OMB Clearance Memo

Memorandum

Date: January 2, 2013

To: Julie Wise, OMB Desk Officer

Through: Lynnette Williams, PRAB Branch Chief, Food and Nutrition Service

From: Judy Wilson, Staff Director, Senior Nutrition Advisor

USDA – Food and Nutrition Service

Re: Under Approved Generic OMB Clearance No. 0584-0524

Request Approval to Perform Formative Research –

Testing the Modified FNS Core Nutrition Messages for Spanish-Speaking Audiences

____________________________________________________________________________

The Food and Nutrition Service (FNS) of the USDA Food, Nutrition and Consumer Services is requesting approval for formative research under the agency’s Approved, Generic Clearance to Conduct Formative Research, OMB Control No. 0584-0524, Expiration date 4/30/13.

This research represents stage 2 of the core nutrition messages initiative under which the agency will conduct formative testing the Spanish translations of the previously developed messages and related tips and advice. This research will be used to further refine these products to enhance the clarity, relevance, feasibility and motivational attributes of these materials for Spanish speaking moms. This package includes versions of the testing stimuli and associated handouts to be investigated in the formative research to test and refine the Spanish-language Modified FNS Core Nutrition Messages.

The following information is provided for your review:

1. Title of Project: Testing the Modified FNS Core Nutrition Messages for Spanish-Speaking Audiences

2. Control Number: 0584-0524

3. Public affected by this Project: Individuals

• Mexican American mothers who are between the ages of 20 and 40 years old, whose primary language is Spanish, with at least one child of preschool age (two to five years old), who reside in households participating in one or more of the nutrition assistance programs (e.g., SNAP, WIC, Free or Reduced Price School Lunch), and/or whose income falls at or below 185 percent of the Federal poverty line (i.e., are eligible to participate in such programs).

• Mexican American mothers who are between the ages of 20 and 40 years old, whose primary language is Spanish, with at least one child of elementary school age (six to 10 years old), who reside in households participating in one or more of the nutrition assistance programs (e.g., SNAP, WIC, Free or Reduced Price School Lunch), and/or whose income falls at or below 185 percent of the Federal poverty line (i.e., are eligible to participate in such programs).

See Section 7, Project Purpose, Methodology, and Design for an outline of the number of focus groups for each audience. Research will be conducted only with Spanish-speaking audiences.

4. Number of respondents:

The number of persons that will be screened takes into account the following: (1) partials and non-responders (i.e., generally, for every 10 respondents, five will not complete the entire screener and may terminate after introduction or after one of the other questions); (2) seven and a half out of every 10 individuals screened will be eligible based on prior experience working with local community-based organizations to recruit and screen participants; (3) 60 percent of those successfully screened will refuse to participate based on prior experience; (4) recruitment of an additional four individuals for each group as experience demonstrates that many individuals who agree to participate in focus groups do not attend for various reasons; and (5) the target size for each group is eight to 10 individuals (we calculated burden based on 10 participants).

Focus Group Recruitment Screener*

Target Audience	Number of Persons Screened
Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	235
Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	118
Total	353

Focus Groups

Target Audience	Number of Groups	Desired Number of Participants per Group	Total Number of Participants
Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	4	10	40
Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	2	10	20
Total	6	Not applicable	60

5. Time needed per response:

In the tables below, the time per response is an average of the response per respondent and takes into consideration that respondents may be terminated during the recruitment process due to a response to a question or the respondent may choose to terminate at any point during the screening. This time also takes into consideration the time it will take to explain to participants the Informed Consent to Participate in Focus Groups & Agreement of Security of Comments for Low-income Mothers (see Attachment E). Experience has demonstrated that the time for screening and obtaining consent and agreement to the security of comments often takes less time than when using a focus group recruiter since the staff is already familiar and well known to the respondents.

Time Needed Per Focus Group Screening Questionnaire*

Target audience	Time (minutes)	Time (hours)
Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	15	0.25
Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	15	0.25

The Focus Group time includes the time required to present and discuss the materials in the Moderators Guides (see Attachments B, C and D).

Time Needed Per Focus Group*

Target audience	Time (minutes)	Time (hours)
Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	120	2
Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	120	2

6. Total Burden Hours on Public:

(a) Affected Public	Respondent Type	(b) Survey Instruments	(c ) No. Respondents	(d) Frequency of Responses	(e) Est. Total Annual Responses per Respondent (d x e)	(f) Hours Per Response	(g) Total Burden (f x e)
Individuals	Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	* Screener Questionnaire	235	1.00	235	0.25	58.75
	Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	Focus Group	40	1.00	40	2	80
	Low-income Spanish-speaking, Mexican American mothers of pre-school age children (2-5 years)	* Screener Questionnaire	118	1.00	118	0.25	29.5
	Low-income Spanish-speaking, Mexican American mothers of elementary school age children (6-10 years)	Focus Group	20	1.00	20	2	40
Total			413		413		208

*Includes burden for those answering none or some of the screening questions (See notes under 4-5) and review of Informed Consent to Participate in Focus Groups & Agreement of Security of Comments for Low-income Mothers (see Attachment E).

7. Project Purpose, Methodology and Design:

Background:

The mission of FNS is to provide children and needy families better access to food and a more healthful diet through its nutrition assistance programs and comprehensive education efforts. Nutrition education is a top priority for all of the FNS programs. As part of these efforts, FNS works to facilitate, coordinate, and provide resources to State and local service providers with implementing science-based education and intervention approaches to motivate consumers to use dietary practices that more closely align with current guidance.

FNS recently released a new set of core nutrition messages (CNM), supporting content (tips, advice, guidance, and recipes) and communication tools that complement and expand the existing messages released in 2008. The Agency developed these materials to assist nutrition educators, program staff and others who work with low-income mothers of preschool and school age children with delivering consistent and accurate messages that support national goals. These resources communicate key aspects of the Dietary Guidelines for Americans (DGA) and MyPlate in ways that resonate with this population and inspire them to take steps toward adopting the new guidance (DGA & MyPlate). These consumer-tested materials were designed and tested with English-speaking African American, Caucasian and Hispanic mothers for use in the nutrition assistance programs administered by FNS and others serving similar populations.

While a large number of Hispanic mothers and children speak English, many new immigrants do not and some prefer Spanish. In addition, there are a disproportional number of diet related health problems among Hispanic groups. The Health, United States, 2011 report¹, developed by the Center for Disease Control and Prevention, found that 22.4 percent of Mexican American boys, and 24.3 percent of Mexican American girls aged six to 11 years old were overweight; compared to 14 percent and 18.6 percent for Non-Hispanic White boys and girls, respectively. This high prevalence of young, overweight Mexican American children is particularly troubling as one-third of the United States Hispanic population are minors. It is a concern because excessive body weight in children is associated with higher rates of chronic diseases in childhood and adulthood. Additionally, the 2010 Census found that Mexican Americans are the largest self-identified Spanish-speaking population in the United States (63 percent of all the Hispanic or Latino population). As such, it is critical to communicate science-based nutrition guidance to Spanish-speaking Mexican American mothers of young children in ways that are not only relevant and clear, but also alerts them to the importance of healthy eating habits, as well as inspires them to take appropriate action.

With the aid of partners and a contractor, the agency has translated the CNM and related tips into Spanish, modifying them to reflect the dialect and culture of Mexican Americans. Using focus groups, the contractor will test these Spanish language messages and related resources to ensure the materials are clear, feasible, culturally relevant, and motivating to the target audience of low-income, Spanish-speaking, mothers of young and school-aged children (i.e., two to 10 years old). Focus group participants will be Mexican American mothers who are between the ages of 20 and 40, primarily speak Spanish, receive benefits from one or more or the nutrition assistance programs, and/or have a household income at or below 185 percent of the Federal poverty line (i.e., eligible for the WIC, SNAP, or other nutrition assistance programs).

Based on the outcomes of this research, FNS will work with the contractor and partners to refine the translated messages and supporting content. The agency will share the final Spanish language materials with State and local programs and other partners to assist with nutrition education and promotion activities. These resources will have applications for use in a variety of formats and settings, including printed materials, public service announcements, social marketing, individual and group sessions, as well as other channels.

Purpose:

The purpose of the research is

1. To test the translated messages and related tips with the target audience and obtain feedback regarding clarity, (i.e., understanding of the content) and relevance; and,

2. To explore whether the target audience finds the Spanish language materials feasible, appealing and motivational.

Methodology/Research Design:

Research will be conducted via six qualitative research sessions structured as focus group discussions. A trained Spanish-speaking moderator will facilitate the discussions as described in the Moderators Guides (Attachments B, C & D).

Two focus group sessions will be held in each of three cities containing large populations of Mexican Americans (See below Sampling Procedures and Site Selection for details). Each focus group will include eight to 10 women from the target audience (i.e., Mexican American mothers who are 20 to 40 years of age, who primarily speak Spanish, with children aged two to 10 years old, who participate in or are eligible for one or more or the nutrition assistance programs). All participants will have a household income at or below 185 percent of the Federal poverty line. Mothers of similarly aged children will be grouped together for focus group discussions concerning sets of messages that are either age appropriate for their children or relevant for all ages. Eligible mothers will only be recruited for one group, even if they have children who are both pre-school and school age. The focus groups will be conducted entirely in Spanish.

The messages and related materials are designed to appeal to mothers of preschool children (i.e., two to five years old), mothers of elementary school-aged children (i.e., six to 10 years old), and to mothers of both groups. Due to the significant number of messages to be tested and the need to give the participants enough time to give thoughtful consideration to each, no one group will review all of them. Each message will be reviewed by at least two groups in different sites, thus minimizing the risks of idiosyncratic results based on individual group dynamics. As there are more messages designed for mothers of preschoolers than for elementary school-aged children, we will conduct four sessions with mothers of preschool children and the two with mothers of elementary school-aged children. We segmented the messages and materials to be tested as follows:

Message Segmentation

Messages	Site 1 (San Antonio, TX)		Site 2 (Corpus Christi, TX)			Site 3 (Houston, TX*)
	Mother of Preschoolers	Mothers of Elementary School Children	Mothers of Preschoolers		Mothers of Elementary School Children	Mothers of Preschoolers	Mothers of Elementary School Children
All Child Feeding Practices Messages and Supporting Content			X			X
Milk Messages and Supporting Content	X	X		X			X
Whole Grain Messages and Supporting Content	X	X		X			X
Fruit/Vegetable/ Availability/Accessibility Messages and Supporting Content		X		X

*Houston, TX is the most populous location making it easier to recruit for two sessions with mothers of preschool age children.

Sampling Procedures and Site Selection:

Based on the desired characteristics of the target audience and cost efficiency, the research will take place in three Texan cities representing a mix of small and large urban areas where: 1.) Mexican Americans account for at least one-third of the city’s population; 2.) 18 percent of the total population has incomes below the poverty level; and 3.) a significant percentage of the city’s Hispanic population has incomes below the poverty line.

Three cities meet the criteria for appropriate locations for this research: San Antonio, Corpus Christi, and Houston. A demographic summary of the selected focus group cities is presented below:

Demographic Summary of Selected Sites*

	San Antonio, TX	Corpus Christi, TX	Houston, TX
Total Population (2010)	1,327,407	305,215	2,099,451
Population Hispanic or Latino origin, percent (2010)	63.2%	59.7%	43.8%
Population Female Hispanic or Latino origin who are 20-39 years, percent (2010)	10.5%	8.8%	7%
Persons Hispanic, 5 to 9 years, percent (2010)	5.3%	5.2%	3.9%
Persons Hispanic, under 5 years, percent (2010)	5.4%	5.0%	4.6%
Persons below poverty level, percent (2006-2010)	18.9%	18.8%	21.0%
Persons Hispanic below poverty level, percent (2006-2010)**	13.4%	13.1%	11.0%

*Information secured from the US Census Bureau American Community Survey Estimates.

** These numbers represent percentages based on the total population and not just the Hispanic population in the city.

While Hispanic and Mexican American populations represent a large proportion of the population in these three cities, the number of potential Hispanic mothers who are 20 to 40 years of age is much lower (i.e., 10.5 percent to seven percent) posing challenges for efficiently locating and screening individuals for eligibility. Based on past experience with similar target audiences, FNS’s contractor will work with community-based organizations (CBO) in the targeted cities to identify, screen and recruit participants as well as to confirm/remind them about their upcoming participation. The CBOs will also host the focus group discussions. These organizations are located in or near predominantly Hispanic neighborhoods and serve low-income, Spanish-speaking, Mexican American families. Front line staff who work with and are known to the targeted audience will be trained by the contractor in the proper procedures for identifying potential focus group participants, using the Focus Group Screening Questionnaire (please see Attachment A: Focus Group Screening Questionnaire), obtaining informed consent as well as obtaining the security of comments agreement (see Attachment E: Informed Consent to Participate in Focus Groups & Agreement of Security of Comments for Low-income Mothers).

Partnering with CBOs is a highly beneficial strategy for reaching this particular target audience. The CBOs’ staff is familiar with the women in their community and will have some knowledge as to their potential eligibility prior to contacting them – as a result, screening is very efficient and fewer people are screened that are ineligible. In addition, staff are known and trusted sources in these communities, and will be afforded the opportunity to discuss participation in the focus groups – as a result, recruitment is often more successful. Given that the CBOs are located in or near where the participants live, they represent easy and known places for participants to travel to; the location and transportation will be less of a barrier to participation. Since the CBOs are familiar settings, participants may be more at ease and more comfortable when the discussion starts.

Recruitment of Participants:

The trained CBOs’ staff will recruit Mexican American mothers that meet the criteria below:

• are between the ages of 20 and 40

• speak Spanish as primarily language;

• have at least one child two to 10 years old;

• reside in households participating in one or more of the nutrition assistance programs (e.g., SNAP, WIC, Free or Reduced Price School Lunch), and/or whose income falls at or below 185 percent of the Federal poverty line (i.e., are eligible to participate in such programs).

Given that much of the material to be tested is text-based, only mothers who are comfortable reading Spanish will be recruited. Comfort in reading Spanish will be ascertained through questions on the Screener Guide regarding educational attainment and individual self-assessment for comfort reading Spanish, as well as CBOs’ staff’s knowledge of the women’s background and experience.

It is standard focus group practice to recruit more individuals than will be needed for any particular focus group session. Illness, transportation difficulties, childcare arrangements falling through, changes to work schedules, etc. can cause even willing and able participants not to show up as planned. Therefore, the CBOs will recruit 14 to seat eight to 10 individuals². Based on experience, CBOs are often reluctant to send home willing participants who show up, fearing that by doing so they are damaging their own relationship with the target audience. Also, participants recruited through CBOs are more motivated to attend, feeling a certain social responsibility or obligation to the organization that provides services. CBOs are also often in a position to assist participants with overcoming obstacles to participation. If all 14 participants attend the session, the contractor and CBO will send the balance of confirmed participants home.

Focus Groups Location and Duration:

The focus group sessions will be held at a CBO facility. The locations will be convenient and familiar to the participants. As necessary, CBOs will assist with arranging transportation and childcare for participating mothers. CBO staff will greet participants when they arrive, check in each participant as they arrive to make sure that there is a signed Informed Consent to Participate in Focus Groups and Agreement of Security of Comments for Low-income Mothers, and assist the contractors as necessary with setting up the facility for the discussion.

The planned duration of the focus groups is two hours³ due to 1.) the amount of material that needs to be covered in the session; 2.) the target number of people participating (eight to 10 per session); and 3.) the level of engagement required of the participants. The two hour time period allows adequate time to discuss all of the content, probe as appropriate for greater clarity and understanding, ensure everyone participates, and that conversation is not prematurely ended.

Incentives

As an added incentive, participants will receive a cash stipend of $75.00. The selection of this amount comes from past experience of the agency and the contractor in the recruitment of similar populations for focus groups.

Data Analysis:

For each focus group, respondent feedback will be documented in the following ways:

1. An observer will take notes from the focus group discussions about the materials on whole grains, milk, fruits and vegetables, and child feeding practices. The notes will include preferences related to terminology, specifically comments that indicate the rationale behind their preferences.

2. Audio recording of each focus group will be made and transcribed into Spanish and translated into English.

3. Message handouts and supporting content/narrative paragraphs with photos will be collected that include the participant’s selection of words/phrases that stand out and words/phrases they dislike or don’t understand.

Focus group findings will be analyzed via three principal steps once all of the focus group discussions are completed. These steps will take place concurrently between the moderator and onsite observer representative.

First, the observer’s notes will be compiled and summarized from the whole grain and milk product discussion into one document. This summary will reveal the respondents’ word preferences and the rationale behind their preference, as well as final terminology recommendations based on these discussions. These conversations will also reveal possible obstacles (real or perceived) to the participants’ likelihood and ability to follow the FNS guidelines.

Second, the audio recordings/transcripts of each focus group will be reviewed to capture the participants’ responses in terms of their opinions, thoughts and feelings about the materials they are asked to review into another separate document. Quotes will also be pulled from the audio recordings that best express the respondents’ feedback.

Third, the moderator and onsite observer will review all of the participants’ notes on the message handouts, supporting content/narrative paragraphs, and picture exercises. Based on this review, they will organize and present their key findings and recommendations.

Once the three sources of qualitative data have been analyzed and initial findings compiled, all of the research findings will be reviewed as one cohesive unit and compiled into a final report. Differences across group location and audience will be noted when appropriate, but given the qualitative nature of this research, findings will be considered descriptive and directional but not definitive.   No attempt will be made to generalize the findings to be nationally representative or statistically valid. In addition to providing an analysis of the findings and final recommendations for the materials, the report will reference relevant cultural nuances and feedback on the images reviewed.

Outcome:

Information and formative input gathered from the specific target audiences through the research will help to refine and finalize the translation of these materials for Spanish-speaking, Mexican American mothers. FNS may decide to publish summary findings of the focus group research either electronically or in print, but such documents will not include information that personally identifies focus group participants.

8. Security of Comments: Participants will be informed of confidentiality and privacy act provisions before the focus group (see Attachments F). System of Record FNS-8, FNS Studies and Reports, published in the Federal Register on 4/25/1991 at 56 FR 19078, covers personal information collected under this study and identifies safeguards for the information collected.

9. Federal Costs: Contract costs, message revision, research tasks and reporting (for low-income Spanish-speaking, Mexican American mothers children two-10 years old): $130,924.00

10. Research Tools/Instruments:

• Attachment A: Focus Group Screening Questionnaire

• Attachment B: Focus Group Moderator’s Guide All Child Feeding Practices Messages and Supporting Content Testing with Mothers of Preschool Age Children (2-5 years)

  • Attachment B1: Message Handout – All Child Feeding Practices Messages and Supporting Content

• Attachment C: Focus Group Moderator’s Guide Whole Grain and Milk Messages and Supporting Content Testing with Mothers of Preschool Age Children (2-5 years)

  • Attachment C1: Message Handout – Whole Grain Messages and Supporting Content

  • Attachment C2: Message Handout – Milk Messages and Supporting Content

• Attachment D: Focus Group Moderator’s Guide Whole Grain, Milk, Fruit/Vegetable Availability/

Accessibility Messages and Supporting Content Testing with Mothers of Elementary Age Children (6-10 years)

• Attachment D1: Message Handout – Whole Grain Messages and Supporting Content

• Attachment D2: Message Handout – Milk Messages and Supporting Content

• Attachment D3: Message Handout – Fruit/Vegetable/Availability/Accessibility Messages and Supporting Content

• Attachment E: Informed Consent to Participate in a Focus Group & Agreement of Security of Comments for Low-income Mothers

1 http://www.cdc.gov/nchs/data/hus/hus11.pdf

2 The burden estimates are based on the maximum number of people who will be seated for a session. The ideal number for a discussion is eight to ten.

3 Note that while this is longer than previous FNS sponsored focus group times, it is not outside of industry norms - see http://www.howto.gov/customer-service/collecting-feedback/focus-group-fact-sheet,

http://socrates.berkeley.edu/~pbd/pdfs/Focus_Groups.pdf, and http://www.csc.noaa.gov/digitalcoast/_/pdf/focus_groups.pdf  (see page 4).

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