Focus Group Interviews on Racial and Ethnic Attitudes: METHODS

We used a qualitative study design to better understand racial and ethnic differences in knowledge, attitudes, and perceptions regarding adult vaccinations and to assess the practicality of delivering adult vaccinations in community churches. Content analysis was performed to analyze the narrative data obtained through four focus groups completed in Catholic community churches in San Francisco between April and June 2003. The focus groups were conducted in the language of preference (English or Spanish). Participants were presented with a basic definition of the three primary adult vaccinations (e.g., flu, pneumonia, and tetanus) at the beginning of the focus group. Then, several open-ended questions were posed, such as, “Please tell us in your own words what you have heard about adult immunizations,” “Have you heard of the flu or tetanus vaccine?,” or “What do you know about the pneumonia vaccine?” Each focus group was professionally taped, transcribed verbatim, translated (Spanish to English), and submitted for thematic analysis by four of the investigators. Phrases and sentences were the unit of analysis.

Data Collection Methods and Recruitment

We used a two-step recruitment method to enroll racial and ethnic minority adults from faith-based organizations as focus group participants. First, invitations to participate were sent to selected San Francisco religious leaders and church-governing bodies representing faith-based organizations located in low socioeconomic neighborhoods with >50% African-American and/or Latino members. Faith-based organizations that expressed interest in participating were invited to an informational group meeting to review the purpose of the project and to explore partnership arrangements. We sought to build relationships with interested faith-based organizations over a period of time before recruiting focus group participants from within their membership. Second, faith-based organizations that agreed to participate were asked to inform their members during church announcements and in weekly bulletins that University of California, San Francisco (UCSF) researchers were available to discuss and enroll eligible members in an adult vaccine focus group study. Church members were asked to stay after religious services for a baseline screening eligibility session. If a member was eligible and willing to participate, an appointment was made at a time, date, and location for a scheduled focus group. We recruited church members who were 1) age 50 or older, 2) adults with chronic heart or lung diseases or diabetes mellitus who had not routinely been immunized against influenza, or 3) adults age 65 or older who had never been vaccinated against pneumococcal disease. Individuals who received the influenza vaccine in the preceding year or the pneumococcal vaccine anytime in the past were excluded from the study.
Conducting the Focus Groups

The study was approved by the Committee on the Protection of Human Subjects at UCSF. All of the study materials were available in English and Spanish. Each focus group participant signed informed consent, received instructions on the interview process, and was encouraged to freely express opinions during the interview. A short sociodemographic questionnaire was administered at the beginning of the focus group. The identity of the participants was kept confidential, and a code number was used to identify each participant’s response and the focus group itself. Participants received $20 grocery vouchers for their participation in the group interview.

All focus group leaders were bilingual and bicultural skilled and experienced healthcare researchers with doctoral backgrounds. The two Latino focus groups were conducted in Spanish; the African-American and Caucasian focus groups were conducted in English. Standard moderation techniques were used throughout, and all focus groups lasted approximately an hour.
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Data Analyses

Data from the short sociodemographic questionnaire were analyzed using descriptive statistics. Measures of central tendency were used for interval/ratio data. Nominal and ordinal data on participants’ characteristics were analyzed with frequencies and proportions. Data analysis for responses to the open-ended questions was conducted through content analysis. The focus groups were transcribed, translated if applicable, and reviewed by research investigators who performed content analysis to identify major themes. All investigators read each transcript, identified major themes, and extracted exemplifying quotations. The analysis incorporated line-by-line open coding of each phrase, statement, or response. The investigators coded the data independently and met at a later date to reconcile the emerging themes and to discuss the analysis of theme clusters and categories.

Investigators accomplished data reduction by selecting and grouping themes according to their conceptual association. The codes were clustered to display categories of themes. The last step included verification of emerging themes and their categorization to describe these responses in the context of racial and ethnic differences. Only major themes and specific passages from focus group transcripts are presented herein. pharmacy united kingdom


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