Formative Research to Revise Materials for Mothers and Child Care Providers of Infants (SLT)

OMB Control # 0584-0524 | Expiration Date: 9/30/2019 | Page 3

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524.  The time required to complete this information collection is estimated to average 45 minutes per response, of which 15 minutes are estimated to review the stimulus materials. This also includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information.

ATTACHMENT E – Director and Provider Interview Guideline

Research Objectives: To understand providers’ perceptions of the draft materials and any barriers/supports to implementation.

Note: Optional probing questions appear in italics. These probes are intended to provide options for the researcher to obtain feedback that supports the study objectives.

Introduction (2 Minutes)

Hello my name is _____and I’ll be conducting this interview. The purpose of this interview is to get your feedback on drafts of excerpts from a guide on feeding infants in child care settings and materials to support breastfeeding mothers, including a mother’s guide, a poster, and a message graphic. As you may know, the US Department of Agriculture (USDA), Food and Nutrition Service (FNS) created these materials to support child care providers in meeting the guidelines of the updated Child and Adult Care Food Program (CACFP) meal pattern for infants. We want to make sure these materials are easy to understand, usable, and meet your needs as a child care director or provider. Keep in mind that we are only talking to 12 child care directors and providers across the country so your feedback is very important!

• First, there are no wrong answers. We are here today to hear what you think.

• Participation is voluntary, so you don’t have to answer every question.

• Also, so you know, I didn’t create any of the materials and I don’t work for USDA/FNS. So, please be honest if there are things you like or don’t like. Your responses won’t affect me either way.

• Lastly, everything we talk about here will be kept private. That means we will not use your name in any of our reports.

• We’d like to record this conversation. The recordings will only be used to confirm our notes and allow us to revisit this conversation. Only members of the project team will hear the recordings, and any transcriptions of this conversation will not include any names. All information will be stored on a secured server. Is that ok with you?

(Note to moderator: If participant is uncomfortable do not record the conversation, but take detailed notes).

Do you have any questions?

Objective: Understand general feeding patterns at site and providers’ perceptions of breastfeeding.

Questions First, I’d like to learn about how infants are fed here. How are infants given bottles at this site? Do you feed them all at the same time? Where are they fed? How do you prepare the formula? What kind of formula do you use? (Probe to check if it is iron-fortified infant formula) How is breastfeeding handled here at the site? Probe for bottle feeding with breastmilk, mother’s feeding on site. How do you promote breastfeeding at your site? How do you coordinate feeding with mothers who come to breastfeed their babies at your site? What are your biggest challenges with feeding infants here? What strategies have you used to help moms continue to breastfeed once their baby is in child care? Are you familiar with the acronym CACFP? Do you know what CACFP stands for? Where have you heard or seen that acronym? Are you familiar with the updated CACFP infant meal pattern? Is there anything that you feel is challenging to implement related to the new requirements?

General Feeding Practices & Attitudes (7 minutes)

Feedback on Feeding Infants Guide (15 minutes)

We have a lot to get to so I’m going to jump in and start showing you some draft materials. The first things I’m going to show you are from a larger guidebook for child care providers.

Objective: …clarity, appeal, and novelty of Tell If a Baby is Hungry	[Show Attachment O: Research Stimulus: Feeding Infants Guide: Hunger and Fullness Charts (English) ] Let’s take a look at these charts. As you read through it, please underline anything that doesn’t make sense. What is your first impression of this handout? Do you like it? Not like it? Why? Are these charts easy to understand? Is it clear from this chart when a baby is hungry? Is it clear from this chart when a baby is full? What is confusing about these charts? How do you usually monitor hunger cues at your site? Is this information similar to what you already know? Is there any information in this chart that is new to you?
…clarity, appeal, and willingness to use Developmental Readiness Chart	Questions Before I show you this next item, have you ever heard the term Developmental Readiness? What does this term mean to you? [Show Attachment P: Stimulus: Feeding Infants Guide: Developmental Readiness (English) ] Take a second to read this paragraph. As you read it, please underline anything that doesn’t make sense. What is your first impression of this handout? Do you like it? Not like it? Why? Is the paragraph clear and easy to read? Is there anything confusing about it? Are there terms within this paragraph that are unclear? Is the information useful to you? Why/why not? In what situations would you read something like this? What would you do with this information? What other signs do you use to know if a baby is developmentally ready for solid foods? Do you agree with this information? Why/why not? Does this information clarify the concept of Developmental Readiness as you understand it? Why/why not? Do you need more information to understand the concept of developmental readiness?
…clarity, appeal, and willingness to use Ready for Solid Foods	Now we are going to talk about feeding infants solid foods. How do you know when to introduce solid foods to the infants that you care for? [Show Attachment Q: Stimulus: Feeding Infants Guide: Solid Foods(English) ] Now take a look at this handout for parents. Take a second to look it over. As you read it, please underline anything that doesn’t make sense. What is your first impression of this handout? Do you like it? Not like it? Why? How would you use this type of handout at your site? Would you give it out to parents? Why/why not? Would you use it yourself? Why/why not? How is this similar or different to any handouts you use now? What is the best way to share information with mothers? Probe specifically on electronic communication with parents. Handouts? Something electronically? How do you usually distribute handouts to parents (talk with parents about them, leave them in a pile for them to take, or put it with the infants’ belongings)?
…cohesiveness and usability of the materials as a whole.	[Show Attachment O: Research Stimulus: Feeding Infants Guide: Hunger and Fullness Charts (English), Attachment P: Stimulus: Feeding Infants Guide: Developmental Readiness (English) and Attachment Q: Stimulus: Feeding Infants Guide: Solid Foods (English) ] Now think about all these materials together. How would you use these types of materials? Would you read them all when you first received them or as needed? Would you share them with parents or other child care providers? How would you like to receive these types of training tools? Would you prefer printed or digital copies? How would you share these materials with other providers at your site? What other information would you want about feeding infants?

Feedback on Breastfed Babies Welcome Here Guide (8 minutes)

Objective: Understand providers’ perceptions of BBWH Guide: appeal, clarity, willingness to use.

Questions [Show Attachment L: Stimulus: Breastfed Babies Welcome Here: Help with Child Care (English)] Take a look at this handout for mothers. As you read it, please underline anything that doesn’t make sense. What is your first impression of this handout? Do you like it? Not like it? Why? How would you feel receiving this type of checklist from a mother? Would it be helpful to receive this information? Why/why not? What other information would you include in this check list? What information would you remove from this check list? What would you do with this information? How do you feel about mothers providing breastmilk for their baby to consume while at your site? Are you comfortable receiving, storing, and preparing breastmilk? What are some of the challenges you face with receiving, storing, and preparing breastmilk? What information do you need to help you receive, store, and prepare breastmilk? What kind of training would you need to help you receive, store, and prepare breastmilk? Now I want to get your feedback on some specific terms that could be used in the materials. Which term do you prefer: human milk or breastmilk? Why? Is there another term you’d prefer to use? (Probe for what other term) How about expressed milk? What does that term mean to you? Which term do you prefer, expressed milk, pumped milk or a different term (probe for what other term)?

Feedback on Poster (5 minutes)

Objective Understand perceptions of the poster and intention to use.

Questions [Show Attachment S: Breastfed Babies Welcome Here Poster (English)] What are your first impressions of this poster? What do you think the message of the poster is? What is confusing about this poster? How do you feel about the look of the poster? What do you think about the graphic? What do you think about the colors used? What do you think about the words on the poster? Would you display this poster at your site? Why/why not? What purpose would you have for using this poster? Where would you hang it? What size would you want the poster? What would be the best way for you to get this poster? (via mail, digital download, etc). Probe for size and type. Would you rather have something else other than a poster? If so, what would you prefer to have? What changes would you make to this poster? How would you feel if the poster said something like “Ask us how we can support you!" or "Ask us for more information!"? Do you think this would make mothers feel more comfortable talking to you or other child care providers about breastfeeding? If it said that, would you feel comfortable talking to parents about how you can support them? Why/why not?

Feedback on Message Graphics (8 minutes)

Objective: Understand providers’ perceptions of message graphics and preferred graphic.

Questions [Show Attachment R: Breastfed Babies Welcome Here Message Graphic (English) ] Take a look at this message graphic (point to the first message graphic). What’s your first impression? Do you like it? Not like it? Why? What do you think the purpose of this message graphic is? What is the message graphic trying to portray? Take a look at this message graphic (point to the second message graphic). What’s your first impression? Do you like it? Not like it? Why? What do you think the purpose of this message graphic is? What is the message graphic trying to portray? Now let’s look at both graphics together. Which one do you like better? Why? Which one do you think does a better job of representing the materials we looked at today? What changes would you make to improve this message graphic? Where would you imagine seeing these graphics? Do you imagine them on their own? As part of something bigger? If you would, how would you display or use the message graphic? Where would you hang it? (e.g. as a window cling, on a bulletin board) How do you use social media at your site? How would you share this on social media? What kinds of flyers or printed materials do you distribute to parents? Would you include this message graphic on those materials?

Those are all the questions I have. Thank you so much for taking the time to talk with me. This was very helpful!