Focus Group Interview - USVI Females

OMB Control No: 0920-XXXX

Exp. Date XX/XX/XXXX

USVI Focus Group Instrument for Female Participants

Screening criteria for participation:

• Female of reproductive age (18 – 44 years) who is not pregnant and/or is not planning to become pregnant within the next 12 months

• Sexual activity with a male in the last three months

• Resident of USVI

INTRODUCTION

Thank you for participating. Our discussion should take about 2 hours. Please know that your answers are completely confidential. That means we will not identify you or link your answers to your identity. We will not let anyone outside of this project know of your participation. We are only interested in your opinion, and there are no right or wrong answers. If you don’t understand the question, feel free to let me know and I can ask it another way. This is not a test, so feel free to say you don’t know or don’t have an opinion to offer. If you feel uncomfortable with any of the topics, you do not need to participate in that part of the discussion. You may also end your participation at any time. I also want to let you know that we will be recording this session, and we have a note taker to make sure that we capture all your comments.

• First let’s get to know each other. [MODERATOR to add standard introductory section, which allows for participants to introduce themselves, break the ice, and also for sound-check to make sure that the recording devise is working. Moderator to also encourage women to choose a pseudonym to use throughout the focus group to avoid using real names].

PREGNANCY

• In what ways do women in your community talk about planning a family (reproductive life planning)?

Probes:

• Do women generally discuss plans to have kids/delay having kids?

• Who do women generally discuss this with?

  • Partner/spouse? Family members? Friends?

• Do you think people are looking to delay/prevent pregnancy in the context of Zika?

  • 

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    Why/Why not?

    • Do you think women are worried about Zika? Do you think women know about Zika?

• If a woman in the US Virgin Islands wants to delay/prevent pregnancy, what can she do?

  • What types of resources are available (clinics/facilities, providers)?

TYPES OF BIRTH CONTROL

• Birth control is sometimes called contraception. Are there other words/names women in your community have for it? [Use the name/word preferred throughout remainder of conversation]

• Can you tell me about the types of birth control methods you are familiar with?

• What seems to be the most common birth control methods used in the US Virgin Islands?

MODERATOR: Now, I’m going to ask you about two specific types of birth control options that can be effective for a long time, but you can choose to stop using them whenever you want. They are called long-acting reversible contraceptives (LARC) and they include implants and IUDs.

• Do you think women in the US Virgin Islands are familiar with or have heard of an implant?

Probe:

• Have you heard about it before today? If so, what have you heard about this birth control method? How did you hear about this birth control method?

• Do you think women in the US Virgin Islands are familiar with or have heard of an IUD?

Probe:

• Have you heard about it before today? If so, what have you heard about this birth control method? How did you hear about this birth control method?

MODERATOR: An implant is a small rod, the size of a match-stick, that’s inserted under your skin to prevent pregnancy. An implant is very effective for preventing pregnancy. It releases hormones consistently while it’s implanted in your arm so that you don’t get pregnant. An implant can stay in your arm and continue working for as long as 3 years. They are very effective for preventing pregnancy but a doctor can remove it at any time if you decide that you want to become pregnant.

• Do you think women in your community would be interested in getting more information about this method?

Probe:

• Why/Why not? Cost? Insurance? Support of partner/family/etc.? Concerns about method itself?

• Do you think women in your community would you consider talking to their health care provider about this method?

Probe:

• Why/Why not? Discomfort talking on birth control? Discomfort talking with health care provider? Concerns about confidentiality?

• What do you think women in your community might be concerned with about this method?

MODERATOR: An intrauterine device or IUD is a small plastic T-shaped device that a doctor places in your uterus. There are different types of IUD. Some IUDs can prevent pregnancy for 3 years while others are effective in preventing pregnancy for up to 10 years. Some IUDs contain no hormones while others have a very low dose of hormone. IUDs can be taken out at any time. They are very effective for preventing pregnancy, but a doctor can remove an IUD at any time if you decide that you want to become pregnant.

• Do you think women in your community would be interested in getting more information about this method?

Probe:

• Why/Why not? Cost? Insurance? Support of partner/family/etc.? Concerns about method itself?

• Do you think women in your community would you consider talking to their health care provider about this method?

Probe:

• Why/Why not? Discomfort talking on birth control? Discomfort talking with health care provider? Concerns about confidentiality?

• What do you think women in your community might be concerned with about this method?

ACCESS/USE OF BIRTH CONTROL

• Please describe what you know about how women in the US Virgin Islands get birth control. Would you describe their experiences to be good? Bad?

Probe:

• Where did women get birth control (private clinics, community health centers, university clinics, etc.)?

• What type of clinical providers do women typically go to (ob/gyn, family medicine physician, nurse midwife, nurse practitioner, etc.)?

• Did they face any difficulties or barriers getting birth control?

• Who do you think would be supportive of women using birth control?

Probes:

• Partner/spouse, family members, friends,…

• What are some reasons that you think they would be supportive?

• What are some reasons that you think they would not be supportive?

• Who do you think would be against women using birth control (or not supportive)?

Probes:

• Partner/spouse, family members, friends,…

• What are some reasons that you think they would not be supportive?

• What are some of the things that make it hard for women in your community to get birth control if they wanted to prevent pregnancy?

Probes:

• How does religion play a role?

• How do fears of side effects play a role?

• How does the support of significant others play a role (e.g., partner/spouse, family members, friends, etc.)?

• Are there cultural/community norms or expectations of abstinence among young women or those who are not married?

• Limited access to health care (few clinics/health care providers; distance from clinic/ transportation to clinic)?

• Limited access to contraception (few/no clinics offering contraceptive counseling/services; limited availability of contraceptive options; few contraceptive products available on the island/in the clinic)?

• How do women usually pay for contraception? Insurance coverage? Medicaid coverage? Go to a clinic with a sliding scale?

• What are some of the things that make it easy for women in your community to get birth control if they wanted to prevent pregnancy?

• When discussing which birth control method can be used by a woman, who do you think should be involved in the decision-making process?

Probes:

• The woman? Her physician? Her sexual partner/spouse? Family members?

• Who do you think should be most responsible?

INFORMATION-SEEKING/MESSAGE DISSEMINATION

• How do women in your community learn about birth control?

• Where do women in your community look for information about birth control?

Probes:

• Friends, family members, media, health care provider…?

• Is it easy/hard to find information on birth control in your community?

  • What makes it easy/hard to find information about birth control in your community?

• Who do you think would be a good person to inform you and other women like you in the US Virgin Island about birth control options?

Probes:

• A physician, celebrity, religious or spiritual leader, someone like you…

• Are there any organizations that are really trusted as a reliable sources of health information women in the US Virgin Islands?

Probe:

• What about organizations specifically for birth control?

• What type of information do you think women in US Virgin Islands would you like to receive about different types of birth control methods?

• What would be the best way for us to provide this information?

Probes:

• Videos? If so, where should videos be available? Online? Clinic waiting rooms? Local businesses? Community organizations?

• Radio? What stations would be most appropriate?

• Community/public meetings? What types of meetings?

• Online/Internet? Where do women go online? Social media? Other sites?

• Educational pamphlets? How should these be distributed?

ZIKA

• Have you heard about the Zika virus?

Probes:

• What have you heard?

• Where are you all getting information about Zika?

• Are you concerned about it?

• What if anything are you doing to protect yourself from it?

• Do you know anyone who has been affected by Zika?

Probes:

• Do you know anyone who has had a pregnancy affected by Zika?

• Has Zika impacted your thinking about pregnancy or pregnancy planning?

MODERATOR: I’m going to read you a statement about Zika. Please listen closely and take notes to help you remember anything that you didn’t know, questions, or if something surprises you:

“Zika is spread to people primarily through the bite of an infected Aedes species mosquito but can also be spread through sexual activity. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly as well as other severe fetal brain defects.”

• Did you hear anything you didn’t yet know?

• Did you know it was possible to contract Zika virus through sexual activity?

• How, if at all, does this impact your thinking about pregnancy or birth control?

• Is there anything that could motivate you to consider using birth control if you were interested in delaying or avoiding pregnancy, especially now with Zika being an issue?

CLOSING

Thank you for participating in this focus group. The information you provided will be extremely helpful to women in the US Virgin Islands during this Zika outbreak. We appreciate your time and insights.

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