Form 0990-0281 Focus Group Moderator's Guide

Form Approved

OMB No. 0990-0281

Exp. Date XX/XX/XX12

ODPHP/AIR Focus Groups on Dietary Guidelines for Americans

Moderator’s Guide

INSTRUCTIONS TO MODERATOR

MODERATOR: This is a GUIDE only. It is not a script from which you will read questions verbatim. You should adapt the order of the questions to best suit the dynamics of the group and comments from participants.

Objectives: To explore beliefs, attitudes and behaviors related to healthy eating among adults with low health literacy and assess ways to better communicate healthy eating guidelines to this audience.

Materials: Flipchart, test messages, visuals related to food portions.

Organization:

I. Introduction and Ice-Breaker 15 minutes

II. Making Food Decisions 20 minutes

3. Understanding Barriers, Motivators and Behaviors 30 minutes

4. Understanding and Use of Foods 25 minutes

5. Visualizing Food Portions 10 minutes

6. Actionable Goals and Messages 15 minutes

7. Closing 5 minutes

Total time: 120 minutes

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0281. The time required to complete this information collection is estimated to average 120 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

FOCUS GROUP GUIDE

I. INTRODUCTION AND ICE-BREAKER (15 mIN.)

Hi, my name is _______ and I work for the American Institutes for Research (AIR). Thanks for coming. AIR is helping the United States Department of Health and Human Services to hold these discussions here and in other cities. They want to learn about your thoughts and experiences related to eating for better health. The Department of Health and Human Services is developing some materials to let Americans know about new recommendations for healthy eating that will be announced later in the year. What they decide to do will be partly based on these discussions, so your contributions are VERY IMPORTANT.

Before we begin, I’d like to explain a few things about how the discussion group will work.

[LOGISTICS]

• Restrooms

• Refreshments

• Turn off cell phones & pagers

[PROCEDURES]

First, I am going to ask you several questions about different topics on which I will ask you to share your thoughts and experiences. We will also share with you several pictures or diagrams related to healthy eating and ask you about them. Finally, we will review several ways to tell people about the guidelines and ask for your opinion. Before we finish the group, I will ask you to fill out a short form with some questions.

You may have noticed that there is a microphone and a video camera. We will be recording the discussion group. Behind me is a one-way mirror. Some of the people working on this project are in the next room. This allows them to hear your opinions directly from you. Some of them may be taking notes.

I will use the notes and the recordings to help me with a report that I have to write about these discussions. However, we will not include your name, address or phone numbers in any of the notes or the report. Also, we will not give this information to anyone. Everything that you say here will be kept private. So, feel free to say what you really think and feel.

Please speak one at a time so that we can all hear each other clearly. Speak at least as loudly as I am speaking now so the recording comes out clear. The recording is only for the use of the people working on this study. We will destroy all the notes and recordings by October 2011.

I am not an employee of the Department of Health and Human Services. So, I am not going to feel bad if you tell me that you do not like something. There is nothing you can say that will offend me. It helps me to do a good job if you tell me what you honestly think, so I know what kind of information is most useful and what ideas work or don’t work.

You do not have to answer every question I ask. But, I would like to hear from everyone at different points in the discussion. There are not right or wrong answers. All of your comments—whether positive or negative—are welcome. Negative comments or those that tell us about what is missing or what is wrong are sometimes more useful than positive comments.

The discussion group will last about two hours. Sometimes, I will let the group know that we need to move on to another topic. There are a lot of things I need to get your input on and I want to make sure that there is enough time to discuss them all.

Do you have any questions?

[ICE-BREAKER]

Let’s start by introducing ourselves. Here we will use only first names. So, let’s go around the table. Tell us:

• Your first name

• What is your favorite food and what do you especially like about it?

II. Making Food Decisions (20 min.)

Let’s get started and talk about how we make decisions about food.

1. How do you decide what to eat and what not to eat? What makes you eat one thing and not another?

(It might help you to think about how you decided what to eat this week or yesterday or at breakfast, lunch, or dinner)

1. Do you usually decide what to eat ahead of time or do you pretty much decide on the spot?

2. Do you sometimes plan your meals and other times decide bite by bite? Why do you think that is? What are some of the things that sometimes allow you to plan and others not?

3. Are there other people who influence what you plan to eat or what you decide to eat at a certain time?

4. Do you decide what to eat based mostly on your own needs, or, are there other people that you also need to think about? Who?

2. If or when you plan out your meals ahead of time, how do you actually go about it? What do you do to plan them?

[Do you usually plan what you are going to eat for a whole week, for the next day, or from meal to meal?]

III. Understanding Barriers, Motivators and Behaviors (30 min.)

OK, let’s talk more about food and some of the other reasons why you choose certain foods and not others.

3. What do you think of when I say “healthy eating”? What does “healthy eating” or “eating healthy” mean to you?

4. When did you first hear about “healthy eating”? How did you hear about it?

5. How does “healthy eating” or thinking about health affect what you, personally, decide to eat?

6. What kind of things are you doing now to help you eat healthier and make better food choices?

[PROBE FOR SPECIFIC ACTIONS RELATED TO:]

1. Shopping for food

2. Preparing foods

3. Eating out

7. What gets in the way when you try to choose healthier foods?

8. What makes it easier for you to choose healthier foods?

9. Who can you turn to for support to help you eat healthier foods? 

   1. Who would you trust to help you with this (among the persons you know)? 

   2. Who would not be helpful or would discourage you from eating healthy? 

   3. Where else would you turn for information?

10. How does wanting to stay at the same weight or lose weight affect what you decide to eat?

1. What are some of the ways you know if a food is more “fattening” than another? Do you think about calories? [Carbohydrates? fat? fiber?]

IV. Understanding and Use of Foods (25 min.)

Let’s move now to talk about types of foods.

[HAVE LIST(S) ON FLIPCHART- SIDE by SIDE- AND READ ALOUD]

FOODS:

• Fruits

• Vegetables

• Whole grains

• Alcoholic beverages

THINGS ABOUT FOODS:

• Calcium-rich foods

• Protein

• Fats

• Salt

• Sugars

11. Let’s look at the first list of foods. What does each of these [fruits, vegetables, whole grains, alcoholic beverages] mean to you?

    1. Can you give me some examples of each one [fruits, vegetables, whole grains, alcoholic beverages]?

    2. For which ones are you not sure what it means? [Probe for “Whole Grains”]

12. Let’s look at the second list of things about foods. What does each of these [calcium-rich foods, protein, fats, salt, sugars] mean to you?

    1. Can you give me some examples of foods high in [mention items on the list]?

13. In terms of fat, what do “good fats” mean to you? What about “bad fats”?

    1. How about non-fat foods? Examples?

    2. What about low-fat foods? Examples?

14. Now look at both lists. How do the things listed here relate to healthy eating or choosing healthy foods?

15. Are you making changes [OR planning to make changes- CHOOSE DEPENDING ON GROUP SEGMENT] about anything that is on the list?

1. For example, are you trying to eat [planning to eat] more of some of these or eat less of some of these? [ONLY IF NEEDED: For example, eating more fruits, reducing foods high in fat]

2. Are there any other changes you are making or [planning to make] with respect to the food you eat?

16. Which foods or aspects about food on these 2 lists do you want to get more information about? [GO THROUGH EACH LIST SEPARATELY]

    1. How would you go about finding out more information about each of these?

V. Visualizing Food Portions (10 min.)

Thanks, your comments and ideas are very helpful. Let’s talk now about food portions. One of the ways we can make healthier choices is by eating the right amount of each food. However, we can’t always measure exactly how much we served ourselves

They say that a picture can be worth 1,000 words. I am going to share with you several drawings or pictures. They are supposed to help people choose the right amounts of food they should eat. We have heard that these pictures don’t always work. I would like to know whether these work for you or not.

[SHOW EACH VISUAL SEPARATELY ON FLIPCHART OR SCREEN, HAND OUT COPIES, AND ASK THE FOLLOWING QUESTIONS.]

17. In your own words, what does this picture or drawing tell you? What does the picture or drawing mean?

18. Does the picture or drawing help you understand better how much you should eat of certain foods to be healthy? How does it do that?

1. Is any part of this picture or drawing confusing?

2. What are some ways they could make this picture or diagram easier for you to understand?

19. If you saw this picture in a booklet or a Web site, would it grab your attention? Why/Why not?

[MOVE TO NEXT IMAGE AND FOLLOW THE SAME PROCEDURES. REMIND PARTICIPANTS TO THINK OF EACH IMAGE SEPARATELY.]

[PRESENT ALL VISUALS TOGETHER AND HANDOUT PAGE WITH ALL OF THEM]

Comparison of Visuals

OK, I just handed out a piece of paper with small versions of each of the drawings we just discussed. Take a few minutes to yourself, look these over and draw a circle around the picture that is the easiest for you to understand. Then, go ahead and look over them again and put an X over the picture that YOU like the best. [DEMONSTRATE] It could be the same one or a different one.

20. OK, so which one of these drawings did you think was easiest to understand? Why? What makes it easier to understand?

21. Which one do you like best? Is it the same one? What do you like about it?

VI. Actionable Goals and Messages (15 min.)

Thanks, your comments and ideas are very helpful. We have talked about a lot of things today- about things that make it easier for you to eat healthy and others that make it harder, about specific foods, about who are the people that you go to for support. Let’s talk more now about some ways that you, personally, can make healthier choices about the food you eat.

Take a few minutes now and think about the question I am going to ask you now. After you do, go ahead and write down your answer and we will talk about these as a group.

22. Given everything that we’ve talked about today [tonight], what 3 things would you like try to do in the next month to eat healthier? In other words, what would be your 3 goals to help you eat healthier?

[MODERATOR: WRITE MAIN ANSWERS DOWN ON A FLIPCHART AS PARTICIPANTS MENTION THEM IN TURN]

1. Why did you list these 3 goals and not others?

2. How have these ways of eating healthier worked for you before or helped others you know?

3. Are there other goals listed here that would definitely be helpful to you and you feel that you could do?

[PROMPT PARTICIPANTS WITH EXAMPLES BELOW ONLY IF THEY LOOK LIKE THEY DON’T KNOW WHAT IS BEING ASKED OF THEM]

• [How about what to do when you eat out?]

• [How get more fiber in your diet?]

• [How to eat a variety of foods and not just one type?]

• [How to eat more healthy fats and avoid the less healthy fats?]

• [Are all carbohydrates bad? So, how do you eat more healthy carbohydrates?]

VII. CLOSING (5 min.)

23. Is there anything else the people from the Department of Health and Human Services who are working on the recommendations for healthy eating should know? Any words of wisdom you want to give them?

Thank you so much for participating in this discussion and sharing your ideas. All your comments and opinions will be very helpful in designing the materials on physical activity.