Methods
Study Design
In 2012, three focus group meetings were held among employees with CANS; all sessions took place at the HAN University of Applied Sciences (Nijmegen, the Netherlands). The Radboud university medical center medical ethic committee declared (registration number 2013/317) that the study does not fall within the Dutch law on 'Medical Research involving Human Subjects' (the WMO) and that therefore, for performance of this research, no approval is required from a medical ethic committee. The research protocol fulfilled the criteria of the Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects.
We used focus groups to investigate the range of ideas that people have about a certain topic; such groups can uncover factors that influence opinions, behavior or motivation.[34] Focus groups can be used in program development and have proven helpful in the needs assessment, mostly because they provide an interactive environment in which ideas can emerge from the group.[34] A group possesses the capacity to become more than the sum of its parts, and to exhibit a synergy that individuals alone do not possess.[34] Therefore, focus groups were considered to be the most suitable method in view of the aim of this study, i.e. to identify the problems (at work) as experienced by employees with CANS.
Participants
A purposive, homogeneous sampling technique was used to identify potential participants. Participants were recruited from the staff of the HAN University of Applied Sciences and the Radboud university medical center (both located in Nijmegen, the Netherlands). Participants were recruited via electronic occupational news mails and informed about the research project by occupational health staff. Generally, self-management interventions focus on chronic conditions and, therefore, participants were only included if they had any complaints of the arm, shoulder and/or neck persisting for longer than 12 weeks, and if the complaints were caused or worsened by their job and/or limited their participation in work. The inclusion criteria used for the present study will also be used to include participants in the adapted self-management intervention for employees with chronic non-specific CANS. Each participant was informed that participation was voluntary and that data would be used anonymously. Employees fulfilling the inclusion criteria were asked to fill out a short questionnaire (demographics) prior to the focus group meeting.
All participants gave informed consent to participate in the study and to allow audio-recording of the sessions. All participants received a gift of 20 euro for their participation.
Focus Group Meetings
Following the recommendations of Krueger and Casey[34] a question guide with open-ended questions was developed (Additional file 1). The content and the order of the different question categories were developed based on the recommendations of Krueger and Casey.[34] The selected topics were based on a recent multidisciplinary guideline for nonspecific CANS[21] and on the original self-management program as developed by Detaille et al.[30] The selected topics ensured the multifactorial perspective of the focus group sessions. Each focus group session was moderated by the first author (NH) using a standardized script. The group members were asked about their experiences at work and their needs for continuing work despite their complaints. The topics included participants' experiences with their complaints, experienced problems with work activities, dealing with work problems, support and help of others (at work and at home), and communication about their complaints. In addition, a healthy lifestyle was discussed. When the group discussion was not sufficiently facilitated by the question alone, or if the question was not clear enough, the moderator could give some examples. The moderator actively stimulated interaction and discussion between the participants. Finally, participants were asked what kind of information related to CANS they would like to receive and what they would like to learn if they would follow a self-management intervention.
All focus group sessions were audio-recorded and notes were taken by an assistant (LD). In each meeting the question guide was followed. The moderator made sure that every participant was involved in the discussions. Each session lasted about 120 min. Debriefing was performed after each session.
Data Analysis
The audio-recordings were transcribed by the assistant (LD). Member checks were performed after drafting the manuscript, one year after the focus group sessions. If no response to the first email was received from participants within 10 days, a reminder was sent by email. The first author (NH), trained in qualitative research methods, performed the data analysis. Data were analysed using conventional content analysis,[35,36] which is generally used with a study design whose aim is to describe a phenomenon.[35] The aim of content analysis is 'to provide knowledge and understanding of the phenomenon under study'.[37] Content analysis has a long history in research and is used to analyze text data and can be used in analyzing focus groups.[35]
After reading each transcript multiple times, the transcript was analyzed using content analysis with an open-coding system.[36] New codes were added when considered necessary. After this, the codes were sorted into categories based on how different codes are related and linked.[35] Then, the emergent categories were used to organize group codes into meaningful clusters,[35] expressing the experiences of employees with CANS.
The Atlas.ti (version 7.082) program was used for analysis. During data analysis, the emerging themes were discussed in a small expert group (NH, YH, SD). Moreover, by reading all the transcripts, the expert group checked that no themes were missed. The supporting quotes related to each theme were discussed in the expert group.
BMC Musculoskelet Disord. 2014;15(141) © 2014 BioMed Central, Ltd.
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