Procedure
This study was approved by the research ethics committee at Jordan University Hospital. All methods were carried out in compliance with the latest guidelines and regulations of the Declaration of Helsinki. All the participants provided informed written consent prior to participation in the study.
To allow for successful discussion and interaction among participants, it is suggested to include between six to eight participants in each focus group19. Therefore, we started by conducting one focus group of seven female participants to encourage dynamic discussions and enrich emerging data. To gain a deeper understanding of their experience, we conducted additional in depth semi-structured interviews with females until data saturation was achieved after the 7th interview where new information did not emerge20. Few female participants declined to take part in the study and all reported personal reasons including lack of time, cannot come alone, lives far away from the hospital, and not interested.
All potential male participants whom we contacted refused to participate in the study except for one and because of time restrictions to complete the study we conducted one semi-structured interview for him to explore his knowledge and experience in details and no focus group with males was performed.
The recommended procedures for focus groups and semi-structured interviews were followed19,21. The participants came once to the meeting room at the physiotherapy department at a main local university for a session that lasted approximately 90 minutes. The following information was collected from each participant: age, height, weight, living status, work status, education, duration since diagnosed with knee OA, and other medical conditions.
The principle investigator (L.K.) was the moderator for the focus group and the semi-structured interviews. She is a female physiotherapist who holds a PhD degree in Rehabilitation and works as an Assistant Professor at the Department of Physiotherapy since 2012. She had previous experience in conducting focus groups and interviews as she has several qualitative studies in progress. To improve the credibility of the data, the moderator ensured rephrasing, repeating and further explaining the questions when needed22. A relationship was not established with the participants before the start of the study. They were informed of the background of the principle investigator and the aims of the study.
Two note takers from the research team assisted the principle investigator during the focus group and the interviews. These notes were compared with the transcribed data to improve the confirmability of the data22.
The same topic guide was used for both the focus group and semi-structured interviews (Table 1). A conceptual review of the literature was performed to identify constructs relevant to knowledge of knee OA and its impact on health. Many key references were identified and included in the review23-30.
The topic guide was developed after a consensus meeting was held to agree on key constructs relevant to the research question. The researchers ensured that all relevant constructs from the literature were included in the topic guide to establish construct validity31. Constructs included were; knowledge of body changes with the disease, reasons for change in symptoms, management options to relief symptoms, and the impact of knee OA on physical activity and participation. The topic guide was translated to Arabic by two researchers separately, a final version was approved by both researchers and shared with the research team.
The first focus group was a pilot for the topic guide. The results were reviewed by the research team and there was a consensus that richness, variety and relevance were demonstrated in participants’ responses that serves the research aims. Therefore, this focus group was included in the subsequent main analysis and no modification to the topic guide was performed.