Focus Group-1 Focus Group Discussion Protocol

ATTAChment D1

consumer focus group Discussion Guide

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F4A. consumer focus group discussion guide for the Text4baby evaluation

Introductions (7 minutes) 1 minute	Let’s get started. There will be time at the end to finish the questionnaire if you need it. My name is [FILL IN] and this is [FILL IN]. Thank you very much for joining us today. We are meeting with groups of women in different parts of the country to talk about the types of health information women find useful when they are pregnant or have a new baby. You were invited to be here because you signed up to receive text messages on your cell phone from a program called text4baby. We do not work for text4baby; we are independent evaluators trying to find out what works well and what could be improved.
1 minute	We have a few things to go over before we talk about text4baby. [MY COLLEAGUE] will take notes as we talk. Our notes will be on what gets said, not who said what. So we will only use each other’s first names today. We want everyone to be able to speak, but only one person at a time. Please don’t have side conversations with the person next to you. We would like to record the conversation in case we miss something in our notes. We will keep the recording private and use it only for this project. Please speak in a voice at least as loud as mine so we can hear it on the recording. At the end of the discussion, please turn in your completed questionnaire to receive your thank-you gift card. Is it ok for me to begin recording? [IF NO, INDIVIDUAL(S) MAY LEAVE. PROVIDE A GIFT CARD UPON COMPLETION OF THE PARTICIPANT INFORMATION FORM AND SIGNING OF RECEIPT.]
5 minutes	Let’s go around the table and introduce ourselves. Please say your first name and, if you are pregnant, say whether this is your first time having a baby. If you are already a mom, please say how many children you have and their ages. [BEGIN WITH PARTICIPANT TO MODERATOR’S RIGHT] That’s the only time we will go around the table one by one. For the rest of the questions, anyone can answer first and then others can jump in.

Public Burden Statement:  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.  The OMB control number for this project is 0915-0347.  Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:  HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-49, Rockville, MD 20857.

Awareness & Participation (15 minutes) Q1 5 minutes

Please tell me how you learned about text4baby. Anyone who remembers can go first. (PROBE AS NECESSARY) Did you see a poster in a health care facility or health fair? What do you remember about the poster? Did you learn about text4baby on the internet? What kinds of information were you looking for when you saw something about text4baby? Did a friend or relative tell you about text4baby? What did they say about the service? Did a health care professional tell you about it? What did they say? Did you learn about it at work? Did a colleague tell you, was there a presentation, or did you see a poster where you work? Did you find out about it on the MTV show “16 and pregnant”? Other sources of information? If you have seen or heard about text4baby in more than one way, which way was most important in getting you to sign up, and why? Which ways were less important, and why?

Q2 5 minutes

Why did you decide to sign up for text4baby? Was there something special about the service you thought you would like? What was it? (Probe as needed on types of information, messages timed to due date or baby’s age, message length, message frequency, Spanish availability) Did you sign up because you trust the advice or opinion of the person who recommended it to you? Did anyone have questions about text4baby before signing up? What kinds of questions did you have? How did you go about learning more about text4baby before signing up? Did anyone sign up to receive text4baby messages in Spanish? [SHOW OF HANDS; RECORD COUNT] If you speak Spanish (but don’t get text4baby messages in Spanish), did you know you could get messages in Spanish?

Q3 4 minutes	How long ago did you first sign up? Was that when you were pregnant or after the baby’s birth? How many months pregnant were you at that time? How old was your baby at that time? How did you sign up for text4baby? Did you sign up with your cell phone or with a computer? Did anyone help you sign up? (Who helped you sign up?) How easy or difficult was it to sign up? Have you stayed signed up ever since? If not, why not? Sometimes people lose their cell phones, stop using them for a while, or change their phone number. Was anyone not signed up for a while for a reason like that? Was there another reason?
Q4 1 minute	Has anyone ever texted the word STOP to 511411 to stop messages? [SHOW OF HANDS; RECORD COUNT] Why did you want to stop receiving messages? And why did you decide to start the messages again later? Has anyone texted the word HELP to get help with the service? [SHOW OF HANDS; RECORD COUNT] What kind of help did you need and what happened? Has anyone texted the work UPDATE to change your due date? [SHOW OF HANDS; RECORD COUNT] Did that work ok?
Engagement with text4baby (28 minutes) Q5 5 minutes	Let’s talk more about what text4baby is like. How often do you get messages? How many times per week? What days of the week? What time of day? Do you read all, most, some, or only a few of the messages you get from text4baby? Do you read them right away or wait for a while? Do you read them once or sometimes more than once? Who else reads messages that way? Who does something different? What do you do and why? Do you look forward to getting your messages? Why or why not?

Q6 5 minutes	What are the text4baby messages about? What specific examples do you remember? PROBE FOR SPECIFICS: Reminders to get certain services (for example, regular checkups, flu shots) How to get free or low cost services Normal/abnormal symptoms (for example, bleeding, mood swings, feeling tired) Baby development Starting healthy habits or breaking unhealthy habits (for example, taking vitamins, stopping smoking) Getting emotional support (for example, keeping a journal, talking to a girlfriend or other new mothers) Toll-free numbers to call for more information. (We’ll talk in a minute about whether you have called those numbers.) How easy is it to understand the messages? Are they clear? What is unclear? Do some messages have words you don’t know? Probe for comments on Spanish version if applicable
Q7 2 minutes	When you get a text4baby message, how often do you think, “I already know that or I’ve heard that before”? How do you feel then—is it reassuring, is it annoying, do you just ignore the message? Which text4baby messages make you feel that way?
Q8 3 minutes	Now I’ll ask another way: How often do you get a message and think, “I didn’t know that or I hadn’t thought about the subject like that before”? How do you feel then—do you trust the information, does text4baby tell you things you wouldn’t learn another way? Which text4baby messages make you feel that way?
Q9 2 minutes	Do you ever get a text4baby message and think, “I would do that if I could, but I can’t.” Which messages make you feel that way and why? Messages that suggest doing something that may be difficult (like healthy eating) Messages that suggest visiting the doctor, but you don’t have a regular doctor, or don’t have health insurance Messages that suggest you call a particular phone number, but you don’t want to use your cell phone minutes Anything else?
Q10 5 minutes	Of all the different messages you have been describing, which ones are the most useful to you? What makes you say that? Which text4baby messages are least useful? Why?

Q11 2 minutes	Besides getting text messages on your cell phone, does anyone visit text4baby’s website or visit them on Facebook? IF YES: What do like about or learn from the website and Facebook that you don’t get from the text messages?
Q12 2 minutes	Now let’s talk about things you might do with text4baby messages. Do any of you share the text4baby messages with other people? Who do you share with and why? Do any of you share messages with the baby’s father, or has the father signed up himself? Why or why not? Do you share with friends or other family members? Have any of your friends or family members signed up as a result? Do you talk about the text4baby messages with other people? Who do you talk with and why? Does anyone talk about text4baby with a doctor, midwife, or other health care provider? What is useful about doing that? For example, does text4baby remind you of questions to ask?
Q13 2 minutes	Some of the text4baby messages include toll-free numbers that you can call for more information about a topic. Who has called any of these numbers? [SHOW OF HANDS; RECORD NUMBER] Could some of you describe your experiences? What type of information were you calling about? What happened when you called? Did you get useful information from the call? If you haven’t called any of the toll-free numbers, why not? Are you not interested in the information being offered? Do you not like to call numbers if you don’t know who or where you are calling?
Other Health Information Sources (5 minutes) Q14	How else do you get the information you need about being pregnant or having a new baby? Do you use books, internet, magazines, e-newsletters, health professionals such as doctors, nurses, or midwives? Friends & family? Other? How does text4baby fit in with those other sources? Is it more, less, or equally important to you? Or is it just different? What makes you say that?

Reflections on Behavior Changes (10 minutes) Q15

Some text4baby messages are about starting healthy activities or behavior, and some are about stopping unhealthy activities or behavior. Has anyone changed their behavior because of text4baby? What change did you make? Even if the change seems small, please tell us. Even if the change was only partly because of text4baby, please tell us. How did text4baby help you make the change? Were you thinking about making the change anyway, and text4baby motivated you? Did text4baby teach you something you didn’t know before? Did text4baby give you a resource to help you make a change? Has text4baby helped anyone stick with a habit? What types of habits? How does text4baby help you?

Recommendations and Wrap Up (10 minutes) Q16

We are almost finished. What suggestions do you have for making text4baby better? More of some types of messages? Which ones? Less of some types of messages? Which ones? Messages more or less often, at different times of day, or different days of the week? Other suggestions? How could more women find out about the service? How many of you would recommend text4 baby to other women who are pregnant or have a new baby? [show of hands/record count] Why would you recommend it? Or not? Those are all the questions I have today. Please give your completed questionnaire to [MY COLLEAGUE] so we can give you your gift card. Thank you for coming and talking with us. Good luck with the rest of your pregnancy and your baby’s first year!