2.2.1 Focus Groups
Participants were self-selected, responding to either an email invitation (Appendix A) or flyers (Appendix B) posted on a university campus. Flyers were posted in
buildings utilized frequently by nursing students. All flyers included the title of the study, eligibility criteria, explanation to interested volunteers to self-select themselves based on the eligibility criteria listed, compensation, researcher‟s contact information and stamp of approval from the IRB. Prior to posting the flyers, a stamp of approval was received from Student Services at Drexel University‟s College of Nursing and Health Professions (CoNHP). Permission was received to make copies of the stamped flyer. Email invitations were sent via a mass emailing to all nursing students with approval from the Provost and assistance from Drexel University‟s Office of Information Resources and Technology (IRT). The researchers of the study complied with IRT‟s policies for the distribution of mass emails (57). Interested students contacted the researchers almost immediately following distribution of the mass email. The mass emailing to students seemed to be much more effective than the flyers. Word of mouth was also utilized to recruit students by attending a nursing class and a meeting for the Undergraduate Nursing Diversity Organization.
Inclusion criteria for participants: 18 years or older and either a junior or senior nursing student in Co-operative program (Co-op) or any level student in the Accelerated
Career Entry Degree (ACE) program. The sample was limited to junior or senior nursing students in the Co-op program and all ACE students because these students would have completed their nutrition requirements for the nursing program. Co-op students are required to complete 2 nutrition courses during their freshman and sophomore year while ACE students are required to complete 1 nutrition course prior to beginning Drexel‟s nursing program.
Interested students contacted the researchers via telephone. Eligibility was confirmed via a telephone screening questionnaire (Appendix C) and again prior to the focus group session using a brief screening questionnaire (Appendix D). Only the first name and telephone number of participants were recorded. First names and telephone numbers were used to make reminder phone calls to each student within 48 hours prior to each focus group. The final list of participants for each focus group was used as a check- off list to ensure that the people who showed up for the focus group were the same people who had completed the telephone eligibility screeners. Only two individuals attended a focus group who had not previously signed up via telephone. The screening
questionnaires were conducted with these students prior to their participation in the focus group. Following each focus group, telephone numbers and names were destroyed.
At the beginning of each focus group, participants were informed of the
following: that their participation was voluntary, that they were free to leave at any time without consequence, that they did not have to answer any questions that they were not comfortable answering and that there were no right or wrong answers. The participants were also informed that the discussion was audio recorded and that results would be kept anonymous.
Three focus groups were conducted with eligible nursing students from Drexel University‟s CoNHP nursing programs. Focus groups were held in January and February of 2010 each lasting no longer than 90 minutes. All focus groups were held on Drexel University‟s Center City Campus in the New College Building Room 3204 based on this being a convenient location for nursing students.
Following a brief screening upon arrival, participants were asked to complete a short questionnaire (Appendix E) which familiarized the participants with the discussion topic. The questionnaire also provided data on participants‟ opinions prior to being influenced by a group discussion. The questionnaire consisted of the following three questions 1) In your opinion, what is the role of nurses in providing general nutrition advice in healthcare settings?, 2) In your opinion, what is the role of nurses in providing nutrition advice for diabetes in healthcare settings? and 3) Explain how you would respond to a patient who has asked you for nutrition advice.
The focus group moderator was a Drexel University graduate student who had previously completed a university course involving training and experience in moderating focus groups. The moderator had no nutrition or diabetes background which allowed her to have an unbiased approach toward the topic. The graduate student researcher of this study, who also completed a university course on focus groups, observed each focus group discussion while taking field notes.
Participants were seated in a circular arrangement so that each participant‟s voice could be heard and body language seen. Participants were asked to wear a name tag to enhance group discussion. Name tags were destroyed at the end of the focus groups. Each focus group session began with an introductory statement by the moderator and a
welcoming message to the participants. Participants were informed that the session was audio recorded and were reassured that the results were kept anonymous. The moderator explained that all participants were encouraged to share their opinions but could refrain from answering any question they were not comfortable answering.
After the introduction, the moderator used a questioning route (Appendix F) that was developed by the researchers of this study. The questioning route included a list of open-ended questions for the purpose of directing each focus group discussion and
maintaining consistency of questions asked to each group. The list of questions consisted of opening, introductory, key, ending and conclusion questions. The opening question invited all participants to introduce themselves and state their current status in their nursing program. Introductory questions were related to the topic and prompted the participants to think about the focus group topic. Key questions focused on nursing students‟ comfort level, perceived confidence and perceived role of nurses in giving nutrition advice to patients with diabetes. Ending questions prompted participants to list 3 words or phrases to summarize their perceived role of nurses in giving nutrition advice to patients with diabetes and if there were any other issues they would have liked to discuss. Finally, the participants‟ thoughts and ideas were summarized and the moderator asked for any additional input that they would like to share. The participants were
thanked for sharing their time and opinions. At the end of each focus group, each participant received a $40 cash payment for their participation.
2.2.2 Survey
Recruitment of participants to complete the survey was done using a mass email (Appendix G) sent to approximately 2,000 Drexel nursing students and 350 nurses at
Hahnemann University Hospital. The researchers complied with IRT and Hahnemann University Hospital policies on distributing mass emails. The email included the
eligibility criteria, explanation to interested volunteers to self-select themselves based on eligibility criteria listed, incentive, researcher‟s contact information and statement of approval from Drexel University‟s Institutional Review Board. Inclusion criteria
included: 18 years or older AND 1 of the following: nursing student at Drexel University or a registered or licensed nurse. Interested subjects were prompted to click the survey link within the email only if they consented to participate in the survey. At the end of the survey, participants were asked whether or not they would like provide their email to be entered in the drawing for $100. Participants were given the option of clicking “no” if they chose not to submit their email address. At that point, the participant was directed to the final page of the survey thanking them for their time. All surveys were anonymous except for the responders who submitted their email address voluntarily. These email addresses were obtained for the sole purpose of informing the winner of random drawing for the $100 incentive that he or she has been selected.
Survey Development and Administration
The survey of this study focused specifically on the attitude and current knowledge level among nurses and nursing students regarding the nutritional
management of diabetes. The survey was developed by the researchers of this study based on the American Diabetes Association nutrition guidelines (6) and review of surveys found in the literature that focus on diabetes and/or nutrition knowledge levels among nurses (33, 34, 38, 42, 46-48). After completion and analysis of the focus groups, the survey was modified based on the results of the focus group discussions. For
example, many participants in the focus groups suggested that the carbohydrate content of whole milk is much greater than the carbohydrate content in low-fat or nonfat milk. Carbohydrate content is actually the same in milk regardless of the fat content and so this belief was formulated into a question format and added to the survey. The survey was then reviewed by a focus group expert, members of the Drexel nursing faculty and two Certified Diabetes Educators/Registered Dietitians for content validity and clarity. Appropriate changes were made based on the reviewers‟ feedback. Several questions were eliminated from the survey if they were interpreted differently by reviewers
indicating unreliability. The survey was pilot tested with graduate nutrition students who had received similar diabetes education as nursing students. Nutrition students reported that it took approximately 10-15 minutes to complete the survey. The approved survey was administered to Drexel nutrition students to determine the length required to complete the survey and to assess perception of survey questions. The final instrument was a 36-item survey (Appendix H) including 7 demographic questions, 9 attitude questions and 20 knowledge questions.
After receiving IRB approval for the final version of the survey, a mass email was used to distribute the survey to all Drexel Nursing students and nurses at Hahnemann University Hospital (HUH). The researchers complied with all IRT and hospital policies regarding mass email distribution. The mass email contained a link to the online survey and participants were asked to click on the survey link to complete the study.