KAB for Antibiotic Use - discussion guides

ATTACHMENT 5: Discussion Guides

Discussion Guide: Mothers of young children

Form Approved

OMB No. 0920-0798

Exp:01/31/2011

research objectives

Explore knowledge, attitudes and experiences of the public related to:

• the appropriate use of antibiotics for upper respiratory infections

• benefits and risks (including complications/reactions and antibiotic resistance)

• current and future education efforts about antibiotic use (messages, communication tools, sources, openings, and message vehicles)

Introduction 10 minutes

Hello everyone, this is MODERATOR’S NAME, can everyone hear me clearly? ... As you know, we’re here to learn from you about your experiences with caring for your children when they don’t feel well. All of you have at least one child between the age of two and twelve. So, today/tonight we want to hear from you about your experiences with them when they get some common illnesses or infections.

First, let’s introduce everyone on the line, so we all know who is here. Then I’ll talk about more about the nature and purpose of this discussion. And then we’ll get right into the fun, discussion part of your session as quickly as possible. When I call your first name -- LET’S USE FIRST NAMES, THIS IS INFORMAL and secure -- please tell me if that’s the first name you’d like us to call you or what is. And don’t let me mispronounce your name. Also, please tell us what part of the United States you’re in.

[CALL NAMES]

Public reporting burden of this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798).

Some tips for getting the most out of the session. When you have something to say, jump right in; don’t wait to be called on. I can’t see you raising your hand, so please jump right in.

When you speak, please say your name in the first sentence, so people can respond to you.

And please feel free to talk to each other, not just to me. Agree, disagree, expand on what people say. That’s why we’re talking in a group: to get your reactions to each other’s ideas. AGREE? LET’S HEAR A CHORUS.

Let’s hear from as many people as possible.

Call waiting or another line. Please try to stay with us during the discussion, and don’t take other calls. As you know, we are planning the discussion to take about 90 minutes.

Any questions?

Oh, one last thing, a legal technicality: audio recording for research only. Nobody outside this group will ever know from us what you, personally, said. Some of my research team is also observing to help with the report.

OK, now it’s your turn to talk and I’ll sit back and listen. Let’s start with...

Dealing with children’s (URI) symptoms 10 minutes

1. … some common symptoms of illness respiratory infections your child(ren) has(have) had? Everyone jump in and name ONE.

3. [IF NOT MENTIONED, PROBE]:

• coughing

• congestion

• runny or stuffed nose

• ear pain

• sore throat

• pressure or pain around the head, eyes, or cheeks

4. What would you call this collection of symptoms? (Have you ever heard of “upper respiratory infections”?)
   
   

5. What do you THINK when you see these kinds of symptoms in your child?

Probe:

• It could be something serious (What could it be?)

• He/she can’t afford to miss school

• I can’t afford to miss work

• What else?

6. What do you DO?

Probe:

• Call your child’s doctor?

• Wait to see if it clears up?

  • What do you wait for and how long?

  • What do you do to help your child in the meantime?

With the doctor 15 minutes

1. What in particular prompts you to call the doctor for URI symptoms? Think back to the last time you did, Which URI symptoms prompt you to call your child’s doctor?

• Some symptoms in particular (for example, runny nose compared with a sore throat)?

• The symptoms don’t go away in a few days? A week? How long?

• Symptoms get worse?

• More symptoms appear?

• High fever

[IF NOT MENTIONED]: Do/did you expect or want an antibiotic?

IF YES: What makes/made you expect or want it?

• Symptoms, as above

• Needed to get child back to school/ self back to work

• For child to feel better faster after taking antibiotics?

• Make the disease no longer contagious?

• Prevent him/her from developing a secondary infection, such as pneumonia?

• Received an antibiotic last time

• What else?

IF NO: What else did you expect or want? Why?

• Excuse letter for school (or mom’s work)

• Suggested other medicines to relieve symptoms

• Reassurance that it’s not serious

• Clear explanation

• What else?

2. Has a doctor ever refused to write you a prescription for an antibiotic for your child’s URI?

   • Ask why

   • Insist, persist

   • Find it elsewhere

   • Do what doc says (What’s that?)

3. When your doctor prescribes an antibiotic for a URI, what does he or she say about it and what do you say about it?

Complications/reactions to antibiotics 15 minutes

1. Do you think antibiotics could harm your child/children? How? (Complications (Which?),

IF YES: How?

• Diarrhea

• Cramps

• Mild fever

• Rash

• Allergic reaction (which? How severe?)

• Antibioti resistance (individual, community)

• Other? What?

2. IF NOT YET MENTIONED: Has your doctor, pharmacist, or anyone else other than your doctor talked with you about the possibility of reactions or complications related to antibiotics?

IF YES:

• Who?

• How did you ask him/her or how did he/she bring it up?

• What did he/she tell you?

• What did you think about that?

• Who else? (REPEAT ABOVE QUESTIONS AS NEEDED FOR EVERY KIND OF PERSON NAMED)

Desired Information 15 minutes

1. Now, what more do you wish you knew about antibiotics for upper respiratory infections for your children?

PROBE EXHAUSTIVELY

2. Where would this kind of information be placed

• So that you would most likely come across it even if you weren’t looking? (Which web site(s)? TV programs Radio programs (which?) Magazines? Newspapers? )

• If you were looking?

3. From whom do you wish to hear it?

   • Which organizations (Private? Governmental?)

   • Which professionals?

   • Which people (friends or relatives with experience/knowledge)?

CURRENT AND FUTURE EDUCATION EFFORTS 20 minutes

Now, let’s get your reactions to some possible sample messages about antibiotics. Please open the page marked [CODE]. We need your honest reactions; I didn’t write any of these so I won’t take any of these comments personally. I’m going to read it aloud while you follow along in silence. …

[AFTER READING:]

1. First I’d like to get some overall reactions. Then we’ll go through it in more detail. What are your first impressions – thoughts and feelings as you were hearing and reading it:

• What jumps out at you?

• What is the main point?

• How does it make you feel?

2. Now, please take a moment to review this page. As you do so,

• Think about what’s important here. Put a plus sign to the left of any point that you consider IMPORTANT.

• Next, look over the plus-marked points and pick the TWO MOST IMPORTANT.

• Let’s talk: Name ONE of the two you just picked and what made you pick it [EVERYONE GETS TWO TURNS]

3. Considering this whole page …

• What, if anything, was hard to understand?

• What, if anything, hard to believe?

• What unanswered questions do you have?

• How does it make you feel? (Scared? Better prepared? etc.)

REPEAT FOR NEXT MESSAGE

AFTER ALL MESSAGES HAVE BEEN COVERED:

4. Of the two messages we have discussed,

• Which most caught your attention? What made it do that?

• If you had a friend or relative who is concerned about her child’s health which message would you most likely share with her? How would this help her?

PROBE:

• Put her at ease?

• Raise important concerns?

• Give her needed information (to do what?)

5. After discussing antibiotics for URIs with this group, what, if anything, has changed in your thinking?

Probe:

• Insisting that your doctor prescribe an antibiotic for your child’s runny nose, cough, or sore throat?

• Sending your child to daycare or school with a runny nose, cough, or sore throat after starting to take an antibiotic?

• A daycare or school that permit children to return if they have taken an antibiotic, even if they have URI symptoms such as a runny nose, cough, fever, or sore throat?

6. Overall, would prefer to encounter this message:

• In print? (read) (Where?)

• Hear on the radio? (What kind of program?)

• See on TV? (What kind of program?)

• See on the Internet?

• Handed to you by your doctor?

• Somewhere else (Where)?

CHECK IN WITH OBSERVERS

Wrap-up 5 minutes

1. What else do you want to know about the risks and benefits of antibiotics for upper respiratory infections for children?

2. [INTERVIEWER CLEARS UP ANY RISKY MISPERCEPTIONS]

3. For additional information, please visit http://www.cdc.gov/getsmart

4. Remind of payment

5. THANK AND END

Discussion Guide: HEALTHY ADULTS

RESEARCH objectives

Explore knowledge, attitudes and experiences of the public related to:

• the appropriate use of antibiotics for upper respiratory infections

• benefits and risks (including complications/reactions and antibiotic resistance)

• current and future education efforts about antibiotic use (messages, communication tools, sources, openings, and message vehicles)

Introduction 10 minutes

Hello everyone, this is MODERATOR’S NAME, can everyone hear me clearly? ... As you know, we’re here to hear from you about your experiences with health related issues. All of you at some point in your life have had a cold, sore throat, cough, etc. So, tonight we want to hear from you about your experiences with that.

First, let’s introduce everyone on the line, so we all know who is here. Then I’ll talk about more about the nature and purpose of this discussion. And then we’ll get right into the fun, discussion part of your session as quickly as possible. When I call your first name -- LET’S USE FIRST NAMES, THIS IS INFORMAL and secure -- please tell me if that’s the first name you’d like us to call you or what is. And don’t let me mispronounce your name. Also, please tell us what part of the United States you’re in.

[CALL NAMES]

Some tips for getting the most out of the session. When you have something to say, jump right in; don’t wait to be called on. I can’t see you raising your hand, so please jump right in.

When you speak, please say your name in the first sentence, so people can respond to you.

And please feel free to talk to each other, not just to me. Agree, disagree, and expand on what people say. That’s why we’re talking in a group: to get your reactions to each other’s ideas. AGREE? LET’S HEAR A CHORUS.

Let’s hear from as many people as possible.

Call waiting or another line. Please try to stay with us during the discussion, and don’t take other calls. As you know, we are planning the discussion to take about 90 minutes.

Any questions?

Oh, one last thing, a legal technicality: audio recording for research only. Nobody outside this group will ever know from us what you, personally, said. Some of my research team is also observing to help with the report.

OK, now it’s your turn to talk and I’ll sit back and listen. Let’s start with...

Dealing with (URI) symptoms 10 minutes

1. … some common symptoms of illness you get? Everyone jump in and name ONE.

[IF NOT MENTIONED, PROBE]:

• coughing

• congestion

• runny or stuffed nose

• ear pain

• sore throat

• pressure or pain around the head, eyes, or cheeks

2. What would you call this collection of symptoms? (Have you ever heard of “upper respiratory infections?”)
   
   

3. What do you do when you have these kinds of symptoms?

Probe:

• Wait to see if it clears up?

  • What do you wait for and how long?

  • What do you do about the symptoms in the meantime?

With the doctor 15 minutes

1. What in particular prompts you to call the doctor for URI symptoms for yourself? Think back to the last time you did.

• Some symptoms in particular (for example, runny nose compared with a sore throat)?

• The symptoms don’t go away in a few days? A week? How long?

• Symptoms get worse?

• More symptoms appear?

[IF NOT MENTIONED]: Do/did you expect or want an antibiotic?

IF YES: What makes/made you expect or want it?

• Symptoms, as above?

• Needed to get to school/work?

• To feel better faster after taking antibiotics?

• Make the disease no longer contagious?

• Prevent a secondary infection, such as pneumonia?

• What else?

IF NO: What else did you expect or want? Why?

• Excuse letter for school (or your work)

• Suggested other medicines to relieve symptoms

• Reassurance that it’s not serious

• What else?

• Is this different for a child of yours over seven years old? How?

3. Has a doctor ever refused to write you a prescription for an antibiotic? What do you do -- or would you do -- if the doctor won’t prescribe an antibiotic for your URI?

• Ask why

• Insist, persist

• Find it elsewhere

• Do what doc says (What’s that?)

• When your doctor prescribes an antibiotic for a URI or does not, what does he or she say about it and what do you say about it?

Complications/reactions to antibiotics 15 minutes

1. Do you think antibiotics could harm you? How? Complications? Which?

IF YES: How?

• Diarrhea

• Cramps

• Mild fever

• Rash

• Allergic reaction (Which? How severe?)

• Antibiotic resistance (individual, community)

• Other? What?

2. IF NOT YET MENTIONED: Has your doctor, pharmacist or anyone else other than your doctor talked with you about possible reactions or complications from antibiotics?

IF YES:

• Who?

• How did you ask him/her or how did he/she bring it up?

• What did he/she tell you?

• What did you think about that?

With whom else did you discuss reactions or complications from antibiotics? (REPEAT ABOVE QUESTIONS AS NEEDED FOR EVERY KIND OF PERSON NAMED)

Desired Information 15 minutes

1. Now, what more do you wish you knew about the risks and benefits of antibiotics for upper respiratory infections?

PROBE EXHAUSTIVELY

2. Where would this kind of information be placed?

• So that you would most likely come across it even if you weren’t looking? (Which web site(s)? TV programs Radio programs (which?) Magazines? Newspapers?)

• If you were looking?

3. From whom do you wish to hear it?

   • Which organizations? (Private? Governmental?)

   • Which professionals?

• Which people? (Friends or relatives with experience/knowledge)

CURRENT AND FUTURE EDUCATION EFFORTS 20 minutes

Now, let’s get your reactions to some possible sample messages about antibiotics. Please open the page marked [CODE]. We need your honest reactions; I didn’t write any of these so I won’t take any of these comments personally. I’m going to read it aloud while you follow along in silence. …

[AFTER READING:]

1. First I’d like to get some overall reactions. Then we’ll go through it in more detail. What are your first impressions – thoughts and feelings as you were hearing and reading it:

• What jumps out at you?

• What is the main point?

• How does it make you feel?

2. Now, please take a moment to review this page. As you do so,

• Think about what’s important here. Put a plus sign to the left of any point that you consider IMPORTANT.

• Next, look over the plus-marked points and pick the TWO MOST IMPORTANT.

• Let’s talk: Name ONE of the two you just picked and what made you pick it? [EVERYONE GETS TWO TURNS.]

3. Considering this whole page …

• What, if anything, was hard to understand?

• What, if anything, hard to believe?

• What unanswered questions do you have?

• How does it make you feel? (Scared? Better prepared? etc.)

REPEAT FOR NEXT MESSAGE

AFTER ALL MESSAGES HAVE BEEN COVERED:

4. Of the two messages, we have discussed

• Which most caught your attention? What made it do that?

• If you had a friend or relative who is concerned about her child’s health, which message would you most likely share with her? How would this help her?

PROBE:

• Put her at ease?

• Raise important concerns?

• Give her needed information (to do what?)

5. After discussing antibiotics for URIs with this group, what, if anything, has changed in your thinking? …

Probe:

• Insisting that your doctor prescribe an antibiotic for your child’s runny nose, cough, or sore throat?

• Sending your child to daycare or school with a runny nose, cough, or sore throat after starting to take an antibiotic?

• A daycare or school that permit children to return if they have taken an antibiotic, even if they have URI symptoms such as a runny nose, cough, fever, or sore throat?

6. Overall, would prefer to encounter this message:

• In print? (read) (Where?)

• Hear on the radio? (What kind of program?)

• See on TV? (What kind of program?)

• See on the Internet?

• Handed to you by your doctor?

• Somewhere else (Where?)

CHECK IN WITH OBSERVERS

Wrap-up 5 minutes

1. What else do you want to know about the risks and benefits of antibiotics for upper respiratory infections for children?

2. [INTERVIEWER CLEARS UP ANY RISKY MISPERCEPTIONS]

3. For additional information, please visit http://www.cdc.gov/getsmart

4. Remind of payment

5. THANK AND END

C-0