Development of CDC's Act Against AIDS Social Marketing Campaigns Targeting Consumers

Formative Research and Tool Development

Att 2i Exploratory-HIV Testing-FG

Development of CDC's Act Against AIDS Social Marketing Campaigns Targeting Consumers

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0920-0840 Formative Research and Tool Development




Attachment 2i: Exploratory- HIV Testing

Focus Group Interview Guide








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Attachment 2i: Exploratory- HIV Testing Focus Group Interview Guides



Welcome

Thank you for coming today. Your participation is very important. I’m _______ and I’m from RTI, a non-profit research organization. The Centers for Disease Control and Prevention (CDC) is sponsoring this research. The purpose of this interview/focus group is to hear your views and opinions on important health topics concerning HIV/AIDS. Your insights are very important to us and your time today is appreciated. We will have about 2 hours for our discussion.

Before we begin, I want to review a few ground rules for our discussion.

  • Most importantly, there are no right or wrong answers. We want to know your opinions and what you think about the issues we will be discussing. I do not work for the people who are sponsoring this research, so don’t hold back from giving me your honest opinions.

  • You have probably noticed the microphones in the room. They are here because we are audio taping. I want to give you my full attention and not have to take a lot of notes. At the end of our discussion, I have to write a report and will refer to the tape when writing the report.

  • Behind me is a one-way mirror. Some of the people working on this project are observing this discussion so that they can hear your opinions directly from you and take notes so that your opinions are accurately captured. However, your identity and anything you personally say here will remain secure to the extent allowable by law. Your name, address, and phone number, which only the facility knows, will not be given to anyone and no one will contact you after this interview is over.

  • There may be some sensitive questions asked during this discussion. If at any time you are uncomfortable with my questions, you can choose not to answer. Simply let me know that you prefer not to answer.

  • Be sure to only use first names during the discussion. Please do not use your last name. Also, if you bring up a friend or other person you know as an example in our discussions, please do not use their last name either. So, whenever you mention a name, it should only be a first name and never a last name.

  • Please turn your cell phone or beeper to vibrate or silent mode. The interview/focus group will last no more than 2 hours.

  • If you need to go to the restroom during the discussion, please feel free to leave, but please return as soon as possible.

  • Do you have any questions before we begin?

Warm-up

Before we begin our discussion, let’s spend a little time getting to know one another.

  1. Please tell me your first name, where you are from, and your favorite X

Health and Health Care

Let’s start out today by talking about our health. We all do some things that are good for our health and some things that aren’t as good.

  1. How often do you go to the doctor for health screening tests or exams?

  2. What are some reasons why you go to visit a doctor or clinic?

    • What type of health screening tests or exams do you get on a regular basis?

    • Do you ask for the tests or exams or does the doctor recommend the tests or exams?

    • If requests tests, what test or exams do you request?

    • If doctor recommends tests, what tests or exams does your doctor recommend?

  3. Where do you go to get your health care?

  • Clinic?

  • Private practice?

  • ER?

  • Other



HIV Testing and Testing Experiences



Now, let’s switch gears and talk about HIV testing and testing experiences.

  1. How do you go about finding a place where you can get an HIV (e.g., ask friend, look on the internet, ask doctor, etc.)?

    • When you think about getting an HIV test, do you usually think about HIV testing alone or do you think about it along with other tests for STDs or sexually transmitted diseases?

  2. Why might someone want to get tested for HIV [with x frequency]?

  3. What are some reasons why a person may not want to get tested [with x frequency]?

  • Can you think of some reasons why a person may not want to know their HIV status?

[Examples for discussion if not brought up]

  • Fear of being positive/stigma/treatment availability

  • Fear of needles, doctors, etc.

  • Cost of test

  • [If necessary] Some people think that they might have HIV, but never get tested. Why do you think this is so?

  1. What do you think might convince someone who has never been tested for HIV because [INSERT REASON BROUGHT UP BY PARTICIPANT(S)] to get tested for HIV?

  2. Where are some places that you could get an HIV test (e.g., doctor’s office, health fair, free clinic)?

  • Have you ever had a health screening at a mobile unit/van? If so, what was the screening for? Where was the mobile unit?

  1. What types of HIV tests are available?

  2. Have you heard of an oral fluid test?

An oral fluid HIV test is done by taking a swab of your gums. On the other hand, blood tests either prick your finger for a sample of blood or a vial of blood is withdrawn from your arm for testing.”

  1. If the doctor’s office or clinic gave you the choice between an oral fluid test or a test that required blood (finger stick or complete blood test), which would you prefer? What about this method do you prefer?

  2. Has a health care provider ever talked to you about HIV or STDs? What did your health care provider say? What do you think about what your health care provider said?

  • Who first brought up the topic about HIV or STDs? You or your health care provider?

  • Did they ask you if you wanted to have an HIV test?

  • Did they talk about prevention against HIV or STDs?

  1. How often do most people you know get tested?

  • Do you have friends who don’t get tested as often as you think they should? Why is that?

  • How often do you think people should get tested? Why?

  • Should some people get tested more often? Why?


  1. Have you ever been tested for HIV?

If no, skip to NEVER TESTED SECTION

  1. Please tell me about the last time you were tested for HIV.

  • Did you assume that an HIV test was part of a group of tests done at an exam?

  • Did your doctor offer the test or did you ask for it?

  1. How often do you get tested for HIV?

  • If routine, probe: Why do you get tested every X months?

  1. How often do you think you should get tested? Why do you say that?

  2. When were you last tested? OR How long has it been since you were last tested? How often do you get tested?

  • If they mention at a physical exam or doctor’s appointment, probe for whether the doctor offered the test or if they asked for it.

  • How do you know if you were tested for HIV (check to see if he assumed testing was part of a group of tests)

  1. Why did you decide to get tested?

  • Doctor asked, family/friend encouraged me to get tested, partner encouraged me to get tested, made a “mistake”/multiple partners, heard/saw an ad, routine/regular screening

  • Have you ever gotten tested because you had unprotected sex with a partner with unknown HIV status or with an HIV positive partner?

  • If yes, probe: How long after the unprotected sex did you wait to get tested? If answer is <3 months, OK, let’s say that your test came back negative, would that assure you that you weren’t infected that time you had unprotected sex?

  • If no, probe for whether they did not have unprotected sex at all, or whether they had unprotected sex and didn’t get tested. Why? Let’s say that you had unprotected sex with someone who either didn’t know their status or who knew they were positive. If you went in and got tested within two months of having unprotected sex with that person and the test came back negative, would that assure you that you weren’t infected? Or, is it possible that you could be positive on a future test – say a few months later?

  • When should you get an HIV test after having unprotected sex with a man/woman?

  1. Where were you tested? (clinic, private doctor’s office, etc) Have you ever been tested anywhere else? Where?

  2. What type of test did you have? (oral, finger prick, blood draw)

  3. Is there something about your testing experience that could change that would motivate you to get tested again?

  • Location (More convenient location, mobile units?)

  • Facilities (improve waiting area, provide reading materials/magazines/music, improve appearance of facility)

  • Service (professional/courteous staff, privacy/confidentiality, lower cost or free, shorter waiting time)

  1. Did you get the results of your test?

  • If yes, how long did you have to wait for your results?

  • How would you feel if you could get your results more quickly?

  • If no, why not?

  • What, if anything, could have encouraged you to get your results?

  1. Did anyone go with you when you got tested?

  • Partner, friend, relative?

  1. What was the result of your most recent HIV test?

  • [If positive] When did you first test positive for HIV?

  1. Who is (or would be) supportive of you getting tested at least every X months?

  2. Who does (or would) encourage you to get tested [with x frequency]?

  3. Who is (or would be) opposed to you getting tested [with x frequency]?

  4. Does (or would) anyone discourage you from getting tested [with x frequency]?

  5. If you were to test positive on a future HIV test, would you be afraid that you would be thought of or treated differently? How might you be thought of or treated differently, and by whom? [If necessary: How would your family react if you tested positive? How about your friends? How about people you work or go to school with?]



NEVER TESTED QUESTIONS

  1. How often do you think a person should get an HIV test?

  2. In general, are some people more likely than others to get an HIV test? Who? Why?

  3. What kind of things would convince you to get a test?

  4. When do you think a person should get an HIV test?

  5. What keeps you from being tested?

  6. If necessary, do not believe you are at risk? Afraid to find out results? Worried what others might think? Afraid of being rejected by family or friends? Other reasons?

  7. What kind of things would convince you to get an HIV test?

  8. Where are some places that you could get an HIV test? [If necessary, doctor’s office, health fair, free clinic]

  9. Have you ever had a health screening at a mobile unit/van? If so, what was the screening for? Where was the mobile unit? What would you think about a mobile van/unit that offered HIV testing?

  10. Do you know if any of your close friends have been tested for HIV?

  11. If tested, does knowing that they were tested change how you think about them? Why or why not?

  12. If not tested, what would you think if you found out that your friend was tested for HIV? Would you think differently about him or her? Why or why not?

  13. Have you ever wanted to get tested because you had unprotected anal sex with a partner with unknown HIV status or with an HIV positive partner?

  • If yes, probe: How long after the unprotected sex would you want to get tested?

  • If no, probe for whether they did not have unprotected sex at all, or whether they had unprotected sex and didn’t get tested. Why?

  1. How often do most people you know get tested?

  2. Do you have some friends who don’t get tested as often as you think they should? Why is that?

  3. Who would be supportive of you getting tested [with x frequency]?

  • Who would encourage you to get tested [with x frequency]?

  1. Who would be opposed to you getting tested [with x frequency]?

  • Would anyone discourage you from getting tested [with x frequency]? Why?

  1. If you were to test positive on a future HIV test, would you be afraid that you would be thought of or treated differently? How might you be thought of or treated differently, and by whom? [If necessary: How would your family react if you tested positive? How about your friends? How about people you work or go to school with?]



[BOTH TESTERS AND NON TESTERS CONTINUE HERE]



HIV Testing Perceptions and Preferences

  1. What do you think are the advantages to getting an HIV test [with x frequency]?

  2. What do you think are the disadvantages to getting an HIV test [with x frequency]?

  3. If you could sign up to be reminded to get an HIV test every [insert timeframe], would you?

  4. What kinds of reminders would work best for you (e.g., text, email)?

  5. What should the reminder say?



Potential Barriers to HIV Testing

  1. What are some reasons why some people don’t get tested for HIV?

  2. Do you think that people need medical insurance to get an HIV test?

  3. Do you think the cost of someone’s medical insurance would go up or they would be dropped if they had an HIV positive result? Why/why not?

  4. Do you think that people are afraid that getting tested or testing positive might affect their medical insurance? Do you think this fear keeps people from getting tested?

  5. Do you think getting an HIV test may hinder your ability to get a job? What if your test result was positive, how would do you think it may impact your ability to get a job?

Probe: Does this fear keep you from getting tested? Do you think it keeps others from getting tested?

  1. Are there any other reasons why some people don’t get tested for HIV?



Theoretical Concepts: Perceptions of Risk, Attitudes, Normative Beliefs, Behavioral Beliefs (re: HIV test and support/treatment)

  1. How often do you think your partner should get tested? Why do you say that?

  2. Let’s say you just went to get an HIV test, how would your partner react if (s)he found out?

  3. How would your friends react?

  4. How would your family react?

  5. When you think about their possible reactions, does it make you more or less likely to get an HIV test in the future?

  6. Would you want your partner to get tested with you?

  7. How would your family/friends react if you tested positive?

  8. Do you know anyone in your community, friend, or a family member who is HIV positive?

  9. What do people think about them?



Relationship Status and Sexual Partners

  1. Are you currently in a relationship?

  2. If yes, how would you describe your relationship? [If necessary, is it strictly monogamous or do you have a main partner as well as casual partners?]

Now, let’s talk about your main partner

  1. Has your partner been tested for HIV?

  2. What do you think about your partner getting (not getting) tested?

  3. Does knowing that he/she does/doesn’t get tested change how you think of them?

If partner tested:

  1. How often does your partner get tested?

  2. Do you know the results of his/her last test?

  3. How did you find out his/her/her test results?

PROBE:

    • They told me

    • Saw a copy of his/her test results

    • Went to the doctor/clinic with him

    • Does your main partner know your HIV status?

  1. How did your main partner find out your HIV status?

PROBE:

  • I told him/her

  • I showed him/her a copy of my test results

  • He/she went to the doctor/clinic with me



STD testing

  1. Has a doctor or health care provider ever suggested that you be tested for any STI besides HIV?

  2. Have you ever been tested for any other STI besides HIV? If yes, which ones?

  • Chlamydia, gonorrhea, syphilis, genital herpes, genital warts, HPV





  1. Do you have any unanswered questions about HIV or HIV testing?

  • [If YES] What are the unanswered questions? How do you think you can get the answers you need?

  • [If NO] Do you feel you know everything you need to know about HIV and HIV testing? How did you get this information?



Closing

Okay, we are pretty much out of time. Do you have any last thoughts?

Excuse me for one moment while I see if the people observing have any questions that I have not asked. I will be right back.

Thank you for your participation. There is a brochure for you to take with you if you would like. It has information about HIV/AIDS and locations where you can get further information. Have a good day/evening.




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