van Rijssen et al. BMC Public Health 2010, 10:666 http://www.biomedcentral.com/1471-2458/10/666 insurance physicians. These groups were recruited by randomly approaching chairpersons from the list of all chairpersons of the monthly meetings of the Dutch Institute of Employee Benefit Schemes (the most impor- tant employer of social insurance physicians in the Netherlands). These chairpersons were asked to partici- pate voluntarily with their complete group. All partici- pants had to have been recently involved in face-to-face contact with claimants in a medical disability assessment interview (Table 1 provides more information about Dutch social insurance physicians). The participants agreed to devote one of their meetings to a discussion about their perception of claimants in face-to-face phy- sician-claimant encounters during medical disability assessment interviews, mostly because they considered it to be an important and interesting subject, or because they did not yet came up with another subject for their next monthly meeting. Data were collected in three focus group meetings, which were the first three groups of physicians that agreed to participate in the study within a reasonable time. We declined four other groups that applied, because their availability did not match our time schedule. Also, in two groups not all physicians wanted to participate and thus the groups decided not to join. Because over 10 physicians in one meeting might hinder the discussion and interaction (important ingredients for a successful focus group meeting), the three groups were held separately. In the research design we selected focus group meetings, because little is known about stereotyping in medical disability assess- ment interviews, and we expected the interaction between the participants to provide more information and more in-depth information than individual interviews. Three researchers were present at each meeting: a process facilitator, an observer and content expert, and a researcher who took notes. Each focus group meeting lasted for approximately two hours, with a short break after one hour. Because of its negative connotation, the researchers refrained from using the term ‘stereotyping’ Table 1 Characteristics of Dutch social insurance physicians In the Netherlands, most social insurance physicians are employed by the Dutch Institute of Employee Benefit Schemes. On average, a physician working there interviews 10 claimants - who may have all kinds of disabilities - each week. The medical disability assessments they perform, are mainly based on an assessment interview, which includes an examination. In addition, usually the physicians have information available from the claimant’s occupational physician and the treating physician, or they can consult these professionals [33,34]. Most often, after the interview with the social insurance physician, a labour expert examines which jobs the claimant should be able to perform with the medical disabilities as assessed by the social insurance physician [35]. The combination of the findings of both professionals determines whether or not a claimant is eligible for a benefit. Page 3 of 13 during the focus group meetings. At the beginning of the focus group meeting, the participants were informed about the general aim of the project, being to make an inventory of how social insurance physicians apply clas- sifications of claimants during medical disability assess- ment interviews, and how these classifications might help or hinder them in the physician-claimant commu- nication. After the meeting was over, the researchers explained more about the study and research project to those who showed interest. A summary of the interview protocol is provided in an additional file 1 (Appendix 1 - summary of the interview protocol). No ethical approval was needed according to the Dutch law, because no claimants were included in the study and the physicians were not exposed to any intervention. Directly after the meeting, all participants completed a short questionnaire about demographic characteristics. Also, they received a summary of the content of the focus group meeting which they were asked to check. They were asked to contact the researchers if they found any errors or omissions. Analysis All the meetings were audio-taped and transcribed. Qualitative analyses of the transcribed focus group meetings, combined with additional notes taken by one of the researchers, were performed in four successive steps, according to the grounded theory [17,18] and the principle of constant comparison [19]. Firstly, in the exploratory phase, free coding was applied to all data, i. e. all text concerning a particular topic was given a matching descriptive code. Secondly, axial coding was applied, i.e. coding aimed at generalisation of the free codes. This is the phase of specification in which themes and sub-themes emerge. Thirdly, selective coding was applied in the reduction phase. The aim of this phase was to elaborate on the core themes and concepts, and to identify relationships between these themes and con- cepts. In this phase the results can be summarised in a model. Fourthly, all codes were integrated in the inte- gration phase, and the results of the interviews were compared with those in the formulated model. This entire analysis is an open process in which questions can be adapted for future focus group meetings accord- ing to the findings and experiences in former meetings, and therefore only one group is insufficient [19]. The results presented below are the final results after com- pleting the entire analysis. The software package Atlas.ti 5.2 was used to label the transcripts by assigning codes, to order codes, and to visualise relationships according to the four above-men- tioned steps. The first author performed all the coding and the third author also independently performed half of the coding. After all the coding had been completed,