HMTS Supplement Document

Testing of Spanish-language Messages for the National Diabetes Prevention Program (National DPP)

Supplement to the HMTS Expedited Review Form

• Project Summary 1

• Background 2

• Methodology 2

• Modes for Testing 4

• Overview of Focus Groups 4

• Gifts 5

• Duration of Focus Groups 5

• Burden 6

Appendices

1. Recruitment Process and Screener

2. Side-by-side English-Spanish translation of messages to be tested

3. Protocol and materials for in-person focus groups with the primary audience

4. Protocol and materials for the online focus group with the primary audience

5. Protocol and materials for the in-person focus groups with family members

Project Summary

Goal: To conduct message testing activities to ensure that CDC disseminates culturally and linguistically appropriate diabetes prevention messages for selected Hispanic/Spanish speaking audiences.

How Information Will Be Used: To determine whether the Spanish language translations and graphics are usable in their current forms, or if they need modification to be clear, persuasive, and useful to the target audiences.

Methods: Messages will be discussed and tested in 9 focus groups. 8 focus groups will be conducted in-person and 1 focus group will be conducted online.

Respondent Population: The primary target audience is Hispanics ages 45-70 who are at risk of developing type 2 diabetes and speak solely Spanish or prefer to speak Spanish (Spanish dominant).

For this activity, persons are considered to be at risk for type 2 diabetes if they meet any of the following self-reported criteria:

• Have been diagnosed with prediabetes

• Are overweight

• Have a family member who has/had type 2 diabetes

• Ever gave birth to a baby that weighed more than 9 pounds

• Ever had diabetes while pregnant (gestational diabetes)

A secondary audience is family members of individuals in the primary target audience. Family members may be ages 18-70.

Analysis Techniques:

Focus group notes will be analyzed to identify major themes. The themes and the details will additionally be explored to look for differences by sex as well as for differences between reactions of people online as compared to those in person. The family member reactions will be compared to those of the primary audience.

Background

CDC’s National Diabetes Prevention Program (National DPP), which is part of the Division of Diabetes Translation, has developed messages to test with people at risk for type 2 diabetes as well as family members. Messages include those about prediabetes and being at risk for type 2 diabetes; the National DPP lifestyle change program; calls to action; and reasons to prevent type 2 diabetes will be tested.

Many of these messages are duplicates or modifications of existing English-language National DPP messages, adapted to reflect research-identified cultural contexts. Messages will be tested in Spanish. The testing is being done to create culturally sensitive and relevant Web content and outreach materials for use with Spanish-dominant Hispanics. Thematic messages are being tested in prototype “contexts” to show visually as well as in written language, what the thematic messages are conveying. The testing will focus specifically on the language of the thematic message, not on the visual elements.

See Appendix 2 for side-by-side English-Spanish translations of the messages to be tested.

Methodology

Focus groups with men and women at risk for type 2 diabetes and family members of individuals at risk for diabetes will be conducted in-person in one of two locations, TBD. Focus groups will be conducted in Spanish as this effort seeks to test messages in Spanish to inform CDC’s communication efforts with Spanish-speaking audiences.

Four audience groups will participate in the message testing:

1. Men at risk for type 2 diabetes. Three focus groups will be conducted with Hispanic men. Research and past CDC efforts suggest that men have unique motivators and barriers to health, disease prevention, and joining health programs. They also often have different roles and responsibilities in their household as it relates to health-related decisions and behaviors, such as food purchasing and preparation. Additionally, given that fewer at-risk men participate in lifestyle change programs than at-risk women, it remains important to speak to men to determine how they might be influenced to see the benefits of participation in a lifestyle change program. The focus groups with men will include a mix of low acculturation or moderate/high acculturation, and all will be Spanish-language dominant and at risk for type 2 diabetes. Questions related to language have been included in the screener to help assess acculturation level. The participants will be recruited to represent a mix of countries of origin, age groups, and levels of education. All participants will be ages 45–70.

2. Women at risk for type 2 diabetes. Three focus groups will be conducted with Hispanic women. Research and past CDC efforts suggest women are different from men with regard to core cultural values, and they frequently serve as the center of the family. They are typically the functional food and nutrition decision makers and seek health information and make health care decisions for all family members. Because they are potentially the primary audience for health information and health program messages, they are important to hear from alone. Additionally, it is important to note that women in mixed-sex groups can be reticent to participate as fully as men. The focus groups with women will include a mix of low acculturation or moderate/high acculturation, and all will be Spanish-language dominant and at risk for type 2 diabetes. Questions related to language have been included in the screener to help assess acculturation level. The participants will be recruited to represent a mix of countries of origin, age groups, and levels of education. All participants will be ages 45–70.

3. Persons at high risk for developing type 2 diabetes with a potential preference for online program participation. One focus group will be conducted with individuals with a potential preference for an online CDC-recognized lifestyle change program to explore any unique differences or considerations for individuals who may be more active online users and who would want to join an online program and those who would prefer an in-person program. National DPP lifestyle change program is currently offered in-person and on-line. This group will be used to test messages relevant to the on-line program specifically. All participants will be Spanish-language dominant and at risk for developing type 2 diabetes. All participants will have accessed the Internet in the past 7 days and looked at health websites in the past 30 days. We will also attempt to recruit a mix of men and women with low and moderate/high acculturation. Questions related to language have been included in the screener to help assess acculturation level. All participants will be ages 45–70.

The focus group with individuals with a potential preference for the online program will be conducted remotely given that they are being recruited for their increased level of online use. This will also permit participants from around the country to participate in the same discussion with minimal effort, as do CDC-recognized online lifestyle change programs.

4. Family members of individuals at risk for type 2 diabetes. Two focus groups will be held with family members of individuals at risk for type 2 diabetes. This audience was selected because research and past CDC efforts suggest family members (e.g., adult children, spouses, other relatives) are potential gatekeepers of diabetes prevention information for others in the family at risk for type 2 diabetes. In other words, individuals who perhaps are not themselves at risk for diabetes may still be an audience for National DPP messages and materials as they may share this information with at-risk family members (e.g., parents, grandparents, aunts/uncles) they may be concerned about. Therefore, it will be important to explore the reactions of family members of at-risk individuals to messages. Although family members who may share information may not necessarily be Spanish-dominant themselves, given that the messages and concepts to be tested will be in Spanish, the individuals recruited will report either a preference for speaking and reading in Spanish or an equal preference for Spanish and English. All participants will report having a family member (e.g., parent, grandparent, son/daughter, brother/sister, aunt/uncle) ages 45–70 they believe is at risk for developing type 2 diabetes (e.g., is overweight/obese). All participants will be at least 18 years of age and no older than 70. We will also attempt to recruit a mix of men and women with low and moderate/high acculturation. Questions related to language have been included in the screener to help assess acculturation level.

Modes for Testing

The National DPP is proposing data collection using two modes of focus groups: in-person focus groups and remote focus groups using a telephone and a computer for simultaneous viewing of messages. After being screened and agreeing to participate, participants will be sent an email to which the information sheet is attached. See Appendix 1 for the screening tool.

For in-person focus groups, which will take place with the primary and secondary audience (persons at risk for type 2 diabetes and family members of persons at risk for type 2 diabetes), messages will be presented on separate sheets of paper which will be passed out to the participants (see subsequent pages for how each of the messages will be presented to participants). See Appendices 3 (persons at risk) and 5 (family members) for further details about procedures that will be followed for in-person focus group participants.

For remote focus groups, discussions will be conducted remotely using a toll-free telephone line and by computer using the GoToMeeting web conferencing service. Instructions on how to join the discussion by phone and computer will be provided to the participants by e-mail. During the focus group, messages will be presented to the participants in a fashion similar to how they are shown to the in-person focus group participants, except that the remote participants will be viewing them on their computer screen. See Appendix 4 for further details about procedures that will be followed for remote focus groups and for screenshots of how messages will be viewed by remote participants.

Overview of Focus Groups

Type of Respondents	Type of Focus Group	No. Focus Groups	No. Respondents per Group	Total No. Respondents
Hispanic men ages 45-70 who are at risk of developing type 2 diabetes and speak solely Spanish or prefer to speak Spanish	In person	3*	10	30
Hispanic women ages 45-70 who are at risk of developing type 2 diabetes and speak solely Spanish or prefer to speak Spanish	In person	3*	10	30
Hispanic men and women ages 45-70 who are at risk of developing type 2 diabetes and speak solely Spanish or prefer to speak Spanish	Online	1	10	10
Family members, ages 18-70, of Hispanic men and women ages 45-70 who are at risk of developing type 2 diabetes and speak solely Spanish or prefer to speak Spanish	In person	2	10	20
TOTAL		9		90

*2 focus groups will be conducted with participants who are Internet users. 1 focus group will be conducted with participants who report no Internet use or limited Internet use.

Gifts

All participants will receive a $75 gift card to show appreciation for their participation. Recruiting firms have indicated that $75 is the current standard minimum amount needed as a show of appreciation for general audience participation in focus groups. Because these are focus groups, not surveys, and because the same intensity of participation is required for both in-person and on-line focus group participants, all will be given the gift card to show appreciation for their participation.

The in-person focus group participants (consumers) will receive the incentive at the focus group facility immediately after the conclusion of the discussion groups. Remote participants will receive their incentive by mail upon completion of the discussion group in the form of a $75 gift card (e.g., Visa Gift Card).

Duration of Focus Groups

The duration of the focus groups, by type of group/audience, will be as follows:

• Focus groups (9-10 participants) with consumers: 90 minutes

• Focus groups (9-10 participants) with family members: 90 minutes

Focus groups with consumers will last for 90 minutes. Focus groups with family members will also last for 90 minutes. The allotted time of 90 minutes will allow time for all participants to share their thoughts and provide their input.

Moderator guides will be used to facilitate the focus group discussions with consumers and family members. The guides for all focus group discussions have been included in the appendices.

Burden

Type of Respondents	Form Name	Number of Respondents	Number of Responses per Respondent	Burden per Response (in hr)	Total Burden (in hr)
Consumers - 1	Consumer Discussion Group Recruitment Screener	60	1	15/60	15
	Moderator’s Guide for Focus Groups with Consumers	60	1	90/60	90
Consumers -2	Internet Preference Discussion Group Recruitment Screener	10	1	15/60	3
	Moderator’s Guide for Focus Groups with Internet Preference	10	1	90/60	15
Family Members	Family Members Discussion Group Recruitment Screener	20	1	15/60	5
	Moderator’s Guide for Focus Group with Family Members	20	1	90/60	30
	TOTAL				158