The role of focus groups in a randomised controlled trial : the ADEPT study

In a recent study we developed a decision aid for prenatal testing of fetal abnormalities. The effectiveness of the decision aid compared with a pamphlet in increasing women's informed choice and decreasing conflict was evaluated using a cluster randomised controlled trial, A DEcision aid for Prenatal Testing for fetal abnormalities (ADEPT) [ISRCTN22532458]. Challenged with the need to ensure that the decision aid best suited the needs of women and health professionals involved General Practitioners (GPs), we explored the potential of both quantitative and qualitative methodologies to inform the development phase. In this article we discuss our rationale for, and provide some insights regarding our experience of, using qualitative methods during the development phase of the decision aid.

Assessing cultural and linquistic appropriateness of the Rose Angina questionnaire in three ethnic groups

Introduction. Meeting the needs of migrant groups in Europe requires cross-culturally valid questionnaires, a substantial challenge to researchers. The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It consists of seven items that collectively yield a diagnosis of angina. It has been shown to perform inconsistently across some ethnic groups in Britain. This study aimed to assess the need for modifying the RAQ for cross-culturally valid use in the three main ethnic groups in Scotland.

Methods. Interviews were carried out with Pakistani Punjabi speakers (n=26), Chinese Cantonese speakers (n=29) and European-origin English speakers (n=25). Bilingual project workers interviewed participants and provided translation and commentary to the English-speaking researcher. Participants were asked about general and cardiovascular health beliefs and behaviours, and about attitudes to pain and chest pain. They were also asked to comment on their understanding of an existing version of the RAQ in their language.

Results. No dominant themes in the cultural construction of health, pain or cardiovascular knowledge emerged that may significantly influence RAQ response between language groups. Problems were encountered with the Punjabi and Cantonese translations of the RAQ. For example, the translation for “chest” was interpreted by some Pakistani and fewer Chinese women to mean “breasts”. “Walking uphill” was translated in Chinese as “walking the hill”, without stipulation of the direction, so that some Cantonese speakers interpreted the question as meaning walking downhill. In addition, many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording.

Conclusion. Existing Punjabi and Cantonese versions of the RAQ should be modified before being used in multi-ethnic surveys. Current versions are unlikely to be yielding data that is comparable across groups. Other language versions also require similar investigation to study the cardiovascular health of Europe’s migrant groups.

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

Objective To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.

Design Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability.

Results The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated.

Conclusions Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Reinventing liberatory practice : how do we work with groups of which we are not a part?

The research that informed this paper asked: how can we work as allies of groups of which we are not a part? This question is particularly focused on work with people who have experienced colonisation by those who are aligned (by race, class, gender, culture or position) with the colonisers or oppressors. The research brings together literature in the fields of community work, adult education, and feminist and postcolonial theory, with Indigenous viewpoints and experience. An analysis of Indigenous viewpoints identified a range of key ideas about achieving social change.

These ideas are developed into several frameworks, two of which will be discussed here. The first framework offers a way of conceptualising work against oppression and proposes that it must involve a focus on fostering emancipatory agency. Emancipatory agency involves the capacity to know and to act towards social justice ends via meaning making which follows ethical criteria. An ethics of meaning making is proposed which includes a focus on: multiplicity and difference; the partial nature of all knowings; the context / situatedness of meaning; and the critical / reflective attitude in meaning making. This type of agency is dependent on the process of transformative dialogue which is inherently communal and is based on four micro processes: affirming the O/other; encountering, exploring and experiencing of multiple and partial views; moving between positions of self and others; and enacting meaning into the world. A second framework operationalises these ideas in the field of community development, and offers a method of practice.

Undertaking public health research in collaboration with disenfranchised groups

Examines a series of projects conducted by a university research centre in collaboration with a sex worker organisation. The aim was to establish guiding principles for a practical, ethical, and methodologically sound approach to conducting collaborative participatory health research with disenfranchised groups.

Selection of priority groups for obesity prevention current approaches and development of an evidence-informed framework

Resources for obesity prevention interventions are inevitably limited, necessitating the selection of priority groups to ensure effective and equitable use of funds. This paper aims to review published approaches to selection of priority groups ('target populations') for obesity prevention, and to present the development of a new systematic framework for organizing and assessing evidence for selecting priority groups. A review was conducted of the process and justification described for selecting priority groups in a sample of obesity prevention publications. Using the results of this review and adaptation of theory and frameworks in both the obesity prevention and health promotion priority-setting literature, a framework was developed for assessment of potential priority groups for obesity prevention. The published literature lacks discussion of and explicit processes for selection of priority groups for obesity prevention intervention. The new framework describes specific types of evidence that should be considered in the assessment of a potential priority group for obesity prevention and has applications for funding and implementing community-based or settings-level obesity prevention interventions and research. Application of this framework has the potential to enhance the effective use of limited obesity prevention resources and to identify areas in need of additional research evidence.

Finding rule groups to classify high dimensional gene expression datasets

Microarray data provides quantitative information about the transcription profile of cells. To analyse microarray datasets, methodology of machine learning has increasingly attracted bioinformatics researchers. Some approaches of machine learning are widely used to classify and mine biological datasets. However, many gene expression datasets are extremely high dimensionality, traditional machine learning methods cannot be applied effectively and efficiently. This paper proposes a robust algorithm to find out rule groups to classify gene expression datasets. Unlike the most classification algorithms, which select dimensions (genes) heuristically to form rules groups to identify classes such as cancerous and normal tissues, our algorithm guarantees finding out best-k dimensions (genes) to form rule groups for the classification of expression datasets. Our experiments show that the rule groups obtained by our algorithm have higher accuracy than that of other classification approaches.

Motivators and barriers of ethnic groups to engage in arts performance

This paper aims to highlight the behavioural processes of ethnic minority group consumers in relation to arts performance in Australia. Our findings indicate that Chinese, Vietnamese, Italians and Greeks have varying perceptions, practice and experiential decision-making. The major barriers for ethnic audiences to attend arts events were cost and time; a lack of understanding of or exposure to some artforms; language difficulties. Motivating factors for ethnic audiences were events associated with their own ethnic backgrounds; socialising/meeting with friends/people, and familiarity with the art-form. Our research will be critical for future arts marketing and cultural research and contribute to socially inclusive communities where every resident can act as a contributor to build socio-economically strong cities and nations