We concluded that a qualitative rather than a purely quantitative approach to collecting and analyzing data on families' perspectives on quality was appropriate for this study. Survey data, in which individuals are asked to respond to a series of questions, provides an anonymous "snapshot," or in the case of longitudinal studies, a series of "snapshots" of a person's responses to a given topic at a particular point in time. However, as Miles and Huberman (1994) note "Qualitative data, with their emphasis on people's lived experience,' are more fundamentally well-suited for locating the meanings people place on the events, processes, and structures of their lives..." Further, qualitative social research attempts to gather data from the perspective of those being studied (Strauss, 1987, Werner and Schoepfle, 1987 and Whyte, 1984). Because of the nature of the information we were attempting to collect and because we wanted family members' concepts of quality to be placed within the context of their experience and that of their loved ones, we concluded that a more formative, qualitative approach was called for. The focus group method, one well-known qualitative approach to collecting data, seemed best suited to our analytic needs.
Focus groups provide information generated in a natural environment and are particularly useful in exploring domains of meaning and social norms within a specified community or group of people with shared experiences, as Krueger (1994) notes:
Focus groups produce qualitative data that provide insights into the attitudes, perceptions and opinions of participants. These results are solicited through open-ended questions and a procedure in which respondents are able to choose the manner in which they respond and also from observations of those respondents in a group discussion. The focus group presents a more natural environment than that of an individual interview because participants are influencing and influenced by others -- just as they are in real life. The researcher serves several functions in the focus group: moderating, listening, observing, and eventually analyzing using an inductive process. The inductive researcher derives understanding based on the discussion as opposed to testing or confirming a preconceived hypothesis or theory. (Krueger, 1994).
Thus, for our purposes, focus groups were an ideal method. We wanted family members' discussion to generate our hypotheses and measures of quality for residents with dementia for the larger National Study of Assisted Living for the Frail Elderly. Focus groups were used in this project because of their ability to provide insight into family members' experiences and feeling, the group dynamics around quality and care issues, and social norms about caregiving for persons with dementia. Further, they allowed us to solicit greater detail from participants about specific program features or elements of quality they might mention. Finally, as suggested by their widespread use in market research, focus groups are enormously effective in helping determine what a particular population wants or might like to have. This is precisely the situation that obtained in the Alzheimer's Association study.
Last, but not least, we were drawn to the focus group method because of the explicit nature of the interaction among participants that a well-moderated group generates. As Morgan (1988) notes, the "hallmark of focus groups is the explicit use of the group interaction to produce data and insights that would be less accessible without the interaction found in a group (italics added)." These group discussions, organized around a topic and specific questions, yield a large amount of information over a relatively short period of time. While ideosyncractic and anecdotal information is revealed during focus groups, the group dynamic provides a window on social norms, values and customs regarding the focus group topic. However, reaching consensus is not usually the objective. Rather, focus group study aims to explore a broad range of views on a relatively limited and focused subject.
Finally, we want to note the context in which our focus group results are presented. Unquantitative research, such as population surveys, the sample used for qualitative research usually not representative. Thus results of data collected from qualitative approaches are statistically speaking, generalizable to some population. For this reason, generalization for qualitative data is necessarily tentative. Although qualitative research may provide some definitive answers (such as "what vocabulary do people use when talking about assisted living facilities") qualitative methods are more useful for providing an introduction to the issues, themes and meanings of life situations as lived by the participants. This information can then be used, as we plan to in National Study of Assisted Living for the Frail Elderly, to generate hypotheses, formulate measures (i.e., of quality), construct more focused items and relevant response categories instruments to be used in a population survey, and to help us interpret the findings from quantitative analyses.