Pandemic Influenza

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Audience Research for Pandemic Flu Communications
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Why do it?

• Need to learn
• How hard-to-reach communities get information,
  especially during emergencies
• Who would be most trusted to give public health
  messages to specific groups
• Need to frame and deliver messages about pandemic
  flu that are
• Culturally appropriate
• Relevant to diverse communities
• Respond to needs and concerns of specific groups

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Determine what you want to know

• Possible topics
• Media usage
• Sources of health information
• Trusted leaders
• Beliefs and knowledge about illness
• Beliefs and customs about death
• Reactions to possible pandemic measures
• Attitudes toward government and public health

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Select target audiences

• Possible criteria
• What groups are most difficult to reach (e.g.,
  most isolated, least trusting of government)?
• What are the largest language groups?
• Which groups are not well connected to advocates
  or social services that could otherwise provide
  information?
• Which groups do you know least about?
• Do you have partnerships with organizations
  serving any potential target communities?

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Options for Research Methods
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Consider Partnership withCommunity-Based
Organizations (CBOs)
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Key informant interviewsWho to interview?

• Look for individuals immersed and trusted in the
  target communities
• They may or may not identify as members of the
  target communities
• Do you have partners in the community whose staff
  could be interviewed?
• Ask interviewees for suggestions for other
  interviewees
• Possible interviewees CBO staff (social service
  agencies, advocacy groups, neighborhood
  organizations), medical interpreters, clergy and
  religious leaders, ethnic media publishers

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Key informant interviewsDeveloping an interview
guide

• Develop a standardized interview guide that
  explores issues of interest with open-ended
  questions
• Make sure questions dont inadvertently place
  value or judgment on the issue at hand
• Allow interviewers to improvise questions
  according to the direction of the interview, but
  highlight the critical questions that must be
  asked in each interview
• Train all interviewers by going over the
  interview guide together and explaining what kind
  of information youre seeking with each question
  (this will help interviewers probe more deeply)
• Do test interviews to 1) make sure your questions
  are understandable and elicit in-depth answers,
  and 2) your instructions are clear

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Tips for key informant interviews

• Provide informed consent for all interviews
• Introduce yourself and the project before
  starting the interview
• Audio record the interview and jot down notes on
  key items (notes are very helpful when the audio
  quality is poor)
• Conduct the interview in as quiet a room as
  possible

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Key informant interviewsLanguage considerations

• Options if the target audience speaks a language
  other than English
• Interview bilingual individuals
• Interview key informants who are immersed in
  community, but also speak English
• Use simultaneous interpretation (expensive!)
• Recruit bilingual interviewers (need to
  translate the interview guide and transcriptions
  of the interviews)

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Q-Method What is it?

• Q method is an approach and a method to
  understanding different opinions that people have
  about a particular topic
• It uses a combination of qualitative and
  quantitative tools to characterize opinion types
• Participants are presented with a set of opinion
  statements on cards and asked to sort or rank
  the opinion statements along a continuum (such as
  most important to least important)

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Q-Method What is it useful?

• Q-method is excellent at uncovering nuances in
  opinions across different people
• Subjects who do the Q-sort have an opportunity to
  systematically think through their opinions about
  a topic
• Most people really enjoy doing the Q-sort its
  fun to do

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Q-Method Where can I get moreinformation on the
method?

• Q-method has a key website for anyone interested
  in Q method http//www.qmethod.org/
• The site has links to bibliographies, tutorials,
  and articles on Q, as well as a list serv
  http//www.lsoft.com/SCRIPTS/WL.EXE?SL1Q-METHODH
  LISTSERV.KENT.EDU)

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Example of Q-sort activity

• 1) We created 31 opinion statements related to
  pandemic flu, based on key informant interviews
• 2) Participants were each given a set of the
  opinion statements, written on cards, and a
  game-board showing most important to least
  important
• 3) Using the cards and gameboard, participants
  individually ranked the statements from most
  important to least important. (See the Focus
  Group Guide for the script used for the Q-sort
  activity)

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Example of Q-sort opinion statements
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Example of Q-sort gameboard
Most Important
Least Important
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Value of the Q-sort activity to focusgroup
interviews

• Creates an aggregate snapshot of an
  individuals opinions
• Forces participants to think about their own
  values and priorities related to pandemic flu
• Reduces the influence of other participants on an
  individuals opinions
• Provides rich starting place for discussion

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Analyzing the Q-sort

• Q sorts can be analyzed using free software
  available at http//www.lrz-muenchen.de/schmolck/
  qmethod/
• The sorts are correlated and factor analyzed into
  types of people who view the topic the same way
  
• This analysis is not done at the focus group, but
  is completed after all the interviews are
  finished

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Focus Groups

• Group dynamic can stimulate rich discussion of
  issues, but requires skilled facilitation
• May be preferred over one-on-one interviews in
  group-oriented cultures (such as some Native
  American, Asian, and Latino cultures)

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Planning for focus groups

• Develop a standardized focus group guide
• Try to host focus groups within the target
  audiences community
• Allow time for debriefing with facilitators and
  note-takers to capture their impressions
• A health educator should provide a simple
  overview presentation of pandemic flu
• Provide preparedness action steps

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Training for focus group facilitatorsand
note-takers

• Ideas and tips for training
• Model a focus group, with facilitators and
  note-takers acting as participants
• Then go over the focus group guide,
  point-by-point, to explain what key information
  you seek at each discussion point
• Provide time for practicing
• Give clear instructions on the role of both the
  facilitator and note-taker
• Provide examples of what notes should look like
  for the note-takers and give feedback on practice
  notes

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Focus group tips

• Provide an incentive (gift card, free meal, cash)
• Consider renting audio equipment
• Ensure that focus groups are held in a quiet
  space
• Inform recruited participants in advance that
  children may not attend focus groups (provide
  child care if possible)

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Focus groups on other languages

• Translate all materials for facilitators and
  participants
• Recruit bilingual CBO staff or public health
  staff to facilitate and take notes
• Transcription and translation of focus group
  recordings is most accurate, but very expensive
• Simultaneous interpretation could be distracting
• Another option is to ask bilingual facilitators
  and note-takers to listen to the audio recordings
  with you and provide their interpretations of
  what was said

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Resources in the APC toolkit

• Key Informant Interview Guide
• Consent Form (English, Spanish, Vietnamese)
• Focus Group Guide (English, Spanish, Vietnamese)
• Focus Group Tips for Facilitators and Note Takers
• Game Board (English, Spanish, Vietnamese)
• Q-Statements (English, Spanish, Vietnamese)
• Q-Answers
• What Do You Pay Attention To? Survey (English,
  Spanish, Vietnamese)
• Information Sources Survey (English, Spanish,
  Vietnamese)
• Introduction to Pandemic Flu (English, Spanish,
  Vietnamese)
• Pandemic Flu PowerPoint Presentation (English,
  Spanish, Vietnamese)
• Preliminary Findings
• Audience Research Lessons Learned