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Variations for Children/Young Persons

It is often challenging to get children and younger teenagers in nominal group discussions to begin to talk openly about their fears and frustrations. It is essential to build trust with them before hand. The nominal group process should be modified in any way possible to create an open, trusting atmosphere. Here are some points to remember:

  1. Stratify the group by age as much as possible. The issues experienced by 15-year-olds can be vastly different from that of 10 year-olds. Younger children may feel intimidated by teenagers, and teenagers may not want to talk openly in the presence of younger children.
  2. As far as possible, avoid having siblings in the same group. The presence of siblings may hinder openness about personal fears and frustrations.
  3. Spend more time at the beginning of the session building trust with the group.
  4. Don't rush the session, but if the children become restless and unfocused, you may need to eliminate some of the planned questions. Ask only the most essential questions and end the session earlier.
  5. Plan for the discussion to take two hours, but depending on the age of the group and their attention span, you may only have an hour or less of optimal discussion.
  6. Younger children often have difficulty writing down their thoughts adequately. You may consider modifying the silent generation of ideas process so that they do not have to write down their answers. Ask a question, request they think about it silently for a minute, then take turns to share their ideas verbally. As they talk, add their points to the list on the flip chart.
  7. Be graphical when appropriate. Use pictures and icons to help them understand a task or point. For example, you could draw a worried or angry face by the keywords "Fears, frustrations, problems."
  8. Use age-appropriate language and terminology when asking questions and when writing their points on the flip charts. Use their words as much as possible when rephrasing items on the list. For example, you might use the words "stay in the hospital" instead of "hospital admission" or "hospitalization."
  9. When prioritizing needs, children sometimes have difficulty ranking the most important issue with the highest number. Reverse the rank order if this is a problem. Have them rank the most important issue as #1, the second most important as #2, and so on. Make sure you indicate the ranking order clearly on the flip chart to avoid misinterpretation later by the research team who is compiling and analyzing the data.
  10. Simplify the prioritization process if needed by asking them to raise their hands to vote for the items they think are important to solve. Limit the number of times they can raise their hands to narrow down the selection of priority issues. An alternative to voting with raised hands would be to have the children come one at a time to the charts and rank number the items most important to them.

Sample questions for younger group participants:

(Open group dialog, no particular order for contributing comments.)

  1. Some people are born with asthma, and some people get it when they are older. Tell me when you started to have asthma, and if you can remember, tell me who told you about it.
  2. There are many different ways that an asthma attack happens or feels. How does an asthma attack feel like to you? Describe what happens from the very beginning. How do you know one is beginning?

(Round-robin)

  1. Think back to a time when you had a really scary asthma attack. What made you scared or worried?
  2. What does your family do when you have an attack? What things do you wish they would wouldn't do, or would do better when you're having an attack?
  3. Think about a time when you had to see a doctor because your asthma was making you feel sick. Try to remember how you were feeling that day. Tell me what things made you scared, worried, or maybe even made you really mad when you were at the hospital or clinic, or when you met with the doctor.
  4. How many of you have to take medicine for asthma everyday? (Raise hands.) What about just once in a while when you need it? (Raise hands.) Good. Now think about some of the problems or difficulties you have taking your medicine. Tell me what some of those problems are.
  5. What things do you want to know about asthma? What don’t you understand? This can be anything at all.

If you sense resistance to a line of questioning, move on to a different question. You may try re-phrasing the question later to see if they respond differently, especially if it takes a while to build trust.

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