Rehabilitation: collective construction of a concept in a focus group

Strategies

The perceptions on the proposed topic emerged from brainstorming techniques, with the elaboration of a conceptual map in focus group workshops. The data were registered in a diary²⁹ that was later interpreted by thematic analysis and resulted in the collective conception.

The methodological course was based on the related literature: 1) Brainstorming promoted the collection of ideas and perceptions through insights about the topic and enabled cognitive associations and interpretations by the group with the help of a mediator. Its principles and rules reinforce the group’s ideas as complementary⁸; 2) The concept map developed by Novak⁹ from the Learning Theory by David Ausubel¹⁰ aimed at expressing the representation of the existing associations that formed the cognitive propositions, such as the connectives between one or more constructs of semantic units. The proposition was to explain the formation and association of meanings at the participants’ cognitive level¹¹ and; 3) As a non-directive technique, the focus group provided semi-structured discussion practice to obtain information about cognitive meanings, enabling an in-depth discussion of ideas.¹²

Participants and reflexivity

The study included 13 researchers from several regions of Brazil, from multidisciplinary areas related to health sciences, such as nursing, physiotherapy, pedagogy, psychology, and social work, and members of the teaching and research laboratory. The participants were selected and invited because they were specialists in the area, and they were all researchers from the rehabilitation laboratory. 92% of participants were of female sex and 8% were of male sex, and they were aged between 25–62 years. Of these, 15.38% were at the postdoctoral level, 7.7% at the doctoral level, 30.77% had a master’s degree, 30.77% were graduates, and 15.38% were at the undergraduate level. Notably, 84.62% were professionals in addition to participating in the research group. The authors of this manuscript represent 76.93% of the workshop participants. The other participants were specialists in the field, have experience in rehabilitation studies and/or practices. There is no relevance in relation to the sex and/or gender of the participating individuals.

The group was led by a facilitator who is one of the authors of this study. He has a master’s degree in health and work management, is a doctoral student in nursing and health, and has experience in training and developing work teams. The facilitator and the participants are from the same research laboratory and declared interest in the collective construction of the concept of rehabilitation, accepting to participate in the group.

Data collection

The data were collected in three synchronous meetings, in May 2021, totalling 12 hours, in the Google Meet platform meeting room due to the COVID 19 pandemic. The meetings took place exclusively with the participants, and were supported by PowerPoint with manually annotated observations, conducted by the facilitator author. The first was attended by the 13 participants and provided, respectively: 1) brainstorming experience and 2) concept map development. It aimed at expressing the understanding of cognitive associations discussed over the years regarding the term. The experience of brainstorming was obtained as a product. Subsequently, a conceptual map of the knowledge on the subject was created, which was used as a methodological tool and didactic strategy to problematise and synthesise epistemological and scientific thoughts.¹³

The second meeting also had exclusively 13 participants, and involved the following activities: 3) associations around the propositional focal question; 4) discussion of concepts and propositions; The third meeting was for 5) synthesis and validation of ideas for cognitive and collective conceptualisation. For the synthesis, the participants were invited to provide statements that they considered adequate and meaningful to the concept of rehabilitation. Thus, they formed phrases and/or sentences connecting the expressed words.

Administration of the methods

The first meeting included (1) a brainstorming experience; after an informal course, the participants saw a slide with empty balloons and the word (RE)HABILITATION in the centre. Subsequently, they suggested words associated with the exposed content as they came to mind, regardless of order. The words and content were arranged in a cloud in the shape of a heart (Figure 1).

Consequently (2), we proceeded to the elaboration of a conceptual map (Figure 2), where we queried about the meaning of (RE)HABILITATION as a focal theme, using the cloud to reorganise ideas and make connections. Therefore, it was necessary to understand the semantic units presented by each member and their association with the contextual universe (Table 1). Thus, the expressions suggested in column one were presented to the participants and they were asked to provide the semantic units in column two for each expression. The units in column two are all the expressions suggested as more adequate to the participants’ understanding of the research topic (RE)HABILITATION.

The subsequent processes (3 and 4) were used to answer the proposed question about the conception of the meaning of (RE)HABILITATION. The discussion led to the semantic evolution in which the words gained meanings that were expanded, valued, derived, and allocated according to the mental unit that visualised the object of rehabilitation care, i.e., the wholeness of the person. Afterwards (5), there was a synthesis and validation by the participants. They structured sentences from the provided connectives about rehabilitation, according to their understanding. Next, the material produced in the three meetings was read so that they could be confirmed/validated by the group participants.

Ethics and consent

This study aimed to explore the meanings attributed to a specific topic in the health area, configuring a public opinion that, according to Resolution 510/2016, Article 1, does not require registration and evaluation by the National Research Ethics Commission (CONEP), waiving ethical approval. The analysis was based on the perception of the participants and this analysis does not identify and does not offer physical or moral risks. Even so, all participants signed consent forms authorizing the publication of their data.

Analysis

The analysis begins with notes, searching for meanings, ideas and coding schemes. After familiarization with the data, brainstorming was used to generate the initial codes (themes) that emerged from the main research theme – (RE)HABILITATION. Afterwards, the levels of approximation to the larger theme were verified through the connectives arranged in the conceptual map, as a thematic map of analysis.¹⁴ The themes were presented in column one of Table 1 and associated and discussed in their semantic relationships expressed in column two.

Derived from the research theme – (RE)HABILITATION – 13 codes (themes) were precisely identified, mentioned by the participants and justified in their speech during the group meeting with simultaneous notes in the PowerPoint schemes and field diary. The description of the conceptual map used for decoding is shown in Figure 2. The data were manually managed in loco, without the use of software.

After producing the map and discussing its contents, the participants who were not authors left the group, and the participating authors proceeded with (5): a synthesis of the data collected in the meetings (3), (4) to form the concept of the term rehabilitation through thematic analysis.¹⁴ The relationship between the words displayed on the map was established according to its degree of functionality, meaning and action in a rehabilitation process aimed at a whole person, as discussed with group participants. Therefore, it was essential to validate with the participants to analyse specific connectives (associations between the terms found associated with the larger theme – Rehabilitation) and provide cohesion to phrasal relationships and conceptual production. Above all, it was necessary for capturing the expression of the experience produced by the group of researchers in the concept and in the connections and disconnections of the constructive process of collective conception and confirm the statements.

Brainstorming — exploring the group’s understanding

Thinking about a term that encompasses as many meanings as rehabilitation is a task that requires us to delve deeper into the subject to reach common certainties and uncertainties that can be discussed and elaborated in a group. Thus, the idea of having a brainstorming session to create a conceptual map seemed applicable to this group. The objective of all the participants was to conceptualise rehabilitation as a health practice common to all professionals in the area. At first, several disconnected words were attributed to the term.

Field notes from the discussion were used to build a word cloud. In Figure 1, a word cloud in the shape of a heart shows the expression of the words that appeared in the brainstorming with their frequency and intensity (participants’ emphasis): intersubjectivity, well-living, praxis, reconstruction, resignification, becoming, empathy, diversity, identity, respect, esteem, love, and self-determination.

Figure 1. (RE)HABILITATE group brainstorming experience (own source).

Semantic sense of expressions

The proximity and synonymy of the ideas represented by different words, typically used in each specialty, indicated the need for deeper articulation to connect ideas and make a cohesive construction of collective thinking that could elucidate the concept of rehabilitation in the conception of the interdisciplinary group, which led to an overall view of the actions.

An analysis of the meaning through which each word was associated with the main term: (RE)HABILITATION was conducted. At that moment, semantic units appeared with their correspondents. The discussion consisted of finding the associated terms most appropriate to the context, as shown in Table 1.

Connectives between ideas

Once the semantic units of the words that appeared associated with the concept of (RE)HABILITATION were discussed and understood, connectives were suggested and arranged between several linguistic elements to generate assertions to validate a meaning for the group in the universe of the person undergoing rehabilitation. The conceptual map (Figure 2) expresses the main ideas that generated the concept of rehabilitation conceptualised by the (RE)HABILITATE group. The connection of ideas through semantics and connectives allowed the articulation and cohesion of a sequence of expressions to construct a collective conception that gave rise to the basic concept of rehabilitation actions for the group.

The themes were reorganized in a circular fashion according to the participants’ understanding of the importance and proximity in the rehabilitation process, defining the levels of the process, and not organised as a hierarchy.

Figure 2. (RE)HABILITATE group conceptual map (own source).

Strengths and limitations

This study is strengthened by bringing together several mutually dependent facets of rehabilitative care, which aim at human integrality rather than dichotomous conceptions. It denotes the conception of a multidisciplinary group specializing in rehabilitation that works on research in this area. It shows how comprehensive person-centered rehabilitation practices can be strengthened.

This research extensively explored the conceptions of the participants, through the discussion of each term that appeared in the formation of the concept.

However, there are limitations to the generalization of the concept, since other teams have not been tested, even due to the lack of joint work with the sole purpose of rehabilitation. Thus, further studies with multidisciplinary teams are suggested. The strengths and limitations of this study indicate the need to continue research in understanding the conception of care teams, since motivations influence rehabilitative care.