Running focus groups with elderly and disabled elderly participants

*Corresponding author. Tel.: #44-1327-262-563; fax: #44-1865-227-596.

E-mail address: [email protected] (J. Barrett).

Applied Ergonomics 31 (2000) 621}629

Running focus groups with elderly and disabled elderly participants

Julia Barrett*, Stuart KirkThe Disability Information Trust, Mary Marlborough Centre, Nuzeld Orthopaedic Centre, Headington, Oxford OX3 7LD, UK

Received 21 June 1999; accepted 1 June 2000

Abstract

This paper is based on a study to determine the information needs of elderly, disabled elderly people, and of their carers, in the UK.Four focus groups were run with a total of 20 participants to identify major themes and aid in the creation of a questionnaire fora national survey. This paper does not describe the "ndings of the focus groups but reports on the lessons learned from running them,in the light of the increasing importance of such methods. A number of di$culties arose, most associated with age-related declines insensory, perceptual, cognitive and communication abilities. These di$culties are described, together with the steps that need to betaken to eliminate, or at least ameliorate, them, so that this powerful method of collecting information can be used fruitfully on elderlyand disabled elderly people. ( 2000 Elsevier Science Ltd. All rights reserved.

Keywords: Elderly and disabled elderly people; Focus groups; Di$culties and solutions

1. Introduction

1.1. An aging population

It is well known that the world's population is aging,with more developed regions leading the process, becauseof increasing survival to older ages as well as smallernumbers of births (United Nations Population Division,1998 revision). Consequently, the support of this ever-expanding elderly population has become of increasingconcern. Another consequence of the demographic shiftis the need to give greater attention to the design ofproducts and services for older consumers*who nowexercise the power of the so-called &grey pound' (TheHenley Centre and DesignAge, 1997).

In the UK, the number of people aged 65 and over isprojected to increase from 9.3 million in 1996 to 12million in 2021, peaking at over 15 million during the2030s. On the other hand, the number of people underage 16 will drop from 12 million in 1996 to 11 million in2021. If current trends continue those aged 65 and overwill exceed those under 16 for the "rst time in 2016(O$ce for National Statistics, 1998). Proportionally, the

biggest increase has been in the oldest old, that is thoseover 85, who are more likely to have chronic illness anddisability, and to need care at home, in residential homesor in hospitals.

In the context of this study an &elderly' or &older' personis an individual aged 60 or above.

1.2. Health and aging

In 1996, 59% of people in the UK aged 65}74 and 66%of people aged 75 and over had a long-standing illness,compared with 35% of people of all ages. Furthermore,41% aged 65}74 and 52% aged 75 and over said thatthey had a long-standing illness that limited their lifestyle(General Household Survey, 1998). Disability increasesrapidly with age, with 4% of those with a disability being16}24 in age, compared to 23% aged 65}74 and 26%aged 75 and over (Department of Health, 1998). Thenumber of residents in all homes for the elderly or adultswith a physical or sensory disability rose by 11% be-tween 1986 and 1996, with a rise of 84% in private homesfor the same period (O$ce for National Statistics, 1998).

1.3. Providing support in the UK

The provision of support to elderly people is describedwith respect to the situation in the UK, where the studywas based. In UK, most frail older people live in the

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community, supported by family or friends. Often, thecarers of very elderly people are themselves pensionerswho are also likely to be frail, with limited and decreasingability to provide care (Age Concern, 1999). In 1996, 21%of men and 39% of women aged 65}74 lived alone and31% of men and 58% of women aged 75 and over livedalone (General Household Survey, 1998). The proportionof people of all ages living alone is increasing and ispredicted to continue doing so (Department of the Envi-ronment, Transport and the Regions, 1999)*womenover age 60 form the largest proportion of this group(O$ce for National Statistics, 1998).

Although the number of elderly people living at homein the UK is increasing, fewer are receiving support athome. Although the number of contact hours of homehelp provision increased by about 50% between 1993and 1997, the number of households receiving this helpdecreased by 7% over this period (Department of Health,1998). There is a trend towards increasing intensive sup-port for more heavily dependent people at home (AgeConcern, 1999), but a reduction in the number of peoplereceiving less intensive help. Due to pressure on re-sources, Social Services departments are making &per-sonal care' a priority over providing domestic help withhousework, gardening, laundry, home maintenance andrepairs (Clark et al., 1998). However, a recent study byClark et al. (1998) suggests that such &low-level' servicesproviding domestic assistance both enhance the qualityof life for older people and also help them maintain theirindependence. Keeping a well-maintained house wasfound to be central to a sense of well being and being partof society, as well as giving con"dence about coping athome. Bowling et al. (1997) found that, for elderly peopleliving at home, poor and worsening satisfaction with lifewas most clearly associated with some worsening abilityto perform everyday tasks and with declining health,particularly for those aged 85 and over. Anxiety anddepression were consistently associated with poor ordeteriorating levels of ability to perform routine tasks.

Increasingly, the responsibility rests with elderlypeople and their families to:

f seek information and advice about health and socialmatters;

f "nd out about their entitlements in terms of moneybene"ts and services;

f choose and purchase adaptations and equipment.

There is a substantial amount of information of vary-ing quality currently available in many formats to elderlypeople and their carers to help them cope at home. This,however, is not being readily and widely accessed bythose who have the greatest need for it, in particulardisabled elderly people, one of the most disadvantagedgroups in society. For example, there are a number of freepamphlets, fact sheets, and telephone helplines givingdetails of government bene"ts for the over 60s. However,

the Department of Social Security estimated that in1995/96 between 34 and 40% of pensioners who wereentitled to Income Support, between 11 and 14% whowere entitled to Housing Bene"t, and between 26 and34% entitled to Council Tax Bene"t did not claim (De-partment of Social Security, 1996). It is the disadvantagedgroups that most need care, help and information. Ifdisabled elderly people and their carers possess the in-formation they want, in a form that is easy to understandand use and delivered using methods that are acceptableto them, they will be more independent and require lesssupport from the health and social services.

2. Determining the needs of elderly people*using focusgroups and surveys

What support do elderly people living at home, andtheir carers, want to enable them to manage as easily aspossible and to maintain their independence for as longas possible? To determine the information, advice andpractical help that elderly people living at home wantand how they want to obtain it, a national survey ofelderly people and carers of disabled elderly people wascarried out. This will be reported in Applied Ergonomicsin the near future.

As a preliminary to the survey, and to render itmore e!ective by identifying the major points thatneeded to be covered, a series of focus groups was under-taken with elderly people and carers of disabled elderlypeople in Oxford. The initial aim of the study, and there-fore of the focus groups, was to determine the appropri-ate design and content of a publication containinginformation, advice and products to help make life easierfor elderly people living independently at home. Thefocus group participants were potential users of sucha publication. Issues determined using the focus groupsresulted in a broadening of this aim for the nationalsurvey.

The focus group was an appropriate technique to usefor preliminary data gathering in order to obtain aninsight into the research topic and the needs of a speci"cgroup of people. Researchers have described the bene"tsof the focus group as a tool for obtaining informationabout how people think and feel and, consequently, itsusefulness in questionnaire design (e.g. Caplan, 1990;Krueger, 1994; Morgan, 1997, 1998). Practitioners suchas Krueger (1994) and Morgan (1997, 1998) have pro-vided guidelines on how to plan for and run successfulfocus groups, based on their own and other's experiences.However, special considerations for elderly and disabledelderly participants are lacking in the literature.

According to Krueger (1994), the focus group is bene"-cial for identi"cation of major themes and is an e!ectivemeans of obtaining information from special audiences.Unlike one-to-one interviews and questionnaires, the

622 J. Barrett, S. Kirk / Applied Ergonomics 31 (2000) 621}629

focus group enables group interaction and greater insightinto people's experiences and opinions. The focus groupdiscussion is particularly e!ective in providing informa-tion about why people think or feel the way that they do(Krueger, 1994; Morgan, 1997, 1998). Participantscan respond freely and spontaneously, without the lim-itation imposed by close ended questions (Krueger,1994). Such participant interaction can rapidly producevaluable ideas rather than the individual responses ob-tained with questionnaires and one-to-one interviewing(Caplan, 1990). Focus groups can become more thanthe sum of their participants and can generate ideas thatwill not emerge from individuals (Krueger, 1994).Conducting such a discussion several times with similartypes of participants can identify trends and patterns inperceptions.

Focus groups are useful in developing questionnaires(Morgan, 1997, 1998). According to Morgan (1997), thereare three basic ways that focus groups can contribute tothe development of surveys. The "rst is by identifying allthe &domains' that need to be measured in the survey.Thus, rather than basing the survey on the researcher'sown assumption about what is relevant, focus groupsensure that the researcher has as complete a picture ofparticipants' thinking as possible. Secondly, focus groupsare an e$cient tool in determining the dimensions thatmake up each domain because a relatively small numberof groups can generate a large number of ideas about theitems that are needed to cover each questioning area.Finally, focus groups can provide insights into appropri-ate question wording.

Consequently, focus groups reduce the chances ofmaking errors in creating survey questions and, henceimprove validity (Morgan, 1997). However, Morgan(1997) warns that it is important not to let a chanceremark by a participant either destroy a good idea orpush the researcher into a decision that is not supportedby broader data.

Focus groups were used in this study to provide someinsight into what elderly people and their carers wantedto make life at home easier, particularly in terms ofinformation and advice, and the reasons why. This wasthen used in developing a questionnaire for the nationalsurvey. Three discussions were held with small groups ofelderly and disabled elderly people. A fourth focus groupwas conducted with carers of disabled elderly people,who were themselves aged over 60.

The purpose of this paper is methodological. Ratherthan reporting on the "ndings of the focus groups interms of the information, advice and help the participantswanted we will describe the lessons learned from runningfocus groups with elderly, and particularly disabled el-derly, participants. A number of important methodologi-cal issues arose that have implications for future researchusing disabled elderly people when the focus group is themeans of gathering data. These issues need to be taken

into account when planning, designing and running focusgroups with such subjects.

3. Method

3.1. Focus group participants

Aiming for a minimum focus group size of 6 people,8 people were invited to each of four focus group dis-cussions. People selected for the "rst three focus groupswere those aged 60 and over who lived in their own homeand who were trying to stay as independent and active aspossible. The people selected for the fourth focus groupwere non-professional carers of disabled elderly people.

A total of 20 people participated in the series of fourfocus group discussions.

Focus Group 1: Five women aged between 60 and 80,three of whom lived alone. One participant was disabled.

Focus Group 2: Three men and three women, agedbetween 60 and 78. None of the participants lived alone.Two of the men were disabled.

Focus Group 3: Five disabled men, aged between 61and 88, who lived independently in their own homes,visiting a Social Services Day Care Centre one or twodays a week. One participant lived alone, the rest livedwith their wives who acted as carers.

Focus Group 4: Three women and one man, all agedover 60. All were non-professional carers, caring for theirdisabled elderly spouse, and living with the persons theycared for in their own homes.

3.2. Moderators

A 71 yr old disabled female acted as moderator forFocus Groups 1 and 2. A 68 yr old male, experienced inrunning focus groups, acted as moderator for FocusGroups 3 and 4.

3.3. Procedure

Once the people selected to participate had given theirverbal agreement to attend, an invitation letter was sentto them 1}2 weeks before the scheduled focus groupsession. The letter was in large print (14 point). It ex-plained the purpose of the study, background informa-tion, why the person's views were important to theresearchers, and an introduction to the discussion topics.Participants were asked to think about these topics be-fore attending the discussion. These points were alsoexplained to the participants in greater detail just beforethe discussion began at the focus group meeting that theyattended.

No "nancial or gift incentive to attend was o!ered asit was felt that those invited would be su$cientlymotivated by stressing the importance and value of their

J. Barrett, S. Kirk / Applied Ergonomics 31 (2000) 621}629 623

participation in the invitation letter. As Krueger (1994)states, money is not the only incentive and other factorssuch as the topic, previous participation in focus groupsand interest in participating all play a role. He also pointsout that other incentives such as food can be e!ective. Asstated in the invitation letter, food and drinks were pro-vided. Preliminary talks with disabled elderly people in-dicated that the opportunity to in#uence the provision ofinformation to elderly people in the UK, combined withfood and drink, would be su$cient incentive to attend.

Focus group meetings were held at a location that theparticipants regularly attended and at a date and timethat they were usually there. A local sports and leisurecentre catering for elderly and disabled people was usedfor Focus Groups 1 and 2 and a local Day Care Centrefor disabled elderly people for Focus Groups 3 and 4.Thus, there were no unusual transport arrangements orunfamiliar surroundings involved. A suitably quiet, warmand well-lit room was used for the focus groups. Toprevent interruptions a &do not disturb' sign was placedon the door of the room. The participants and moderatorsat around a large table (Focus Groups 1 and 2), or ina circle (Focus Groups 3 and 4). The discussions wererecorded on tape and an assistant moderator took notes.The participants were asked to speak one at a time sothat everyone's comments could be heard on the tapelater on. The discussions were designed to last for 1.5 h.Participants were o!ered a break, with refreshments halfway through the session.

Focus Group 1 was run in a free and open manner todetermine the key issues and the questions that needed tobe asked in further focus group discussions. Very generalquestions were prepared for Focus Group 1 by talking toexperts and disabled elderly people and these were re-viewed by a disabled elderly person. The questions de-veloped for the subsequent focus groups were dividedinto di!erent topics (groups of 2}6 questions) and eachtopic was introduced to the participants before the ques-tions were asked, to establish the context of the next fewquestions. Serendipitous questions from the moderatorand assistants were allowed at the end of each topic ofquestions. The precise questions put to the group ofcarers (Focus Group 4) varied slightly from those put tothe other groups as they concerned both the carer'spersonal experiences and those of their disabled elderlyspouse.

Following Focus Group 1, it was decided to giveparticipants in subsequent discussions a questionnaire toobtain personal details and other information that theymay not have wished to reveal in front of others, e.g.receipt of bene"ts, use of home adaptations and specialequipment, health and disabilities. This large print (14point) questionnaire was administered after the dis-cussion and participants were o!ered help and/or privacyto complete it. All participants were sent a large printletter thanking them for taking part.

4. Methodological issues

4.1. Planning the discussion

4.1.1. AttendanceDespite careful planning in the selection of suitable

participants and the most convenient time and locationfor those people to meet, not all of the people invitedshowed up. Reasons given included illness and hospitalappointments. Getting carers to attend was particularlyproblematic, as they were unable to leave the people theylooked after without arranging alternative care. Thecarers' discussion was held in a Day Care Centre ata time when they were usually present at the centre fora meeting. However, some were still prevented fromcoming due to the demands of their caring duties.

4.1.2. Duration of discussionTo avoid fatiguing the participants and to avoid con-#icts with the participants' usual activities the discussionswere planned to be short, lasting a maximum of 1.5 h,including a refreshments break. Nevertheless, partici-pants demonstrated di$culty in sustaining attention (seebelow).

4.1.3. Moderator and participant interactionIn selecting an appropriate moderator for the dis-

cussions, it was felt that elderly participants would feelmost comfortable with a moderator that they perceivedas similar to them. As Krueger (1994) states, participantsmust feel that the moderator is the appropriate person toask the questions. Participants seemed at ease and willingto speak about personal experiences, including those thatthey found distressing, to the moderators who were elder-ly and were open about their own experiences. Partici-pants also appeared comfortable with each other andwilling to discuss the topics together, once the moderatorhad initiated discussion (see below).

4.1.4. QuestionsRecognition, comprehension and memory for spoken

information in older people have been shown to bene"tfrom prior context cues (Tun and Wing"eld, 1997). In thisstudy participants were provided with background in-formation and an overview of the discussion topics priorto the discussion. In addition, changes in topic wereintroduced before the relevant questions were asked. Dueto the working memory limitations of elderly people,spoken sentences with especially complex syntax causeproblems (Tun and Wing"eld, 1997). For the focusgroups in this study, the questions were designed to beshort, using simple language, and concerning one issueonly. Nevertheless, participants would occasionally sit insilence after a question was asked. Calling on an indi-vidual could cause them to give a response that wasirrelevant to the question just asked. In such cases, it


helped the participants to understand what was wanted ifthe moderator provided cues by speaking of his or herown experiences before repeating the question.

4.2. Elderly participants' performance

4.2.1. CommunicationThere were some communication problems. A partici-

pant with speech impairment could be understood by theresearchers with di$culty during the discussion, but cre-ated problems when it came to subsequently transcribingthe tape. In older people, the rich linguistic structure andprosodic patterns of natural speech aid speech compre-hension and memory (Tun and Wing"eld, 1997). It isuncertain to what degree the speech impairment a!ectedcomprehension of that person's comments by other par-ticipants. A number of the participants used a hearing aidand sometimes had problems hearing the moderator andother participants speak.

4.2.2. AttentionOlder people exhibit declining attentional capacities

(Morrow and Leirer, 1997; Tun and Wing"eld, 1997;Vercruyssen, 1997). In this study, some participants dem-onstrated a di$culty with concentrating on the particu-lar topic currently under discussion. They becamedistracted by irrelevant comments from others. Irrelevantcomments were not ignored, rather attention wasdiverted towards these inappropriate remarks. This indi-cates a di$culty with focused attention.

A few participants were inclined to treat the discussionas a therapy session, taking the opportunity to speakabout their particular problems rather than concentrat-ing on the issues generated by the moderator. Localissues, such as safety when crossing the road, fear ofgoing out at night, loss of a milkman, and lack of friendlyneighbours, were of more concern to some participantsthan the stated goal of the discussion. However, this maybe due, in part, to the nature of the questions in thisstudy, some of which concerned day-to-day di$cultiesand the problems experienced in getting the information,advice and help wanted. Those in need of advice ona particular subject were later provided with the appro-priate information by the researcher.

In addition, some participants would recall a particu-lar salient memory, perhaps having been in#uenced bya comment from someone else, and remain focused onthis, continually referring to it throughout the discussion,even though it might have been irrelevant. Failure toattend to the current topic of conversation was the result.Other participants demonstrated full awareness of thepurpose of the discussion, remaining focused throughoutand spoke about relevant issues.

Thus, certain participants demonstrated di$cultieswith focused attention and working memory processes.They were easily distracted, unable to ignore irrelevant

comments and continued to remember irrelevant in-formation. These observations concur with the "ndingthat older people show a lowered ability to focus atten-tion and inhibit or suppress irrelevant information (Tunand Wing"eld, 1997; Morrow and Leirer, 1997). Failureto inhibit irrelevant information results in: increased ac-tivation of material in working memory that is not di-rected toward the goal of the current task; ine$cientallocation of attentional resources; and comprehensionand memory de"cit for the target information (Tun andWing"eld, 1997). Older adults also seem to keep irrel-evant information activated for longer than youngeradults (Hamm and Hasher, 1992).

Studies have shown that older people also experiencedi$culties with divided attention. In dichotic listeningtasks, older people have di$culty repeating the informa-tion presented in one ear if competing information ispresented to the other ear (Kline and Scialfa, 1997). Theyalso need more time to switch attention from one ear tothe other, thus missing information that younger peoplehear (Wickens et al., 1987). These di$culties have impor-tant implications for the performance of older people innoisy environments or conditions where more than oneperson is speaking at the same time (Kline and Scialfa,1997).

4.2.3. Sustaining attention and mental fatigueSome participants, particularly those with sensory or

physical disabilities, became fatigued towards the end ofthe discussion, losing interest and attention, and becom-ing distracted by activities that they were due to take partin after the discussion. This was most evident for FocusGroups 3 and 4, in which the participants declined a re-freshment break, preferring to get the discussion over anddone with sooner. Laboratory studies have shown thataging is associated with increased di$culty in sustainingattention and performance over long periods of time(Vercruyssen, 1997).

4.2.4. Information processing time and speed of responseIn elderly people the declining ability to perceive

auditory information, de"cits in focused and dividedattention, slowed information processing, and workingmemory limitations all a!ect speech processing (Tun andWing"eld, 1997). When the occasional question was metwith silence it was, initially at least, unclear whetherthe participants did not hear the question, did notunderstand it, needed time to give their response, ordid not wish to answer. Of course, each participantmay have had di!erent reasons for not responding. Occa-sionally, when an individual was then called upon torespond, he or she would speak about a problem that wasirrelevant to the question, implying that the question hadnot been heard or fully understood. Here, participantsmight have bene"ted from more context cues given inadvance.


A more common occurrence, however, was a partici-pant giving a reply that was relevant to a previousquestion or even a previous topic, sometimes providinguseful information relating to the earlier point of dis-cussion. Older adults need more time than youngeradults to process information (Morrow and Leirer, 1997;Tun and Wing"eld, 1997; Vercruyssen, 1997), torecall material from semantic memory (Howard and Ho-ward, 1997), to retrieve the correct words in languageproduction, and to plan what to say and how to say it(MacKay and Abrams, 1996). It appears that participantsmay have been continuing to think about a question andtheir response to it as the discussion proceeded, afterother questions had been asked and even after the nexttopic had begun. Such events broke the #ow of thediscussion, and could cause other participants to diverttheir attention. The skills of the moderator in focusingand guiding the discussion were put to the test. Sub-sequent organisation of the resulting data, so that it canthen be described and interpreted, also becomes a morecomplicated task.

4.2.5. MemoryTests of working memory that require people to simul-

taneously manipulate or process the information showa performance de"cit for older people, particularly whenthe processing demands are heavy (Howard and Ho-ward, 1997). The di$culty in inhibiting task-irrelevantinformation means that this information competes withmore relevant information for working memory capacityand makes older people more susceptible to disruption ofmaterial in working memory by interference when atten-tion is diverted (Morrow and Leirer, 1997). In this seriesof focus groups, decay and interference of material inworking memory due to diverted attention could be seenwhen a speaking participant was interrupted by othermembers of the focus group. When the moderator laterreturned to that person, he or she had forgotten whatthey had started to say, even when reminded of their "rstfew words and the discussion leading up to their inter-rupted remark. In this case, potentially useful informa-tion was lost.

At the end of the discussion participants wereasked what they felt to be the most important thingdiscussed. Many were unable to answer this. Some sim-ply replied &everything'. Tun and Wing"eld (1997) statethat care must be taken not to overload the workingmemory of older people in situations that require simul-taneous maintenance and manipulation of spoken in-formation.

Some participants had di$culties retrieving the namesof local organisations that they had used for informationor advice, but were able to describe the function andlocation in the town. Recall from semantic memory (ourstore of world knowledge) can be di$cult for olderpeople if processing time is limited (Howard and Ho-

ward, 1997). From about age 37 the frequency of so called&Tip-of-the-Tongue' experiences (when a person is unableto retrieve some or all of the phonological aspects ofa familiar word) increases with age (MacKay andAbrams, 1996).

5. Conclusions and recommendations

It appears that the guidelines set down by Krueger(1994) and Morgan (1997, 1998) for running focus groupsare especially important when using elderly people, andparticularly disabled elderly people, as participants.Less-structured focus group discussions with low levelsof moderator involvement can still run successfully andprovide useful information. However, focus groups witholder adults as participants appear to be more of a test ofthe design and organisation of the questions and themoderator's skills. As Howell (1997) states `often, theaging process simply exacerbates suboptimal design fea-tures that, to a lesser extent, a!ect everyone's perfor-mancea.

5.1. Design of the questions

It is especially important for elderly focus group par-ticipants that, as recommended by Krueger (1994), thequestions are simple, short, and use words that the par-ticipants understand. The wording of the questions canbe tested out on people similar to the target participantsbefore use in an actual discussion (Krueger, 1994). Care-ful preparation is important and involves not onlythe design of the questions themselves, but also the waythe questions are organised and introduced to help focusthe discussion. Focusing is helped by starting the dis-cussion with a general introduction to the topic andbeginning with more general questions then progressingto more speci"c ones (Krueger, 1994; Morgan, 1997).Krueger (1994) recommends providing background in-formation about the purpose of the study and establish-ing the context of the questions. These requirements canbe achieved in the invitation letter as well as the moder-ator's introductory speech. Krueger (1994) and Morgan(1997) stress the importance of the "rst few moments ofthe session (the welcome, the overview of the topic, theground rules and the "rst question). Recognition, com-prehension and memory of spoken information in olderpeople appear to bene"t from prior context cues (Tunand Wing"eld, 1997). Thus, establishing a context for thequestions before the discussion begins, and also beforesub-groups of questions, should help elderly participantsto process the subsequent questions. In the current study,although the questions were divided into groups of 2}6questions and the topic of each group was describedbeforehand, the participants still seemed to have prob-lems understanding some questions. More frequent


context cues, possibly before every question, may berequired.

5.2. Recruitment of participants

Krueger (1994) states that focus groups are uniquewithin information gathering techniques in terms of theinvestment in time and e!ort that must be made by theparticipants. For recruits of any age the motivation toattend may be improved by compensating them for theirinvestment with an incentive such as payment or anappropriate gift. However, such incentives will have littlee!ect when circumstances beyond an individual's controlprevent attendance, such as, in the case of this study,illness, hospital appointments or the demands of lookingafter a disabled person. Such situations are more likely toarise with elderly and disabled elderly people and thisneeds to be taken into account when recruiting partici-pants. It is important to over-recruit to allow for peoplenot showing up on the day. Morgan (1997) recommendsover-recruiting by 20%. The experience of this studysuggests that it is wise to increase the extent of over-recruitment when planning focus groups with elderly,disabled elderly people and their carers.

5.3. Moderator

The moderator needs to be adept and experienced incommunicating clearly, listening carefully and sensitive-ly, guiding the conversation, controlling the participants,encouraging responses, making participants feel thattheir responses are valued, and keeping the discussionfocused on the aim of the study. Although moderators ofa younger generation than the participants were not triedin this study, moderators of similar age were found to bee!ective in putting participants at ease. By referring totheir own life experiences, the elderly moderators wereable to encourage participants to speak about personalexperiences and to provide cues to questions that partici-pants found di$cult to answer.

The moderator needs to speak slowly and clearly andallow the participants time to think about the questionand to respond. The moderator should try to ensure thatonly one person speaks at a time, not only for ease oftranscribing the tape later on, but also to allow fordi$culties that elderly people experience in dividing at-tention between more than one speaker. If more than oneperson does speak, then the moderator should ask eachto repeat what they have said in turn. Interruptionsshould also be prevented and a participant allowed tocomplete a comment, rather than allowing the interrup-tion and returning to the interrupted participant later on.As occurred in this study, if the participant later forgetswhat they had started to say, the researcher is left witha tantalising few words that may have gone on to provideuseful information to the study.

5.4. Printed materials

When preparing printed materials for elderly partici-pants guidelines on designing text to improve legibilityand reduce working memory demands for elderly readersshould be considered (e.g. Hartley, 1994; Morrell andEcht, 1997). Recommendations include using a large typesize of 12}14 point, avoiding use of all capitals in the textbody and using simple language. Careful considerationshould be given to whether reading materials are abso-lutely necessary: those with poor literacy skills may bemade extremely uncomfortable, and resentful, if requiredto carry out a task involving reading in a group situation.Of course, focus groups consisting purely of discussionwill not discriminate against those with poor literacy.

5.5. Environment

For older people, increased illumination and contrastenhance legibility (Kline and Scialfa, 1996). However,older people have increased susceptibility to glare andhave a longer recovery period after exposure, so careshould be taken with directed light (Kline and Scialfa,1996; Kline and Scialfa, 1997). The lighting arrangementin the focus group meeting room should avoid glare and,if visual materials are going to be used (e.g. #ip chart,handouts, questionnaires) the lighting should be ad-equate for the participants to read easily.

Age-related de"cits in speech perception, demon-strated by many researchers, are small when the speechoccurs in a quiet environment, but increase markedly innoisy or reverberant environments (Kline and Scialfa,1996, 1997; Tun and Wing"eld, 1997). Thus, a quiet andecho-free environment is essential. Reverberation ina room can be reduced by the use of carpets, curtains,plants, etc. Other considerations are an easily accessiblelocation that does not require climbing #ights of stairs,a warm room temperature and comfortable seating.

5.6. Arrangement of participants

In this study the discussions were held at locationsfamiliar to the participants. Nevertheless, they were metat the entrance and greeted by the moderator and assist-ant moderator. Krueger (1994) stresses the importance ofsmall talk prior to moving into the meeting room for thediscussion. This can be used to ascertain dominanttalkers, self-appointed experts, shy people, and ramblersso that they can then be seated at appropriate locationsin relation to the moderator, making them easier tocontrol during the discussion. With elderly participants,those who have di$culty hearing should be seated near-est the moderator. Participants should be asked whatthey prefer to be called, and these names written in largeletters on name cards or labels so that the moderator andparticipants are relieved of the burden of remembering


everyone's name. The moderator should also be identi-"ed in this way.

5.7. Duration of discussion

The discussion should be kept short. In this studyelderly participants were able to sustain attention andinterest for 1.5 h if a short mid-session refreshment breakwas o!ered. It is a good idea to keep participants contin-ually updated on the time remaining.

The requirements of keeping the discussion short andrunning it at an overall slower pace than for discussionswith younger adults mean that a researcher should ex-pect to cover fewer topics in a focus group session witholder adults.

To conclude, the focus groups in this study did notalways run in quite the way expected and, as described,some di$culties were experienced. Nevertheless, con-siderable care and patience, both in terms of running thefocus groups and analysing the resulting data, enableduseful information to be obtained. As Krueger (1994)states, focus groups are robust: major themes tend tosurface despite di$culties. Major issues were identi"edand the information generated by the focus groups wase!ective in aiding the construction of survey questions.By using focus groups together with surveys, this combi-nation of qualitative and quantitative methods makea powerful tool for obtaining information about howpeople think or feel about something. The survey resultsfor this study will be reported in Applied Ergonomics inthe near future. This paper raised a number of issuesconcerning the handling of elderly and disabled elderlyfocus group participants that need to be taken into ac-count when planning, designing and running focusgroups with such subjects in future.

Acknowledgements

The Disability Information Trust gratefully acknow-ledges the trustees of The Helen Jean Cope Trust forgenerous "nancial support provided to make this studypossible. We would also like to thank the managers of theShotover Day Centre and the chairman of OXSRAD fortheir helpful co-operation.

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Running focus groups with elderly and disabled elderly participants

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