Focus Group Question Categorization

Attachment 9. Focus Group Question Categorization

Research Question
Key topic: Challenges that Rural Clinicians Face in Diagnosing and Managing TBI across the Severity Spectrum
Focus Group Discussion Question	Purpose
A1. Tell us about the risk of concussion or mild TBI in your patient population. How often do you assess a potential concussion or mild TBI in a month? A2. What are the most common causes of mild TBI and concussion among residents in your community?	These questions will allow us to get a feel for the level of experience among the focus group participants in treating patients who have experienced a TBI.
Research Question: What are the challenges and difficulties faced by rural health care providers in diagnosing and managing/treating TBI?
Focus Group Discussion Question	Purpose
B2. Do you experience any challenges or difficulties in diagnosing mild TBI? What is the primary challenge you face in diagnosing mild TBI? B3. Are any of these challenges or difficulties unique to diagnosis of mild TBI in children and adolescents?	These are the main questions that are used to assess challenges among the providers. If necessary, we will prompt them to speak about their challenges with equipment, staffing, training, and patient perceptions.
Research Question: What challenges exist for rural providers as they relate to access to services following TBI (across the spectrum of TBI severity)?
Focus Group Discussion Question	Purpose
C1. Are patients diagnosed with mild TBI treated and managed within your practice/organization or are they referred/transferred elsewhere? C1i. If patients are treated locally: Do you experience any challenges or difficulties in treating mild TBI? What is the primary challenge you face? C1ii. If patients are referred/transferred: Do you experience any challenges or difficulties in referring/transferring these patients? What is the primary challenge you face?	These questions will allow us to get insight into whether the providers are able to treat patients with TBI in-house or they have to refer out for more specialized care.
Research Question: What obstacles do rural providers see in their patients/community to either obtaining initial care following a TBI or for getting follow-up care?
Focus Group Discussion Question	Purpose
D1. What, if any, are the patient barriers to obtaining initial care following a mild TBI? D2. What, if any, obstacles do patients face in getting follow-up care following a mild TBI?	These questions will allow respondents to talk about barriers to care that they see among their patients.
Research Question: What TBI-related information is lacking among rural health care providers?
Focus Group Discussion Question	Purpose
B1. What tools do you use to diagnose mild TBI?	This question will allow us to see what tools the rural providers use to diagnose TBI; whether they are using up-to-date, evidence-based tools; and how we might be able to convey to them the information they would need to take advantage of these tools.
F2. What mild TBI-related information would be helpful to improve patient knowledge and awareness of TBI in your community?	This question will allow us to directly assess what TBI information these providers think is lacking among themselves and their peers.
Key Topic: Develop a Knowledge Base to Address Gaps in Services to Improve Clinical Care
Focus Group Discussion Question	Purpose
F6. What do you want the CDC to know about mild TBI in rural communities?	This question will allow respondents to speak to any TBI-related issue that is important to them; we hope that responses to this question will expand our view of what’s happening on the ground in rural areas and let us know exactly where the challenges and opportunities lie.
What processes do rural health care providers and educators engage in to ensure that children return to school and play following a TBI in a way that minimizes academic disruption? What are the unique challenges in managing this process in a rural setting, if any?
Focus Group Discussion Question	Purpose
E1. Some communities have adopted what are called “return to school” or “return to learn” policies that are meant to help children and adolescents successfully transition back to school after experiencing a concussion or mild TBI. Are you aware of return to school policies following concussions in children adopted by your local school district or state?	This questions gauges how much the respondents know about their communities’ return-to-learn policies. It is possible that their communities have such policies but the providers do not know about them or that their communities have no such policies (both of which would provide an opening for improvement).
E2. What steps do you take to help children return to school after they have experienced a mild TBI? E2i. What kinds of interactions have you had with parents or educators about returning children to school after experiencing a mild TBI?	These questions are meant to elicit the providers’ protocols, if they exist, for ensuring a safe return of students to school following a TBI and whether they coordinate with parents and educators for this process. They could also open up the discussion about challenges that these providers face in doing so, if they do not have a protocol or they have trouble getting the parents on board, for instance.
E3. What steps do you take to help children return to playing sports in a way that reduces the likelihood of a second concussion or mild TBI? E3i. How do you talk with parents and coaches about this process?	As a companion to E2, these question asks about providers’ experience with returning youth to play/sports safely following a concussion. Often this portion is just as important as returning to school for young athletes, and presents unique challenges (for instance, if the child is serious about athletics or has a coach that is pushing for a quick return).
Which, if any, innovative approaches have rural providers tried or would like to try to overcome these challenges?
Focus Group Discussion Question	Purpose
B4. How do you manage these challenges?	This is a follow-up question to the general “do you experience any challenges or difficulties in diagnosing/treating/referring” TBI question. B4 will allow the providers to talk about their experience and ideas about managing these challenges, in both typical and innovative ways that might be of use to other rural healthcare providers in similar situations.
F1. How would/do you approach barriers to the diagnosis, treatment, and/or management of mild TBI?	These questions directly inquire as to the ways that the respondents have tried to overcome the challenges that they faced and if they have innovative ideas/solutions that they have either thought of or implemented.
Research Question: What resources are needed for rural providers to improve their TBI-related practice, including any training and decision support tools?
Focus Group Discussion Question	Purpose
A3. How prepared do you feel to diagnose and manage patients with mild TBI?	This question will serve as a way for us to learn about challenges and difficulties the providers face in diagnosing and managing TBI in their patient populations. The participants can let us know if they feel unprepared, why they might feel this way, and whether training or lack of training plays a role in this feeling.
A3i. What kind of training, if any, have you received on mild TBI/concussion?	This question will allow us to determine what types of training rural providers have already seen and by contrast, what types of training are lacking.
F3. What clinical training/continuing education would be helpful to improve your mild TBI-related practice? F4. What kind of mild TBI training experiences have you found helpful? These can be informal or formal. F5. What other resources would be helpful to improve your mild TBI-related practice?	These questions directly ask the providers what type of training and experiences they have had in the recent past and what they would like to see in the future to help them improve their TBI practice.

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