Formative Research for Sepsis and Antibiotic Use Campaigns

Form Approved

OMB Control No. 0920-1154

Exp. Date: 01/31/2020

Antibiotic Use Campaign

Round 1 Consumer Focus Group Moderator Guide

Consistent with the CDC-approved formative research plan (FRP), the Persuasive Health Message Framework (PHM) serves as the theoretical framework guiding formative research to generate an effective campaign to raise knowledge and awareness of antibiotic use. This moderator guide has been developed to gather information to answer the overarching research questions and provide data for PHM constructs to create viable campaign messages for consumer audiences.

Introduction to Group Processes and Procedures (5 min)

Thank you for taking the time to join us for this online focus group discussion. My name is [INSERT NAME] and I work for ICF, a research and consulting firm in Atlanta, Georgia. First, I want to take a few minutes to tell you what to expect from our conversation. After that, I’m going to give each of you a chance to introduce yourself and then we’ll begin our discussion.

As you may recall from when you were recruited, we are conducting this study on behalf of the Centers for Disease Control and Prevention (CDC), to learn about consumer antibiotic use and to gather feedback on potential messages for an upcoming CDC communication campaign on antibiotic use. This information will help CDC develop a communication campaign to raise knowledge and awareness about antibiotic use in the US.

My role is to simply facilitate the discussion, make sure we stay on topic, and keep us within our 90 minutes. I am not here to push any particular agenda or point of view, but rather to hear your frank and honest opinions. There are no right or wrong answers, and nothing to be ashamed of. We all have our own likes and dislikes, our own thoughts and feelings.

I’m going to ask a series of questions, but mainly I want to hear from you today. As I mentioned, my role is just to guide the discussion. Sometimes we may really get going on one question, and I’ll have to move you on to the next question so that we may cover everything. Please don’t take it personally! We just need to hear from everyone about several topics.

Our discussion here is private. We will not report your comments by name, and we ask that you respect one another’s privacy in the same way. We don’t expect you to tell us anything that you would be uncomfortable sharing with the group. But we do hope that you will be honest with your responses to the questions I ask.

Now we are going to review the informed consent form. [Moderator reads the form.]

Also, during this discussion, a lot of questions might come up that you would like me to answer. Since we are mainly interested in hearing your thoughts and opinions, I may not be able to answer all the questions. But please keep track of your questions. If you like, you can send them to me using the chat feature. After we finish with our discussion, I will share the CDC website with you so you can visit it to get additional information about antibiotic use if you want it.

There are also a few ground rules that I would like us to adopt for our discussion:

• You have been asked here to offer your views and opinions.

• Everyone’s input is important. We will encourage everyone to participate.

• Respect the privacy of your fellow group members.

• Avoid side conversations.

• Let one person speak at a time.

• I may need to cut a discussion short to get through the whole discussion.

• Please turn off all cell phones!

• There are no right or wrong answers.

• All answers will be maintained in a secure manner, so feel free to speak your mind.

• Respect one another at all times.

• It’s okay to disagree.

• Most importantly, please try to speak up, speak clearly, and one at a time. We are audiotaping the discussion so that we can have an accurate record of the discussion.

We have observers from CDC and ICF on our online space, and on the phone line listening and taking notes during our discussion today. In addition, we have an ICF technology support person to assist with any of our technical needs during our discussion.

Do you have any questions before we get started?

Participant Introductions and Warm-up Exercise (5 min)

So we can get to know each other a little, let’s go around the room and introduce ourselves. Please tell me your first name, your hometown and one way that you like to spend your free time. Thank you. Now, let’s get started with our discussion.

Discussion

Section 1. General Knowledge, Beliefs, and Perceptions (15 min) (RQ 1, 3)

First, I would like to talk in general about antibiotics, such as when they should be used and for what illnesses.

Antibiotics and Antibiotic Resistance

1. Generally speaking, when should antibiotics be taken?

2. What does the term “antibiotic resistance” mean to you?

   1. In your opinion, how serious of a problem is antibiotic resistance?

   2. Do you believe that reducing the amount of antibiotics used will help to reduce antibiotic resistance? Why or why not?

   3. Do you believe you have a role in improving unnecessary antibiotic use? Why or why not?

Section 2. Personal Antibiotic Use (10 min) (RQ 2)

Now, I’d like to talk about how you feel about [taking antibiotics, giving antibiotics to your child], as well as when you typically [take, give] them.

Perceptions on Antibiotic Use

3. What are your general feelings about [taking, giving your child] antibiotics?

   1. Who has played a role in influencing your decisions about [taking, giving] antibiotics, whether negatively or positively?

   2. Did you agree with their decisions about using antibiotics? Why or why not?

Section 3. Perceived Susceptibility (10 minutes) (RQ 1, 2, 3)

Now I’d like to talk specifically about antibiotic side effects.

Antibiotic Side Effects and Antibiotic-Resistant Infections

4. Are you concerned about [getting, your child getting] an antibiotic-resistant infection? Why or why not?

   1. [If yes] How serious of a concern is this for you?

5. Are there any potential dangers associated with [your, your child] taking antibiotics that you are concerned about?

   1. [If not mentioned] How about C. difficile, which can cause serious and sometimes deadly diarrhea?

   2. How serious of a concern is this for you?

Section 4. Antibiotic Behaviors and Self-Efficacy (15 minutes) (RQ 1)

Now, let’s talk about how you interact with your healthcare professional around taking antibiotics.

Antibiotic Demanding and Expecting

6. [Self-demanders and caregiver-demanders ONLY] Have you ever asked your healthcare professional for an antibiotic for [yourself, your child]?

   1. [If yes] What was your healthcare professional’s response to your request?

   2. Do you believe that healthcare professionals should prescribe antibiotics when patients [or parents] request them even if the healthcare professional thinks that the antibiotic is unnecessary?

[Self-expectors and caregiver-expectors ONLY] Have you ever expected your healthcare professional to prescribe an antibiotic for [yourself, your child] even though you did not ask for one?

1. [If yes] Do you believe [your, your child’s] healthcare professional recognized that you wanted an antibiotic even though you didn’t ask for one? Why or why not?

2. Did your healthcare professional prescribe antibiotics at that time?

3. Do you believe that healthcare professionals should prescribe antibiotics when patients [or parents] want them even if the healthcare professional thinks that the antibiotic is unnecessary?

Satisfaction and Self-Efficacy

Next, I’d like to describe some scenarios involving your healthcare professional and get your thoughts on them.

7. Let’s say your healthcare professional said [you, your child] “does not need an antibiotic at this time,” when you requested or expected one. Would you be satisfied with the visit?

   1. [If no] What would help you feel satisfied with the visit? For example, something to relieve [your, your child’s] symptoms, advice on how to feel better at home, or when or for what symptoms to come back to the healthcare professional if you are not better or are worse.

8. Now, let’s say your healthcare professional said an antibiotic is not needed at this time, but gave you a prescription for an antibiotic and asked you to wait 24-48 hours to see if [you get, your child gets] better before filling it. If [you, your child] is better, the healthcare professional would instruct you not to fill the antibiotic prescription. How confident are you that you would wait before filling the prescription?

   1. Would you be satisfied with this plan?

9. How likely would you be to [go to, take your child to] another healthcare professional if [your, your child’s] healthcare professional did not prescribe an antibiotic when you [requested, expected] one?

   1. Where would you go to get a prescription for antibiotics in a situation like this?

Section 5. Message Set Testing (25 minutes) (RQ 5)

Next, I am going to show you some informational messages and calls to action that may or may not be used in the upcoming antibiotic use communication campaign. Informational messages are the key points that CDC wants to convey to its audiences. Calls-to-action are the behaviors, or actions, CDC wants people to take. I would like to get your honest thoughts and opinions about these, so please speak freely.

Informational Message Testing

10. First, I am going to show you some informational messages developed for [consumers, parents, first-time parents] about antibiotic use. I will show you one message at a time and ask you a series of questions about each.

[Moderator shows appropriate message on slide and reads. Table is for purposes of moderator guide ONLY.]

Audience	Relevant Information Message
Self- demanders	Antibiotics aren’t always the answer; they won’t make you feel better if they’re not needed. Antibiotics may not help you feel better when you have a virus, like a cold or flu. Antibiotics may do more harm than good when they aren’t needed.
Caregiver- demanders	Antibiotics may do more harm than good when they aren’t needed. Antibiotics may not help your [child/loved one] feel better when they aren’t needed. Antibiotics may not help your [child/loved one] feel better when you have a virus, like a cold or flu.
Self- expectors	Antibiotics aren’t always the answer; they won’t make you feel better if they’re not needed. Antibiotics may not help you feel better if you have a virus, like a cold or flu. Antibiotics may do more harm than good when they aren’t needed.
Caregiver- expectors	Antibiotics may do more harm than good to your child when they aren’t needed. Antibiotics may not help your [child/loved one] feel better when they aren’t needed. Antibiotics may not make your [child/loved one] feel better when they have a virus, like a cold or flu.

1. What are your general thoughts about this message?

2. What are your feelings and emotions about this message?

3. Does this message change how you perceive antibiotics? Why or why not?

4. What do you think about the specific words and phrasing used in this message?

5. Would any changes to the words or phrasing better convey that antibiotics aren’t always necessary and can cause more harm than good if taken when not needed? Please describe.

11. Of the two messages I’ve shown you, which do you prefer? Why?

[Moderator shows slide with the two messages appropriate for each audience. Table is for purposes of moderator guide ONLY.]

Call to Action Testing

Now I would like to get your thoughts and opinions on a call to action about antibiotic use.

12. I am going to show you a call to action for [consumers, parents, first-time parents] about antibiotic use.

[Moderator shows appropriate message on slide and reads. Table is for purposes of moderator guide ONLY.]

Audience	Call to Action
Self-demanders Self-expectors	Ask your healthcare professional about the most appropriate treatment for your illness. Alt: Ask your healthcare professional about the best treatment for your illness.
Caregiver-demanders	Ask your healthcare professional about the most appropriate treatment for your family. Alt: Ask your healthcare professional about the best treatment for your family.
Caregiver-expectors	Ask your child’s/loved one’s healthcare professional about the most appropriate treatment for your child’s/loved one’s illness. Alt: Ask your child’s/loved one’s healthcare professional about the best treatment for your child’s/loved one’s illness.

1. What are your general thoughts about this call to action?

2. Is the message easily understandable?

3. What do you think about the specific words and phrasing used in this call to action?

4. Do you believe this call to action is an appropriate request? Why or why not?

5. Does this call to action seem realistic? Why or why not?

6. What would the benefits of this call to action be? For example, what good things could happen for you/your family if you took this action?

7. Can you see yourself taking this action? Why or why not?

   1. How confident are you that you would take this action if it was recommended?

8. How likely would you be to take this action?

9. What kinds of things, if any, would make it difficult for you to take this action?

10. What would make it easier for you to do what is being asked?

13. Of the two messages I’ve shown you, which do you prefer? Why?

[Moderator shows slide with the two messages appropriate for each audience. Table is for purposes of moderator guide ONLY.]

14. Is there anything else about these messages you would like to add?

Closing (5 minutes)

Well, that’s the last of my questions. Do you have any questions for me?

Thank you again for taking the time to participate in this discussion. We sincerely appreciate and value your input!

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