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This method derives from market research strategies in which theories of social psychology and communication were applied and rarer incorporated into social sciences research methods. A special manual for the use of focus group discussions in health research is now available (see Dawson, Manderson and Tallo, 1993).
In a focus group discussion. people from similar backgrounds or experiences (e.g., mothers, young married men, birch attendants/mid-wives) are brought together to discuss a specific topic of interest to the investigator(s). Homogeneous samples are preferred because mixing age/ gender groups may inhibit some people, especially women, from expressing their views.
Purpose
• To explore the range of opinions/views on a topic of interest.• To collect a wide variety of local terms and expressions used to describe a disease (e.g., diarrhea) or an act (e.g., defecation).
• To explore meanings of survey findings that cannot be explained statistically.
Materials
A range of materials including tape recorders, if appropriate, and pictures to introduce topics for discussion, can be used. Recording the discussion on tape has the advantage of being able to play it back and pick up salient points after the discussion is over. The disadvantage is that transcribing from tape takes a long time - it can take up to five hours to transcribe an hour's tape recording of a focus group discussion plus another couple of hours to listen to the tape again and check the transcription for accuracy. Even then important points may be missed if the tape recording is not accompanied by detailed notes on who the participants were, the order in which they spoke, and the non-verbal language which accompanied what was said. If the discussion took place in a language not understood by the investigator(s), translation can mean added time and financial costs. See Box 23 for an example of notes transcribed from a focus group discussion held with committee members of a Harambé, a self-help, rainwater harvesting project in Kenya (P signifies participants whose names were coded by the letters of the alphabet and M stands for the discussion moderator. The discussion was conducted in Kiswahili).
Procedure
• Identify suitable discussion participants and invite a small group to a meeting at an agreed place and time. The ideal number of participants is six to eight, but be flexible about numbers - do not turn away participants after they had arrived at the meeting and do not pressure people to come to the meeting. Study the Focus Group Manual for detailed guidance (see also Chapter 3).• Be mentally prepared for the session; you will need to remain alert to be able to observe, listen, and keep the discussion on track for a period of one to two hours.
• Make sure you arrive at the agreed place before the participants, and be ready to greet them.
• Maintain a neutral attitude and appearance, and do not start talking about the topic of interest before the official opening of the group discussion.
• Begin by introducing yourself and your team (even if the participants have already met them individually), and ask participants to introduce themselves.
• Explain clearly that the purpose of the discussion is to find out what people think about the practices or activities depicted by the pictures. Tell them that you are not looking for any right or wrong answer but that you want to learn what each participant's views are. It must be made clear to all participants that their views will be valued.
• Bring the discussion to a close when you feel the topic has been exhausted, and do nor let the group discussion degenerate into smaller discussions. Be sincere in expressing your thanks to the participants for their contributions. Refreshments may be served at the end of the meeting as a way of thanking the participants and maintaining good rapport with them.
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BOX 23. Extract of Notes from a Focus Group Discussion Transcribed and Literally Translated from Kiswahili into English From a Village in Kenya P(A): Even what that one has said is higher (important) that is what we have heard, that one continues and the goodness of it is this. It has helped us in the health of our children. M: Say according to the way you see. Don't say according to the way you think we would like to hear. Now you yourself since you got that tank, how do you see it has helped? You have a tank at home, how has 'It helped? P(A): It has helped us very much because I can see when we drink water there are no diseases like stomachaches. It has helped very much and me, I can see when you drink other water 'it is not as good as the one in the tank. M: And do you use this water for cooking? P (A): Yes. M: Does 'It help you and you don't have to fetch water in the mornings, so you don't get tired? P(F): Yes we don't get tired these days, because when there were no tanks we had to go with ) arcane to the river, but, now, I can see these days I just sit and then I just fetch water and come to cook and help to wash clothes. These days I don't go to the river. Yes, and even the cows and calves they drink at home. Yes, it has helped very much. P(C): It has taken money. P(B): Yes, that has taken our money. (Laughter) We can see that others cannot help build. Because they come to our home to beg for good water for drinking. But we see if they help build another if we get some little help, because others cannot build. (Interruption) Yes, so that we can build. M: Is there anything you want to say about the sanitation? P(H): Yes, concerning matters about latrines? Yes there I could say this is something we need very much. Latrines for use, because many people, despite many people trying to dig latrines and build, me, I see that they make them 'In the proper way-You find people have dug holes (for the latrines) but the next year the latrine has collapsed and cannot be used ... Something that will be needed in this matter of sanitation is these people, technicians, those who know how to build latrines, like those technicians of AMREF. We have seen the ones they have built in schools and now even people are waiting anxiously... People should go on building latrines and they should be helped to build those ones of now (modern ones). The ones they can use nicely and for a long time. I was saying the idea of the water tanks is good rather than for people to wait for rain water to go down the stream, sweeping all the dirt then go for it, they would rather collect it from the roofs, so I must say this water tanks have assisted a lot. Yeah, for those who have, they see the sense and importance of it. And for those who don't have, very many are more than willing to build these water tanks. Yes. M: Do you want to say something on sanitation? Talk in Kiswahili. P(A): For the truth, AMREF has really tried very much because they have built latrines in the schools. There is where the students learn and it would be useful so much, if sanitation is followed. Now I can see even the way we have succeeded in building latrines in schools even now I can say, I wish we could go to the communities and build latrines if we can because we have succeeded in schools. Since latrines have been made in schools, we have seen many diseases have decreased. Diseases like tapeworms have decreased in hospitals. Now, I would like, if AMREF would continue to build latrines for people. We can take at least one person from every village. Me, I think, on matters concerning sanitation that is all. |
Management, Review, and Use of Information
The Focus Group Manual (Dawson, Manderson and Tallo, 1993) suggests that all discussion be transcribed. If you decide to use a tape recorder, you may prefer to transcribe parts of the discussion only to save time. In this case, listen carefully to the tape at least once, and mark down the sections that you wish to have transcribed, using the counter and summarize the information. Once you have a transcript before you, have checked it with the tape, and made any necessary corrections, then mark up the text.
We have found it practical for the intended users of this handbook to use a modified form of focus group discussion in which pictures (often selected from the sets prepared for three-pile sorting or gender tasks and resources analysis) are used to introduce often sensitive topics such as defecation behaviour and associated hygiene practices. Using pictures helped to stimulate discussion of specific issues very quickly. Without pictures, people tend to feel that they have to make a set speech every time they intervene, and they tend to cover more than one topic at a time (as can be seen in Box 23).
Study team members take the roles of a discussion facilitator/moderator, a note-taker, and an observer. All three would then meet afterwards to write up comprehensive notes, including the facilitator's impressions, the observer's notes, and the note-taker's detailed notes.
The general rule is that no single method and/or tool on its own is perfect for assessing hygiene practices. One may be good for one purpose (for example, gathering information in a short period of time) while another may be good for another purpose (for example, obtaining detailed and extensive indepth information). Given that it is desirable, if not necessary, to use more than one method and/or tool in your study, decisions about which ones to select may be easier once you have consulted our appraisal of individual methods and tools from a predominantly practical perspective. Weighing the strengths and limitations of each method and tool is essential in deciding which combination(s) of methods and tools to use (see Table 4).
TABLE 4. Strengths and Limitations of the Methods and Tools Described in Chapter 6
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Method/Tool |
Strengths |
Limitations |
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Three-Pile Sorting |
+ Good for breaking the ice and initiating discussion on sensitive topics, particularly when investigators' knowledge of the local culture and language(s) are limited (for instance, explicit pictures of open defecation will introduce the topic of discussion more directly and effectively than words can). |
- Requires time and special skills to prepare, pretest, and subsequently modify the pictures. |
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+ Effective for finding out which hygiene behaviours and activities are locally considered to be good, bad, or in-between and more importantly, why. |
- Requires well-trained and skilled facilitator(s). | |
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+ Allows study participants to engage in investigative and analytical processes which will increase their awareness of their own hygiene practices-a step towards instigating change where it may be necessary. |
- Difficult to document results by using words (text) only, thus costly (in terms of time and money) to document. | |
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Pocket Chart |
+ Relatively quick and effective way of gathering quantifiable information and interpreting it quickly and reliably. |
- Requires time and special skills to prepare, pretest, and subsequently modify the pictures. |
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+ Allows study participants to engage in investigative and analytical processes which will increase their awareness of their own hygiene practices-a step towards instigating change where it may be necessary. |
- Requires well-trained and skilled facilitator(s). | |
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+ Easy to document results. |
- Requires time and patience/motivation from study participants, particularly if the number of variables involved exceeds three or four. | |
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- Difficult to conduct effectively with large groups (more than twenty people). |
TABLE 4. Strengths and Limitations of the Methods and Tools Described in Chapter 6 (continued)
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Method/Tool |
Strengths |
Limitations |
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Semi-Structured Interviews |
+ Allows investigators to gain indepth knowledge of the subject under study. |
- Requires highly skilled and/or trained investigators, interviewers, and note-takers. |
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+ Relatively easy to document findings, e.g., without investing in visual aids. |
- May be intrusive to study participants, especially if hurriedly done and/or with little tact. | |
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- Presents difficulty for interviewers if they are project personnel who are seen by the study population more as teachers/experts than as learners-respondents may give all the "right answers" which may not reflect their own practices, or may demand that the interviewer(s) gives them answers to difficult questions as she/he is an expert anyway. | ||
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- Requires considerable amounts of time and energy for information management and review. | ||
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Focus Group Discussions |
+ Useful for gauging the range of opinions and beliefs on the topic of enquiry. |
- Information obtained cannot stand on its own, i.e., it needs to be complemented by survey data, to show the distribution of opinions and beliefs uncovered. |
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+ Useful for exploring issues for investigation at the outset of a study and/or for interpreting data obtained by other methods (including quantitative surveys) in the final stages of a study. |
- Presents difficulties in information management and review, particularly if tape-recorders are used. | |
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+ Easily modifiable to facilitate its use, e.g., by using pictures to Introduce topics for discussion and for stimulating/maintaining a lively discussion. |
- If more than one language is in use, translation can mean added time and financial costs. |