Healthy Start Focus Group Protocol

Attachment H

Healthy Start Focus Group Protocol

Healthy start participant focus group protocol

Introductions Total: 5 minutes	Let’s get started. There will be time at the end to finish the form if you need it. My name is [fill in] and this is [fill in]. Thank you very much for joining us today. We are meeting with groups of women in different parts of the country to talk about their experiences with Healthy Start, or what you might know as [fill local Healthy Start Grantee name]. As you may know, the Healthy Start program is overseen by the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services. Its goal is to help women, infants and their families live healthier lives. *FILL LOCAL HEALTHY START GRANTEE NAME FOR HEALTHY START FOR REMAINDER OF FOCUS GROUP You were invited to be here because you use some of the services that Healthy Start offers. We do not work for Healthy Start; we are independent evaluators trying to find out more about your experiences with Healthy Start services and other services in your community, so we can report on what works well and what could be improved.
	We have a few things to go over before we talk about Healthy Start. [My colleague] will take notes as we talk. Our notes will be on what gets said, not who said what. So we will only use each other’s first names today. We want everyone to be able to speak, but only one person at a time. Please don’t have side conversations with the person next to you. Some of the topics we will discuss may seem personal. If there are any topics that you do not feel comfortable talking about with the group, you do not have to share anything. You should feel free to share as much or as little as you want. All of the information you provide will be kept confidential to the extent allowed by law. We would like to record the conversation in case we miss something in our notes. We will keep the recording private and use it only for this project. Please speak in a voice at least as loud as mine so we can hear it on the recording. At the end of the discussion, please turn in your completed survey to receive your thank-you gift card. Is it ok for me to begin recording?
	Let’s go around the table and introduce ourselves. Please say your first name, and how many children you have. [Begin with participant to moderator’s right] That’s the only time we will go around the table one by one. For the rest of the questions, anyone can answer first and then others can jump in.
Outreach & Participation Total: 4 mins Q1	Please tell me how you learned about Healthy Start. Anyone who remembers can go first. (PROBE AS NECESSARY) Did a doctor, nurse or other health care professional tell you about it? What did they say? Did you see a poster or sign somewhere? Was it in a health care facility like a clinic or doctors office? Did you hear about it at a Health Fair? Did you receive a brochure about Healthy Start? Where did the brochure come from? Did you learn about it on the internet? What kinds of information were you looking for when you saw something about Healthy Start? Did a friend or relative tell you about Healthy Start? What did they say about the service? Did you hear about it on TV or the radio? Other sources?
Q2	Why did you decide to participate in or use some of the services offered by Healthy Start? Did you hear that Healthy Start could help you with something in particular, like finding a doctor or getting health insurance? What did you want Healthy Start to help you with? PROBE AS NEEDED ON TYPES OF SERVICES: Case management services Help finding doctors for yourself or your child Help applying for health insurance Support groups for quitting smoking or dealing with problems at home Help getting more information about things like parenting, having a baby or eating healthier Help getting food, clothing or housing
Q3	When did you first start getting help from Healthy Start? Were you pregnant? If so, how many months pregnant were you? Had you recently had a baby? If so, how old was the baby?
Healthy Start Services Overview Total: 2 minutes Q4	Let’s talk more about the things Healthy Start does to help you and your family. Since you enrolled in Healthy Start, what are some of the ways that Healthy Start has helped you and your family? PROBE AS NECESSARY: Did somebody from Healthy Start… Help you find a doctor for yourself or your children? Help you sign up for health insurance? Send somebody to your house to show you how to care for yourself and/or your baby? Give you tips and help with breastfeeding? Help you quit smoking or give you the phone number for a quit line? Tell you some place you could go to talk about your feelings or problems at home? Help you get a developmental screening for your baby to make sure that your baby was growing at a healthy rate? Tell you where you could take GED classes or get help finding a job? Tell you where you could go to get TANF/food stamps or clothing? Help you sign up for classes with other women about topics like having a baby, being a better mom, eating healthier foods or finding ways to deal with stress? Tell you where you could go to see a nutritionist or take exercise classes?
Case management/ Service coordination Total: 8 minutes Q5	Now we are going to talk about some of the specific ways that Healthy Start may have helped you. Since you started participating in Healthy Start, has anyone from the program told you about different places you can go in the community to get important services (like health care, counseling, child care services, food/ clothes, etc.)? Do you call this person or group of people case manager(s)? If not, what term do you use to describe this person or group of people who help you get the services you need? [USE THIS TERM FOR REMAINDER OF SECTION] Do you have one person who is your case manager or is there a group of people?
Q6	How often do you meet with your case manager(s) in-person? How long are your in-person meetings? Where do the in-person meetings take place? (At Healthy Start? At your home? Some other location in the community?) Do you ever talk on the phone with case managers? How often do you usually talk on the phone with them? Do you call them or do they call you? Do you ever talk to case managers through email or text message? How often do you usually talk to them through email or text message?
Q7	What are some things that case managers have helped you with? PROBE FOR TOPICS: Did your case manager(s)… Help you figure out where you or your family could go to see a doctor? Tell you where you could go to get other kinds of help in the community? Remind you about an important doctor’s appointment for you or your kids? Help you sign up for health insurance? Help you get transportation to an important appointment? Tell you about different classes or groups that are being offered that you might be interested in? Talk to you about whether or not you want to have more kids? Give you tips about how to take better care of yourself or your kids?
Q8	Has somebody at Healthy Start (like a case manager) ever referred you to some other place in the community? Where did they refer you or suggest that you go? PROBE IF UNCLEAR WHAT TYPE OF PLACE IT IS: What types of services do they offer at the place? Medical services for yourself or your children? Some place in the community you could go for counseling services? WIC/nutrition support? Somebody who could help you get insurance? Some place in the community that could help you get TANF or food stamps? Some place in the community that could help with child care? Some place in the community that could help you get clothes for yourself or your family, A shelter or some other place that could help you get housing for yourself and your family Organization in the community that offers GED classes? Did you go to the place(s) that they suggested? Why or why not? PROBE IF NECESSARY: Did you not have transportation to the place? Did you not want the services being offered? Not enough time? Did anybody follow-up with you to see if you went to the place that they suggested? How did they follow-up (phone, text, email, in-person)? Were you happy with the services or help you got at the place?
Q9	What do you find useful about having people like case managers? Can you provide examples of when they were helpful? Do they let you know about opportunities and resources that you would not use on your own? Do they make you feel more knowledgeable about how to take care of yourself and your family? Do you feel like you can talk to them about things that are bothering you and get good advice on where you can go for help? What do you dislike about working with case managers? Do you feel like you cannot trust them? Do you think they do not really understand your needs? Do you hear from them more than you want to?
Q10	Are other family members ever invited to come when you meet with case managers? Which family members? Your spouse/ partner? Your child’s father (even if he is no longer your partner)? Your parents? Older children that you may have? Other family members, like siblings or grandparents? IF FAMILY MEMBERS ARE INVITED TO ATTEND: Did you ever bring a family member with you when you met with your case manager? How was the experience?
Home Visiting Total: 5 minutes Q11	Now let’s talk about another type of help you may receive from Healthy Start. Have you ever received home visiting services? Home visiting is when somebody, usually a nurse or other trained professional, comes to your home to show you how to take care of yourself and your baby, if you have one. Usually women get these services when they are pregnant or right after they have a baby. How did you find out that you could have somebody come to your home to teach you about how to take care of yourself or your baby? Did somebody at Healthy Start tell you? Did a doctor or health care provider tell you? A friend or neighbor? A family member? What type of person came/comes to your home? (case manager, nurse, some other person)
Q12	When did someone visit your home to show you how to take care of yourself or your baby? Were you pregnant at that time (if so, how many months)? Did you just have a baby (if so, how old was the baby)? Is somebody still coming? How often did/ does the person come to your home and how long did they stay each time? PROBE IF NECESSARY: Did the person come to your home a certain number of times? Did the person come every week or every month? Did/ does the person usually stay for a set amount of time, like an hour? Did/ do the length of the visits differ depending on different things you had/ have going on in your life?
Q13	Thinking about all the times you have had these visits at your home in the past, what types of things did you do during the visits? What topics did you discuss? PROBE AS NEEDED FOR ACTIVITIES/TOPICS [SHOW OF HANDS]: Did your home visitor show you how to put your baby to sleep? Did your home visitor help you with breastfeeding? Did your home visitor do any medical tests in your home, like a blood test? Did your home visitor give you advice on things you can do to spend time with your children? Did you talk about your physical health, including any abnormal symptoms you may have been concerned about or any existing health conditions you may have had? Did you talk about your feelings and your mental health? Did you talk about behaviors that you may be trying to change, like smoking, drinking or other substance use? Did you talk about your children’s health? Did you talk about any issues that may have been going on with your family or friends? Did you talk about how to make your home a safer place for your children? Did you talk about how you and your family could eat healthier? Did the home visitor suggest places you can go for help with child care or other types of help?
Q14	What do you like about the visits? Can you think of a day when you were really looking forward to the visit? What was happening on that day, and how did the visit go? Was it convenient to have somebody come to your home? Did you feel like you got good advice on where you can go for help? Was it good to have a chance to ask questions? What do you dislike about the visits? Can you remember a day when you wanted to cancel the visit? What was happening on that day, and how did the visit go? Do you feel like they are invading your personal space? Do you wish the visits could have gone on for longer than they did? Do you think the person visiting does not really understand your needs? Do you feel like you do not really need the tips and advice that you get? Can you give examples of what you learned? What were some of the favorite things you learned?
Q15	Are your family members encouraged to be around during the visits? Which of your family members were usually around when you received visits in the past? Your spouse/ partner? Your parents? Older children that you may have? Other family members, like siblings or grandparents? If you have a child or are pregnant, has your child’s father ever been around during a home visit?
Counseling and Support Groups Total: 5 minutes Q16	Now let’s talk about the types of support you might have gotten about different things that may have been going on in your life, such as quitting smoking, eating healthier food, or getting emotional support for things going on in your life. Did somebody at Healthy Start ever tell you where you could go to talk to somebody one-on-one or meet in a group with other women to get support on some of these topics (like smoking, eating healthier or things going on at home with your family)? PROBE IF NEEDED [SHOW OF HANDS]: Did you ever meet with a group of women, where you could talk about your experiences and get support? Did you meet with somebody one on one, like a counselor? IF NO: Did you ever want to talk to somebody or meet with a group where you could get support for things going on in your life?
Q17	Where did you go to get support (either by talking to somebody one on one or meeting with a group of women)? PROBE: Did you talk to somebody or meet with a group at: Healthy Start? A health center? IF GROUP: the YMCA? Some other place in the community?
Q18	What were some of the things you talked about? PROBE IF NEEDED: Quitting smoking? How things were going at home? How you were feeling after having a baby? Not drinking during pregnancy? Dealing with stress? Other topics?
Q19	In general, would you say the support you got was helpful? PROBE IF NEEDED [SHOW OF HANDS]: IF ONE ON ONE: Was it nice to talk to somebody one on one and share your feelings? IF ONE ON ONE: Did the person give you good advice? IF ONE ON ONE: Did you ever feel like the person you met with didn’t understand how you felt? IF GROUP: Was it helpful to be around other women who shared similar experiences? IF GROUP: Did you feel like people in the group understood how you felt? IF GROUP: Did you feel like you could not relate to the other people in the support group?
Q20	Were you ever encouraged to bring family members or friends to meet with the person or group? Which family members? Your spouse/ partner? Your parents? Older children that you may have? Other family members, like siblings or grandparents? Friends or neighbors? IF FAMILY/ FRIENDS ARE INVITED: Did you ever bring any family members or friends? Which ones?
Other Services Total: 10 minutes Q21 Group health education classes	Now let’s talk about classes. Did you ever participate in a class with others at Healthy Start or someplace else in the community that Healthy Start suggested to you? Classes can be about many different topics, like giving birth, how to be a parent, or exercising more. Was the class offered at Healthy Start or somewhere else in the community, like a YMCA or health center? What topics did you discuss in the class? Childbirth/ Prenatal classes: prenatal vitamins, getting a flu shot, normal/ abnormal symptoms, what to expect when giving birth, getting ready for the baby (crib, car seat, etc.), getting health insurance for the baby, emotional support during pregnancy, how to lower stress levels during pregnancy, going to the dentist, getting a flu shot, quitting smoking, abstaining from drinking, eating healthy Parenting: how to put your baby to sleep, breastfeeding, child safety, car seats, making sure the baby is getting all the necessary immunizations, bringing your baby to the dentist, Classes involving yoga and reducing stress Classes about nutrition and exercise Can you give examples of what you learned? What were some of your favorite things that you learned?
Q22 Reproductive Life Plan	Did anybody at Healthy Start ever talk to you about if and when you might want to have children and talk about ways to help plan a family? They may have called this a reproductive life plan. [SHOW OF HANDS] Who at Healthy Start talked to you about this (Case managers? Somebody who came to your home? Some other person?) Was anybody else, like your spouse or partner, involved in any of these conversations about planning a family? Do you think it was useful or helpful to talk about your plans for having more kids in the future?
Q23 Developmental Screenings	Did anybody at Healthy Start ever talk to you about having your baby tested to make sure your baby is healthy and learning the things and acting in ways that is expected? They may have called this a developmental screening. [SHOW OF HANDS] Who tested your baby? Was it a doctor, a nurse, a case manager, a home visitor or some other type of person? Where did they test your baby? Was it at a doctor’s office or medical center, at Healthy Start, in your home or in some other location? Did you have any questions or concerns about having your baby tested for healthy development? Did anybody answer your questions?
Q24 Risk Assessments	Did anybody ever talk to you about your health risks and needs? They may have asked you about your experiences and health conditions to help figure out what services you might want. This may have happened when you first signed up to become a Healthy Start participant. [SHOW OF HANDS] Who talked to you about your health risks and needs? Was it a doctor, a nurse, case manager, somebody who came to your home or some other type of person? Where did they talk to you about your health risks and needs? Was it at a doctor’s office of medical center, at Healthy Start, in your home or in some other location? Did you have any questions or concerns about the process? Was anybody able to answer your questions?
Q25 Perinatal Depression Screening	Did anybody ever talk to you about feeling down or having the baby blues during or after your pregnancy? [SHOW OF HANDS] Who talked to you about this? Was it a doctor, a nurse, a case manager, a home visitor or some other type of person? When did they talk to you about this—while you were pregnant or after the baby was born?
Q26 Male Involvement	Has your child’s father ever done anything at Healthy Start, like take classes with other fathers or meet with a Healthy Start staff member? [SHOW OF HANDS] How has your child’s father been involved with Healthy Start (what types of activity or service did they participate in at Healthy Start)? Who suggested that your child’s father get involved in Healthy Start? Are you happy that your child’s father got involved with Healthy Start? What about it makes you happy? Has it changed the way the father behaves with the child or with you? How? Has it changed the father’s behavior or attitude in other ways?
Health Promotion/ Education Total: 10 minutes Q27	Now let’s switch gears and talk about the types of information you might have gotten about how to be healthy, either at Healthy Start or at some other place that somebody at Healthy Start suggested to you. Think about all of the information that you have received from Healthy Start and other places that Healthy Start suggested to you (like doctors offices, WIC, pregnancy classes, etc.). Did they ever give you information about…[SHOW OF HANDS] Taking prenatal vitamins Getting a flu shot when pregnant What to expect when giving birth How to lower your stress levels Quitting smoking Not drinking during pregnancy How to eat healthier food How to put your baby to sleep Breastfeeding Getting a car seat Child safety Making sure your baby is getting immunizations Bringing your baby to the dentist Getting more exercise Would you say that most of the information you got was new to you or had you heard it before? IF THEY GOT NEW INFO: What are some things that you didn’t know? IF THEY HAD HEARD IT BEFORE: Was it a good reminder?
Q28	Who (from Healthy Start or some other place that Healthy Start suggested) gave you the information about these topics? PROBE AS NEEDED: Did you learn from… A health educator or someone that comes just to give the classes? Your case manager(s)? Doctors? Nurses? Somebody who came to your home to show you how to take care of yourself or your baby? Classes with other women? Somebody at WIC? How did you get this information? PROBE AS NEEDED: One-on-one during an appointment? At your home? In a group with other women (for example, a pregnancy class or a class about reducing stress)? Through brochures/ hand-outs? On the internet? Which of these sources of information gave you the most information about how to take care of yourself and your kids?
Q29	Most likely, some of the health information you received from Healthy Start and your other health providers was about healthy activities or behavior. Have any of you changed your behavior because of health information you received from Healthy Start or somewhere that Healthy Start suggested you go? What change did you make? Even if the change seems small, please tell us. Even if the change was only partly because of Healthy Start, please tell us. PROBES: For example, if you used to smoke and you tried to quit a few times in the past, and then Healthy Start told you about a quit line that helped you to actually quit, that would be a behavior change. Another example would be about getting a flu shot. Maybe you weren’t planning on getting a flu shot but then somebody from Healthy Start or one of your doctors told you that you should get one, so you did. That would also be an example of behavior change.
Medical home Total: 10 minutes Q30	Now we are going to talk more about the health care services that you and your family receive. First let’s talk about the health care services that you receive. Do you have a place where you usually go for health care services if you are sick or need medical advice? IF YES: Is this place a medical center? A health clinic? A private doctor’s office? A hospital emergency room? IF YES: Did somebody from Healthy Start refer you to this place or suggest that you go to this place for medical care?
Q31	How long have you been going to this place for health care services? Did you go to the same place for health care services before you participated in Healthy Start?
Q32	Is it easy or hard to make appointments at this place? If you call with a health problem, how long do you usually have to wait to get an appointment? Can you get an appointment the same day? Do you ever need appointments outside the normal 9 – 5 business hours (for example, can you go after work or on weekends)? Can you get appointments at times when you need them? If the place where you usually get health services is closed but you have a question about your health, can you generally get in touch with a doctor or other health provider at this place to get medical advice? When you have an appointment, how long do you usually have to wait to see your doctor? How organized is the place you usually go for medical care? In other words, do things usually seem to be running smoothly there or is the waiting room packed and the doctors seem stressed and confused?
Q33	Do you get a check-up even when you are healthy? IF YES: Is this the same place you go when you are sick? IF NO: Where do you go to get check-ups and health services when you are healthy? IF NO: Why don’t you get check-ups (PROBE IF NECESSARY: No time? Don’t know where to go? Always forget to get them?)
Q34	If you ever need additional health services from a specialist, like an eye doctor, does your doctor or health care provider usually refer you to someplace? To which kind of specialist did your usual doctor refer you? (eye doctor, ob/gyn, other)
Q35	Do you generally trust the doctors and nurses at the place that you go for health care services? Why or why not?
Q36	Now let’s talk about your experience getting health care services for your children. Is there a place where you usually take your children if they are sick or you have a question about their health? IF YES: Is this place a medical center? A health clinic? A private doctor’s office? A hospital emergency room? IF YES: Did somebody from Healthy Start refer you to this place or suggest that you could take your children to this place for medical care?
Q37	When did you start taking your children to this place? Do you take your children to this place to get check-ups and immunizations?
Q38	Is it easy or hard to make appointments at this place? If you call with a health problem, can you usually get an appointment the same day? Do you ever need appointments outside the normal 9 – 5 business hours (for example, can you go after work or on weekends)? Can you get appointments at times when you need them? If the place where you bring your children for health care services is closed but you have a health question, can you usually get in touch with a doctor or other health provider at this place to get medical advice? When your child has an appointment, how long do you usually have to wait to see a doctor or medical professional? In general, would you say the place you take your children for medical care seems relatively organized? In other words, do things usually seem to be running smoothly there or is the waiting room packed and the doctors seem stressed and confused?
Q39	If your children ever need additional health services from a specialist, like an ear doctor, what does your child’s doctor or medical provider do? To which kind of specialist did your usual doctor refer your child?
Q40	Do you generally trust your child’s doctors and the advice that they give you? Why or why not?
The Community Total: 10 minutes Q41	Now I want to switch gears again and ask you about the community you live in. Would you say this is a good community to raise children in? Why or why not? Would you say that in general, people can depend on each other in this community? Why or why not? Do you feel like you can get help from the community if you need it? Why or why not? Where do you go or who do you talk to in the community when you need help or support? Do you talk to family? Which family members? Do you talk to friends? Do you talk to a pastor or somebody from a religious group/ organization? Do you talk to neighbors? When you have questions about your health, who is usually the first person you try to contact? Does it depend on the question? Do you call the place where you usually receive medical care? Do you call case managers at Healthy Start? Do you call a friend or family member? If you have question about where you can get help on a specific aspect of being a parent, for example with breastfeeding, who is the first person you try to contact? Case manager, doctor, WIC, other health provider, internet? Do you call the place where you usually receive medical care? Do you call your case manager? Do you call a friend or family member? Do you call up a counselor at WIC? If you have question about how you can get help getting things like food, clothing or shelter, who is the first person you try to contact? Do you call the place where you usually receive medical care? Do you call your case manager? Do you call a friend or family member? Do you call up a counselor at WIC? If you are having personal or family problems at home, who is the first person you usually try to contact? Do you call the place where you usually receive medical care? Do you call your case manager? Do you call a friend or family member? Do you call up a counselor at WIC? The police?
Wrap-Up Total: 5 minutes Q42	We are almost done. I just have a few more questions. How satisfied are you with your experience as a Healthy Start participant? Do you have any suggestions for what could be improved? Do you think Healthy Start helps you access important services? Do you think Healthy Start helps you keep track of appointments and reminds you to take care of important things, like when your baby needs immunizations? Do you feel like there are people at Healthy Start that you could call if you need help? Does anybody have anything else they want to share about their experiences at Healthy Start? Those are all the questions I have today. Thank you for coming and talking with us. Please hand in your questionnaire and I will give you a gift card.