Focus Groups on Childhood Obesity Education (Formative Research)

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Moderator’s Guide

CFSAN Childhood Obesity Focus Groups

OMB No. 0910-0497 Expiration Date: 10/31/2020

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_Summary

Research Objective: Conduct focus groups with low-income participants with children aged 3-6 years to understand their experience of and attitudes around feeding their children. This includes purchasing food, preparing food at home, eating food prepared outside the home, and beliefs about “healthy children” and “overweight children.”

NOTES TO REVIEWER:

This focus group guide is not a script and, therefore, should not be read verbatim. The moderator will use these questions as a roadmap and probe as needed to maintain the natural flow of conversation.

Research Questions

RQ1. What are low-income parents’ experiences related to making healthful food choices at the grocery store?

RQ1a. Do these experiences vary by access level?

RQ1b. Are there any cultural differences to these experiences?

RQ2. What are low-income parents’ experiences related to making healthful food choices at home?

RQ2a. Do these experiences vary by access level?

RQ2b. Are there any cultural differences to these experiences?

RQ3. What are low-income parents’ experiences related to making healthful food choices at restaurants and when serving food prepared outside the home?

RQ3a. Do these experiences vary by access level?

RQ3b. Are there any cultural differences to these experiences?

RQ4. What do low-income parents believe constitutes a healthy, well-fed child?

RQ4a. To what extent does this belief vary by access level?

RQ4b. Are there any cultural differences to these experiences?

RQ5. What are low-income parents’ attitudes and perceptions related to childhood obesity and body image?

RQ5a. Are there any cultural differences to these attitudes and perceptions?

RQ6. What resources (e.g., health professionals, health educators) do low-income parents have to overcome childhood obesity? Additionally, what are their perceived barriers?

RQ6a. To what extent does having lower access to supermarkets exacerbate these barriers?

RQ6b. Are there any cultural differences to these experiences?

SESSION OVERVIEW: Total time 90 minutes

SECTION 1: Introduction and Warm-Up (8 min.)

The moderator will explain the purpose of the research, present the ground rules, allow the participants to ask any questions, and get to know the participants.

SECTION 2: Food Shopping (10min.)

The purpose of this section is to gain a deeper understanding of participants’ experiences in grocery shopping. This includes experience getting to the grocery store, thoughts around what to purchase, and actions within the grocery store.

SECTION 3: Food Preparation in the Home (10 min.)

The purpose of this section is to understand considerations around what and how much to serve for meals prepared in the home.

SECTION 4: Eating Outside the Home (10 min.)

The purpose of this section is to understand participant experiences of purchasing food for their children prepared outside the home such as at a restaurant or store.

SECTION 5: Attitudes Toward the Concept of “Healthy” and “Healthy Eating” in their Child (15 min.)

The purpose of this section is to gauge perceptions of the word “healthy” as it relates to their child’s eating.

SECTION 6: Perception of “Overweight” and their Child’s Weight. (20 min)

The purpose of this section is to understand parents’ attitudes toward their children’s weight change as well as toward overweight in children more generally.

Section 7: Resources for and Perceived Barriers to Healthy Eating (12 min.)

The purpose of this section is to understand barriers that parents face when trying to help their children eat healthfully, as well as the strategies that parents use to overcome these barriers.

Section 8: Conclusion (5 min)

The moderator wraps up the discussion and ensures that all questions have been answered and all comments have been heard.

_{Section 1: Introduction and Warm-Up (8 min.)}

Thank you for joining us today. I’m _____, and I’m from Fors Marsh Group. We are an applied research company in Arlington, Virginia. We are conducting research on behalf of the U.S. Food and Drug Administration. Today I am going to be asking you to talk about your family’s food and eating behaviors. I understand that this can be a fairly personal topic and I want to emphasize that I am not here to judge you or tell you what’s right or wrong. I’m here to learn from you and hear what you have to say about these topics, so please feel free to speak openly and honestly. Your full participation today is going to help us better understand how people think about and make decisions around food. What you have to say is very important to us and your time today is appreciated. We will have about 90 minutes for our discussion.

Before we begin, I want to review a few ground rules for our discussion.

• There are no right or wrong answers in today’s discussion. We want to know your honest opinions and experiences.

• We are audio and video recording this conversation so that I can give you my full attention and not have to take a lot of notes. In addition, I have a colleague listening to our conversation to take notes so that your opinions are accurately captured. Some project staff from our research team will be watching the discussions from the video recording or in the observation room behind us.

• When writing up our findings, we will not include any information that could identify you. Your name, address, and phone number will not be given to anyone, and no one will contact you about this research after this group is over. Essentially, nothing you say will be tied directly to you. We are interested in what is being said, not who is saying it.

• Everyone’s participation is important; we want to hear from everybody.

• It is OK to disagree.

• Please speak up (speak loudly).

• Please speak one at the time so we can hear all the responses—no side conversations.

• Please turn off your cell phones or anything else that may make it difficult to concentrate.

• If at any point you feel uncomfortable with a question, simply let me know that you prefer not to answer that question. You can also leave the groups at any time.

• In any questions where we ask about “your children” please refer only to your children who are 3-6 years old.

• Finally, please keep an open mind and remain respectful of your fellow participants. This means please do not interrupt people and please keep specifics of what we discuss to yourself after the group.

• Do you have any questions before we begin?

Warm-Up. Thanks again for being here. Everyone in the room has something in common—you are all parents or caregivers of young children. Let’s warm up by going around the room and saying your first name, your children’s ages, and their favorite foods.

_{Section 2: Food Shopping (10 min.)}

RQ1. What are low-income parents’ experiences related to making healthful food choices at the grocery store?

RQ1a. Do these experiences vary by access level?

Let’s talk a little bit more about shopping for food for your family…

1. *Tell me about your experience shopping for groceries.

• Where do you go? E.g. food pantry, convenience store, bodega, dollar store, superstore

• Probe for: Do you usually shop at the closest grocery store to where you live? If not, why?

• Probe for: How often do you go grocery shopping? What factors influence how often you go shopping?

• Probe deeper if mentioned: What barriers do you experience when trying to get to or shop for food at the store? What strategies do you use to overcome these barriers? Do you plan your shopping trips ahead of time (e.g., making a shopping list)?

2. *Now, picture yourself walking into a grocery store and shopping. Walk me through what you do and what you think about.

• Note: If most participants indicate they get groceries primarily from someplace other than a grocery store, have them picture the food section of that store and what they do.

• Probe for: Any sections that you specifically go to or any that you avoid?

• Probe for: From which sections of the grocery store do you typically buy things?

• Probe for: Which types of items do you typically buy?

• *Probe for: What influences your decisions? Does healthfulness of the food item ever affect your decision on what to buy?

_{Section 3: Food Preparation in the Home (10 min.)}

_{RQ2. What are low-income parents’ experiences related to making healthful food choices at home?}

_{RQ2a. Do these experiences vary by access level?}

_{ome (15 min)}

Let’s talk about preparing food for your children in your home. Just reminding you that we’re talking about your children who are 3-6 years old.

3. *Tell me about a typical meal you prepared for your family.

• *Probe: Do you prepare the same foods for young children as for the rest of the family?

• *Probe: What are your priorities when preparing this meal? How does the healthfulness of the meal factor, if at all, into what you prepare?

• (If parents mention picky eaters): You mentioned that your child is a pickier eater; how do you think this affects the food you serve?

• (If parents mention thinking about quantity of food that their child eats): How do you know how much your child should eat?

4. *Tell me about a time where you’ve tried to encourage your child to eat more or less of a certain food. What did you do? Why did you do it? What was the outcome?

_{Section 4: Eating Outside the Home (10 min.)}

RQ3. What are low-income parents’ experiences related to making healthful food choices at restaurants and when serving food prepared outside the home?

RQ3a. Do these experiences vary by access level?

So, now, let’s switch gears slightly from food prepared in the home to serving your children food prepared by any sort of restaurant or store. Grab a post-it note and draw a face that shows me how you feel about taking your kids out to eat. Please hold up your post-it when you’re done (moderator uses this activity to engage people with interesting responses or participants who haven’t spoken much yet).

5. *I see that you drew a ____. Tell me about your typical experiences and routine each week with eating food prepared at a restaurant or store and why you drew this picture?

• Probe: What might be the reasons you choose to take your children to a restaurant or buy prepared food from a store to eat?

• Probe: What types of places do you go to with your children when you eat out or bring prepared food in?

• Probe: Is there a difference between work days and days off? (e.g., sit down vs. fast food/takeout)

6. *When you’re eating restaurant food with your child, tell me about the process of deciding and ordering what your child will eat.

• Probe: What do you think about when helping your child to choose their food? (Adapt depending on whether caregivers decide or help child to choose.)

• Probe for more detail if parent mentions any of the following: to get something the child will enjoy, choosing a meal that will get eaten, to get full, to get nutritional variety, to choose a healthier meal.

• Probe: What about HOW MUCH your child should eat?

  • How do you gauge what is an appropriate amount of food?

_{Section 5: Attitudes toward “Healthy” and “Healthy}

_{Eating” in their Child (15min)}

RQ4. What do low-income parents believe constitutes a healthy, well-fed child?

RQ4a. To what extent does this belief vary by access level?

7. *Thank you for this great discussion so far. So let’s take a step back for a second and think about the word “healthy.” What does this word mean to you?

8. *Now, what words come to mind when you think of a healthy child?

• Note: Moderator writes these words on the board and picks which words to probe on.

• Probe: “Tell me more about that…” for words related to food (well-fed, eats healthy, etc.) and weight (not too heavy, not too thin, strong, good-looking, etc.).

• Probe: What are your thoughts on the connection between the type of food a child eats and that child’s health?

• Probe: What are your thoughts on the connection between eating too much or eating too little and a child’s health?

9. *Describe to me any health concerns that you have about your child related to what they eat.

10. *What does it mean to “feed your child well?” What do you do to make sure your child is fed well?

• Probe: How about eating too much food?

• Note: This is in response to a statement about how a child who is fed well is one who has enough to eat. If this is already adequately answered, do not ask again.

• Probe: Which foods would help your child be “fed well”?

_{Section 6: Perceptions of “Overweight” and their Child’s Weight (20 min.)}

RQ5. What are low-income parents’ attitudes and perceptions related to childhood obesity?

RQ5a. Do these attitudes and perceptions vary by access level?

*Activity. (Moderator passes out figure rating chart). Each of you has a number next to your name, please write that number at the top of your sheet.

As you can see here, there are seven drawings of a boy and seven drawings of a girl, both aged 3-6. For the boy and for the girl…

Please put a circle AROUND the child or children that you think are “fed well.”

Please draw a triangle OVER the child or children that you think look “healthy.”

Please draw a box AROUND the child or children that you think look “overweight.”

Note: Make sure that participants don’t make changes to their charts during this discussion/sharing period. Additionally, ensure that participants understand that they should be identifying at least one boy and girl for each question.

11. *Let’s start with being “fed well,” what did you think about when choosing which children to circle?

• Probe: What was it about the other children that made you think they were not fed well?

• Probe: Which children did you identify as “fed well?”

12. *What about healthy? What did you think about when choosing which children looked healthy to you?

• Probe: What was it about the other children that made you think they were not as healthy?

• Probe: Which children did you identify as “healthy?”

13. *What did you think about when choosing which children looked overweight to you?

    • Probe: Which children did you identify as “overweight?”

14. *Did anybody choose different answers for the boy versus for the girl? If so, tell me about that.

15. *What concerns or thoughts, if any, do you have about YOUR child’s weight change as he or she grows? (If parent mentions having concerns or thoughts about their child’s weight, probe for…)

• Have you ever wanted to change your child’s weight status?

• If so, why? What have you done?

(Collect charts; track by participant/seat number.)

_{Section 7: Resources for and Perceived Barriers to}

_{Healthy Eating (12 min.)}

_{RQ6. What resources (e.g., health professionals, health educators) do low-income parents have to overcome childhood obesity? Additionally, what are their perceived barriers?}

_{RQ6a. To what extent does having lower access to supermarkets exacerbate these barriers?}

_{RQ6b. Are there any cultural differences to these experiences?}

16. *Thank you for a great discussion so far. Who do you talk to as your main source of information on healthy eating and nutrition?

    • Probe: Whose advice do you trust the most?

    • Note: If participants mention “doctor”/”pediatrician”, ask if the doctor ever gave materials on nutrition/eating healthy.

    • Note: If participants mention “internet”/”website”, ask if there is a particular blogger or entity that they follow.

    • Probe: Did you ever make any changes based on the advice you received? If so, what about that advice resonated with you? If not, why not?

    • Probe: What information do you find MOST useful? What information do you find NOT useful? (if not addressed in previous probe)

    • Probe: What other information or resources would help you in helping your children eat more healthy foods?

17. *Some parents report challenges and barriers to getting their young children to eat healthfully and maintain a healthy weight. Tell me about your experience.

    • Probe: What are some of the challenges or barriers that you face? (if not already answered)

    • Probe: What are the consequences of these challenges?

• Probe: What, if anything, might you do to overcome these barriers?

• Probe: Anything else that you have found helpful in encouraging your child eat more healthfully?

_{Section 8: Conclusions (5 min.)}

False Close (5 min)

Thank you very much for participating in this focus group. I appreciate you sharing your time and valuable feedback. Is there anything that you would like to share that you did not have a chance to share yet?

If you will excuse me for just a moment, I would like to check with my team to see if there are any follow-up questions for you. (Moderator goes to back room to see if there are any new questions.)

Close (2 minutes)

Great, I believe we are all done here. Thank you so much for your time!

(Moderator stops recording and directs participants to the assistant who will administer incentives and obtain receipts.)

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