Exploring Gaps in the Existing Healthcare System
in Rural Tamil Nadu

Chiai Uraguchi, Maki Ueyama, Sunayana Sen

Methods

Qualitative research instrument

This research aims to integrate data from individual interviews and group discussions. One on one interviews consisted of an in-depth conversation on an individual level. In-depth interviews contributed to providing feedback on empirical and personal aspects of input, activities, outputs, outcomes and impacts of the healthcare system. The interviews were initially targeted with several authorized people: Village President/Vice President/Panchayat Leaders/ other village leaders, headmaster/teacher of a school, and a Self-help leader in order to obtain their empirical cases and the indirect information they have often examined in their village. In order to provide general understandings of community norms, interviewing the key community leaders can contribute to a fast overview of a community and its needs and concerns.

While in-depth interviews were conducted with individuals, group concerns were also explored. Topics that may not arise in individual interviews thus could be addressed in focus groups. Through discussing a topic in the same Tamil language and with familiar neighbors, group discussions contributed data and insights or personal and deep information that would be less accessible without interaction in a group setting. Only a school teacher, a school headmaster, a self-help group leader, and a self-help group member participated in this key informant interview due to unavailability of other target participants. Through interviewing authorized people, bridge of social network was developed so that it helped to easily recruit focus group participants. Additionally, any information that was gathered had refined question banks to be used for focus group discussions.

The focus group discussion is facilitated by a facilitator and observed by a recorder. The role of a facilitator is to ensure that all participants had an opportunity to participate, and were asked for clarification or elaboration – if needed – but did not direct the content of participants’ comments. A recorder plays the role of recording the discussions and taking notes not only for the participants’ expressions but also to note the environment and atmosphere where the discussions were conducted and thus audits comments and reactions. The focus groups were conducted in neutral settings with 6 to 8 participants. Each 45 minute to 1 hour session was audio-taped and then transcribed for analysis purposes.

In regard to participants and their recruitment for focus group discussions, two age-stratified groups (21–40, 41–60) of 6 to 8 participants of both females and males were selected. Age groups of 20 to 40 and 41 to 60 of both males and females were eligible to participate in this study discussion. Dividing into two different age groups allowed us to discern educational levels, different health issues, social status such as marriage, etc. Potential participants were recruited randomly, so that people from different backgrounds in similar age groups could contribute diverse and empirical opinions. In the process of recruitment, social networks built through key informant interviews, helped to recruit participants easily. Group members used a common language (Tamil language) to describe similar experiences. Compared to key informant interviews, group discussions produce data and insights that would be less accessible without the interaction found in a group setting; for instance, listening to others’ verbalized experiences stimulates memories, ideas, and experiences in participants.

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