Sexual and reproductive health of adolescents
Asking young people about sexual and reproductive behaviours
Topics for in-depth interviews and focus group discussions: partner selection, sexual behaviour and risk taking
By Roger Ingham, Nicole Stone
Individual semi-structured interviews and focus group discussions are ideally suited to obtaining relevant data on the meaning, identities and contexts associated with sexual behaviour among young people. In this core module suggested topics to be covered in interviews and group discussions with young people regarding sexual behaviour, dating patterns and risk perceptions are outlined.
The topics listed provided are suggestions for areas or themes that could be covered during the interviews and discussion groups along with key elements, example questions and suggestions for probing. These lists however should not be regarded as exhaustive. It is important to note that the focus of the instruments is that of 'topics' rather then specific questions per se, and where questions are suggested in the following sections, they are essentially illustrative, and not to be taken as the only way, or indeed the optimum way, of exploring the issue. It is imperative that researchers using this module appreciate that they must develop their own individual style of questioning in order to gain information in culturally appropriate and sensitive ways. Each research team is expected to spend time in refining and agreeing on the final topic list dependent on their particular research interests. Furthermore, it is recommended that the research team meet at regular intervals to discuss improvements in the interview schedule, the wording of questions and so on.
The topic list is ordered into blocks. It is recommended that a pre-interview schedule covering demographic details is also included to gain both an overall assessment of the sample characteristics of the interviewees and also to form the basis of preliminary comparisons both within and between respondents. For example:
- Age, sex, current relationship status, offspring, siblings, ethnic/language group, religion
- Where they lived and where they live now, type of accommodation, urban/rural
- With whom have they lived and with whom they live now
- Schooling received / are receiving
- Current occupational status, income
- Parental occupational status
When considering the blocks it is vital to conceptualise each block's topic list as a 'trigger' list rather than a 'question list'; the triggers enable all researchers to develop more detailed 'question lists' which are appropriate to the culture in which they are researching and the issues of most interest. Ascertaining affect, behaviour, cognition and context is crucial and information relating to these four aspects should be sought in every section included in the final interview schedule; for example, 'What did you think about that?', 'How did that happen?', 'How did you feel about that?', 'What was the wider situation?', 'What else was going on?'. It is also important to constantly probe for the respondent's understanding of why certain events, feelings and situations have materialised. Some researchers may find it useful to raise some of the areas in terms of dimensions or contrasts; for example, there are many different dimensions of sexual risk, or abuse, or feelings about sex. Similarly the use of contrasts both within the respondent's own life, and between the experiences of the respondent and their peers can be helpful; for example, asking whether their parents were more open than their friends' parents.
Block One: Sources of information
Block one explores the respondent's knowledge and sources of information regarding relationships, sex and contraception. Emphasis is placed on the role of parents and elders as well as the education system and the media in informing young people about sexual health matters. The quality and relevance of the information received is investigated in conjunction with the barriers to improved information. Information and knowledge of alternative sources of advice and support are also sought, including their personal usage of them.
Blocks Two & Three: Sexual development and first intercourse
Blocks two and three focus on relationships and sexual development up to and including a full account of the contexts of first intercourse. Affect, behaviour, cognition and context are crucial here. The main aim of block two is to gain insight into the development of the respondent's sexuality and factors shaping this development including parental attitudes, peer pressure and cultural norms. Block three focuses on the first time sexual intercourse took place, the context of first intercourse and risk taking behaviour. One important dimension is that of control over the tempo and activities on that occasion, and, more generally, in their sexual dealing up to that point.
Researchers should ensure that they understand what kinds of relationships the respondent had, and their level of graduality and mutuality. The central theme is that of the extent of the respondent's perceived control, or lack of control, over their sexual dealings with others.
A key theme in the development of sexual compulsivity versus contact-oriented approaches to sexual relations is that of the meaning and importance of sex. Solosex activities are included as a measure of whether sexuality is important in itself, in addition to or in contrast with, sex as being essentially relational.
Researchers should bear in mind that not all sexual experiences might have been heterosexual and some respondents may have been abused as children. If this does appear to be the case, then suitable sensitivity will be needed to obtain as much information as possible, and distinctions should be made in the interview between such occasions of sexual activity and those which might be regarded as more voluntary.
Block Four: Sexual inexperience
Since some of the respondents may be sexually inexperienced, the interview schedules should be designed accordingly. Block four has been designed to investigate the reasons why a respondent has yet to experience first intercourse and how they feel about, and others view, their current status.
Block five: Subsequent sexual behaviour
Block five follows a chronological order, with the respondent being asked to recall and describe their sexual history, feelings and relationships, since first intercourse, including detailed accounts of more recent events and relationships. Particular attention should be paid to detailed descriptions of recent interactions, where possible, including examples of both safer and less safe activities so that comparisons can be made. The use of contraception is explored in detail, as well as perceptions of risk, vulnerability, and related issues.
Researchers incorporating this block in an interview should focus on the respondent's 'choice' of partners, patterns of relational behaviours and the occurrence and development of protective behaviours. In this way it is possible to ascertain how interactional competencies develop, by, for example, exploring how sexual pressures have been dealt with.
Block six: Risk taking behaviours
Block six is closely linked to block five and extends the exploration of risk taking behaviour, perceptions of risk and vulnerability as well as the mechanisms employed to avoid risk.
Block seven: Use of sexual health services
Block seven focuses on the respondents knowledge, attitudes and usage of the sexual health services provided for young people in their locality, including health centre based services and those provided by youth organisations. Opinions are sought on the appropriateness of the services and facilities offered as well as on their personal experiences and ideas on how services could be improved upon.
As with other blocks the researchers should be aware that some respondents will have not yet sought, and possibly never will, sexual health information and advice from a recognised source, hence alternative questioning should be incorporated.
Focus Group Discussions
Focus group discussions (FGD) are particularly useful for obtaining data on social norms and cultural expectations on various issues. The theoretical basis underlying the use of FGD is that the sexuality of young people is, to a large extent, shaped and influenced by conversations and interactions with peers. Although individual reactions to peer norms and pressure will be very diverse (conforming, rejecting, ignoring, and so on), an identification of discourses will add relevant information to individually collected data.
The aim of the focus group is not specifically to gather information on individual reactions as in an in-depth interview. FGD are not suitable for the collection of accounts of individual reactions and behaviour, except in very general terms. Rather, the group approach is used to get a feel for the language, the values expressed by this language, the range of meanings and to identify areas in which there is agreement or disagreement between members of communities.
FGD are also valuable in sensitising the researchers conducting the qualitative analysis of individual data to the social or group dimensions of the individual's conduct - language, dominant discourses, social pressures, and so on. It cannot be expected of individual respondents, especially the younger ones, that they are able to verbalise or reflect on these social dimensions. The content analysis of the group discussions may produce an interpretative framework for the individual interviews, where they tap into discourse on sex education, gender differences and sex, risks and responsibilities, setting, guarding and breaking rules, and views on condoms and other safe sex techniques, including postponing sex.
The coverage of topics for FGD overlaps considerably with those identified as being suitable for individual interviews, with the obvious exception of the more personal aspects of past and present behaviour.
For more information and advice on how to conduct interviews and focus group discussions please refer to the following articles:
Hennink M & Diamond I (1999) Using focus groups in social research. In Handbook of the Psychology of Interviewing. pp113-144. Edited by Memon A & Bull R. John Wiley & Sons Ltd. Ingham R, Vanwesenbeeck I & Kirkland D (1999) Interviewing on sensitive topics. In Handbook of the Psychology of Interviewing. pp145-164. Edited by Memon A & Bull R. John Wiley & Sons Ltd.
Ingham R, Vanwesenbeeck I & Kirkland D (1999) Interviewing on sensitive topics. In Handbook of the Psychology of Interviewing. pp145-164. Edited by Memon A & Bull R. John Wiley & Sons Ltd.