Using Telephone Focus Groups Methodology to Examine the Prostate Cancer Screening Practices of African-American Primary Care Physicians Louie E. Ross, PhD; Leonardo A. Stroud, MD, MPH; Shyanika W. Rose, MA; and Cynthia M. Jorgensen, DrPH Atlanta, Georgia and Durham, North Carolina The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency. African-American men have a greater burden from prostate cancer than do white men and men of other races/ethnicities in the United States. To date, there have been no studies of how African-American primary care physicians screen their patients for prostate cancer. The purpose of this study was to examine the use of telephone focus groups as a methodology and to learn about this practice among a group of African-Amencan primary care physicians. A total of 41 physicians participated in eight telephone focus groups. Results from the study are found in a separate article. Regarding telephone focus group methodology, we found that a majonty of the physicians in this study preferred telephone focus groups over the conventional face-to-face focus groups. We also discuss some of the advantages (e.g., no travel, high acceptance rates, more flexibility than in-person groups, and general cost efficiency) as well as disadvantages (e.g., nonverbal communication limits and reduction of group interaction) of this methodology. This methodology may prove useful in studies involving African-Amencan physicians, physicians in general and other difficult-to-reach healthcare professionals. Key words: prostate cancer U screening U focus groups U Afrcan Americans © 2006. From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-55, Atlanta, GA (Ross, Stroud, Jorgensen) and Battelle Centers for Public Health Research and Evaluation, Durham, NC (Rose). Send correspondence and reprint requests for J NatI Med Assoc. 2006;98:1296-1299 to: Dr. Louie E. Ross, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717; phone: (770) 4883087; fax: (770) 488.4639; e-mail:
[email protected]
INTRODUCTION n 2006, an estimated 234,460 new cases of prostate cancer will occur and about 27,350 men will die from this disease.' African-American men have a greater burden from prostate cancer when compared to 1296 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
white men and men from other race/ethnic groups in the United States,2 and African-American primary care physicians are more likely to serve poor people, members of minority groups and those who live in underserved areas.3 We conducted a series of telephone focus groups with African-American primary care physicians to explore their prostate cancer screening and counseling practices, discuss their practice patterns and assess their use of educational materials. This brief report explores the use of telephone focus group methodology among a group of African-American primary care physicians only. Face-to-face focus groups are a widely used qualitative method of collecting data. These groups generally involve interaction and discussion among participants about a number of topics and issues. A moderator, who remains neutral, leads the discussion and encourages participation. The moderator generally has a set of questions or guide to ensure that most topics are covered within each group. This method allows for more thorough discussions and opinions. However, these groups are deemed exploratory and are typically not generalizable in their findings to the larger population. A telephone focus group is a moderated group discussion similar to a conference call. Although traditional focus groups involve face-to-face interactions, telephone focus groups are becoming more common, especially among health researchers.4 Telephone focus groups have typically investigated issues related to clinical practices, opinions or resource needs of these health professionals.4 This methodology has been used with physicians and other healthcare professionals since it can accommodate geographic diversity; eliminate travel, facility and other costs; and can be built around physicians' busy schedules.5 A previous telephone focus group study was conducted on the prostate cancer screening practices and opinions of physicians from the larger population of primary care providers.6 For this study, the Centers for Disease Control and Prevention (CDC) conducted eight exploratory focus groups between August and October 2003. The current VOL. 98, NO. 8, AUGUST 2006
PROSTATE CANCER SCREENING PRACTICES
study includes only African-American primary care physicians to supplement a previous study that included too few African-American physicians for meaningful analysis.6 We could find few studies that addressed cancer screening practices among African-American primary care physicians7'8 and no studies that focused on prostate cancer screening among African-American primary care physicians. The purpose of this paper is to: 1) describe the relatively new method of exploratory telephone focus groups; 2) discuss the usefulness of telephone focus groups involving an understudied group, i.e., a sample of African-American primary care physicians; and 3) discuss some of the strengths and limitations of this method. Descriptive and other findings from the study are presented in a separate manuscript.9
METHODS The sample for the current study was obtained from the National Medical Association (NMA) physician directory list. Physicians in the sampling frame included those physicians who specialized in family medicine, general practice or internal medicine; reported that they served a male population that included men aged 240 years; and conducted health maintenance examinations and prostate cancer screenings. Physicians employed by government or academic institutions were excluded. All physicians reported serving varying percentages of African Americans with some serving predominantly if not all African-American patients. The target population included primary care physicians practicing in the United States who self-designated as black or African-American, had a patient population composed of 22O% males, had male patients who were 40-70 years old, and spent 220 hours per week in direct patient care. A total of 2,500 (1,000 during wave 1 and 1,500 during wave 2) invitations were sent to physicians' offices via overnight mail. Each packet included: 1) an invitation letter on CDC letterhead describing the study; 2) a sign-up and screening form; and 3) a return fax cover sheet. The sign-up form included questions that screened each physician for eligibility. Physicians were considered eligible if they reported that they: spe-
cialized in family medicine, general practice or internal medicine; served a population of 220% males that included men 40-70 years old; and conducted health maintenance examinations, including screenings for prostate cancer. All physicians reported that they served some percentage of African-American patients, and some reported serving predominantly African-American male patients. A description of the focus group response rate is listed in Table 1. Of the 383 physicians who responded to the invitations, a total of 181 were eligible and agreed to participate. Each call was to take one hour. The telephone focus groups were offered during various hours of the day and evening to accommodate physicians' schedules. Physicians were asked to circle their preferred dates and times on the sign-up form. Physicians were scheduled for their preferred date and time whenever possible. Confirmation letters and consent forms were faxed to each selected physician. All physicians were given a reminder call 1-2 days before each focus group. Physicians were reimbursed $150 each for their participation. General questions for physicians included prostate cancer screening practices using prostate-specific antigen (PSA) and/or digital rectal examination (DRE), discussions of the screening tests before offering the tests, factors influencing screening practices, adherence to clinical guidelines and willingness to use educational materials.
Telephone Focus Groups An experienced independent professional moderator conducted the focus groups using a guide developed by the authors. A total of 41 physicians out of the 64 scheduled physicians participated in the eight focus groups. There were 3-6 participants per group, or an average of five physicians on each call. Participants are described in Table 2. Participants represented 22 states and were given the option to remain anonymous during the call. Those physicians who agreed to participate displayed a strong interest in these focus groups-that is, participants seemed excited that they could participate and make a contribution in these groups from flexible locations (home, office, hotel, etc.). There was greater participation during the evening hours (6:30 and 8:00
Table 1. African-American physician mailings and response rates Response Invitations sent No reply Incorrect contact information Replies Ineligible* Agreed Declined *
Wave 1 1,000 855 17 128 92 32 4
Wave 2 1,500 1,132 113 255 102 149 4
Total 2,500 1,987 130 383 194 181 8
The reasons for ineligibility at this state included: physician was not in primary care (45%), physician had retired (20%), physician's
practice included
