Focus Group Moderator Guide

GenIC Clearance for CDC/ATSDR

Formative Research and Tool Development

Food Safety Communication Evaluation: Assessing Food Safety Messages, Knowledge, and Attitudes

Attachment 8 - Focus Group Moderator Guide

Contact: Sara Bresee, MPH

Office of the Director

Division of Foodborne, Waterborne, and Environmental Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, NE

Atlanta, Georgia 30333

Phone: (404) 639.3371

Email: [email protected]

Form Approved

OMB No. 0920-1154

Exp. Date: 3/31/26

Focus Group Moderator Guide (to be used by focus group moderator)

CDC estimates the average public reporting burden for this collection of information as 60 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1154).

Thank you for joining us today. I’m _______ and I’m from Banyan Communications, a public health communications consulting firm. The Centers for Disease Control and Prevention (CDC) is sponsoring this project. The purpose of this discussion is to hear your views and opinions on important health topics concerning food safety. Your insights are very important to us, and your time today is appreciated. We will have about 60 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.

• 1-2 notetakers from Banyan and observers from CDC will be observing to hear your opinions directly and take notes so that your opinions are accurately captured.

• Your identity and anything you personally say here will remain secure and no one will contact you after this interview is over.

• If at any time you are uncomfortable with my questions, you can choose not to answer.

• Be sure to only use first names during the discussion. Please do not use your last name. Also, if you bring up a friend or other person you know as an example in our discussions, please do not use their last name either.

Some Zoom considerations:

• Please mute your mic if you aren’t speaking.

• Please do not speak over each other and wait until someone is finished before speaking. However, if mistakes happen, no worries.

• Let’s use the “raise your hand” feature, especially if you can’t get into the conversation. It’s the button on the reactions panel. Let’s give that a test.

• Please use the chat! If someone is speaking and you really need to get your idea out there, put it in the chat. We will get to it.

• If you can, please leave your camera on. It’s helpful to see your faces!

• If you need to go to the restroom during the discussion, please do so. No need to inform us. Simply turn off your camera and mic before you get up.

• Please turn your cell phone to vibrate or silent mode.

• Please do not answer your phone during this group unless it is an emergency.

• We ask that you please not drive or operate a vehicle while you are in this group as it is dangerous.

Do you have any questions before we begin?

• The session will be recorded and recordings will be destroyed after project completion.

If I have your consent to participate and record this session, we can begin [wait for consent of each participant]

FGD facilitator note: focus groups will be divided into different demographics (see table 1 in Supporting statement B for the list of different demographics). Certain questions will only be used for specific demographics. That is noted throughout this document.

Today, we’re going to talk about food safety, specifically food safety for [INSERT FG DEMOGRAPHIC HERE]. Let’s go around and introduce yourself - tell us the name you’d like us to call you and your pronouns. It’s wonderful to meet you—let’s get started.

First, I am going to ask a few questions about what you know about food safety.

Section A: Food safety knowledge and awareness

1. “Food safety” is about keeping food clean and safe to eat so that it does not cause illness. What comes to mind when you hear “food safety”?

   • Probes: Perhaps a specific food comes to mind? Or an organization that supports food safety?

2. How does food safety show up in your daily lives?

   • Probes: Certain food safety practices you’ve heard of? Or that you personally do?

3. What comes to mind when you hear “foodborne illness”?

   • Probes: Perhaps a specific news story? Or a time you experienced foodborne illness? Perhaps a specific type of foodborne illness? Or you know a specific germ that causes foodborne illness? Maybe you’ve heard something online or on social media, on TV or on the news?

   • [If no or low response] you may have also heard of foodborne illness more commonly referred to as ‘food poisoning’.

     • What do people in your community call food poisoning?

[For caregivers of children <5]

4. When you think of food safety for babies and kids under 5 what comes to mind?

   • Probe: Certain foods they should or should not eat? Ways to protect children from getting sick?

   • Probe: Powdered formula

[For all participants]

5. What are some ways you know of to keep food safe?

   • Probe: How to clean certain foods before you cook them? How long does food need to be cooked? Putting things in the fridge? Handwashing?

   • [If no or low response] Food thermometers? Separate cutting boards?

   • Have you used any of these methods?

• If so, what are some pros and cons of these methods?

  • Probe: Takes time? Forget?

6. Are you aware of any recent outbreaks of foodborne illness?

   • [If yes] What did you hear? Where did you hear this? Did you have any concerns?

Section B: Food safety risk norms, perceptions and concerns

1. Who do you think is most likely to get food poisoning?

   • Probe: Do you think some people are more likely than others to get sick from food poisoning?

   • Probe: Who? Certain ages? People who eat certain foods? People who have other health issues? Pregnancy?

2. From what you know, how does foodborne illness affect people [INSERT DEMOGRAPHIC]

3. ]?

   • Probe: Does it affect all [INSERT DEMOGRAPHIC] more or less?

   • Maybe they get more sick? Are there certain foods that are better or worse?

People who are pregnant are at increased risk for foodborne illness.

Some people have health problems or take medicines that lower the body’s ability to fight germs and sickness. This is also called a weakened immune system. People with weakened immune systems have increased risk for foodborne illness. This may include people with HIV/AIDS, Cancer, Diabetes, Liver disease, Kidney disease, Lupus, Multiple sclerosis (MS), or Inflammatory bowel disease (IBD).

4. Why do you think the risk of foodborne illness is increased for [INSERT DEMOGRAPHIC]? For what reasons?

5. If there is someone in your life who is [INSERT DEMOGRAPHIC], do they/did you take any actions to protect themselves/yourself from foodborne illness?

   • If yes, what have you done?

     • Probes: Change eating habits? Shopping? Avoid certain foods?

     • Where did you learn this practice?

       • Your doctor? Family?

   • If you didn't, why not?

   • What or who was your biggest influence on this decision to take this action?

     • Doctor? Friends? Social media?

[For lower SES only ]Let’s talk about the topic in the context of your family and friends.

6. What conversations have you had or heard around food safety with your family and friends?

   • Probe: Any specific concerns around particular foods? Are there any “dos'' or “don’ts” around food safety? Any family rules or practices?

7. How likely do you think it is that your friends and family will get food poisoning?

   • Probe: Where do they get their food? Grocery stores, corner stores, farmers’ markets, restaurants?

   • Probe: Do you think where they live affects their risk of foodborne illness? How? Do they have access to transportation? Are there certain steps or safety practices they take to avoid food poisoning?

8. Where do you buy food? Grocery stores? Small neighborhood stores?

   • Do you feel you can get safe food?

   • How do you get to the store to buy your food?

9. What might motivate you to make changes in your food safety practices?

   • Probe: What behaviors would you change? Why?

[For parents/caregivers only]

1. Do you think babies and kids under 5 are more likely to get food poisoning?

   • Probe: Why or why not?

   • Probe: Powdered formula

Children younger than 5 are at increased risk for foodborne illness.

2. Have you used any food safety practices to prevent your child from getting foodborne illness/food poisoning?

   • If yes, what have you done?

     • Avoiding certain foods? Where did you learn this practice?

   • If no, why not?

     • Probe: didn’t think it was necessary? Didn’t know how?

3. Do you plan on making any changes to your behaviors around food safety for your baby or child?

   • Probe: Taking certain precautions? Learning more information?

Rotate the Zoom polls throughout the different FGDs

[All participants]

We are now going to ask you some questions using Zoom polls. Let’s practice.

1. What is your favorite drink?

   • Water

   • Coffee

   • Soda

   • Juice

   • Tea

   • None of these

Great! Do you have any questions?

2. What food safety topics would you like to learn more about?

   • Learn how to prevent food poisoning, who is more likely to get it, and when to see a doctor

   • Learn when and how to wash your hands to avoid food poisoning

   • Learn how you can help solve a foodborne outbreak

   • None of these

3. What about eating out and food delivery information? Would you like to learn more about:

   • How to safely handle subscription meal kits and grocery deliveries to prevent food poisoning

   • How to eat out safely and store and eat leftovers so that you avoid food poisoning

   • None of these

4. What about seasonal and holiday food safety? Would you like to learn more about food safety tips related to:

   • Thanksgiving turkey storage and preparation

   • Foods commonly cooked for holidays

   • Hosting a sport gathering at your home

   • Buffet and party food

   • Grilling

   • Home canning

   • None of these

5. Which foods that can cause food poisoning would you like to learn more about?

   • Chicken and how to prevent illness

   • Fruits and vegetables and how to prevent illness

   • Oysters and how to prevent illness

   • Lettuce and other leafy greens and how to prevent illness

   • Eggs and how to prevent illness

   • Raw dough and batter and how to prevent illness

6. Which germs that cause food poisoning would you like to know more about (list examples of this or provide context if people ask)?

   • E. coli and how to prevent illness.

   • C. perfringens and how to prevent illness.

   • Norovirus and how to prevent illness.

   • Salmonella and how to prevent illness.

   • Antimicrobial (or antibiotic-resistant( germs and how to prevent illness.

   • Cronobacter infection in infants and how to prevent it.

   • I don’t know what these mean

   • none

Follow after each Zoom question with the following questions:

• Why/why not did you choose the answer you picked in the Zoom polls?

• Was there anything you had never heard of before?

Section C: Food Safety Behaviors

[Provide correct information as needed:

• Thaw frozen food safely in the refrigerator, in cold water, or in the microwave. Never thaw food on the counter because bacteria multiply quickly in the parts of the food that reach room temperature.

• Wash or scrub fruits and vegetables under running water—even if you do not plan to eat the peel. Germs on the peel or skin can get inside fruits and vegetables when you cut them. Washing fruits and vegetables with soap, detergent, or commercial produce wash is not recommended. Do not use bleach solutions or other disinfecting products on food.]

1. How often do you follow [INSERT CDC food safety recommendation]? Why?

   • When do you it?

   • Why/why not?

   • What makes it difficult? Easy?

   • What would make this easier for you?

2. If you eat [INSERT FOOD] how do you typically cook it?

   • How do you know when it’s done?

     • Probe on: Following the label instructions

3. Have you ever heard of [INSERT PATHOGEN]?

   • What do you know about it?

   • How do you prevent it?

4. Whose responsibility is it in your household to keep the food safe?

   • Is it hard or easy to keep food safe? Why/why not?

Section D: Food safety health information seeking

Let’s shift gears a bit to sources of information through a series of Zoom polls.

Zoom poll

1. Where do you look for health information?

   • search engine/Google

   • Family/friends

   • Doctor or healthcare provider

   • Social media

   • TV News

   • Online news

   • Books

2. What media do you look at or watch that is related to food?

   • TV shows about food

   • Recipe websites

   • Cooking blogs

   • Food magazines

   • Books

   • YouTube

   • A newspaper website

   • Social media (TikTok, Facebook, Instagram, Twitter, etc.)

3. Where have you heard about food safety for [INSERT DEMOGRAPHIC]?

   • Social media

   • Movies

   • TV cooking shows

   • TV news

   • Radio news

   • Newspaper websites

   • Parenting blogs

   • Cooking blogs

   • Cookbooks and food magazines

   • Health departments

4. Who do you trust as a reliable source of information on food safety?

   • Federal government (CDC, FDA, USDA)

   • State or local government

   • Healthcare professionals

   • Health department

   • Family or friends

   • Online search

   • TV news

   • Radio news

   • Newspapers

   • Social media (TikTok, Facebook, Instagram, Twitter, etc.)

   • Cookbooks or food magazines

5. Thinking of the social media platforms you use, where would it be most helpful to get information about food safety?

   • Twitter

   • Facebook

   • Instagram

   • TikTok

   • YouTube

   • Pinterest

   • Snapchat

   • Something else

6. What types of social media content about food safety information would you find most useful?

   • Photos or images

   • Videos/stories

   • Memes

   • Games

   • Infographics

   • Factsheets

   • Messages

7. How would you want to learn more about food safety?

   • Social media

   • Ads

   • Text alerts

   • Print materials

   • Online articles

   • Email listservs

8. Who would you want to deliver these food safety messages to you?

   • Celebrity

   • Chef

   • Influencer

   • Scientific expert

   • Medical expert

   • Government official

9. Do you get food safety information from food packages, such as recipes, cooking directions and/or labels?

   • Yes

   • No

Section E: Message Testing

[Interviewer will rotate materials to every participant out of the materials noted in Attachment 13 Messages and Materials for Testing and ask the series of questions 1-8 below for each of the materials. Repeat a sequence of questions until all 4 materials have been reviewed. If time permits additional messages will be rotated randomly through the demographic categories (Supporting Statements A and B) to ensure messages are seen by various high-risk participants and other demographics.]

1. In your own words, what is the main idea that this message set is trying to get across?

2. How effective do you think the message set is in getting that message across?

   • Probe: What made it effective? What made it ineffective?

3. How new was this idea for you? Have you ever heard anything like this before?
   
   

4. How likely are you to do [INSERT BEHAVIOR]?

   • Why would you consider doing [INSERT BEHAVIOR]?

   • What might keep you from doing [INSERT BEHAVIOR]

   • What might make you more or less likely to [INSERT BEHAVIOR]?

   • Who or what might influence your decision to [INSERT BEHAVIOR]?

     • Probe: certain demographics (e.g., parents, socioeconomic status), certain psychographics, those with certain pre-existing conditions

5. How easy was it for you to understand these recommendations?

   • What, if anything, makes the recommendations difficult to understand?

   • Are there easier ways we could present this information?

6. What is confusing, unclear, or hard to understand about this message?

   • Probe [if needed]: Are there any words or phrases that bother you or that you think should be phrased differently? How might you rephrase the message?

7. How could this information be improved?

8. Who do you think this message is trying to reach?

   • Probe [if they say themself]: What in the message suggested it was talking to you?

   • Probe [if they say anyone but themself]: Why don’t you think this was meant for you?

   • Probe [if they say anyone but themself]: Why do you think this was meant for that audience?

Section F: Presentation of web pages, social media messages and/or materials

Now I would like you to look at a few [INSERT MATERIAL] that discuss information on food safety. I'll have you look at the website and then we will discuss it.

[Interviewer will provide the link and ask the participant to open the website on their personal computer. Interviewer will give a few minutes for the participant to read the page and then ask the questions 1-6 below. Repeat until all predetermined webpages for each participant have been reviewed. Interviewer will choose a few pages (Attachment 13) for the participant to review before the interview. If time permits the interviewer may ask the individual to review other pages listed in Attachment 13. Pages will be rotated randomly through the demographic categories (Supporting Statement B) to ensure pages are seen by multiple high-risk participant categories.]

1. How would you sum up in a few words your first impression of this [INSERT MATERIAL]?

   • Do you like it? Dislike it?

   • What makes you say that?

2. What is the main idea that this is trying to get across?

3. Is there anything confusing, unclear, or hard to understand?

   • If yes: What?

   • Probe (if needed): Are there any words or phrases that bother you or that you think should be said differently?

4. What do you think about the length?

   • Probe (for webpage): What do you think about how long you have to scroll?

   • Probe (if needed): Is it too long/short?

5. How do you feel about the color choices and graphics?

   • What do you like/dislike about them?

6. Is there anything you want to know about this topic that this does not tell you?

Section G. Closing

1. Before we close, I would like to know:

   • What topics have we not covered on food safety that you might want to learn more about?

   • Are there other channels/formats that we have not discussed that you would prefer to receive food safety messages from?

Okay, that’s all the time we have for today. Do you have any final thoughts?

Excuse me for one moment so I can check with our notetakers to ensure no additional questions need to be asked.

Thank you for your participation. We value your time and appreciate your feedback on how to improve information and messages about food safety. Have a good day/evening.

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