The investigator used a modified nominal group technique with each group. After a question was asked, participants wrote short answers as they came to mind.28 The nominal group technique was chosen to avoid unconscious group-censoring effects. Next, participants shared answers in a random round-robin format without a group response to individual answers. All answers were written on a flip chart. This procedure continued until no new answers were presented. If needed, the investigator asked participants to clarify responses. Unlike individual interviews, the focus group methods allow for gauging how terms are used and received among providers. All note paper, demographic forms, and flip-chart papers were retained for analysis.
Each group session was digitally recorded; recordings were transcribed without identifiers other than provider type. Demographic data were entered in the IBM Statistical Package for the Social Sciences (IBM SPSS Version 19, Armonk, NY). The transcriptions and recordings were compared for accuracy. Two researchers independently coded the transcrip- tions to enhance the rigor and minimize individual bias or error.
During the coding, similarities in responses among the provider types were noted. When at least one member of a physician group and one member of a midwife group had a comparable answer, it was considered a similar response between a physician and midwife group. Similarly, when both physician groups had a comparable answer and neither midwife group identified a similar answer, or if the midwife groups had a comparable answer and neither physician group identified a similar response, it was noted as a difference between the physician and midwife groups.