Full text of DOI:10.1111/j.1753-6405.2001.tb01838.x

Methodology
Focus group composition: a comparison between
natural and constructed groups
Abstract
Julie Leask, Penelope Hawe and Simon Chapman
Department of Public Health & Community Medicine, University of Sydney,
New South Wales
Objective: To provide insight into the
effects of focus group composition.
Method: In an early phase of an ongoing
study of parental reception to messages
about childhood immunisation, we
conducted four focus groups; two with
participants who had never met before
(constructed groups) and two with
participants who were part of a pre-
established first-time mothers’ group
(natural groups).
n the literature on focus group methods,
there is ongoing discussion about the
relative merits of constructed and natu-
considered to be socially divergent, might
be reluctant to talk with strangers.
I
In an ongoing qualitative research project
aimed at developing communication strate-
gies for parents who were ambivalent about
childhood immunisation, a comparison be-
tween natural and constructed groups has
ral groups. Constructed groups (where par-
ticipants have not met before) are held to be
useful when the researcher wishes to mini-
mise the potential for group conformity
Results: Marked differences were noted in
the group dynamics, depth of interaction
and diversity between groups. Discussions
with constructed groups were animated,
enthusiastic, expressed more divergent
views and articulated greater complexities
of the topic. Discussions with natural
groups were generally flatter and less
enthusiastic, displaying a higher level of
apparent conformity to conventional
wisdom. The need to protect other
participants from potentially disturbing
information about vaccination was
expressed across groups but acted to
censor natural groups, where participants
knew more of each others’ sensitivities.
Implications: Insight into the factors
contributing to such differences may
enhance understanding of the contexts in
which constructed groups are more
appropriate. The processes of social
censorship may be of primary interest to
the researcher. However, where it is
paramount to elicit a range of opinions
about a potentially controversial topic, we
suggest that natural groups in the delicate
stage of norming be avoided. The
brought about by pre-established group further illuminated circumstances in which
norms and patterns of leadership.1-4 Partici-
pants who are unlikely to meet again face
less personal cost if they express divergent
views and are more likely to be honest.2,5 In
addition, newly formed groups that lack pre-
established preoccupations are also less
likely to attempt to set the discussion agenda
– something that can be problematical when
the intention is a focused discussion on a
particular topic.
constructed groups are more appropriate.
Methods
To explore parental reception of pro- and
anti-immunisation messages, four initial
focus group discussions were held with par-
ents recruited via Early Childhood Health
Centres (ECHC) in the northern suburbs of
Sydney in 1999. Two groups comprised pre-
existing first-time mothers’groups (natural)
and two comprised mothers who had never
met before who were recruited individually
via the waiting room (constructed). Three of
the groups were recruited via the same
ECHC and the other, a constructed group,
was recruited via another centre.
Natural groups must suffice when they
are necessitated by pragmatic constraints
or when the goals of the research require,
or are enhanced by, the presence of a pre-
existing group dynamic. They are typically
used when studying natural interactions,
such as family, peer group or organisational
dynamics and in very narrow target
populations, where recruiting groups of
strangers is impossible. They are also used
when the research goal is to elicit conversa-
tions and interactions, which might occur in
the normal environment where attitudes are
negotiated and formed.6 Natural groups have
been used by researchers interested in ex-
ploring interactions between participants as
a phenomenon in itself.6 Finally, natural
groups might be preferred when exploring
sensitive topics where a group, who are
brought together on the basis of factors
During the focus groups, the same struc-
ture was followed, beginning with an open
discussion about childhood immunisation,
after which two video prompts were shown.
One was an excerpt from a controversial tel-
evision documentary. It was chosen as re-
flecting many of the anti-vaccination
discourses identified in a previous paper and
included footage of children allegedly
harmed by vaccines.7 The other prompt was
an excerpt from a tabloid current affairs pro-
gram about a pertussis outbreak and was gen-
erally pro-vaccination, featuring footage of
babies hospitalised with the illness.
peculiarities of each individual research
circumstance are best explored in pilot
studies.
(Aust N Z J Public Health 2001; 25: 152-4)
Correspondence to:
Submitted: February 2000
Revision requested: December 2000
Accepted: March 2001:
Ms Julie Leask, Department of Public Health & Community Medicine, Edward Ford Building
A27, University of Sydney, NSW 2006. Fax: (02) 9351 7420; e-mail: JulieL@health.usyd.edu.au
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Methodology
Focus group composition
A day after the groups, all participants were telephoned by the
interviewer and asked for any further insights into the issues dis-
cussed and any other reactions to the television prompts. This
was also seen by the researchers as an opportunity to hear from
participants who were less vocal in groups, to debrief them about
the video prompts and allow them to take on a more consultative
role.
which were more openly discussed in the constructed groups where
participants were more likely to voice disagreement. For example:
The risk of my child having a one in 10,000 chance of having brain
damage or something, is far less than him having polio or some-
thing ...
I don’t think it’s all that conclusive ...
During one post-group telephone interview, a participant from
a focus group held later in this study (not included in this analy-
sis) shed further light on the group conformity dynamic. As well
as participating in a constructed group for our study, she was part
of a new mothers’group that she said had brought together women
from very different backgrounds who happened to attend the same
ECHC. In their attempts to establish group rapport and bridge
such differences, she suggested that members were seeking areas
of common ground and would do this by finding issues such as
immunisation to agree upon.
The recruitment, group moderation and post-group interviews
were all conducted by the same person (JL). In three of the groups,
another member of the research team was present as an observer.
All group discussions were taped and transcribed. At an early
meeting to review our methodological approach, investigators
unanimously agreed to abandon the use of natural groups. To in-
dependently verify our decision another investigator, not present
during the groups and blinded to our initial identification, read
transcripts from each category and correctly identified the ‘cold’
group.
In addition to group conformity was a ‘protection dynamic’
where participants expressed a need to guard others in the group
from divergent or disturbing stories about vaccination generated
through discussion or via the videos. This was found across natu-
ral and constructed groups, but led to differing effects. In the con-
structed groups it was made explicit during the discussion. For
example, one participant with three children openly voiced her
concern about the effect of the anti-vaccination video on two first-
time mothers in the group:
Results
Participants in all four groups were from middle-class areas of
Sydney and did not differ markedly in age, education, ethnicity
(predominantly Caucasian) and socio-economic background. In
the natural groups, all women were primiparous. In the constructed
groups, there was more diversity in parity, ranging from mothers
of one very young baby to mothers of three children aged up to
16 years.
I feel in a way disappointed, that especially (name) and (name)
saw that, because I think it could sow a seed of doubt ...
Strong differences were noted between the constructed and
natural groups. In the former, participants were more willing to
contribute, more animated about the topic and tended to interrupt
each other. The groups were more difficult to conclude and took
longer. There was also more diversity in opinion about vaccina-
tion and the reactions to the television footage appeared less
guarded. In contrast, the natural group discussions were ‘cold’ –
a phenomenon where “participants are quiet and seemingly re-
luctant to participate”.2 There was less enthusiasm and interest
demonstrated in the topic and the moderator needed to provide
many more prompts to generate discussion. Participants talked
less, tended to agree with each other more and the groups con-
cluded sooner. In addition, there was a higher level of conformity
to positive ‘conventional wisdom’about vaccines that had emerged
at the beginning as being dominant. Differences in non-verbal
communication supported these findings, with participants from
the natural groups being more flat in their affect. Post-group
interviews supported our observations. Participants from the con-
structed groups described enjoying the opportunity to discuss the
issue and meet other mothers, whereas participants from the natural
groups described the session as informative, even though it was
not intended, nor perceived by the researchers, to be.
These women then had the opportunity to reflect on their own
responses to the videos and respond to this participant’s concerns.
Conversely, in the natural groups, the protection dynamic acted
as more of a censor. For example, in one post-group interview a
participant from a new mothers’ group who was also a health
professional admitted to feeling reluctant to discuss her own
experience of caring for hospitalised children she claimed were
vaccine-damaged and subsequent concerns about vaccinating her
own child because this might upset one group member whom she
described as being particularly sensitive.
Participation in the constructed groups was also more ‘fresh’.
The women who did not already know each other were more ea-
ger to share their own personal stories with the group. One new
mother, for example, asked the group “Can I tell you about my
experience?” and continued with a powerful account of her infant
being subject to a whooping cough scare in the maternity unit.
Had she been part of an existing group, it is likely that this story
would have already been told.
Discussion and implications
In this preliminary investigation, we found pressures of group
conformity and a protection dynamic were accentuated in natural
groups.The taboo of voicing concerns about vaccination appeared
to be mediated by group composition. Participants from the natu-
ral groups were at the delicate stage of establishing group norms
and wanting to fit in. This group consensus dynamic may apply
In all groups, support for immunisation dominated. Non-
immunisation tended to be talked about in terms of deviance and
something which put other children at risk. This dynamic made
the further discussion of doubts about immunisation a taboo and
it was necessary for the moderator to tease out such concerns,
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Leask, Hawe and Chapman
Practice Note
with other controversial topics, where participants who will meet
again are less likely to express divergence of views or where the
level of homogeneity that comes with natural groups acts to re-
duce diversity in findings. In addition, a desire to be protective of
others may be intensified when participants feel they are familiar
with the personal sensitivities and vulnerabilities of others. For a
pre-established group, the job of being part of a research process
is usually novel because the group exists for entirely different
reasons. While successful in some circumstances, it may be awk-
ward for members to adapt to the new function of the group that
includes the presence of an outsider as leader. We investigated
the possibility that alternative explanations might account for our
observations, particularly given the fact that women in the natu-
ral groups were first-time mothers who were more eager to ap-
pear to be doing ‘the right thing’ by voicing support for
immunisation. Although this probably occurred to some extent,
our conclusion that group composition was the prime determi-
nant was supported by comments made by participants in the in-
dividual, telephone-based, post-group interviews.
the benefit of having research participants identify with and spark-
off each others’comments was seen to be essential to understand-
ing our underlying phenomenon of interest (how ‘pro’ and ‘anti’
immunisation messages appeal to parents). The testing process
also underscored our ethical responsibilities to have both skilled
facilitation and individual follow-up procedures in place to at-
tempt to ensure that any doubts about immunisation raised by the
research process did not cause harm.
Acknowledgements
This research is being funded by a National Health and Medi-
cal Research Council project grant. The authors would like to
acknowledge the contribution and support of Margaret Burgess
from the National Centre for Immunisation Research and Sur-
veillance ofVaccine Preventable Diseases, Margaret Gibbons from
Western Sydney Area Health Service, Julie Rogers from North-
ern Sydney Area Health Service and the Early Childhood Nurses
from the centres used in this aspect of the study. The generosity
and contribution of the women who took part in the focus groups
is also gratefully acknowledged.
The tendency of the natural groups to incline quickly towards
group consensus when discussing vaccination issues could be
treated as a ‘finding’(rather than a design flaw) and, indeed, some-
thing that a researcher might seek to explore, should the central
aim of the research be to understand more about how social proc-
esses affect the way mothers talk about vaccination. In our case,
however, we felt that the need to determine the full range of par-
ticipants’responses was greater and, hence, we are avoiding natural
groups, while continuing on the principle of placing ‘like with
like’ – for example, placing people with similar socio-economic
status together. We recommend that other researchers also en-
gage in pilot procedures such as this to determine which contex-
tual influences are most salient in relation to their particular
research topic. While general guidelines exist,1-4 each situation
brings unique considerations and tradeoffs. We were disinclined
to abandon focus group interviews for individual interviews, as
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