By Alexie Touchette
In a time of rapid change, we’re all trying to adjust to a new normal. Our health, both as individuals and society as a whole, is of utmost importance, but we also need to figure out how to stay connected in a time where meeting in-person is not an option. We’re learning to do things different — digitally — and there’s a learning curve. Given that things will likely not return to normal for a while, research teams need to be even more adaptable and flexible with data collection methods, prioritizing safety while still aiming for meaningful and inclusive participation.
This post highlights one example of using an alternative approach to customary in-person focus groups: asynchronous online focus groups. Thanks to the work of Dr. Jacquie Ripat, Associate Professor in Occupational Therapy at the University of Manitoba, we are able to share some firsthand experiences with this method.
What is an Asynchronous Online Focus Group?
Asynchronous online focus groups are semi-structured group discussions, usually in the format of a virtual message board. Other names for this method include:
- Internet-based focus groups
- Electronic focus groups
- Chat-based focused groups 
- Online bulletin board research 
In asynchronous online focus groups, participants are asked one or more pre-determined questions. These can be posted at varying time intervals (or all at once) and participants move topics along through conversations — or ‘threads’— on each question.
Though the purpose is the same as for in-person focus groups (i.e. answering a research question, giving feedback on a product or process), the asynchronous format means participants can respond to each other at any time. They can even go back to previous comments or conversations to add depth and insight. This not only allows people to contribute at a preferred time, location, and pace , but also permits multiple conversations to happen at the same time, without disrupting the overall group flow.
Our Experience: Developing a Winter Toolkit
As many Canadians know too well, winter can mean months of freezing temperatures, buildup of ice and snow, and strong winds — all of which make getting around treacherous and nearly impossible for Canadians with limited mobility (i.e. who use assistive devices like walkers and wheelchairs). As part of a larger project to inform development an evidence-based online Winter Toolkit of accessibility solutions (including knowledge, products, and resources), Dr. Ripat’s team conducted both a scoping review  and a series of asynchronous online focus groups.
Obviously, asking people with limited mobility to join in-person focus groups in the middle of winter would be remiss; but their insight and lived experience is invaluable for creating relevant, useful and appropriate content. With that in mind, we conducted five separate week-long (non-concurrent) online focus groups, organized by geographical location in Canada. This included one for each of British Columbia (BC), Manitoba, Ontario, Nova Scotia, and Quebec (en Francais). To be eligible, participants needed to be:
- Mobility aid users (e.g. canes, walkers, scooters, wheelchairs);
- 19 years of age or older;
- Able to access the Internet;
- Willing to spend a minimum of 30 minutes daily (for the entire week) answering questions and responding to comments.
We used WordPress to create an online discussion board. Each day, a study team member posted a question on the discussion board relating to the research topic (winter accessibility). At the end of the week, small honorariums ($20 gift cards) were mailed to participants, individual access to the discussion board was cancelled, and the site was cleared and prepared for the next group. Though the total time allotted for focus group discussions was 35 days (5 groups at 7 days each), the overall process — including examining findings, recruitment, etc. — has extended over several months.
Potential participants were recruited in each province through posters and email advertisements shared through organizations relevant to Canadians with mobility limitations (i.e. Cerebral Palsy Association, Spinal Cord Injury Canada), universities, and mobility aid vendors. People who expressed interest in participating were mailed the consent form, and those who mailed back the signed consent form were sent an email with instructions to create an account. Overall, we recruited 24 participants from across Canada, who participated in focus groups for BC (n=8), Manitoba (n=6), Ontario (n=5), Nova Scotia (n=3), and Quebec (n=2). Using WordPress, the study team was able to provide access only to specific user accounts, creating a private and secure digital environment.
How to Set Up an Online Focus Group
1) Choose a secure platform, based on ethical & pragmatic needs
Research teams should carefully consider the pros and cons of any platform they plan to use. We chose WordPress based on the following factors:
- Security (password-protected; requires admin permission to join)
- Privacy (minimal collection of identifying information, such as IP addresses; option to use pseudonym)
- Accessibility of data (option to download discussion board to a Word file)
- Familiarity (we had already used WordPress in a previous study ; no learning curve)
- Cost (free to use)
- Web-based (not an app, that could function differently on different devices)
- Customization and appearance (it looks nice!)
For more detailed discussion of the use of WordPress for online focus groups, check out this article . Though there is limited evidence on the use of various platforms for asynchronous online focus groups, other potential venues include:
- Private Facebook groups 
- Google Groups
- Commercial platforms like QualBoard, Further, FocusVision, and itracks 
2) Develop discussion questions that address study aims
Since our goal was to inform development of the Winter Toolkit, we based our questions on:
- Literature on toolkit development [9, 10, 11];
- Study team expertise; and
- Emerging results of our scoping review 
We structured questions based on the International Classification of Functioning, Disability and Health (ICF), a framework used to describe and organize factors affecting functioning and disability. The ICF consists of four domains: (1) body function, (2) body structure, (3) activities and participation, and (4) environmental factors. Since our work was focused on environment, we used environmental factors (physical, social, and attitudinal) to guide question development. Examples of environmental factors include climate and terrain, social attitudes, institutions, and laws .
3) Post questions, moderate, and send reminders
Each morning, a study team member would post the daily question (creating a ‘thread’) relating to the topic of interest. Study team members had moderator privileges on the site, giving them the ability to approve group members, create new posts, and delete comments if needed. They facilitated online discussions by probing for detail, asking follow-up questions, and providing general support, while also aiming to not overwhelm participants. Between days 5 and 6, Dr. Ripat sent a reminder email to encourage overall involvement and continued participation.
4) Collect and analyze data
Qualitative data was downloaded from WordPress and analyzed with NVivo 10 software. We also recorded the number of comments and likes for each individual to get a sense of participation for each of the five groups. The Framework Method was used to analyze qualitative focus group data, allowing comparison (similarities and differences) between focus groups by region . Using this method, we created categories and superordinate themes, that were then used to guide development of the Winter Toolkit.
5) Implement feedback and validate
The next step of our process was rapid prototyping of the Winter Toolkit. To ensure accuracy of our qualitative analysis of participant input, we validated the initial prototype of the toolkit by asking for feedback from focus group participants.
Pros & Cons of Asynchronous Online Focus Groups
To help readers determine whether this approach is appropriate for their research topic, we’ve included some of the benefits and limitations of the asynchronous online focus group method below, gathered from relevant sources and our own experiences.
Benefits of Asynchronous Online Focus Groups
Convenience of Participation
Participation is totally flexible — not only for participants, but also for study team members. This reduces a lot of the work involved in traditional focus groups, such as scheduling, travel time, finding an accessible and appropriate location, providing refreshments, and preparing materials that would be needed for in-person meetings.
Efficacy & Cost
The online format also allows teams with limited funding the opportunity to conduct focus groups without incurring all the associated costs of an in-person meeting (i.e. parking, food, materials). In addition, by using WordPress, qualitative data was already in typed format, easily downloadable to Microsoft Word — so no transcription was needed (often one of the largest chunks of a focus group budget).
Inclusion of People from Various Geographic Locations
In addition to physical distancing, online focus groups allow for inclusion of geographically distributed participants. For example, even though our study team is located in Manitoba, our largest focus group was with BC participants (n=8). Separating groups by province also permitted analysis of findings by location, and important consideration for winter accessibility needs, considering how different winter conditions can be between places like BC and Manitoba. There were also local resources mentioned in discussion that were relevant to one location and not others; for example, accessible pathways that were well-cleared in a particular city or town.
Allows Time & Space for Reflection
The asynchronous online format gives people more time to process, reflect, and respond to others. This might be particularly helpful for sensitive topics that require time for thoughtful and metered responses, and to process emotions between bits of conversation. It also allows people with complex communication needs the time they need to compose messages and comments.
Allows Inclusion of More Voices
Some people may find attending in-person groups or interviews difficult, or even impossible, for various reasons (travel, lighting, time of day, etc.). For these people, the online format provides an opportunity to participate in research and share advice and experiences with others facing similar issues. It is also able to provide a voice to those who are less heard in a physical group setting, where more vocal and outgoing personalities may dominate conversation. The study team can use moderator controls to prevent participants from explicitly (or tacitly) controlling discussions .
Encourages Peer Problem-Solving
Unlike traditional focus groups, where moderators may feel the need to bring topics back to the main focus, the asynchronous online format permits conversations to occur between participants that don’t disrupt the overall flow of topics. These side conversations, which may seem off-topic, may actually provide even richer insights for the study team .
One quote from a participant in the Ontario focus group speaks to how these groups support peer problem-solving:
“I agree, the reason I enjoy focus groups is mainly to interact with others that have similar experiences, but to also further the knowledge and resources for individuals who are in similar situations. One more helpful resource for someone equals one less thing to stress about, and our lives have enough stress, I’d say.”
Online discussions are also perceived as having increased anonymity, and because of this, participants may speak more openly and candidly about their perspectives and experiences . Compared to in-person groups, online discussions also seem to reduce concerns about how participants are perceived by the moderator, discouraging people from withholding what might be considered embarrassing information . For these reasons, online focus groups may be particularly useful for sensitive topics, such as stigmatized behaviour .
Limitations of Asynchronous Online Focus Groups
Lack of Face-to-Face Interaction
Participants can neither hear nor see each other, so there are no verbal or physical cues (body language, facial expressions, tone of voice) by which to gauge each other’s comments, responses, and reactions. This can lead to miscommunication and misunderstandings, resulting in disagreements or negative attitudes. However, with frequent and sensitive input, study team members can help resolve conflict and keep conversations appropriate and neutral.
Accessibility & Inclusivity
Probably the most important consideration for use of online groups is accessibility — is everyone you wish to include actually able to access the internet, and do they have a computer or device that they can use for the focus group? Some may have to use a public computer and/or WiFi, limiting not only the time they are able to contribute, but also their ability to provide honest, in-depth responses. Even if their device and internet connection are private, connectivity may be spotty, particularly for those in rural and remote communities. There may be additional costs associated with the use of technology and internet. There may also be issues with device compatibility, screen size, and difficulties entering large bodies of text.
Participants also won’t all have the same level of technological knowledge (whether they share this or not), causing frustration, limiting their ability to participate, and potentially resulting in their withdrawal from the study. This can be mitigated (at least in part) by providing detailed step-by-step instructions, and having a study team member available to help with technology use and troubleshooting (e.g. over the phone). People with limited vision or mobility may require additional resources or products to meaningfully participate in a non-verbal, written, screen-based environment.
Considering these potential limitations, and budgeting for additional accessibility needs (such as tablets, USB sticks, and internet access) is critical to ensuring everyone who wants to participate is able to do so.
We often exclude people from research whose voices are important to our work through existing research culture, systems, and structures. While we risked excluding some groups using the asynchronous online focus group format (e.g. those without internet/computer access or fluency), we were able to get others (e.g. people in rural settings) that wouldn’t have attended an in-person focus group. It also respects the fact that some people require assistance to physically participate in in person focus groups (e.g. support workers, drivers), and this did not put additional demands on others. Like any data collection method, the method selected must match the research objectives and population — and the asynchronous online focus group method provides yet another option for research teams looking to engage with participants and collect feedback and insight on important topics.
About the Author
Alexie Touchette is a Research Coordinator with the Department of Community Health Sciences at the University of Manitoba.
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