Focus groups and the collective construction of meaning: Listening to minority women

"I Would Consult a Doctor, But What the Rabbi Says Goes": Ultra-Orthodox Jews' Relationships with Rabbis and Doctors in Israel

We examine relationships among ultra-Orthodox Israeli Jews, their doctors, and rabbis when medical decisions are made. Analyzing excerpts from sixteen focus groups with 128 ultra-Orthodox Jews, we determine how their belief system affects their decisions about whom to trust and follow when the doctor's instructions contradict the rabbi's advice. We argue that the strict behaviors described here with regard to relations among doctors, rabbis, and patients, function as social capital that raises the status of ultra-Orthodox Jews as members of an exclusive club that balances health decisions with the social demand to obey their religious leaders.

Patients' Perspectives on Informational Support and Education in the Perinatal Period: "The Quicker They Could Be Done With Me, the Better"

INTRODUCTION

The overall purpose of this study was to elicit perspectives from a diverse group of postpartum individuals about their perinatal outpatient informational support and education. In addition, suggestions from participants are provided. Although informational support is crucial in the peripartum period, it is often inadequate or biased. Qualitative research, which offers a nuanced and patient-centered perspective, is limited. The qualitive research that does exist is limited to the prenatal period only, neglecting perspectives throughout the entire peripartum period.

METHODS

This qualitative descriptive study was part of a larger observational cross-sectional study of postpartum individuals in Kalamazoo, Michigan in 2017. Two years after the initial study (2019), participants were recruited into 8 focus groups. Trained facilitators guided focus group conversations using semistructured interview questions. The questions centered on overall experiences with perinatal outpatient health care experiences and informational support. Thematic analyses were used in data analysis. Interrater reliability between coders ranged from 92% to 100%.

RESULTS

Fifty-four individuals (22.1% response rate) participated in a total of 12 focus groups. The overarching theme was the need for recognition of individuality of patients. Three subthemes emerged, including time, multiple modalities of information support, and agency.

DISCUSSION

This study extended previous qualitative findings across the entire peripartum period and that individualized prenatal care is an important distinction in perceived quality of care. Health care organizations should consider allocating time differently for perinatal office visits, offer flexible visit times based on individualized needs, offer information in multiple modalities, and promote agency of patients. This study was strengthened by the community involvement, women of color only focus groups, and oversampling of Black women. This study was limited by the self-selected, homogenous sample and potential for recall bias.

Woman-centred ethics: A feminist participatory action research

INTRODUCTION

Contemporary ethical issues in the maternity system are nuanced, complex and layered. Medicalisation and the reported rise in incidence of mistreatment and birth trauma, has been described as unethical. Some authors suggest bioethical principles are limited in terms of guiding everyday care of pregnancy and birth. There is currently no known published research which explores what birthing people say is ethical.

AIMS

This study sought to explore women's experience of maternity care from an ethical perspective.

METHOD

A Feminist Participatory Action Research (FPAR) was conducted over three years, in two phases. A Community Action Research Group (CARG) was formed of nine participants, and data were captured from five focus groups. A further ten participants were recruited for individual in-depth interviews, the data corpus was combined, and thematic analysis was applied. All 19 participants had experienced a midwifery model of care in Western Australia.

RESULTS

A unique ethical perspective was described by the participants. The central theme: 'Radical desires: Individuals values and context' placed the woman at the centre of the care, in determining what is ethical. Two categories captured the care experienced: Woman-centred ethics or Authoritarian ethics. A conceptual model Woman-centred ethics is offered to enhance everyday ethical midwifery care.

DISCUSSION

The participants in this study perceived care as either ethical or unethical based on the quality of the relationship, the knowledge that was shared and the manner of the care given. The Woman-centred ethics model may be a starting point for moving the field forward in ethical discussion.

Perspectives on reporting non-verbal interactions from the contemporary research focus group

BACKGROUND

The main defining attribute that delineates focus groups from other methods of collecting data is that data are generated through participants communicating with each other rather than solely with the group moderator. The way in which interactions take place across group interviews and focus groups varies, yet both are referred to as focus groups, resulting in a broad umbrella term for its numerous manifestations.

AIM

To reflect on how focus groups are adopted and reported, including the use of the term 'focus group'.

DISCUSSION

The authors recognise that the term 'focus group' is sometimes used synonymously with 'group interview' but argue that this practice must be challenged. They suggest using terms that indicate the type of space and synchronicity of the focus group, prefixed with 'in-person' or 'conventional' to identify traditional focus groups. They also suggest separating virtual group interviews into 'synchronous' and 'asynchronous', based on whether the participants and researchers can engage with each other in real time.

CONCLUSION

There is a need for qualitative researchers to reach a consensus about the nature of focus groups and group interviews, as well as where their differences and similarities lie.

IMPLICATIONS FOR PRACTICE

The authors hope to encourage nurse researchers to think about these issues when labelling, planning, analysing and reporting studies involving focus groups.

Bottle-feeding, a neglected area of learning and support for nurses working in child health: An exploratory qualitative study

Breastfeeding is the ideal infant feeding modality; however, the reality is some parents need or choose to use bottles to feed their infants. Parents who bottle-feed have been identified as not receiving adequate levels of bottle-feeding information and advice from health professionals. This study's aim was to explore nurses' knowledge of the components in the bottle-feeding act. Twenty-one nurses working in early parenting residential units participated in three focus groups. Three themes were identified relating to nurses' bottle-feeding knowledge: experience not evidence-based, it is hard to know what to advise, we will support whatever choice they make. The nurses identified a deficit in their knowledge, education and training related to the components of bottle-feeding. The nurses struggled with their interpretation of infant feeding policies and the provision of bottle-feeding information to parents. Nurses working in child and family health were motivated to inform, educate and enable parents to confidently make decisions concerning infant feeding. The healthcare system and the infant feeding policy drivers appear to have a mixed and at times negative impact on nurses' practice. Further research is required across a larger population of nurses.

"I Kind of Want to Want": Women Who Are Undecided About Becoming Mothers

This study focuses on women who define themselves as being undecided about becoming mothers. It addresses the question of how these women navigate their lives between two main conflicting cultural directives and perceptions: pronatalism and familism entwined in perception of linear time on one hand; and individualism and its counterpart, the notion of flexible liquid society, on the other. The research is based on group meetings designated for these women, which were facilitated by the first author. Ten women participated in the study—of whom, most were heterosexual, half were single, and half were partnered. Data were collected using (1) questionnaires completed during individual interviews that preceded the group encounter; (2) transcripts of the discussions held during the ten group sessions; and (3) questions regarding the status of the women’s doubts about motherhood asked 4 years after participating in the group. Our findings expand the existing typology of women’s reproductive decision-making, and demonstrate how categories that are commonly perceived as binary intersect when one challenges the rigid classifications of “active decisions” and “passive decisions”; “motherhood” and “non-motherhood,” and “want to be a mother” and “do not want to be a mother.” The findings also suggest that after becoming mothers, women can change their maternal status from “non-mother” to “mother,” yet still continue to view themselves as indecisive regarding motherhood. Based on our findings, we will argue that while indecisiveness about motherhood derives from individualized neoliberal rhetoric, it simultaneously undermines that same rhetoric and contradicts the injunction to “know, to decide, to strive.” It opposes the expectation in post-feminist discourse, that women will make choices about their bodies and exert them, while also opposing the pronatalist rhetoric, and the temporal linear discourse positing that women should “move forward” toward motherhood along with the ticking of the “biological clock.” Whereas some women sought to resolve their indecisiveness, other women found that the indecisiveness leaves all options open in a manner that expands their boundaries of autonomy in a society that seeks to limit it.

Ontological Security, Trauma and Violence, and the Protection of Women: Polygamy Among Minority Communities

In this article, we examine the special challenges posed by the practice of polygamy to minority women, focusing on the ways that the state and the women confront the related experiences of violence and trauma associated with this practice. Based on analysis of both policy and interviews with women, we demonstrate the tension between the different mechanisms adopted by the state as opposed to those adopted by the women themselves. We suggest that the concept of ontological security is valuable for a deeper understanding of the range of state motivations in cases related to minority women, violence, and the right for protection. Our case study is the Bedouin community in Israel. We explore the relationship between individual and state-level conceptions of violence and trauma and the complex relationship between these two. We examine state discourses of ontological security through a gendered lens, as frameworks of belonging and mechanisms of exclusion.

Examining clinical training through a bicultural lens: Experiences of genetic counseling students who identify with a racial or ethnic minority group

Biculturals are individuals who have had significant exposure to more than one culture and who possess more than one cultural frame of reference. In the United States, this term has been used to describe both immigrants and members of racial or ethnic minority groups who live within the majority white culture. Biculturals develop a distinct repertoire of social and cognitive skills and have been shown to engage in a process of cultural frame switching in response to salient cultural cues. Through a conceptual lens offered by current research on biculturalism, this article examines transcripts of focus groups we collected for a study on the clinical training experiences of genetic counseling students who identify with a racial or ethnic minority group. We conducted a constructivist grounded theory study, collecting data via 13 videoconference focus groups with 32 recent graduates of genetic counseling training programs who identify with a racial or ethnic minority group. We focus here on two of the thematic categories identified in that study related to participants’ experiences interacting with patients during supervised clinical rotations. We find three ways in which being bicultural influenced these genetic counselors’ patient interactions. First, participants described interactions with both culturally concordant and culturally discordant patients that highlighted the salience of their racial, ethnic, or cultural identity in these encounters. Second, they reported sensitivity to social nuances between and within cultures, reflecting the findings of prior research about heightened cultural awareness in biculturals. Third, they described switching cultural frames in response to their patients’ identities which, at times, created conflict between their professional and culturally concordant frameworks. The results of this study suggest that the influence of a student's racial, ethnic, or cultural identity on interactions with patients should be discussed within the supervisory relationship, and that being bicultural confers advantages in learning to provide culturally responsive care.

Supporting a sense of inclusion and belonging for genetic counseling students who identify as racial or ethnic minorities

Racial and ethnic minority graduate students in a variety of academic and professional disciplines have been reported to experience microaggressions and feelings of isolation during the course of their training. The purpose of this constructivist grounded theory study was to characterize the training experiences of genetic counseling students who identify as racial or ethnic minorities. The goal of enhancing racial and ethnic diversity has been discussed for decades within the genetic counseling profession, but the actual training experience of underrepresented minorities has yet to be fully explored. We conducted 13 videoconference focus groups with 32 recent graduates of genetic counseling training programs who identify as racial or ethnic minorities. This paper presents results from three of the thematic categories identified in that larger study: Participants' interactions with classmates, Sense of belonging in the GC profession, and Available or desired supports. Participants reported experiencing negative interactions within their training program, during supervised clinical rotations, and at professional events; negative interactions included comments suggesting they did not belong in the United States, being confused with another non-white classmate, and intrusive questions or assumptions about their family, culture, or religion that were not similarly directed at white classmates. Trainees who were Muslim or Black/African American reported feeling particularly isolated by these incidents. Participants reported that they sought support from a variety of sources following negative experiences. Non-minority program faculty were perceived as able to offer listening or action but not understanding or guidance, which were perceived as more likely to be available from individuals who identify as racial or ethnic minorities. Results of this exploratory study suggest the need for training programs to ensure that appropriate supports are available to minority students, including diverse faculty and staff and non-program resources.

Listening to Hospital Personnel's Narratives during the COVID-19 Outbreak

Healthcare workers (HCWs) facing the COVID-19 pandemic are required to deal with unexpectedly traumatic situations, concern about contamination, and mounting patient deaths. As a means to address the changing needs of our hospital’s HCWs, we conducted a narrative analysis study in the early stages of the covid-19 outbreak. A focus group of medical experts, conducted as the initial step, recommended that a bottom-up research tool be used for exploring HCWs’ traumatic experiences and needs. We therefore conducted 450 semi-structured in-depth interviews with hospital personnel. The interviews were based on Maslow’s Pyramid of Needs model, and the narratives were analyzed by applying the Listening Guide methodology. The interviewees expressed a need for physical and psychological security in the battle against Covid-19, in addition to the need for attachment and meaning. Importantly, we also found that the interview itself may serve as a therapeutic tool. In light of our findings, we recommended changes in hospital practices, which were subsequently implemented. Further research on HCWs’ traumatic experiences and needs will provide evidence-based knowledge and may enable novel approaches in the battle against Covid-19. To conclude, the knowledge generated by listening to HCWs’ narratives may provide suitable support programs for professionals.

"Enclave in Transition": Ways of Coping of Academics from Ultra-Orthodox (Haredim) Minority Group with Challenges of Integration into the Workforce

Traditional societies around the world face various challenges with the introduction of “modern” values as a result of various globalization processes occurring worldwide. In the research literature, these groups are generally referred to as a “transitional societies.” The focus of the research discourse on “a society in transition” is the social change derived from the undermining of that traditional society and the weakening of its constituent values with the acquisition of higher education and modification of traditional division of roles in the family. In the last two decades, the ultra-Orthodox society in Israel has undergone far-reaching changes that are reflected in the acquisition of higher education and the accelerated entry into the employment market. In light of these changes, this study seeks to examine how the academic ultra-Orthodox deal with this integration into a work place outside the “enclave.” Methodologically, the study is based on qualitative content analysis of four focus groups, two for men and two for women, as is customary in ultra-Orthodox society. During the group discussion, participants were asked to describe how they cope with conflicts and their general professional challenges in the workplace. The findings of the study show that both the men and the women, described themselves as adaptable and coped well, despite the social difficulties facing their community and professional challenges in the employment space. The analysis of the major themes relies on the Stress and Coping theories.

Conscripted curriculum: The experiences of minority genetic counseling students

While the lack of racial and ethnic diversity in the genetic counseling profession has been discussed for decades, little attention has been paid to the training experiences of under-represented minorities. Under-represented minority graduate students in other disciplines have been reported to experience microaggressions and feelings of isolation during training, and they are often informally enlisted to educate classmates about issues related to race. In 2019, sociologist Lauren Olsen coined the term conscripted curriculum to describe the utilization of minority medical students to elucidate issues of race or ethnicity for their classmates. The conscripted curriculum arises when these topics are taught in a small-group discussion format that relies on students sharing their individual experiences to educate their classmates. In classrooms with limited diversity, the expectation to contribute falls disproportionately on students from non-majority groups. In this qualitative study, we conducted videoconference focus groups with 32 recent graduates of genetic counseling training programs who identified as racial or ethnic minorities. We present the results of two thematic categories that emerged from that study: the participants' perspectives on the cultural competency curriculum in their training programs and the participants' feelings of being pressed into service as spokespeople for their cultural groups. Participants described the cultural competency training as occurring primarily in a small-group discussion format in which students were expected to share their personal experiences. During these discussions, minority students, especially those in less-diverse class cohorts, felt obliged to contribute their perspectives in order to educate non-minority classmates about issues of race and ethnicity, leading to feelings of frustration and exhaustion. The results reflect a conscripted curriculum as described by Olsen (2019). Journal of Health and Social Behavior, 60(1), 55-68, in which minority students bear the burden of educating their classmates about the social basis of race. Genetic counseling training programs should critically examine their cultural competency curriculum to create a more equitable training environment.