Creative Methodologies to Stimulate Children’s Participation during Focus Group Discussions in Rural Cambodia

Child labour is a global phenomenon. Out of the total population of an estimated 4 million children aged five to 17 in Cambodia, there are 429,380 who are child labourers. An estimate of 48 percent of the aforementioned child labourers surveyed had dropped out of school. The majority of literature based on quantitative research regarding influences of child labour on school attendance does not use qualitative methodologies to explore the phenomenon. This paper describes strengths and challenges of implementing creative participatory methodologies during Focus Group Discussions (FGDs) conducted with children in rural Cambodia. The method provided a safe and social space for children to explore the context of their work and how it affects their school attendance. A strength of the participatory method includes trust building with child participants through creative play. Challenges include power differences between the research team and child participants, conducting cross-cultural child-focused research in a developing country and effectively implementing FGDs to generate rigorous data.


Introduction
Child labour is an extensive issue in the developing world and can have detrimental effects on children's school attendance [1].There is mixed evidence regarding the relationship between children's engagement in work and school attendance.Moreover, the majority of research concerning this phenomenon is predominately quantitative and does not incorporate children's voice through qualitative methodologies.
Therefore, the purpose of this paper was to explore what creative methodologies used during FGDs were critical to stimulating and enhancing the participation of children in a wider research project implemented in rural Cambodia.This wider research project explored how children's participation in work during the rice harvest season affected their school attendance in grade five to grade eight in Svay Rieng and Banteay Meanchey Provinces, Cambodia.The methods that were incorporated in this study enabled the researchers to explore the context of children's participation in work and how this influenced their attendance at school.Additionally, this paper also encompasses discussion around the strengths and challenges experienced by the researchers while implementing FGDs with children in rural Cambodia.

Background Child labour
Children's participation in work is a widespread problem in developing countries with approximately 168 million children aged 5 to 17 involved in child labour worldwide [1].Furthermore, the Asia and Pacific Regions have the highest number of children aged five to 14 (122.3 million) who are engaged in some form of child labour including, child trafficking, child domestic work, hazardous child labour, child bonded labour and the like [2].More specifically, 70% of the Cambodian population continue to work in agriculture including 75% of 1.5 million children [3,4].
Child labour is defined as work that harms children's well-being, hinders their social and educational development and future livelihoods [5,6].When many people hear the term child labour, they visualise poor children working in factories, mines or other market work, however, in reality only a minority of children are engaged in this type of work [7].Instead, the majority of children in developing countries are engaged in more hidden forms of child labour such as, family farming, household chores and the family business [8].The hidden forms of child labour are often unaccounted for in employment statistics resulting in incomplete knowledge regarding children who are engaged in child labour [9].

Children's school attendance
Globally, in 2009 there were 67 million primary school-aged children out of school [11].

Children's work and school attendance
Children in developing countries engage in several types of work and/or schooling [10].There is mixed evidence concerning the relationship between children participating in work and longer term educational, vocational and economic outcomes.Rosati and Rossi [14] conclude from their quantitative analysis of children's working hours and school enrolment in Pakistan and Nicaragua, that many children in these countries take on occupations for which work experience is more important than formal education.Data from qualitative and quantitative scholarly studies conducted in sub-Saharan Africa about child labour practices, found that working on the family farm can have positive cultural and societal significance for both the child and their families [15].
Kana, Phoumin and Seiichi [16] concluded after conducting household surveys in four rural Cambodian villages that child labour had a positive effect on children's school attainment.These villages relied heavily on farming as their main source of income.It should be noted that Kana, Phoumin and Seiichi [16] conducted their research during the month of September when children engage in limited agricultural work-related tasks.Therefore, this could have resulted in under-reporting of working hours for the children.
These findings challenge the frequently cited notion that child labour has detrimental effects of children's school attendance in less developed regions such as Latin America, Asia and Africa [17,18].In spite of the cultural, societal and economic significance of children's participation in farm work Beegle, Dehejia and Gatti [19] concluded from national survey data in Vietnam that there are long term negative individual and social effects that result from children's engagement in work.Once families place their children in work instead of attending school, the likelihood of them not acquiring sufficient skills needed to participate in quality future employment increases, which in turn contributes to poor economic growth in families, communities and the nation [20].
These contradicting findings highlight the necessity for further qualitative exploration of this phenomenon to further understand the factors which contribute to either positive or negative outcomes.

Research methodologies used to explore children's work and school attendance
Quantitative studies provide one dimensional insight into the complex phenomenon of children's work and school attendance and often do not provide a rich analysis of individual's discourse regarding their experiences of child labour and education.There are few qualitative studies that explore the multifaceted factors that influence child worker's lives including their engagement in education [21][22][23].However, Omonkhodion and Uchendu's [22] qualitative study prioritises the parents' perception on child labour practices in Nigeria using qualitative interviews.Moreover, Morrow and Vennam [21] and Togunde and Carter [23] chose to only conduct interviews with children regarding their work and schooling.Contrary to this, Gibson [24] advises that FGDs provide an interactive group setting for children to discuss their values, beliefs and understandings of issues without feeling the pressure of a face-to-face interview with a researcher.
Moreover, there is limited literature that addresses the importance of warm up and cool down activities during child focused FGDs, including Bissell, Manderson and Allotey's [25] implementation of FGDs with former child garment workers in Bangladesh.Bissell, Manderson and Allotey [25] utilised a documentary film entitled, Voices of Children [26], which depicted working children.The film proved to be an evocative tool to stimulate meaningful discussion among FGD participants regarding child labour and their own experiences of working.Bissell, Manderson and Allotey [25] adopted this visual tool to achieve the difficult task of engaging children in FGD research by encouraging personal connection between FGD participants and the children in the film.However, Bissell, Manderson and Allotey [25] did not include warm up activities with the children to build trust with the research team and encourage interaction between the children prior to the FGD.Furthermore, there was no debriefing conducted at the completion of the FGD even though it was reported that children had emotional reactions while watching the working children in

Rationale
There has been limited empirical research conducted that explores child labour in Cambodia besides a few studies that are predominately quantitative, small site-based research projects conducted by development agencies that explore issues such as the reasons for children's engagement in work and ways of eliminating the worst forms of child labour [29,30].Moreover, there are very few documented child participatory qualitative studies that explore the issue of child labour and education in cross-cultural contexts.Therefore, this paper provides insight into the qualitative creative methodologies employed during FGDs with children in Cambodia and how these methods were critical to stimulating and enhancing children's participation.The aforementioned FGDs were conducted as a part of a larger study that explored how children's work involvement during the rice harvest season affects their school attendance in grade five to grade eight in rural Cambodia.Furthermore, this paper explores the strengths and challenges that the researchers faced while implementing the FGDs.A clear strength was trust building with child participants through creative play.While challenges included conducting cross-cultural child-focused research in a developing country, power differences between the research team and child participants and effectively implementing FGDs to generate rigorous data.

Research Methodology
The qualitative nature of this study employed an interpretive phenomenological research paradigm which Liamputtong [31] suggests is "an approach that seeks to understand, describe and interpret human behaviour and the meaning individuals ascribe to their experiences".Although children are rarely asked for their opinion in the Cambodian culture due to significant power imbalances between adults and children, it is important that children were included in this study as their experiences of school, work and family influence their ability and desire to attend school.The FGDs used creative play focused methodologies including seasonal diagramming [32,33] to provide a comfortable, trusting and fun environment for Cambodian children to discuss their perceived associations between school attendance and their participation in the rice harvest season.Implementing the FGD method is especially useful when researchers are engaging with 'silenced' individuals, such as children, who may be reluctant to express their views in a one-to-one interview environment [34].

Recruitment
The research team comprised of the non-Khmer speaking female researcher (first author) and a bilingual (Khmer and English) speaking female research assistant.During the FGDs there were three facilitators including the Cambodian research assistant acting as the moderator, the female researcher who posed the discussion questions and a male Cambodian born Khmer speaking note-taker.difficult to recruit because they were too shy to express interest in participation when recruited in a public space.It was thought that this occurred because the research team comprised of two females in their 20's creating gender and age barriers between them and the potential male participants.This barrier was overcome by visiting more households and inviting male children individually to participate which gave them the opportunity to express interest in the FGD outside the public space.

Gaining informed consent from child participants and their parents or guardian
A protectionist stance was adopted when gaining informed consent and voluntary participation from the children [38].If children expressed interest in participating, then a Plain Language Statement (PLS) and Consent Form was read aloud in the Khmer language to the child and their parent or guardian.The research team informed the children and their parents or guardian that participation is voluntary and that the children were free to withdraw at any stage of the study without any consequences [39].
Children and parents or guardians were invited to ask questions regarding the study.If children expressed interest in participating (with agreement from their parents or guardians) they were asked to verbally repeat their understanding of involvement in the study to ensure they understood what participation entailed [32,37].
At the time the FGD was conducted, informed consent was gained from children by reading the Consent Form aloud together and placing their thumb print on the Consent Form.Each parent or guardian was asked to provide informed consent by providing their thumb print on the Consent Form prior to the commencement of the FGD.Thumb prints have equal significance to a written signature in Cambodia [40].FGDs were audio recorded with the consent from the children and their parents or guardians [41].

Conducting pilot FGDs
Three pilot FGDs were conducted to assess the participatory methodologies and to ensure the children were comfortable speaking together in the group setting with a particular focus on their age, gender and reading and writing abilities [42].The pilot FGDs participants consisted of eight females in grade seven and eight; three females and three males in grade six; one male and three females in grade five and six.Two pilot FGDs had a mixed gender composition to test whether or not this would affect children's participation in the FGD and the information they shared with the group.The gender mix in the two pilot FGDs did affect children's participation in the group discussions.It was decided to keep the gender composition of each FGD separate to ensure that participants were comfortable to share information with other participants of the same gender.Children were asked to draw and write on the timeline to indicate yearly events, discussed below.However, younger children were reluctant to draw or write on the timeline because they lacked confidence in their reading and writing skills.The FGD methodology was improved to suit children's low literacy levels by removing the expectation that the children would draw and write on the seasonal diagram which resulted in children being more willing to participate.Instead, the research team drew colourful pictures of yearly events and asked participants to stick the pictures on the seasonal diagram to indicate when yearly events occurred.This generated participatory group discussions about the placement of the pictures on the diagram.
During pilot FGDs, the researcher tested several types of socially and culturally relevant warm up and cool down activities [27].Children responded positively to both activities which led to building good rapport between the research team and participants in both pilot FGDs and FGDs (discussed below).
Drawing on lessons learnt from the pilot FGDs, the research team conducted nine more FGDs to gain an in-depth understanding of children's schooling and participation in the rice harvest season.

Creative methods employed during FGDs
To create a social environment for the child participants, Khmer music was played on their arrival to the FGD and snacks and water were provided throughout.As suggested by Ennew [37], FGDs were organised to include participants with similar characteristics.All child participants knew one another as they were either friends or from the same village.Each child was given a yellow card at the outset of the FGD.The research team explained to the group that raising the yellow card indicated that they would like to terminate their participation in the FGD [27].If this occurred, they would be taken to the side of the room by the note taker and asked to provide a thumb print on a Revocation of Consent Form.However, this did not occur during the FGDs.
Each participant was asked to think of a pseudonym for themselves, such as a movie star's name or an animal name which was used in the FGD instead of their own name.The research assistant asked each child for their demographic information including age, gender, grade, living situation, family's source of income, family land ownership and whether or not they participated in the rice harvest; the demographic data informed and strengthened the qualitative data analysis [43].

Warm up activities
A warm up game was organised to develop trust, generate group communication and maintain children's interest at the outset of the FGD.Participants were asked to stand in a circle and place their hands in the middle of the circle.Each participant was instructed to join each of their hands with a hand belonging to two different participants that resulted in a tangle.The children were then instructed to communicate with one another and move to untangle themselves and form a circle again without letting go of each other's' hands.The research team also participated in the game to build rapport and trust with the children [44].
Once the game finished, each participant, including the research team, introduced themselves and spoke about their families which provided additional demographic information and aided in understanding participants' lived experiences.This activity provided an opportunity for participants to become familiar with the research team members' background.Ultimately, the warm up game helped maintain children's interest in the FGD as their attention was beginning to wane during the demographic data collection activity.

Seasonal diagramming
Seasonal diagramming is commonly used in agricultural research such as that conducted by Conway [45] in Pakistan.He describes seasonal diagramming as "a schematic device which presents information in a readily understandable visual form" [45].
Seasonal diagramming was considered an appropriate method to explore children's perception of how their involvement in work influenced their school attendance.This was conducted with children in grade five to grade eight as it allows for creativity and an avenue for illiterate or semi-illiterate children to visually convey yearly events affecting their school attendance.This method allows for in-depth discussion that centres on the diagram which provides an insight into months of the year when children are at risk of not attending school and how they adjust school-based learning around their out-of-school responsibilities such as working in agriculture.
The researcher drew a timeline on a long piece of paper and colourful pictures associated with the Khmer New Year festival, Khmer religious festivals, the wet and dry seasons, the rice harvest and planting seasons, school holidays and the time of year when children start and finish school.The seasonal diagram was clearly explained to children as a normal year in rural Cambodia.Children placed the pictures on the timeline while others drew lines indicating when different seasons started and stopped.This created discussion around the complex social, economic and cultural factors that influence child labour and school non-attendance.Children told of their work commitments and experiences at school.The children said that they were most busy with out-of-school work during the rice harvest season, which they described as a social and cultural event.

Cool down activities
At the completion of the group discussion about the seasonal diagram, participants were given time to free draw which the research team also engaged in.This activity provided an opportunity to debrief about whether or not they enjoyed the FGD, school life and their work commitments.
Finally, participants engaged in a game where everyone stood in a circle and passed around a paper ball while Khmer music played in the background.Once the music stopped, the participant left holding the ball was asked to unwrap one layer of paper to find an instruction that told them to dance, sing or behave like a familiar animal in their village.The ball was passed around until all the layers of the paper ball had been removed and they found the prize.This proved to be a culturally relevant game because the children enjoyed dancing, singing popular Khmer songs and laughing together as they acted out sounds and actions of familiar animals found in their village.

Confidentiality
In order to provide a place where children felt safe and parents were comfortable for their child to participate, all FGDs were conducted in accessible open spaces including a village meeting area and a school classroom.However, selecting these public venues made it difficult to provide children with an assurance of confidentiality.
During the course of the FGD in the village venues, onlookers watched the FGDs because they were interested in the uncommon visitation of a foreigner and the interactive activities they had organised.However, the school room provided greater confidentiality for participants, yet there were still onlookers present.The researcher considered that the presence of onlookers had limited effect on participants' responses during discussions, which may be because the participants were a part of a small community where most information is shared amongst families.However, some participants were too shy to play the cool down game because others were watching them.Participants were asked if they wanted more privacy and whether they wanted the onlookers to leave; most children expressed indifference.
Nevertheless, the research team explained to the onlookers that participants needed space to participate in the FGD.Some onlookers understood this explanation and refrained from watching while other onlookers continued to watch the FGDs.It should also be noted that FGDs do not allow for assurances of confidentiality as the researchers cannot guarantee that other participants will not disclose information shared during the FGD.

Relationship between the research team and child participants
At the outset of the study it was evident that the researcher's involvement in data collection would create a significant power differential due to her perceived social standing in the community, i.e. white, educated foreigner and the age difference between the participants and the researcher and research assistant.Steps were taken to minimise this power differential by building trust and acknowledging that the child participants' decision to participate would be respected at all times.Despite these interventions some children took much longer than others to develop trust in the research team.
In Cambodia, adults rarely treat children as their equal [27].So the children who participated in the FGDs needed time to become familiar with this new kind of relationship afforded to them by the research team.To achieve this, the research team invested time in building rapport with the children as well as implementing a rights-based approach to the research [37].Some of the guiding principles of the rights based approach include respect for the children and to ensure that they were not embarrassed, humiliated, laughed at, look down upon or corrected during the FGD, for example when they placed the picture on the seasonal diagram in an unlikely spot [27].Once children displayed trust in the research team it became evident that they felt safe and were able to voice their thoughts regarding their education and work resulting in robust and comprehensive data.

Relationship between participants in FGDs
The relationship dynamic between FGD participants had a significant influence on a child's willingness to be interactive.in the FGD were more reserved.To address this issue the research team encouraged the children to suggest friends who may want to participate in the FGD with them.Friendships amongst the participants lead to immediate chatter and laughter during the warm up game and ease in the placement of pictures on the seasonal diagram.This open interaction between participants led to discussions regarding their thoughts on schooling and work while referring to the seasonal diagram.

Conducting cross-cultural focus group research
There are important considerations regarding language that need to be acknowledged when conducting FGDs in a cross-cultural context with children.As Watkins-Mathys [46] states, "language is context and time bound, and creating shared meaning thus poses certain challenges because of its dependency on the way in which language is used within its context at a certain time".
Communicating through interpreters can lead to misunderstanding participants' views [47,48].Despite the fact that the researcher was an ethnographer with an outsider perspective of the local communities [49]; she was fully aware that translation-related problems such as inaccuracy were inevitable.Translation became increasingly difficult if the number of participants in each FGD was above six.However, the research team ensured that the warm up and cool down games did not require Khmer language.Instead it relied on actions which resulted in laughter and trust building between the research team and participants.Efforts were made to implement Liamputtong's [50] suggestions, that researchers listen, paraphrase and clarify participant's stories and observe the manner in which children reacted to the discussion questions and interact with others.Additionally, the researcher worked closely with the research assistant and debriefed after each interview to ensure they had a thorough understanding of the full intended meaning expressed by participants [51].
One suggestion to overcome this limitation would be to reduce the power imbalance and translation barrier by fostering a Western researcher to collaborate and further train Cambodian researchers in qualitative methodologies.This will empower local Cambodian researchers to develop research designs and participatory research skills that are locally and culturally relevant in order to explore the voices of local communities around the issue of children's education.

Conclusion
Gathering qualitative data using creative participatory methods such as seasonal diagramming in FGDs demonstrates the strengths and highlights the challenges of working with children in cross cultural settings.It provides a case study example of how to employ games, colour and diagrammatic models in a real research context to engage children in developing countries in research that explores their lived experiences, such as work and school attendance.The implementation of the interactive methodologies during FGDs allowed the research team to build trust with child participants while effectively and creatively working with children, especially those with low literacy levels.Nevertheless, researchers who conduct studies with children in similar research sites need to consider power differential between the research team and child participants, the sensitivities and ethical issues associated with the conduct of cross-cultural research and the time required to effectively implement FGDs.
Conducting child-focused research in developing countries such as Cambodia empowers vulnerable members of society that then informs local organisations and NGOs about ways to increase effectiveness and efficiency of community programs.

MEDICINA ISSN 1698-9465 Journal of Healthcare Communications ISSN 2472-1654
mixed methods study and found that children indicated that they were less involved in school and more involved in work outside of school than did the adults responding for them.However, only parents' responses were analysed because the parental data was more complete than data obtained from children.Therefore, this study omitted children's perspectives.

ARCHIVOS DE MEDICINA ISSN 1698-9465 Journal of Healthcare Communications ISSN 2472-1654 the
[27].Providing warm up and cool down activities during FGDs for child participants is necessary.This ensures that children are prepared to participate at the beginning of the FGD and debriefed at the completion of the FGD[27].Kampuchean Action for Primary Education (KAPE) [28] conducted a mixed methods study in Kampong Cham Province, Cambodia that involved FGDs with children regarding school dropout and retention; the FGDs were part of a larger mixed methods study.Data from the FGDs indicates that finances, peer groups, household work, teacher absence, school environment and teaching quality all influenced student's decisions to either attend or not attend school.Interviews with Cambodian parents also revealed that most children had poor school attendance during the cassava harvest season in January.Nonetheless, the KAPE [28] study did not document their FGD methodologies.
It was noted however, that boys tended to dominate the FGDs despite facilitators' attempts to include all students.Such findings highlight the need for increased documentation of FGD research methodology to determine strengths and weaknesses of the method when employed with children.Also important is to consider key methodological issues such as grouping participants with similar traits in FGDs to promote equal participation, especially females who are often at risk of school dropout.Finally, the KAPE study focused on one province in Cambodia that relies on the cassava crop and it did not explore the relationship between the school dropout rate and the rice harvest season; a crop that many rural Cambodians rely on for their livelihood.The review of the aforementioned studies stresses the importance of prioritising qualitative research methodologies such as FGDs that seek to enquire about children's engagement in work during the rice harvest season instead of attending school.
Fliers were handed out to all children in grades five to eight in four primary schools and two high schools as well as to all households in two villages in Chup Veary Commune in Banteay Meanchey Province and two villages in Kiri Commune in Svay Rieng Province.The research team visited the schools and villages numerous times to play games and speak with the children to build trust prior to the FGDs.Both Communes have a strong focus on rice production and border neighbouring countries (Svay Rieng borders Vietnam and Banteay Meanchey borders Thailand).Therefore, this allowed the opportunity to compare children's work involvement during the rice harvest with the influences of out-migration on children's education in different parts of the country.Many female participants expressed interest in participation when we visited the schools, however male participants proved to be