Enhancing the Potentials of the Focus Group Discussion – Engaging Frequently Neglected but Essential Situational Factors for Analyzing Data

Abstract

This research examines the critical role situational factors play in shaping focus group discussions by investigating into them through an empirical study on the mental health challenges faced by university students in China in the post-pandemic era. Although the method of focus group has long been used across disciplines, the impact of situational factors on influencing the dynamics and outcomes during the discussions is yet to be fully explored. To fill this research gap and enhance the richness, completeness, and quality of the results yielded by the focus group discussion, we draw on Vicsek’s (2007) framework to investigate three key situational factors – interactional elements, participant characteristics, and moderator influence – to find out how they affected participants’ sharing, interactions, and engagement when they discussed topics on mental health issues. Data were drawn from six focus groups conducted among 57 participants, including 39 female students and 18 male students from a Chinese university. Our findings highlight situational factors’ significant influence on the depth, development, and richness of group discussions. By engaging and analyzing these factors, researchers can enhance the methodological quality and credibility of qualitative research, which may help them gain deeper insights into participants’ experiences and perspectives.

Introduction

Chinese university students are one of the groups of people that are severely affected by the COVID-19 pandemic in terms of mental health (Chen et al., 2020). It is reported that around 7.7% university students developed depressive symptoms during the pandemic, and common symptoms such as acute stress, depression, and anxiety are still found among university students in China in the post pandemic era (Chen et al., 2020; Li et al., 2021). Therefore, it is of critical importance and urgency to study the mental health challenges experienced by university students in China after the COVID-19 pandemic.

First appeared as a marketing research tool in the 1920s (Colucci, 2007), the focus group method has been extensively used in academia to collect data across a variety range of disciplines such as healthcare, psychology, and sociology (Berrondo & Gámbaro, 2023; Mahon & Hevey, 2021; Makowska, 2022). The uniqueness of focus groups is that it enables researchers to examine group dynamics, and participants are encouraged to express, clarify, and defend their beliefs and viewpoints (Adler et al., 2019; Cyr, 2019). Smithson (2000) indicates that focus group discussion is by nature a social event, where opinions are constructed via interactions. The social nature of focus groups facilitates participants’ spontaneous expressions, generating more in-depth data than other research tools (e.g., individual interviews) (Guest et al., 2017). In focus groups, participants’ perspectives play an important role in affecting the course of group discussion. They are given the freedom to exchange beliefs, raise questions, and comment on each other (Cyr, 2019; Gawlik, 2017). Group dynamics may shift the conversations into an unanticipated direction (Kook et al., 2019; Nyumba et al., 2018).

As data acquired through focus group discussions are derived from a social situation where group rules, norms, and expectations are constructed, followed, and perpetuated, situational factors whether or not to the awareness of participants engaged in the discussion, may play a critical role in affecting the process and results of the focus group discussion, which should be included in analyzing the results (e.g., Cyr, 2019; Luke & Goodrich, 2019; Mishra, 2016). Overlooking situational factors may lead to an incomplete or misleading explanation of data and undermine the methodological quality of the qualitative research (Gawlik, 2017). Nonetheless, few empirical research has been done to investigate how situational factors shape the course of focus group discussions and their outcomes. To fill this research gap, the current study follows the framework of situational factors proposed by Vicsek (2007) to specifically focus on interactional factors, participants’ characteristics, and moderator factors to analyze how these situational factors could affect focus group discussions held to understand Chinese university students’ mental health challenges in the post-pandemic era. This research contributes to elucidating how situational factors can be considered, analyzed, understood, and presented, which illuminates on how focus group as a qualitative method can enhance the quality, richness, and credibility of research.

Literature Review

To better analyze how the situational factors impact the focus group discussions, Vicsek (2007) proposes a framework of situational factors, which assumes that six critical factors in the group situation can affect the discussion process, and they are: interactional factors, the moderator, characteristics of the participants, the environment, the content, and time factors.

Interactional factors refer to psychological mechanisms that take place in social interactions: polarization, depolarization, minority influence, conformity, conflict avoidance, the effect of mood, repression…These phenomena can be observed between the participants and the moderator and also among participants (Vicsek, 2007). A recent study about health services in Ethiopia observed social desirability tendencies and conformity in focus group discussions. Participants were found to depict local health services in a socially desirable manner. Also, when one of the research participants was of higher social status, other members would comply with his/her opinion (Bergen & Labonté, 2020).

Vicsek (2007) identifies several moderator characteristics that can influence group dynamics: the moderator’s social and demographic characteristics, style, control, roles, expertise, knowledge, and social power. The importance of the moderator has been highlighted by many authors (e.g., Adler et al., 2019; Djohari & Higham, 2020; Wood & Ristow, 2022; Nyumba et al., 2018). For example, Jenkinson et al. (2019) maintained that a sensitive, empathetic, and flexible moderating style can be more appropriate and effective than a neutral, detached approach when discussing highly personal issues.

Characteristics of the participants are pivotal to the course of discussion (Vicsek, 2007), which include personality, demographic and socioeconomic information, roles, social status, physical properties, previous experiences, and familiarity with the subject matter (Nicholson & Shrives, 2022; Orvik et al., 2013). The influences of personal characteristics on group dynamics are twofold: on the individual level, individual characteristics determine how participants think and behave. On the group level, factors like group composition affect group behaviors (Vicsek, 2007). Dolberg et al.’s (2019) research on mental health indicated the effect of the gender composition of the groups on group dynamics. Compared with gender-mixed groups, members of all-women groups created an open climate and thus displayed higher levels of personal exposure. In their research with Finnish adolescents, Katainen and Heikkilä (2019) suggest that participants’ performances were affected by their social class positions. Middle or upper-class teenagers were more likely to be actively engaged in the conversation than peers from the working class.

Features of the venue (e.g., levels of formality, decoration, location, seating, degrees of distraction, and group numbers) can affect the group discussion (Nyumba et al., 2018; Vicsek, 2007). A study conducted by Sheppard and Raby (2023) showed the effects of location on group dynamics, and the focus groups held in school café observed a higher occurrence of side conversations than a classroom focus group.

Several aspects of discussion contents can influence the process of group interaction. These factors include questions’ style, wording, and order; exercises or techniques used in the session; the degree to which the topic discussed is personal; the extent to which participants are informed about the research purpose; personal or societal expectations of the topic. Researchers argue that using interactive exercises (e.g., projective tools, storytelling, role-playing) can keep participants engaged and yield valuable data on their attitudes, beliefs, and perspectives (Berrondo & Gámbaro, 2023).

Time factors are worthy to be considered. The time and duration of sessions can exert an impact on group synergy. The latter should be examined together with the participants’ cognitive ability to concentrate (Vicsek, 2007).

Extending from Vicsek’s framework, Orvik and colleagues (2013) propose three more situational factors: perceived psychological safety, organizational issues, and ethical issues. A lack of perceived psychological safety may cause group members to disengage from discussions. This can be ameliorated by creating a nonjudgmental and open environment where members can exchange ideas openly (Frazier et al., 2017; Gawilk, 2017; Newman et al., 2017). In addition, ethical issues (e.g., anonymity, confidentiality, risks of harm, over-exposure, and consent; Sim & Waterfield, 2019) can influence the group process. There are possibilities for some participants to feel discomfort or distress during the session (Buus et al., 2013). As indicated by Sim and Waterfield (2019), focus group settings should provide a safe environment that reduces the potential harm due to public vulnerability. It is suggested that the moderator should take strategies to address such issues (Halcomb et al., 2007; Sim & Waterfield, 2019). Moreover, the group process may be affected by organizational factors, i.e., the presence or absence of institutional support and constraints. Coyne et al. (2009), e.g., met several organizational barriers (e.g., short hospital stays, time clash between children’s daily routine and group sessions) when conducting focus groups with hospitalized children.

It has been sixteen years since Vicsek (2007) proposed the model of situational factors. To the best of our knowledge, only a few studies have directly investigated the situational factors’ impacts on group dynamics (Bekafigo et al., 2019; Jenkinson et al., 2019; Kook et al., 2019). However, the previous research has not thoroughly applied situational factors to analyze the results, hence little has been known regarding how these factors could affect participants’ discussion. As Luke and Goodrich (2019) note, a focus group deserves to be viewed as an independent study. Analyzing the influences of situational factors has the potential to provide novel approaches for interpreting focus group results (Vicsek, 2007). To fill in the gap, this study aims to delve into the effects of situational factors on the group process. We particularly investigate three situational factors, namely interactional factors, characteristics of participants, and moderator related factors.

Methodology

This is part of a research project that investigates into Chinese university students’ mental health challenges in the post-pandemic era. The data collection was carried out in one university in Zhuhai, Guangdong, China from April 2022 to October 2022. Participants were recruited through WeChat groups that were set up for mental health promotion and snowball sampling through initial participants. Data for this study were collected through focus group discussions, each of which lasted approximately one and half hour. An interview guide was prepared to probe into the mental health challenges experienced by Chinese university.

The focus group discussions were conducted at Beijing Normal University-Hong Kong Baptist University United International College (UIC) in Zhuhai City, Guangdong Province, China from April to October 2022. Six focus groups were held with group sizes ranging from 7-13 participants. Altogether 57 college students, including 39 females and 18 males aged 18 to 24, participated in the study. All the six focus group discussions took place in a room designed to promote students’ well-being on the UIC campus. Written consent was obtained from all the participants before the start of the focus group discussions, and the anonymity of participants’ personal information and their rights to withdraw at any point were guaranteed. Each participant was asked to wear a numerical badge to substitute his or her real name during the discussions. The focus group discussions were conducted in Mandarin, which was the moderators and participants’ first language.

All focus group discussion data were audio-recorded and transcribed, which facilitated data analysis. The transcriptions were translated by two members of the research team who participated in all six focus group discussions and understood the psychological dilemmas faced by the college students, allowing them to translate the data appropriately and ensuring the quality and accuracy of the data (Wong & Poon, 2010).

Data analysis was guided by thematic coding to ensure rigor in data interpretation and for improved confirmability and dependability while maintaining flexibility and reflexivity (Braun & Clarke, 2019; Castleberry & Nolen, 2018). After independently reading and studying the data, we open coded line by line, generating initial codes that indicated important features in the data. We grouped recurring and similar codes together, which helped to organize the codes into broader categories and themes. Thereafter, we came together to discuss each other’s analysis in depth and ultimately refine the themes. This two-step data analysis process reduced analytical biases due to personal biases, thereby increasing the confirmability of the results (Nowell et al., 2017).

Results

Interactional Factors

Initial Opinion Sharing Will Affect Later Sharing

The initial opinion sharing of a dominant participant, in terms of both the use of language and sharing frequency, may lead the directions of group discussion establish communication barriers, thereby diminishing the enthusiasm of other participants.

For instance, within the sixth focus group, Participant 7 was the first to respond to the inquiry regarding impressions of the term “mental illness”.

“I’d like to share a thought from a book that I recently read, which states that self-harm reflects individuals’ lack of self-worth. This highlights a widespread crisis in our society that people depend on external validation due to their inability to generate self-value within. The book primarily explores how the prevalence of digitalization and virtualization in society tends to homogenize individuals rather than fostering independence. As a result, people gradually lose their unique qualities, leading to a scarcity of self-reward and self-value. This, in turn, contributes to individuals’ various psychological issues.” (Focus group 6, Participant 7#, male)

This participant shared opinions from a book, engaging third-party information to substantiate his viewpoint rather than disclosing personal experiences. Such impersonal sharing can instill wariness and conformity among other participants, reducing the possibility of following sharing of personal experiences while encouraging imitation of this participant’s discursive style.

Regarding the viewpoint mentioned earlier by Participant 7, who emphasized the significance of individuality, particularly among adolescents, some of whom might intensify their mental disorder symptoms in pursuit of attracting others’ attention. This pursuit can lead to unhealthy comparisons and worsen their mental health situation. (Focus Group 6, Participant 4#, female)

The sharing led by initial participants with an objective tone induced a homogeneity of follow-up discussion by excluding personal experiences. Participants increasingly adopted this mode of expression, utilizing second or third personal pronoun in their sharing and offering analyses and evaluations of peers’ mental health challenges.

Nowadays, college students seem to only have two main pursuits: either pursuing further education in Mainland or studying abroad. It feels like there are limited options, and it can be quite anxiety-inducing. (Focus group 6, Participant 7#, male)

This trend resulted in a significant increase in the frequency of participants who favored and adapted to this sharing pattern. Simultaneously, it isolated participants who were not accustomed to this form of expression, which built up communication barriers and diminished their inclination to actively contribute to the discussion. For instance, when discussing the impact of the COVID-19 pandemic on mental health and the influence of intimate relationships on psychological wellbeing, the majority of opinion sharing clustered around Participants 4, 6, and 7.

What I want to express is also related to the broader societal environment. The mainstream discourse emphasizes the need to be excellent, asserting that you must excel and become a pillar of the nation. It doesn’t allow for a sense of ordinariness. While praising the ordinary workers as the foundation of the nation, there’s a contradictory tone implying that those who can’t do certain things are worthless. It’s quite conflicting and doesn’t embrace the idea that not everyone excels in the same way, which makes students feel overwhelmed. (Focus group 6, Participant 6#, female)

As I mentioned earlier, many of my friends are less trusting of counseling. I think one of the reasons is that there is so much pressure from all aspects nowadays, and they want to adjust quickly so as to enter the next stage of their life. However, counseling is not a one-time treatment, it is a long-term process, which is contrary to their desire to solve their psychological problems immediately. Therefore, they prefer to choose things that can bring quick pleasure, such as smoking, drinking, self-harming and so on. (Focus group 6, Participant 4#, female)

Participant 4 voluntarily disclosed examples closely tied to daily life and personally relevant experiences at the onset of the focus group discussion. Their detailed and sincere response quickly bridged the gap with other participants, instilling a sense of trust. This trust propelled subsequent participants to similarly share genuinely personal stories, gradually lowering their defenses and actively engaging them in the discussion.

My high school classmate is an art student and paints every day. But he started art much later than others, so he put a lot of pressure on himself and drew until 2 or 3 in the morning every day. Then he suddenly broke down and developed a serious mental illness, which took years to cure. I could feel that he lived in a state of extreme pain every day, and his whole life was affected. That’s why I feel that mental illness is very scary. (Focus group 2, Participant 4#, female)

Participant 2 shared,

I was scheduled to graduate last year. However, I’m currently in my senior year as I had taken a gap year. This happened because during that gap year, I went through a tough breakup with my first boyfriend, who was seven years older than me. Breaking up was easy for him, but it hit me hard. Back then, I was on the slimmer side and struggled to put on weight. I lost a significant amount of weight, and my parents were really worried about me. They suggested that I took a year off, came back home, and had a nice place to recover. (Focus Group 3, Participant 2#, female)

When discussing psychological challenges in intimate relationships, Participant 9 from Group 4 responded,

Speaking about intimate relationships, I find myself a bit confused. During my freshman and sophomore years, I was in a relationship, and looking back, there were many moments that I now consider cringe-worthy and somewhat self-destructive. Back then, I had a lot of free time, which led to overthinking, and my own thoughts were not particularly healthy. The management of my emotions during my first two years of college was chaotic, including a messy relationship during the second semester of my sophomore year. (Focus Group 4, Participant 9#, male)

Participant 9 shared his three intimate relationship experiences, which was detailed and lengthy. Moreover, he disclosed his gay identity to other participants during his sharing, which was followed by an extended interaction with the moderator on discussing the relationship between his same-sex orientation and his mental health. This elicited resonance from other participants, directing their thoughts towards intimate relationships and prompting them to share their perspectives and issues within their own intimate relationships.

Participant 3 stated,

I’m currently in a relationship, and we moved pretty quickly. We met in September, my freshman year— he was a senior. We broke the ice and started dating during spring break. I’ve been in this relationship for a while, and there was a time when I felt lost. We have a two-year age difference, and he’s about to graduate. Sometimes when you start thinking, you’ll end up overthinking. There’s no need for it, it just creates anxiety. The things you worry about might not even happen. Focusing on the present issues, and don’t dwell on potential problems. (Focus Group 4, Participant 3#, female)

Even when the moderator shifted the question towards addressing mental health issues associated with intimate relationships, some participants still had a strong urge to echo with Participant 9’s sharing on his sexual orientation, and they continued to share opinions related to this, as evidenced by Participant 6, who stated,

I want to highlight that sexual orientation is not something we should stigmatize about, and I know some data claiming that 83% of women might be bisexual, though it hasn’t been confirmed. Additionally, with the increasing acceptance of same-sex relationships, societal attitudes are evolving. I think any sexual orientation is entirely normal, which is not a matter of morality but your personal choice. I believe it’s unnecessary to harbor biases or judgments about it. (Focus group 4, Participant 6#, female)

This indicates that the extensive sharing by the initial respondent on a specific topic and in-depth sharing of personal experiences can to some extent confine subsequent participants’ contributions to that particular subject.

Participants’ Familiarity With the Topic

The degree of participants’ familiarity with a given topic significantly affects the dynamics of interaction, including the elicitation of resonance and spontaneous conversational exchanges.

When mentioned the impact of the pandemic on mental health, nearly every participant actively engaged in the discussion. Taking Group 5 as an example, the majority of participants contributed to the conversation. Participant 7 expressed,

From my perspective, last semester, the university was under closure due to the control of the pandemic, and we had no clue when this would end, which made me severely anxious. (Focus Group 5, Participant 7#, female)

The sharing by Participant 3 aroused other participants’ resonance and willingness to share their own experiences. As Participant 2 stated,

I have a lot to say about the pandemic because I experienced it during my senior year of high school. At that time, the COVID-19 situation was severe in Tianjin. So, in the two weeks leading up to the college entrance exam, I didn’t go to school. I went directly from home to the exam venue, which was quite scary. I was preparing for the exam through online classes every day. However, it was challenging because teachers were not very engaging in online classes, which were already not very appealing. The stress before the college entrance exam made it even more difficult to focus. So, at home, I mostly studied and did practice questions on my own. Moreover, during the pandemic, there was uncertainty about how long it would last and how much longer I had to stay at home. (Focus Group 5, Participant 7#, male)

Due to the deep familiarity of each participant with the topic of the pandemic, discussions on this matter not only fostered resonance among participants but also encouraged them to disclose their in-depth personal feelings and experiences, leading to spontaneous conversational interactions by participants themselves without facilitators’ much moderation.

Similarly, due to the shared experience of living on campus among most participants, many of them actively contributed to discussions on the psychological stress arising from dormitory-related issues. Taking Group 1 as an example, Participant 12 shared,

In our dorm, there are four of us. While my parents often say that the most important relationships in university are those with your dormmates, I find it’s often not the case. Your closest connections are likely to be with classmates in the same major, as you spend more time together. Dormmates, on the other hand, can cause you lots of troubles, leading to various peculiar encounters. For example, in the morning, there’s competition to use the bathroom in my dorm. Someone might rush to use it, even if they don’t have an early morning class. It can be quite inconvenient and annoying. (Focus Group 1, Participant 12#, female)

The engaging and amusing nature of Participant 12s sharing elicited laughter from other participants, generating a relaxing atmosphere and subsequently enhancing their willingness to share their experiences of living in dormitories. For instance, Participant 3 stated,

I believe dormitory relationships can significantly impact a college participant’s well-being. While I personally have a great relationship with my dormmates, I know many friends who have changed dorms several times. Some maintain a cold and indifferent relationship with their roommates, where they simply ignore each other. Others escalate to verbal conflicts or even physical confrontations, leading them to exacerbated mental health issues, significantly affecting their daily lives and studies. (Focus Group 1, Participant 3#, male)

Participant 2 shared his experience by including more private details,

I used to live in a four-person room and later decided to change to a different dorm. An unpleasant incident occurred when one roommate liked to sleep naked, and my other roommates found it disruptive. This led to various confrontations, which escalated later on. For me, the stress from the negative atmosphere outweighed any other stressor related with a particular living arrangement. Therefore, I moved to another dorm, and now, living with a roommate from the same department makes me feel more relaxed. Roommate relationships can indeed significantly affect one’s college experience. (Focus Group 1, Participant 2#, male)

Participants’ familiarity with the discussion contents elicited autonomous sharing and discussions by themselves, which created a relaxing atmosphere by engaging more participants to share their personal experiences. The discussions revealed detailed information on how roommate relationships could affect individual well-being by including both male and female participants’ perspectives, leading to a well-rounded understanding of students’ dorm related mental health challenges.

Characteristics of Participants - Participants’ Experience of Mental Health Challenges

Among the six focus group interviews, over half of the participants in Group 3 were experiencing or had experienced severe mental health challenges. Unlike participants in other groups, these participants tended to use negative vocabulary during their discussions. They frequently emphasized their emotions using words such as “very,” “much,” “enormous”, etc. For example, Participant 1 mentioned,

During the online learning period, I developed a strong aversion to attending online classes. Facing this new format of learning during the pandemic added to my stress. Interacting with my peers online, whether communicating with friends or engaging with new classmates, it triggered intense anxiety for me. Despite appearing to be confident in conversation, I actually felt immense pressure during face-to-face interactions. (Focus Group 3, Participant 1#, female)

Participant 12 said,

In the first two weeks, the constant emphasis from the teacher on preparing for the final group project left me feeling lost and extremely anxious. I encountered difficulties of forming a group and it took a long time for my group to make a small progress. The frustration and anxiety have been overwhelming, and I did not know whom to talk to. It has been a source of considerable stress for me. (Focus group 3, Participant 12#, female)

Additionally, due to the unique characteristic of Group 3, most participants’ discussions throughout the entire focus group discussion revolved around real examples of existing mental issues or disorders. The sharing of individual experience encouraged participants with similar experiences to actively engage in the conversation and interact. For example, Participant 7 mentioned

Before the pandemic, in my first year of high school, I had been feeling uneasy every day. My mom noticed and arranged me to see a psychologist who had a good reputation. I went for a session that lasted for one and a half hours. I spoke for about 1 hour and 20 minutes, and the remaining 10 minutes were spent discussing what I had said. I thought maybe it was just the first session, so I went for 10 sessions in total. However, it always felt like I was the one doing the talking, as if I was solving my own problems. The psychologist only briefly inquired about my situation. Overall, I didn’t find it very useful. (Focus Group 3, Participant 7#, female)

Participant 12 asked,

Have you ever read that book called “Mr Toad Goes to Therapy” or something like that? You can check it out. In the book, Mr Toad also has psychological issues, and he goes to see a therapist. During his sessions, he keeps talking, and the therapist becomes impatient, similar to what you described. It might be worth taking a look. (Focus Group 3, Participant 12#, female)

However, the deep sharing of personal mental health challenges and counselling experiences also created a barrier, isolating participants who had not faced psychological challenges (such as Participants 11, 3, and 5). They could only contribute to discussions on topics that they were familiar with. For instance, Participant 11 only spoke on the topics of the pandemic and how to face mental health challenges throughout the entire focus group discussion. Similarly, Participant 3 only spoke on the topics of associating mental illness and how schools should assist students’ mental health.

Moderator

The Moderating Style – Balancing Authority and Amiability

The moderators consistently followed a structured approach at the beginning of each focus group discussion, providing all participants with a confidentiality commitment and emphasizing on the importance of respecting diverse viewpoints and equality during the discussion. The moderators stated the rules to maintain an authoritative position and cultivate the idea that participants should be respectful of each other and take this focus group interview seriously. For instance, in Group 1, the primary moderator stated,

Here are some basic principles for today’s group discussion that we hope every student will adhere to. First, each person’s viewpoint should be welcomed and considered important. The crucial aspect of this group discussion is not to judge others’ perspectives. You can share your own perspective and different insights, but you should avoid judging others. Second, we will ensure that whatever we share should be kept confidential. This is to protect yourself and your peers. Third, each of us must understand that confidentiality only works when everyone in this meeting room adheres to this agreement. Therefore, we want you to decide for yourself what you are willing to share and what you prefer to keep private.

Meanwhile, the moderator holds a teacher-student relationship with the participants, and most participants are familiar with the moderator, which means that they know of the moderator’s affable, inclusive, and open-minded nature. This familiarity contributes to participants perceiving the moderator as trustworthy and authoritative, fostering a serious attitude towards the focus group discussion, and increasing the possibility of their providing sincere and high-quality contributions. As seen in Group 2, the moderator expressed, “And most of you present here are my students.”

The primary moderator noticed that participants were hesitant to share the mental health challenges related with their dormmates, as they were concerned that other participants might have the overlapping relationships with their dormmates and thus possibly leak the sharing to other students. The primary moderator cited a joke to make the participants feel relaxed and bring up an atmosphere that increased participants’ relatedness with this question. The primary moderator stated,

There is this very famous saying online that for a dorm that is consist of seven students, there exists usually at least six WeChat groups.

Participants all laughed, and the atmosphere was thus lightened as one student started to echo this saying and share his on-campus living experience by only mentioning details bothered him without disclosing personal information of his dormmates.

Moderator’s Facilitation of the Flow of the Discussions

The moderator’s facilitation of the focus group was critical to make the discussions flow smoothly and elicit effective answers from the participants. First, the moderator posed questions in a clear and concise manner to make sure that no subjective opinions were involved so that the participants’ sharing would not be directed towards certain directions. The questions were asked not very frequently but posed when participants seemed to become unfocused and detour from the topics.

In Group 2, the moderator posed a clear question,

In this prolonged period where students are unable to leave or return to the campus easily, and travel restrictions may result in unexpected quarantine situations, what psychological health challenges or issues do you think you are facing? Can any of you share your experiences with the current pandemic situation?

This clear and accurate questioning facilitated responses from participants that directly addressed the specific aspects of the question. For example, Participant 5 responded,

I am a sophomore now, and the pandemic broke out when I was in the last year of my high school. At that time, we had no experience in epidemic prevention and limited resources of medications. So, I have been living in this kind of terrifying situations since then. Even now, including the beginning of this year when there was a suspected case of Omicron in my city and rumours of possibly locking down the city together with university’s daily check on traveling codes and daily nucleic acid test, I felt ever more scared and anxious. I was in a serious sense of panic as if clock was turned back in 2020. (Focus Group 2, Participant 5#, female)

Participant 8 shared,

I might have experienced the most significant challenge personally. I am a person that extremely enjoy traveling, as I believe experiencing different customs and cultures would help me to grow. However, during this time, I find myself trapped in this cycle of ‘forgetting it,’ feeling like I cannot control the situation. This had created a significant sense of discrepancy, which might lead to a certain psychological state, where I felt distressed and hesitant whenever I wanted to pursue something. I have developed strong hesitation and an inability to make decisions, fearing that my efforts might go to waste. (Focus Group 2, Participant 8#, male)

The moderator also posed consecutive follow-up questions, which contributed to a deeper understanding of the participants’ thoughts and made the participants feel valued, consequently encouraging them to provide further responses.

In Group 4, when Participant 8 mentioned,

I was also in a long-distance relationship before, experiencing a really tough period in that relationship, which caused severe harm to me. Unlike Participant 9, I did not hesitate to start a new one. (Focus Group 4, Participant 8#, female)

The participant delicately and vaguely shared her experience, so the moderator proceeded with follow-up questions,

I would like to continue on the topic that Participant 8 brought up. In your previous long-distance relationship that caused significant harm, how did you handle it? How did you cope with the harm caused by that relationship?

Participant 8 then responded,

To explain it a bit more, we started dating in high school, and when she entered college, we broke up after two or three months. About six months later, she approached me for reconciliation, and I agreed. Initially, our relationship was really good, and I became attached to that her. However, she kept finding excuses to end our relationship. It devastated me and I tried unhealthy ways like binge on drinking and eating to alleviate my pain, which just worsened my health mentally and physically. (Focus Group 4, Participant 8#, female)

Impact of Situational Factors on Analyzing Data from Focus Group Discussions

Interactional Factors

When analyzing focus group data, it is essential to be aware of the how interactions among participants could shape the discussions, and being discernible to think beyond the presented data is critical for researchers to profoundly interpret the results. Based on our results, dominant participants or those who choose to express their opinions early in the discussion can significantly affect the emergence and development of the themes from the data. This is because when a participant shares a strong opinion or frames a topic in a particular way, they often set a precedent that others may follow consciously or unconsciously to align their responses with the initial viewpoint. This phenomenon can result in biased opinions, as the strength, length, and timing of specific contributions made by participants might be limited and restrained. Therefore, during the data analysis process, researchers should be mindful of the initial, over-length, and profound sharing of certain participants and pay attention to the following sequence of discussion to pick up hidden cues of diverging opinions on the surface of seemingly agreement made by the following participants. Meanwhile, adopting an intersection perspective to understand and interpret the data when closely investigating the discussion sequence is critical as participants’ familiarity with the questions and topics would affect the depth and relevance of their sharing and thus influence their peers’ sharing.

For instance, in Group 5, Participant 2 often shared his strong opinions earlier and more frequently than other participants. When the participants were asked about the influence of the COVID-19 pandemic had exerted on their mental health, Participant 2 was the first one to make a long response by sharing his friend’s experience of experiencing severe depression due to academic stress, which led to similar responses from other participants. Among these responses, one sharing contributed by Participant 3 echoed with Participant 2’s opinion that online learning could intensify students’ anxiety and stress during the pandemic, but self-disciplined students might find online learning effective. This opinion was not echoed later on by other participants, however, by carefully taking notes on this passingly mentioned opinion and linking it with all the responses provided by Participant 3 in the entire focus group, a clear positive experience that demonstrated how the COVID-19 pandemic enhanced Participant 3’s mental health by enabling him to study online was detected. After we carefully analyzed all of the six focus groups and compared data across these group discussions, positive feedback on online learning which was contingent on individuals’ level of self-discipline had become a clear theme that was otherwise hidden in the majority of negative responses offered by most participants.

The sequence shows how a single comment can set the tone for the discussion, influencing others’ responses and possibly skewing the data toward certain biases. It is therefore important to recognize and account for instances where dominant participants or early opinion sharing may have directed the course of the discussion and potentially skewed the findings. Taking specific notes of the sequence of responses and consider how often certain themes recur independently, as well as how they are introduced and reinforced throughout the discussion is necessary. By actively seeking to identify and mitigate the influence of dominant voices, researchers can strive for a more balanced and accurate representation of the group’s viewpoints without taking nuances for granted.

Participant Characteristics

In our study, focus groups are made up of participants with a variety of differences in terms of their demographics, prior experience of mental health challenges, social and cultural norms, and mental health literacy. Researchers should carefully consider these participant characteristics when analyzing focus group data to avoid over-representing certain viewpoints or marginalizing others.

For example, in our study, students’ prior experiences of seeking help from professional mental health service providers heavily affected their attitude toward seeking help from formal support. In Group 4, multiple participants shared their own experiences of seeking professional help from psychiatrists and counselors, which made the positive attitude toward formal support dominate the group discussion. However, when we compared their attitude with participants in other focus groups, diverging opinions that were closely contingent on students’ prior successful experience of using professional mental health services arose. This point thus became a critical angle, from which we needed to further detect latent codes and themes that might be closely related with participants’ personal experiences. By overlooking the hidden contents caused by participants’ characteristics, the interpretation of the qualitative data would be superficial to only partially explain the problems.

By disaggregating data based on participants’ characteristics such as gender, socioeconomic status, and experiences, researchers can identify latent patterns that may indicate bias or over-representation of particular perspectives. Additionally, during the thematic analysis process, it is important to remain aware of how these factors may shape the discussion. Attention should be paid when discussions based on personal characteristics are heavily directed toward certain directions. Researchers’ conscious efforts to balance perspectives will enhance the validity of the data and lead to more nuanced interpretations.

Moderator Influence

When analyzing focus group data, it’s important to consider how the moderator’s style, framing of questions, and the types of interventions used during sessions may have shaped the discussion. Researchers should be aware of how moderator’s facilitation throughout the focus group discussion might intertwine with other situational factors and thus lead to the obtained sharing. The moderator’s approach can unintentionally guide participants toward specific themes or even discourage open expression in some cases, or a more directive questioning style might lead participants to respond in ways that align with the moderator’s perceived expectations, whereas a lack of neutral facilitation may cause some topics to receive undue emphasis. Therefore, participants’ willingness, sincerity, and engagement should be taken into consideration when analyzing their responses, as these aspects might be affected by the moderator.

In Group 1 and 2, the moderator provided a nonjudgmental environment by reiterating the importance of confidentiality and respect for all opinions, which likely encouraged participants to share openly. Nonetheless, when the focus groups started with the moderator’s supportive and non-judgmental remarks, a noticeable length of silence had remained until the moderator gently nudged the students to start with general remarks. By taking the moderator’s facilitation into consideration, participants’ lack of mental health literacy and stigma toward mental illness could be detected, as they were not willing to share and incapable to share in-depth at the beginning.

Researchers should reflect on the moderator’s role and consider how their presence may have affected participants’ sharing and interactions. Strategies such as reviewing session recordings for instances of leading questions, using coding to identify where moderator interventions aligned with particular responses, and triangulating findings with other data sources can help account for potential biases. These steps will enhance the accuracy and profoundness of the analysis, reducing the risk of neglecting the hidden points beneath the surface.

Discussion

The results presented by this study highlight three important situational aspects that have been rarely taken into consideration when researchers analyze the focus group discussions. These aspects affect the flow, dynamics, and the depth and relativity of participants’ sharing during the focus groups.

First, this study has identified two important interactional factors, namely initial opinion sharing and participants’ familiarity with the topic, which would affect the depth and scope of participants’ sharing and discussion. Initial opinion sharing in the focus group discussion could lay a basic tone for later discussion and thus limit the discussion scope and reduce the engagement of the participants who do not share similar experiences or perspectives. The sharing frequency, length, and relativity of personal experience of the first one or two participants can navigate the discussion to focus on detailed topics and encourage subsequent sharing in a correlated manner. Our findings support Vicsek’s (2007) identification of social influence within focus group discussions, which explains participants’ conformity and minor influence from a sociopsychological perspective. The findings also echo with Bergen and Labonté’s (2021) study in Ethiopia, which illustrates that social desirability tendencies and conformity among participants contribute as one of the most apparent and common interactional factors in focus group interviews or discussions. Another interactional factor found by this research is that participants’ familiarity with the topic could affect group dynamics. When participants demonstrated high familiarity with the topic, group discussions among participants themselves without much moderation and intervention from facilitators were able to take place. Resonance obtained from others’ sharing helped to build up interconnectedness and sense of security among participants within a same focus group, which elicited in-depth sharing and disclosure of personal feelings and experience. This result is also supported by prior research that similarly investigates the effect of students’ familiarity with the contents of group discussions, which indicates that the more familiar students are with the contents, the more natural and interactive the discussions would be (Abdalla et al., 2019). To better facilitate the focus group discussion and engage all the participants, facilitators need to take the initial responses seriously into consideration, so as to use them to engage more sharing from the participants. Meanwhile, facilitators should control the flow and directions of the discussion after participants’ initial sharing, so to make the discussion revolve around the intended topics and subtly break down the barriers engendered by the initial participants.

Second, our research revealed that participants’ characteristic of related experiences was essential for the focus group discussion to go in-depth. Participants who had related experiences were willing to share their personal feelings and stories with sincerity, which brought up strong engagement and resonance from others. Nonetheless, barriers were set up as well for those participants who did not share similar related experiences. The discussion atmosphere was not smooth and natural even with certain participants’ active engagement with the discussion, as other participants who did not share similar experiences felt left out, which inhibited their willingness to participate. As the participants who were less related with the topic might not help but compare the response they sensed after their sharing with the response to the sharing from other participants who were more related with the discussion topic, and thus they would feel discouraged and therefore shy to share more as they perceived that other people did not think they contribute profoundly to the discussion. Our study reinforces the literature’s emphasis on the pivotal role of participants’ characteristics in shaping discussion dynamics (Vicsek, 2007).

Moreover, our findings revealed critical effect that moderators could exert on focus group discussions in two detailed aspects: the moderating style and moderating of the flow of group discussions. Moderators’ characteristics, as highlighted by Vicsek (2007) and supported by Jenkinson et al. (2019), play a crucial role in shaping group dynamics in focus group discussions or interviews. The importance of a sensitive and empathic moderating style, especially when discussing sensitive topics, was established in all six focus group discussions by our study, which emphasized the need for moderators to navigate discussions with flexibility and empathy by maintaining an authoritative position but reducing the sense of power imbalance between moderators and participants. By establishing a structured approach and emphasizing confidentiality commitments, the moderators created an environment of authority, which gained trust from the participants to ensure further discussion. Meanwhile, moderators’ use of stories and sayings that could make participants feel connected and related was essential for participants to increase their willingness to engage in the discussion. Moderators’ control of the flow of the group discussion was essential in steering the discussions. Clear and concise questioning by the moderators helped to engage participants’ sharing revolving around the intended topics. The moderators’ ability to pose questions that addressed specific aspects of the topic facilitated detailed and valuable responses from the participants. The moderators paid attention to the consecutive follow-up questions which further deepened the understanding of participants’ thoughts, contributing to a richer discussion while avoiding the interruption of ideas.

Besides the three aspects of situational factors, our findings also indirectly revealed the extended situational factors including perceived psychological safety, organizational issues, and ethical concerns. Expanding on Vicsek’s model, Orvik and cooperators (2013) introduced additional situational factors. Our study supports the relevance of perceived psychological safety, organizational issues, and ethical concerns in shaping the focus group process. Insights into the potential disengagement caused by a lack of perceived psychological safety align with the literature (Gawilk, 2017). Additionally, ethical considerations emerged as crucial, resonating with the work of Sim and Waterfield (2019) and Buus et al. (2013). It is important to ensure that the focus group discussion take place in a safe physical and psychological environment that is ethically approved and professionally designed.

Conclusion

Our study aims to bridge the research gap in the situational factors of focus group methodology, with a specific focus on interactional factors, characteristics of participants, and moderator-related factors. As Luke and Goodrich (2019) emphasize, viewing a focus group as an independent study highlights the need for a nuanced analysis of situational factors to provide novel approaches for interpreting results. As such, the findings of our study underscore the intricate interplay of situational factors in shaping focus group dynamics. Future research should continue to explore the nuanced impacts of these factors, providing insights into effective strategies for moderating discussions, considering participant characteristics, and creating environments that foster open and meaningful dialogue. Additionally, ongoing efforts to address ethical considerations and organizational barriers are crucial for ensuring the validity and reliability of focus group research.

Given the essential contributions of this paper, there still exists certain limitations. First, as these focus groups all took place in the same time-slot and venue, we did not investigate into situational factors of time and environment. Second, the number of participants engaged in this study was limited, which might homogenize the results.