Barriers to Label Use Focus Group Study

Barriers to Label Use Focus Group Study

Appendix II

Moderators Guide

1. Opening remarks: Introduction and Rules, Ice Breaker

Thank you for being here tonight. Today we will be discussing your ideas about ways to maintain good health and preventing disease.

Before we start, let’s go around the room and introduce ourselves. Tell us just your first name, and what you would normally be doing this evening if you weren’t here with us.

2. Introduction: Beliefs about Factors that Contribute to Good Health

OK, now I would like for each of you to share some of your thoughts about what it means to be healthy and some things people can do to stay healthy.

• When you think about “maintaining good health,” what immediately comes to mind?

  • Record responses on a flipchart.

  • Ask respondents to rank the various factors that emerge during the brainstorm session.

  • Have respondents share with the group the items they think are the most important and why.

• Do you ever try to find information about health, or staying healthy? Where do you get your information about staying healthy?

• What about disease? Do the things that you do to stay healthy help prevent certain diseases or reduce your risk of getting certain diseases?

• What types of diseases do you think can be prevented?

• What are some things that might cause you to develop these diseases?

• How, if at all, can such diseases be prevented?

If necessary, guide discussion toward chronic diseases such as diabetes, heart disease, etc., and away from diseases such as colds, and the flu.

• How do you know about these diseases? Where would you turn to learn more about them? How concerned are you about getting these diseases?

3. Thought Exercise

Ok, now I want us to do a little exercise. I’m going to tell you about a situation that you could find yourself in one day. I want you to think about the situation and imagine how you would react, as if it were really happening to you. Then, I’ll ask you to share with the group how you think you would react. Please be honest - and remember that there are no right or wrong answers.

I want you to imagine that you’ve gone to the doctor for a routine checkup. He or she has taken your vitals and measurements and then expresses concern about your future health. You’re OK now, but the doctor thinks that if you don’t make some changes to your daily habits you may be at risk of getting a serious health problem. He says you could find yourself with high blood pressure or diabetes in 10 years or so.

• How familiar are you with these two diseases?

• How might one get high blood pressure or diabetes?

• What kinds of changes do you think the doctor would like you to make to your daily routine?

• How would you react? [Remind participants to be honest as possible, that they should pretend that this is happening today.]

• What types of things would you do?

• If nothing, probe for reasons why.

OK, now I want you to pretend that a few years have passed, and you are at the doctor again for a routine checkup. Now he says that you are “prehypertensive,” that is, your blood pressure is high, but it’s not high enough to be called “hypertension” or “high blood pressure.” The doctor is also concerned that you are pre-diabetic, that is your blood sugar levels are high, but not quite high enough to be called “diabetes.”

• How would you react to this news?

• What types of things would you do? Probe:

  • If changes to diet are mentioned, ask what they would do and why.

  • If exercise, ask if they would make any other changes.

  • If prescription drugs are mentioned, ask if they would also make other changes.

• Would you try to look for information about these conditions? What type of information would you look for? Where would you look for it?

• Would you talk to anyone else about this?

  • Probe: Ask about information sources, e.g., which do they find most trustworthy, which are they most likely to use and why.

 If diet is not mentioned above, add to the scenario the following: The doctor is also recommending that you change your diet. He says that it’s been shown that people who have diets rich in fruits, vegetables, and whole grains and low in saturated fat are less likely to develop these conditions.

• What do you think of this information?

• How, if at all, would you change your diet based on this information? – Probes:

  • Would you increase your intake of fruits and vegetables?

  • Would you try to reduce fats in your diet, especially saturated fats?

  • If so, how would you go about doing that?

  • After you make changes, how likely do you think it will be that you will get better?

• For those who say they would not change their diet – Probes:

  • What are your reasons for not following the doctor’s recommendation?

  • What changes, other than your diet, might you make to reduce your disease risk?

The doctor also says that he could give you some prescriptions to control your blood pressure and reduce your blood sugar levels. They work pretty well, but she or he warns you that there are side effects from the drugs. It’s also not certain if the drugs intended to reduce blood sugar actually reduces your risk of getting diabetes, or if it just delays when you actually get diabetes.

• If given the option between taking a pill and improving your diet, which would you choose? Why? What are the pros and cons of each option?

Probe: If difficulty of changing diet is mentioned, ask what makes changing diet so hard? What would help make it easier?

• What do you think of this information? – Probes:

  • If someone asks about side effects, read from a list of potential side effects (see beta-blockers, glucosidase inhibitors). Get reactions.

  • How would you react?

4. Food choices

If foods were discussed at length in the above scenario, then say “Let’s talk a little more about foods and how they might affect disease.”

If foods were only briefly discussed in the scenario, then say “I noticed that there wasn’t much discussion about foods in our thought exercise. Let’s talk about this for a little bit.”

• In your opinion, what role does one’s diet play in preventing or causing the onset of chronic diseases?

• Probe: if people say that diet cannot reduce the risk of a disease, determine why they have this belief, and ask if they believe there is any way to reduce the risk of a disease.

• What foods might help reduce the risk of disease?

• How about foods that might increase the risk of disease?

• What is in these foods that might reduce or increase the risk of diseases?

• Probe: What sorts of nutrients may contribute to the onset or prevention of such diseases?

• Are there other things we can do about our diet to reduce the risk of disease? What diseases?

Now let us discuss how you make food choices.

1. How often do you go grocery shopping?

2. How about eating out?

3. What kinds of foods do you eat on a regular basis?

4. How do you decide what foods to buy or eat?

5. What things are the most important for choosing the foods you buy?

   1. Record items on flipchart.

6. How do you choose between different brands of the same type of food, for example between different brands of crackers or potato chips?

7. When, if ever, do you think about your health when you make your food choices?

8. For you personally, how important or unimportant is it to choose foods that are “healthy” or “nutritious?” What makes it important/unimportant to you?

9. How do you decide if a food is “healthy” or “nutritious?”

10. Do you ever look for health and nutrition information about which foods to eat and which to avoid?

    1. If yes, where do you usually look for this information? Where else could you find this information?

    2. If no, why don’t you look for this information?

4. Food Labels

When you were asked to join us for this group, you told us that you rarely or never use the food label when buying a food for the first time. Let’s talk about this for a few minutes.

• What did you think of when we asked about the food label?

• Why did you say that you rarely use the food label?

• If NFP, ask why they don’t use it?

  • Probes : difficult to use, not relevant, not useful.

[Distribute mock packages of food]

Here are some packaged foods that have labels – these are foods that you won’t buy at the deli counter, or in fresh fruits and vegetables, or self serve items.

• Is there any information at all on the food package you consider important?

• If yes – what information?

  • Probe for details.

• Have you ever used the food label in making your packaged food choice decision?

• When you did so, what label information did you use?

  • Probe for details.

• Why did you use that piece of information?

• Have you ever tried to use the label to determine if a packaged product is healthy?

• If yes, what information did you use to see if it was healthy?

  • Probe for details. Health claims? Other claims? The NFP?

[SHOW ENLARGED EXAMPLE OF NFP]

Many of you may have already seen this on the label. This is the part of the label called the Nutrition Facts Panel.

• Have you ever used this part of the food label to help you make a decision?

• Why or why not?

  • Probes : difficult to use, not relevant, not useful

• Why do you think this nutrition information is found on packages?

• Based on what you know, do you believe this is mandatory or voluntary labeling?

  • Probe: if respondents say “mandatory,” ask who requires this labeling.

• Who do you think would find this type of information is important or helpful?

• For those people you think would find this important, what information do you think would be of greatest interest to them? Why? What information is less important or unimportant to you? Why?

Probe for reasons:

• Do recall ever being taught in school or elsewhere about how to use the information on this label?

  • Probe: If not, ask how they learned how to use the label information.

• Do you find this information easy to use?

• Would changing information on food labels help? If so, what information would you want to see?

6. Wrap-up

OK, now that we’ve talk about food choices and the food label. Let’s think about our scenario again.

• Do you think that knowing more about the food label would help you if you found yourself in the situation we described earlier? [Refresh memory of scenario, if necessary.]

  • If yes, how? Would you be more likely to use the label in that situation?

  • If no, why not? Would anything change about how you reacted to the scenario before?

Before closing for the evening, does anyone have any final thoughts or comments that they would like to share?

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