Post-intervention Focus Groups Research Articles

Feasibility of Using a Community-Supported Agriculture Program to Increase Access to and Intake of Vegetables among Federally Qualified Health Center Patients

ObjectiveThis study explored the feasibility of using a 23-week subsidized community-supported agriculture program to increase access to and intake of vegetables among Federally Qualified Health Center patients. MethodsOutcomes were measured using pre-post intervention surveys (n = 9). Process data were collected in post-intervention surveys and focus groups (n = 15). ResultsMost participants (77%) indicated that the program improved their health and all (100%) reported that they were eating a greater variety of vegetables because of their participation in the program. Three themes emerged from the focus groups: increased access to fresh and/or organic vegetables, improved diet quality, and the importance of social support during the program. Conclusions and ImplicationsLinking subsided community-supported agriculture programs with Federally Qualified Health Centers has the potential to increase access to and intake of vegetables among low-income patients. However, further research is needed with a larger sample size and a more robust study design.

The Co-creation and Feasibility of a Compassion Training as a Follow-up to Mindfulness-Based Cognitive Therapy in Patients with Recurrent Depression

The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.

Feasibility of a Latin Dance Program for Older Latinos With Mild Cognitive Impairment.

This study investigates the feasibility of a Latin dance program in older Latinos with mild cognitive impairment (MCI) via a feasibility mixed methods randomized controlled design. Spanish-speaking older Latinos (N = 21, 75.4 [6.3] years old, 16 females/5 males, 22.4 [2.8] Mini-Mental State Examination [MMSE] score) were randomized into a 16-week dance intervention (BAILAMOS) or wait-list control; the control group crossed over at week 17 and received the dance intervention. Feasibility was determined by assessing reach, retention, attendance, dance logs, and postintervention focus groups. Reach was 91.3% of people who were screened and eligible. Program retention was 95.2%. The dropout rate was 42.8% (n = 9), and attendance for all participants was 55.76%. The focus group data revealed 4 themes: enthusiasm for dance, positive aspects of BAILAMOS, unfavorable aspects of BAILAMOS, and physical well-being after BAILAMOS. In conclusion, older Latinos with MCI find Latin dance as an enjoyable and safe mode of physical activity.

Reach Out Churches: A Community-Based Participatory Research Pilot Trial to Assess the Feasibility of a Mobile Health Technology Intervention to Reduce Blood Pressure Among African Americans.

Innovative strategies are needed to reduce the hypertension epidemic among African Americans. Reach Out was a faith-collaborative, mobile health, randomized, pilot intervention trial of four mobile health components to reduce high blood pressure (BP) compared to usual care. It was designed and tested within a community-based participatory research framework among African Americans recruited and randomized from churches in Flint, Michigan. The purpose of this pilot study was to assess the feasibility of the Reach Out processes. Feasibility was assessed by willingness to consent (acceptance of randomization), proportion of weeks participants texted their BP readings (intervention use), number lost to follow-up (retention), and responses to postintervention surveys and focus groups (acceptance of intervention). Of the 425 church members who underwent BP screening, 94 enrolled in the study and 73 (78%) completed the 6-month outcome assessment. Median age was 58 years, and 79% were women. Participants responded with their BPs on an average of 13.7 (SD = 10.7) weeks out of 26 weeks that the BP prompts were sent. All participants reported satisfaction with the intervention. Reach Out, a faith-collaborative, mobile health intervention was feasible. Further study of the efficacy of the intervention and additional mobile health strategies should be considered.

A Pilot, Web-Based HIV/STI Prevention Intervention Targeting At-Risk Mexican American Adolescents: Feasibility, Acceptability, and Lessons Learned.

Information technology provides new avenues to increase opportunities to deliver HIV/STI prevention interventions in a confidential, sensitive, and engaging manner for youth. While technology-based HIV/STI interventions show promise in preventing HIV/STI among different populations, few have targeted young Latinas. This pilot study examined the feasibility and acceptability of a bilingual, web-based HIV/STI prevention intervention among Latino females aged 15-19. We used a mix-method approach, including a prospective 2-group design with 3 repeated measures, and a post-intervention focus group discussion. We recruited 14 participants from an alternative high school and randomized into each study condition. Participants took 5 structurally equivalent modules focusing on either HIV/STI prevention (intervention) or nutrition/exercise (comparison) and completed assessments before the intervention, immediately post-intervention, and 2 months post-intervention. The findings suggested that the intervention had high levels of feasibility and acceptability. We discuss the keys to success, challenges encountered, and future directions.

‘It doesn’t seem like PE and I love it’: Adolescent girls’ views of a health club physical education approach

School-based physical education (PE) is the most efficient and cost-effective means of increasing girls’ physical activity. Therefore, this project used a health club (HC) approach to alter a high school PE experience for 17 grade nine girls (M age = 14.6 ± .49). As part of a larger mixed-methods study, this qualitative element gauged adolescent girls’ perceptions of their HC experience using the frameworks of interpretive description and practice-referenced research. Students participated in both pre- and post-intervention semi-structured focus group interviews and completed journals throughout the 14-week intervention. Results revealed autonomy as one organizing theme, including students reporting the importance of choice, variety, and novelty. A second organizing theme was relatedness, with subthemes specific to how girls appreciated having a single-gender PE experience, and their desire for a positive relationship with the research assistants who were leading the experience at the health club.

A Study of the Impact of an Educational Intervention on Nurse Attitudes and Behaviours toward Mobile Device Use in Hospital Settings

Introduction: Mobile applications (apps) provide nurses with evidence-based information at the bedside. Librarians encourage app use by purchasing licenses and promoting their features. While many high-quality nursing apps exist, there is inconsistency in published reports on whether nurses use them in patient care. The aim of this research is to describe the use of mobile apps by nurses at two urban hospitals and to examine the impact of educational sessions led by hospital librarians and educators on nurse usage, attitudes and behaviour as they relate to mobile apps.Methods: Phase I consisted of a descriptive, cross-sectional survey of in-patient nurses to determine mobile app use and attitudes. Phase II involved a one-group pre/post-test design to examine the impact of education sessions led by librarians and hospital educators on nurse attitudes, usage and behaviours. A post-intervention focus group captured thoughts on using mobile apps at the bedside.Results: Results indicate that most nurses who have a personal mobile device are interested in using them at the bedside though few are currently doing so. While nurses cite many conveniences and uses, they also highlight a number of barriers associated with using mobile devices that must be addressed in order to realize the benefits in patient-centred care.Discussion: Hospital librarians and educators should work together to provide the education and support nurses require to realize the benefits of using apps at the bedside. Larger studies are needed to determine the impact of educational sessions on patient and health provider satisfaction with mobile device use.

Learning to BREATHE: A Pilot Study of a Mindfulness-Based Intervention to Support Marginalized Youth.

Mindfulness-based curricular interventions can support adolescents who are at risk of school failure as they negotiate the transition from high school into young adulthood. Researchers hypothesized that a 6-week mindfulness-based intervention would lower participants’ perceived stress while increasing their reported levels of self-esteem. Participants (N = 23) ranged in age from 17 to 20 years while the majority were male students of color. Pre- and postintervention survey mean responses revealed statistically significant differences on the Single-Item Self-Esteem Scale and 3 items on the Perceived Stress Scale (with small to moderate effect sizes). Postintervention focus group (n = 8) data indicated that the most valued daily practice was the body scan technique. Open coding of the focus group data also revealed several key themes in the form of overarching codes as participants discussed intervention benefits. These included (a) self-regulation, (b) attention-awareness, and (c) positive thinking.

Perspectives on a whole class mindfulness programme

This study sought to establish pupil and teacher views about a six-hour, whole-class mindfulness programme called Paws.b. Pupil post-intervention focus groups and teacher semi-structured interviews were used to ascertain what was interesting and useful about Paws.b, and how it could be developed. Audio recordings were transcribed and thematically analysed. Findings indicated the vast majority of pupils enjoyed Paws.b and it was deemed to be both accessible to pupils and feasible for teachers to deliver. A number of themes highlighted the impact of Paws.b upon pupils’ attention but also on their metacognition and social/emotional functioning, both within and beyond the classroom. Several potentially fruitful adaptations were also proposed. Findings are discussed relative to mindfulness and educational psychology literature, and future directions for research are outlined.

Feasibility and acceptability of active book clubs in cancer survivors – an explorative investigation

Background: While the increasing number of people surviving cancer is promising, the long-term health effects warrant broad, innovative interventions. We investigated the feasibility and acceptability of a 24-week intervention called ‘Active Book Club’ comprising audio book listening, pedometer walking and supervised book club meetings.Material and methods: An exploratory and descriptive design was applied. Qualitative data included baseline and post-intervention focus group interviews as well as post-intervention individual interviews. The study also included data on retention, attendance, and adherence. Seventeen self-referred cancer survivors with various oncological and sociodemographic backgrounds were included.Results: Eight (47%) participants completed the entire intervention. Their median attendance at the book club meetings was eight [interquartile range (IQR) 6–9] of nine possible, and they reached the walking step goal in a median of 11 (IQR 7–12) of the first 12 weeks, and seven (IQR 1–10) of the last 12 weeks. The qualitative analysis revealed five themes including: Motivation and expectations (i.e. reasons for enrollment), Attentive listening (i.e. experiences of the audio book format), Affected by the story (i.e. experiences of the content of the books), Group involvement (i.e. experiences of the book club meetings) and Walking regularly (i.e. experiences of the walking program). Overall, findings revealed that while audio books may bring new meaning to physical activity and serve as a relief from own concerns, certain stories may affect some individuals negatively. The substantial dropout rate, however, suggested that modification is necessary and that patient involvement in choice of literature may be critical to enhance acceptability.Conclusion: The ‘Active Book Club’ represents a novel psychosocial intervention potentially supporting physical activity adoption and mental health in cancer survivors. However, several issues related to feasibility and acceptability including choice of literature genre, format and supervision of book club meetings need to be considered before larger scale clinical trials are initiated.

“It's very challenging for everyone”: Developing an educational intervention to enhance care of hospitalized older adults with impaired cognition

Abstract Purpose To design and evaluate an educational intervention to enhance care of hospitalized older adults with impaired cognition. Method Pre- and post-focus groups were employed to design and evaluate the intervention. Results Four categories emerged from the pre-intervention focus groups: many knowledge gaps; reliance on outside expertise; limited involvement in care planning; and preferences for in-person training. Three categories emerged from the post-intervention focus groups: addressing learning needs/preferences; awareness and use of best practices; and many factors affect knowledge application. Conclusions The intervention resulted in self-reported improvements in knowledge and the ability to apply this knowledge into patient care.

"This Method, I Think, Can Shed New Light": Haitian-American Women's Reflections on Risk, Culture, and Family Planning Decisions From a Short-Term Trial of a Cervical Barrier (Femcap™).

Improving the reproductive health of immigrant populations requires understanding the specific context of risk and need. As part of a field trial of the FemCap™, a woman-initiated cervical barrier contraceptive, we conducted postintervention focus group discussions (FGDs) with 20 women (five FGDs) of Haitian background, the majority of whom were born in Haiti and spoke Haitian Créole at home, at a community health center in south Florida. Participants discussed the role of religion and inequitable gender norms in Haitian traditions about family planning decisions and provided important insights into the gender-power nuances of their partnership dynamics vis à vis the use of female barrier methods. Encouraged by more equitable gender norms in the United States, participants were eager to serve as health education agents, with strong altruistic sentiments toward other Haitian girls and women who they felt could be encouraged to negotiate for greater reproductive decision-making power.

Supporting parents in late modernity through parent education: A mixed-methods study in Hong Kong

Summary While the increasing awareness of risk in late modernity has resulted in the proliferation and complication of parental roles and choices, few attempts have been made to explore how parent education can empower parents to reconstruct parenthood and transform parental lives. Based on the results of a mixed-methods study conducted in Hong Kong, this article discusses the possible outcomes and experiences of a parent education program that aimed to facilitate parents’ holistic growth in dealing with the prevailing culture of intensive parenting. The program was composed of 30 h of seminars and workshops. The participants included 387 Hong Kong Chinese parents recruited from seven primary schools and 27 nursery schools. A pretest–posttest assessment survey and postintervention focus groups were adopted for the evaluation methods. Findings The quantitative results showed that the participants experienced an enhancement in confidence, understanding, and trust in parenting. The qualitative findings indicated that the program helped the participants reflect upon the meaning of parenthood, underline the gains and accomplishments of parenting, and adjust parental expectations. They could also foster parent–child relationships in accordance with their children’s developmental needs, uniqueness, and emotions. As a result, these parents were more ready to face the challenges of the anxious parenting culture. Applications The findings support the reconceptualization of parent education as a reflexive practice. Such practice can unleash parents’ capacity to construct knowledge from their lived experiences and reconstitute their reflexive and emotional selves to negotiate life choices among the diversity of options in childrearing.

Social media and gamification: Engaging vulnerable parents in an online evidence-based parenting program

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than $15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online—a public health approach to protect and improve the development of vulnerable children.

The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation.

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n=20) and South Carolina (n=20), and one rural Appalachian church in Kentucky (n=21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.

‘A sort of black and white past and present thing’: high school students’ subject positions on South Africa’s recent past

This article examines the discursive positions South African high school students take up in response to a teaching intervention that invites them to historicize their identities. It thus seeks to contribute to the growing body of education research on how to meaningfully engage young people in post-conflict societies with their recent past. Drawing on lesson transcripts as well as post-intervention focus group discussions with students in two different high schools, I use poststructuralist theories of discourse and subjectivity to attempt to understand students’ reluctance to see themselves as historically located. The analysis shows that students feel interpellated in uncomfortable ways by a historical narrative that works to tie subject positions to fixed, racialized identities. Their attempts to escape these predetermined positions constitute ongoing negotiation of multiple discourses tied to race, history and their generational locations. Implications for curriculum and pedagogy are briefly considered.

Effectiveness of Fresh to You, a Discount Fresh Fruit and Vegetable Market in Low-Income Neighborhoods, on Children’s Fruit and Vegetable Consumption, Rhode Island, 2010–2011

IntroductionEating fruits and vegetables is associated with lowered risk for many chronic diseases. However, most Americans, especially members of low-income and minority populations, do not eat adequate amounts. Fresh to You is a public–private partnership program that brings discount fresh produce markets into low-income neighborhoods. We conducted a mixed-methods evaluation of Fresh to You to assess the effect of the program on children’s consumption of fruits and vegetables.MethodsA local produce distributor brought the Fresh to You markets to 6 community organizations serving low-income families in Rhode Island. The markets, held weekly for 5 months at each site, sold fresh produce at below-retail prices. Parents (N = 480) of children aged 3 to 13 years were recruited at the markets to participate in a 5-month cohort study. The primary outcome was change in children’s fruit and vegetable intake, measured by a validated screener. We also conducted postintervention focus groups at each site with parents and qualitative interviews with site contacts to collect feedback about Fresh to You.ResultsFrom baseline to 5 months, there was a significant increase in children’s daily fruit and vegetable consumption of 0.48 cups (t = 4.16, P < .001). Data from follow-up parent surveys, focus groups, and site contact interviews provided positive feedback about Fresh to You and recommendations for improvement.ConclusionFresh to You was effective at increasing consumption of fruits and vegetables among racially and ethnically diverse low-income children aged 3 to 13 years whose parents shopped at the markets. The intervention could serve as a model program for replication in other cities. Refinements and a more rigorous evaluation are needed.

Increasing collective efficacy for physical activity: Design and rationale of Moms UNITE for Health

BackgroundMothers are a population that engages in low levels of physical activity due to unique barriers to physical activity. As such, there is a need to develop and implement physical activity interventions for mothers that can be delivered in community settings. The objective of this article is to describe the Moms UNITE (Using Networks to Increase Togetherness and Efficacy) for Health walking intervention. This intervention, based on social cognitive theory, is designed to compare a collective efficacy enhanced intervention to a standard intervention for increasing physical activity and secondary outcomes. MethodsIn this 6-week, randomized controlled trial, mothers will be assigned to either the standard or intervention (collective efficacy) group. Both groups will receive the same walking intervention and an evidence-based health education program. Strategies and messages focusing on building collective efficacy will be used in the intervention group. Data will be collected at baseline, post-intervention, and follow-up (after a 3month no-intervention period) using a mixed methods approach. ResultsQuantitative data will include anthropometric measurements, objective physical activity, and questionnaires assessing self- and collective-efficacy. Post-intervention focus groups and weekly process evaluation surveys will describe participants' experiences within the program. ConclusionsThis paper will serve as a theoretical framework for researchers and public health practitioners to develop and implement community-based walking programs for mothers.

Introducing global health into the undergraduate medical school curriculum using an e-learning program: a mixed method pilot study.

BackgroundPhysicians need global health competencies to provide effective care to culturally and linguistically diverse patients. Medical schools are seeking innovative approaches to support global health learning. This pilot study evaluated e-learning versus peer-reviewed articles to improve conceptual knowledge of global health.MethodsA mixed methods study using a randomized-controlled trial (RCT) and qualitative inquiry consisting of four post-intervention focus groups. Outcomes included pre/post knowledge quiz and self-assessment measures based on validated tools from a Global Health CanMEDS Competency Model. RCT results were analyzed using SPSS-21 and focus group transcripts coded using NVivo-9 and recoded using thematic analysis.ResultsOne hundred and sixty-one pre-clerkship medical students from three Canadian medical schools participated in 2012–2013: 59 completed all elements of the RCT, 24 participated in the focus groups. Overall, comparing pre to post results, both groups showed a significant increase in the mean knowledge (quiz) scores and for 5/7 self-assessed competencies (p < 0.05). These quantitative data were triangulated with the focus groups findings that revealed knowledge acquisition with both approaches. There was no statistically significant difference between the two approaches. Participants highlighted their preference for e-learning to introduce new global health knowledge and as a repository of resources. They also mentioned personal interest in global health, online convenience and integration into the curriculum as incentives to complete the e-learning. Beta version e-learning barriers included content overload and technical difficulties.ConclusionsBoth the e-learning and the peer reviewed PDF articles improved global health conceptual knowledge. Many students however, preferred e-learning given its interactive, multi-media approach, access to links and reference materials and its capacity to engage and re-engage over long periods of time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0421-3) contains supplementary material, which is available to authorized users.

Reviving Parents’ Life Momentum: A Qualitative Evaluation of a Parent Education Program Adopting an Existential Approach

This paper reports the results of a qualitative analysis of the participants’ perceptions and experiences of a parent education program adopting an existential approach. With a critical review of the changing social context of parenthood and the provision of parent education in Hong Kong, the paper discusses the theoretical underpinnings, key components, and the design of a growth- and meaning-oriented parent education program. This program comprised six 5- hour sessions held weekly. The participants included 43 Hong Kong Chinese parents. An evaluation study was conducted to explore the outcomes of the program, which was composed of a non-equivalent comparison group design, a subjective outcome evaluation survey, and post-intervention focus group interviews. The current paper focuses on reporting the qualitative examination of the data collected through five post-intervention focus groups. Twenty-five participants were randomly selected and invited to join the groups. The recurrent themes extracted from their narratives reveal their perceptions of the impacts of the program on their enhancement of self-understanding and personal growth, integration of life through life review, reset of life priority, affirmation of the parent-child relational connection, changes in parent-child relationships and interactions, and cultivation of mutual support and mutual learning. Based on the qualitative findings, the paper explores the relevance and potentials of this approach in re-conceptualizing parent education in the Hong Kong Chinese context.