Focus Group Guide

Form Approved

OMB No. 0920-0800

Exp. Date 11/30/2014

Focus Group Discussion Guide

Public reporting burden of this collection of information is estimated to average 2 hours 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0800)

Instructions:

Use this Discussion Guide for Focus Groups among the general public and Health Care providers. Most questions will be used in both focus groups; however some questions that are only relevant to the public or providers have been included in separate sections. Questions that are not relevant to an audience segment should be omitted to avoid unnecessary burden to respondents.

Aims of information collection:

Goal: To assess the clarity and appropriateness of current materials, refine existing materials as needed, and inform the development of new targeted, culturally appropriate Inside Knowledge: Get the Facts about Gynecologic Cancer campaign materials for the public and health care providers in populations with a high gynecologic cancer burden. Qualitative information will be collected to better understand the public and health care providers’ knowledge, behavior, attitudes, and practices related to the 5 main types of gynecologic cancer (cervical, ovarian, uterine, vaginal, and vulvar cancers), including risks, symptoms, and prevention strategies. Participants will be asked about their knowledge, attitude, and behaviors at the beginning of the session. Following a facilitated discussion of Inside Knowledge materials (fact sheets on all five cancers available from www.cdc.gov/cancer/knoweldge), questions regarding respondent knowledge, attitude and behavior will again be asked to ascertain the knowledge, attitude, and behavioral intentions. We will look for differences in knowledge, behavior, and attitudes at the end of the session and we will also ask for suggestions to improve the Inside Knowledge materials in terms of appeal, saliency, and effectiveness at communicating key messages.

The following are goals of the Inside Knowledge campaign with regard to gynecologic cancer knowledge and behavior. After facilitated discussion of materials, it is expected that participants will be able to:

• Identify the five main types of gynecologic cancer

• Identify certain signs and symptoms associated with each gynecologic cancer

• Identify risk factors associated with each of the gynecologic cancers

• Know when to seek medical attention for abnormal symptoms (public focus groups)

• Know what the Pap Test screens for and when to get it

• Know what the HPV vaccine prevents and who is eligible for the vaccine

Moderator’s Guide

I. Introduction and Procedural Details (5 minutes)

Moderator: Hello. My name is ______. I do not work for the Centers for Disease Control and Prevention. I am an independent consultant. Thank you for coming here today and agreeing to participate in this discussion. All your comments from today’s discussion will remain anonymous and your name will not be mentioned in any of the reports. If you need to go to the restroom, please leave one at a time. And please remember to turn off all cell phones and pagers.

II. Purpose (10 minutes)

Moderator: You’re here today to take part in a focus group. It’s a discussion to find out your opinions – like a survey, but with broad, general questions. This focus group is being sponsored by the Centers for Disease Control and Prevention, also known as the CDC. We’ve asked you to be in this discussion to get your feedback on some statements, messages or ideas related to gynecologic cancer. CDC runs a campaign to raise gynecologic cancer awareness called Inside Knowledge: Get the Facts About Gynecologic Cancer. You may have seen some of the information from this campaign on the TV or around your neighborhoods. Over the course of our discussion today, I will show you some materials that are distributed by CDC and appear on TV, radio, or in a magazine. These materials contain key messages about gynecologic cancer, and I will ask your reactions to them and assess whether the messages are clear to you, and appeal to you. I will also ask some important questions about your knowledge of gynecologic cancers to see whether the materials are getting the messages across to you. Your answers will help CDC revise and improve these materials and make them more appropriate for some women.

First, I want to assess your knowledge and awareness of the Inside Knowledge campaign and your general gynecologic cancer knowledge. I will then introduce and discuss five fact sheets (one on each gynecologic cancer) from the Inside Knowledge campaign, and ask about your reactions to them. At the end, we will revisit the knowledge questions to determine what you thought about the fact sheets, if the key messages came across to you, and/or changed your knowledge in any way.

I personally have no part in developing any of the materials from the CDC, so feel free to tell me what you really think. All of your comments, whether positive or negative, are welcome.

III. Campaign Awareness and Gynecologic Cancer Attitudes/Knowledge Questions (20 minutes)

Moderator: Now, before we look at the fact sheets, I would like us to start by talking, in general, a little bit about your knowledge of gynecologic cancers.

1. Do you remember seeing, hearing, or reading any TV, radio, newspaper, or online advertising about the Inside Knowledge campaign?

   1. Where did you see it?

   2. What did it say, what message can you remember it conveying?

2. What was your overall reaction to the ad?

   1. Was it visually pleasing?

   2. Did it provide you with information you wanted to know?

   3. Was the message memorable, clearly described, and did it increase your knowledge?

3. Was there anything you didn’t like about what you saw?

   1. Would you change the message in anyway?

   2. What would make it more appealing to you? Or your family/friends?

Moderator: Now I’m going to ask you about your knowledge of and attitudes toward gynecologic cancers.

4. Do you know for which gynecologic cancers there is an effective screening test? (probe for cervical cancer, ovarian cancer, uterine cancer, vaginal cancer, vulvar cancer answers)

5. Do you know the main risk factor for uterine cancer?

6. Do you know which cancers are associated with the Human papillomavirus (HPV) sexually transmitted virus?

7. Do you know the risk factors for ovarian cancer?

8. Do you know at what age females can get the HPV vaccine?

9. Do you know what gynecologic cancer the Pap test screens for?

10. Do you know if smoking increases the risk for gynecologic cancers?

11. Are some gynecologic cancers genetic?

For Public Focus Groups Only (Attitude):

12. Do you think vaginal bleeding and discharge are symptoms that doctors should be aware of/treat?

13. Do you believe that gynecologic cancer is an important women's health issue?

14. Do you believe women should be generally aware of gynecologic cancer signs and symptoms?

15. Is gynecologic cancer a problem for you/in your family?

16. Have you heard of cervical cancer/ovarian cancer/uterine cancer/vaginal cancer/vulvar cancer? (each cancer type will be asked about sequentially)

For Provider Focus Groups Only (Attitude):

17. Do you believe healthcare providers should make a strong effort to promote appropriate screening guidelines for gynecologic cancer?

18. Is gynecologic cancer a problem in your patient population?

IV. Reactions to Messages/Behavioral Intention Questions (70 minutes)

Moderator: As I mentioned at the beginning of our discussion, we are going to look at the five fact sheets that the Inside Knowledge campaign has developed on each of the five gynecologic cancers. All are available free for downloading at (www.cdc.gov/cancer/knowledge.) I would like to show you each one and read to you several statements, messages or ideas and ask you some questions to get your thoughts on each of them. I would like to start by reading/showing you the following [show first fact sheet, and continue with next one in sequential order; the order the fact sheets are presented in does not matter]

1. What do you think of this fact sheet?

   1. How would you sum up in just a few words your first impression of this message? Do you like it? Not like it? What makes you say that?

   2. Are there any words or phrases here that you think are especially attention-getting or appealing?

2. What is the main idea that this message is trying to get across, in your own words?

   1. How well do you think the main idea comes across?

   2. Was this a new idea or something that you’ve heard before?

3. Is this message believable or not? Why or why not?

   1. [If not believable] What additional information would you need in order to more strongly believe this message?

4. Who would you say they are trying to reach?

   1. Does it seem like this message is talking to you, and people like you? Or someone else?

   2. What in the message suggested it was talking to you and people like you or someone else?

5. Are there any words or phrases that bother you or that you think should be said differently?

6. Does this message make you want to do anything?

1. Does this motivate you to take action?

For Public Focus Groups Only:

In next 6-12 months, how likely are you to-

1. quit smoking?

2. get the HPV vaccine?

3. get regular Pap tests according to your doctor's recommendations?

4. talk to your doctor about genetic testing for the BRCA1 and BRCA2 genes?

5. talk about gynecologic cancer with your family? Your friends?

6. bring up gynecologic cancer and gynecologic cancer symptoms the next time you visit your healthcare provider?

7. look for more information on gynecologic cancer?

For Provider Focus Groups Only:

In the next 6-12 months, how likely are you to-

i. initiate a conversation with your patients about gynecologic cancer and gynecologic cancer symptoms?

ii. feel confident in educating your patients about gynecologic

iii. feel confident in conducting appropriate tests for a patient with gynecologic cancer?

iv. refer patients suspected of a gynecologic cancer to a gynecologic oncologist?

Moderator: Now that we’ve gone over all the materials, I am going to ask you some of the same questions I asked at the beginning to see whether the information and key messages came across clearly, stayed with you, and may have changed your knowledge.

Specific knowledge (Public and Provider Focus Groups)

7. Do you know for which gynecologic cancers there is an effective screening test? (probe for cervical cancer, ovarian cancer, uterine cancer, vaginal cancer, vulvar cancer answers)

8. Do you know the main risk factor for uterine cancer?

9. Do you know which cancers are associated with the Human papillomavirus (HPV) sexually transmitted virus?

10. Do you know the risk factors for ovarian cancer?

11. Do you know at what age females can get the HPV vaccine?

12. Do you know what gynecologic cancer the Pap test screens for?

13. Do you know if smoking increases the risk for gynecologic cancer, if so which ones?

14. Are some gynecologic cancers genetic?

V. General Information Gathering Questions (10 minutes)

Moderator: Finally, I’d like to ask you some very basic questions about you, just for information gathering purposes

1. In which of the following categories does your age fall?

• 18-24 years of age

• 25-34 years of age

• 35-44 years of age

• 45-54 years of age

• 55-64 years of age

• 65-74 years of age

• 75 years of age or older

2. Please indicate your race and ethnic background.

Ethnicity:

• Hispanic or Latino

• Not Hispanic or Latino

Race: SELECT ONE OR MORE.

• White/Caucasian

• Black or African-American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

For Public Focus Groups Only:

3. What is the highest level of education you have completed?

• Grade school

• Less than high school graduate/some high school

• High school graduate or completed GED

• Some college or technical school

• Received four-year college degree

• Some post graduate studies

• Received advanced degree

For Provider Focus Groups Only:

4. What is your gender

• Male

• Female

5. Please indicate your specialty:

• Family Medicine

• Obstetrics and Gynecology

• Physician’s Assistant

• Nurse Practitioner

• Nurse

• Other

6. Which of the following best describes your work environment?

• Inpatient (e.g., hospital)Obstetrics and Gynecology

• Outpatient (e.g., clinic, office)Nurse Practitioner

• Combination inpatient/outpatient

• Other

7. On average, how many patients do you see per day?

• Less than 10

• 10 to 20

• 21 to 30

• 31 to 40

• Greater than 40

• Other

• Don’t know/not sure

VI. Wrap-up and Adjourn (5 minutes)

Thank you for your time today. The information you have provided will greatly help CDC. [Ask if there are additional questions and dismiss].

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