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This Manual is designed to help researchers and members of control programmes to use qualitative research methods in order to learn more about important social and cultural issues relating to the transmission, control, prevention and treatment of disease These methods may be used instead of social survey research methods, or they may supplement other methods. Qualitative research methods, including interviewing, observations and focus groups, are valuable methods for understanding about ideas and beliefs, practices and behaviors. Usually they are used by trained social scientists, especially anthropologists. In many countries, however, including countries where tropical diseases are endemic, there are few anthropologists, and they may already be busy with other projects. This Manual will help you use one of these methods, focus groups, even if you have no formal training.

Focus groups can be used alone or with other qualitative research methods in a number of different kinds of projects. For example, they can be used before an intervention programme to identify various social or cultural factors that need to be taken into account in the design and implementation of the programme. They can be used during the intervention to provide an ongoing assessment of the programme, or after it is completed as an evaluation tool. Focus groups are often used as a Rapid Assessment Procedure too, where a research team or a Ministry of Health needs to quickly find out about the range of social factors that influence the prevalence of a disease or its control. Sometimes, too, focus groups are used as the sole method of a research project (Aubel and Mansour 1989), although we prefer to use a combination of methods.

Focus groups have been used by social scientists since the 1930s, but were developed particularly within market research in industrialised countries from the 1950s. Today, they are used widely by all kinds of social researchers. Focus groups are formally constituted, structured groups of people brought together to address a specific issue within a fixed time frame and in accordance with clearly spelled out rules of procedure. This Manual explains to you how to organise and conduct these groups, in order to ensure that they run smoothly and that you are able to use them as successfully as possible for your project.

All kinds of methods and techniques can provide information to help you understand social issues related to a given health problem, and you may use several of them in your project to answer different questions. Interviews with individuals are one way of gaining valuable qualitative information, while questionnaires can be administered to households to gather good quantitative data. Observation - watching what is really going on in the field setting - is one way in which you can check reported behaviour. You can also use clinic records, village census data, and other published information.

If you are visiting a village or some other settlement, and stop by a house to chat with the household head, it's quite likely that others will come up to listen in and join the conversation. Often, domestic work and other household work, such as weaving, sewing, or basket making, is done in groups rather than by people on their own. As a consequence, informal focus group discussions are easy to hold: you simply start talking to a group of people, wherever you find them and whilst they continue with their other tasks. These informal group discussions build upon the social networks that operate in a natural setting. In a village, they might include both kin and other neighbours: a woman, her daughter, her daughter-in-law, and her unrelated immediate neighbour for example. These groups of people might also be the ones involved in decision-making in the event of illness: deciding, for example, what kind of illness a child has, whether he or she needs to go to a clinic, or lending money so the mother can take the child for treatment. Such decisions are rarely carried out by one caregiver alone: she draws on those around her. As a result, discussions with such groups can provide fairly accurate data regarding the diagnosis and treatment of illness, choices regarding health services, and so on. However, in contrast to formal focus groups, they do not indicate well the range of attitudes and practices within a particular residential or cultural setting (Khan and Manderson 1992).

Focus groups are a more formal way of getting groups of people to discuss select issues with each other. They are organised in advance, and you will be deciding who you want to speak with, about what subjects, and when you will speak with them. Even though they are formally organised, still their basic structure is not an unfamiliar one. For example, village decisions may be made by groups (such as a village committee or council) rather than individuals, and community participation interventions often also use focus groups for health education, programme design, planning and delivery.

Part I of this Manual is addressed to researchers who may wish to use focus groups in their research projects, or to members of control programmes or departments of health who are responsible for projects and who may be training others to conduct focus group research. In Part I, we describe the purposes, structure and conduct of focus group discussions, and pay attention to some of the techniques which are useful to keep discussion going in the group.

Part II of the Manual has been written as a series of training sessions for others who will be involved in the project. This manual was developed during a research project on acute respiratory infection in Bohol, The Philippines (Dawson, Gunsalam, Khan and McNee, 1991), and because none of the investigators spoke Boholano, the local language, they developed with Veronica Tallo a method for using focus groups where interpreters are needed. These techniques are described in Part II. Of course, focus groups run best when the people conducting them speak the same language as participants, and most of the training sessions set out in Part II presume native language skills.

We have referred to other work occasionally in the text, and there is a short list of references at the end of the Manual too, in case you want to read further. In describing techniques and explaining aspects of the method, we have used examples that might be relevant to tropical disease research. These examples will give you some idea of the issues which you might explore using focus groups. The Manual does not provide complete question guides for any of the tropical diseases, however, as this is a separate task. You will need to develop your own question lines and focus within your own project, concentrating on the issues that are most important to you.

We hope that the Manual will assist you with your work. If there are parts of it which are not clear, then please write to us and let us know, so that we can revise it for future use.

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