Examples of Moderator=S Guides for Focus Group Discussions

ANNEX D:

EXAMPLES OF MODERATOR=S GUIDES FOR FOCUS GROUP DISCUSSIONS

Example 1:

Bangladesh Diarrhoea Study - Moderator's Focus Group Guide for Prescribers

Example 2:

Bangladesh Diarrhoea Study - Moderator's Focus Group Guide for Pharmacists

Example 3:

Bangladesh Diarrhoea Study - Moderator's Focus Group Guide for Mothers

Example 4:

Nigeria Malaria Study Moderator's Focus Group Guide for Nurses

Example 5:

Nigeria Malaria Study - Moderator's Focus Group Guide for Community Members

Example 6:

WHO/CDD Drug Sellers Study - Moderator's Focus Group Guide for Drug Sellers

1.Introduction

[Narrative welcoming participants, describing the reasons for the discussion, and setting up the general ground rules for the session].

2.Diarrhoeal Disease as a Problem

First, I would like to know a bit about the type of diarrhoea cases you commonly see. How would you describe them?

3.Diagnosis and Treatment of Diarrhoea by Prescribers

3.1Can we talk about how you also deal with diarrhoea cases starting with diagnosis. What do you depend on for diagnosis of diarrhoea?

Probe:Do you depend mostly on clinical features.

What investigations do you think are necessary in these cases?

How often are these done?

3.2Use of ORS by prescribers

How do you feel about ORS as a way of treating diarrhoea?

Probe:Do you always prescribe ORS?

Why or why not?

For what kinds of cases does ORS work best?

Are there cases when ORS is not enough or not necessary?

Are there times when there is no supply of ORS?

If so, what do you do then?

4.Use of other Drugs in Diarrhoea Treatment

I would like to talk about other drugs for treating diarrhoea. Can you tell me a bit more about the other drugs that you sometimes use?

Probe:What are the names of some of these drugs?

Why do you use those particular drugs?

How do you decide when to use them?

When you are treating children, what are the advantages and disadvantages of using:

* antibiotics?* metronidazole?

* antidiarrhoeals?* injections? (IV fluid)

Are there any other useful drugs we have not talked about?

What guideline do you follow for prescribing in diarrhoeal cases?

5.Knowledge of Health Workers about Mothers'

Perceptions of Diarrhoea

I would like to know something about the mothers who come to your clinic to get treatment for diarrhoea for their children. How do mothers present diarrhoea cases to you?

Probe:At what point in the episode do they usually come for treatment?

What questions do you usually ask them?

Do they usually treat these kinds of cases at home before they come to your clinic?

Could you give me some examples of how?

What do you think about these home treatment?

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6.Influence of Patient Expectations

I would like to know more about mothers and how they feel about treating diarrhoea in their children. When they come to see you, do mothers usually come with any expectations about the kind of treatment they will receive?

Probe:Do they have any prejudices about certain kinds of treatment?

How strongly do they usually feel about that?

Do they ever ask for injections?

What would they do if you ignored their expectations?

Do you ever try to convince them differently?

What usually happens then?

7.Patients Knowledge and Attitudes Toward ORS

Can you tell me something about what mothers know about ORS?

Probe:How (where/whom) do they usually get to know about ORS?

Do they ever use ORS on their own when their children get diarrhoea?

8.Promotion of the Use of ORS

What is the reaction of mothers when they are given only ORS when they come for treatment?

Probe:Are they satisfied?

Why or why not?

Could you convince mothers who are not satisfied to accept only ORS as treatment?

How would you do this?

9.Role of prescribers in Education of Mothers

Do you think that mothers know enough in general about how to prevent diarrhoea, and how to manage it when their children become sick?

Probe:What else do mothers need to know? (Hint: from doctors experience)

How should this be done?

What role could you play in this?

What things would need to change for this to happen?

10.Role of Pharmacist

Has the pharmacist in your health complex any role/say in the choice of drugs for patients?

Probe:Do you have discussions with the pharmacist about drugs used for treatment?

Do you get regular feedback from the pharmacist, about these drugs?

11.Prescriber Education About Therapeutics

I would like to hear about how you get/learn new information about treatment of health problems and drugs. Can you tell me something about this?

Probe:What would you do if you had a health problem you had not treated before?

Do you ever have difficulties hearing about new drugs or new information on treatment of diseases?

Do you have suggestions on how to obtain such information easily?

Have you ever discussed the treatment of diarrhoea with medical representatives (Drug Reps)?

12.Closing

Finally are there any other major things influencing prescribing for diarrhoea that we have not yet talked about? What are these?

[Narrative to terminate the discussion, elicit questions and ask participants their impressions about the conversation, and thank them for their co-operation].

ANNEX D - 1

1.Introduction

(Narrative welcoming of participants, describing specific reasons for the discussion, and setting up the general ground rules for the session)

2.The Role of Pharmacist in the Health Facilities

First, I would like to know about your position and role in the health facility where you work. I am interested in what you think and feel about this role.

Probe:Are you also involved in ordering or procurement of drugs to the dispensary?

Do you also maintain an inventory of drugs?

If the prescribed drug is not available, what do you do?

How do prescribers see your role?

How do patients see your role?

What is your feeling about the patient load?

Do you have any suggestions for improving drug procurement and storage?

3.Diarrhoeal Disease as a Problem

Can we talk about diarrhoeal diseases and their treatment in your health complexes? What are the types of main outpatient diarrhoea cases that are presented.

Listen to responses, then

Probe:Does it regularly affect all age groups?

How do you feel about it?

4.Use of ORS What do you think/feel about ORS as a way of treating diarrhoea?

Probe:How often is ORS prescribed?

For what kinds of cases does ORS work best?

Are there instances when ORS alone is not enough for treatment?

Do you think the taste of ORS has any influence in its use for children? How?

Do you have any suggestions about this?

5.Use of Other Drugs in Diarrhoea Treatment

5.1I would like you to talk about other drugs that are usually prescribed by doctors for treating diarrhoea.

Probe:What are the names of some of these drugs?

Can you tell me the reasons why these drugs are prescribed?

Do you often dispense those drugs with ORS?

What about these (if not mentioned)

* antibiotics?* metronidazole?

* antidiarrhoeals?* injections?

5.2Are there any other useful drugs for diarrhoea we have not talked about?

6.Drug Prescribing And Dispensing

6.1What is your opinion about prescribing by trade names.

Probe:When the suggested trade name is not available, what do you do?

6.1.1Do you think the dosage schedule is properly given in the prescription?

-Why or why not?

-Is there anything you could do about this?

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Probe:If you know that the dosage schedule is not correct, what do you do?

Do the patients ask you for directions about drugs prescribed for them?

Do you see any other problems related to prescription?

6.1.2Can we talk about dispensing in your facility. I would like to know specifically about how you actually dispense different dosage forms.

Probe:How do you dispense two or more types of tablets to patients?

Are you confident that patients will identify and take them (various drugs) properly?

Are there any suggestions to improve the situation?

6.2Can you tell me what you know about the way doctors in your facility treat diarrhoea?

-Does the practice of private doctors/drug outlets influence the way doctors in your facility prescribe?

-If yes, how?

7.Knowledge of Pharmacists About Mother's perceptions of Diarrhoea

I would like to know about the perception of mothers (who come to the health complexes to get treatment) about diarrhoea (in their children). How do mothers determine when their children have diarrhoea?

Probe:At what point in the diarrhoeal episode do they usually come for treatment?

Do they normally try some solution before they come for treatment?

Could you give me some examples of these home treatments?

What do you think about these (home treatments)?

8.Patients Knowledge and attitude Toward ORS

Could you tell me about how mothers get to know/hear about ORS?

Probe:What do they think about it?

Do they ever use ORS on their own when their children get diarrhoea?

Why or why not?

Are mothers able to make "home made solution" on their own?

9.Promotion of the Use of ORS

Are mothers usually satisfied when their children get only ORS when they come for treatment for diarrhoea?

Probe:Why or why not?

Could you convince mothers who are not satisfied to accept ORS as the only treatment to do so?

How would/could this be done

10.Role of Pharmacist in Educating Mothers

Do you think that mothers know enough in general about how to manage diarrhoea, when their children suffer from it?

Probe:Is there anything else that mothers need to know?

How should this be done?

What role could you play in this?

What things need to be changed for this to happen?

11.Pharmacist Education About Therapeutics

Finally, I would like to hear about how you get new information about new drugs. What are some of the ways that you learn about these things?

Probe:Do you have difficulties in learning about new drugs?

Are there any suggestions you could make to remedy this situation?

Do you think you need further training?

What type of training do you need?

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How would you benefit from such training?

12.Closing

Before we close the discussion, is there anything that you would like to add or to give new comments to what have been discussed before?

(Narrative to terminate the discussion, elicit questions and ask participants their impressions about the conversation, and thank them for their co-operation).

ANNEX D - 1

Introduction

[Narrative welcoming participants, describing the reasons for the discussion and setting up the general ground subjects for the session]

1.Perception and Knowledge About Diarrhoea

First, I would like to get some idea from you about diarrhoea. How are you able to tell when your child has diarrhoea? What are some of the main symptoms you look for to determine that it is diarrhoea?

Probe:Listen to response and probe:

Please tell me beside loose stool what else would you look for in a diarrhoeal child?

What may be the cause of diarrhoea?

Is there a way to prevent your children getting diarrhoea?

Do you think that when you get diarrhoea, the baby may get it from you?

What preventive measures do you take?

2.Severity or Threat of Diarrhoea

Please tell me if your child is not treated what are the problems the child is likely to undergo.

Probe:Are you worried that the child may be seriously ill?

Why do some child die from diarrhoea? Can you tell me about that?

3.Management of Diarrhoea by Mothers

I would like to know about what you do when your child gets diarrhoea. What do you do when you suspect this?

Probe:What else do you do? Do you go to a practitioner?

What type of practitioner do you go?

What happens when your child does not respond to this kind of treatment?

How many days after the onset of diarrhoea do you send/bring your child to the hospital?

4.Knowledge about ORS

I would like to hear what you know about ORS. Can you tell me please.

Probe:Can you describe what ORS does and how it works?

How and where did you learn about ORS? Can you prepare it yourself, How?

How do you give it and for how long?

Have you used any other kind of fluids to treat diarrhoea before knowing about ORS?

What are those fluids?

Did you like ORS or these fluids when you used them?

Why or why not?

5.Sources for obtaining ORS

Can you tell me some possible sources for obtaining ORS?

Probe:Do you ever have problems in getting ORS when you want it?

What kind of problem is it? Is the problem due to its cost?

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6.Attitude Towards ORS

Are you satisfied when you are given only ORS to treat diarrhoea when you go to the health centre? Why or why not?

Probe:Do you feel that ORS is a good treatment for diarrhoea?

Why or why not?

Do you prefer home made or packed ORS? Why or why not?

When ORS does not cure the diarrhoeal baby, what is your feeling about ORS then?

7.Educational about Diarrhoea Management

I would like to know about how confident you feel about managing diarrhoea yourself.

Probe:Do you like to know any thing more about the home management of diarrhoea?

Where would you be able to find out about such information you want to know?

Is there any one whose opinions about these things you specially trust?

8.Feeding and Breast feeding Practice

Can you tell me something about what you think children should eat and drink while they are having diarrhoea?

Probe:Is this different from what you normally give your child?

Do you increase or decrease certain kinds of food?

Should you continue to breast feed your child during diarrhoea episode?

Why do you prefer the kind of diet when your child has diarrhoea?

9.Use of Other Drugs to treat Diarrhoea

I would like to hear about some of the other medication besides ORS that your child receives for diarrhoea at the health centre. Can you describe any other drugs children sometimes receive there to treat diarrhoea?

Probe:Do you like it better when your child get one of these other drugs.

Do you think your child needs these drugs?

What do these drugs do?

Do you insist on the other drugs or the doctor prescribed it himself?

If these drugs are not provided at the thana do you ever go somewhere else to get them?

Where do you go?

Did you get to know of these drugs from any worker at the health centre?

10.Attitude Towards System

I would like to hear about your views on the health services delivered to you?

What were your expectations when you arrived at the health centre?

Were the expectations fulfilled?

Why or why not? What time did you come to the health centre

If late, why did you come late?

11.Closing: [Narrative to terminate discussion, elicit questions and ask participants their impression about the conversation, and thank them for their co-operation].

ANNEX D - 1

1.Introduction

I am ______from ______, and my colleague who is assisting in this session is ______.

We have been asked by the Federal Ministry of Health to learn more about the problem of malaria in this area in order to establish programs to improve the treatment of this important health problem. We would like to welcome you, and thank you for agreeing to participate in this discussion.

We know that as nurses working in health centres and hospitals, you are on the front-line in dealing with the problem of malaria. Your insights and opinions will teach us a great deal about the perceptions of community members about malaria, and how personnel within the public health system are dealing with malaria treatment.

[Set up the general ground rules for the session.]

i)90 minutes (tape recorded; observer and note taker)

ii)Speak clearly/one at a time

iii)Conversations/all participate

iv)Want everyone's opinions

v)No right/wrong answers

vi)Courage of convictions

2.Common Health Problems in Community

First, I would like to know more generally about the diseases seen at the health centres in this area. What are the most common ones? [If malaria is not mentioned, specifically bring it up].