Participant observation and field notes of focus group dynamics among tribal and local health care providers

Background: American Indian reservations often share the same land mass and public health challenges with two or more counties within a state. For the Confederated Salish and Kootenai Tribes in Montana, responsibility for their members overlaps with three counties. Although tribal sovereignty, authority, and responsibility to care for tribal members is carefully observed, nurses from both the tribe and counties recognize the relative unimportance of boundary lines during a disaster, biological outbreak, or the effects environmental contaminants might have on the pediatric population. On January 29, 2010, tribal and county public health nurses and other local healthcare providers gathered at a conference on the Flathead reservation to increase their knowledge of environmental health toxins that could impact the health of the fetus, infant, or child and discuss local priority issues of concern. The purpose of this study was to gather participant observation of the social interactions, contextual and relational aspects of the conference, and describe the interplay between diverse but common perspectives. Methods: Detailed field notes captured snippets of qualitative observations throughout the day based on an agenda of events and the scheduled focus group activities at the end of the day. Data collection included textual, maps, still photos, and diagrams of seating and interactions among local and tribal participants, organizers, exhibitors, and vendors. Results: Individuals and groups were observed as they engaged in activities in a very scheduled and tightly managed day of events. Voluntary seating and groupings at the beginning of the conference (self selection) was contrasted with prescribed seating (organizer pre-arranged) during the focus groups. Free-range, casual conversations and interactions during breaks and before and after the day's events were influenced by the agenda, speakers, and materials/resources available to participants. Substantive and guided discussions were directed by trained focus group moderators and a series of questions developed by the conference organizers to stimulate dialogue on key issues. Conclusions: Participant observation provides additional data points in the iterative, mixed methods process that leads to a better understanding of the community's perspective on a public health issue. Active engagement by local providers is an essential component.