Foundational Focus Groups

Foundational Focus Group Discussion Guide

Research Objective: Explore key audiences’ perceptions and attitudes to COVID-19 and what preventive measures they take daily to avoid transmission.

NOTE TO REVIEWERS: The discussion guide is written in a purposefully colloquial style to better engage with participants. Question probes are below each main question and may change. These are suggestions for the moderator to follow and will be used as deemed relevant and necessary in the natural flow of discussion. The discussion guide is developed for a 90-minute session. Moderator instructions are highlighted in yellow and bracketed.

Guidelines and Introductions	5 minutes
Current Situation, Moods, and Feelings Routines Family Vaccines Preventive Measures [Rotating Topic]	15 minutes 10 minutes 5 minutes 20 minutes 17 minutes 13 minutes
Wrap-Up	5 minutes
TOTAL TIME	90 minutes

Guidelines AND Introductions (5 MIN)

Guidelines

Thank you for speaking with me today. My name is _________, and I work for a private research company. Today we want to get your thoughts and opinions about COVID-19 and how it is affecting life in the United States. We would also like to better understand what precautions you and your family take when it comes to avoiding infection from the virus. This group is one of several group discussions taking place across the country and will help better inform researchers of the current public situation.

Before we begin, I want to go over a couple of things:

• There are no wrong answers. Our whole purpose for being here is to hear what you think, so please speak up, especially if what you have to say is different than what someone else is saying. You may represent what a lot of other folks think.

• As we’re going through the questions, we want you to think about not only your current situation but also how you feel other people in your life, including family and friends, are responding to particular situations. We’re not asking you to reveal any personal information that you don’t want to discuss but rather general perceptions and thoughts about the questions that we ask during this session.

• There may be times I ask you to clarify or ask you to tell more about what you just said. This is simply to make sure I understood and accurately capture what you think, not because I’m challenging your point of view.

• Your participation is voluntary. If I ask any questions you do not wish to answer, you do not have to answer them. I do want to hear from everyone though, so I might call on you at some point.

• We want to hear from everyone, but I ask that you speak one at a time, although I understand it can be difficult, especially online. I simply want to make sure I hear everything that everyone says.

• Nothing you say will be tied back to you. Your name and any identifying information will not be used in any of our reports.

• There are some other people listening in who are helping me take notes so that I can fully focus on our conversation and be respectful of your time. At the end of the group, they might have a couple of clarifying questions for us.

• I’ll be video recording our conversation; it will only be used to confirm our notes. Only the research staff will have access to this taping and no personally identifiable information will be used in connection with the recording. Does everyone agree to be recorded? [ASK FOR AGREEMENT THROUGH A SHOW OF HANDS OR HEAD NOD] I am going to start the recording now.

• Our discussion should take no more than 90 minutes. Coming out of the focus group, we have additional information and resources available. I appreciate the time that you carved out to be here, and I want to be respectful of that, so I may interrupt us so that we stay on track.

Do you have any questions before we begin?

Introductions/Ice Breaker

I’d like to start by getting to know each of you a bit better. So, I’m going to have everyone go around and share their first name, where in the country you live, what you do, and your favorite type of food to make at home.

I can go ahead and get us started.

• [Moderator introduces self, answers the questions, and then has each participant introduce themselves and respond to the icebreaker questions.]

• [MODERATOR TO PROBE AS NEEDED TO GET PARTICIPANTS COMFORTABLE AND TO ESTABLISH RAPPORT/ENSURE THAT PARTICIPANTS’ VOLUME IS AT THE RIGHT LEVEL.]

CURRENT SITUATION, MOODS, AND FEELINGS (15 MIN)

[MODERATOR: FOCUS ON THE BOLDED QUESTIONS.]

Thank you—I look forward to getting to know you all better over the course of the conversation.

• To start off, I want everyone to think about COVID-19. What are the first words or phrases that come to mind when you hear the word “COVID-19”?

• [WHITEBOARD ACTIVITY: Write down all words and phrases that the group brings up. Ask about each one to the group for consensus or discussion.]

• [PROBE FOR EACH]:

  • When you see this word, what thoughts come to mind?

  • How have you dealt with COVID-19 in your daily life?

• How likely do you believe you are to get COVID-19?

• How does someone become infected?

• Who is most at risk of catching COVID-19?

  • [MODERATOR: LISTEN TO SPECIFIC CHARACTERISTICS AND LIGHTLY PROBE TO GET SPECIFIC SUBPOPULATION DEMOS OR SOCIOECONOMIC CHARACTERISTICS.]

• Who is most at risk of dying from a COVID-19 infection?

  • [MODERATOR: LIGHTLY PROBE ON SPECIFIC DEMOGRAPHICS OR SUBPOPULATION CHARACTERISTICS.]

• How would you describe the symptoms of COVID-19 infection?

• How much do you worry about COVID-19?

  • [PROBE]: State of personal health? Family health? The economy?

• Now we want to change the discussion to talk more about any changes you and your family may have experienced since the start of the COVID-19 pandemic. How is your and your family’s life different today than it was one year ago?

• How has your daily life changed?

• What are some things you could do to make the situation better for you and your family?

• [WHITEBOARD: Write out sources as they mention them] Where do you turn for information about COVID-19?

• What resources do you think would provide the best information about COVID-19?

  • [PROBE] Can you list any specific people? Organizations?

  • How often do you get information from these sources?

  • [PROBE around any disconnect between sources they use and sources they feel provide the best information.]

• I’m going to show a list of sources on the screen and I want everyone to vote on whether each is a trustworthy source. We’ll discuss afterwards. [SHOW LIST OF SOURCES]

  • [LIST: National public officials, state/local public officials, government health care officials, state/local health care officials, news programs, magazines, doctors, or nurses in my doctor’s office]. [FOR EACH, ASK]:

    • What about this source makes you want to use it?

    • What about this source draws any concerns?

    • How much trust do you have in these sources to provide you with accurate information about the coronavirus or COVID-19?

    • What other news or information do you get from these sources?

• [SHOW LIST OF ORGANIZATIONS]: CDC, FDA, HHS]

  • How many organizations on this list do you recognize?

  • What kind of information do they provide about the COVID-19 pandemic?

  • What about these sources, if anything, make them trustworthy?

• How often do you visit social media platforms to get information about COVID-19?

  • Do you visit specific pages?

ROUTINES (10 MIN)

• Now I want to focus our discussion on what your day-to-day life has looked like during the COVID-19 pandemic. We’re really interested in how you do some common activities, so the more detail the better in this regard. Please be as descriptive as possible so that we have a good understanding of what you do in each situation.

• How often do you leave your house? For what kinds of activities in general?

  • How often do you do each of these?

    • [PROBE: Trying to get at the need to get out as well]: Are these activities necessary each time? Do you try to do these as little or as much as possible?

    • [PROBE]: How do you feel when you do these activities? Describe your thoughts when you do each one the best you can.

• Thinking about the past week, what kinds of measures have you taken to try to protect yourself from getting COVID-19?

  • What was your experience like when you most recently went to a store?

• In what ways has the pandemic changed what a typical weekday looks like for you?

  • In what ways do you structure your day differently than you did before?

• For those who are going into a work location right now, what do you do differently to prepare and get ready for work? What do you take to work with you?

  • Is there anything you do differently at the end of the day?

    • [PROBE]: If you leave home, how do you prepare to return home at the end of the day?

• [For those currently employed] I’m interested in learning about any actions your employer has taken related to COVID-19.

  • Have they implemented any kind of leave policy that differs from previous policies?

  • What actions has your employer taken to protect your physical health?

  • What actions has your employer taken to provide for your safety?

familY (5 MIN) – Add for Family groups to above section

• For those of you who have children at home, what kinds of changes have you implemented for them since the beginning of the COVID-19 pandemic?

• How has their school day changed?

  • Are they distance learning, going to the school building, or a mix of the above?

    • [PROBE FOR EACH MENTIONED]: What have been the challenges associated with this for you? For them?

    • If they leave for school, are they doing anything different when they leave the house? [PROBE IF NEEDED]: Taking anything different with them? Is there anything that you do to prepare for their return?

    • How does their schedule compare to the time prior to the pandemic?

• How often do they socialize with friends? Think about socializing both indoors and outdoors.

  • What do their social interactions look like?

  • [Probe around indoor vs. outdoor activities] On average, how many friends do they interact with?

  • What precautions, if any, do they need to take when interacting with friends?

• Are there any house rules that you have introduced since the beginning of COVID-19?

VACCINES (20 MIN)

• Now I want to talk about vaccines. In general, what are some words you would use to describe vaccines? [PROBE: Listen to THE LANGUAGE THEY USE to describe taking vaccines].

• [PROBE] Tell me about your most recent experience with vaccines, if any.

• When you hear the phrase “getting a vaccine,” what do you expect that process to look like? What does it look like to “take a vaccine?” How are those the same or different?

• Have you gotten a flu shot this year? Do you typically get one each year?

• In general, how often do you get recommended vaccines?

• [PROBE for specific reasons they do/don’t get vaccines.]

• [PROBE]: How convenient is it for you to get vaccines? Where would you typically go if you needed a vaccine?

• How affordable are vaccines?

• Once an FDA-authorized vaccine to prevent COVID-19 becomes available to you at no cost, how soon would you get vaccinated?

• How effective do you feel initial vaccines will be when they are first available?

• How safe do you believe a vaccine will be?

  • [PROBE]: How concerned are you about potential side effects of a vaccine?

• How important is a COVID-19 vaccine? How necessary?

  • Why should someone get a COVID-19 vaccine?

• Under what conditions would you get a COVID-19 vaccine?

  • When would you be likely to get a vaccine?

  • What are the benefits of taking a vaccine when it first comes out?

  • What are the benefits, if any, of waiting to take it?

  • What, if anything, would it take for you to get a vaccine immediately when it is available?

• Are there particular people you would look for to find out more information about taking a vaccine?

  • [PROBE]: Primary doctor? Government officials? Health care professionals?

[PROBE]: Are there health care professionals you trust when it comes to inquiring about vaccines? Who are they?

• What questions or concerns do you have about getting a COVID-19 vaccine?

• What kinds of information would you look for to better understand if you should take a COVID-19 vaccine when it is available?

• What fears, if any, would you have about any of the vaccines that become available?

• Of those people closest to you, how many of them want you to get a vaccine?

• Where would you go to learn more about a COVID-19 vaccine?

• What information would you be looking for?

  • [PROBE]: Effectiveness of the vaccine? Statistics on any side effects or the number of people with side effects?

  • Is there anything specific that you would want to know more about?

  • Would recommendations from certain individuals or groups impact your decision? [PROBE IF NEEDED]: Whose recommendation would count the most?

    • [PROBE]: Would you want to know if it is backed by federal health officials?

    • [PROBE]: Your primary physician?

    • [PROBE]: Other experts?

  • Where should information about COVID-19 be made available?

• When you hear the term “herd immunity,” what does that mean to you?

• In your opinion, how effective is “herd immunity”?

PREVENTIVE MEASURES (17 MIN)

• What most worries you about the possibility of you or your family or friends getting COVID-19?

• Do you ever worry that you may get COVID-19 but not show any symptoms?

• How are your friends and extended family reacting to the situation?

• How important do you think it is to take precautions to “slow the spread” of coronavirus?

• What are some of the reasons you say that?

• [WHITEBOARD ACTIVITY: Write down responses and ask for consensus or anything new.] What measures do you take to slow the spread of COVID-19? [Discuss each briefly.]

• [If mentioned or not] There are several protective measures that have been mentioned here or by others in the community. First, let’s discuss handwashing.

• How has COVID-19 changed your handwashing routine (if at all)?

  • [PROBE]: Did it become more frequent as a result of COVID-19?

  • [PROBE]: At what times during the day, or during what situations, do you usually wash your hands?

  • [PROBE]: Has the length of time you wash your hands differed since the start of the COVID-19 situation? How long do you think you need to wash your hands? For example, for how many seconds?

• Under what conditions would you use hand sanitizer instead of washing your hands?

  • Are the two interchangeable for what is needed to protect against COVID-19 infections?

  • How do you generally apply sanitizer to your hands?

  • How often do you carry hand sanitizer with you?

    • [PROBE]: Are there issues with carrying hand sanitizer with you? Why wouldn’t someone carry it?

• Let’s talk about another preventive measure that is discussed in the community. Why has the public been told to wear masks in public?

• [PROBE]: Who does mask wearing protect?

• Thinking about the past 7 days, can you describe a situation where you wore a mask?

  • What are the reasons that people wear masks during the COVID-19 situation?

  • What are some reasons why someone wouldn’t wear a mask when they were out in public?

    • [PROBE]: Are there any barriers to wearing a mask?

• Now let’s discuss social distancing. What does the term “social distancing” mean to you?

• Think about the past 7 days. Can you give me an example of how you have “socially distanced”?

• What are the benefits of social distancing?

  • How does it work? How well does it work at preventing the spread of COVID-19?

• How difficult is it for you to socially distance? What makes social distancing difficult?

  • Are there situations where it is impossible to social distance?

• Over the last 30 days, have you limited your trips out in public due to COVID-19?

• What caused you to limit your trips out in public?

• Why wouldn’t someone limit their trips out in public?

  • [PROBE]: Need to get away from the house?

  • [PROBE]: Too many errands to run?

• [WHITEBOARD] What information sources do you use to find information on ways to slow the spread of COVID-19?

• [USE WHITEBOARD RESPONSES FROM FIRST ACTIVITY ON COVID-19 SOURCES] Are these the same sources as the list we discussed earlier in this group?

  • Are there differences?

  • [If there are differences] Why are there differences in the sources used for information about COVID-19 and the preventative measures?

• How often do you think people in your community practice these preventive measures?

• What are some reasons that people might not practice these behaviors all the time?

• What are the main challenges in practicing these behaviors?

PROTECTING THE HOME (13 MIN – ROTATING)

• When it comes to protecting your home from COVID-19, do you do anything to your home to make you feel safer?

• How have your housecleaning processes changed, if at all?

  • [PROBE]: What, if anything, do you do differently since the beginning of the COVID-19 situation?

  • Where have you looked for information about proper cleaning procedures?

  • How do you clean the surfaces of your home?

  • Have these actions differed from what you used to do before?

• Have you introduced any additional cleaning tools to the home?

  • [PROBE IF NEEDED]: Any kind of filtration, air exchange, or similar tools and methods?

• How has having people at your home changed, if at all?

  • [PROBE] Do you have people over as often as you did prior to COVID-19?

    • Think about the last time you entertained at your home. What was different, if anything?

  • Who are you usually hosting at your home?

    • [PROBE]: Under what conditions do you invite people over?

  • What do you expect of your guests?

    • [PROBE]: Prior to entering the house?

    • [PROBE]: While at your house?

• [If children in the house] How has your children’s hosting of friends changed, if at all?

  • How often do they invite others to play at your home? In play areas close to your home?

  • If they invite others over, are they limited to certain areas of the house?

  • If they have others over, what do you expect them to do:

    • Prior to entering the house?

    • While at your house?

  • What do you expect of your children, in terms of precautions when playing with their peers?

    • Where do they play?

    • What kinds of preventive measures, if any, do they take while playing with others?

    • How closely are you able to monitor how well they take precautions in their activities?

TRAVELING (13 MIN – ROTATING)

• What are your thoughts about traveling during the COVID-19 pandemic?

• Have you been able to travel somewhere outside your local area since the beginning of the COVID-19 outbreak?

• How did your travel in 2020 changed compared to a typical year? [PROBE ON Frequency, destination, mode of travel]

• If you have traveled during this time, or are planning to, how has the planning process changed since prior to the pandemic?

  • How have your plans changed?

  • Where would you go to find out more information to help you plan your trip? What specific information would you look for?

• Regardless of whether you have traveled recently or not, what would you be sure to pack that you may not have packed before?

  • [PROBE]: Sanitizer, soap? Extra clothes?

• What precautions have you taken while traveling during COVID-19, or what precautions would you take if you were to take a trip right now?

  • Is there anything that you would do more while traveling than while you are at home or in your local community?

• What are some of the reasons that you might not want to travel during this time?

  • [PROBE]: What kind of concerns do you have about traveling during the pandemic?

  • [PROBE]: What information would you want to know about traveling to certain areas? Where would you go for this information?

• Thinking about life in general right now, how are you preparing for the first several months of 2021?

• Are you making plans for travel?

• How has this year changed your plans, if any, compared to the same time last year?

  • Are you doing activities differently than you would’ve in the past?

  • Have your family activities changed much?

SOCIAL EVENTS (13 MIN – ROTATING)

• How has planning for social events changed since before COVID-19?

• [PROBE]: Taking more precautions?

• How are you preparing for these events?

  • What specifically are you doing differently considering COVID-19?

• Have you attended any other social events since the beginning of the pandemic?

• How often have you turned down an invitation or decided not to participate in a social event during this time?

• What were some of the reasons you decided not to attend? What could have been changed about the event to make you feel comfortable attending?

• Prior to the pandemic, how often did you attend any of the following entertainment events? [SHOW LIST OF EVENTS: Live professional or collegiate sporting events; live kids sporting events; concerts; movies at the theater; plays at the theater]

• Have any of these opened where you live?

• [If not] If any of these were open today, how likely would you be to attend?

• Thinking about the events we talked about so far, what would the venue need to do to ensure proper cleanliness?

• Which of these would be essential before thinking about attending the event?

• [SHOW LIST BELOW] Which of the following would you need to know or have before attending the event? Rate it on a scale of 1 to 5, with 1 being it is not necessary to 5 being that it is essential to know or have before considering attendance at the event.

  • Clear cleaning/sanitizing procedures posted

  • Is the event indoors or outdoors?

  • If indoors, are the windows open? Adequate ventilation?

  • What is the bathroom situation?

  • Evidence of following cleaning/sanitizing procedures

  • Limited admission

  • Timed admissions

  • Large enough space to effectively social distance

  • Other? [ASK FOR ANY OTHERS]

• Now I want to switch slightly and talk about going to restaurants. How do you feel about going out to eat at a restaurant during this time?

• How have your local restaurants responded to COVID-19?

• What precautions, if any, are they taking in slowing the spread of COVID-19 in restaurants?

• What actions, if any, have you found concerning when it comes to restaurants serving their patrons?

  • [PROBE] Cleaning procedures?

  • [PROBE] Keeping distances between people?

  • [PROBE] Mask wearing?

• What do you look for before deciding to go to a restaurant? If you haven’t visited a restaurant during the pandemic, what would you want the restaurant to do before you would consider going to that place?

WRAP-UP (5 MIN)

• We have one final question. What is the one thing that you look forward to doing once the pandemic has been declared “over” or “under control?”

• Those are all the questions I have for you. I just want to check to see if any of my colleagues have any final questions.

• Is there anything you would like to share that you have not had the chance to before we wrap up?

• [SHOW LIST OF COVID-19 RESOURCES] On the screen there are some resources you can use to find additional information on COVID-19.

• Thank you very much for participating in this discussion. I appreciate your time, and your feedback has been extremely helpful.

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