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What works best for worksite cholesterol education? Answers from targeted focus groups.

Focus group discussions are an effective way to determine the needs and interests of a target population. In August 1989, eight focus group discussions were conducted with municipal employees in Phoenix, Ariz, to determine the needs and interests of potential participants in a worksite cholesterol education program. Employees were selected for the focus groups on the basis of an initial screening that determined their motivation to change customary eating habits. Individuals categorized as "somewhat motivated" were invited to participate in the focus groups because researchers thought they would best represent the motivation level of the majority of potential participants in the cholesterol education program. The focus group participants indicated that they preferred educational formats and approaches that appealed to diverse learning styles and recognized individual differences. Several of the program features identified by the focus groups are consistent with principles of adult education, especially active participation in the learning activity. The focus group participants wanted information presented in a simple, easy-to-understand manner, and they asked for behavioral directives rather than background information or medical jargon. Release time from work and employer commitment to the program were viewed as important to the success of the program. We conclude that employees respond best to worksite wellness programs that are simple, practical, and relevant and that allow them to participate actively in the learning activity during work time.

Cholesterol, Dietary

Assessing beliefs of older rural Americans about nutrition education: use of the focus group approach.

We used the focus group interview technique as a preliminary research step in developing a nutrition education intervention for rural seniors who, because of less than optimal eating habits and changing demographics, are an important target audience. Sixty-eight well, active, rural North Dakota seniors, 60 years or older, from communities of 2,500 or fewer people, participated in five focus groups conducted in late summer 1988. As a qualitative research approach, focus group interviews offer a means of obtaining in-depth information on a specific topic from representatives of a target audience in a discussion group atmosphere. Focus groups require careful preparation and structuring and should include a capable moderator, a prepared discussion guide, carefully recruited participants, and a comfortable setting. The process generated ideas that we are using to develop a health promotion nutrition intervention that will be a mailed-home approach, including use of incentives, social role models, cholesterol screening, and learning activities. The intervention relies on the interest and ability of seniors to make positive health changes. We conclude that the focus group approach is useful in developing nutrition education interventions.

Aged

Use of focus groups in evaluating nutrition education materials.

Focus groups were used to study public reaction to the nutrition education material, Dietary Guidelines for Americans, US Department of Agriculture bulletin HG232. Respondents were asked to comment specifically on the content and format of bulletin HG232 and to compare it with several other commonly used nutrition education print materials. The focus group discussions were recorded on videotape and the information was analyzed by two independent reviews of the tapes. The focus groups produced good information on perceived usability of a variety of nutrition education print materials and made specific suggestions for improving HG232. Although there are limitations to using focus groups as a data collection technique (data are not quantitative, making data analysis difficult; responses are influenced by group dynamics; and some suggestions made by the group are not appropriate), the richness and innovativeness of the data collected make focus groups a worthwhile evaluation method for nutritionists.

Female

Focus group interviews with seniors.

The focus group interview technique provides in-depth information on a specific topic in a group discussion setting and can be effectively used with older adults. Successful focus group interviews include careful question preparation and participant recruitment as well as securing a capable moderator and comfortable setting. The technique is used as a preliminary research step to elicit feelings, attitudes and perceptions about a topic. However, results should not be generalized without further quantitative research.

Aged

The use of focus groups in social and behavioural research: some methodological issues.

The use of focus groups as a qualitative method for rapid assessment is discussed. A focus-group session is an in-depth discussion in which a small number of people (usually 8-12) from the target population discuss topics that are of importance for a particular study or project. Generally the participants are chosen purposively, and it is recommended that they should be homogeneous with respect to characteristics which might otherwise impede the free flow of discussion. Focus groups can be used for idea generation, in conjunction with a quantitative method, or as a primary data-collection method. However, if focus groups are used as a primary data-collection method, their results must be treated with caution. The main advantage of using focus-group discussions during rapid assessment is that they provide in-depth information without requiring full-scale anthropological investigations. The informal group setting is believed to make people feel at ease, encouraging them to express their views freely. However, there are a number of limitations to focus-group discussions. The samples are small and purposively selected, and therefore do not allow generalization to larger populations. In addition, as with other qualitative methods, the chances of introducing bias and subjectivity into the interpretation of the data are high. There are a number of methodological issues which still need to be addressed in order to further develop the method. Little is known about how many discussion sessions are needed to be reasonably sure that most aspects related to the subject of inquiry have been explored.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection

The role of focus groups in health education for cervical cancer among minority women.

Focus groups were used in the development of community-based public health education designed to reduce mortality from cervical cancer among black women in Forsyth County, North Carolina. The educational goals of this National Cancer Institute (NCI) funded project were to increase the proportion of black women, age 18 and older, who obtain Pap smears on a regular basis and return for followup care when necessary. A series of four focus groups were conducted to help develop the conceptual basis for designing educational messages and materials. The groups were led by a black, female professional focus group moderator, and explored a variety of health-related topics ranging from general, ordinary concerns of daily living to knowledge and attitudes about cancer screening. The group discussions suggested that health is regarded as very important to the target population, particularly when related to family functioning. Regarding the Pap smear, most women knew about the test, but had little awareness of its role in the early detection of cervical cancer. Fear and fatalism were clearly the dominant, top-of-mind reactions to cancer, and there was little differentiation among sites or types of cancer. Despite the overall pessimism, the groups agreed that early diagnosis and treatment provide the best hope for good outcomes with cancer.

Black or African American

Underrepresented voices in a Colorado Biobank: Perspectives from focus groups on motivations, return of results, and data sharing.

Most participants in large cohorts, such as biobanks, are of European descent. This lack of representation has been an ongoing challenge in genomic research. Understanding the perspectives on genomics research and participation in biobanks of historically underrepresented populations could provide insight into ways to better engage with these groups. We conducted a series of virtual and in-person focus groups with individuals who self-identified as American Indian or Alaska Native (AI/AN), African American/Black (AA/B), or Hispanic/Latino (H/L) and who were enrolled in the Colorado Center for Personalized Medicine (CCPM) biobank. The focus group discussions were centered on participant experiences, including but not limited to their motivations, return of results, and data sharing. There was a total of 23 participants across the six focus groups. The majority of participants identified as AI/AN (60.9%), followed by H/L (39.1%), and AA/B (21.7%); many participants identified with multiple race/ethnicities. The motivations for participating in the biobank included the potential to advance science and health, the potential for return of results, to learn more about one's ancestry, and a few indicated that they were interested in helping the biobank be more representative of all populations. Notably, many expressed positive feedback of the focus groups and felt that their views were valued, illustrating the importance of community-centered work. Our findings can be used to guide recruitment and engagement of biobank participants, especially from diverse backgrounds, contributing to enhanced partnerships advancing knowledge and healthcare.

biobank

[Focus groups--presentation of a qualitative research method].

The Focus Group is a qualitative research method based on group dynamics. The group participants are chosen by random sampling from the study population. They all have something in common in regard to the question being focused on. Well planned discussions provide knowledge on a specific topic. The method is not very expensive, and does not take too much time. Focus Groups have been used in marketing, and in sociological and psychological research. The authors conclude that the method is of interest for medical research.

Evaluation Studies as Topic

Using focus groups to identify clinical learning opportunities for registered nurses.

A series of focus groups was organized at five metropolitan teaching hospitals. Participants were encouraged to identify opportunities for and barriers to learning for registered nurses employed at ward level, and to suggest practical strategies for maximizing clinical learning. The focus groups had a dual purpose: data collection and action learning. The experience of group participation heightened awareness of learning opportunities, increased understanding and tolerance of differing viewpoints and generated commitment to identified strategies to enhance clinical learning.

Education, Nursing, Continuing

Use of focus groups to study absenteeism due to illness.

Reasons for sick leaves are often complex and influenced by nonmedical factors. We have used focus groups, a qualitative research method, to study the relationship between working conditions and absenteeism due to illness in both an industrial company and an insurance company. We organized 10 focus groups within each company, with participants randomly selected from departments having similar work tasks within each company. According to the groups, the most important working conditions that influenced absenteeism were (a) feeling of well-being at work (mainly defined as security in social relations), (b) the organization of the work, and (c) the department leader. Factors considered to be less important included: number of employees, male/female ratios, group norms for absenteeism, age distribution, work-related illness, substance abuse, and work loads. There was substantial agreement between the groups, indicating that our findings may be relevant to other companies.

Absenteeism

Barriers to bicycle helmet use among children. Results of focus groups with fourth, fifth, and sixth graders.

As a preliminary step in the development of a school-based educational intervention to promote bicycle helmet use among children, focus group encounters were conducted with fourth, fifth, and sixth graders at three elementary schools in the Boston, Mass, area. Analysis of transcripts of encounter tape recordings indicated that (1) the prevalence of helmet ownership and use was low, (2) children were concerned that helmet use would invite derision from their peers, and (3) children tended to respect other children who wore helmets. We concluded that focus groups can be useful in conceptualizing health education interventions and suggest that school-based peer-led bicycle helmet programs may be effective in developing normative change toward helmet use among elementary schoolchildren.

Adolescent

Use of focus groups to explore consumers' preferences for content and graphic design of nutrition publications.

The purpose of this research was to determine consumers' preferences for the content and design of nutrition print materials through the use of focus group interviews. Thirty-seven non-pregnant, non-nursing female consumers 20 to 50 years of age attended one of six focus group interviews. Existing nutrition print materials were used to stimulate discussion on content and graphic design features of the materials. Content features discussed included glossaries, quizzes, diet evaluation checklists, diet monitoring forms, and "factual" vs. "how to " information. Graphic design features discussed included color, format, size, organization, and general appearance. Participants were asked to discuss the personal impressions and practical considerations that formed the basis of their opinions regarding each feature and to elaborate on how the existing materials might be improved to meet their particular needs. Features that drew the most positive reactions were bright food colors, organizational cues, clear information and explanations, features that help personalize the issue being addressed, and "how to" information.

Adult

Focus group sessions on formats of nutrition labels.

Four consumer focus group sessions, with a total of 40 participants, were conducted to gather information on the utility and appropriateness of selected components of nutrition label formats. The formats reviewed were bar graphs, pie charts, numeric listings, and adjectival descriptors such as high and low. Participants were asked to compare food labels using various format types and to discuss the utility and interpretability of the formats. The outcomes suggested that these consumers did not find pie charts useful. They considered bar graphs confusing or unnecessary when numeric values were provided. Participants expressed concern that adjectival descriptors could be misleading. The numeric listing format they considered the most useful consisted of two columns of numbers: one listing the amounts of food components present in a serving of the food, and a second listing either the percentage of the label reference value (eg, the US Recommended Daily Allowance) or the quantity established as the label reference value. Participants repeatedly stressed their interest in a simple label. The results form one component of the Food and Drug Administration's efforts to evaluate nutrition label formats and will be used in conjunction with ongoing experimental and quantitative research studies.

Adult

Assessing the acceptability of NORPLANT implants in four countries: findings from focus group research.

In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.

Communication

Influences on adolescent sexuality in Nigeria and Kenya: findings from recent focus-group discussions.

Continuing high rates of adolescent childbearing in sub-Saharan Africa indicate a need for improved understanding of factors affecting adolescent sexuality. As traditional cultural influences on adolescent sexuality in Africa have diminished, peer interaction and modern influences have gained importance. To study peer interaction and societal factors and their impact on adolescent attitudes toward sexuality and contraception, the authors conducted a series of single-sex-focus-group discussions with in-school and out-of-school youth in urban and rural areas of Kenya and Nigeria in 1990. Out-of-school youth generally receive information on sexuality and family planning from peers (and the media), while in-school youth receive information in school, although not necessarily relevant information. Young women interviewed perceived unwanted early childbearing as something that affected them, an important precursor to family planning use. However, young people tended to have better information and more positive attitudes about induced abortion than about family planning.

Abortion, Induced

Development of AIDS education and prevention materials for women by health department staff and community focus groups.

The New York City Department of Health (NYCDOH) has developed a comprehensive, empowering, and educational booklet for women in response to (1) the rapid increase in AIDS among women; (2) the lack of woman-specific, current, language-appropriate literature; and (3) the need to address the multitude of direct and indirect effects of the HIV/AIDS epidemic on women. Drafts of the booklet were developed during a 12-week series of consensus-driven meetings attended by a core group of women from various professional and personal backgrounds. Following NYCDOH approval, community focus groups reviewed the booklet to ensure that it met the needs of targeted women, community HIV/AIDS educators and other health and social service providers. This paper describes the issues encountered when designing materials for women of diverse cultures and roles (e.g., pregnant women, IV drug users, lesbians), as well as the dynamics of the development process and its benefits and difficulties. Criteria and guidelines for this development process are outlined.

Acquired Immunodeficiency Syndrome

Employer evaluation of graduates: use of the focus group.

Traditionally, employer evaluation of new graduates has involved survey techniques. The authors describe a different approach--the use of focus groups to have employers evaluate baccalaureate nursing graduates 1 year following employment.

Education, Nursing, Baccalaureate