Be Antibiotic Aware Campaign

Form Approved

OMB Control No.: 0920-0572

Expiration date: 8/31/2021

FINAL – cleared by DHQP and NCEZID.

Antibiotic Use Campaign – Moderator Guide

Consumers—Caregivers of Nursing Home (NH) Adult Residents

Welcome, Overview, AND rules [5 MINUTES]

Welcome and thank you for agreeing to participate in this focus group. My name is __________ and my role is to guide the discussion. I’m not an expert in the topic we’ll discuss, so I have no particular agenda or point of view. I work for ICF, a private research organization. The Centers for Disease Control and Prevention, or CDC, is sponsoring this health communication initiative. I did not develop any of the messages you will be seeing so I want to get your honest and frank opinions about them.

The purpose of this focus group is to hear your views and opinions on important health topics concerning antibiotic use. We will also ask for your feedback on a few materials. Your insights are very important to us, and CDC will use your feedback to improve the materials you will see. Your time today is appreciated. We will have about an hour and 15 minutes for our discussion.

Before we begin, I want to point a few things out:

• Most importantly, there are no “right” or “wrong” answers to the questions I’m going to ask. Please relax and enjoy the discussion.

• We are recording this discussion to ensure that we capture all the information that is provided. I want to give you my full attention and not have to take a lot of notes. At the end of our discussion, I have to write a report and will refer to the recording when writing the report.

• Also, some of the people working on this project are observing or listening to this discussion.

• Everything you have to say will be kept private and any identifying information will be removed from reports and other data. While those of us here today know your name, only the recruitment team/facility knows your address and phone number, and this information will not be given to anyone and no one will contact you after this focus group is over. 

• Information learned from these discussions may be presented in documents or materials like reports, conference presentations or posters, or publications. The information may also be shared with other health departments and organizations working to improve antibiotic use to assist with their efforts. Please know that the information you share will not be linked to your name or any other identifying information.

• If at any time you are uncomfortable with my questions, you can choose not to answer. Simply let me know that you prefer not to answer. Your participation in this project is completely voluntary.

• Be sure to only use first names during the discussion or use a made-up name, if you prefer. Please do not use your last name. Also, if you bring up a friend or other person you know as an example in our discussions, please do not use their last name either. So, whenever you mention a name, it should only be a first name and never a last name.

Finally, a few requests before we begin:

• Please respect the other participants’ opinions.

• Please maintain privacy - what is said here remains here.

• Please speak one at a time.

• Please turn off your cell phone or put it in vibrate or silent mode.

And as mentioned when you were recruited to participate, you will receive a token of appreciation for participating. At the end, there will be a few minutes to address questions you may have about antibiotic use with a CDC team member.

Do you have any questions before we get started?

GENERAL KNOWLEDGE OF ANTIBIOTICS AND SOURCES OF INFORMATION ABOUT ANTIBIOTICS [10 MINUTES]

Ok, let’s get started. First, I’m going to ask you a few general questions about antibiotics and where you go to get information about them.

1. What do you know about antibiotics?

   1. PROBE: When should and shouldn’t they be used?

   2. PROBE: What do they treat?

   3. PROBE: What are your feelings about taking them?

2. Where do you usually get your information about antibiotics? (HMTS 69d)

   1. PROBE: What about healthcare providers? Which ones?

   2. PROBE: What websites, if any, do you go to for information about antibiotics?

   3. PROBE: What other media sources do you use to get information about antibiotics? [Prompt: This can include TV shows, radio programs, podcasts, etc.]

   4. PROBE: Why do you choose to get your information from these sources?

   5. PROBE: Is it because you trust them, or because they are convenient? Why?

3. What, organizations, if any, do you trust as a reliable source of information about antibiotics? (HMTS 74d)

   1. PROBE: Why do you trust these organizations?

4. Have you ever seen, heard, or read any TV, radio, newspaper, or online advertising about Be Antibiotics Aware?

   1. Probe: [If yes] Where have you seen or hear about Be Antibiotics Aware: on TV? on social media? Through email? On a website?

CONDITIONS ANTIBIOTICS DO AND DON’T TREAT – TESTING CURRENT CDC MESSAGING [10 MINUTES]

In the last few minutes you all told me what antibiotics can and cannot treat and where you get information about antibiotics. Let’s move on to our first material. Take a few minutes to read this material and then we’ll discuss it [give 1-2 minutes to review].

5. What would you say is the main message of this material? (HMTS 1d)

6. Are these new ideas or something you have heard before? (HMTS 12d)

   1. PROBE: If you’ve heard this information before, where have you heard it?

   2. PROBE: [If new] How does this new knowledge impact the way you think about antibiotics?

7. What information in this chart, if any, is confusing, unclear, or hard to understand? (HMTS 6d)

8. Are there any words that are unusual or unfamiliar? (HMTS 4d)

   1. PROBE: [If yes], which words are unusual or unfamiliar to you?

9. What, if anything, do you want to know that this chart doesn’t tell you? (HMTS 29d)

   1. PROBE: What other illnesses, if any, do you think should be included on this chart?

Now I have a few questions about the visual aspects of the piece.

10. Overall, how appealing is this material to you? (HMTS 7e)

    1. PROBE: Why?

11. Where would you expect to see this material? (HMTS 64d)

    1. PROBE: What about social media?

    2. PROBE: In a doctor’s office?

12. Is there anything about the material that you really don’t like?

    1. PROBE: [If yes] Why?

RISKS OF ANTIBIOTICS – TESTING CURRENT CDC MESSAGING [20 MINUTES]

Ok, let’s move on to our second material. Please take a few minutes to read through it before I ask questions (give 4-5 minutes).

https://www.cdc.gov/antibiotic-use/week/pdfs/antibiotics_nursing_home_brochure_508.pdf

13. What’s your general reaction to the way this brochure looks? (HMTS 6e)

    1. PROBE: What do you think about the layout of the information?

    2. PROBE: What do you like about this brochure?

    3. PROBE: How could this brochure be improved?

14. Is this brochure easy or difficult to read? Why?

15. What do you think about the images?

    1. PROBE: Are they appropriate for this material? [If not] What is inappropriate and why?

    2. PROBE: What images, if any, would be better? (HMTS 4e)

Placement of information

16. Where would you expect to see this material? (HMTS 64d)

17. If your loved one’s healthcare provider gave this material to you, would you read it? (HMTS 61d)

    1. PROBE: Why or why not?

18. Would another type of material with this information be more helpful? If so, what type and why would it be better?

    1. PROBE: What about a poster for a doctor’s office?

    2. PROBE: What about a message on the TV at the doctor’s office?

Risks of antibiotics – antibiotic resistance

Now we are going to look at a specific section in the brochure, called “Why does taking antibiotics lead to antibiotic resistance?” Before you start to read this section…

19. Have you heard of antibiotic resistance before?

    1. PROBE: [If yes] What do you know about it?

    2. PROBE: [If yes] Where did you hear about it?

Great. Thanks for that discussion. Now, take a minute to read this section, “Why does taking antibiotics lead to antibiotic resistance?” (give 1–2 minutes).

20. What would you say is the main message of this section? (HMTS 1d)

21. What information in this section, if any, is new to you? (HMTS 12d)

22. What information in this section, if any, is confusing, unclear, or hard to understand? (HMTS 6d)

23. How could the information in this section be improved? (HMTS 33d)

    1. PROBE: What do you think about the amount of text?

24. Is there anything you want to know about antibiotic resistance that this section of the brochure doesn’t tell you? (HMTS 29d)

Risks of antibiotics – side effects

Thanks for that discussion. We are going to move on to our third material, a graphic. Before I pass this out, ….

25. Do you think a person can have side effects from taking antibiotics?

    1. PROBE: [If yes] What are the side effects that you know about?

Great, now take a moment to review this infographic (give 1–2 minutes).

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Do-antibiotics-have-side-Infographic_8_5x5_5_2_508.pdf

26. What is the main idea that this material is trying to get across? (HMTS 1d)

27. Are these new ideas or something you’ve heard before? (HMTS 12d)

    1. PROBE: Have you heard the term C. difficile or C. diff before?

    2. PROBE: [If they say yes to probe above] Where did you hear it?

    3. PROBE: What do you know about it?

28. What information in this piece, if any, is confusing, unclear, or hard to understand? (HMTS 6d)

29. What do you think about the images used in this infographic? (HMTS 5e)

    1. PROBE: What messages do you think the images convey? (HMTS 2e)

    2. PROBE: Is it clear how you could be affected by antibiotic side effects from these graphics?

    3. PROBE: What changes, if any, would you make to the graphics?

30. How could this material be improved? (HMTS 33d)

    1. PROBE: What do you think about the amount of text?

31. What, if anything, do you want to know about antibiotic side effects that this material doesn’t tell you? (HMTS 29d)

Placement of infographic

Now, let’s talk a little bit about where you might expect to see this information.

32. Where would you expect to see this material?

33. In what formats would you prefer to see this information presented? (HMTS 67d)

    1. PROBE: Would you like to see it on a poster? Why?

    2. PROBE: Would you want to see it on social media, like Facebook, Instagram, or Twitter? Why?

    3. PROBE: Would you want to see it in a brochure from the doctor’s office? Why?

34. If your loved one’s healthcare provider gave this material to you, would you read it? (HMTS 61d)

    1. PROBE: Why or why not?

    2. PROBE: Do you think it would be helpful to get information similar to this from a pharmacist? Why or why not?

Now, let’s take a couple of minutes to look at the infographic side by side with the antibiotic resistance section in the brochure that we discussed earlier. I want you to focus on these concepts—not the words or images on these materials.

35. Which concept –antibiotic resistance or antibiotic side effects– is more likely to motivate you to recommend that your loved one take antibiotics only when you need them? (HMTS 110d)

    1. PROBE: Why?

36. [For the concept that the participant didn’t identify as motivating] Why is this concept less likely to motivate you?

    1. PROBE: Can you suggest any changes to make it more effective? (HMTS 120d)

TESTING NH STEWARDSHIP COMMITMENT LETTER [10 MINUTES]

Great, thanks for that discussion. Now let’s move on to our last material for our discussion today. This is a letter that nursing homes can share this with residents and their families about antibiotics. Take a few minutes to read the letter and then we will discuss it. (give 2-3 minutes).

https://www.cdc.gov/longtermcare/pdfs/Stewardship-Committment-Poster-508.pdf

37. What is the main idea that this message is trying to get across? (HMTS 1d)

38. What do you like about this commitment letter?

39. How could this piece be improved? (HMTS 33d)

    1. PROBE: What, if anything, is confusing, unclear, or hard to understand? (HMTS 6d)

40. Is there anything you want to know that this piece doesn’t tell you? (HMTS 29d)

    1. PROBE: What about information about the side effects of antibiotics, like C. diff infection?

    2. PROBE: What about information about specific infections?

41. Overall, how would you feel if you received this letter from your loved one’s nursing home? [For positive or negative response] Why?

Now, let’s talk a little bit about where you might expect to see this material.

42. What would be the best way for you to receive this letter?

    1. PROBE: What about by e-mail or mail?

    2. PROBE: What about receiving this as a handout when visiting your loved one?

    3. PROBE: What about reviewing this in a resident council meeting?

    4. PROBE: Would you like for the nursing home staff to review this information with you?

43. Would you prefer to see this information in a different format?

    1. PROBE: Where and why? (HMTS 67d)

CLOSING [10 MINUTES]

This has been really great – thank you so much for sharing your thoughts and opinions. Do you have any comments or questions about the materials that you’d like to bring up before we end our discussion?

[After comments/questions are addressed] Let me step out for a moment and check in with my team to see if there are any additional questions before I invite a CDC expert in to answer any question you may have.

[Ask question if project team had any. After or if there are no questions, invite CDC expert in and introduce them for QA.]

Thanks for those questions. I hope you found the information helpful. I will go ahead and conclude our discussion now. Please visit www.cdc.gov/antibiotic-use for more information on appropriate antibiotic prescribing. Thanks so much again for your participation.

Public reporting burden of this collection of information is estimated to average between 5 and 75 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0572