4 Family Focus Group Protocol (Co-definition & Summary Pha

OMB No: 0906-XXXX

Expiration Date: XX/XX/20XX

Public Burden Statement: This collection of information will be used to understand caregivers’ impressions of the services they received during the study. 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. The OMB control number for this information collection is 0915/0906-XXXX and it is valid until XX/XX/202X. This information collection is voluntary. Data will be kept private to the extent allowable by the law. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov. Please see https://www.hrsa.gov/about/508-resources for the HRSA digital accessibility statement.

Family Focus Group Protocol

Thank you for taking the time to talk with us today. My name is [NAME] and this is [co-facilitator/notetaker NAME(s)]. We work as research analysts with The Policy & Research Group (PRG). On behalf of the Health Resources and Services Administration (HRSA), and in collaboration with the Office of Planning, Research, and Evaluation (OPRE) in the Administration for Children and Families (ACF), we are carrying out a project that aims to identify, develop, study, and share evidence-informed strategies and resources that early childhood home visiting (ECHV) programs like [NAME OF HV PROGRAM] may use to improve home visiting services, and, outcomes for children and families. Today we are going to be talking about your experiences with home visits and the ways your [HOME VISITOR TITLE] has tried to keep your child or children interested, focused, and involved in the home visit.

• [Phase 1: Co-Definition]

  • We are particularly interested in hearing about how your home visitor has worked to keep your child’s attention and keep them involved during virtual visits or visits conducted through video. We’ll also talk about how these experiences compare to in-person visits.

• [Phase 4: Summary]

  • As we are nearing the end of the study, we want to hear about your recent experiences with how your home visitor has tried to get and keep your child’s attention and get them to participate during virtual home visits. We’ll talk about what you liked, what you felt worked, and maybe didn’t work as well.

Your participation in our discussion today is completely voluntary, and you can leave the call at any time. Your decision about whether to participate in this focus group or to answer any specific questions will not affect any services that you receive. I may ask you a question directly, but you don’t have to answer anything you don’t want to. This is just an effort to make sure we hear from everyone today. Please know that the information you share today is confidential and only study staff will have access to the notes, recordings, and transcripts. Study staff may summarize what we discuss today to share with interested parties (e.g., staff in your program, HRSA, or other programs participating in the study), but no identifiable information or individual responses will be shared. We ask you to please respect each other’s privacy by not sharing any personal information or experiences discussed during the focus group.

There are no known risks to your participation in this focus group. Although you may not see direct benefits associated with your participation, the information we gather will be used to improve home visiting services in the future. As a token of our appreciation, we will offer you a $40 gift card after the focus group ends.

[When caregivers agreed to join this focus group, they were asked if they were comfortable being audio-recorded. Everyone who agreed is in this session. If anyone did not agree, they will be on a separate call and when holding that call, this same protocol is used, and this paragraph is skipped.]

When you agreed to participate in this focus group, each of you said you were comfortable being recorded. You may leave this discussion at any time – by remaining you are agreeing to participate and have the discussion recorded. Does anyone have any questions before I start recording? [Answer questions]. I’m going to begin the recording so that we can make sure we accurately capture what is said (that we remember the discussion correctly).

As we are getting things set up to record and get our discussion underway – I’m going to send out a link to a quick survey in the Zoom chat [via email, if using phone]. The survey asks you to answer a few questions about yourself, so we have an understanding of who participated in our discussions. Like your participation in this discussion, filling out the survey is voluntary. You do not have to respond to all or any of the questions. Your name is not on the survey and will not be connected to your responses. By filling out the survey you are agreeing to allow the study team to see your responses and use your answers to describe (summarize) who was involved in the focus groups we conducted. Is everyone able to click on the link? [troubleshoot as necessary]. Great. If you are willing to fill out the survey, please take a few minutes to do so now and we’ll get started in [5 minutes, at TIME].

Ok. We are set up and I’m going to begin recording now. [Start to record]. Before we get started, I’d like us to set a few ground rules for the conversation.

[If using Zoom by video or calling in]

Since we are using Zoom today, I’ll keep my video on the whole time, but you can choose to have your video on or off. We want to make sure that everyone has the opportunity to have their thoughts and opinions heard. So, to avoid us talking over each other, I’ll be helping to direct the conversation. If you want to speak, you can let me know in the chat, click the “raise hand” button, or just chime in when there is a pause in conversation (this is particularly important if calling in instead of using video). Also, I want to emphasize that there are no right or wrong answers, and we are interested in hearing both positive and negative comments and opinions – or whatever you think is important to share. We only ask that you do not use the names of clients or staff outside of this focus group to help maintain everyone’s privacy. Those are all of the guidelines I have - does anyone have additional guidelines for our conversation that you would like us to consider? Does anyone have any questions about Zoom or the guidelines for our discussion? [Confirm that everyone understands Zoom features and can mute/unmute].

[If using Phone/conference call]

We want to make sure that everyone has the opportunity to have their thoughts and opinions heard. So, to avoid us talking over each other, I’ll be helping to direct the conversation. If you want to speak, you can chime in when there is a pause in conversation, otherwise, before we move on to different topics, I will provide an opportunity for people to voice their opinions. Also, I want to emphasize that there are no right or wrong answers, and we are interested in hearing both positive and negative comments and opinions – or whatever you think is important to share. We only ask that you do not use the names of clients or staff outside of this focus group to help maintain everyone’s privacy. Those are all of the guidelines I have - does anyone have additional guidelines for our conversation that you would like us to consider? Does anyone have any questions about the guidelines for our discussion? [Confirm that everyone understands how to mute/unmute].

In all, this should take between 30 minutes and an hour. Does anyone have any questions before we get started? [Answer questions.]

Part 1: Background

[The questions in this section are asked during Phase 1: Co-Definition only. This section is intended to introduce all members of the focus group to each other and open the conversation before moving in the next section.]

First, I’d like us to go around and introduce ourselves. I know that we’re all just meeting each other, so I can share a little more about myself first. [facilitator can share information about self, then cofacilitator, and can also introduce notetaker]

Great. Now if each of you could introduce yourselves telling us your first name only (to protect privacy), how long you’ve participated in [NAME OF HV PROGRAM] and the age of your child or children who participate. Let’s start with [insert first name, roll call rest of participants].

Thanks everyone. Now that we know a little bit about each other, let’s begin by talking about your experiences with [NAME OF HV PROGRAM].

Part 2: Strategies Implemented

[The questions in this section are asked during Phase 1: Co-Definition only. This section builds our baseline understanding of how families experience strategies implemented to enhance/increase virtual engagement.]

Question: Overall, how have virtual home visits been going for you and your child (or children)?

Question: How often do you have virtual visits?

Question: What are the reasons you have had virtual visits?

• Follow-up: Have you requested a virtual visit? If so, can you tell me why?

• Follow-up: What are the reasons your home visitor explains for requesting a virtual visit?

Question: Can you think of and describe for me a specific virtual visit that you feel went well?

Question: What do you like about virtual visits?

Question: Can you think of and describe for me a specific virtual visit that felt more challenging?

Question: What don’t you like about virtual visits?

Question: What are some differences in how your child behaves or interacts during an in-person visit versus a virtual/video visit?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions]

Part 3: Facilitators of and Challenges to Implementation

[The questions in this section are asked during Phase 1: Co-Definition and Phase 4: Summary. This section gathers information on supports and barriers that families experience in relation to child engagement during virtual home visits.]

Question: Can you first describe the situations in which you’ve had virtual home visits lately?

• Follow-up: Have you asked to have a virtual visit instead of an in-person visit? Can you briefly share why?

• Follow-up: Has your [HOME VISITOR TITLE] asked to have a virtual visit instead of an in-person visit? Can you briefly share if they explained why?

Question: What app or platform do you use for virtual visits? (for example: Facetime, Zoom, WhatsApp)

Question: What have you needed to make a virtual home visit go smoothly? (such as Wi-Fi, help setting up an account online, a call to happen during a specific time of day, etc.)

Question: What makes virtual visits hard or challenging for you and your child/children?

• Follow-up: Can you give an example of challenges or issues you’ve had when trying to have a virtual home visit?

• Follow-up: Which of these examples is the most challenging?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions.]

Part 4: Perception of Strategies

[The questions in this section are asked during Phase 1: Co-Definition and Phase 4: Summary. This section gathers information about caregivers’ experiences of virtual engagement strategies before the program implements practice changes (Phase 1: Co-Definition) to set a baseline understanding, and after the study implementation has been completed (Phase 4: Summary) to get family feedback on their experiences and any challenges]

[Phase 1: Co-Definition]

Question: Can you think of any times when your child has gotten distracted during a virtual visit? If so can you remember and tell me about what your home visitor has done to get their attention or to keep them focused?

• Follow-up: Can you provide any examples or explain what your home visitor has done?

• Follow-up: How has your child reacted to your [HOME VISITOR TITLE]’s efforts or attempts to keep them interested, focused, or involved during a virtual home visit?

• Follow-up: What does your child do when your [HOME VISITOR TITLE] tries to get their attention or to do something with them during a virtual visit?

Question: Do you feel like your [HOME VISITOR TITLE] knows how to keep your child’s attention and interested during virtual home visits?

Question: Are there different approaches or things your [HOME VISITOR TITLE] does to keep your child’s attention when you are having virtual visits versus (as compared to) in person home visits?

• Follow-up: Can you share any examples?

Question: Can you tell me about the type of interaction you and your [HOME VISITOR TITLE] have with your child during virtual visits?

• Follow-up: When your child is doing an activity during a home visit, are you interacting with your child mostly or is your [HOME VISITOR TITLE] the one mostly interacting with your child? (or both of you the same amount)

• Follow-up: During virtual visits, is your [HOME VISITOR TITLE] interacting with your child through the screen?

• Follow-up: During virtual visits, are you often helping your child do an activity your [HOME VISITOR TITLE] has suggested?

Question: Do you feel like your [HOME VISITOR TITLE] gives you ways to engage with your child during virtual visits?

• Follow-up: Can you think of any examples?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions]

[Phase 4: Summary]

Question: Have you noticed any recent changes with how your [HOME VISITOR TITLE] works to get your child interested, focused, and involved in the home visits? If so, can you explain or provide an example?

• Probe: description of home visitor’s attempts to get the child’s attention or participate in an activity

• Follow-up: What does your [HOME VISITOR TITLE] do when your child loses interest or focus during a (virtual) home visit?

Question: During virtual home visits in the past few months, did your home visitor do [strategy chosen by site for implementation] or [(if applicable), strategy with adaptations identified through rapid learning throughout the study].

• Follow-up: Did this seem to impact how interested and engaged your child was during that visit?

  • Probe: description of how strategy worked

Question: Considering your recent experiences with how your [HOME VISITOR TITLE] has worked to keep your child interested, focused, and involved, how well do you think what they are doing is working?

• Follow-up: Does your child/children seem more or less interested or involved in recent home visits?

• Follow-up: Have the tactics your [HOME VISITOR TITLE] is using to get or keep your child’s attention affected the way you react to or interact with your child during the visit?

• Follow-up: Have the tactics your [HOME VISITOR TITLE] is using to get or keep your child’s attention affected the relationship or how comfortable and connected you and your child/children feel with your [HOME VISITOR TITLE]?

Question: How satisfied are you with how your [HOME VISITOR TITLE] is keeping your child interested and involved during home visits?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions.]

Part 5: Wrap-up/Final Questions

[This section is asked during Phase 1: Co-Definition and Phase 4: Summary. This section is the closing of the focus group and is used to make sure we address any outstanding questions and ensure we ask if anyone has anything additional to share before we end the focus group.]

Question: In closing, is there anything else you’d like to share?

Thank you very much for participating in this focus group! If you have questions about this discussion, or how the transcript will be used, feel free to contact me.

[Phase 1: Co-Definition]

Our next focus group will be [provide timing] and will be Phase 4: Summary, of the study process. It will take place after the program has implemented practice changes related to virtual home visits. We will then be gathering your feedback on these changes and your general experiences with virtual home visiting again at that later date.

If you have any questions about the study, please contact Teresa Smith at The Policy & Research Group (teresa@policyandresearch.com or (225) 281-3783).

If you have questions about your rights as a research volunteer, you can call Health Media Lab Institutional Review Board at (202) 549-1982.

The Policy & Research Group 7