A total of four focus groups were conducted with First Nations and Métis caregivers in London and Midland-Penetanguishene, Ontario, respectively. Two focus groups were held in Midland-
Penetanguishene in partnership with the MNO, and the latter two focus groups took place London in collaboration with SOAHAC. These discussions were led by an experienced Indigenous facilitator, and provided rich descriptions of challenges to healthy eating, including food insecurity.
3.3.1 Sample
The focus groups discussions involved a total of 32 people, with each focus group ranging from five to eleven people. Caregivers, as opposed to only parents, were included because Aboriginal children
Wallace, 2011; Statistics Canada, 2013a). Service providers from the MNO and SOAHAC were included in the focus groups if they chose to participate. Service providers were often also parents or caregivers and participated in the focus groups in this capacity. While separating service providers from the other participants may be desirable, it is apparent from the first focus group that their participation improved trust and comfort in the focus group setting.
In Midland-Penetanguishene, the sample selection criteria were parents or caregivers of Métis children under the age of 18. Similarly, in London, Ontario, participants were parents or caregivers of First Nations children under 18 years of age.
3.3.2 Recruitment
Participants in Midland-Penetanguishene were recruited using an advertisement in a local newspaper (Appendix A). The MNO also employed purposive, convenience sampling and personally contacted community members to participate in the focus groups. Recruitment was similarly conducted in London using a promotional flyer (Appendix B) with the aid of SOAHAC service providers. Using the Aboriginal organizations as liaisons to reach out to participants avoided issues of time and establishing rapport and trust. The recruitment materials were created by Dr. Cooke and the MNO or SOAHAC for the focus groups in Midland-Penetanguishene and London, respectively.
Focus group participants were provided several incentives for their participation, including: coffee, snacks or a traditional dinner, $20 grocery gift card, reimbursement for transportation if necessary, and licensed childcare during the focus groups.
3.3.3 Setting
The first two focus groups in Midland-Penetanguishene took place at the Georgian Bay Recreation Centre. The latter two focus groups in London were held at the Centre Branch YMCA of
3.3.4 Procedure
A semi-structured interview was conducted with focus group participants. Each focus group was scheduled for 90 minutes, and involved parents and caregivers, an Elder or Spiritual Leader who opened the focus group discussion, an Indigenous facilitator (Little Brown Bear), myself as a recorder/transcriber (for the focus groups in London only), three members of our research team (Dr. Cooke, a service provider from the MNO or SOAHAC, and Terri Morrow, a First Nations Registered Dietitian who was present for the sessions in Midland-Penetanguishene only).
The interview script was written and reviewed by our research team and the MNO (for the focus groups in Midland-Penetanguishene) and SOAHAC (for the focus groups in London), and aimed to obtain a better understanding of the barriers and facilitators to healthy eating, as well as the relationships between food insecurity, diet, and child obesity in these communities. The MNO and SOAHAC were partners throughout the entire process, as they helped design the questionnaires and interview script, conducted recruitment, and organized all of the focus group meetings. The same questions were asked during all focus groups, however the scripts for the focus groups in Midland-Penetanguishene and
London differed slightly based on the revisions suggested by the MNO and SOAHAC, respectively (refer to Appendix C and D for scripts 1 and 2, respectively).
At the beginning of each focus group, an Elder or Spiritual Leader opened the discussion. The facilitator then provided an overview of the information contained in the Participant Information Form
(Appendix E and F for Midland-Penetanguishene and London, respectively), the Consent Form (Appendix G and H), explained why audio recording was necessary, and set ground rules for the discussion. Once consent forms were returned and checked, audio-recorders were turned on. Participants were then administered a Background Questionnaire (Appendix I and J) following the focus group in order to collect personal, demographic information. A debriefing with the facilitator, service providers, and research team took place following the focus groups. Audio recordings were professionally transcribed.
3.3.5 Data Analysis
3.3.5.1 Procedure
Following the focus group sessions, the transcripts were read in full and questions were analyzed using NVivo qualitative data analysis software (QSR International Pty Ltd. Version 10, 2012). A thematic analysis was conducted, which involved sorting individual quotes into major topic or question categories (Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006). This process allowed for reoccurring, prominent themes to be identified and examined within and across focus groups (Krueger & Casey, 2000). The experiences of food insecurity, coping strategies, as well as barriers and facilitators to healthy eating were themes of particular interest.
The coding process involved several stages. Codes were created for every distinct idea that emerged from the discussion, and sub-codes were created for related thoughts or tangents. If new codes emerged during the development of the coding manual, the transcripts were reread and codes were reassigned as appropriate. The codes in the manual were then reorganized by the theme to have some logical organization. The manual was initially organized based on the a priori research questions and concepts, however was modified based on the content of the focus group discussions (Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006).
The next step involved testing the reliability of these codes, whereby two coders were provided with a copy of the Coding Manual (refer to Appendix K) and asked to code all of the transcripts
(Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006). If a particular segment of text was missing a code or was assigned an inappropriate code, the second coders were asked to create a new code and add it to the manual. After debriefing with the second coders about the manual and transcript coding, a
consensus was reached on all codes, and these were then input into NVivo. In some studies, second coders will create a new manual and compare this to the original created by the researcher. However, both
Fereday & Muir-Cochrane, 2006). Codes were later sorted and clustered so that themes could be readily identified.
A reliability check was also conducted with the second coders’ feedback. This process is described in the following section on qualitative rigor. Next, the transcripts were uploaded into NVivo, and the codes from the manual were entered as nodes into the program. Organizing nodes within the software allowed for easy identification of similarities and differences between each focus group and setting. After reviewing the organized output, a set of themes were created from the codes, which
involved clustering ideas into more concise phrases or terms. While some codes were also themes, not all codes later became themes. As mentioned, the codes were exhaustive to ensure nothing was left out; however, not all codes were relevant to the discussion. The themes reflected the key ideas from the study questions as well as unique concepts that came up during the discussions. The coding process was reviewed to ensure that the themes were representative of the Coding Manual, research questions, as well as the broader contexts in which these ideas were discussed in the focus groups (Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006). While the data analysis was guided by the research questions, the findings were not categorized based on “a priori expectations or models” (Thomas, 2006). The research questions provided a focus for conducting the analysis instead of a specific set of expectations for the findings (Thomas, 2006).
3.3.5.2 Qualitative Rigor
Rigor is defined as “demonstrating integrity and competence within a study” (Fereday & Muir- Cochrane, 2006). Several key components of qualitative rigor include credibility, transferability and dependability (Appleton, 1995; Baxter & Eyles, 1996; Kurasaki, 2000). Credibility refers to whether or not the data represents the true or authentic experience of the participant (Appleton, 1995; Baxter & Eyles, 1996). Transferability is when study results or situations are applicable to other contexts and settings (Baxter & Eyles, 1996). Dependability of study results refers to minimizing subjectivity and
sampling was employed to ensure that the participants recruited for the focus groups would be
representative of First Nations and Métis experiences with the phenomena of interest (Baxter & Eyles, 1996). The key recruitment criteria were: living in Midland-Penetanguishene or London, and having children under the age of 18. While these criteria did not have specific indicators for income level, food insecurity, or child weight status, the recruitment criteria were left open to enable inclusivity and to capture of a broad range of community member experiences, as opposed to limited feedback to personal stories. Having children within the household indicated that these caregivers had some experience or exposure to the issues discussed. Additionally, results were shared with the MNO and SOAHAC and their feedback was used to ensure that the Métis and First Nations people in these communities were
appropriately represented (Appleton, 1995; Baxter & Eyles, 1996). The redundancy of the focus group themes by the last session also suggests that an authentic representation of caregivers’ lived experiences was captured (Baxter & Eyles, 1996). Purposive sampling and rich descriptions of the results also increases transferability.
Dependability was addressed in several ways. First, debriefing occurred following each focus group, which allowed for sharing of ideas and interpretations among members of the research team. Following the creation of the coding manual and prior to creating any themes during the analysis phase, a second set of coders reviewed and coded the transcripts (Appleton, 1995; Baxter & Eyles, 1996; Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006). Inter-rater reliability (IRR) is defined as “a measure of agreement between multiple coders about how they apply codes to the data” (Kurasaki, 2000) and is a standard practice for testing the dependability of a qualitative study (Baxter & Eyles, 1996; Miles & Huberman, 1994). It allows coders to determine the degree of agreement they have for coding a particular set of transcripts (Kurasaki, 2000; Miles & Huberman, 1994). For this study, second coders reviewed the coding manual and coded two out of the four transcripts (one from each setting). The coded transcripts were then reviewed, and the number of agreements and disagreements were tabulated. The IRR
Number of agreements . x 100 Number of agreements + disagreements
For the first focus group in Midland-Penetanguishene, the IRR was 87.86%. In London, the IRR for one focus group was 85.71%. An IRR of 70% is considered the minimum score to pass the reliability test (Miles & Huberman, 1994). A debrief meeting was then set up with the second coders to go through all of the disagreements. The majority of disagreements were a result of the second coders not being able to locate the appropriate code in a very lengthy manual. During the meeting, a consensus was quickly reached on all codes to obtain a revised IRR of 100% for the two focus groups analyzed. The final IRR was 93.39% and was calculated as follows:
(IRR Midland-Penetanguishene) + (IRR London) + (Revised IRRs). x 100 4 (total number of IRRs)
Several measures were taken to improve the qualitative rigor of this study. The focus groups and data analysis were conducted such that credibility, transferability, and dependability were maximized under the given conditions.
3.4
Ethics
Ethics approval was obtained from the Ethics Board at University of Waterloo to conduct focus groups in Midland-Penetanguishene and London. Focus groups were audio-recorded with the permission of all participants and transcribed verbatim.
Aboriginal peoples are a marginalized group who have a history of discrimination in Canada, hence there are special concerns for conducting research with this population (CIHR, NSERC, & SSHRC, 2010; Kingfisher, 2007; Willows, 2005; Willows et al., 2012). As researchers, culturally sensitive
population (i.e., food insecurity and poverty is an issue, hence we want to avoid reinforcing stereotypes) (CIHR et al., 2010; Kemmis & McTaggart, 2000; Kingfisher, 2007; Ladson-Billings, 2000). In order to address these concerns, the qualitative aspect of this study was conducted in collaboration with the MNO and SOAHAC, who revised the focus groups scripts and actively participated in recruitment and
execution of the focus group discussions (CIHR et al., 2010). Moreover, results and reports from both the quantitative and qualitative analyses were shared with these organizations to help with initiatives in the Aboriginal communities under study, and to ensure that the portrayal of Métis and First Nations people was culturally acceptable (CIHR et al., 2010).