Community Health Assessment Focus Group and Key Informant

Community Health Assessment Focus Group and Key Informant Interviews: Brief Training for Facilitators (Name) NATIONAL INDIAN HEALTH BOARD (Title) 5/9/18 National Indian Health Board (Event Name) (Date)

Topics • Community/Tribal Health Assessment • Qualitative Data • Focus Groups • Key Informant Interviews • Survey Design • Data Analysis Overview

Community/Tribal Health Assessment • “A community health assessment is a process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community. ” -NACCHO

Community/Tribal Health Assessment • Purpose of a CHA’s or THA’s: • To inform decision making • To prioritize public health problems • To develop and implement community health improvement plans • Meets measures for Public Health Accreditation • Quantitative data (numbers and statistics) • Example: % adults with diagnosed diabetes • Qualitative data (verbal, written) • Example: people’s beliefs about diet and exercise

Quantitative Data • Can provide information on • How much, how often, how many and to what extent? • Collected through observation and measurement • Examples: • A 1 c levels, blood pressure (risk factors for diabetes/related chronic disease) • Disease prevalence (how many people have diabetes) • Dialysis rates, Death rates (to what extent diabetes causes disability/death)

Why Include Qualitative Data? Qualitative Data… • …answers questions that can't easily be asked or answered on a written survey. • …supplements the knowledge you can gain from written surveys. • …are more open ended, and may address ideas you did not consider. • … may show a broader and more in depth picture of what is going on in the community.

Why Include Qualitative Data? • Can provide information on • • • How, why, what? Why people behave the way they do Opinions, attitudes or feelings Social/cultural realities What’s important • Community readiness to change or adopt new behaviors/policies

Collecting Qualitative Data

What is a focus group • A focus group is a formal gathering people in the target population (who have background in the area of interest) • A way to gather first hand knowledge through qualitative data (opinions, beliefs, attitudes) • A guided discussion led by a facilitator (that’s you!)

Why do a focus group? • As a way to capture data that can’t be captured through a survey or numbers- more in depth information • For the CHA: as part of a mixed mode survey design

Focus Group Protocols Before the Focus Group: • Determine how many focus groups you want to run • Identify your participants • Generate you questions- all facilitators should use the same list • Develop a script • Select a facilitator • Choose a location • Secure a note-taker

Focus Group Protocols Conduct the Focus Group • Bring Materials • Arrive before the participants to set up • Introduce yourself and the note-taker • Conduct the Session

Focus Group Protocols • Conducting the Session Guidelines: • Introduce yourself and give an overview for the purpose of the focus group • Collect consent if necessary • • • Set a positive tone Make sure everyone is heard; draw out the quieter group members Probe for more in depth answers Monitor your questions and the time closely (note-taker can help) Don’t argue with a participant Thank participants at the end and share next steps and how data will be used

Focus Group Protocols Facilitator’s role: • Guide discussion • Keep people on task, but don’t cut them off when they are sharing • Don’t impose your opinion- remain neutral • Ask question the same way each time. • Don’t try to lead people or insert your own inflection • If asked to clarify a question, make sure your explanation doesn’t change the meaning • Do a mock run through with all the facilitators to make sure you are all asking the question in the same way

Focus Group Protocols Note-taker’s role • Observe what is happening in the room such as Record the meeting audio or through video Responses Body language Anything that stands out in the focus group Record any questions that facilitator cannot answer during the session for follow up • Take note of any question the facilitator asks that confuses participants so that your focus group can be improved in the future • • •

Sample Script for Facilitator • Welcome and thank you for coming. We are conducting this focus group to learn more about [topic]. You have been invited because [why you chose the participants]. Your views on this are very important and will be used to gain a better understanding of [topic]. • Before we get started, [insert statement about consent]

Sample Script for Facilitator Ground rules: • There are no right or wrong answers • We want to hear what you think • Its ok to disagree with something that is said, but please respect others • You don’t have to respond to anything if it makes you uncomfortable • Nothing you share is unimportant or silly • This should be a discussion- feel free to talk to one another

Some Additional Tips • Provide participants with name tags, paper, and pencils, etc. • Allow participants to introduce themselves prior to the session.

Focus Group Protocol After the Focus Group • Facilitators and note-takers should write a quick summary of their impressions. • Data will be analyzed by you or someone else. • Report is written, usually for dissemination or program guidance.

What is a Key Informant Interview • Key informant interviews are qualitative indepth interviews with a small number of people who know what is going on in the community. • Examples of participants include Tribal leaders, community members, medical or public health providers, etc. • A way to gather first hand knowledge through qualitative data (opinions, beliefs, attitudes) from people who have knowledge of the community’s health. • Can be by phone or in person • Generally ask probing questions

Why do a Key Informant Interview • You want to get in depth information from a few people with connections to the community. • To understand the community’s motivation and beliefs. • Interviewees may be able to generate recommendations. • Interviewees can guide the discussion towards what is important to them and their community.

Key Informant Interview Protocols Before the Key Informant Interview: • Steps are generally the same as for a focus group • Remember that key informants are often knowledgeable on the topic • Key informants should be carefully selected • Facilitators should be knowledgeable on the topic • This may be conducted in person or by phone. Set up the meeting accordingly Conduct the Session: • Steps are generally the same as for a focus group • The facilitator may not act as the note-taker • Be prepared with knowledge about the topic- you may need to lead the discussion or ask more probing questions than a focus group After the Key Informant Interview: • Steps are generally the same as for a focus group

Key Informant Interview Protocols Facilitator’s role: • Guide discussion • Keep people on task- but don’t cut anyone off when they are sharing! • Don’t impose their opinion- remain neutral • Ask question the same way each time. • Observe your interviewees responses • Take notes (whether or not you have a note-taker) • Record the session

Sample Script for Facilitator • Welcome and thank you for coming. We are conducting this key informant interview to learn more about [topic]. You have been invited because [why you chose the participant]. As a [community leader, health provider, etc. ] your views on this are very important and will be used to gain a better understanding of [topic]. • Before we get started, [insert statement about consent]

Sample Script for Facilitator Ground rules: • There are no right or wrong answers • We want to hear what you think • You don’t have to respond to anything if it makes you uncomfortable • Nothing you share is unimportant or silly

Sample Script for Facilitator Some Additional Tips: • Ask the most important questions first in case you run out of time • Don’t move to a new question prematurely • Don’t get stuck on a question the interviewee may not want or be able to answer

Survey Design- Understanding the Questions You’re Asking What might impact results? • Moderator Bias: Moderator’s facial expression, body language, inflection, or the way they ask a question can influence the way an attendee responds. Trying to remain neutral and asking questions in the same way each time can minimize, but not fully prevent this bias Don’t do this!

Survey Design- Understanding the Questions You’re Asking What might impact results? • Method Error: The way you ask the questions • If there are differences between the way focus groups/key informant interviews are run, this can influence the data collected. Following procedures and asking questions the same way each time can reduce, but not fully prevent this bias.

Survey Design- Understanding the Questions You’re Asking What might impact results? • Informant Bias: Respondents may give the answer they think the moderator or group wants to hear. They may not give information if they are embarrassed by a topic. You should encourage participants to think of this as a safe space where they can give an honest answer without a negative impact. By encouraging openness you can reduce, but not fully prevent this bias.

Data Analysis Overview What happens to the data you collect? Qualitative Data Analysis • Looking for: • Patterns or common themes • Deviations from the pattern • Interesting stories • Missing data we can collect in the future • Does the data support or contradict other data you have collected?

Thank you!!! For more information contact Sarah Price Public Health Associate National Indian Health Board 202 -507 -4078