Focus Group Discussions on Costs: the value of evidence

Facilitator Marvin Centeno coordinates a focus group discussion about the baseline evidence in Managua.

Once we had the first baseline results and the CIET facilitators had gone into the neighbourhood and started getting to know the people, we conducted 30 focus groups (one per neighbourhood) with neighbourhood leaders about the costs incurred by residents and the Ministry of Health for protection against mosquitoes and treating dengue fever patients. Along with the feedback to surveyed households, focus groups on costs were the first activities undertaken to socialise the evidence from the baseline survey.

The process was carried out in 30 neighbourhoods in Managua, which make up the Camino Verde trial’s intervention sites. Average participation was 15 persons per group; two thirds of these were women and all had some level of community responsibility.

The purpose of the focus groups was not to persuade others about a specific option in response to dengue risk. The activity was led by the facilitators, who were trained to foster reflection rather than teach, and also to promote respect for the different viewpoints that might be expressed.

Community leaders reviewed the evidence from their own neighbourhoods obtained through the baseline measurement and other available sources.

These are some of the questions used in one neighbourhood to generate a discussion:

• What comments could the group make about the costs of caring for a dengue fever patient?
• What comments could the group make about money spent on chemicals to fight the adult mosquito?
• What comments could the group make about the notion of dedicating time to looking for and eliminating larvas and pupas?
• What comments could the group make about the fact that 19 out of every hundred households did not agree with the idea that “the best way to avoid mosquitoes is by placing larvicides in water and fumigating?”

The following are summaries of some general observations about the focus group experience:

• While the baseline measurement and previous contacts contributed to understanding each neighbourhood’s situation, this exercise allowed researchers to better undrestand the relationship dynamics between community leaders and members. The opportunity to identify each community’s ways of communicating, its management styles and its internal conflicts was highly valuable for further work there.
• Every group in its own way demonstrated the potential of the evidence to foster dialogue and decision-making. While several groups came to the conclusion that “the best way to prevent dengue is placing larvicide in water containers and fumigating,” all groups indicated in one way or another the need to distribute this information about costs of dengue and its control to all households in the neighborhood and promote the same kind of reflection on the implications of this information. This led to each of them deciding to form its own SEPA brigade.
• It was appropriate to focus the discussion on the costs of dengue since many people did not consider the risk of dengue infection to be one of their main concerns, especially when its prevention was considered a government responsibility. When the groups became aware of the economic burden of dengue, considered that the investment of household and State resources in chemical products doesn’t yield the expected results (“… they fumigate and use larvicide, but the mosquitoes are still there”), and saw that there is a way to reduce both the household and public expenses needed to treat the illness, they began to see that dengue prevention might be achievable in their own communities and with resources that were already to hand.