Comparison of the two focus groups

As two focus groups were carried out in different countries, the opportunity was taken to draw comparisons and differences between them. Despite being in different countries, minimal variation between the responses to the focus group questions was found. There were similarities in the groups’ understanding of evidence for example, it was interesting to note that both focus groups, used the word ‘proof’ to define evidence. The way in which proof was used, expressed a desire to have a definitive, documented reason for introducing change. There was a sense that without such clarity then change would not be able to occur, resources would not be made available, and senior leaders would not support it. There was the inference that participants could not just put across a verbal argument but hard evidence would be needed for the process of change to occur. The need for tangible proof to substantiate reasoning underpinning changes in practice was an illustration as to why both groups, in their own way, were supportive of the use of evidence based

guidelines. The idea of the contextualisation of guidelines is an added layer in making a solid foundation on which to place such an argument, whilst increasing the applicability of the guideline. This was highlighted in both focus groups as they understood the utility and need for guidelines to be context specific.

143 Using clinical guidelines was identified in both groups as being a normalised embedded practice. The overall impression given was that whilst there may be too many clinical guidelines to choose from and there was not identification of how choices were made, there is not the infrastructure in either country to enable the production of their own to the extent that would suit the needs of the country. Choice of which guideline to use was then reported as being made based on factors such as best fit, most accessible or most up to date.

Facilitation was regarded as being organisationally led by both groups, thus placing

responsibility primarily on the system. However, in Malta it was also seen as coming from a person / people.

Workload was identified in both situations as being restrictive and in Malta was attributed to a lack of human resources and an already overworked workforce. The Maltese focus group identified a number of resource orientated barriers however the Jordanian group did not place the same emphasis on resources, either financial or human. In the Jordanian focus group, culture was referred to on a number of occasions and the restrictions it causes were clearly articulated. In Malta, the attention was more on the context i.e. Malta and the multifaceted consequences of being an island with a small population.

The influence of politics was strongly identified in Malta but not in Jordan. In the Maltese group there was identification of not only the influence of politics in healthcare but how patients can influence politics. This was not evident in the Jordanian group, which may be due to the fact that the group were primarily composed of army personnel and the influences on the provision of healthcare is different.

6.2.7

Summary

In sum, the focus groups achieved their purpose which was to provide a background and an understanding of the healthcare systems in Jordan and Malta and an opportunity to check phraseology and concepts. The focus groups in Jordan and Malta provided an opportunity to explore the meaning of evidence, the participants’ understanding of how it related to their work, how they used healthcare guidelines and the barriers associated with the implementation of new ways of working. There was an emphasis on evidence being easily used and for it being a means of providing the proof to underpin any new initiatives, an acknowledgement that they worked within environments that facilitated learning, the difficulties of having an already demanding workload and the pressure of resources.

144 As the case study was to continue in Malta, contextualisation of why obesity had been chosen as the guideline topic was also provided as the group spoke of the scale of the problem of obesity in Malta and other activities, policies and programmes that were taking place to address it.

Participants confirmed that the terminology used by the researcher, such as evidence based practice was the same in Malta as in the UK, an important step to avoid

misunderstanding during later stages of the research. The opportunity was taken within the focus group setting to gain a good understanding of how the healthcare system in Malta worked and the relationships between the department of health, public health and the hospital systems. Funding was also discussed and the huge impact that this has on the provision of patient care. As the topic of obesity had already been identified, the group provided an opportunity for the researcher to understand the extent of the problem of obesity within Maltese society, establish a comprehensive understanding of the healthcare systems and be aware of recent government interventions and Acts. .