0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Imple

Form Approved
OMB Control No.: 0920-0879
Exp. Date: 08/31/2026

Attachment D2. Focus Group Discussion Guide—Moderate MAHC Use and
Implementation

Welcome and thank you all for agreeing to participate in today’s discussion. My name is [NAME] and I
will be leading our discussion.
The purpose of our discussion today is to help us learn about your opinions and experiences related to the
Model Aquatic Health Code (MAHC) and accompanying Annex. We will use the information you share
with us to help inform revision of the MAHC and to make the MAHC a more user-friendly product.
The terms use and implementation will be referenced in our discussion about the MAHC, and we would
like to define those terms clearly before we get started:
When we say “use” or “using the MAHC” we mean incorporating the MAHC language into your
jurisdictions’ public aquatic venue code OR referencing the MAHC or Annex to address a need that may
not be directly addressed in your jurisdiction.
When we say “implement” or “implementing the MAHC” we mean operationalizing the Code or
information in the Annex (for example, training inspectors and pool operators, updating inspection forms,
and educating health officials and operators on new expectations).
We will put these terms and definitions in the chat in case you want to reference them again during our
discussion.
*Researcher paste “use” and “implementation” definitions above into chat*
We would like to hear your honest opinions about the topics we discuss. There are no right or wrong
answers to any of the questions, and your thoughts and opinions are greatly valued and appreciated. We
encourage you to speak openly and honestly about your opinions and experiences. You can choose not to
respond to a question at any time. Your participation in this study is voluntary, and you can leave at any
time.
We will be audio recording this session and taking notes. The recordings and notes will help us
summarize today’s discussion. None of the comments you make during today’s discussion will be linked
with your name or jurisdiction in any way, and all information from this discussion will be summarized
anonymously.
Today’s discussion should take about 60-minutes.
Does everyone agree to the recording of today’s discussion?
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*Researcher start recording*
Before we start, does anyone have any questions?
Let’s begin.

Question 1: Is the MAHC or Annex used in your jurisdiction? If yes, we have some follow up questions.
a. Do you directly incorporate chapters/sections of the MAHC into your code? Why or why not?
b. Do you reference certain sections of the MAHC to address a need that may not be directly
addressed in your jurisdictions’ code? Why or why not?
c. Do you reference the Annex for rationale or explanation? Why or why not?
d. When did your jurisdiction begin using the MAHC as a resource? Do you know which version
you first began using, and which version is currently used?
e. How has your use of the MAHC or Annex changed over time (if at all)?
Question 2: What factors/facilitators have helped your jurisdiction use MAHC language or information in
the Annex to revise aquatic facilities regulations?
a. Why do you think these factors contributed to the successful incorporation of the MAHC?
b. Could these facilitators be adopted by other states? Why or why not?
Question 3: What factors/barriers have prevented your jurisdiction from using MAHC language or
information in the Annex to revise aquatic facilities regulations?
a. How were barriers addressed?
b. Where these efforts successful? Why or why not?
Question 4: Has your jurisdiction ever consulted the MAHC looking for guidance and found it was not
there?
a. If yes, what topics, codes, or standards would be helpful to you when utilizing the MAHC that are
not currently included?
Question 5: Does your jurisdiction (or any other groups you work with) use or reference any aquatic
codes or standards other than the MAHC? Some examples include the International Swimming Pool and
Spa Code (ISPSC), the International Code Council (ICC), the Uniform Mechanical Code (UMC), the
Uniform Plumbing Code (UPC), the Pool and Hot Tub Alliance (PHTA), and the Uniform Swimming
Pool, Spa, Hot Tub Code (USPSHTC).
a. If your jurisdiction uses any other codes or standards, why do you use these codes rather than the
MAHC?
Question 6: The MAHC is currently revised and released every 3 years.
a. Do you see a benefit in CDC continuing to update the MAHC? Why or why not?
b. Do you feel the update is too frequent/infrequent?

c. How does this frequency impact your jurisdiction? For example, does the revision impact
personnel, training/education, or budgetary matters?
d. How would a different frequency of revision affect your jurisdiction? For example, what would a
five- or seven-year revision and release period look like for you?
e. Do you feel a different frequency of release might increase your use or implementation of the
MAHC? Why or why not?
Question 7: If CDC ever stopped updating the MAHC, would that be a problem for your jurisdiction?
Why or why not?
Question 8: Who do you work with when updating your pool regulations?
a. If you work with others, how do you work with them? Essentially, what is the approach you take
to working together to update pool regulations?
b. Have you encountered any problems working with others to accomplish this?
c. Are there partners you are not working with but might be helpful to interact with to accomplish
this?
The next few questions will be about the MAHC and Annex documents.
Question 9: What aspects of the MAHC or Annex do you find useful? Prompt: For example, this could
be aspects of the Code, the Annex or accompanying tools, such as fact sheets or infographics, or the
overall content.
a. Why do you find these aspects useful?
b. How could they be improved to make them even more useful?
Question 10: What aspects of the MAHC or Annex do you not find useful? Prompt: For example, this
could be aspects of the Code, the Annex or accompanying tools, such as fact sheets or infographics, or
the overall content.
a. Why do you not find these aspects useful?
b. How could they be improved to make the MAHC more useful?
Question 11: Do you think the MAHC and Annex documents are easy to understand? Prompt: For
example, do you think the organization and structure of the documents and the code language aspect of
the MAHC are easy to understand?
a. What aspects make them easy to understand?
b. Other aspects that make them easy to understand?
Question 12: Do you think the MAHC and Annex documents are difficult to understand? Prompt: For
example, do you think the organization and structure of the documents and the code language aspect of
the MAHC are difficult to understand?
a. What aspects make them difficult to understand?
b. Other aspects that make them difficult to understand?

At this point in our conversation, we wanted to take a moment to remind you of the definitions for MAHC
use and implementation that we discussed at the start of our time together. So, we first began talking about
use of the MAHC, which means incorporating the MAHC language into your jurisdictions’ public aquatic
venue code OR referencing the MAHC or Annex to address a need. The next couple questions will be
about implementing the MAHC, which means operationalizing the Code or information in the Annex and
putting this guidance into practice.
Question 13: Do you think the MAHC and information in the Annex are easy to implement or put into
practice? For example, informing training of inspectors and pool operators, updating inspection forms, or
educating health officials.
a. What makes it easy to implement the information into practice?
b. Are there any lessons learned you might share with other jurisdictions on implementing the
MAHC?
Question 14: Do you think the MAHC and information in the Annex are difficult to implement/put into
practice?
a.
b.
c.
d.
e.
f.
g.

What makes it difficult to implement the information into practice?
How could the MAHC be improved to make it easier to implement?
What resources does your jurisdiction have to implement the MAHC?
What tools or resources could CDC provide to make the MAHC easier to implement?
What do you think could be done at a state level?
What do you think could be done at the local level?
What else would increase your ability to put the MAHC into practice?

Question 15: Is there anything else you would like to tell us about utilizing the MAHC Code or Annex at
either the state, territorial, tribal, county or city level?
Question 16: If your jurisdiction has referenced the MAHC Annex for explanation or used the MAHC
Code to revise aquatic facilities regulations, would you consider participating in a case study to help CDC
better understand your work, and share it with others?