Focus groups and vulnerable populations. Insight into client strengths and needs in complex community health care environments.

Focus groups are a useful qualitative research technique to assist in interpreting quantitative community assessment data. Data obtained from focus groups can provide sociological and psychological insights into the perceptions of population subgroups and suggest answers to the "why" questions raised by descriptive data about such issues as teen pregnancy, poverty, immunization levels, or lifestyle-related morbidity and mortality. Application of these insights can lead to the better use of community strengths and the creation of community-specific responses to barriers to health care. * Focus groups work well for involving hard-to-reach members of a community in program development, planning, and evaluation. They may be more effective than face-to-face interviews and questionnaires because people often have not thought about how they feel and tend not to form opinions in isolation (1). The information sought through the use of focus groups is not randomly distributed in the population. Thus, groups are not randomly selected, and data are not gathered with the intent to generalize to all populations. The Research Study To add to the understanding of quantitative statistical data about health outcomes, the current study gathered and analyzed qualitative data about the perceptions of vulnerable people regarding their health needs, community strengths, and community barriers to health care. The term vulnerable people was used to refer to persons disadvantaged because of poor education, poverty, language barriers, ill health, living in high-risk environments, or social bias related to race, age, or gender. The efforts of such persons to stay healthy and safe within the constraints of their life situations are often ineffective and result in dependence on assistance programs to meet basic needs (2,3). Moreover, such persons may be at particular risk for illness. Aday states, "Some individuals and groups are apt to be more at risk than others at any given point in time. Being in poor physical health (such as having a debilitating chronic illness) may also make one more vulnerable (at risk) of poor psychological (depression) or social health (few supportive social contacts)." Aday points out that "the beginning point for understanding the factors that increase the risk of poor health originates in a macro-level look at the availability and distribution of community resources" (4, p. 5). More than 2,000 counties in the United States are classified as medically underserved. The National Association of Community Health Centers collects data on 12 health, economic, and demographic underservice measures. These measures indicate that poverty, residential isolation, disability and heath status are key determinants of medical underservice. Of the counties classified as underserved, 95 percent can be considered so solely on the basis of their poor overall community health status (5). The use of the focus group technique to involve vulnerable community people and build a "culture of participation" for a community health initiative aimed at improving services to this vulnerable population was based on three premises (6-8): * People involved in identifying a problem are more likely to become engaged in the solution. * Community program outcomes are more successful if people are involved early and personally with community assessment steps. * People engaged in meeting their own needs will build competence and effectiveness as health care consumers. Setting and Sample The setting was a county in the mid-western United States that largely consists of two cities with a combined population of 150,000. More than 20 percent of this population has been deemed to be at risk for inadequate access to health care, according to the Public Health Service Act definition regarding the ability to pay for services and accessibility and availability of health professionals (9). The sample population consisted of clients from primary health care settings within a consortium that provides primary care services in the urban areas of the county. …