetes. For people with untreated hearing loss, health care costs are 46% higher and inpatient stays occur 1.5 times more often than for those without hearing loss.

Overcoming these health and economic burdens is made even more difficult by limited access to quality audiological care. In the U.S. today, only one audiologist exists for every 14,000 people, and over 15% of American adults nationwide — around 40 million people — have trouble hearing. This highlights the urgent need for precision audiology to support targeted treatment (for example, hearing aids, cochlear implants or, ultimately, biopharmaceutical approaches), rehabilitation, and identification of population and individual-specific risk factors.

“We are grateful for Purdue's support to help synergize our team's expertise in auditory neuroscience, clinical audiology and data analytics to address the significant issue of untreated hearing loss, which has numerous societal health and economic implications,” Heinz said. “Our Indianapolis presence within the innovation hub in the 16 Tech Innovation District, adjacent to the AMP artisan marketplace and food hall, provides a unique opportunity for us to establish APARC in a community-based ecosystem that includes many other initiatives aimed at accelerating transformative health solutions for central Indiana and beyond.”

At the new APARC in Indianapolis, researchers will be looking for innovative ways to address challenges associated with hearing loss, especially in low-resource urban and rural communities in the state. Indiana-specific populations with elevated risk for untreated hearing loss include farmers, Indianapolis Motor Speedway workers and fans, and those with significant health disparities residing in underserved neighborhoods. The APARC is the latest example of how Purdue is expanding its presence in central Indiana by applying significant education, instruction and research efforts to this real-life issue at 16 Tech, where world-changing discoveries and economic opportunities are being created right in the heart of Indiana’s capital city.

“APARC is a great example of an innovative program that is improving patient outcomes through technology,” said Emily Krueger, president and CEO of 16 Tech Community Corp., the nonprofit manager of the innovation district. “By locating in 16 Tech, APARC joins a growing cluster of health tech and med tech companies that have access to resources that help them scale and the diverse communities they aim to serve.”

Purdue’s Department of Speech, Language, and Hearing Sciences in the College of Health and Human Sciences is highly recognized worldwide for its undergraduate and two clinical graduate and PhD programs. The Doctor of Audiology program ranked No. 8 in the 2024-25 U.S. News and World Report Best Graduate Schools rankings due to the exceptional work of the clinical and academic faculty, who promote evidence-based practice with a deep scientific foundation.

The overarching goal of the college is to positively impact people’s behavior, health and quality of life, which aligns with the needs of patients and Purdue students.

About Purdue University in Indianapolis

Purdue University in Indianapolis is a new, fully integrated extension of the West Lafayette campus, expanding the academic rigor and accessible excellence that Purdue is known for to central Indiana. As the state’s only public top 10 university, most trusted university and most innovative university, Purdue is focused and committed to strengthening its presence in Indiana’s industrial and technological center. Purdue University in Indianapolis will create an innovative, STEM-based collegiate experience by connecting future-ready Purdue students and faculty in Indianapolis to local businesses to accelerate Indiana’s STEM pipeline and tech ecosystem, fueling impact for our region and the world. Realignment of the existing IUPUI partnership will be completed by the start of the fall semester in 2024. Learn more about Purdue’s latest giant leap at https://www.purdue.edu/campuses/indianapolis/ .

About 16 Tech

Opened in 2020, the 16 Tech Innovation District is a growing destination for innovation and entrepreneurship and a driver of the tech enablement of the life sciences and advanced manufacturing industries key to Indiana’s economy. Connected to diverse neighborhoods in downtown Indianapolis and intentionally resourced with facilities and programs to foster innovation, 16 Tech is home to three buildings with a variety of office, wet- and dry-lab spaces and makerspaces, and 200-plus innovation-related entities that employ more than 800 people. At full build-out, 16 Tech anticipates more than 2 million square feet of innovation-related space that support 3,000 jobs.

Writer/Media contact: Derek Schultz, [email protected]

Sources: Michael Heinz [email protected] , Karen Plaut, Emily Krueger

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What is a Focus Group
Just like other research methods, focus groups come with advantages and disadvantages. Advantages. They are fairly straightforward to organize and results have strong face validity. They are usually inexpensive, even if you compensate participant. A focus group is much less time-consuming than a survey or experiment, and you get immediate results.
Focus Groups
A focus group is a qualitative research method used to gather in-depth insights and opinions from a group of individuals about a particular product, service, concept, or idea. The focus group typically consists of 6-10 participants who are selected based on shared characteristics such as demographics, interests, or experiences. The discussion ...
Chapter 12. Focus Groups
Doing Focus Groups. 2nd ed. Thousand Oaks, CA: SAGE. Written by a medical sociologist based in the UK, this is a good how-to guide for conducting focus groups. Gibson, Faith. 2007. "Conducting Focus Groups with Children and Young People: Strategies for Success." Journal of Research in Nursing 12(5):473-483. As the title suggests, this ...
Focus Groups: The Definitive Guide
Advantages and disadvantages of focus groups. Like any research method, focus groups come with a variety of pros and cons that are typically associated with any type of qualitative research. Advantages of focus groups. They give you qualitative insights. Exploring the 'why' behind people's behaviors, views and decisions
What Is a Focus Group?
A focus group is a qualitative research method that involves facilitating a small group discussion with participants who share common characteristics or experiences that are relevant to the research topic. The goal is to gain insights through group conversation and observation of dynamics. In a focus group: A moderator asks questions and leads a group of typically 6 to 12 pre-screened ...
What is Focus Group Research? Definition, Types, Methods ...
Focus group research is defined as a qualitative research method used to gather data from a small, diverse group of people in a facilitated group discussion. Learn more about focus group research types, methods, and examples.
Focus Groups 101
Focus Groups 101. Therese Fessenden. July 31, 2022. Summary: Well-run focus groups help gather some initial feedback from a group of people. However, their bias potential makes them insufficient as a standalone research method. Workshop techniques can help maximize participation and reduce the potential for bias.
Qualitative Research: Introducing focus groups
Focus groups are a form of group interview that capitalises on communication between research participants in order to generate data. Although group interviews are often used simply as a quick and convenient way to collect data from several people simultaneously, focus groups explicitly use group interaction as part of the method.
Focus Group Method
Among the range of methods for doing research inclusively, the focus group method merits attention. Once the realm of market research, focus groups have gained popularity in social research (Morgan et al. 2008).The focus group method has also enjoyed considerable diversification, meaning that reference to more recent literature on the method will lead the reader to a range of focus group forms ...
Interviews and focus groups in qualitative research: an update for the
The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital ...
Focus Groups: Everything You Need to Know
In general, all focus groups have the following five steps: 1. Identifying the goals and objectives. Before conducting a focus group, it is important to clearly define the goals and objectives of the discussion. This will ensure the focus group is productive and enable the moderator to design an effective discussion guide.
UCSF Guides: Qualitative Research Guide: Focus Groups
Publication Date: 2018. Focus Groups by Richard A. Krueger; Mary Anne Casey. ISBN: 9781483365244. Publication Date: 2014-08-14. Print book available through Interlibrary Loan. Focus groups as qualitative research by David L. Morgan. ISBN: 0761903429. Focus Groups in Social Research by Michael Bloor; Jane Frankland; Michelle Thomas; Kate Stewart.
Focus Groups
Focus groups can be used across a variety of different fields. Ravitch and Carl described focus groups as being suited for studies that explore opinions, attitudes and experience in specific contexts or groups.They are also appropriate for inquiry about social interaction processes, or research questions that examine how knowledge and ideas develop, are constructed and operate within a ...
Methodological Aspects of Focus Groups in Health Research
Focus groups have been widely used in health research in recent years to explore the perspectives of patients and other groups in the health care system (e.g., Carr et al., 2003; Côté-Arsenault & Morrison-Beedy, 2005; Kitzinger, 2006).They are often included in mixed-methods studies to gain more information on how to construct questionnaires or interpret results (Creswell & Plano Clark, 2007 ...
What is a Focus Group? Definition, Questions, Examples and Best
A focus group is a qualitative research method used in market research and social sciences, where a small group of people, typically 6 to 10 individuals, participate in a guided discussion about a particular topic. Learn more about focus group with examples, questions and best practices.
PDF Focus Groups as Qualitative Research
Focus Groups as Qualitative Research. PLANNING AND RESEARCH DESIGN FOR FOCUS GROUPS. Contributors: David L. Morgan Print Pub. Date: 1997 Online Pub. Date: Print ISBN: 9780761903437 Online ISBN: 9781412984287 DOI: 10.4135/9781412984287 Print pages: 32-46 This PDF has been generated from SAGE Research Methods. Please note that the pagination of ...
A Qualitative Framework for Collecting and Analyzing Data in Focus
Traditionally, focus group research is "a way of collecting qualitative data, which—essentially—involves engaging a small number of people in an informal group discussion (or discussions), 'focused' around a particular topic or set of issues" (Wilkinson, 2004, p. 177).Social science researchers in general and qualitative researchers in particular often rely on focus groups to ...
Focus Group Research: An Intentional Strategy for Applied Group Research?
Quantitative and Mixed Methods Perspectives on Focus Group Research. When focus groups are used within mixed or quantitative research, they tend to be employed as part of instrument development (Nagel & Williams, Citation n.d.).These focus groups are positioned as an adjunct to the quantitative data collection, and appear to be centered on task-focused aims (Department of Health and Human ...
What Is a Focus Group?
A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest. Table of contents.
LibGuides: Qualitative study design: Focus groups
Focus groups use a group setting to generate data different to that obtained in a one-to-one interview. The group context may allow for better examination of beliefs, attitudes, values, perspectives, knowledge and ideas. Focus groups can be useful in action research methodology and other study designs which seek to empower research participants.
SAGE Research Methods: Find resources to answer your research methods
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Future research could focus on the methods used to monitor participants and the possibility of opening up the online focus groups to a much wider audience. In-person focus groups must take place in a single physical location where the participants gather and can be directly monitored by the researchers.
How to use and assess qualitative research methods
The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [1, 14, 16, 17]. Document study These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.
Thematic Analysis for Focus Groups
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The Role of Focus Groups in UX Research: Pros and Cons
The Case Against Focus Groups (Nay) Of course, no research method is without its flaws, and focus groups are no exception. Critics argue that focus groups can be influenced by group dynamics, where dominant voices overshadow minority perspectives, leading to biased or inaccurate conclusions.
The Asian American Experience: Highlights from our focus groups
Browse excerpts from our focus groups with the interactive quote sorter below, view a video documentary focused on the topics discussed in the focus groups, or tell us your story of belonging in America via social media. The focus group project is part of a broader research project studying the diverse experiences of Asians living in the U.S.
Methodology: 2023 focus groups of Asian Americans
Pew Research Center conducted 18 in-person focus groups with 144 adult participants from across the United States from Feb. 7 to Feb. 23, 2023. Recruited participants are from 11 Asian origin groups. Each person was offered an incentive amount of $225 to participate. Focus groups were 1.5 hours in length.
Systematic review on the frequency and quality of reporting patient and
In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient ...
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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town ...
Purdue to open Accessible Precision Audiology Research Center in
The new facility at 16 Tech Innovation District will address hearing health needs, with a focus on underserved groups. INDIANAPOLIS — Leveraging Purdue's internationally recognized expertise in audiology and auditory neuroscience and AI-driven data analytics, Purdue University announced plans for the new Accessible Precision Audiology Research Center (APARC) in Indianapolis on Wednesday ...

Focus Groups – Steps, Examples and Guide

Focus Group

Types of Focus Group

Traditional Focus Group

Mini Focus Group

Dual Moderator Focus Group

Teleconference or Online Focus Group

Client-led Focus Group

How To Conduct a Focus Group

Define the Research Question

Recruit Participants

Select a Venue

Conduct the Session

Record the Session

Analyze the data

When to use Focus Group Method

Exploratory Research

Product Development

Marketing Research

Customer Feedback

Public Policy Research

Examples of Focus Group

Purpose of Focus Group

Generating New Ideas and insights

Understanding Consumer Behavior

Testing Concepts and Ideas

Gathering Customer Feedback

Advantages of Focus Group

Limitations of Focus Groups

Characteristics of Focus Group

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What is a focus group?

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When should a focus group be used?

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Remote focus groups

How to run a focus group: Step-by-step guide

1. Research and define your goal

2. Choose a moderator

3. Choose a location

4. Recruit the right participants

5. Create a discussion guide

6. Conduct the focus group

7. Debrief and iterate

8. Analyse and report on the findings

How many people should be in a focus group?

Focus groups vs in-depth interviews

The benefits of focus groups over in-depth interviews

The benefits of in-depth interviews over focus groups

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Advantages of focus groups

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