Table 4.

Key themes from each focus group and their context

Focus group	Context (major themes in bold)	Sample quotation
1	When discussing changes within their commune, one participant brought up the issue of Hoang Tay being overwhelmed with problems.	‘The water sources are polluted with Arsenic … with wastewater. The population … is imbalanced in terms of gender ….’
	Another participant pointed out the community's increasing awareness of environmental concerns and effects on community health.	‘… if they don't care, it will directly influence people's health … bring about new diseases … environmental pollution’.
	Many participants also emphasized the importance of governance when it comes to addressing the garbage issue.	‘If the leaders … don't directly care about the issue, nothing can be done. In the People's Council, we have no budget, so we must have contributions and coordination of the people ….’
2	The best-case scenario was called: The environment is clean, green, and beautiful. It showed a positive projection of government activities, showed wishful thinking, far from the current reality.	‘The roads in my commune are clean; the drainage system has been built spaciously. The People's Committee building is very beautiful, enough rooms for everyone’.
	The remainder of the scenario assigns roles for different groups in the community and describes how the ideal solution would work.	‘… the responsible group should be from the Women's Union, combined with a village health worker who can communicate how to separate your garbage, which can be composted, and things that can't, how to dispose of it. Those working in the cadastral sector are building roads and the sewage system and the health sector is managing, monitoring, and communicating this work’.
	The worst-case scenario was called: Disaster. It describes how their environment and food system is making them sick, with a direct economic impact, affecting their ability to access health services.	‘… our commune now has a lot of diseases … mainly originating from livestock, seafood, vegetables from the Nhue River and pesticides. I don't know where our food comes from …. The health of people deteriorates slowly, no one can go to work, and disease treatment expenses are high ….’
	The scenario also emphasized that economic priorities will overshadow health impacts.	‘People are concerned about making a profit, why think about health?’
	While discussing the future direction of drivers, participants insisted there were no other possibilities to their assumptions.	‘I want to use the word ‘nhan thuc’ (awareness) because when this is high, ‘y thuc’ (consciousness, and thus influencing their decisions) will follow in the same manner’. ‘There will be more guidance from the government; it's not possible that there will be less’.
3	Participants kept referring to when implementation of the Rural Development Proposal would begin, as there were no other possibilities.	‘… then wait until 2013 when we will have the land for a dump site’.
	Participants struggled to come up with other possibilities, assuming they could not address existing constraints (no other possibilities).	‘… this is a math problem with no solution’.
	After pushed to consider other perspectives (as a leader, the environmental sector, the business sector, and a farmer), there was agreement on possible alternative options.	‘… propaganda to increase consciousness of people (to keep the commune sanitary)’ ‘… advocate families to give up land (for government re-distribution) in order to have a place for a dumpsite’ ‘… if they still litter … one warning, a second warning, the third time is a penalty. With this in writing, then people will remember’. ‘Families (should) destroy their own (garbage)’, ‘first by separating garbage, recycling, re-using’, ‘applying (organic waste) to the fields’, ‘bury the rest’.
	Participants expressed that the first step was someone else's responsibility; various stakeholders are needed but the way forward is still top down (importance of governance).	‘The government leaders should assign tasks to stakeholders and other sectors should coordinate together, but first we have to communicate with and persuade the people’.
4	Participants were beginning to understand and learn from the process because they could articulate the reasons for each step.	‘We put the drivers in a graph because it's easier to understand, to create the best and worst cases’.
	The tool was useful for planning because it had logical steps.	‘This method is scientific’.
	It offered an alternative way of doing things (consideration of the worst case scenario) and a tool that could be applied in other sectors.	‘If we just have one way, we just evaluate how this will turn out. If this doesn't turn out the way we expect, this thinking is not useful’. ‘… for development of trade services, small scale industries at the provincial level, and social, cultural, and economic issues in rural areas’
	Participant feedback revealed how they were originally viewing their own participation.	‘… we answered your questions so you could do your job … write reports about our sanitation situation. But actually, we can see now that this method could be useful for us … for planning in other sectors’.