Concept reintegration for youth focus group engagement and empowerment

Abstract

Youths’ views on how community and social influences impact dating violence are virtually absent in research literature, in part because it is difficult to capture. When researchers ask youth what causes dating violence, responses focus on dating violence “triggers.” The few multi-level influences identified revolve around restraining orders and punishing abusers. In this article, we review formats that have been used for youth focus groups, especially in research on teen dating violence. We note that conventional focus groups and concept mapping processes rely on facilitator prompts to elicit discussion based on cause and effect that are assumed to be in line with the researcher’s social science understanding of causality. We then propose a new focus group format that begins with conventional focus group prompts followed by integration of participant concepts with concepts added by the researcher. The new format reverses the typical coding process in which the researcher gleans knowledge from focus group participants post-interview through the lens of the scientific knowledge base. We present pilot results based on three focus groups with 37 youth and 10 adults. We report the effect of the new format on participation, engagement, complexity of discussion, critical thinking about social structure, and participant empowerment. We discuss specific areas in which the focus group formats differed and suggest important implications for focus group methods and practice with groups, especially youth groups.

Keywords

Focus group young people domestic violence action research empowerment participatory research

Introduction

Our empirical knowledge of teen dating violence (TDV) is precariously based on knowledge from adult relationships, imprecise measurement, and a paucity of critical and reflective youth input. Few qualitative studies have been conducted concerning TDV (Sears et al., 2006). Most measures of TDV were created for adults or were created from the researchers’ perspective as opposed to the teens’ perspective (Dahlberg et al., 2005). In addition, there are few TDV prevention studies in the literature, and even fewer that pertain to urban youth of color (Black and Weisz, 2004; Weisz and Black, 2010) and gay and lesbian youth (Gallopin and Leigh, 2009). Ocampo et al. (2007) and later Martin et al. (2012) proposed that more research is needed to explore terminology of participants and their health-seeking behavior as a basis to design more effective interventions (Martin et al., 2012; Ocampo et al., 2007). Similarly, Baker and Helm (2010) suggest there is a need to understand teens’ perceptions of violence, specifically what is considered violent. Further, schools should be included as a venue for research and prevention programming (Baker and Helm, 2010). Lastly, the public health and violence prevention fields widely acknowledge the need for knowledge and effective prevention programming to address multi-level factors that influence TDV, including relationship, community, and societal influences on TDV (Offenhauer and Buchalter, 2011).

Qualitative forms of inquiry offer appropriate approaches to gain a more in-depth analysis of multi-level influences on TDV (Próspero, 2006). We think that focus groups are an ideal method for exploring this area of study. For many adolescents, especially those with a history of having been corrected and judged by adults, focus groups may provide a more relaxed atmosphere and may be less intimidating than an individual interview (Liamputtong, 2009). In fact, Punch (2002: 48) found teens preferred focus groups to in-depth interviews because “they were in the supportive company of peers.” Also, focus groups may meet teens’ need for social interaction. Teens tend to socialize in groups in school and afterschool activities; thus, groups are familiar (Heary and Hennessy, 2002). When teens are asked sensitive questions, focus groups may be preferred, because there is less pressure for any one person to answer (Heary and Hennessy, 2002).

While focus groups have many advantages, there are some disadvantages of using this research method with adolescents. Focus groups require interaction between the participants and the facilitators. Adolescents who are shy or feel intimidated by their peers may not feel comfortable participating. Facilitators, therefore, need to ensure that focus groups are a safe place with established rules (Hennessy and Heary, 2005). In addition, confidentiality among the group participants can be problematic once they leave the group (Hennessy and Heary, 2005). Adolescents may be inclined to discuss the particulars of the group dialogue with friends who were not in the group or in the presence of those who were not in the group. Facilitators should discuss this possibility and implore the focus group participants to refrain from such discussions.

Focus group formats with youth

In this section, we review formats that have been used for youth focus groups, especially in TDV research. Focus groups are a prevalent method used to study adolescents’ perspectives of health issues (Daley, 2013). Focus groups have been employed to study a wide range of health concerns of adolescents such as smoking cessation (Patten et al., 2009), antiretroviral therapy (Rao et al., 2007), physical activity (Whitehead and Biddle, 2008), and alcohol use (Coleman and Cater, 2007; Randolph et al., 2013). Focus groups involve the carefully planned recruitment of participants with similar characteristics to meet in small groups to discuss a common topic, usually with question prompts posed in sequence by a facilitator (Krueger and Casey, 2009). The facilitator or moderator is trained to encourage and invites all participant perspectives without judgment (Krueger and Casey, 2009). There are several strengths of focus groups. First, focus groups foster the generation of ideas within the group context (Breen, 2006; Guzman et al., 2009). Second, focus groups allow researchers to delve into the socially constructed meanings that participants ascribe by probing the participants’ responses (Guzman et al., 2009; Heary and Hennessy, 2002). Third, the process allows researchers the opportunity to understand the complexity of an issue from the perspective of the focus group participants (Doody et al., 2013).

Focus groups also present methodological challenges. For instance, results cannot be generalized to the broader population, because focus groups generate knowledge that is regarded as unique to the group studied (Heary and Hennessy, 2002). Daley (2013), in her systematic review of focus group limitations cited three other methodological concerns: limitation in wording of research questions and focus group questions, interpretation bias, and lack of member checks (i.e., feedback from participants about the results and conclusions of the study are often not conducted). In addition, research questions and focus group questions can limit the depth and breadth of responses from participants (Ginsburg et al., 2002; Sanders and Munford, 2005). Ginsburg et al. (2002) noted in their study of resiliency of adolescents living in a high-crime urban area that their use of the word community limited the generation of solutions pertaining to the individual or relationship levels. Thus, the authors suggest that the language and diction of focus group questions may influence the group’s response (Ginsburg et al., 2002). Rao et al. (2007) noted in their study of adolescents’ attitudes toward highly active antiretroviral therapy that interpretive bias may have been a methodological limitation given the explorative nature of their investigation. Finally, in a study of Alaskan Native adolescent tobacco users using focus groups, Patten et al. (2009) noted that not using member checks was a limitation of their study.

The gender, sexual orientation, and ethnic composition of focus groups are also important to consider. Composition decisions are often based on creating a space in which the participants, especially if they are from a stigmatized population, feel free to talk without retribution or to obtain information from an infrequently studied group. For instance, Baker and Helm (2010) explained that they provided separate focus groups based on ethnicity in their study of adolescents of Native Hawaiian, Samoan, Filipino, and Euro-American descent to increase the comfort level of the participants. Gallopin and Leigh (2009) included one focus group that consisted exclusively of youth who identified as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ) because of the dearth of research on this population.

Finally, format and composition can influence focus groups with adolescent populations. Formats employed in focus group research usually consist of multiple focus groups with a specific population pertaining to an identified issue (Martin et al., 2012; Patten et al., 2009; Rao et al., 2007). Focus group formats typically include interviews (Coleman and Cater, 2007), surveys (Ginsburg et al., 2002), and participant observation (Banister and Schreiber, 2001). Sanders and Munford (2005) proposed a framework for youth focus groups that used eco-maps, geographic mapping, concept mapping, and life stories to explore concepts with youth. The authors found that facilitating reflection on developing concepts resulted in rich information about meaning, contexts, and interactions among individuals, events, and contexts.

Focus groups in TDV research

We conducted a targeted review of focus group-based TDV research literature. Several studies used focus groups with minority populations of adolescents such as African-American youth (Guzman et al., 2009; Johnson et al., 2005; Love and Richards, 2013; Martin et al., 2012; Teitelman et al., 2013), Hispanic youth (Black and Weisz, 2004; Guzman et al., 2009; Haglund et al., 2012; Ocampo et al., 2007; Próspero, 2006; Toews et al., 2011; Williams et al., 2012), LGBTQ youth (Gallopin and Leigh, 2009), and Native Hawaiian, Samoan, and Filipino youth (Baker and Helm, 2010). Akers et al. (2011) conducted a novel study comprising 19 focus groups with African-American families. The focus groups explored how families discuss sexual health including TDV. The parents attended focus groups separate from their adolescents aged 15–17 (Akers et al., 2011). Three studies concentrated on adolescent females’ perceptions of dating violence (Haglund et al., 2012; Hays et al., 2009; Teitelman et al., 2013) while one study focused on adolescent mothers (Toews et al., 2011). Johnson et al. (2005) included adjudicated youth and youth from a training center for disadvantaged youth.

Most of the studies reviewed used a semi-structured format comprising an interview guide with predetermined questions regarding TDV. However, some studies included surveys (Akers et al., 2011; Baker and Helm, 2010; Ocampo et al., 2007; Reeves and Orpinas, 2012), vignettes (Teitelman et al., 2013), artworks and photographs (Hays et al., 2009), skill-based education programing (Ocampo et al., 2007; Toews et al., 2011), and surveys for future use (Próspero, 2006, 2007). Most of the studies explored adolescents’ perception of dating violence, preferences for help-seeking, and views on girls’ and boys’ involvement in dating violence. Other studies also concentrated on identifying components of a healthy dating relationship (Akers et al., 2011; Fredland et al., 2005; Hays et al., 2009), cultural aspects of a healthy relationship (Guzman et al., 2009; Haglund et al., 2012; Williams et al., 2012), gender effects and biases (Próspero, 2006; Sears et al., 2006), and the effect of number of sexual partners (Teitelman et al., 2013).

Research questions

We determined that extant TDV research is lacking youths’ views and experience of school-level influences. The few studies that tap youth knowledge of multi-level influences have thus far identified a narrow set of issues pertaining mainly to TDV punishment (Carlson, 2003; Gallopin and Leigh, 2009; Offenhauer and Buchalter, 2011). Notably, studies asking open-ended questions about what causes TDV have obtained answers primarily about TDV symptoms or “triggers” (Carlson, 2003; Gallopin and Leigh, 2009). Because youth may not share the researcher’s training, they may not be able to give or respond to an academic articulation of cause and effect; therefore, more innovative methodologies such as those proposed in the present study are needed.

To gain knowledge of school influences, we refined and pilot tested an innovative two-segment focus group method to facilitate youth and adult identification of school influences on TDV. The principal investigator had successfully utilized a similar approach in five youth focus groups in Florida previously. In the first segment, participants responded to conventional focus group questions about perceptions and experiences of TDV and the school. During this segment, a research assistant took note of the participants’ responses on 5.5″ by 8.5″ cards. The multi-level concepts from the literature were also written on 5.5″ by 8.5″ cards. In the second segment, the participants had the opportunity to integrate their ideas noted on the cards with concepts from the literature pertaining to community and school influences. The facilitator reviewed participant ideas from the first segment and placed them at the top of an adhesive cling wall. The facilitator also presented the concepts from the literature pertaining to school climate and community influence and placed them at the bottom of the adhesive cling wall. Participants were asked questions about relationships between the participant ideas and research concepts. The cards were then reorganized as participants connected their own ideas with the concepts derived from the literature.

This focus group pilot study explores three questions. (1) Can a team of three people effectively utilize this method to encourage participation, gather ideas quickly, and cover adequate a priori content? (2) How do youth and their parents and teachers respond—in terms of participation and affect—to the new focus group method? (3) Does the proposed focus group format facilitate articulation and expression of critical multi-level influences on TDV?

Methods

We conducted the focus group pilot study in a racially and socio-economically diverse high school in the South eastern United States (roughly 57% of students were White, 37% were Black, and 30% received an income-based lunch subsidy). The research was approved by the school district and the University’s office of human subjects research compliance. We conducted three 90-min to 2-h focus groups, all in one high school. Youth participants were recruited using flyers and a school-wide (speaker) announcement. Parents and teachers were recruited with flyers and the Parent Teacher Student Organization (PTSO). All participants were offered $25 to take part. While demographic information was not collected from individuals, the facilitators agreed on a best guess of race and gender among participants. Further, in the cultural context of the high school and surrounding community, individuals identify as White, African-American or Black, or Latino/a. The guidance counselors were not aware of youth who might identify as Latino/a and Black, or Latino/a and White. The first focus group was for ninth graders (n = 21). This was an unintentionally large focus group that we engaged with due to community partner enthusiasm and scheduling needs. Strictly based on the facilitators’ observations, 52% of participants were female, 90% were African-American, and 10% were Latino. The second focus group (n = 16) was for higher grades and comprised students in all four grades: one ninth grader, four 10th graders, six 11th graders, and five 12th graders. Based on the facilitators’ observations, 56% of participants were female, 49% were White, 38% were African-American, and 13% were Latino. The third focus group was with adults recruited through the PTSO. Based on the facilitators’ observations, 100% of participants were female, 80% were White, and 10% were Latino.

Prior to the focus groups, the researchers wrote concepts—drawn from the literature—on 5.5″ by 8.5″ cards. These concepts were captured in short phrases for readability and pertained to school influences (e.g., teacher support for learning, physical environment, and relationships with school administration) as well as family and community influences (e.g., safe shelter and environment, decision-making ability, and work and volunteering). The first part of each focus group was based on open-ended prompts about participants’ views on what TDV is and what causes it. During the first segment, one of the facilitators wrote short phrases to capture participants’ ideas on 5.5″ by 8.5″ cards. Then, the facilitators placed all concepts (from the literature and those from participants) on a portable (9″ × 4.5″) adhesive wall during the break between the first and second segments. Thus, the cards on the cling wall included all ideas emerging from the first focus group segment (15–20) and 20 influences on TDV gleaned from the literature. During the second part of each focus group, participants were asked to connect their prior responses with concepts drawn from the research literature regarding school and community influences on TDV.

The focus groups were facilitated by a three-person team, with one person prompting questions (lead facilitator), one person writing ideas on cards and facilitating the movement of cards on the adhesive wall, and one person recording focus group process. The same lead facilitator and process recorder conducted all three groups. The process recording included the following documentation for each focus group segment: proportion of planned content/questions omitted, percent of participants actively participating in segment, eagerness of participation (noted as very low, low, medium, high, and very high), and percent of participants exhibiting only pro-group behavior (no-interruption, etc.). To record pro-group behavior, the process recorder counted behaviors, noting who exhibited the behavior. The process recorder also noted observations about nonverbal behaviors. After the focus groups, another facilitator reviewed the process record to validate ratings and observations, and to provide additional notes.

With participant assent and consent, we recorded the focus groups and had them transcribed by a certified transcription agency. Analyses were conducted by a team of four researchers using NVivo 10. The coding team included the authors and two graduate research assistants. The team implemented a thematic coding approach, with the research assistants coding ideas and initial themes in separate source documents and reporting to the team for discussion. All four team members conducted independent coding checks of 50% of the transcripts to enhance quality and credibility. Inconsistencies were resolved through group meetings. To improve inter-rater reliability, the two lead researchers came to agreement on selective coding through four iterations, beginning with one researcher conducting selective analyses, followed by revisions by the other researcher, and so forth. We used the resulting coding density and node diversity to describe influences of focus group format below. We used the results of the final coding structure to determine whether the first or second focus group segments yielded more critical reflection and integration on multi-level concepts.

Results

In this section, we present the focus group pilot results according to three process domains: content coverage, participation and engagement, and yield of ideas pertaining to multi-level influences on TDV. We then compare and contrast between focus group segments and participant groups. Thus, for example, the reader can consider the focus group process domain (e.g., engagement) and reflect on differences and similarities that we found in quality between the two formats used and between focus groups.

Content coverage

One of our research questions pertained to whether the two-part format would facilitate adequate coverage of concepts pulled from the research literature: Can a team of three people effectively utilize this method to encourage participation, gather ideas quickly, and cover adequate a priori content? Our goal was to facilitate a process of bringing forward and prioritizing what the participants had shared in the first segment, while also covering a majority of concepts that we had identified from the TDV literature. This required quickly documenting diverse new ideas gleaned from the first segment so that they could be placed on the wall in the second segment. To accomplish this, we asked a graduate student to listen for new ideas and use two- and three-word phrases to capture these ideas for later discussion. We focused the phrases on being able to facilitate later recall of the idea rather than attempting to precisely pinpoint the idea in two to three words—which would likely have been infeasible.

In all three focus groups, we were able to move through all prompts in the first focus group segment. In the two student focus groups, we were able to discuss 90% of the concepts from the literature and link them to 90% of the ideas brought forth from the first half of the focus group. In the adult focus group, however, we had greater challenges in moving through concepts from the first half of the focus group as well as concepts from the research literature. Participants expressed that they were “done” talking about the ideas from the first segment. We noted that adults appeared less interested in seeing their ideas from the first part of the focus group from a new perspective inherent in the process of linking prior ideas to relationship and community context. While we did find a greater yield in articulating multi-level concepts and connections (see below), this was not to the same degree that we noted among youth.

Participation and engagement

All three focus groups had fluid participation in the second stage, even though adults were less apt to reframe ideas. In the first focus group segment, the facilitator offered new prompts when discussion lagged. In the second segment, the level of discussion was more participant-driven. As the discussion of a given idea ebbed in the second section, participants proactively looked at the cards still at the bottom of the board and chose the next ones for discussion. The result was a conversational pace and fluidity in the second segment due to a high level of involvement and participant-driven concept engagement.

Differences in participation levels between segments are summarized in Table 1. All groups demonstrated higher participation rates and more eagerness to participate in the second segment compared to the first segment. Pro-group behaviors remained the same. Interestingly, the participants engaging in pro-group behavior and the forms of potentially disruptive behaviors shifted from the first to the second segments. Among the ninth graders in the first segment, several participants were moving and making faces and three were attempting to dominate the conversation. In the second segment, potentially disruptive behavior shifted to side conversations in which students would quietly whisper to someone sitting next to them, attempting to be nondisruptive, while pointing at the board—even stating, “Yeah, yeah. Do the best one, do the best one. Pick the best one” when the facilitator explained that it was the end of the focus group but there was time for one more question if they wanted. Similarly, youth in the upper grade focus group shifted from some exhibiting withdrawal in the first segment to a few brief side conversations during the second segment. The focus group with adults remained fully attentive throughout, with brief side conversations in the second segment, encouraging each other with statements such as, “that’s an excellent point.”

Table 1.

Focus group participation.

Group	n	First segment			Second segment
Group	n	Participation rate	Eagerness	Pro-group behavior	Participation rate	Eagerness	Pro-group behavior
9th graders	21	62%	Medium	90%	86%	Very high	90%
Upper grades	16	75	High	94	88	Very high	94
Adults	10	60	Medium	100	80	High	100

Across all three groups, participants expressed excitement and appreciation at seeing their ideas on cards on the adhesive wall. As one ninth grader excitedly declared, “that was mine!” Participants also spontaneously used ownership of the idea to regulate participation. In all groups, participants used ideas to recall discussion from the first segment and to draw the “owner” participant into the current discussion. Frequently, this led to a more elaborate explanation of what the participant had meant, which allowed everyone to understand a more complex idea shared by the participant. One adult in the PTSO went further, and connected each idea to a participant if no one readily brought the idea into discussion.

Ideas pertaining to multi-level influences on TDV

After completing the qualitative analysis of influences on TDV, reported elsewhere, we summarized the codes according to focus group segment and type of code. We report two types of codes: one pertaining to TDV triggers—typically reported in focus group findings in the literature—and one pertaining to multi-level influences on TDV, the discovery of which was the objective of the present study.

As Table 2 depicts, the first focus group segment based on a traditional focus group format resulted in slightly more codes and a greater density of textual references per code. The first segment also yielded a wider array of codes pertaining to TDV triggers than the second segment did. The second segment appears to have resulted in overall significantly more codes pertaining to multi-level influences on TDV compared to the first segment (χ²(1) = 18.74, p < .001). Because the second segment introduced concepts from the literature, many of which required multi-level thinking to link to TDV, the significant difference was expected.

Table 2.

Number of text references and codes per focus group segment.

Focus group segment	Text references	Codes	TDV triggers	Multi-level influences
First segment	413	92	46	22
Second segment	398	119	40	61

Discussion

Existing knowledge and practice in the area of TDV are unnecessarily reliant on experiential knowledge from adult relationships due to a paucity of youth input. We set out to conduct qualitative research to better understand youth experiential knowledge and views on what influences TDV. We determined that focus groups would be an ideal method for conducting such an exploration, but existing popular focus group methods and format appeared to fall short of tapping knowledge of multi-level influences on TDV. Based on the concern that youth may have understandings of complex multi-level phenomena that are not adequately tapped through existing formats, we developed and pilot tested a new focus group format that integrated participant concepts by design and presented them as a guide to reflecting on concepts from the literature. This new format reverses the typical coding process in which the researcher gleans knowledge from focus group participants post-interview through the lens of the scientific knowledge base. Our approach, therefore, directly addresses two limitations of the focus group method: interpretation bias and participant/member checks (Daley, 2013).

In this article, we have described ways in which the new focus group method facilitated articulation and expression of critical multi-level influences on TDV. We also reported on the benefit to participation that we observed among all groups of participants. Finally, the format was feasible with three facilitators, but may be unwieldy for one or even two facilitators due to the need to write down participant ideas in the first segment and move cards on the adhesive wall during the second segment.

It is important to note that the contrasts we report between formats are embedded in the full focus group format and may be influenced by participant personalities. The second part of the focus group cannot be viewed as a stand-alone segment because the material covered in the second segment was dependent upon successful sharing of ideas in the first segment. Also, while participants were unaware of the format, youth in the mixed-grade focus group had independently volunteered to take part in a focus group. Given this behavior, participants in this particular focus group could be more extroverted than those who did not volunteer. The adults in the PTSO and the ninth grade focus group participants, however, were recruited as entire groups from the PTSO and a standing group of at-risk youth, respectively. Participation was voluntary, but no one declined to participate, even with advance notice. The fact that contrasts were apparent across independent volunteers and members of standing groups, as well as our findings that quieter participants engaged more fully in the second segment, supports the potential for this format with varied personalities.

The samples are small as well, and substantive results may differ in different regions and among groups with differing demographics. In particular, we are not certain of the racial and ethnic background, and we are unaware of sexual orientation and socio-economic status. While the school guidance counselors suggested that youth in the high school identify as White, African-American or Black, and Latino/a in ways that are congruent with physical features such as skin tone, the researchers contend that this is a limitation of the results. Because we were unable to ask each youth’s race and gender identity (due to the potentially identifying nature of this information), we were unable to disentangle possible incongruence among the cultural awareness of the guidance counselors and the youth. This phenomenon is beyond the scope of the present study and data collection, but should be considered in future studies.

The observed racial and ethnic composition indicates a small participation rate from Latino/as. We are encouraged, however, to note that evidence on very small subgroups in focus groups suggests that rich and dynamic perspectives rooted in the experiences of those from the subgroups are still obtainable (Toner, 2009).

Further, the three focus groups that we report provide an early, tentative test of the focus group format feasibility, and potential areas of promise. To better understand the promise of this focus group method, future studies will need to test the format with different groups of facilitators and regarding different subject matter.

We conclude that the two-part focus group method based on conventional focus group prompts followed by integration of participant concepts with concepts from the research knowledge base shows great promise. The technique successfully elucidated a more complex discussion of important ideas about multi-level influences on TDV, particularly among youth participants. Moreover, participant engagement was markedly higher in the second segment. These benefits appear to extend to adults in our limited pilot, but we note the lack of flexibility in our one adult focus group as a potential limitation to explore further. We suspect that the focus group format produced a sense of empowerment, especially among youth, by bringing forward the participants’ ideas, validating them, and subjecting concepts from the research to the scrutiny of participant judgment. This is, ultimately, the framework for a new way of thinking about qualitative research, one which positions youth as active participants in creating knowledge.

Footnotes

Declaration of Conflicting interests

The authors declared no conflicting interests with respect to the authorship and/or publication of this study.

Funding

This research received funding from an internal competitive award through the University of South Carolina College of Social Work Dean’s Office.

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