Focus Group Guide - Non-Z-CAN Women English

Attachment H-3. Focus group discussion guide for women not enrolled in Z-CAN

Screening criteria for participation:

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

• 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)

• Has not participated in the Z-CAN program

Ensure all participants have provided their written informed consent.

INTRODUCTION

Thank you for participating. Our discussion should take about 1.0-1.5 hours. Please know that your answers will be kept completely private. That means we will not use your name or 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 opinion, and there are no right or wrong answers. If you don’t understand the question, 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. Some of the topics that we will be discussing may be sensitive. If you are uncomfortable with any of the topics, you do not need to participate in that part of the discussion. You may also end your participation in the discussion at any time. 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, to break the ice, and also for confirming that the tape recorder is working. Moderator will encourage women to choose a pseudonym to use throughout the focus group to avoid using real names to identify group participants].

[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 do they use? What is common?

• 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, others?

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

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

• 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?

Z-CAN PROGRAM

MODERATOR: We would like to ask you about the Zika Contraception Access Network (Z-CAN program).

• What have you heard about the Z-CAN Program?

Probes: Where did you hear about it? From someone in your community, on the radio, posters, or other method?

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

Probes: Have you heard good things? Bad things?

• Do you know of anyone who has used Z-CAN services? Who?

• Are you interested in participating in the Z-CAN program? Why or why not?

ZIKA VIRUS

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

• 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

MODERATOR: 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, as well as a contact so that you can learn where you can go to access services.

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