Appendix A
Focus Group Guide
Before Beginning the Interview:
Hello, and thank you for speaking with me today. My name is ______ and I am a field researcher at DCOR. I am conducting a research study to understand the attitudes and beliefs of people in this community. Thank you so much for agreeing to participate and taking time out of your day.
Do you have any questions about the research and your participation before we start?
Warm-up Questions
I’m new to this community, [name District], can you tell me a little bit about it? For example, what kind of food do people eat here? And what do people do to earn money?
Women’s Role in the Community
What are some of the typical things that women in this community do throughout the day? (probe: things like cooking, cleaning, taking care of kids, working outside the home, spending time with her husband).
Do women in this community have enough energy or time to these things each day?
How are men and women treated differently in this community?
For women’s life in general, are things getting better or worse?
What are some of the concerns that women in this community have? (probe: concerns about health, money, their family, themselves, their future)
Some people think that (woman’s name) should first take care of her husband and kids before she worries about her own health. Other people think that she should first take care of her own health.
How do you think most women in this community feel about that? What about most men?
In some families in Odisha, women eat after their husband, children and mother in law eat. In others, women eat at the same time. What do you think about that? Is this changing?
Anemia and Iron Folic Acid (IFA) Knowledge
(Show an IFA tablet and liquid IFA)
Can someone tell me what this is? (probe: What does it do?)
Have you ever heard of anemia?
Many people in this community may not use the word “anemia” but they may have other words or phrases to talk about anemia. Can you tell me what some of those phrases are?
Tell me a little bit about what happens when someone has anemia (use the word or phrase identified above instead of “anemia”). Tell me how this person feels or how this person acts when they have anemia.
What do you think causes anemia? (probe: Not eating enough iron rich foods?)
What do you think makes anemia go away? (Probe: Can IFA tablets help? How about changing your diet? What kind of foods might help it go away?).
Anemia Related Behavior
Ok, now we’re going to make up a character. She is a female aged 23 years old. What should we call her? (Ask for suggestions and decide on a name together). She just got married and is 3 months pregnant with her first child. Her doctor just told her she has anemia.
The doctor told her to take iron tablets.
IFA Norms
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Is Anemia is a problem in the community? If yes How much of a problem?
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In general, who is typically expected to take IFA tablets? (Probe: pregnant women, adolescent girls, non-pregnant women?)
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Please think about most women like (name) who live in this community. How many of them take IFA tablets? Some? Few? Most?
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Is there anyone in (woman’s name) family (or her husband’s family) that she can talk to about taking IFA tablets? How much do you think she’ll listen to what they have to say about IFA tablets?
Information Sources
Imagine another woman who is not pregnant but interested in learning more about her health. What should we call her? (Ask for suggestions and decide on a name together).
Where does she go for information about health related matters?
Where can she get information about pregnancy, anemia, and IFA tablets from?
How easy is it for her to get information about pregnancy, anemia, and/or IFA tablets? What difficulties would come up when trying to get this information?
When a woman gets IFA tablet, what kind of information does she get about them?
Probe: Dose, when to take or why to take it?
For those of you that participate in self-help groups, can you tell me what kind of things you discuss?
Closing
That is the end of the questions I have for you, but do you have anything else you’d like to add to the discussion? Any little stories about anemia or IFA use in this community?
As a reminder, please do not share anything we spoke about today with anyone outside of this group.
Any questions?
Thank you for your time.
Appendix B
Key Informant Interview Guide
Before Beginning the Interview:
Hello, and thank you for speaking with me today. My name is ______ and I am a (your role) at ______. I am conducting a research study to understand the attitudes and beliefs that effect IFA tablet use in _____(selected county)____.
Thank you so much for agreeing to participate and taking time out of your day.
Do you have any questions about the research and your participation before we start?
Warm-up Questions
Can you tell me about your role? I’m new to this community [name district], can you tell me a little bit about it? Like what do people do to earn money? What types of jobs are normal for women to have? How often do people move in and out of the town? What do people eat here?
Anemia in this Community
How common is anemia in Odisha? Is it a state priority? A country priority?
How does the diet in Odisha contribute to anemia? (probe: for example do people here eat iron rich foods like meat or green leafy vegetables?)
Knowledge about Anemia
Can you tell me a little bit about how big of a problem anemia is in this community? What is your understanding of some of the health risks of anemia?
How aware are residents in Odisha of the prevalence of anemia? How familiar are they with the health risks of anemia?
IFA Availability
Are you familiar with IFA tablets? How about IFA syrup?
Can you tell me who distributes the tablets and how? (probe: Are they private or government distributors?)
How widely dispensed are the IFA tablets? In your opinion, how easy is it for the average resident of [say village] to get IFA tablets?
Typically, how much do IFA tablets cost? Is this cost a lot to people in the community? How many tablets does a person get at a time?
If a woman wanted to get IFA tablets, where could she get them? How difficult is it to get IFA tablets?
IFA use
How difficult is it to take IFA tablets? (probe: what are some of the reasons that someone stops taking them?)
How difficult is it to continue to take IFA tablets regularly? How about taking them every day? probe: what are some of the reasons that someone stops taking them?)
Can women in Odisha overcome these barriers? What would help?
Prior Interventions
Which programs in this community try or have tried to reduce anemia or increase IFA tablet use? Can you describe these programs to me? How well liked were they? What worked well for the programs and what didn’t?
What, if at all, was the relationship between the other programs on anemia and IFA use and the self-help groups?
Barriers and Facilitators to IFA use
What do people in the community know about the benefits of taking IFA tablets regularly? (probe: do most people in this community know about the connection between IFA tablets and anemia?)
What do people think are the drawbacks of taking IFA tablets? (probe: what are some of the potential side effects of the tablets? How do they feel about these side effects?)
IFA Norms
Who is typically expected to take IFA tablets? (probe: men, all women, adolescents, only pregnant women? how regularly? When do they take them? Morning, after a meal, bedtime?)
Please think about most women who live in this community. How many of them take IFA tablets? Some? Few? Most? Are they motivated to take IFA? To what extent?
Please think about most men and children who live in this community. How many of them take IFA tablets? Some? Few? Most? How motivated to take IFA?
Is there any pressure to take IFA? (Probe: How much pressure exists to take IFA tablets? Where does this pressure come from? family, friends, health systems, etc.)
Role of Health Workers (Aganwadi worker, ANM and ASHA)
Can you tell us a little bit about the Aganwadi workers, the ANMs and the ASHA? What is their relationship with each other?
What is their relationship with the self-help groups?
Self Help Groups
Are there any SHGs in this village? What are they expected to do? (probe: what kinds of things do they discuss? What type of women join? Why do they join?)
What are the attitudes within the self-help groups? (probe: do people view it as helpful? In what ways do you think it is helpful?)
What is the SHGs relationship with other departments like? (Probe: how do they interact with the ministry of health or local NGO’s?)
ANC/Anemia Care System
What are some other places where women can find information about anemia or IFA tablets? (probe: how about antenatal care clinics when they’re pregnant?)
What are the common screening and treatment practices for anemia?
Healthcare access
Where can someone get information about health? (Probe: health clinic, from family members).
Where can someone receive information specifically about anemia, and IFA tablets? (probe: how often do women visit or speak with them?
How easy is it to get information about anemia, and/or IFA tablets? Does the amount of information that women get about anemia or IFA change during pregnancy?
Are traditional healers or doctors more commonly used? (Probe: why is one is better than the other?)
Are private or government run health clinics more commonly used? (Probe: why is one is better than the other? How about to get screened for anemia? How about to get IFA tablets?)
Closing
That is the end of the questions I have for you, but do you have anything else you’d like to add to the discussion? Any little stories about anemia or IFA use in this community?
Any questions?
Thank you for your time.
Appendix C
Structured Observation Check Lists
Antenatal Care Health Centers & Kiosks/IFA dispensaries:
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◦ How are IFA tablets dispensed? Please describe the process.
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◦ Describe the general conditions of the clinic/kiosk (cleanliness, crowding, wait-time, etc.).
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◦ Are IFA tablets available at the clinic? What is the cost?
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◦ How are IFA stocked?
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◦ If possible to observe, how often are they provided to pregnant women and to non-pregnant women of reproductive age?
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◦ Are there educational materials about anemia or IFA tablets in the clinic? Any other health related materials?
Self-help Groups:
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Where do the self-help groups meet? What type of area are they in? What is the composition of members (age/caste)
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Describe the type of information given to group participants
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Describe the activities conducted.
◦ What is the nature of the activity?
◦ Who participates?
◦ Who leads the activity?
◦ What information is exchanged during the activity? Is there anything related to anemia or IFA tablets? General health information?
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Describe any interactions related to anemia or IFA.
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How well functioning does the group appear? What is the overall sentiment from participants and leaders?
Food markets & general community observation:
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Describe all anemia or IFA related media content. Where were these found?
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Describe all health related content. (posters, advertisements, brochures, etc.)
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Describe the engagement in physical activity.
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Describe the food that is purchased or eaten. What is the quantity? Variety? What types of vegetables? Does the food vary by season?
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Are people growing their own food in a garden or on a farm? If so, how much and what kinds?
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What type of labor (work) are people doing in the village? How physically active is it? Are both men and women participating?