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Methods
Focus group interviews are appropriate to use when the goal is to explore people's knowledge and experiences. Data collection was performed in four focus groups consisting of GPs, GP interns, and heads of primary health care units (Table 1). A GP in Sweden is a physician with a 5-year specialist training in family medicine, whereas a GP intern is a trainee within this specialty. The heads of the units have the overall financial responsibility for a primary care unit, which includes costs for prescribed drugs. Recruitment of participants was performed by two of the authors (S.A.S., S.M.W.), by approaching personal contacts by e-mail and by telephone. In all, 65 persons were approached and 21 agreed to participate and were included in the study (Table 1). The most commonly stated reason for declining participation was a lack of time. A letter was sent 1 week before each focus group discussion was scheduled, containing detailed participant information.
The focus group discussions were performed in 2011 at two different health care units in Gothenburg (a city of about 600,000 inhabitants). Apart from the participants and the moderator, one additional researcher took part as an assistant moderator, taking field notes. We chose to alternate between moderators in the focus groups because we believed that our different backgrounds could have an impact on the discussions. The researcher with the most experience of focus groups (T.M.H.: pharmacist, Ph.D.) was moderator twice and the other two researchers acted as moderators once (S.A.S.: GP intern, Ph.D.; S.M.W.: clinical pharmacologist, Ph.D.). The study protocol was approved by the Regional Ethical Review Board in Gothenburg, Sweden.
Each group discussion started with a short, structured introduction by the moderator, and participant information was again distributed to each person together with a consent form to be signed before the discussion started. To facilitate the discussion, we used an interview guide (Table 2), including two fictitious patient cases. Each focus group lasted between 1.5 and 2 hours. The discussions were recorded on a digital voice recorder. After the fourth group, the research group agreed that no new factors had emerged and data saturation was attained.
The focus group discussions were transcribed verbatim and all transcripts were read by all researchers. Names of participants were replaced by codes (fictitious initials). NVivo 9 software was used for data management. We used manifest content analysis, according to Graneheim and Lundman, which is an analysis of what the text says rather than what the text talks about (latent content analysis). For each focus group, meaning units were identified, extracted, condensed, and assigned a descriptive code by two researchers independently (Table 1). In the next step, these two researchers met and discussed all codes for that particular focus group until consensus was reached. The three researchers together then sorted the various codes, for all four focus groups, into categories. The categories were discussed at a seminar with other qualitative researchers. As a last step, we identified emergent themes, each one being a thread of an underlying meaning on an interpretative level. Throughout the process of analysis, any disagreements were resolved through discussions.
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