Editor’s note: Steve Lewis is a co-founder and vice president of Development II, Inc., a Woodbury, Conn., market research firm. Misty Hathaway works in international administration and marketing at the Mayo Clinic, Rochester, Minn.
Those who believe we’re living in an ever-shrinking world need only spend an evening conducting (or viewing) a focus group outside of their native culture. Flexibility, the capacity to endure large masses of ambiguity, and a great sense of humor (including the ability to laugh at oneself) are the three essential personality traits required to enter the world of cross-cultural information gathering.
Focus groups in North America have become an inherent part of our business culture. After all, we’ve been running focus groups since just after World War II when Madison Avenue "discovered" the power of rapid responses from a core group of carefully profiled consumers. Focus groups are quick, relatively inexpensive and can provide profound insight into the thought patterns of consumers. Indeed, even politicians have succumbed to their allure.
We must issue a general warning about focus groups. Focus groups are a proven methodology for collecting qualitative information. Place special emphasis on the word "qualitative." When eight to 10 people are together in a room exploring ideas, perceptions and opinions, the information collected is anything but cohesive. Even with a skilled moderator at the helm, focus groups have a tendency to take on a life of their own, trekking up paths that no one can foresee.
In the early ’90s, Development II worked for a Swedish bus company that was having difficulty attracting senior citizens to its bus tours. The bus company’s young management team concluded that the problem must relate to the routes or destinations and proceeded to make major changes based upon internal perceptions. After this strategy failed to attract the number of seniors the company desired, the management team asked Development II to conduct a series of focus groups with retirees in Sweden.
The Swedes are great to work with in groups. They’ll show up if they say they will, and they arrive on time -- not one minute too early or too late. During the focus groups we explored all of the previously concocted ideas and received great concurrence that it was definitely the destinations that discouraged the elderly from these bus tours. Late in one of the sessions, a soft-spoken elderly man commented that he didn’t take bus tours because there were no toilets on the bus, and the bus drivers didn’t make frequent enough stops. The other participants didn’t even acknowledge the comment.
When we listened to the audio tapes from these focus groups (hint: always audio tape your groups; video taping is optional), we noted this man’s comment and eventually incorporated it into the questionnaire designed to survey a wider audience. We sent out about 1,000 questionnaires and received about 750 completed and returned. Far and away, the primary reasons these senior respondents did not take bus trips were the lack of adequate toilet facilities on the bus and too few stops. The bus company’s management team heard the message, made adjustments, and began to discretely advertise the change in facilities and stops along the way. Within a year, they had exceeded their passenger-on-board goals and needed additional buses.
Had we listened only to the consensus of the focus groups and based our decisions upon that qualitative data, we would have been stuck following the same unsuccessful route as before. By carefully listening to all of the responses, even the "minor" ones, and quantifying the responses, the customers ultimately told us the solution.
Social understanding
Conducting focus groups requires some science but mostly social understanding. The organizational and operational nuances depend largely upon the culture of the participants. In the late ’60s, the Social Democratic party in Sweden passed the "du" law ("du" is the informal pronoun for "you"), obligating everyone to use the first name in greetings. Previously one was greeted as "Engineer Johansson" or "Professor Gustafsson." With the "du" law those individuals became known as Sven or Göran. As a reflection of the equalizer orientation, it’s easy to get Swedes to participate in focus groups, vocalize and listen to each other’s opinions.
Japan on the other hand is a society still rife with cultural hierarchy, especially within the business community. In typical Japanese business meetings, the head man sits at the conference table with his back to the wall and as far away from the door as possible. (Perhaps this is a holdover from the days of social feudalism when the person in power could never be sure who his friends were). His next in command sits to his right and left and so on around the table, until all are seated according to job title. In our experience, this head man is the first to express an opinion; however, he is also a good listener and generally will not reach a decision until all have been heard, and a consensus is reached. The Japanese rules governing groups are very well defined.
When conducting focus groups in Japan, we disrupt this rigidity, and the Japanese can be as much fun and as creative as any groups we’ve worked with. Since we know who’s been invited, we know the job title and societal expectations. We place our guests around the table in places they might not ordinarily be seated. We begin our conversations making certain that the top-rated person speaks last. We joke and try to instill lightness to the party. In every country except Japan we use native speakers to conduct the groups. In Japan, though, we’ve discovered that having an American in the group using an interpreter elicits greater creativity and candor from the participants. It’s as if it’s okay for them to disrupt the status quo with an American in their midst. We’re allowed to break the rules in this environment and the Japanese thoroughly enjoy it.
Focus groups with Muslim participants
Recently Development II worked with the Mayo Clinic in Rochester, Minn., on five focus groups to explore expectations and satisfaction among international -- in this case, Middle Eastern - patients. Observing the needs of these primarily Muslim participants required us to use Arabic speaking moderators, to separate the men’s and women’s groups, to plan around evening prayer time, and to offer foods that didn’t violate cultural and religious practices.
Recruitment for the groups also required flexibility. While standard recruitment would have involved a letter to a random sampling of patients’ homes and return postcard enclosures, this methodology was not feasible. Instead, we needed to recruit from among these non-English speaking patients already in Rochester. This was very challenging. Interpreters were used to identify and invite patients already being served in the Mayo Clinic system, and invitation cards printed in Arabic were required for each session. The interpreters had to call the patients and confirm the sessions multiple times to ensure attendance, given the unfamiliarity and relative suspicion towards the process.
In most of the Arabic-speaking countries, focus groups are not standard fare. Inviting these patients involved overcoming reluctance in some cases and outright suspicion in others. The fact that the Mayo Clinic sponsored the groups helped tremendously since a positive relationship was already established. We initially tried to keep the groups segmented by country in order to compare responses and to avoid any potential regional friction. As it turned out, several countries were represented in most groups with no ill effect.
As we anticipated, the Middle Easterners’ sense of time did not compare to that of the Swedes. We expected some casualness with respect to arrival time and established meeting times appropriate to the culture. Despite our preparations, however, we were definitely unprepared for one of the women’s groups. It seems that one of their princes was arriving at the Mayo Clinic for a check-up around the same time as our 5:30 group was scheduled. Most of the women went to greet their leader and pay their respects. At 6:00 we had one woman in our group (out of nine recruited). Panic set in. As 6:30 approached the women began trickling in, satisfied that they had greeted their prince and thrilled with the idea that the Mayo Clinic was asking them to express their opinions. One woman arrived at 6:50, remarkably surprised that we had already begun the discussions. The poor moderator had to start this session about a half-dozen times.
Not surprisingly, once gathered, Middle Eastern participants had little trouble expressing their opinions and providing valuable input to the Mayo Clinic’s international administration. At the same time, the native Arabic-speaking moderators encountered unusual challenges in keeping conversations focused on the Mayo Clinic, as opposed to politics, prayer, praise for national leaders, or household relationships. There was a particularly interesting interaction during one of the women’s groups. While one woman expounded with pity on the experience of her husband who traveled alone to the United States for health care, the others re-directed the discussion to challenge her on her wifely duties, wondering aloud why she had allowed him to travel by himself under such trying circumstances.
We also conducted focus groups in Mexico City for Spanish-speaking patients of the Mayo Clinic. Recruitment for these groups offered different opportunities for flexibility and required yet another level of attention to detail. The mailing of the recruitment letter (in Spanish) was not as easy as a mailing to Mayo Clinic patients in Minnesota or Iowa. Despite attempts to make the registration process international, the Mayo Clinic’s electronic forms are not entirely receptive to international addresses, and a non-Spanish speaking registrar may not enter data as accurately as desired. Many addresses of Mexican patients had to be revised and manually edited by a Spanish-speaker familiar with a map and postal system of Mexico City. International telephone numbers do not fit in the "three-digit area code plus seven-digit number" slots designed for U.S. communication; similarly, phone numbers had to be retrieved manually from alternate screens in the system.
As it turned out, the location of our research partner’s focus group facility in Mexico City happened to be a street where a Mexican deputy was recently murdered. We decided it inappropriate to invite Mayo Clinic patients to such a locale. To ensure their confidence and maintain a safe and reputable image, we transferred the groups to a local, well-reputed restaurant and again provided a schedule and menu in keeping with the lifestyle of the Mexican capital city.
Embrace the unpredictable
In conclusion, conducting focus groups in non-American settings and cultures can be both fun and enlightening. You’ll need flexibility, a willingness to deal with and embrace the unpredictable, and a strong dose of cultural understanding - understanding that must not be applied universally but rather to each specific culture. You can’t expect Middle Eastern cultural norms to apply to Mexicans or Swedes, nor can you assume that everyone will behave like the Americans. You’ll be more successful if you take the time to learn the nuances of each distinct culture you’re working with. And then, just when you think you’ve got them figured out and have covered everything . . .
Just expect the unexpected.