Community Health Assessment for MCH Programs & Policy Practice

Community Health Assessment for MCH Programs & Policy Practice
Wendy N. Nembhard, PhD University of South Florida, College of Public Health Department of Epidemiology & Biostatistics AMCHP 2009 Annual Conference Washington, DC February 21, 2009

Credits & Acknowledgements
This presentation is a compilation of presentations from: Dr. William Sappenfield (Needs Assessment) Dr. Rita Debate (Needs Assessment Methods) Dr. Debate’s slides have green shading in the heading My slides I am very thankful for their willingness to share these presentations. Please do not reproduce these slides without obtaining permission. Thank you!

William M. Sappenfield, MD, MPH
Better Focusing on Our Problems: Needs Assessment & the Planning Process William M. Sappenfield, MD, MPH State MCH Epidemiologist Florida Department of Health

Public Health Planning Cycle
Act I Public Health Planning Cycle

Being Effective in Public Health

Being Effective in Public Health?

Health Problem: Late PNC Entry South Carolina

Needs Assessment Underreporting of prenatal visits
Physicians not starting to 2nd trimester Late entry into the WIC program Problem recognition by Community Transportation & child care barriers Unintended pregnancy

Potential Strategies Underreporting of prenatal visits
Vital registration manual Clerk training Health department record transfer Physician record transfer Standardized prenatal care record Physician & hospital education Monthly reporting system Hospital standards Incentive awards

Chosen Strategies Underreporting of prenatal visits
Vital registration manual Clerk training Health department record transfer Physician record transfer Standardized prenatal care record Physician & hospital education Monthly reporting system Hospital standards Incentive awards

Health Problem: Late PNC Entry South Carolina

So Why Doesn’t It Happen?
Over-commited staff Lack of political will Committed to present activities Previous planning failures Limited expertise Insufficient resources Competing priorities/desires

Act II Needs Assessment

Definition of Needs Assessment
Systematic collection and examination of information

Systematic collection and examination of information to make decisions

Systematic collection and examination of information to make decisions to formulate a plan

Systematic collection and examination of information to make decisions to formulate a plan for the next steps leading to public health action.

Needs Assessment Qualities
Conceptual Visionary Systematic Resourceful Pragmatic Action-oriented Cohesive

Types of Needs Assessment...
Community--Healthy Communities Population--Title V (MCH) Health Systems--Emergency Response Program--Title X (Family Planning) Health Services--Prenatal Clinic Location Health Problem--Infant Mortality

Needs Assessment Phases
Part 1 Health problem identification and measurement Prioritization of health problems Analysis of a particular health problem Assess potential strategies to address targeted aspects Part 2

Part 1 Health problem identification and measurement Prioritization of health problems Analysis of a particular health problem Assess potential strategies to address targeted aspects. Part 2

What is a health problem?
Community perception? Health status measure? Risk Factor? Health Service Deficiency? Measurement? Comparison?

Problem Identification & Verification
Extent Duration Expected future course Variation Purpose: Define, describe & validate

Types of Prioritization
Group consensus Voting Criteria-based rating Q sort Purpose: Build consensus/support

Q-Sort Procedure: Priority Log Sheet for 25 MCH Needs
5th 4th 6th 3rd 7th 2nd 8th 1st 9th

Part 1: Identification & Prioritization Selection Criteria
Magnitude of the problem Trend Severity/consequences Perceived Preventability National/state goals Agency priority Political/community acceptability

Part 1: Identification & Prioritization Real Selection Criteria
State or agency political will Current program priority Currently funded activity Fits current staffing/resource patterns People available to work on the issue Important issue to the heart

Matrix of MCH Problems Criteria Weight LBW Peri HIV Smoking Magnitude
2 Trend 3 Severity Preventable Goal Priority 1 Acceptable

Clear Scoring Criteria
Magnitude Low incidence/prevalence Moderate in some subgroups Moderate in all groups High in some subgroups High in all groups

Matrix of MCH Problems Criteria Weight LBW Peri HIV Smoking Magnitude
2 2 x 4 2 x 1 Trend 3 3 x 4 3 x 1 3 x 2 Severity 3 x 3 Preventable 2 x 2 2 x 3 Goal Priority 1 1 x 1 1 x 3 Acceptable

Problem-Oriented Needs Assessment
Act III Problem-Oriented Needs Assessment

Part 1 Health problem identification and measurement Prioritization of health problems Analysis of a particular health problem Assess potential strategies to address targeted aspects. Part 2

Problem Map: Basic Components
Precursors Before Problem Consequences After

Precursors Problem Tertiary: Secondary: Direct: Continuation
Initiation Continuation Use of Direct: of Sexual of Sexual Contraception Activity Activity Problem Teen Pregnancy

Precursors Problem Tertiary: Secondary: Direct: Partner Age
Unsupervised Access to Disparity Confidential Activities Services Initiation Continuation Use of Direct: of Sexual of Sexual Contraception Activity Activity Problem Teen Pregnancy

Precursors Problem Tertiary: Secondary: Direct: Social Norms After
School Programs Health Policy Secondary: Partner Age Unsupervised Access to Disparity Confidential Activities Services Initiation Continuation Use of Direct: of Sexual of Sexual Contraception Activity Activity Problem Teen Pregnancy

Precursors Problem Tertiary: Secondary: Direct: Social Youth
Sex/Contraceptive Role Norms Unemployment Models Education TV/Movies Parenting At Risk After Tertiary: & Music Knowledge Educational School Programs Programs Racism Health Policy Poor School Poor Family Sex/Contraceptive Connectedness Secondary: Connectedness Knowledge Partner Age Unsupervised Peer Access to Disparity Group Confidential Activities Services Risk Life Goals Parental Family Beliefs & Behaviors Abuse Income Acceptable Behaviors Method Initiation Continuation Use of Direct: of Sexual of Sexual Contraception Activity Activity Problem Teen Pregnancy

Consequences Problem Direct: Secondary: Tertiary: Teen Pregnancy
Abortion Fetal Death Live Birth Secondary: Tertiary:

Abortion Fetal Death Live Birth LBW/Prematurity Secondary: School Delay or Drop Out Abortion Consequences Tertiary:

Abortion Fetal Death Live Birth LBW/Prematurity Secondary: School Delay or Drop Out Abortion Consequences Tertiary: Impaired Economic Productivity

Abortion Fetal Death Live Birth Medical LBW/Prematurity Complications Secondary: School Delay Poor Growth or Drop Out Environment Economic Abortion Difficulties Consequences Limited Limited Limited Father Maternal Family Tertiary: Support Involvement Skills Poverty Repeat Cycle Pregnancy Day Care Slowed Subsidy Development Impaired Economic Medicaid Social Child Productivity Support Support Neglect

Need for Services Standards--Professional or Consensus
Demand--Waiting Lists Population at Risk--At Risk Not Using Relative--Population Comparisons Perceptions--Reported Needs

Why Do You Need A Problem Map?
Many causes & risk factors Many levels of influence Different opinions--causes & solutions Vast scientific knowledge Stacks of local data

Simple Map to Show You Where to Go!

What Is A Problem Map? Oriented around a health problem
Shows causes & solutions Shows consequences Consensus of opinions, knowledge, & and information Defines boundaries of what is known Provides a map for use

Steps for Making A Problem Map
Obtain community thoughts Review scientific information Obtain & review local information Develop consensus Determine gaps in information Determine potential actions Develop an action plan

Bill's Steps for Problem-Oriented Needs Assessment
Theoretical Framework Gather Readily Available Information Frame and Choose Critical Questions Choose and Develop Methods Analyze and Answer Your Questions Summarize Your Problem Present the Results

Gather… Other Needs Assessments Available Reports Key Data People
Key Community People

Frame & Choose Critical Questions
What Are Remaining Questions? What is Gained By Answering the Question? Do Something Different? Can the Question Be Answered? What Will It Cost? Will It Be Part of the Big Picture?

Bill's Steps for Problem-Oriented Needs Assessment
Theoretical Framework Gather Readily Available Information Frame and Choose Critical Questions Choose and Develop Methods Analyze and Answer Your Questions Summarize Your Problem Present the Results

Summarize the Findings!!!
Problem statement Trends Individual contributors Community contributors Individual strengths Community strengths

Systematic collection and examination of information to make decisions to formulate a plan for the next steps leading to public health action.

Needs Assessment Debates
Qualitative or Quantitative Assets or Problems Assessment or Surveillance One Time or Ongoing Ourselves or Contract Science or Art Performance or Pretty

Linkage of Assessment to Planning
Act IV Linkage of Assessment to Planning

What are objectives? Where do objectives come from?

Program Hypothesis Problem Analysis Access to poison by children
Provide childproof containers Ingestion of poison Reduce poison consumption Death from poison consumption Reduce child poison deaths Program Hypothesis

Problem Analysis Program Hypothesis Reduce child poison deaths
Death from poison consumption Reduce poison consumption Ingestion of poison Provide childproof containers Access to poison by children Problem Analysis

What is a program hypothesis?
How do objectives form a program hypothesis?

Program Hypothesis Goal Policy Program Operational
Change in health of community Policy Change in health status of recipients Program Change in characteristics of recipients Operational Activities of the program

Program Hypothesis Goal: A broad statement of desired health status which does not have to be measured. All of the objectives must be state in measurable terms. Policy: A specific, measurable statement about the desired extent of improvement in a health status problem. Program: A specific, measurable statement of desired change in knowledge, behavior, biomedical measures or other intermediate characteristics that are expected to occur. Operational: A specific, measurable statement of an activity to be carried out by the program or intervention.

Program Hypothesis Goal: A broad statement of desired health status which does not have to be measured. All of the objectives must be state in measurable terms. Policy: A specific, measurable statement about the desired extent of improvement in a health status problem. Program: A specific, measurable statement of desired change in knowledge, behavior, biomedical measures or other intermediate characteristics that are expected to occur. Operational: A specific, measurable statement of an activity to be carried out by the program or intervention. Number Timing Control Available

What are the qualities of a good objective?

Good Objectives Connected to the problem analysis
Simple/Straight forward Measurable Available Baseline and target measures Time period

What are the advantages and disadvantages of defining a program by its objective?

Community Health Assessment Methods
Rita Debate, PhD University of South Florida College of Public Health Department of Community & Family Health

Getting Started: Identifying Concerns and Needs
Upstream: What causes the health problem? Midstream: What is the issue of concern, and who has the need for change? Downstream: What are the effects of the health problem?

Case Study: You have been hired by USF Wellness Committee to develop a comprehensive wellness program to meet the health needs of USF Tampa campus students. What are the Health Issues of Concern? Who has a need for change?

Community Needs Assessment: Gathering information to understand the health issues of concern
Method Purpose Sources Using existing records and data Collect critical social indicators and perceived needs Census data, maps, govt. documents, medical and public health data references, literature reviews, newspaper review Asset Mapping Identify existing resources Windshield walking tour (physical layout) Town hall meeting Find out about community concerns, etc. Community groups, residents Nominal Group Process Identify and rank health priorities Community groups, target population, key leaders Key informant survey Gain leader’s opinions and support Local political figures, community and health service workers, other professionals and business contacts Community opinion survey Find out about community attitudes and behavior Informal leaders, community residents via, observation, informal conversation, interview, focus group, survey. Central location intercept interviews Obtain information from a large number of people Priority population (can assess quality of life, social capital, perceived needs) Focus Group Explore, assess knowledge, attitudes, beliefs, values, skills

Method 1: Using Existing Records and Data
Disadvantages Limited to information collected by others for purposes that may not meet your needs Hard to know quality of data or how consistently or accurately it was collected Assessment may be limited for legal or ethical reasons Advantages Low cost and convenience Less demands on planning group’s time

“No scientific discipline can be any better than the quality of its raw data”.

“Improvements in study design or in analytic techniques cannot compensate for data of questionable quality generated by epidemiologic investigations”. Leon Gordis

Method 2: Asset Mapping Disadvantages Advantages
May fail to identify some needs and resources It may be hard to control who responds to the inventory Advantages Fairly simple Low cost Provides overview of community needs and resources Strengthens communication and coordination among organizations and agencies

Asset Mapping Identifies Community Assets
Community Assets can be: Person, physical structure or place, business, organization, group Why identify community assets? When should we identify community assets?

Asset Mapping How do you facilitate Asset Mapping?
1. Get map of community 2. Locate noticeable physical structures which can be considered assets 3. Brainstorm other assets: people, physical structures, businesses, organizations Use other sources of information, yellow pages, town directories, lists of organizations, newspaper, bulletin boards, friends and colleagues 4. Windshield walking tour Identify other assets Refine and revise list Map Community Assets Asses “people” assets

Method 3: Town Hall Meetings
Disadvantages Does not allow for problem solving Advantages Low cost Good for engaging a large number of people Helps identify and prioritize issues

Method 4: Nominal Group Process
Disadvantages Does not allow for problem solving Advantages Low cost Good for enlisting participation from group members having unequal power or expertise Helps identify and prioritize issues

Method 5: Key informant survey
Disadvantages Leaders’ opinions may be different from community at large (political issues) Advantages Low cost Establishes connection to community leaders Helps identify which leaders support or approve your efforts

Method 6: Community Opinion Survey
Disadvantages Can be expensive and time consuming Requires appropriate skills in sample selection, interviewing, focus groups, and data analysis Advantages Gives well rounded view of the population Identifies the concerns, knowledge, attitudes, beliefs, values, behaviors of people you want to reach in your health promotion efforts Allows people to give input to your health promotion efforts

Developing Surveys

Constructing a Questionnaire
What is the purpose of the study/questionnaire? Before you construct a questionnaire, the variables that are to included should be identified and listed But what are the variables? How do you determine which variables to include? How do you translate the variables into questions?

Study Variables Characteristics that are measured are called variables
Dependent variable is the outcome Independent variables are the risk factors or predictor variables A composite variable is a variable that is based on 2 or more other variables E.g., adiposity: measured by BMI (weight/ht)

Study Variables Variables are selected based on relevance to the study objectives Key study variables should have been identified in the study objectives Start with a list of ALL variables that have been shown (or suspected) to be associated with your outcome (dependent variable) previoiusly identified in the literature

4 Types of Variables Universal variables e.g., sex, age, parity, marital status, ethnic group, religion, social class, place of residence, geographic mobility Measures of Time Ecological measures Environmental measures Aggregate measures Global measures Variables that delineate the study population

How many variables should I include?
“As many as necessary and as few as possible”

Clarifying Variables 2 aspects that need to be addressed:
Operational definition must be formulated Clearly defining the variables in terms of objectively measurable facts; and How these facts are to be obtained Scale of measurement to be used in data collection

Defining Variables Conceptual definition – defines the variable as we conceive it (dictionary definition); definition of the characteristic we want to measure Operational definition – defines the characteristic we want to measure (working definition); phrased in terms of objectively observable facts & is sufficiently clear and explicit to avoid ambiguity

Example of Defining Variables
CONCEPTUAL DEFINITION “Obesity” excessive fatness; over-weight; a bodily condition which is socially regarded as constituting fatness

OPERATIONAL DEFINITION “Obesity” – A weight, based on weighing in underclothes and without shoes, which exceeds, by 10 percent or more, the mean weight of persons of the subject’s sex, age, and height (in a specified population at a specified time)

OPERATIONAL DEFINITIONS “Obesity” – A skinfold thickness of 25 mm or more, measured with a Harpenden skinfold caliper at the back of the right upper arm, midway between the tip of the acromial process and the to of the olecranon process (this level being located with the forearm flexed at 900), with the arm hanging freely and the skinfold being lifted parallel to the long axis of the arm

OPERATIONAL DEFINITIONS “Obesity” – A positive response to the question, “Are you definitely over-weight?” OR A positive response to the question “Does your husband/wife think you are too fat?”

Operational Definitions of Variables
It is helpful and important to develop the conceptual definitions of your study variables; however Developing an operational definition is not only important but ESSENTIAL and ALWAYS necessary

Proxy Variables Constructs or characteristics which would like to measure may not be directly measurable or extremely difficult to measure E.g., growth of baby in utero, pressure of blood in arteries, social class Often must use proxy variables to approximate the true characteristic

Questions to Consider When Developing Operational Definitions
Occupation – present or usual occupation? Occupation for which the person was trained or work actually employed? If retired or unemployed, will previous occupation be used? Education - # of years of education or last grade attained? Type of educational institution last attended or age at completion of full-time education?

Income – personal income, family income, household income, or average family income per member? Income from all sources, or only from gainful employment? Total (gross) earnings or net earnings after subtraction of income tax, etc.? Is income “in-kind” included?

Social class – based on occupation, education, crowding index, income, neighborhood of residence, home amenities, or subject’s self perception? Based on one or a combination? If a combination, which variables? Ethnic Group – in terms of race: country of birth, father’s country of birth, mother’s country of birth, tribe, religion, or subject’s self-perception? Which documentation do you use: medical records, school records, death records?

Marital status – in terms of legal status (single, married, widowed, divorced, common law, separated)? In terms of stability of the union? Present status, or total married experience? Parity – total # of previous pregnancies or only those terminating in still births or live births, or # of children delivered?

Defining the Disease (Outcome)
First priority is to develop a definition which will distinguish the disease (outcome) from other diseases (outcomes) Operational definition is often formed using diagnostic criteria A set of rules for the diagnosis of the disease based on the presence or absence of specified criteria Manifestations Causal experiences

Operational Definitions of Disease
Manifestations are usually: Physical findings Symptoms Behaviors Course of illness Response to therapy Etc. Causal Experiences are thought to be the “Cause” of the illness Examples: difficult birth An accident Exposure to lead Contact with a case of TB

Specificity of the Definition of Disease
How high should the specificity be? IT DEPENDS on the purpose of the study Highly specific definitions are best if the aim is to identify person who almost certainly have the disease Less specific definitions are best if the aim is to detect all persons with disease even if you obtain false positives

Operational Definitions of Disease
The second purpose of the operational definition is to delimit the disease along its own biological gradient Can use standard criteria proposed by expert committees (or panels) May use second-hand diagnostic information Diagnosis is left to someone else Report of the disease is taken as evidence of its presence

Questions, Questions and More Questions
When constructing the questionnaire you can choose to: Develop new questions Use questions developed previously for a different project, or Borrow questions from published scales

Borrowing Questions ADVANTAGE: DISADVANTAGES:
Already tested & validated in populations Results of your study can be compared to a previously published study DISADVANTAGES: May not have been tested in your population, thus you may need to revalidate May not be the appropriate reading level May not be culturally appropriate

Before you start writing questions:
Determine if a survey is appropriate Describe your purpose Categorize your needs Behaviors, knowledge, beliefs, perceptions Search for pre-existing surveys (BRFS) Determine which segment of the population is most likely to have the information that you need Consider whether the people you approach willing to fill out the survey

Design Concerns: How will the survey be administered?
Self? Paper/pencil? Computer assisted? Interviewer? Face-to-face? Paper & pencil? Computer-assisted? Telephone? Postal? Internet?

Computerized Collection Methods
Computer-Assisted Telephone Interviewing (CATI) Used with telephone interviewing. The questionnaire is programmed and displayed on a terminal or laptop. The interview asks the questions displayed on the screen and then enters the respondent’s response in to the computer using a keyboard or a mouse. Computer-assisted personal interviewing (CAPI) Is programmed into a portable computer that the interviewer takes to the respondent’s home or other location for interview

Computerized Collection Methods
Computer-assisted self-interviewing (CASI) Video-CASI and audio-CASI make use of video and audio capabilities of small portable computers to present the questions on the computer screen or over headphones connected to the computer to respondents who then enter their answers on the computer keyboard. Personal digital assistants (PDAs) small, portable handheld, computerized device which can be adapted to collect data Internet

Drafting Questions: There should be a specific rational for each item
Always utilize a theoretical framework!!! Social capital Community readiness How will the questions be analyzed? This will determine the types of answer categories to provide How will each question fit into the logical sequence and context of the questions? How will each question be perceived/understood?

Questions & Response Rates
Response rates are critical to the success of your study But there are often competing factors: Response rate Participant burden The need to collect a lot of information The need to measure constructs well

Four Stages of Responding to Survey Questions
Comprehension – the respondent interprets the meaning of the question Retrieval – the respondent searches long term memory for relevant information Estimation/judgment – the respondent evaluated the information retrieved from memory & its relevance to the question; the respondent may then combine the separate items of information to form a response or alternatively, the respondent may decide that the recalled information is inadequate & uses that information as a starting point in forming an estimated response

Four Stages of Responding to Survey Questions
Response Stage – the respondent weighs factors such as sensitivity of the question, social desirability of the answer, probable accuracy of the answer, etc., and then decides what answer to provide

How to Word Questions: Keep questions short Keep questions manageable
No more than 20 words Keep questions manageable KISS—Keep it simple and straightforward Be precise Make a question easy to answer Make instructions clear Use questions that can stand alone Ask for one variable at at time State questions positively Keep questions neutral Don’t make assumptions

Good Question Wording Be specific Use simple words No double negatives
No jargon One question, one answer No leading questions Don’t be vague Don’t talk down to respondents Don’t be too specific Revise, revise, revise and revise again PRETESTING IS CRITICAL

Strategies to Improve Validity on Questionnaire/Interviews
Use simpler wording Define or decompose the question into several simpler ones (reduces error) Improve memory/recall Generic memory vs. specific memory Use psychological decomposition Administration of a series of questions to help subjects recall aspects of a specific event Use construction of a personal timeline Uses calendar and placement of personal events to trigger recall of specific events

Strategies to Improve Validity on Questionnaire/Interviews
Social cognition/Memory Structure How is information about health conditions structured in the lay person’s memory? Recall of medical conditions might be improved by structuring health questions in the same way that lay people structure the conditions in their memory

3 Questions To Guide Your Selection of A Collection Method
Which method is most appropriate, given the study question and population of interest? Which method is most readily available? How mcuh money has been budgeted for carrying out this study?

How to Ask Sensitive Questions:
Put demographics at the END Create a favorable context Try the past tense Give a time frame Avoid being too specific

Sequencing: State the purpose
On the survey Cover letter Start with non-threatening “hook” questions to capture their attention Group items logically by topic Arrange questions in groupings Create a smooth flow Include explanation before each new group

Good Questions? Do you agree with radical environmentalists who claim that 40,000 loggers should be put out of work to save 200 spotted owls? Do you agree with timber company executives who argue that habitat for the few remaining spotted owls should be sacrificed so loggers can keep their jobs for the rest of their lives?

Writing Good Questions
It is VERY hard to do; takes lots of time & energy Questions have 2 general forms: Open-ended (free response) – subject answers in his/her own words Close-ended (fixed alternative) – subject answers by choosing from a # of fixed alternative responses

Developing Response Items:
Make response choices mutually exclusive Eliminate “Halo” effect by changing the expected order of responses Keep response options short If the purpose is to assess knowledge, include at least four options

Open-Ended Questions Often produces difficulty in interpreting responses (answers are often incomplete) Also may result in answers that are not codable Can also have difficulty categorizing or classifying similar answers

Close – Ended Questions
Provides greater uniformity & simplifies the analysis Response list should be comprehensive and categories must be mutually exclusive When there is a range of responses extending from one extreme to the opposite extreme, an equal # of alternatives should be presented on each side of the scale. You should also offer a neutral category

Layout and Appearance:
Cover page and title with date and name of organization with phone number Number items consequently Place response choices on the page uniformly and consistently Avoid splitting questions Limit skip sequences If you do have them, give specific directions Give clear directions For groups For individual questions Copies should be clear, lots of space on the page Single sided Book layout increases responses

Pre-testing: JUST DO IT
Colleagues for understandability, directions, typos, grammar With people similar to target population SMOG test

Method 7:Central location intercept interviews
Disadvantages May not statistically represent the entire priority population Advantages Obtain information from a large number of people Low cost opportunity to get opinions and interests of hard to reach priority populations

Method 8: Focus Groups

Conducting Focus Groups
An excellent vehicle for community assessment, program planning and evaluation Qualitative research technique Used to gather opinions, perceptions, ideas Focus group roots are in Marketing research Can be utilized alone, but best if used in conjunction with other forms of qualitative and quantitative data

Focus Group Benefits Excellent for exploring attitudes, beliefs, values, knowledge, perceptions Teaching and learning take place at many levels Can be a marketing tool They are a social experience They can serve as a support group

When do you use/not use Focus Groups?
Don’t use FG when: You want to answer a simple question You want answers to questions that are too complex and/or sensitive for public discussion Peer pressure would inhibit response A large amount of stimulus material must be evaluated Respondents are geographically disperse

Use a Focus Group When: You want to explore ideas or stimulate richer responses You want to observe the interaction between people Peer pressure is valuable You need to find out why You do not have a sensitive topic You want some feedback You can gather people from the target population

Setting up a Focus Group
Specify objectives Rational, objectives, theoretical framework Describe methods (design, data collection) Moderator’s guide, participant recruitment, logistics (participant stipend, location, time) Describe analysis NUDIST, Ethnograph Establish timeline and budget Conduct group Analyze data

Focus Group Participants
Composition Homogenous (all from target population) among groups Heterogeneous between groups (gender, race, SES, age) Recruitment Newspaper ad, flyer, invitations, asking members of community-based coalitions or key leaders, random selection, existing groups Confirm, confirm, confirm

Focus Group Participants
Incentives? Group size 8-12 Recruit double or triple the amount you want in your group Group length 1-2 hours—usually only 1 hour How many groups? Plan for 4 and if you have not reached saturation, continue to add until you do Multiples of two between groups Setting Convenience, closed space, tables, chairs, electrical outlets

Moderator Should have previous experience
Not part of the target population Similar in age, gender, race

Moderator’s Guide Includes:
introduction, ground rules main discussion questions conclusion Should be based upon a theoretical framework Plan for probing cues

Focus Group Preparations
Set up room Chairs, tables, audio-taping equipment Name tags Consent forms Describe FG, purpose, confidentiality of information, use of information, age—over 18, contact name and phone number Set up note takers Set up demographic sheets Set up stipend procedures

Moderator’s Role Follow moderator’s guide Involve all participants
Know when to probe Know when to let participants talk, disagree, tell stories Know when to KINDLY cut off participants Involve all participants Be aware of body language Do not offer comments or facial expressions Keep discussions under control Trouble shoot Calm down participants if needed Pep up participants if needed

Note Taker’s Role Do not offer comments or facial expressions
Be aware of facial expressions Follow along with moderator and guide and write down statements from participants in bullet fashion Record non-verbal communication Record seating chart Record group dynamics

Post Focus Group Have a transcriptionist transcribe audio-tapes
Once you receive transcriptions Read and listen to tape to check for accuracy Again check for accuracy by comparing to notes from note taker Code data Enter data into qualitative analysis software program NUDIST Ethnograph

Writing the Report Background and objectives Methodology Findings
Why you felt the need for a focus group and what you hoped it would clarify Methodology Description of participants Recruitment technique Description of how you developed moderators guide Theoretical framework Attach copy of moderators guide Findings Specific topics introduced Summary of what the focus group said Implications What should next steps be

Community Health Assessment for MCH Programs & Policy Practice

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