Jane T. Bertrand

Techniques for Analyzing Focus Group Data

Focus groups are widely used in the field of public health as a quick, low-cost means of obtaining information from selected groups in the target population for programmatic purposes. Much has been written about techniques for conducting focus groups, but there is limited practical information on systematic analysis of the results. The current article outlines three methods of recording information from focus groups onto paper, as well as three techniques for condensing hours of free-flowing discussion into a readable article that accurately reflects the main points of the focus group discussions. The value of using microcomputers in organizing the focus group information is also discussed.

The Comparability of Focus Group and Survey Results Three Case Studies

This article compares focus group findings with those of surveys on the same topics in three studies in order to determine the extent to which the two methodologces yield similar results. The studies included two follow-ups of tubal ligation acceptors (in Guatemala and Zaire) and research concerning attitudes toward vasectomy in Honduras. On 88% of the variables, the results from the two methods were similar; moreover, in half of the cases, the focus groups provided additional detail. The research suggests that focus groups and surveys provide consistent results on the types of variables for which focus groups are appropriate.

Diffusion of Innovations and HIV/AIDS

As the HIV/AIDS epidemic continues its relentless spread in many parts of the world, DOI provides a useful framework for analyzing the difficulties in achieving behavior change necessary to reduce HIV rates. The DOI concepts most relevant to this question include communication channels, the innovation-decision process, homophily, the attributes of the innovation, adopter categories, and opinion leaders. The preventive measures needed to halt the transmission of HIV constitute a “preventive innovation.” This article describes the attributes of this preventive innovation in terms of relative advantage, compatibility, complexity, trialability, and observability. It reviews studies that incorporated DOI into HIV/AIDS behavior change interventions, both in Western countries and in the developing world. Finally, it discusses possible reasons that the use of DOI has been fairly limited to date in HIV/AIDS prevention interventions in developing countries.

Changes in contraceptive method mix in developing countries

CONTEXT Understanding shifts in contraceptive method mix is key to helping policymakers, program managers and donor agencies meet current contraceptive demand and estimate future needs in developing countries. METHODS Data from Demographic and Health Surveys, Reproductive Health Surveys and other nationally representative surveys were analyzed to describe trends and shifts in method mix among married women of reproductive age from 1980 to 2005. The analysis included 310 surveys from 104 developing countries. RESULTS Contraceptive use among married women of reproductive age increased in all regions of the developing world, reaching 66% in Asia and 73% in Latin America and the Caribbean in 2000-2005, though only 22% in Sub- Saharan Africa. The proportion of married contraceptive users relying on the IUD declined from 24% to 20%, and the proportion using the pill fell from 16% to 12%. The share of method mix for injectables rose from 2% to 8%, and climbed from 8% to 26% in Sub-Saharan Africa, while the share for condoms was 5-7%. The overall proportion of users relying on female sterilization ranged from 29% to 39%, reaching 42-43% in Asia and in Latin America and the Caribbean in 2000-2005; on average, the share of all method use accounted for by male sterilization remained below 3% for all periods. Use of traditional methods declined in all regions; the sharpest drop-from 56% to 31% of users-occurred in Sub-Saharan Africa. CONCLUSIONS To meet the rising demand for modern methods, it is critical that future programmatic efforts provide methods that are both accessible and acceptable to users.

Monitoring quality of care in family planning programs: a comparison of observations and client exit interviews.

Monitoring quality of care in family planning programs is important but the complexity and subjectivity of the topic create many challenges. The Quick Investigation of Quality (QIQ) was developed to monitor quality of care by using observations of client-provider interactions exit interviews with clients and facility audits. The QIQ was field-tested in multiple countries in 1998-99. Using linked data for 583 clients in Ecuador 539 in Uganda and 736 in Zimbabwe this analysis examines the comparability of results from observations and exit interviews. For a given indicator levels of agreement between data from observations and interviews varied across countries but within a country results were consistent between instruments. For the three countries combined agreement was good to excellent (kappas 0.47-0.98) on 13 of 14 indicators examined; observations and exit interviews yielded consistent responses in 63-99% of cases. Agreement was highest on the indicators that measured interpersonal relations. Inconsistencies reflected primarily that clients received information outside of the observed client-provider interaction. Observations and client exit interviews provide very similar results for many indicators. However while some programs may opt for one instrument over the other because of resource constraints the combination provides a fuller assessment of quality of care. (authors)

AIDS-related knowledge, sexual behavior, and condom use among men and women in Kinshasa, Zaire.

This study was conducted in 1988 among a random sample of 6,625 men and women of reproductive age in all 24 administrative zones of Kinshasa, the capital city of Zaire, to determine existing levels of knowledge regarding AIDS (acquired immunodeficiency syndrome), sexual behavior, knowledge and use of condoms in marital and extramarital relations; perceived risk of AIDS, and attitudes toward testing for the human immunodeficiency virus (HIV). Awareness of AIDS is almost universal, and the vast majority know the four main modes of transmission. Almost half believed in transmission by mosquitoes and in a vaccine or cure for AIDS. The majority of male respondents knew of condoms, but negative attitudes toward condom use are widespread, and few respondents perceived them to play a central role in combatting AIDS.

Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire

As a first step in designing an AIDS prevention program at a large factory in Kinshasa, Zaire, we collected information on attitudes towards human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) from factory foremen and their wives. Trained moderators conducted twelve focus group discussions (from November through December 1987) that addressed knowledge, attitudes and beliefs about HIV infection and AIDS. In general, participants were familiar with HIV infection and AIDS and considered these conditions leading health problems in Kinshasa. Although participants had a fairly accurate understanding of the causes of HIV infection, modes of transmission and preventive measures, many myths and misconceptions existed. Many participants did not believe that condom use would consistently prevent infection through sexual intercourse. Participants strongly favored the counseling of seropositive persons but showed less consensus about whether the spouse of a seropositive person should be notified of the partners test result. Participants predicted that couples in which one member is seropositive and the other is not would experience marital discord and friction with family, neighbors and co-workers. These findings were applied to the development of a counseling and educational program for seropositive factory employees and their spouses.

Empirically based conversion factors for calculating couple-years of protection.

Couple-years of protection (CYP) is one of several commonly used indicators to assess international family planning efforts. It has been the subject of much debate, relating in part to the specific conversion factors used to translate the quantity of the respective contraceptive methods distributed to a single measure of protection. This article outlines a comprehensive effort to revisit those conversion factors based on the best available empirical evidence. In most instances, the analysis supports previously established standard conversion factors. However, there are two notable departures. Fewer condoms and spermicides are recommended for each CYP (120 vs. 150), primarily because coital frequency among condom users is lower than previously assumed. Furthermore, for sterilization, the authors recommend the use of country or region-specific conversion factors. Every program evaluation indicator has strengths and weaknesses, and the best program evaluation efforts use a variety of indicators. If CYP is used to evaluate programs, however, the authors believe that the conversion factors presented reflect the best available evidence.

Quality of care in family planning services in Morocco.

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.

Family planning among indigenous populations in Latin America.

This article provides case studies in Guatemala and Bolivia that are useful strategies for family planning and health outreach to indigenous populations. A general discussion of barriers to contraceptive use identifies multiple barriers including poverty and illiteracy rural residence mistrust of outsiders and political unrest belief systems in conflict with modern health systems Catholicism social disapproval and womens status and male attitudes. Institutional barriers are identified as reliance on Spanish language materials that are difficult to understand by indigenous groups discrimination lack of indigenous personnel in decision making positions and unrealistic donor expectations. Qualitative and quantitative data from eight small towns in El Quiche Guatemala reveal that 71% had never been to school. 75% of the women and 48% of the men were unable to read. 12% had electricity. Access to mass communication was limited. The mean number of children still living was 6.6. Live births averaged 8.3. 43% were satisfied with birth spacing. 31% viewed birth spacing as undesirable. 26% had no opinion about birth spacing. 32% referred to Gods will in response to queries about the ideal family size. The most common ideal was 5.0 children among those responding. Only 15% reported satisfaction with their last birth. 19% of the 123 pregnant women were not happy about being pregnant. 23% of nonpregnant women did not want any more children. Focus group respondents differed from interview respondents who reported greater use of modern methods. 90% reported interest in a home visit about healthy children. 57% reported ever use of health centers or posts. Based on both case studies and other experiences it is argued that programs can be improved through use of community workers offering a mix of services and providing local bilingual personnel. Program involvement of local indigenous people was strongly suggested. It is urged that indigenous men be targeted for family planning and community outreach. Political and religious barriers need to be overcome.