Asynchronous Online Focus Groups: An Effective Approach to Engage Young Adult Women in Discussions on Mental Health Problems

Introduction

Focus groups have long been an established method for qualitative research, valued for generating rich data through in-depth discussions that capture a wide range of perspectives on nuanced topics such as mental health (Kitzinger, 1994, 1995; Schilder et al., 2004). Focus group discussions encourage open communication between individuals, allow participants to reflect upon each other’s ideas, and provide insight into the framework on which ideas and opinions develop (Cyr, 2016; Kitzinger, 1994). However, traditional focus groups are not without limitations. Group discussions may create a group norm, silencing those with opposing opinions (Kitzinger, 1994, 1995). Participants may also experience a loss of confidentiality due to the presence of other participants, which may impede individuals from sharing, especially about personal topics (Kitzinger, 1994). Further, focus groups may be limited in generalizability due to their traditional design of recruiting a specific group of individuals, able to travel and join in person, to discuss a certain topic (Cyr, 2016). To overcome these limitations, the innovation of traditional qualitative methods may facilitate an alternative approach to collecting qualitative information.

One recent innovation in qualitative data collection that addresses the limitation of participants being unable to physically convene is the facilitation of focus groups via online video conferencing platforms such Zoom, Microsoft Teams, Skype, and Google Meet. These virtual focus groups offer a convenient and flexible approach to qualitative data collection, allowing participants from diverse geographic locations to join from the comfort and familiarity of their own home (Keen et al., 2022). Although virtual focus groups allow for greater convenience than in-person focus groups, they still require participants to be available at a specific scheduled time. To maintain the convenience of virtual focus groups, but increase flexibility, alternative approaches to qualitative data collection should be considered.

Asynchronous online focus groups (AOFGs) are digital-based focus groups where participants can join and interact from anywhere at any time, within the parameters set by the moderator posting discussion prompts (Zwaanswijk & van Dulmen, 2014). Freedom from temporal and geographic coordination gives AOFGs several advantages. First, AOFGs are useful for collecting data from populations that are typically hard to reach, such as minoritized groups and geographically diverse populations, contributing to rich qualitative data from a wide variety of cultures and backgrounds (Gordon et al., 2021). Another benefit of AOFGs is that participants can post on their own time from any place they have internet access, making them accessible to those who have a busy schedule or face barriers that keep them from traveling to an in-person focus group (Boateng et al., 2016). Finally, without having to join all together at the same time or place, AOFGs allow participants to remain anonymous, which can be beneficial when discussing sensitive health topics (Brown et al., 2021; Genuis et al., 2023; Reisner et al., 2018).

Notably, while AOFGs offer accessibility and confidentiality to participants, they also maintain the ability to facilitate robust and valuable discussions. Online focus groups are capable of producing data that is comparable in richness and in quality to in-person focus groups (Jones et al., 2022). This is critical because it demonstrates that online focus groups can be a feasible and comparable alternative to in-person focus groups depending on the research context.

Few studies have examined the levels of interaction and engagement between participants in AOFGs, which are important components of qualitative focus group content and conversational dynamics. In May 2023, our research team conducted the Learning Insights from Girls for Health (LIGHT) (Schmidt et al., 2026) research study, which utilized an AOFG to assess mental health concerns and potential solutions for young women across the United States. Participants responded to prompts about mental health problems and their potential determinants and were invited to provide recommendations on solutions on a discussion board over three days. Following the online discussions, participants’ perspectives were assessed with a post-study satisfaction survey.

The current study aimed to evaluate the feasibility and utility of AOFGs as a platform for engaging young women in discussions about mental health. Specifically, we wanted to (1) identify the strengths and limitations of the approach using data from the post-study focus group, and (2) characterize participant engagement and interaction within the group by analyzing discussion board content from the LIGHT study. By integrating findings from participants’ satisfaction survey responses and their engagement and interactions within the discussion boards, we aimed to identify the perceived strengths and limitations of the AOFG approach and to evaluate its potential as a method for qualitative research in mental health.

Methods

Results

There was a total of 52 women who participated in the AOFGs. The average age was 21.6 years (SD = 2.1), ranging from 18–25. Fifty participants (96.2%) identified as cisgender, one participant as genderqueer/gender non-conforming, and one participant preferred not to disclose their gender identity. The majority (69.2%) of women identified as heterosexual, followed by 19.2% as bisexual, 5.8% as lesbian, 3.9% as asexual, and 2% as questioning. Regarding race, 46.2% identified as White, 34.6% as Black/African American, 7.7% as Asian, 2% as American Indian/Alaskan Native, and 9.6% Multiracial as. In terms of ethnicity, 84.6% identified as non-Hispanic, 9.6% as Hispanic, and 5.8% preferred not to answer.

Discussion

Results of this study indicate that the young adult women participating in the LIGHT study found the AOFGs to be an accessible and valuable space to discuss mental health issues and connect with other young women. The participants endorsed the methodology through their responses on the post-study satisfaction survey – 94.2% said they were “Extremely satisfied” or “Somewhat satisfied” with the approach – and highlighted several important strengths of the approach, including Confidentiality, Flexibility, Connection and perspective sharing, and Equitable participation.

Young women participating in the LIGHT study felt secure sharing personal details of their experiences with mental health due to the Confidentiality of the AOFGs. Meanwhile, the Flexibility of the online discussion format allowed for a more diverse population to be reached, contributing to a wide variety of opinions and meaningful conversation. Confidentiality and flexibility have been commonly noted as strengths in other studies utilizing AOFGs (Brown et al., 2021; Genuis et al., 2023; Gordon et al., 2021; Guest et al., 2020; Reisner et al., 2018; Ybarra et al., 2019; Zwaanswijk & van Dulmen, 2014). Previous literature has shown that the confidentiality of AOFGs fosters a sense of safety and anonymity within the group, allowing participants to feel comfortable sharing personal stories and sensitive information (Gordon et al., 2021; Reisner et al., 2018). A study utilizing AOFGs by Zwaanswijk and van Dulmen (2014) highlighted flexibility as the most important strength of the approach as stated by the participants of the study, including the ability to participate when it was most convenient for them, as well participate from home. The AOFGs created a space where women were encouraged to engage in open dialogue about their perspectives on mental health topics, facilitating an environment for Connection and perspective sharing. A similar study noted that encouraging participants to share and comment on each other’s perspectives on of a specific health topic fosters rich and insightful conversations between participants (Reisner et al., 2018). Equitable participation was also evident throughout the study – there was no issue of one participant dominating the conversation, participants getting spoken over or interrupted, or participants not getting the chance to speak out of fear or worry. Everyone was encouraged to engage in whatever way they felt most comfortable, leading to open, honest, and diverse conversations among the participants. A study conducted by Gordon et al. (2021) similarly mentioned this strength of AOFGs as compared to face-to-face focus groups.

Effective features of the approach also emerged within the qualitative data from the discussion board responses, which demonstrated high levels of engagement and interaction between participants. Two themes generated from the discussion transcripts further endorsed the strengths the participants noted in the post-study satisfaction survey: (1) Engagement through storytelling elevates insights around mental health experiences and (2) Participant interactions included offering support in the form of advice, validation, and empathy. Participants used personal stories to share accounts of their own mental health journeys and those of their immediate social networks to support their responses. Meanwhile, the participants also built a sense of camaraderie by sharing encouraging responses to one another while endorsing each other’s thoughts, feelings, and ideas. The participants were able to act as a support system for one another in an online platform where they felt safe, comfortable, and supported. This strength is further supported by a similar study that characterized participant interactions in the form of support and affirmation, practical advice, and developing ideas together (Genuis et al., 2023). Participants consistently exceeded the expected level of engagement and interaction by offering in-depth and often personal stories, underscoring the utility of the AOFGs as a method for garnering rich and meaningful qualitative data.

Participants also noted limitations of the AOFG approach for the LIGHT study, which are important to consider and address when utilizing this methodology. First, participants commented that they sometimes could not grasp the full extent of some responses due to the Lack of nonverbal and paraverbal cues. Similar studies also highlight this as a key limitation of AOFGs (Jones et al., 2022; Reisner et al., 2018). One future recommendation to address this is to provide guidance on adding emotional cues to text, such as exclamation points and emojis, which can help to clarify the emotion and tone behind written responses. A study assessing the effect of emojis on the perception of written text found that when using a positive emoji with a positive or neutral message, the perceived positivity increases, and when a positive emoji is used with a negative message, the perceived negativity decreases (Boutet et al., 2021). Similarly, when using a negative emoji within any message, the perceived negativity increases (Boutet et al., 2021). Using emojis can be a valuable indicator of the writer’s emotion and tone, acting as a “ubiquitous language” that everyone can easily understand despite language or cultural differences (Lu et al., 2016).

The second limitation that emerged was a sense of Disjointedness in the discussions due to varying lengths of responses and the unique times of day that individuals posted. The participants indicated that it was sometimes difficult to create robust conversations if responses were shorter or less detailed. Participants who posted on the discussion board early in the morning indicated that they often had to return later in the day to respond to other comments since there were typically not many posts first thing in the morning. There is a lack of literature addressing the disjointed nature of AOFGs, highlighting the need for further research on how to effectively manage this issue. Perhaps narrowing the time window that participants must answer each prompt could lead to a higher sense of responsiveness among the group. It could also allow for more moderator participation, allowing them to shift the topic of conversation if it is stagnant and probe for deeper insight when appropriate.

A few participants highlighted User and technical error as another limitation of AOFGs. One participant noted that they experienced issues with internet connectivity, and two participants expressed that they had difficulty navigating Discourse.com. Although, participants received an instructional video on how to use the platform, as well as an email address to reach the moderators to discuss any technical issues that are inherent to online approaches. Few studies have acknowledged this limitation, but Boateng et al. (2016) address this issue and point to the need for further research on how to handle varying levels of internet literacy among participants. Providing detailed and comprehensive guidance on how to navigate the website is critical to participants to help reduce the frustration of learning how to navigate a new platform.

This study contributes to the growing body of literature on AOFGs by presenting participants’ perception of the strengths and limitations of the approach and by highlighting how these strengths manifested in practice through the dynamics of participant engagement and interaction. The strengths and limitations of the approach were directly expressed by the participants in the post-study satisfaction survey, and these strengths were shown through high levels of engagement and interaction between participants. Other studies on AOFGs, such as Gordon et al. (2021) and Genuis et al. (2023), have examined participant engagement and interaction through quantitative measures such as number of responses and the length of responses. The current study characterizes how participants engaged and interacted through qualitative analysis, demonstrating that participants went beyond what was asked of them in the prompts through detailed storytelling and offering support, validation, and empathy to fellow participants. This high level of engagement and interaction between the participants in the group further exemplifies the strengths of the approach as stated by the participants and offers new insights into how AOFGs can facilitate meaningful conversations and generate rich qualitative data for mental health research.

This study has several limitations worth acknowledging. As mentioned in the primary outcomes paper of the LIGHT study, the sample was not nationally representative, limiting the generalizability of the results. Second, there is potential for sampling bias due to the method of social media recruitment. The participants already had an active online presence and were aware of the study’s purpose. These individuals may have been open to participating in a focus group about mental health and may have had different experiences and opinions surrounding mental health than those who decided not to participate in the study.

Results of this analysis show that AOFGs are a valuable platform for facilitating candid and engaging discussions about mental health, particularly among younger generations, and are a strong alternative to traditional focus groups. Participants highlighted multiple strengths of the approach and found the discussion boards to be a safe space to talk about personal mental health experiences. In addition to offering a convenient, flexible, and practical approach to conducting qualitative research, online spaces like this digital discussion forum are very familiar to this age group and can act as a comfortable space to open the conversation about mental health. The approach allows more flexibility for both the participants and the researchers without sacrificing rich data and high levels of engagement and interaction between participants. AOFGs provide an accessible and supportive avenue for young women to share their experiences and perspectives around mental health.