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.