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2. Methods

2.4 Conduct of the focus groups

Characteristics of the focus groups

Most of the focus groups (18 out of 24) took place in a building associated with the University of Geneva Faculty of social and economic sciences, one was organized in the premises of an association, three in those of a church, one in charitable organisation and one in a private home. The location did not have a noticeable impact on the focus groups dynamic. We considered important to conduct them in a non medical setting, in order to allow women to talk freely about their experiences and the barriers they had encountered in relationships with cervical cancer screening.

All discussions were tape-recorded, with the authorization of participants. The focus groups lasted between 90 and 120 minutes on average. Seventeen focus groups were conducted in French, five in Spanish and 2 in Portuguese. Most discussions (all those in French and three in Spanish) have been moderated by the research assistant hired in the project. A Master student in sociology moderated the two focus groups in Portuguese4, and a Bachelor student conducted two focus groups in Spanish5. The information document and consent form had been translated for these groups. The focus groups purposively included only women

4 Isabela Vieira Bertho participated to the project as an intern from September to December 2012. In the continuation of this internship, she is conducting fieldwork on cervical cancer attendance in Brazil that will be used for her Master thesis in sociology.

5 Juliette Fioretta conducted these focus groups for her Bachelor thesis in sociology. These covered a wider range of issues but also provided important data on cervical cancer. She has kindly accepted that we include them in the analyses presented in this report.

(participants and researchers), as a strategy to encourage women to share their experiences and views.

The focus groups included on average 5 participants. In two cases only two participants showed up (minimum) and in another case (organized in a church setting) eleven women participated (maximum). Across all groups, 36 women who had committed to participate did not show up for the focus group, 17 of them did not provide any explanation. In three quarters of the focus groups, participants did not know each other previously; in 6 focus groups, organized by resource persons in specific settings (associations, church) the participants knew each other.

Empirical constraints – including available time and resources, difficulties in recruitment, women’s limited availability, last minute drop-outs – have affected the possibility to systematically apply in the organization of the groups the recruitment criteria described above. Consequently, focus groups have more than expected mixed participants with contrasting characteristics. However, despite this heterogeneity, a minimum coherence could be maintained and in each focus group, participants shared at least one common characteristic. At the same time, their heterogeneity on other criteria enhanced the comparison of diverse experiences and preferences, across screened and non screened women or across different age categories.

In regards to the screening status of participants, eight focus groups included only regularly screened women; eight non screened women only6 and eight combined screened and non screened women. Number of participants per group and common characteristics of the participants, when available, are summarized in Table 1.

Focus groups process

At the beginning of each focus group, the information document and consent form were distributed to participants. The objectives of the study were reminded to them and guarantee of confidentiality was reiterated.

Following the interview guide, the moderator led the discussion in a rather directive manner, with participants being directed to the central issues instead of getting distracted in side-discussions. However, according to a qualitative methodological approach, the extension towards topics spontaneously brought up by participants was not discouraged as long as it related to cervical cancer screening. Participants were also encouraged to react to others’

opinions and experiences. Particular attention was paid to avoiding embarrassing situations and when they occurred, the discussion was moved to another topic by the moderator.

Inevitably, some leaders – less inhibited women, those knowing more about cervical cancer – talked more easily and kept others from expressing their views, despite the efforts of the moderator to balance the discussion.

6 ‘non screened’ refers to women who have not been screened in the last three years. For women recruited through the DEPIST study, this refers to their status before their participation to the study.

Table 1: Characteristics of the focus groups

Focus group identification Number of participants Common characteristic, when available Women screened regularly distressing experiences. More generally, extensive sharing of information and experience occurred over the discussion dynamics. At the end of focus groups, participants often expressed their appreciation of having been able to exchange with other women on intimate issues. Such appreciation about the participation to a research on cervical cancer has been reported in other studies (Forss et al. 2001, Markovic et al. 2005), some participants seeing it as a way to gain information and then sharing it with other women. The capacity of focus groups to generate empowerment and reflexivity among respondents has been emphasized (Barbour 2008).

Despite efforts to clarify from the start the status of this research and the non medical affiliation of the moderators, participating women often thought that they could obtain information during the focus group. This suggests a potential bias in the participants: those who wanted information might have been keener to participate to a focus group than those who did not have this urge; this limitation is further discussed in the conclusions of the report. When faced with these demands, the researcher moderating the discussion systematically referred participants to specialized websites and health professionals.

As a standard practice, refreshments were proposed to participants during the focus groups, as a way to facilitate exchanges among participants. In acknowledgement of her participation and engagement in the study, each participant received a sheet of post stamps (value: 18.50 CHF) at the end of the focus group.

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