Considerations for Pivoting to Virtual Audiology Research : The Hearing Journal

The COVID-19 pandemic has affected how audiology research is being conducted, with anticipated lasting effects beyond the pandemic. With such change comes the potential to improve our methods for the future as we embrace more flexible, inclusive, person-centered research designs. As we work toward a “new normal” in the research landscape, it is helpful to pause and reflect on the practical and ethical considerations to successfully pivot research. Virtual research methods, mediated by technological innovation, enable interaction, collaboration, and data collection via web-based systems, thus allowing researchers to pivot some or all aspects of planned research from in person to virtual. Harnessing new skills and techniques required to conduct virtual research can ensure that your research is conducted efficiently, effectively, and safely. Among the many benefits of virtual research design is the ability to alleviate recruitment constraints, allowing researchers to access demographically and geographically diverse participants. Communication can also be tailored to participants and across varying daily life environments, improving flexibility and convenience and limiting the costs of physical site operations. This article highlights important considerations that our research team made when pivoting from an in-person to a virtual design to facilitate focus group research (Fig. 1).

ADJUST YOUR RESEARCH LENS

As a first step, it may be important to reflect on the unanticipated challenges you may have faced when conducting previous projects and how you were able to brainstorm possible solutions. In line with typical scientific processes, including planning ahead, confronting challenges, and persevering, Elmer and Durocher¹ suggest considering the following when pivoting your research methods:

• Are you able to address your original research question(s) and hypotheses?
• Can you carry out your intended research plan amid possible future interruptions to in-person testing?
• Can your project be carried out safely without the need to adapt your research methodology to fit within current/-anticipated constraints?

If you answered “no” to any of the above, you may already be brainstorming how to adjust your research design. If you have deemed your study to be a good fit for virtual methods, pivoting your research design may help you better achieve your overall goals. Health and safety challenges specific to conducting group-based qualitative research may be circumvented by eliminating the “in-person” requirement or the requirement to be in the same physical location as your participants. This does not mean that you need to eliminate the “face-to-face” component of your research. Instead, consider integrating video-based tools such as videoconferencing, which allows researchers to maintain face-to-face participant interaction, important when conducting research with participants who are D/deaf or hard of hearing.

PIVOTING TO VIRTUAL RESEARCH

Traditional interview-style research involves the use of one-on-one or group-level discussion. Focus group research is used to generate information on a particular topic, providing access to unique discussion topics and language using the collective views of many participants in group discussions.^2,3 Virtual focus groups allow researchers to investigate and achieve similar goals and outcomes compared to in-person research but requires the use of new technology-focused methods. For example, virtual focus groups can be conducted synchronously with real-time participant interaction (e.g., videoconferencing or real-time chat platforms); asynchronously, using store-and-forward methods for information exchange (e.g., email or discussion forums); or using a hybrid of these methods. Videoconferencing tools allow for direct participant interaction, including visual and nonverbal components. Researchers can set up a comfortable virtual space for participants, removing or reducing external factors that may impact group communication and discussion.⁴ Qualitative data from virtual focus groups can also be collected asynchronously using text-based focus groups that can be performed at the participants’ convenience.⁵ However, synchronous virtual focus groups overcome a major downside of asynchronous modes: they create a better focus on targeted discussion items via synchronous moderation and improve the dynamic of the group discussion.⁶ Synchronous methods are also suitable for gathering more immediate or in-the-moment responses that can facilitate discussion similar to natural thought processing, depending on the topic.⁷

IMPORTANT CONSIDERATIONS IN AUDIOLOGY RESEARCH

Participation in synchronous virtual focus groups should focus on hearing accessibility, including frequent breaks to reduce listener fatigue and smaller group sizes when compared to asynchronous or in-person formats. Participants who wear hearing aids can be encouraged to use assistive listening devices to stream audio. Smaller groups (with six to eight participants) allow for greater participant engagement, increased quality of face-to-face interaction (on-screen visualization of lip reading and other nonverbal cues), and easier moderation of discussion.^8,9 Researchers should consider the following steps when adjusting moderation techniques to better facilitate virtual methods:

1. Prepare a discussion guide and prompts in advance.¹⁰

a) Guides and prompts should be easy to read on or near the screen.

b) Prompts can be made available as on-screen text for participants.

2. Ensure the speakers’ faces are visible at all times by encouraging participants to look directly into the camera.

3. Adjust the videoconference platform settings to include a view of all participants on the screen.

4. Encourage turn taking during the entire discussion.

To further assist with hearing accessibility, choose platforms/tools with features designed to support interaction with participants who are D/deaf or hard of hearing. Many videoconferencing platforms now offer automatic speech recognition (ASR) for closed captioning (CC) and/or the option to incorporate or assign a live closed captioner into a virtual synchronous focus group.¹¹ When evaluating the accuracy and efficiency of ASR in synchronous qualitative research, we found both benefits and limitations. Real-time ASR used to support CC was found to be an overall useful feature. In our experience, the accuracy of ASR CC was influenced by both the quality and type of discussion. The inclusion of specialized terms unique to the field of audiology introduced more errors along with the presence of multiple speakers of added background noise.

INCORPORATING ASR INTO RESEARCH

To analyze the data collected from virtual focus groups, transcripts of the focus groups can be produced in different ways, including manual transcription of an audio recording or by using ASR-generated transcription. Many videoconferencing platforms now offer ASR transcripts as an efficient way to produce a text-based record of the discussion. Our virtual focus groups were conducted using Cisco WebEx software that enabled both real-time ASR (CC) and post-processed ASR transcription. In our experience, the word-for-word match accuracy of ASR transcription was greater than 90% compared with that of manual transcription. ASR transcription methods were also found to be at least 30% more efficient than manual transcription when comparing the time required to complete manual transcription with the time required to review and edit the ASR transcript; this was found to vary slightly across discussion groups. Our focus groups included clinical audiologists who often used field-specific language. Our transcriptionists, therefore, required an understanding of and training around these specialized terms to identify errors and understand concepts mentioned throughout the focus groups.

OTHER TIPS & TRICKS

Participants of our virtual focus groups were given a digital infographic outlining tips to improve communication during videoconferences (Fig. 2), such as tips to improve connectivity, recommended devices, virtual etiquette, environment optimization, etc. When it comes to technology-enabled research, planning is important. In our research, participants were provided with instructions on how to access and test required videoconferencing software before attending a discussion group. Assistance from the research team to troubleshoot connectivity challenges was provided when needed. Participants were also reminded to charge all devices in advance or to ensure devices were directly connected to a power source during focus group discussion. Alternative communication methods such as dial-in options were discussed, in the case of connection failures.

For our focus group research, participants were required to use a camera and microphone to enable face-to-face interaction with both audio and video components. We observed that visualized turn taking helped guard against participants talking over one another. Ultimately, single-talker transcripts can help improve the accuracy of ASR transcription and the ability to analyze the data.¹² Participants in virtual synchronous focus groups should be encouraged to mute their microphone when not talking, to enable the production of high-quality recordings and to ensure the final transcript does not contain misidentified speakers or additional noise. It can be useful for participants to have a pen and paper to write down ideas during turn taking to capture in-the-moment ideas; the first few moments in focus group discussion can be critical in capturing unique thoughts and ideas.⁹

Although significant communication challenges were not encountered during our virtual synchronous focus groups, other strategies can help support virtual research, such as optimizing the virtual environment by reducing environmental distractions, placing good lighting in front of the speaker to increase facial visibility,¹² and using headphones to reduce background noise and improve the accuracy of ASR transcription. When technical issues arise, resulting in delayed audio/video, participants can be encouraged to turn off their camera and/or mute their microphone when not speaking.

DATA SECURITY & CONFIDENTIALITY

As the first step in data security and confidentiality, review your main research question(s) and limit the collection of information to that which is necessary to address the goals of the study. Ensure that all members of the research team are adequately prepared to safely and securely collect, retain, use, disseminate, and dispose of data; methods should align with best practices according to applicable governing ethical boards. Methods should include a variety of physical, administrative, and technological safeguards to protect confidential information shared over a virtual focus group.¹³ Participants should be made aware of any potential risks of participating in virtual research, and researchers must take the time to set up secure communication channels.³ Not all technologies offer the same level of information privacy standards. When choosing a tools/platform to enable virtual research, verify that the security notices fulfill local and/or national legislation, thereby minimizing potential risks to participation.¹⁴ Security in virtual research can be improved by using password-protected videoconferencing sessions and using secure methods to transfer links and passwords. Recorded transcripts and other materials should always be stored in secure locations; common practice includes the removal of all identifying information prior to storage.

The COVID-19 pandemic has shifted the way research is conducted, including pivoting to virtual research. When applied to audiology research, video-based platforms can help maintain face-to-face interaction. Recent advancements in speech-to-text software have made real-time CC possible and improve the efficiency of transcription via automated processes. In addition, the use of features/tools for hearing accessibility and tips to optimize the research environment allow for greater participation in virtual research when in-person methods are not feasible. When integrating technology-enabled research, consider information privacy and security at each stage of your research. Future research should expand virtual focus group methods to other populations, including children and those who are D/deaf or hard of hearing.

Acknowledgments: This work was in part completed in fulfillment of an Independent Study Course at Western University, awarded to Kyla Munoz Galarza, and is part of ongoing research being conducted at the National Centre for Audiology.

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