Asynchronous Online Focus Groups: An Effective Approach to Engage Young Adult Women in Discussions on Mental Health Problems

Abstract

As society becomes increasingly digital, qualitative research methods must continue to adapt and evolve to remain relevant and effective. This study aimed to evaluate the feasibility and utility of asynchronous online focus groups (AOFGs) as a platform to engage young women in discussions about mental health. The Learning Insights from Girls for Health (LIGHT) study utilized an AOFG to assess mental health problems and potential solutions among 52 young women, 18–25 years old, across the United States. This study analyzed survey data and transcripts from the LIGHT study to assess participants’ perceptions and satisfaction with the AOFG approach, and to characterize participant engagement and interaction within the AOFGs. Over half (59.6%) of participants were “Extremely satisfied” with the approach, and 34.6% were “Somewhat satisfied.” Participants highlighted Confidentiality, Flexibility, Connection and perspective sharing, and Equitable participation as strengths of the approach, and Lack of nonverbal and paraverbal cues, Disjointedness, and Prone to user and technical error as limitations. Two themes generated to characterize participant engagement and interactions in the AOFGs included (1) Engagement through storytelling elevates insights around mental health experiences and (2) Participant interactions included offering support in the form of advice, validation, and empathy. Results of this study indicate that AOFGs are a valuable platform for facilitating discussions about mental health in young women and are a practical and flexible approach to conducting qualitative research.

Introduction

Focus groups have long been an established method for qualitative research, valued for generating rich data through in-depth discussions that capture a wide range of perspectives on nuanced topics such as mental health (Kitzinger, 1994, 1995; Schilder et al., 2004). Focus group discussions encourage open communication between individuals, allow participants to reflect upon each other’s ideas, and provide insight into the framework on which ideas and opinions develop (Cyr, 2016; Kitzinger, 1994). However, traditional focus groups are not without limitations. Group discussions may create a group norm, silencing those with opposing opinions (Kitzinger, 1994, 1995). Participants may also experience a loss of confidentiality due to the presence of other participants, which may impede individuals from sharing, especially about personal topics (Kitzinger, 1994). Further, focus groups may be limited in generalizability due to their traditional design of recruiting a specific group of individuals, able to travel and join in person, to discuss a certain topic (Cyr, 2016). To overcome these limitations, the innovation of traditional qualitative methods may facilitate an alternative approach to collecting qualitative information.

One recent innovation in qualitative data collection that addresses the limitation of participants being unable to physically convene is the facilitation of focus groups via online video conferencing platforms such Zoom, Microsoft Teams, Skype, and Google Meet. These virtual focus groups offer a convenient and flexible approach to qualitative data collection, allowing participants from diverse geographic locations to join from the comfort and familiarity of their own home (Keen et al., 2022). Although virtual focus groups allow for greater convenience than in-person focus groups, they still require participants to be available at a specific scheduled time. To maintain the convenience of virtual focus groups, but increase flexibility, alternative approaches to qualitative data collection should be considered.

Asynchronous online focus groups (AOFGs) are digital-based focus groups where participants can join and interact from anywhere at any time, within the parameters set by the moderator posting discussion prompts (Zwaanswijk & van Dulmen, 2014). Freedom from temporal and geographic coordination gives AOFGs several advantages. First, AOFGs are useful for collecting data from populations that are typically hard to reach, such as minoritized groups and geographically diverse populations, contributing to rich qualitative data from a wide variety of cultures and backgrounds (Gordon et al., 2021). Another benefit of AOFGs is that participants can post on their own time from any place they have internet access, making them accessible to those who have a busy schedule or face barriers that keep them from traveling to an in-person focus group (Boateng et al., 2016). Finally, without having to join all together at the same time or place, AOFGs allow participants to remain anonymous, which can be beneficial when discussing sensitive health topics (Brown et al., 2021; Genuis et al., 2023; Reisner et al., 2018).

Notably, while AOFGs offer accessibility and confidentiality to participants, they also maintain the ability to facilitate robust and valuable discussions. Online focus groups are capable of producing data that is comparable in richness and in quality to in-person focus groups (Jones et al., 2022). This is critical because it demonstrates that online focus groups can be a feasible and comparable alternative to in-person focus groups depending on the research context.

Few studies have examined the levels of interaction and engagement between participants in AOFGs, which are important components of qualitative focus group content and conversational dynamics. In May 2023, our research team conducted the Learning Insights from Girls for Health (LIGHT) (publication on results under review) research study, which utilized an AOFG to assess mental health concerns and potential solutions for young women across the United States. Participants responded to prompts about mental health problems and their potential determinants and were invited to provide recommendations on solutions on a discussion board over three days. Following the online discussions, participants’ perspectives were assessed with a post-study satisfaction survey.

The current study aimed to evaluate the feasibility and utility of AOFGs as a platform for engaging young women in discussions about mental health. Specifically, we wanted to (1) identify the strengths and limitations of the approach using data from the post-study focus group, and (2) characterize participant engagement and interaction within the group by analyzing discussion board content from the LIGHT study. By integrating findings from participants’ satisfaction survey responses and their engagement and interactions within the discussion boards, we aimed to identify the perceived strengths and limitations of the AOFG approach and to evaluate its potential as a method for qualitative research in mental health.

Methods

LIGHT Study

The LIGHT study was conducted to better understand the mental health challenges that young women face and how to address them. Fifty-two young adult women aged 18–25 were recruited via social media and invited to participate in AOFGs discussing mental health topics over three consecutive days. The discussion boards were active from May 3 to May 5, 2023, from 9am to 9pm EST each day. The AOFGs took place on Discourse.com, a secure online platform that allowed the participants to anonymously answer questions and respond to each other. Before the study began, the participants were given a video that guided them through the functionality of Discourse.com and presented community guidelines which emphasized the importance of respect, honesty, engagement, safety, and confidentiality within the AOFGs.

Over the course of the 3 days, participants were asked to respond to each of six open-ended prompts as well as respond to other participants in the group. All responses were open-ended. Two prompts were posted each morning, and the participants were notified via email when the discussion boards were open. The prompts were, (1) “What are the main mental health problems among young females your age?”, (2) “What do you think is causing mental health problems among young females your age?”, (3) “If you had mental health concerns, who would you talk to about it, and what place or platform would you feel most comfortable sharing?”, (4) “What kind of questions would you want someone to ask if they wanted to see how you are?”, (5) “If you had mental health concerns, what type of help would you like?”, and (6) “What do you think would be helpful in regard to mental health problems for young females?”

Study moderators reviewed and approved each response from the participants to ensure they followed the community guidelines. Moderators reviewed incoming responses in real time and posted them to the discussion board immediately after review. Because the AOFGs remained open for a 12-hr period, this allowed the moderators to continuously monitor incoming responses and post them in real time without disrupting the pacing of discussions in the group. Nearly all responses were approved immediately, with only a few requiring participants to make edits to ensure confidentiality. Moderators convened twice daily to discuss the ongoing conversations within the AOFGs and draft follow-up prompts to pose to the group. These prompts encouraged participants to elaborate on topics further and thanked them for their engagement. Although participants were not required to respond, these prompts were intended to facilitate further engagement and interaction and help the participants feel the presence and support of the moderators.

After the 3 days, participants were compensated with a $20 Amazon gift card for each day they responded to the prompts and engaged with at least two peer posts. Participants were given a post-study satisfaction survey to answer questions about their experience with the AOFGs and the overall study. Using a 5-point Likert scale, participants were asked to rate their satisfaction with the AOFGs from “Extremely dissatisfied” to “Extremely satisfied.” Next, the participants were asked two open-ended questions: (1) “What would you consider are the strengths of the asynchronous online focus groups?” and (2) “What would you consider the limitations of the asynchronous online focus groups?” Both qualitative and quantitative data from the LIGHT study discussion boards and post-study satisfaction survey were used to assess the feasibility and utility of AOFGs, as well as the strengths, limitations, and overall satisfaction with the approach as described by the participants.

Analysis

Quantitative and qualitative data from the post-study satisfaction survey were reviewed and analyzed. The frequencies and percentages of each Likert-scale response were calculated to characterize satisfaction ratings across the participants. Three co-authors (CAD, RDS, STG) reviewed the responses to the two open-ended survey questions independently and used a qualitative inductive approach to generate themes that reflect the data (Thomas, 2006). A total of 48 responses were coded for strengths, and 38 responses were coded for limitations. Responses were not coded if participants did not provide enough details to interpret what was meant or did not have anything to share (i.e. “Nothing”, “N/A”). The three co-authors then came together to discuss and finalize themes. Then, each co-author independently assigned each response to one or more themes based on the content. Finally, they reconvened to reach a consensus as to what theme or themes each response best fit within. The analysis resulted in four themes for strengths and three themes for limitations.

Next, a secondary qualitative analysis was conducted using transcripts previously analyzed in the LIGHT study according to Braun and Clarke’s thematic analysis (Braun & Clarke, 2012, 2023). The 79 quotes that were coded as “personal stories with mental health,” “indirect experience with mental health,” and “positive participant interaction” were selected for the current analysis to demonstrate the sentiment of the response and the dynamics of participant engagement and interaction within the group. Although these quotes were initially coded in the LIGHT study, they were not described in the primary outcomes paper as they did not directly answer the posed research questions. All other codes were applied to understanding the primary research questions of the LIGHT study. Three co-authors (CAD, RDS, STG) reviewed the coded transcripts independently and came together to discuss the content and the purpose of the statements. The three codes were then organized into two themes that showcase the underlying sentiment of the statements and participant interactions.

Recognizing the importance of reflexivity in qualitative research, we provide the following statement on our positionality as the study team who interacted with participants in the AOFGs, analyzed the qualitative data, and contributed to manuscript development. We are a group of women with direct representation in or close connections to the communities involved in this study and bring important insight to our efforts. Our team brings expertise from various disciplines including prevention science, clinical psychology, psychiatry, qualitative research, and mental health research. Our professional experience in these areas coupled with our personal connection to the study population allowed us to approach the topic with both empathy and scientific rigor. We employed rigorous methodologies to minimize bias and ensure balanced perspectives. Sharing our team’s positionality with our audience offers valuable context about who we are and our commitment to elevating participants’ voices and advocating for solutions for the communities reflected in this work.

Results

There was a total of 52 women who participated in the AOFGs. The average age was 21.6 years (SD = 2.1), ranging from 18–25. Fifty participants (96.2%) identified as cisgender, one participant as genderqueer/gender non-conforming, and one participant preferred not to disclose their gender identity. The majority (69.2%) of women identified as heterosexual, followed by 19.2% as bisexual, 5.8% as lesbian, 3.9% as asexual, and 2% as questioning. Regarding race, 46.2% identified as White, 34.6% as Black/African American, 7.7% as Asian, 2% as American Indian/Alaskan Native, and 9.6% Multiracial as. In terms of ethnicity, 84.6% identified as non-Hispanic, 9.6% as Hispanic, and 5.8% preferred not to answer.

Post-Study Satisfaction Survey

Out of 52 participants, 59.6% said they were “Extremely satisfied,” 34.6% were “Somewhat satisfied,” 3.8% were “Neither satisfied nor dissatisfied,” 0% were “Somewhat dissatisfied,” and 1.9% were “Extremely dissatisfied.” Participants were then asked, (1) “What would you consider are the strengths of the asynchronous online focus groups?” and (2) “What would you consider the limitations of the asynchronous online focus groups?” A total of 51 participants responded to the strengths question, and 50 participants responded to the limitations question.

Participant responses around the strengths of the AOFGs were organized into four summary themes. Frequencies of each theme for both strengths and limitations are reported to convey the relative salience of each theme across participant responses.

Strength 1: Confidentiality

Eighteen participants highlighted Confidentiality as a strength of AOFGs. Participants shared that the anonymous nature of the group allowed them to speak freely without worrying about judgement, speaking in front of a group, privacy concerns, or social pressure. One participant stated, “I feel that being online and anonymous, I somehow had confidence in leaving more personal comments without fear of being judged by an exterior facade.” Participants expressed feelings of safety being open and vulnerable in a space where their identity was not attached to them. Another participant said, “There is a sense of anonymity and it felt like a non-judgmental group where I felt safe to share anything!”

Strength 2: Flexibility

Twenty-one participants highlighted Flexibility as a strength of AOFGs. Flexibility was characterized by being able to access the group at any time of the day and from anywhere. One participant noted flexibility as a strength by saying, “The ability to get a wider range of perspectives from people with different schedules.” Participants were able to post on the discussion boards whenever it best fit their schedules, allowing them to participate when it was most convenient. Furthermore, participants also noted that they were able to take all the time they needed within the day to think about their responses, allowing for more detailed and mindful responses. Participants further highlighted the flexibility of the platform by saying, “Participants have more time to think about their answers and responses, which can lead to deeper and more thoughtful insights.”

Strength 3: Connection and Perspective Sharing

Seventeen participants highlighted Connection and perspective sharing as a strength of AOFGs. Participants in the group said they valued being able to share their unique perspectives and experiences and hear others’ perspectives. One participant shared that “The open forum base question and answer meant we really got to be broad and share our different perspectives.” Another participant noted, “It allows for women to see the perspective of others.” The responses indicated that the participants found that group encouraged open discussion, allowing the women to share their stories and viewpoints, while engaging in dialogue and connecting with others. Participants expressed the strength of “being able to connect live with peers” and “being able to be in touch with others” through the discussion forum.

Strength 4: Equitable Participation

Nine participants highlighted Equitable participation as a strength of AOFGs. One participant stated, “Everyone gets to share as much as they want when they are comfortable to.” Due to the online nature of the group, participants shared that they did not face the same struggles they may have dealt with during in-person focus groups, such as speaking in front of a group. One participant stated, “Being introverted and feeling like I often get talked over in synchronous focus groups, I felt like I could truly express my opinions and thoughts regarding women’s mental health in this kind of setting. There wasn’t pressure to jump in at a certain point or feel like I’m interrupting someone, I could jump in on any person’s comment, whether it be to agree, give more input, or somewhat refute, at any point in time and I thought that was valuable.” Participants described the AOFG as a space where they could openly express their opinions at their own pace. They mentioned that the format also prevented participants from dominating the conversation, allowing everyone to share as much or as little as they wanted.

Participant responses to the limitations of the AOFGs were organized into three summary themes:

Limitation 1: Lack of Nonverbal and Paraverbal Cues

Twenty participants highlighted Lack of nonverbal and paraverbal cues as a limitation of AOFGs. Participants noted that not being able to pick up on body language, mood, and tone made it difficult to grasp the full extent of what others were saying and could lead to responses being misunderstood or misconstrued. One participant stated, “I’m not able to hear or see someone’s tone or facial expressions. I think this could be somewhat alleviated if people were more inclined to use tone indicators (like/s for serious), but that is one drawback because you could misconstrue what someone’s talking about if it’s ambiguous.” Another participant said, “Sometimes you don’t get the full spectrum of what someone is saying, but that goes for anything happening over text or email.”

Limitation 2: Disjointedness

Twenty participants highlighted Disjointedness as a limitation of AOFGs. Disjointedness includes no real-time interaction and the varying length of responses. One participant stated, “Perhaps the limitation was that sometimes you could not fully delve into what the participants said, because clearly there was no direct or instant feedback of ‘what do you mean?’ ‘You could tell us a little more,’ which might or might not happen in a synchronous focus group. Also, the fact that the comment window was wider, did not allow everyone to read all the posts, since it is possible that people only the posts until a certain time, so the other comments were not analyzed.” Without real-time responses, participants expressed that they could not fully engage with each other’s responses to further the conversation. Another participant said, “Some comments, especially those made later in the day, don’t get recognized or responded to even though they’re very insightful.” Another participant shared, “It is hard to create conversations if people are posting very quick/short responses.” The participants were able to share as much or as little as they wanted, leading to a wide variety of response lengths. When responses were very short, participants expressed that they found it difficult to respond and create dialogue without much content to work with.

Limitation 3: Prone to User and Technical Error

Three participants highlighted Prone to user and technical error as a limitation of AOFGs. One participant stated, “I think it can be hard to navigate a new platform and get used to filtering comments on it.” Another participant said, “Technical issues such as poor internet connectivity or difficulties with the online platform can limit participation or cause frustration for participants.” One participant noted that poor internet connectivity affected her participation on the discussion board.

LIGHT Study Discussion Board Responses

Two themes were generated from the responses that were previously coded in the LIGHT Study as “Personal Stories with Mental Health”, “Indirect Experiences with Mental Health”, and “Positive Participant Interactions” which are described below.

Theme 1: Engagement Through Storytelling Elevates Insights Around Mental Health Experiences

Throughout the study, participants demonstrated high levels of engagement in the groups through detailed personal stories about their experiences regarding mental health and those of their friends, families, and peers. They provided detailed accounts of experiences and stories to offer insight into specific mental health problems, as well as support their response to the prompt. In response to the prompt, “What are the main mental health problems among young females your age?” one participant shared, “These type of [body image] issues having been going on for a long time. As time goes on they have evolved into even more insecurities. Its really sad speaking from personal experience I remember going online and hearing about thigh gaps and feeling like I unlocked a new insecurity. Something that I was never worried about before suddenly became very setting to me because it was something I didn’t have but was shown as something attractive or favorable I began obsessing about it.” Rather than simply answering the prompt, this participant not only provided her response, but also supported it with a detailed personal story to further elevate her answer to the question.

Participants also shared stories about the mental health experiences of their families, friends, and peers. They emphasized these indirect experiences with mental health to also support their answers to the prompts. In response to the prompt “What are the main mental health problems among young females your age?”, another participant shared, “Being a high school student, I feel that many of my female peers struggle mainly with anxiety and depression. From my experience and observations, this makes attending school hard. I have noticed a significant decrease in attendance in many girls I am aware that struggle with these mental health problems. I feel it is common for girls my age, especially in highschool to be medicated for their anxiety and depression as well.” The participant used this response to directly answer the question that was posed by the moderator and supported this answer with personal experiences and observations of girls at school. These detailed responses demonstrate high levels of engagement within the group spanning beyond the scope of the prompts.

Theme 2: Participant Interactions Included Offering Support in the Form of Advice, Validation, and Empathy

Participants often went beyond simple, passive responses and utilized the discussion board as a space to positively engage with one another, offering support and encouragement and endorsing each other’s ideas. While the rules of the study required participants to respond to at least two other posts per prompt, interactions occurred more frequently than required and were always positive. For example, in response to a participant’s post about her poor experience opening up to others about her mental health, another participant responded, “I too have gotten judged by others for my mental health before. I’m sorry to hear that even professionals weren’t able to provide you with a sage space to express yourself.” With this response, she was able to connect with the other participant by expressing that she had shared a similar experience and offered sympathy. Another participant responded to a post about a participant’s experience with an eating disorder by saying, “I definitely agree with poor mental health taking a toll on a person’s life and their ability to fit into society, especially with roles like keeping a job. I also wanted to add, good job for getting yourself at a healthy weight! I know firsthand how issues like anxiety and depression can make something like that difficult.” In this response, she endorsed the other participant’s idea and offered words of support and encouragement on her journey of becoming a healthy weight. The responses demonstrated how participants acted as a support system for one another when discussing sensitive topics like mental health, creating a safe space where everyone could feel comfortable sharing their stories.

Discussion

Results of this study indicate that the young adult women participating in the LIGHT study found the AOFGs to be an accessible and valuable space to discuss mental health issues and connect with other young women. The participants endorsed the methodology through their responses on the post-study satisfaction survey – 94.2% said they were “Extremely satisfied” or “Somewhat satisfied” with the approach – and highlighted several important strengths of the approach, including Confidentiality, Flexibility, Connection and perspective sharing, and Equitable participation.

Young women participating in the LIGHT study felt secure sharing personal details of their experiences with mental health due to the Confidentiality of the AOFGs. Meanwhile, the Flexibility of the online discussion format allowed for a more diverse population to be reached, contributing to a wide variety of opinions and meaningful conversation. Confidentiality and flexibility have been commonly noted as strengths in other studies utilizing AOFGs (Brown et al., 2021; Genuis et al., 2023; Gordon et al., 2021; Guest et al., 2020; Reisner et al., 2018; Ybarra et al., 2019; Zwaanswijk & van Dulmen, 2014). Previous literature has shown that the confidentiality of AOFGs fosters a sense of safety and anonymity within the group, allowing participants to feel comfortable sharing personal stories and sensitive information (Gordon et al., 2021; Reisner et al., 2018). A study utilizing AOFGs by Zwaanswijk and van Dulmen (2014) highlighted flexibility as the most important strength of the approach as stated by the participants of the study, including the ability to participate when it was most convenient for them, as well participate from home. The AOFGs created a space where women were encouraged to engage in open dialogue about their perspectives on mental health topics, facilitating an environment for Connection and perspective sharing. A similar study noted that encouraging participants to share and comment on each other’s perspectives on of a specific health topic fosters rich and insightful conversations between participants (Reisner et al., 2018). Equitable participation was also evident throughout the study – there was no issue of one participant dominating the conversation, participants getting spoken over or interrupted, or participants not getting the chance to speak out of fear or worry. Everyone was encouraged to engage in whatever way they felt most comfortable, leading to open, honest, and diverse conversations among the participants. A study conducted by Gordon et al. (2021) similarly mentioned this strength of AOFGs as compared to face-to-face focus groups.

Effective features of the approach also emerged within the qualitative data from the discussion board responses, which demonstrated high levels of engagement and interaction between participants. Two themes generated from the discussion transcripts further endorsed the strengths the participants noted in the post-study satisfaction survey: (1) Engagement through storytelling elevates insights around mental health experiences and (2) Participant interactions included offering support in the form of advice, validation, and empathy. Participants used personal stories to share accounts of their own mental health journeys and those of their immediate social networks to support their responses. Meanwhile, the participants also built a sense of camaraderie by sharing encouraging responses to one another while endorsing each other’s thoughts, feelings, and ideas. The participants were able to act as a support system for one another in an online platform where they felt safe, comfortable, and supported. This strength is further supported by a similar study that characterized participant interactions in the form of support and affirmation, practical advice, and developing ideas together (Genuis et al., 2023). Participants consistently exceeded the expected level of engagement and interaction by offering in-depth and often personal stories, underscoring the utility of the AOFGs as a method for garnering rich and meaningful qualitative data.

Participants also noted limitations of the AOFG approach for the LIGHT study, which are important to consider and address when utilizing this methodology. First, participants commented that they sometimes could not grasp the full extent of some responses due to the Lack of nonverbal and paraverbal cues. Similar studies also highlight this as a key limitation of AOFGs (Jones et al., 2022; Reisner et al., 2018). One future recommendation to address this is to provide guidance on adding emotional cues to text, such as exclamation points and emojis, which can help to clarify the emotion and tone behind written responses. A study assessing the effect of emojis on the perception of written text found that when using a positive emoji with a positive or neutral message, the perceived positivity increases, and when a positive emoji is used with a negative message, the perceived negativity decreases (Boutet et al., 2021). Similarly, when using a negative emoji within any message, the perceived negativity increases (Boutet et al., 2021). Using emojis can be a valuable indicator of the writer’s emotion and tone, acting as a “ubiquitous language” that everyone can easily understand despite language or cultural differences (Lu et al., 2016).

The second limitation that emerged was a sense of Disjointedness in the discussions due to varying lengths of responses and the unique times of day that individuals posted. The participants indicated that it was sometimes difficult to create robust conversations if responses were shorter or less detailed. Participants who posted on the discussion board early in the morning indicated that they often had to return later in the day to respond to other comments since there were typically not many posts first thing in the morning. There is a lack of literature addressing the disjointed nature of AOFGs, highlighting the need for further research on how to effectively manage this issue. Perhaps narrowing the time window that participants must answer each prompt could lead to a higher sense of responsiveness among the group. It could also allow for more moderator participation, allowing them to shift the topic of conversation if it is stagnant and probe for deeper insight when appropriate.

A few participants highlighted User and technical error as another limitation of AOFGs. One participant noted that they experienced issues with internet connectivity, and two participants expressed that they had difficulty navigating Discourse.com. Although, participants received an instructional video on how to use the platform, as well as an email address to reach the moderators to discuss any technical issues that are inherent to online approaches. Few studies have acknowledged this limitation, but Boateng et al. (2016) address this issue and point to the need for further research on how to handle varying levels of internet literacy among participants. Providing detailed and comprehensive guidance on how to navigate the website is critical to participants to help reduce the frustration of learning how to navigate a new platform.

This study contributes to the growing body of literature on AOFGs by presenting participants’ perception of the strengths and limitations of the approach and by highlighting how these strengths manifested in practice through the dynamics of participant engagement and interaction. The strengths and limitations of the approach were directly expressed by the participants in the post-study satisfaction survey, and these strengths were shown through high levels of engagement and interaction between participants. Other studies on AOFGs, such as Gordon et al. (2021) and Genuis et al. (2023), have examined participant engagement and interaction through quantitative measures such as number of responses and the length of responses. The current study characterizes how participants engaged and interacted through qualitative analysis, demonstrating that participants went beyond what was asked of them in the prompts through detailed storytelling and offering support, validation, and empathy to fellow participants. This high level of engagement and interaction between the participants in the group further exemplifies the strengths of the approach as stated by the participants and offers new insights into how AOFGs can facilitate meaningful conversations and generate rich qualitative data for mental health research.

This study has several limitations worth acknowledging. As mentioned in the primary outcomes paper of the LIGHT study, the sample was not nationally representative, limiting the generalizability of the results. Second, there is potential for sampling bias due to the method of social media recruitment. The participants already had an active online presence and were aware of the study’s purpose. These individuals may have been open to participating in a focus group about mental health and may have had different experiences and opinions surrounding mental health than those who decided not to participate in the study.

Results of this analysis show that AOFGs are a valuable platform for facilitating candid and engaging discussions about mental health, particularly among younger generations, and are a strong alternative to traditional focus groups. Participants highlighted multiple strengths of the approach and found the discussion boards to be a safe space to talk about personal mental health experiences. In addition to offering a convenient, flexible, and practical approach to conducting qualitative research, online spaces like this digital discussion forum are very familiar to this age group and can act as a comfortable space to open the conversation about mental health. The approach allows more flexibility for both the participants and the researchers without sacrificing rich data and high levels of engagement and interaction between participants. AOFGs provide an accessible and supportive avenue for young women to share their experiences and perspectives around mental health.