Focus-group methods: effects on village-agency collaboration for child survival

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Abstract
In the West African nation of Togo an essential element of health education in support of child survival is the training of mid-level health workers to conduct focus-group interviews with caretakers of children under 5 years of age. The intent is to develop the capability of the National Health Education Unit to establish qualitative data bases that complement survey data on maternal practices related to child health. These data are used to design and evaluate the health education component for programmes of childhood immunization, the control of diarrhoeal diseases, and malaria. Following a five-day training programme in late 1986, health workers collected and prepared for analysis data from 81 focus-group interviews involving a total of 324 mothers living in nine rural Togolese villages. In addition, two unanticipated effects were observed during and after training. First, the focus-group method democratized data gathering by forcing health workers out of their perceived roles as experts and teachers, and mothers out of being helpless villagers and learners. Second, by stimulating this shift in roles, the focus-group process enhanced the development of community competence, thereby promoting collaborative programme planning by health workers and target villages. Dramatic increases in childhood immunization rates offer evidence that focus-group interviews can play an important role in stimulating the needed interaction between clients and providers to plan and carry out a community education ‘mini-campaign’ in each village. It is from such group processes that collective awareness of needs, and actions to resolve them, can arise. Child survival projects should consider training mid-level health workers to gather focus-group data as an action-research approach to planning, implementing and evaluating their community health education programmes.

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