SAFE CHILDBIRTH CHECKLIST COLLABORATION

Instructions for Using Focus Group Discussion

This template is provided as a guide for using Focus Group Discussion. This technique together with Key Informant
Surveys or other Qualitative Techniques can be used to learn about the “Usability, Feasibility and Acceptability of the
Checklist”, and also to provide feedback to the WHO Safe Childbirth Checklist Collaboration. Conducting focus group
discussions or other qualitative techniques could be relatively feasible for many participating institutions in the WHO
Collaboration. This template provides some guide on how to proceed with conducting the technique and on the type of
questions to be covered in the discussion. Additional information on how to conduct other qualitative techniques can be
obtained from the “WHO Methodological Guide for Research in Data Poor Hospitals” and related materials, available at
http://www.who.int/patientsafety/research/methodological_guide/en/index.html and
http://www.who.int/patientsafety/research/methodological_guide/method_tools/en/index3.html.
For guidance on how to build a report based on these techniques, please consult the “Template: building a report about
the usability, feasibility and acceptability of using the SCC checklist”, which is part of the WHO SCC Collaboration
resources.

Introduction: this survey intends to assess the reaction of healthcare professionals to the checklist
content, format, and use. It may be used to explore:
 usefulness of checklist
 perceptions of efficacy of checklist
 format/presentation of checklist
 content/language of checklist
 barriers/solutions to adhering to particular process measures that tend to have poor adherence)
 barriers/solutions to implementation
Participants: Healthcare providers involved in childbirth and using the checklist can be selected as
participants in the focus group. Ideally participants should reflect a range of ages, levels, professions and
patterns of working (e.g. workers that represent both night and day shifts).
Participant Consent: Participants will sign a consent form to participate in the focus group discussion. One
copy of the informed consent form should be given to participants and a second copy should be kept by the
focus group facilitator. Participants should be informed if any audio-taping will be used for data collection.
Demographic data: It is important to collect anonymous demographic data from focus group participants.
Simple questionnaires for this purpose could be handed out as participants arrive, then collected at the end
of the focus group and kept with the tapes of the focus group.
Facilitator/Moderator: Running an effective focus group is a skill and requires planning. The WHO Patient
Safety Programme has produced some training materials to prepare Nominal Group Techniques, which may
be helpful in the preparation of focus groups. Please see:
http://www.who.int/patientsafety/research/methodological_guide/en/index.html
http://www.who.int/patientsafety/research/methodological_guide/method_tools/en/index3.html
Discussion guides: A discussion guide may facilitate structuring the focus group discussion by highlighting
the topics that need to be covered. Though it is not to be used rigidly, like a questionnaire. At the focus group
discussion, the facilitator encourages participants to explore topics in depth, to reflect, to raise their own
issues, etc.
Data collection: The discussions can be audio-taped if agreed by participants, and transcribed verbatim for
analysis. The recordings need to be securely stored until transcribed and then destroyed. The transcription
shall not contain information that would allow individuals to be linked to specific statements. Confidentiality
will be strictly preserved, except where disclosure is mandated by a court of law.
Time and Place for Focus Group: The focus group can last about two hours, and can have breaks in
between for refreshments. Participants need to receive clear details of where and when the focus group will
take place and how long it will last.

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TEMPLATE FOR CONDUCTING FOCUS GROUP DISCUSSION

FOCUS GROUP: DEMOGRAPHIC DETAILS QUESTIONNAIRE

Please answer the following questions in the spaces provided, circle or tick the most
appropriate options.
1. Age:…………………………………………………………………………
2. Are you: (please tick as necessary) □ Male □ Female

3. What is your professional background?

□ Midwife or Nurse Midwife
□ Nurse
□ Obstetrician
□ Pediatrician/Neonatologist
□ Medical officer
□ Other: (please describe) __________________________________

4. How many deliveries have you done in the last month (approximately)? _______________
5. How many years of experience have you had in this current job?
□ <1 Year □ 1-2 Years
□ 2-5 Years □ 5-10 Years
□ >10 Years

6. Experience in Health Care (optional):

□ <1 Year □ 1-2 Years
□ 2-5 Years □ 5-10 Years
□ >10 Years

Thank you for taking the time to complete this questionnaire

FOCUS GROUP: DISCUSSION GUIDE

Facilitator’s welcome, introduction and instructions to participants

Welcome and thank you for volunteering to take part in this focus group. You have been asked to participate as
your point of view is important. I realize you are busy and I appreciate your time.
Introduction: This focus group discussion is designed to assess your current thoughts and feelings about the
quality improvement program which involves the introduction of the Safe Childbirth Checklist in your healthcare
facility. The focus group discussion will take no more than two hours. May I tape the discussion to facilitate its
recollection ? (if yes, switch on the recorder)
Anonymity: Despite being taped, I would like to assure you that the discussion will be anonymous. The tapes
will be kept safely in a locked facility until they are transcribed word for word, then they will be destroyed. The
transcribed notes of the focus group will contain no information that would allow individual subjects to be linked to
specific statements. You should try to answer and comment as accurately and truthfully as possible. I and the
other focus group participants would appreciate it if you would refrain from discussing the comments of other
group members outside the focus group. If there are any questions or discussions that you do not wish to answer
or participate in, you do not have to do so; however please try to answer and be as involved as possible.
Ground rules
 The most important rule is that only one person speaks at a time. There may be a temptation to jump in when
someone is talking but please wait until they have finished.
 There are no right or wrong answers
 You do not have to speak in any particular order
 When you do have something to say, please do so. There are many of you in the group and it is important that
I obtain the views of each of you
 You do not have to agree with the views of other people in the group
 Does anyone have any questions? (answers).
 OK, let’s begin
Warm up
 First, I’d like everyone to introduce themselves. Can you tell us your name ?
Introductory question
I am just going to give you a couple of minutes to think about your experience of providing care to women during
childbirth since the introduction of the Safe Childbirth Checklist. Is anyone happy to share his or her experience?
Guiding questions
 What are the attitudes of you and other staff towards the checklist? (What did people think/say/do?)
 What drove the positive/negative reaction? If negative, how could it be rectified?
 What do you think about the aims of having the Checklist as a one page reminder of important things one
must not forget during childbirth? (explore patient safety, patient outcomes, efficiency in the labour and
delivery rooms, teamwork and communication)
 Do you think the checklist is likely to improve the safety of childbirth? If not, why not? (similar questions for
outcomes, efficiency, teamwork and communication)
 What are your thoughts on the format? (explore different options i.e. separate sheets, information on the
backside, posters etc.)
 What are your thoughts on the content? Is there anything that needs to come off? Is there anything you feel
should be on and is not? Was the language easy to understand?
 When thinking back to how the checklist was introduced to you, are there ways that could have been
introduced to make it easier/better for you?
 What are the main issues around actually using the checklist here?
 What are the barriers to using the checklist? What are the enablers?
 Did you feel comfortable with using the checklist? Do you think there is a need for training? (if yes, explore
who would need training, how and where?)
 How would you make it easier to use/implement?
Concluding question
 Of all the things we’ve discussed today, what would you say are the most important issues you would like to
express about this checklist?
Conclusion
 Thank you for participating. This has been a very successful discussion
 Your opinions will be a valuable asset to the study
 We hope you have found the discussion interesting
 If there is anything you are unhappy with or wish to complain about, please contact the local PI or speak to
me later
 I would like to remind you that any comments featuring in this report will be anonymous
 Before you leave, please hand in your completed personal details questionnaire

Please, write your report based on the results of the focus group. Please remember to maintain confidentiality of
the participating individuals by not disclosing their names.