Split-Session Focus Group Interviews in the Naturalistic Setting of Family Medicine Offices

Article Figures & Data

Table 1

Framework of the Split-Session Focus Group Approach

Step	Comment
1. Conduct a joint session with both physicians and staff members	Some aspects of project implementation required a joint discussion with all staff and physicians present Questioning is focused on aspects of the system that would affect both parties
2. Dismiss staff so they can prepare for patients	Staff members are able to follow regular practice workflow Physicians can be interviewed without staff present and make comments about potentially sensitive staff issues without concerns about offending anyone
3. Interview physicians only	While staff are preparing patients, physicians often have relative down time Aspects affecting only the physicians could be asked and discussed efficiently without staff being onlookers
4. Dismiss physicians to resume clinical care	Physicians can complete patient care as usual and even extend into the noon hour without disruption to the usual work schedule
5. Interview staff only when patient care is completed (eg, before, during, or after lunch)	In the usual workflow, staff complete preparing patients for physicians and are available for noon-time discussions With physicians out of the room, staff may be more comfortable stating opinions about implementation that they might otherwise feel too inhibited to voice if their employer were present

Table 2

The Split-Session Focus Group Procedure (Morning-Start Format)

Session^a	Participants	Activity	Comment
1	Staff and physicians	Role play followed by short question and answer for general issues	Joint whole-group format allows general exposure, understanding, and questions
2	Physicians only	Focus group interview: physician-specific issues are addressed	Provides staff time to prepare patients for physician clinical care
3	Staff only	Focus group interview: staff-specific issues are addressed	Staff often finish early, while physicians often run late; focus group interview is more convenient with staff during their lunch break while still leaving some time for lunch

↵a Each session lasts 30 minutes. Third session takes place during lunch break.
Note: With the morning-start format shown, the procedure begins before patients arrive in the morning and ends during lunchtime. An alternate lunch-start format is described in Results.

Table 3

Advantages and Disadvantages of Focus Group Interviews in Naturalistic Settings and Neutral Settings

Setting	Advantages	Disadvantages
Naturalistic	Convenience for participants Participant comfort in the setting Immersion in environmental stimuli and setting, allowing for consideration of application of the proposed technologic intervention in their office Simple payment mechanism: office receives lump sum for participation	Potential distraction by impending work to be done when focus group interview completed Possible reluctance to criticize own office’s procedures Potential lack of space in practice to hold sessions Compensation to the practice may have limited benefit for office staff
Neutral	Lack of distraction by environmental stimuli Lack of distraction by immediacy of the time clock Potential sense of security in voicing opinion, especially if negative, about the system under investigation Freedom to use the participation incentive as desired	Need to travel to the location chosen for session Expectation that staff members will use their lunch time to participate

Table 4

Advantages and Disadvantages of Split-Session Focus Groups and Traditional Focus Groups

Focus Group Approach	Advantages	Disadvantages
Split session	Fits into existing practice workflow Generates dialog and interaction among the full group Allows gathering of data from distinct subgroups having different perspectives Permits staff and physicians to speak freely without the other present Allows recruitment of more participants for each session Nets an overall cost savings	Requires that practice must be willing to accommodate focus group interviews at their location Necessitates a conference room, waiting room, or other suitable area be available on site to conduct sessions Limits time with subgroups, which may yield less rich data
Traditional (unsplit)	Allows ability to conduct multiple groups at one time Enables bringing together participants from multiple practices at once	Yields lower participation rates Requires participants to travel to location May constrain staff and physicians from speaking freely when other is present May require additional incentives