ANNEX C:
EXAMPLES OF MODERATOR=S GUIDES FOR IN-DEPTH INTERVIEWS
Example 1:
Bangladesh Diarrhoea Study - In-Depth Interview Guide for Administrators
Example 2:
Bangladesh Diarrhoea Study - In-Depth Interview for Prescribers
Example 3:
Nigeria Malaria Study - In-depth Interview for Prescribers
Example 4:
Nigeria Malaria Study - In-depth Interview for School Teachers
Example 1:
Bangladesh Diarrhea Study - In-depth Interview Guide for Administrators
Introductory Remarks
I am _______________ from _____________________
General purpose of the study
Aims of the interview
How long it will last
Any questions?
Warm Up
How long have you been the administrator of this thana health complex?
Could you please give a brief description of your daily activities?
Probe : Time spent in patient care;
Private practice after hours
Extent of Diarrhoeal Problem and Felt Concern about it
How serious a problem is diarrhoeal disease in your thana (at this time)?
Probe: Severity of the child's condition
Describe a typical case
What proportion needs hospitalization
Criteria for hospitalization
How frequently cases arrive very late
Extent and sources of worry
Mothers Perception of Diarrhoea and Education About Diarrhoea
At what stage of the disease do mothers bring their children here for treatment? How much distress do these mothers
feel when they bring in the child?
Probe: Why they do wait so long?
What do they try at home first?
At home, what can mothers do that would improve the way that diarrhoea is managed?
Probe: Continue breast feeding;
Home made ORS
Early start to management
What activities are currently carried out by this thana health complex to promote/improve diarrhoea management at
home by mothers?
Probe: How do mothers feel about ORS as a main treatment?
Do they like it/Why/Why not?
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Attitudes towards Prescribing for Diarrhoea
What are the main factors that influence the decisions that prescribers make in relation to diarrhoeal diseases?
Probe: Patient's condition?
Previous drugs already started taking?
Whether expect mother to return for follow up?
Mothers demand for specific drugs?
Do you feel that certain patients with diarrhoea need antibiotics for treatment?
Probe: Which ones?
Advantages and disadvantages of antibiotics?
Many M.Os also have a private practice after they finish work at the thana. In what ways does the M.O.s prescribing
practices for private patients influence how they prescribe at the thana?
Probe: What influence do "Medical Reps" have in the M.O.s prescribing practices?
Administrator's Role in Management of Diarrhoeal Cases
For diarrhoea cases, what are the major problems you face in providing effective services at this Thana ?
Probe: How can these major problems be solved?
What do you think are the most effective ways for influencing the way medical officers prescribe for diarrhoeal
cases?
Probe: Do you have discussions with them?
What issues do you discuss with them?
What role do you see for pharmacists?
How can pharmacists give feedback to prescribers?
Comments
Are there any other major influences on prescribing for diarrhoea that we have not talked about? What are those?
CLOSE:
Thank administrator for his/her comments.
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Example 2:
Bangladesh Diarrhea Study - In-depth Interview for Prescribers
Introduction
I am _________________________ from ________________________.
General purpose of the study
Aims of the interview
How long it will last
Any questions?
Knowledge About Diseases In The Community
What are the most common diseases/illnesses reported by patients in this health facility?
Probe: How about diarrhoeal diseases? (If not mentioned)
How common is it in relation to other common diseases?
Nature Of Diarrhoeal Cases
Can you describe to me the characteristics of patients who usually suffer from diarrhoeal diseases?
Probe: Age, socio-economic status
Housing and water supply
What is the usual condition of children with diarrhoea when they come to see you?
Probe: Some types of diarrhoea more severe than others?
Some types of children worse than others?
Do you have any concerns about this?
Knowledge About Mothers= Perception of Diarrhoea
What do mothers think about diarrhoea when their children get it.
Probes: What are their anxieties?
What feeding practices do they adopt/observe (i.e., breast feeding, home-made fluids)
Do they use medications before seeking treatment?
Capacity for Diarrhoea Case Management
Do you think this facility is adequately equipped for diarrhoeal case management?
Probes: Is there a standard treatment guideline?
Investigation facilities
Sources of obtaining new information on case management
Have you had any special training in diarrhoea management?
Probe: When was the training?
What were the contents of the training?
Any comment on usefulness and adequacy of training?
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Diarrhoea Management Strategies
How do you treat a "typical" diarrhoeal case?
Probe: Do you feel confident treating diarrhoea with only ORS?
Why or why not?
What are some of the drugs you normally use and why do you use them?
Probe: How about antibiotics?
Anything to stop the diarrhoea?
What kinds of things influence you to use other drugs besides ORS in managing diarrhoea?
Probe: Any specific clinical signs?
Length of recovery
Concern for patients expectations?
Does patient load play any part in this?
Staff Functions and Relationships
How do the different members of the staff contribute to patient (curative) care?
Probes: Head of facility
Other prescribers
Pharmacists
Can you think of ways that other staff might contribute more to care for diarrhoea?
Probe: What are some of the shortfalls?
Who has time available to spend with patients?
Promoting ORS
What suggestions do you have for promoting the use of ORS in treating watery diarrhoea?
Probe: Among prescribers
By mothers
By drug sellers
In the community.
Comments
Is there anything else important you can think of about treating diarrhoea that we have not talked about?
CLOSE:
Thank health worker for his/her comments.
ANNEX C - 4
Example 3:
Nigeria Malaria Study - In-depth Interview for Prescribers
INTRODUCTORY REMARKS
I am _______________ from _____________________
You are? _________________________________________________________
We=ve been told that malaria is one of the common health problems in this area. We are interested to know more about
your view about malaria and how you manage it. We are also interested in any problems or concerns you might have. We
would appreciate it if you could spend about 20-30 minutes with us discussing malaria treatment. Is this okay with you?
Do you have any questions?
WARM UP
What is your position here?
How long have you been working here?
Do you have a heavy work load? How many patients would you say you see in a week?
On average, about how many patients a week do you end up treating for malaria?
DIAGNOSIS
How do malaria cases usually present here? What kinds of symptoms do patients usually have?
Probe: Any other way they present?
How do you decide that patients presenting this way have malaria?
Probe: Questions asked in history
Physical examination - temperature blood smear
How do you decide if the malaria is mild or severe?
How do you decide about whether a patient needs to be hospitalized?
Probe: Any specific clinical signs?
What percentage of cases need hospitalization?
Do you get cases arriving very late?
TREATMENT AND COST
How do you usually treat mild malaria?
Probe: What would a typical prescription look like How many drugs/injections do you prescribe?
What are they?
ANNEX C - 5
Why do you recommend this treatment/combination of treatments?
Probe: Any concerns about drug resistance?
Preference for injections?
Patient preference
How do you usually treat severe malaria?
Probe: What would a typical prescription look like How many drugs/injections do you prescribe?
What are they?
How much does it cost to treat a typical case of malaria?
Probe: What about a serious case?
Are patients able to afford this cost?
Are patients able to get the drugs they need here most of the time or do they have to go elsewhere?
Probe: Which drugs are not available?
Why are those drugs not available?
Where do patients go to get these drugs?
PATIENT EXPECTATIONS
Do you think that patients expect a specific treatment of malaria from you?
Probe: What kind of treatment?
Any injections expected?
Why do they feel this way?
COMMENTS
Is there anything else that we have not covered that you can tell me about malaria and how you treat it?
CLOSE: Thank you.
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Example 4:
Nigeria Malaria Study - In-depth Interview for School Teachers
INTRODUCTORY REMARKS
I am _______________ from _____________________
You are? _________________________________________________________
We=ve been told that malaria is one of the common health problems in this area. We are interested to know more
about the views of community members about malaria, and your experience with it as a teacher. We are also
interested in any problems or concerns you might have. We would appreciate it if you could spend about 15-20
minutes with us discussing malaria. Is this okay with you?
I would like to go over some of the general rules for our conversation.
There are no correct answers
Want your opinions
Confidentiality
Minimal interruptions
No observers
Do you have any questions?
WARM UP
What is your position here at the school?
How long have you been working here?
Probes: How long living in this area?
Where is your home area?
Do you think that malaria is an important problem in this school and in this area?
COMMUNITY PERCEPTION OF MALARIA
Can you describe to me some of the things that people in this community believe about malaria?
Probes: What do they think causes the disease?
What is your view on this?
How do people in this community know when someone has malaria?
What is your opinion about this?
Do you think most people have a good idea of when they have malaria?
Do people here do anything to try to prevent malaria?
Probes: Do they take any herbs of drugs to prevent getting the disease?
Use bednets?
Use insecticides?
Any environmental sanitation?
Avoid going out at certain hours?
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MALARIA TREATMENT
I am interested in what someone usually does when they think they have malaria. What do people do first?
Probe: What are the reasons for these actions?
Does everyone do that?
What do they do next if that does not work?
How do people treat malaria in this community?
Probes: What type of treatment do people prefer for malaria when they go to the health centres?
Name/colour/taste of tablets preferred.
Do they have any preference between injections and tablets?
Why?
What are some of the home remedies people use in treating malaria?
Probes: Which are the most popular?
Which are the most effective?
When do people use home remedies rather than drugs?
When people go to a government clinic or hospital to treat malaria, what do they expect?
Probes: Are their expectations usually fulfilled?
If not, what would they do?
How about you?
Are people given enough information on how to take medicine when they go to the clinic?
Probes: What are some of the things they are not told?
Who do you think should be telling them these things?
How could this be improved?
COMMENTS
Are there any suggestions or comments about malaria that we haven't yet talked about which you want to discuss?
CLOSE: Thank you.
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