Justification After You Deliver

SUBJECT: Under Approved Generic OMB Clearance No. 0584-0524

Request Approval to Perform Formative Research –

“After You Deliver” Focus Groups

TO: Karen Matsuoka, OMB Desk Officer, Food and Nutrition Service

THROUGH: Rachelle Ragland-Greene, Food and Nutrition Service, Information Clearance

Officer

FROM: Patricia N. Daniels, Director, Supplemental Foods Programs Division,

USDA – Food and Nutrition Service

The Food and Nutrition Service (FNS) of the USDA Food, Nutrition and Consumer Services is requesting approval for formative research under Approved Generic OMB Clearance No. 0584-0524.

The following information is provided for your review:

1. Title of Project: “After You Deliver” Focus Groups

2. Control Number: 0584-0524

3. Public affected by this Project: Low-income women, currently participating or a recent participant (in last 6 months) in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) will be asked for feedback on the English and Spanish versions of the WIC brochure “After You Deliver” (Program Aid number 1602, December 1997). Qualitative research will be conducted in Denton, Maryland, Brooklyn and New York City, New York and Los Angeles and Irwindale, California. In each location, one focus group will be conducted.

4. Number of respondents: In each city, a total of 15 women will participate for a grand total of 75 respondents.

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TEST GROUPS BY Gender, Race and Ethnicity (per location)

GROUP	GENDER	RACE	ETHNICITY	LOCATION
1	15 Female	Black or African American	Not Hispanic or Latino	New York
2	15 Female	Asian	Not Hispanic or Latino	California
3	15 Female	White	Not Hispanic or Latino	Maryland
4	15 Female	Hispanic or Latino	Hispanic or Latino	California
5	15 Female	Hispanic or Latino	Hispanic or Latino	New York
TOTAL 5	FEMALES: 75

5. Time needed per Response: FNS intends to have a maximum of 15 participants per focus group. There will be five focus groups conducted (75 participants). In order to achieve the desired number of participants, it is standard practice to screen three times the desired number (3 x 15 = 45 x 5 groups = 225) as many of the women screened will not qualify for participation for one reason or another. The focus group sessions are two-hour sessions.

10 minutes per screening interview estimated

120 minutes per focus group respondent

6. Total Burden Hours on Public: Of the 225 women that initially begin the screening process, 11 women will refuse the screen and 214 will complete the process. Seventy-five women from those that complete the screen will be selected to participate in the focus group session.

WIC participants screening interview and focus group session (75 respondents x 1 annual responses x 2.171 burden hours = 162.825)

WIC participants screening interview only (139 respondents x 1 annual response x 0.167 burden hours = 23.213)

WIC participants screening non-response (11 respondents x 1 annual response x 0.0501 burden hours = 0.5511)

Total Annual Burden Hours = 186.038

7. Project Purpose, Methodology and Design:

Background

WIC serves to safeguard the health of low-income women, infants and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care. The nutrition education provided to Program participants Karen Matsuoka

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helps participants to achieve a positive change in dietary and physical activity behavior that would continue even after participation in WIC has ended. WIC helps parents and caregivers make healthy food choices and lifestyle changes through the provision of nutrition education, nutritious supplemental foods and referrals to other health and social services. WIC nutrition education is considered a benefit of Program participation and is provided at no cost to the participant. WIC nutrition education is designed to be easily understood by participants, and it

should bear a practical relationship to participants’ nutritional need, cultural preference and household situation.

Project Purpose, Methodology and Design

Purpose

The overall goal of the project is to revise the English and Spanish versions of the WIC brochure “After You Deliver” (Program Aid number 1602, December 1997) to be consistent with key national nutrition policy and to incorporate a more client-centered approach to the key messages from the brochure. The purpose of the brochure is as an exit brochure for participants who are graduating from the WIC Program and is intended to reinforce a healthy lifestyle and dietary choices. The original brochure was developed in response to a congressional mandate set forth in the House Appropriations Committee’s Report accompanying the Fiscal Year 1994 Agriculture, Rural Development, Food and Drug Administration, and related Agencies Appropriations Act (Public Law 103-111), to provide information to the participating WIC mother who was “graduating” from WIC so that the important health information received through WIC participation were reinforced as she leaves the Program. The current brochure

includes legislatively required themes, such as the importance of eating right and avoiding tobacco, alcohol and other drugs. The target audience is postpartum WIC mothers.

Methodology

Design/Sampling Procedures

A total of five 2-hour focus group sessions will be held. Each session will have a maximum of 15 female participants. The five groups will include: Black or African American (not Hispanic or Latino), Asian (not Hispanic or Latino), White (not Hispanic or Latino), Hispanic/Latino (Spanish-speaking only); and Hispanic/Latino (bilingual). Race and ethnicity are both screening criteria that will be used to screen participants “in” or “out” of the focus groups. The groups will provide valuable cultural perspective for the update of the brochure. The Contractor, using the “scripted” Participant Screening Questionnaire (Attachment A), will screen and select focus group participants. A moderator, fluent in both English and Spanish, will facilitate each focus group session to solicit participants’ opinions and suggestions about the content and graphic elements of the “After You Deliver” Brochure. The moderator will facilitate the session using the “scripted” Focus Group Moderator’s Guide (Attachment B) to ensure all groups are asked the same questions. An on-site note taker will manually record the responses from each session. In addition, each session will be audio recorded. The note taker will compile and analyze data from Karen Matsuoka

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all focus groups and produce a written report, including an executive summary, key findings, and recommendations.

Site Selection

In order to achieve a broad spectrum encompassing geographic, racial/ethnic representation, and urban/suburban locations, the Contractor will conduct focus groups in two regions of the country.

• Los Angeles and Irwindale, California, provides a western urban and suburban sampling

• Brooklyn and New York City, New York, provides an eastern urban sampling

• Denton, Maryland provides an eastern rural sampling.

Recruitment of Participants

The Contractor will work with local agency contacts to promote the study and recruit focus group participants. The Contractor will design a promotional flyer containing pertinent details about the study and submit it to local agency contacts for them to display and distribute to WIC Program participants. Interested WIC participants will contact the Contractor via phone or email regarding their interest in participating in the study. The Contractor will use the Participant Screening Questionnaire via telephone with interested participants to determine that they meet the eligibility criteria and to obtain their consent to participate in the focus group. Participants will receive a cash stipend in the amount of $75.00 intended to reimburse them for expenses such as transportation and childcare costs related to their attending the sessions.

The stipend amount proposed is a standard, acceptable, “fair market” stipend for the target population of WIC participants/low-income persons. In order to obtain reliable data, the focus group sessions will need to have a high participation rate in each group. USDA/FNS is asking WIC participants for two hours of their personal time to provide critical information from the “end user” perspective about the brochure “After You Deliver” and to travel to and from the focus group site. Feedback and input from the actual target audience of the brochure will be more accurate and valuable to updates that meet the needs of a culturally varied WIC audience. The purpose of the stipend is to enable WIC participants, who have low-income status, to afford the cost of childcare and transportation (the two biggest barriers to participation) plus moderate compensation for their time and information.

This screening questionnaire covers all questions to be used in the selection process.

Focus Group Sessions

The Contractor will conduct five focus group sessions (one in each city listed above) to obtain target audience feedback about the content and graphic elements of the “After You Deliver” brochure. Focus group testing will be done at a local research facility or the WIC agency in each

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city. Each focus group session will last two hours. The feedback will be used to revise the

current brochure to make it more client-centered for the target audience. Upon arrival to the focus group session, each participant will be asked to sign in on the attendance roster. The Focus Group Moderator’s Guide will be used by the moderator to guide each group’s conversation during the sessions. Each session will be audio recorded, and a note taker will be present to manually record

participants’ comments as well. At the conclusion of the session, each participant will be given a $75 stipend for their participation.

Focus groups are ideal to measure reactions to the proposed changes to the “After You Deliver” brochure as they generate group discussions, which stimulate feedback.

Data Analysis

All discussions will be audio recorded and manually recorded, and reviewed by the Contractor. A summary report of common themes and feedback will be submitted to FNS from the focus group sessions. Reactions to the elements of the brochure such as content, readability, design, flow of information, cultural concerns and volume and usefulness of information, will be synthesized by reviewing all of the discussion groups. No attempt will be made to generalize the findings to be nationally representative or statistically valid.

Outcome

Information and formative input data gathered from participants will help FNS update the brochure to be consistent with national nutrition policy and to incorporate a more client-centered approach to the key messages in the brochure. Data collected will be used only for purposes outlined and will not be published.

7. Federal Costs: Contract costs, formative research task $75,000

7. Requested Approval Date:

7. Formative Research Tools:

Attachment A: Participant Screener Guide (English and Spanish)

Attachment B: Focus Group Moderator Guide (English and Spanish)

Attachment C: Confidentiality Statement (English and Spanish)

Attachment D: Recruitment Flyer (English and Spanish)

FINAL:FNS:SFPD:PPDB:Anne.Bartholomew:sl:02/20/08:703-305-2747

Redraft: 2/19/08

DOC: PUB-4

I/PPDB/Anne/nutrition education folder/After You Deliver subfolder/clearance memo