Focus Groups on Childhood Obesity with Hispanic Primary Caregivers (CFSAN)

Appendix II

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Focus Groups with English- and Spanish-Speaking
Hispanic Low-Income Parents on Childhood Obesity
Appendix II: Moderator’s Guide

The target audience for these focus groups is low-income U.S. adult (18+) consumers who are parents/caregivers to children (3 to 6 yrs.).

Recruiting Goals

• Twelve (12) focus groups will be conducted, and segmented as follows:

Group	Access and Facility Type	Race/Ethnicity/Language
Mock*	TBD	TBD
Group 1	High Access; Conventional Facility	English-Speaking Hispanics
Group 2	High Access; Conventional Facility	English-Speaking Hispanics
Group 3	High Access; Conventional Facility	Spanish-Speaking Hispanics
Group 4	High Access; Conventional Facility	Spanish-Speaking Hispanics
Group 5	High Access; Conventional Facility	English-Speaking, Non-Hispanic White
Group 6	High Access; Conventional Facility	English-Speaking, Non-Hispanic White
Group 7	Low Access; Non-Conventional Facility	English-Speaking Hispanics
Group 8	Low Access; Non-Conventional Facility	English-Speaking Hispanics
Group 9	Low Access; Non-Conventional Facility	Spanish-Speaking Hispanics
Group 10	Low Access; Non-Conventional Facility	Spanish-Speaking Hispanics
Group 11	Low Access; Non-Conventional Facility	English-Speaking, Non-Hispanic White
Group 12	Low Access; Non-Conventional Facility	English-Speaking, Non-Hispanic White

*Data collected from mock focus group will not be included in analysis

Purpose:

To better understand consumer behaviors, motivations, and attitudes toward child obesity. The findings from these groups will inform audience-focused public information and education that addresses childhood obesity.

NOTES TO REVIEWER:

This focus group guide is not a script and, therefore, should not be read verbatim. The moderator will use these questions as a roadmap and probe as needed to maintain the natural flow of conversation.

Research Questions

RQ1. What are low-income parents’ experiences related to making healthful food choices at the grocery store?

RQ1a. Do these experiences vary by access level?

RQ1b. Are there any cultural differences to these experiences?

RQ2. What are low-income parents’ experiences related to making healthful food choices at home?

RQ2a. Do these experiences vary by access level?

RQ2b. Are there any cultural differences to these experiences?

RQ3. What do low-income parents believe constitutes a healthy, well-fed child?

RQ3a. To what extent does this belief vary by access level?

RQ3b. Are there any cultural differences to these experiences?

RQ4. What are low-income parents’ attitudes and perceptions related to childhood obesity and body image?

RQ4a. Are there any cultural differences to these attitudes and perceptions?

RQ5. What resources (e.g., health professionals, health educators) do low-income parents have to overcome childhood obesity? Additionally, what are their perceived barriers?

RQ5a. To what extent does having lower access to supermarkets exacerbate these barriers?

RQ5b. Are there any cultural differences to these experiences?

Introduction and Warm-Up (10 min.)

Thank you for joining us today. I’m _____, and I’m from Westat, a research firm in Rockville, MD. We are conducting research on behalf of the U.S. Food and Drug Administration. Today I am going to be asking you to talk about your family’s food and eating behaviors. I’m here to learn from you and hear what you have to say about these topics, so please feel free to speak openly and honestly. Your full participation today is going to help us better understand how people think about and make decisions around food. What you have to say is very important to us and your time today is appreciated. We will have about 90 minutes for our discussion.

Before we begin, I want to review a few ground rules for our discussion.

• There are no right or wrong answers in today’s discussion. We want to know your honest opinions and experiences.

• We are audio and video recording this conversation so that I can give you my full attention and not have to take a lot of notes. We are also livestreaming the discussion so that project staff from our research team can watch.

• IF IN CONVENTIONAL FACILITY, There are also staff in the observation room behind us. I have a colleague who is assisting with the technology for the recordings and livestreaming.

• When writing up our findings, we will not include any information that could identify you. Your name or contact information will not be given to anyone, and no one will contact you about this research after this group is over. Essentially, nothing you say will be tied directly to you. We are interested in what is being said, not who is saying it.

• Everyone’s participation is important; we want to hear from everybody.

• It is OK to disagree.

• Please speak up (speak loudly).

• Please speak one at a time so we can hear all the responses—no side conversations.

• Please turn off your cell phones or anything else that may make it difficult to concentrate.

• If at any point you feel uncomfortable with a question, simply let me know that you prefer not to answer that question. You can also leave the groups at any time.

• In any questions where we ask about “your children” please refer only to your children who are 3-6 years old.

• Finally, please keep an open mind and remain respectful of your fellow participants. This means please do not interrupt people and please don’t share what we discuss with others after the group.

• Do you have any questions before we begin?

Warm-Up. Thanks again for being here. Everyone in the room has something in common—you are all parents or caregivers of young children. Let’s warm up by going around the room and saying your first name, your children’s ages, and their favorite foods.

Food Shopping (15 min.)

1. Let’s start off by talking about getting groceries for your family…

• Where do you usually get your groceries from?

• In a typical month, how often do you go?

  • IF NEEDED, Probe on whether participants time shopping to line up with EBT disbursement or other payments

• What challenges do you face to get there?

  • Transportation, child care, etc. are likely to emerge as barriers here.

2. When you get groceries, how do you typically decide what you get?

• PROBE on cost, healthfulness, making sure there’s enough food for the week, etc.

• Do you get different things for your child as compared to what you get for yourself?

• Do you get different things when your child is with you than when you go alone?

• Are there any sections where you tend to make most of your selections? Explain.

• Conversely, are there any sections that you tend to avoid? Explain.

Food Preparation in the Home (15 min.)

Let’s talk about preparing meals for your family.

1. Let’s look at the recipes you brought with you.

• Tell me about the recipe. Why is it something you cook often?

  • PROBE AS NEEDED: appealing to kids, economical, fast, healthfulness

  • INCLUDE RESPONDENTS WHO DON’T BRING A RECIPE IN THE DISCUSSION

• What other foods do you usually serve with this dish? How do you decide which foods should be included in the meal?

2. What kinds of things do you consider/take into account when you’re preparing a meal for your family?

• PROBE AS NEEDED: picky eaters, something different for the youngsters, enough food to eat, healthfulness

Attitudes toward “Healthy” and “Healthy Eating” (15 min.)

1. Let’s take a step back for a second and think about the word “health.” What does this word mean to you?

2. Now, what words come to mind when you think of a healthy child?

• Moderator writes these words on the board and picks which words to probe on. Tell me more about that…” for words related to food (well-fed, eats healthy, etc.) and weight (not too heavy, not too thin, strong, good-looking, etc.)

3. Let’s discuss a little more about how food is related to your child’s health…

• PROBE: type of food, how much the child eats (adapt probing depending upon discussion at Q2)

• Parents often have concerns about what their children eat. Is anyone here concerned about what foods your child eats? Tell me about that.

  • PROBE on what the “right kinds of foods” means to them.

• Sometimes parents worry about how much their children eat, that they may be eating too much or too little of a certain food. Has anyone here had that concern?
  IF YES: What steps, if any, have you taken to address that with your child? How effective have they been?

4. What does it mean for a child to be “well-nourished”? What do you do to make sure your child is well-nourished?

• PROBE: How would you know if your child is well-nourished? What signs would you look for?

• PROBE: Which foods would help your child be “well-nourished”?

Perceptions of “Overweight” and their Child’s Weight (25-30 min.)

Activity. We talked about the term “healthy child” earlier. Now let’s do an activity that builds upon that.
MODERATOR HAS LARGE CARDS WITH EACH FIGURE.

Each of these cards has a drawing of a child about 3-6 years old. For each card, you’ll decide as a group whether the child is “healthy” or “not healthy.”

• Write “healthy” and “not healthy” as headings on the board or easel.

ALTERNATE MALE/FEMALE FIGURES BY GROUP. For each figure:

1. Is this child “healthy” or “not healthy”? Why?

• Probe on reasons for classification, e.g., size, body characteristics

• Who disagrees? Why?

  • Elicit reasons for disagreement, e.g., inability to assess “healthy” by body weight; individual body size differences unrelated to health

  • For each figure, place in a “healthy” or “not healthy” pile, based on either consensus or, if needed, majority vote.

2. Let’s look at all of the cards together.

• Hang figures under the relevant header.

• What are the differences between the “healthy” and “not healthy” groups?

  • Probe on commonalities within each group, as well as differences across groups.

  • If participants wish to change classifications based on comparing the groups, discuss reasons why.

REPEAT WITH FEMALE/MALE FIGURES.

• Probe on any gender differences if raised by respondents.

3. What concerns or thoughts, if any, do you have about YOUR child’s weight?

• If parent mentions having concerns or thoughts about their child’s weight, probe for…

• Concerns as the child/ren grow(s) older

• Have you ever wanted to change your child’s weight status?

• If so, why? What have you done?

Resources for and Perceived Barriers to Healthy Eating (12 min.)

1. If you’ve had questions about your child’s eating and nutrition, where have you gone – or who have you talked to – to get answers?

• What source/s of info have been most useful for you? What changes, if any, have you made based on those recommendations?

• What sources have been least useful to you?

• What did you do when you had conflicting advice?

• What areas/issues do you still have questions about?

Summary

We’ve talked a lot about different challenges parents face making sure their young children eat a healthy diet and maintain a healthy weight. Are there any particular issues you’ve faced that we haven’t already discussed?

• OPEN for discussion

False Close

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 new questions.

Close

Great, I believe we are all done here. 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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