Digital focus groups in healthcare interventions: A reflexive methodological analysis of how socio-technical and relational factors co-produce qualitative data

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BACKGROUND: Digital focus groups are increasingly used in health research, yet their methodological implications within complex interventions remain insufficiently examined. When conducted with pre-existing cohorts, digital focus groups may function not only as evaluative tools but also as relational and socio-technical encounters that shape the generation of qualitative data. The goal of the present study was to examine how digital focus groups operate within this context. METHODS: This study presents a methodological re-analysis of focus group material originally collected for the evaluation of a hybrid psychosocial prevention intervention, examining how digital focus groups operate within this context following the perspective of Situational Analysis. Digital focus groups were conducted with participants who had completed the hybrid intervention together in fixed cohort groups, meaning participants were already acquainted with one another prior to the focus group sessions. For the analysis, the transcripts were examined using descriptive, inductive coding. Verbatim quotations were used as methodological markers to illustrate how relational, emotional and technological factors shaped the data. RESULTS: Pre-existing cohort cohesion strongly influenced how participants engaged in the digital setting, fostering emotional safety, peer-supported learning, motivational reinforcement and opportunities for self-regulation. Digital platforms structured visibility, turn-taking and synchronization, while differences in devices, connectivity and digital literacy affected participation and the stability of group interaction. The researcher role expanded to include facilitation, technical troubleshooting and emotional anchoring, making the research team part of the socio-technical infrastructure. At times, the focus groups elicited supportive or motivational effects that echoed elements of the intervention itself, blurring the line between evaluation and unintended interventional effects. CONCLUSIONS: Focus groups in intervention research operate as relational encounters rather than neutral data-collection tools. This applies particularly to Digital Focus Groups. Recognizing how pre-existing relationships, technological environments and researcher involvement shape interaction is essential for methodological transparency and rigorous interpretation. The findings highlight the importance of reflexivity, attention to digital differences, and awareness of unintended interventional dynamics when designing and interpreting digitally mediated qualitative methods in healthcare contexts. Furthermore, the findings indicate that the choice between digital and in-person FGs should not be guided by pragmatic considerations alone, but by the relational, technological and institutional conditions of the research situation. TRIAL REGISTRATION: DRKS-ID: DRKS00033080 (registration date: December 7, 2023).