Risk of Alcohol Use During Pregnancy: Message Testing and Materials Development

Form Approved

OMB No. 0920-0919

Exp. Date: 01/31/2015

Risk of Alcohol Use during Pregnancy: Message Testing and Materials Development

Moderator Guide for CDC FASD Consumer Focus Groups

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 test several adcepts (visual and text versions of ideas presented as “posters”) that will be used to develop communication products as part of an effort to decrease the risk of alcohol use during pregnancy; and to test a brochure for the same purpose. The adcepts are for products designed to raise awareness among women of reproductive age of the importance of not drinking alcohol while pregnant or while planning for being pregnant. In addition to raising awareness, the brochure is also meant to increase knowledge and understanding of these risks.

Materials: Flipchart and markers, pencils or pens and small pads, small clock, 2 laptops with Internet connection; video recording services; name tents, list of alcohol consumption behaviors and FASD for flipchart; adcept boards; copies of test brochures; adcept handouts (individual and comparison), brochure comment handouts, post-group screener forms; extra consent forms, and receipt forms; fetal development graphic or PowerPoint slide (optional, if use request screen and projector); notes template; debriefing forms. The facility may have some of these, check ahead of time.

I.           Introduction and Ice-Breaker                                                   10 minutes     

II.          Individual Adcepts (6)                                                                40 minutes

1. Comparison of Adcepts                                                             30 minutes

2. Brochure Usability Testing                                                        30 minutes

3. Closing                                                                                          10 minutes

                                                                                                 TOTAL Time: 120 minutes

INFORMATION ABOUT THE FOCUS GROUP

Name of Moderator:

Name of Notetaker:

Date of Group:

Group Number (1-8):

Location (Atlanta; Baltimore):

Pregnancy Status of Group (Recent Pregnancy, Trying for Pregnancy):

Age Group (18-30 yrs; 31-44 yrs):

[MODERATOR: Vary the order of presentation of the adcepts, indicate order of presentation from first (1) to sixth (6) and note in the table accordingly]

Table Order of Adcepts Presented

Name of ADCEPT	TRYING Group	RECENTLY PREGNANT Group (proxy for pregnant)
BABY Bottle Both Drink WP/WT	[INSERT ORDER No.]
STOP Bottle WP/WTP
NO Bottle WP/WTP
RISK Bottle WP/WTP
DIRECT Power woman WTP
THOUGHTFUL Power woman WTP
CONFIDENT Power smiling pregnant woman WP
BELLY Both Drink WP

I. Welcome and Introductions (10 min)

Welcome everyone. Thank you very much for taking part in this group discussion to give your opinions on possible ideas for materials for the promotion of women’s health. Your opinions are very important to us.

My name is _______ and I work for the American Institutes for Research (AIR). AIR is a not for profit organization that conducts health-related studies and develops consumer materials. I will be leading today’s discussion but remember that here you are the experts. I am here with _____ who is also from AIR. She will be taking notes and may come in during the discussion to help me out. The Centers for Disease Control and Prevention, also called the CDC, asked us to organize these discussions. The CDC is the government agency that works to improve detection and prevention of many different diseases and health conditions, all over the country.

Our goal today is to get your opinions about several different ideas that could be used to promote women’s health all over the United States, so your feedback is very important. We are having these discussions in several parts of the country.

I am not a doctor or nurse so I will not be able to answer any medical questions you may have. If you have medical questions, please plan to ask your doctor or nurse.

Procedures

I’d like to explain a few things about how the discussion group will work today/tonight.

1. First of all, I want everyone to know there are no right or wrong answers. We want to know your honest ideas and opinions. Some of you may disagree. This is fine. We are here to learn from you. We want to hear from everyone and learn what each of you thinks about the issues we will be discussing.

2. If you do not understand a question that I ask, please let me know. I’ll try to re-phrase it or explain what we are trying to get at with the question. We will be video-recording this discussion. I want to give you my full attention and not have to take a lot of notes. We will be writing a summary report of the findings from all the discussions we conduct and having the recordings with the notes helps me do a good job. When we write our report, we will report on what was said, but not on who said it. The report will not include your name, addresses or telephone numbers.

3. The video recording is for the use of the people working on this project.

4. There are also some people from the project team observing our discussion today because they want to be able to hear directly from you. You won’t be able to see or hear anything from them because they are in a room behind the mirror.

5. Because we are recording, it is important that you try to speak up and speak one at a time. I may occasionally interrupt you when two or more people are talking at once in order to be sure everyone gets a chance to talk and that responses are accurately recorded. Sometimes I may need to move the discussion along to make sure we cover everything, and I may ask those people who have contributed a lot to the discussion to give others a chance to speak.

6. As a courtesy to everyone, please turn your cell phones off or if you need to put it on silent or vibrate. Also, please turn off anything else that “makes noise”.

7. Should you need a break at any point during the discussion, please let me know. We would appreciate it if only one person leaves at a time.

8. Please don’t hold back from giving us your honest opinions. If you have something negative to say, that’s alright. Sometimes the negative things are the most helpful. Remember, that there are no right or wrong answers, you are the experts in what works best for you. I did not develop any of the ideas or the brochure we are going to discuss, so there is nothing you can say that will offend me. Don’t worry about hurting my feelings with anything you might say. It helps me to do a good job if you tell me what you honestly think.

9. Do you have any questions before we start?

10. Confirm Informed Consent

[REVIEW FOLLOWING KEY POINTS FROM CONSENT]

• Your participation today is voluntary. If any question makes you feel uncomfortable, you do not have to answer it. You can also choose to end your participation at any time.

• We will write a summary report of the findings from all the discussions we conduct. Your name won’t be used. We ask that you respect each other’s privacy as well. That is, what we say in this room stays in this room.

• You will receive $75 as a token of appreciation for your participation.

• If you have any questions regarding this discussion after it is over, there are telephone numbers at the bottom of the consent form that you can call.

So, let’s get started. The group discussion will last about an hour and a half. First we will do introductions, then I will ask for your opinion on several ideas for that could be used for ads or materials; then I will ask you for your opinion on an early version of a brochure I am going to share with you; and we will finish with some general questions.

Introductions

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

• Your first name

• What is your favorite time of the year and why?

II. Individual Adcept Testing (40 min)

[PROCEDURES:] Now that we have introduced ourselves, I’d like to get your feedback on several ideas that the CDC is thinking about using. Remember that these are just ideas. The words are not the final words. They haven’t made any decisions yet. This is where you come in! They want to know how you feel about these ideas and then decide what they should do. This is why telling me what you really think is so important.

I’m going to show you each idea separately first, and then you will compare them to each other. When you see the whole idea it may look like a poster but remember that this idea would be used for a variety of materials- posters, ads, brochures, etc.

This is what we will do for each of the ideas I am going to share with you during the discussion. First, I will ask you to look at the main text for the idea, just the words. Then, I’m going to ask you to look at the whole idea- the text and a picture. After that, I am going to ask you to spend some time on the details.

Headlines and Tag Lines

Now, here is the [first/next] idea. [FOR EACH OF THE 6 ADCEPTS, SHOW BOARD WITH TEXT ONLY AND THEN READ IT.]

1. What is the first thing that comes to mind when you read this? What does it make you think of?

2. How do you feel when you read these statements? Anything positive? Anything negative?

3. In your own words, what do you think they are trying to say?

4. Does what it says here grab your attention or not? Why/Why not?

5. Now, on your own, read what it says here again. What do you see in the blank space?

PROBE: Close your eyes for a minute and I will read it again. What picture comes to your mind?

Complete Adcept

[DISTRIBUTE ADCEPT COPIES. DISPLAY ADCEPT BOARD] [FOR EACH NEW ADCEPT, REMIND PARTICIPANTS TO THINK ABOUT EACH ONE INDEPENDENTLY]

Now, here is the whole idea- the text and a picture. Remember that these are not necessarily the final words or the final pictures; these may be revised. Take a few minutes to look it over.

6. How would you sum up in a few words your first impression of this idea as a whole?

PROBE: Do you like it? Not like it? What makes you say that?

7. How does it make you feel?

PROBE: Anything positive? Anything negative?

8. If you saw an ad or poster that looked like this when you were walking down the street, would it get your attention? Why or why not?

9. In your own words, what are they trying to tell you?

10. Who are they trying to reach?

PROBE: Are they trying to reach women like you or someone else?

PROBE: Are they trying to reach women in general, women planning to get pregnant, and/or women who are already pregnant?

11. What are they asking you to do, if anything?

PROBE: Does the ad or poster refer to certain types of alcohol or alcohol in general? What type or types of alcohol did you think of when you saw it?

PROBE: Are certain types of alcohol safer to drink than others in terms of the health of your future baby? Which ones are safer? Which ones are not as safe?

12. How do you feel about the colors; the design? What do you like/dislike about them?

13. What do you think about the lettering? Too big, too small? Easy to read/hard to read?

14. Is there anything here that is confusing, unclear, or hard to understand?

15. Is there anything that offends anyone in the group or makes you feel uncomfortable?

Images

Thanks, everything you are saying is very helpful. Let’s look at the image or picture for the idea more closely now.

16. What is the main idea of this picture? What does it tell you?

17. Does the picture add to what they are saying? Does the picture go together with the words, or not?

18. How appealing is this image to you personally? What about it catches your attention?

19. Are there things about the picture that bother you in any way? Which ones?

Body Copy

[EXERCISE: HAND OUT COPIES OF TEXT FOR EACH ADCEPT]

Finally, before going on to the next idea, I would like you to take a look at the text more carefully. Here is a copy of the text. Working on your own, I would like you to do the following:

a. Circle the sentences or words that are particularly important to you; the ones that most affected you in one way or another.

b. Draw a line across any words or sentences that are confusing, unclear or offensive to you.

20. What did you indicate as important, significant? What did you particularly like?

21. What text did you cross out because it was confusing/ unclear/ inappropriate/ offensive?

22. [OPTIONAL] Have you heard anything like this before?

PROBE: Where? What companies or organizations say something like this now?

III. Comparison of Adcepts (30 min)

[DISPLAY ALL 6 CONCEPTS SIDE-BY-SIDE IN THE SAME ORDER THEY WERE PRESENTED] [HAND OUT COMPARISON WORKSHEETS]

[EXERCISE:] OK, now I’d like you to compare the adcepts. The CDC is developing these ideas to share information with women about the importance of not drinking alcohol during pregnancy and even, while trying to get pregnant. When turned into products, these ideas should help women keep this in mind, know about the risk of drinking alcohol at these critical times, and avoid alcohol. Some ideas are for both women trying to get pregnant and women who are already pregnant, while others are directed to only one group or the other.

I am going to hand out a piece of paper with a picture of each of the ideas and I will also have them up here so you can take a look at each of them again. I am going to ask you to first do it by yourself and then we will discuss this as a group.

Think about what I just told you about the purpose of these ideas and what the CDC would like women to know about. Now with that in mind and based on your own experiences when you looked at these ideas earlier on and the group discussion do the following:

• Put a circle around the picture of the idea that works best for you (the one you like the most).

• Cross out or put an “x” over the picture of the idea that works the least well for you; (the one you like the least).

[ADRESSING THE GROUP, ASK FOR A SHOW OF HANDS. BUT THEN GO AROUND THE TABLE INDIVIDUALLY]

23. Which idea do you like most? Why did you pick this idea and not another?

PROBE: What specifically makes it work better for you? What do you like about it? Is this one the most inspiring? What about this particular one is most engaging?

24. Which of the ideas do you like the least? Why is that?

PROBE: What specifically do you dislike about it? How did you decide which one was the worst? Is it the one least likely to attract your attention? Is it the one that you would be the least likely to read? Is it the one you are least likely to act upon?

25. [PROBE FOR OTHERS NOT PICKED AS BEST OR WORST] What about this one? How many of you kind of like it? How many of you kind of don’t? Why?

Thanks for sharing your opinions with us. Everything you have said here is very helpful.

IV. Brochure Testing (30 min.)

[HAND OUT DRAFT BROCHURE AND RATINGS FORM]

[EXERCISE: Here is a brochure that the CDC would like to have your feedback on so they can see what works well and what doesn’t. Go ahead and do what you would normally do if you picked it up at your doctor’s office or somewhere like that. I don’t expect you to be able to read it all so just look at what you are interested in. Take about 5 minutes to look it over on your own and answer the questions on this form, by yourself, without discussing it with your neighbor. Then, we will talk about it as a group.

[HAND OUT RATINGS FORM AND EXPLAIN HOW TO FILL OUT]

[OBSERVE AND NOTE: What do they do with the brochure? What do they look at first? What do they look at first? What are their facial expressions? Where are they spending more time reading or looking at the brochure?]

[COLLECT RATINGS FORMS BEFORE BEGINNING THE GROUP DISCUSSION OF THE BROCHURE]

26. What about the brochure caught your attention first? What did you spend most of your time on? Why is that?

PROBE: Would this brochure catch your attention if you saw it lying around at your doctor’s office?

27. What do you think about the cover? Would you prefer to see any of the adcepts as a cover instead of the current cover? Which one? Why?

28. What do you like the most about this brochure? Why?

29. What do you like the least about this brochure? Why?

30. Did you find the information you that you expected to find? Is there any information missing that you would like to see here?

PROBE: Is there too much information; too little; just enough?

31. What information is most helpful to you? What was least helpful?

32. What in this brochure is confusing or hard to understand, if anything?

PROBE: Which words or sentences are confusing to you?

[ASK ABOUT OTHER WORDS/PHRASES THEY HAVE TROUBLE UNDERSTANDING]

33. Is anything in this brochure—either about what it says or what it shows that bothers you? Is there anything else that offends you or makes you feel uncomfortable?

34. Is the information you are interested in easy or hard to find in this brochure?

PROBE: Is there too much information/too little/just enough information?

35. Is the size of the letters (font size) easy or hard read in each section? Is it large enough or too small?

36. What do you think about how the brochure looks?

PROBE: What do you think about the design? How do the colors make you feel?’

Quotation

[MAKE SURE TO ASK ABOUT EACH QUOTE IF NOT DISCUSSED ALREADY]

37. What do you think about the quote? What is it about? Does it speak to you? What makes you say that?

Usability: Fetal Development Diagram

[PROJECT IMAGE OF DIAGRAM OR HAVE LARGE VERSION ON A POSTER BOARD]

Now I would like you to take a look at this diagram more carefully. Take a couple of minutes to do so. [MAKE SURE THEY HAD A CHANCE TO REVIEW THE DEVELOPMENTAL CHART. THEN ASK THE FOLLOWING QUESTIONS]

38. What do you think they are trying to show in this drawing or diagram?

[PROBE on sequence of types of possible birth defects, body parts affected, scale at top, bar at bottom]

PROBE: What do the numbers up top mean [POINT TO TIME PERIOD SCALE]? What about the colored bars?

Do the different colors in the bars have any meaning? What do they mean?

39. Would you use this diagram or not? How OR Why not?

40. Where are some ways you can get more information about drinking and pregnancy? 

VI. Summary and Closing (10 min.)

Thanks! I just have a few more questions.

41. {OPTIONAL} Would you use this brochure if you got a copy of one or not? How would you use it?

42. {OPTIONAL} Who do you go to for advice on things like the ones we discussed today? Anyone else?

43. What would you tell a friend who was trying to get pregnant or was pregnant about what you read or saw in this brochure?

44. Is there anything else that you think is important to tell the people who developed this brochure that we haven’t had a chance to discuss?

Everything you have said is very helpful. Your comments are going to be very useful to make the brochure better.

The public reporting burden of this collection of information is estimated to average 120 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-0919)