‘Could you please pass one of those health leaflets along?’: exploring health, morality and resistance through focus groups
Introduction
In contemporary social science and health related research, focus groups are frequently used in combination with survey methods, as a means of exploring substantive themes arising in research and examining in more depth differences between individuals and groups (see Bowling, 1997; Grbich, 1999). Typically in such studies, fragments of discussion are pulled out of focus groups and presented as illustrations of more general themes being analysed in the research. As Wilkinson (1999, p. 77) has recently argued, research with focus groups has tended to focus almost exclusively on the content, rather than process of interaction.
This is somewhat problematic because the traditional use of focus groups frequently results in an over simplistic presentation of complex discussions (Green & Hart, 1999, p. 25). Accordingly, alternative modes of analysis which pay more attention to group dynamics and the way in which people negotiate and construct reality and identities during the course of talk and interaction, have recently been advocated (Barbour & Kitzinger, 1999; Bloor, Frankland, Robson, & Thomas, 2001). From this perspective, the focus group is not just a ‘fertile setting’ for the emergence of salient ideas and themes. Instead, it can be seen as a site of constant negotiation of meanings, identities and stances over a limited period of time (Kitzinger & Faqhuar, 1999; Waterton & Wynne, 1999, p. 139). Focus groups provide insight into the ‘relational construction of beliefs’ and ‘social processes of belief formation’ (Waterton & Wynne, 1999, p. 127). It is for this reason that Myers and McNaughten (1999) have argued for the importance of presenting larger chunks of transcripts which enable the analysis to illustrate the context in which remarks were made and to capture the sense of dynamic change during the course of the group (as people shift their position, accommodate, or challenge one another).
Theoretically, these ideas resonate with social constructionist approaches (such as discourse analysis, conversation analysis and rhetorical analysis) which similarly criticised the traditional use of individual interview methods for a reliance on ‘realist’ assumptions and a failure to take account of the social interactive and constitutive dimensions of the interview situation (see Billig, 1987; Potter & Wetherell, 1987). Collectively, these approaches challenged the notion that traditional psychological attributes such as attitudes or beliefs could simply be taken as coherent, internal, self sufficient and discrete entities—‘reflected’ in the use of language. Instead, the standard fare of psychological investigation—peoples’ thoughts and attitudes, were reconceptualised as emerging during processes of social interaction, argument, debate and negotiation. Moreover, when people made reference to their thoughts and attitudes during such interactive episodes, they were not simply ‘reflecting’ something that already existed in the heads, but performing certain social actions (such as allocating blame, making excuses, accepting responsibility, etc). Any analysis, which omitted these dimensions of social interaction, missed the complexity and ambivalence of people's thoughts and attitudes in relation to particular areas.
The main aim of this paper is therefore to take some of the above ideas on board and provide a detailed working example of an alternative approach to the analysis of focus groups to that routinely encountered in health research. One of the reasons why this approach was adopted was because, although the author has previously utilised focus groups on health issues in the more traditional manner (Crossley (2000c), Crossley (2001c)), it was felt that this more ‘content’ based approach failed to capture some of the important processes of social action and moral negotiation occurring during the course of focus groups. Although these processes are of general concern to research informed by a social constructionist perspective, this paper is grounded in the belief that they are of particular interest and importance to issues of health and illness which people tend to orient to as intrinsically morally laden issues (Crossley (2000a), Crossley (2000b), Crossley (2001a)).
Section snippets
Procedure
In previous research, I have used focus groups exploring peoples’ attitudes towards health and health promotion as a means of drawing out substantive details and the thematic content of focus groups. In particular, as part of a study to develop an instrument to measure ‘resistance’ to health promotion, I conducted focus groups as a first step in identifying issues to be incorporated into a questionnaire. This involved conducting a number of focus groups in a Northern British city with diverse
Analysis
The next section of this paper reproduces six extracts from the focus group in which participants explore their conceptions of health and discuss and negotiate the roles and responsibilities played by individuals in health and illness. Six extracts were chosen in order to represent each of five main themes covered over the course of the focus groups. These included: (1) perceptions of self and health (extract 1); (2) individual responsibility for health (extract 2); (3) attitudes towards
Discussion
One of the main aims of this paper has been to pay greater attention to the way in which people negotiate and construct reality and identities during the course of talk and interaction, specifically with regard to issues of health and illness which are commonly oriented to as intrinsically moral phenomena. Analysis of the previous six extracts has attempted to do this, but it is now necessary to bring together some of the themes and group dynamics into a more coherent whole.
On the basis of
Conclusion
This paper has attempted to illustrate an alternative approach to the analysis of focus groups by providing a detailed analysis of the way in which people negotiate and construct reality and identities with specific regard to issues of health and health promotion. In congruence with recent developments in sociological, psychological and cultural theory, the results from this focus group suggest that ‘lay’ concepts of health are indeed heavily interlaced with moral concepts of ‘goodness’,
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