3 Discussion Guide NICHD NCMHEP Maternal Obesity

OMB CONTROL NO.: 0925-0046

EXPIRATION DATE: 07/31/2019

NICHD FOCUS GROUP AND IDI DISCUSSION GUIDE

Public reporting burden for this collection of information is estimated to average 120 minutes for focus groups or 60 minutes for IDIs 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0046).  Do not return the completed form to this address.

Note: All questions will be asked in both focus groups and IDIs unless specifically noted. Items marked “FOCUS GROUPS:” will only be asked in focus groups, not IDIs.

OBJECTIVES:

General:

• Deep understanding of the current context with which patients and providers approach obesity during pregnancy

• Gain insight into care-seeking practices and conversations with providers

• Direct messaging and creative concept development using preliminary creative materials (images and language)

Specific:

• Understand the questions, concerns, and emotions that obese patients have around speaking with HCPs about pregnancy overall and their weight during pregnancy

• MET Goal: uncover core values and trigger points (through visuals and sensory information gathered through homework) which creative teams can then infuse into ads, messaging, and imagery so that they are better able to connect to the target audience

• Identify what language should be infused into messaging and communications so they deem the information authentic and actionable

1. Introduction – (FOCUS GROUP TIME: 10 minutes)

A. Moderator introduces self

B. Purpose: talking about experiences with pregnancy and prenatal care

100. Sponsorship: Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of NIH; BUT, independent moderator

4. Disclosures: recording, [FOCUS GROUPS:] mirror/observers

5. FOCUS GROUPS: Ground rules: (e.g., everyone participate, talk one at a time, avoid side conversations, no “wrong” answers, anonymity protected)

6. Housekeeping items (e.g., cell phones on vibe, bathrooms)

7. Participant introductions:

1. First name for recording,

2. How far along or how old baby is (for new mother group),

3. If they have other children at home,

4. Something that has surprised them the most so far about the pregnancy or baby

2. Sharing Homework/Metaphor Elicitation Technique – (10 minutes/20-minute mark)

Homework Instructions

Metaphor Elicitation

HOMEWORK ASSIGNMENT GIVEN TO RESPONDENTS IN ADVANCE: In preparation for the discussion, please collect 3-5 images that represent your thoughts, feelings, impressions, and concerns about your greatest fears and your greatest hopes related to your pregnancy. 

The images should reflect your thoughts and emotions about your greatest fears and your greatest hopes for your pregnancy.  We are looking for analogies or metaphors for your feelings. We know this can be a different way of thinking, so I’d like to share some examples from unrelated projects. This is just to jump start your thinking based on images other people have picked to represent feelings or thoughts.

Please note: these are meant to be examples, to give you an idea on the types of pictures you could use and the ideas they can represent. You do not need to use these examples, specifically.

• A fuzzy sock to represent comfort, softness

• A picture of an iceberg to show there are some things hidden that you can’t see

• A picture of a river stone to illustrate time, smoothness

1. First, how did you feel about the homework assignment? Was it easy, difficult, fun, stressful?

2. Let’s start by sharing your positive images, or what you brought in to represent your greatest hopes related to your pregnancy.

1. FOCUS GROUP: HAVE PARTICIPANTS GO AROUND THE ROOM AND SHARE POSITIVE IMAGES/IDEAS FROM HOMEWORK; MODERATOR POST TO EASEL OR WHITEBOARD

2. PROBES AS NECESSARY: What idea or feeling about your pregnancy does this represent?

   1. When did this feeling or idea occur – when you found out? As the baby was developing?

3. SUMMARIZE THEMES: Now that everyone has shared, what themes do you see? What do your images and ideas all have in common?

3. Now, let’s share the images related to your greatest fears related to your pregnancy.

1. FOCUS GROUP: HAVE PARTICIPANTS GO AROUND THE ROOM AND SHARE FEAR IMAGES/IDEAS FROM HOMEWORK; MODERATOR POST TO EASEL OR WHITEBOARD

2. PROBES AS NECESSARY: What idea or feeling about your pregnancy does this represent?

   1. When did this feeling or idea occur – when you found out you were pregnant? As the baby was developing?

3. FOCUS GROUP: SUMMARIZE THEMES: Now that everyone has shared, what themes do you see? What do your images and ideas all have in common?

3. Interactions with Healthcare Providers – (15 minutes; 35-minute mark)

1. I’d like to spend some time talking about your experiences with your healthcare provider, or the OB/GYN practice you are going to/went to during your pregnancy.

2. Let’s think back to your very first appointment after finding out you were pregnant—what was that experience like? What do you remember most?

3. Overall, what have your experiences been like?

1. What has surprised you most?

2. Do you see the same doctor every time, or do you rotate through other providers in the practice? Do you see other types of providers (nurse, midwife, etc.)? Tell me about that…whom do you see?

3. Do you feel like you are on the same page as your doctor? How do you know if you are on the same page as your doctor?

4. Does it vary depending on who in the practice you are seeing?

4. What has your provider(s) focused on with you so far? What have they talked to you about?

1. Have they flagged any concerns? What?

5. What have you brought up with them?

1. Have you brought up any concerns with them? What?

6. Did you get any advice from your doctor BEFORE you got pregnant, or to prepare for becoming pregnant?

1. IF YES: tell me about that experience. Who brought it up?

2. What advice/recommendations did they give?

7. Overall, does your provider make you feel positively about your pregnancy, or like you are making good decisions?

1. Tell me about that. In what ways do they make you feel good about your pregnancy?

2. OR, what has been going on? In what ways have they made you feel badly about your pregnancy?

8. NEW MOMS: What about post-partum? Have you seen your doctor since you delivered?

1. IF YES: What kind of conversations have you had? What did they focus on? Did they make any recommendations to you post-delivery?

9. Do you feel like you are a partner in your pregnancy with your doctor?

2. PROBE: Do you feel like your prenatal care is a two-way conversation with your doctor, or do they just talk to you, and you listen? Tell me more about your relationship with your provider.

4. SEGUE, ONLY AS NEEDED - (3-5 minutes; 40-minute mark)

1. Tonight, we are going to be talking about weight and the role weight plays in having a healthy pregnancy.

2. First, when I say that, what comes to mind? What reaction do you have?

3. Have you talked to your doctor about your weight, as it relates to your pregnancy? IF NO: What about others in the practice?

1. IF YES: How has it come up? Who brought it up—you, or them?

2. IF YES: What have they talked to you about?

5. Terminology (10-15 minutes; 55-minute mark)

1. In talking to your doctor about weight, what terms or phrases have they used? [LISTEN UNAIDED FOR BMI, PLUS-SIZED OR OBESE]

1. What terms or phrases do you use to talk about your weight? Is this the same way you talk about weight with your doctor? How is it similar/different?

2. FOCUS GROUP: LIST TERMS BELOW ON EASEL AND GET REACTION ONE AT A TIME

3. Are you familiar with the term “BMI”? Is that something your doctor has talked about? Do you know what the term stands for? Do you know what your BMI is?

   1. IF NEEDED: BMI stands for body mass index. What does that mean or sound like to you?

4. What about the term “plus-sized”? Is that language your doctor has used with you, or you with them?

5. What about the word “obese” or “maternal obesity?” Have either of those terms ever come up?

6. In general, how have these terms comes up? How did your healthcare provider use them, or talk to you about these topics?

7. What term or terms are you most comfortable with, when it comes to talking about weight with your doctor?

1. Do these different terms we have talked—BMI, plus-sized, obese and maternal obesity—give you a different feeling?

8. Has your doctor ever used the term “high-risk” with you?

1. IF YES: In what way did they use it? Give me some background.

2. What does that term mean to you? How does it make you feel?

6. Resources or Information and Empowerment Questions (10 minutes; 1:05 mark)

1. What do you know about having a plus-sized [OR USE WHATEVER TERM THE GROUP/ PARTICIPANT PREFERS] pregnancy? [UNAIDED/GENERAL]

2. RESOURCES: Where have you gotten your information?

1. LISTEN FOR DOC, FRIENDS/PEER GROUPS, INTERNET RESOURCES (BABY CENTER, BLOGS, ETC.), SOCIAL MEDIA, ETC.]

2. Is the information you have gotten from different sources [DOC, OTHER PROVIDERS, FRIENDS/PEERS, INTERNET RESROUCES] the same or different?

1. Have you seen materials specifically for plus-sized women who are pregnant, or considering becoming pregnant? Where/What?

1. Where would you want to find those materials?

4. Are you aware of any organizations that cater to plus-sized pregnant women? Which ones?

5. What about your doctor/practice? Do you feel like they are “plus-sized” friendly?

6. Do you know any women who have avoided care during pregnancy, because they felt uncomfortable or judged by their doctors about their weight? Talk to me about that.

7. Knowledge-Based/Lifestyle Questions (10 minutes; 1:15 mark)

1. Thinking more specifically about the information you have seen or been told, do you know how much weight you should gain during pregnancy to have the best outcome for your baby? [WRITE DOWN A NUMBER AND THEN TALK]

2. Are there guidelines your healthcare provider has talked with you about, or that you know about some other way?

3. What do you know about diet during your pregnancy? Where did you learn this information?

4. What do you know about exercise during your pregnancy? Where did you learn this information?

5. Have you adopted any new practices before or since getting pregnant around diet and/or exercise?

1. IF YES: What or who caused you to do so?

   1. NEW MOMS: Did those practices change after the baby was born? How so?

2. IF NO: Do you think pregnancy is a good time to start changing habits? Who would you want to guide you on that?

8. Creative: Messages (30 minutes; 1:45 mark)

Attention Getting Messages: For the rest of our time today, I want to get your reactions to some statements and visuals on the topic of weight and healthy pregnancy. First, I have some statements printed on a piece of paper that you could see around promoting healthy pregnancies among plus-sized women. Circle all the statements that catch your attention, and would peak your interest to learn more. And cross-out any statements that either turn you off, or don’t mean much to you.

PLACEHOLDER FOR FINAL MESSAGES

1. DISCUSS: Let’s go through what each of you CIRCLED; FOCUS GROUPS: MODERATOR TO TALLY CIRCLED MESSAGES ON EASEL/TALK ABOUT STRONGEST MESSAGES FIRST (IF ALMOST ALL ARE CIRCLED, HAVE THEM REFINE TO TOP 3)

2. FOR EACH: What stood out to you about this and caught your attention? What was appealing?

1. Are there specific words or phrases that you like?

2. How does this make you feel?

3. How well does it address your concerns about pregnancy? Your hopes? [MODERATOR PULL IN THEMES FROM HOMEWORK DISCUSSION]

4. If you saw this on a pamphlet, poster or a website, would you stop to learn more? Why or why not?

3. AFTER ALL DISCUSSED: Which of these is the strongest? What makes you feel that way?

1. Is there anything missing from these?

2. Is there anything you would change to make these messages stronger?

4. Let’s go through what each of you CROSSED-OUT; FOCUS GROUPS: MODERATOR TO TALLY

5. FOR EACH: What about this message was less appealing/attention-getting?

1. Was there something specific you didn’t like?

2. If you saw this on a pamphlet, poster or website, how would it make you feel?

Calls-to-Action: Now I have another set of statements. All of them are asking you to do something. This time, circle the statements that [IF PREGNANT] cause you to want to take this action, [IF POST-PARTUM] might have caused you to take this action during your pregnancy.

PLACEHOLDER FOR FINAL MESSAGES

1. What did you circle? FOCUS GROUPS: MODERATOR TALLY STATEMENTS AROUND THE ROOM, AND START WITH STRONGEST (IF ALMOST ALL ARE CIRCLED, HAVE PARTICIPANTS REFINE TO TOP 3)

2. How likely are you/would you have been to do what this is asking? How attainable is it? What makes you say that?

3. Are there specific words and phrases that stood out to you in a positive way?

1. In a negative way?

4. Did you learn anything NEW?

1. IF YES: How important is that information?

5. What didn’t make the cut?

1. What about these statements didn’t work?

2. Is it what they were asking you to do, or something else about it?

6. Messenger: WHO would you want to hear these messages from?

1. PROBE: A healthcare provider/doctor, or another pregnant woman like you? What makes you feel that way?

9. Creative: Visuals (5-10 minutes; 1:55 mark)

PLACEHOLDER FOR FINAL VISUALS

1. I have one last thing for you to look at today. We’ve talked about what statements work best, but if these statements made it onto a poster or pamphlet, there would also likely be some sort of image. I have some different pictures you can look through,

and I’d like you to work together as a group to sort the pictures into a few groups based on the feeling they convey to you.

2. LET PARTICIPANTS WORK TOGETHER IN FOCUS GROUPS (NOT APPLICABLE/WILL EVALUATE INDEPENDENTLY IN IDIs)

3. DISCUSS: What did you decide on? What feeling does each group of pictures convey?

1. Now, I’d like you each to pick the top 1 or 2 that you would showcase with these messages promoting healthy pregnancies among plus-sized women. What about this/these images worked better compared to the others?

2. What does this image represent to you?

3. How do they relate to the messages?

1. If your preferred messages and preferred image were tied together, what overall feeling do you get? How do these images change or set the tone for the messages?

2. How do these images relate to or compare to the pictures you brought in for your homework assignment?

1. Would you use one of those images, from the beginning of our discussion, instead?

1. How do you feel about seeing messages and images around promoting healthy pregnancies specifically among plus-sized women?

1. Do you prefer messages tailored to plus-sized women, or messages to all pregnant women? Why?

1. Wrap-Up (5 minutes; 2 hours)

   1. Collect follow-up questions from observers

   2. Thank and dismiss

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