Focus Group Guide - Z-CAN Women English

Attachment H-1. Focus group discussion guide for women enrolled in Z-CAN (English)

Screening criteria for participation:

• Female of reproductive age (18 or older) (Probe for year of birth)

• Participant in the Z-CAN program

• Not currently pregnant or planning pregnancy

• At risk for unintended pregnancy

  • Able to become pregnant

  • Currently sexually active (has had sexual intercourse in the past 3 months)

• Resident of Puerto Rico

• Spanish fluency (Focus groups will be conducted in Spanish)

Ensure all participants have provided their written informed consent.

INTRODUCTION

First, I want to thank you all for participating. Our session should take about 1.0-1.5 hours. Please know that your answers will be kept completely private. That means we will not identify you or link your answers to your identity. As we start the discussion, please think of a name (different from your real name) to use during the discussion. We will not let anyone outside of this project know of your participation. We are only interested in your opinions, 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. I also want to let you know that we will be tape recording this session and taking notes, so that we can be sure to capture all of 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 confirming that the tape recorder is working. Moderator will also encourage women to choose a pseudonym to use throughout the focus group to avoid using real names to identify speakers].

[MODERATOR: In the focus group, every time we say “community”, we are referring to family, work, neighborhood, friends, and other people in one’s life.]

PREGNANCY

• In what ways do people talk about planning a family in your community? That is, in your family, among your friends or co-workers, or among other groups of people that you talk with?

Probes:

• How do people generally discuss plans to have children/delay having children?

  • Who do they generally discuss this with? Partner/spouse? Family members? Friends? Healthcare providers? Others?

• How do you think people see delaying/prevent pregnancy in the context of Zika?

• If a woman in Puerto Rico wants to delay or prevent pregnancy, what can she do?

Probes:

• How acceptable are the various options mentioned?

• How feasible are the various options mentioned?

BIRTH CONTROL

• If a woman in your community wanted information about birth control, what are some ways she could get that information?

Probes:

• What makes it easy or hard to find information on birth control in your community?

TYPES OF BIRTH CONTROL

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

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 IUDs and implants.

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

Probe: Do you think women in Puerto Rico are familiar with or have heard of an implant?

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

Probe: Do you think women in Puerto Rico are familiar with or have heard of an IUD?

MODERATOR: An implant is a thin rod, the size of a match-stick that is inserted under your skin in your upper arm to prevent pregnancy. The implant releases a hormone so that you don’t get pregnant. An implant can stay in your arm and continue working for up to 3 years. The implant is 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 this method?

Probes: Why or why not? Please explain.

• Do you think women in your community would be interested in talking with their health care providers about this?

Probes: Why or why not? Please explain.

• 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. 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 this method?

Probes: Why or why not? Please explain.

• Do you think women in your community would be interested in talking with their health care providers about this?

Probes: Why or why not? Please explain.

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

ACCESS/USE OF BIRTH CONTROL

• Think about people you may know who are currently using birth control…

Probes:

• What types of birth control are commonly used?

• Please describe what you know about their experiences getting birth control. Good? Bad?

• Did they face any difficulties or barriers?

• Who do you think would be supportive of women using birth control? What are some of the reasons that you think they would be supportive?

Probes: partner/spouse, family members, friends, healthcare providers, others?

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

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

Probes:

• What is the impact of religion?

• How do fears of side effects play a role?

• How does limited access to health care and or contraception affect it?

• How does cost affect the decision?

• How do you feel about discussing it with your partner?

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

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

• When discussing which birth control method can be used by a woman, who do you think should be most responsible for making the decision? Why?

Probes: The woman? Her physician? Both the woman and her physician together?

• All of you received services through the Z-CAN program. Thinking back about a year ago, before the Z-CAN program, what challenges did women encounter when seeking contraception?

Probes:

• Access to appointments?

• Access to patient-centered contraceptive counseling?

• Access to long-acting reversible contraception, such as IUDs and implants?

• Insurance coverage/cost of different types of birth control?

EXPERIENCES WITH PATIENT-CENTERED CONTRACEPTIVE COUNSELING

[SOME WOMEN MAY NOT FEEL COMFORTABLE SHARING THEIR INDIVIDUAL EXPERIENCES. MODERATOR WILL NEED TO CAREFULLY GUIDE THIS SECTION.]

MODERATOR: Now, I’m going to ask you about your experiences with the Z-CAN program.

Thinking back to your experience at your first Z-CAN visit…

• Who counseled you on contraceptive methods?

Probes: A clinic staff member/nurse? Your physician? Both?

• Were multiple contraceptive methods discussed with you during your counseling session?

Probes: What methods were mentioned?

• Do you feel like you had a choice in what contraceptive method you received at your Z-CAN visit?

Probes: Why or why not?

• Were you satisfied with the contraceptive counseling you received through the Z-CAN program?

Probes: Why or why not?

• What suggestions do you have for improving contraceptive counseling in the Z-CAN program?

EXPERIENCE WITH BIRTH CONTROL THROUGH Z-CAN

[SOME WOMEN MAY NOT FEEL COMFORTABLE SHARING THEIR INDIVIDUAL EXPERIENCES. MODERATOR WILL NEED TO CAREFULLY GUIDE THIS SECTION.]

• Are you satisfied with the contraceptive method you received through the Z-CAN program?

Probes: Why or why not?

• Do you think you will continue with your contraceptive method over the next 6 to 12 months?

Probes: Why or why not?

• If you are using a method other than an IUD or an implant, has it been easy or difficult to get your birth control refilled?

Probes: Why or why not?

• How has using contraception impacted your quality of life?

Probes: Please explain.

THOUGHTS ABOUT THE Z-CAN PROGRAM

MODERATOR: Now, we would like to hear about your experience with the Z-CAN program overall.

• How did you find out about the Z-CAN program?

Probes:

• Advertisement? What kind? Where (radio, posters, other)?

• A community event?

• Healthcare provider?

• Partner/spouse, friends, family, others?

• Was it difficult for you to access services through the Z-CAN program?

Probes: Why or why not?

• Were you satisfied with the services you received through the Z-CAN program?

Probes: Why or why not?

• What suggestions do you have for improving the Z-CAN program?

• What do women in your community think about the Z-CAN program?

Probes: Have you heard good things? Bad things?

• Have you talked about Z-CAN with a friend or family member?

Probes: Would you recommend Z-CAN to a woman who was interested in contraception?

ZIKA VIRUS

MODERATOR: Last but not least, we would like to explore with you details about the Zika virus in Puerto Rico.

• What were some issues that were important to you when seeking contraception?

Probes:

• What would you say was the most important factor in your decision to use contraception?

• Were you concerned about Zika?

• What have you seen or heard about the Zika virus?

Probes:

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

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

  • If you know of a woman whose pregnancy has been affected, how has the pregnancy been affected?

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

Probe:

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

• What do women in Puerto Rico think about the Zika virus? Are they worried about it or not so worried about it? Why or why not?

• What are you doing to protect yourself from it?

Concluding Question

• I want to make sure that I captured everything you wanted to say correctly. Is there anything else you would like for me to know about Z-CAN or contraceptive access in Puerto Rico?

CLOSING: I want to thank you all for participating in this focus group session today. If any of you are interested in learning more about the Z-CAN program, we are happy to provide you with additional information.

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