Fourteen practitioners were approached by written invitation in order to bring eight practitioners together without scheduling conflicts. Practitioners were senior teachers of training institutes with over 10 years of practical experience and living in the San Francisco Bay Area in California, an area exposed to a wide and comprehensive spectrum of mind-body approaches. This group included practitioners who previously had presented their methods in classes for medical students and clinical services at the University of California, San Francisco (UCSF), had participated in research at UCSF or were otherwise nationally and internationally renowned representatives of their respective approaches. The practitioners represented the most common approaches claiming to enhance body awareness[44
] and were recruited to participate in two focus groups for two hours each. This paper pertains only to the first focus group session and the discussion of the body awareness construct. The second session had the goal of item collection for the development of a new questionnaire and will be presented in a separate publication. The focus group session was facilitated by an independent, experienced moderator with extensive experience in qualitative studies conducted by universities and major private corporations. The facilitator followed a topic guide developed by the authors.
Each practitioner provided a list of 4-6 clients from their practice. No specific criteria were given for this selection other than representing the variety of their clientele. From this list eight patients were selected by the research team based on a review of the patients' anonymized demographic and clinical background information. We used three criteria in order to ensure a diverse and representative group of participants: (a) Seeking the practitioner for a disease versus other reasons; (b) highest level of education; (c) current employment status. Patients also were recruited to attend two focus groups, however, only the first group for the discussion of the construct is described in this paper. The patient focus group session was facilitated by the same independent moderator following an approved topic guide.
The study was approved by the Committee of Human Research at UCSF. All participants signed informed consent which included the publication of their statements. Participants received the interview questions by mail several days before the focus group and were encouraged to review a 2-page handout explaining various aspects and dimensions of body awareness that might be of importance to their experience. The focus group sessions were conducted between September and December 2009 in a group room at the Osher Center for Integrative Medicine, UCSF, in San Francisco. In addition, practitioners received $100 and patients $50 for the session they participated in.
Practitioners were asked the following questions:
1) "In a nutshell (1 minute), can you tell us about your work and describe a typical client for your method, the reason he/she came to see you, what he/she hopes to get from your method, and what you hope the client gets from it?"
2) "Understanding that different practices use different types of language to describe what they do, what does body awareness mean to you and how is it a part of your work?"
3) "If you consider your specific approach, how, or in which way, do you think it improves a client's body awareness?"
4) "If you talk about body awareness with your clients, how do you talk about it? What words or terms do you use? If you don't verbalize about body awareness, how do you address it in your practice?"
5) "Do you think a client's body awareness has an impact on her/his health condition? Can you please illustrate this for us with an example from your practice?"
Patients were asked the following questions:
1) "Please, tell us in a nutshell (about 1 minute) about the therapy you received and why you went to this practitioner? What was your goal in seeing this practitioner?"
2) "Please, tell us about your experience and what you learned. Did this approach help you pay attention to your body sensations?"
Probing questions: "Do you feel that paying attention to body sensations was helpful, unhelpful, or not relevant to your particular therapy? Did your way of relating to your physical body change as a result of this therapy? How did it change? Did you feel different within your body after this therapy? In which way did you feel different?"
3) "If you saw your practitioner for a specific health condition, do you think this therapy had an impact on your health condition? Can you please illustrate this for us with an example from your experience? Do you think the changes in your body awareness had anything to do with the changes in your health condition?"
All focus group sessions were digitally recorded and transcribed verbatim. Transcripts were reviewed for accuracy by core research team members who witnessed the sessions and took notes. The qualitative team (WEM, JW, VG) used a team-based approach[48
] to identify and code themes[49
] separately for practitioners and patients following the strategy of Lincoln and Guba[50
]. The team members read the group discourse with individual accounts closely several times, noting themes and marking sections of text relevant to each theme. The team met regularly to review and compare their identified themes until an agreed upon set of themes for the two groups was developed. Each theme was given a code and one team member (JW) assigned the codes to relevant sections of discourse using ATLAS.ti software. The other two team members read the coded transcripts for final verification. The qualitative team then grouped the themes according to how they addressed the question of interest regarding body awareness. The themes are described and illustrated in the Findings section (Table ).
Overview of Themes and Sub-Themes Presented by Practitioners and Patients