Presentation on theme: "Community Health Assessment for MCH Programs & Policy Practice"— Presentation transcript:
1 Community Health Assessment for MCH Programs & Policy Practice Wendy N. Nembhard, PhDUniversity of South Florida, College of Public HealthDepartment of Epidemiology & BiostatisticsAMCHP 2009 Annual ConferenceWashington, DCFebruary 21, 2009
2 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 headingMy slidesI am very thankful for their willingness to share these presentations. Please do not reproduce these slides without obtaining permission. Thank you!
3 William M. Sappenfield, MD, MPH Better Focusing on Our Problems: Needs Assessment & the Planning ProcessWilliam M. Sappenfield, MD, MPHState MCH EpidemiologistFlorida Department of Health
4 Public Health Planning Cycle Act IPublic Health Planning Cycle
9 Needs Assessment Underreporting of prenatal visits Physicians not starting to 2nd trimesterLate entry into the WIC programProblem recognition by CommunityTransportation & child care barriersUnintended pregnancy
10 Potential Strategies Underreporting of prenatal visits Vital registration manualClerk trainingHealth department record transferPhysician record transferStandardized prenatal care recordPhysician & hospital educationMonthly reporting systemHospital standardsIncentive awards
11 Chosen Strategies Underreporting of prenatal visits Vital registration manualClerk trainingHealth department record transferPhysician record transferStandardized prenatal care recordPhysician & hospital educationMonthly reporting systemHospital standardsIncentive awards
24 Types of Needs Assessment... Community--Healthy CommunitiesPopulation--Title V (MCH)Health Systems--Emergency ResponseProgram--Title X (Family Planning)Health Services--Prenatal Clinic LocationHealth Problem--Infant Mortality
25 Needs Assessment Phases Part 1Health problem identification and measurementPrioritization of health problemsAnalysis of a particular health problemAssess potential strategies to address targeted aspectsPart 2
26 Needs Assessment Phases Part 1Health problem identification and measurementPrioritization of health problemsAnalysis of a particular health problemAssess potential strategies to address targeted aspects.Part 2
27 What is a health problem? Community perception?Health status measure?Risk Factor?Health Service Deficiency?Measurement?Comparison?
31 Part 1: Identification & Prioritization Selection Criteria Magnitude of the problemTrendSeverity/consequencesPerceived PreventabilityNational/state goalsAgency priorityPolitical/community acceptability
32 Part 1: Identification & Prioritization Real Selection Criteria State or agency political willCurrent program priorityCurrently funded activityFits current staffing/resource patternsPeople available to work on the issueImportant issue to the heart
33 Matrix of MCH Problems Criteria Weight LBW Peri HIV Smoking Magnitude 2Trend3SeverityPreventableGoalPriority1Acceptable
34 Clear Scoring Criteria MagnitudeLow incidence/prevalenceModerate in some subgroupsModerate in all groupsHigh in some subgroupsHigh in all groups
35 Matrix of MCH Problems Criteria Weight LBW Peri HIV Smoking Magnitude 22 x 42 x 1Trend33 x 43 x 13 x 2Severity3 x 3Preventable2 x 22 x 3GoalPriority11 x 11 x 3Acceptable
37 Needs Assessment Phases Part 1Health problem identification and measurementPrioritization of health problemsAnalysis of a particular health problemAssess potential strategies to address targeted aspects.Part 2
38 Problem Map: Basic Components PrecursorsBeforeProblemConsequencesAfter
43 Consequences Problem Direct: Secondary: Tertiary: Teen Pregnancy AbortionFetal DeathLive BirthSecondary:Tertiary:
44 Consequences Problem Direct: Secondary: Tertiary: Teen Pregnancy AbortionFetal DeathLive BirthLBW/PrematuritySecondary:School Delayor Drop OutAbortionConsequencesTertiary:
45 Consequences Problem Direct: Secondary: Tertiary: Teen Pregnancy AbortionFetal DeathLive BirthLBW/PrematuritySecondary:School Delayor Drop OutAbortionConsequencesTertiary:ImpairedEconomicProductivity
46 Consequences Problem Direct: Secondary: Tertiary: Teen Pregnancy AbortionFetal DeathLive BirthMedicalLBW/PrematurityComplicationsSecondary:School DelayPoor Growthor Drop OutEnvironmentEconomicAbortionDifficultiesConsequencesLimitedLimitedLimitedFatherMaternalFamilyTertiary:SupportInvolvementSkillsPovertyRepeatCyclePregnancyDay CareSlowedSubsidyDevelopmentImpairedEconomicMedicaidSocialChildProductivitySupportSupportNeglect
47 Need for Services Standards--Professional or Consensus Demand--Waiting ListsPopulation at Risk--At Risk Not UsingRelative--Population ComparisonsPerceptions--Reported Needs
48 Precursors Problem Tertiary: Secondary: Direct: Social Norms After SchoolProgramsHealth PolicySecondary:Partner AgeUnsupervisedAccess toDisparityConfidentialActivitiesServicesInitiationContinuationUse ofDirect:of Sexualof SexualContraceptionActivityActivityProblemTeenPregnancy
49 Why Do You Need A Problem Map? Many causes & risk factorsMany levels of influenceDifferent opinions--causes & solutionsVast scientific knowledgeStacks of local data
51 What Is A Problem Map? Oriented around a health problem Shows causes & solutionsShows consequencesConsensus of opinions, knowledge, & and informationDefines boundaries of what is knownProvides a map for use
52 Steps for Making A Problem Map Obtain community thoughtsReview scientific informationObtain & review local informationDevelop consensusDetermine gaps in informationDetermine potential actionsDevelop an action plan
53 Bill's Steps for Problem-Oriented Needs Assessment Theoretical FrameworkGather Readily Available InformationFrame and Choose Critical QuestionsChoose and Develop MethodsAnalyze and Answer Your QuestionsSummarize Your ProblemPresent the Results
54 Gather… Other Needs Assessments Available Reports Key Data People Key Community People
55 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?
56 Bill's Steps for Problem-Oriented Needs Assessment Theoretical FrameworkGather Readily Available InformationFrame and Choose Critical QuestionsChoose and Develop MethodsAnalyze and Answer Your QuestionsSummarize Your ProblemPresent the Results
57 Summarize the Findings!!! Problem statementTrendsIndividual contributorsCommunity contributorsIndividual strengthsCommunity strengths
58 Definition of Needs Assessment Systematic collection and examination of information to make decisions to formulate a plan for the next steps leading to public health action.
60 Needs Assessment Debates Qualitative or QuantitativeAssets or ProblemsAssessment or SurveillanceOne Time or OngoingOurselves or ContractScience or ArtPerformance or Pretty
61 Linkage of Assessment to Planning Act IVLinkage of Assessment to Planning
62 What are objectives?Where do objectives come from?
63 Program Hypothesis Problem Analysis Access to poison by children Provide childproof containersIngestion of poisonReduce poison consumptionDeath from poison consumptionReduce child poison deathsProgram Hypothesis
64 Problem Analysis Program Hypothesis Reduce child poison deaths Death from poison consumptionReduce poison consumptionIngestion of poisonProvide childproof containersAccess to poison by childrenProblem Analysis
65 What is a program hypothesis? How do objectives form a program hypothesis?
66 Program Hypothesis Goal Policy Program Operational Change in health of communityPolicyChange in health status of recipientsProgramChange in characteristics of recipientsOperationalActivities of the program
67 Program HypothesisGoal: 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.
68 Program HypothesisGoal: 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.NumberTimingControlAvailable
70 Good Objectives Connected to the problem analysis Simple/Straight forwardMeasurableAvailableBaseline and target measuresTime period
71 Precursors Problem Tertiary: Secondary: Direct: Social Norms After SchoolProgramsHealth PolicySecondary:Partner AgeUnsupervisedAccess toDisparityConfidentialActivitiesServicesInitiationContinuationUse ofDirect:of Sexualof SexualContraceptionActivityActivityProblemTeenPregnancy
72 What are the advantages and disadvantages of defining a program by its objective?
73 Community Health Assessment Methods Rita Debate, PhDUniversity of South FloridaCollege of Public HealthDepartment of Community & Family Health
74 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?
75 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?
76 Community Needs Assessment: Gathering information to understand the health issues of concern MethodPurposeSourcesUsing existing records and dataCollect critical social indicators and perceived needsCensus data, maps, govt. documents, medical and public health data references, literature reviews, newspaper reviewAsset MappingIdentify existing resourcesWindshield walking tour (physical layout)Town hall meetingFind out about community concerns, etc.Community groups, residentsNominal Group ProcessIdentify and rank health prioritiesCommunity groups, target population, key leadersKey informant surveyGain leader’s opinions and supportLocal political figures, community and health service workers, other professionals and business contactsCommunity opinion surveyFind out about community attitudes and behaviorInformal leaders, community residents via, observation, informal conversation, interview, focus group, survey.Central location intercept interviewsObtain information from a large number of peoplePriority population (can assess quality of life, social capital, perceived needs)Focus GroupExplore, assess knowledge, attitudes, beliefs, values, skills
77 Method 1: Using Existing Records and Data DisadvantagesLimited to information collected by others for purposes that may not meet your needsHard to know quality of data or how consistently or accurately it was collectedAssessment may be limited for legal or ethical reasonsAdvantagesLow cost and convenienceLess demands on planning group’s time
78 “No scientific discipline can be any better than the quality of its raw data”.
79 “Improvements in study design or in analytic techniques cannot compensate for data of questionable quality generated by epidemiologic investigations”.Leon Gordis
80 Method 2: Asset Mapping Disadvantages Advantages May fail to identify some needs and resourcesIt may be hard to control who responds to the inventoryAdvantagesFairly simpleLow costProvides overview of community needs and resourcesStrengthens communication and coordination among organizations and agencies
81 Asset Mapping Identifies Community Assets Community Assets can be:Person, physical structure or place, business, organization, groupWhy identify community assets?When should we identify community assets?
83 Asset Mapping How do you facilitate Asset Mapping? 1. Get map of community2. Locate noticeable physical structures which can be considered assets3. Brainstorm other assets: people, physical structures, businesses, organizationsUse other sources of information, yellow pages, town directories, lists of organizations, newspaper, bulletin boards, friends and colleagues4. Windshield walking tourIdentify other assetsRefine and revise listMap Community AssetsAsses “people” assets
89 Method 4: Nominal Group Process DisadvantagesDoes not allow for problem solvingAdvantagesLow costGood for enlisting participation from group members having unequal power or expertiseHelps identify and prioritize issues
90 Method 5: Key informant survey DisadvantagesLeaders’ opinions may be different from community at large (political issues)AdvantagesLow costEstablishes connection to community leadersHelps identify which leaders support or approve your efforts
93 Method 6: Community Opinion Survey DisadvantagesCan be expensive and time consumingRequires appropriate skills in sample selection, interviewing, focus groups, and data analysisAdvantagesGives well rounded view of the populationIdentifies the concerns, knowledge, attitudes, beliefs, values, behaviors of people you want to reach in your health promotion effortsAllows people to give input to your health promotion efforts
96 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 listedBut what are the variables? How do you determine which variables to include? How do you translate the variables into questions?
97 Study Variables Characteristics that are measured are called variables Dependent variable is the outcomeIndependent variables are the risk factors or predictor variablesA composite variable is a variable that is based on 2 or more other variablesE.g., adiposity: measured by BMI (weight/ht)
98 Study VariablesVariables are selected based on relevance to the study objectivesKey study variables should have been identified in the study objectivesStart 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
99 4 Types of VariablesUniversal variables e.g., sex, age, parity, marital status, ethnic group, religion, social class, place of residence, geographic mobilityMeasures of TimeEcological measuresEnvironmental measuresAggregate measuresGlobal measuresVariables that delineate the study population
100 How many variables should I include? “As many as necessary and as few as possible”
101 Clarifying Variables 2 aspects that need to be addressed: Operational definition must be formulatedClearly defining the variables in terms of objectively measurable facts; andHow these facts are to be obtainedScale of measurement to be used in data collection
102 Defining VariablesConceptual definition – defines the variable as we conceive it (dictionary definition); definition of the characteristic we want to measureOperational 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
103 Example of Defining Variables CONCEPTUAL DEFINITION“Obesity”excessive fatness;over-weight;a bodily condition which is socially regarded as constituting fatness
104 Example of Defining Variables 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)
105 Example of Defining Variables 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
106 Example of Defining Variables OPERATIONAL DEFINITIONS“Obesity” –A positive response to the question, “Are you definitely over-weight?”ORA positive response to the question “Does your husband/wife think you are too fat?”
107 Operational Definitions of Variables It is helpful and important to develop the conceptual definitions of your study variables; howeverDeveloping an operational definition is not only important but ESSENTIAL and ALWAYS necessary
108 Proxy VariablesConstructs or characteristics which would like to measure may not be directly measurable or extremely difficult to measureE.g., growth of baby in utero, pressure of blood in arteries, social classOften must use proxy variables to approximate the true characteristic
109 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?
110 Questions to Consider When Developing Operational Definitions 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?
111 Questions to Consider When Developing Operational Definitions 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?
112 Questions to Consider When Developing Operational Definitions 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?
113 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 criteriaA set of rules for the diagnosis of the disease based on the presence or absence of specified criteriaManifestationsCausal experiences
114 Operational Definitions of Disease Manifestations are usually:Physical findingsSymptomsBehaviorsCourse of illnessResponse to therapyEtc.Causal Experiences are thought to be the “Cause” of the illnessExamples:difficult birthAn accidentExposure to leadContact with a case of TB
115 Specificity of the Definition of Disease How high should the specificity be?IT DEPENDS on the purpose of the studyHighly specific definitions are best if the aim is to identify person who almost certainly have the diseaseLess specific definitions are best if the aim is to detect all persons with disease even if you obtain false positives
116 Operational Definitions of Disease The second purpose of the operational definition is to delimit the disease along its own biological gradientCan use standard criteria proposed by expert committees (or panels)May use second-hand diagnostic informationDiagnosis is left to someone elseReport of the disease is taken as evidence of its presence
117 Questions, Questions and More Questions When constructing the questionnaire you can choose to:Develop new questionsUse questions developed previously for a different project, orBorrow questions from published scales
118 Borrowing Questions ADVANTAGE: DISADVANTAGES: Already tested & validated in populationsResults of your study can be compared to a previously published studyDISADVANTAGES:May not have been tested in your population, thus you may need to revalidateMay not be the appropriate reading levelMay not be culturally appropriate
119 Before you start writing questions: Determine if a survey is appropriateDescribe your purposeCategorize your needsBehaviors, knowledge, beliefs, perceptionsSearch for pre-existing surveys (BRFS)Determine which segment of the population is most likely to have the information that you needConsider whether the people you approach willing to fill out the survey
120 Design Concerns: How will the survey be administered? Self?Paper/pencil?Computer assisted?Interviewer?Face-to-face?Paper & pencil?Computer-assisted?Telephone?Postal?Internet?
121 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
122 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 dataInternet
123 Drafting Questions: There should be a specific rational for each item Always utilize a theoretical framework!!!Social capitalCommunity readinessHow will the questions be analyzed?This will determine the types of answer categories to provideHow will each question fit into the logical sequence and context of the questions?How will each question be perceived/understood?
124 Questions & Response Rates Response rates are critical to the success of your studyBut there are often competing factors:Response rateParticipant burdenThe need to collect a lot of informationThe need to measure constructs well
125 Four Stages of Responding to Survey Questions Comprehension – the respondent interprets the meaning of the questionRetrieval – the respondent searches long term memory for relevant informationEstimation/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
126 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
127 How to Word Questions: Keep questions short Keep questions manageable No more than 20 wordsKeep questions manageableKISS—Keep it simple and straightforwardBe preciseMake a question easy to answerMake instructions clearUse questions that can stand aloneAsk for one variable at at timeState questions positivelyKeep questions neutralDon’t make assumptions
128 Good Question Wording Be specific Use simple words No double negatives No jargonOne question, one answerNo leading questionsDon’t be vagueDon’t talk down to respondentsDon’t be too specificRevise, revise, revise and revise againPRETESTING IS CRITICAL
129 Strategies to Improve Validity on Questionnaire/Interviews Use simpler wordingDefine or decompose the question into several simpler ones (reduces error)Improve memory/recallGeneric memory vs. specific memoryUse psychological decompositionAdministration of a series of questions to help subjects recall aspects of a specific eventUse construction of a personal timelineUses calendar and placement of personal events to trigger recall of specific events
130 Strategies to Improve Validity on Questionnaire/Interviews Social cognition/Memory StructureHow 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
131 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?
132 How to Ask Sensitive Questions: Put demographics at the ENDCreate a favorable contextTry the past tenseGive a time frameAvoid being too specific
133 Sequencing: State the purpose On the surveyCover letterStart with non-threatening “hook” questions to capture their attentionGroup items logically by topicArrange questions in groupingsCreate a smooth flowInclude explanation before each new group
134 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?
135 Writing Good Questions It is VERY hard to do; takes lots of time & energyQuestions have 2 general forms:Open-ended (free response) – subject answers in his/her own wordsClose-ended (fixed alternative) – subject answers by choosing from a # of fixed alternative responses
136 Developing Response Items: Make response choices mutually exclusiveEliminate “Halo” effect by changing the expected order of responsesKeep response options shortIf the purpose is to assess knowledge, include at least four options
137 Open-Ended QuestionsOften produces difficulty in interpreting responses (answers are often incomplete)Also may result in answers that are not codableCan also have difficulty categorizing or classifying similar answers
138 Close – Ended Questions Provides greater uniformity & simplifies the analysisResponse list should be comprehensive and categories must be mutually exclusiveWhen 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
139 Layout and Appearance: Cover page and title with date and name of organization with phone numberNumber items consequentlyPlace response choices on the page uniformly and consistentlyAvoid splitting questionsLimit skip sequencesIf you do have them, give specific directionsGive clear directionsFor groupsFor individual questionsCopies should be clear, lots of space on the pageSingle sidedBook layout increases responses
140 Pre-testing: JUST DO IT Colleagues for understandability, directions, typos, grammarWith people similar to target populationSMOG test
141 Method 7:Central location intercept interviews DisadvantagesMay not statistically represent the entire priority populationAdvantagesObtain information from a large number of peopleLow cost opportunity to get opinions and interests of hard to reach priority populations
144 Conducting Focus Groups An excellent vehicle for community assessment, program planning and evaluationQualitative research techniqueUsed to gather opinions, perceptions, ideasFocus group roots are in Marketing researchCan be utilized alone, but best if used in conjunction with other forms of qualitative and quantitative data
145 Focus Group BenefitsExcellent for exploring attitudes, beliefs, values, knowledge, perceptionsTeaching and learning take place at many levelsCan be a marketing toolThey are a social experienceThey can serve as a support group
146 When do you use/not use Focus Groups? Don’t use FG when:You want to answer a simple questionYou want answers to questions that are too complex and/or sensitive for public discussionPeer pressure would inhibit responseA large amount of stimulus material must be evaluatedRespondents are geographically disperse
148 Use a Focus Group When:You want to explore ideas or stimulate richer responsesYou want to observe the interaction between peoplePeer pressure is valuableYou need to find out whyYou do not have a sensitive topicYou want some feedbackYou can gather people from the target population
149 Setting up a Focus Group Specify objectivesRational, objectives, theoretical frameworkDescribe methods (design, data collection)Moderator’s guide, participant recruitment, logistics (participant stipend, location, time)Describe analysisNUDIST, EthnographEstablish timeline and budgetConduct groupAnalyze data
150 Focus Group Participants CompositionHomogenous (all from target population) among groupsHeterogeneous between groups (gender, race, SES, age)RecruitmentNewspaper ad, flyer, invitations, asking members of community-based coalitions or key leaders, random selection, existing groupsConfirm, confirm, confirm
153 Focus Group Participants Incentives?Group size8-12Recruit double or triple the amount you want in your groupGroup length1-2 hours—usually only 1 hourHow many groups?Plan for 4 and if you have not reached saturation, continue to add until you doMultiples of two between groupsSettingConvenience, closed space, tables, chairs, electrical outlets
154 Moderator Should have previous experience Not part of the target populationSimilar in age, gender, race
155 Moderator’s Guide Includes: introduction, ground rulesmain discussion questionsconclusionShould be based upon a theoretical frameworkPlan for probing cues
156 Focus Group Preparations Set up roomChairs, tables, audio-taping equipmentName tagsConsent formsDescribe FG, purpose, confidentiality of information, use of information, age—over 18, contact name and phone numberSet up note takersSet up demographic sheetsSet up stipend procedures
157 Moderator’s Role Follow moderator’s guide Involve all participants Know when to probeKnow when to let participants talk, disagree, tell storiesKnow when to KINDLY cut off participantsInvolve all participantsBe aware of body languageDo not offer comments or facial expressionsKeep discussions under controlTrouble shootCalm down participants if neededPep up participants if needed
158 Note Taker’s Role Do not offer comments or facial expressions Be aware of facial expressionsFollow along with moderator and guide and write down statements from participants in bullet fashionRecord non-verbal communicationRecord seating chartRecord group dynamics
159 Post Focus Group Have a transcriptionist transcribe audio-tapes Once you receive transcriptionsRead and listen to tape to check for accuracyAgain check for accuracy by comparing to notes from note takerCode dataEnter data into qualitative analysis software programNUDISTEthnograph
160 Writing the Report Background and objectives Methodology Findings Why you felt the need for a focus group and what you hoped it would clarifyMethodologyDescription of participantsRecruitment techniqueDescription of how you developed moderators guideTheoretical frameworkAttach copy of moderators guideFindingsSpecific topics introducedSummary of what the focus group saidImplicationsWhat should next steps be