Now we come to the sixth step in Barrier Analysis: organizing and analyzing the results. In this session we will look at how this step is executed when you have used option #1—the focus group approach.

In order to organize and analyze your results from Barrier Analysis done through focus groups, you will fill out a table similar to this one (34kb) with the eight barriers and positive attributes of the behavior listed across the top (at least two sheets will probably be necessary) and the bulleted items below as rows. Follow steps 1 through 9 to fill out the table with all those who facilitated or observed the focus group discussion.

• Is this a problem for Doers?

• Is this a problem for Non-Doers?

• To what degree is this a barrier?

• Current messages that are in use (e.g., by the PVO or Ministry of Health) to address the barrier

• Messages that need to be developed or modified concerning this barrier (given the degree to which it is a barrier)

• Changes to make to the project design given this barrier (development of support activities)

• Sample monitoring indicators

In the rest of the exercise the example used comes from the focus groups in the Dominican Republic, and discusses the barrier of perceived susceptibility. (You will repeat the follow steps for each of the remaining barriers.)

1. As a group, read through the notes recorded for each question in the question guide used during the focus groups with Doers and then with Non-Doers. For the first barrier, perceived susceptibility, the Dominican Republic’s notes could have said:
   
   “Most mothers said that their children can get diarrhea from drinking dirty water. There was no disagreement about this except for one woman who said that her child never gets sick. However, they believe that clear water is pure water. All of the mothers said that they believe that the water they drink from the borehole – where they usually get their drinking water – is clean. Upon probing, we found that the borehole is not covered and there are often animals that gather around it. Mothers said that the water taken from the water-pan is not clean, but they said that they do not generally use that water for drinking. These mothers had very little doubt that the water that they give their children is pure.”

2. As you read through these notes, you should have the group members call out the things that they think are pertinent in the responses for the barrier,.

3. Start filling out the table, beginning with the first two rows (the group should determine whether this is a problem for Doers and for Non-Doers).

4. In the third row, decide as a group the degree to which a particular determinant is considered a barrier. You should not discuss this as a generic barrier (i.e., the degree to which low self-efficacy is a problem in most projects), but rather the degree to which it is a barrier in the target population that participated in your focus groups (i.e., the degree to which low self-efficacy is a problem in terms of ORS use with the mothers who participated in your focus groups).
   
   This is a subjective measure, but participants should be encouraged to use a minus [-] if they think that the determinant is not a barrier at all, and between 1 plus and 5 pluses [+] if the determinant is considered to be very problematic for the behavior that was studied and the group that was interviewed. One plus [+] indicates a slight barrier to action, and five pluses [+++++] indicate a major barrier.
   
   As you do this, compare the comments made by those in the Doers focus groups with those who were in the Non-Doers focus groups:

   • If the barrier did not appear to be a problem for most Doers, but it was a barrier for most Non-Doers then you should assign the barrier a higher score on the tabulation sheet; ie., more plusses (e.g., ++++ rather than ++). Things that are barriers for Non-Doers but not for Doers are generally more important in terms of behavior change. These should get more attention when you are creating behavior change messages and making modifications to your program design.

   • If the barrier appeared to be a problem for both Doers and Non-Doers, you should assign the barrier a lower score; ie., less plusses (e.g., ++ rather than ++++). Things that are barriers for both groups are generally not as important in terms of behavior change. These may still be a barrier to some degree, but should receive less attention.

   • If the barrier was a problem for Doers, but not for Non-Doers then it should receive a low score. This should be interpreted to mean that even though people who do the behavior see some things that inhibit them from doing the behavior, these things are not so problematic that they keep them from doing the behavior. These things should get less attention.

   • If the barrier did not appear to be a problem for either group (Doers and Non-Doers) then it should receive a low score; ie., less plusses or even a [-]

5. You should then fill in the cell for the first barrier on “Current messages used that confront this barrier.” It is entirely possible that no messages will currently address a particular barrier. (If that is so, just put “None” in this cell.) If there are messages currently in use that deal with the particular barrier, list those in this cell. Be sure not to include general health promotion messages here – just the ones that specifically deal with the barrier you are examining. For example, for perceived susceptibility, the message, “AIDS respects no one -- anyone can get AIDS” deals directly with perceived susceptibility. The message, “AIDS is everyone’s problem” does not deal directly with perceived susceptibility. “Our community can do something about AIDS” is an educational message, but it does not deal with perceived susceptibility. Since it deals with self-efficacy, it would not be listed in the column dealing with perceived susceptibility.

6. Next, list the messages for the first barrier on “Messages that need to be developed or modified concerning this behavior.” If the barrier you are examining (in this case, perceived susceptibility) was not a problem in your analysis, this can be left blank. If it was a problem then you should brainstorm messages that could be used to confront this barrier. For example, in the Dominican Republic, one message could have been, “Everyone, especially young children, can get diarrhea from water that is not purified.” Another message that could have been used is, “Water that is clear may still be contaminated. Purify all drinking water to be safe.”

7. Now you should fill out the cell for the first barrier on “Changes to make in the project design given this barrier.” Once again, if the barrier you are examining was not a problem in your analysis (i.e., it received a low score), this can be left blank. If it was a problem then you should brainstorm changes in your program design that could be used to confront this barrier. For example, if perceived susceptibility was a problem in a set of communities, you would want to ask the people in your target group what would convince them that their water was impure. In the Dominican Republic, one possible addition to the project design could be to begin regular testing of water at the source and/or at the household level for contamination.

8. If you choose to monitor changes in each barrier found to be a problem, you can also add monitoring indicators. The indicators that you use for this should be directly related to the messages that you will be using to confront the barrier. In the Dominican Republic, if perceived susceptibility was a problem in terms of purification of water with bleach, they could choose to do regular water testing to change that and tell mothers the results of the testing. The indicator related to this barrier could be, “proportion of mothers who can correctly report the results of the last water test in their community.”

9. Once you have completed the entire column for perceived susceptibility, proceed to each of the remaining columns (for the other barriers) using the focus group notes from the Doers and Non-Doers groups, and the group members’ knowledge of the project.