Focus Groups with Nutrition Educators (CFSAN)

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Appendix II

Moderator’s Guide

Focus Groups with Nutrition Educators

SUMMARY

Research Objectives

The goal of this focus group study is to better understand nutrition educators’ work - both the challenges they have faced and the important things they have learned while providing nutrition education to the populations they serve. The findings from this study will provide foundational information about nutrition education best practices and obstacles, inform recommendations for more effective education and outreach, and identify ways that FDA can best support the efforts of its nutrition education stakeholders.

Research Questions

1. Who do these nutrition educators serve?

2. Where and how do these nutrition educators interact with the populations they serve?

• How, if at all, do nutrition educators use “telehealth”?

3. What topics do nutrition educators cover in their work?

• What do nutrition educators teach on the Nutrition Facts label?

• [If time allows] What do nutrition educators teach on Menu Labeling?

4. What challenges do nutrition educators face while providing nutrition education to the populations they serve?

• What resources would help educators in their day-to-day work?

5. What important lessons learned or useful tips do nutrition educators have to share?

6. How can FDA better support nutrition educators’ work?

Notes to Moderator

This focus group moderator’s guide is not a script and, therefore, should not be read verbatim – although responses to all main questions are required. The moderator will use these questions as a roadmap and probe as needed to maintain the natural flow of conversation.

Section 1. Welcome and Ground Rules (5 mins)

Thank you for taking the time to join us today. I am _______ from ________ and we are conducting a research study on behalf of the U.S. Food and Drug Administration (FDA). The purpose of [today’s/tonight’s] discussion is to talk about your experience as a nutrition educator. Your feedback is very important to us. Our discussion will last about 90 minutes.

Before we start, I want to review a few important things.

FOR IN-PERSON GROUPS:

• Please mute your cell phones or turn them completely off. If you need to use the restroom, please feel free to step out and rejoin us when you are done.

• Your participation today is voluntary, and you have the right to leave the focus group at any time.

• None of my questions are very personal, but you can choose not to answer any of them if you are uncomfortable. Just let me know that you prefer not to answer.

• Audio/video/observers:

• We are audio and video recording this discussion so that I can give you my full attention and not have to take notes. When writing up our findings, we will not include any information that could identify you. Your name, address, and phone number will not be given to anyone, and no one will contact you about this research after this group is over.

• Some members of the study team from RTI and FDA are observing the discussion remotely via livestream. Some are doing so in another room at this location, and I may go check with them at the end to see if they have any additional questions for you.

• All of your comments will be kept secure to the extent provided by law, so feel free to say exactly what is on your mind. I will draft a report of the focus group session, and may include direct quotes in my report, but I will never attribute any quote to any particular person. Your name will never appear in any report I develop about this research.

• Anyone can speak out; you don’t need to wait for me to call on you, just make sure you speak up and speak one at a time. I may occasionally interrupt when two or more people are talking in order to be sure everyone gets a chance to talk and to make sure that we get through all of the topics that we have planned for today.

• Most importantly, there are no right or wrong answers and we are not looking for consensus. We want to hear all of your opinions. I do not work for the people sponsoring this research, so please provide your honest opinions. Also, I am not an expert about the topics we are going to discuss today so you may have questions that I can’t answer.

Do you have any questions before we continue?

FOR ONLINE GROUPS:

• Please silence your cell phones and minimize any distractions for the next 90 minutes.

• Your participation today is voluntary, and you have the right to leave the focus group at any time.

• None of my questions are very personal, but you can choose not to answer any of them if you are uncomfortable. Just let me know that you prefer not to answer.

• Audio/video/observers:

• We are audio and video recording this discussion so that I can give you my full attention and not have to take notes. When writing up our findings, we will not include any information that could identify you. Your name, address, and phone number will not be given to anyone, and no one will contact you about this research after this group is over.

• Some members of the study team from FDA and RTI may be observing the discussion remotely.

• Please mute your cell phones and minimize any distractions for the next 90 minutes.

• Anyone can speak out; you don’t need to wait for me to call on you, just make sure you speak up and speak one at a time. I may occasionally interrupt when two or more people are talking in order to be sure everyone gets a chance to talk and to make sure that we get through all of the topics that we have planned for today.

• All of your comments will be kept secure to the extent provided by law, so feel free to say exactly what is on your mind. I will draft a report of the focus group session, and may include direct quotes in my report, but I will never attribute any quote to any particular person. Your name will never appear in any report I develop about this research.

• Most importantly, there are no right or wrong answers and we are not looking for consensus. We want to hear all of your opinions. I do not work for the people sponsoring this research, so please provide your honest opinions. Also, I am not an expert about the topics we are going to discuss today so you may have questions that I can’t answer.

Do you have any questions before we continue?

Section 2. Participant Introductions and Warm-Up (5 mins)

Let’s go around the room and say your first name and your favorite thing about being a nutrition educator. Please remember to speak up so I can hear you clearly.

Section 3. General Questions (20 - 25 mins)

As I mentioned earlier, we are working with FDA to hear more about your experiences as nutrition educators and how FDA can best support your work. I first want to start with some general questions about your work as a nutrition educator.

• Tell us about the populations you deliver nutrition education to.

  • [Probe if not mentioned] What are the demographics of the population (age, race/ethnicity, sex, income, etc.)?

  • [Probe if not mentioned] What medical conditions do you most commonly see in the populations you serve?

  • How do your clients learn about you and your services? [Note to Moderator: we want to learn whether clients go to the nutrition educators voluntarily or not (e.g., WIC participants are required to take nutrition education) or if it’s a mix]

• Where do you deliver nutrition education to your clients?

• How do you deliver nutrition education to your clients?

• [Probe if not mentioned] Do you provide nutrition education in a group setting? One-on-one sessions?

• [Probe if not mentioned] Do you provide any online/remote education or communications to your clients?

• [If yes] How does online/remote education compare to in-person education?

• How frequently do you see or contact your clients?

• What topics do you discuss with your clients? [Note to Moderator: For in person groups: Write the topics on a white board/poster and circle the ones participants mention as topics they get asked about the most. For online groups: Type on a shared screen so participants can see the topics and/or read aloud]

• What topics do your clients ask you about most?

• How do you decide what topics to discuss with your clients?

• What topics do you wish you had more information on?

• Where do you get your nutrition education materials from?

• [Probe if not mentioned] Do you ever develop your own materials or modify existing materials?]

• Where do you find the background information to inform your own materials?

• Why do/would you decide to make/modify your own education materials? What was missing or not appropriate for your needs?

• What information format do your clients like the most? [Note to Moderator: examples include brochures, social media, trinkets, etc.]

  • Do you have the resources to make copies of downloadable materials—for example, a fact sheet that you find on a website?

Section 4. FDA-Regulated Topic – NFL (30 - 35 mins)

Now we would like to switch gears and focus in on one topic - the Nutrition Facts label.

Nutrition Facts label:

[Note to moderator: We are not looking for feedback on the Nutrition Facts label itself, move them away if they move towards that discussion.]

• Do you provide your clients with any information on the Nutrition Facts label? [Note to moderator: Please ask for show of hands here and say the number out loud so that the information makes it into the transcript.]

  • [For those who say yes] What do you teach your clients about the Nutrition Facts label?

  • [For those who say yes] Do you provide one-time or continuous education on the Nutrition Facts label?

  • [For those who say no] Why do you choose not to discuss the Nutrition Facts label with clients?

The U.S. Food and Drug Administration (FDA) has updated the Nutrition Facts label on packaged foods and drinks. FDA is requiring changes to the Nutrition Facts label based on updated scientific information, new nutrition research, and input from the public. This is the first major update to the label in over 20 years. The label's design and updated information will make it easier for consumers to make informed food choices that contribute to lifelong healthy eating habits.

[Note to moderator: Show the old and new Nutrition Facts label side by side. For virtual groups, show participants old and new NFL on the same screen.]

• How familiar are you with the changes to the Nutrition Facts label?

  • What changes are you aware of?

• How much of what you teach is information that is on the new Nutrition Facts label?

• How much of what you teach is information that is on the old Nutrition Facts label? Why?

• Do you provide information on how to use the Nutrition Facts label? [Note to moderator: either old or new.]

  • Are there specific parts of the Nutrition Facts label you focus on (e.g. calories, serving size, % Daily Value, specific nutrients, etc.)?

• What information do you think is the most important for your clients to know about the Nutrition Facts label?

• How does this compare to what you get asked the most by your clients about the Nutrition Facts label?

• In your experience, do different client groups (e.g. different age groups) have different interests in the Nutrition Facts label? If so, how do they differ?

• Where do you get the information or updates on the Nutrition Facts label?

  • [Probe if not mentioned] Do you use information that was developed by FDA?

    • If yes, what specific information?

  • Where do you get your educational materials on the Nutrition Facts Label?

• What, if any, information on the Nutrition Facts label is confusing to clients? How can this information be clarified?

• What information can FDA provide that would help you better educate clients about the Nutrition Facts label?

Section 5: Challenges and Lessons (20 mins)

Now we would like to learn more about the challenges you face or have faced in the past while providing nutrition education to your clients.

• What are the challenges? [Note to moderator: Please write the challenges on whiteboard while going through this probe.]

  • What is the biggest challenge? Why?

• How have you overcome some of these challenges?

• What information or resources do you wish you had?

• What, if any, information or resources could FDA provide that would be helpful in addressing some of these challenges? Why/Why not?

Section 6: Conclusions (5 mins)

False Close

Thank you very much for participating in this focus group. I appreciate you sharing your time and valuable feedback. Is there anything that you would like to share that you did not have a chance to share yet?

If you will excuse me for just a moment, I would like to check with my team to see if there are any follow-up questions for you. [Moderator goes to back room to see if there are any additional questions or if virtual checks the internal chat box.]

Close

Great, I believe we are all done here. Thank you so much for sharing your experiences and your valuable input. Just so you know, FDA offers nutrition education materials and a health educator’s nutrition toolkit on their website. You can get them at fda.gov/nutritioneducation.

You can also get specific Nutrition Facts label information from the FDA website, at www.fda.gov/newnutritionfactslabel .

Thank you so much for your time!

[Moderator stops recording and directs participants to the assistant who will administer incentives and obtain receipts.]

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