SOCW 6311 Week 5 Assignment: Analyzing Focus Group Findings 

Hello, SOCW 6311 Scholars,

I am attaching instructions for the Week 5 assignment. I have broken down the assignment this week and came up with this plan to help you, because identifying and analyzing themes in qualitative research in a systematic, non-emotional manner can be difficult if you don\\\’t have experience with the process.

 

If you have learned a different system, feel free to use it, but you must use the transcript in these instructions and answer the questions in the instructions I have sent, some of which have been copied in whole from the Dashboard. You will be unable to complete all the question (and thus lose points) if you use the transcript in the learning resources.  Use the transcript attached here.

 

I am attaching an article on the process of identifying themes in qualitative studies and an extra table you can use to tally the themes from the remarks for your assignment. I have also linked a video to the assignment instructions which explains the process, too.

 

Please contact me if you have difficulties with any of these procedures.

 

I am sending extra copies of the transcript of the focus group and the tally sheet for coding for your convenience, along with a brief article about the process.

 

Assignment: Analyzing Focus Group Findings 

This assignment contains the assignment instructions, the transcript of statements from the focus group (pages 3-5 of this assignment),  and a table for coding the themes in those statements (on page 6 of this assignment).  Use the transcript in this assignment as the other transcript in the learning resources has been confusing.

A selection of scholarly articles that are useful for this assignment (in addition to others of your choosing) follows these instructions on page 10.

Your challenge: Imagine that focus groups have been conducted with providers in a healthcare setting that serves a high proportion of Asian American citizens and recent Asian immigrants  [hereafter, referred to as the Asian community] in a large urban city [Walden Heights]. Health care providers and community observers have noted that many Asian American citizens and immigrants have expressed some dissatisfaction with their interactions in healthcare settings.

To further understand this issue, service providers including social workers, chaplains, doctors, and nurses participated in focus groups to discuss problems and needed changes in health care services that would improve relationships with the Asian community and encourage them to use the medical services more often as needed.

Focus group discussions were taped and transcribed. Two social work graduate students in a research course analyzed the content of the transcripts for themes, found on the pages entitled Transcript of comments from focus group of health professionals (pp. 3-5), coded them on a data sheet (p. 6) and made recommendations.  

As the social worker [on the research team], you have been asked to analyze the focus group data. After reviewing the results, you will work with an advisory board in the community to recommend practices that would reduce barriers and dissatisfaction with care, using ecological model.  (adapted from Walden University, Week 5 Assignment, SOCW 6311)

After you have reviewed the transcript from the focus group, you become aware that there may be barriers to health care for several reasons, from finances and the beliefs and expectations of the Asian community, to the attitudes and anxiety of the service providers, and differing professional cultures of doctors, nurses, chaplains, and social workers, each with their own professional values and standards for quality care. Cultural misunderstandings about the roles of health professionals between the professionals and the Asian community members play a role in creating barriers to care and dissatisfaction with the Western model of healthcare by  the Asian community in Walden Heights.

 

Your task is to analyze the comments of the focus group participants, identify the main themes raised by the participants, find areas of consensus and disagreement, and make recommendations for social work practice in health care settings that attempt to serve the Asian American and Asian immigrant community.

Data analysis in qualitative research

Data in qualitative research involves reviewing conversations, interviews, observations, and artifacts consisting of pictures, home furnishings, jewelry, and other personal items that reveal the day-to-day lives of the individuals whose experiences are being studied through qualitative research. From this information, researchers cull broad themes that aid understanding of social problems and the challenges, priorities, and strengths of individuals and communities.

According to Flynn et al. (2020), “Research conducted with culturally diverse populations in the United States indicates that negative health care experiences have psychological and behavioral consequences that significantly impact subsequent care (p. 271). [… Specifically,] factors such as shame, distress, and a lack of trust in one’s provider have been identified as predictors of medical avoidance” (p. 273).

Although financial burdens may contribute to the problem, it is not the only issue. Having financial resources and insurance does not always reduce those barriers, explain Bustamente and Van der Wees (2012), who noted that

[e]ven if immigrants are covered by public or private health plans, coverage does not automatically translate into access. Recently arrived immigrants are often used to health systems that are differently organized and administrated than the U.S. health care system. Differences in care quality, prices, methods of payment, patient expectations, or patient-physician relationship are some of the aspects that immigrants have to become familiar with. Lack of familiarity with the system may contribute to low health care use among the foreign-born.

The health care professionals at Walden Heights Clinic want to make positive changes, so they called in the social work students from the MSW program located in Walden Heights for assistance.  You have been assigned to the team.

You learn that a focus group was conducted to discover what the providers had observed regarding cultural differences and cultural responsiveness in the clinic. The remarks made by professionals that provide health care to members of the Asian community (physicians, nurses, social workers, and chaplains) are listed in the transcript on pp. 3-5. They are adapted from the learning resources transcript.  The staff providing the information included diverse members of different professions, ethnic groups, and races. Minority staff members have varying lengths of time living in the United States. Some were born in the US, some came as children and are bilingual, and others came for advanced education to the US and stayed after graduation.  Asian staff have recent knowledge of cultural practices in Asian countries.

Among the topics raised by providers were problems and concerns about cultural competence at the clinic.  While the professionals agreed on the issue, each profession comprised a separate set of stakeholders with  its own unique professional culture, views of their roles and the roles of other professional groups, codes of ethics, and views on the elements that comprise quality services. Therefore, in addition to dealing with cultural competence at the clinic, the professionals needed a better understanding of the roles, challenges, needs, and limitations of the members of the different professional groups in delivering culturally-informed care.

Your task is to identify themes from the remarks of the people who attended the focus group, listed in the transcript on pages 3-5 of this assignment.

How to identify themes.  Identifying themes in transcripts may be a new experience for you. To assist with this task, look for word repetitions (including synonyms), metaphors, and group jargon (see the attached handout by Ryan & Bernard, 2003).  Each community or profession has its own labels and phrases (jargon) that express a collective view on a topic.  Repeated words and synonyms expressing the same idea suggest the most common themes arising from a focus group. Your analysis of repetitions and synonyms will locate areas of consensus and difference of opinions among the focus group attendees.

This fourteen-minute video will also be very helpful in describing the process of coding and identifying themes:  Analyzing Qualitative Data. Coding 101: What to do with all those words. https://www.youtube.com/watch?v=BnDUARfEu5I

Finding the themes in the transcript.

Begin by counting words or patterns of words that are said more than once. Find as many as you can, which will help you identify the primary concerns of the group that can be categorized as themes. Put a mark each time a theme was stated in the column corresponding to the stakeholder group that expressed it.  Remarks may include more than one theme. Students may disagree on the themes expressed by the focus group. Complete the table, then paste a copy and submit it with your assignment.  You do not have to cite this table, as it was  designed as part of this assignment.  Tally the themes on the coding sheet on page 6.

___________________________________________________________________________________________

Transcript of comments from focus group of health professionals at a clinic in Walden Heights, USA

  1. 1. I think the [challenge] is mainly with the immigrants [who] do not have insurance…. A lot of these people are like self-pay, so if they want to go to a doctor, they have to think “How much is it going to cost?” [from a South Asian physician]
  2. Filling out the forms for financial help – they don’t do that because they think it means that they are not

grateful for the care. [from an American social worker who is an immigrant from India]

 

  1. Figuring out how to fill out the financial aid forms is a nightmare for anyone, especially someone who is ill and struggles with the language. They can do it online, but the system is often down or not user-friendly. Many words are unfamiliar, so a lot of patients just give up. [from an African-American nurse]

 

  1. I tried to convince a patient to let us get home health care to dress his incision after surgery but he refused because he thought that someone coming into the home might judge them negatively for cultural practices, such as having a shrine to Buddha in the living room. Sometimes they have trouble believing that non-Asian health care professionals will respect their culture [from a nurse, ethnicity not specified]

 

  1. Even within families in our community whose members have achieved external markers of success (for example, advanced education, high-income employment), health care costs associated with a life-limiting illness can be devastating [from an Asian physician].

 

  1. Pervasiveness of so-called “model minority” stereotypes can mask the considerable cultural diversity among South Asian Americans living in the United States. As a result, there are biases about what to expect from Asian patients, but they can be very different from each other. [from a social worker, ethnicity not specified]

 

  1. Families often think that assessment of family well-being and provision of family support is a responsibility of the health care team, and that appearing rushed is a sign of disrespect. [from a social worker]

 

  1. I think the systems are completely broken and completely just un-navigable… I have a Master’s degree, and I have trouble talking to the Financial Assistance Office at the hospital. Think of the people that are actually using the Financial Assistance Office as their lifelines, especially if they are sick. If I can’t get through, if I have to wait days for a phone call back, what do you think those people are doing? [from a White social worker]

 

  1. Cultural responsiveness can be shown by using improved language interpretation services, support for religious rituals, and access to culturally familiar food [from diverse nursing, chaplaincy, and social work staff].
  2. I find that there’s mistrust with non-Asian providers because the patient thinks that I am going to judge them if they are using herbs or seeing the traditional healer. They think we won’t understand and they don’t want to have to explain to us, so they shy away. [from a Non-Asian physician; ethnicity was not specified]

 

  1. S. South Asians possess many different immigration statuses, many of which prevent a person from getting health care coverage from programs such as Medicare, resulting in barriers to numerous sources of care. [from a social worker and concurred by a care management nurse, ethnicity not specified]

 

  1. Many of them won’t talk about [their issues] unless they trust you…. Sometimes they think we are in connection with the secret services or the government, and if they find out that the patient needs services, they’ll be forced to leave the county. So they are reluctant to tell you [their problems]. [from a White physician].

 

  1. Asian patients who are close to their cultural heritage (more recent immigrants and those living in immigrant communities) often see health care professionals as healers that they have to develop relationships with. They may come to the clinic with small gifts to show respect. They feel that the provider is disinterested in them if they refuse or they are typing on a laptop while the patient speaks instead of facing and engaging with them. That’s not unique to our Asian patients, either. We have to ask Asian doctors what to do in those cases if one is available. [from a Hispanic physician].

 

  1. The family was happy with some elements of the palliative care they got, but there were other things that they wanted for health care that they could not communicate to me or I could not understand. This happens a lot. We have a doctor who is from the country that most of our immigrants are from, so I send them to her. [from a Non-Asian physician; ethnicity was not specified]

 

  1. We have a culturally diverse staff with a lot of the nursing staff that come from the Asian community in our area. We don’t want to offend anyone or make a mistake, so we just make sure that the immigrants and other people of color get a nurse that looks like they are from the same ethnic group. It’s too hard to remember everything about all these cultures! [from a White nurse]

 

  1. Patients from my country think it is rude to question the doctor because they think that the doctor was chosen by God and they do not want to offend God. This causes confusion over medical practices because they don’t ask questions if there is something that they don’t understand. [from a South Asian nurse]

 

  1. Sometimes there are these expectations because they think that we are the experts and know what they need better than the patient does: “You’re my [nurse], you have to solve this for me or do that for me.” And we have to tell people again and again, I can help you with this and that issue, I’m here to help you with this, but this and that you have to do yourself. “ They think that telling them to do self-care means that we don’t want to care for them. [from an Asian physician].

 

  1. My mother says her spiritual beliefs tell her that I was indebted to my brother in my past life; this is why I have to settle my debt now [by caregiving], because he is here to get his compensation. [from an Asian nurse]

 

  1. Some patients have strong values around gender issues and modesty. Maybe some of our OB practices should be adjusted because some patients skip prenatal care because they feel immodest. [from a White nurse]

 

  1. Some patients were non-compliant with medical care and did not follow the doctors’ recommendations. They believed that their illness was the result of karma for something they had done. They thought if they took the medications, it would make the karma worse at a later time or be passed on to their descendants. [from an African-American chaplain, and concurred by an Asian-American social worker]

 

  1. [The patient’s son] felt the family should continue aggressive care, even though [the patient] had no apparent quality of life. I remember [the son] said it was because he knew that his father would do anything that he could to make his family happy, and it made them happy that he was alive…. The [patient] was shaking and… sweating, and his eyes were rolled back in his head, and it was terrible to see the suffering. [from a White nurse]

 

  1. Staff needs to be trained to work with elderly Asians. Some cannot verbalize quickly, and service providers get impatient. The Asian patients may not answer right away—staff walk away thinking that their job is done. They need [to show] respect and give the elders more time to ask questions. But with packed schedules, that is very hard to do without being late for other patients. [from an Asian social worker]

 

  1. My patient was diagnosed with diabetes in the hospital but we could not get her sugars to come down. She had a visit with the dietician, but nothing worked. Then we learned that family members were bringing her traditional foods because she would not eat the American food in the hospital, which kept her blood sugars out of balance. [from a White physician]

 

  1. There will be a lot of conflicts in [South] Asian families. If the family is to make a decision, there will be more conflicts among family members than agreement…. If the [patient] is not able to make a decision and… has never had an advance directive, there will be a lot of conflicts on what to do. [from Hispanic social worker]

 

  1. Upon [the patient’s] death, what most struck the ICU [providers] was that the family expressed their grief with this incredible yelling, screaming, beyond what they had ever really experienced before from family members…. Several actual members of the ICU team… came to me afterwards to talk about the experience…. [They] didn’t know how to respond to it. [from an African-American and Hispanic biracial chaplain]

 

  1. In our culture, sons, particularly the eldest son, were responsible for taking care of their aging parents. When a daughter marries, you give away your daughter. Your son stays with you. That leaves sons to take care of their parents, not the married daughters, who are now considered a member of another family. But young second-generation immigrant [millennials] don’t see it that way, and that causes conflicts with their parents and parents-in-law. [from an Asian social worker]

 

  1. Families can become upset if we give the patient a poor prognosis. In [our home country], we stress making the best of the time remaining and give the details to family to tell as they see fit. In the US, the patient is expected to make their own choices, so they are told all the details about their illness. Families think that letting the patient plan their own final arrangements makes them depressed because they feel alone and isolated. [from an Asian care-management nurse]

 

  1. I approached one of our doctors to encourage him to spend more time with the family because they seemed to be struggling to understand the information that he gave them about their mother’s illness. He said to me “you’re a social worker – are you here to tell me how to do my work?” [from a White social worker].

 

 

Table 1.                                           Coding Themes from Stakeholders

Theme identified in focus group transcript Who said it? Which of the stakeholders below expressed a comment about the theme?   How often is this theme found in the transcript?
Physicians Nurses Social workers Chaplains
Financial issues

 

         
Barriers to getting care (“the system”)

 

         
The importance of taking time to build trusting relationships

 

         
Doctors shift responsibility for culturally competent care to nurses who are more familiar with the patient’s culture.          
Providers may hold incorrect cultural assumptions about Asian patients.

 

         
Patients have unrealistic expectations  about what the healthcare team should do.

 

         
Issues of spirituality/religion play a large role in understanding and dealing with illness.          
Patients think that the health team will not approve of native healing herbs, foods, and practices, so patients don’t tell them.          
Some patients believe that asking questions or wanting to help with decision-making may be seen as disrespectful.          
Providers, hospitals, and clinics should offer more culturally responsive tools like videos in patients’ languages and food choices.          
Family roles and conflicts play a large role in the care received and response to it.

 

         
Any other themes you identify          

Proceed through the transcript, finding words or synonyms spoken by participants that convey their ideas.

A summary of these ideas will enable you to identify the major themes that emerged from this group. You will use them to answer the questions on the next page.

The advantage and the challenge with qualitative studies is that they involve subjective judgments –yours! You may group the themes differently than a fellow scholar (or your instructor!)  in the class. That is expected. Different people may interpret the same things in slightly different ways. Working out these differences advances our knowledge. There is no wrong answer to your impressions if your reasoning is plausible and defensible, supported by scholarly literature.

For more details on this method of analyzing content, see Ryan and Bernard, 2003, linked in the reference list.

CONTENT OF YOUR REPORT. Your paper should not exceed three pages, including the references,  beginning with the table placed on the first page. Officials and funding sources often must read and react to a report in 10 minutes, obliging us to give them the information that they need clearly, concisely, accurately, and briefly so they can make an informed decision. A 3-page report like this is quite realistic for local funders. I have heard that some funding decisions are made in this time frame because there are so many proposals that have to be considered. Decision makers have no time to pour over the proposals looking for details.

 

CONTENTS

Type your name and Week 5 Assignment in the header: Do not include a title page or abstract. Please put your name in the upper margin where the running head would otherwise be placed.

 

Your report must include the information listed below. Use the format beneath this list.

  1. Place your completed table at the beginning of the assignment (page 1).
  2. Respond to each question (1-6). Formats are provided for questions 1-5. Question 6 may be answered freely.
  3. THEMES (maximum 6 sentences to respond to each question on the next page. Be clear and to the point).

Theme 1.

  1. What appears to be the main perspective of the different stakeholder groups who discussed this theme?  (Look at your table and see whom you checked as discussing the theme).
  2. Are the stakeholders in agreement, seeing the problem in the same manner with the same causes? If stakeholders are not in agreement, what is the likely cause of the difference, if indicated in the transcript? If they are not in agreement and there is no explanation in the transcript, use the following article to propose a possible cause for the difference, particularly the discussion and tables from page 114-117 of Asian Americans’ Reports of Their Health Care Experiences: Results of a National Study It can be retrieved from the Walden library or here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492145/

THEME 2: Answer the same questions (a & b) found under THEME 1.  (Maximum 6 sentences)

THEME 3: Answer the same questions (a & b) found under THEME 1.  (Maximum 6 sentences)

 

 

Format for question 1:

The three themes that I found to be most prominent in the transcript are ____, ____, and ____.

  1. Theme 1:

The stakeholders who discussed this theme are ____.  The perspective of [stakeholder] was ____ which [agreed/disagreed] with [different stakeholder name] who stated _____ and [different stakeholder (if any) whose position was _____] . According to [article] possible reasons for these differences _____.  (Maximum: 6 sentences)

 

  1. Theme 2:

The stakeholders who discussed this theme are ____.  The perspective of [stakeholder] was ____ which [agreed/disagreed] with [different stakeholder name] who stated _____ and [different stakeholder (if any) whose position was _____] . According to [article] possible reasons for these differences _____. (Maximum: 6 sentences)

 

  1. Theme 3:

The stakeholders who discussed this theme are ____.  The perspective of [stakeholder] was ____ which [agreed/disagreed] with [different stakeholder name] who stated _____ and [different stakeholder (if any) whose position was _____] . According to [article] possible reasons for these differences _____. (Maximum: 6 sentences)

  1. Describe what you might do as the social worker-researcher to ensure your understanding of the views of the stakeholders, including the physicians, nurses, chaplains, and social workers, being careful to represent each group equally (no bias in favor of social workers, in other words) . (3-4 sentences). Support your ideas with references from assigned readings and/or additional scholarly literature.

Format for Question 2:

If I were the social worker-researcher in this situation, I would do ____  to ensure my understanding of the views of the stakeholders, including the physicians, nurses, social workers, and chaplains (Provide a rich, detailed description), citing at least one scholarly source, such as a research article ) which states “___________” (pp. ___).  (Maximum: 3-4  sentences).

  1. Find a study in the Walden library or Google Scholar that addresses strategies for reducing health care barriers related to the theme you found. Look for terms like “Asian barriers to health care”, “Barriers to health care in Asian communities”, “Barriers to mental health care for Asians”. Articles in the reference list will be useful. Use the study to answer the following question:

Format for Question 3:

If asked to make a recommendation on a theme, I would consider this theme to be most important, based on my interpretation of a research study [name it here] and focus group remarks: ____ [write it out; don’t state “Theme 2” for example]. (1 sentence)

 

 

 

 

 

  1. Describe two social work recommendations in the to address the barrier or issue described in the theme you chose. Explain how the recommendations you propose will reduce obstacles posed by the barrier and may increase use of the mental health services by the Asian community in Walden Heights and/or improve the services delivered. (3 sentences).

Format for Question 4:

 

Based on the research and identified themes, two social work recommendations I would make to address the issue of [your selected theme  _____] are _____ and _____.

  1. Think about the consequences of implementing your recommendations. Consider positive effects and if there could be negative consequences for another stakeholder group in the community. Support your recommendations and ideas with references from assigned readings and/or additional scholarly literature such as the articles on page (attached for your convenience on pp. 6-7).

If you don’t envision any problem implementing the recommendation, provide a reason, and explain how your recommendation will be beneficial.

If you might expect friction or resistance to your recommendation, explain how you might mitigate it, respecting the fact that medical providers operate under intense time pressures for meeting standards of quality care.

 

Format for Question 5.

These recommendations could be expected to improve the issue of [selected theme] by ______ [describe a benefit for Asian patients and/or clinic personnel if the problem is addressed]. (2-3 sentences; provide a rationale from one or more research articles).

—or—

These recommendations may cause [negative effect – more work, more time, staffing issues, etc.] for [affected stakeholder group]. I would mitigate these negative effects by _____ (2-3 sentences).

  1. Reflect on your own cultural background by answering the next two questions since “social workers’ self-awareness and understanding of their own ethnic and racial identity plays a vital role in the helping relationship and propensity toward cultural competence”( Bender et al. , 2010), p. 37).
    1. Explain how your cultural values and beliefs may have influenced how you interpreted the focus group data. When you have encounter problematic situations that are similar to that of your client or that are triggered by your client, what self-care practices or strategies for maintaining boundaries might be useful? (You wouldn’t be human if these did not arise at times!)   (1-2 sentences).
    2. What specific cultural knowledge do you think you may need to conduct culturally responsive research with physicians, nurses, chaplains, and other social workers working in a specific marginalized community? The community may be any ethnic group, religious minority, closed professional group such as clergy, military, incarcerated individuals, and law enforcement, or any extreme social economic group such as homeless, highly affluent, or powerful figures. Recall that each group of stakeholders has its own culture with its values, perspectives on health care services and delivery, and expectations (including their views on social workers!)  (2 sentences).