Editor’s note: Laura Swart, M.A., is with Chalfont Healthcare Research, Inc., Chalfont, Pa.

There is a familiar tension in health care focus groups. As the client, you need certain topics covered. But as respondents, the physicians or patients have their own agendas. As a result, respondents in health care focus groups tend to focus on their own issues related to health care. This article is about several tangents that arise so often in health care focus groups that they are almost universal.

The good news is that these tangents may be managed if the moderator recognizes them happening and implements the right techniques to re-focus the conversation.

The bad news is that, if you purchase health care focus groups, you are very likely to find respondents introducing these tangents. Further, these tangents are emotionally charged, so respondents will derail the conversation from the topic of the research if the tangent is not identified and managed. These tangents arise in health care-related interviews as well as focus groups, but group dynamics can make the tangents more challenging to control in focus groups than in individual interviews.

  • Tangent 1: managed-care bashing. These days, managed care sparks potentially unruly tangents in most health care focus groups. If allowed, physicians will complain at length about formularies, billing, decreasing autonomy to take care of patients, and alienation from the systems that control physicians’ practices. And if allowed, patients will gripe at length about their grievances with insurance coverage and copays.

Regardless of how legitimate these complaints may sometimes be, managed care is typically not a productive topic for lengthy discussion in a focus group. Managed-care reform is usually beyond the research objectives or beyond the client’s control.

It should be standard procedure for the moderator to explicitly discourage managed-care bashing early and adamantly. After the topic is aired once, the moderator should sympathetically but firmly prohibit repetition, and interrupt as participants attempt further repetition. This interruption should be cordial but assertive.

As a preemptive measure, it helps to indicate, during introductory comments at the start of the focus group, that you will interrupt discussions of managed care and insurance. This early warning prevents respondents from taking umbrage later on when you interrupt their managed-care bashing. It is also helpful, with the client’s permission, to state that the client is not an insurer and no insurer will see the research results (when this is the case).

  • Tangent 2: unlikely health care reforms. Another class of digressions common in health care focus groups involves decisions that the client could, but probably will not, change. For example, managed-care pharmacy directors and medical directors cry out for lower drug prices and more favorable contracts with pharmaceutical companies. Physicians object to direct-to-consumer advertising on the grounds that a little information may be dangerous when shared with patients who are unaware of the alternative treatments. Patients opine that medical centers and hospitals should not advertise because they should be altruistic healing enterprises rather than businesses.

If your prices are already fixed, or if you already know that you will advertise, as soon as a participant objects, your moderator should state that the decision is already made and is not a topic of the research.

  • Tangent 3: group therapy. Some patients attempt to use focus groups as therapy sessions. They want to unload the emotional baggage that resulted from their illnesses. They want to compare physical symptoms. They want to commiserate about the emotional upset and inconvenience of being ill, and in some cases they want to complain about the traumas inflicted upon them by health care providers. When these topics are the intended focus of the research, group therapy dynamics may be productive.

However, often these therapeutic topics are not the intended focus of the research. Even when these topics are relevant, the client needs to devise solutions and not just hear problems, so group therapy should be curtailed in favor of a discussion of viable solutions.

With a few limitations noted below, it is legitimate and necessary for the moderator to minimize the time used for therapeutic tangents. After all, the research incentive pays the participant to give the client guidance. Participants have not paid for, and should not expect to receive, therapy during the research.

Generally, when a group takes a therapeutic digression from the research objectives, the moderator should acknowledge the point and quickly change the subject before the digression gains momentum. Patients with survivable diseases that do not debilitate them should not expect to indulge in therapeutic tangents for very long.

In research dealing with the more heartbreaking, terminal or debilitating illnesses, there should be limitations to this rule on humanitarian grounds. For example, consider patients stricken with terminal cancer or ALS. These diseases are devastating and can involve intense feelings of victimization associated with a medical system that cannot save patients’ and/or cannot offer much relief from symptoms. Expecting these patients to avoid therapeutic tangents would be unrealistic and ruthless. Seriously-ill groups have a more legitimate need to express grief and frustration, and the "minimal therapy" rule should apply more loosely to them than to other groups.

For research with long-suffering patients, if possible the moderator should build in extra time for therapeutic tangents. That way, there is time to cover the research objectives and time for respondents to indulge in a therapeutic discussion.

Danger and salvation

How can tangents be controlled? Unlike breakfast cereal, political elections and many other topics, health care involves danger and salvation, and even matters of life or death. People feel strongly about health care. Knowing this, you may ask whether the type of control discussed in this article can really be achieved.

The answer is that it can be achieved to a large extent by setting the ground rules early and sticking to them, while still maintaining an accepting, relaxed atmosphere so that respondents feel safe sharing their opinions. If your moderator is not experienced with health care, you may wish to alert him or her to expect and control these tangents during your health care focus groups.