Focus group design and group dynamics: Lessons from deaf and hard of hearing participants

Focus groups are a common tool in evaluation. Here we report experience conducting focus groups with deaf and hard of hearing people, from which we reflect on lessons learned about how we can more effectively "listen" to people in all focus groups-particularly those that don't intentionally include people with a hearing loss. We learned that: (1) focus groups with deaf and hard of hearing people can be highly productive on even the most sensitive issues and across disparate socioeconomic and ethnic differences if they share a common interest and mode of communication; (2) the physical environment of group communication may count more than we usually notice; (3) insuring communication requires a very high level of vigilance by moderators and observers; (4) it is hard to "focus" fetus groups in some cultures, so one must allow for that; (5) genuine communication may require more time and patience than one might expect; (6) confidentiality in a marginalized community may require special attention; (7) an experienced moderator who is an "outsider" to the group's culture or experience can be very useful; and (8) feedback from observers, evaluators, and participants can improve communication. Most of all, we learned that focus groups can be much more productive when we are sensitized to invisible communication difficulties.