In a small community, use of a facilitator who is from the community (an "insider") or not from the community (an "outsider") influences the way information is shared and possibly its content. With an outside facilitator, participants minimize their use of "insider" jargon (ie, local terms for places and agencies) and may elaborate on specific behaviors or conditions participants perceive as unfamiliar to the outside facilitator. This clarity of information is useful in analyzing and disseminating the information for an outside audience. However, for the participants, the time needed to explain the "basics" may detract from discussing more complex issues related to the topic.

Working in CBPR projects, Kieffer et al (1) and Christopher (6) in her work with American Indians and reminiscent of the work of Banner et al indicate that their community partners advocated for community members to be trained to facilitate focus groups. An ideal facilitator should be a trusted community member familiar with the informal and formal power and social structures of the community. This person should not be a formal community leader at the time of conducting the focus groups and should be known as a nonjudgmental listener. Being known as an "ardent adviser" or as strongly opinionated is not desirable for a focus group facilitator. A facilitator should be perceived locally as a moderate. A socially influential facilitator might elicit habitual or even defensive responses from participants and may not invite the reflective, open responses desired in a focus group.

These characteristics are more important if the discussion includes politically, socially, or personally sensitive topics. We recommend investing time to solicit anonymous recommendations from local collaborators. One method we have used successfully is to list the 3 desirable traits discussed above (listener, nonjudgmental, and political/social moderate) and ask several community collaborators to identify 3 local people who best exemplify these traits. In our experience, collaborators identify 1 to 3 of the same people.

Focus groups can best discuss some topics if the facilitator has the same ethnic background as the participants if a fairly ethnically homogenous group is recruited (1). The importance of this characteristic should be discussed and a decision made by the investigative CBPR team. In our experience, having an outside facilitator of the same ethnicity as the focus group participants was met with mixed response and even concerns of internalized racism: "She looks like us, but she still doesn't know us" and "She thinks we are uneducated. You can tell. Her voice was flat and she never laughed." This reaction is noted by Christopher (6) and reminiscent of the work of Banner et al (9) with Native Hawaiians, who reacted negatively to surveyors who used a standard neutral voice tone and showed little response to interviewees' answers.

In keeping with the principles of CBPR, the facilitator(s) should be engaged in discussions of the direction and wording of focus group questions, in the development of recruitment strategies to fit local behaviors and networks, in data analysis to align the interpretation with the local context, and in dissemination to ensure that outcomes are understandable and applicable to the community. As experts in local behaviors, community members can best predict if potential participants will take part in focus groups, for example,  in the evening or on a Saturday morning and if transportation or child care are potential barriers and should be provided. If facilitators are paid an hourly rate, the amount should reflect the local assurance and legitimacy the community facilitator is bringing to the process.

Christopher (6) provides a guide to using a CBPR approach to train community interviewers. Although these recommendations are drawn from work with an American Indian community, this guide is useful in training community members from other socially and culturally connected settings. A key concept discussed is incorporating local ways of interacting, questioning, and probing to yield a comfortable and natural process.

In a small community, focus group participants may be concerned that their voice will be recognized if sessions are audiotaped. This concern may be present regardless of the topic discussed. In our experience, focus group participants discussing local recreational resources elected not to participate if the sessions were audiotaped. This example highlights the importance of using a CBPR approach; sensitivity is defined by the social and cultural context.

When audiotaping was a deterrent, we used scribes to manually document discussions. We avoided using a laptop computer because the sound of notetaking was distracting to some participants. Two scribes or notetakers were used to provide a complete account of the responses. Notetakers worked together to draw a duplicate map on their writing pad illustrating the seating arrangement of the participants, the facilitator, and the notetakers, and to assign a position number to each participant. The participant's position number was used to document his or her comments and nonverbal gestures that might add meaning to the discussion (1,2). Both notetakers worked to record all statements. An alternative approach — assigning certain participants to each notetaker — distributes the flow of the discussion, but notetakers become disengaged and do not produce coherent notes. An ideal arrangement in a CBPR setting would be to have an inside investigator such as a trained community member conduct the focus group and to have 1 notetaker be a community member and 1 be an outside investigator. In this configuration, the community or inside notetaker would understand any local jargon or references and the outside notetaker would pick up local statements that may seem commonplace to the inside notetaker but are valuable for further investigation.

Immediately or within a day of the focus group, the notetakers should meet to synthesize their notes and produce a collective and single document of the discussion including the seating map and start and end times.

In small communities, researchers should consider the local culture to ensure that the intent of the question is clear. For example, in the aforementioned focus groups about recreational facilities, the investigative team modified questions extracted from a national program and used local terms. The national question, "Do you use local outside recreational resources such as walking paths and sports courts?" yielded responses of "we don't have those resources in our community." The phrase implies the formal development of a path designed specifically for recreational walking. Yet the community has several footpaths worn down by community members walking to and from church, the store, or the post office. The question was reworded as "Do you use the Church Hill loop or the store path for exercise?"

Guides to focus group question development generally advise facilitators to ask participants to speak from experience and encourage response in the first person. Krueger and Casey (4) offer a generally useful strategy of asking participants to complete a statement (eg, "When I found out my cholesterol was high, I felt . . ."). In small communities, this approach may ask the participant to reveal too much personal information. In our experience, the recommended first-person approach yielded silence or terse responses. We have found that modifying the question to allow for a third-person response yielded a less guarded response: "When a person finds that his/her cholesterol is high, he/she might feel . . . ." Rephrasing the statement does solicit a different response. Asking participants to project how someone might feel does not solicit information about a personal experience, but respondents often do speak from personal experience. If the intent of the investigation is to gather personal stories and experiences in the first person, in a small community these data might be best collected in face-to-face interviews rather than in focus groups.

In all communities, the setting can affect participants' comfort level in discussing particular topics (4,7). For example, participants may give guarded responses to questions about teenage pregnancy if the setting is a church meeting room or school. In a small community with limited meeting spaces, outside investigators should be aware of recent local events that temporarily affect the aura or atmosphere of a particular setting. For example, funeral services and wakes are sometimes held in local gymnasiums and community centers, and scheduling a focus group in that building in the days following may affect community members' willingness to participate or talk about certain topics. Death and other seminal events affect most everyone in a small community. The best strategy, especially if no other site is available, is to postpone the focus group for a week or so to get more accurate responses.

Researchers should schedule focus groups to match the availability of the target group; for example, evenings or weekends are best if potential participants work a standard 8-hour day, and mid-morning may work for older adults who congregate for lunch at a senior center.

Other circumstances to consider are local or cultural seasonal events or rituals that would influence community members' willingness and ability to participate. Not scheduling focus groups around recognized religious or national holidays seems obvious to many investigators, but other conflicting events may be less apparent. An outside investigator who attempted to recruit a focus group in an American Indian community around a multiday, annual culture-specific event was frustrated by her lack of success. She rescheduled her sessions after a community member explained the conflict to her. This situation reinforces the importance of using a CBPR approach; local experts should contribute to a discussion of scheduling and site selection.

A CBPR approach is invaluable to the development of appropriate recruitment strategies (6). In small communities, word of mouth can be effective especially if a local contact or referral person is available and easily accessible. Many small communities have weekly, monthly, or bimonthly newsletters or newspapers. The deadline for submitting notices may be as much as a week before the distribution date. Missing the deadline for a monthly publication can significantly delay the scheduling of a focus group.

Other recruitment avenues include announcements on local radio stations and posting notices in local high-traffic areas. In our experience, announcements broadcast from nonlocal radio stations are not effective in reaching eligible participants. If a local station is available, get information on formats, available time slots, costs, protocols for submission and review, and other requirements. Community collaborators should take the lead in developing the announcement to ensure that the message is easily understood and explains community benefits and participant compensation. If the local radio announcer will not be reading the announcement, the local reader should be a well-respected community member. Be prepared to compensate people who do not work for the project for their time and willingness to lend their reputation to validate the focus group process.

Posted notices are pervasive in small communities. Recruitment materials need to be visually appealing  and eye-catching to stand out. We recommend using graphics and color print or paper. Consider using a short phrase in large print that capitalizes on a popular local saying or mass media advertisement campaign (eg, "GOT THOUGHTS?" or "WHAT DO YOU THINK?") to catch the eye of people passing by a community bulletin board covered with local flyers. The notice should include eligibility criteria and a local contact person, both telephone numbers and physical location to accommodate those lacking telephone access.

A challenge in focus groups administered in a socially connected small community is assuring participants that their statements will be confidential. Researchers should address confidentiality during the training of facilitators (6) and discuss it at the onset of the focus group. Remind participants that they, the facilitators, and notetakers are entrusted with the information being shared in the focus group.

To reinforce the credibility of the focus group process, facilitators should explain the following:

Although these statements are written on the subject consent or disclaimer form signed by the participants, repeating the concepts reinforces the significance of the activity. In addition, the local facilitator and notetakers must be trustworthy to assure confidentiality.