Thanks to Sophie Chalmers for sharing these insights and resources with us.
During a recent #ReSNetSLT tweet chat on Patient and Public Involvement (PPI) in research, a question was raised about how PPI can be conducted. Although the tweetchat was specifically focused around PPI in research, PPI can also be used to inform service provision and delivery.
I shared some information about a locally run focus group for patient and public engagement to inform our speech and language therapy service development priorities in terms of the delivery of patient services. I thought I would share the successes and challenges of running a focus group in a clinical setting to help other clinicians.
The aim: To examine the positive and negative experiences of patients that have used a variety of speech and language therapy services in order to improve future service provision and delivery.
Methods: ‘We’ (the SLT team) decided to run one focus group to ‘test the water’. This was the first focus group the SLT team had run therefore it was in actual fact a ‘pilot’ and in doing so mistakes were going to be made and lessons learned.
- We decided to include a range of patient aetiologies
- from across the SLT service (voice, head and neck, neuro, stroke).
- Random patient selection from the caseload (random number generation) and check with their known SLT whether they would be suitable to attend and participate using the criteria below.
- We created a topic guide of broad questions and then specific prompts to further facilitate the discussion
- We ran a 30-45 minute focus group discussion to account for any fatigue of our patients.
- A SLT led the session; 2 SLTs/assists made details online notes ensuring inter-rater reliability with recording.
- The session was not audio recorded as appropriate IT systems for confidentiality could not be established
- All patient details were made anonymous
Communication strategies:
We enabled access to whiteboards for patients to write or SLTs to write key terms/words, alphabet charts, picture boards, written group ground rules, 1:1 support for patients who required maximal communication support, gesture, time. Other focus group members were helping others with communication strategies and were supportive towards each other throughout.
Additional tools that could have been used: talking mats, ipad with internet for searching, carer involvement.
Criteria for attendance:
- Cognitively able to participate in a group conversation
- Independently mobile or has carer support to facilitate (as limited staff competency to assist mobility and toileting requirements)
- Able to travel to location (SLT office/clinic location)
- Have adequate comprehension to participate in a group conversation
- To be able to communicate to participate in a group conversation (verbal/written/gestural/total communication/pictorial/AAC etc)
- Mental wellbeing enables participation
Analysis and interpretation: We gathered all the notes written by the SLT and SLT assistants during the session and analysed these by
1. Reading the data
2. Identifying broad themes
3. Developing subthemes
4. Charting themes
5. Interpreting prominent themes
Plan to disseminate findings: This was the biggest challenge in my opinion. In reality some projects can lose direction and drive, and without a clear plan to disseminate findings this is in some ways what happened. Key themes were based around group therapy vs 1:1 therapy, consistency of delivery approaches across the aetiologies, links between SLT discharge and broader / charity services and support. In hindsight, we required focused thought towards the following:
- Who was our audience? Internal SLT team, the wider MDT, stakeholders?
- What did we want to share? Our service priorities, what patients wanted from our service, what patients described as a successful service?
- When and where to communicate findings? Where will the audience be and when are they going to be receptive?
- What method can we share findings? Poster, presentation, write up, email, newsletter?
Additional considerations: On reflection I asked myself what would be benefits or drawbacks of grouping patients by medical aetiology or SLT diagnosis, or neither. I considered what was the impact of the location; were we excluding some patients because of difficulties travelling to the location? How could we incorporate carers perspective of service delivery? How could we make sure that a dissemination plan was successful?
These questions I certainly do not have answers to myself and I hope that demonstrates that I am giving my personal clinical experiences of running a focus group and by no means have all the answers. I hope my sharing these experiences we can learn from each other.
Resources:
Running Focus Groups for Patient and Public Engagement – NHS England
Using Patient Feedback – Picker Institute