Focus group interviews with risk-taking gay men: appraisal of AIDS prevention activities, explanations for sexual risk-taking, and needs for support

The analysis of focus group data: A challenge to the rigour of qualitative research

Focus groups have become increasingly popular as a source of data in nursing research. Although the methodological issues involved in this method of data collection have been addressed in the literature, there has been little work on the process of data analysis. This paper reports a case study that was undertaken to examine Hong Kong Chinese women's experiences and perceptions of screening for cervical cancer and considers some of the issues involved in the analysis of data from focus group interviews. In the first stage of the study, 100 women were given structured interviews. Subsequently, 52 of the women were recruited, using convenience sampling, to participate in focus groups, which provided the data for the second stage of the study. The 12 focus group interviews, undertaken in Chinese, were audiotaped, transcribed and translated. The process of analysing the data was found to be time-consuming and difficult. Factors such as the unit of analysis, dynamics within the groups, between-group variations, consistency of the data, and the translation, all contributed to the complexity of data analysis. During the focus group interviews, many topics were discussed which, although not directly related to the research question, were of interest to the researchers. Women's health beliefs and attitudes to sexuality are two examples. The challenges to the rigour of the research findings created by these methodological issues are considered.

Accounts of HIV seroconversion among substance-using gay and bisexual men

Statistical associations between substance use and seroconversion among gay and bisexual men abound. However, these associations often ignore men's own interpretations of their seroconversion. Using in-depth interviews with gay and bisexual men who reported using drugs or alcohol at the time of their seroconversion, we identify how these men explain the events that led to HIV transmission. Whereas a small minority of respondents reported substance use to explain their seroconversion, the majority reported three competing explanations. These participants claimed that they lacked sufficient knowledge about the behavioral risks that led to their seroconversion; that their decision to engage in unsafe sex was because of negative personal affect; and that they "trusted the wrong person." We link these findings to prevention and suggest that gay and bisexual men who use substances for recreational purposes will benefit from prevention efforts designed to address issues of gay and bisexual men rather than substance-using men.

AIDS optimism, condom fatigue, or self-esteem? Explaining unsafe sex among gay and bisexual men

This study examines leading explanations for unsafe sex in light of in-depth interviews with 102 high-risk gay and bisexual men in Toronto to see how well they engage with the social circumstances and reasoning processes of men in their sexual relationships. We argue that there is an inadequate fit between some of the leading explanations and the discursive accounts provided by high risk men themselves. Their accounts focus on unsafe sex occurring as a resolution to condom and erectile difficulties, through momentary lapses and trade offs, out of personal turmoil and depression, and as a byproduct of strategies of disclosure and intuiting safety. This study examines, in particular the circumstances and rationales associated with men who identify their practices as "barebacking." We conclude with recommendations for communicating prevention messages to those most at risk based on the self-understandings of gay and bisexual men who most frequently practice unprotected sex.

An agenda for future research on HIV and sexual behaviour among African migrant communities in the UK

The epidemiology of the recent rise in HIV cases in Britain highlights the need for more research among the heterosexual African migrant population. New research should not, however, only extend the limited number of studies that describe observable patterns in sexual health but should also seek to determine their underlying social causation. To achieve this, both methodological and ontological shifts are necessary in the existing research paradigm; we advocate that a broad range of qualitative techniques be deployed both to uncover the empirical details of specifically African sexual behaviours and to highlight and explore the 'relational' nature of sexual decision-making. Rather than fixing on individuals, analysis must situate them within the broader discursive and material frames that structure the boundaries of decision-making. In addition, researchers need to utilise the parallel literature on the social embeddedness of HIV in Africa to inform analysis of the British context. It would then be possible to address the crucial question of whether the social conditions known to cause high-risk behaviours and facilitate transmission in Africa persist, or are transformed, after migration to the UK. A key, and neglected, dimension of this is the role of spatial context in relational sexual decision-making and the constitution of social relationships in particular arenas. This needs further thought, particularly in relation to domestic space and gender identities. We believe that the research agenda proposed herein has much to contribute to interventions and service provision. Nevertheless, we are mindful of the need for self-reflexivity about our role in the production of powerful knowledges about sex. Our final proposal is that researchers seek ways to work with, not on, African communities in order to facilitate their own informed management of sexual health.

The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men

To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial-ethnic and sexual identity development, self-esteem, social support, male gender role stress, HIV prevention self-efficacy, psychological distress, and life satisfaction. The results indicate that AAGBM who possess more positive (i.e., integrated) self-identification as being African American and gay reported higher levels of self-esteem, HIV prevention self-efficacy, stronger social support networks, greater levels of life satisfaction, and lower levels of male gender role and psychological distress than their counterparts who reported less positive (i.e., less well integrated) African American and gay identity development. Although higher levels of racial-ethnic identity development were associated with greater levels of life satisfaction, sexual identity development was not.

"If it burns going down... ": how focus groups can shape fetal alcohol syndrome (FAS) prevention

Despite public health campaigns and clinical interventions that encourage women to abstain from alcohol during pregnancy, some women continue to drink while pregnant. To provide a more in-depth understanding of how at-risk women regard--and emotionally react to--warnings about drinking alcohol during pregnancy, we conducted focus groups in 1997 with 11 pregnant and recent postpartum Native American and African American women in Los Angeles, California. The main objective of these groups was to uncover relevant aspects of women's beliefs and opinions about drinking during pregnancy that may not have been elicited by other research instruments. Results would then be used to shape a large survey of pregnant at-risk women. Analysis of the transcripts revealed three emergent themes, which had the greatest impact on our subsequent survey. These were women's exposure to and perceived believability of messages, their perception of risk associated with drinking, and the barriers to cutting down on alcohol consumption during pregnancy. Questions added to our survey instrument because of these findings included whether women think that some alcohol beverages are safer to drink than others; how they value cutting back alcohol use; their views on the irreversibility of fetal alcohol syndrome; and what pressures they feel from peers and family to drink during pregnancy. Given the small sample size associated with focus groups, these results cannot be generalized to larger populations; however, these women's words revealed important underlying issues and barriers that should be considered in studying and intervening with larger representative samples.

Quality of care from the patients' perspective: from theoretical concept to a new measuring instrument

INTRODUCTION: Patient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. OBJECTIVE: To develop a conceptual framework for measuring quality of care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health care and business research. RESULTS: Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or 'needs') and experiences. A conceptual framework - based on the sequence performance, importance, impact - and quality judgements of different categories of patients derived from importance and performance scores of different health care aspects, is elaborated upon and illustrated with empirical evidence. CONCLUSIONS: The new conceptual model, with quality of care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting quality of care aspects, a category-specific approach is recommended including the use of focus group discussions.

An analysis of the effectiveness of focus groups as a method of qualitative data collection with Chinese populations in nursing research

Although there has been a significant increase in the use of focus groups as a qualitative method of data collection in health and nursing research, literature on the use of this method with Chinese populations is limited. This study was therefore undertaken to explore the contribution of focus groups as a method of data collection amongst Hong Kong Chinese women. The study involved the comparison of the data obtained from two concurrent research studies which both employed case study design and focus groups as a major method of data collection. In both studies the samples involved Chinese women. The findings demonstrate that factors such as recruitment to the groups and interaction of group members did not adversely affect the quality of the data. Indeed the depth of data obtained on a range of sensitive topics suggests that the use of focus groups provides an effective method of collecting qualitative data with the Chinese populations in the described studies. However, a particular issue to emerge from this method of collection relates to the complexity of transcription and translation of the Chinese data which in the author's view has implications for the quality of the data. This finding indicates the importance of undertaking data analysis in the language of the interview, rather than that of the translated data, to avoid compromising the quality of data obtained from non-English speaking populations.

Current perspectives on AIDS/HIV education and counseling

This whole issue of Patient Education and Counseling is devoted to current perspectives on AIDS/HIV education and counseling. The results of 15 completed empirical studies and empirically-based reviews are described, highlighting the central role of education and counseling in research and clinical practice in the AIDS/HIV arena in the USA, UK, Australia, The Netherlands, and Israel. The articles concern: readability of educational materials, format of informed consent, participation of drug users in HIV-testing, measurement of condom use, safe sex among the young and non-monogamous, sexual network analysis, high-risk sexual behavior among gay men, prostitution, public reactions towards people with AIDS, teachers' attitudes towards AIDS, measurement of mental adjustment to AIDS, influencing quality of life by counseling, satisfaction with HIV counseling, the influence of psychosocial factors on the course of HIV infection, and a report on the recently held 10th International Conference on AIDS.