Continuous Focus Groups: A Longitudinal Method for Clinical HRI in Autism Care

Foglino Caterina; Ghiglino Davide; Wykowska Agnieszka

arxiv: 2604.18197 · v1 · submitted 2026-04-20 · 💻 cs.HC · cs.RO

Continuous Focus Groups: A Longitudinal Method for Clinical HRI in Autism Care

Ghiglino Davide , Foglino Caterina , Wykowska Agnieszka This is my paper

Pith reviewed 2026-05-10 03:53 UTC · model grok-4.3

classification 💻 cs.HC cs.RO

keywords continuous focus groupslongitudinal qualitative methodshuman-robot interactionautism spectrum disorderrobot-assisted therapystakeholder engagementethical safeguards

0 comments

The pith

Continuous focus groups let stakeholders iteratively refine robot-assisted autism therapies by sustaining dialogue across intervention phases.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper proposes continuous focus groups to overcome the limits of one-off qualitative methods in clinical HRI. Three focus groups are held at successive stages of a robot-assisted protocol so that clinicians and families can revisit and adjust their earlier comments as the therapy unfolds. This structure builds trust, brings tacit clinical knowledge into design choices, and gives participants a way to renegotiate involvement if new concerns arise. The approach matters because families already carry heavy burdens and cannot easily join repeated separate studies, yet their changing perspectives are essential for safe, usable robots.

Core claim

Continuous focus groups, organized across successive phases of a robot-assisted therapeutic protocol, enable participants to revisit and refine earlier views as the intervention progresses. Results show that continuity fostered trust, supported the integration of tacit clinical expertise into design decisions, and functioned as an ethical safeguard by allowing participants to renegotiate involvement and surface new concerns.

What carries the argument

Continuous focus groups: a longitudinal co-agential method that sustains dialogue with assistive care professionals through three phased meetings tied to the stages of the robot intervention.

If this is right

Stakeholder perspectives on robot therapies can be captured as they evolve rather than frozen at one moment.
Tacit clinical expertise is more likely to shape design decisions when input continues through the intervention.
The method supplies an ethical check by letting participants adjust or withdraw involvement at later stages.
The same structure supplies a transferable template for other HRI domains where direct repeated access to users is restricted.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

Similar phased groups could be tested in elder-care or pediatric rehabilitation robots to see whether trust and design integration benefits hold outside autism.
Pairing the qualitative record with quantitative outcome measures from the same therapy sessions would test whether refined designs actually improve measured clinical results.
The number of sessions could be varied experimentally to find the minimum continuity needed before added burden outweighs the gains in insight.

Load-bearing premise

That three focus groups spaced across the therapy phases are sufficient to track evolving views, build lasting trust, and avoid adding unacceptable burden on families and clinicians.

What would settle it

A follow-up study in which stakeholder input collected via the continuous format shows no meaningful changes from single-session data or in which dropout rates rise because of the added meetings.

read the original abstract

Qualitative methods are important to use alongside quantitative methods to improve Human-Robot Interaction (HRI), yet they are often applied in static or one-off formats that cannot capture how stakeholder perspectives evolve over time. This limitation is especially evident in clinical contexts, where families and patients face heavy burdens and cannot easily participate in repeated research encounters. To address this gap, we introduce continuous focus groups, a longitudinal and co-agential method designed to sustain dialogue with assistive care professionals working with children with autism spectrum disorder (ASD). Three focus groups were organized across successive phases of a robot-assisted therapeutic protocol, enabling participants to revisit and refine earlier views as the intervention progressed. Results show that continuity fostered trust, supported the integration of tacit clinical expertise into design decisions, and functioned as an ethical safeguard by allowing participants to renegotiate involvement and surface new concerns. By bridging the therapeutic iteration of families, children, and clinicians with the research-design iteration of researchers and developers, continuous focus groups provide a methodological contribution that is both feasible in practice and rigorous in design. Beyond autism care, this approach offers a transferable framework for advancing qualitative research in HRI, particularly in sensitive domains where direct user participation is limited and continuity is essential.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Desk Editor's Note private letter to a colleague

Continuous focus groups look like a workable longitudinal tweak on standard qualitative methods for clinical HRI, shown through one autism therapy case.

read the letter

The main point is that this paper gives a clear example of running focus groups in three stages tied to the phases of a robot-assisted autism intervention. That continuity lets participants revisit earlier comments as the therapy unfolds, which the authors say builds trust, pulls in clinical know-how, and lets people adjust their involvement if needed. They report it worked without adding too much load on families and clinicians, and it helped link the day-to-day therapy work with the robot design choices. That framing of focus groups as ongoing and co-agential is the actual new piece; most prior HRI qualitative work stays one-off. The write-up stays grounded in what happened in their sessions and sticks to standard qualitative reporting, so the claims about trust and ethical checks line up with the data they collected. No big contradictions or overreaches in the case itself. The soft spot is that everything rests on a single protocol with one robot and one set of participants, so we still do not know how well the approach travels to other robots, other clinics, or bigger groups. Three sessions may or may not be the right number in every setting, but the paper does not claim it is universal. This is the kind of paper that helps people running similar clinical HRI projects see a concrete option for keeping stakeholder input alive over time. It is worth a referee's time because the method is described enough to try and the results are reported plainly enough to evaluate. I would bring it to a reading group if the group is looking at qualitative methods in HRI, but I would not cite it in my own work unless I were adapting the approach directly.

Referee Report

0 major / 3 minor

Summary. The paper introduces continuous focus groups as a longitudinal, co-agential qualitative method for clinical HRI in autism care. It describes organizing three focus groups across successive phases of a robot-assisted therapeutic protocol, allowing stakeholders (families, children, clinicians, researchers, developers) to revisit and refine perspectives over time. The authors report that this continuity fosters trust, integrates tacit clinical expertise into design decisions, and serves as an ethical safeguard by enabling renegotiation of involvement and surfacing new concerns. The central claim is that the method bridges therapeutic iteration with research-design iteration, proving feasible in practice and rigorous in design, while offering a transferable framework for other sensitive HRI domains where direct participation is limited.

Significance. If the reported observations hold, this provides a practical methodological contribution to HRI by addressing the limitations of static or one-off qualitative approaches in dynamic clinical settings with vulnerable populations. It could enhance ethical oversight, stakeholder engagement, and iterative design relevance through sustained dialogue, with the descriptive case study serving as a model for co-agential research. The emphasis on longitudinal continuity and bridging iterations adds value to qualitative methods in HRI, particularly where participant burden is high.

minor comments (3)

Abstract: The phrase 'rigorous in design' is used without an early definition or criteria; consider adding a brief clause on what constitutes rigor (e.g., iterative refinement, ethical renegotiation) to set reader expectations.
Results section: Participant reflections on trust and expertise integration are summarized effectively, but including one or two anonymized verbatim quotes per outcome would make the reported benefits more concrete without altering the qualitative style.
Discussion: The transferability claim to 'other sensitive domains' is stated but could be strengthened by naming one or two example domains (e.g., eldercare robotics) and briefly noting analogous challenges.

Simulated Author's Rebuttal

0 responses · 0 unresolved

We thank the referee for the positive and constructive review. The summary accurately reflects the paper's introduction of continuous focus groups as a longitudinal, co-agential qualitative method that sustains dialogue across robot-assisted therapy phases in autism care, fostering trust, integrating clinical expertise, and providing ethical safeguards. We appreciate the recognition of its significance in addressing limitations of static qualitative approaches in dynamic clinical HRI settings with vulnerable populations, and its potential as a transferable framework. Given the recommendation for minor revision and the absence of specific major comments, we will incorporate any editorial or minor clarifications as needed in the revised version.

Circularity Check

0 steps flagged

No significant circularity in methodological proposal

full rationale

The paper introduces continuous focus groups as a longitudinal qualitative method through a descriptive case study of three sessions conducted across phases of a robot-assisted ASD therapy protocol. No equations, fitted parameters, or quantitative predictions exist that could reduce to inputs by construction. The central claim rests on reported participant outcomes (trust-building, expertise integration, ethical renegotiation) presented as direct observations from the implementation, without reliance on self-citation chains or ansatzes that presuppose the result. The derivation is self-contained as an experiential framework proposal, consistent with standard qualitative reporting norms and independently verifiable through the described protocol details.

Axiom & Free-Parameter Ledger

0 free parameters · 2 axioms · 1 invented entities

The contribution rests primarily on domain assumptions about clinical burdens and the value of continuity; the method itself is the invented entity with no independent evidence provided in the abstract.

axioms (2)

domain assumption Qualitative methods are important to use alongside quantitative methods to improve HRI
Opening premise of the abstract used to justify the need for improved qualitative approaches.
domain assumption Families and patients face heavy burdens and cannot easily participate in repeated research encounters
Justification for why standard repeated methods fail and why a continuous but low-burden alternative is needed.

invented entities (1)

continuous focus groups no independent evidence
purpose: Longitudinal and co-agential method to sustain dialogue with assistive care professionals across therapy phases
Newly proposed method whose benefits are asserted but not independently validated beyond the abstract description.

pith-pipeline@v0.9.0 · 5518 in / 1496 out tokens · 68403 ms · 2026-05-10T03:53:14.096885+00:00 · methodology

discussion (0)

Reference graph

Works this paper leans on

26 extracted references · 26 canonical work pages

[1]

Bødker, S. (1994). Creating conditions for participation: Conflicts and resources in systems design. DAIMI Report Series, 13(479). doi:10.7146/dpb.v13i479.6952

work page doi:10.7146/dpb.v13i479.6952 1994
[2]

de A., Giacon-Arruda, B

Bonfim, T. de A., Giacon-Arruda, B. C. C., Galera, S. A. F., Teston, E. F., Nascimento, F. G. P. D., & Marcheti, M. A. (2023). Asistencia a familias de niños con Trastornos del Espectro Autista: percepciones del equipo multidisciplinario. Revista Latino-Americana de Enfermagem, 31. doi:10.1590/1518-8345.5594.3779

work page doi:10.1590/1518-8345.5594.3779 2023
[3]

L., Edwards, K., Shenton, D., Winnington, R., Thill, S., & Jones, R

Bradwell, H. L., Edwards, K., Shenton, D., Winnington, R., Thill, S., & Jones, R. B. (2021). User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study. JMIR Rehabilitation and Assistive Technologies, 8(4), e30337. https://doi.org/10.2196/30337

work page doi:10.2196/30337 2021
[4]

Camilleri, A., Dogramadzi, S., & Caleb-Solly, P. (2022). Learning from Carers to inform the Design of Safe Physically Assistive Robots - Insights from a Focus Group Study. 2022 17th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 703–

work page 2022
[5]

https://doi.org/10.1109/hri53351.2022.9889658

work page doi:10.1109/hri53351.2022.9889658 2022
[6]

Charmaz, K. (1995). Grounded theory. In J. A. Smith, R. Harré, & L. Van Langenhove (Eds.), Rethinking Methods in Psychology (pp. 27– 49). doi:10.4135/9781446221792.n3

work page doi:10.4135/9781446221792.n3 1995
[7]

Dautenhahn, K. (2009). Socially intelligent robots: Dimensions of human–robot interaction. In R. Dunbar & L. Barrett (Eds.), Social Intelligence: From Brain to Culture (pp. 313–351). Oxford: Oxford University Press. doi:10.1093/oso/9780199216543.003.0014

work page doi:10.1093/oso/9780199216543.003.0014 2009
[8]

R., et al

Fraune, M. R., et al. (2022). Lessons learned about designing and conducting studies from HRI experts. Frontiers in Robotics and AI, 8. doi:10.3389/frobt.2021.772141

work page doi:10.3389/frobt.2021.772141 2022
[9]

A., & Schultz, A

Goodrich, M. A., & Schultz, A. C. (2007). Human–robot interaction: A survey. Foundations and Trends in Human–Computer Interaction. doi:10.1561/9781601980939

work page doi:10.1561/9781601980939 2007
[10]

Everybody just freezes. Everybody is just embarrassed

Gray, D. E. (2002). “Everybody just freezes. Everybody is just embarrassed”: Felt and enacted stigma among parents of children with high functioning autism. Sociology of Health & Illness, 24(6), 734–

work page 2002
[11]

doi:10.1111/1467-9566.00316

work page doi:10.1111/1467-9566.00316
[12]

A., de Vries, P

Guler, J., Stewart, K. A., de Vries, P. J., Seris, N., Shabalala, N., & Franz, L. (2022). Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa. Autism, 27(3), 751–

work page 2022
[13]

https://doi.org/10.1177/13623613221117012

work page doi:10.1177/13623613221117012
[14]

M., Rueben, M., Grimm, C

Krupp, M. M., Rueben, M., Grimm, C. M., & Smart, W. D. (2017). A focus group study of privacy concerns about telepresence robots. 2017 26th IEEE International Symposium on Robot and Human Interactive Communication (RO-MAN), 1451–1458. https://doi.org/10.1109/roman.2017.8172495

work page doi:10.1109/roman.2017.8172495 2017
[15]

S., Guba, E

Lincoln, Y. S., Guba, E. G., & Pilotta, J. J. (1985). Naturalistic inquiry. International Journal of Intercultural Relations, 9(4), 438–

work page 1985
[16]

doi:10.1016/0147-1767(85)90062-8

work page doi:10.1016/0147-1767(85)90062-8
[17]

Lim, W. M. (2024). What Is Qualitative Research? An Overview and Guidelines. Australasian Marketing Journal, 33(2), 199–229. https://doi.org/10.1177/14413582241264619

work page doi:10.1177/14413582241264619 2024
[18]

Markham, A., & Buchanan, E. (2017). Research ethics in context. In M. T. Schäfer & K. Van Es (Eds.), The Datafied Society (pp. 201– 210). Amsterdam: Amsterdam University Press. doi:10.1515/9789048531011-017

work page doi:10.1515/9789048531011-017 2017
[19]

same level of care that any other person deserves

Mazurek, M. O., Sadikova, E., Cheak-Zamora, N., Hardin, A., Huerta, I., Sohl, K., & Malow, B. A. (2021). They deserve the “same level of care that any other person deserves”: Caregiver perspectives on healthcare for adults on the autism spectrum. Research in Autism Spectrum Disorders, 89, 101862. https://doi.org/10.1016/j.rasd.2021.101862

work page doi:10.1016/j.rasd.2021.101862 2021
[20]

A., Kadylak, T., & Bayles, M

Rogers, W. A., Kadylak, T., & Bayles, M. A. (2022). Maximizing the benefits of participatory design for human–robot interaction research with older adults. Human Factors, 64(3), 441–450. doi:10.1177/00187208211037465

work page doi:10.1177/00187208211037465 2022
[21]

Sanders and Pieter Jan Stappers

Sanders, E. B.-N., & Stappers, P. J. (2008). Co-creation and the new landscapes of design. CoDesign, 4(1), 5–18. doi:10.1080/15710880701875068

work page doi:10.1080/15710880701875068 2008
[22]

Smakman, M., Vogt, P., & Konijn, E. A. (2021). Moral considerations on social robots in education: A multi-stakeholder perspective. Computers & Education, 174, 104317. doi:10.1016/j.compedu.2021.104317

work page doi:10.1016/j.compedu.2021.104317 2021
[23]

Spinuzzi, C. (2025). What does the minimal viable product actually help us to develop? Three routes toward a design methodology. Proceedings of the 2025 IEEE International Professional Communication Conference (ProComm), 72–78. doi:10.1109/procomm64814.2025.00022

work page doi:10.1109/procomm64814.2025.00022 2025
[24]

R., & Borges da Matta Souza, L

Taquette, S. R., & Borges da Matta Souza, L. M. (2022). Ethical Dilemmas in Qualitative Research: A Critical Literature Review. International Journal of Qualitative Methods, 21. https://doi.org/10.1177/16094069221078731

work page doi:10.1177/16094069221078731 2022
[25]

big-tent

Tracy, S. J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837–851. doi:10.1177/1077800410383121

work page doi:10.1177/1077800410383121 2010
[26]

Veling, L., & McGinn, C. (2021). Qualitative Research in HRI: A Review and Taxonomy. International Journal of Social Robotics, 13(7), 1689–1709. https://doi.org/10.1007/s12369-020-00723-z

work page doi:10.1007/s12369-020-00723-z 2021

[1] [1]

Bødker, S. (1994). Creating conditions for participation: Conflicts and resources in systems design. DAIMI Report Series, 13(479). doi:10.7146/dpb.v13i479.6952

work page doi:10.7146/dpb.v13i479.6952 1994

[2] [2]

de A., Giacon-Arruda, B

Bonfim, T. de A., Giacon-Arruda, B. C. C., Galera, S. A. F., Teston, E. F., Nascimento, F. G. P. D., & Marcheti, M. A. (2023). Asistencia a familias de niños con Trastornos del Espectro Autista: percepciones del equipo multidisciplinario. Revista Latino-Americana de Enfermagem, 31. doi:10.1590/1518-8345.5594.3779

work page doi:10.1590/1518-8345.5594.3779 2023

[3] [3]

L., Edwards, K., Shenton, D., Winnington, R., Thill, S., & Jones, R

Bradwell, H. L., Edwards, K., Shenton, D., Winnington, R., Thill, S., & Jones, R. B. (2021). User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study. JMIR Rehabilitation and Assistive Technologies, 8(4), e30337. https://doi.org/10.2196/30337

work page doi:10.2196/30337 2021

[4] [4]

Camilleri, A., Dogramadzi, S., & Caleb-Solly, P. (2022). Learning from Carers to inform the Design of Safe Physically Assistive Robots - Insights from a Focus Group Study. 2022 17th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 703–

work page 2022

[5] [5]

https://doi.org/10.1109/hri53351.2022.9889658

work page doi:10.1109/hri53351.2022.9889658 2022

[6] [6]

Charmaz, K. (1995). Grounded theory. In J. A. Smith, R. Harré, & L. Van Langenhove (Eds.), Rethinking Methods in Psychology (pp. 27– 49). doi:10.4135/9781446221792.n3

work page doi:10.4135/9781446221792.n3 1995

[7] [7]

Dautenhahn, K. (2009). Socially intelligent robots: Dimensions of human–robot interaction. In R. Dunbar & L. Barrett (Eds.), Social Intelligence: From Brain to Culture (pp. 313–351). Oxford: Oxford University Press. doi:10.1093/oso/9780199216543.003.0014

work page doi:10.1093/oso/9780199216543.003.0014 2009

[8] [8]

R., et al

Fraune, M. R., et al. (2022). Lessons learned about designing and conducting studies from HRI experts. Frontiers in Robotics and AI, 8. doi:10.3389/frobt.2021.772141

work page doi:10.3389/frobt.2021.772141 2022

[9] [9]

A., & Schultz, A

Goodrich, M. A., & Schultz, A. C. (2007). Human–robot interaction: A survey. Foundations and Trends in Human–Computer Interaction. doi:10.1561/9781601980939

work page doi:10.1561/9781601980939 2007

[10] [10]

Everybody just freezes. Everybody is just embarrassed

Gray, D. E. (2002). “Everybody just freezes. Everybody is just embarrassed”: Felt and enacted stigma among parents of children with high functioning autism. Sociology of Health & Illness, 24(6), 734–

work page 2002

[11] [11]

doi:10.1111/1467-9566.00316

work page doi:10.1111/1467-9566.00316

[12] [12]

A., de Vries, P

Guler, J., Stewart, K. A., de Vries, P. J., Seris, N., Shabalala, N., & Franz, L. (2022). Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa. Autism, 27(3), 751–

work page 2022

[13] [13]

https://doi.org/10.1177/13623613221117012

work page doi:10.1177/13623613221117012

[14] [14]

M., Rueben, M., Grimm, C

Krupp, M. M., Rueben, M., Grimm, C. M., & Smart, W. D. (2017). A focus group study of privacy concerns about telepresence robots. 2017 26th IEEE International Symposium on Robot and Human Interactive Communication (RO-MAN), 1451–1458. https://doi.org/10.1109/roman.2017.8172495

work page doi:10.1109/roman.2017.8172495 2017

[15] [15]

S., Guba, E

Lincoln, Y. S., Guba, E. G., & Pilotta, J. J. (1985). Naturalistic inquiry. International Journal of Intercultural Relations, 9(4), 438–

work page 1985

[16] [16]

doi:10.1016/0147-1767(85)90062-8

work page doi:10.1016/0147-1767(85)90062-8

[17] [17]

Lim, W. M. (2024). What Is Qualitative Research? An Overview and Guidelines. Australasian Marketing Journal, 33(2), 199–229. https://doi.org/10.1177/14413582241264619

work page doi:10.1177/14413582241264619 2024

[18] [18]

Markham, A., & Buchanan, E. (2017). Research ethics in context. In M. T. Schäfer & K. Van Es (Eds.), The Datafied Society (pp. 201– 210). Amsterdam: Amsterdam University Press. doi:10.1515/9789048531011-017

work page doi:10.1515/9789048531011-017 2017

[19] [19]

same level of care that any other person deserves

Mazurek, M. O., Sadikova, E., Cheak-Zamora, N., Hardin, A., Huerta, I., Sohl, K., & Malow, B. A. (2021). They deserve the “same level of care that any other person deserves”: Caregiver perspectives on healthcare for adults on the autism spectrum. Research in Autism Spectrum Disorders, 89, 101862. https://doi.org/10.1016/j.rasd.2021.101862

work page doi:10.1016/j.rasd.2021.101862 2021

[20] [20]

A., Kadylak, T., & Bayles, M

Rogers, W. A., Kadylak, T., & Bayles, M. A. (2022). Maximizing the benefits of participatory design for human–robot interaction research with older adults. Human Factors, 64(3), 441–450. doi:10.1177/00187208211037465

work page doi:10.1177/00187208211037465 2022

[21] [21]

Sanders and Pieter Jan Stappers

Sanders, E. B.-N., & Stappers, P. J. (2008). Co-creation and the new landscapes of design. CoDesign, 4(1), 5–18. doi:10.1080/15710880701875068

work page doi:10.1080/15710880701875068 2008

[22] [22]

Smakman, M., Vogt, P., & Konijn, E. A. (2021). Moral considerations on social robots in education: A multi-stakeholder perspective. Computers & Education, 174, 104317. doi:10.1016/j.compedu.2021.104317

work page doi:10.1016/j.compedu.2021.104317 2021

[23] [23]

Spinuzzi, C. (2025). What does the minimal viable product actually help us to develop? Three routes toward a design methodology. Proceedings of the 2025 IEEE International Professional Communication Conference (ProComm), 72–78. doi:10.1109/procomm64814.2025.00022

work page doi:10.1109/procomm64814.2025.00022 2025

[24] [24]

R., & Borges da Matta Souza, L

Taquette, S. R., & Borges da Matta Souza, L. M. (2022). Ethical Dilemmas in Qualitative Research: A Critical Literature Review. International Journal of Qualitative Methods, 21. https://doi.org/10.1177/16094069221078731

work page doi:10.1177/16094069221078731 2022

[25] [25]

big-tent

Tracy, S. J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837–851. doi:10.1177/1077800410383121

work page doi:10.1177/1077800410383121 2010

[26] [26]

Veling, L., & McGinn, C. (2021). Qualitative Research in HRI: A Review and Taxonomy. International Journal of Social Robotics, 13(7), 1689–1709. https://doi.org/10.1007/s12369-020-00723-z

work page doi:10.1007/s12369-020-00723-z 2021