Introductions and quick icebreaker Questions:
Thank you for those introductions. It is a pleasure to be with you all today. We appreciate your taking the time to talk with us. I would like to begin by discussing the Community Health Club program. While I have heard about this program, I would like to learn about your thoughts.
1. Please describe the Community Health Club program.
Probes: What is the purpose or goal of this program? How did the program work? What did you do as part of this program? What did the members do?
2. Please describe any differences in socio-economic status, community leadership, infrastructure, access to education, or the Club intervention, that you have observed in these communities.
Social Interactions
Great. Thank you for sharing. I would now like ask you a few questions about how people in the communities you supervise interact with each other. Based on your observations of the communities [insert names of sampled communities], describe how people from these communities have interacted and related to each other since the Club was started. I have three specific questions.
3. What does it mean to have trust or confidence in someone?
Probes: how do you define trust? How would you describe the actions or behaviors of someone that you trust?
Now that we have defined trust and given examples of what it means to have trust or confidence in someone, I would like you to think about the following question:
4. Since the Club started in these communities, did you ever observe or feel people in these communities showed trust or confidence in each other? If so, in what ways?
Probes: Please share examples of how people trust or have confidence in each other in these communities. Examples can include letting a neighbor use your favorite bicycle or motorcycle, having confidence that you could leave your home unattended for a week, or believing that what someone tells you is the truth. Please describe any differences between the communities.
Probing questions: How did the Club influence trust or confidence? Do you think the Club helped (increase/decrease) trust amongst Club members? Do you think the Club helped (increase/decrease) trust between Club members and others in the community who did not join the Club? Why did the Club have this effect on trust?
Great. That was a wonderful. Now I would like you to think about the ways that people support or help each other, and how they come together to make change, in your community.
5. Sometimes we help each other in our day-to-day interactions. Since the Club started, did you ever observe or feel that neighbors were willing to help neighbors with personal issues or do things for each other in these communities? If so, please tell me more about how they helped each other or what they did for the other person.
Probes: Please share examples of how people support each other in your community. Examples can include watching a neighbor’s children while he/she goes to market, helping a sick neighbor clean clothes,
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or working in each other’s field to plant or harvest. Please describe any differences between the communities.
Probing questions: How did the Club influence how people help each other or support each other? Do you think the Club helped (increase/decrease) helping amongst Club members? Do you think the Club helped (increase/decrease) helping between other members of the community who did not join the Club? Why did the Club have this effect on helping people?
6. Sometimes we come together as groups to help make change in a community. Since the Club started, did you ever observe people in these communities working together on a project or working together to achieve a common goal? If so, please tell me more about what you observed.
Probe: Please share examples of how people work together to make change in these communities. Examples can include working together to build a house or fix a road. If you observed people working together, were they participating in organized groups like the Community Health Club? Please describe any differences between the communities.
Probing questions: How did the Club influence when people working together to solve problems or achieve a common goal? Do you think the Club helped (increase/decrease) working together to solve problems amongst Club members? Do you think the Club helped (increase/decrease) working together to solve problems in other members of the community who did not join the Club? Why did the Club have this effect on working together to solve problems?
WASH Impact
Thank you everyone. This has been an interesting and engaging discussion. At this point, I would like to change our focus and discuss water, sanitation and hygiene issues in your community. Specifically, I would like to learn more about the impact that the Club program has had on your knowledge and behaviors. I am also interested in learning more about your community’s interest and ability to work together to solve problems around water, sanitation and hygiene.
7. Please describe what people have learned about water, sanitation, hygiene since the Club began.
Probes: how did the club program make the sharing of WASH information and knowledge easier or more difficult?
8. Please describe any new water, sanitation and hygiene practices that people in these communities have started since the Club began.
9. Have the members of these Clubs worked together to solve or fix a water, sanitation or hygiene issue since the Club began? If yes, please describe the problem and what the Club(s) did to solve the problem. Probes: Have members of these communities come together to work on a problem, fix something, or build something specifically related to water, sanitation or hygiene?
Behavior Over Time Graphs
Great, thank you. For the final part of this discussion, I would like you to discuss how specific water,
sanitation and hygiene behaviors and collective action have changed since the Club program started. To help me understand how things have or have not changed, I am going to ask you all to draw some lines that show how things have changed over the past year.
Before we begin, I am going to give you instructions and a couple of examples. First, I would like us to draw a line together that shows the availability of mangoes throughout the year. The horizontal line will be time, starting from January on the left through to December on the right. The vertical line will be the number of mangoes available (Draw an example of the x- and y-axis, which will be used to draw one line for the entire group). We are now going to draw a line that shows how the number of mangoes increases or decreases throughout the year. So in January, do we have a lot of mangoes, some mangoes or no mangoes? How does this change as we move through the year? At what time of year do we have many mangoes? At what time of year are there no mangoes?
Great. Now that we have this line, I want to ask you a few questions. Why are there more mangoes at this time than at others? What are the specific reasons we have more mangoes here and less mangoes here? I am going to write those reasons on the line so that we can better understand the things that affect the availability of mangoes.
Ok. Let us look at another, slightly more complicated example. Think about how tired you are during the day. I would like you to draw a graph that shows how tired you are throughout the day, from morning until evening. Again, our horizontal line will be time; starting from when you wake up in the morning until you go to bed at night. The vertical line will be your level of tiredness, from not at all tired on the bottom to very tired or unable to stay awake on the top. So, how tired are you when you wake up? How does this change throughout the day? Does it go up or down at different points in time? What about at mid-morning (9 or 10am)? Mid-day? Afternoon? Early evening? Night? Before you go to sleep? After people have drawn a graph, have them quickly explain their graph. Why are you more or less tired at different times of the day? Does everyone understand how to make these lines and think they can do it themselves? Great. Now I am going to have everyone draw his or her own lines. In total, we are going to draw three lines, but we will draw them one at a time. Let us begin with WASH behaviors. I would like each of you to draw a line showing how WASH behaviors have changed in these communities since the Club program began. Reflect back on what the participants have already said about WASH behaviors and use no more than two (2) specific examples. To make this easier, we will focus on two behaviors that this group identified as important or meaningful. When I asked about the new behaviors or practices that people in these communities have adopted because of the Club program, you mentioned (hand washing with soap) and (defecation practices). Can we use those behaviors for this activity? Great. Let us graph one behavior at a time, one community at a time, starting with (hand washing).
10. Please draw a line that shows your perceptions of how often people in these communities (washed your hands with soap at key times (before eating/cooking, after defecating, etc) during the day) before the Club program started? How did this change once the Club program started? What about as the Club program continued? What about once the Club program ended?
After you draw your line, please take a moment to consider why you think the change (increase or decrease) happened. What factors, issues, or events contributed to that change? Then I would like you to make notes that explain what factors, issues, or events led to that change. Repeat for the second community. Give the participants at least 5 minutes (no more than 7 minutes) to draw and annotate their lines.
Now I would like you to describe your lines. Who would like to go first? As each person describes their lines, ask the following probing questions for each (discussion should be no longer than 10 minutes):
Probes: Why did this change (increase/decrease)? What specific events or factors led to each change? What do others think about this line and the changes it shows? What specific Club activities contributed to this change in hand washing practices? Why? How did the Club influence the hand washing practices of those that did not join the Club? Does your line represent the hand washing practices of people who are not Club members? Why are non-members different/the same?
If the discussants did not mention any social capital factors like trust, social support or social pressure, then ask the following probes: I would also like to know how the social issues we talked about at the beginning of our discussion contributed to the changes you noted. Did trust, group participation, social support, social pressure or other social issues influence these changes? If so, please describe how.
11. Now let us draw a line showing your perceptions of how often people in these communities practiced safe defecation practices (used a toilet, latrine, or buried your feces). Before the Club program started, how often did members of these communities practice safe defecation practices during the day? How did this
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change once the Club program started? What about as the Club program continued? What about once the Club program ended?
After you draw your line, please take a moment to consider why you think the change (increase or decrease) happened. What factors, issues, or events contributed to that change? Then I would like you to make notes that explain what factors, issues, or events led to that change. Repeat for the second community. Give the participants at least 5 minutes (no more than 7 minutes) to draw and annotate their lines.
Now I would like you to describe your line. Who would like to go first? As each person describes their line, ask the following probing questions for each (discussion should be no longer than 10 minutes):
Probes: Why did this change (increase/decrease)? What specific events or factors led to each change? What do others think about this line and the changes it shows? What specific Club activities contributed to this change in defecation practices? Why? How did the Club influence the defecation practices of those that did not join the Club? Does your line represent the defecation practices of people who are not Club members? Why are non-members different/the same? If the discussants did not mention any social capital factors like trust, social support or social pressure, then ask the following probes: I would also like to know how the social issues we talked about at the beginning of our discussion contributed to the changes you noted. Did trust, group participation, social support, social pressure or other social issues influence these changes? If so, please describe how.
12. Wonderful! We have one more line to draw and discussion. Our last line will show your perceptions of how often people in these communities have joined others to work on a common project or solve a collective goal. Reflect back on what they already told you about WASH collective action and use specific examples from what they said. When the program started, how often did people in these communities come together to work on problems? How did this change once the Club program started? What about as the Club program continued? What about once the Club program ended?
After you draw your line, please take a moment to consider why you think the change (increase or decrease) happened. What factors, issues, or events contributed to that change? Then I would like you to make notes that explain what factors, issues, or events led to that change. Repeat for the second community. Give the participants at least 5 minutes (no more than 7 minutes) to draw and annotate their lines.
Now I would like you to describe your line. Who would like to go first? As each person describes their line, ask the following probing questions for each (discussion should be no longer than 10 minutes):
Probes: Why did this change (increase/decrease)? What specific events or factors led to each change? What do others think about this line and the changes it shows? What specific Club activities contributed to this change in working together to (insert the problem they described)? Why? How did the Club influence those that did not join the Club? Does your line represent people who are not Club members? Why are non-members different/the same?
If the discussants did not mention any social capital factors like trust, social support or social pressure, then ask the following probes: I would also like to know how the social issues we talked about at the beginning of our discussion contributed to the changes you noted. Did trust, group participation, social support, social pressure or other social issues influence these changes? If so, please describe how.
Conclusion
Great work everyone. Is there anything else you would like to tell me about the CHC intervention or the social resources here in your community?
At this point, I do not have any more questions or activities for you. However, I do want to give you an opportunity to ask me questions. I am only able to answer questions about this discussion or the broader study. Do you have any questions?