Attachment 6 - Use of Telephone Focus Groups

Attachment 6:
Items Discussing the Use of Telephone Focus Groups
SELECTED REFERENCES DOCUMENTING THE VALUE AND APPROPRIATE
USE OF TELEPHONE FOCUS GROUPS
This is a small sample of the most relevant articles and reports on telephone focus
groups. Please note articles appearing in boxes indicate those for which full or partial
text is attached. Also note the article by M. Simon, “Focus Groups by Phone: Better
Ways to Research Health Care” appeared in Marketing News as early as 1988. (Text for
this article is not provided here because it must be retrieved from archives by an
American Marketing Association member, but can be obtained upon request.)
Appleton, A. et al. (2000) Living With an Increased Risk of Breast Cancer: An
Exploratory Study Using Telephone Focus Groups. Psycho-Oncology, 9(4), 361.
Balch, G.I. (2005) C.A.T. (Computer-Assisted Telephone Focus Groups): Better,
Faster, Cheaper, Social Marketing Quarterly, 7(4), 38–40.
Cooper, C. P., Jorgensen, P.H. & Merritt, T.L. (2003) Telephone Focus Groups.
Journal of Women's Health, 12(10), 945-951.
Frazier, L.M., Miller, V., Horbelt, D.V, Delmore, J. , Miller, B.E. & Paschal, A.M. (2010)
Comparison of Focus Groups on Cancer and Employment Conducted Face to Face or by
Telephone, Qualitative Health Research, 20(10), 1-11.
Hurworth, R. (2004) The Use of Telephone Focus Groups for Evaluation, Paper
presented at the Australian Evaluation Society International Conference.
Krueger, R. (1994) Focus Groups. Thousand Oaks, Ca: Sage. (book)
Krueger, R. (2002) Focus Group Interviewing on the Telephone.
http://www.tc.umn.edu/~rkrueger/focus_tfg.html
Ruef, M.B. (1997) The Perspectives of Six Stakeholder Groups in the
Challenging Behavior of Individuals with Mental Retardation and/or Autism.
PhD Dissertation. Lawrence, KS: University of Kansas.

Silverman, G. (1994) Introduction to Telephone Focus Groups.
http://www.mnav.com/phonefoc.htm
PLEASE NOTE: This article contains several errors that seem to be typographical; it
appears to the Contractor that when the article was uploaded to the Market Navigation
Web site several sentences were cut off. The Contractor did not alter this article in any
way. Although it includes such errors, the article is cited frequently as one of the most
thorough and authoritative sources on telephone focus groups.
Silverman, G. (2003) Face-to-Face vs. Telephone vs. Online Focus Groups.
Market Navigation, Inc: http://www.mnav.com/onlinetablesort.htm
Simon, M. (1988) Focus Groups by Phone: Better Ways to Research Health
Care. Marketing News, 22, 47.
Stewart, D. & Shamdasani, P. (1990) Focus Groups. Newbury Park, Ca: Sage.
(book)
White, G.E & Thomson, A.N. (1995) Anonymised Focus Groups as a Health Tool
for Health Professionals. Qualitative Health Research, 5, 256.
CDCynergy: http://www.cdc.gov/healthmarketing/cdcynergy/
CDCynergy was developed by CDC’s National Center for Health Marketing as a
multimedia CD-ROM used for planning, managing, and evaluating public health
communication programs. This innovative tool is used to guide and assist users in
designing health communication interventions within a public health framework.
Originally created for use within the CDC, the idea of an institution-wide planning model
found its way outside of the agency. CDCynergy has been adapted for use by public
health professionals on a national, state, and/or local level. The CDCynergy CD-ROM
discusses the value of telephone focus groups in its section on formative research. To
order a copy of CDCynergy Basic Edition please contact the Public Health Foundation at
http://bookstore.phf.org/prod838.htm

COMMERCIAL SOURCES THAT DEMONSTRATE THE MAINSTREAM
USE OF TELEPHONE FOCUS GROUPS
From a basic Google search on terms “telephone focus groups,” about 94,000
listings appeared covering a wide range of academic discussion, peer-reviewed
journal articles -- but predominantly commercial entities offering their
services. This represents a small sample, ranging from large research firms to
niche firms.
Market Navigation, Inc.
www.mnav.com
Reactions and Opinions, Inc.
http://www.reactionsopinions.com/Admin/Tools/FocusGroups/tabid/70/Defa
ult.aspx
Kaplan Research, Inc.
http://www.kaplanresearch.com/telefocus.html
Group Wisdom, Inc.
http://group-wisdom.com/index.php?page=Telephone Groups
Ervin Marketing Inc.
http://www.ervin-marketing.com/whitepapers/wp_focus.htm
Survey Digital, Inc.
http://www.surveydigital.com/research/techniques.html
Focus Research, Inc.
http://www.focusresearchinc.com/
JRH Marketing Services, Inc.
http://www.jrhmarketingservices.com/services/services.html
Lake Research, Inc.
http://www.lakeresearch.com/tools/index.asp

Social Science Research and Evaluation, Inc.
http://www.ssre.org/services.html

INTRODUCTION TO TELEPHONE FOCUS GROUPS
Market Navigation, Inc.
By George Silverman
President, Market Navigation, Inc.

Who should read this report
This Special Report is for marketing executives, marketing managers and marketing
researchers of client companies, agencies, marketing research companies and independent
moderators who are just learning about telephone focus groups. It is intended as an
introduction to acquaint you with the basics: when to use them, how they compare with
face-to-face groups, and some of the logistics.
I also offer a course on how to run telephone focus groups, for experienced moderators who
want to learn to actually run telephone groups. If you're interested, let me know.
Much of the following material has appeared as articles in my Market Navigator Newsletter.
I have left in some redundancies where I thought the material important enough to be
included for the person only reading that particular section.
What you will learn


Six important lessons I learned from the invention of the telephone focus group.



The answers to the 16 most frequently asked questions about telephone focus
groups.



Why telephone focus groups are actually superior to face-to-face groups in most
situations.



The electronic advances that enable telephone focus groups to work so well.



How to identify and reach the people who are even more important than your
customers.

The Important Lessons I Learned from the Invention and Development Of The
Telephone Focus Group
Many years ago, I conducted my first telephone group. I had been an amateur magician all
my life, but this was real magic - strangers from all over the country talking with each other
as if they had known each other for years! I still remember the feeling of amazement and
exhilaration that people talked with each other more interactively and openly than they do
face to face. I wondered, “Has anyone else noticed this? Why don’t more people use
conference calls, especially for other things than boring sales meetings? How can this
undiscovered capability be used to create valuable products and services which would make
a lot of money?”
I know that you want to get right into the nuts and bolts of how to use telephone focus
groups. But I thought that you'd enjoy it - and get a deeper understanding - if I first told
you about how I developed this technique. If you're one of those people who wants to get

right into the machinery, just skip to the next section, frequently asked questions about
Telephone Focus Groups..
I ran my first telephone groups in 1969. Ron Richards - then President of TeleSession Corp.
and now a marketing consultant and president of Venture Network in San Francisco - and I
were trying to develop a way to bring people together so that they could learn from each
other, instead of from more formal education from teachers. This is called peer learning. I
was Executive Vice President of the company and also a practicing psychotherapist. I had
been a school psychologist, and had extensive training in Group Dynamics, a field of study
which had just come into its own in the 1960's. That was the time of the encounter group,
the sensitivity training group and the T-group, among others. Everything in those days was
attempted in groups, and I do mean everything. A great deal was learned at the time about
how groups work, how to create the right atmosphere for participation, and how to interpret
what was going on in groups.
Our advertising agency ran several focus groups to develop and refine a previous business
concept. The moderation was unimpressive, to say the least, even though the moderator
was a high level, very bright person in a major agency, later to go on to become quite well
known in the agency business. That lead us to:
Lesson #1: Not everyone, no matter how bright and knowledgeable, can - or
should - moderate focus groups.
Since I had just spent several years learning how to moderate groups, Ron and I decided
that we would conduct future focus groups ourselves. We conducted about 50 face-to-face
focus groups, on all aspects of the business: concept, marketing and advertising, with
different possible market segments. It's interesting to note that we couldn't run telephone
groups because one of the things that we were investigating was people's attitudes toward
telephone groups. If we had run the groups on the phone, many of their qualms would have
been satisfied before they were expressed.
We eventually developed a concept and an advertising campaign which offered conference
calls to people for the purpose of exchanging information with each other. The people
themselves would pay for participation, for the fun and information they would get from
talking with people who shared their interests. It was something like a high-level version of
the 900 number chat lines that later developed, except that the phone company wouldn't
develop such a service at the time. They wouldn't offer a way to bill customers for services
delivered over phone lines, and they wouldn't sell conferencing equipment. They were
making quite enough money as a monopoly, thank you. They wouldn't even listen. "We
don't do that." Things sure changed when they became a business! The ordinary conference
call: terrible quality but great dynamics - when they worked.
In the meantime, I had been experimenting with conference calls set up by the phone
company. The experiments convinced us that the conference call was a superb and totally
undeveloped delivery mechanism for the exchange of information, but that the phone
company's equipment and procedures were woefully inadequate. About half of the calls
broke down from howling noises, static and other problems. We had outside consultants
develop equipment for us that would allow the kind of interaction and control that we
wanted. That lead to:
Lesson #2: The equipment makes a tremendous difference
But even with the inadequacies of the existing equipment, I was struck by how much
more comfortable and open people were in phone groups than in face to face
groups. More importantly, I was struck by how much more productive the discussions

were: there was more cognitive information and more emotional content. I couldn't believe
my ears, so I conducted informal experiments with randomly selected people alternatively
assigned to face to face groups, blindfolded groups and telephone groups. Independent
observers rated the telephone groups to be much more informative, with the blindfolded
groups a close second. When I told one of my former group dynamics professors about this,
she conducted groups of people alternatively facing in toward each other (in visual contact)
and facing outward away from each other (not in visual contact). She reported that the
content of the discussion was more to the point, more focused and more productive when
participants were not able to see each other's faces. However, participants were intensely
uncomfortable being next to each other without being able to see each other. The phone, of
course, eliminated this discomfort. This lead to:
Lesson #3: Discussions are more productive on the phone than face to face, but
the participants don't necessarily realize it
We started testing our peer exchange service by bringing together gourmet cooks/cookbook
writers, photographers and international travelers in dozens of conference calls. The
information flow was nothing short of astounding. However, the participants would not pay
for the service at price levels that would make the service profitable, given our billing costs.
Then, I got the idea: If manufacturers of food products, photography equipment and
providers of travel services could only hear the sessions we were conducting, they would be
able to respond to their customers' needs better.
Since we had agreed to maintain confidentiality with our participants, we were just about to
ask our participants if we could run some special, non-confidential sessions when a couple
of people from ad agencies who had heard about our services asked if we could run focus
groups of hard-to-reach, geographically dispersed people.
Of course, we jumped at the chance. I was open with them about my lack of marketing
knowledge at the time. I said that I could get virtually any category of people to participate
in any legitimate discussion, and that I was expert at getting information, even of a deep
psychological nature, from people; however I would need guidance about what information
was needed. Fortunately I had some pretty savvy and patient clients, about half of the top
20 advertising agencies (the other half thought the idea of focus groups on the phone was
too unusual to try at first.) and some very large and sophisticated companies. This lead to:
Lesson #4: If you admit what you don't know, knowledgeable people may be
willing to teach you.
At about the same time, we approached pharmaceutical companies because their
customers, physicians, are among the most inaccessible people. I had grown up in my
father's pharmacies, always pestering him to explain to me what every drug was for, so I
was knowledgeable about prescription drugs and comfortable with physicians and medical
terminology.I was selling better groups, they were buying hard-to-get respondents
Trying to sell telephone focus groups was a baptism of fire, since what I was selling was
more interaction, openness, information and creative ideas. No one believed me, and it
didn't matter anyway since what they were buying was access to difficult-to-reach
physicians, particularly specialists. Prospective clients would challenge me by asking if I
could get dermatologists specializing in a particular condition, or heads of burn clinics, or
alcoholism specialists, or Parkinsonism specialists. These were, in fact, our first groups. I
would brashly say, "Sure, even if you want red-headed, left-handed gynecologists, if you
give me a list and I can't get them, you don't pay." We got a lot of business. This lead to:

Lesson #5: Given the right methods, you can get almost anyone into telephone focus
groups. (More about this later)
We discovered that the additional openness of people in phone groups was even greater for
physicians than for most other people. Physicians have a lonely job. They operate under
conditions of information overload, high expectations and extreme ambiguity and
uncertainty. They want to, but can't, discuss their mistakes, knowledge gaps and doubts so
that they can learn from each other. They need to "let their hair down" with their peers, but
can't afford to do so with people in their immediate area. In telephone focus groups, we
discovered that physicians are routinely willing to even discuss how they have killed people
by using inappropriately high dosages of medications, how they had incorrectly diagnosed
and treated patients, how they cut corners from accepted practice, and where they are
uncomfortable with the gaps in their knowledge. Most clients became converts after their
first session.
It is also interesting to note that most of my initial clients, especially in the pharmaceutical
industry, who were among the first to dare to use this radically new technique, are now
among the top people in the industry. When I had to conduct a focus group of
pharmaceutical company presidents a few years ago, I was able to recruit most of them
from former clients. I'm not claiming that telephone focus groups made them what they are
today, but instead that these were the kinds of people who were not afraid to take
leadership in trying something new.
I have always believed that I'm offering a better group in the sense of providing more
information. My clients are primarily buying access to difficult to reach and geographically
dispersed people. Since there's no conflict between what I'm selling and what they're
buying, everyone's happy. This lead to:
Lesson #6: What you are selling isn't necessarily what the customer is buying.
I was selling better groups, they were buying access.
Answers To The Most Frequently Asked
Questions About Telephone Focus Groups
Why Run Telephone Focus Groups?
In comparison to face-to face groups, telephone focus groups deliver:


Difficult-to-recruit people



High level



Geographically dispersed



Low incidence



Higher quality respondents



Lower cost



Greater openness, interaction, focus and intensity. Less posing.



Wider geographical representation: nationwide, regional or district



Ability for your highest level people to listen in without travel



Greater speed from initial order to first groups, and from first group to completed
project.

When should I think of using telephone focus groups?
Anytime that you are thinking of conducting focus groups or individual interviews, you
should seriously consider telephone focus groups. Participants are less intimidated and more
open because they can't see each others' expressions of disapproval, and because they are
from different cities (so they are not actual or potential competitors or colleagues). They are
more willing to disagree with each other. You get greater frankness and group support on
the phone, so that even sensitive topics - where you would ordinarily think of individual
interviews - can be conducted by telephone focus group. The times when telephone focus
groups are particularly effective are:
1. Anytime it is difficult or impossible to recruit people into focus groups. This includes
the obvious "impossible" people: Experts, physician specialists, high-level
executives, department heads and store owners. Also, to reach other kinds of
"prescribers" and "recommenders" who don't necessarily buy directly: Physicians,
pharmacists, nurses, researchers, technicians, consultants, engineers, architects,
store salespeople, chain buyers, managers, economists, legislators, corporate
presidents, hospital administrators and your own star salespeople.
2. When respondents are rare, "low incidence," or widely dispersed geographically:
Heads of various kinds of clinics, famous thought leaders, users of a prototype, beta
testers, users of a newly introduced product, rural practitioners, etc.
3. When there are issues which are so sensitive that anonymity is needed, so you must
get people from a wide geographical area: users of stigmatized products, high
income individuals, competitors, people who are doing something "wrong," etc.
4. When speed is essential;
5. When people are unwilling to open up;
6. When you want greater informality, willingness to speculate, more creative ideas;
7. When you want nationwide or region wide representation;
8. When you are testing an unusual concept;
9. When you only want to conduct a couple of groups, but want nationwide
representation.
It sounds like you would totally replace face-to-face groups with telephone focus
groups!
No, not quite, I conduct face-to-face focus groups when people have to "kick the tires," for
easier-to-get respondents, for day-long creativity sessions, with young children, when video
tapes have to be shown during the session, and when clients have to go to a fun city like
San Francisco in order to get key company executives to come along to listen to the
sessions!
How do telephone focus groups work?
Respondents are invited by phone, from your lists or ours, to participate in a nationwide
group telephone discussion at a specific day and time. We send them a confirmation letter.
We place a reminder call a day before the session. About 15 minutes before the session, we
call each participant, remind him/her that we will be calling, and ask the participant to
inform any members of the family that the call will be coming in. At session time, we call
them at their home or office anywhere in the country from our high-quality, state-of-the-art

telephone conference system. They hear carefully selected music for a few seconds, and the
technical assistant welcomes each participant individually and checks the line. The music
stops and our moderator guides the discussion using techniques designed to create
maximum interaction between participants. You and your colleagues can call in from
anywhere. You can have notes passed to the moderator by faxing them, or by pressing *0
on your telephone touch-tone pad. You can give inputs to the moderator's assistant without
being heard by the participants, as if you were behind a one way mirror. The sessions last
for about an hour and a half and provide about as much information as a two hour face-toface session, because they are more intense, and no warm-up is needed.
But don't you have to see facial expressions and body language?
No. This is the most misunderstood and hotly debated - usually before people have heard
their first groups - issue about telephone focus groups.
The phone is hardly an alien mode of communication. Most people turn gestures and facial
expressions into "verbal gestures" on the phone. Without even realizing it, they make
remarks like, "Uh-huh, yeah, nah, umm," they laugh, etc. Our conference system allows us
to hear these clearly, unlike others which only allow one voice at a time to be heard. In fact,
there are many advantages to phone groups which arise from the fact that the participants
can't see each other: (1) People on the phone will usually verbalize in whole sentences what
would have only been a scowl or head nod. (2) The phone is a very intimate and focused
medium, allowing us to cover more in less time. (3) People don't have a sense of group size
on the phone, so they are less inhibited. (4) Silence is less tolerable on the phone, which
draws people out. We use first names, encouraging informality and protecting anonymity.
Since there are less social distractions, the participants settle down to a productive
discussion faster. Since people don't usually know each other, there is less role playing.
More about this later.

How do you know who's talking? What keeps it from becoming a chaotic free-forall?
Telephone focus groups over our state-of-the art equipment, using our methods, are more
orderly, yet more interactive, than face-to-face discussions. The participants use their
names when they talk. This becomes quite natural, even during rapid interaction. If two
people try to talk at the same time, our computer screen indicates who they are, and if one
does not defer to the other, it's a simple matter for the moderator to call on one of them,
then the other. Of course, in a telephone focus group, all remarks are automatically directed
to everyone, so the conversation never breaks down into side conversations.
Is any kind of special equipment needed for the participants or the listeners?
No. Any ordinary telephone, cordless phone, or speakerphone is OK. On our end, we have a
state-of-the art teleconferencing facility specially designed for telephone focus groups.
There is instant dial out to participants so people do not wait more than a few seconds
before being greeted by a live person and beginning their discussion with the moderator.
Our features include the use of a fiber optic network which maintains the highest possible
fidelity and audio quality. People sound like they are right next door. There is no voice
blocking (where only one voice at a time is heard, with the others blocked), so barriers
between participants disappear and interactive conversation increases. The moderator is
able to view asterisks on a computer screen which indicate who is speaking. This enables
him/her to respond instantly to people by name and know where they stand on any issue.
Instant electronic participant polling is possible as well as instant client contact with the
moderator. Clients may participate from ordinary telephone handsets, or take advantage of
our remote talker ID capability. This lets a client dial into the conference system by modem,
and view the same screen the moderator is seeing. The client can know at all times who is
talking and who is voicing agreement. For more information on our system features call me
at 914-365-0123. There is also some more detailed information on the conference system
later in this report.
What kind of participant incentives do you offer?
For 17 years, I offered no monetary incentives, not even to physicians! The reason they
participate is to compare their experiences with a nationwide group of other people similar
to themselves, and to learn from each other, without any inconvenience. A major part of the
creativity that we bring to project design is in selecting topics which are interesting enough
to the participants to attract them, yet which serve the purposes of the research without
biasing the results. At this point, we offer honoraria. When this is done, we get somewhat
higher attendance rates and greater participant cooperation. The rates are usually a little
less that we offer to people to participate in face-to-face groups.
How does the cost compare with face-to-face groups?
Telephone groups are usually slightly less expensive, for comparable respondents and
moderators (keep in mind, however, that we are almost always going after a higher level of
respondent). Sometimes, when you compare the cost of just the recruiting and facility
rental, this difference may be as little as 10%, or even less.
However, it’s in the “hidden costs,” which are not so hidden anymore, that the savings
really become important. Often, because of better geographical representation, you can
conduct less groups. So a six group project on all regions of the country, may turn into a

four group project, or stay at six groups with more depth (and therefore more value). Then
you have to consider such hidden expenses as travel, extra people wanting to tag along,
and entertainment. When you add up slightly lower facility, recruiting and incentive cost, no
respondent or client food, no travel, and less groups telephone groups can be dramatically
less expensive, sometimes even 20-40% less. The research director of one company called
me up when I previously quoted such a figure and said that I was way off base: he said that
he usually has to travel with about 10 other colleagues to each group. His travel is much
more than the price of the groups! In his case, he can cut his research costs by more than
half! Using the new remote video technology might be an answer, but it isn’t available in
many of the smaller towns that he has to cover, and video has its own severe limitations
(such as the camera often being pointed at the speaker rather than the rest of the group, or
all of the rest of the limitations of face-to-face groups that are explained later in this
report).
This, of course, doesn't take into account the less wear and tear on the moderator and the
client research manager and its consequent improvement in productivity. You may have to
stay on the phone a few evenings, but there are no plane delays, airline food, or other
travel wear and tear. You can be back at work the next morning rather than on a plane
going to the next city.
Your mileage and savings may vary.
How long does it take to set up groups?
About two to three weeks is usual, depending on our work load, types of respondents,
complexity of screening, etc. We have conducted groups in as little as one day after our
client was hit with an emergency. Since we do not have to travel, we can run more groups
per week to get your study done faster.
I've heard telephone focus groups that were terrible, with little interaction, poor
audio quality and an impersonal feeling from the moderator and the participants.
I've listened to similar groups, both face to face and telephone. Unfortunately, not everyone
running groups is cut out for it. Conducting telephone groups requires an extra measure of
sensitivity, together with an ability to project informality, friendliness, naturalness,
openness and psychological safety. The telephone is an extremely intimate, personal, and
informal medium, but it is also very intense, and tends to magnify and deficiencies of the
moderator. The moderator has to be able to take advantage of this intimacy, informality
and intensity. When you try telephone focus groups, make sure that you use an extremely
experienced moderator. If you have a favorite face-to-face moderator, don't judge the
entire technique of telephone groups by that one moderator's first groups.
On the issue of poor audio quality: there is no excuse for it. The session should sound as
least as good as or even better than, a regular telephone call. With the proper equipment
and training of technical assistants, there is no reason to settle for anything but perfect
audio quality and a high level of professionalism from the people running the equipment.
They should sound conspicuously not like "operators." Every detail, even the opening music
that is used while people are waiting for the session to begin, has an effect on the dynamics
of the group.
What do we get?

Usually included in our fee is: Design consultation, recruiting, use of third-party telephone
conference system, participants' telephone line charges, moderating, summary report,
recording, telephone client/moderator debriefing session. The only thing not included is
clients' telephone line charges, since they call into the session. Clients usually provide an
inviting list. An added bonus in most projects is a Decision Support Analysis, which is a
detailed breakdown of where the participants are in the decision making process, including
recommendations for how to move them ahead toward adoption of the product. It is based
on the Decision Map, a flowchart of the product adoption process based upon our
experience with thousands of groups.
What is your background?
I am a completely recovered and reformed psychologist. My training is in educational and
clinical psychology, but my primary interest is in the psychology of marketing, decisionmaking and persuasion, for which the formal study of psychology has not prepared me, but
several decades of marketing consulting has. I have written and lectured widely on
marketing and marketing research, am the inventor of the telephone focus group, the
Decision Map, Persuasion Design Laboratories and Electric Advisory Groups, discoverer of
Total Decision Support and co-inventor of the peer word of mouth group. I have been a
Founding Member, Treasurer and member of the Board and Executive Committee of the
Qualitative Research Consultants Association (QRCA), and have been Chairman of its
Professionalism Committee. I co-founded TeleSession in 1970. As Executive Vice President,
I was responsible for the development of all programs and services for nine years. In 1979 I
founded Market Navigation, Inc. and The Teleconference Network. I am completing a book
on Total Decision Support. In a strong belief that a marketing consultant needs to be well
rounded, I'm an avid photographer and windsurfer. I'm a member of the Parent Assembly of
the Society of American Magicians and have appeared in its New York Close-up Magic Show,
and am also a member of the Academy of Magical Arts (The Magic Castle) in L.A. I just like
to do the impossible.
What are the different kinds of research purposes that can be accomplished by
telephone focus groups?
I have conducted PhoneFocus groups for the following purposes:
Ad testing

New product
Product tracking
design

Concept
development

Opinion
analysis

Questionnaire
generation

Copy testing

Taste tests

Questionnaire
follow-up

Decision
analysis

Persuasion
design

Reasons for
heavy usage

Idea
generation

Problem
solving

Reasons for "try
& drop"

Image
studies

Product
acquisition

Packaging tests

Needs
analysis

Product
positioning

Word of mouth
analysis

What is the best way to try them?
Try running a small project of 2-4 sessions, on a subject where you anticipate having
difficulty getting respondents to participate. That way, the methodology is easy to justify to
skeptics within your organization: it's either telephone groups, individual interviews (lacking
interaction and depth), or nothing at all. If you can, try it for the first time with a subject
which is a little less important, and thereby a little safer, because you usually don't want to
try any new methodology on a critically important issue. About half of our new clients try us
in this way. The other half have a crucial issue, with high level respondents, that must be
investigated in a few weeks, where they want many people from the home office to listen to
the groups. Telephone groups are the only way to go. This last scenario lets you and us
become heroes (we've always come through), but, if at all possible, it's better to try to get
to know telephone focus methodology under less stressful conditions. Under normal
circumstances, telephone groups are relaxing, with you at home in comfortable clothes, with
your feet up and favorite drink in hand, and your dog at your side. Also, you can sleep in
your own bed that night, with better research results to talk with your colleagues about in
the morning.
The Shocking Truth about Telephone Focus Groups
A surprising thing happened as I was writing this report. I originally intended to write a
guide to the telephone focus group, outlining its specialized uses for difficult-to-reach
people. As I put down in one place things that I had never seen together before, I began
see them in a whole new light. I came to an astonishing conclusion, which I'll get to in a
moment.
After writing the first section on how I developed the telephone focus group, I examined the
conditions under which both face-to-face and telephone groups are conducted. In looking
back at the thousands of both kinds of groups I have conducted over the last two and a half
decades, I began to realize that I have been falling into a trap all these years: I have been
defending telephone focus groups as almost as good as face-to-face groups, assuming with
everyone else that they could never be quite as good because you lose the visual element
which so enhances the ability to interpret what is being said. The obvious justification of
telephone groups, I thought, was to bring together low incidence, hard-to-reach,
geographically scattered professional and business people.
I was wrong, wrong wrong. (The only other time I was wrong was in 1972, when I thought I
had made a mistake! [Just kidding.])
For me, the amazing and unavoidable realization that has emerged is:
The telephone is the preferable way to conduct most focus groups.
This may sound outrageous to you, but let me share some of my experiences and thinking
with you, and see if you arrive at the same conclusion. Don't accept at face value anything I

say. Judge for yourself. After all, if I'm right, you may be able to cut down the time you
spend on airplanes, in hotels, and behind - or in front of - one-way mirrors.
What happens when you put a group on the telephone?
The phone has its advantages and disadvantages. Let's understand them by first looking at
the environment of face-to-face groups and then comparing what happens when you put a
group of people on the phone.
Face-to-face sessions are the ones that are unnatural
Most people reading this will have seen so many face to face focus groups that they no
longer notice how artificial the situation is. As the saying goes, "The fish is the last to
discover water."
Ever since the focus group was moved out of people's living rooms and clients started
tagging along, the whole situation has become very unnatural. (In fact, focus groups
and individual depth interviews are the only kinds of marketing research where the client
attends the actual the collection of the data and is therefore able to jump to conclusions in
the middle of the research instead of waiting until after it is over to jump to the same
conclusions.)
Since clients attend focus groups, cities are often selected according to where the client
wants to visit, rather than based upon strictly research considerations.
Respondents are asked to leave home to go to a facility in a mall or office building. They
often dress up - even professional people - since they are going to a special place. They are
anxious about what will happen, what people will think of them, and even if they will find
the facility (those few who have not been there many times before). They walk into a place
of business, with desks, fluorescent lights, a waiting room, strangers walking around, and
some very friendly people trying to make them "feel at home." They are usually asked to fill
out a questionnaire, then ushered into a room with a table, or a phony living room, with a
big mirror covering one wall, and microphones hanging down from the ceiling.
A wonderfully engaging moderator welcomes them, tries to get them to relax, and tells
them that there are "no wrong answers," an obvious lie. In the meantime, they don't know
where to look, how to behave or what will happen. Even before they introduce themselves,
they are trying to size each other up. During the discussion, they may worry about what will
get back to family, friends, professional colleagues or competitors. It is usually inadvisable
to mix men with women, doctors with nurses, users with ex-users, or other combinations
where people will tend to intimidate or bias each other.
It is difficult to think of a situation which is It is a real tribute to the better moderators,
who can loosen people up as much as they do under these trying circumstances.
That's the situation. There are also abuses which should not be blamed on the face to
face situation itself, but which are made easier by the setting: Respondents often see the
clients in the hallway or hear them behind the one-way mirror. Friends are often invited to
different groups, briefing each other between sessions. Of course there is the chronic
problem of "professional respondents," people who attend focus groups on a regular basis to
supplement their incomes.
There is also the overused respondent, which is unavoidable in some cases. For example,
some medical specialists such as rheumatologists (arthritis specialists) are in short supply.

You have to have a minimum of about 50 in an area in order to recruit a group. This leaves
about 6 cities in which you can conduct a face-to-face group. The rheumatologists in these
cities use the focus group as a social occasion. They are invited almost weekly to someone's
focus group. They are very selective, participating every few months. They pick and choose
according to what topic sounds most interesting. In Atlanta, I heard such comments as, "Hi
Joe [another physician], haven't seen you since the last focus group." "Are we going to be
doing a concept test, or position a product? I hope you have animatics. I love them." They
even stayed at the end of the session, inviting me to listen while they gave me a "critique"
of my moderating, knowing that my clients were behind the one-way mirror! Fortunately, I
had warned my client that these would be far from "virgin" respondents. Also, their critique
of my moderation was extremely positive. (They weren't so complimentary about the food,
however. One cupped his hands around his eyes and pressed them to the one way mirror,
enabling him to see into the observation room. He said, "How come they get better food
that we get?")
I'm not saying that all participants are uncomfortable in face-to-face groups, although most
of them are at least somewhat wary. Some are excited, and glad to get other adults to talk
to. Some are eager to perform. The point is that they are in a very unnatural situation
which tends to distort their responses.
This is widely regarded as the "regular" and "natural" way to run focus groups!
Let's contrast this with the phone.
Telephone groups are more natural
The participant is invited, usually from lists provided by the client, to participate in a
telephone discussion on a particular topic. Participants are selected with a representative
mix of urban and rural participants, from different geographical regions, in fact,
with whatever geographical restrictions are most appropriate to the research objectives. The
participation of professional respondents and frequent respondents are minimized,
since we have the whole country to pull from and don't have to stay with the same people in
the major cities.
No one has to travel anywhere, since the participant will use whatever phone he/she
designates, usually at home in the evening, sometimes in the office during the day. There
is, therefore, no anxiety about finding the location, or what will be found there.
Dressing up is obviously inapplicable. Quite the contrary, people report that they have
gotten out of their work clothes into something more comfortable. An occasional participant
has mentioned participating in his or her pajamas.
They don't have to be made to "feel at home." They Most people have a room with a
phone extension in which they can participate without distraction. They are not "eyeballing"
each other, judging how they are dressed, pre-judging who they are and who they remind
each other of. There is no one-way mirror, no special microphone (it's already there in the
mouthpiece of their phone), no artificiality of any kind.
They feel safer in their own natural environment, talking into their own phone, eating
and drinking their own snacks, sitting in their own favorite chair, in (or out of!) their most
comfortable clothes. As they look around, they notice nothing alien or out of the ordinary.
Adding to the feeling of safety is the subconscious realization that if it gets too
uncomfortable, or is not what was promised, they are secure in the realization that
escape is easy; all they have to do is hang up, which is extremely rare. No one sees them
"walk out." (Of course, my sense of safety is enhanced by the fact that I can disconnect any

participant who is disrupting the group, without the group knowing that they have left. I've
only had to do this twice in twenty five years.)
They listen for a while to some music which is known to put them in the right mood of
relaxed anticipation (not elevator or waiting room music!). A very friendly, and
conspicuously informal moderator gets on the phone with them, introduces them to each
other, gives them some tips on participating, and starts the discussion. The introduction
sounds so personal that often participants are already responding to the statements in the
introduction as if the moderator is personally talking to them, saying "Uh, huh," "Sounds
good," "Will do." This is because when the moderator, or anyone else, is talking, his voice is
going into each and every person's ear as if he is talking directly to that person. In contrast,
in a face-to-face group, when I am looking at one person, I am perceived as talking to him
or her, since I'm not looking at the others. If I move my eyes to all of the participants, I'm
perceived as not making personal contact with anyone. So, in a face-to-face group, even
though people are.
Everyone is introduced by first names except for experts, who are introduced by full names
but urged to participate on a first-name basis. The informality of the telephone
encourages this.
People are freer to interact, especially to disagree with each other, since they can't see
each other and don't anticipate disapproving scowls from the other people. They quickly and
naturally learn to identify themselves when they talk by mentioning their first names: "This
is Joe, and I'd like to add to what Mary said..." Also, since they can't see each other,
there is very little perception of group size. An eight person group usually feels like
only about three or four people. No one is at the head of the table, no one is sitting closer to
the moderator, or next to anyone else. Side conversations, sitting in the "power chair,"
passing notes, and other distractions are eliminated. Also, people are drawn out even
further because silence on the telephone is even more aversive than it is face to face, so
people are quickly drawn in to fill the vacuum. Yet, interruptions are less frequent on the
phone.
The electronics at our end process every line, dramatically enhancing sound quality,
volume, frequency response and clarity. At the participants' end, they notice nothing
different except an unusually clear connection. What the participant hears usually sounds
like a normal phone call at its best, as it would be from a friend down the block. What you
hear is the best focus group tape you've ever heard, since the microphones are an inch from
each participant's mouth!
Our electronics make it very easy for the moderator or participants to interrupt, so that you
can hear grunts, groans, laughter, etc. This is absolutely necessary for moderator control
and participant involvement.
Since there is less intimidation, heterogeneous groups are not only possible, they
are highly productive. People you would never mix before, such as surgeons and
dietitians, or cardiologists and nurses, can be mixed as long as they are not from the same
city. A nurse will take on several leading cardiologists on the phone in ways that are
unthinkable face to face. Of course, you are not restricted only to the major cities to get
medical specialists, or factory managers, or hardware store owners, or car dealers.
Competitive issues are minimized or eliminated. There are few professional or overused
respondents, since you can reach out into the whole country, rather than be restricted to
the largest cities for certain types of respondents.
I have conducted extensive post session interviews with both telephone and face to face
focus group respondents. The telephone respondents do have some anxiety and discomfort,

but it mostly centers around how eight people can possibly interact naturally on the phone
without chaos. There is also some performance anxiety, just as in face to face groups. But
there is no doubt that telephone participants are more relaxed and comfortable before and
during the session.
In summary, the telephone focus group is characterized by informality and comfort, coupled
with the perception that "everyone is talking with me," a lack of visual distractions and
intimidation, a feeling of safety since participants are hiding behind their telephones in their
own natural environments, and a more accepting and intimate contact. In a word,
naturalness. All of these combine to make people interact with each other more openly. In
addition to the greater interaction, participants can be chosen more appropriately, since
there are no geographical constraints.
This brings us to the conclusion:
The Telephone Focus Group is the more natural, less artificial,
superior "environment" for a focus group.

It's not "the next best thing to being there." It's better than being there since it
opens people up by removing artificiality and introducing certain elements which work
toward openness.
For years, I have been justifying why telephone focus groups are almost as good as face to
face. People ask me questions which clearly come from their willingness to believe that
telephone groups can be almost as good, but lacking the visual element, telephone groups
obviously could never hope to be quite as good. What I have now realized is that it is
precisely the lack of the visual element which creates the conditions that allow telephone
focus groups to be better than face to face.
Interpretation: how to do it when you can't see facial expressions and body
language.
O.K., but the case still needs to be made for telephone focus groups being the preferred
way of running a focus group. I have established that the environment is more natural and
people are more open, but do you really get more information?
After all, people may be more open, but if you can't access the information, you haven't
achieved anything. Undeniably, you are cut off from the visual channel in a telephone focus
group. You can't see facial expressions, gestures and body language, so how do you
interpret what the participants are saying?
Non-verbals are the key
Facial expressions, gestures and body language are part of a more general class of
expression called non-verbal communication. The "non-verbals" as they are called
familiarly, are an essential part of communication. They tell us a whole range of
information, such as emotional content, strength of beliefs, credibility and sincerity. Certain
things like irony, sarcasm, annoyance and other emotions are usually communicated
entirely non-verbally. Non-verbals are particularly important when they don't match
verbalizations. If you've ever read a transcript of a group that you have seen, I'm sure you
were amazed at the difference. It just isn't the same group. The transcript is the pure
example of verbalizations without non-verbals. As such, it is so misleading that it is
completely invalid as a data collection tool. You can't read a group from a transcript alone.

There are other non-verbals besides the visual
But facial expressions, gestures and body language are not the only non-verbals.
They are only the ones which are. If you've ever had the pleasure of knowing a blind
person, you know the kind of sensitivity they develop without visual input. It's uncanny.
They often sense emotions and mood changes before you are aware of them yourself. How?
By hearing nuances in tone of voice, choice of vocabulary, pitch level, number and kind of
hesitations, rate of speed, trailing off or picking up of volume, and many other speech
subtleties. There are many other non-verbals communicated auditorily, such as "verbal
gestures" like "Uh- huh," "Nah," and the like. A blind person can't drive a car, but in the
area of tuning into people, they are far from handicapped; many can claim the advantage.
Just as I have trained myself to pick up subtle visual variations, such as changes in skin
color, I have trained myself, over thousands of groups, to pick up auditory variations. I'm
not nearly as skilled as a blind person, but I'm getting there.
Furthermore, most people have learned to control their visual non-verbals. People
practice in front of mirrors. Also, they have been to school, where they learned to fake
attention and interest so they wouldn't be "called on." Some people have become very
skilled at having a "poker face." However, two things usually give them away: Their eyes
and their voices. People have even learned to look you right in the eye when they are lying.
But most people have not learned to control their voices. They certainly don't stand in front
of tape recorders practicing.
In telephone focus groups, it's not only the voices that you can learn to read. It's also the
pace of the session, how fast people jump in spontaneously, how much they ask questions
of and react to each other, their verbal gestures, laughter, sarcasm, jokes, and silences. In
short, there is an abundance of non-verbals in telephone groups.
It's even better than that. When people can't see each other, they translate many of their
gestures into words, grunts, groans and similar auditory communications. It's funny to see a
small child gesturing into the phone. Some adults still do this, but most have learned to
communicate on the phone orally what would have come out as gestures. People actually
change their behavior on the phone, expressing visual non-verbals into a different channel
(oral/aural).
In addition, I have an indication on my computer screen when there is the slightest sound
on a line. Since the mouthpiece is so close to everyone's mouth, I can hear and see even
slight intakes of breath, sighs, clearing of throats and other subtle signs which would be
impossible to discern face to face.
I actually use the fact that I can't see participants to encourage greater expression. I tell
them that since I can't see them nodding or shaking their heads, I have to know whether a
given person is speaking for all of them, or is a minority of one. But I also don't want them
to waste their time repeating someone else's comments to agree with them. So, I say, I
would appreciate a chorus of "Yeah, uh- huh, I agree," or "Nah, disagree, nope." They catch
on fast, and it is often easier to tell consensus or disagreement on the phone than it is
looking into a bunch of wooden faces. Of course, when this doesn't work, a simple "Where
are the rest of you on this?" works just as well as in a face-to-face group.
The fact is that in both kinds of groups, there is an embarrassment of non-verbal riches more than you can pay attention to anyway and certainly enough to read the group.
To sum up, in a telephone group you get greater openness, willingness to engage each
other, willingness to express divergent thinking. In short, more information.

You do miss the visual element, but this element, valuable as it is, is not as essential as one
might at first think.

With skillful attention and probing, you can "read" a telephone group just as well
as a face-to-face group, sometimes better.

In balance, I firmly believe that you gain more than you lose.
Why they have not caught on more
The main reason that telephone groups have not caught on even more than they have (their
growth has been phenomenal) is that, while participants are more comfortable on the phone
than face to face, the moderator and the client are not. Most of us have been trained to rely
on the visual element far too much, both for control and for interpreting events around us.
Most of us have many years invested in learning to "observe." The observance of "body
language" has practically become a cult, with an almost mystical flavor. No one wants to
run a focus group "blind." Everyone who runs telephone groups, including myself even after
all these years, feels the lack of the visual channel as a loss.
The other reason that more telephone focus groups are not conducted, especially in
situations where face to face is adequate, is that "that's the way we do them, that's the way
they've always been done." There is no problem, so "if it ain't broke, don't fix it." This
traditional thinking makes it very difficult to justify telephone focus groups to bosses and
clients.
When someone wants to try them, they usually wait for groups that can't be done any other
way, since that's what will rationalize their use. Then everyone at their company gets the
idea that telephone focus groups are for high level, rare and/or geographically dispersed
respondents, a belief which I have unfortunately encouraged. I don't know of anyone who
has heard telephone groups who has not become a convert to the technique, but I'm
frustrated by how many of them have narrowly positioned telephone focus groups for only
specialized applications. I even had one client who thought the only use of phone groups
was for in-home taste tests in distant test markets!
Some added benefits
It's much easier to get people back at the home office interested in listening to telephone
groups. There are the people considered too "low level" to be allowed to attend face-to-face
groups who should (like writers, or assistant product managers, or trainees) or people
considered too "high level" to travel to groups (like company presidents, general managers,
and directors of R&D). They'll dial into groups they wouldn't dream of traveling to.
When to use Telephone Focus Groups
I have spent too much time over the years falling into the trap of trying to justify and
defend telephone focus groups. I realized writing this report that telephone focus groups do
not have to be justified, it is face to face groups that do. So, the answer to the question
"When should telephone groups be the method of choice?" is: Always, except in the
relatively few places where face-to-face groups are unavoidable. I can't avoid conducting
face-to-face groups when the participants must actually handle the product (as distinct from
being sent a videotape), when security considerations are such that you have to show them
something that they can't be sent in the mail, for day-long creativity sessions, and for

groups of young children. For most other sessions, even with relatively easy-to-get
participants, don't ask me to justify why focus groups should be done on the phone;
tell me in any givin situation why they should be done face to face.
Where it's all going
I remember the days in the late 60's and early 70's when there was a great debate, believe
it or not, about whether you could do quantitative surveys over the telephone. I'm referring
to the kind of surveys which require yes/no, multiple choice or numerical answers. Procter
and Gamble and others did a great deal of research comparing sending someone around to
ring doorbells (malls didn't exist in those days, but fortunately people answered their
doorbells) vs. calling them on the phone. It was found that, if anything, phone surveys were
more accurate. Then the debate turned to whether open-ended, qualitative studies could be
done over the phone. Many experiments found that it is easier to discern over the phone
whether people are lying. It became acceptable to conduct depth interviews by phone.
Someday, the phone will be just as acceptable, even the preferred way, to conduct focus
groups. Most focus groups will be conducted that way in the future.
Still Skeptical?
If you're still skeptical, I'll bet it's because you haven't heard a phone group or you've heard
some bad ones.
If you have heard some unimpressive phone groups, let me point out a few traps.
Not every good moderator is cut out for phone groups. The major mistake is formality
coupled with a failure to get participants to respond to and talk with each other.
Also, most telephone conference equipment was designed by engineers to cut down on
noise. But one man's noise is another man's data. You want to hear snickers, titters, grunts
and groans. But most systems are voice blocked, so that you can only hear the person
talking. This inhibits interaction and makes people feel invisible and ignored. You must be
able to hear the other participants in the background and, above all, the sound must be
natural, loud and clear. The electronics of most systems shut down the group, rather than
make them more accessible and intimate.
If you've encountered any of these problems, don't blame them on the telephone focus
group technique any more than you would let poor moderation or an inadequate facility
invalidate the whole face-to-face methodology.
There's no doubt about it: telephone focus groups require an investment of training in
listening skills and moderator techniques; initial discomfort; and risk in convincing bosses
and clients. However, the gains are worth it.
Those of you who haven't used telephone groups, I urge you to give them a try. Those of
you who keep using them for specialized applications, think about why you were so
impressed. Don't you think those reasons are enough to justify making telephone focus
groups the rule rather than the exception?
All you have to lose are your airline tickets.
Telephone Conference System Capabilities that Improve Telephone Focus Groups
Several telephone conference system capabilities vastly improve telephone focus groups.
I've gone through seven generations of technology since I began conducting telephone

focus groups. The new generation is a much larger improvement for the client than all of
the other generations put together.
The improvements are the result of a state-of-the-art teleconference system.
The groups not only sound different; the exciting thing to me is that they are completely
different psychologically. They have a different flavor: more open, more energetic and more
responsive.
The current generation conference system allows greater moderator responsiveness and
control, more participant interaction, and several new ways to run groups. Here are some of
these new capabilities:
A New Level of Audio Quality - barriers between participants disappear
Our conference system uses a digital fiber optic network, originally designed for high speed
computer use, with multiples more bandwidth than is usually used for voice transmission.
This means that the highest possible fidelity is maintained, absolutely without static. This
makes much more of a difference than I thought it would. Everyone sounds like they are
right next door. There is a "presence" that has to be heard to be appreciated. It all sounds
so natural that you almost forget that you are in the phone!
Also, since several people can be heard at the same time, you can hear people saying "Uhhuh, yeah, I agree." While this might sound like a disadvantage to the uninitiated, it is
actually a major improvement. I can now hear respondents agreeing and disagreeing in the
background, in contrast to the old voice blocked systems where you can only hear one
person at a time. In voice blocked systems, there is a feeling of invisibility caused by the
lack of response to someone talking. Now I can even hear someone clearing his/her throat
prior to speaking, so that I know that the person has something to say because I can hear it
in the background. Sort of the audio equivalent of seeing someone with her mouth open.
The moderator can see on a computer screen an indication of who is talking, clearing their
throat, chuckling, etc. If several people try to talk at the same time, the moderator can
easily sort out who is trying to talk. What this all adds up to is a more relaxed, friendly and
interactive conversation, with more participant, moderator and client energy.
Instant participant polling - an indispensable tool
It is now possible to poll participants electronically.
I have always been frustrated by the following situation: I ask a question. The first response
is deeply felt and expressed fervently. That's why it's first! If other people in the group
agree, I don't know if the other participants originally felt differently, but were swayed by
the first remark. It takes time and special techniques to uncover whether there were opinion
shifts.
With our teleconference system, before I open a topic for discussion, I can take a poll by
asking the question in a form that can be expressed as a number. For instance, "On a scale
of 1 to 9 (with one the lowest and 9 the highest) how satisfied are you with product X?" The
participants can then press the appropriate buttons on their phones. I instantly see the
votes next to each name and am able to know the relative degree of satisfaction. This
screen can be printed out at the push of a button, to be reported later.
This capability has been an indispensable tool in some recent concept tests, where I was
able to quickly zero in on the parts of the concept that were exciting and the parts that were
problematic to particular participants. At the end of each sentence of the concept statement

I had the participants push their phone buttons to indicate their degree of enthusiasm. It
took only seconds longer than reading the statement straight through, but saved about 15
minutes of sorting out individual comments. I could then probe the problems and the
participants in a much more fruitful way.
Remote Talker ID
Another feature is the ability for the client to dial into the conference system through a
computer modem and be able to see the same screen that the moderator is seeing. The
client can see the marks that tell the moderator who is talking, and see the results of the
polls. The client can know at all times who is talking and who is voicing agreement.

Breaking down into smaller groups
A technique frequently used by advanced moderators is to break a group down into
subgroups. For instance, the face-to-face moderator may have four negative participants
and four positive participants huddle in opposite sides of a room to marshal their thoughts.
They then meet as a large group to have each sub group try to convince the other side of a
particular position. Or, especially in idea generation sessions, the moderator might have the
participants break off into dyads (two people at a time) to break the ice and get the ideas
flowing. They are then brought back to report the ideas they think were best and the ideas
they thought were most ridiculous.
This breaking into subgroups can now easily be accomplished electronically. So, any
combination of people can be mixed and matched instantaneously. A group can even be
allowed to listen in to another group, then the tables can be turned.
Instant contact with the moderator
In the older conference systems, the client had to call out to get the assistant's attention in
order to pass a note to the moderator. Now, the client can press *0 on their touch tone pad,
and have the assistant come on to their line much more quickly. Clients can huddle in a
completely separate conference.
Instant dial out
Ordinary conference calls from the phone company can take 10-15 minutes to convene 1012 participants (including client lines). Before the installation of the current generation of
equipment, we used to take about 3 minutes. It now takes under a minute, because all of
the lines can be dialed at the same time, rather than sequentially. This means that the first
participant does not have to wait for longer than a few seconds before a live person greets
him or her, and before the moderator starts the discussion, further reducing the wait and
increasing professionalism.
Other features
There are other future features that are not as relevant to focus groups, but are major
breakthroughs in other applications. For instance, there is now a question feature that lets
people who are on muted lines listening to experts, indicate by touch tone that they have a
question. Their lines can be un-muted in order to ask their question. There is even a way to
indicate that their question has already been asked or answered, so that they are not called
on unnecessarily.
Many features for medical seminars and large sales forces are also being developed.
The old-style telephone groups, especially the ones you may have heard on other
company's conference systems, are a thing of the past. They started a little more slowly,
people couldn't hear quite as well, you didn't always know who was talking, people
sometimes felt invisible. They have been replaced by a relaxed and open atmosphere, with
absolute clarity, where the moderator is able to respond instantly to people by name and
instantly know where they stand on any issue. I can go deeper psychologically in a
friendlier, safer atmosphere. It's amazing how a bunch of seemingly small improvements
can make such a tremendous difference. I invite anyone who is interested in telephone
focus groups to call us and set up a short demo to hear what state of the art sounds like.

Are you overlooking these people
in your marketing?
Telephone focus groups can help you get inside the heads of people who are otherwise
difficult to research - people who you wouldn't even consider researching under most
circumstances, let alone trying to get into focus groups!
This section is intended to stimulate you to think about the kinds of people who you aren't
researching, but should.
Leveraged influencers
Every product that I have ever looked at has people who influence the ultimate purchaser:
People who are up the distribution chain, or who serve as advisors or who otherwise
influence the decision.
For instance, if a pharmaceutical product isn't prescribed by physicians, it won't be bought
by the patient. And it might not be prescribed unless it's endorsed by the experts, or chief
pharmacists, or other formulary committee members. A replacement auto part will not be
installed if the technicians or parts jobbers don't stock it. If a product isn't liked by the store
clerk, the customer might be talked into another product.
These people can have a tremendous effect on how well your product is adopted. They may
persuade, prescribe, endorse, advise, specify, approve or recommend the product to others.
I call these people "leveraged influencers" because by concentrating your effort on just the
right place, their decisions are multiplied and amplified. In many cases, they are actually
more important for the marketer to influence than the ultimate purchaser.
They are very hard to research. They are besieged by requests for interviews. They don't
want to fill out or participate in surveys. They have very little patience for one-on-one
interviews. Even when you can get them into one-on-one's, their answers are often very
terse, or extremely verbose. You are often left with a confusing mess of contradictory
opinion. You don't know how they would react to the opinions of others. What you really
need are focus groups of these people, with the richness and depth that you get from
interaction, but focus groups are out of the question because of the logistics.
These people are too busy and geographically scattered. In the rare cases where experts
agree to attend a focus group, they often have to be flown to a central location. It's not
unusual for such a focus group to cost tens of thousands of dollars, when you add up
incentives, travel and entertainment. If the people are from the same geographical area,
often they don't want to talk to competitors. One way to get them is at a convention, but
the people who will attend focus groups at conventions tend to be a little weird. They are
the types of people who will attend a focus group at six o'clock in the evening in San
Francisco. Don't they have anything better to do? They tend to be the social misfits. I call
them the "plaid pants crowd."

Qual Health Res OnlineFirst, published on February 8, 2010 as doi:10.1177/1049732310361466

Advancing Methods

Comparison of Focus Groups on
Cancer and Employment
Conducted Face to Face
or by Telephone

Qualitative Health Research
XX(X) 1­–11
© The Author(s) 2010
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1049732310361466
http://qhr.sagepub.com

Linda M. Frazier,1 Virginia A. Miller,1 Douglas V. Horbelt,1
James E. Delmore,1 Brigitte E. Miller,2 and Angelia M. Paschal1

Abstract
Findings from telephone focus groups have not been compared previously to findings from face-to-face focus groups.
We conducted four telephone focus groups and five face-to-face focus groups in which a single moderator used the
same open-ended questions and discussion facilitation techniques.This comparison was part of a larger study to gain a
better understanding of employment experiences after diagnosis of gynecologic cancer. Offering the telephone option
made it easier to recruit women from rural areas and geographically distant cities. Interaction between participants
occurred in both types of focus group. Content analysis revealed that similar elements of the employment experience
after cancer diagnosis were described by telephone and face-to-face participants. Participants disclosed certain
emotionally sensitive experiences only in the telephone focus groups. Telephone focus groups provide useful data
and can reduce logistical barriers to research participation. Visual anonymity might help some participants feel more
comfortable discussing certain personal issues.
Keywords
cancer, psychosocial aspects; focus groups; group interaction; technology, use in research; workplace

Interviews provide an opportunity to gather detailed
information on what it is like to experience a particular
health problem from individuals who have lived through
the experience. Two methods of conducting interview
research are to speak with one person at a time and to
hold focus group discussions with several study participants. Focus groups enable participants to react to and
build on the comments made by other members of the
group, yielding opinions and experiences that might not
surface during individual interviews (Creswell & Plano
Clark, 2007). The conversational atmosphere of a focus
group comprised of peers can seem less intimidating than
a one-on-one interview with a researcher, removing a
potential barrier to recruitment. When conducting focus
groups, enrollment barriers can be reduced by offering
participation by telephone, especially for geographically
dispersed individuals, such as those living in rural areas
or those with relatively uncommon health problems
(Cooper, Jorgensen, & Merritt, 2003). Eliminating the
need for meeting facilities can reduce expenses and logistical issues, especially for focus groups held during the

evening or on weekends to accommodate participants
who have schedule conflicts during traditional business
hours.
Telephone focus groups have been criticized because
they lack nonverbal communication, which might reduce
the richness of the qualitative data gathered (Krueger &
Casey, 2000). Another criticism is that group interaction
is difficult to manage because the moderator cannot see
the participants. Those criticisms notwithstanding, telephone focus group participants appear more willing to
discuss certain experiences or sensitive topics (Cooper
1

University of Kansas School of Medicine–Wichita, Wichita, Kansas,
USA
2
Comprehensive Cancer Center at Wake Forest University,
Winston-Salem, North Carolina, USA
Corresponding Author:
Linda M. Frazier, Department of Obstetrics and Gynecology,
University of Kansas School of Medicine–Wichita, 1010 N. Kansas
Ave., Wichita, KS 67214, USA
Email: [email protected]

2
et al., 2003). Visual cues such as jewelry or hairstyle do
not accentuate differences between participants when
research is conducted by telephone; this can help to
establish a sense of shared social identity in the group
(Lea, Spears, & Watt, 2007). Sharing identity with the
group might lower the social stigma associated with disclosing potentially embarrassing experiences (Joinson,
2001).
Despite the potential advantages, the qualitative data
gathered in telephone focus groups have not been evaluated to determine if they can meet research objectives as
well as data gathered in face-to-face focus groups. In the
present study, face-to-face and telephone focus groups
were conducted by a single moderator using a standardized set of interview questions. This provided an
opportunity to evaluate similarities and differences in the
data according to focus group type.

Study Context
Employment and Cancer
We compared the findings from focus groups conducted
face to face to those conducted by telephone in the context of a larger study that we carried out on employment
and cancer (Frazier, Miller, Horbelt, et al., 2009; Frazier,
Miller, Miller, et al., 2009). The goal of the primary study
was to generate ideas about ways in which health professionals such as oncology nurses and oncologists might
assist cancer patients with stressful job problems that
occur in the months following diagnosis. Previous
research has shown that most employed cancer survivors
return to work (Taskila & Lindbohm, 2007). Jobs provide
income and health insurance, and cancer patients often
receive social support from their coworkers. Many
patients, however, lose their jobs, decide to quit working,
or become disabled. Pooled results from 36 studies that
were conducted in the United States, Europe, and other
countries revealed that 33% of the 20,366 cancer patients
who were employed at diagnosis were no longer
employed when followed up between 9 months and several years later (de Boer, Taskila, Ojajarvi, van Dijk, &
Verbeek, 2009). The cancer patients were more than
twice as likely to have become unemployed during follow
up as the 157,603 healthy controls.
Individuals who remain employed after cancer diagnosis often lose income by reducing their working hours.
Among cancer survivors in Colorado who remained
employed 2 years after diagnosis, 46% had decreased
their work week by an average of 16 hours because of
their cancer (Steiner et al., 2008). Almost half of the
group said they avoided changing jobs because they
feared they would lose their health insurance. In a study

Qualitative Health Research XX(X)
of breast cancer survivors in Canada, more than half said
that the cancer had affected their work or career (Stewart
et al., 2001). They were much less likely to disclose their
diagnosis to work colleagues or to their supervisor than to
their friends. Reasons for nondisclosure ranged from
wanting to avoid being the subject of gossip to fear that it
might negatively affect their job or career prospects.
Counseling about employment is a recommended
component of cancer care (Hewitt, Greenfield, & Stovall,
2006). Oncology nurses, oncologists, and social workers
provide psychosocial support for newly diagnosed cancer
patients who are undergoing primary treatment such as
chemotherapy, radiation, and surgery. Much research has
helped provide these professionals with improved methods of treating physical symptoms that affect role
function, such as nausea and vomiting during chemotherapy, and psychological symptoms such as anxiety and
depression (Jacobsen, 2009). In contrast, little research is
available to provide frontline clinical interventions to
prevent or lessen psychosocial distress from employment
problems during cancer treatment (Feuerstein, 2005;
Steiner, Cavender, Main, & Bradley, 2004).
Employment-related counseling can be provided by
specialists such as vocational counselors, occupational
therapists, physiatrists (rehabilitation physicians), and
others. In some communities, however, there is limited
access to such service providers. Unmet psychosocial
needs having to do with employment remain prevalent
among cancer survivors. One in seven cancer survivors in
a large Pennsylvania study said that during cancer diagnosis and treatment they had at least one unmet
psychosocial need related to doing their work or keeping
their job (Barg et al., 2007). To begin developing educational materials and interventions to address these
psychosocial needs, we sought information characterizing these experiences by conducting a focus group study.
We studied women with gynecologic cancer because they
are underrepresented in previous qualitative studies of
the employment experiences of cancer survivors (Taskila
& Lindbohm, 2007).
Our study was guided by the philosophical traditions
of phenomenology in which the aim is to understand
unique individuals and their subjective experiences and
interactions with others (Lopez & Willis, 2004; Starks &
Trinidad, 2007). We used the two main phenomenologic
research approaches—descriptive and interpretive (hermeneutic)—to choose the focus group interview questions
and to guide the data analysis. Descriptive phenomenology is used to characterize the key elements of an
experience, especially aspects that have not previously
been described thoroughly (Lopez & Willis, 2004). In the
hermeneutic tradition, the researchers’ expert knowledge
and published research are used to help design the study,

3

Frazier et al.
collect the data, and interpret the findings to suggest
ways in which patient care could be improved.

Descriptive Component of Our Primary Study
Our primary study included a descriptive phenomenology aspect because existing research on role function
during cancer treatment has incompletely conceptualized
the positive and negative contributions of employment to
quality of life (Steiner et al., 2004). The most common
employment endpoint in cancer studies—and often the
only employment endpoint—is whether or not the individual returned to paid work. When researchers want to
assess role function using a scale endpoint, typically a
quality-of-life instrument is used which asks about
employment-related role function as well as ability to fulfill roles outside of work in each role function question.
An example is the Functional Assessment of Cancer
Therapy instrument family, which directs individuals to
rank the extent to which they are “able to work (include
work at home)” (Cella et al., 1993).
To collect these descriptive data, our moderator asked
participants to talk about what quality of life means to
them, and how it had been affected by their jobs or work
relationships. During data analysis, we primarily used
inductive reasoning. Our main finding was that blending
role function at home with that at work did not capture
adequately the influence of employment on quality of
life. Return to postoperative role function, for example,
often proceeded more quickly at home because the cancer
survivor could take frequent breaks when doing household tasks, but could not do so at a paid job. Based on
these findings, we recommend that cancer researchers
consider supplementing standard quality-of-life instruments with additional employment-related items (Frazier,
Miller, Horbelt, et al., 2009).

Interpretive Component of Our Primary Study
We used an interpretive phenomenology approach to
identify ways in which oncology professionals might be
able to help employed patients prevent or improve
common job problems (Lopez & Willis, 2004; Starks &
Trinidad, 2007). We used social cognitive theory when
selecting focus group interview questions and analyzing
our data because it provides a promising conceptual
framework for designing interventions to help patients
adopt health-related behaviors (Bandura, 2001; Kinzie,
2005; Rogers et al., 2004). Social cognitive theory states
that there is an ongoing interaction between behavior,
environmental factors, and personal factors. Environmental factors range from socioeconomic conditions to
characteristics of the physical environment, such as an
employee’s work station or commute. An important

personal factor is self-efficacy—the belief in one’s ability
to meet a goal or solve a problem. Other personal factors
that work together to influence behavior are valuing a
certain outcome, and believing that a behavior will produce the desired outcome (positive expectation) or that
refraining from the behavior will produce an undesired
result (negative expectation). Also important are knowledge and skills (behavioral capability), and forethought
manifested, for example, as setting personal goals.
Behavior is reinforced by direct learning (personal experiences or training), vicarious learning (observing the
outcomes when role models and other people choose to
engage in or refrain from the behavior), and by reflecting
on these experiences in the context of personal values and
aspirations (Bandura, 2001).
Applying social cognitive theory to our study, we
chose, for example, the interview question, “After cancer
diagnosis, to whom did you turn for advice about your
job?” Patients with low self-efficacy might not feel confident enough to ask others for advice or assistance when
symptoms interfere with being productive at work. We
hoped that participants would provide examples of selfefficacy by describing how they sought and received such
help. Thus, a deductive element in our interpretive analysis was to look for quotations illustrating constructs that
could be used in education materials to help increase
patient behaviors that would help them prevent or manage
job problems. We also used inductive reasoning in the
interpretive analysis because of the paucity of preexisting
interventional research on improving employment
outcomes (Steiner et al., 2004). We summarized our interpretive analysis as a set of clinical recommendations for
frontline cancer care providers (Frazier, Miller, Miller,
et al., 2009). During analysis of the data in our primary
study, we noticed that participants discussed certain topics
only in the telephone focus groups. We therefore returned
to our data to compare the similarities and differences in
the data obtained according to focus group type.

Methods
The methods we used in the primary study for recruiting
participants, conducting the focus groups, and analyzing
the data are summarized below. The data analysis methods used for the comparison of data by focus group type
are then presented.

Recruitment
The research protocol was approved by the institutional
review boards of the University of Kansas School
of Medicine (Wichita, Kansas) and the Wake Forest
University School of Medicine (Winston-Salem, North
Carolina). Each participant provided written informed

4
consent. We designed the recruitment to assemble a group
of women who had experienced the phenomenon of interest, i.e., those who had had been diagnosed at least 3
months previously with ovarian, endometrial, or invasive
cervical cancer and who were employed when their
cancer presented. Nearly all of the cancer survivors were
recruited by the health professionals at the gynecologic
oncology clinic at each medical school campus using a
flyer about the study. The remaining participants learned
about the study from notices in local newspapers, on an
Internet message board, or by word of mouth. We
obtained some information from medical records and by
questionnaire to help describe the participant group (e.g.,
cancer type and occupation), but collected our main data
in focus groups. We offered the option of participating by
telephone to help make the study more convenient for
employed women and individuals who lived far from the
research center.

Focus Groups
Audio recordings were made of the focus groups and the
sessions lasted 60 to 75 minutes. A woman moderator led
all focus groups by following a single interview guide.
She asked participants not to state their last names,
assured them that there were no wrong answers, and said
they could each choose how much they wanted to talk or
not talk. The guide began with open-ended questions on
quality of life. The four remaining questions were on
employment after cancer diagnosis; specifically, feelings
about having a job or career, advice sought about employment matters after diagnosis, help received with job
issues during treatment; and tips about employment for
newly diagnosed women. After posing these questions,
our moderator listened for employment-related experiences and followed up with nondirective prompts such
as, “Tell me more about that,” or “Does anyone else want
to comment on this issue?”

Data Analysis
Primary study. A content analysis was performed (Elo
& Kyngas, 2008; Starks & Trinidad, 2007). The focus
group moderator made notes concurrently about the
topics under discussion in each focus group and transcribed the audio recordings afterwards. We began
analyzing the transcripts soon after the first focus groups
were conducted and we proceeded continuously as additional focus groups were completed. A data immersion
approach was used (Crabtree & Miller, 1999). Our moderator and another investigator read and reread the
transcripts independently to conduct open coding, conferring frequently to establish the definition of each topic
in the evolving coding scheme. We extracted participant

Qualitative Health Research XX(X)
quotations and copied them onto a spreadsheet, grouping
them by topic.
We combined or split topic groups to create overarching
categories after discussing options and coming to consensus (Creswell & Plano Clark, 2007; Krueger & Casey,
2000). Employment-related topics, for example, fell into
categories that represented tasks faced by cancer survivors
in three time periods: immediately after diagnosis, during
primary treatment, and during extended survivorship.
Learning about expected job restrictions was one of the
tasks that occurs first, when the treatment plan unfolds just
after diagnosis. We conducted text searches using synonyms for keywords in the quotations for a given topic to
ensure that all such quotations were identified. We again
reread the transcripts to ensure that we represented the
context accurately for quotations that we selected to represent the data in reports or patient education materials. We
asked the study participants and other stakeholders (participants’ family members, physicians, nurses, human
resources professionals, and others) to critique these materials. This feedback revealed, for example, that the three
time periods derived from topic categorization were a
good way of organizing health-related employment tasks
that occur after cancer diagnosis.
Present study. After noticing the possible differences in
topics by focus group type, reimmersion in the data was
accomplished by rereading the transcripts with special
attention to focus group type. We defined a focus group
in this analysis as a mediated discussion meeting among
4 to 8 study participants (Creswell & Plano Clark, 2007;
Krueger & Casey, 2000). We therefore excluded data
from the primary study that was obtained during a session
attended by less than four women (28 cancer survivors)
or by questionnaire only (one cancer survivor).
Because participant interaction is one of the advantages of focus groups compared to individual interviews
(Creswell & Plano Clark, 2007), we looked for encouraging statements that women made to each other, and
instances in which several women engaged in an extended
dialogue with each other in the absence of interspersed
prompting by our moderator. A major characteristic of
telephone communication is lack of visual information,
so we looked for statements in the face-to-face focus
group transcripts that reflected participant opinions about
the appearance of other participants.
Using the content analysis results from our primary
study, we sorted the quotations that we had coded by topic
and overarching categories so that we could make side-byside comparisons by focus group type. We also compared
each topic by whether it represented sensitive personal
information. Whether personal information is considered
sensitive varies according to sociocultural context. We
considered sensitive topics to include sexuality, bodily
functions such as bowel or bladder control, poor hygiene,

5

Frazier et al.
actions considered by some to be immoral or cowardly,
and illnesses that the participants described as having been
caused by personal failing; topics such as these are generally regarded as potentially stigmatizing (Breitkopf, 2004;
Brondani, MacEntee, Bryant, & O’Neill, 2008; Culley &
Hudson, 2007; Griffiths et al., 2006).

Results
Participants
A total of 44 women attended a focus group: 25 women
participated in one of five face-to-face focus groups (4 to
8 women per group) and 19 women participated in one of
four telephone focus groups (4 to 7 women per group).
The women’s jobs at the time of cancer presentation represented a broad spectrum of occupations in sales or
service, health care, manufacturing, education, and other
white-collar fields. The age distribution, types of gynecologic cancer, and other participant characteristics were
similar in the face-to-face and telephone focus groups
except that rural residence was more common among
women who participated by telephone (61.1% were from
rural areas in the telephone groups compared to 20.0% in
the face-to-face groups). Offering the telephone option
enabled women to participate in the study from the comfort of their homes, as illustrated by the following
quotation from a woman receiving chemotherapy for a
recurrence of ovarian cancer: “Actually, I am not feeling
good today. I have been in bed all day. When you called,
I was asleep. I have been in bed most of the day. I am on
my third day of Doxil.”

Similarities in Group Dynamics
Interpersonal exchanges were common in both types of
focus groups. In the same way that participants in the faceto-face focus groups often talked animatedly to each other
while waiting for the session to start, in the telephone groups,
when our moderator came back on the line after calling in all
participants, conversations between the women were already
in full swing. Telephone group participants made supportive
statements to each other as they elaborated on a topic, and
extended exchanges occurred:
Moderator:  What does quality of life mean to
you?
Participant (P) 1:  I think to me it means being
able to keep my routine. Being able to continue
to pretty much do my normal life. I guess that is
what it would mean in a nut shell. You know, just
being able to see friends and go out and do things
that I enjoy.

P2: I agree with that summary, P1. I like to live as
normal a life as I can. I don’t think I have
changed anything. I do the everyday things
that I have always done.
P3: I agree with that too, P1, to be as normal as
you can.
P4: I think that to have good quality of life, also
you let go and not worry about all the little
fine details anymore.
P3: Very true. This is P3 agreeing with you.
P4: Not to be so worried about if the house is perfectly clean anymore or anything.
Women in both types of focus group appreciated the opportunity to participate in the research. For example, a woman
in a telephone group said, “Thank you for including me in
the group. I have enjoyed being here and taking part in this
effort. I got a lot out of our conversation this evening.”

Similarities in Employment Topics Discussed
The telephone focus groups generated employment experience topics that were very similar to those generated in
the face-to-face focus groups. In both types of focus
groups, women talked about positive experiences such as
developing a greater appreciation for the important things
in life after cancer diagnosis. A comment in a face-to-face
group was, “I feel more appreciation toward everything.
Even the grass and seeing the trees.” In a telephone focus
group a woman said, “I have more patience. I didn’t have
a lot of patience before.” Examples of similarities in
employment topics categorized by the four work-related
questions on the focus group interview guide are provided below.
What are your feelings about having a job or career? Women
in both types of focus groups said that work was one of the
priorities in their lives. Being able to work was described as
beneficial, illustrating the social cognitive theory construct
of positive expectation from the behavior of returning to
work after diagnosis. For example, a woman in a face-toface group said, “It is real important. I do not think I would
have a sense of identity without it.” A telephone focus group
participant made a similar statement: “[Work] gets you out
of the house and you don’t dwell on the fact that you have
cancer. You interact with people.”
After cancer diagnosis, to whom did you turn for advice
about your job? Both types of focus groups generated a list
that included the same types of people who provided support and advice: family members, health professionals,
friends, people at work, and other cancer survivors.
Below is an example from a face-to-face group participant that illustrates vicarious learning to increase one’s
repertoire of behaviors for managing symptoms during

6
cancer treatment (the social cognitive theory construct of
improving behavioral capability):
There was a lady who had had breast cancer that I
talked to a lot. She worked too. I knew she had
worked while she went through it. She gave me
advice. That kind of helped me a lot as I went
through it. . . . She had told me there were times
when she would have to go home and maybe take a
longer lunch, rest and come back.
A similar social environment was described in a telephone
focus group: “A lot of the people I work with—not a lot
I guess—there have been about 8 who had breast cancer.
They are survivors of breast cancer. So we have got kind
of our own little cancer group.”
The types of work recommendations that women
reported receiving from physicians were similar in the faceto-face and telephone focus groups. Oncology nurses also
played a substantial role in helping cancer patients manage
work issues. This quotation from a woman in a face-to-face
group was typical of both types of focus groups, and illustrates self-efficacy as well as the value she placed on
receiving advice from an experienced nurse:
I call my doctor, actually his nurse. . . . I can bounce
an idea off her. . . . She is very understanding. She
is very calming. It is nice to have someone who is
experienced—who is just very matter of fact about
things. . . . She helps with work issues.
Which people at work helped you with a cancer-related problem? Comments about help received from occupational
health nurses were remarkably similar in the two types of
focus groups. In a face-to-face group, a woman said,
I worked at the factory. . . . They have what they
call a First Aid Office with a nurse in there all the
time. . . . And they told me when I checked in and
went through the process of coming back into the
shop . . . “Any time you feel tired or whatever, you
come down here and you lay down.”
In a telephone group, an occupational health nurse
was described as very helpful, even though the cancer
survivor worked at a remote location:
My company did have a nurse that came out from
our headquarters monthly to our station, and so she
always spent extra time with me, and kind of went
over everything, and was always available. . . . She
was wonderful.

Qualitative Health Research XX(X)
Women in both types of focus groups gave mixed
reviews of supervisors and coworkers. A supervisor
helped a woman who asked for help with lifting when her
coworker refused, as described by a face-to-face focus
group participant:
I tried to do all the work I could. There was a little
lifting and I could not do that. I had to ask one
girl. . . . And so I said, “Can you help me lift these out
of the box?” “I’m busy.” She turns her head. But then
I told the boss, “You know, I need some help here.”
And then he ended up doing the lifting for me.
The above comment illustrates self-efficacy in finding
needed assistance in the workplace. In the telephone
groups, participants also described positive coworker
reactions to their postoperative lifting restrictions, illustrating the physical as well as the social environment
constructs of social cognitive theory:
I do a lot of lifting in my job. . . . My doctors
advised me not to because, they said, “You don’t
want to come here and have a hernia.” . . . And my
people, my team would not let me lift. . . . Even
now, I have a lot of them that say, “Get out of the
way. I will do this.”
Negative experiences with coworkers were also
described, such as this social environment description by
a woman who participated by telephone:
I worked in car sales. . . . We were one where you
didn’t take a turn selling cars—it was the first one
who got to the customer. Fight your way out the
door. . . . I mean they didn’t think anything of stealing your deal from you. . . . So it was pretty
cut-throat.
What tips about work would you suggest for women newly
diagnosed with cancer? Advice provided by the cancer survivors was similar in both types of focus groups. Women
said that keeping one’s supervisor informed improves
work experiences during cancer treatment. Another recommendation was to keep in touch with coworkers to
receive social support. These comments from a woman in
a telephone group who lived in a rural area were typical
of this experience for both types of focus groups, and
illustrate a positive expectation of a desired outcome
resulting from a behavior:
I was out here by myself. . . . And finally when I got
to be in touch with the real world, these ladies
would send me emails and it was just the highlight

7

Frazier et al.
of my day to be able to converse with somebody. . . .
So [my coworker] starts sending me cards. It was a
hoot! He would send me Valentine’s Day cards and
St. Patrick’s Day cards. It was really nice.
Women in both types of focus groups said to find out
early about the employer’s benefit program. Experiences
that described the advantages of doing so included getting all the benefits to which one is entitled and preventing
stress from having to complete confusing Family and
Medical Leave Act paperwork shortly after major surgery
(Family and Medical Leave Act, 1993). Women in both
types of focus groups described how cancer caused them
to put their jobs into perspective, illustrating the construct
of self-reflection to modify personal aspirations. In a
face-to-face group a woman said,
I used to get very stressed about [my job]. . . . I was
making it much more than it was. My husband said
to stop obsessing about it. So I did stop getting
stressed about it. . . . I learned to pull back to what
was important.

courageously overcame her fear or that she had gained
anything from having been so afraid:
There’s nights that I can’t sleep. And that is certainly on my mind at times like that—at quiet
times, in the middle of the night, and things like
that. There is certainly that fear of, of death, and
recurrence again and what it’s going to mean.
In contrast, the fear experienced by a participant in a
face-to-face group was portrayed as being under control
and improving:
I don’t think I will ever get over the fear of getting
it or having it recur. Now, they say as time goes by
it gets better. I think about it every day, several
times a day. There were times earlier that it was
every minute.
Certain topics were only mentioned in the telephone
focus groups. One of these was guilt about taking a new
job after receiving support from coworkers and managers
in the workplace:

In a telephone group, a similar revelation was,
I think sometimes, especially as women, you think,
even if you’re not feeling really good, you should
keep plugging along. And I think a lot of women do
that even when they have been told to stop, enough
is enough, take care of yourself. If someone on the
outside had told me that, that would have been
nice.
Women in both types of focus groups said that sharing
a lot of personal information about one’s cancer is not
necessary. In a face-to-face group, a woman took the
stance of a role model when she gave this advice: “I do
not mean that you have to tell them everything, but, you
know, I think we need to be honest with ourselves as well
as with the people that we work with.” Similarly, in a
telephone group, a woman recommended not burdening
coworkers with too much information: “I get tired of
hearing about the same thing every day, over and over
and over—I don’t want to plague them with hearing it
every day just over and over and over.”

Differences in Sensitive Topics Discussed
Fears were described more vividly in the telephone focus
groups. The telephone group participant who made
the following remark did not end her statement on an
upbeat note, or return to the topic later to say that she

When I was diagnosed, I had been at my job for
two years. It was really good, I mean everybody
was very supportive. . . . I think I stayed home for
probably eight weeks . . . but they still kept me on
their payroll, at regular pay. I wasn’t getting my
commission, but still I was getting something. And
then I was offered a job probably three months after
I returned to work. And I felt guilty leaving because
they had been so good to me over my treatment and
stuff.
Sexuality was only mentioned in the telephone focus
groups. One woman described being afraid that sex could
cause her cancer to metastasize: “That was one of the
questions I asked the doctor—if my husband and I get
intimate, can he stir up things to have those floaters to go
someplace?” A sexually stigmatizing experience was
related by a woman who was labeled by a coworker as
promiscuous after being diagnosed with ovarian cancer
(even though sexual activity is not actually a risk factor
for ovarian cancer):
He [my coworker] said that one of the women had
said that ovarian cancer only comes if you’ve had
multiple sexual partners. . . . I was like, “Oh my
gosh, let me tell you what a boring sexual life I
have had.” But yeah! And it really hurt my
feelings.

8
Being able to see each other in the face-to-face focus
groups resulted in negative behavior between participants
on one occasion. The following face-to-face discussion
occurred in a focus group during which most of the conversation was mutually supportive and cordial. One
woman (P5) said that pain would have a worse effect on
her quality of life than a handicap or disfigurement. A
young, attractive participant (P6) replied that a handicap
or disfigurement would matter to her. An older woman
(P7) then made an envious statement about the younger
woman’s appearance, and belittled her by referring to her
in the third person. Our moderator attempted to diffuse
the tension, but the older woman took the floor immediately and admonished the younger woman to live her life
differently, again using the third person:
P5: Pain would be an issue [for my quality of
life]. It depends on the level of course. A
handicap is not an issue. A perfect body
would not be an issue.
P6: It is for me.
P7 [referring to P6]:  She is not over 50, and if she
is, I want to look like her. I think we all want
to look like her.
Moderator:  Any other issues on survivorship or
the quality of life or the difference between
before the diagnosis and after the diagnosis?
P7: I realize how short life is. . . . My life is
almost over. There are so many things I wish
I had done different. I really do. . . . Not realizing that at her age [motioning to P6], to do
all these things and be all these things in spite
of yourself.

Discussion
To our knowledge, no previous study has compared qualitative data gathered in telephone focus groups with that
from face-to-face focus groups. We found that participants interacted with each other spontaneously in the
telephone focus groups, which allowed memories to be
stimulated under a group process that was similar to the
interactivity in the face-to-face focus groups. Our content
analysis revealed that, in both types of focus groups, similar elements of the employment experience after cancer
diagnosis were described and a mixture of positive and
negative employment experiences were shared. Statements in both types of focus groups represented social
cognitive theory constructs such as environmental influences, behavioral expectations, the value placed on
expected effects of behaviors, and vicarious learning
(Bandura, 2001; Rogers et al., 2004). Examples of the
important construct of self-efficacy were shared by

Qualitative Health Research XX(X)
participants in both types of focus groups, such as asking
an oncology nurse for advice about managing work, and
asking a supervisor for help with lifting. A rich collection
of quotations was obtained from both types of focus
groups to use in developing patient and health provider
education materials.
Using telephone focus groups helped us recruit participants from rural areas and from two states. In a similar
fashion, telephone and face-to-face focus groups were
used by researchers in Maryland to identify how communities could help promote early diagnosis of oral
cancers (Horowitz, Siriphant, Canto, & Child, 2002).
Urban participants attended the face-to-face focus groups,
whereas the telephone focus groups were more convenient for the participants from the rural areas of
Maryland’s eastern shore. In a study of the psychosocial
aspects of living with the risk of breast cancer (Appleton,
Fry, Rees, Rush, & Cull, 2000), telephone-based methods
were used to enhance access to the study by geographically dispersed women. Those focus groups were
reportedly easy to organize and conduct by telephone.
Using this design also eliminated travel and meetingrelated expenses.
Our findings suggest that telephone focus groups
might yield some information that is different than that
generated in face-to-face focus groups. Certain topics
such as sexuality were only brought up by women who
participated by telephone. Unconquered fear was
described by telephone but fear disclosed in the face-toface focus groups was portrayed as under control or
improving. Visual anonymity during the telephone focus
groups could have made women more comfortable disclosing sensitive information. This phenomenon has been
observed in studies that were conducted to explore the
Social Identity Model of Deindividuation Effects (Lea
et al., 2007). According to this model, group membership
(social identity) can prompt individuals to take on attributes of the group (deindividuation). If there are fewer
perceived interpersonal differences among members of a
group, group cohesiveness improves and individuals
believe that other members of the group are trustworthy
(Lea et al., 2007; Tanis & Postmes, 2005).
Gynecologic cancer survivors formed a type of social
group to which all of our research participants belonged.
Even though this was something that everyone in the
study had in common, the women differed in many ways.
Some were in their late 50s and others were in their 30s.
Clothing styles sometimes suggested that women were
from different social classes. Some women’s cancers had
been cured and they looked healthy, and others had suffered relapses and looked less healthy. In our face-to-face
focus groups, these differences were plainly visible, and
on one occasion, provoked antisocial behavior toward a

9

Frazier et al.
participant whose youth and beauty perhaps defined her
as an outsider in the eyes of the older participant.
In our telephone focus groups, removal of visual identification probably enhanced the sense of belonging and
fostered trust and sharing of sensitive information. Telephone participants in our study knew that other
participants could not see them. Visual anonymity can
help people feel more comfortable talking about personal
experiences and reduce the social stigma associated with
disclosing potentially embarrassing opinions or experiences. These effects have been documented in studies of
computer-mediated compared to face-to-face communication (Joinson, 2001). Results in that study suggested
that visual anonymity encouraged disclosure of personal
information. Because sharing one’s personal story tends
to increase a feeling of intimacy between individuals,
visual anonymity encourages other members of a discussion group to reciprocate. Trusting behavior during
communication by computer is affected by perceived
group membership. When subjects communicated with a
partner perceived to be a member of their social group,
trusting behavior was more likely (Tanis & Postmes,
2005). Lack of personal information about their partner
did not inhibit trusting behavior as long as the partner
belonged to the subject’s social group in that study.
Another way that the sense of anonymity is probably
greater in telephone compared to face-to-face communication is that participants might come from geographically
distant locations, making it unlikely they would meet by
chance. Anonymity of this type is less well assured in
face-to-face focus groups because participants typically
live in the same geographic area and might even receive
health care at the same clinic. Telephone communication
also removes visual distractions that would be present in
face-to-face focus groups. When reflective thought is
interrupted by loud noise, visual images, or performance
of a competing task, introspection and self-awareness are
reduced. Removal of distractions promotes more frequent and more accurate disclosures of personal
information (Joinson, 2001).
A limitation of telephone focus groups is that discourse analysis could be more challenging because body
language supplementing verbal communication cannot
be evaluated (Starks & Trinidad, 2007). There are some
limitations in the applicability to the present study of
research that has used computer-mediated communication to investigate the Social Identity Model of
Deindividuation Effects (Joinson, 2001; Lea et al., 2007;
Tanis & Postmes, 2005). This is because social processes
in groups of four to eight individuals might differ in
some ways from social processes in pairs of study subjects. In focus groups, a moderator is present to promote
an atmosphere of trust and support and to help stimulate

conversation about the research topics. Telephone communication is different than computer-mediated communication;
anonymity is less complete in telephone communication
because voices have identifying characteristics.

Conclusions
Telephone focus groups can foster interpersonal conversations among participants and generate content analysis
results that are similar to those generated in face-to-face
focus groups. Offering a telephone option is a promising method for increasing access to participation in
focus group research among individuals who live in
rural areas. Participants from geographically distant
sites can join the same focus group, and groups of adequate size can be formed to study individuals with
relatively uncommon disorders such as cervical or ovarian cancer. Telephone focus groups are more convenient
for some participants, such as those who are well enough
to hold a telephone conversation but feel too ill to travel
to the research center. Telephone methods might be
especially well suited for studying sensitive personal
experiences.
Declaration of Conflicting Interests
The authors declared no conflicts of interest with respect to the
authorship and/or publication of this article.

Funding
The authors declared receipt of the following financial support
for the research and/or authorship of this article: Funding for
this project was provided by grant # 5R03CA110911-02 from
the National Cancer Institute.

References
Appleton, S., Fry, A., Rees, G., Rush, R., & Cull, A. (2000).
Psychosocial effects of living with an increased risk of
breast cancer: An exploratory study using telephone focus
groups. Psycho-Oncology, 9, 511-521.
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.
Barg, F. K., Cronholm, P. F., Straton, J. B., Keddem, S., Knott, K.,
Grater, J., et al. (2007). Unmet psychosocial needs of
Pennsylvanians with cancer: 1986-2005. Cancer, 110,
631-639.
Breitkopf, C. R. (2004). The theoretical basis of stigma as
applied to genital herpes. Herpes, 11, 4-7.
Brondani, M. A., MacEntee, M. I., Bryant, S. R., & O’Neill, B.
(2008). Using written vignettes in focus groups among older
adults to discuss oral health as a sensitive topic. Qualitative
Health Research, 18, 1145-1153.
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, G., Linn, E.,
Bonomi, A., et al. (1993). The Functional Assessment of

10
Cancer Therapy scale: Development and validation of the
general measure. Journal of Clinical Oncology, 11, 570-579.
Cooper, C. P., Jorgensen, C. M., & Merritt, T. L. (2003).
Report from the CDC. Telephone focus groups: An emerging method in public health research. Journal of Women’s
Health, 12, 945-951.
Crabtree, B. F., & Miller, W. L., (Eds.), (1999). Doing qualitative research (2nd ed.). Thousand Oaks, CA: Sage.
Creswell, J. W., & Plano Clark, V. L. (2007). Designing and
conducting mixed methods research. Thousand Oaks, CA:
Sage.
Culley, L., & Hudson, N. (2007). Using focus groups with
minority and ethnic communities: Researching infertility
in British South Asian communities. Qualitative Health
Research, 17, 102-112.
de Boer, A. G., Taskila, T., Ojajarvi, A., van Dijk, F. J., &
Verbeek, J. H. (2009). Cancer survivors and unemployment:
A meta-analysis and meta-regression. Journal of the American Medical Association, 301, 753-762.
Elo, S., & Kyngas, H. (2008). The qualitative content analysis
process. Journal of Advanced Nursing, 62, 107-115.
The Family and Medical Leave Act of 1993, 29 U. S. C. §2601
et seq. Retrieved October 5, 2009, from http://www.dol.gov/
whd/regs/statutes/fmla.htm#content
Feuerstein, M. (2005). Cancer survivorship and work. Journal
of Occupational Rehabilitation, 15, 1-2.
Frazier, L. M., Miller, V. A., Horbelt, D. V., Delmore, J. E.,
Miller, B. E., & Averett, E. P. (2009). Employment and quality of survivorship among women with cancer: Domains not
captured by quality of life instruments. Cancer Control, 16,
57-65.
Frazier, L. M., Miller, V. A., Miller, B. E., Horbelt, D. V.,
Delmore, J. E., & Ahlers-Schmidt, C. R. (2009). Cancerrelated tasks involving employment: Opportunities for clinical assistance. Journal of Supportive Oncology, 7, 229-236.
Griffiths, K. M., Nakane, Y., Christensen, H., Yoshioka, K.,
Jorm, A. F., & Nakane, H. (2006). Stigma in response to
mental disorders: A comparison of Australia and Japan.
BMC Psychiatry, 6, 23, doi:10.1186/1471-244X-6-21.
Hewitt, M., Greenfield, S., & Stovall, E. (Eds.). (2006). From
cancer patient to cancer survivor—Lost in transition
(pp. 13, 345, 363-433). Washington, DC: National Academies Press.
Horowitz, A. M., Siriphant, P., Canto, M. T., & Child, W. L.
(2002). Maryland dental hygienists’ views of oral cancer
prevention and early detection. Journal of Dental Hygiene,
76, 186-191.
Jacobsen, P. B. (2009). Promoting evidence-based psychosocial
care for cancer patients. Psycho-Oncology, 18, 6-13.
Joinson, A. N. (2001). Self-disclosure in computer-mediated
communication: The role of self-awareness and visual
anonymity. European Journal of Social Psychology, 31,
177-192.

Qualitative Health Research XX(X)
Kinzie, M. B. (2005). Instructional design strategies for health
behavior change. Patient Education and Counseling, 56,
3-15.
Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks,
CA: Sage.
Lea, M., Spears, R., & Watt, S. E. (2007). Visibility and anonymity effects on attraction and group cohesiveness. European Journal of Social Psychology, 37, 761-773.
Lopez, K. A., & Willis, D. G. (2004). Descriptive versus interpretive phenomenology: Their contributions to nursing
knowledge. Qualitative Health Research, 14, 726-735.
Rogers, L. Q., Matevey, C., Hopkins-Price, P., Shah, P.,
Dunnington, G., & Courneya, K. S. (2004). Exploring social
cognitive theory constructs for promoting exercise among
breast cancer patients. Cancer Nursing, 27, 462-473.
Starks, H., & Trinidad, S. B. (2007). Choose your method:
A comparison of phenomenology, discourse analysis,
and grounded theory. Qualitative Health Research, 17,
1372-1380.
Steiner, J. F., Cavender, T. A., Main, D. S., & Bradley, C. J.
(2004). Assessing the impact of cancer on work outcomes:
What are the research needs? Cancer, 101, 1703-1711.
Steiner, J. F., Cavender, T. A., Nowels, C. T., Beaty, B. L.,
Bradley, C. J., Fairclough, D. L., et al. (2008). The impact
of physical and psychosocial factors on work characteristics
after cancer. Psycho-Oncology, 17, 138-147.
Stewart, D. E., Cheung, A. M., Duff, S., Wong, F., McQuestion,
M., Cheng, T., et al. (2001). Long-term breast cancer survivors:
Confidentiality, disclosure, effects on work and insurance.
Psycho-Oncology, 10, 259-263.
Tanis, M., & Postmes, T. (2005). A social identity approach to
trust: Interpersonal perception, group membership and trusting behavior. European Journal of Social Psychology, 35,
413-424.
Taskila, T., & Lindbohm, M. L. (2007). Factors affecting cancer
survivors’ employment and work ability. Acta Oncologica,
46, 446-451.

Bios
Linda M. Frazier, MD, MPH, is a professor of obstetrics and
gynecology at the University of Kansas School of Medicine–
Wichita, Wichita, Kansas, USA.
Virginia A. Miller, MS, is a senior research associate in the
Department of Obstetrics and Gynecology, University of
Kansas School of Medicine–Wichita, Wichita, Kansas, USA.
Douglas V. Horbelt, MD, is a gynecologic oncologist and professor and chair of the Department of Obstetrics and Gynecology,
University of Kansas School of Medicine–Wichita, Wichita,
Kansas, USA.

Frazier et al.
James E. Delmore, MD, is a gynecologic oncologist and a professor of obstetrics and gynecology, University of Kansas
School of Medicine–Wichita, Wichita, Kansas, USA.
Brigitte E. Miller, MD, is a professor of obstetrics and gynecology and section head of Gynecologic Oncology at the
Comprehensive Cancer Center at Wake Forest University,
Winston-Salem, North Carolina, USA.

11
Angelia M. Paschal, MEd, PhD, is a medical sociologist and an
assistant professor in the Department of Preventive Medicine
and Public Health at the University of Kansas School of
Medicine–Wichita, Wichita, Kansas.

THE USE OF TELEPHONE FOCUS GROUPS FOR EVALUATION
Rosalind Hurworth
Rosalind Hurworth
[email protected]
Centre for Program Evaluation, University of Melbourne
Paper presented at the Australasian Evaluation Society 2004 International
Conference, 13-15 October-Adelaide, South Australia www.aes.asn.au
Abstract
Similar to most evaluators, I had only ever used face-to-face focus groups in a variety of
evaluations that ranged from needs assessments to impact evaluations. Then in 1995 I
needed to talk to people who were unlikely to come to a centre. I decided to try focus
groups using teleconferencing and was amazed at the quality of the data. Since then I
have used the technique many times. This paper examines the technique in detail
including how to organise such groups, how the interviewer has to adapt moderation, and
the advantages and limitations of the approach. Throughout the paper, comparisons with
face-to-face groups are raised.
Introduction
For many years I had carried out face-to-face focus groups as a common evaluation
technique. Projects had ranged from finding out the training needs of dieticians to
ascertaining how parents select schools for their children, and from evaluating a course to
talking to chefs about the use of pork. To be able to do this I had followed the ideas and
procedures suggested by authors on the subject such as Morgan and Krueger (1996).
The use of the telephone to carry out such groups had never occurred to me until 1995
when I was asked to lead a statewide needs assessment of the education needs of the over
60s. Funders were keen for me to talk to all kinds of older adults, both those who were
undertaking education programs and those who were not. They felt sure I would be able
to recruit and run groups with those who were engaged in learning, such as those in the
University of the Third Age, the School for Seniors or the Council of Adult Education.
However, they felt certain that I would be unable to arrange the ‘hard to get to’ groups
such as the frail, carers or those who live in Housing Commission flats. In response to
their cynicism, I dug my heels in and vowed that I would try to get such people involved.
The focus group literature of the time had little or nothing about use of the telephone to
cope with such challenges (except for half a page presented by Stewart & Shamdasarni,
1

1990:60 and Krueger, 1994:221). Fortuitously, I happened to meet the manager of the
Wesley Mission ‘Do Care Buddy’ program; a telephone link up program for older people,
that is mainly used for social contact. I told her of my need and she said; ‘I can arrange
link ups for you. How about one group down the Eastern suburbs of Melbourne and one
down the West? And I can get you people who are on educational programs and others
who are not, as we run all kinds of educational activity down the phone (such as German,
a telephone choir and the history of Collins St!). Interviews were arranged for the
following Saturday evening and Sunday morning and I ran them from home with a notetaker on the upstairs line and me leading the interview downstairs. Amongst the
interviewees was an 86 year old woman who had been the chief archivist of the ABC in
the 1930s and extremely mentally alert (although now very frail), and an 84 year old man
who kept the rest of the group amused with frequent jokes. At the end of the interviews
they all said that it had been “fantastic to have an intellectual discussion from our
homes.” and I felt that it had enabled the acquisition of an excellent set of data.
After the project I returned once more to face-to-face interviews until another evaluation
arose involving the (then) Overseas Services Bureau. They were quite happy with the
procedures for sending out volunteers to work overseas but were dissatisfied with coming
home procedures. They wanted me to talk to groups of returned volunteers about how to
improve the procedures for returning to Australia. They began negotiating logistics such
as where interviews would be held around the country and about when I would be free to
travel. At this point I called a halt to proceedings and suggested, that instead of expensive
plane fares, hotel accommodation and the prospect of trying to lure people into major
centres it would be much simpler to hold telephone groups. They were pleased at this
more economic and easier solution. Consequently, one Wednesday evening, for example,
I found myself talking to an engineer in Darwin, a weaver from New South Wales, a
teacher in Hobart and a farmer on a remote farm in Queensland. Once again the interview
series proved most successful.
By this time I decided that this form of focus group was to be favoured for certain
populations, especially when it was difficult to get people to come to an interviewing
centre. So other examples where I have decided to use this approach have been:
• with bank managers across Australia to discuss how to improve staff training. Such
busy people are extremely difficult to synchronise at a central venue so I asked the Bank
what would be a good time to catch such staff by phone. They replied that the best time
would be at the end of the working day. Armed with that advice I found it was no
problem to obtain groups who would sink into their office chairs and talk for an hour on
their office phones from 5-6pm. At the same time this and the previous example had
confirmed Krueger’s observation that; “the telephone focus group offers the advantage of
allowing participants to interact over distances at a fraction of the cost of transporting
the same people to a central location.” (1994:221)
• with the new Hospital-in-the Home nurses about how their role has evolved and what
training was needed. Only a few of these nurses exist around the State and some work in
rural areas. While it would have been easy just to talk to groups of metropolitan nurses, it

2

seemed important to include nurses right across the State and so phone groups were set
up.
• with those suffering from lymphoedema to discuss Statewide services. Once again it
was important to organise interviews about this condition across both rural and
metropolitan areas and phone interviews were the best way to achieve this.
A Surprising Lack of Associated Literature
So what are the major features of this technique? And what seem to be to the advantages
and disadvantages of using telephone focus groupsz? Surprisingly, very little has been
written to answer these questions. For instance, Cooper et al. (2003) recently searched the
medical and social science literature in seven databases to find what researchers have to
say about employing telephone focus groups. They found only thirteen studies had been
reported and twelve of these concerned health projects. And amongst the thirteen studies,
only five had used telephone focus groups as the major/sole way to collect data (Appleton
et al 2000a, 2000b, MacMahon & Patton, 2000, Ruef, 1997, Ruef & Turnbull, 2001,
White et al. 1994, White and Thomson, 1995, Wright et al., 2002) However, none of
these addressed any methodological issues to any extent except to say that the technique
is useful to overcome geographical remoteness.
So how are such groups organised and run, what advantages do they provide, what are
their limitations and are these limitations justified? The remainder of this paper attempts
to answer some of these questions.
Organisation of Interviews
Telephone focus groups can be conducted at various levels of sophistication. At a basic
level they can be run in the same way as a simple conference call (and this is how I run
them). For these, any ordinary telephone, cordless phone or speakerphone can be used.
However, it is possible to use more sophisticated equipment where it is possible to have a
console with lights, name tags to identify those speaking, special switching devices that
only allow one person to speak at a time and a device to measure how long people have
spoken for. Thus the moderator is able to draw out quiet participants just as in a more
typical group. Unfortunately, such devices cost thousands of dollars and are out of the
price range for most research projects.
Once one has recruited (as for normal focus groups) and sent a confirmation letter, it is
quite simple to organise the conference type call. I always use Telstra ‘Conferlink’. With
at least 24 hours notice the telephone company is provided with the names and numbers
of those to be interviewed as well as the number of the interviewer and note taker. Other
information to be provided includes the organization or number where the bill will be
sent, whether the interview is to be taped and, if so, the address to where the tape should
be sent.

3

Next the participant is given a reminder call the day before the session. Then at the time
of interview the telephone conference organiser rings the interviewer first and asks
whether everything is ready because they have already linked up all interviewees. At this
point they also tell the interviewer whether everyone is on the line or not and, if not, keep
trying the missing person/people while the interview is in progress. They then take a roll
call, give a number to ring and conference call number in case there are any technical
problems, tell the participants that the discussion will be taped and then asks the
interviewer to go ahead.
I, as the interviewer, always introduce myself and also tell people that there is a notetaker, on the line, who is then introduced. This avoids potential ethical problems. I also
repeat that the interview will be taped and that the only people to listen to the tape will be
the interviewer or note-taker, who, of course, will have heard it all already! If there are
more than four people I also ask for people to say their name each time before speaking.
While this may sound cumbersome, I have found that people are excellent at fulfilling
this request.
At the end of questioning I often let the interviewees have ten minutes free conversation.
This allows them to discuss anything of interest that has cropped up during the interview.
For instance, in the lymphoedema interviews many people gave names and addresses
associated with local support groups or where to buy special support garments. Then
quite often, if members of groups know each other it also allows them to catch up on
news and family matters. This happened with the bankers who had often trained or
worked together but had then been posted to opposite sides of the country.
Once the interview is over, I then tell interviewees that the notetaker and I are to stay on
line longer to organise ensuing groups. This allows the pair to debrief and to consider
some of the major ideas that might have emerged during the conversation.
Meanwhile, the telephone company look after the tape. It is labelled with date, time and
name of project and sent in an express bag that is delivered to the transcriber within the
next 24 hours. In the course of many interviews over ten years I have never yet had a tape
go astray.
Other things to think about include:
• Only recruit four to six people for an interview. This is smaller than for a face-to-face
interview but seems to work well (Krueger &Casey, 2002:2). Quite often you can
recognise that number of voices quite quickly and this may negate the need for people to
announce their names each time they speak.
• Thinking of ways to respond such as; ‘That’s interesting’, ‘Thank you for that’ and so
on as there is no way to show your interest by body language, such as nodding, that is
used in face-to-face groups.
Advantages of the Telephone Focus Group

4

I have found telephone groups to be advantageous in many ways:
• They can provide “the richness of group interaction desired with people who cannot be
easily brought together face-to face” (Silverman, 1994). This occurs because of:
-wide geographical dispersal
This is the most common reason for using telephone focus groups. For example, they
were used for contacting hospital-in-the home nurses across Victoria (Hurworth, 1996)
and in discussions with school counsellors across Queensland (McMahon & Patton,
2000).
Others not likely to come to a centre are those who are:
-hard to recruit because of busy schedules (e.g. GPs, high level executives)
-ill or housebound (Hurworth, 1995)
-‘rare on the ground’ e.g. state emergency managers, those with less common
medical conditions (Hurworth, 2004)
• They offer an increased level of anonymity. With this in mind, White and Thomson
(1995) thought that an investigation into physicians’ relationships with patients would be
easier by phone. Similarly, in relation to doctors, Silverman described how:
Physicians have a lonely job. They operate under conditions of information
overload, high expectations and extreme ambiguity and uncertainty. They want to
but can’t discuss their mistakes, knowledge gaps and doubts so that they can
learn from each other. They need to ‘let their hair down’ with their peers but
can’t afford to do so with people in their immediate area. During telephone focus
groups, we discovered that physicians are willing even to discuss how they have
killed people by using inappropriately high dosages of medications, how they
have treated patients incorrectly and, how they cut corners from accepted
practice and where they are uncomfortable with gaps in their knowledge.
(Silverman, 1994:6)
• For the interviewee and interviewer there is no need to travel to a central venue. This
means there is no need for any party to move from the office, place of work or home.
This in turn results in:
-no expensive travel
-no expense in relation to venue hire
-no need for refreshments
-no need to ‘dress up’ for the occasion (in fact I have carried out interviews from
home in dressing gown and slippers!)
I have also found that not needing to move means that many interviews can be held out of
the usual 9-5 work hours. For example, I have held many interviews at 6 or 8 o’clock on
a Saturday evening or 10 o’clock on a Sunday morning. While most people would baulk

5

at those times to go out for an interview, they are quite willing to give up an hour to talk
at those sorts of times if they do not have to move from home. Furthermore, because of
convenience and ease, the acceptance rates to participate tend to be higher and the
eventual participation rate is high. (Face-to-face interviews are notorious for people
saying they will be there and then not showing up).
• The work tends to be completed more quickly i.e. it seems to be quite easy to carry out
a number of groups over a few days while this would be more difficult and exhausting if
run face-to-face.
• They are held in a more natural way . People are used to talking on the phone every day
whereas bringing them to a venue creates an unnatural event
• They are easier to control than face-to-face groups
• If negotiated (and you tell participants for ethical reasons) you can allow the
commissioner(s) of the focus groups to listen in to the conversations to hear what people
are saying. This is the auditory equivalent to market researchers using a two-way mirror
to observe interviews.
• There is less necessity to pay interviewees. People talking for an hour on their home or
office phones are less likely to expect payment. Meanwhile those who come in for
interviews these days expect to receive at least their ‘out-of-pocket’ expenses , if not
more, for the inconvenience of time taken to travel and take part at a central venue.
As a result of such savings telephone groups tend to be considerably cheaper to run than
face-to-face groups and therefore are most cost-effective. It also means that you can
conduct them in as many locations as there are participants. So, if you have five
respondents they can come from five different towns, states or even countries.
Quality of Data
• With tapes recorded on the best equipment available to the telephone company this
often means that the sound quality is often better than the original phone call
• I have found the quality and amount of data to be as good as, if not better than, the faceto-face interview. This has been confirmed by others who have reported that telephone
focus groups “have been shown to be uncannily accurate in identifying and defining the
most important opinions, attitudes, concerns and priorities of stakeholder groups.”
(GuideStar Communications, 2003:1). One reason is because there can be a greater
degree of openness due to anonymity in the interviews, especially where people have
never met one another. This allows people to be emotional and personal because the lack
of visual contact, together with the ordinariness of telephone conversation creates a kind
of psychological distance and (therefore) safety. Therefore they are also ideal for dealing
with more sensitive or difficult topics.

6

As Silverman concurs:
Telephone groups are ideal to create safety for sensitive topics. In some ways they
are better then individual interviews because of the group support effect ..
The openness of people in telephone groups is legendary… The pull to
participate, extraordinary. It is hard to sit on the phone without talking…People
have compared the same groups of teenagers on the phone versus face-to-face
focus groups and have found that the teenagers were much more comfortable
talking on the phone. The production was much higher, gender groups could be
mixed and phone groups were superior. (Silverman, 2003:4)
Another reason for good quality information is that, unlike the face-to-face interview,
there is not the same tendency to talk over the top of one another. On telephones people
are much more likely to talk one at a time and to feel that whoever is talking is talking to
them personally. Thus on telephones no fragmentary, side conversations are possible and
conversation is not ‘lost’ as can happen in the face-to-face group when several people are
talking at once.
Arguments Against Perceived Limitations
The Method is Not Widely Accepted
While face-to-face focus groups are almost totally recognised as an evaluation tool,
telephone groups have yet to be widely accepted. Clients often have not heard about, or
considered them and so are usually sceptical –that is, until they have tried them! Then
they are ‘sold on the idea’!
Discussion May Be Less Spontaneous
Krueger (1994) suggests that the use of a telephone stifles discussion and that therefore
there is a lack of the spontaneity and creativity found in face-to-face groups. I have never
found this—in fact it is usually the case that you have to curtail conversations rather than
having to push them along and very rich conversation can occur.
There is No Possibility of Seeing Body Language
Some writers criticise the approach because you can’t see people’s body language or
facial expressions (Krueger & Casey, 2002). They feel that such non-verbal
communication can be critical for determining when further questions or probing is
needed but I would respond to this by saying a) that in most evaluative work we are
looking for factual information, b) that the voice anyway can convey a wide range of
emotion and other messages through sarcasm, sighing, laughing, emphasis, types of
inflection, speed of speech, hesitancy, speaking calmy or angrily and so on, c) people on
a phone have to verbalise what in face-to-face interview may merely be a nod of the
head. Finally, as Silverman (1994) points out; “If this is the only way to get participants,
the lack of the visual is not a high price to pay”.

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It’s Harder for the Moderators to Control the Group
Researchers such as Stewart and Shamdasani (1990) claim that the moderator’s role is
made harder because it is more difficult to control participants, to quiet dominant
speakers and to recognise less active group members. I have never found it any more
difficult to run than the face-to-face interview. In fact people are extremely polite and
good at turn-taking.
The Moderator Needs to Have Particular Qualities
While the face-to-face interviewer needs to have strong interpersonal and group process
skills the telephone interviewer who cannot be seen, has to have extra ability in
projecting friendliness, naturalness and informality and in being able to fill any ‘gaps’.
Consequently, Krueger and Casey (2002: 5) point out that one of the major challenges for
the telephone moderator is to keep the conversation moving along and so, during long
pauses, will need to say: ‘I’d like to hear more comments about this’ or ‘Perhaps there is
more that could be added here.’
Claims that There is no Possibility of Using Stimuli
Some suggest that the use of photos, cartoons, pictures etc, which help to stimulate some
kinds of focus group interview, cannot be used during phone focus groups. However, I
have sometimes mailed or faxed out material in advance or have material ready on the
Web for people to access from computers near their phones.
Conclusion
Technology in its various forms is making an impact on evaluation. One way is through
teleconference focus groups. They can: expand the pool of participants so that those
dispersed geographically or are otherwise difficult to reach can take part; allow greater
flexibility in scheduling; increase anonymity thereby encouraging the discussion of
sensitive topics; and be cheaper to run than traditionally run groups.
In addition, there has been a long-term belief that, due to the lack of visual cues,
telephone groups can only be second best. From what I have experienced, I can only
corroborate Silverman’s conclusions (1994:15, 18) that; “it is precisely the lack of the
visual element which creates the conditions that allow telephone focus groups to be
better than face-to-face ones” and as a consequence it is possible that “most focus groups
will be conducted that way in the future”.
References
Appleton, A. et al. (2000a) Living with an Increased Risk of Breast Cancer: An
Exploratory Study Using Telephone Focus Groups. Psycho-Oncology 9, 4, 361.
Appleton, A. et al. (2000b) Psychological Effects of Living with an Increased Risk of
Breast Cancer: An Explanatory Study Using Telephone Focus Groups. Psycho-Oncology
9, 4, 511.

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Cooper, C. P., Jorgensen, P.H. & Merritt, T.L. (2003) Telephone Focus Groups: An
Emerging Method in Public Health Research. Journal of Women’s Health, 12, 10, 945951.
GuideStar Communications (2003) Telephone Focus Groups-Qualitative ‘Pulse’
Research. http://www.guidestarco.com/Telephone-focus-groups.htm
Hurworth, R. (1995) Living Longer, Learning Later. Report for the Adult, Community
and Further Education Board. Melbourne: ACFE.
Hurworth, R. (1996) Hospital-in-the-Home Nurses: Roles Revealed and Reviewed.
Melbourne: Centre for Program Evaluation, University of Melbourne.
Krueger, R. (1994) Focus Groups. Thousand Oaks, Ca: Sage.
Krueger, R. & Casey, M.A. (2002) Focus Group Interviewing on the Telephone.
http://www.tc.umn.edu~rkrueger/focus_tfg..html
McMahon, M. & Patton, W. (2000) Conversations on Clinical Supervision: Benefits
Perceived by School Counsellors. British Journal of Guidance Counseling, 4, 71.
Morgan, D & Krueger, R. (1996) The Focus Group Kit. Thousand Oaks, Ca: Sage
Ruef, M.B. (1997) The Perspectives of Six Stakeholder Groups in the Challenging
Behavior of Individuals with Mental Retardation and/or Autism. PhD Dissertation.
Lawrence, KS: University of Kansas.
Ruef, M.B. & Turnbull, A.P. (2001) Stakeholder Opinions on Accessible Informational
Products Helpful in Building Positive, Practical Solutions to Behavioural Challenges of
Individuals with Mental Retardation and/or Autism. Education and Training in Mental
Retardation and Developmental Disabilities, 36, 145.
Silverman, G. (1994) Introduction to Telephone Focus Groups.
http://www.mnav.com/phonefoc.htm
Silverman, G. (2003) Face-to-Face vs. Telephone vs. Online Focus Groups. Market
Navigation Inc: http://www.mnav.com/onlinetablesort.htm
Simon, M. (1988) Focus Groups by Phone: Better Ways to Research Health Care.
Marketing News, 22, 47
Stewart, D. & Shamdasani, P. (1990) Focus Groups. Newbury Park, Ca: Sage.
White, G.E., Coverdale, J.A. & Thomson, A.N.(1994) Can One Be a Good Doctor and
Have a Sexual Relationship with One’s Patients? Family Practice, 11, 389.

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White, G.E & Thomson, A.N. (1995) Anonymised Focus Groups as a Health Tool for
Health Professionals. Qualitative Health Research, 5, 256.
Wright, E.P. et al. (2002) Social Problems in Oncology. British Journal of Cancer, 87:
1009

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Computer Assisted Telephone (CAT) Focus Groups1
Telephone focus groups have been in use for over 35 years, and have been enhanced by computer
technology invented in the late 1980s. Organizations are increasingly finding them valuable for reaching
people from all over the U.S., going beyond the usual less-than-a-handful of major markets to represent
many locations and kinds of participants that could not otherwise be considered. This is especially useful
where participants are geographically dispersed, relatively rare, reluctant or unable to travel to a central
facility, or in need of anonymity.
People can participate from the comfort of their home, office, or other private place where they have access
to a phone. This permits equal ease across locations. Participants may also feel more candid than in faceto-face groups because there is less opportunity for facial “intimidation.” All are equal on the phone. There
is less distraction, less silence, less formality and posturing, and a greater sense of privacy.
Everyone can hear everyone else clearly. Interaction starts fast and is often more natural and intense than in
face-to-face groups. The fact that participants cannot see each other is not unusual or problematic. People
use the phone to communicate all the time. Participants use complete sentences and nonverbal remarks,
like “uh-huh” to substitute for the nonverbal head nods. They are encouraged to “chorus” their agreement
or disagreement. Pauses become more obvious and meaningful. Many other auditory cues supplement the
conversation, such as participants using their name each time they speak (which also improves transcript
quality).
The computer technology provides several unique advantages. While participants are on their own
telephone the moderator can identify who is talking -- on a computer screen. Observers can call in from
anywhere to listen without being heard and can pass notes to the moderator by using their telephone
touchpad or on-line chat to contact a technical assistant; the notes appear unobtrusively on the moderator’s
computer screen without interrupting the group. Removal of the (rare) disruptive participant is quick,
simple, and invisible to other participants.
Compared to face-to-face focus groups, CAT focus groups are more representative, faster and easier to
recruit, and faster to set up. They eliminate the costs, time, and inconvenience of travel for client observers
as well as for participants. They permit involvement by a greater number and variety of participants and
observers (such as executives and implementers). They can also provide greater depth of response and
flexibility of research designs (e.g., mixing participants in a group who might not be feasible or desirable
to mix in person).
1For further detail, see: Balch, G.I. (2005). C.A.T. (Computer-Assisted Telephone) focus groups: better, faster, cheaper, Social Marketing

Quarterly, 7, 4, 38-40; Cooper C.P., Jorgensen, C.M., & Merritt, T.L. (2003). Report from the CDC, telephone focus groups: An emerging method
in public health research. Journal of Women's Health, 12(10): 945-951; Hurwith, R. (2004); Telephone focus groups (1994). Social Research
Update, 4, Winter: ; Silverman, G. (1994). Introduction to Telephone Focus Groups.
.

George I. Balch, Ph.D.
Principal
BALCH ASSOCIATES
[email protected]
(708) 383-5570