Parent Focus Groups in the USA and Canada

In 2004, Dan Jones and Associates of Salt Lake City, Utah, USA were hired to conduct the United States Parent Focus Groups on the PURPLE materials. The primary purpose was to obtain in-depth understanding about attitudes regarding infant crying, what people know about SBS, and how new parents cope with incessant crying by their infants.

Specific issues addressed in the group testing included:

• Perceptions about normal amounts of crying, and if respondents infants fall into what they see as the normal range;
• Current coping strategies;
• Behaviors once infant crying becomes extremely frustrating;
• Variances in opinions between new moms and new dads with regard to feelings and coping mechanisms;
• Differences between what was expected and what has been experienced with regard to levels of infant crying;
• Variances between what new moms and dads think, say and feel when they feel overwhelmed and frustrated by crying infants;
• Assessments of the Period of PURPLE Crying packet, including evaluations of the video, booklet and magnet;
• What people know about informing and educating infant caregivers about the Period of PURPLE Crying;
• Measurements of the effectiveness of key messages intended by components of the packet;
• And, to solicit suggestions as to how the packet and information therein could be enhanced.

A total of six focus group sessions were conducted on September 28 - 29, 2004. Prospective participants were screened to ensure that they had infants six months old or younger. A total of 63 people participated in the research: 42 new moms and 21 new dads. Males and females were separated by groups and represented a broad range of socio-economical and geographical areas within the Salt Lake City, Utah metropolitan area.

A summary of the findings from these first focus groups included:

• Evaluations of the marketing materials for PURPLE Crying show they are some of the most effective ever tested by Dan Jones & Associates in 30 years of market research. In fact, a few respondents called the company to thank them for the opportunity to participate, and to note appreciation for the new information, which they have already shared with spouses and caretakers.
• The message is simple, resonates with new parents, and the video/booklet format and delivery match the feelings associated with new parenting, specifically crying infants and the frustrations that go along with it.
• Viewers and readers of the materials appreciate the packet because the messengers are real people in real situations. That contributes to the credibility of the message.
• Respondents report very few criticisms with the packet; none of the criticisms significant. Respondents say the components of the packet – video, booklet and to some extent the magnet, complement each other.

Canadian Parent Focus Groups: Prevent SBS British Columbia also coordinated the evaluation of the PURPLE educational materials from the National Center on Shaken Baby syndrome for their suitability to the Canadian culture in 2004. Samsara Communications was hired to facilitate the focus group presentations, to train project personnel to appropriately handle the comments from participants, and to elicit feedback from participants. MTM Research was hired to analyze the results and report the key findings.

The primary purpose of the research was to elicit feedback and opinions on
dimensions of the materials such as:

• Clarity of the message
• Ease of understanding the message
• Sources of ambiguity in the message
• Attractiveness of the message
• How memorable the message was
• Meaningfulness of the message (Does it “speak to you as a parent”?)
• Appropriateness (or inappropriateness) of the message
• Helpfulness of the message
• Value added (what is new?) in the message
• Importance of message for caregivers (parents, in-laws, occasional caregivers) of infants

In order to meet the objectives, 8 focus group sessions were conducted between June 1st and November 16th, 2004 throughout the Vancouver, Vancouver Island and Fraser Valley Health regions. These areas included Chilliwack, Duncan, Port Moody, Richmond, Surrey, and Vancouver. A total of 66 parents (59 mothers, 6 fathers, and 1 elder) representing various backgrounds of race, economic status and family makeup participated. Participants were biological or adoptive parents of infants <6 months old (excluding the elder) and were proficient in spoken and written English.

A professional moderator representing Samsara Communications Services facilitated the groups. The discussion guide was developed jointly by representatives of the National Center on Shaken Baby syndrome (NCSBS) and the moderator.

During the focus group session, participants were asked for their opinions and feedback on the Period of PURPLE Crying intervention materials developed by the NCSBS . The parental materials included (a) a 10 minute video/DVD; (b) a brochure; (c) a refrigerator magnet; (d) a bib; and (e) a caregiver checklist. The health-care professional materials included (a) a lapel button; (b) an office/ward poster; and (c) a brochure. Participants were informed that a note taker was present and that the session was audio-taped.

• The overall impression of the booklet was very positive. Participants found the messages to be informative, comforting, and concise. Important issues stood out and the PURPLE acronym was easy to understand. One participant reported that it was “comforting to know you are not alone”. Another participant felt the information in the booklet was “just what you need to deal with the situation. [It] normalizes crying and offers alternatives about what to do”.
• Visually, participants found the booklet to be inviting and catchy. Everyone agreed that if they saw the brochure they would pick it up and read it.
• All of the participants understood the term shaken baby syndrome. However, several respondents did not feel that the relationship between the Period of PURPLE Crying and shaken baby syndrome was fully discussed in the booklet.
• Most of the participants thought the use of cartoons was “good”, “appealing” and helped “lighten the mood”. One participant stated that “they (the cartoons) got my attention because they look like what you feel like”.
• Many participants enjoyed the video as it gave them the option to learn by watching the materials rather than reading it. One participant believed that, “movies are extremely helpful”.
• Most of them reported being comfortable sharing information and discussing the Period of PURPLE Crying with other parents and caregivers.

At the end of the session, concluding comments were:

• Creating awareness is good.
• Whole package is good.
• Shaken baby syndrome needs more focus – physical things that can happen.
• There is too much stuff out there. It would have to be really special and catch my attention.
• When is it coming out?

The focus group sessions were formulated to provide the opportunity for ‘iterative’ evaluations of the components of the parent and professional materials, both individually and as a group of materials.

Translation Focus Group Testing
Translation Focus Group Testing: Prevent SBS British Columbia has also coordinated focus groups in the process of translating the PURPLE materials into several languages. The goal of the translation project for the Period of PURPLE Crying is to receive a culturally sensitive, accurately translated product that keeps the clarity and cohesiveness of the message.

The objective was to utilize a professional translation company that could provide the most comprehensive service that would meet the criteria necessary for academic publishing. The Provincial Language Services (PLS) was hired to perform the translation procedures. The programs expertise in translations within the health care community was necessary and they offered a comprehensive service which included community testing procedures.

There were additional measures added to ensure our specific project received the highest quality product. First, an initial focus group made up of five qualified and working healthcare interpreters analyzed the materials in order to provide suggestions to the translator in difficult areas. Secondly, once the unilingual parent focus group had viewed the product in the subject language and adjustments were made, an English back translation was requested from a separate translator with no previous knowledge of the product.

The process included two types of focus groups: 1) The Interpreter Focus Group, and 2) the Parent Focus Group.

1. Interpreter Focus Group: The interpreter focus group included 5-6 participants who were certified interpreters currently working within the health care field. These groups were held on the hospital grounds and participants generally received the documents a day or two before the group. A bilingual facilitator lead the group which also included authors of the materials; Dr. Ronald G. Barr, Director, Centre for Community Child Health Research and Marilyn Barr, Executive Director of the National Center on Shaken Baby syndrome. The translator and coordinators for the PURPLE team and the Provincial Language Services were also present, but not directly part of the group. The facilitator followed guidelines provided by the PLS and based an equal amount of time for both documents (11 page booklet and 10 minute film transcript). The focus groups were scheduled for two hours and the order of the materials was counterbalanced to provide equal coverage. The facilitator kept his/her own notes and provided a report with group suggestions.


2. Parent Focus Group: The parent focus group participants were recruited by multicultural community agencies and usually held at the agencies’ location. The criterion for recruitment was parents with children under two with as little English as possible. This was not always appropriate, however, as in the Punjabi community it is customary for grandparents to be the primary caregivers so they were included in that particular focus group. Materials to be discussed were only viewed in the target language. Coordinators from the PURPLE team and the PLS were present to answer questions, but did not participate. The facilitator followed guidelines provided which were similarly laid out as the interpreter focus group. The group was given a choice at the end to view the English film and depending on the level of English it was sometimes shown. Again, the facilitator kept his/her own notes and provided a written report with group suggestions.

As an example, the Punjabi parent focus group general comments are below:

Initial Impression:

• The information will be very useful and new.
• The focus group view of the script was that it made sense.  One mom agreed that shaking a baby was dangerous and could lead to disabilities. Another mom said that one should have self control.

Main Messages:

• The main message is perfectly conveyed in the DVD and is- do not shake the baby.
• Shaking babies is not good
• The main message about shaking infants is understandable
• The group agreed with each other.
• When probed as to why they get this message, one mom cited an example in US where somebody shook the baby when it wouldn’t stop crying and the infant was handicapped. Another mom said that maybe the infants neck muscle are weak so it can be a shock and dangerous.

Cultural Relevancy:

• The group felt the PURPLE materials were appropriate for the Punjabi community. The group wanted this DVD to be sent to India for the people to learn.
• The group liked the translation except for 2-3 words which are dealt in page wise review.

Images:

• The images were well liked by the group and met the expectations.

Translation focus groups will continue to occur with each new language chosen. As of December 1, 2007 the program has been translated into the following languages: Cantonese, Punjabi, Spanish (Mexican-dialect), Korean, Vietnamese, and Japanese. By mid-2008, it was also be available in French and Portuguese (Brazilian Dialect). In 2009 it was translated in Somali. The process above was required for each of these languages.

Through this process it has become very apparent that the program messages are relevant to all parents, of all kinds of families in all the cultures included in this process. It was a very rewarding process to know the program was valued by so many.