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writing the results of qualitative research is a very different experience from writing quantitative research findings. In part, this is because of the nature of the data being reported (textual not numerical data) and also the different role that writing plays in qualitative research. Writing the results of qualitative research is much more than simply presenting the outcomes of data analysis; it is a component of analysis itself.
Writing the study findings also leads to the final outcome of the research. This aspect of writing is the focus of this chapter. In writing the study findings consider the key messages of the study, the intended audience, and the most effective way to present the study findings. This requires presentation strategies that reflect the nature of the qualitative evidence and also effectively interpret this research evidence. Effectively presenting textual data and demonstrating valid interpretations of the data can be challenging. It can also be difficult to present qualitative research findings in a concise, coherent, and compelling way and still maintain the character and complexity of the data. As with Chapter 3, the focus of this chapter is on writing results for academic audiences; however, the guidance can also be applied to writing for other audiences.
This chapter begins with a description of some of the challenges in writing qualitative study results, highlighting particular issues in reporting focus group data. This is followed by guidance
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on different aspects to consider when writing focus group results. These include the importance of structure and presenting a coherent argument, the use of quotations, and how to present interaction found in focus group data. Visual presentation strategies are described and how to reflect context throughout the study findings. A key aspect of writing focus group results is demonstrating that the issues reported are "grounded," or well evidenced by data, and strategies for grounding the findings are described. Finally, focus group study findings are often presented as part of mixed methods research; therefore, guidance for the presentation of mixed methods study results is provided. Several common pitfalls in writing focus group results are highlighted throughout the chapter with suggestions to overcome these pitfalls.
Challenges in Writing Focus Group Results
The overall purpose of the results section is to present the study findings in a clear and compelling way in response to the research objectives. In this way writing the results of qualitative research is similar to reporting quantitative research. However, qualitative research and focus group discussions in particular generate a different type of evidence to quantitative studies, which present different writing challenges. Writing the results of focus group research shares many of the challenges of writing qualitative results in general, yet the group nature of data collection provides additional opportunities for presentation of results. Reporting focus group data also needs to respect the tradition in which data were collected and capitalize on the strengths of this approach. Focus group data offer the opportunity to identify variation, explain nuances, and present a group narrative, all of which can be exploited in writing the results. Writing study results can seem challenging at first, but can also become one of the most rewarding aspects of the research process. Some of the challenges in reporting focus group results are highlighted next and reflected throughout this chapter.
Writing as Data Analysis
One of the initial challenges in writing focus group results stems from understanding the circular process of writing as a component of data analysis. In qualitative research writing the study results
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is an integral part of data analysis and not simply a final task of "writing up" the study findings. Wolcott (2001, p. 22) states that in qualitative research "writing is thinking... [or] one form that thinking can take." Writing the results of qualitative research is actually a circular process whereby one begins to identify the study findings and the core messages from the study, which inevitably generates further questions about the data, identifies clarifications needed, or gaps in the emerging study findings, and this leads back to the data for further analysis to refine the study findings. This process may be repeated multiple times creating a circular process between writing, further analysis, and back to writing, each time gaining a clearer understanding of the research issues and how to effectively report these. In this way, "the act of writing is a rich and analytic process as you find yourself not only attempting to explain and justify your ideas but also developing them" (Rapley, 2011, p. 286). Coffey and Atkinson (1996, p. 109, cited in Ritchie & Lewis, 2003, p. 288) describe this circular process; they state that "writing and representing is a vital way of thinking about one's data. Writing makes us think about data in new and different ways. Thinking about how to represent our data forces us to think about the meanings and understandings, voices and experiences present in the data. As such writing actually deepens our level of analytic endeavor. Analytical ideas are developed and tried out in the process of writing and representing." Therefore, writing the study results is another analytic tool to further interpret, refine, and conceptualize data, and is thus conducted simultaneously with further exploration of data. This circular process can seem confusing for those more familiar with the linear approach of research whereby data analysis and writing the results are seen as separate consecutive tasks. Understanding the integration of writing and data analysis is an important first step to writing the results of focus group research. Of course, writing also produces the final product of the research, and is an outcome of this circular process.
Data Reduction
Focus group discussions produce a large volume of data and data reduction is a core challenge in writing the study findings. It can seem overwhelming to write the study results at first because of the large volume of data to synthesize and the difficulty in identifying
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core findings from the complex range of issues discussed. However, data reduction is an essential precursor to writing the study findings and is achieved initially through data analysis. For example, data analysis identifies core themes or categories of issues in the data, conceptualizes data, or develops a framework for structuring the results, all of which contribute to data reduction. Not all study findings are included in the final report, therefore further data reduction involves identifying the most salient and meaningful study results that respond directly to the research objectives. Data reduction therefore begins to make sense of the research findings and forms the "story" of the data, which helps to effectively structure the study findings. Writing the study results without sufficient data reduction can be extremely challenging. When writing results seems difficult, it is often due to insufficient data analysis to clarify the core issues because they are still obscured within the volume of data. In these situations it is necessary to return to data analysis to gain greater clarity on the study results. Although data reduction is needed before writing the study results, the process of writing can also help to find logic and structure in the study results or identify gaps where further analysis is needed to clarify specific findings (as described previously). Therefore, data analysis leads to data reduction, which facilitates writing the study results.
The results section of a focus group study can be lengthy because results are presented in narrative form (versus a concise table of statistics) and illustrated with quotations, both of which add to the word length of the results. In addition, there is often more interpretive text presented in the results section to help the reader navigate the context and complexities in the issues presented. It can be challenging to synthesize the study findings concisely yet still reflect the depth, variation, and complexity of the issues. The challenge is to reflect the depth and complexity of focus group results, yet manage the word limits prescribed by academic journals. Qualitative research can attract criticism for the presentation of superficial results, when in reality space limits may have constrained presenting issues in fuller detail.
Reporting Group Data
Focus group data are unique in that they can be reported as individual comments from participants or as a collective group
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narrative, or as interaction data. The challenge is to identify the appropriate way to report the study findings, and whether using different types of reporting may be effective. Most focus group data are treated as individual comments and reported in much the same way as in-depth interview data. This involves presenting comments from individual participants, often grouped under specific topics. This approach is often sufficient to meet the objectives of most research projects. However, focus group data have an added benefit of presenting a group narrative, which reflects the group nature of data collection and its influence on shaping individual comments. Although individual comments may still be reported they are used to provide evidence of a broader collective narrative developed through the group discussion. Focus group data also contain interactive discussion between participants, which provides a unique opportunity to analyze and present interaction data (see Chapter 2 on data analysis). A key challenge is deciding whether (and how) to report interaction between participants. Group interaction itself can become the focus of data analysis whereby the nature of the interaction becomes the analysis. However, group interaction can also be reflected when reporting the issues discussed in the focus group, by presenting extracts of group dialogue around a specific issue. Reporting group interaction adds depth to the issues described, reflects the group environment in which data were generated, and demonstrates how issues are discussed between participants. Reporting issues and the interactive exchange that produced them is a unique and effective way to present focus group research findings. It can also be effective to use an extract of group dialogue to demonstrate the development of a group narrative. A combination of reporting approaches may be used throughout the research report. Effective reporting of focus group results may use various reporting strategies as appropriate to the study findings and the purpose of the study.
Structure and Argument
Another challenge in writing focus group results is to identify a clear structure, argument, or central message to frame the study results. A well-written results section comprises more than a collection of findings but also presents a coherent argument, narrative, or explanation of issues that is based on the study findings.
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The underlying structure or argument helps the reader to navigate the findings presented and understand the conclusions stated. A common pitfall in writing focus group research is the absence of a strong structure, argument, or theoretical framework in presenting the study findings. A related concern is that the results section swamps the reader with data, such as presenting multiple or lengthy quotations, with little narrative text to put the data extracts in context or indicate how they contribute to the overall research findings. This equates to presenting the reader with sections of data and letting them make their own conclusions from the evidence presented. Therefore, an effective results section presents a clear structure or argument and uses data judiciously to support a central narrative. Presenting the study results within a clear structure or theoretical framework also reflects comprehensive data analysis and thoughtful conceptualization of the results, which in turn reflects quality research.
There is no set formula for writing qualitative research findings, so the structure of the results section may look very different across various projects. The presentation of qualitative research findings may also differ from a commonly structured academic report. Typically, an academic report begins with a theoretical or conceptual framework, which is used to guide the description of the study design and provides an anchor for the presentation of the study findings. Although this structure is also used in much qualitative research, additionally a qualitative study may have developed a conceptual framework for understanding the study findings. Therefore, rather than beginning with a theoretical framework the results section may present an empirical framework Because this is an outcome of the research, it is presented in the results section and may provide the structure for reporting the study results. This structure is contrary to the expected structure for academic writing, and may therefore need a descriptive justification, although it is entirely appropriate for reporting qualitative research.
Presenting Variation
When writing focus group results it is necessary to demonstrate both centrality and diversity in the issues reported, which can be challenging at first. Within the large volume of data that focus
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group's generate it is common to focus on reporting common issues and typical perspectives, or to report normative behavior. This is warranted and in itself can be a challenge in a large and complex textual data set. However, focus group data are unique in that they collect data with implicit variation because of using a group of participants contributing to a discussion. Although it is not given that this necessarily produces different views, it is likely to uncover some variation, because even when participants broadly agree on an issue they may have different individual experiences or reasoning for that agreement. The absence of any variation is also an important finding to report. Therefore, focus group data provide an opportunity to capture variation and present nuances in the study results in addition to highlighting a dominant or common perspective. Data analysis may go further to explicitly examine certain deviant perspectives, which may be indicative of underlying social issues, and therefore add considerable depth to the study findings. The challenge is not to become restricted by presenting only centrality in the study findings, because unique and important findings can also be found in diversity where focus group data provide some advantage.
Distinguishing Results and Interpretation
A particular challenge in writing focus group study findings is to distinguish between the presentation of results and their interpretation by researchers. Most stages of qualitative research involve simultaneous analysis and interpretation, which can spur deeper reflection on study findings. Although this is a strength of qualitative research, some academic journals, particularly those in the health sciences, often require a separation between the presentation of results and their interpretation. This is imposed in the required structure of articles submitted, which involve writing a results section that focuses on objective reporting of the study findings followed by a discussion section where these findings are interpreted. However, in qualitative research separating the presentation of results from their interpretation may be an artificial divide, because reading qualitative results often requires understanding the context and nuances that shape these study findings. Without an interpretive narrative in the results section qualitative research results may make less sense. Therefore, presenting
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qualitative research in an objective format that divides reporting of results from their interpretation can present some writing challenges. Academic journals differ in their flexibility to accommodate these aspects of writing qualitative research, so qualitative researchers may need to adapt to writing in this format or indicate in the results section when interpretations (versus results) are being presented. This requires a different style of writing study findings to accommodate the presentation of results as required by academic journals.
Grounding Study Findings
In writing focus group results, it is important to demonstrate that findings are valid and well-grounded in the data. All study findings should be empirically supported through using rigorous analytic techniques, conducting validity checks, and managing interpretive subjectivity. In qualitative research it can be challenging to demonstrate that the results presented are empirically grounded and not the outcome of a researcher's subjective influence. Many reviewers of qualitative studies equate the presentation of quotations as the only evidence that an issue was indeed present in the study data, and therefore question the validity of results where no data extracts are presented. The challenge lies in demonstrating rigor and validity independent of presenting quotations, because this deflects potential criticism that results are unsupported and not empirically grounded in the data. Furthermore, reporting the strategies used to validate the study findings can also provide evidence that the results of focus group research are well supported by empirical data (see Chapter 5 for discussion on demonstrating validity).
Coherence between Results and Methods
The study results should be a logical outcome of the analytic approach applied as stated in the methods section. Coherence between the methods used and results presented is critical and provides an indicator of scientific rigor in the research report. Therefore, clear coherence is needed between what was said in the methods and what was actually done, as presented in the results. For example, if the research methods indicate that the study used a grounded theory approach, then the results section needs to present the concepts developed, theory extended,
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or conceptual framework that was derived from this approach to textual data analysis. Unfortunately, too many studies apply a methodological label by stating that a particular approach was used when the study results do not reflect the outcome of the stated approach. Grounded theory, narrative analysis, conversational analysis, content analysis, and case study analysis all have a distinct analytic approach that generates a different type of research result. The challenge is to ensure coherence between the methodological approach stated and analytic outcomes presented in the results.
Ethical Reporting of Data
Ethical reporting of focus group study findings can be more challenging than for other types of research, particularly because participants own words are reported in quotations. Presenting verbatim quotations is a powerful way to directly present the perspectives of study participants. It is a long-standing tradition of focus group research, and reflects the rich contextual detail that makes the study findings unique. However, care is needed to report quotations ethically by not revealing the identity of study participants that could cause potential harm. Although most researchers understand that participant's names should not be reported, there may be other information in a quotation that could inadvertently reveal the identity of participants. This is particularly problematic when presenting research findings in a case study where more fine grain detail or atypical examples are presented compared with comments from individuals in the group discussion, which can be more easily made anonymous. Furthermore, there is an ethical responsibility to represent participants viewpoints fairly and respectfully, providing a balanced report of the issues discussed without giving undue importance to quotations or viewpoints that may represent atypical positions. Therefore, ethical reporting of focus group data is both critical and challenging.
Writing the Results Section
Beginning to Write Results
Beginning to write the results of focus group research can seem like a daunting task. Focus group data are complex and lengthy,
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analysis can lead in multiple directions, and it may be difficult to know when to stop analysis and start writing. This is particularly challenging in qualitative research because writing and analysis are often conducted simultaneously; however, insufficient analysis can stifle writing and frustrate the development of the results. When should writing the results then begin? In general a point is reached during data analysis where the findings become clear and fewer new insights are gained during analysis, although questions about the study findings may remain. This is a good point at which to begin to write because writing not only starts to clarify the findings even further but also uncovers areas that remain unclear and warrant further investigation in the data. At this point the circular process of writing and further analysis becomes most fruitful. During this time the core findings and main messages of the data also become clearer and the task of how to best report these findings begins.
Before beginning to write it is useful to have a "roadmap" of what to include in the results and the broad message of the study that will be presented. It is therefore useful to begin with an outline of the content of the results section, even though this may evolve during the writing process. This is particularly useful because focus group research can generate many study findings, but not all are included in the results or are relevant to the research objectives. It is also useful to take stock of all the writing that has been done thus far in the project, so as not to begin with a completely "blank page." There are likely to be multiple forms of preliminary results that can offer a starting point for writing the results, for example, interim reports to a sponsor, oral presentations, conference abstracts, or a whole array of analytic documents, such as early conceptualization of data and development of themes. Analytic memos may have been developed during data analysis, which highlight key findings, thoughts, and reflections, and provide useful points to begin to shape the results. Reviewing these outputs can provide a useful starting point to begin shaping the study results section.
It is important to make time for writing. Qualitative research takes considerably more time to write than other types of research, because of the process of simultaneous writing and further analysis to refine and verify emerging issues. Although this circular process in itself takes time, time is also needed to reflect deeply
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on data and how it informs the research problem. Good reflective writing simply takes time, which may not be valued if writing is perceived as simply recording an end product.
Developing an Argument
Study results are not presented in isolation. They are typically presented within a narrative or argument that takes the reader through the findings and indicates how each finding contributes to the overall message of the study. An argument offers a line of reasoning to make sense of the collective findings; it presents a perspective or develops an explanation for the phenomenon studied. An argument therefore provides the intellectual structure for the study results, within which the narrative descriptions of study findings and extracts of data are presented. A well-written results section offers a clear and coherent argument and uses the data well to support this underlying argument. Even when focus group research is used in mixed methods research, the findings still form one component of the research evidence that is used to construct an overall argument. In the beginning the writing may lack a clear argument that weaves the study findings together into a broader narrative or framework. Try to avoid writing study results like a descriptive "shopping list" of issues or the presentation of consecutive quotations with little narrative to guide the reader through the relevance of the issues to the overall research question.
There are many ways to construct an effective argument to present the study results. The most suitable type of argument to use is determined by the objectives of the study, the research question, and the nature of the study findings. Some examples of different types of arguments include the following.
Types of Arguments
A developmental argument	Used to explain how a social phenomenon develops (e.g.. How do children become obese? What is the process of marriage migration?).
A mechanical argument	Used to explain how social phenomenon work (e.g.. How do community gardens improve nutrition?).
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A comparative argument	Used to compare different aspects of a phenomenon (e.g., Why are married women at greater risk of HIV transmission than single women? Why does unemployment cause greater stress in males than females?).
A causal argument	Used to explain why certain phenomena influence particular outcomes or occur in a specific context (e.g., How does delayed childbearing increase women's empowerment? Why is vitamin intake low despite free provision?).
An argument effectively embraces the study findings to convey the broader message of the study. An effective argument has several characteristics. First, an argument needs to be credible and convincing by using the study findings to demonstrate that the argument presented is the most plausible interpretation of the study findings. "Scholarly writers have to... express an argument clearly enough so that readers can follow the reasoning and accept the conclusions" (Becker, 1986, cited in Silverman, 2011b, p. 385). This involves not only presenting evidence to support the argument but also indicating why alternative explanations are implausible and addressing any contradictions in the study findings. Second, an argument should be systematic, by carefully demonstrating how the conclusions were developed and verified. This demonstrates the logic of how the conclusions were developed from the textual data and validated through rigorous data analysis. Third, an effective argument in qualitative research presents not only the central findings but also provides an indication of the variability and nuances within those findings. This provides the depth and richness expected of qualitative research findings. Fourth, it should be clear how the data presented in the argument were selected, what they represent, and how they are relevant to the overall argument presented. Data extracts need to be tightly woven into the argument and their contribution made clear, to avoid misinterpretation by readers. Overall, an effective argument in qualitative research needs to be transparent, so that readers not only understand the conclusions reached but also how these conclusions were arrived at, why they are plausible, and that they were
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based on thorough data analysis. For further reading on developing an argument see Mason (2002).
Structuring Narrative Accounts
The results of focus group research are often presented in narrative form and use quotations to exemplify issues. The results section can therefore be lengthy, detailed, and complex and readers can quickly become lost in the detail. An effective structure is therefore critical to help readers navigate the study findings and understand the central message of the study. A poor structure can obscure the study findings and their impact is then lost.
The first task in structuring a narrative account is to identify the key findings and the core message of the study. This can sometimes be the most challenging part. It involves identifying the main "story" of the data, the essential components of that story, and how to best tell the story. Although the study findings stem from rigorous data analysis, most focus group data are complex and reveal multiple findings, interrelationships, and cross-cutting themes. There may be multiple "storylines" or alternative outcomes for different subgroups of study participants, all of which increase the complexity of the results and add to the challenge of how to present them. It is easy to become overwhelmed by the volume and details of the data and lose sight of the central message of the study findings. It is important to remember that many details could be presented, but to remain focused on the most pertinent findings that respond to the research objectives.
It can also be useful to provide the reader with "signposts" to navigate the results section. For example, providing an overview paragraph that orients the reader to how the results are presented. This is particularly useful for focus group results, which may be presented in very different ways. Adding short sentences to indicate what is covered in each section, indicating how each section of the results contributes to the overall research problem, or using subheadings can assist readers to navigate a lengthy results section.
There are many ways to structure the results of focus group research. Some approaches are outlined next. Although this is not an exhaustive list, it provides a range of effective strategies to frame study findings. The most suitable structure to use is
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determined by the nature of the study findings and the purpose of the study.
Key Concepts
Focus group results may be structured by key concepts or themes. These are not the text-level codes that were used to code data during analysis, but higher level categories that are the product of data analysis. They may encompass a group of codes but represent a broader concept. Key concepts or themes may be used as subheadings followed by a descriptive narrative of each concept and how it contributes to an overall understanding of the study phenomenon. Using key concepts to structure the results reflects a higher level of abstraction from data, whereas the descriptive narrative or example quotations clearly link the findings back to the data.
An example of this structure is shown in a focus group study aimed at understanding the beliefs of diabetes prevention in the Bangladeshi community in the United Kingdom (Grace, Begum, Subhani, Kopelman, & Greenhalgh, 2008). This study used seven key concepts to structure the study results; some concepts included "responsibility" for diabetes prevention, which encompassed issues of control, faith, fear, and knowledge. Another concept was "structural constraints" to a healthy lifestyle, which included issues of time, money, childcare, safety language, and dietary choice. Each concept was used as a subheading in the results section and included a narrative description of the components of the concept using quotations to exemplify different issues. The study also included three types of study participants (lay people, religious leaders, and health professionals) whose perspectives on each concept were compared in the narrative descriptions. Another study by Sheu et al. (2012) presented focus group study findings by five key themes in relation to decision-making on renal replacement therapy. Each theme was used as a subheading in the results section, for example, "Theme Three: Poor awareness of alternative RRT options" and "Theme Five: family members' supportive involvement in RRT decisions." The description of each theme also included comparisons among the subgroups of the study participants (patients and family members; African Americans and non-African Americans).
Research Questions or Topics
Focus group results can be structured by research questions or topics. Research questions frame data collection and guide analysis,
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and can become a useful structure for presenting results. This structure involves presenting the question or topic discussed and then a synthesis of the issues identified. This is a useful structure when the research question presents distinct topics or when focus group data respond to a defined research question, as may be the case in mixed methods research. Where space is limited, results may be presented in table format, listing the question or topic with the range of responses, or example quotations included under each.
In a study of physician decision-making (O'Donnell, Lutfey, Marceau, & McKinlay, 2007) results were structured by five key questions that were asked in the focus group discussions. The results of each question were presented in table format that included the question asked and example quotations showing the range of responses by the two study populations of physicians in the United Kingdom and United States. This enables a summary of the focus group results to be gleaned from the table itself, including comparative differences between each group of physicians, whereas the narrative text provided a more detail description of the findings and a discussion of their implications. An example of one of the tables presented in this study is shown in Figure 4.1. The presentation of results in table format is optional, although a highly useful space-saving strategy.
Study results can also be structured by research questions but without the use of a summary table of results, as described in the previous example. Jette, Wilson, and Sparks (2007) conducted a focus group study on young women's' perceptions of smoking in popular films among smokers and nonsmokers. The study results were presented separately for smokers and nonsmokers and each section included results of two research questions: the effect of films on youths' smoking behavior and the impact of tobacco imagery on young viewers. The third research question identified differences in perception of smokers and nonsmokers. Using the research questions to structure the results can be a simple but effective presentation strategy for some focus group studies.
Population Subgroups
Focus group results can be structured by subgroups of the study population. This may involve presenting issues related to one subgroup followed by another, and is particularly effective for comparative research or where each subgroup presents different
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Reasons to Participate in a Research Study	
Question: 'What particular features of a research study would encourage	
you to participate?'	
U.S Physicians	U.K General Practitioners
R: Being paid	R:The topic
R: Who asked you and	R: An angle to do with sort of
whether you're compensated	improving health care. Improving
R: And the virtue of the	medical practice, improving
study... if you think it's	conditions of practice
going to accomplish	R: And here's a small amount
something	of money for your time, 1 think
R: And not sell more pills,	that would buy more GPs than
but it's going to really make	anything else, very sadly but it
you answer a very important	would.
question, and what you're	R: Ask to speak to the practice
saying is important, then 1	manager
would think you'd find more	R: There's a thing about when
people participating for	you phone . . .
nothing	R: You want to write the chairman of
R: Doctors are highly	the primary group because they're
motivated by a sense of	the professional lead.
professionalism and	
collegiality	
Figure 4.1. Presentation of focus group results by key questions. Reproduced with permission from "Using Focus Groups to Improve the Validity of Cross-National Survey Research: A Study of Physician Decision-Making," by A. O'Donnell, K. Lutfey, L. Marceau, and J. McKinlay, 2007, Qualitative Health Research, 17(7), p. 971-981.
perspectives on the research issues, such as presenting results from different study sites (e.g., urban and rural) or different target populations (e.g., patients and clinicians). This structure is particularly effective for focus group research, which often comprises inbuilt subgroups where each focus group comprises participants of different socio-demographic backgrounds or characteristics. For example, focus group research in Lesotho, southern Africa, examined perceptions on the introduction of school sex education among school teachers, pupils, and parents, which provided an effective comparative structure to present the different issues
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and perspectives from the three subgroups of study participants (Mturi & Hennink, 2005).
Research Method
Where focus groups comprise a component of a mixed methods study, study results may be presented by each method of data collection. This may involve presenting the results of a quantitative method (e.g., a survey) followed by the focus group results, or vice versa. This structure is effective when each research method collects data on a different aspect of the research topic, for example a quantitative survey may collect sociodemographic data on the study population, whereas focus group discussions may collect data on specific topical issues. Alternatively, mixed methods research can be presented by topic thereby integrating the quantitative and qualitative findings for each topic (see later section on presenting mixed methods study results).
Typology
Study results may be presented as a typology that was developed during data analysis. A typology presents a categorization of phenomenon, such as different types of behaviors, perspectives, or outcomes. The results are then structured around a description of the categories that form the typology, using narrative or quotations to exemplify how each category is distinct. This is a more conceptual structure for presenting study results, therefore it can be useful to provide an example or brief case study of each "type" to balance the conceptual nature of a typology with tangible examples from the data.
Problem Solving
Focus group results may be presented in a problem-solving format, whereby the research problem is clearly stated and then study findings unroll a range of evidence-based solutions. This type of structure is effective where focus group data highlight a range of potential strategies or solutions to the research issues discussed.
Theory Development
Study results may be structured around describing how the findings contribute to the development of new theory or understanding of the phenomenon examined. In this structure focus group findings are used to present the empirical evidence for a new
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theory or explanation developed. Alternatively, study results may be presented to demonstrate how they "fit" or extend an existing theory, or how a theory can be made more culturally relevant to a certain study population. A conceptual diagram may visually depict the theory or phenomenon examined. Some examples are described next.
A focus group study by Woods-Giscombe (2010) aimed to develop a conceptual framework to understand the phenomenon of the "strong black woman/superwoman" and how it affects health and stress among African American women. The results section begins with the presentation of the conceptual framework (shown in Figure 4.2), which characterizes participants' perceptions of the superwoman role, their views on its development, and its perceived benefits and liabilities. The study results then follow this framework to describe in detail each component of the superwoman phenomenon, highlighting how perceptions of the phenomenon differ by age and education of participants from different focus groups. Throughout the narrative there is also a description of how the phenomenon of the super-woman influences health, particularly stress, among African American women.
In another study, Holmes, Winskell, Hennink, and Chidiac (2011) developed an empirical theory, using data from focus group discussions and in-depth interviews, to explain how the negative socio-economic cycle of HIV is reversed with microcredit. First, the negative economic cycle of HIV is described, whereby people with HIV have poor health and reduced work capacity, which reduces their economic resources so that they are unable to access treatment to improve their health. This negative cycle is perpetuated by the negative social perceptions of people with HIV, who are viewed as "living dead," an economic burden, and seen as non-contributing members of society. The study then developed an empirical theory that microcredit loans to people with HIV actually reverse this negative economic cycle, whereby microcredit loans provide capital that enables access to treatment, leading to improved health and increased work capacity. This positive economic cycle also changes the social perceptions of people living with HIV to be contributors to society, creditworthy, and seen as "cured." This theory was presented visually in two conceptual
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What are the characteristics?
• Obligation to manifest strength
• Obligation to supress emotions
• Resistance to being vulnerable or dependent
• Determination to succeed, despite limited resources
• Obligation to help others
What are the contributing contextual factors?
• Historical legacy of racial or gender stereotyping or oppression
• Lessons from foremothers
• Past history of disappointment, mistreatment or abuse
• Spiritual values
What are perceived benefits?
• Preservation of self/survival
• Preservation of African American community
• Preservation of African American family
What are the perceived liabilities?
• Strain in interpersonal (e.g. romantic) relationships
• Stress-related health behaviors (e.g. postponement of self-care, emotional eating, poor sleep)
• Embodiment of stress (e.g. anxiety, depressive symptoms, adverse maternal health)
Figure 4.2. Conceptual framework of the "strong black woman/super-woman" phenomenon. Reproduced with permission from "Superwoman Schema: African American Women's Views on Stress, Strength and Health," by C. Woods-Giscombe, 2010, Qualitative Health Research, 20(5), p. 668-683.
diagrams (shown in Figure 4.3) showing the negative and positive socio-economic cycle of HIV and microcredit.
Chronology
Focus group results may be structured as a chronology, a process, or as stages of an event. This involves first distinguishing each stage of a chronology and then describing the issues or influences at each stage. For example, focus group research among young people in Pakistan used a chronology of life events from puberty to marriage to present the study findings on knowledge acquisition about sexual health, which differed distinctly at various life stages (see Figure 4.4). This chronologic structure allowed a comparison of knowledge acquisition by gender at each life stage (Hennink, Rana, & Iqbal, 2005).
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Poor health
Negative socio-economic HIV/AIDS cycle
Access to
Positive socio-economic HIV/AIDS cycle
Figure 4.3. Visual presentation of theory development. Reproduced with permission from K. Holmes, K. Winskell, M. Hennink, and S. Chidiac, "Microtinance and HIV Mitigation among People Living With HIV in the Era of Anti-Retroviral Therapy: Emerging Lessons from Cote d'lvoire," 2011, Global Public Health, 6, p. 458.
YOUNG WOMEN
YOUNG MEN
MENARCHE Sources: mother, older sister, sister-in-law, friends Information: personal hygiene, menses, social & religious behavior.	-►	SEXUAL DEVELOPMENT Sources: friends, magazines, TV & film, Islamic books. Information: romance &	—►	PREMARRIAGE Sources: married family members. Information: marital responsibilities; social behavior & expectations.
		relationships, marital relations & motherhood.		
PUBERTY Sources: friends, male		SEXUAL DEVELOPMENT Sources: internet, video.		PREMARRIAGE Sources: video & books
family members, religious sources. Information: physical development, personal hygiene for religious practices.		cable TV, friends, gym clubs. Information: sexual techniques, pleasure, pregnancy, religious hygiene.		married family members. Information: sexual techniques.
WEDDING
Sources: close married family members.
Information: references to sexual behavior.
PREGANACY
Sources: medical professionals.
Information: biology of conception, contraception.
Figure 4.4. Process of knowledge acquisition on sexual development among young people in Pakistan. Adapted and reprinted with permission from M. Hennink, I. Rana, and R. Iqbal, "Knowledge of Personal and Sexual Development amongst Young People in Pakistan," 2005, Culture, Health and Sexuality, 7(4), p. 319-332.
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Using Quotations
Perhaps the most common form of reporting focus group research is to include verbatim quotations of participants' words to highlight issues described. The textual narrative of the report typically provides a synthesis of the issues, whereas quotations provide the richness and detail of participants' own words. Quotations therefore provide "a direct link between the more abstract content of the results and the actual data; in addition, they are also the strongest connection between the reader and the voices of the original participants" (Morgan, 2010, p. 718). Quotations can also convey more subtle information, such as emotions or reactions of participants to the issues discussed. These details can be lost in a strictly textual description of the issues. Presenting quotations therefore has strong benefits and remains a long-standing tradition of reporting qualitative research.
The use of quotations is also seen as a tool to validate the issues reported, to demonstrate that they were indeed present in the data. Quotations provide tangible examples of participant's words and expressions. However, the use of quotations as a tool to assess validity of the research findings can lead readers and reviewers to expect quotations in all qualitative reports as a validity check for the issues reported. Qualitative research can therefore be criticized for making unsupported assertions when readers do not see a quotation to support each issue presented. Although it is possible to present quotations for explicit issues, for others the presentation of quotations is not possible. For example, some issues may be well grounded in data but the evidence is spread throughout the data, so there may be no explicit quotation that highlights the issue clearly or succinctly enough to include in the report (Corden & Sainsbury, 1996). Other research findings may be more conceptual, presenting concepts derived analytically and although well evidenced by the data the presentation of a quotation is not possible. In these situations, the lack of quotations should not detract from the validity of the concepts described. The expectation of quotations as the only evidence that results are empirically grounded is unfortunate. This situation can corral qualitative researchers into presenting simple descriptive results using quotations as evidence, whereas studies using qualitative data to develop theory or more conceptual explanations are not given the credit
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deserved. There are multiple ways to demonstrate validity of the study findings aside from the presentation of quotations. These are discussed in the section on grounding study findings and in Chapter 5.
It is tempting to fill the results section with data extracts. However, consider the reasons for including quotations and use them judiciously so they make a clear contribution to the study results. Quotations should have a clear purpose and support the narrative argument presented in the report. Effective quotations add value to the results presented; however, if a quotation conveys no more than can be stated in the narrative text there is little benefit in its inclusion. For example, a quotation stating "the services are expensive for us" contributes little that cannot simply be stated in the text. An alternative quotation stating "the service is so expensive it will take a whole month of my salary just to pay the consultation fee" conveys more detail on the magnitude of the issue and its impact on a participant. Quotations can also be used to convey more subtle information than the words themselves, such as conveying emotions or language used by participants, thereby providing greater detail on the issue being reported.
The number of quotations to use is determined by their purpose. For example, one quotation may be sufficient to show a typical response to an issue, two quotations may be used to compare different stances on an issue, whereas a series of quotations can demonstrate a range of issues in the data. Avoid the temptation to use too many quotations because this quickly diminishes their effect, and can swamp readers with data that detracts from the main message of the results. Ritchie and Lewis (2003, p. 290) state that "the overuse of cited passages can make a research account tedious to read, voluminous in length and easily distract from the clarity of the main commentary." Careful consideration of the purpose of each quotation reduces their overuse in the study results.
Consider how quotations are selected to avoid presenting overly vivid extracts that may provide an unbalanced perspective of the issues. Bogdan and Taylor (1975, p. 145) suggest that "you should resist the temptation to overuse certain colourful materials at the expense of others. If you cannot find an alternative example, the point you are trying to make may not be as important as thought originally."
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It is also useful to check the balance between narrative text and quotations. The narrative text should provide a clear argument or structure to guide the reader through the study findings, with quotations used to illustrate the issues and provide contextual detail. Therefore, the text essentially reports the outcome of data analyses, whereas quotations represent the raw data. If too much of the results section is taken up with quotations and little narrative text, it equates to presenting the reader with unprocessed data. This suggests that little effort has been given to data analysis and interpretation. Therefore, quotations should be used thoughtfully and embedded within the broader descriptive text rather than replacing the text.
Some guidelines for selecting and using quotations are provided next, as adapted from Hennink, Hutter, and Bailey (2011, p. 281).
Guidelines for Using Quotations
Type	Is a quotation from an individual participant most appropriate? Is an extract of group interaction relevant? How can interactive dialogue be included?
Purpose	What is the purpose of the quotation? (e.g., typical view, contrasting views) What issue does the quotation highlight? Does it add value to the text or duplicate it?
Clarity	Is the issue clear from the quotation? Can editing improve the clarity of the quotation? Should the moderator's question be included?
Relevance	Is the quotation relevant to the argument made in the text? Does the quotation add value to the results?
Balance	Is there a balance of narrative text versus quotations? Are the quotations effectively embedded in an argument? Do the quotations exemplify the text or replace it?
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Length	Is the quotation long enough to provide context to the issue highlighted? Is the quotation too long?
Number	How many quotations are included for the same issue? How many quotations are in the entire report? What is the justification for including each quotation?
Selection	How was the quotation selected? Can alternative quotations be found for the issue?
Reference	How is the quotation referenced to the data? Can attribution add to the clarity of the quotation? (e.g., "unmarried men's group," "rural women")
Ethics	Is the quotation anonymous? Can the participant be identified from the quotation?
Data extracts are sometimes edited to reduce their length and improve readability. Textual data reflects participants' natural speech, which may comprise incomplete thoughts, repetition, pauses, rambling statements, or interruptions by other participants. Quotations may be presented exactly as they were spoken or edited to improve the readability or clarity of the point being made; however, any changes should not alter the meaning of the original comment. Editing may involve removing sections of speech not related to the issue being reported or adding words to complete the logic of a comment. Missing text is often replaced by ellipses, such as (...), and added words included inside square brackets. Other edits may be made to maintain confidentiality. Rubin and Rubin (2005, p. 262) state that "as long as the meaning is preserved, the words that are quoted were actually said, and you mark the places where you made omissions, this practice is acceptable." The example below shows edits to the original text to improve clarity, while indicating where changes have been made with elipses and square brackets.
Original text: "I can tell you about that place. They just shout at us, like we are illiterates, yes, it happens, my daughter was there
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for her pregnancy, it was her fourth child she was knowledgeable but, they didn't, even her child was there with her. It's a terrible service, you leave feeling worse than when you arrived!"
Edited text: "[Nurses] just shout at us, like we are illiterates ... It's a terrible service, you leave feeling worse than when you arrived!"
Providing attribution to quotations helps readers to better interpret a comment. Attribution involves indicating the characteristics of the focus group from which the quotation was taken, such as certain sociodemographic characteristics of the group (e.g., gender, age range, ethnicity, and so forth) or details of the study sites (e.g., rural or urban). Attribution can be included after a quotation, such as "(unmarried males)" or "(rural women's group)." Alternatively, attribution may be embedded in the sentence before the quotations, such as "The following extract from the discussion among unmarried males in the rural study site illustrates the importance of marriage." Attribution is important because it provides context about the quotation as the meaning of a comment can differ depending on the characteristics of the speaker. For example, the quotation "Vaccinations for children should be the choice of the parents alone" is interpreted differently if the speaker is a parent or a medical provider. In addition, attribution can indicate that quotations were selected from a range of focus group discussions to indicate the pervasiveness of an issue across the data, thus also indicating analytic rigor. Attribution is particularly useful when comparing comments from different types of focus group discussions, such as men and women's groups or rural and urban groups.
Reporting Group Interaction
Focus group data provide a unique opportunity to present interaction among participants, which can add additional insight to the issues reported. During a focus group discussion participants present ideas, exchange views, and react to the comments of others; there may be rapid exchanges as they debate issues or multiple comments can show consensus on an issue. This type of interaction is critical for generating focus group data, and is encouraged by a moderator and by the design of the questions
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asked. Focus group data therefore inherently include interaction and provide an opportunity to report exchanges between participants that are not available in data from in-depth interviews. However, group interaction is rarely reported in focus group research. A review of studies using focus group discussions published between 1946 and 1996 found that focus group data are most frequently presented as quotations from individuals with interactions among participants rarely reported or shown (Wilkinson, 1998), thereby seeming as if there was no interaction. Group interaction has therefore been described as a source of data that is underused and under-reported in focus group research (Duggleby, 2005).
There are two broad approaches to analyzing, and thus reporting, focus group interaction. For some studies, the focus of analysis is on how participants discuss issues in a group discussion, whereas for others the focus is on the substantive content of what is said in the discussion (Morgan, 2010). Researchers focusing on how participants talk are clearly most interested in examining the interactive exchanges among participants, using analytic approaches, such as conversation analysis, discourse analysis, and others. In this type of research the interaction among participants becomes the data that are analyzed and the focus of analysis is on the nature of the interactions. These studies are most likely to present and discuss interaction among participants in reporting focus group findings. In contrast, researchers interested in the substantive content of the group discussion focus almost exclusively on the issues discussed, which requires little attention to the interactive component of the discussion. These studies typically report the issues themselves, often presenting quotations from individual participants to reflect these issues. The interactive discussion from which the issues arose is not the focus of the analysis and is therefore seldom reflected in reporting the findings. This is entirely appropriate for the goals of reporting substantive issues. However, even in substantive research there are situations where reflecting interaction can add richness to the data presented and additional insight to the research findings. Group interaction may be reported implicitly or explicitly in substantive research as described next. The following suggestions are drawn primarily from Morgan (2010) and Duggleby (2005).
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Interaction among focus group participants may be implied when presenting quotations from individual participants, even though it is not reported directly. Reporting an interactive exchange between participants can add considerable length to a research report. Therefore, quotations from an individual participant may be used to sum up a discussion or to present a "typical" comment from the discussion of an issue, without reporting the actual interactive discussion. This enables the length of the research report to be managed yet still implicitly suggest that interaction occurred. Alternatively, a series of quotations from individuals may be presented to identify the range of issues discussed on a topic, rather than presenting the actual interactive exchange on this topic. These strategies do not report or describe interaction per se but implicitly suggest interaction occurred during the group discussion.
There are four approaches to report interaction more explicitly. The first two approaches involve describing interaction in a narrative paragraph using "lead-in" or "follow-out" text, and then presenting a single illustrative quotation from the discussion. The third approach involves directly presenting an extract of interactive dialogue among several participants on an issue. A fourth approach uses text as a joiner between quotations to reflect group interaction.
The first approach to reporting group interaction is to use a "lead-in." A "lead-in" is a brief paragraph that describes the nature of the group discussion on a specific issue, before including a single illustrative quotation of the issue. This strategy reflects group interaction on the issue without including lengthy segments of interactive dialogue. A "lead-in" can provide useful context about the group's interaction on the issue, for example if the issue was discussed with reluctance, or led to a heated debate, whether it was a lengthy discussion, if there was consensus or divided perspectives on the issue. By providing this descriptive context about the discussion only an illustrative quotation is then needed to exemplify the issue. A "lead-in" can therefore summarize the group interaction more concisely than including an extract of the interactive discussion in the results. The following example shows a "lead-in" paragraph before a quotation that conveys the nature of the group interaction (validating, affirmative); the receptive group environment; and indicates unspoken aspects
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of communication within the group, such as laughter, humor, and head shaking.
The first group member to do so in each case was met with validating statements such as, 'Yes, to me, too, it happened.' Group laughter and affirmative head shaking formed the receptive environment in which additional personal revelation were made by group members. Humor seemed to ease the conversation, as in the way this woman described her husband's behavior when she had first fallen ill:
I was so thin he didn't even want to look at me. Even to look at me, when he goes out at night and comes back when he finds me sleeping. 'Move. Let me sleep! Let me sleep! Are you still alive!' [The women laugh]. T am alive. You thought I was dead when my time has not yet come? When my time comes, you will hear of it on the road—your wife is gone. But right now I am still around.' I was suffering alone with my children... (Mkandawire-Valhmu & Stevens, 2010, p. 689)
A "follow-out" is a second approach to reporting group interaction, which is the reverse of the "lead-in" approach. A "follow-out" provides interpretive comment about the nature of the group discussion after presenting a single quotation, thereby extending the context of interaction after a quotation. "Follow-out" text after a quotation may indicate the commonality of the issue expressed in the quotation, what followed from the discussion of this topic, what was concluded from the period of discussion, reactions of participants to a comment, and so forth. The example below is taken from an article about the influence of popular film on young people's smoking behavior (Jette et al, 2007). It shows a "follow-out" paragraph after a quotation that provides interpretive comment on the two reasons influencing the issue described in the quotation that were reflected in the broader discussion of the issue. This example also includes a brief "lead-in" sentence to indicate that this was an issue raised by participants.
Members in one of the groups discussed the possibility that smoking in films by a favorite actor might influence young people to start to smoke. As one participant explained, And if they like... the character, or whatever, and they kind of relate to the character, then it makes it more like, bh well,
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I can be like her in that movie. Oh, I look just like her, like, or him.' Right? So, it does kind of influence, but you don't like to say it. Like, you don't like to actually think you're doing it because that person is doing it? But it does kind of, like in a subtle way.
Embedded in the last comment are two insights into why young people might deny that movies might influence their smoking uptake. The first is that the influence is so subtle that they are not aware of it. The second is that young people (and people in general) do not like to admit that they are influenced by the mass media, as is suggested by the comment, "You don't like to actually think you're doing it because that person is doing it" (Jette et al., 2007, p. 330).
The "lead-in" and "follow-out" are simple strategies for reflecting group interactions when reporting focus group data that add depth and context to reporting the study results. They embed interaction within the body of the text itself, providing brevity and depth to the study results. They also allow greater insight into the nature of the interactive discussion on specific issues, which provides an additional lens through which to report the research issues. Both approaches can also be used together. The following example is taken from an article about women living with HIV in Malawi (Mkandawire-Valhmu & Stevens, 2010). It demonstrates the use of a "lead-in" and "follow-out" strategy, whereby the "lead-in" text is used to describe the nature of group interaction around the topic of stigma, such as agreement about stigma among participants; the language used (the collective we); and the commonality of the issue. A single exemplary quotation is then presented, followed by a "follow-out" paragraph that describes participants reactions (laughter, recognition, affirmation), and indicates that the discussion continued on the topic.
As women agreed with each other about the frequency of such circumstances and explained their actions, they build consensus about what stigma meant to them as women living with HIV and about how best to respond to it. The collective we was frequently used in their explanations and responses to each other. For instance, in the following excerpt a woman characterized the gossip spread in her village:
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They just whisper about us. 'Have you seen those with AIDS? They are not going to complete this year. When they start taking that medicine, they get fat. They just die, those that have AIDS!' But we feel, as long as we know our future, as long as we are taking medications—'You go ahead and laugh at us.' Women laughed with recognition and affirmation of this circumstance, quickly following with similar accounts. After agreeing that she had endured similar humiliations one woman detailed her interpretation... (Mkandawire-Valhmu & Stevens, 2010, p. 688)
A third approach to reporting focus group interaction involves directly presenting segments of interactive discussion in the research report. This format presents the reader directly with the context of the group discussion and can convey additional information about how an issue was discussed by participants. For example, a segment of interactive discussion may highlight a range of perspectives on an issue indicating broad diversity, whereas short rapid responses may indicate an issue is highly charged; or a range of similar comments in the dialogue may indicate a broad consensus among participants about an issue. Presenting excerpts of interaction can have clear benefits. The challenge is to balance the often lengthy sections of interactive discussion with the word limits of typical journal articles. Morgan (2010) suggests that when faced with the choice of presenting a segment of interactive discussion versus a comment from one participant, where both are similar in length and impact, presenting interaction is preferable because it connects the reader directly with the dynamics of the group discussion in which the issue was discussed. An additional benefit of showing interaction is to demonstrate how group participants cocon-struct meaning around the research issues during the discussion (Wilkinson, 1998; Duggleby, 2005), which may be relevant to some research goals.
The following example is taken from the same focus group study described previously on the influence of popular film on young people's smoking behavior. It shows how interactive dialogue among participants is reported to exemplify how scenes in a film resonated with participants real life experiences of
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smoking. The direct presentation of group interaction is beneficial here because it demonstrates consensus among participants on this issue.
Often, discussion with smokers about the believability of a clip segued into conversations about 'real life' smoking, as the participants drew on personal experiences with cigarettes and compared the smoking depiction in the movie clip to their life. The following represent typical responses: Speaker 1: She [Julia Roberts] knew that she wasn't allowed to smoke in there, but she didn't care because she was upset or whatever... Because when you are stressed, the first thing you go for, if you're a smoker, is your smokes... Speaker 2: This morning. Speaker 1: Yeah, like after a bad test.
Speaker 3: If you're in a bad mood, then you need a smoke. (Jetteetal, 2007, p. 331)
Presenting quotations of interactive dialogue is also beneficial to demonstrate short "lightning strike" responses on an issue. For example, the following extract shows an interactive exchange about name-calling toward people who are on antiretroviral medication for HIV in Malawi. Presenting the actual interactive exchange in the study results demonstrates the shared experiences of public humiliation among participants, who were HIV-positive women, and the sense in which this issue was discussed, with laughter. The following extract shows the name-calling the women experienced.
Participant 1:'You're eating ARVs [antiretroviral medication]!' they say.
Participant 2: 'Aren't you eating ARVs?' 'Those who eat ARVs!'
Participant 1: Our name becomes "Those who eat ARVs'
Participant 3: 'Have you seen the one on ARVs?'
Participant 1: 'She lives a life of ARVs' When you are passing by you hear, 'Look at the one on ARVs' [The women laugh]. (Mkandawire-Valhmu & Stevens, 2010, p. 690)
A fourth approach to reflecting group interaction is to separate the presentation of quotations with a sentence to reflect the
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interactive discussion that took place. For example, after the presentation of one quotation and leading into a second quotation use a sentence such as the following:
'Another woman followed with...'
Another participant reinforced this collective experience of...' "This was quickly followed by similar accounts...' 'The group interaction continued with another woman agreeing that...'
'Others in the group responded with empathy...'
Alternatively, after the presentation of a quotation indicate the general response of others, for example [several women, in agreement, say 'Yes, its true.'] or [most participants nodded in agreement with the speaker].
These examples show different approaches to reflect interaction in reporting focus group results. Consideration is needed on which format is most suitable for presenting data extracts from focus group data, whether to present actual segments of interactive discussion versus an illustrative quotation with a "lead-in" or "follow-out" narrative paragraph about the nature of the interaction. The purpose of presenting each type of data extract needs to be clear for the reader and contribute to the overall argument presented in the study results.
Visual Presentation of Results
Narrative description of study findings forms the foundation of many focus group reports. However, study findings can also be effectively presented in visual formats, which can range from a structured list of issues to a flow chart or a more elaborate conceptual diagram. Visual presentation of focus group results can simplify a complex process, display core linkages between components of data, or summarize a key message, thereby making the study findings more accessible to readers. Whether or not a diagram is appropriate depends entirely on the type of results being presented and whether these lend themselves to a visual presentation format. In general, diagrams are most effective when used sparingly. They should be simple and easy to follow and need to be explained in the textual narrative of the results, because few diagrams are completely self-explanatory.
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Using visual displays to communicate focus group results has multiple benefits. A diagram can assist in data reduction because it essentially summarizes information that may otherwise need several pages of descriptive text. Visual displays reduce long textual descriptions of the study findings; however, some explanation of a diagram is always required to ensure its correct interpretation by readers. Visual displays can also simplify the presentation of complex relationships because they can show different dimensions and levels and the relationships between these, which provides the reader with an immediate summary of the research findings from which to better understand the narrative text. Visual presentation of data can also convey depth of the research findings by displaying the range and diversity of study issues, for example by presenting a typology of issues or a concept map of key components of the study results. For example, a study by Wong, Sands, and Solomon (2010) aimed to conceptualize perceptions of "community" among users of mental health services. The authors presented the results of the study in a concept map, which displayed the four types of communities identified by study participants (their cultural identity community, treatment community, faith community, and neighborhood community) and a range of domains depicting the needs that each type of community fulfills. The diagram showed that some domains were common to all communities, whereas others were specific to a single community. Overall the concept map provided a visual display of the components of data and the linkages between them, which were then described in the text with example quotations. Finally, visual displays of study findings can also break up a qualitative research report, which is typically long and textually dense. In another study, Humbert et al. (2006) summarized the key findings of focus group research in a table using an ecologic framework (see Figure 4.5), whereby results were presented at three levels (intra-personal, social, and environmental influences on physical activity) and two columns were used to compare results by high and low socio-economic status of participants. This provides the reader with a quick snapshot of the overall findings, which were then described in the narrative text with example quotations.
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Factor	High Socioeconomic Status	Low Socioeconomic Status
Intra personal	Time barriers: work, homework, other scheduled activities	Time barriers: family obligations, homework
	(e.g. piano Fun: perceived competence, perceived skill	Fun: perceived competence, perceived skill
Social	Friends	Friends
	Parental involvement	Adult involvement
Environmental	Type of activity: seasonal programming, diverse choices	Proximity Cost Facilities Safety
Figure 4.5. Presentation of focus group results using an ecological framework and socioeconomic status. Reproduced with permission from M. Humbert, et al., "Factors that Influence Physical Activity Participation among High- and Low-SESYouth," 2006, Qualitative Health Research, 16(4), p. 467-483.
Developing visual displays of focus group results may begin while writing study results or even earlier during data analysis. The process of analyzing data may have produced a working diagram to understand emerging issues, such as the sketch of a timeline, a grouping of issues, or an elementary flow chart. These early sketches may have been used as tools for conceptualizing data during analysis but they can often be further developed and become effective formats for presenting the results in the final report. Therefore, it is worth revisiting working documents of data analysis to spur ideas for presenting focus group results visually. A study report may include several diagrams, such as a list of issues and a more elaborate conceptual framework; however, the overuse of diagrams begins to diminish their effect. There are endless possibilities for visual presentation of study findings, some possibilities are described next.
A structured list can bring together seemingly diverse issues from a group discussion under logical topics. A list of issues may also be ranked, grouped, or simply highlight characteristics of a phenomenon.
A flowchart can highlight a distinct process, by showing discrete stages, or the sequence of events. This may take the form of a timeline, lifecycle, or pathway diagram.
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An inductive model is a conceptual framework that describes or explains the study phenomenon. It demonstrates how the study findings link together to understand the research problem more conceptually and is usually presented as a diagram (examples are seen in Figures 1.2, 4.3, and 4.4).
A theoretical framework may present how the study findings developed a theoretical framework or extended or modified an existing theory, perhaps by developing new explanations or concepts, or adapting it for a specific population subgroup (Figure 4.2 is an example).
Reporting Numbers
It may be unclear whether focus group research findings can be presented numerically in addition to narrative text. Qualitative research is typically presented as narrative text, which may include descriptions of the study issues, narrative case studies, or quotations from study participants. However, some journal reviewers or editors feel compelled to encourage researchers to report qualitative data in numerical terms, by indicating the frequency or distribution of issues in the study population, as is usual for quantitative data.
Reporting qualitative data in numerical terms can be inappropriate for several reasons. First, using numerical terms, such as frequencies or percentages, to report qualitative findings can be misleading because it suggests to readers that data are representative and therefore study results are generalizable. Second, and more importantly, reporting study findings in numerical terms simply fails to embrace the benefits of qualitative research, which is to describe the characteristics of issues, explain phenomenon, and understand contextual influences on complex social phenomenon rather than to represent findings numerically. Reducing qualitative findings to a number simply neglects these benefits. In addition, quantifying results from focus group discussions maybe ineffective because the unit of data collection is the group, so only the number of groups reporting an issue could potentially be quantified and this may provide little insight on the issues examined.
Instead, reporting how issues are distributed within focus group data can be achieved in descriptive ways, thereby avoiding
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misrepresenting the data by using numerical measures. For example, use descriptive words (e.g., many, most, few) to highlight whether an issue is common or rarely mentioned, which indicates pervasiveness of issues without using numerical measures that suggest statistical prevalence. Focus on describing the issues themselves by examining their context, meaning, and influences, rather than reporting the number of participants who reported those issues. Describe the variation in issues raised, different perspectives on those issues, or categories of responses to identify patterns in data or to explain issues. These approaches to reporting focus group data reflect the qualitative tradition in which data were collected and capitalize on the strengths of this approach, rather than attempting to report issues in numerical terms.
This is not to say that simple counting is not used at all in focus group research. Making a tally of certain issues is often used as an analytic tool in qualitative research to identify patterns and identify issues that are more or less common. However, these tally counts are usually not reported in the study results. Focus group data present challenges for such simple counting of issues, however, because not every participant responds to each issue discussed. Therefore, presenting a descriptive narrative of the issues from focus group data is more appropriate.
Reflecting Context in Results
All social phenomenon need to be understood in context; however, reporting context can sometimes be overlooked. Many types of contexts can be reported in focus group research, such as the personal context of the moderator, the sociocultural context of the study population, the physical context of the study site, the broader political or historical context that shaped the research issues, or the methodological context in which data were collected. These aspects of context are often reported in the background or methods section of the report (see Chapter 3), but can also be reflected in the study results.
Contextual influences often shape the phenomenon studied in focus group research and therefore it is important to include different aspects of context in reporting study results. Using quotations from study participants is a common strategy to convey context in the study results. A verbatim quotation can convey
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a great deal of contextual information. Quotations not only help to present the research issues in the words of the study participants, but also communicate expressions used by participants and the emotion with which issues are conveyed, which can have a greater impact on a reader than simply describing the issues in narrative form. For example, the results section may indicate that the main barrier to using a service was its cost; however, a quotation may state, "Of course we would like to use it, but it's the cost, it's too expensive. Most of the people here are unemployed, how can we afford it? We would have to decide either to pay for food or go to the clinic, it's that simple." This short quotation conveys not only that cost is a barrier to service use, but also the social context of unemployment, the widespread nature of this issue among study participants, and the trade-offs needed to use the service because of its cost. Therefore, well-chosen quotations can provide very powerful examples of context and add richness to focus group results.
Reporting quotations can also reflect the methodological context in which data were collected. Including a segment of dialogue among focus group participants not only presents the issues raised but also conveys the group context in which the issues were discussed. Similarly, it can be useful to include the moderator's question or prompt before a participant's comment to reflect the qualitative context of data collection and provide greater insight into the comment made. Furthermore, identifying the characteristics of the focus group participants after a quotation also reflects the context of the speakers. This can be done by including attribution after a quotation, such as "unemployed men's group." Attribution provides contextual information about the study participants, which helps to interpret a quotation. For example, a comment on the importance of breastfeeding is interpreted differently if spoken by breastfeeding mothers versus medical providers. Therefore, identifying who is speaking provides additional context to a quotation that helps readers to interpret the comment.
Contextual detail can also be included in the descriptive narrative of issues in the results section. Providing descriptive depth about the study results provides rich contextual information that is a hallmark of qualitative research. In reporting study results, examine whether the descriptive narrative provides sufficient contextual information to understand the issue, highlight its context within
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the study findings by indicating if the issue is central or peripheral in the study findings, and describe variation within the issue itself by including any nuances around the issue. For example, if travel time is reported as problematic, do the physical road conditions in the research sites or the lack of public transport in the area need to be described? Providing descriptive depth enables the study findings to be interpreted in the relevant context. Including photographs can be another way to convey context visually, particularly the physical context of the study location. However, ethical issues need to be considered whenever presenting photographs.
Reporting reflexivity in the study findings, where appropriate, can also provide contextual information on whether characteristics of the research team may have influenced a particular study finding. At times a focus group moderator may share personal information with study participants that may have influenced what participants share in the group discussion. This is worth reporting in the study findings, because it influences how a finding may be interpreted.
Finally, in making recommendations from the study findings, it is important to place these within the appropriate context. This may involve, for example, highlighting the social or cultural context of the study participants, the broader political context, or the economic context of an institution or social setting. For example, it is futile to recommend that women use contraception to reduce fertility in socially conservative contexts where women are not afforded such decision-making power or the social context is such that high fertility is desired. Therefore, recommendations need to be contextually relevant, feasible, and evidence based.
Grounding the Results
Focus group research can be criticized for making seemingly unsupported assertions when reporting study findings. Even though the study findings presented may be the outcome of rigorous data analysis, it is still necessary to demonstrate how the findings were "grounded," or well supported by data. Grounding study findings means demonstrating that findings emerged from data, that they are indeed supported by data, and that the explanations or arguments developed actually fit the data. Demonstrating how study findings are grounded is typically described in the
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methods section of the research report, but is also necessary in reporting the study results. This deflects any criticism that findings presented are unsupported by data and therefore a result of interpretation bias.
In the methods section it is important to describe the analytic procedures used to ground study findings. A range of strategies may have been applied during data analysis to ensure that findings reported, concepts developed, and explanations or theories presented were empirically supported. For example, an issue may have been validated by its constant repetition throughout the data, a concept may be validated as it encompasses a range of well-grounded themes, whereas an explanation may have been validated through participant feedback meetings. There are many strategies for grounding study findings relevant to the analytic approach used. What is important is that these are explicitly described in the research methods.
The results section needs to reflect the strategies used to validate the study findings. Some strategies for grounding study findings are simply conducted as analytic tasks and stated in the study methods, whereas other strategies for grounding study findings can be reflected in the way the study findings are presented or described. Three writing strategies can be used to demonstrate that study findings are well grounded. First, demonstrate that each component of data reported is grounded in the data itself or how it was validated. For example, using in vivo terms (from participants own words) when describing an issue demonstrates that it originated from participants own words, stating that a particular issue was repeatedly mentioned throughout the data shows it is well supported, or when describing a concept highlight the specific issues that contributed to the development of that concept. These strategies can concisely demonstrate how different components of the results are evidenced in data and thus well grounded. Second, show how the argument or theory presented fits the study data, which implicitly demonstrates that it is well supported by the study data. Showing the fit of interpretations demonstrates the robustness of the argument or theory and convinces a reader that what is presented is plausible and supported by data. This involves not only presenting evidence to support the stance described but also involves showing why the data do not support alternative explanations. Describing the absence of alternative explanations
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or presenting data that explicitly refute alternative views is a strong indicator that the explanations proposed actually fit the study data. Finally, show the nuances or limitations of the study findings, to demonstrate how data were used to refine study results. Describe the nuances found in issues presented, or whether some findings relate only to a sub-group of study participants, or the conditions under which certain findings are valid. These details provide contextual detail to demonstrate how each issue is shaped and supported by the study data.
Transferability of Results
In writing the results of focus group research, there is an inevitable question about whether results are relevant outside of the specific context in which the study was conducted. This is referred to as "generalizability" in quantitative research, which is somewhat problematic to apply directly to qualitative research; therefore, the term "transferability" is often used instead. Transferability refers to the wider relevance of qualitative study findings and their applicability to other contexts, without being generalizable in a statistical sense. The transferability of study results is typically addressed in the results or discussion sections of an academic report. Although some results of qualitative research are not transferable, much qualitative research does have resonance outside the specific context of the study. In the study results, it is important to note how the study results may be relevant to other contexts. This involves outlining the nature and context in which the study findings may be transferable. Ritchie and Lewis (2003) describe three forms in which qualitative research findings may be considered as transferable. They suggest considering (1) whether the issues and concepts reported are reflective of those found in a larger parent population (i.e., representation); (2) whether study findings can be applied to other contexts outside the study itself (i.e., inference); and (3) whether results contribute to development or refinement of empirical theory (i.e., theoretical relevance). Each of these is described more fully in Chapter 5. In writing and interpreting study findings it is important to clarify for the reader the type of transferability that is applicable; the context in which results may be transferable; and the validity of transferability (i.e., why the study results can be applied more broadly).
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Presenting Mixed Methods Study Results
Focus group discussions are commonly used in mixed methods research, either with quantitative methods (e.g., a survey) or with other qualitative methods (e.g., in-depth interviews or observation). A mixed methods research design enables the research issue to be examined from different perspectives, thereby providing more comprehensive understanding of the issue than using a single approach. However, qualitative and quantitative research generate very different data, which cannot simply be woven together without an acknowledgment of their differences. One of the challenges in presenting the results of mixed methods research is to identify the most effective strategy to present the different types of research results.
The study design, the purpose of each method of data collection, and the nature of the study findings all influence how to present the results of mixed methods research. Data from each method of data collection first need to be analyzed according to procedures appropriate to the research paradigm in which the data were collected. Qualitative data need to be analyzed by following procedures of the interpretive paradigm, whereas quantitative data are analyzed in the positivist paradigm (see Chapter 2 for more on research paradigms). After the study findings from each method of data collection have been generated, the most effective method to present the study results to meet the research objectives can be determined.
One of the first decisions is which type of data will lead the study findings. Will the focus group data shape the main story of the research with quantitative data used to supplement this, or will the quantitative findings shape the structure of the study findings with extracts from the focus group discussions used to provide contextual evidence? One drawback of the latter approach is that qualitative research is often only used to provide illustrative quotations rather than being used to its full potential in providing contextual explanations and identifying variation and nuances in the study findings.
A subsequent decision is whether to integrate or separate the findings from mixed methods research. Integrating study findings is possible where each method of data collection covered similar topics or issues, whereby the results may be presented by topic,
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integrating relevant findings from each type of data. For example, results of survey data may present the prevalence of certain behavior, whereas focus group data are used to describe the context of that behavior. One of the challenges of integrating study findings in this way is that qualitative methods generate much more data, therefore requiring succinct presentation of study findings. A further issue arises when the findings from different research methods present contradictory findings on the same issue. In this case the reasons for the discrepancy should be explored and, if possible, explained. If the discrepancy remains unexplained, such as when there is insufficient data to explore it further, this should then be noted in the study findings for further examination in future research.
An alternative strategy for presenting findings from mixed methods research is to present findings from each method of data collection separately, such as presenting quantitative research findings followed by qualitative findings, or vice versa. This strategy is appropriate when the issues from each method of data collection do not overlap, and so cannot be integrated by topic, as described previously. Study results may also be presented by each research question, whereby study findings from one method of data collection may align with a specific study objective, whereas for others results from several research methods may be integrated. Whenever results are integrated from different methods of data collection, the source of data reported needs to be made clear for the readers, so that results can be properly interpreted.
Key Points
• Qualitative research generates a different type of evidence to quantitative studies, which presents different writing challenges.
• The purpose of the results section is to present study findings in a clear and compelling way in response to the research objectives.
• Writing provides another analytic tool in qualitative research and is often conducted simultaneous with further analysis to refine study findings.
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• Study results need to be a logical outcome of the analytic approach described in the methods section; such coherence is an indicator of scientific rigor.
• Data reduction is an essential precursor to writing study results and can help identify the core message or story of the results.
• Focus group results are often presented in narrative form, and use quotations to illustrate issues presented. However, quotations should be used judiciously, presented ethically, and contribute to an overall argument.
• Results should be presented in a clear structure or coherent argument that identifies how individual issues contribute to the central message of the study.
• Focus group data provide an opportunity to present variation and nuances in issues, in addition to highlighting a common perspective. Presenting interaction can add additional insight to the issues reported.
• Study results can also be presented in visual formats, which can simplify the presentation of complex processes and make findings more accessible.
• Reflecting the context of study findings improves the understanding of the research issues.
• Study results need to be well grounded in data to avoid the criticism of making unsupported assertions.
• Focus group results are often presented as part of mixed methods research, where a key decision is whether to integrate or separate the findings of each method of data collection.