FOCUS GROUPS

INTRODUCTION

Four focus groups were conducted with older drivers to better understand the perceptions and concerns that they may have about participating in future NHTSA-sponsored studies where they would be asked to: (1) disclose their usage of prescription and over-the-counter medications; and (2) participate in an assessment of their driving abilities. These focus groups were intended to explore a variety of methods by which each of the above two phases of future research might be accomplished.  Although focus groups are not statistically representative of the demographic groups from which the panelists are drawn, they provide other analytical advantages that are worthwhile, including creation, validation, or dismissal of working hypotheses concerning the objectives being studied. 

Focus group panelists were queried to determine:

1. Their general willingness to participate in such research studies.
2. Their preferences for how data on their use of medications would be collected.
3. Their preferences for how the effects of medications on their driving abilities would be observed or measured.
4. Concerns that could prevent older drivers from willingly participating in such research.
5. Incentives which might improve the willingness of older persons to participate in these studies.

Location

During the month of December 2005, four 2-hour focus groups were conducted by a project consultant³ , who is a professional focus group moderator.  Two focus groups each were conducted in the vicinity of Tampa, FL and Philadelphia, PA, at professional facilities with their own staff and equipment dedicated to focus group support (one-way mirror observation rooms, recording equipment, etc.). 

Participants

Roughly equal numbers of male and female drivers were recruited by focus group facility staff, with at least 25 percent minority participation.  At the Pennsylvania site, recruitment of African-American participants was emphasized, without excluding other minorities, and in Florida, recruitment of Hispanic-Latino participants was emphasized. All participants were compensated according to local market conditions.

On average, each focus group consisted of ten panelists.  The groups were divided according to age; at each site there was one group of panelists age 55 to 69 and one group of panelists age 70 to 85.  All panelists held a valid driver's license, stated that they drive on a regular basis (at least 5 trips per week), and use a variety of prescription and over-the-counter medications on a regular basis.   Appendix H presents the “screener” developed by project staff that was used for subject recruitment. 

Focus Group Protocol

The focus group discussion guide is presented in Appendix I.  The protocol for the groups is summarized below.  The moderator spent the first 10 minutes introducing himself and the research topic, and provided assurance to the panelists that he was an independent moderator, that they would not be asked to disclose anything that makes them uncomfortable, and that their driving privilege would not be affected in any way as a result of their participation in the discussion.  He then asked participants to briefly introduce themselves, and then engaged them in a warm-up topic for approximately 15 minutes about how driving may have changed for them over the past few decades, before delving into discussions about their preferred methodologies for identifying medication use and measuring driving performance.  

Methods of Identifying Medication Use

For the first topic of interest—methods of determining what medications older people take—the moderator spent 30 minutes generating discussion and feedback from participants about their willingness to participate in research, based on which of 14 different potential methods of collecting medication data are used. These are listed below.

METHOD 1:	Bringing all your medications in a bag to your family doctor or a nurse at the practice so a complete list can be made, and a discussion can take place about when and how you take the medications.
METHOD 2:	Bringing all your medications in a bag to your pharmacist, so a complete list can be made, and a discussion can take place about when and how you take the medications.
METHOD 3:	Bringing all of your medications in a bag to someone at the company who is conducting the research (research assistant), so a complete list can be made, and a discussion can take place about when and how you take the medications.
METHOD 4:	A nurse comes to your home to make a list of prescription and over-the-counter medications, and has a discussion with you about when and how you take your medications.
METHOD 5:	A pharmacist comes to your home to make a list of prescription and over-the-counter medications, and has a discussion with you about when and how you take your medications.
METHOD 6:	A researcher comes to your home to make a list of prescription and over-the-counter medications, and has a discussion with you about when and how you take your medications.
METHOD 7:	An occupational therapist comes to your home to make a list of prescription and over-the-counter medications, and has a discussion with you about when and how you take your medications.
METHOD 8:	Filling out a survey that the researchers mailed to you, asking you to list all the medications you take, the dosages, and how often you take them.
METHOD 9:	Coming to the researcher’s office by yourself to talk about what medications you take (without bringing them in).
METHOD 10:	Coming to the researcher’s office to talk about what medications you take (without bringing them in), and bringing a significant other with you (spouse or companion who lives with you) to help you remember what medicines you take.
METHOD 11:	Giving your consent to a researcher to send a letter to all of your doctors, asking them to list all the medications they prescribed for you.  The doctors would send that list back to the researcher.
METHOD 12:	If the researchers had obtained a list of medications that had been prescribed to you, would you then feel comfortable bringing your over-the-counter medications to the research group so those could be added to your list of medications, and then talking to the researcher about whether you still take all the prescription medications the doctors listed?
METHOD 13:	Having special caps placed on the medications you take that record the date and time of day each time you open the container.
METHOD 14:	Researchers would obtain information about the prescription drugs you take by accessing pharmacy databases (which are created when you fill and refill a prescription).

Following the discussion of the pros and cons of the various methods of collecting data about medication use, participants spent 20 minutes completing a card-sorting task.  For this task, participants were given a stack of 14 cards, each describing one of the 14 methods.  Participants were asked to sort the cards into two piles: a “bad pile” containing cards with the methods they find unacceptable, and a “good pile” containing cards describing methods with which they would be comfortable as research participants.  They were then asked to draw an “X” through each of the cards in the “bad pile,” and to rank-order the methods in the “good pile” from most preferred (rank of 1) to least preferred.

Methods of Measuring Driving Performance

For the second topic of interest—methods of measuring driving performance—the moderator spent 20 minutes generating discussion and feedback from participants about their willingness to participate in research using 6 potential methods assessing driving performance. The 6 methods are listed below:

METHOD 1:	Studies where you drive a vehicle with dual controls (like a driver education car) on a closed course and either a driving instructor or an occupational therapist sits in the passenger seat while you drive the car.
METHOD 2:	Studies where you drive a vehicle with dual controls (like a driver education car) on the road in traffic, and either a driving instructor or an occupational therapist sits in the passenger seat while you drive the car.
METHOD 3:	Studies conducted where you drive your own car, on a closed course, and either a driving instructor or an occupational therapist sits in the passenger seat while you drive the car.
METHOD 4:	Studies conducted where you drive your own car, in traffic, and either a driving instructor or an occupational therapist sits in the passenger seat while you drive the car.
METHOD 5:	Studies conducted where you drive your own car, in traffic, and miniature audio or video recording instruments are mounted in the vehicle to record the driving scene and how you respond to it (braking, steering, speed control).
METHOD 6:	Studies that measure your vision, your memory, and physical abilities such as your strength and flexibility in your arms and legs, that are known to be important for safe driving and which may be affected by medications.  These would be brief tests, using paper and a pencil, or might be presented on a computer.

Following the discussion of the pros and cons of the various methods of assessing driving performance, participants spent 10 minutes completing the same type of card-sorting task described above, for the 6 methods. 

Concerns about Participating in Future Research and Research Incentives

The focus groups closed with a 10-minute discussion to highlight the biggest concerns older drivers may feel about participating in future research studies, where they would be asked to disclose their medication use and have their driving skills assessed.  Other points of discussion included the kinds of assurances of confidentiality that would be needed and the kinds of incentives/compensation that could increase the likelihood of participation in future studies of this nature.