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

OMB Control # 0584-0524 | Expiration Date: 9/30/2019 | Page 4

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 60 minutes per response, of which 20 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 D – Expecting Mothers Focus Group guideLine

Research Objectives: To understand expecting mothers’ feeding attitudes, knowledge, and perceptions as well as their perceptions of the draft materials.

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 & Warm Up (6 Minutes)

Thanks so much for taking the time to talk to us today. I’m [moderator name] and I’ll be moderating this focus group. The purpose of this conversation is to hear your opinions and experiences around breastfeeding and get your feedback on some materials being developed to support moms like you.

When these materials are finalized, they will be available for free to moms across the country. Keep in mind that we are only talking to 8 groups of mothers, so your opinions are incredibly valuable! Before we start, I want to mention a few things:

• First, there are no right or wrong answers. We’re here today to hear what you think, and it’s ok if people have different opinions.

• Participation is completely voluntary, so you don’t have to answer every question. However, your feedback is important so we hope to hear from everybody today, so I might call on you at some point.

• I did not create any of the materials you’re going to see. So, please be honest if there are things you like or don’t like. Your responses won’t affect me either way.

• Everything we talk about here will be kept private. That means we will not use your name in any of our reports. We also ask that you not share what was talked about outside of this room.

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?

Do you have any questions?

Can everybody go around and tell us your first name, when your baby is due, and something you’re excited to do with your baby. I’ll go first…

Section I: Current Feeding Practices & Info Sources (12 minutes)

Thank you all for sharing a little something about yourselves. We’re going to jump right in with some questions about breastfeeding.

Objectives …perceptions & experiences with breastfeeding and feeding.	Questions How do you plan to feed your baby? [Probe different combination of practices: breastfeeding, pumping, formula] For those of you with older children, do you plan to do anything differently now than with your other children? What are some of your concerns about breastfeeding your baby? What are your feelings about pumping breastmilk? What have you heard about pumping? For those that are planning to pump, when do you think you will start?
…preferences and perceptions of specific breastfeeding terms.	Before we continue, there are a few words we’d like your opinion about. Which term do you use prefer, human milk or breastmilk? Why? Which have you heard more often? Which is clearer? Why? Which of these terms do you prefer, expressed milk or pumped milk? Which have you heard more often? Which is clearer? Why?
...perceptions of truest sources of nutrition information.	What different things are you considering as you make plans for feeding your baby? Is there specific information you received? Where did you get this information? In general, how do you prefer to receive information about health and nutrition for your baby? Where do you look for information about breastfeeding and feeding? Are there particular sources that you would trust? (Probe for familial influences, Pediatrician, CDC, USDA) Would you consider a child care provider a good source of information about feeding and breastfeeding?
…perceptions & experiences around feeding and child care.	For those of you planning to use child care, are there any specific concerns you have about feeding your baby when they’re in child care? Are there challenges you have heard about, or had in the past, with breastfeeding your baby in child care? How challenging do these seem to you personally? Are these concerns enough to prevent you from breastfeeding? Are these concerns enough to prevent you from using child care? What kind of support would you want to continue breastfeeding with your child in child care? How important is it that your baby’s child care center encourages breastfeeding? Do you plan to breastfeed when you go back to work or school? Why/why not? Tell us about your plan: will you breastfeed on site? Will you pump at work/school? What challenges do you anticipate in making the transition? What resources or support do you already have in place or plan to use? Would you like your child care provider to offer you support in continuing to breastfeed your baby when you go back to work or school? What type of support would you want?

This is really helpful information; thank you for sharing your thoughts. We have a limited time so I want to switch it up and get your feedback about some materials.

(Note to moderator: before the focus group begins, use the rotation chart below to organize the order in which research stimulus is presented and the specific sections that is included in each group. Each Section corresponds to a particular research stimulus.)

(Note to reviewers: as the Table below demonstrates, sections IV – VII will be rotated between focus groups such that each group participates in two sections. Therefore the total time required for this focus group (60 minutes) includes only two of these sections.)

Group #1	II. Message Graphic & Poster2		III. Body Make Milk*	IV. Develop-mental Readiness	V. Help w/ Child Care	VI. Bottle-feeding	VII. Hunger & Fullness	VIII. Closing
B1	Graphic 1	Graphic 2	X		X		X	X
B2	Graphic 2	Graphic 1	X	X		X		X
B3	Graphic 1	Graphic 2	X		X	X		X
B4	Graphic 2	Graphic 1	X	X			X	X
B5	Graphic 1	Graphic 2	X			X	X	X
B6	Graphic 2	Graphic 1	X	X	X			X
B7	Graphic 1	Graphic 2	X	X		X		X
B8	Graphic 2	Graphic 1	X		X		X	X

¹ “B” denotes Breastfeeding Mothers group. The specific group codes will be determined and specified after focus groups are scheduled.

² The SECTION II Poster/Message & SECTION III “Body Make Milk” will be shown to all groups as they are priorities for this project.

Section II - Message Graphic/Posters (10 minutes)

Objective …appeal, comprehension, and relevance of message graphics.

Questions [Note: Show Graphic 1 - Attachment R - Breastfed Babies Welcome Here Message Graphic] – I want everybody to take a look at this image here… What are your first impressions of this image? How do you feel about this image? Does this remind you of anything you’ve seen before? Where do you imagine seeing something like this? What is it about this image that you like or don’t like? What does this image say to you? What’s the purpose of this image? What is confusing about this image? [Note: Show 2nd graphic 2 - Attachment R - Breastfed Babies Welcome Here Message Graphic] – Now please take a look at this next image… What are your first impressions of this image? How do you feel about this image? Does this remind you of anything you’ve seen before? Where do you imagine seeing something like this? What is it about this image that you like or don’t like? What does this image say to you? What’s the purpose of this image? What is confusing about this image? [Note: Show both images together] – We talked about both of these separately. Now let’s look at them together… Which of these images do you like more? Why? Which of these is easier to understand? Why? Which of these do you think is more memorable or recognizable? Why? If your child care provider used this image, would it encourage you to continue breastfeeding when you go back to work or school?

…appeal, comprehension, and relevance of poster.

[Note: Show Attachment S: Breastfed Babies Welcome Here Poster] – Ok. Now let’s take a look at this poster idea. What are your first impressions of this poster? What stands out to you? Does this poster remind you of anything you’ve seen before? What do you think this poster is trying to communicate? What’s the purpose of this poster? What is confusing about this poster? Who do you think this poster is for? What changes would you make to this poster so it would be more appealing for moms like you? …so it would be more informative for moms like you? …so it would be useful for moms like you? How would you feel about a message at the bottom of the poster that says: "Ask us how we can support you!” Do you think this would encourage you to contact child care providers? For moms with older children, did you talk to your child care providers about continuing to breastfeed?

Section III: Handout “Body Make Milk” (10 minutes)

Objective: …appeal, comprehension, relevance, usability of handout.

Questions [Note: Distribute Attachment N Breastfed Babies Welcome Here: Body Make Milk] – Please take a minute to look through this handout. You don’t need to read everything, but skim through the pages and use the pen in front of you to underline anything you don’t understand and put an X on anything you don’t like. [Provide 2 minutes to review] What are your first impressions of this handout? What stood out for you? Does this look like something designed for mothers like you? Is there anything confusing about this handout? What about the amount of information? Would this information help you to continue breastfeeding? Does this help clarify the challenges we discussed earlier? What other questions do you have that you don’t see answered here? What other information or resources would you want? What would you change to make this easier to use or more helpful for moms like you? Which parts of this handout would be useful for you or moms like you? Probe for feedback on: images, tables, tips, & “Jose’s Story”. How do you imagine using something like this? Does this handout answer the questions or concerns you have about pumping/expressing breastmilk? Why or why not? How important is this issue for you? Do you think the information in this handout is accurate/ believable? Why, why not? What would make it more believable or reliable?

Section IV- Handout “Developmental Readiness (8 Minutes)

Objective: …appeal, comprehension, relevance, usability of handout.

Questions [Note: Distribute Attachment P Feeding Infants Guide: Developmental Readiness] – Again, take a minute to skim through this information. Please underline anything you don’t understand and put an X on what you don’t like. [Provide 1 minute to review] What are your first impressions of this handout? What stood out for you? Does this look like something designed for mothers like you? Probe images and callout boxes. Would this information help you determine whether your baby is ready for solid foods? What other information would you want to know? How would you imagine using this handout? How important is this information for you? Do you have any other questions about solid foods that are not answered here? How would you feel receiving this from your child care provider? Would you feel comfortable giving this information about your child to your provider? What would you change to make this easier to use or more helpful for moms like you? Anything about the way the information is presented? Are you familiar with the term developmental readiness? What does that mean to you?

Section V- Handout “Help With Child Care” (8 Minutes)

Objective: …appeal, comprehension, relevance, usability of handout.

Questions [Note: Distribute Attachment L: Breastfeeding Babies Welcome Here: Help with Child Care] – Again, take a minute to skim through this information. Please underline anything you don’t understand and put an X on what you don’t like. [Provide 1 minute to review] What are your first impressions of this handout? What stood out for you? Does this look like something designed for mothers like you? Is there anything confusing about this handout? What about the amount of information? Probe for images and page title. How important is this information to you? Have you thought about this before? What kinds of things have you heard? Would this information help you talk to your child care provider about how you want them to feed your baby? Why or why not? How would you imagine using this handout? What other information or resources would you want to help talk to your child care provider? How important is this information for you? What would you change to make this easier to use or more helpful for moms like you? If your child’s child care had a room or place for mothers to breastfeed or pump, do you think you would use it? Would you prefer this to be more private or more social?

Section VI- BBWH Section “Bottlefeeding” (8 Minutes)

Objective: …appeal, comprehension, relevance, usability of handout.

Questions Note: Distribute Attachment K Breastfeeding Babies Welcome Here: Bottlefeeding– Again, take a minute to skim through this information. Please underline anything you don’t understand and put an X on what you don’t like. [Provide 1 minute to review] What are your first impressions of this handout? What stood out for you? Does this look like something designed for mothers like you? Probe images, callout boxes, & tips. What about the amount of information? Do you think this information would help you bottle feed your baby with breastmilk? Why or why not? What other information would you want to know? How would you imagine using this handout? How important is this information to you? What would you change to make this easier to use or more helpful for moms like you? Anything about the way the information is presented? Do you think this information is accurate and reliable? Why or why not?

Section VII- Handout “…Hunger Charts” (8 Minutes)

Objective: …understand participants’ knowledge and clarity of handout images.

Questions [Note: Display Attachment M Breastfeeding Babies Welcome Here: Hunger and Fullness Charts - Now, before we look at this next handout, I want everybody to take a quick look at these images. From looking at these images, which of these babies appear to be full? How can you tell? Which ones appear to still be hungry? How can you tell?

…appeal, comprehension, relevance, usability of handout.

[Note: Display Attachment M Breastfeeding Babies Welcome Here: Hunger and Fullness Charts – Again, take a minute to skim through this information. Please underline anything you don’t understand and put an X on what you don’t like. [Provide 1 minute to review] What are your first impressions of this handout? What stood out for you? Does this look like something designed for mothers like you? What about the amount of information? Is this information important to you as expecting moms? Would this handout help you understand when babies are still hungry? Why or why not? Are there specific images that are clearer than others? How important is this information for you? Is there anything confusing or unclear about Table 1? Would this handout help you understand when babies are full? Are there specific images that are clearer than others? How important is this information for you? Is there anything confusing or unclear about Table 2? How would you imagine using this handout? Do you think this information is accurate and reliable? Why or why not? Have you heard of “paced bottle feeding” before?

Section VIII- Closing (6 Minutes)

Objective:

Questions [Note: Reintroduce graphic messages, posters] Now that we have looked at all of these materials, which of these are the most useful for you or moms like you? Why? What makes this useful? Is there anyway to make the rest of the materials as useful as this? Which of these catches your attention the most? Why? Do these all appear to be related to each other? Why, why not? Is that important? Why, why not? Which of these would you share with other moms like you? Why? Do either of these images [show graphic messages] seem to be more related to all of the materials we’ve discussed? Why? Does anybody have anything else they’d like to add about the materials you’ve seen today?

Thank moms for participation.